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FROM HARM TO HEALING: COMMUNITY-ROOTED STRATEGIES TO SUPPORT FAMILIES IMPACTED BY SUBSTANCE USE IN GRANVILLE AND VANCE COUNTIES, NORTH CAROLINA
Get PDFThis proposal addresses the County Commissioners’ request for upstream strategies to improve community health in Granville and Vance Counties, North Carolina, targeting the Social and Community Context domain of Social Determinants of Health, which includes social cohesion, community support, and family dynamics. It focuses on the impact of parental or caregiver substance use on adolescents aged 13–17, proposing the Social Roots Initiative to implement equitable, trauma-informed interventions to mitigate adverse childhood experiences (ACEs) and health disparities. Using health data and resource mapping, it identifies service gaps and recommends three policies: amending the 1115 Medicaid Waiver for youth behavioral health, establishing Youth Recovery Navigators, and creating Family Resilience Advisory Councils. Led by a 25-member Steering Committee, the initiative emphasizes inclusive leadership, data-driven evaluation, and community engagement to break trauma cycles, aiming for integrated care by 2026, expanded school-based mental health by 2027, and sustainable health improvements by 2030.Master of Public Healt
A MULTICOMPONENT STRATEGY TO PROMOTE HEALTH EQUITY IN OLDER ADULTS BY REINFORCING THE NEIGHBORHOOD AND BUILT ENVIRONMENT IN GRANVILLE AND VANCE COUNTIES
Get PDFThe neighborhood and built environment in Granville and Vance Counties significantly shape the health of aging adults, especially in rural communities facing food insecurity, inadequate infrastructure, and housing instability. Through four Deliverable 1 analyses, Policy, Leadership, Engagement, and Quality, key barriers were identified, including exclusionary zoning ordinances, digital inequities, limited access to public health data, and insufficient community-led decision-making. These intersecting factors contribute to disproportionately high rates of chronic disease and social isolation among older adults in these counties. Deliverable 2 expanded on these findings by proposing governance strategies focused on accountability, cross-sector collaboration, and sustainability. Recommendations included shared measurement systems, inclusive coalition structures, and conflict resolution frameworks. Together, the deliverables emphasize the urgent need for equity-focused, community-driven solutions to improve access to affordable housing, broadband, and environments that support aging. This work offers a roadmap for advancing structural change to ensure that all residents can age with dignity in healthy, connected communities.Master of Public Healt
Data for "Quantification of the relative contribution of phase aberration and reverberation in transcranial ultrasound imaging: an experimentally calibrated fullwave study in 2-D and 3-D" Part 3
No full textData for "Quantification of the relative contribution of phase aberration and reverberation in transcranial ultrasound imaging: an experimentally calibrated fullwave study in 2-D and 3-D
The economic and health impact of substandard uterotonic use for prevention of postpartum hemorrhage in three Sub-Saharan African countries: a comparative analysis
Get PDFBackground Uterotonics are essential in reducing the risk of postpartum haemorrhage (PPH) and saving mothers’ lives. However, numerous quality-testing studies have found that uterotonics in many low- and middle-income countries are substandard. This study compares the economic, health, and policy implications of poor-quality uterotonics in three West African countries: Ghana, Nigeria, and Senegal. The economic impact of poor-quality uterotonics has not been previously compared. Methods We utilized a decision-tree model to examine the implications of using substandard uterotonics (oxytocin and misoprostol) in three countries. The model simulated the place and mode of delivery, use and quality of uterotonics, risk and diagnosis of PPH and resulting economic and health outcomes. Country-specific inputs were derived from demographic and health surveys and published literature. Given large variations in population size, results were compared across 100 000 women giving birth. Results Ghana demonstrated the greatest benefit from improvements in uterotonic quality, with US 1.1 million (7%) and US 89 million in Nigeria, US 1.3 million in Senegal, leading to 100 000 fewer PPH cases per year overall. These simulated results were primarily driven by high proportions of substandard uterotonics and high facility use in Ghana, high numbers of home births in Nigeria and substandard misoprostol use in Senegal. Conclusions Improving uterotonic quality would bring significant cost savings and maternal health improvements across countries. Specific policies to improve uterotonic quality and bring about the economic and health benefits may need to be tailored by country. Ensuring the quality of uterotonics is essential in improving medicine equity and would contribute towards efforts to achieve universal health coverage by ensuring that medications adequately achieve their value for money
Impact of acute stress exposure on genome-wide DNA methylation
Get PDFDNA methylation (DNAm) is a stable epigenetic modification, yet plasticity in DNAm is associated with exposure to a broad range of experiences. Evidence from animal studies suggests that acute stress can induce DNAm changes in adulthood. However, there has been limited exploration of plasticity in the human epigenome in response to acute stress. In the current study we examine whether acute stress-induced shifts in DNAm occur in male (N = 27) and female (N = 28 female) participants who undergo a lab-based stress-induction protocol. Results from our within-subjects design indicate that acute stress induces both hypermethylation and hypomethylation in salivary DNA, including CpG sites within the GATA3, NINL, BACH2, PHACTR1 and KRTAP19-3 genes. Sex-specific effects of acute stress were found within the COL4A1 gene, with females exhibiting an increase, and males exhibiting a decrease in DNAm following acute stress. Further, we found that psychological stress reactivity (but not cortisol reactivity) predicted post-stress DNAm, and cortisol reactivity (but not psychological stress reactivity) predicted epigenetic aging. Taken together, these novel findings (a) support the hypothesis that DNAm can shift in response to an acute stressor, and (b) highlight the importance of understanding the unique pathways through which hormonal versus psychological responses to stress influence the epigenome
Substituents Effects on the Electrocatalytic CO2 Reduction by Cobalt Corroles in Solution
Get PDFElectrochemical CO2 reduction catalysis with cobalt corrole complexes in solution is reported. Corroles have attracted attention as contracted and trianionic tetrapyrrolic macrocycles that can be compared to leading porphyrin catalysts for CO2 reduction, but most studies focus on heterogenized systems with poorly defined electrochemical responses. Electrochemical studies of cobalt corroles bearing axial triphenylphosphine ligands to ensure solubility are reported. The voltammetry provides mechanistic insights supporting CO2 activation after the formal CoII/CoI reduction. The series of cobalt complexes, including a newly designed corrole with mixed perfluorophenyl/ortho-dimethoxyphenyl substituent pattern, provide evidence for electron-rich catalysts having stronger interactions with CO2. The primary product of CO2 reduction is CO, formed at a rate of ca. 90 s-1
Increased Extra‐Axial Cerebrospinal Fluid Volume in Children With Angelman Syndrome: Links to Sleep Problems and Seizures
Get PDFBackground Previous studies demonstrated that children with autism have enlarged volumes of extra‐axial cerebrospinal fluid (EA‐CSF) and an increased ratio of EA‐CSF to brain volume, indicating that EA‐CSF is disproportionally increased beyond macrocephaly often observed in autism. It is unknown whether EA‐CSF is disproportionally enlarged in Angelman syndrome (AS), which shares phenotypic features with autism (sleep problems, seizures) but is characterized by microcephaly. This study examined EA‐CSF and total cerebral volume (TCV) in AS children compared with neurotypical (NT) controls to test whether EA‐CSF is disproportionally enlarged and is associated with sleep problems and seizures. Methods Magnetic resonance imaging scans were acquired in n = 29 AS (M[SD] = 6.95 ± 2.83 years) and n = 27 NT children (M[SD] = 7.96 ± 2.24). EA‐CSF and TCV were compared using analysis of covariance (ANCOVA), controlling for age, sex, and group interactions. In AS, associations between EA‐CSF, sleep quality, and seizure severity were evaluated by linear regression. Results Children with AS had 22% smaller TCV ( p < 0.0001) yet nearly identical EA‐CSF volumes ( p = 0.35). The ratio of EA‐CSF to TCV was 48% higher in AS ( p < 0.0001). Increased EA‐CSF ratio in AS was associated with sleep initiation problems ( p = 0.002) and seizure severity ( p = 0.032). Conclusion Children with AS have disproportionally higher EA‐CSF volume than would be predicted by their smaller brain size. EA‐CSF was associated with sleep problems and seizures, which impact quality of life and are target endpoints of current AS clinical trials. Excessive CSF suggests that CSF circulation might be perturbed in AS, which could have implications for brain waste clearance and impact the biodistribution of AS therapies delivered via CSF
Effect of Acute Gut Butyrate Delivery on Blood Pressure in Black Individuals With Hypertension: A Proof-of-Concept Randomized Controlled Study.
Get PDFBACKGROUND: Hypertension is a global health crisis linked to increased heart disease and stroke. Black individuals have the greatest burden of hypertension and related diseases. Recent research suggests that the gut microbial production of short-chain fatty acids, such as butyrate, is associated with blood pressure (BP) regulation. We hypothesize that acutely increasing gut butyrate would lead to a significant reduction in BP within a 24-hour period. METHODS: Ten Black adults with normal BP and 10 with stage 1 hypertension (age and sex-matched) participated in this study. In a crossover experiment, participants with hypertension randomly self-administered a low dose (5 mmol/L) and a high dose (80 mmol/L) butyrate enema 7 days apart. Blood butyrate levels were measured before and 30 minutes post enema, with BP monitored via 24-hour ambulatory devices. Preintervention fecal samples were sequenced via the V4 region of the 16S rRNA gene and microbiome characteristics assessed. RESULTS: We observed that daytime systolic BP was significantly lower after the 80 mmol/L butyrate enema. There was no significant difference in blood butyrate between controls and the group with hypertension before or after either enema. Microbial diversity did not significantly differ between groups; however, pathways for carbohydrate fermentation were significantly lower with differentially abundance butyrate-producing microbes in participants with hypertension compared with those with normal BP. CONCLUSIONS: This study suggests that increasing gut butyrate availability can improve BP. The findings bolster the evidence that gut butyrate regulates BP and supports studies needed to test strategies to boost gut butyrate availability for BP control. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier NCT04415333
Efficacy and safety of dapagliflozin in patients hospitalized with COVID-19 with and without type 2 diabetes: a prespecified analysis of the DARE-19 randomized trial
Get PDFBackground Although several previous studies tested SGLT2 inhibitors in the setting of an acute, non-cardiovascular illness, detailed information on their efficacy and safety among participants with and without type 2 diabetes (T2D) from double-blind randomized trials is lacking. In this secondary prespecified analysis of the Dapagliflozin in Respiratory Failure in Patients with COVID-19 (DARE-19) trial, we sought to evaluate the safety and efficacy of initiating dapagliflozin during acute illness with COVID-19 in patients with and without T2D. Methods The DARE-19 trial randomized 1250 patients hospitalized with COVID-19 and cardiometabolic risk factors to dapagliflozin or placebo. T2D was present in 636/1250 (50.9%) of the cohort. Dual primary outcomes were evaluated: prevention (time to new or worsened organ dysfunction or death) and a hierarchical composite outcome of recovery (change in clinical status by day 30). Key biomarkers (serum bicarbonate, estimated glomerular filtration rate [eGFR], hematocrit, and glucose) and safety were assessed in participants with and without T2D during index hospitalization. Results Among patients with T2D, the prevention outcome occurred in 10.9% receiving dapagliflozin versus 13.9% receiving placebo (hazard ratio [HR] 0.76, 95% CI 0.49–1.18). In patients without diabetes, the event rate was 11.5% with dapagliflozin versus 13.3% with placebo (HR 0.86, 95% CI 0.55–1.35; interaction p = 0.668). For the primary recovery outcome, no significant differences were observed between dapagliflozin and placebo groups regardless of diabetes status (interaction p = 0.222). Close laboratory monitoring revealed similarities in serum bicarbonate, eGFR, or hematocrit for the dapagliflozin and placebo groups, irrespective of T2D status. Any serious adverse event was reported in 12·7% of patients in the dapagliflozin group, 14·3% in the placebo group among patients with T2D, and in 8·5% of patients in the dapagliflozin group, and 11·9% in the placebo group in patients without T2D. Diabetes ketoacidosis was reported in two patients with T2D in the dapagliflozin group. Conclusions Initiating dapagliflozin in patients hospitalized for acute COVID-19 was well tolerated and safe, irrespective of T2D status. Serum biomarker levels remained stable and comparable between treatment groups, indicating no increased risk of adverse metabolic or renal effects with dapagliflozin in this clinical scenario. Trial registration The trial was registered on ClinicalTrials.gov (NCT04350593)
A Cross-Sectional Survey to Identify Current Pneumococcal Vaccination Practices and Barriers in Rural Community Pharmacies
Get PDFBackground: Pneumococcal vaccination rates in the United States (US) remain suboptimal, especially for adults aged 19 to 64 with high-risk medical conditions. Community-pharmacy-based immunization services increase vaccine access, particularly in rural areas. This study describes the provision of pneumococcal immunization services, assesses the processes used to identify and confirm patient eligibility, and determines barriers to immunization services in rural community pharmacies. Methods: A cross-sectional survey was emailed to members of the Rural Research Alliance of Community Pharmacies, located in the southeastern US. The survey assessed which pneumococcal vaccines were offered, age groups, prescription requirements, and how patient eligibility was determined. In addition, participants were asked to rate a series of patient-related and organizational barriers to pneumococcal vaccination. Results: Ninety-four pharmacies completed the survey, with most (96.8%) offering pneumococcal vaccines, most commonly PCV20 (95.6%). Most pharmacies vaccinated patients upon request (98.9%) or when patients presented with a prescription (82.4%), but few proactively contacted patients to schedule the vaccination (17.6%). Pharmacists most often administered pneumococcal vaccines to patients aged 65 and older and used patient age and immunization information systems to identify eligible patients. The most common patient-related barrier was the patient’s belief that they do not need the vaccine. The most common organizational barriers were inadequate reimbursements for vaccine administration and vaccine products. Conclusions: Pneumococcal vaccinations are commonly offered in rural community pharmacies, which play an important role in immunization access. With recent guideline changes to the age-based recommendation, there is an opportunity to optimize strategies to increase vaccine uptake