As evidence supporting the effectiveness of mental health and psychosocial interventions grows, more research is needed to understand optimal strategies for improving their implementation in diverse contexts. We conducted a qualitative process evaluation of a multicomponent psychosocial intervention intended to promote well-being among refugee, migrant and host community women in three diverse contexts in Ecuador and Panamá. The objective of this study is to describe the relationships among implementation determinants, strategies and outcomes of this community-based psychosocial intervention. The five implementation strategies used in this study included stakeholder engagement, promoting intervention adaptability, group and community-based delivery format, task sharing and providing incentives. We identified 10 adaptations to the intervention and its implementation, most of which were made during pre-implementation. Participants (n = 77) and facilitators (n = 30) who completed qualitative interviews reported that these strategies largely improved the implementation of the intervention across key outcomes and aligned with the study’s intervention and implementation theory of change models. Participants and facilitators also proposed additional strategies for improving reach, implementation and maintenance of this community-based psychosocial intervention.

Historically underrepresented groups in biomedical research have continued to experience low representation despite shifting demographics. Diversity fosters inclusive, higher quality, and innovative team science. One avenue for diversifying research teams is integrating diversity-focused initiatives into Clinical and Translational Science Award (CTSA) Programs, such as the integrated Translational Health Research Institute of Virginia (iTHRIV). In 2020, iTHRIV participated in Building Up, developed by the University of Pittsburgh CTSA, and intended to increase representation and improve career support for underrepresented groups in the biomedical workforce. Drawing lessons from this study, iTHRIV implemented the “inspiring Diverse Researchers in Virginia” (iDRIV) program. This yearlong program provided education, coaching, mentoring, and sponsorship for underrepresented early career investigators in the biomedical workforce. To date, 24 participants have participated in the program across three cohorts. Participants have been predominantly female (92%), with 33% identifying as Hispanic/Latinx, 29% as Black, and 13% as Asian. Notably, 38% of scholars have subsequently achieved at least one accomplishment, such as receiving a local research honor or award and an extramural funding award from a foundation or federal agency. The iTHRIV iDRIV program serves as a model for providing career support to developing investigators from underrepresented backgrounds, with the overall goal of improving patient health.

Critical Race Theory (CRT) has become a flashpoint of elite political discord, yet how Americans actually perceive CRT is unclear. We theorize that Republican elites utilized a strong framing strategy to re-define CRT as an “empty signifier” representing broader racial and cultural grievances. Using a survey and a pre-registered experiment among U.S. adults (N = 19,060), we find that this strategy worked. Republicans exhibit more familiarity with CRT and hold more negatively valenced (and wide ranging) sentiments toward CRT, relative to Democrats. Moreover, compared to teaching the legacy of racism in schools, Republicans are significantly more opposed to teaching CRT while Democrats express greater uncertainty. Our findings suggest that by framing CRT as a broad term that envelopes many grievances (including those beyond the scope of CRT), Republican elites have shaped a subset of Americans’ understanding of and attitudes toward CRT.

The GINI project investigates the dynamics of inequality among populations over the long term by synthesising global archaeological housing data. This project brings archaeologists together from around the world to assess hypotheses concerning the causes and consequences of inequality that are of relevance to contemporary societies globally.

Most family violence research has been conducted in high-income countries, although family violence rates are higher in low- and middle-income countries (LMICs), and outcomes more severe. Given the strong associations of family violence with substance use and mental illness, the aim of this systematic review was to examine interventions that targeted familial violence and at least one other condition of substance use or mental illness to determine effective treatments in LMICs. We conducted a systematic review of interventions that addressed family violence and mental illness or substance use. A committee of three researchers independently screened titles and abstracts and conducted full-text eligibility assessments. Two researchers conducted a risk of bias assessment. Data were extracted using a structured spreadsheet and narratively synthesized. Our search identified 29 articles produced from 19 studies conducted in 13 LMICs. Most (n = 15) studies randomized to study condition. Lack of blinding was the most common threat. The external validity of studies was generally poor. Fourteen studies had a primary intervention target of family violence, mental health, substance use, economic improvement, or HIV. None of the studies showed improvements in all intervention areas. Child maltreatment was less likely to be addressed than intimate partner violence (IPV). Targeted interventions for substance and mental health mostly improved primary outcomes, although they were less effective in reducing IPV. Evidence-based treatments must be rigorously evaluated before innovations in implementation can occur. Interventions overwhelmingly addressed IPV victimization and should consider how to work with couples and include men and children.

Post-traumatic stress disorder (PTSD) after traumatic birth can have a debilitating effect on parents already adapting to significant life changes during the post-partum period. Cognitive therapy for PTSD (CT-PTSD) is a highly effective psychological therapy for PTSD which is recommended in the NICE guidelines (National Institute for Health and Care Excellence, 2018) as a first-line intervention for PTSD. In this paper, we provide guidance on how to deliver CT-PTSD for birth-related trauma and baby loss and how to address common cognitive themes.

Early caregiving adversity (ECA) is associated with elevated psychological symptomatology. While neurobehavioral ECA research has focused on socioemotional and cognitive development, ECA may also increase risk for “low-level” sensory processing challenges. However, no prior work has compared how diverse ECA exposures differentially relate to sensory processing, or, critically, how this might influence psychological outcomes. We examined sensory processing challenges in 183 8-17-year-old youth with and without histories of institutional (orphanage) or foster caregiving, with a particular focus on sensory over-responsivity (SOR), a pattern of intensified responses to sensory stimuli that may negatively impact mental health. We further tested whether sensory processing challenges are linked to elevated internalizing and externalizing symptoms common in ECA-exposed youth. Relative to nonadopted comparison youth, both groups of ECA-exposed youth had elevated sensory processing challenges, including SOR, and also had heightened internalizing and externalizing symptoms. Additionally, we found significant indirect effects of ECA on internalizing and externalizing symptoms through both general sensory processing challenges and SOR, covarying for age and sex assigned at birth. These findings suggest multiple forms of ECA confer risk for sensory processing challenges that may contribute to mental health outcomes, and motivate continuing examination of these symptoms, with possible long-term implications for screening and treatment following ECA.

Politics and science have become increasingly intertwined. Salient scientific issues, such as climate change, evolution, and stem-cell research, become politicized, pitting partisans against one another. This creates a challenge of how to effectively communicate on such issues. Recent work emphasizes the need for tailored messages to specific groups. Here, we focus on whether generalized messages also can matter. We do so in the context of a highly polarized issue: extreme COVID-19 vaccine resistance. The results show that science-based, moral frame, and social norm messages move behavioral intentions, and do so by the same amount across the population (that is, homogeneous effects). Counter to common portrayals, the politicization of science does not preclude using broad messages that resonate with the entire population.

OBJECTIVES/GOALS: The goal of this study was to examine the attitudes of central Pennsylvania rural residents toward data sharing in the setting of the COVID-19 pandemic. We determined their willingness to provide cell phone data and personal information to public health staff investigating COVID-19 cases, as well as their concerns about sharing this information. METHODS/STUDY POPULATION: We used the electronic medical records of an academic healthcare institution in central Pennsylvania to obtain names and addresses of patients who had visited an outpatient clinic or been an inpatient within the prior three years, were 18 years or older, and who resided in a community defined as rural by the Commonwealth of Pennsylvania. The survey included four statements about contact tracing, three statements about intent to receive the COVID-19 vaccine, and validated scales for general trust and for distrust in healthcare organizations. All study variables were summarized to determine their distributions, and bivariate binomial logistic regression was conducted. A multivariable model including all of the independent variables was then fit for each outcome variable. RESULTS/ANTICIPATED RESULTS: The response rate was 19.5%. 95 % of respondents were white, 56% were female, and nearly two-thirds were older than 60 years. Binomial logistic regression showed that both distrust in healthcare organizations and political values influenced respondents willingness to share information with contact tracers as well as their concerns about sharing. In multivariate analysis, political values were a consistent predicator of willingness to share and concerns about sharing. Respondents who indicated that they wanted to get vaccinated as soon as possible were significantly more likely than those who did not want to be vaccinated to be willing to share their cell phone location data and personal data. Conversely, they were less likely to be concerned with these data being shared without their permission. DISCUSSION/SIGNIFICANCE: Understanding rural residents concerns about sharing personal information is critical if we are to develop successful strategies for lessening the impact of COVID-19 and managing future pandemics. This study is a first step in eliciting such concerns in the context of COVID-19and has implications for directing a successful pandemic response.

OBJECTIVES/GOALS: Vaccination for COVID-19 is a primary public health strategy to control the pandemic. In this study, we examined how various sociodemographic variables influence rural residents intentions to receive the COVID-19 vaccine. We also examined the role of distrust in healthcare organizations in these intentions. METHODS/STUDY POPULATION: sing the electronic medical records of an academic healthcare institution in central Pennsylvania, we obtained names and addresses of patients who had been an inpatient or outpatient within the prior three years, were 18 years or older, and who resided in a community defined as rural by the Commonwealth of Pennsylvania. The survey included three statements about the intent to receive the COVID-19 vaccine, an open-ended question about concerns regarding the vaccine, and validated scales for general trust and for distrust in healthcare organizations. All study variables were summarized to determine their distributions, and then bivariate binomial logistic regression analyses were conducted. Responses to the open-ended question were coded and used as variables in the bivariate analysis. RESULTS/ANTICIPATED RESULTS: Respondents reporting conservative political views were more likely (compared to those liberal political views) to never want to be vaccinated for COVID-19. Those who expressed distrust in healthcare organizations were less likely to want to be vaccinated soon. Conversely those who were more trusting said they were more likely to want to be vaccinated soon. Respondents dominant concerns about the COVID-19 vaccine were that it was new and that the process for its development was rushed. Respondents who believed that COVID-19 was a hoax were unlikely to ever want to be vaccinated, while those who distrusted the process in some way (new vaccine or rushed vaccine) were more likely to want to wait to be vaccinated. DISCUSSION/SIGNIFICANCE: These findings confirm the impact of political orientation on COVID-19 vaccination intention and suggest that distrust in healthcare organizations may prevent people from being vaccinated. These data provide evidence that people delaying vaccination hold different beliefs than those who will never vaccinate.

Over 40 million people around the world are victims of modern forms of slavery: forced labour and human trafficking. People are tricked into working under onerous conditions, and unable to leave or return home due to physical, psychological or financial coercion, and many of these trafficking victims produce goods for United States (US) and other multinational corporations that profit by relying on the lower wages earned by workers in their global supply chains. Well-developed legal standards prohibit these practices, and governments, intergovernmental organizations, business associations and non-governmental organizations have developed mechanisms to prevent, detect and provide redress to victims. Some businesses lead or comply with the standards and enforcement mechanisms, but too many do not. US law offers a powerful but under-utilized tool to address trafficking: the 2008 Trafficking Victims Protection Reauthorization Act (TVPRA), which imposes civil liability on those who ‘knew or should have known’ about forced labour or human trafficking in their corporate ventures. Unfortunately, courts have ignored or misinterpreted this standard, at times confusing civil and criminal provisions of the statute. Correct and vigorous legal enforcement is key to addressing the accountability gap between the well-developed standards and the continuing use of forced labour and human trafficking. This article is the first to demonstrate that, with regard to the TVPRA standard, corporations have long been on notice of both the obligation to effectively monitor labour conditions and the mechanisms that would accomplish that task. US courts must enforce the ‘knew or should have known’ standard to protect workers – the most vulnerable people in the supply chain – and to prevent an unfair competitive advantage over companies that have established compliance programmes that actually prevent and punish human trafficking and forced labour.

Background: Urinary catheters, vascular catheters, and wounds, such as pressure injuries are often hidden from view under gowns and sheets (ie, out of sight, out of mind), contributing to prolonged catheter use, infections, delayed interventions, and diagnostic errors for symptoms (eg, fever or delirium) related to catheters and wounds. We developed and pilot tested a digital bedside Patient Safety Display of catheter and wound information to improve awareness by rounding providers (ie, physicians and advanced practice providers, APPs). Methods: The display development was informed by clinical observations of provider rounds and nurse handoffs, interviews, and iterative prototype testing with clinicians in simulated cases using catheterized mannequins with wounds. The display reports the presence and duration of urinary and vascular catheter use, urinary catheter indication, and wound presence and severity, from real-time mandatory nurse documentation in the electronic medical record (Fig. 1). We conducted a pilot study in a tertiary-care medical-surgical step-down unit with 20 private rooms, including a preintervention period and a postintervention period including 10 rooms without the display (control rooms) and 10 rooms with the display (intervention rooms). We surveyed individual providers directly after rounds to assess their awareness of their patients’ catheters and wounds compared to medical record documentation. We also assessed display utility and usability from postintervention clinician interviews and we identified major themes using an adapted grounded theory approach. Results: In total, 787 surveys were completed: 681 medicine service with 89% response rate, 106 surgery service with 47% response rate; 363 preintervention surveys, and 424 postintervention surveys. The surveys involved 176 unique patients and 47 unique providers. Among all 787 patient encounters, 156 (19.8%) had a transurethral indwelling urinary catheter (Foley), 314 (39.9%) had a central venous catheter (including PICCs), and 247 (31.4%) had at least 1 pressure injury. Figure 2 summarizes provider awareness of catheters and pressure injuries when present as assessed for patients in the preintervention and postintervention periods. Moreover, 13 clinician postintervention interviews yielded preliminary themes regarding the display’s benefits and limitations (Fig. 3). Conclusions: In this pilot study of a novel Patient Safety Display, although provider awareness of Foley catheters, CVCs, and pressure injuries appeared higher for patients in the intervention rooms compared to awareness as measured in the preintervention rooms and/or postintervention control rooms, most of these comparisons did not meet statistical significance. Clinicians varied widely in their personal assessments of the display as a useful tool for improving awareness and prompting discussion about catheters and wounds.

Funding: This work was funded by the Agency for Healthcare Research and Quality (AHRQ) grant P30HS024385. Dr. Meddings’ effort was initially partially funded by concurrent support from AHRQ (K08 HS19767).

Disclosures: Dr. Meddings has reported receiving honoraria for lectures and teaching related to prevention and value-based purchasing policies involving catheter-associated urinary tract infection. The remaining authors report no conflicts of interest.

Self-harm is a major international public health concern and is especially prevalent among prisoners. In this editorial, we explore recent trends in prisoner self-harm during the coronavirus lockdown, and consider strategies for improving the prevention and management of self-harm in prisons as we emerge from the pandemic.