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Community health workers (CHWs) have a long, rich global history of extending essential health services and helping address social determinants of health for underserved populations.1 The 1978 Declaration of Alma-Ata, which called for the achievement of \"health for all,\" explicitly defined a role for CHWs as an integral member of primary health care teams.2 In the United States, CHWs have historically been patient health educators and advocates, particularly for patients who have limited health knowledge or whose first language is not English. The 2010 Affordable Care Act called for the integration of CHWs into primary care settings to help improve the provision of care to culturally diverse patients. Despite these efforts, the CHW workforce in the United States has been underrecognized and underutilized, and many have called for policy change to better integrate CHWs into the US health system.3,4 CHWs have been largely neglected in health workforce planning, with existing programs often led by multiple actors without coordination, with fragmented or disease-specific foci, unclear links to the health system, and unclear identities because of wide-ranging job titles. Small programs and demonstration projects have shown the efficacy and promise of CHWs to improve population health outcomes,5,6 but monitoring and evaluation systems for large-scale CHW programs have been weak, and evidence of their real-world effectiveness and cost-effectiveness has been limited.In this issue of AJPH, Heisler et al. (p. 766) describe an innovative multisector partnership between Medicaid health plans, a local health department, community-based organizations, and academia that implemented and evaluated a health plan-led CHW program in a low-income neighborhood in Detroit, Michigan. One year in, the study found that emergency department visits and costs were lower in the intervention group of Medicaid beneficiaries randomized to the CHW program compared to beneficiaries who received usual care. Outpatient ambulatory care costs were higher in the intervention group. Although total costs did not differ between the two groups, increases in ambulatory care use among low-income, medically underserved populations are a clear marker of success, and future longitudinal studies may demonstrate important implications for long-term savings and health outcomes.

Austerity should be replaced by economic alternatives that prioritise wellbeing, gender equality, and human rights, writes Natalia Rodriguez Malagon

Community health worker (CHW)-led education is an important strategy to increase awareness and access to breast cancer screening in medically-underserved communities. This study aimed to develop a context-specific, culturally-appropriate training intervention for South Florida CHWs to educate Latinx immigrant farmworkers on breast cancer and early detection. A community-based participatory research (CBPR) study, conducted 2017-2019, informed the design of a training curriculum for CHWs and educational dissemination materials. Twenty-two CHWs were trained and knowledge gains were measuring using a one-group pre-and post-test design. Triangulated evaluation consisted of field observations of CHW-client interactions, CHW self-reports, and rapid assessment surveys of community members. A community stakeholder-informed breast cancer training curriculum resulted in significant, sustained breast cancer knowledge gains among CHWs when comparing pre-, post-, and 4-6 month post-training follow-up test scores. Field observations of educational material dissemination, CHW self-reported evaluations, and community rapid assessment surveys at three health fairs demonstrated this was an effective strategy to engage female Latinx farmworkers in breast cancer education. Community and key stakeholder participation in the development of a breast cancer educational intervention allowed for tailored design priorities around knowledge-based content, comprehensiveness, relevance, appropriateness, and ease of dissemination to community members. This model of participatory CHW training intervention design can enable future train-the-trainer approaches to disseminate and scale-up evidence-based health education interventions.

Background Polyploidy is ubiquitous in eukaryotic plant and fungal lineages, and it leads to the co-existence of several copies of similar or related genomes in one nucleus. In plants, polyploidy is considered a major factor in successful domestication. However, polyploidy challenges chromosome folding architecture in the nucleus to establish functional structures. Results We examine the hexaploid wheat nuclear architecture by integrating RNA-seq, ChIP-seq, ATAC-seq, Hi-C, and Hi-ChIP data. Our results highlight the presence of three levels of large-scale spatial organization: the arrangement into genome territories, the diametrical separation between facultative and constitutive heterochromatin, and the organization of RNA polymerase II around transcription factories. We demonstrate the micro-compartmentalization of transcriptionally active genes determined by physical interactions between genes with specific euchromatic histone modifications. Both intra- and interchromosomal RNA polymerase-associated contacts involve multiple genes displaying similar expression levels. Conclusions Our results provide new insights into the physical chromosome organization of a polyploid genome, as well as on the relationship between epigenetic marks and chromosome conformation to determine a 3D spatial organization of gene expression, a key factor governing gene transcription in polyploids.

This paper reviews the literature concerning technology used for creating and delivering accessible museum and cultural heritage sites experiences. It highlights the importance of the delivery suited for everyone from different areas of expertise, namely interaction design, pedagogical and participatory design, and it presents how recent and future artificial intelligence (AI) developments can be used for this aim, i.e.,improving and widening online and in situ accessibility. From the literature review analysis, we articulate a conceptual framework that incorporates key elements that constitute museum and cultural heritage online experiences and how these elements are related to each other. Concrete opportunities for future directions empirical research for accessibility of cultural heritage contents are suggested and further discussed.

Cervical cancer screening rates are declining in the US, with persistent disparities among vulnerable populations. Strategies to better reach under-screened communities are needed. The COVID pandemic sparked major shifts in healthcare delivery, including the accelerated development and adoption of rapid diagnostic testing, broadened access to remote care, and growing consumer demand for self-testing, which could be leveraged for cervical cancer. Rapid tests for the detection of Human Papillomavirus (HPV) have the potential to improve cervical cancer screening coverage, and if coupled with patient-collected cervicovaginal samples, create an opportunity for self-testing. The objectives of this study were: 1) to examine whether COVID influenced clinician perspectives of rapid testing as a screening modality; and 2) to assess clinician awareness, perceived benefits and limitations, and willingness to adopt point-of-care HPV testing, patient self-sampling, and rapid HPV self-testing with self-collected samples. The methodology adopted consisted of an online cross-sectional survey (n = 224) and in-depth interviews (n = 20) were conducted with clinicians who perform cervical cancer screening in Indiana, ranked in the top ten states for cervical cancer mortality and with marked disparities across socio-demographic groups. The main findings show that about half the clinicians reported that the COVID pandemic had influenced their views on rapid testing as a screening modality both positively (greater public acceptability of rapid testing and impact on patient care) and negatively (concerns regarding accuracy of rapid tests). The majority of clinicians (82%) were willing to adopt rapid HPV testing at the point-of-care, while only 48% were willing to adopt rapid HPV self-testing with self-collected samples. In-depth interviews revealed provider concerns around patients’ ability to collect their own sample, report results correctly, and return to the clinic for follow-up and other preventive care. Addressing clinician concerns about self-sampling and rapid HPV testing, such as ensuring that rapid tests include sample adequacy controls, is necessary to mitigate barriers to adoption for cervical cancer screening.

Encapsulins are self‐assembling protein compartments found in prokaryotes and specifically encapsulate dedicated cargo enzymes. The most abundant encapsulin cargo class are Dye‐decolorizing Peroxidases (DyPs). It has been previously suggested that DyP encapsulins are involved in oxidative stress resistance and bacterial pathogenicity due to DyPs’ inherent ability to reduce and detoxify hydrogen peroxide while oxidizing a broad range of organic co‐substrates. Here, we report the structural and biochemical analysis of a DyP encapsulin widely found across enterobacteria. Using bioinformatic approaches, we show that this DyP encapsulin is encoded by a conserved transposon‐associated operon, enriched in enterobacterial pathogens. Through low pH and peroxide exposure experiments, we highlight the stability of this DyP encapsulin under harsh conditions and show that DyP catalytic activity is highest at low pH. We determine the structure of the DyP‐loaded shell and free DyP via cryo‐electron microscopy, revealing the structural basis for DyP cargo loading and peroxide preference. This work lays the foundation to further explore the substrate range and physiological functions of enterobacterial DyP encapsulins. Encapsulins are self‐assembling bacterial protein compartments loaded with cargo enzymes. The most abundant encapsulin cargo class are Dye‐decolorizing Peroxidases (DyPs). In this study, we structurally and biochemically characterize a DyP encapsulin found in many enterobacteria. We highlight its low pH stability and activity and show that lipid peroxides are not valid DyP substrates.

Background The COVID-19 pandemic laid bare some of the United States’ most devastating health and social inequities faced by people experiencing homelessness. Homeless populations experience disproportionate rates of underlying health conditions, stigma and marginalization that often disenfranchise them from health and social services, and living conditions that potentiate the risk of COVID-19 transmission and adverse outcomes. Methods Guided by the socio-ecological model, this community-based participatory research study examined the impacts of the COVID-19 public health crisis on people experiencing homelessness in Tippecanoe County, Indiana, and the ways in which homeless service providers prepared for, experienced, and responded to the pandemic. Eighteen (18) semi-structured interviews were conducted with representatives of 15 community-based organizations, including shelters and other homeless service providers. Results Qualitative content analysis revealed myriad challenges at the individual and interpersonal levels faced by people experiencing homelessness as a result of the pandemic, and multilevel responses for COVID-19 impact mitigation in this community. Many of the emergency measures put in place by homeless service providers in Tippecanoe County, Indiana created opportunities for innovative solutions to longstanding challenges faced by homeless populations that are informing better service delivery moving forward, even beyond the COVID-19 pandemic. Conclusions Community-based organizations, including homeless shelters, are uniquely qualified to inform pandemic response and disaster risk mitigation in order to respond appropriately to the specific needs of people experiencing homelessness. The lessons learned and shared by homeless service providers on the frontline during the COVID-19 pandemic have important implications to improve future disaster response for homeless and other vulnerable populations.

In January 2021, the US Interagency Council on Homelessness (USICH) published a report detailing outcomes of its efforts to address the effects of the COVID-19 pandemic on people experiencing homelessness (PEH) in 2020.1 USICH consists of leaders from 19 federal agencies and was authorized by Congress in 1987 to coordinate the federal response to homelessness.2 The council's stated mission in its COVID-19 response, which its report claims to have achieved, was to \"save lives and not crash the emergency medical system.\"1We write as an interdisciplinary team conducting ongoing community-based research in partnership with homelessness service organizations in Indiana. Since April 2020, we have examined the challenges faced by PEH during the COVID-19 pandemic and the organizational-, community-, and system-level responses with respectto risk and impact mitigation.3 Our findings, although specificto Indiana, raise critical questions about the conceptual framings, methodologies, and conclusions presented in the USICH national report.Although the USICH report was published under the previous administration, whose attempts to defund the council and multiple low-income housing programs have been well documented,4 it nonetheless continues to be the latest available federal report on the effects of the pandemic on homeless populations in the United States. Given its authoritative position as a governmental^ sourced communication, we urge new USICH leadership to critically interrogate how these data on PEH were conceptualized, collected, and used5; to be clear about the report's limitations; and to provide a more nuanced and evidence-based update on the status of the council's ongoing efforts.

Background Effective community-partnered and patient-centered outcomes research needs to address community priorities. However, optimal sampling methods to engage stakeholders from hard-to-reach, vulnerable communities to generate research priorities have not been identified. Methods In two similar rural, largely Hispanic communities, a community advisory board guided recruitment of stakeholders affected by chronic pain using a different method in each community: 1) snowball sampling, a chain- referral method or 2) purposive sampling to recruit diverse stakeholders. In both communities, three groups of stakeholders attended a series of three facilitated meetings to orient, brainstorm, and prioritize ideas (9 meetings/community). Using mixed methods analysis, we compared stakeholder recruitment and retention as well as priorities from both communities’ stakeholders on mean ratings of their ideas based on importance and feasibility for implementation in their community. Results Of 65 eligible stakeholders in one community recruited by snowball sampling, 55 (85 %) consented, 52 (95 %) attended the first meeting, and 36 (65 %) attended all 3 meetings. In the second community, the purposive sampling method was supplemented by convenience sampling to increase recruitment. Of 69 stakeholders recruited by this combined strategy, 62 (90 %) consented, 36 (58 %) attended the first meeting, and 26 (42 %) attended all 3 meetings. Snowball sampling recruited more Hispanics and disabled persons (all P  < 0.05). Despite differing recruitment strategies, stakeholders from the two communities identified largely similar ideas for research, focusing on non-pharmacologic interventions for management of chronic pain. Ratings on importance and feasibility for community implementation differed only on the importance of massage services ( P  = 0.045) which was higher for the purposive/convenience sampling group and for city improvements/transportation services ( P  = 0.004) which was higher for the snowball sampling group. Conclusions In each of the two similar hard-to-reach communities, a community advisory board partnered with researchers to implement a different sampling method to recruit stakeholders. The snowball sampling method achieved greater participation with more Hispanics but also more individuals with disabilities than a purposive-convenience sampling method. However, priorities for research on chronic pain from both stakeholder groups were similar. Although utilizing a snowball sampling method appears to be superior, further research is needed on implementation costs and resources.