Navigating Insulin Access for Pediatric Type 1 Diabetes: Caregivers\u27 Experiences and Challenges

Between 2012 and 2018, the annual 14% increase in insulin prices made Type 1 Diabetes (T1D) the most expensive chronic health condition, significantly raising out-of-pocket costs for uninsured or underinsured individuals in the United States (Hayes & Farmer, 2020; Willner et al., 2020). This study utilized a qualitative content analysis methodology to explore the challenges and experiences of parents with children diagnosed with T1D with accessing insulin for their child. Five participants from various areas of the United States responded to open-ended questions both in person and via Zoom. The analysis revealed three main themes: pragmatics of managing diabetic care, the emotional impact and caregiver concerns, and the art of coordination and support networks. Three subthemes emerged: financial constraints, insulin injections/pump, and navigating insurance. The study emphasizes the importance of access to healthcare services in order to address the multifaceted needs of children with T1D and their families, and also raises clinical implications related to T1D management. Practical recommendations for clinicians, educators, and policymakers to enhance support and improve outcomes for pediatric patients with T1D are provided and discussed. Future research should prioritize inclusive recruitment strategies and address barriers to participation among minority populations to ensure interventions are tailored to the diverse needs of all individuals and families affected by T1D, particularly given the widespread mistrust within the healthcare system among marginalized communities. Additionally, exploring systemic barriers, including social determinants of health (SDOH), and advocating for policy reforms aimed at expanding healthcare coverage and promoting health equity are essential steps in addressing healthcare disparities and improving access to care for vulnerable populations affected by T1D

Digital health paradox: international policy perspectives to address increased health inequalities for people living with disabilities

The COVID-19 pandemic accelerated the uptake of digital health worldwide and highlighted many benefits of these innovations. However, it also stressed the magnitude of inequalities regarding accessing digital health. Using a scoping review, this article explores the potential benefits of digital technologies for the global population, with particular reference to people living with disabilities, using the autism community as a case study. We ultimately explore policies in Sweden, Australia, Canada, Estonia, the United Kingdom, and the United States to learn how policies can lay an inclusive foundation for digital health systems. We conclude that digital health ecosystems should be designed with health equity at the forefront to avoid deepening existing health inequalities. We call for a more sophisticated understanding of digital health literacy to better assess the readiness to adopt digital health innovations. Finally, people living with disabilities should be positioned at the center of digital health policy and innovations to ensure they are not left behind

Developing a Framework for Population Health in Interprofessional Training: An Interprofessional Education Module

Interprofessional education (IPE) is based on the concept that health professional students are best trained on the skills, knowledge, and attitudes that promote population health when they learn with and about others from diverse health science fields. Previously, IPE has focused almost exclusively on the clinical context. This study piloted and evaluated an IPE learning experience that emphasizes population health in a sample of public health undergraduate students. We hypothesized that students who completed the 2-hour online asynchronous module would better understand the value of public health's role in interprofessional teams, the benefit of interprofessional teamwork in improving health outcomes, and the value of collaborative learning with other interprofessional students. Students engaged in pre- and post-training assessments and individual reflections throughout the module. Sixty-seven undergraduate public health students completed the module and assessments. After completion, a greater proportion strongly agreed that students from different health science disciplines should be educated in the same setting to form collaborative relationships with one another (19 vs. 39% before and after completion, respectively). A greater proportion also strongly agreed that care delivered by an interprofessional team would benefit the health outcomes of a patient/client after the training (60 vs. 75% before and after, respectively). Mean scores describing how strongly students agreed with the above two statements significantly increased post-training. A greater proportion of students strongly agreed that incorporating the public health discipline as part of an interprofessional team is crucial to address the social determinants of health for individual health outcomes after taking the training (40 vs. 55% before and after, respectively). There was little change in attitudes about the importance of incorporating public health as part of an interprofessional team to address social determinants of health for population health outcomes, which were strongly positive before the training. Most students reported being satisfied with the module presentation and felt their understanding of interprofessional practice improved. This training may be useful for students from all health disciplines to recognize the benefits of engaging with and learning from public health students and to recognize the important role of public health in interprofessional practices

A Note on Conserved Charges of Asymptotically Flat and Anti-de Sitter Spaces in Arbitrary Dimensions

The calculation of conserved charges of black holes is a rich problem, for which many methods are known. Until recently, there was some controversy on the proper definition of conserved charges in asymptotically anti-de Sitter (AdS) spaces in arbitrary dimensions. This paper provides a systematic and explicit Hamiltonian derivation of the energy and the angular momenta of both asymptotically flat and asymptotically AdS spacetimes in any dimension D bigger or equal to 4. This requires as a first step a precise determination of the asymptotic conditions of the metric and of its conjugate momentum. These conditions happen to be achieved in ellipsoidal coordinates adapted to the rotating solutions.The asymptotic symmetry algebra is found to be isomorphic either to the Poincare algebra or to the so(D-1, 2) algebra, as expected. In the asymptotically flat case, the boundary conditions involve a generalization of the parity conditions, introduced by Regge and Teitelboim, which are necessary to make the angular momenta finite. The charges are explicitly computed for Kerr and Kerr-AdS black holes for arbitrary D and they are shown to be in agreement with thermodynamical arguments.Comment: 27 pages; v2 : references added, minor corrections; v3 : replaced to match published version forthcoming in General Relativity and Gravitatio

Self-sampling kits to increase HIV testing among black Africans in the UK: the HAUS mixed-methods study.

BACKGROUND: Timely diagnosis of human immunodeficiency virus (HIV) enables access to antiretroviral treatment, which reduces mortality, morbidity and further transmission in people living with HIV. In the UK, late diagnosis among black African people persists. Novel methods to enhance HIV testing in this population are needed. OBJECTIVES: To develop a self-sampling kit (SSK) intervention to increase HIV testing among black Africans, using existing community and health-care settings (stage 1) and to assess the feasibility for a Phase III evaluation (stage 2). DESIGN: A two-stage, mixed-methods design. Stage 1 involved a systematic literature review, focus groups and interviews with key stakeholders and black Africans. Data obtained provided the theoretical base for intervention development and operationalisation. Stage 2 was a prospective, non-randomised study of a provider-initiated, HIV SSK distribution intervention targeted at black Africans. The intervention was assessed for cost-effectiveness. A process evaluation explored feasibility, acceptability and fidelity. SETTING: Twelve general practices and three community settings in London. MAIN OUTCOME MEASURE: HIV SSK return rate. RESULTS: Stage 1 - the systematic review revealed support for HIV SSKs, but with scant evidence on their use and clinical effectiveness among black Africans. Although the qualitative findings supported SSK distribution in settings already used by black Africans, concerns were raised about the complexity of the SSK and the acceptability of targeting. These findings were used to develop a theoretically informed intervention. Stage 2 - of the 349 eligible people approached, 125 (35.8%) agreed to participate. Data from 119 were included in the analysis; 54.5% (65/119) of those who took a kit returned a sample; 83.1% of tests returned were HIV negative; and 16.9% were not processed, because of insufficient samples. Process evaluation showed the time pressures of the research process to be a significant barrier to feasibility. Other major barriers were difficulties with the SSK itself and ethnic targeting in general practice settings. The convenience and privacy associated with the SSK were described as beneficial aspects, and those who used the kit mostly found the intervention to be acceptable. Research governance delays prevented implementation in Glasgow. LIMITATIONS: Owing to the study failing to recruit adequate numbers (the intended sample was 1200 participants), we were unable to evaluate the clinical effectiveness of SSKs in increasing HIV testing in black African people. No samples were reactive, so we were unable to assess pathways to confirmatory testing and linkage to care. CONCLUSIONS: Our findings indicate that, although aspects of the intervention were acceptable, ethnic targeting and the SSK itself were problematic, and scale-up of the intervention to a Phase III trial was not feasible. The preliminary economic model suggests that, for the acceptance rate and test return seen in the trial, the SSK is potentially a cost-effective way to identify new infections of HIV. FUTURE WORK: Sexual and public health services are increasingly utilising self-sampling technologies. However, alternative, user-friendly SSKs that meet user and provider preferences and UK regulatory requirements are needed, and additional research is required to understand clinical effectiveness and cost-effectiveness for black African communities. STUDY REGISTRATION: This study is registered as PROSPERO CRD42014010698 and Integrated Research Application System project identification 184223. FUNDING: The National Institute for Health Research Health Technology Assessment programme and the BHA for Equality in Health and Social Care

Missing children: risks, repeats and responses

Investigating reports of missing children is a major source of demand for the police in the UK. Repeat disappearances are common, can indicate underlying vulnerabilities and have been linked with various forms of exploitation and abuse. Inspired by research on repeat victimisation, this paper examines the prevalence and temporal patterns of repeat missing episodes by children, as well as the characteristics of those involved. Using data on all missing children incidents recorded by one UK police service in 2015 (n = 3,352), we find that: (a) 75% of missing incidents involving children were repeats, i.e. attributed to children who had already been reported missing in 2015; (b) a small proportion of repeatedly missing children (n = 59; 4%) accounted for almost a third of all missing children incidents (n = 952, 28%); (c) over half of all first repeat disappearances occurred within four weeks of an initial police recorded missing episode; and (d) children recorded as missing ten times or more over the one year study period were significantly more likely than those recorded missing once to be teenagers, in the care system or to have drug and/or alcohol dependencies. We conclude by discussing the implications of our findings for future research and the prevention of repeat disappearances by children

Unauthorized Horizontal Spread in the Laboratory Environment: The Tactics of Lula, a Temperate Lambdoid Bacteriophage of Escherichia coli

We investigated the characteristics of a lambdoid prophage, nicknamed Lula, contaminating E. coli strains from several sources, that allowed it to spread horizontally in the laboratory environment. We found that new Lula infections are inconspicuous; at the same time, Lula lysogens carry unusually high titers of the phage in their cultures, making them extremely infectious. In addition, Lula prophage interferes with P1 phage development and induces its own lytic development in response to P1 infection, turning P1 transduction into an efficient vehicle of Lula spread. Thus, using Lula prophage as a model, we reveal the following principles of survival and reproduction in the laboratory environment: 1) stealth (via laboratory material commensality), 2) stability (via resistance to specific protocols), 3) infectivity (via covert yet aggressive productivity and laboratory protocol hitchhiking). Lula, which turned out to be identical to bacteriophage phi80, also provides an insight into a surprising persistence of T1-like contamination in BAC libraries