The best interest of the child : an exploration of the sociocultural agendas associated with the care of orphaned and vulnerable children in China.

The purpose of this study is to explore the set of sociocultural agendas that emerge around the care of orphaned and vulnerable children (OVC) in China. While there is general agreement among stakeholders about the need to work for the best interests of OVC, there is significant variance in how these best interests are constructed and defined. An ethnographic scan of attitudes and awareness of OVC and OVC care in Henan Province, China, provide the initial context for exploration. This context is the basis for the subsequent nested case study of a multi-party, intergovernmental cooperative project designed to develop and disseminate alternative non-institutional care systems for OVC in China. Central to this project was the proposed re-purposing of China\u27s Child Welfare Institutes (CWIs), the large state-run congregate orphan care institutions that represent the core of China\u27s OVC care strategies and policies. Organizations involved in the development, funding, and implementation efforts include both Chinese and US faith-based NGOs, and Chinese and US Governmental bodies. A case study analysis of the participating organizations and their interactions provide the basis for identifying the behaviorally-expressed agendas advanced by these stakeholders in the context of OVC care. The results of this analysis illustrate that the essence of the debate around the best interests of OVC is not primarily a Chinese vs. Western set of sociocultural agendas, but rather is a conflict between traditional Western models of institutionally-based orphan care and a Progressive/Universalist model of family- and community-based OVC care

A Multivariable Model of Parent Satisfaction, Pain, and Opioid Administration in a Pediatric Emergency Department

Introduction: Children and adolescents are not impervious to the unprecedented epidemic of opioid misuse in the United States. In 2016 more than 88,000 adolescents between the ages of 12–17 reported misusing opioid medication, and evidence suggests that there has been a rise in opioid-related mortality for pediatric patients. A major source of prescribed opioids for the treatment of pain is the emergency department (ED). The current study sought to assess the complex relationship between opioid administration, pain severity, and parent satisfaction with children’s care in a pediatric ED. Methods: We examined data from a tertiary pediatric care facility. A health survey questionnaire was administered after ED discharge to capture the outcome of parental likelihood of providing a positive facility rating. We abstracted patient demographic, clinical, and top diagnostic information using electronic health records. Data were merged and multivariable models were constructed. Results: We collected data from 15,895 pediatric patients between the ages of 0–17 years (mean = 6.69; standard deviation = 5.19) and their parents. Approximately 786 (4.94%) patients were administered an opioid; 8212 (51.70%) were administered a non-opioid analgesic; and 3966 (24.95%) expressed clinically significant pain (pain score \u3e/= 4). Results of a multivariable regression analysis from these pediatric patients revealed a three-way interaction of age, pain severity, and opioid administration (odds ratio 1.022, 95% confidence interval, 1.006, 1.038, P = 0.007). Our findings suggest that opioid administration negatively impacted parent satisfaction of older adolescent patients in milder pain who were administered an opioid analgesic, but positively influenced the satisfaction scores of parents of younger children who were administered opioids. When pain levels were severe, the relationship between age and patient experience was not statistically significant. Conclusion: This investigation highlights the complexity of the relationship between opioid administration, pain severity, and satisfaction, and suggests that the impact of opioid administration on parent satisfaction is a function of the age of the child

Heroin Use and Sex: Some Patterns in Miami-Dade County, Florida

Much of the literature on heroin and opioid addiction holds that regular, long-term users of heroin and other opioids lose interest in sex as their drug using careers lengthen. Analysis of self-reports collected from IDUs in two cross- sectional surveys on patterns of risk behavior in Miami-Dade County, Florida, reveals that large proportions of IDUs report using heroin before or during sex across a wide range of self-injection experience, from as little as twelve months to over 40 years. One half or more of respondents to both surveys reported using heroin in their recent sexual experiences, with similar proportions reported by both males and females. The same IDUs, however, tend not to report using prescription painkillers before or during sex. This finding indicates that co-occurring risk behavior related to both sexual behavior and heroin use may be more prevalent among long-term IDUs than previous literature has suggested

Prospectus, April 28, 1982

BOARD PLANS FOR COLLEGE EXPANSION; News Digest; Candidates present views; Previewing really is censorship; Second StuGo forum flops on its back; ERA supporters rally together at capital; Don\u27t push your opinions, beliefs on others; Variety of students enroll in art transfer program; P.C. Happenings...: May Day festival to be featured, Music program to be performed, Phi Beta Lambda attends convention, Walks planned through woods, Help yourself to health, Learning to adjust to newborn baby; Parkland serves area through TV classes; Event offers chance to sell food; Origin of Arbor Day hazy; Parkland plans for Arbor Day activity; Soft pretzels make good party snacks; Rathskeller jams at 1st Parkland outdoor concert; Classifieds; Gettin\u27 lucky rocking with Loverboy; \u27Swamp Thing\u27 nothing but entertainment; Talking with the roadies; Tornado Shelter Guide; Mother Nature at her worst...: Watch for tornadoes; Mayor discusses Champaign projectshttps://spark.parkland.edu/prospectus_1982/1020/thumbnail.jp

Results of the Cooperative Uniform Soybean Tests, 1948 Part I. North Central States

United States Department of Agriculture, Agricultural Research Administration; Bureau of Plant Industry, Soils, and Agricultural Engineering, Division of Forage Crops and Diseases Cooperating with State Agricultural Experiment Station

Effects of Antiretroviral Therapy and Depressive Symptoms on All-Cause Mortality Among HIV-Infected Women

Abstract Depression affects up to 30% of human immunodeficiency virus (HIV)-infected individuals. We estimated joint effects of antiretroviral therapy (ART) initiation and depressive symptoms on time to death using a joint marginal structural model and data from a cohort of HIV-infected women from the Women's Interagency HIV Study (conducted in the United States) from 1998–2011. Among 848 women contributing 6,721 years of follow-up, 194 participants died during follow-up, resulting in a crude mortality rate of 2.9 per 100 women-years. Cumulative mortality curves indicated greatest mortality for women who reported depressive symptoms and had not initiated ART. The hazard ratio for depressive symptoms was 3.38 (95% confidence interval (CI): 2.15, 5.33) and for ART was 0.47 (95% CI: 0.31, 0.70). Using a reference category of women without depressive symptoms who had initiated ART, the hazard ratio for women with depressive symptoms who had initiated ART was 3.60 (95% CI: 2.02, 6.43). For women without depressive symptoms who had not started ART, the hazard ratio was 2.36 (95% CI: 1.16, 4.81). Among women reporting depressive symptoms who had not started ART, the hazard ratio was 7.47 (95% CI: 3.91, 14.3). We found a protective effect of ART initiation on mortality, as well as a harmful effect of depressive symptoms, in a cohort of HIV-infected women

Results of the Cooperative Uniform Soybean Tests Part I. North Central States 1949

United States Department of Agriculture, Agricultural Research Administration; Bureau of Plant Industry, Soils, and Agricultural Engineering, Division of Forage Crops and Diseases Cooperating with State Agricultural Experiment Station

Opioids exacerbate inflammation in people with well-controlled HIV

IntroductionPeople with HIV (PWH) are known to have underlying inflammation and immune activation despite virologic control. Substance use including opioid dependence is common in this population and is associated with increased morbidity and reduced lifespan. The primary objective of the present study termed opioid immunity study (OPIS), was to investigate the impact of chronic opioids in PWH.MethodsThe study recruited people with and without HIV who had opioid use disorder (OUD). Study participants (n=221) were categorized into four groups: HIV+OP+, n=34; HIV-OP+, n=66; HIV+OP-, n=55 and HIV-OP-, n=62 as controls. PWH were virally suppressed on ART and those with OUD were followed in a syringe exchange program with confirmation of OP use by urine drug screening. A composite cytokine score was developed for 20 plasma cytokines that are linked to inflammation. Cellular markers of immune activation (IA), exhaustion, and senescence were determined in CD4 and CD8 T cells. Regression models were constructed to examine the relationships of HIV status and opioid use, controlling for other confounding factors.ResultsHIV+OP+ participants exhibited highest inflammatory cytokines and cellular IA, followed by HIV-OP+ for inflammation and HIV+OP- for IA. Inflammation was found to be driven more by opioid use than HIV positivity while IA was driven more by HIV than opioid use. In people with OUD, expression of CD38 on CD28-CD57+ senescent-like T cells was elevated and correlated positively with inflammation.DiscussionGiven the association of inflammation with a multitude of adverse health outcomes, our findings merit further investigations to understand the mechanistic pathways involved

Project T-SHARP: study protocol for a multi-site randomized controlled trial of tele-harm reduction for people with HIV who inject drugs

Background The resurgence of HIV outbreaks and rising prevalence among people who inject drugs (PWID) remain exigent obstacles to Ending the HIV Epidemic in the USA. Adapting a low threshold, comprehensive treatment model for PWID with HIV can leverage syringe services programs (SSPs) to increase availability and accessibility of antiretrovirals (ART), medications for opioid use disorder (MOUD), and hepatitis C cure. We developed Tele-Harm Reduction, a telehealth-enhanced, harm reduction intervention delivered within an SSP venue. Methods The T-SHARP trial is an open-label, multi-site, randomized controlled superiority trial with two parallel treatment arms. Participants (n=240) recruited from SSPs in Miami, Ft. Lauderdale, and Tampa, Florida, who are PWID with uncontrolled HIV (i.e., HIV RNA>200) will be randomized to Tele-Harm Reduction or off-site linkage to HIV care. The primary objective is to compare the efficacy of Tele-Harm Reduction for initiation of ART at SSPs vs. off-site linkage to an HIV clinic with respect to viral suppression across follow-up (suppression at 3, 6, and 12 months post randomization). Participants with HIV RNA<200 copies/ml will be considered virally suppressed. The primary trial outcome is time-averaged HIV viral suppression (HIV RNA <200 copies/ml) over 3-, 6-, and 12-month follow-up. Secondary outcomes include initiation of MOUD measured by urine drug screen and HCV cure, defined as achieving 12-week sustained virologic response (negative HCV RNA at 12 weeks post treatment completion). A cost-effectiveness analysis will be performed. Discussion The T-SHARP Trial will be the first to our knowledge to test the efficacy of an innovative telehealth intervention with PWID with uncontrolled HIV delivered via an SSP to support HIV viral suppression. Tele-Harm Reduction is further facilitated by a peer to support adherence and bridge the digital divide. This innovative, flipped healthcare model sets aside the traditional healthcare system, reduces multi-level barriers to care, and meets PWID where they are. The T-SHARP trial is a pragmatic clinical trial that seeks to transform the way that PWID access HIV care and improve HIV clinical outcomes. Trial registration ClinicalTrials.gov NCT05208697. Trial registry name: Tele-Harm Reduction. Registration date: January 26, 2022

Combinatorial Polymer Electrospun Matrices Promote Physiologically-Relevant Cardiomyogenic Stem Cell Differentiation

Myocardial infarction results in extensive cardiomyocyte death which can lead to fatal arrhythmias or congestive heart failure. Delivery of stem cells to repopulate damaged cardiac tissue may be an attractive and innovative solution for repairing the damaged heart. Instructive polymer scaffolds with a wide range of properties have been used extensively to direct the differentiation of stem cells. In this study, we have optimized the chemical and mechanical properties of an electrospun polymer mesh for directed differentiation of embryonic stem cells (ESCs) towards a cardiomyogenic lineage. A combinatorial polymer library was prepared by copolymerizing three distinct subunits at varying molar ratios to tune the physicochemical properties of the resulting polymer: hydrophilic polyethylene glycol (PEG), hydrophobic poly(ε-caprolactone) (PCL), and negatively-charged, carboxylated PCL (CPCL). Murine ESCs were cultured on electrospun polymeric scaffolds and their differentiation to cardiomyocytes was assessed through measurements of viability, intracellular reactive oxygen species (ROS), α-myosin heavy chain expression (α-MHC), and intracellular Ca2+ signaling dynamics. Interestingly, ESCs on the most compliant substrate, 4%PEG-86%PCL-10%CPCL, exhibited the highest α-MHC expression as well as the most mature Ca2+ signaling dynamics. To investigate the role of scaffold modulus in ESC differentiation, the scaffold fiber density was reduced by altering the electrospinning parameters. The reduced modulus was found to enhance α-MHC gene expression, and promote maturation of myocyte Ca2+ handling. These data indicate that ESC-derived cardiomyocyte differentiation and maturation can be promoted by tuning the mechanical and chemical properties of polymer scaffold via copolymerization and electrospinning techniques