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Review question Q1: What are the factors that influence individual service provider response to parents who are victims/survivors and/or perpetrators of IPVA and their exposed children? Q2: What are the factors that influence the way in which agencies work together in response to parents who are victims, survivors and/or perpetrators of IPVA and their exposed children? Searches We will search the international literature using electronic databases: MEDLINE (OVID), PsychoINFO (OVID), CINAHL (EBSCO), Scopus, Applied Social Science Index and Abstract (ASSIA) (ProQuest). Searches will be limited to publication dates ranging from of 2004-2022 to capture literature that is relevant to current legislation, such as the Children Act (2004), The Care Act (2014), the Children Act 1989 guidance and regulations (2021) and the Domestic Abuse Act (2021), which is the context in which service providers operate. Types of study to be included The review will include qualitative studies using narrative data to report approaches to service provision for adults and children affected by IPVA. Studies with at least some qualitative data collection, analysis, and reporting will be included. Studies including only quantitative methods, analysis and reporting will be excluded. Condition or domain being studied The condition being studied is Professional Practice in relation to Intimate Partner Violence and Abuse (IPVA) when it includes working with parents and children (up to 18 years of age) who experience IPVA. We will include papers which discuss factors including, but not limited to, the primary mandate of service providers, core components of working with affected parents and their children (as determined by models of service provision, processes, enablers, constraints and outcomes at individual, organisational and systems level), and service providers’ staff perceptions of service delivery. Participants/population Study participants will be practitioners, professionals and managers in

Review question Q1: What are the factors that influence individual service provider response to parents who are victims/survivors and/or perpetrators of IPVA and their exposed children? Q2: What are the factors that influence the way in which agencies work together in response to parents who are victims, survivors and/or perpetrators of IPVA and their exposed children? Searches We will search the international literature using electronic databases: MEDLINE (OVID), PsychoINFO (OVID), CINAHL (EBSCO), Scopus, Applied Social Science Index and Abstract (ASSIA) (ProQuest). Searches will be limited to publication dates ranging from of 2004-2022 to capture literature that is relevant to current legislation, such as the Children Act (2004), The Care Act (2014), the Children Act 1989 guidance and regulations (2021) and the Domestic Abuse Act (2021), which is the context in which service providers operate. Types of study to be included The review will include qualitative studies using narrative data to report approaches to service provision for adults and children affected by IPVA. Studies with at least some qualitative data collection, analysis, and reporting will be included. Studies including only quantitative methods, analysis and reporting will be excluded. Condition or domain being studied The condition being studied is Professional Practice in relation to Intimate Partner Violence and Abuse (IPVA) when it includes working with parents and children (up to 18 years of age) who experience IPVA. We will include papers which discuss factors including, but not limited to, the primary mandate of service providers, core components of working with affected parents and their children (as determined by models of service provision, processes, enablers, constraints and outcomes at individual, organisational and systems level), and service providers’ staff perceptions of service delivery. Participants/population Study participants will be practitioners, professionals and managers in

We proposed a multilevel model of structural influences on HIV-risky sexual partnerships in a diverse sample of 1793 youth residing in 23 states and the District of Columbia. We examined the influence of concentrated disadvantage, HIV stigma, and sexual and gender minority stigma on engagement in HIV risky sexual partnerships and whether youth's participation in opportunity structures, anticipation of HIV stigma, and perceptions of their community as youth-supportive settings mediated structural effects. After controlling for age, HIV status, and race, we found structural HIV stigma had deleterious indirect effects on youth's participation in HIV-risky sexual partnerships. Concentrated disadvantage and structural sexual and gender minority stigma had direct negative effects on youth's perceptions of their communities as supportive and on their participation in prosocial activity. Support perceptions had direct, protective effects on avoidance of HIV-risky sexual partnerships. Structural stigma undermines youth's belief that their communities invest in their safety and well-being.

We assessed the relationships among HIV-related social and behavioral outcomes resulting from an adolescent-focused HIV structural change initiative in eight urban sites operating Connect to Protect (C2P) coalitions. Over a 4-year period, annual cross-sectional panels of adolescents (N = 2,248) completed an audio-computer-assisted interview, providing data on satisfaction with their communities as adolescent-supportive environments, internalized HIV stigma, lifetime HIV-testing, lifetime sexual risk-taking, and number of sexual partners in the prior year. We used structural equation modeling to estimate hypothesized links between time since coalition mobilization to our social and behavioral outcomes. Over the 4 years, adolescents perceived their communities to become more supportive (p < .05). Positive perceptions of community support were associated with lower lifetime HIV sexual risk (p < .05). The effect of time on risk behavior was mediated by perceptions of community support. Stigma was unchanged over time. Stigma had damaging effects on risk behavior, effects which were also mediated by perceptions of community support. Special efforts are needed to address the deleterious effect of HIV stigma on high-risk urban adolescents.

We proposed a multilevel model of structural influences on HIV-risky sexual partnerships in a diverse sample of 1793 youth residing in 23 states and the District of Columbia. We examined the influence of concentrated disadvantage, HIV stigma, and sexual and gender minority stigma on engagement in HIV risky sexual partnerships and whether youth's participation in opportunity structures, anticipation of HIV stigma, and perceptions of their community as youth-supportive settings mediated structural effects. After controlling for age, HIV status, and race, we found structural HIV stigma had deleterious indirect effects on youth's participation in HIV-risky sexual partnerships. Concentrated disadvantage and structural sexual and gender minority stigma had direct negative effects on youth's perceptions of their communities as supportive and on their participation in prosocial activity. Support perceptions had direct, protective effects on avoidance of HIV-risky sexual partnerships. Structural stigma undermines youth's belief that their communities invest in their safety and well-being.

We assessed the relationships among HIV-related social and behavioral outcomes resulting from an adolescent-focused HIV structural change initiative in eight urban sites operating Connect to Protect (C2P) coalitions. Over a 4-year period, annual cross-sectional panels of adolescents (N = 2,248) completed an audio-computer-assisted interview, providing data on satisfaction with their communities as adolescent-supportive environments, internalized HIV stigma, lifetime HIV-testing, lifetime sexual risk-taking, and number of sexual partners in the prior year. We used structural equation modeling to estimate hypothesized links between time since coalition mobilization to our social and behavioral outcomes. Over the 4 years, adolescents perceived their communities to become more supportive (p < .05). Positive perceptions of community support were associated with lower lifetime HIV sexual risk (p < .05). The effect of time on risk behavior was mediated by perceptions of community support. Stigma was unchanged over time. Stigma had damaging effects on risk behavior, effects which were also mediated by perceptions of community support. Special efforts are needed to address the deleterious effect of HIV stigma on high-risk urban adolescents.

In the United States, youth aged 13-24 comprised approximately 21% of new HIV infections in 2017; 13% of these infections occurred among women, the majority of whom (86%) acquired HIV through heterosexual contact (Centers for Disease Control and Prevention. 2019a. HIV and youth. Retrieved from https://www.cdc.gov/hiv/group/age/youth/index.html, Centers for Disease Control and Prevention. 2019b. HIV among women. Retrieved from https://www.cdc.gov/hiv/group/gender/women/index.html). We fit and validated a developmentally appropriate empirical model of Connell's Theory of Gender and Power (Connell, R. W. 1987. Gender and power: Society, the person and sexual politics. Stanford, CA: Stanford University Press, Connell, R. W. 2013. Gender and power: Society, the person and sexual politics. Hoboken, NJ: John Wiley & Sons) in a sample of young women and assessed whether gendered powerlessness reflected a multidimensional higher-order latent factor, as the theory implies. Anonymous computer-assisted interviews were administered to at-risk, sexually active young women (N = 1,101). Factor analyses and structural equation modeling were used to determine the dimensionality of gendered powerlessness. Associations with condom use were examined to validate the model. We fit a three-component model of gendered powerlessness, but not a higher-order latent factor. We observed that high scores on two dimensions of gendered powerlessness - cathexis and sexual division of power - were associated with lower likelihood of condom use. Our three-component model helps elucidate the role that components of gendered powerlessness play in young women's health behaviors and underscores the need for measures tailored to young women at high risk of contracting HIV.

In the United States, youth aged 13-24 comprised approximately 21% of new HIV infections in 2017; 13% of these infections occurred among women, the majority of whom (86%) acquired HIV through heterosexual contact (Centers for Disease Control and Prevention. 2019a. HIV and youth. Retrieved from https://www.cdc.gov/hiv/group/age/youth/index.html, Centers for Disease Control and Prevention. 2019b. HIV among women. Retrieved from https://www.cdc.gov/hiv/group/gender/women/index.html). We fit and validated a developmentally appropriate empirical model of Connell's Theory of Gender and Power (Connell, R. W. 1987. Gender and power: Society, the person and sexual politics. Stanford, CA: Stanford University Press, Connell, R. W. 2013. Gender and power: Society, the person and sexual politics. Hoboken, NJ: John Wiley & Sons) in a sample of young women and assessed whether gendered powerlessness reflected a multidimensional higher-order latent factor, as the theory implies. Anonymous computer-assisted interviews were administered to at-risk, sexually active young women (N = 1,101). Factor analyses and structural equation modeling were used to determine the dimensionality of gendered powerlessness. Associations with condom use were examined to validate the model. We fit a three-component model of gendered powerlessness, but not a higher-order latent factor. We observed that high scores on two dimensions of gendered powerlessness - cathexis and sexual division of power - were associated with lower likelihood of condom use. Our three-component model helps elucidate the role that components of gendered powerlessness play in young women's health behaviors and underscores the need for measures tailored to young women at high risk of contracting HIV.

Eutrophication is a challenge to coastal waters around the globe. In many places, nutrient reductions from land-based sources have not been sufficient to achieve desired water quality improvements. Bivalve shellfish have shown promise as an in-water strategy to complement land-based nutrient management. A local-scale production model was used to estimate oyster (Crassostrea virginica) harvest and bioextraction of nitrogen (N) in Great Bay Piscataqua River Estuary (GBP), New Hampshire, USA, because a system-scale ecological model was not available. Farm-scale N removal results (0.072 metric tons acre year) were up-scaled to provide a system-wide removal estimate for current (0.61 metric tons year), and potential removal (2.35 metric tons year) at maximum possible expansion of licensed aquaculture areas. Restored reef N removal was included to provide a more complete picture. Nitrogen removal through reef sequestration was ~ 3 times that of aquaculture. Estimated reef-associated denitrification, based on previously reported rates, removed 0.19 metric tons N year. When all oyster processes (aquaculture and reefs) were included, N removal was 0.33% and 0.54% of incoming N for current and expanded acres, respectively. An avoided cost approach, with wastewater treatment as the alternative management measure, was used to estimate the value of the N removed. The maximum economic value for aquaculture-based removal was $105,000 and $405,000 for current and expanded oyster areas, respectively. Combined aquaculture and reef restoration is suggested to maximize N reduction capacity while limiting use conflicts. Comparison of removal based on per oyster N content suggests much lower removal rates than model results, but model harvest estimates are similar to reported harvest. Though results are specific to GBP, the approach is transferable to estuaries that support bivalve aquaculture but do not have complex system-scale hydrodynamic or ecological models

Eutrophication is a challenge to coastal waters around the globe. In many places, nutrient reductions from land-based sources have not been sufficient to achieve desired water quality improvements. Bivalve shellfish have shown promise as an in-water strategy to complement land-based nutrient management. A local-scale production model was used to estimate oyster (Crassostrea virginica) harvest and bioextraction of nitrogen (N) in Great Bay Piscataqua River Estuary (GBP), New Hampshire, USA, because a system-scale ecological model was not available. Farm-scale N removal results (0.072 metric tons acre−1 year−1) were up-scaled to provide a system-wide removal estimate for current (0.61 metric tons year−1), and potential removal (2.35 metric tons year−1) at maximum possible expansion of licensed aquaculture areas. Restored reef N removal was included to provide a more complete picture. Nitrogen removal through reef sequestration was ~ 3 times that of aquaculture. Estimated reef-associated denitrification, based on previously reported rates, removed 0.19 metric tons N year−1. When all oyster processes (aquaculture and reefs) were included, N removal was 0.33% and 0.54% of incoming N for current and expanded acres, respectively. An avoided cost approach, with wastewater treatment as the alternative management measure, was used to estimate the value of the N removed. The maximum economic value for aquaculture-based removal was $105,000 and $405,000 for current and expanded oyster areas, respectively. Combined aquaculture and reef restoration is suggested to maximize N reduction capacity while limiting use conflicts. Comparison of removal based on per oyster N content suggests much lower removal rates than model results, but model harvest estimates are similar to reported harvest. Though results are specific to GBP, the approach is transferable to estuaries that support bivalve aquaculture but do not have complex

In the United States, youth aged 13-24 comprised approximately 21% of new HIV infections in 2017; 13% of these infections occurred among women, the majority of whom (86%) acquired HIV through heterosexual contact (Centers for Disease Control and Prevention. 2019a. HIV and youth. Retrieved from https://www.cdc.gov/hiv/group/age/youth/index.html, Centers for Disease Control and Prevention. 2019b. HIV among women. Retrieved from https://www.cdc.gov/hiv/group/gender/women/index.html). We fit and validated a developmentally appropriate empirical model of Connells Theory of Gender and Power (Connell, R. W. 1987. Gender and power: Society, the person and sexual politics. Stanford, CA: Stanford University Press, Connell, R. W. 2013. Gender and power: Society, the person and sexual politics. Hoboken, NJ: John Wiley & Sons) in a sample of young women and assessed whether gendered powerlessness reflected a multidimensional higher-order latent factor, as the theory implies. Anonymous computer-assisted interviews were administered to at-risk, sexually active young women (N = 1,101). Factor analyses and structural equation modeling were used to determine the dimensionality of gendered powerlessness. Associations with condom use were examined to validate the model. We fit a three-component model of gendered powerlessness, but not a higher-order latent factor. We observed that high scores on two dimensions of gendered powerlessness - cathexis and sexual division of power - were associated with lower likelihood of condom use. Our three-component model helps elucidate the role that components of gendered powerlessness play in young womens health behaviors and underscores the need for measures tailored to young women at high risk of contracting HIV.

Connect to Protect (C2P), a 10-year community mobilization effort, pursued the dual aims of creating communities competent to address youth's HIV-related risks and removing structural barriers to youth health. We used Community Coalition Action Theory (CCAT) to examine the perceived contributions and accomplishments of 14 C2P coalitions. We interviewed 318 key informants, including youth and community leaders, to identify the features of coalitions' context and operation that facilitated and undermined their ability to achieve structural change and build communities' capability to manage their local adolescent HIV epidemic effectively. We coded the interviews using an a priori coding scheme informed by CCAT and scholarship on AIDS-competent communities. We found community mobilization efforts like C2P can contribute to addressing the structural factors that promote HIV-risk among youth and to community development. We describe how coalition leadership, collaborative synergy, capacity building, and local community context influence coalitions' ability to successfully implement HIV-related structural change, demonstrating empirical support for many of CCAT's propositions. We discuss implications for how community mobilization efforts might succeed in laying the foundation for an AIDS-competent community.

ImportanceMost human immunodeficiency virus (HIV)-infected youths are unaware of their serostatus (approximately 60%) and therefore not linked to HIV medical or prevention services. The need to identify promising and scalable approaches to promote uptake of HIV testing among youths at risk is critical.ObjectiveTo evaluate a multisite HIV testing program designed to encourage localized HIV testing programs focused on self-identified sexual minority males and to link youths to appropriate prevention services after receipt of their test results.Design, setting, and participantsTesting strategies were evaluated using an observational design during a 9-month period (June 1, 2015, through February 28, 2016). Testing strategies were implemented by 12 adolescent medicine HIV primary care programs and included targeted testing, universal testing, or a combination. Data were collected from local youth at high risk of HIV infection and, specifically, sexual minority males of color.Main outcomes and measuresProportion of sexual minority males and sexual minority males of color tested, proportion of previously undiagnosed HIV-positive youths identified, and rates of linkage to prevention services.ResultsA total of 3301 youths underwent HIV testing. Overall, 35 (3.6%) of those who underwent universal testing in primary care clinical settings, such as emergency departments and community health centers, were sexual minority males (35 [3.6%] were males of color) compared with 236 (46.7%) (201 [39.8%] were males of color) who were tested through targeted testing and 693 (37.8%) (503 [27.4%] were males of color) through combination efforts. Identification of new HIV-positive cases varied by strategy: 1 (0.1%) via universal testing, 39 (2.1%) through combination testing, and 16 (3.2%) through targeted testing. However, when targeted tests were separated from universal testing results for sites using a combined strategy, the rate of newly identified HIV-positive cases identified through

ImportanceMost human immunodeficiency virus (HIV)-infected youths are unaware of their serostatus (approximately 60%) and therefore not linked to HIV medical or prevention services. The need to identify promising and scalable approaches to promote uptake of HIV testing among youths at risk is critical.ObjectiveTo evaluate a multisite HIV testing program designed to encourage localized HIV testing programs focused on self-identified sexual minority males and to link youths to appropriate prevention services after receipt of their test results.Design, setting, and participantsTesting strategies were evaluated using an observational design during a 9-month period (June 1, 2015, through February 28, 2016). Testing strategies were implemented by 12 adolescent medicine HIV primary care programs and included targeted testing, universal testing, or a combination. Data were collected from local youth at high risk of HIV infection and, specifically, sexual minority males of color.Main outcomes and measuresProportion of sexual minority males and sexual minority males of color tested, proportion of previously undiagnosed HIV-positive youths identified, and rates of linkage to prevention services.ResultsA total of 3301 youths underwent HIV testing. Overall, 35 (3.6%) of those who underwent universal testing in primary care clinical settings, such as emergency departments and community health centers, were sexual minority males (35 [3.6%] were males of color) compared with 236 (46.7%) (201 [39.8%] were males of color) who were tested through targeted testing and 693 (37.8%) (503 [27.4%] were males of color) through combination efforts. Identification of new HIV-positive cases varied by strategy: 1 (0.1%) via universal testing, 39 (2.1%) through combination testing, and 16 (3.2%) through targeted testing. However, when targeted tests were separated from universal testing results for sites using a combined strategy, the rate of newly identified HIV-positive cases identified through

Connect to Protect (C2P), a 10-year community mobilization effort, pursued the dual aims of creating communities competent to address youth's HIV-related risks and removing structural barriers to youth health. We used Community Coalition Action Theory (CCAT) to examine the perceived contributions and accomplishments of 14 C2P coalitions. We interviewed 318 key informants, including youth and community leaders, to identify the features of coalitions' context and operation that facilitated and undermined their ability to achieve structural change and build communities' capability to manage their local adolescent HIV epidemic effectively. We coded the interviews using an a priori coding scheme informed by CCAT and scholarship on AIDS-competent communities. We found community mobilization efforts like C2P can contribute to addressing the structural factors that promote HIV-risk among youth and to community development. We describe how coalition leadership, collaborative synergy, capacity building, and local community context influence coalitions' ability to successfully implement HIV-related structural change, demonstrating empirical support for many of CCAT's propositions. We discuss implications for how community mobilization efforts might succeed in laying the foundation for an AIDS-competent community.

The aim of this thesis is to explore interprofessional collaboration between general physicians and emergency department teams in Brussels and the French speaking regions of Belgium, and the continuity of care for patients between these two levels of care. Results shed light on “how” collaboration between providers could be associated to continuity of care as perceived by patients. They also highlighted the challenges of promoting interprofessional collaboration across care levels. Relationships between general physicians and emergency departments’ teams were tightly linked to organizational factors and the general macro-environment. This macro-environment did not create opportunities of collaboration for the involved actors. Reinforcing primary care is therefore of great relevance, especially with the current shift towards community-based care; early hospital discharge; aging populations and comorbid chronic diseases, which are expected to put further strain on primary care., (SP - Sciences de la santé publique) -- UCL, 2019

Quantitative sensory testing (QST) is used in a variety of pain disorders to characterize pain and predict prognosis and response to specific therapies. In this study, we aimed to confirm results in the literature documenting altered QST thresholds in sickle cell disease (SCD) and assess the test-retest reliability of results over time. Fifty-seven SCD and 60 control subjects aged 8-20 years underwent heat and cold detection and pain threshold testing using a Medoc TSAII. Participants were tested at baseline and 3 months; SCD subjects were additionally tested at 6 months. An important facet of our study was the development and use of a novel QST modelling approach, allowing us to model all data together across modalities. We have not demonstrated significant differences in thermal thresholds between subjects with SCD and controls. Thermal thresholds were consistent over a 3- to 6-month period. Subjects on whom hydroxycarbamide (HC) was initiated shortly before or after baseline testing (new HC users) exhibited progressive decreases in thermal sensitivity from baseline to 6 months, suggesting that thermal testing may be sensitive to effective therapy to prevent vasoocclusive pain. These findings inform the use of QST as an endpoint in the evaluation of preventative pain therapies.

Reducing HIV incidence among adolescents represents an urgent global priority. Structural change approaches to HIV prevention may reduce youth risk by addressing the economic, social, cultural, and political factors that elevate it. We assessed whether achievement of structural changes made by eight Connect-to-Protect (C2P) coalitions were associated with improvements in youth's views of their community over the first 4 years of coalitions' mobilization. We recruited annual cross-sectional samples of targeted youth from each C2P community. We sampled youth in neighborhood venues. We interviewed a total of 2461 youth over 4 years. Males (66 %) and youth of color comprised the majority (52 % Hispanic/Latinos; 41 % African Americans) of those interviewed. By year 4, youth reported greater satisfaction with their community as a youth-supportive setting. They reported their needs were better met by available community resources compared with year 1. However, these findings were moderated by risk population such that those from communities where C2P focused on young men who have sex with men (YMSM) reported no changes over time whereas those from communities focused on other at-risk youth reported significant improvements over time in satisfaction and resource needs being met. Internalized HIV stigma increased over time among those from communities serving other at-risk youth and was unchanged among those from YMSM communities. The very different results we observe over time between communities focused on YMSM versus other at-risk youth may suggest it is unreasonable to assume identical chains of structural causality across youth populations who have such different historical relationships to HIV and who encounter very different kinds of entrenched discrimination within their communities.

Reducing HIV incidence among adolescents represents an urgent global priority. Structural change approaches to HIV prevention may reduce youth risk by addressing the economic, social, cultural, and political factors that elevate it. We assessed whether achievement of structural changes made by eight Connect-to-Protect (C2P) coalitions were associated with improvements in youth's views of their community over the first 4 years of coalitions' mobilization. We recruited annual cross-sectional samples of targeted youth from each C2P community. We sampled youth in neighborhood venues. We interviewed a total of 2461 youth over 4 years. Males (66 %) and youth of color comprised the majority (52 % Hispanic/Latinos; 41 % African Americans) of those interviewed. By year 4, youth reported greater satisfaction with their community as a youth-supportive setting. They reported their needs were better met by available community resources compared with year 1. However, these findings were moderated by risk population such that those from communities where C2P focused on young men who have sex with men (YMSM) reported no changes over time whereas those from communities focused on other at-risk youth reported significant improvements over time in satisfaction and resource needs being met. Internalized HIV stigma increased over time among those from communities serving other at-risk youth and was unchanged among those from YMSM communities. The very different results we observe over time between communities focused on YMSM versus other at-risk youth may suggest it is unreasonable to assume identical chains of structural causality across youth populations who have such different historical relationships to HIV and who encounter very different kinds of entrenched discrimination within their communities.

Reducing HIV incidence among adolescents represents an urgent global priority. Structural change approaches to HIV prevention may reduce youth risk by addressing the economic, social, cultural, and political factors that elevate it. We assessed whether achievement of structural changes made by eight Connect-to-Protect (C2P) coalitions were associated with improvements in youth's views of their community over the first 4 years of coalitions' mobilization. We recruited annual cross-sectional samples of targeted youth from each C2P community. We sampled youth in neighborhood venues. We interviewed a total of 2461 youth over 4 years. Males (66 %) and youth of color comprised the majority (52 % Hispanic/Latinos; 41 % African Americans) of those interviewed. By year 4, youth reported greater satisfaction with their community as a youth-supportive setting. They reported their needs were better met by available community resources compared with year 1. However, these findings were moderated by risk population such that those from communities where C2P focused on young men who have sex with men (YMSM) reported no changes over time whereas those from communities focused on other at-risk youth reported significant improvements over time in satisfaction and resource needs being met. Internalized HIV stigma increased over time among those from communities serving other at-risk youth and was unchanged among those from YMSM communities. The very different results we observe over time between communities focused on YMSM versus other at-risk youth may suggest it is unreasonable to assume identical chains of structural causality across youth populations who have such different historical relationships to HIV and who encounter very different kinds of entrenched discrimination within their communities.

Using an ecological perspective, we sought to elucidate the perceived barriers preventing HIV service access among two groups of U.S. youth (ages 12-24) disproportionately affected by HIV, men who have sex with men and high-risk women. We content analyzed interviews with 318 key informants to identify distinct service barriers. The 29 barriers informants named were organized into six categories (service-seeking demands, stigmas, knowledge and awareness, service quality, powerful opposition, and negative emotions). Findings suggest that barriers impacting access to HIV prevention, testing, and linkage-to-care services are remarkably similar and point to the need for comprehensive approaches to improving youth's access services that address both individual-level barriers and extra-individual barriers simultaneously. Findings can be used to guide future research, programming and interventions to reduce the disproportionate spread of HIV among US youth.

Using an ecological perspective, we sought to elucidate the perceived barriers preventing HIV service access among two groups of U.S. youth (ages 12-24) disproportionately affected by HIV, men who have sex with men and high-risk women. We content analyzed interviews with 318 key informants to identify distinct service barriers. The 29 barriers informants named were organized into six categories (service-seeking demands, stigmas, knowledge and awareness, service quality, powerful opposition, and negative emotions). Findings suggest that barriers impacting access to HIV prevention, testing, and linkage-to-care services are remarkably similar and point to the need for comprehensive approaches to improving youth's access services that address both individual-level barriers and extra-individual barriers simultaneously. Findings can be used to guide future research, programming and interventions to reduce the disproportionate spread of HIV among US youth.

Using an ecological perspective, we sought to elucidate the perceived barriers preventing HIV service access among two groups of U.S. youth (ages 12-24) disproportionately affected by HIV, men who have sex with men and high-risk women. We content analyzed interviews with 318 key informants to identify distinct service barriers. The 29 barriers informants named were organized into six categories (service-seeking demands, stigmas, knowledge and awareness, service quality, powerful opposition, and negative emotions). Findings suggest that barriers impacting access to HIV prevention, testing, and linkage-to-care services are remarkably similar and point to the need for comprehensive approaches to improving youths access services that address both individual-level barriers and extra-individual barriers simultaneously. Findings can be used to guide future research, programming and interventions to reduce the disproportionate spread of HIV among US youth.

Mitigating coastal eutrophication is a global challenge. In many places where land-based management has reduced nutrient discharges, coastal waterbodies remain impaired. This study examined ‘bioextraction’ of nutrients from the water by oyster aquaculture in Long Island Sound, Connecticut, as an example of how aquaculture might complement land-based measures in urban estuaries. Eutrophication status, nutrient removal, and ecosystem service value were estimated through eutrophication assessment, application of hydrologic, circulation, and local- and ecosystem-scale models, and economic valuation. System-scale modeling estimated that current oyster aquaculture, via sequestration into tissue and shell only, removes an equivalent of 1.31%, and expanded production could remove 2.68%, of total annual land-based nitrogen inputs by aquaculture alone. Up-scaled local-scale results were similar to results from the system-scale modeling, suggesting that this upscaling method could be useful in waterbodies without circulation models. The minimum value of the ecosystem service of nitrogen removed by oyster production was estimated by means of an avoided costs method, which uses the cost of alternative nutrient management measures such as wastewater treatement and urban Best Management Practices to estimate the value of the removed nitrogen, to be $8.5 million per year, with maximum value at expanded production of $470 million per year. Removal and value estimates are conservative because they do not include removal by clams in Connecticut due to the lack of a clam model, or by oysters and clams in New York due to data limitations, nor denitrification losses. If oyster associated removal from all Connecticut and New York lease acres (5% of bottom area) and denitrification losses for both states are included, nitrogen removal estimates increase to 10% – 30% of total annual inputs. The total N removal could be higher if removal by clams is included. Additional research is needed fo

The Affordable Care Act has changed the face of health care provision and services in this country, expanding access to more than 30 million people (Buerhaus et al., 2012). With increased coverage comes increased use of health care systems, in a system already saddled with a deficient number of providers (HIS Inc., 2016). The solution to this has been the inclusion of advanced practice nurses (APNs) into both primary and specialty care services. Within cardiovascular medicine, there has been a surge in the recruitment of APNs to care teams (Virani et al., 2015). With this increased need comes the recognition that generalist education and preparation does not prepare an APN to be a competent cardiovascular medicine provider. Advanced practice nurse training has long left specialization to the postgraduate orientation period (Kells, Dunn, Melchiono, & Burke, 2015), and the demands of the healthcare system outweigh the current training models. This has opened the door for the creation of postgraduate fellowship programs for APNs (Taylor, Boryhill, Burris, & Wilcox, 2017). This project focused on the evaluation of existing cardiovascular APN fellowships and proposed the creation of a postgraduate APN fellowship in cardiovascular medicine at Oregon Health and Science University (OHSU).

The stability of levees in the Sacramento-San Joaquin Delta is threatened by continued subsidence of Delta peat islands. Up to 6 meters of land-surface elevation has been lost in the 150 years since Delta marshes were leveed and drained, primarily from oxidation of peat soils. Flooding subsided peat islands halts peat oxidation by creating anoxic soils, but net accumulation of new material in restored wetlands is required to recover land-surface elevations. We investigated the subsidence reversal potential of two 3 hectare, permanently flooded, impounded wetlands re-established on a deeply subsided field on Twitchell Island. The shallower wetland (design water depth 25 cm) was almost completely colonized by dense emergent marsh vegetation within two years; whereas, the deeper wetland (design water depth 55 cm) which developed spatially variable depths as a result of heterogeneous colonization by emergent vegetation, still had some areas remaining as open water after nine years. Changes in land-surface elevation were quantified using repeated sedimentation-erosion table measurements. New material accumulating in the wetlands was sampled by coring.Land-surface elevations increased by an average of 4 cm/yr in both wetlands from 1997 to 2006; however, the rates at different sites in the wetlands ranged from -0.5 to +9.2 cm/yr. Open water areas of the deeper wetland without emergent vegetation had the lowest rates of land-surface elevation gain. The greatest rates occurred in areas of the deeper wetland most isolated from the river water inlets, with dense stands of emergent marsh vegetation (tules and cattails). Vegetated areas of the deeper wetland in the transition zones between open water and mature emergent stands had intermediate rates of land-surface gain, as did the entire shallower wetland. These results suggest that the dominant component contributing to land-surface elevation gain in these wetlands was accumulation of organic matter, rather than mineral sedime

The stability of levees in the Sacramento-San Joaquin Delta is threatened by continued subsidence of Delta peat islands. Up to 6 meters of land-surface elevation has been lost in the 150 years since Delta marshes were leveed and drained, primarily from oxidation of peat soils. Flooding subsided peat islands halts peat oxidation by creating anoxic soils, but net accumulation of new material in restored wetlands is required to recover land-surface elevations. We investigated the subsidence reversal potential of two 3 hectare, permanently flooded, impounded wetlands re-established on a deeply subsided field on Twitchell Island. The shallower wetland (design water depth 25 cm) was almost completely colonized by dense emergent marsh vegetation within two years; whereas, the deeper wetland (design water depth 55 cm) which developed spatially variable depths as a result of heterogeneous colonization by emergent vegetation, still had some areas remaining as open water after nine years. Changes in land-surface elevation were quantified using repeated sedimentation-erosion table measurements. New material accumulating in the wetlands was sampled by coring.Land-surface elevations increased by an average of 4 cm/yr in both wetlands from 1997 to 2006; however, the rates at different sites in the wetlands ranged from -0.5 to +9.2 cm/yr. Open water areas of the deeper wetland without emergent vegetation had the lowest rates of land-surface elevation gain. The greatest rates occurred in areas of the deeper wetland most isolated from the river water inlets, with dense stands of emergent marsh vegetation (tules and cattails). Vegetated areas of the deeper wetland in the transition zones between open water and mature emergent stands had intermediate rates of land-surface gain, as did the entire shallower wetland. These results suggest that the dominant component contributing to land-surface elevation gain in these wetlands was accumulation of organic matter, rather than mineral sedime

PurposeHispanic/Latino adolescents and young adults are disproportionately impacted by the HIV/AIDS epidemic; yet little is known about the best strategies to increase HIV testing in this group. Network-based approaches are feasible and acceptable means for screening at-risk adults for HIV infection, but it is unknown whether these approaches are appropriate for at-risk young Hispanics/Latinos. Thus, we compared an alternative venue-based testing (AVT) strategy with a social and sexual network-based interviewing and HIV testing (SSNIT) strategy.MethodsAll participants were Hispanics/Latinos aged 13-24 years with self-reported HIV risk; they were recruited from 11 cities in the United States and Puerto Rico and completed an audio computer-assisted self-interview and underwent HIV screening.ResultsA total of 1,596 participants (94.5% of those approached) were enrolled: 784 (49.1%) through AVT and 812 (50.9%) through SSNIT. HIV infection was identified in three SSNIT (.37%) and four AVT (.51%) participants (p = .7213).ConclusionsDespite high levels of HIV risk, a low prevalence of HIV infection was identified with no differences by recruitment strategy. We found overwhelming support for the acceptability and feasibility of AVT and SSNIT for engaging and screening at-risk young Hispanics/Latinos. Further research is needed to better understand how to strategically implement such strategies to improve identification of undiagnosed HIV infection.

PurposeHispanic/Latino adolescents and young adults are disproportionately impacted by the HIV/AIDS epidemic; yet little is known about the best strategies to increase HIV testing in this group. Network-based approaches are feasible and acceptable means for screening at-risk adults for HIV infection, but it is unknown whether these approaches are appropriate for at-risk young Hispanics/Latinos. Thus, we compared an alternative venue-based testing (AVT) strategy with a social and sexual network-based interviewing and HIV testing (SSNIT) strategy.MethodsAll participants were Hispanics/Latinos aged 13-24 years with self-reported HIV risk; they were recruited from 11 cities in the United States and Puerto Rico and completed an audio computer-assisted self-interview and underwent HIV screening.ResultsA total of 1,596 participants (94.5% of those approached) were enrolled: 784 (49.1%) through AVT and 812 (50.9%) through SSNIT. HIV infection was identified in three SSNIT (.37%) and four AVT (.51%) participants (p = .7213).ConclusionsDespite high levels of HIV risk, a low prevalence of HIV infection was identified with no differences by recruitment strategy. We found overwhelming support for the acceptability and feasibility of AVT and SSNIT for engaging and screening at-risk young Hispanics/Latinos. Further research is needed to better understand how to strategically implement such strategies to improve identification of undiagnosed HIV infection.

There is a considerable amount of theoretical and empirical research on child temperament; yet there is little consensus on the theoretical perspective, definition, or measurement. In addition, the empirical research has been limited by a small age span and a focus on one temperament dimension. The theoretical framework of this study was the transactional model which views the development of a child as a product of the complex interplay between the continuous, dynamic influences of the child's biological heritage and his/her life experience provided by family and social contexts. This longitudinal, descriptive, correlational research study examined the stability, structure, and effects of perinatal morbidity on child temperament from 1 month of age to 17 years of age in a longitudinal sample of children born with prematurity and various perinatal risks. Three perinatal groups were a full-term healthy control group, a healthy preterm group, and a preterm with morbidity group. The aims were designed to determine and compare the factors of temperament across various temperament instruments, assess measurement equivalence for the instruments, evaluate the stability of child temperament dimensions from infancy to adolescence, and compare the effects of perinatal morbidity on temperament dimensions. With the exception of one instrument, study data matched the temperament dimensions defined by the instrument authors. Stability in unpredictability, activity, attention, and persistence were small in effect across time. There were no significant differences among the perinatal groups on predictability at infancy, age 8, or age 17. The full-term group had significantly higher attention at age 12 and higher activity at age 17 than the preterm with morbidity group. The preterm with morbidity group had higher persistence than the full-term group at age 17. With a greater understanding of child temperament, nurses can then meet the environmental demands and expectations of childre

Proceedings from 3rd Simulation Based Acquisition conference, 15-17 May 2001, sponsored by NDIA, The original document contains color images. Viewgraphs only.

Enregistrement : 3/1989

Personalisation has become a key aspiration of adult social care policy in England. Perspectives vary though as its meaning and the extent to which it signals a new paradigm in care. It is being seen as not only relevant to those directly accessing care but also for their carers. Carers’ support is an area in which third sector organisations (TSOs) have traditionally played a significant role, and changes to funding and the expected model of care will therefore potentially have an impact on the third sector. This study explores the issues that arise for TSOs who work with carers from the introduction of personalisation, through interviews with TSOs and public sector commissioners and policy makers.

The concept of commissioning has risen in prominence in recent years as a result of ongoing reforms to the funding and delivery of public services in the UK. The model of commissioning constructed by policy has however been overlaid on existing practices, which themselves differ between different service areas. This paper, focusing on commissioning of third sector organisations (TSOs) in the field of community mental health services, shows that its introduction has not led to the straightforward public sector ‘marketisation’ that advocates desire or that critics fear. Instead, commissioning has led to an indeterminate outcome or 'halfway house' position in which the status and role of commissioning remains somewhat muddled – both internally to participants within public sector organisations and externally in terms of the experience of the interface by TSOs. We found that commissioning as it is actually practiced remains contested and political – it is a highly relational process dependent on personal practices and skills and on personal relationships between stakeholders – and is therefore not fully managerialised or marketised. This has implications for the policy and practice of commissioning and the interpretation of more 'open' public services.

The heat of the debate about the ‘privatisation’ of the NHS has been intense. The role of the private sector in the NHS is a development which needs serious consideration, but only by resisting the temptation to use generalisations, miscommunications and allegations will we be able to have a proper and nuanced discussion of both the concerns and the possibilities, argue Robin Miller and Martin Powell.

The concept of commissioning has risen in prominence in recent years as a result of ongoing reforms to the funding and delivery of public services in the UK. The model of commissioning constructed by policy has however been overlaid on existing practices, which themselves differ between different service areas. This paper, focusing on commissioning of third sector organisations (TSOs) in the field of community mental health services, shows that its introduction has not led to the straightforward public sector ‘marketisation’ that advocates desire or that critics fear. Instead, commissioning has led to an indeterminate outcome or 'halfway house' position in which the status and role of commissioning remains somewhat muddled – both internally to participants within public sector organisations and externally in terms of the experience of the interface by TSOs. We found that commissioning as it is actually practiced remains contested and political – it is a highly relational process dependent on personal practices and skills and on personal relationships between stakeholders – and is therefore not fully managerialised or marketised. This has implications for the policy and practice of commissioning and the interpretation of more 'open' public services.

Personalisation has become a key aspiration of adult social care policy in England. Perspectives vary though as its meaning and the extent to which it signals a new paradigm in care. It is being seen as not only relevant to those directly accessing care but also for their carers. Carers’ support is an area in which third sector organisations (TSOs) have traditionally played a significant role, and changes to funding and the expected model of care will therefore potentially have an impact on the third sector. This study explores the issues that arise for TSOs who work with carers from the introduction of personalisation, through interviews with TSOs and public sector commissioners and policy makers.