Search

Emancipatory entrepreneuring, the actions taken to liberate oneself from work and life constraints, transforms the lives of entrepreneurs’ and has implications for entrepreneurial identity. However, this phenomenon is poorly understood. In this conceptual paper, we draw from literature of entrepreneurial discovery and emancipatory entrepreneuring to develop a typology of entrepreneurial transformation experienced by nascent entrepreneurs, thereby contributing to existing work on constructions of entrepreneurial identity. The main contribution of this paper is the conceptualization of four types of entrepreneurial transformation (minimal, career, personal, and existential) involving changes to the entrepreneur’s personal life, career, or both. The fourth quadrant of this typology—Existential Transformation, shows the highest level of transformation to both the personal and career lives of the entrepreneur. In this quadrant, we see emancipatory entrepreneuring as a fully agentic exercise, with one dually focusing on the identification and pursuit of change at the level of self to become the person one wants to be, integrated with the pursuit of a successful entrepreneurial venture that aligns what one does for a living with whom one wishes to be. We discuss all four types of entrepreneurial transformation, the factors that induce them, and implications to theory and practice.

Research indicates that the adverse effects on post-secondary students from the COVID-19 pandemic are unprecedented on a global scale. Specifically, there is limited research that focuses on international students’ mental wellness, resilience, and well-being experiences during the COVID-19 pandemic. This study qualitatively explores the resilience and mental wellness experiences of international university students at a mid-size, research-intensive, public university in British Columbia, Canada. Nine international students, between the ages of 18 and 30, participated in narrative-style interviews. Data were analyzed by using thematic analysis and applying a resilience lens framework. The findings highlight students’ mental wellness challenges and the key factors that were instrumental for supporting their mental wellness and enacting their resilience. These findings help to mitigate the negative impacts that can result from studying during a pandemic and offers recommendations for universities on how to support international students’ overall wellbeing, particularly during significant disruption and isolation.

Abstract BackgroundMemory and learning deficits are among the most impactful and longest-lasting symptoms experienced by people with chronic traumatic brain injury (TBI). Despite the persistence of post-TBI memory deficits and their implications for community reintegration, memory rehabilitation is restricted to short-term care within structured therapy sessions. Technology shows promise to extend memory rehabilitation into daily life and to increase the number and contextual diversity of learning opportunities. Ecological momentary assessment and intervention frameworks leverage mobile phone technology to assess and support individuals’ behaviors across contexts and have shown benefits in other chronic conditions. However, few studies have used regular outreach via text messaging for adults with chronic TBI, and none have done so to assess and support memory. ObjectiveThis study aimed to develop and test the usability of memory ecological momentary intervention (MEMI), a text message–based assessment and intervention tool for memory in daily life. MEMI is designed to introduce new information, cue retrieval of the information, and assess learning across time and contexts. We tested MEMI via an iterative, user-centered design process to ready it for a future trial. MethodsWe developed MEMI by leveraging automated text messages for prompts using a REDCap (Research Electronic Data Capture)/Twilio interface linking to the Gorilla web-based behavioral experimental platform. We recruited 14 adults with chronic, moderate-severe TBI from the Vanderbilt Brain Injury Patient Registry to participate in 3 rounds of usability testing: one round of ThinkAloud sessions using the platform and providing real-time feedback to an experimenter (n=4) and 2 rounds of real-world usability testing in which participants used MEMI in their daily lives for a week and provided feedback (n=5/round). We analyzed engagement and quantitative and qualitative user feedback to assess MEMI’s usability and acceptability. ResultsParticipants were highly engaged with MEMI, completing an average of 11.8 out of 12 (98%) possible sessions. They rated MEMI as highly usable, with scores on the System Usability Scale across all rounds equivalent to an A+ on a standardized scale. In semistructured interviews, they stated that MEMI was simple and easy to use, that daily retrieval sessions were not burdensome, and that they perceived MEMI as helpful for memory. We identified a few small issues (eg, instruction wording) and made improvements between usability testing rounds. ConclusionsTesting MEMI with adults with chronic TBI revealed that this technology is highly usable and favorably rated for this population. We incorporated feedback regarding users’ preferences and plan to test the efficacy of this tool in a future clinical trial.

Background School food standards are a legal requirement for state-funded schools in England and are designed to promote healthy eating in pupils. However, state-funded academies/free schools established between 2010 and 2014 are exempt from this legislation. To complement the school food standards, the government launched the School Food Plan in 2013, which outlines voluntary actions that schools can take to support healthy eating and increase school meal uptake. There has been little evaluation of the school food standards and School Food Plan in secondary schools. Objectives To compare implementation and costs of the school food standards and School Food Plan, and pupil dietary and dental outcomes in two groups of secondary schools: those mandated and those not mandated to comply with the school food standards legislation. Methods An observational, multiple-methods study. We sampled state-funded secondary school academies/free schools, pupils aged 11–15 years, and school staff/governors with a role in food provision/education from the Midlands. We collected qualitative data in four schools. The primary outcome was pupil free sugar intake at lunch; across the school day; and during 24-hours. Secondary outcomes were additional nutritional outcomes and dental caries measures. We assessed school food standards/School Food Plan implementation and costs using researcher observation, document analysis, and surveys with staff/governors, schools and pupils. Dietary intake and dental outcomes were measured online using 24-hour dietary recall and surveys, respectively. In the qualitative study we conducted staff/governor interviews and pupil focus groups in a subsample of schools. We used multilevel analyses to explore variation in pupil outcomes across the school food standards-mandated and school food standards-non-mandated school groups. Data were analysed using the Framework approach. Results Thirty-six schools (13 school food standards-mandated, 23 school food standards-non-mandated), 2453 pupils and 151 staff/governors participated. On average, schools were compliant with 64% of school food standards and implemented 41% of School Food Plan actions, with no differences across school food standards-mandated/non-mandated schools. There was a wide variation in annual costs of the school food standards and School Food Plan reported by schools (mean of £195 per pupil). Pupils in school food standards-mandated schools had lower lunch intakes of free sugar than those in school food standards-non-mandated schools (adjusted mean difference = –2.78 g, 95% confidence interval –4.66 to –0.90 g). After further adjustment for total energy intake, there was no significant difference in free sugar intake, but the school food standards-mandated group had lower fruit and vegetable intake at all time points, and higher consumption of confectionery during the school day and sugar-sweetened beverages over 24 hours. There were no differences in dental outcomes between the two groups. Twenty-one staff/governors and 137 pupils participated in the qualitative study. Staff described balancing school food standards compliance with conflicting priorities related to financial viability. Some pupils felt that school food did not meet their needs for convenience, speed, value for money and taste, and disliked the lunchtime experience. Little time was afforded to healthy-eating education within the curriculum. Limitations There were large numbers of missing data for some study elements, including assessment of some School Food Plan actions and cost data. Conclusions In the secondary school context, the current school food standards are difficult to comply with and the School Food Plan has not achieved the desired outcomes. We found no evidence to show that school food standards legislation has positively influenced nutritional intake. Future research We need to develop healthy secondary-school food provision models that meet pupils’ preferences, and better understand how to situate the food and healthy-eating agenda in secondary schools. Trial registration This trial is registered as ISRCTN68757496. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme (NIHR award ref: 17/92/39) and is published in full in Public Health Research; Vol. 12, No. 12. See the NIHR Funding and Awards website for further award information. Plain language summary Why have we done this research? We wanted to find out how well secondary schools meet the school food standards in England and how these standards influence the dietary intake and dental health of pupils. We also wanted to explore how secondary schools provide other ways of supporting pupils’ healthy eating. What did we do? We compared schools that are required to meet the school food standards with those that are not required to meet them. We looked at school food, menus, and eating environments in 36 secondary schools and did surveys with 151 staff/governors. We asked 2453 secondary school pupils about their diet and dental health. We held interviews with 21 staff/governors and focus groups with 137 pupils at four schools. We gathered their views on school food and healthy eating. What did we find? On average, the schools met 64% of the school food standards, regardless of whether they were required to meet them. Pupils in the schools required to meet the standards had lower intakes of sugar and calories at lunchtime than pupils in the schools not required to meet them; however, they ate less fruit and vegetables. Pupils in the schools required to meet the standards ate more confectionery during the school day and drank more sugary drinks overall. There were no differences in the dental health of pupils in the two school groups. School staff told us that some standards were difficult to meet. Catering staff had to think about pupil preferences and financial considerations, as well as the school food standards. Some pupils felt that school food did not meet their needs and preferences. Some pupils disliked the lunchtime experience. Healthy-eating education was not very visible within the curriculum. What does this mean? Secondary schools are struggling to meet the school food standards and implement actions to support healthy eating. We found no evidence to show that the school food standards have improved dietary intake in secondary school pupils. Scientific summary Background National school food standards (SFS) legislation has been in place since 2006. In 2013, the School Food Plan (SFP) was introduced, which contained recommendations for schools to support healthy eating. Following this, in 2015, the government introduced updated SFS legislation. Evaluation of the impact of the 2006 SFS on nutritional intake has focused on primary school-aged children, and evidence relating to secondary school pupils is more limited. To the best of our knowledge, implementation of the updated SFS and the SFP, and their impact on pupil nutritional intake, has not been evaluated in secondary schools. The national SFS legislation applies to state-funded schools in England, except for academies and free schools established between 2010 and 2014. The exemption of these schools provided an opportunity to compare implementation of the SFS and SFP, pupil nutritional intake, and dental health between schools that are mandated and schools that are not mandated to comply with the SFS. However, exempt schools have been encouraged to voluntarily comply with the standards, and in the last 18 months of this study there has been a government expectation that all schools, regardless of their exemption status, should comply with the SFS. Despite their legislative status, there are no formal national arrangements for monitoring or reporting schools’ compliance with the SFS. Objectives The three research objectives were: in secondary schools either mandated (SFS-mandated) or not mandated (SFS-non-mandated) to comply with the national SFS legislation, to compare – school food provision and compliance with the SFS the school food environment/culture and the food curriculum, and implementation of the SFP actions the nutritional intake and dental health of school pupils, focusing on free sugar intake as the primary outcome the costs of food provision, food curriculum delivery and other measures to influence the school food culture and environment. to explore the variation in compliance with the SFS and implementation of SFP actions in secondary schools and use this to develop a typology of schools to use the developed school typology to explore associations between the school types and pupil dietary and dental outcomes. Methods We conducted an observational, multiple-methods study comprising two phases: (1) collecting a variety of data to assess school SFS/SFP implementation, pupil dietary intake and dental outcomes in SFS-mandated and SFS-non-mandated schools and (2) a qualitative case study with four school sites to understand the experiences of schools in implementing and embedding the SFS and SFP. In addition, we undertook an economic evaluation to assess how the costs and outcomes compared across SFS-mandated and SFS-non-mandated schools. State-funded secondary school academies/free schools were sampled from the Midlands, England, using a stratified sampling approach. Pupils were sampled from one class in each of years 7 (age 11–12 years), 9 (age 13–14 years) and 10 (age 14–15 years) in participating schools. School staff and governors with a role in food provision or education were also recruited. Schools were recruited by invitation, and for participating in the study they received a £300 payment and a report detailing the school’s implementation of the SFS/SFP. Case study schools received an additional £150. Written, informed consent was provided by all participants. Parents of invited pupils provided passive consent for their child’s participation. Pupils were given a £5 voucher as a thank-you for their participation. Data collection was guided by a logic model and was undertaken at the school and pupil level. It incorporated assessment of food provision (to assess compliance with the SFS); the school food culture, curriculum and environment (to assess implementation of the SFP actions); costs related to food provision and the food culture/curriculum/environment; school contextual data; and pupil nutritional and dental outcomes. School food standards and School Food Plan implementation Assessment of SFS implementation was guided by published checklists and comprised a 1-day researcher observation of all school mealtimes and food outlets and a review of school menus. Assessment of implementation of SFP actions was guided by published resources for schools and comprised researcher observation, document analysis, and surveys to schools, staff and pupils. Compliance with each SFS was judged as a binary yes/no, and level of implementation of each SFP action was categorised into high, medium or low. The embedding of the SFS and SFP policies overall was assessed through school/catering staff and governor surveys. Contextual data were provided by schools via surveys and/or documents. School-level data were also used to develop a school typology using a two-stage process. In stage 1 we used SFS compliance data to generate school types based on high/medium/low compliance with two sets of standards relating to two key dietary patterns: (1) food/drinks that are energy-dense and/or high in fat or sugar; and (2) variety/balance of food groups. In stage 2, we identified subtypes based on the implementation of selected SFP actions. Pupil outcomes The primary outcome was pupil free sugar intake (defined as all sugars added to foods by the manufacturer, cook or consumer, and natural sugars found in honey, syrups and unsweetened fruit juices). Secondary nutritional outcomes were percentage of total energy intake (TEI) from free sugars; TEI (kcal); total fat intake (g); fibre intake (g); number of portions of fruit and vegetables (F&V) consumed; number of sugar-sweetened beverages (SSB) consumed; number of confectionery items consumed; and number of foods high in fat, sugar and salt (HFSS) consumed. These nutritional outcomes were calculated for three time periods: the school day lunch; while present at school; and during the full 24-hour period of the same school day. Additional secondary nutritional outcomes were free sugar intake providing ˃ 5% of 24-hour TEI; consumption of five or more portions of F&V during a 24-hour period; and number of eating/drinking occasions (excluding plain water) during a 24-hour period. Dental outcomes were the presence of dental caries symptoms in the previous 3 months; the number of dental caries symptoms in the previous 3 months; and past dental caries treatment. Data on nutritional outcomes were collected by pupil self-report using an online 24-hour dietary recall (Intake24), with one or two recalls per participant on non-consecutive school days. Dental outcome data and sociodemographic data were collected by pupil self-report using online surveys. Postcodes were mapped to Index of Multiple Deprivation (IMD) 2019 scores and used to obtain water fluoridation levels at participants’ homes. Linear or Poisson multilevel models were used to explore differences in pupil outcomes across the SFS-mandated and SFS-non-mandated school groups. The models were adjusted for relevant school-level and pupil-level variables. We explored two-way interaction effects between school SFS-mandated/non-mandated status and lunch source (school-provided vs. obtained from elsewhere), year group and IMD group. We conducted exploratory analyses to compare pupil outcomes across identified school types. Statistical analyses were conducted in Stata version 17 (StataCorp LP, College Station, TX, USA). Economic evaluation The economic evaluation took the form of a micro-costing and a cost–consequences analysis. Costs to schools associated with school food were collected via a school survey. In addition, public data on catering expenditure were used to supplement the analysis. Pupil expenditure on school food was collected through the online surveys. Outcomes were pupil dietary intake and dental health (detailed above); pupil health-related quality of life (HRQoL), measured via the online surveys using the Child Health Utility 9-Dimensions tool; and school-level educational outcomes relating to absenteeism and attainment (publicly available). Case study We explored the way in which the SFS, SFP and local school policy or initiatives were introduced, embedded and sustained in the schools, and their perceived influence on the dietary intake of pupils. We selected four schools from the phase 1 sample based on their SFS-mandated/non-mandated status, the percentage of pupils eligible for free school meals (FSM), and their catering model. We conducted four to six interviews per school with relevant staff/governors and three focus groups with pupils from years 7, 9 and 10. All interviews/focus groups were thematically analysed using the Framework approach. Public involvement At multiple time points, we consulted with public representatives (young people, parents and school staff/governors), who advised on participant information, recruitment, data collection tools, interpretation of the findings and dissemination. Results Thirty-six schools participated (SFS-mandated, n = 13; SFS-non-mandated, n = 23) and 2453 pupil participants provided nutritional and/or dental outcome data (SFS-mandated, n = 836; SFS-non-mandated, n = 1617). On average, schools were compliant with 64% of SFS, with standards applying to lunchtime provision (average of 81% of standards met) more likely to be implemented than those applied to food provided across the whole school day or outside lunch (average of 43% and 64% standards met, respectively). The standards with low compliance mostly related to the restriction of HFSS foods and drinks. On average, schools implemented 41% of SFP actions to a high level. SFS compliance and SFP implementation were similar across SFS-mandated and SFS-non-mandated schools. School Food Plan assessment revealed a lack of implementation of actions relating to leadership and oversight on school food, engagement (with pupils, parents and the community) and catering practices (catering staff encouraging healthy behaviours and nutritional balance) in the majority of schools. Implementation of actions relating to the lunchtime experience was variable; for example, most schools (77%) had strategies in place to reduce queuing, but many schools (58%) did not ask for feedback on the lunchtime experience from their pupils. Curricular education relating to food and healthy eating was well implemented in most schools, but education around growing and extracurricular food education was not. Specifically relating to leadership and oversight on school food, governor leadership and engagement with school food, independent checking of compliance of the school with the SFS and governor review of school food uptake data were actions that were poorly implemented across schools (implemented to a low level in 64%, 79% and 74% schools, respectively). None of the governors responding to the staff/governor survey reported that they were involved in managing or overseeing the implementation of the SFS, and only 31% of senior leader respondents stated that they were involved. Compared with pupils in SFS-non-mandated schools and adjusting for other variables, pupils in SFS-mandated schools had lower free sugar intake (–2.78 g, 95% CI –4.66 to –0.90 g) and lower TEI (54.97 kcal; 95% CI –88.87 to –21.07 kcal) at lunch, but there was no significant difference in the percentage of energy intake from free sugars. When TEI was adjusted for, compared with pupils in SFS-non-mandated schools, pupils in SFS-mandated schools had a significantly lower intake of F&V at lunch (–0.20 portions; 95% CI –0.32 to –0.08 portions), during the school day and over 24 hours. There was also significantly higher consumption of confectionery during the school day and SSB over 24 hours in the SFS-mandated schools group than in the SFS-non-mandated school group, when TEI was adjusted for. Participants who had a 100% school-provided lunch had lower lunchtime free sugar, TEI, fat, fibre and F&V intake. There were no significant differences in dental outcomes between the SFS-mandated and SFS-non-mandated school groups, and no clear interaction effects between school SFS-mandated/non-mandated status and lunch source, IMD group or year group. We identified four school types based on SFS compliance and two further subtypes based on SFP implementation in stages 1 and 2 of our school typology development. We noted some differences in pupil nutritional outcomes across the four school types. Compared with type 1 schools (low implementation of obesity/dental health-related SFS and high implementation of dietary variety-related SFS), pupils in the type 2 school (medium implementation of both sets of SFS) had a lower percentage of TEI from free sugar at lunch (–8.12%, 95% CI –14.48% to –1.76%) but higher consumption of confectionery items during the school day [incidence rate ratio (IRR) 2.70, 95% CI 1.30 to 5.59]. Pupils in the type 4 school (high implementation of obesity/dental health-related SFS and dietary variety-related SFS) had a higher consumption of confectionery items at lunch than those in type 1 schools (IRR 2.15, 95% CI 1.16 to 3.98). Twenty-two schools contributed data on costs related to food (SFS-mandated, n = 6; SFS-non-mandated, n = 16). Annual ongoing costs of food provision from a societal perspective included costs to schools, costs to catering providers and volunteer time, and ranged from £8500 to £974,563, with a mean of £207,094. The annual ongoing costs per pupil (from a societal perspective) ranged from £9 to £982, with a mean of £195 (based on the total number of pupils). Staff costs constituted the largest cost category. The average annual ongoing costs of implementing and delivering the SFS and SFP and of food provision was lower in SFS-mandated schools than in SFS-non-mandated schools (£167 vs. £206 per pupil). SFS-mandated schools also reported spending slightly less on catering, on average, than SFS-non-mandated schools (£128 vs. £133 per pupil, based on the total number of pupils). Pupils in SFS-mandated schools reported slightly higher HRQoL than pupils in SFS-non-mandated schools (0.8302 vs. 0.8274); however, potential confounding factors were not adjusted for, and there was variation in the number of missing HRQoL data across SFS-mandated/non-mandated groups. Twenty-one staff/governors and 137 pupils from 4 schools participated in the qualitative case study phase, with variation across the schools in relation to FSM eligibility (9–53%), SFS-mandated/non-mandated status (50% SFS-mandated) and catering model (50% external). Schools described patchy implementation of the SFS, acknowledging that some standards were difficult to adhere to, especially at breakfast/breaktime. Staff described balancing SFS compliance with conflicting priorities around maintaining viable levels of school food uptake, cost/profit and pupil preferences. Drivers of pupils’ food choices included convenience, speed, perceived value for money and taste. Some pupils felt that these were not met by school food and described negative lunchtime experiences, which discouraged a sit-down meal and influenced their eating behaviours. Some school staff felt that their influence on pupils’ food choices was limited, acknowledging difficult social and environmental contexts. School staff/governors had a low awareness of the SFP and generally were not taking steps to implement it. The time dedicated to healthy eating in relevant lessons was perceived to be low, despite staff acknowledging its importance, while pupils felt that healthy-eating education was sporadic. In general, governors reported minimal oversight of school food and SFS compliance. Conclusions Our findings suggest that the current SFS are difficult to comply with in a secondary school context, partly due to the style of food provision (e.g. extensive provision at breakfast/breaktime) and the need to provide foods and drinks to meet the pupils’ demands to ensure school food uptake and financial viability. There is currently a lack of oversight and monitoring of SFS compliance within schools. Our findings also indicate that the SFP has not achieved the desired outcomes in the secondary school setting, which suggests that a different approach may be needed to better support secondary schools in cultivating a healthy-eating culture. Finally, our findings suggest that even when the SFS are relatively well implemented, this may have no beneficial effect on the nutritional intake of pupils or may even lead to marginally worse nutritional intake. Schools need to be considered as only one part of the food system that influences adolescents’ dietary intake, and it is important to address other aspects of this system to substantially influence nutritional intake in this age group. A key focus for future research is to develop alternative models of healthy food provision that better meet the needs of secondary school pupils and to better understand how to situate the food and healthy-eating agenda in secondary schools. Trial registration This trial is registered as ISRCTN68757496. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme (NIHR award ref: 17/92/39) and is published in full in Public Health Research; Vol. 12, No. 12. See the NIHR Funding and Awards website for further award information.

IntroductionThe vast majority of studies on aging, cognition, and dementia focus on non-Hispanic white subjects. This paper adds to the extant literature by providing insight into the African American aging experience. Here we describe the study design and baseline characteristics of the African American Dementia and Aging Project (AADAPt) study, which is exploring aging and cognition in African American older adults in Oregon.MethodsAfrican American older adults (n = 177) participated in AADAPt, a longitudinal study that collected data on cognitive, physical, and social functioning in annual visits since 2000.ResultsAADAPt participants had risk factors for developing dementia in future, such as hypertension and hyperlipidemia, but also reported protective factors such as high social engagement.DiscussionThe AADAPt project offers new insights into aging in older African Americans that includes data on cognition, social engagement, and physical health, which are crucial for understanding the experience of under-represented groups and making future studies more inclusive.

Background: Since October 2022, multiple high-income countries have reported an increase in invasive group A streptococcal (iGAS) infections. This study describes trends in iGAS infections in Aotearoa New Zealand (NZ) between 2017 and 2023, and examines associations of iGAS incidence, COVID-19 eras, and acute respiratory infections (ARI). Methods: Analyses include national-level surveillance data on iGAS and ARI. Multivariable Poisson regression was used to examine relationships between COVID-19 era and iGAS incidence, and Pearson pairwise correlations were calculated to examine trends between ARI and iGAS. Findings: A sharp increase in iGAS was observed in 2023, with notable increases among children aged under ten years. Indigenous Māori and Pacific peoples were disproportionately affected. emm1 and emm12 were commonly reported in 2022–2023. Compared to pre-pandemic, iGAS decreased significantly during the COVID-19 restrictions era and increased once COVID-19 restrictions were relaxed, after adjusting for ethnicity, sex, and age. ARI was moderately correlated with iGAS (r = 0∙55) in 2022–2023. Interpretation: Though delayed, NZ’s recent iGAS trends mirror those seen in the 2022/2023 multi-country iGAS surge. These findings expand existing research, suggesting a link between the easing of COVID-19 measures, increased ARI circulation, and the rise in iGAS. Continued and improved iGAS surveillance, is needed to better understand iGAS epidemiology and support public health response. iGAS in NZ will become notifiable in late 2024, which should help improve iGAS monitoring and support public health response. Funding: This research received no specific funding, though iGAS surveillance and typing in NZ is funded by the Ministry of Health, which was not involved in the analysis, interpretation, design, or any aspect of this study. No authors were paid to write this manuscript.

Putu Duff,1 Tom Rubaale,2 Walter Kipp1,21School of Public Health, University of Alberta, Edmonton, Canada; 2Community ARV Project, Fort Portal, UgandaBackground: The aim of this study was to describe the perceptions of married men about barriers to accessing and accepting highly active antiretroviral therapy (HAART) by pregnant/postnatal women positive for human immunodeficiency virus (HIV) and registered in Kabarole District’s Program for the Prevention of HIV from Mother to Child (PMTCT-Plus).Materials and methods: Our study was a qualitative descriptive exploratory study using thematic analysis. Four focus group discussions were held with a convenience sample of 40 married men.Results: Lack of disclosure of a positive HIV diagnosis to the partner and stigmatization of persons with HIV were two major obstacles for women in accessing HAART. In addition, men felt that their low knowledge of HAART and their low HIV testing rate also constituted important barriers to these women taking treatment. Men complained that they were not sufficiently involved in the reproductive care of women and that couples’ counseling could be a step towards addressing this problem.Conclusion: Barriers to HAART experienced by pregnant/postnatal women need to be addressed in order to improve their uptake of treatment, increase their low treatment coverage, improve their survival, and at the same time dramatically reduce HIV transmission from mother to child.Keywords: men, highly active antiretroviral therapy, pregnant women, Uganda

Abstract Breath analysis is an area of significant interest in medical research as it allows for non-invasive sampling with exceptional potential for disease monitoring and diagnosis. Volatile organic compounds (VOCs) found in breath can offer critical insight into a person’s lifestyle and/or disease/health state. To this end, the development of a rapid, sensitive, cost-effective and potentially portable method for the detection of key compounds in breath would mark a significant advancement. Herein, we have designed, built and tested a novel reagent-less atmospheric pressure photoionisation (APPI) source, coupled with mass spectrometry (MS), utilising a bespoke bias electrode within a custom 3D printed sampling chamber for direct analysis of VOCs. Optimal APPI-MS conditions were identified, including bias voltage, cone voltage and vaporisation temperature. Calibration curves were produced for ethanol, acetone, 2-butanone, ethyl acetate and eucalyptol, yielding R2 > 0.99 and limits of detection

Informal outreach programs can provide authentic science experiences for elementary school students, who may not have these experiences in formal school settings. Research indicates that students lose interest in science in middle school, so it's important to reach them early. To address this need, we designed a summer camp focused on exposing children in 5th grade to current research projects being conducted by STEM faculty and graduate students at the university to increase their understanding of science practices and interest in STEM. This paper describes the outreach model focused on authentic science research projects and direct exposure to scientists and their work. We investigated the influence of participating in the camp on students' understanding of the nature of science, and their interest in science. Data collection included pre-and post-student surveys, observation data, and artifacts. Students reported gains in understanding of authentic science practices on the surveys (p = 0.0055), while observation data exhibited a progression of learning throughout the week. Additional data were collected to monitor student engagement with the activities to improve future iterations of the camp as a summer program.

BACKGROUND: Galectin-3, a biomarker of inflammation and fibrosis, can be associated with renal and myocardial damage and dysfunction in patients with acute heart failure (AHF). METHODS AND RESULTS: We retrospectively analyzed 790 patients with AHF who were enrolled in the AKINESIS study. During hospitalization, patients with galectin-3 elevation (> 25.9 ng/mL) on admission more commonly had acute kidney injury (assessed by KDIGO criteria), renal tubular damage (peak urine neutrophil gelatinase-associated lipocalin [uNGAL] > 150 ng/dL) and myocardial injury (≥ 20% increase in the peak high-sensitivity cardiac troponin I [hs-cTnI] values compared to admission). They less commonly had ≥ 30% reduction in B-type natriuretic peptide from admission to last measured value. In multivariable linear regression analysis, galectin-3 was negatively associated with estimated glomerular filtration rate and positively associated with uNGAL and hs-cTnI. Higher galectin-3 was associated with renal replacement therapy, inotrope use and mortality during hospitalization. In univariable Cox regression analysis, higher galectin-3 was associated with increased risk for the composite of death or rehospitalization due to HF and death alone at 1 year. After multivariable adjustment, higher galectin-3 levels were associated only with death. CONCLUSIONS: In patients with AHF, higher galectin-3 values were associated with renal dysfunction, renal tubular damage and myocardial injury, and they predicted worse outcomes.

Studies on the reading of appositive relative clauses (ARCs) have found that ARCs seem to exhibit less influence in later parsing and decision-making than similar constructions (Dillon et al. 2014, 2017), a pattern we call discounting. Existing accounts often link discounting to the status of ARCs as independent segments in systems of pragmatic representation. This would predict discounting for other constructions as well. In this study, we test that prediction by investigating the reading of direct discourse speech reports and causal adjuncts in English. Diagnostics supplied by the theoretical literature show that these constructions contribute the same independent segments as ARCs in two different systems of pragmatic organization: direct discourse reports contribute an independent speech act, and causal adjuncts contribute their own discourse units. Nevertheless, in a series of five experiments, we find no evidence of ARC-like discounting for either. We conclude that discounting should not be linked to either of these pragmatic representations, and discuss the outlook for other approaches to the phenomenon.

AimsKidney function changes dynamically during AHF treatment, but risk factors for and consequences of worsening renal function (WRF) at hospital admission are uncertain. We aimed to determine the significance of WRF at admission for acute heart failure (AHF).Methods and resultsWe evaluated a subgroup of 406 patients from The Acute Kidney Injury Neutrophil gelatinase-associated lipocalin Evaluation of Symptomatic heart failure Study (AKINESIS) who had serum creatinine measurements available within 3 months before and at the time of admission. Admission WRF was primarily defined as a 0.3 mg/dL or 50% creatinine increase from preadmission. Alternative definitions evaluated were a ≥0.5 mg/dL creatinine increase, ≥25% glomerular filtration rate decrease, and an overall change in creatinine. Predictors of admission WRF were evaluated. Outcomes evaluated were length of hospitalization, a composite of adverse in-hospital events, and the composite of death or HF readmission at 30, 90, and 365 days. Biomarkers' prognostic ability for these outcomes were evaluated in patients with admission WRF. One-hundred six patients (26%) had admission WRF. These patients had features of more severe AHF with lower blood pressure, higher BUN, and lower serum sodium concentrations at admission. Higher BNP (odds ratio [OR] per doubling 1.16-1.28, 95% confidence interval [CI] 1.00-1.55) and lower diastolic blood pressure (OR 0.97-0.98, 95% CI 0.96-0.99) were associated with a higher odds for the three definitions of admission WRF. The primary WRF definition was not associated with a longer hospitalization, but alternative WRF definitions were (1.3 to 1.6 days longer, 95% CI 1.0-2.2). WRF across definitions was not associated with a higher odds of adverse in-hospital events or a higher risk of death or HF readmission. In the subset of patients with WRF, biomarkers were not prognostic for any outcome.ConclusionsAdmission WRF is common in AHF patients and is associated with an increased length of hospitalization, but not adverse in-hospital events, death, or HF readmission. Among those with admission WRF, biomarkers did not risk stratify for adverse events.

Background Implementation of the cardiovascular disease (CVD) prevention guidelines in the UK has been repeatedly evaluated under the auspices of the British Cardiovascular Society in three Action on Secondary and Primary Prevention by Intervention to Reduce Events (ASPIRE) surveys in 1994–1995, 2008–2010 and 2017–2019. The primary care arm of ASPIRE-2-PREVENT (A-3-P) was conducted to evaluate lifestyle and medical risk factor management in people at high risk of atherosclerotic CVD in everyday clinical practice.Methods A-3-P was a cross-sectional survey in 27 general practices and health centres across 5 English National Health Service regions. Patients with no history of atherosclerotic CVD started on blood pressure and/or lipid and/or glucose lowering treatments were identified retrospectively and interviewed at least 6 months after the initiation of medication.Results 557 patients attended the interview and examination (45.8% women; mean age 61.7±10.8 years). The risk factor control was poor: 9.3% of patients were smokers, 38.1% obese (body mass index≥30 kg/m2) and 53.5% centrally obese (waist circumference≥88 cm for women, ≥102 cm for men). Only 37.8% of patients on blood pressure-lowering therapies achieved the target of

Background Higher cardiac troponin is associated with worse outcomes in patients with acute heart failure. The significance of repeat measurements over hours remains unclear. We assessed whether a repeat measurement and the Δ between measurements of high‐sensitivity cardiac troponin I (hs‐cTnI) were associated with outcomes in hypervolemic patients with acute heart failure without acute coronary syndrome. Methods and Results We analyzed 582 individuals from AKINESIS (Acute Kidney Injury Neutrophil Gelatinase‐Associated Lipocalin Evaluation of Symptomatic Heart Failure Study) with hs‐cTnI measured ≤12 hours from admission and repeated ≤6 hours thereafter. Associations between hs‐cTnI levels and their Δ with short‐term (death, intensive care unit admission, receipt of inotropes, or positive pressure ventilation during hospitalization) and long‐term (death or heart failure readmission within 1 year) outcomes were assessed. The average age was 69±13 years, 62% were men, 65% were White, 46% had coronary artery disease, and 22% had chest pain. Median hs‐cTnI levels were 27 (interquartile range [IQR], 13–62) ng/L initially and 28 (IQR, 14–68) ng/L subsequently, with a Δ of 0 [IQR, −2 to 4] ng/L over 3.4±1 hours. Only the second measurement was associated with short‐term outcomes (odds ratio, 1.14 per 2‐fold higher [95% CI, 1.02–1.28]). Both individual measurements and the Δ were associated with long‐term outcomes (hazard ratios, 1.09, 1.12, and 1.16 for first, second, and Δ, respectively). Associated risk for the first and second measurements were not constant over the year but highest early after being measured and decreased over 1 year. Conclusions Repeat measurements of hs‐cTnI over hours can identify individuals with acute heart failure without acute coronary syndrome at risk for short‐ and long‐term outcomes.

Background: A new cardiopulmonary resuscitation technique, chest compressions with sustained inflation (CC + SI) might be an alternative to both the neonatal [3:1compressions to ventilations (3:1C:V)] and paediatric [chest compression with asynchronous ventilation (CCaV)] approaches. The human factors associated with this technique are unknown. We aimed to compare the physical, cognitive, and team-based human factors for CC + SI to standard CPR (3:1C:V or CCaV). Methods: Randomized crossover simulation study including 40 participants on 20 two-person teams. Workload [National Aeronautics and Space Administration Task Load Index (NASA-TLX)], crisis resource management skills (CRM) [Ottawa Global Rating Scale (OGRS)], and debrief analysis were compared. Results: There was no difference in paired NASA-TLX scores for any dimension between the CC + SI and standard, adjusting for CPR order. There was no difference in CRM scores for CC + SI compared to standard. Participants were less familiar with CC + SI although many found it simpler to perform, better for transitions/switching roles, and better for communication. Conclusions: The human factors are no more physically or cognitively demanding with CC + SI compared to standard CPR (NASA-TLX and participant debrief) and team performance was no different with CC + SI compared to standard CPR (OGRS score).

Group A Streptococcus (GAS) is a strict human pathogen possessing a unique pathogenic trait that utilizes the cooperative activity of NAD+-glycohydrolase (NADase) and Streptolysin O (SLO) to enhance its virulence. How NADase interacts with SLO to synergistically promote GAS cytotoxicity and intracellular survival is a long-standing question. Here, the structure and dynamic nature of the NADase/SLO complex are elucidated by X-ray crystallography and small-angle scattering, illustrating atomic details of the complex interface and functionally relevant conformations. Structure-guided studies reveal a salt-bridge interaction between NADase and SLO is important to cytotoxicity and resistance to phagocytic killing during GAS infection. Furthermore, the biological significance of the NADase/SLO complex in GAS virulence is demonstrated in a murine infection model. Overall, this work delivers the structure-functional relationship of the NADase/SLO complex and pinpoints the key interacting residues that are central to the coordinated actions of NADase and SLO in the pathogenesis of GAS infection.

Through an expansive international effort that involved data collection on 12 small-angle X-ray scattering (SAXS) and four small-angle neutron scattering (SANS) instruments, 171 SAXS and 76 SANS measurements for five proteins (ribonuclease A, lysozyme, xylanase, urate oxidase and xylose isomerase) were acquired. From these data, the solvent-subtracted protein scattering profiles were shown to be reproducible, with the caveat that an additive constant adjustment was required to account for small errors in solvent subtraction. Further, the major features of the obtained consensus SAXS data over the q measurement range 0-1 Å-1 are consistent with theoretical prediction. The inherently lower statistical precision for SANS limited the reliably measured q-range to 2.2 Å-1 showed good mutual agreement, affirming that this region has interpretable features for structural modelling. SAS measurements with inline size-exclusion chromatography (SEC) proved to be generally superior for eliminating sample heterogeneity, but with unavoidable sample dilution during column elution, while batch SAS data collected at higher concentrations and for longer times provided superior statistical precision. Careful merging of data measured using inline SEC and batch modes, or low- and high-concentration data from batch measurements, was successful in eliminating small amounts of aggregate or interparticle interference from the scattering while providing improved statistical precision overall for the benchmarking data set.

Sahra Ibrahimi,1– 3 Bamba Youssouf,4 Christine Potts,1 Alexandre Dumouza,1 Rani Duff,1 Landry-Serges Malaba,1 Bettina Brunner1 1International Development Division, Abt Associates, Rockville, MD, USA; 2Department of Global Health, Denison University, Granville, OH, USA; 3Department of Family Science, School of Public Health, University of Maryland, College Park, MD, USA; 4Matchboxology, Johannesburg, Gauteng, province, South AfricaCorrespondence: Sahra Ibrahimi, Global Development Group, Abt Associates, 6130 Executive Blvd, Rockville, MD, USA, Tel +1 413-406-4401, Email ibrahimi.sahra3@gmail.comBackground: In response to limited contraception availability and a lack of knowledge about family planning (FP) in the Democratic Republic of the Congo (DRC), the United States Agency for International Development (USAID) Integrated Health Program (IHP) in the DRC has been providing FP services, including outreach programs in the DRC. Our study aims to assess the FP outreach program by understanding the participants’ perception of the campaign, its impact on their behavior, and their feedback regarding the campaign. Additionally, we draw insights from lessons learned and provide recommendations.Methods: Between July and August 2022, we conducted 47 in-person participant interviews with women of reproductive age who used the outreach services provided by USAID IHP. Participants were randomly selected from Sud-Kivu, Kasai-Oriental, Haut-Katanga, and Tanganyika provinces. Consent and confidentiality were assured, and responses were recorded and transcribed in a Word document. We used Excel for data coding and analysis.Results: The campaign reached 95.7% of women interviewed; however, some participants could not recall specific message details. Most respondents (89.3%) reported that the campaign motivated them to make FP decisions and change their behaviors. While 14.8% of women reported making FP decisions independently, 85.1% reported making the decision jointly with their partners. Our analysis resulted in three emerging themes: 1) Increased FP outreach and improved perception of FP, 2) Improved perceived behavioral changes due to FP outreach, and 3) The need for program improvement by including men and providing additional information about possible FP side effects.Implications: Our study provides insights into how women receive information and whether they find it useful and share it with other women in their community. In particular, women’s feedback about the FP outreach program and our recommendations can inform future policies and interventions.Keywords: DRC, family planning, reproductive health, community outreach, USAID

The exponential growth of food demand due to the increasing global population has the potential to seriously threaten the quality and quantity of food supplies due to climate change. This study explores the utilisation of green urban spaces for achieving food self-sufficiency by investigating the extent to which sustainable urban farms could be used to reduce the consumption of imported produce in the UK. It also examines urban farming stakeholders’ perspective on how food self-sufficiency can help realise the SDGs especially SDG 2 (Zero hunger) and SDG 13 (Climate action). The study adopts a mixed method approach through a survey with 115 respondents and semi-structured interviews conducted with 12 respondents from 4 different urban farming stakeholder groups. The findings of this study presented a strong correlation between stakeholders who had concerns about where their food came from and the carbon footprint of imported produce. The research shows that, urban farms will no doubt play a vital role in the future of food security in our cities/communities and that the SDGs could be realised through sustainable urban farms implemented within the relevant planning regulations/policies.

Abstract Otitis media (OM) is one of the most globally pervasive pediatric conditions. Translocation of nasopharynx-resident opportunistic pathogens like nontypeable Haemophilus influenzae (NTHi) assimilates into polymicrobial middle ear biofilms, which promote OM pathogenesis and substantially diminish antibiotic efficacy. Oral or tympanostomy tube (TT)-delivered antibiotics remain the standard of care (SOC) despite consequences including secondary infection, dysbiosis, and antimicrobial resistance. Monoclonal antibodies (mAb) against two biofilm-associated structural proteins, NTHi-specific type IV pilus PilA (anti-rsPilA) and protective tip-region epitopes of NTHi integration host factor (anti-tip-chimer), were previously shown to disrupt biofilms and restore antibiotic sensitivity in vitro. However, the additional criterion for clinical relevance includes the absence of consequential microbiome alterations. Here, nine chinchilla cohorts (n = 3/cohort) without disease were established to evaluate whether TT delivery of mAbs disrupted nasopharyngeal or fecal microbiomes relative to SOC-OM antibiotics. Cohort treatments included a 7d regimen of oral amoxicillin-clavulanate (AC) or 2d regimen of TT-delivered mAb, AC, Trimethoprim-sulfamethoxazole (TS), ofloxacin, or saline. Fecal and nasopharyngeal lavage (NPL) samples were collected before and several days post treatment (DPT) for 16S sequencing. While antibiotic-treated cohorts displayed beta-diversity shifts (PERMANOVA, P

Abstract Brain dynamic functional connectivity characterises transient connections between brain regions. Features of brain dynamics have been linked to emotion and cognition in adult individuals, and atypical patterns have been associated with neurodevelopmental conditions such as autism. Although reliable functional brain networks have been consistently identified in neonates, little is known about the early development of dynamic functional connectivity. In this study we characterise dynamic functional connectivity with functional magnetic resonance imaging (fMRI) in the first few weeks of postnatal life in term-born (n = 324) and preterm-born (n = 66) individuals. We show that a dynamic landscape of brain connectivity is already established by the time of birth in the human brain, characterised by six transient states of neonatal functional connectivity with changing dynamics through the neonatal period. The pattern of dynamic connectivity is atypical in preterm-born infants, and associated with atypical social, sensory, and repetitive behaviours measured by the Quantitative Checklist for Autism in Toddlers (Q-CHAT) scores at 18 months of age.