Connecting the Point(s), Hunts Point, Bronx, New York

Hunts Point is a notoriously over-planned neighborhood. As the exploration of recent plans on page 15 illustrates, Hunts Point has been both the beneficiary and victim of planning efforts that have left many in the community feeling over-surveyed with inadequate results to show for it. Our client made it clear from the beginning that the community did not need another plan to sit on a shelf. Therefore, the team chose to focus on small-scale, actionable interventions that could be implemented without significant capital outlays. To this end, we began by conducting an analysis of existing conditions, investigating both the physical and social landscape of Hunts Point in order to begin to identify opportunities for transformative action that can be taken on by local community groups. We interviewed experts within and outside the community. We engaged residents in community preference mapping, gaining valuable information about the key physical assets in the neighborhood, including an understanding of where local people felt safe or unsafe. Through this work, we identified a number of challenges and opportunities. Through decades of poor land use planning decisions, Hunts Point has become a community beset with vacant and underutilized land and buildings. We chose to look at this as an opportunity: physical space that is not being used to its full potential offers the basic unit for a process of reimagining. It can activate the potential of both the space itself and the community that lives and works around it. Lots and buildings also lend themselves to piecemeal intervention: they can be imagined in connection with one another as a network or tackled one by one — a community garden here, new housing there, a farmers’ market here, a community center there. They offer the opportunity for small-scale intervention that adds up to large-scale transformation. We conducted a vacant land survey in order to determine the scale of this resource and develop an up-to-date and accurate catalog of vacant spaces in the area — a data set we are making publicly available to community stakeholders who are looking to take real, concrete action around these spaces. As we began the broader community outreach portion of our research, it was with the question of how to activate the potential already existing within the community. We hosted a series of meetings in which we posed a question, first to a small Advisory Committee of key community stakeholders (see page 8), and then to a larger forum of community members. We wanted to know what they wanted to see done with the vacant land, anticipating that out of this work we would achieve at least two outcomes: concrete ideas for vacant space repurposing, and a larger narrative about the most immediate concerns for Hunts Point residents. To complement and quantify this research, we also conducted outreach around questions of connectivity. It is not enough simply to activate spaces in isolation — in fact, Hunts Point has some beautiful newly-created park spaces, but many are outside of a reasonable walking distance for most residents and require walking down industrial streets burdened with heavy truck traffic. We wanted to get a sense of how residents perceive access to existing park spaces in order to facilitate recommendations on improving connections to these amenities. Alongside this questionnaire, we conducted a GIS analysis showing the number of residents within a 5, 10 or 15 minute walk of each of the neighborhood’s parks. The connectivity survey also included questions about access to healthy and affordable food. Given that food access had come up throughout our research, we saw an opportunity to quantify residents’ perceptions of their access to food, while also developing a data product that we could share with those seeking to advocate for food-based projects within the community. To complement this survey, we aggregated information about food vendors in Hunts Point and compiled the data into an accessible and easy-to-use map. We’ve been able to produce a vision for the spaces and places that could be reimagined in order to transform Hunts Point into a place that better meets the needs of residents. We’ve also identified potential places to improve connectivity to neighborhood amenities, which are currently cut off from the rest of the community. And we’ve developed recommendations on what form the transformation of spaces could take, while developing datasets that can be used by others seeking to carry this work forward

Respiratory chain deficiency in nonmitochondrial disease.

OBJECTIVE: In this study, we report 5 patients with heterogeneous phenotypes and biochemical evidence of respiratory chain (RC) deficiency; however, the molecular diagnosis is not mitochondrial disease. METHODS: The reported patients were identified from a cohort of 60 patients in whom RC enzyme deficiency suggested mitochondrial disease and underwent whole-exome sequencing. RESULTS: Five patients had disease-causing variants in nonmitochondrial disease genes ORAI1, CAPN3, COLQ, EXOSC8, and ANO10, which would have been missed on targeted next-generation panels or on MitoExome analysis. CONCLUSIONS: Our data demonstrate that RC abnormalities may be secondary to various cellular processes, including calcium metabolism, neuromuscular transmission, and abnormal messenger RNA degradation

Are We Asking Too Much of the Health Sector? Exploring the Readiness of Brazilian Primary Healthcare to Respond to Domestic Violence Against Women

BACKGROUND: There is growing recognition of the health sector's potential role in addressing domestic violence (DV) against women. Although Brazil has a comprehensive policy framework on violence against women (VAW), implementation has been slow and incomplete in primary healthcare (PHC), and little is known about the implementation challenges. This paper aims to assess the readiness of two PHC clinics in urban Brazil to integrate an intervention to strengthen their DV response. METHODS: We conducted 20 semi-structured interviews with health managers and health providers; a document analysis of VAW and DV policies from São Paulo and Brazil; and 2 structured facility observations. Data were analysed using thematic analysis. RESULTS: Findings from our readiness assessment revealed gaps in both current policy and practice needing to be addressed, particularly with regards to governance and leadership, health service organisation and health workforce. DV received less political recognition, being perceived as a lower priority compared to other health issues. Lack of clear guidance from the central and municipal levels emerged as a crucial factor that weakened DV policy implementation both by providers and managers. Furthermore, responses to DV lost visibility, as they were diluted within generic violence responses. The organizational structure of the PHC system in São Paulo, which prioritised the number of consultations and household visits as the main performance indicators, was an additional difficulty in legitimising healthcare providers' time to address DV. Individual-level challenges reported by providers included lack of time and knowledge of how to respond, as well as fears of dealing with DV. CONCLUSION: Assessing readiness is critical because it helps to evaluate what services and infrastructure are already in place, also identifying obstacles that may hinder adaptation and integration of an intervention to strengthen the response to DV before implementation

Mitochondrial dysfunction in liver failure requiring transplantation.

Liver failure is a heterogeneous condition which may be fatal and the primary cause is frequently unknown. We investigated mitochondrial oxidative phosphorylation in patients undergoing liver transplantation. We studied 45 patients who had liver transplantation due to a variety of clinical presentations. Blue native polyacrylamide gel electrophoresis with immunodetection of respiratory chain complexes I-V, biochemical activity of respiratory chain complexes II and IV and quantification of mitochondrial DNA (mtDNA) copy number were investigated in liver tissue collected from the explanted liver during transplantation. Abnormal mitochondrial function was frequently present in this cohort: ten of 40 patients (25 %) had a defect of one or more respiratory chain enzyme complexes on blue native gels, 20 patients (44 %) had low activity of complex II and/or IV and ten (22 %) had a reduced mtDNA copy number. Combined respiratory chain deficiency and reduced numbers of mitochondria were detected in all three patients with acute liver failure. Low complex IV activity in biliary atresia and complex II defects in cirrhosis were common findings. All six patients diagnosed with liver tumours showed variable alterations in mitochondrial function, probably due to the heterogeneity of the presenting tumour. In conclusion, mitochondrial dysfunction is common in severe liver failure in non-mitochondrial conditions. Therefore, in contrast to the common practice detection of respiratory chain abnormalities in liver should not restrict the inclusion of patients for liver transplantation. Furthermore, improving mitochondrial function may be targeted as part of a complex therapy approach in different forms of liver diseases

From Text to Practice - The role of the Bible in daily living of African people today

That the Bible is a manual for daily living is attested in almost all Christian denominations, how this role is transformed into practice is clearly an area that remains a contested terrain among Christians. This volume is our modest contribution to looking at the relationship between the Bible and our practices. The central question that the articles in this volume respond to is: how is the Bible related to our daily life? This question is especially important on the African continent where religion appears to be gaining influence. Without taking anything away from western biblical scholars, African biblical scholars must also engage with the question: how do we put into practice the teachings of the Bible? This volume contains papers presented at the International Bible Symposium 2009 in Bamberg (Germany) and additional contributions

An evidence-based primary health care intervention to address domestic violence against women in Brazil: a mixed method evaluation.

BACKGROUND: Health systems have a critical role in a multi-sectoral response to domestic violence against women (DVAW). However, the evidence on interventions is skewed towards high income countries, and evidence based interventions are not easily transferred to low-and middle-income countries (LMIC) where significant social, cultural and economic differences exist. We evaluated feasibility and acceptability of implementation of an intervention (HERA-Healthcare Responding to Violence and Abuse) to improve the response to DVAW in two primary health care clinics (PHC) in Brazil. METHODS: The study design is a mixed method process and outcome evaluation, based on training attendance records, semi-structured interviews (with 13 Primary Health Care (PHC) providers, two clinic directors and two women who disclosed domestic violence), and identification and referral data from the Brazilian Epidemiological Surveillance System (SINAN). RESULTS: HERA was feasible and acceptable to women and PHC providers, increased providers' readiness to identify DVAW and diversified referrals outside the health system. The training enhanced the confidence and skills of PHC providers to ask directly about violence and respond to women's disclosures using a women centred, gender and human rights perspective. PHC providers felt safe and supported when dealing with DVAW because HERA emphasised clear roles and collective action within the clinical team. A number of challenges affected implementation including: differential managerial support for the Núcleo de Prevenção da Violência (Violence Prevention Nucleus-NPV) relating to the allocation of resources, monitoring progress and giving feedback; a lack of higher level institutional endorsement prioritising DVAW work; staff turnover; a lack of feedback from external support services to PHC clinics regarding DVAW cases; and inconsistent practices regarding documentation of DVAW. CONCLUSION: Training should be accompanied by system-wide institutional change including active (as opposed to passive) management support, allocation of resources to support roles within the NPV, locally adapted protocols and guidelines, monitoring progress and feedback. Communication and coordination with external support services and documentation systems are crucial and need improvement. DVAW should be prioritised within leadership and governance structures, for example, by including DVAW work as a specific commissioning goal

Interventions in sexual and reproductive health services addressing violence against women in low-income and middle-income countries: a mixed-methods systematic review.

OBJECTIVES: To synthesise evidence on the effectiveness, cost-effectiveness and barriers to responding to violence against women (VAW) in sexual and reproductive health (SRH) services in low/middle-income countries (LMICs). DESIGN: Mixed-methods systematic review. DATA SOURCES: Medline, Embase, Psycinfo, Cochrane, Cinahl, IMEMR, Web of Science, Popline, Lilacs, WHO RHL, ClinicalTrials.gov, Google, Google Scholar, websites of key organisations through December 2019. ELIGIBILITY CRITERIA: Studies of any design that evaluated VAW interventions in SRH services in LMICs. DATA EXTRACTION AND SYNTHESIS: Concurrent narrative quantitative and thematic qualitative syntheses, integration through line of argument and mapping onto a logic model. Two reviewers extracted data and appraised quality. RESULTS: 26 studies of varied interventions using heterogeneous outcomes. Of ten interventions that strengthened health systems capacity to respond to VAW during routine SRH consultation, three reported no harm and reduction in some types of violence. Of nine interventions that strengthened health systems and communities' capacity to respond to VAW, three reported conflicting effects on re-exposure to some types of VAW and mixed effect on SRH. The interventions increased identification of VAW but had no effect on the provision (75%-100%) and uptake (0.6%-53%) of referrals to VAW services. Of seven psychosocial interventions in addition to SRH consultation that strengthened women's readiness to address VAW, four reduced re-exposure to some types of VAW and improved health. Factors that disrupted the pathway to better outcomes included accepting attitudes towards VAW, fear of consequences and limited readiness of the society, health systems and individuals. No study evaluated cost-effectiveness. CONCLUSIONS: Some VAW interventions in SRH services reduced re-exposure to some types of VAW and improved some health outcomes in single studies. Future interventions should strengthen capacity to address VAW across health systems, communities and individual women. First-line support should be better tailored to women's needs and expectations. PROSPERO REGISTRATION NUMBER: CRD42019137167

The Bible and Children in Africa

The relationship between the Bible and Children in Africa is a topic of highest relevance. This book is treating it in two main perspectives which often are intertwined: | The exegetical perspective “Children in the Bible” is dealing with the concepts of childhood in biblical texts, asking for example: How are children conceived in different texts. What is their status in family, society and church? What is their relation to God? What is the metaphoric use of childhood in biblical soteriology? What is the function and meaning of calling adult persons “children” (of God, or of the Apostle)? | The contextual perspective “African children of today and the Bible” is dealing with the different life settings African children find themselves in and how the Bible is present in these life settings. Here the questions for example are: What is the status of children in family and society? How are traditional concepts of childhood changing under the conditions of poverty, HIV/AIDS and violence? How are the ideas and ideals of childhood influenced by the Bible? What is the role of the Bible in child-education? Can children’s rights be established with help of the Bible? This volume of BiAS 17 is collecting the papers presented at the 2012 BiAS meeting in Gaborone, Botswana, with some additional contributions

Effect of an Education Programme for South Asians with Asthma and Their Clinicians: A Cluster Randomised Controlled Trial (OEDIPUS).

BACKGROUND: People with asthma from ethnic minority groups experience significant morbidity. Culturally-specific interventions to reduce asthma morbidity are rare. We tested the hypothesis that a culturally-specific education programme, adapted from promising theory-based interventions developed in the USA, would reduce unscheduled care for South Asians with asthma in the UK. METHODS: A cluster randomised controlled trial, set in two east London boroughs. 105 of 107 eligible general practices were randomised to usual care or the education programme. Participants were south Asians with asthma aged 3 years and older with recent unscheduled care. The programme had two components: the Physician Asthma Care Education (PACE) programme and the Chronic Disease Self Management Programme (CDSMP), targeted at clinicians and patients with asthma respectively. Both were culturally adapted for south Asians with asthma. Specialist nurses, and primary care teams from intervention practices were trained using the PACE programme. South Asian participants attended an outpatient appointment; those registered with intervention practices received self-management training from PACE-trained specialist nurses, a follow-up appointment with PACE-trained primary care practices, and an invitation to attend the CDSMP. Patients from control practices received usual care. Primary outcome was unscheduled care. FINDINGS: 375 south Asians with asthma from 84 general practices took part, 183 registered with intervention practices and 192 with control practices. Primary outcome data were available for 358/375 (95.5%) of participants. The intervention had no effect on time to first unscheduled attendance for asthma (Adjusted Hazard Ratio AHR = 1.19 95% CI 0.92 to 1.53). Time to first review in primary care was reduced (AHR = 2.22, (1.67 to 2.95). Asthma-related quality of life and self-efficacy were improved at 3 months (adjusted mean difference -2.56, (-3.89 to -1.24); 0.44, (0.05 to 0.82) respectively. CONCLUSIONS: A multi-component education programme adapted for south Asians with asthma did not reduce unscheduled care but did improve follow-up in primary care, self-efficacy and quality of life. More effective interventions are needed for south Asians with asthma

The Bible and Violence in Africa. Papers presented at the BiAS meeting 2014 in Windhoek (Namibia), with some additional contributions

BiAS 20 contains papers presented at the BiAS meeting 2014 in Windhoek (Namibia), with some additional contributions. Scholars from Nigeria, Cameroon, Botswana, Zimbabwe, South Africa, Namibia and Germany are dealing with the urgent question of how the Bible is involved in the widespread use of violence in political, social, religious, and gender conflicts. One leading question is how to deal with the textual representation of violence in the Bible. It is taken up by more general hermeneutical contributions. The other leading question is how biblical texts and/or concepts are used to cause and justify violence. This is taken up by a greater number of articles which deal with concrete societal and political contexts in Zimbabwe and other African countries. The conference in Namibia was supported as a Humboldt-Kolleg on the Bible and Violence in Africa by the German Alexander von Humboldt Foundation