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IntroductionThe physical impact of alopecia areata (AA) is visible, but the psychological and social consequences and emotional burden are often underrecognized.MethodsIn this cross-sectional study, 547 participants recruited via the National Alopecia Areata Foundation completed a survey encompassing demographics; AA illness characteristics; and five patient-reported outcome measures on anxiety and depression, perceived stress, psychological illness impact, stigma, and quality of life (QoL). Differences in disease severity subgroups were assessed via analysis of variance (ANOVA) and t tests.ResultsMean age was 44.6 years, and 76.6% were female. Participants with more severe hair loss tended to report longer duration of experiencing AA symptoms (P

To determine if first-generation status, living in an LLC, and campus club involvement affect students' sense of belonging in their first semester of college, the researchers surveyed first-year college students enrolled at a large, public research institution during their first semester. Multiple regression analyses found campus club involvement to be a significant predictor of sense of belonging on all four subscales of the Sense of Belonging Scale: perceived peer support, perceived classroom comfort, perceived isolation, and perceived faculty support. Living in an LLC was also found to be a significant predictor of perceived peer support, but not in perceived classroom comfort, perceived isolation, or perceived faculty support. First-generation status did not emerge as a significant predictor for any of the four areas of sense of belonging. Findings revealed the significant role campus involvement has on college students' sense of belonging in the first semester.

End-of-course evaluations are a central part of the accountability system at American universities. They are used formatively to evaluate the way courses are delivered and the effectiveness of teaching practices. Therefore, institutions may use these instruments to make course changes or tenure and promotion decisions. The purpose of this research study was to gain a better understanding of how faculty use the evaluation results. Faculty from a southeastern U.S., research intensive university received a survey containing 28 Likert-scale items and two open-ended questions. Quantitative data were analyzed with descriptive statistics, while a thematic analysis was used to analyze the qualitative data. Most participants in our study (89%) reported that they use the feedback provided by the end-of-course evaluations to make changes in their courses. In the qualitative section, faculty believe that end-of-course evaluations provide meaningful input regarding student learning; however, they stated that they would like to see more open-ended questions within end-of-course evaluations. Findings from our study suggest that faculty value the information they receive from students, but end-of-course evaluations need to be better targeted to the needs of the course and faculty using it.

What skills and dispositions are most important for higher education assessment professionals to be successful in their work? Emerging professionals and their instructors must be cognizant of what skills and dispositions are necessary in order to be adequately prepared for this work. Utilizing a survey instrument that was developed based on recent research and validated by a panel of experts in higher education assessment, we surveyed 213 higher education assessment professionals from across the United States, assessing their perceptions on the importance of 92 skills and 52 dispositions. We analyzed responses by utilizing descriptive statistics for closed-ended items and thematic analysis of open-ended items. A discussion of the findings, including what skills and dispositions were deemed most important, as well as implications for future research and professional identity are discussed.

IntroductionSafeguarding college students’ mental health and well-being poses a challenge for college administrators and clinicians because of the unique circumstances students face and the limited literature on their needs. Prior to the pandemic, depression and anxiety were already on the rise among college students, but the changes associated with it may have exacerbated these issues. Our study aimed to explore factors influencing college students’ mental health and identify common trends in their experiences that could assist organizations and policymakers in the future.MethodsThe study participants (n = 571) were chosen using a convenience sample of undergraduate and graduate students attending a Central Texas university. We employed the Qualtrics survey platform to collect data on multiple demographic variables, behavioral health, and other health outcomes of students in the summer semester of 2021. Our objective in this study was to investigate the various factors that contribute to mental health conditions, particularly anxiety, and depression, independently and jointly, by employing two validated tools - Patient Health Questionnaire 9 (PHQ-9), which measures depression, and General Anxiety Disorder 7 (GAD-7), which measures anxiety.ResultsBoth the tools displayed satisfactory internal consistency, with Cronbach’s alpha coefficients (α) of 0.921 for the PHQ-9 (9-item) scale and 0.943 for the GAD-7 (7-item) scale. The prevalence of depression and anxiety among participants was 39.4% and 40.1%, respectively, with 31% of participants overall reporting both conditions. Among the explored factors, age, race, parent/guardian’s level of education, campus residence status, and health insurance status were associated with depression (p < 0.05), whereas gender, age, race, and parent/guardian’s level of education were associated with anxiety (p < 0.05). Academically, several factors related to learning difficulties (i.e., staying motivated to learn, finding a quiet place to learn) were associated with the severity of depression and anxiety severity, demonstrated through composite scores.ConclusionRobust longitudinal studies should be carried out to ascertain key influencers that affect students’ mental health, and colleges and universities should create policies and protocols to provide support for students during major catastrophes, such as the COVID-19 pandemic, taking into account these influencing factors.

Background: Early formula supplementation (EFS, formula on birthdate or day after) is associated with maternal obesity and reduced breastfeeding, but the effect of prenatal breastfeeding intention on these relationships is understudied. Objectives: We evaluated how EFS affected breastfeeding outcomes after controlling for obesity, sociodemographic and health factors. Methods: Multivariable regression modeling, stratified by prenatal breastfeeding intention. Conclusions: Our findings suggest that EFS may be less disruptive to breastfeeding in mothers with strong intention to meet breastfeeding recommendations, regardless of maternal BMI.

Background: Managing children with cerebral palsy (CP) in poorly-resourced contexts, especially those with greater functional limitations, is challenging. Unmitigated orthopaedic complications can further restrict already compromised functional capacity. Where rehabilitation skills and knowledge are scarce, primary healthcare worker- and caregiver-implemented routines are warranted. The essential elements of a home-based routine to mitigate musculoskeletal (MSK) complications in children with severe CP in resource-limited settings (RLSs) have not been determined. Objectives: To summarise the evidence for programmes and interventions that mitigate MSK complications in children with severe CP and make recommendations for a programme suited to RLSs. Method: Scientific databases and professional websites were searched for studies and reports describing guidelines, interventions or programmes for children aged 0–18 years with severe, partially- or non-ambulant CP, that included aims for the prevention of MSK complications. Articles reporting on surgical, pharmacological and advanced or expensive technological interventions were excluded. Results: A total of 57 studies or reports were included in the review. Low-grade evidence exists for 24-hour postural management (24-h PM), supported standing, sustained stretching and splinting to mitigate MSK complications in children with CP. Caregiver training and support, and integration of the programme into daily routines were identified as important components for successful implementation. Conclusion: Clinical guidelines and evidence that support caregiver-delivered interventions to reduce MSK complications in children with severe CP are limited, and only weak recommendations can be made. Clinical implications: There is a need for context-specific, home-based intervention programmes to prevent MSK complications in children with CP in RLSs.

In British Columbia (BC), Canada, mental health reforms over the last decade have moved back and forth between calls for practices that restrict human rights and those that are rooted in equity and social justice. In this article, we explore some of these tensions and their implications for human rights and equity in mental health care by critically analyzing three policies guiding mental health reform in BC using an intersectionality-based policy framework. Specifically, we interrogate the effects of a biomedical and individualized framing of mental health and substance use. We argue that such a framing is buttressed by neoliberal ideology and lays the groundwork for public and professional acceptance of coercive practices with particular consequences for Indigenous and racialized populations. This framing is juxtaposed with a holistic wellness and trauma-informed policy framework anchored by an understanding of the impact of colonization. However, what is missing in both policy framings is a full account of the documented ongoing human rights violations experienced by many people accessing BC’s mental health system. Our analysis shows how applying an intersectionality-based policy framework allows for a deeper exploration of the complex, interlocking systems of power and oppression that give rise to these human rights violations. We conclude with a discussion of the important role that decolonizing and intersectional approaches play for capturing the complexities of systemic inequities and advancing mental healthcare that protects and promotes mental wellbeing and human rights.

The mental health situation in Kenya has been termed a silent epidemic threatening the mental wellbeing of the population. Deeply entrenched stigma and discrimination is systematic and directly influences access to mental health care, human rights violations, and social exclusion. Despite commitments to improve mental health care infrastructure, the ongoing impact of colonization perpetuates biomedical responses to mental health. Kenya ratified the UN Convention on the Rights of Persons with Disabilities (CRPD) in 2008 though mental health, criminal, and civil laws continue to be in violation of the Convention. We take a human rights and equity lens to critically analyze the biomedical dominance in mental health policy and practice. We employ an intersectional analytic framework to contextualize experiences of mental health injustices and apply aspects of an Intersectionality Based Policy Analysis Framework to the Ministry of Health’s Kenya Mental Health Policy 2015-2030 (2015) and the Ministry of East African Community (EAC) Labour and Social Protection’s National Plan of Action on Implementation of Recommendations made by the Committee on the Rights of Persons with Disabilities (2016) to explore how policy discourses influence understandings of mental health and responses. We analyze a disjuncture between human rights and social determinants framings of mental health in policy, and how a default to western biomedical solutions for addressing mental distress dominate institutionally and in practice. We urge the Kenyan government to abolish coercive mental health practices, remove systemic barriers that hinder participation, and establish supports to empower people with psychosocial disabilities and their organizational representatives (USP-Kenya) to ensure mental health responses are consistent with international human rights treaties.

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This paper applies an Intersectionality Based Policy Analysis Framework to Ontario’s current mental health plan – The Roadmap: A Plan to Build Ontario’s Mental Health and Addictions Services – in order to identify the contextual influences, underlying values and assumptions, which promote or undermine the uptake of human rights and equity as a mental health policy priority in Ontario. We found that dominant framings of the “problem” of mental health (as lack of access, coordination or integration, as a fiscal drain, as an economic burden, and as a clinical or medical problem) served to obscure and ignore the underlying social and structural conditions that impact mental health and the human rights violations that routinely occur in the context of “care.” We discuss the implications of The Roadmap ignoring social and structural determinants of health, and by way of contrast, explore how citizen engagement and activism can support rethinking mental health policy so that it is more just and equitable.

OBJECTIVES: The purpose of this literature review is to analyze the current body of literature regarding the use of microneedling with a therapeutic agent, to encourage tissue regeneration and gingival health in the periodontium. METHODS: The database used for this literature review was Google Scholar with Augusta University Library accessible articles. The keywords used to find these articles were micro-needling, tissue regeneration, periodontal tissue attachment, guided tissue regeneration, and therapeutic agents. The mesh terms used were needles, periodontitis, tissues, regeneration, and epithelial attachment with the word “AND” between. Articles that were older than five years were filtered out, leaving 428 articles. Then irrelevant articles were manually filtered out. Six articles were then selected, with one of the articles being a literature review used for background information. RESULTS: Each article reviewed showed how micro-needling with therapeutic adjuncts can have a positive effect on the gingiva. These effects range from increased interdental papilla height, increased gingival thickness and collagen formation, decreased inflammation, and decreased severity of the destruction of the periodontal tissues. Micro-needling initiates a natural wound-healing process in the gingiva, and with the help of different therapeutic agents, positive results can be observed. CONCLUSIONS: Each of the articles selected used a different agent and a different micro-needling procedure. The patient's needs and wants are determining factors in which therapeutic agent would be used to assist the micro-needling procedure. Future research is needed to compare additives and procedures, in addition to micro-needling. More long-term studies are necessary to determine the lasting effects on the periodontium and overall health of the patient. In conclusion, micro-needling seems to be a cost-effective, non-invasive treatment with noticeable improvement for tissue regeneration and gingival health, proving to show validity and worth in becoming an accepted practice and treatment option in dentistry. IMPLICATIONS: Micro-needling with a therapeutic adjunct is an efficient way for dental practices to incorporate a minimally invasive treatment into a wide variety of different treatment regimens.

Trauma induced coagulopathy (TIC) describes a complex set of coagulation changes affecting severely injured patients. The thrombomodulin-protein C axis is believed to be central to the evolution of TIC. Soluble thrombomodulin (sTM) levels are elevated after injury. Our objectives were to explore whether sTM (at concentrations found in patients after injury) plays an important role in TIC, and specifically to evaluate the effect of sTM and activated protein C (APC) on thrombin generation (TG) and clot lysis time (CLT). Plasma from healthy volunteers was spiked with rising concentrations of sTM and APC and the effects on TG and CLT were analysed. Plasma samples from a cohort of trauma patients were evaluated using TG and CLT, and results correlated to clinical parameters and FVIII, FV, APC, sTM and fibrinolytic measures. Increasing sTM concentrations in volunteer plasma led to reductions in ETP and prolongation of 50% CLT times, in a dose dependent manner. No effect on TG or CLT was seen with rising APC concentrations. In 91 trauma patients, higher sTM values were associated with greater, rather than reduced, ETP (median 1483 vs. 1681 nM/min) and longer 50% CLT times (41.9 vs. 54.0 mins). In conclusion, sTM concentrations, across trauma ranges, impact both TG and 50% CLT times, unlike APC. Despite increased circulating sTM levels, the overriding dynamic coagulation effects seen after injury are: (a) accelerated thrombin generation and (b) increased rates of fibrinolysis. We find no evidence for sTM as the major determinant of the coagulation changes seen in early TIC.

Arthroscopic anterior cruciate ligament (ACL) reconstruction has been the gold standard of care for ACL injuries for many years. Recently, there has been growing literature and interest in arthroscopic primary ACL repair in select patients with predominantly proximally based ACL tears. This Technical Note demonstrates a surgical technique that offers an efficient minimally invasive and physeal-sparing anatomic ACL repair with all-inside internal brace augmentation that in the short term has offered good results for our patients.

The north coast of Peru is among the most extensively surveyed regions in the world, yet variation in research questions, sampling strategies and chronological and geospatial controls among survey projects makes comparison of disparate datasets difficult. To contextualise these issues, the authors present a systematic survey of satellite imagery focusing on hilltop fortifications in the Jequetepeque and Santa Valleys. This digital recontextualisation of pedestrian survey data demonstrates the potential of hybrid methodologies to substantially expand both the identification of archaeological sites within difficult terrain and, consequently, our understanding of the function of defensive sites. Keywords: South America, Andes, Middle Horizon, Moche culture, satellite imagery survey, pedestrian survey, fortifications, Introduction Pedestrian surveys of the coastal valleys of northern Peru have painstakingly recorded archaeological traces of complex social relations through time (Willey 1953; Daggett 1987; Wilson 1988; Dillehay et al. [...]

Imagery-based survey is capable of producing archaeological datasets that complement those collected through field-based survey methods, widening the scope of analysis beyond regions. The Geospatial Platform for Andean Culture, History and Archaeology (GeoPACHA) enables systematic registry of imagery survey data through a 'federated' approach. Using GeoPACHA, teams pursue problem-specific research questions through a common data schema and interface that allows for inter-project comparisons, analyses and syntheses. The authors present an overview of the platform's rationale and functionality, as well as a summary of results from the first survey campaign, which was carried out by six projects distributed across the central Andes, five of which are represented here. Keywords: South America, Andes, satellite survey, settlement pattern analysis, big data, large-scale imagery survey, QGIS, Scalar challenges in archaeology One of archaeology's most substantial challenges is aligning the scales of our datasets with those of the social worlds that we seek to study. At the [...]

Background: Physical activity (PA) and nutrition in children have an impact on overall physical and mental well-being, cognitive, and social development. This study aims to report on the best current available evidence on PA, body composition proxies, and nutritional status of South African children and adolescents, based on the published findings between 2018 and 2022, which comprise the 2022 Healthy Active Kids South Africa Report Card. Methods: A comprehensive literature search of online databases, along with hand searching and a gray literature search, was conducted based on PA, body composition proxies, and nutrition indicators defined, in part, by the Active Healthy Kids Global Alliance. Results: Compared with the 2018 report card, there was an improvement in the majority of PA indicators which include overall PA (B–), active transportation (B–), physical fitness (B–), and government policy and programs (C). Body composition proxies and most of the nutrition indicators remained unchanged. The indicators that regressed from 2018 to 2022 included community and environmental influences (D), as well as participation in organized sport (D–). Conclusions: Despite the apparent improvement in overall PA levels in children and adolescents, there is a lack of tangible evidence of actual implementation of policies and programs. There was also a lack of nationally representative data for most indicators. Overall, there is a need to identify intersectoral, equitable approaches for promoting PA and healthy eating in South African children and adolescents and ongoing monitoring and surveillance. [ABSTRACT FROM AUTHOR]

As of March 31, 2023, more than 30,000 monkeypox (mpox) cases had been reported in the United States in an outbreak that has disproportionately affected gay, bisexual, and other men who have sex with men (MSM) and transgender persons (1). JYNNEOS vaccine (Modified Vaccinia Ankara vaccine, Bavarian Nordic) was approved by the Food and Drug Administration (FDA) in 2019 for the prevention of smallpox and mpox via subcutaneous injection as a 2-dose series (0.5 mL per dose, administered 4 weeks apart) (2). To expand vaccine access, an Emergency Use Authorization was issued by FDA on August 9, 2022, for dose-sparing intradermal injection of JYNNEOS as a 2-dose series (0.1 mL per dose, administered 4 weeks apart) (3). Vaccination was available to persons with known or presumed exposure to a person with mpox (postexposure prophylaxis [PEP]), as well as persons at increased risk for mpox or who might benefit from vaccination (preexposure mpox prophylaxis [PrEP]) (4). Because information on JYNNEOS vaccine effectiveness (VE) is limited, a matched case-control study was conducted in 12 U.S. jurisdictions,† including nine Emerging Infections Program sites and three Epidemiology and Laboratory Capacity sites,§ to evaluate VE against mpox among MSM and transgender adults aged 18-49 years. During August 19, 2022-March 31, 2023, a total of 309 case-patients were matched to 608 control patients. Adjusted VE was 75.2% (95% CI = 61.2% to 84.2%) for partial vaccination (1 dose) and 85.9% (95% CI = 73.8% to 92.4%) for full vaccination (2 doses). Adjusted VE for full vaccination by subcutaneous, intradermal, and heterologous routes of administration was 88.9% (95% CI = 56.0% to 97.2%), 80.3% (95% CI = 22.9% to 95.0%), and 86.9% (95% CI = 69.1% to 94.5%), respectively. Adjusted VE for full vaccination among immunocompromised participants was 70.2% (95% CI = -37.9% to 93.6%) and among immunocompetent participants was 87.8% (95% CI = 57.5% to 96.5%). JYNNEOS is effective at reducing the risk for mpox. Because duration of protection of 1 versus 2 doses remains unknown, persons at increased risk for mpox exposure should receive the 2-dose series as recommended by the Advisory Committee on Immunization Practices (ACIP),¶ regardless of administration route or immunocompromise status.