Do adolescents receive youth-friendly, person-centered contraceptive care at safety-net clinics in the U.S. South?: An examination of youths’ perspectives

Introduction: Improving the quality of contraceptive care that youth receive improves the patient-provider relationship, satisfaction with care, and contraceptive method use and continuation. In recent years, high-quality contraceptive care for youth has shifted away from tiered effectiveness counseling and toward youth-friendly, person-centered contraceptive counseling (YFPCCC). Rooted in the reproductive justice movement, YFPCCC requires that counseling encourages youth to say what matters to them in their contraceptive method, respects youth’s preferences in their contraceptive method, provides youth with the information necessary to make the best choice for them, and is respectful of youth’s choices. YFPCCC is especially important for minor youth and youth of color who have historically received biased care and for youth in the United States South where restrictive policies may prevent youth from receiving care. This study examined youths’ perspectives of YFPCCC at safety-net clinics in two states in the U.S. South. Methods: Between 2018 and 2022, a survey measuring patient perspectives of their contraceptive counseling was collected from youth (ages 16 to 24) who received care at federally qualified health centers (FQHCs) and health departments (HDs) in Alabama (AL) and South Carolina (SC). A total of 1,052 youth were included in the study (AL n=513 and SC n=539). Four survey items measuring the four components of person-centered counseling and two survey items measuring youth-friendliness (knowledgeable and trustworthy providers) were dichotomized into Yes/No responses and combined to create two new variables measuring PCCC and providers’ youth-friendliness. PCCC and youth friendliness were compared across clinic type, state, age, race/ethnicity, and insurance coverage using logistic regression. P-values less than 0.05 were considered significant. Results: Overall, 56% of youth in the study reported that they received all four components of PCCC and 71% reported that their providers were youth-friendly. Minor youth (ages 16 and 17) were 34% less likely than older youth (ages 20-24) to report receipt of PCCC (aOR 0.66, 95% confidence interval (CI) [0.45, 0.98]). Minor youth were also 39% less likely than older youth to report that their provider was youth-friendly (aOR 0.61, 95% CI [0.40, 0.93]). Non-Hispanic Black youth were 45% less likely than non-Hispanic White youth to report PCCC (aOR 0.55 95% CI [0.40, 0.70]). Similarly, non-Hispanic Black youth were 44% less likely than non-Hispanic White youth to report that their provider was youth-friendly (aOR 0.56 CI [0.41, 0.77]). Discussion: Providing contraceptive care that is both person-centered and youth-friendly is essential in improving the quality of care that youth receive. In this study, minors and non-Hispanic Black youth were the least likely to report that their care was both person-centered and youth-friendly. This gap in the quality of care that non-Hispanic Black youth receive may contribute to lower satisfaction with care which may contribute to lower contraceptive use rates and higher unintended teen birth rates for this group. Clinics can improve their ability to provide YFPCCC by ensuring providers are trained in youth-friendly and person-centered contraceptive care

Early diagnosis of PROstate CANcer for Black men (PROCAN-B): identifying barriers and facilitators

Prostate cancer is the most common cancer in men in the UK with incidence rates projected to rise. Black men are at least twice as likely to develop prostate cancer as white men and the mortality rate is twice as high, evidencing substantial cancer inequalities. Although there currently is no national screening programme for prostate cancer, it is vital that black men are aware of prostate cancer and their elevated risk as this can encourage help-seeking behaviour, and in turn early diagnosis. Early diagnosis can save lives, yet black men tend to present at later stages. This study aims to investigate barriers and facilitators to early diagnosis of prostate cancer for black men in order to tackle this cancer inequality

RED experiment: an assessment of boundary layer effects in a trade winds regime on microwave and infrared propagation over the sea, The

Includes bibliographical references (pages 1364-1365).The Rough Evaporation Duct experiment aimed to see if the effects of ocean waves account for errors in modeling the ranges at which radar and infrared can detect low-flying targets

Improving uptake of breast, bowel and cervical cancer screening among Muslim women: protocol for a non-randomised feasibility study of a peer-led, faith-based intervention (IMCAN project)

Background: Cancer screening and early detection save lives, but Muslim women are less likely to participate in screening than white-British women. This is concerning as incidence rates of cancer appear to be increasing in ethnic minority groups. Faith-based cancer communications provide a culturally acceptable strategy to addressing barriers to screening. This study investigates the feasibility, effectiveness, and implementation of a co-designed, faith-based, and peer-led intervention to improve breast, bowel, and cervical screening uptake among Muslim women in the UK, which we co-designed in 2021 with ten Muslim women. Intervention: The intervention includes a health education component delivered by a GP explaining what is involved in cancer screening and potential risk factors, such as diabetes; personal testimonials reflecting Muslim women’s experiences with cancer and screening; and an Islamic perspective on cancer screening delivered by an Alimah, a female religious scholar. Methods: Underpinned by the Integrated Screening Action Model, we will conduct a non-randomised, two-arm feasibility trial with 200 Muslim women (aged 25-74 years, living in Glasgow or North-East England, not or partially up-to-date with screening). Participants will be allocated to either face-to-face or online delivery of the intervention. To identify opportunities for modification of the interventions, we will conduct semi-structured interviews with key stakeholders (n=6), including Muslim scholars and community liaison, and focus groups with intervention participants (4 groups with n=6-8/group) and peer-educators involved in intervention delivery (n=10). Expected results: An assessment of the suitability of the trial’s parameters will inform the development of a large-scale trial using pre-specified progression criteria and a traffic light system for evaluation of STOP-AMEND-GO criteria. To gain a preliminary indication of intervention effectiveness we will capture knowledge, attitudinal change to screening, and behavioural outcomes, such as intention to screen at baseline, 6, and 12 months follow-up, and NHS screening attendance at 12 months. Conclusion: The development of a co-designed faith-based, peer-led intervention has the potential to improve engagement with cancer screening among Muslim women. Our project represents a rigorous feasibility and process evaluation of a theory-driven and co-designed intervention for Muslim women. The inclusion of religious messages can support cancer screening uptake in this underserved group. We aim to further test intervention effectiveness in a fully powered randomised controlled trial. This would guide the development of cancer control communications for religious minorities in the UK and other countries with existing screening programmes

Diagnosing mucopolysaccharidosis IVA

Mucopolysaccharidosis IVA (MPS IVA; Morquio A syndrome) is an autosomal recessive lysosomal storage disorder resulting from a deficiency of N-acetylgalactosamine-6-sulfate sulfatase (GALNS) activity. Diagnosis can be challenging and requires agreement of clinical, radiographic, and laboratory findings. A group of biochemical genetics laboratory directors and clinicians involved in the diagnosis of MPS IVA, convened by BioMarin Pharmaceutical Inc., met to develop recommendations for diagnosis. The following conclusions were reached. Due to the wide variation and subtleties of radiographic findings, imaging of multiple body regions is recommended. Urinary glycosaminoglycan analysis is particularly problematic for MPS IVA and it is strongly recommended to proceed to enzyme activity testing even if urine appears normal when there is clinical suspicion of MPS IVA. Enzyme activity testing of GALNS is essential in diagnosing MPS IVA. Additional analyses to confirm sample integrity and rule out MPS IVB, multiple sulfatase deficiency, and mucolipidoses types II/III are critical as part of enzyme activity testing. Leukocytes or cultured dermal fibroblasts are strongly recommended for enzyme activity testing to confirm screening results. Molecular testing may also be used to confirm the diagnosis in many patients. However, two known or probable causative mutations may not be identified in all cases of MPS IVA. A diagnostic testing algorithm is presented which attempts to streamline this complex testing process

The clustering of the SDSS-IV extended Baryon Oscillation Spectroscopic Survey DR14 quasar sample: first measurement of baryon acoustic oscillations between redshift 0.8 and 2.2

We present measurements of the Baryon Acoustic Oscillation (BAO) scale in redshift-space using the clustering of quasars. We consider a sample of 147,000 quasars from the extended Baryon Oscillation Spectroscopic Survey (eBOSS) distributed over 2044 square degrees with redshifts $0.8 < z < 2.2$ and measure their spherically-averaged clustering in both configuration and Fourier space. Our observational dataset and the 1400 simulated realizations of the dataset allow us to detect a preference for BAO that is greater than 2.8$\sigma$. We determine the spherically averaged BAO distance to $z = 1.52$ to 3.8 per cent precision: $D_V(z=1.52)=3843\pm147 \left(r_{\rm d}/r_{\rm d, fid}\right)\$Mpc. This is the first time the location of the BAO feature has been measured between redshifts 1 and 2. Our result is fully consistent with the prediction obtained by extrapolating the Planck flat $\Lambda$CDM best-fit cosmology. All of our results are consistent with basic large-scale structure (LSS) theory, confirming quasars to be a reliable tracer of LSS, and provide a starting point for numerous cosmological tests to be performed with eBOSS quasar samples. We combine our result with previous, independent, BAO distance measurements to construct an updated BAO distance-ladder. Using these BAO data alone and marginalizing over the length of the standard ruler, we find $\Omega_{\Lambda} > 0$ at 6.6$\sigma$ significance when testing a $\Lambda$CDM model with free curvature.Comment: Accepted by MNRAS; BAO distance likelihood available in source files 'QSOv1.9fEZmock_BAOchi2.dat'; full set of data to be public eventually from SDSS websit

Strengthening mental health care systems for Syrian refugees in Europe and the Middle East: integrating scalable psychological interventions in 8 countries

The crisis in Syria has resulted in vast numbers of refugees seeking asylum in Syria’s neighbouring countries as well as in Europe. Refugees are at considerable risk of developing common mental disorders, including depression, anxiety, and posttraumatic stress disorder (PTSD). Most refugees do not have access to mental health services for these problems because of multiple barriers in national and refugee specific health systems, including limited availability of mental health professionals. To counter some of challenges arising from limited mental health system capacity the World Health Organization (WHO) has developed a range of scalable psychological interventions aimed at reducing psychological distress and improving functioning in people living in communities affected by adversity. These interventions, including Problem Management Plus (PM+) and its variants, are intended to be delivered through individual or group face to face or smartphone formats by lay, non-professional people who have not received specialized mental health training, We provide an evidence-based rationale for the use of the scalable PM+ oriented programmes being adapted for Syrian refugees and provide information on the newly launched STRENGTHS programme for adapting, testing and scaling up of PM+ in various modalities in both neighbouring and European countries hosting Syrian refugees

Erratum to: Methods for evaluating medical tests and biomarkers

[This corrects the article DOI: 10.1186/s41512-016-0001-y.]

Effect of Hydrocortisone on Mortality and Organ Support in Patients With Severe COVID-19: The REMAP-CAP COVID-19 Corticosteroid Domain Randomized Clinical Trial.

Importance: Evidence regarding corticosteroid use for severe coronavirus disease 2019 (COVID-19) is limited. Objective: To determine whether hydrocortisone improves outcome for patients with severe COVID-19. Design, Setting, and Participants: An ongoing adaptive platform trial testing multiple interventions within multiple therapeutic domains, for example, antiviral agents, corticosteroids, or immunoglobulin. Between March 9 and June 17, 2020, 614 adult patients with suspected or confirmed COVID-19 were enrolled and randomized within at least 1 domain following admission to an intensive care unit (ICU) for respiratory or cardiovascular organ support at 121 sites in 8 countries. Of these, 403 were randomized to open-label interventions within the corticosteroid domain. The domain was halted after results from another trial were released. Follow-up ended August 12, 2020. Interventions: The corticosteroid domain randomized participants to a fixed 7-day course of intravenous hydrocortisone (50 mg or 100 mg every 6 hours) (n = 143), a shock-dependent course (50 mg every 6 hours when shock was clinically evident) (n = 152), or no hydrocortisone (n = 108). Main Outcomes and Measures: The primary end point was organ support-free days (days alive and free of ICU-based respiratory or cardiovascular support) within 21 days, where patients who died were assigned -1 day. The primary analysis was a bayesian cumulative logistic model that included all patients enrolled with severe COVID-19, adjusting for age, sex, site, region, time, assignment to interventions within other domains, and domain and intervention eligibility. Superiority was defined as the posterior probability of an odds ratio greater than 1 (threshold for trial conclusion of superiority >99%). Results: After excluding 19 participants who withdrew consent, there were 384 patients (mean age, 60 years; 29% female) randomized to the fixed-dose (n = 137), shock-dependent (n = 146), and no (n = 101) hydrocortisone groups; 379 (99%) completed the study and were included in the analysis. The mean age for the 3 groups ranged between 59.5 and 60.4 years; most patients were male (range, 70.6%-71.5%); mean body mass index ranged between 29.7 and 30.9; and patients receiving mechanical ventilation ranged between 50.0% and 63.5%. For the fixed-dose, shock-dependent, and no hydrocortisone groups, respectively, the median organ support-free days were 0 (IQR, -1 to 15), 0 (IQR, -1 to 13), and 0 (-1 to 11) days (composed of 30%, 26%, and 33% mortality rates and 11.5, 9.5, and 6 median organ support-free days among survivors). The median adjusted odds ratio and bayesian probability of superiority were 1.43 (95% credible interval, 0.91-2.27) and 93% for fixed-dose hydrocortisone, respectively, and were 1.22 (95% credible interval, 0.76-1.94) and 80% for shock-dependent hydrocortisone compared with no hydrocortisone. Serious adverse events were reported in 4 (3%), 5 (3%), and 1 (1%) patients in the fixed-dose, shock-dependent, and no hydrocortisone groups, respectively. Conclusions and Relevance: Among patients with severe COVID-19, treatment with a 7-day fixed-dose course of hydrocortisone or shock-dependent dosing of hydrocortisone, compared with no hydrocortisone, resulted in 93% and 80% probabilities of superiority with regard to the odds of improvement in organ support-free days within 21 days. However, the trial was stopped early and no treatment strategy met prespecified criteria for statistical superiority, precluding definitive conclusions. Trial Registration: ClinicalTrials.gov Identifier: NCT02735707