Background: Latino men who have sex with men (LMSM) experience HIV and behavioral health disparities. Yet, evidence-based interventions, such as pre-exposure prophylaxis (PrEP) and behavioral health ...treatments, have not been equitably scaled up to meet LMSM needs. To address quality of life and the public health importance of HIV prevention, implementation strategies to equitably scale-up these interventions to LMSM need to be developed. This study identifies themes for developing culturally grounded implementation strategies to increase the uptake of evidence-based HIV-prevention and behavioral health treatments among LMSM. Methods: Participants included 13 LMSM and 12 stakeholders in Miami, an HIV epicenter. Feedback regarding the content, design, and format of an implementation strategy to scale-up HIV-prevention and behavioral health services to LMSM were collected via focus groups (N = 3) and individual interviews (N = 3). Themes were inductively identified across the Health Equity Implementation Framework (HEIF) domains. Results: Analyses revealed five higher order themes regarding the design, content, and format of the implementation strategy: cultural context, relationships and networks, navigation of health information and systems, resources and models of service delivery, and motivation to engage. Themes were applicable across HEIF domains, meaning that the same theme could have implications for both the development and implementation of the implementation strategy. Conclusions: Findings highlight the importance of addressing culturally specific factors, leveraging relational networks, facilitating navigation of health systems, tailoring to available resources, and building consumer and implementer motivation in order to refine an implementation strategy for reducing mental health burden and achieving HIV health equity among LMSM.
Plain Language Summary
Latino men who have sex with men (LMSM) are diagnosed with HIV and experience mental health and substance use problems more than their non-Latino/non-MSM peers. This means there is a disparity: one group is burdened by a disease more than another group. There are interventions, like pre-exposure prophylaxis and mental health/substance use treatment that can address this disparity. But, LMSM do not have enough access to these. This means there is a healthcare disparity: one group does not have as much access to healthcare as another group. The purpose of this study was to create a program to help LMSM get these services and consider how to implement it. LMSM and potential implementers talked about factors to consider in developing this program and implementation. They said the program and implementation need to (1) consider the cultural context in which LMSM are embedded, (2) leverage LMSM and implementers’ networks, (3) increase LMSM and implementers’ ability to navigate complex health systems, (4) be tailored to the resources available to consumers and implementers, and (5) build consumer and implementer motivation. These factors are important to address when developing and implementing programs to help LMSM get HIV-prevention and behavioral health treatments.
Assessing the sustainability of prevention programs and initiatives is better achieved by a a standardized process of measuring determinants and outcomes than by using a single standardized ...instrument.
Abstract
A large knowledge gap exists regarding the measurement of sustainability of evidence-based prevention programs for mental and behavioral health. We interviewed 45 representatives of 10 grantees and 9 program officers within 4 Substance Abuse and Mental Health Services Administration prevention grant initiatives to identify experiences with implementation and sustainability barriers and facilitators; what “sustainability” means and what it will take to sustain their programs; and which Consolidated Framework for Implementation Research (CFIR) elements are important for sustainability. Lists of sustainability determinants and outcomes were then compiled from each data set and compared with one another. Analysis of themes from interviews and free lists revealed considerable overlap between sustainability determinants and outcomes. Four sustainability elements were identified by all three data sets (ongoing coalitions, collaborations, and networks and partnerships; infrastructure and capacity to support sustainability; community need for program; and ongoing evaluation of performance and outcomes), and 11 elements were identified by two of three data sets (availability of funding; consistency with organizational culture; evidence of positive outcomes; development of a plan for implementation and sustainment; presence of a champion; institutionalization and integration of program; institutional support and commitment; community buy-in and support; program continuity; supportive leadership; and opportunities for staff training). All but one of the CFIR domain elements (pressure from other states, tribes, or communities) were endorsed as important to sustainability by 50% or more of participants. It may be more important to implement a standardized process of eliciting determinants and outcomes of sustainability than to implement a single standardized instrument.
The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR) contains numerous changes relevant to disparity-reduction practices, which were focused on ...preventing perpetuating stereotypes. The purpose of this article is to explore these alterations, address updated literature, and consider diagnoses through a lens of ethnocultural, racial, sex, and gender constructions that supports the lesbian, gay, bisexual, transgender, two-spirited, gender-expansive, queer, questioning, intersex, agender, asexual, aromantic, pansexual, and other related identities (LGBTGEQIAP+) community. Further, this article presents resources for counselors counseling LGBTGEQIAP + clients with mental health disorders. Recommendations for future research and implications for counselors are provided.
In 2008, all 18 regional referral NICUs in New York state adopted central-line insertion and maintenance bundles and agreed to use checklists to monitor maintenance-bundle adherence and report ...checklist use. We sought to confirm whether adopting standardized bundles and using central-line maintenance checklists reduced central-line-associated bloodstream infections (CLABSI).
This was a prospective cohort study that enrolled all neonates with a central line who were hospitalized in any of 18 NICUs. Each NICU reported CLABSI and central-line utilization data and checklist use. We used χ(2) to compare CLABSI rates in the preintervention (January to December 2007) versus the postintervention (March to December 2009) periods and Poisson regression to model adjusted CLABSI rates.
Each study period included more than 55 000 central-line days and more than 200 000 patient-days. CLABSI rates decreased 67% statewide (risk ratio: 0.33 95% confidence interval: 0.27-0.41; P < .0005); after adjusting for the altered central-line-associated bloodstream infection definition in 2008, by 40% (risk ratio: 0.60 95% confidence interval: 0.48-0.75; P < .0005). A total of 13 of 18 NICUs reported using maintenance checklists for 10% to 100% of central-line days. The checklist-use rate was associated with the CLABSI rate (coefficient: -0.57, P = .04). A total of 10 of 18 NICUs were independent CLABSI rate predictors, ranging from 1 site with greatly reduced risk (incidence rate ratio: 0.04, P < .0005) to 1 site with greatly increased risk (incidence rate ratio: 2.87, P < .0005).
Although standardizing central-line care elements led to a significant statewide decline in NICU CLABSIs, site of care remains an independent risk factor. Using maintenance checklists reduced CLABSIs.
Purpose Little is known about work-related traumatic brain injuries (WRTBI). This study describes non-fatal WRTBIs treated in US emergency departments (ED) from 1998 through 2007. Methods Non-fatal ...WRTBIs were identified from the National Electronic Injury Surveillance System occupational supplement (NEISS-Work) using the diagnoses of concussion, internal organ injury to the head and skull fracture. WRTBI rates and rate ratios were calculated, and the trend in rates was assessed. Results An estimated 586 600 (95% CI=±150 000) WRTBIs were reported during the 10-year period at a rate of 4.3 (CI=±1.1) per 10 000 full-time equivalent (FTE) workers (1 FTE=2000 h per year). From 1998 through 2007, the rate of WRTBIs increased at an average of 0.21 per 10 000 FTE per year (p<0.0001) and the rate of fall-related WRTBIs increased at an average of 0.10 per 10 000 FTE (p<0.0001). During the same period, the annual rate of WRTBIs resulting in hospitalisation increased 0.04 per 10 000 FTE (p<0.0001). Ten percent of WRTBIs were hospitalised, compared with hospitalisation of 2% all NEISS-Work injuries. Also, workers with highest fall-related TBI rates per 10 000 FTE were the youngest (2.4; CI=±1.4) and oldest (55 and older) workers (1.9; CI=±0.8). Conclusions Non-fatal WRTBIs are one of the most serious workplace injuries among ED-treated work-related injuries. Non-fatal WRTBIs are much more likely to result in hospitalisation compared with other types of injuries. The upward trend of WRTBI rates from 1998 through 2007 underscore the need for more directed effective prevention methods to reduce WRTBI injuries.
Genomic science is increasingly central to the provision of health care. Producing and applying robust genomics knowledge is a complex endeavour in which no single individual, profession, discipline ...or community holds all the answers. Engagement and involvement of diverse stakeholders can support alignment of societal and scientific interests, understandings and perspectives and promises better science and fairer outcomes. In this context we argue for F.A.I.R.E.R. data and data use that is Findable, Accessible, Interoperable, Reproducible,
and
Yet there is a paucity of international guidance on how to engage publics, patients and participants in genomics. To support meaningful and effective engagement and involvement we developed an
. The
is intended to support all those working in genomics research, medicine, and healthcare to deliberatively consider approaches to participant, patient and public engagement and involvement in their work. Through a series of questions, the
prompts new ways of thinking about the aims and purposes of engagement, and support reflection on the strengths, limitations, likely outcomes and impacts of choosing different approaches to engagement. To guide genomics activities, we describe four themes and associated questions for deliberative reflection: (i) fairness; (ii) context; (iii) heterogeneity, and (iv) recognising tensions and conflict. The four key components in the
provide a framework to assist those involved in genomics to reflect on decisions they make for their initiatives, including the strategies selected, the participant, patient and public stakeholders engaged, and the anticipated goals.
is one step in an actively evolving process of building genomics research and implementation cultures which foster responsible leadership and are attentive to objectives which increase equality, diversity and inclusion in participation and outcomes.
The plant pathogenesis related proteins group 1 (PR-1) and a variety of related mammalian proteins constitute a PR-1 protein family that share sequence and structural similarities. GAPR-1 is a unique ...family member as thus far it is the only PR-1 family member that is not co-translationally targeted to the lumen of the endoplasmic reticulum before trafficking to either vacuoles or secretion. Here we report that GAPR-1 may form dimers
in vitro and
in vivo, as determined by yeast two-hybrid screening, biochemical and biophysical assays. The 1.55
Å crystal structure demonstrates that GAPR-1 is structurally homologous to the other PR-1 family members previously solved (p14a and Ves V 5). Through an examination of inter-molecular interactions between GAPR-1 molecules in the crystal lattice, we propose a number of the highly conserved amino acid residues of the PR-1 family to be involved in the regulation of dimer formation of GAPR-1 with potential implications for other PR-1 family members. We show that mutagenesis of these conserved amino acid residues leads to a greatly increased dimer population. A recent report suggests that PR-1 family members may exhibit serine protease activity and further examination of the dimer interface of GAPR-1 indicates that a catalytic triad similar to that of serine proteases may be formed across the dimer interface by residues from both molecules within the dimer.
The human Golgi‐associated PR‐1‐related protein (GAPR‐1) is closely related to plant pathogenesis‐related (PR‐1) proteins, which are upregulated in response to pathogen attack. Family members have ...been identified in a variety of organisms, together constituting the superfamily of PR‐1 proteins. GAPR‐1 is found within lipid‐enriched microdomains on the cytosolic side of the endomembrane system. GAPR‐1 is tightly anchored to membranes and absent from the cytosol, although it does not possess a membrane‐spanning domain. Crystals of recombinantly expressed GAPR‐1 have been grown that diffract to high (1.5 Å) resolution. Complete data sets have been collected on a trigonal crystal form (P3121/P3221), with unit‐cell parameters a = b = 73.5, c = 63.2 Å. Molecular replacement using the NMR coordinates of tomato pathogenesis‐related protein (28% identity) was unsuccessful and a search for heavy‐metal derivatives or alternative phasing methods has been initiated.
Conservation of the 105 species of amphibians, reptiles, and turtles in the northwestern United States and western Canada is represented by a diverse mix of projects and programs across ten states, ...provinces, and territories. In this paper, 29 contributing authors review the status of herpetofauna by state, province or territory, and summarize the key issues, programs, projects, partnerships, and regulations relative to the species and habitats in those areas. Key threats to species across this expansive area include habitat degradation or loss, invasive species, disease, and climate change. Many programs and projects currently address herpetological conservation issues, including numerous small-scale monitoring and research efforts. However, management progress is hindered in many areas by a lack of herpetological expertise and basic knowledge of species' distribution patterns, limited focus within management programs, insufficient funds, and limited communication across the region. Common issues among states and provinces suggest that increased region-wide communication and coordination may aid herpetological conservation. Regional conservation collaboration has begun by the formation of the Northwest working group of Partners in Amphibian and Reptile Conservation.
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