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Abstract Social accountability is often put forward as a strategy to promote health rights, but we lack a programmatic evidence base on if, when, and how social accountability strategies can be used to promote access to quality Sexual and Reproductive Health (SRH) care for stigmatized populations and/or stigmatized issues. In this Commentary, we discuss the potential advantages and disadvantages of social accountability strategies in promoting the availability of a full range of SRH services for excluded and historically oppressed populations. We accomplish this by describing four programs that sought to promote access to quality SRH care for stigmatized populations and/or stigmatized services. Program implementers faced similar challenges, including stigma and harmful gender norms among providers and communities, and lack of clear guidance, authority, and knowledge of Sexual and Reproductive Health and Rights (SRHR) entitlements at local level. To overcome these challenges, the programs employed several strategies, including linking their strategies to legal accountability, budgetary expenditures, or other institutionalized processes; taking steps to ensure inclusion, including through consultation with excluded or stigmatized groups throughout the program design and implementation process; specific outreach and support to integrating marginalized groups into program activities; and the creation of separate spaces to ensure confidentiality and safety. The program experiences described here suggest some general principles for ensuring that social accountability efforts are inclusive both in terms of populations and issues addressed. Further empirical research can test and further flesh out these principles, and deepen our understanding of context.

Alix Hall,1– 3 Jamie Bryant,1– 3 Robert Sanson-Fisher,1– 3 Alice Grady,2– 4 Anthony Proietto,1– 3 Christopher M Doran5 1Health Behaviour Research Collaborative, School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, Australia; 2Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, Australia; 3Hunter Medical Research Institute, New Lambton Heights, NSW, Australia; 4Hunter New England Local Health District, Population Health, Wallsend, NSW, Australia; 5Centre for Indigenous Health Equity Research, Central Queensland University, Rockhampton, QLD, AustraliaCorrespondence: Jamie Bryant Email Jamie.Bryant@newcastle.edu.auObjective: To determine among a sample of Australian cancer patients receiving outpatient oncology care: 1) the most frequently endorsed general health service improvements selected by patients; 2) for the three most endorsed general health service improvements, the proportion of participants endorsing specific health service changes; and 3) sociodemographic, disease and treatment characteristics associated with the most frequently endorsed general health service improvements.Methods: A cross-sectional survey was conducted across six outpatient oncology treatment units located in New South Wales, Australia. Patients receiving chemotherapy for any cancer diagnosis at any of six oncology services were recruited. Participants completed an online survey which included the Consumer Preferences Survey. Logistic regression analyses were conducted to identify sociodemographic, disease and treatment characteristics associated with frequently endorsed health service improvements.Results: A total of 879 eligible patients initiated the survey (72% consent rate). Participants selected a median of two health service improvements. The three most wanted improvements were car parking (56%), up-to-date information about treatment or condition progress (19%), and hospital catering (17%). Age was the only characteristic significantly associated with identifying car parking as a needed improvement.Conclusion: Achieving high quality cancer care requires understanding of the views and experiences of patients about the quality of care they receive. Car parking and access to information were the two most frequently endorsed general health service changes desired by this sample of participants.Practice Implication: Future studies could examine whether enacting changes as per patient feedback improves patient perceptions of quality of care, and health outcomes.Keywords: patient-centered care, cancer, quality of healthcare, patient identified change

Ensuring accountability for the realization of sexual and reproductive health and rights is a human rights obligation and central tenet of strategies to improve health systems and outcomes in humanitarian settings. This pilot study explored the feasibility and acceptability of deploying human rights strategies, specifically through a participatory community-led complaints mechanism, to hold humanitarian health systems to account for the sexual and reproductive health and rights of refugee and host community women and girls in northern Uganda. Over a fifteen-month period we conducted a multi-methods exploratory study with refugee and host community rights-holders and duty-bearers using longitudinal in-depth interviews, focus groups, and secondary data document review. Deductive and inductive coding techniques were used to analyze data iteratively for content and themes. 107 sexual and reproductive health and rights related complaints and feedback were collected through the community complaints mechanism. Complaints concerned experiences of disrespect and abuse by health care workers; lack of adolescent access to sexual and reproductive health services and information; sexual and gender-based violence; and lack of access to acceptable and quality health goods and services. Participants reported an increased understanding and claiming of human rights through the intervention, acceptability of rights-based accountability strategies among humanitarian health system actors, and improved access to remedies when sexual and reproductive health rights are not respected. Findings demonstrate integrating rights-based social accountability mechanisms at the level of humanitarian response as a promising approach for strengthening and holding humanitarian health systems accountable for the sexual and reproductive health and rights of women and girls affected by humanitarian situations.

Medical students face challenging but important topics they must learn in short periods of time, such as autonomic pharmacology. Autonomic pharmacology is difficult in that it requires students to synthesize detailed anatomy, physiology, clinical reasoning, and pharmacology. The subject poses a challenge to learn as it is often introduced early in medical school curricula. To ease the difficulty of learning autonomic pharmacology, we created a free web application, PharmaMemory (www.pharmamemory.com), that interactively depicts the effects of high-yield autonomic drugs on the human body. PharmaMemory provides users with the opportunity to read and quiz themselves on the mechanisms, side effects, indications, and contraindications of these drugs while interacting with the application. We provided PharmaMemory to first-year medical students for three consecutive years of quality improvement and assessed the application's perceived effects on learning via user surveys. Survey feedback showed that users viewed PharmaMemory favorably and self-reported increased knowledge and confidence in the subject of autonomic pharmacology. Comments revealed that users liked the website's visuals, opportunity for challenged recall, and conciseness. PharmaMemory utilizes challenged recall, visual stimulation, and interactive learning to provide users with a multifaceted learning tool. Preliminary data suggest that students find this method of learning beneficial. Further studies are needed to assess PharmaMemory compared with more traditional learning methods such as PowerPoint or text-based learning. Additionally, further research is needed to quantitatively assess reduction in cognitive load.

Mitral annular disjunction (MAD) is a rare and under-recognized entity in the pediatric population. We present 2 cases of MAD in previously healthy pediatric patients and highlight clinical scenarios where MAD should be suspected.

While all learning and knowledge can be attributed to experiences, not all experiences are educative. Experiential learning is a highly utilized theory and pedagogical practice in agricultural education and has been since its inception as a discipline. The purpose of this research is to examine the theory of experiential learning as it applies to agricultural education. Therefore, this philosophical discussion aims to continue the work conducted by Roberts (2006), and aid in further understanding the phenomenon of experiential learning. Specifically, this study includes a synthesis of recent empirical research on experiential learning, especially in agricultural education settings. We also offer considerations from seminal literature by experiential learning theorists. A revised process model that emphasizes experiential learning is not a stepwise process is presented. Also, we provide revisions to the model for contextualizing experiential learning. Lastly, we present a holistic model of experiential learning that includes both the process and context of experiential learning.

An emerging challenge of closing the gap of supply and demand in School-Based Agriculture Education (SBAE) is recruiting and retaining male agricultural teachers. This case study was conducted under the lens of the Theory of Planned Behavior to examine this phenomena. Ten male participants, who were active in SBAE as youth and are currently attending a post-secondary institution, were chosen to discuss their participation in SBAE and their college major selection. The results of these interviews identified factors participants used to select a major in agricultural education versus other agricultural majors. Participants' high school agriculture teacher was found to be the most influential in students' decision to major in agriculture. Participants' parents were found to be supportive of their child's choice of major, but this was not a major factor in influencing their child's selection of major. Furthermore, enrollment in SBAE gave participants the confidence and knowledge to select majors in colleges of agriculture.

Given the shortage of agriculture teachers across the country, understanding individuals' motivation to pursue a career in teaching agricultural education is critical to developing strategies for teacher recruitment and teacher education. Several studies have investigated factors that motivate preservice and in-service agriculture teachers to pursue a career teaching agricultural education based on the Factors Influencing Teaching Choice (FIT-Choice) model. However, little research investigated the topic using different theoretical lenses or a mixed-methods approach, which could provide new perspectives on individuals' motivation to teach. To address the knowledge gap, we investigated Florida preservice teacher recruitment program participants' motivation to teach agricultural education using a mixed-methods approach from the self-determination theory and the theory of planned behavior theoretical lens. We found that individuals' intention to become agriculture teachers was statistically significantly explained by two predictors: attitude toward behavior and perceived behavioral control regarding a career in teaching agriculture. When choosing a career in teaching agriculture, the score for more self-determined motivation was substantially higher than that for less self-determined motivation. Furthermore, inspiring agriculture teachers, positive experiences with SBAE programs, a passion for teaching and agriculture, and paying it forward to students were the main factors that motivated them to pursue a career in teaching agricultural education. Based on the theoretical frameworks and the results, a model for understanding factors influencing individuals to pursue a career in teaching agriculture was proposed to broaden our understanding of the multidimensional nature of individuals' motivation to teach agriculture.

Schools are ideal settings to promote adolescent physical activity (PA), yet school-based interventions have shown limited long-term impact. This position paper presents key issues surrounding school-based PA interventions. Collaborative conceptual thinking drawing on multi-author expertise and available evidence advanced our understanding and opinion. Key arguments: 1) the adoption of a systems approach, which maximizes partnership action and leverages policy, is crucial for understanding the complexities of implementing whole-school programs; 2) a reorientation to an assets perspective optimizes existing strengths and resources allowing greater emphasis on the full range of physical, cognitive, emotional and social benefits that PA provides, and 3) a move beyond traditional positivist research designs to advance our knowledge of what works better, for whom and in what context is needed for greater progress We provide suggestions, specifically advocating for systems approaches, as a realistic way to improve how we support PA in schools in the future.

Experiential learning is widely used at the post-secondary level, but it requires intentional curricular planning, and proper facilitation from the instructor. The effects of experiential learning in agricultural education settings at the higher education level have not been tested extensively. Therefore, additional examination is needed to inform the practice of college faculty, especially those who wish to implement effective experiential learning in their teaching. The purpose of this study was to examine the effects of reflection mode (peer verbal or written journal reflection) and transfer level (same, near, or far transfer) on students' post-course knowledge retention in an undergraduate, animal science, laboratory course. In total, 114 students were divided among six treatment groups using a quasi-experimental, two-way, analysis of covariance (ANCOVA) design. There was no statistically significant interaction effect between reflection mode and transfer level on students' post course retention, nor were there statistically significant differences for theses main effects. While no treatment group was statistically significant, this does not mean that the mode of reflection or level of transfer were not effective practices. Rather, no reflection mode, transfer level, or combination thereof was more effective than the others. Practitioners of experiential education should seek to implement holistic models of experiential learning, which includes the facilitation of learner reflection and application, in order to foster an educative experience.

BACKGROUND: Long-term noise exposure is associated with cardiovascular disease (CVD), including acute cardiovascular events such as myocardial infarction and stroke. However, longitudinal cohort studies in the U.S. of long-term noise and CVD are almost exclusively from Europe and few modeled nighttime noise, when an individual is likely at home or asleep, separately from daytime noise. We aimed to examine the prospective association of outdoor long-term nighttime and daytime noise from anthropogenic sources with incident CVD using a U.S.-based, nationwide cohort of women. METHODS: We linked L50 nighttime and L50 daytime anthropogenic modeled noise estimates from a U.S. National Parks Service model (L50: sound pressure levels exceeded 50 percent of the time) to geocoded residential addresses of 114,116 participants in the Nurses Health Study. We used time-varying Cox proportional hazards models to estimate risk of incident CVD, coronary heart disease (CHD), and stroke associated with long-term average (14-y measurement period) noise exposure, adjusted for potential individual- and area-level confounders and CVD risk factors (1988-2018; biennial residential address updates; monthly CVD updates). We assessed effect modification by population density, region, air pollution, vegetation cover, and neighborhood socioeconomic status, and explored mediation by self-reported average nightly sleep duration. RESULTS: Over 2,548,927 person-years, there were 10,331 incident CVD events. In fully adjusted models, the hazard ratios for each interquartile range increase in L50 nighttime noise (3.67 dBA) and L50 daytime noise (4.35 dBA), respectively, were 1.04 (95% CI: 1.02, 1.06) and 1.04 (95% CI: 1.02, 1.07). Associations for total energy-equivalent noise level (Leq) measures were stronger than for the anthropogenic statistical L50 noise measures. Similar associations were observed for CHD and stroke. Interaction analyses suggested that associations of L50 nighttime and L50 daytime noise with CVD did not differ by prespecified effect modifiers. We found no evidence that inadequate sleep (

BACKGROUND: Despite major improvements in treatment of HER2-positive metastatic breast cancer (MBC), only few patients achieve complete remission and remain progression free for a prolonged time. The tumor immune microenvironment plays an important role in the response to treatment in HER2-positive breast cancer and could contain valuable prognostic information. Detailed information on the cancer-immune cell interactions in HER2-positive MBC is however still lacking. By characterizing the tumor immune microenvironment in patients with HER2-positive MBC, we aimed to get a better understanding why overall survival (OS) differs so widely and which alternative treatment approaches may improve outcome. METHODS: We included all patients with HER2-positive MBC who were treated with trastuzumab-based palliative therapy in the Netherlands Cancer Institute between 2000 and 2014 and for whom pre-treatment tissue from the primary tumor or from metastases was available. Infiltrating immune cells and their spatial relationships to one another and to tumor cells were characterized by immunohistochemistry and multiplex immunofluorescence. We also evaluated immune signatures and other key pathways using next-generation RNA-sequencing data. With nine years median follow-up from initial diagnosis of MBC, we investigated the association between tumor and immune characteristics and outcome. RESULTS: A total of 124 patients with 147 samples were included and evaluated. The different technologies showed high correlations between each other. T-cells were less prevalent in metastases compared to primary tumors, whereas B-cells and regulatory T-cells (Tregs) were comparable between primary tumors and metastases. Stromal tumor-infiltrating lymphocytes in general were not associated with OS. The infiltration of B-cells and Tregs in the primary tumor was associated with unfavorable OS. Four signatures classifying the extracellular matrix of primary tumors showed differential survival in the population as a whole. CONCLUSIONS: In a real-world cohort of 124 patients with HER2-positive MBC, B-cells, and Tregs in primary tumors are associated with unfavorable survival. With this paper, we provide a comprehensive insight in the tumor immune microenvironment that could guide further research into development of novel immunomodulatory strategies.

Invasive herbivores that kill foundation tree species pose a major threat to forest ecosystem sustainability. One important foundation tree species in the interior western United States is quaking aspen (Populus tremuloides Michx.), which is threatened by recent outbreaks of an invasive insect, oystershell scale (Lepidosaphes ulmi Linn.; OSS). OSS outbreaks were first reported in 2016, when OSS began causing dieback and mortality of aspen in wildland forest settings in northern Arizona. Since then, OSS has been observed in other locations across Arizona and in other western states, and recent studies in Arizona have highlighted the threat that OSS poses to aspen sustainability, warranting a comprehensive survey of OSS invasions and their impacts on aspen ecosystems. We sampled aspen populations across Arizona and addressed three questions: (1) What is the geographic extent of OSS in Arizona? (2) What impacts does OSS have on aspen? (3) Which biotic and abiotic factors influence the proportion of aspen stems infested by OSS? OSS was present in 29% of our 220 study plots and had a negative impact on aspen forest health. OSS was associated with crown damage and tree mortality, especially of intermediate-sized, recruiting stems. Climate was the most important driver of OSS infestation, with warmer, drier conditions resulting in significantly more OSS. OSS was also associated with less recent fire, presence of ungulate management strategies (e.g. fenced exclosures) and stands with a greater density of aspen saplings. We conclude by providing OSS monitoring and management recommendations, based on our findings, and emphasise that active management – such as prescribed fire, reduced reliance on ungulate exclosures or thinning – is required to suppress OSS populations and mitigate damage to aspen ecosystems.

Abstract Introduction The prevalence of tendon rupture and tendinopathies (TRT) has not been determined in a large population of patients with atherosclerotic cardiovascular disease (ASCVD). We investigated TRT prevalence among patients with ASCVD and in the general population, using data from the Symphony Health Integrated Dataverse, a large US medical and pharmacy claims database. Methods This retrospective, observational study included patients aged ≥ 19 years from the claims database during the identification period (January 2019 to December 2020) and 12 months of continuous enrollment. The primary outcome was evidence of TRT in the 12 months following the index date (first ASCVD diagnosis in the ASCVD cohort; first claim in the claims database in the overall population). Diagnostic codes (ICD-10 and/or CPT) were used to define ASCVD and TRT diagnosis. Results The ASCVD cohort and overall population included 5,589,273 and 61,715,843 patients, respectively. In the ASCVD cohort, use of medications with a potential or known association with TRT was identified in 67.9% (statins), 17.7% (corticosteroids), and 16.7% (fluoroquinolones) of patients. Bempedoic acid use was reported in 1556 (

In 2021, guidelines for early childhood education and care were released recommending children are provided access to outdoor areas during all free play sessions to reduce the risk of coronavirus disease of 2019 transmission, aligning with the existing recommendations to increase children's physical activity. There is a need to understand how to disseminate guidelines in this setting as dissemination is a prerequisite of adoption and implementation. This randomized controlled trial explored the impact of a video-based strategy to disseminate guidelines on family day care educators' intentions to adopt outdoor free play guidelines. Educators (N = 255) were randomized to receive a video (intervention) or text-based (usual care) resource via email describing recommendations. Educators were invited to participate in a post-intervention survey at 5-week follow-up assessing intentions to adopt guidelines. The secondary outcomes included knowledge, beliefs about capabilities, beliefs about consequences, social/professional role and identity, goals, implementation of guidelines, acceptability of resource and intervention reach. There was no statistically significant difference between groups in intentions to adopt guidelines [[Beta] = 0.01 (95% confidence interval -0.50 to 0.52), P = 0.97], nor for any secondary outcomes. Further investigation is needed to identify effective dissemination strategies in the family day care setting to increase the adoption of public health guidelines.