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Introduction Moral injury among healthcare missionaries leads to negative consequences for the individual, healthcare team, patients, and sending agencies. Conflicting values in clinical care, culture, and spirituality provide unique potentially morally injurious experiences. The purpose of this qualitative study is to explore the phenomenon of moral injury among western healthcare missionaries to develop effective support and treatment strategies. Methods A qualitative interview guide was developed based on the existing literature on moral injury. Twenty-one key informant interviews were completed by two former healthcare missionaries. Participants were based in Africa, Asia, and Eastern Europe healthcare mission settings. Questions were based on clinical, cultural, and spiritual domains of potential ethical and moral conflicts. Protective factors were also explored based on one’s faith and spiritual practices. Interviews were transcribed and coded independently by two analysts. The team reviewed the codes and determined themes from across the three domains. Results Seven themes emerged from the interviews ranging from morally injurious experiences with cultural leadership practices and unfamiliar clinical care experiences to guilt over practicing outside of one’s scope of practice and addressing suffering alongside God’s sovereignty. The themes led to the development of an injury/growth pathway as a potential model for helping healthcare missionaries describe and move through potentially morally injurious experiences. Conclusion The themes allow for healthcare missionary sending agencies to develop strategies, training, and support systems for teams preparing to enter the mission field and for individuals already in the field. Recommendations for growing through potentially morally injurious experiences are suggested to guide practice and support for missionaries in the field. The growth values and strategies could inform the development of a screening tool to assess moral injury among healthcare missionaries.

Abstract Background Large-river decision-makers are charged with maintaining diverse ecosystem services through unprecedented social-ecological transformations as climate change and other global stressors intensify. The interconnected, dendritic habitats of rivers, which often demarcate jurisdictional boundaries, generate complex management challenges. Here, we explore how the Resist–Accept–Direct (RAD) framework may enhance large-river management by promoting coordinated and deliberate responses to social-ecological trajectories of change. The RAD framework identifies the full decision space of potential management approaches, wherein managers may resist change to maintain historical conditions, accept change toward different conditions, or direct change to a specified future with novel conditions. In the Upper Mississippi River System, managers are facing social-ecological transformations from more frequent and extreme high-water events. We illustrate how RAD-informed basin-, reach-, and site-scale decisions could: (1) provide cross-spatial scale framing; (2) open the entire decision space of potential management approaches; and (3) enhance coordinated inter-jurisdictional management in response to the trajectory of the Upper Mississippi River hydrograph. Results The RAD framework helps identify plausible long-term trajectories in different reaches (or subbasins) of the river and how the associated social-ecological transformations could be managed by altering site-scale conditions. Strategic reach-scale objectives may reprioritize how, where, and when site conditions could be altered to contribute to the basin goal, given the basin’s plausible trajectories of change (e.g., by coordinating action across sites to alter habitat connectivity, diversity, and redundancy in the river mosaic). Conclusions When faced with long-term systemic transformations (e.g., > 50 years), the RAD framework helps explicitly consider whether or when the basin vision or goals may no longer be achievable, and direct options may open yet unconsidered potential for the basin. Embedding the RAD framework in hierarchical decision-making clarifies that the selection of actions in space and time should be derived from basin-wide goals and reach-scale objectives to ensure that site-scale actions contribute effectively to the larger river habitat mosaic. Embedding the RAD framework in large-river decisions can provide the necessary conduit to link flexibility and innovation at the site scale with stability at larger scales for adaptive governance of changing social-ecological systems.

Introduction: Research as a focus of healthcare missions is an important component of the evolving role of healthcare missionaries and sending organizations in LMICs. There is a lack of data and understanding on what appetite exists to expand and invest in such research initiatives. Methods: This study surveyed leaders of North American mission sending agencies engaged in healthcare, seeking to ascertain their current and anticipated future involvement in research, education, and healthcare delivery. Results: Forty-seven leaders responded (of 211 contacted) to our survey of whom 37 completed all survey questions. Eighty-two percent of respondents agreed that they had a responsibility as an organization to study how to improve clinical care and public health. Sixty-four percent of respondents anticipated reduced healthcare delivery in the next 10 years. During that same 10-year, time frame, 61% anticipate an increase in health research mentoring, and 79% expect an increased role of student education. However, this emerging shift towards research and education is not yet reflected with a similar degree of perceived enthusiasm among missionaries in doing research or donors in supporting it. Discussion: Across the spectrum of middle- and upper-level leadership in a variety of missions sending organizations, there is recognition of an important and increasing role for healthcare research activities in ministry. About half of the agencies represented in our sample are already involved in research and will need to share best practices with others as healthcare missionaries devote more time and attention to research mentorship. Done well, this can provide additional avenues for disciple-making in both home and host cultures as well as improve the care for populations in those remote and rural areas often most served by healthcare missionaries. Conclusion: Research as mission has, heretofore, been a neglected methodology, but institutional leaders in healthcare missions anticipate an increasingly important ministry role for it.

Abstract Soft structural textiles, or softgoods, are used within the space industry for inflatable habitats, parachutes and decelerator systems. Evaluating the safety and structural integrity of these systems occurs through structural health monitoring systems (SHM), which integrate non-invasive/non-destructive testing methods to detect, diagnose, and locate damage. Strain/load monitoring of these systems is limited while utilizing traditional strain gauges as these gauges are typically stiff, operate at low temperatures, and fail when subjected to high strain that is a result of high loading classifying them as unsuitable for SHM of soft structural textiles. For this work, a capacitance based strain gauge (CSG) was fabricated via aerosol jet printing (AJP) using silver nanoparticle ink on a flexible polymer substrate. Printed strain gauges were then compared to a commercially available high elongation resistance-based strain gauge (HE-RSG) for their ability to monitor strained Kevlar straps having a 26.7 kN (6 klbf) load. Dynamic, static and cyclic loads were used to characterize both types of strain monitoring devices. Printed CSGs demonstrated superior performance for high elongation strain measurements when compared to commonly used HE-RSGs, and were observed to operate with a gauge factor of 5.2 when the electrode arrangement was perpendicular to the direction of strain.

Abstract The popular beaches of the San Diego‐Tijuana (US/MX) border region are often impacted by untreated wastewater sourced from Mexico—via the Tijuana River Estuary (TJRE) and San Antonio de los Buenos outfall at the Pt. Bandera (SAB/PTB) shoreline, leading to impacted beaches and human illness. The US‐Mexico‐Canada trade agreement will fund border infrastructure projects reducing untreated wastewater discharges. However, estimating project benefits such as reduced human illness and beach impacts is challenging. We develop a coupled hydrodynamic, norovirus (NoV) pathogen, and swimmer illness risk model with the wastewater sources for the year 2017. The model is used to evaluate the reduction in human illness and beach impacts under baseline conditions and three infrastructure diversion scenarios which (Scenario A) reduce SAB/PTB discharges and moderately reduce TJRE inflows or (Scenarios B, C) strongly reduce TJRE in inflows only. The model estimates shoreline untreated wastewater and NoV concentrations, and the number of NoV ill swimmers at Imperial Beach CA. In the Baseline, the percentage of swimmers becoming ill is 3.8% over 2017, increasing to 4.5% during the tourist season (Memorial to Labor Day) due to south‐swell driven SAB/PTB plumes. Overall, Scenario A provides the largest reduction in ill swimmers and beach impacts for the tourist season and full year. The 2017 tourist season TJRE inflows were not representative of those in 2020, yet, Scenario A likely still provides the greatest benefit in other years. This methodology can be applied to other coastal regions with wastewater inputs.

In Canada, interprovincial labor migration is a common form of mobile work that is significant for rural communities especially in Atlantic Canada. Unique to this form of labor migration is the gendered nature of the phenomenon resulting in men often leaving their wives, families and rural communities behind for employment opportunities in the oil and gas sectors thousands of kilometers away. As men leave their families and communities for employment, women who are left behind become primary caregivers to children in addition to also being the primary caretakers of the family home. The Tale of Two Islands project was a multi-year, cross regional mixed methods research study that examined labor mobility and its impact on families and communities. This paper examines how labor migration has impacted families and rural communities. Drawing upon focus group, conversational and key informant interviews with families impacted by mobile labor and practitioners who serve them, societal perceptions of gendered norms and perceptions of rural life became illuminated. This has contributed to multiple contradictions and role confusion as families adapt and adjust to periods of reunification and separation while striving to remain connected to their rural communities. Men yearn for opportunities to be an active member of their home communities but cannot a result of living away for extended periods of time. In contrast, women who stay behind in rural communities often chose to isolate from community activities as a result of perceived judgments that are attributed to traditional views of rural life and family roles.

Prostaglandin E2 (PGE2), an arachidonic acid pathway metabolite produced by cyclooxygenase (COX)-1/2, has been shown to impair anti-tumor immunity through engagement with one or more E-type prostanoid receptors (EP1-4). Specific targeting of EP receptors, as opposed to COX-1/2 inhibition, has been proposed to achieve preferential antagonism of PGE2–mediated immune suppression. Here we describe the anti-tumor activity of MF-766, a potent and highly selective small-molecule inhibitor of the EP4 receptor. EP4 inhibition by MF-766 synergistically improved the efficacy of anti-programmed cell death protein 1 (PD-1) therapy in CT26 and EMT6 syngeneic tumor mouse models. Multiparameter flow cytometry analysis revealed that treatment with MF-766 promoted the infiltration of CD8+ T cells, natural killer (NK) cells and conventional dendritic cells (cDCs), induced M1-like macrophage reprogramming, and reduced granulocytic myeloid-derived suppressor cells (MDSC) in the tumor microenvironment (TME). In vitro experiments demonstrated that MF-766 restored PGE2-mediated inhibition of lipopolysaccharide (LPS)-induced tumor necrosis factor (TNF)-α production in THP-1 cells and human blood, and PGE2-mediated inhibition of interleukin (IL)-2-induced interferon (IFN)-γ production in human NK cells. MF-766 reversed the inhibition of IFN-γ in CD8+ T-cells by PGE2 and impaired suppression of CD8+ T-cells induced by myeloid-derived suppressor cells (MDSC)/PGE2. In translational studies using primary human tumors, MF-766 enhanced anti-CD3-stimulated IFN-γ, IL-2, and TNF-α production in primary histoculture and synergized with pembrolizumab in a PGE2 high TME. Our studies demonstrate that the combination of EP4 blockade with anti-PD-1 therapy enhances antitumor activity by differentially modulating myeloid cell, NK cell, cDC and T-cell infiltration profiles.

(1) Background: In the face of persistent and chronically weak labour markets, Atlantic Canada has become increasingly dependent on mobile oil work in Northern Alberta for employment and income. In the regions, most intensely engaged in this form of employment, mobile oil work has largely replaced the dominant industries of the previous century. This geographic shift in Canadian investment and production has created uneven labour markets, with high demand for labour in the Northern Alberta and high unemployment in de-industrialized communities in Atlantic Canada. (2) Methods: There is little quantitative evidence on the flows of mobile workers from the East to the West and the impact of this movement on the Atlantic Canadian economy. Data for this paper were obtained through a special arrangement with Statistics Canada in the fall of 2015 and winter of 2016, from the Canadian Employer−Employee Dynamics Database (CEEDD). (3) Results: Analysis of CEEDD revealed that the oil and gas industry of Northern Alberta has a significant impact on the economies of Atlantic Canada with an increasing dependence for interprovincial workers. (4) Conclusions: To the extent that mobile work has served as a replacement for traditional industries, mobile work is re-structuring the social and economic makeup of Atlantic Canadian communities. The more reliant Atlantic Canadian communities become on oil-related mobile work, the more precarious their economies will become as global markets for oil and gas change and targeted actions on climate change increase.

This article explores the history and experience of social enterprise within Atlantic Canada. As part of the International Comparative Social Enterprise Models (ICSEM) research project, this article aims to describe the unique historical, contextual, and conceptual approaches to social enterprise in Atlantic Canada. Four case studies are provided to illustrate the diversity of social enterprise in the region. The article argues that the historical roots of social enterprise in Atlantic Canada can be found within the Antigonish Movement, and that the founding political economic vision of that movement can inform a progressive and transformative approach to social enterprise in the region. Cet article explore l’histoire et la pratique de l’entreprise sociale dans les provinces de l’Atlantique. Écrit dans le cadre du projet ICSEM (« International Comparative Social Enterprise Models »), cet article a pour but de décrire les approches historiques, contextuelles et conceptuelles envers les entreprises sociales propres aux provinces de l’Atlantique. Il présente quatre études de cas afin d’illustrer la diversité des entreprises sociales de la région. L’article soutient que les racines historiques de l’entreprise sociale dans les provinces de l’Atlantique remontent jusqu’au Mouvement d’Antigonish, et que la vision politico-économique fondatrice de ce Mouvement pourrait sous-tendre une approche envers les entreprises sociales de la région qui soit progressiste et transformatrice.