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Minority adolescents' HIV PrEP awareness and preferences in Alabama
No full textObjective: In the southern United States, adolescents are at elevated risk for HIV acquisition. In Alabama, school-based sexual health and HIV prevention education is strictly regulated and does not address the unique needs of sexual and gender minority (SGM) teenagers. To inform public health efforts, we assessed SGM adolescents' HIV prevention pre-exposure prophylaxis (PrEP) awareness and modality preferences by gender, race, and ethnicity.
Results: Survey data were collected in 2023-2024 from SGM adolescents aged 14-17 years, lived in Alabama, with male sex assigned at birth (N = 206). Recruitment occurred online and in-person at a charter school. Data were analyzed using chi-squares and analysis of variance, controlling for age. Over half of respondents were sexually active, but only 26% had ever been tested for HIV. Half knew about PrEP. Of those with PrEP awareness, 41.9% were aware of daily pills; 32.3% of long-acting injectable PrEP. Pill-based PrEP was highly endorsed. Trans- and gender-non-conforming adolescents reported a greater preference for on-demand pill-based PrEP compared to men who have sex with men (p =.01). Non-Hispanics had a greater preference for a 6-month long-acting injectable option compared to Hispanic adolescents (p =.04). Findings suggest the need for HIV prevention interventions tailored to southern contexts and adolescent knowledge.
Trial registration: Not Applicable.No embarg
Sample size determinations in four-level longitudinal cluster randomized trials with random slope
No full textCluster or group randomized trials (CRTs) are increasingly used for behavioral as well as system-level interventions in many areas e.g. medicine, psychotherapy, policy, and health service research etc. Sample size determination for each level at the design stage is always a key requirement for any intervention trial including CRT. This work addresses this important issue for a four-level longitudinal CRT via detecting the intervention effect over time. A random intercept and random slope mixed effects linear regression model, including a time-by-intervention interaction is used for modeling. Closed-form expression of the power function and sample size for each level are determined to detect the interaction effect. Other than statistical power consideration, several other factors need attention while designing such CRTs. Optimal allocations accounting for subject attrition and cost constraints have been determined here. How sample size determination based on fixed and random slope models affects when between-subject variations in outcome are anticipated to be significant is also studied. The effect of ignoring cluster levels in a four-level CRT, which is often the case in the absence of an appropriate four-level model, is studied in details. Lastly, the proposed model is illustrated via a real-life human immunodeficiency virus prevention study conducted in the Bahamas.No embarg
Evaluating Robotic-Assisted Total Knee Arthroplasty Compared to Conventional Methods: A Systematic Review of the Literature in the United States
No full textBackground: Robotic-assisted total knee arthroplasty (rTKA) offers a new method of surgical management for advanced arthritis of the knee. The objective of this review was to evaluate the current literature evidence comparing rTKA to conventional methods (cTKA) across multiple outcome measures.
Methods: PubMed was used to perform a review of articles that discussed outcomes of primary rTKA. Forty-four articles were selected.
Results: rTKA improves surgical precision and accuracy compared with cTKA, potentially leading to better functional outcomes and fewer complications. rTKA has longer intraoperative times and higher initial costs but leads to shorter hospital stays, lower readmission rates, reduced long-term costs and less revisions. Patient-reported outcomes for rTKA indicate less postoperative pain, reduced opioid use, and improved function.
Conclusions: rTKA may provide improved outcomes compared with cTKA. More robust clinical evidence from US-based multicenter prospective propensity matched trials is needed to fully delineate the long-term benefits and limitations of rTKA.No embarg
Computationally designed proteins mimic antibody immune evasion in viral evolution
No full textRecurrent waves of viral infection necessitate vaccines and therapeutics that remain effective against emerging viruses. Our ability to evaluate interventions is currently limited to assessments against past or circulating variants, which likely differ in their immune escape potential compared with future variants. To address this, we developed EVE-Vax, a computational method for designing antigens that foreshadow immune escape observed in future viral variants. We designed 83 SARS-CoV-2 spike proteins that transduced ACE2-positive cells and displayed neutralization resistance comparable to variants that emerged up to 12 months later in the COVID-19 pandemic. Designed spikes foretold antibody escape from B.1-BA.4/5 bivalent booster sera seen in later variants. The designed constructs also highlighted the increased neutralization breadth elicited by nanoparticle-based, compared with mRNA-based, boosters in non-human primates. Our approach offers targeted panels of synthetic proteins that map the immune landscape for early vaccine and therapeutic evaluation against future viral strains.No embarg
Multicenter Study Evaluating Impact of Patient and Sonographer Demographics on Quality of Focused Cardiac Ultrasounds
Full text linkIntroduction: Demographic inequities in cardiovascular care have been well established, with evidence of effects from sex, age, and body mass index (BMI). For instance, women are less likely to receive guideline-based care for acute myocardial Infarction, bystander cardiopulmonary resuscitation, or recognition of cardiac arrest. We investigated the impact of patient sex, along with other patient demographics such as age and BMI, on the quality of focused cardiac ultrasounds (FOCUS). We hypothesized that females would have lower overall FOCUS quality and more frequently omitted apical four-chamber (A4C) views due to breast tissue. Secondary objectives included evaluating differences in image quality and omission rates by BMI, and by age and sonographer sex and training level.
Methods: In this multicenter, retrospective study we investigated 1,200 total adult patients (100 females and 100 males per site) at six participating sites. The FOCUS quality was determined by two blinded experts per site using a 1-5 ordinal scale per view (parasternal long, parasternal short, A4C, and subxiphoid). The primary outcome, overall quality, was the summed score of the four views, with a maximum score of 20. This scale was then collapsed into three categories for the individual FOCUS views: images inadequate to support diagnosis; images meeting the minimum to support diagnosis; and images supporting the diagnosis well. Secondary outcomes were A4C quality and omission rate. We evaluated associations between sex and FOCUS overall quality using unadjusted mixed-effects models followed by multivariable mixed-effects models adjusted for patient age, BMI, operator sex, and operator experience level.
Results: The A4C images of female patients were of significantly lower quality (P 60% higher odds of a diagnostic A4C view (95% CI 1.3 - 2.0). Overall FOCUS quality decreased as BMI deviated from normal and as age increased. There was no significant difference in overall FOCUS quality between female and male patients.
Conclusion: We did not find sex-based differences in overall FOCUS quality; however, we did find that females received lower quality apical four-chamber views and had this view omitted more frequently. Additionally, overall quality declined as BMI deviated from normal, and as age advanced. Future research should elucidate the clinical implications of these differences in quality and the explanation behind not obtaining high-quality views in older patients, in individuals whose BMI deviated from normal toward either underweight or overweight, or in female patients.No embarg
Strengthening essential emergency departments: Transforming the safety net
Full text linkSafety-net emergency departments (EDs) are a critical component of the US health care system, delivering emergency care for patients in need, including vulnerable populations. EDs provide unscheduled acute care for patients 24 hours a day, 7 days a week, regardless of a person's ability to pay. In addition, EDs have transformed beyond their traditional roles of providing emergency services and being the centers for regionalized trauma, cardiac, and stroke care, to also becoming stewards of public health by leading screening and treatment efforts for nonemergent conditions, such as HIV, hepatitis C, mental health, and opioid use disorder. Many safety-net hospitals and their EDs serve essential roles in urban and rural communities, making the impact of recent closures particularly concerning. In response, we convened clinical, operational, and administrative leaders of key safety-net EDs across the United States in order to develop expert consensus related to critical issues facing safety-net EDs. The goals were to help inform policymakers about current challenges and to offer timely recommendations so that together we can mend the safety net as the country works toward the goal of health equity for all.No embarg
Reasons for COVID-19 vaccination late in the pandemic: A qualitative study
No full textThis study elicited reasons for initiating COVID-19 vaccination in April 2022 or later. We interviewed patients (n = 51) from 2 healthcare systems in central Massachusetts. Participants were 66.7 % female, 39.2 % White non-Hispanic, 15.7 % Black non-Hispanic, and 39.2 % Hispanic. The most common reason for vaccination was that it was required for something the participant wanted to do, cited by 40/51 participants as the main reason for vaccination. Social influences, reported by 27/51 participants, were mostly (n = 22/27) described as secondary reasons. Increased disease risk appraisal and/or increased confidence in the vaccine were noted by 24/51 participants, also predominantly as secondary reasons (n = 14/24). Requirements to be vaccinated for work, school, or to participate in activities are an important lever for promoting COVID-19 vaccine uptake. Commonly cited as secondary reasons, social influences and factors that increase disease risk appraisal and/or vaccine confidence may serve to create a foundation for vaccine requirements.No embarg
Employment Outcomes among People with Disabilities: Employer-Related Determinants
Full text linkA systematic scoping review of research published between 2000 and 2020 on employment of people with disabilities, that was funded by the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR), was conducted by CeKTER researchers. All papers comparing people with disabilities to those without were excluded from the systematic scoping review. Among over 100 publications reviewed there was a wide and very disparate array of findings with numerous variables used and varying research questions. This result belies summative findings. There are numerous ways of organizing the disparate findings. This brief is part of a series of findings from CeKTER’s systematic scoping review. In this brief we report on findings about employer-related determinants impacting the employment of people with disabilities, including the hiring and retention of employees with disabilities. Please note that all comparisons are always about corresponding peers with disabilities.The contents of this product were funded by the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR), Grant #90DPEM0004. NIDILRR is a Center within the Administration for Community Living (ACL). ACL is an agency in the Department of Health and Human Services (HHS). The contents of this product do not necessarily represent the policy of NIDILRR, ACL, or HHS and you should not assume endorsement by the Federal Government.No embarg
Resident Unions in Orthopaedic Surgery
No full textAcross the United States, there is an increasing trend among medical residents to join unions. Even though these entities have existed for almost 100 years, escalating concerns regarding compensation, working conditions, and other factors have influenced thousands of residents to join unions. Unionization can both positively and negatively affect residents, hospital networks, and the communities that the system serves. Most resident unions are nationally organized, but the laws and rules governing these bodies vary among the 50 states. The individual states regulate the collective bargaining of the union with the health-care system, and physician leaders should be aware of the nuances regarding unions at their workplace setting.No embarg
Social Needs Screening and Uptake Patterns of a Produce Prescription Program in an Urban Pediatric Primary Care Clinic
No full textObjective: The WE CARE social needs screener (WC screener) is a self-report instrument for 8 social needs. Our objective was to determine whether screening positive for wanting help with food is associated with increased odds of enrollment in Fresh Connect (FC), a produce prescription program.
Methods: Families who completed the WC screener at a well-child visit (n=1049) and spoke English, Spanish, or Portuguese were called within two weeks and offered FC regardless of screener results. Child age, race and ethnicity, caregiver's preferred language, and insurance were extracted from medical records. A multivariable adjusted logistic regression model was utilized to describe the association between WC responses and likelihood of enrolling in FC.
Results: Overall, 38% of the children were of non-Hispanic White race/ethnicity; 97% of caregivers spoke English, and 52% utilized public insurance. Among caregivers who completed the WC screener, 6% requested help with food. Overall, 20% enrolled in FC. Compared to those who said "no", saying "yes" to wanting help with food did not increase odds of FC enrollment after adjusting for other variables (aOR 0.93, 0.44-1.97), yet saying "maybe later" did (aOR 3.2, 95% CI 1.2-8.3). Additionally, combining "yes" and "maybe later" also did not have significantly higher odds of enrollment compared to those who said no or left the question blank (aOR 1.46, 95% CI 0.86-2.46).
Conclusions: This pilot study is the first to explore concordance between screening responses and produce prescription enrollment. Responding "yes" to wanting help with food on the WC screener was not predictive of FC enrollment, which suggests that future primary care-based interventions should evaluate the role of social needs screeners in the referral pathway and consider, when possible, offering food-related assistance to all families regardless of screening responses.No embarg