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Background: The Kiswahili proverb that serves as the title of this article translates into English as, ‘You can never cross the ocean until you have the courage to lose sight of the shore’. Objectives: To elaborate on the implications for Made in Africa Evaluation (MAE) of the results of previous research that the authors conducted on harm and the monitoring and evaluation (ME) cycle, specifically the connection that the previous study’s participants drew between care and courage. Method: The article uses personal vignettes and insights from African revolutionary praxis in addition to abductive qualitative data analysis of interview data as well as literature on evaluation and Africa to understand and apply findings from an earlier study on harm and the ME cycle. These findings connect care, trust and courage; discuss solidarity across artificially constructed difference; and name systems of oppression. It then reviews the literature on evaluation and Africa that refers to care, trust or courage. This literature tends to focus on three interrelated themes that parallel the interview results: relations between knowledge systems, the quest for a distinctive Africanness and a systems-oriented understanding of evaluation. Results: The article proffers three interrelated paradigmatic shifts in the mental model or narrative for MAE - ‘crossings’ from the familiar shore into uncertain waters - that correspond with each theme above. Focusing on the first, it draws from the personal experience of one of the authors and Ngũgĩ wa Thiong’o’s work on decolonisation through language to propose that MAE cross from translation to courageous conversation as a mental model for relations among knowledge systems. Conclusion: The article suggests three ways that MAE can shift from translation to conversation between knowledge systems: challenging the equation of writing with knowledge and linearity with rationality; keeping indigenous ways of knowing and languages alive to resist atrophy; and recognising these indigenous modalities as forms of protection and resistance against the ongoing subjugation of nonhierachical, systems-oriented knowledge as part of the subordination of African and other indigenous peoples and their lands.

Measurement of physical activity is challenging, and objective and subjective methods can be used. The purposes of this study were to apply structural equation modeling in: 1) examining the associations between three distinct measures of physical activity and three factors that are often found to be correlated to physical activity in children, and 2) examining the associations of the combination of three measures with the same correlates in a cohort of youth followed from 5th to 7th grade. A total of 409 children (45% boys) had complete physical activity data derived from accelerometers, self-report by youth, and proxy-report by parents. The potential correlates of physical activity included self-efficacy, physical activity support, and facilities for physical activity. Structural equation models were used to assess the relationship between physical activity and the correlates. The structural equation models examining associations between individual measures of physical activity and selected correlates showed that parent-reported and child self-reported physical activity were associated with parental support for physical activity and self-efficacy. Objectively measured physical activity was associated only with facilities for physical activity. A structural equation model showed that a composite expression of physical activity, based on the inclusion of all three individual measures, was associated with all three correlates of physical activity. In conclusion, combining measures of physical activity from different sources may improve the identification of correlates of physical activity. This information could be used to plan more effective physical activity interventions in children and youth.

This study examined 78 counseling and psychology supervisees’ perceptions of supervision practices and processes focused on identifying and managing countertransference (CT). They reported that most supervisors paid some attention to CT. They (a) rated supervisors who neglected it entirely as lower on effectiveness and (b) rated supervisory alliance higher when CT was addressed in at least 50% of the sessions. The study also categorized respondents’ reports of (a) what cues had signaled a CT event to them (12 categories: clustered into those concerning feelings, cognitions, and in-therapy behaviors) and (b) how their supervisors had responded to that event (seven categories). [ABSTRACT FROM AUTHOR]

Background: Inspired by intense challenges encountered by patients and clinicians, we examined the experiences of living with sarcoidosis in three of the hardest impacted English-speaking cities during the early COVID-19 pandemic: London, New Orleans, and New York. Methods: A multi-disciplinary, multi-national research team including 6 patient leaders conducted qualitative investigations with analyses rooted in grounded theory. Recruitment occurred by self-referral through patient advocacy groups. Results: A total of 28 people living with sarcoidosis participated. The majority of patients had multi-system and severe sarcoidosis. Dominant themes were consistent across groups with differences expressed in spirituality and government and health systems. Racial, gender, and able-bodied inequity were voiced regarding healthcare access and intervention, societal interactions, and COVID-19 exposure and contraction. Agreement regarding extreme disruption in care and communication created concern for disability and survival. Concerns of COVID-19 exposure triggering new sarcoidosis cases or exacerbating established sarcoidosis were expressed. Pre-COVID-19 impediments in sarcoidosis healthcare delivery, medical knowledge, and societal burdens were intensified during the pandemic. Conversely, living with sarcoidosis cultivated personal and operational preparedness for navigating the practicalities and uncertainties of the pandemic. Optimism prevailed that knowledge of sarcoidosis, respiratory, and multi-organ diseases could provide pathways for COVID-19-related therapy and support; however, remorse was expressed regarding pandemic circumstances to draw long-awaited attention to multi-organ system and respiratory conditions. Conclusion: Participants expressed concepts warranting infrastructural and scientific attention. This framework reflects pre- and intra-pandemic voiced needs in sarcoidosis and may be an agent of sensitization and strategy for other serious health conditions. A global query into sarcoidosis will be undertaken.

Immunologic non-responders (INRs) are a subset of individuals living with HIV who have suboptimal blood CD4+ T cell recovery despite effective antiretroviral therapy (ART). They are at an increased risk of serious non-AIDS co-morbidities and death, and demonstrate enhanced systemic immune activation. In other populations diet has been correlated with markers of systemic inflammation through the Diet Inflammatory Index (DII), but this association has not been studied in persons living with HIV (PLWH). Blood was collected from 28 INR PLWH with a blood CD4+ T cell count

Context: Black women are dramatically underrepresented in the health care profession of athletic training. The research identifies impeding barriers such as racism, sexism, lack of support, and unpreparedness to the successful college completion of ethnically diverse students. However, there are black women who have successfully overcome those impeding barriers to become athletic trainers (ATs). Mentoring is one factor that has been identified as supportive to the retention of ethnically diverse college students. Objective: The purpose of this qualitative study was to identify impeding barriers and promoting factors affecting the retention and credentialing of black women ATs. Design: Qualitative. Setting: Education. Patients or Other Participants: Ten certified ATs who self-identify as black women and matriculated through athletic training programs over the last 4 decades. Main Outcome Measure(s): The perceived factors that impede or promote successful college retention and attainment of the Board of Certification credential of black women athletic training students. Results: There are barriers that impede and factors that promote the successful matriculation of black women athletic training students. Impeding barriers include a lack of support, sexism, and racism. Factors that promote include personal characteristics; experience with white culture; faculty, preceptor, and peer support; and the clinical education experience. Conclusions: Recognizing the factors that impede or promote the academic persistence of black women in athletic training programs allows athletic training educators and preceptors to improve the experiences of black women enrolled in those programs and potentially increase their participation and advancement in the athletic training profession.

Many people in the world lack safe basic drinking water sources and rely on untreated water source. Packaged water can be considered as an alternative to other water sources if measures are put in place to ensure its safety for consumption. This study aimed to assess the bacteriological quality and heavy metal analysis of packaged water produced in Lusaka, Zambia and associated quality control measures. A cross-sectional study was conducted in May 2019 where 18 brands of packaged water were analyzed for total and fecal coliforms as well as concentrations of Lead, Chromium, and Cadmium. The study found that 33.5% of the packaged water produced in Lusaka did not comply with the standard for drinking water on bacteriological quality. We also found that the concentrations for Lead were

Abstract In the freshwater ecosystems of Brazil can be found high biodiversity of fish, about 5160 species. However, the Jacaré-Pepira River, located in the state of São Paulo, Brazil, presents a diversity of fish still to be explored in ichthyological studies. Metazoan parasites of Pimelodus maculatus and Rhamdia quelen were qualitatively and quantitatively diagnosed. Ten species of parasites (Demidospermus sp., D. majusculus, D. bidiverticulatum, D. paravalenciennesi, Ameloblastella paranaensis, Scleroductus sp., Riggia sp., Austrodiplostomum compactum, Helobdella sp. and Neochinorhynchus pimelodi) were collected in P. maculatus and eight species of parasites (Aphanoblastella robustus, A. mastigatus, Phyllodistomum rhamdiae, Crocodilicola pseudostoma, Henneguya jundiai, Contracaecum sp., Rhabdochona sp. and Capillariidae gen. sp.) were collected in R. quelen. All parasites presented aggregate distribution. A significant correlation was observed in P. maculatus concerning the weight with the prevalence of ectoparasite D. majusculus; however, R. quelen showed a relation to the length and weight with the abundance of ectoparasite A. mastigatus and endoparasites. The parasitic community of P. maculatus and R. quelen was characterized by high diversity, high richness, and low uniformity.

Background Although Black adults are more likely to die from coronary heart disease (CHD) compared with White adults, few studies have examined the relationship between cigarette smoking and CHD risk among Black adults. We evaluated the relationship between cigarette smoking, incident CHD, and coronary artery calcification in the JHS (Jackson Heart Study). Methods and Results We classified JHS participants without a history of CHD (n=4432) by self‐reported baseline smoking status into current, former (smoked at least 400 cigarettes/life) or never smokers at baseline (2000–2004). We further classified current smokers by smoking intensity (number of cigarettes smoked per day [1–19 or ≥20]) and followed for incident CHD (through 2016). Hazard ratios (HR) for incident CHD for each smoking group compared with never smokers were estimated with adjusted Cox proportional hazard regression models. At baseline, there were 548 (12.4%) current, 782 (17.6%) former, and 3102 (70%) never smokers. During follow‐up (median, 13.8 years), 254 participants developed CHD. After risk factor adjustment, CHD risk was significantly higher in current smokers compared with never smokers (HR, 2.11; 95% CI, 1.39–3.18); the difference between former smokers and never smokers (HR, 1.37; 95% CI, 1.0–1.90) did not achieve statistical significance. Among current smokers, we did not observe a dose‐response effect for CHD risk. Additionally, in multivariable logistic regression models with a subset of our analytic cohort, current smokers had greater odds of coronary artery calcification score >0 compared with never smokers (odds ratio, 2.63; 95% CI, 1.88–3.68). Conclusions In a large prospective cohort of Black adults, current smoking was associated with a >2‐fold increased risk of CHD over a median follow‐up of greater than a decade.

Background:. Closed incision negative pressure therapy (ciNPT) has been shown to improve wound healing for patients at high risk for wound complications. Current devices consist of opaque interface dressings that do not allow ongoing visual evaluation of the surgical incision and utilize a negative pressure of −80 mm Hg to −125 mm Hg. The Negative Pressure Platform Wound Dressing (NP-PWD) was developed to address these aspects. This case series is the first evaluation of the NP-PWD in a clinical setting. Methods:. Patients aged 18–85 undergoing an operation with an anticipated incision and primary closure were screened. Demographics, comorbidities, and operation performed were recorded. Following closure, the incision was measured and photographed before NP-PWD placement. The NP-PWD was removed at the first postoperative check (POC) between postoperative days (PODs) 3–5. Subjects were followed until PODs 9–14. POCs consisted of incision assessment, measurement, photography, and adverse event monitoring. Results:. A total of 8 patients with 10 incisions were included in the study. Five patients were men. Median age was 56 years (IQR 53–74 years). All incisions were intact and without inflammation or infection at all POCs. Three adverse events, including small blisters and interruption of therapy, were noted. Conclusions:. This case series reports that patients tolerated the NP-PWD on closed surgical incisions well and that all incisions were intact without evidence of inflammation or infection after 2 weeks of follow-up. Future controlled, clinical studies should further examine the safety and efficacy of the use of the NP-PWD.

ObjectiveSerious non-AIDS disease events (SNAE) are experienced disproportionately by immunologic non-responders (INRs), HIV-infected individuals who do not restore CD4 T cells in blood despite effective viral suppression. We aimed to characterize the inflammatory biomarker profile of the INR phenotype.MethodsBlinded cross-sectional cohort study comparing markers of immune activation and gut homing between INR and non-INR individuals. HIV-positive participants had HIV RNA suppression on antiretroviral therapy and were categorized as either INR (N = 36) or Clinical Responders ("CR"; CD4>350/mm3; N = 47). 18 HIV-negative comparator individuals were included. Cellular markers were assessed by flow cytometry, with soluble markers assessed by ELISA and LC/MS-MS. Multivariable linear regression models estimated the association between INR phenotype and markers, adjusting for age, sex, duration of ART, and recent infection/vaccination.ResultsINR participants demonstrated a reduced CD4/CD8 ratio (pConclusionsPeripheral CD4 non-recovery during long-term treated HIV infection is characterized by elevated CD8 activation and CD4 gut homing. Gut-focused interventions may be warranted in the INR context, and CD8 activation may serve as a surrogate endpoint for clinical interventions.