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Family caregivers use tools and technology to provide care for children with medical complexity (CMC) in the home. It is unclear what barriers families experience when using the tools and technology integral to the care and wellbeing of CMC. Our objective was to identify the barriers family caregivers experience in using tools and technology to provide care to CMC in the home. We used contextual inquiry to interview 30 caregivers in their homes and analyzed our data using a deductive content analysis informed by the patient work system (PWS) model and an inductive content analysis to identify emergent barriers. Through these combined analyses, we identified four categories of barriers families experienced using tools and technology to care for CMC: 1) Access and Cost; 2) Usability, which includes the subcategories Functionality, Tool design, Ease of use, and Reliability; 3) Short-term tool impact; and 4) Long-term tool impact. Our results point to the need for further interventions to reduce or mitigate tools and technology barriers to the in-home care for CMC.

Approximately 11.4 million cases of gonorrhea occur in the WHO African Region annually and global incidence has been increasing. We sought to determine the distribution and types of antimicrobial resistance in Neisseria gonorrhoeae (NG) in Kisumu, Kenya. Urethral swab specimens were obtained from men attending Universities of Nairobi, Illinois, and Manitoba sexually transmitted infection clinic with urethral discharge detected on clinical exam between 29 January and 2 July 2018. Gonorrhea was confirmed by culturing on Thayer–Martin GC Culture selective media. Disk diffusion was used to measure resistance to antimicrobials. Of the 138 males with history of urethral discharge or dysuria or urethral discharge on exam identified during the surveillance period, urethral swab samples were obtained from 60 men, and 35 (58%) were culture positive. Interpretation of the disk diffusion results showed high resistance (% of isolates) to: penicillin (97%), tetracycline (100%), ciprofloxacin (100%), and doxycycline (91%). All isolates were susceptible to ceftriaxone (100%) and azithromycin (100%). We observed high rates of resistance to several drug classes, likely driven by background selective pressure, as resistance was not observed among currently recommended Kenyan therapies for urethritis. Expanded surveillance for antimicrobial resistance in NG is warranted. Agar dilution or Etest reference testing is needed for accurate assessment of resistance.

Background: Neuropathic pain (NP) is a debilitating condition that may result from spinal cord injury (SCI). Nearly 75% of all SCIs result in NP affecting 17,000 new individuals in the United States every year, and an estimated 7-10% of people worldwide. It is caused by damaged or dysfunctional nerve fibers sending aberrant signals to pain centers in the central nervous system causing severe pain that affects daily life and routine. The mechanisms underlying NP are not fully understood, making treatment difficult. Identification of specific molecular pathways that are involved in pain syndromes and finding effective treatments has become a major priority in current SCI research. Yoga has therapeutic applications that may prove beneficial in treating subjects suffering chronically from SCI-induced NP, chronic back and associated pain if necessary experimental data are generated. Summary: This review aims to discuss the implications of various mechanistic approaches of yoga which can be tested by new study designs around various nociceptive molecules including matrix metalloproteinases, cation-dependent chloride transporter (NKCC1), etc. in SCI-induced NP patients. Key Messages: Yogic practices could be used in managing SCI-induced NP pain by regulating the action of various mechanisms and its associated molecules. Modern prescriptive treatment strategies combined with alternative approaches like yoga should be used in rehabilitation centers and clinics in order to ameliorate chronic NP. We recommend practical considerations of careful yoga practice as part of an integrative medicine approach for NP associated with SCI.