Completed Surveys Research Articles

Self-Reported Financial Difficulties Among Patients with Multiple Myeloma and Chronic Lymphocytic Leukemia Treated at U.S. Community Oncology Clinics (Alliance A231602CD).

To estimate the proportion and correlates of self-reported financial difficulty among patients with multiple myeloma (MM) or chronic lymphocytic leukemia (CLL). 23 U.S. community and minority oncology practice sites affiliated with the National Cancer Institute Community Oncology Research Program (NCORP). 521 patients (≥18 years) with MM or CLL were consented and 416 responded to a survey (completion rate=79.8%). Respondents had a MM diagnosis (74.0%), an associate degree or higher (53.4%), were White (89.2%), insured (100%) and treated with clinician-administered drugs (68.0%). Observational, prospective, protocol-based survey administered in 2019-2020. Financial difficulty was assessed using a single-item standard measure, the EORTC QLQC30: "Has your physical condition or medical treatment caused you financial difficulties in the past year?" and using an 'any-or-none' composite measure of 22 items assessing financial difficulty, worries and the use of cost-coping strategies. Multivariable logistic regression models assessed the association between financial difficulty, diagnosis, and socioeconomic and treatment characteristics. 16.8% reported experiencing financial difficulty using the single-item measure and 60.3% using the composite measure. Most frequently endorsed items in the composite measure were financial worry about having to pay large medical bills related to cancer and difficulty paying medical bills. Financial difficulty using the single-item measure was associated with having MM versus CLL (adjusted odds ratio [aOR], 0.34; 95% CI, 0.13-0.84; P=.02), having insurance other than Medicare (aOR, 2.53; 95% CI, 1.37-4.66; P=.003), being non-White (aOR, 2.21; 95% CI, 1.04-4.72; P=.04), and having a high school education or below (aOR, 0.36; 95% CI, 0.21-0.64; P=.001). Financial difficulty using the composite measure was associated with having a high school education or below (aOR, 0.62; 95% CI, 0.41-0.94; P=.03). U.S. patients with blood cancer report financial difficulty, especially those with low socio-economic status. Evidence-based and targeted interventions are needed.

Patients and Healthcare Professionals’ Perceptions of Stethoscope Barriers

Stethoscope hygiene is rarely performed despite evidence that they are a potential source of nosocomial infections. Aseptic touch-free disposable stethoscope diaphragm barriers (touch-free barriers) provide a bacteriologically impervious surface; however, little is known about perceptions of touch-free barriers. The purpose of this study was to determine patients’ and healthcare professionals’ perceptions of stethoscope hygiene habits, cleanliness, and patient safety, after respondents viewed videos of stethoscope hygiene with alcohol versus a touch-free barrier, or no hygiene/no barrier. We conducted a cross-sectional study using survey methodology and convenience sampling. Participants viewed three short videos that showed a provider using each of three stethoscope hygiene techniques (barrier, alcohol, or none), followed by completion of a brief survey. Pearson’s chi-square, Fisher’s exact, Wilcoxon rank sum or Kruskal-Wallis tests were used as appropriate. Bonferroni correction was used to control error rate at 0.05 for each question. The sample size of 240 participants included 119 patients and 121 healthcare professionals. Patients rarely witnessed healthcare professionals cleaning stethoscopes, rated clean stethoscopes as important, and were more likely to choose touch-free barrier as easiest for providers. Healthcare professionals rated stethoscope hygiene as important, reported frequent stethoscope hygiene, and felt that touch-free barrier would improve workflow. Touch-free barriers were viewed positively by respondents. Hospitals should consider touch-free barriers as an important strategy to reduce nosocomial infections.

Pediatric Oncology Providers' HPV Vaccine Knowledge, Attitude, Self-Efficacy, and Practice after Communication Training: A Comparison with a National Survey.

Human papillomavirus (HPV) vaccinations prevent HPV infection and related cancers. Despite being at higher risk of secondary cancers linked to HPV, childhood cancer survivors (CCS) are undervaccinated. This study aimed to compare pediatric oncology providers' knowledge, attitudes, self-efficacy, and practices regarding HPV vaccination among those who participated in a multilevel educational HPV vaccine program with those of a national sample of oncology providers. Between February and March 2023, 39 providers from five pediatric oncology clinics in Texas completed online surveys, assessing knowledge about CCS risk for HPV-related cancers, attitudes towards the HPV vaccine, and confidence in recommending the vaccine to CCS. The results were compared with a national survey of providers conducted in 2019 (n = 195). The findings showed that providers who participated in our program had greater knowledge of CCS increased risk for HPV-related cancers (96% vs. 38%; p < 0.001); greater confidence in discussing and recommending the HPV vaccine (100% vs. 66%, p < 0.001) and addressing parental concerns (100% vs. 69%, p < 0.001); and a more positive attitude about oncology providers than general pediatricians, recommending (96% vs. 71%; p = 0.006) and administering the HPV vaccine to CCS (96% vs. 53%, p < 0.001). This study underscores the importance of educating oncology providers about the increased risk of CCS and improving their self-efficacy to recommend the HPV vaccine, promoting vaccination in the oncology setting.

Patient and family views on research priorities and design of clinical trials and research studies in pediatric multiple sclerosis.

This survey study aimed to (1) identify patient/family research priorities in pediatric-onset multiple sclerosis (POMS), and (2) delineate optimized methods for research study/clinical trials design, engagement, and implementation. Participants were as follows: (1) parents of a child (<18 years) with POMS enrolled in a national registry, (2) adolescents (13-17 years) with POMS in the registry, and (3) adults (18-40 years) with POMS receiving care at a registry affiliated clinic. Of 293 eligible participants, 192 completed surveys. Experiences with health care and medications were generally positive but there remain areas of priority improvement. Incentives to participate in clinical trials included medications previously tested and in pill form, bloodwork/study visits required ⩾ every 3 months, cognitive testing ⩽1 hour, compensation for travel and time, ability to continue current multiple sclerosis (MS) medication, option to take study medication if on placebo, and individualized study feedback. Priorities for clinical research were (1) psychosocial impact, (2) cognitive/academic impact, (3) environmental risk, and (4) nutrition. Results highlighted the importance of a holistic approach to study design and a focus on the impact of disease on daily life to best engage patients and families in POMS clinical trials and research.

A novel intervention for acute stress reaction: exploring the feasibility of ReSTART among Norwegian soldiers

ABSTRACT Background: Soldiers in combat may experience acute stress reactions (ASRs) in response to trauma. This can disrupt function, increasing both immediate physical danger and the risk for post-trauma mental health sequelae. There are few reported strategies for managing ASRs; however, recent studies suggest a novel peer-based intervention as a promising approach. Objectives: This study assesses the feasibility of ReSTART training, a peer-based course designed to prepare soldiers to manage ASRs. ReSTART builds on programmes established by US and Israeli militaries. The current study evaluates the ReSTART programme in a Norwegian setting, across distinct groups of soldiers, professionals and conscripts. Methods: Participants included professional soldiers deploying to Mali and conscripts with 6 months of service, who completed the ReSTART training course and surveys administered pre- and post-training. These surveys assessed attitudes and programme acceptability. Analyses included 74 soldiers who provided complete survey responses. Results: ReSTART training received high ratings in terms of usefulness, relevance, and importance in managing ASRs. From pre- to post-training, respondents had significant increases in positive attitudes towards ASR management and confidence in handling ASRs personally, and at the unit level; decreases in stigma-related attitudes associated with ASRs; and increased perception of leadership emphasizing ASR management. Conclusions: ReSTART training shows potential as an effective tool when preparing soldiers to manage ASRs in high-risk environments, enhancing military units’ capacity to support each other and effectively respond to stress-induced functional disruptions. This study adds evidence supporting the utility of peer-based ASR management in operational settings and highlights the need for broader implementation and systematic evaluation.

Rationale and design of CHD PULSE: Congenital Heart Disease Project to Understand Lifelong Survivor Experience

BackgroundWith improved survival of adults with congenital heart disease (CHD) comes a need to understand the lifelong outcomes of this population. The aim of this paper is to describe the rationale and design of Congenital Heart Disease Project to Understand Lifelong Survivor Experience (CHD PULSE), a study to determine long-term medical, neurocognitive, and psychosocial outcomes among adults with a history of intervention for CHD and to identify factors associated with those outcomes. MethodsCHD PULSE is a cross-sectional survey conducted from September 2021 to April 2023 among adults aged 18 and older with a history of at least one intervention for CHD at one of 11 participating U.S. centers in the Pediatric Cardiac Care Consortium. Participants with CHD were asked to complete a 99-question survey on a variety of topics including: demographics, surgeries, health insurance, health care, heart doctors, general health, height and weight, education and work history, reproductive health (for women only), and COVID-19. To construct a control group for the study, siblings of survey respondents were invited to complete a similar survey. Descriptive statistics for demographics, disease severity, center, and method of survey completion were computed for participants and controls. Comparisons were made between participants and non-participants to assess for response bias and between CHD participants and sibling controls to assess for baseline differences. ResultsAmong the 14,322 eligible participants, there were 3133 respondents (21.9%) from 48 U.S. states with surveys returned for inclusion in the study. Sibling contact information was provided by 691 respondents, with surveys returned by 326 siblings (47.2%). The median age of participants was 32.8 years at time of survey completion, with an interquartile range of 27.2 years to 39.7 years and an overall range of 20.1 to 82.9 years. Participants were predominantly female (55.1%) and of non-Hispanic White race/ethnicity (87.1%). There were no differences between participants and non-participants regarding severity of CHD. Compared to non-participants, participants were more likely to be female, of older age, and be of non-Hispanic White race/ethnicity. Enrolled siblings were more likely to be female and slightly younger than participants. ConclusionsWith surveys from 3133 participants from across the U.S., CHD PULSE is poised to provide keen insights into the lifelong journey of those living with CHD, extending beyond mere survival. These insights will offer opportunities for informing strategies to enhance and improve future outcomes for this population of patients.

A Study of Skeletal Survey Disparity in Pediatric Head Injury in the Emergency Department.

The objective of this study was to evaluate disparities in skeletal survey (SS) use for pediatric. head injury patients in the emergency department (ED). This was a multi-site retrospective. cohort study of children <24months with concern for head injury and injury on head CT from. 7/1/12 - 1/1/22. We determined adjusted associations between SS completion and race, ethnicity, language for care, insurance type, and income, with sub-analysis of children <6months and with complex injury. We evaluated occult fracture prevalence. Two-hundred seventy children met criteria and 88 had SS. No statistical association was found between skeletal survey completion and race or ethnicity, language for care, private insurance, median census tract income, or in sub-analyses. Two of 88 (2.3%) patients had occult fracture; both had risk factors for NAT. In conclusion, no statistical association was found between SS completion and demographics. Occult fracture was uncommon. SS use can likely be decreased in lower risk patients.

Learner evaluation of an immersive virtual reality mass casualty incident simulator for triage training

BackgroundTo minimize loss of life, modern mass casualty response requires swift identification, efficient triage categorization, and rapid hemorrhage control. Current training methods remain suboptimal. Our objective was to train first responders to triage a mass casualty incident using Virtual Reality (VR) simulation and obtain their impressions of the training’s quality and effectiveness.We trained subjects in a triage protocol called Sort, Assess, Lifesaving interventions, and Treatment and/or Transport (SALT) Triage then had them respond to a terrorist bombing of a subway station using a fully immersive virtual reality simulation. We gathered learner reactions to their virtual reality experience and post-encounter debriefing with a custom electronic survey. The survey was designed to gather information about participants’ demographics and prior experience, including roles, triage training, and virtual reality experience. We then asked them to evaluate the training and encounter and the system’s potential for training others.ResultsWe received 375 completed evaluation surveys from subjects who experienced the virtual reality encounter. Subjects were primarily paramedics, but also included medical learners as well as other emergency medical service (EMS) professionals. Most participants (95%) recommended the experience for other first responders and rated the simulation (95%) and virtual patients (91%) as realistic. Ninety-four percent (94%) of participants rated the virtual reality simulator as “excellent” or “good.” We observed some differences between emergency medical service and medical professionals regarding their prior experience with disaster response training and their opinions on how much the experience contributed to their learning. We observed no differences between subjects with extensive virtual reality experience and those without.ConclusionsOur virtual reality simulator is an automated, customizable, fully immersive virtual reality system for training and assessing personnel in the proper response to a mass casualty incident. Participants perceived the simulator as an adequate alternative to traditional triage and treatment training and believed that the simulator was realistic and effective for training. Prior experience with virtual reality was not a prerequisite for the use of this system.

Scaling up healthy eating in early childhood education and care: evaluation of the Appetite to Play capacity-building intervention.

The purpose of this study was to examine the dissemination of the healthy eating component of Appetite to Play at scale using the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework. The Appetite to Play capacity-building intervention is a set of evidence-informed implementation strategies aimed at enhancing the adoption of recommended practices for promoting healthy eating and active play in early years settings. The evaluation was pragmatic, employing both quantitative (surveys) and qualitative (interviews) data collection. The Appetite to Play intervention was delivered through in-person community-based workshops, virtual workshops, asynchronous e-learning and online resources. We received completed surveys from 1670 in-person workshop participants (96 % female), and twenty-three (all female) survey respondents also participated in a telephone interview. Approximately two-thirds of all participant groups were certified early childhood educators. Results indicated that Appetite to Play had high reach (25 867 individual website visits, 195 workshops delivered), effectiveness (significant increases in care provider's knowledge, confidence (P < 0·05) and high post-intervention intention to implement), adoption (11 % of educators in BC trained) and implementation (good alignment with implementation strategies and current practices), with a significant maintenance plan to support the intervention's future success. An evidence-based capacity-building intervention with an emphasis on training and provision of practical online resources can improve early years providers' knowledge, confidence and intention to implement recommended practices that promote healthy eating. Further research is needed to determine the impact on child-level outcomes and how parents can be supported in contributing to positive food environments.

The Impact of a Student-Taught Point-of-Care Ultrasound Workshop on Confidence in Medical and Pre-Medical Students

Background: The vast utilization of Point-of-Care Ultrasound (POCUS) across medical specialties has increased the need for enhanced undergraduate medical education in image acquisition and interpretation among medical students. However, challenges such as the need for a standardized medical school curriculum and limited trained faculty preceptors restrict its implementation. The literature highlights the potential of student-taught POCUS workshops in expanding access and enhancing learning. This study seeks to evaluate the efficacy of a student-run POCUS workshop for medical and pre-medical students. Methods: A prospective, cross-sectional study assessed the efficacy of first and second-year medical students teaching a POCUS workshop on the Focused Assessment with Sonography for Trauma (FAST) exam. Student workshop participants were asked to complete pre- and post-workshop surveys to assess their confidence in utilizing POCUS and identifying relevant organs and landmarks. Surveys employed a standardized five-point Likert Scale. Results: Of the 43 initial participants, 29 completed both surveys. Results showed a significant increase in self-reported ultrasound experience (1.7 to 3.2, p &lt; 0.001) and confidence in performing the FAST exam and organ identification (2.2-fold increase, p &lt; 0.001). Both medical and pre-medical student cohorts exhibited similar confidence improvements in confidence. Conclusion: This study supports the literature that student-taught POCUS programs may be a viable adjunct to an institution's ultrasound curriculum. Implementing medical student-led workshops could help address current training gaps, enhance students' teaching and leadership skills, and improve confidence in utilizing and interpreting ultrasound images.

Patient evaluation of Klick, a technology-enabled, nurse-delivered HIV outpatient pathway.

Klick is a clinic-specific, digitally supported outpatient pathway of care for people living with HIV (PLWH). It involves a smartphone application (app) for PLWH to self-manage their care, navigate access to the clinic and communicate with their healthcare provider. We present a patient evaluation of Klick. Patients use Klick to book/reschedule appointments, view laboratory results, request medication, access remote nurse-delivered consultations and communicate with clinicians. In October 2022, Klick was evaluated by PLWH through a questionnaire and interviews. Between August 2020 and April 2024, 5859 patients had registered to use Klick; during April 2024 alone, 2509 (43%) used Klick. In October 2022, 1661 PLWH were invited to complete surveys, of whom 362 (22%) responded. These respondents were 95% (340/358) male and 84% (298/354) white, and 63% (227/359) were in the age range 41-60 years. Respondents felt Klick was easy to use (average score 4.3/5), and 92% thought having a clinic-specific app was important/very important. Respondents valued the following app features as important/very important - online booking (93%); viewable results (94%); prescription requests (90%) - and rated their experience of using them highly - 91% for e-booking and 91% for viewable results. A total of 93% said they would recommend Klick to friends and 82% rated Klick as above average/excellent. PLWH reported high levels of satisfaction using a clinic-specific mHealth app to manage their HIV care and demonstrated sustained active use. Klick was rated easy to use, as helping to meet healthcare needs and as providing a superior experience for some aspects of care. Other HIV clinics or services managing chronic conditions could benefit from the adoption of personalized digital solutions to enhance patient care.

PSX-28 Management of lameness in meat goat herds: A survey of producers in the southeastern US

Abstract Lameness is a persistent animal health concern in the meat goat industry. A survey was developed to describe lameness in commercial meat goat herds in the southeastern US. The survey included 35 multiple-choice questions about general herd attributes, various management practices, and specific herd lameness characteristics. A photo guide of goat hoof lesions was included in the survey package. The survey was sent by postal mail to 629 farms in Tennessee and bordering states with 183 completed surveys returned. The majority of herds managed Kiko (32%), Boer (22%), and Myotonic (19%) goat breeds. Reasons for raising goats included seed stock or breeding stock (78.1%), commercial, market, or slaughter purposes (62.3%), hobby, pets, or show (48.6%), and for brush, vegetation, or weed control (25.7%). Most respondents (90.7%) acquired goats from breeder farms, whereas only 2.7% of respondents purchased goats from sale barns. Most respondents quarantine new animals before adding them to the herd (78.1%), while 19.7% did not quarantine new animals and 1.1% were unfamiliar with the practice. The average monthly lameness rate was estimated to be at 6% with seasonal occurrences identified by respondents as 6% in the fall, 31.4% in the winter, 25.1% in the spring, and 50.5% in the summer. Some respondents indicated no seasonal variation (24.0%) or did not know (3.3%) if seasonal variation existed. Primary causes of lameness identified by respondents were overgrown hooves (50%), foot scald (19%), and foot rot (14%). Other lesions were identified at less than 8%. Sources of lameness treatment information for respondents were other producers (34.9%), veterinarians (30.6%), books (22.4%), online chat groups (19.1%), magazines (8.7%), and the extension service (8.2%). When lame goats were identified, more respondents (56.8%) did not isolate lame goats than those that practiced lame goat isolation (24.0%). Most respondents indicated that they treated lame goats (76.5%), a few did not treat lame goats (4.9%), and notable proportion (19.6%) did not respond to the question. Management approaches to treating lameness identified most frequently by respondents included hoof trimming (85%), topical hoof applications (40%), injectable antibiotics (32%), and footbaths (17%); 4% of respondents noted other methods. As a form of general hoof care management, most producers conducted hoof trimmings two or three times a year (51.9%), compared with trimming hooves once a year (9.8%), monthly (14.2%), or only trim hooves when goats became lame (6.6%). As a culling criterion, 29.5% responded lameness was a cull factor, 45.4% indicated it was not a cull factor, and 25.1% of respondents either did not know or did not response. Survey results showed that lameness is an issue in meat goat herds of the southeastern U.S. and a diversity of management approaches are used by producers to address the concern.

Design and implementation of a Type-2 hybrid, prospective randomized trial of opioid agonist therapies integration into primary care clinics in Ukraine

IntroductionUkraine has high HIV prevalence, concentrated among people who inject drugs (PWID), mostly of opioids. Maintenance on opioid agonist therapies (OAT) is the most effective evidence-based treatment for opioid use disorder. As PWID experience high morbidity and mortality from preventable and treatable non-communicable diseases, international agencies recommend integrating OAT into primary care centers (PCC). MethodsA randomized, type-2 hybrid implementation trial was carried out to compare outcomes of OAT integration in PCC to OAT delivery at specialty treatment centers (STC) – standard-of-care. Tele-education supporting PCC providers in managing OAT, HIV, tuberculosis and non-communicable diseases along with pay-for-performance incentives were used to facilitate implementation. Consenting patients underwent 1:2 randomization to either STC or PCC. Quality health indicators (QHIs), a composite percentage of recommended primary and specialty services accessed by patients (blood/urine tests, cancer screenings, etc.), were defined as efficacy outcomes and were assessed by participant self-report at baseline and every 6 months over 24 months and electronic chart reviews after the completion of the follow-up. The primary outcome is defined as the difference in composite QHI scores at 24 months, in which a repeated measures likelihood-based mixed model with missing at random assumptions will be used. Providers at PCC completed surveys at baseline, 12 and 24 months to assess implementation outcomes including changes in stigma and attitudes towards OAT and PWID. Preliminary resultsAmong the 1459 participants allocated to STC (N = 509) or PCC (N = 950), there were no differences in clinical and demographic characteristics. Self-reported prevalences were available for HIV (42 %), HCV (57 %), and prior tuberculosis (17 %). Study retention at 6, 12, 18, and 24 months was as 91 %, 85 %, 80 %, and 74 %, respectively. ConclusionPWID have a high prevalence of medical comorbidities and integrating OAT into primary care settings has the potential to improve the health of PWID. Findings from this study can help guide implementation of integrated care in Ukraine and throughout similar low-resource, high-burden countries in the Eastern European and Central Asian region.

PSXII-15 Theory of planned behavior-based evaluation of technology adoption in dairy farms

Abstract Studies on the adoption of farm innovations should include underlying psychological constructs that affect decisions and behavior of farmers such as intention, perceptions, and beliefs. Dairy farming technologies are continually evolving, making it necessary to review current farm practices frequently. Dairy farmers are actively exploring various alternative investment options to optimize production processes, minimize costs, and increase overall efficiency. However, careful evaluation is crucial to understanding the knowledge and attitude of farmers to these tools. We utilize psychological constructs from the theory of planned behavior approach to understand the technology adoption behavior of dairy farmers. The theory of planned behavior is a psychological model that explains how human behavior is influenced by attitudes, subjective norms, and perceived behavioral control. We add product marketing as another essential component based on the industry relevance. The objective was to understand the adoption decisions and the perceived usefulness of precision technologies by dairy farmers in Texas. Dairy farmers were delivered printed copies of a pretested survey instrument to assess technology use, on-farm decisions, and producers’ planned behavior related to technology adoption on farms. Thirty-two completed surveys were returned and analyzed for descriptive and Structural Equation Modeling using Microsoft Excel and SAS (ver. 9.4). When choosing a technology, respondents ranked (on a scale of 1 to 5; unimportant to very important) the availability of local tech support as the most important factor (score 4.16; range 3 to 5), followed by proven performance through research (4.0; 3 to 5), simplicity of use (3.82; 3 to 5), benefit to cost ratio (3.66; 2 to 5), and total cost of investment (3.5; 1 to 5). Regarding barriers to investment decisions, 26% ranked lack of access to capital as a primary issue, followed by environmental regulations (12.5%), political environment (12.5%), and sitting regulations (12.5%). The intention of farmers to utilize the technology was influenced by farmers’ evaluation of the use of technology (attitude), their perceptions about the social pressure and marketing (subjective norm), and their perceptions about their utility on farmers (perceived behavioral control). The three most influential behavioral beliefs as the drivers of attitude were an increase in farm production and performance, monitoring cows, and labor savings. The three most influential normative beliefs were drivers of the subjective norm: family and friends, neighbors, and marketing. The three most influential control beliefs were drivers of perceived behavioral control: availability of local tech support, benefit-to-cost ratio, and simplicity and ease of use. Respondents indicate that having a standard price, reduced cost, and providing a detailed cost analysis when marketing the technology increases confidence in purchasing and integration. The findings suggest developing better products, ensuring reasonable pricing, and performing proper validations to enhance the farmer’s trust helps to increase technology adoption in dairy farms.

Transgender-Specific Differentiated HIV Service Delivery Models in the South African Public Primary Health Care System (Jabula Uzibone): Protocol for an Implementation Study.

Almost 60% of transgender people in South Africa are living with HIV. Ending the HIV epidemic will require that transgender people successfully access HIV prevention and treatment. However, transgender people often avoid health services due to facility-based stigma and lack of availability of gender-affirming care. Transgender-specific differentiated service delivery (TG-DSD) may improve engagement and facilitate progress toward HIV elimination. Wits RHI, a renowned South African research institute, established 4 TG-DSD demonstration sites in 2019, with funding from the US Agency for International Development. These sites offer unique opportunities to evaluate the implementation of TG-DSD and test their effectiveness. The Jabula Uzibone study seeks to assess the implementation, effectiveness, and cost of TG-DSD for viral suppression and prevention-effective adherence. The Jabula Uzibone study collects baseline and 12-month observation checklists at 8 sites and 6 (12.5%) key informant interviews per site at 4 TG-DSD and 4 standard sites (n=48). We seek to enroll ≥600 transgender clients, 50% at TG-DSD and 50% at standard sites: 67% clients with HIV and 33% clients without HIV per site type. Participants complete interviewer-administered surveys quarterly, and blood is drawn at baseline and 12 months for HIV RNA levels among participants with HIV and tenofovir levels among participants on pre-exposure prophylaxis. A subset of 30 participants per site type will complete in-depth interviews at baseline and 12 months: 15 participants will be living with HIV and 15 participants will be HIV negative. Qualitative analyses will explore aspects of implementation; regression models will compare viral suppression and prevention-effective adherence by site type. Structural equation modeling will test for mediation by stigma and gender affirmation. Microcosting approaches will estimate the cost per service user served and per service user successfully treated at TG-DSD sites relative to standard sites, as well as the budget needed for a broader implementation of TG-DSD. Funded by the US National Institutes of Mental Health in April 2022, the study was approved by the Human Research Ethics Committee at University of Witwatersrand in June 2022 and the Duke University Health System Institutional Review Board in June 2023. Enrollment began in January 2024. As of July 31, 2024, a total of 593 transgender participants have been enrolled: 348 are living with HIV and 245 are HIV negative. We anticipate baseline enrollment will be complete by August 31, 2024, and the final study visit will take place no later than August 2025. Jabula Uzibone will provide data to inform HIV policies and practices in South Africa and generate the first evidence for implementation of TG-DSD in sub-Saharan Africa. Study findings may inform the use of TG-DSD strategies to increase care engagement and advance global progress toward HIV elimination goals. DERR1-10.2196/64373.

Energy Deficit and Factors Associated with Energy Balance during a Combat Deployment in U.S. Army Special Operation Forces Soldiers.

Forty-six SOF Soldiers (age: 30.1 ± 3.5 yrs, body mass index: 27.7 ± 4.1 kg/m2) completed surveys on demographic data, mission activity characteristics, gastrointestinal issues, ration consumption, resilience, mood state, and dietary intake using a 127-question food frequency questionnaire at the end of a six-month deployment. EE was estimated using a SOF-specific prediction equation with a physical activity factor of 2.1. A paired t-test compared reported energy intake (EI) with estimated energy expenditure (EE). Pearson correlations identified significant variables associated with energy balance, which were then incorporated into a multiple linear regression model. The regression analysis included Profile of Mood States (POMS) anger and POMS depression as predictor variables to determine their influence on energy balance. Reported mean EI was 2512 ± 1059 kcal·d-1, while estimated mean EE was 5272 ± 525 kcal·d-1. The mean energy imbalance was -2854 kcal/d (95% CI: -2655 to -3055, p < 0.001), with all participants in negative energy balance (range: -492 to -3813 kcal/d). POMS depression (r = 0.517, p < 0.01) and POMS anger (r = 0.363, p = 0.020) were associated with energy balance. The regression model was significant (R2 = 0.23, F (2, 38) = 7.02, p < 0.01), with POMS depression significantly predicting energy balance (β = 50.76, p = 0.011). Deployed SOF Soldiers reported high EE and limited EI, which may negatively impact performance. Higher POMS depression scores were associated with lower energy deficits. Future studies should investigate the relationship between mood and energy balance, using direct measures of EI and EE.

The Long Haul to Surgery: Long COVID Has Minimal Burden on Surgical Departments.

Many patients infected with the SARS-CoV-2 virus (COVID-19) continue to experience symptoms for weeks to years as sequelae of the initial infection, referred to as "Long COVID". Although many studies have described the incidence and symptomatology of Long COVID, there are little data reporting the potential burden of Long COVID on surgical departments. A previously constructed database of survey respondents who tested positive for COVID-19 was queried, identifying patients reporting experiencing symptoms consistent with Long COVID. Additional chart review determined whether respondents had a surgical or non-routine invasive procedure on or following the date of survey completion. Outcomes from surgeries on patients reporting Long COVID symptoms were compared to those from asymptomatic patients. A total of 17.4% of respondents had surgery or a non-routine invasive procedure in the study period. A total of 48.8% of these patients reported experiencing symptoms consistent with Long COVID. No statistically significant differences in surgical outcomes were found between groups. The results of this analysis demonstrate that Long COVID does not appear to have created a significant burden of surgical disease processes on the healthcare system despite the wide range of chronic symptoms and increased healthcare utilization by this population. This knowledge can help guide surgical operational resource allocation as a result of the pandemic and its longer-term sequelae.

Rest-Activity Rhythm Phenotypes in Adults with Epilepsy and Intellectual Disability.

Sleep and rest-activity rhythms (RARs) are perturbed in many forms of neuropsychiatric illness. In this study, we applied wrist actigraphy to describe the extent of RAR perturbations in adults with epilepsy and intellectual disability ("E+ID"), using a cross-sectional case-control design. We examined whether RAR phenotypes correlated with epilepsy severity, deficits in adaptive function and/or comorbid psychopathology. Primary caregivers of E+ID adults provided informed consent during routine ambulatory clinic visits and were asked to complete standardized surveys of overall epilepsy severity (GASE, Global Assessment of Severity of Epilepsy), adaptive function (ABAS-3, Adaptive Behavior Assessment System-3) and psychopathology (ABCL, Adult Behavior Checklist). Caregivers were also asked to ensure that subjects wore an Actiwatch-2 device continuously on their nondominant wrist for at least ten days. From recorded actograms, we calculated RAR amplitude, acrophase, robustness, intradaily variability (IV), interdaily stability (IS) and estimates of sleep quantity and timing. We compared these RAR metrics against those from (i) a previously published cohort of adults with epilepsy without ID (E-ID), and (ii) a cohort of age- and sex-matched intellectually able subjects measured within the Study of Latinos (SOL) Ancillary actigraphy study (SOL). Within E+ID subjects, we applied k-means analysis to divide subjects into three actigraphically distinct clusters. 46 E+ID subjects (median age 26 [20-68], 47% female) provided a median recording duration of 11 days [range 6-27]. Surveys reflected low to extremely low levels of adaptive function (ABAS3 General Adaptive Composite score: median 50 [49-75]), and low/subclinical levels of psychopathology (ABCL total score: median 54.5 [25-67]). Compared with E-ID (n=57) and SOL (n=156) cohorts, E+ID subjects displayed significantly lower RAR amplitude, robustness and IS, with significantly higher IV and total daily sleep. K-means clustering of E+ID subjects recognized an intermediate cluster "B", with RAR values indistinguishable to E-ID. Cluster "A" subjects displayed pronounced hypoactivity and hypersomnia with high rates of rhythm fragmentation, while cluster "C" subjects featured hyper-robust and high amplitude RARs. All three clusters were similar in age, body mass index, antiseizure medication (ASM) polytherapy, ABAS3 and ABCL scores. We qualitatively describe RAR examples from all three clusters. We show that adults with epilepsy and intellectual disability display a wide spectrum of RAR phenotypes that do not neatly correlate with measures of adaptive function or epilepsy severity. Prospective studies are necessary to determine whether continuous actigraphic monitoring can sensitively capture changes in chronobiological health that may arise with disease progression, iatrogenesis (e.g., ASM toxicity) or acute health deteriorations (e.g., seizure exacerbation, pneumonia). Similar long-term data is necessary to recognize whether behavioral interventions targeted to 'normalize' RARs may promote improvements in adaptive function and therapy engagement.

Mini Med School: Knowledge and Resources for Underrepresented in Medicine Youth.

Physician demographics in North America do not yet reflect the diversity of the communities they serve, accounted to systemic barriers targeting underrepresented in medicine (URiM) groups. URiM medical graduates are more likely to pursue generalist specialties, including family medicine. Mini Med Schools (MMSs) are pathway programs intended to motivate URiM youth to pursue medicine. A gap in literature exists regarding the potential of MMSs to provide youth with useful information. We examined the extent to which youth reported a change in knowledge about medicine as a career before and after attending an MMS. Asclepius Medical Camp for Youth is a weeklong MMS for high school students, held at one Canadian university. In 2022, 50 youth participants were invited to complete surveys and quizzes measuring their knowledge about pursuing a career in medicine. The mean self-reported knowledge differed significantly precamp (n=34, M=5.87/10, SD=1.9) versus postcamp (n=26, M=8.28/10, SD=1.4; t[35]=7.07, P&lt;.05). Likewise, participants' scores demonstrated a significant difference in mean scores precamp (n=43, M=7.12, SD=2.39) versus postcamp (n=39, M=9.31, SD=1.13; t[42]=5.08, P&lt;.05). These findings highlight MMSs as a promising strategy to provide knowledge about medical careers beyond instilling motivation. By both inspiring and informing URiM youth, the long-term outcome of diversifying medicine may be achieved.

Comparing the Efficacy of 2 WeChat Mini Programs in Reducing Nonmarital Heterosexual Contact by Male Factory Workers: Randomized Controlled Trial.

Male factory workers in China are vulnerable to HIV transmission. Commercial and nonmarital noncommercial contacts are the driving forces of heterosexual HIV transmission among male factory workers in China. There is a lack of effective HIV interventions for male factory workers in China. The primary objective of this randomized controlled trial was to compare the efficacy of an enhanced versus the standard version of a WeChat mini program in reducing sexual intercourse with nonregular female sex partners and female sex workers among male factory workers in Shenzhen, China. A nonblinded 2-arm parallel randomized controlled trial was conducted between December 2021 and April 2023. Participants were adult male factory workers in Shenzhen who had access to a smartphone and WeChat. Those who had oral or anal sex with a man or self-reported as HIV positive were excluded. A total of 247 participants were randomly assigned to the intervention group (n=125, 50.6%) or the control group (n=122, 49.4%); 221 (89.5%) and 220 (89.1%) completed follow-up surveys at T1 (6 months after completion of the interventions) and T2 (6 months after T1). Participants in the control group had access to the standard WeChat mini program that provided basic HIV-related knowledge and information about local free HIV testing services. Participants in the intervention group had access to the enhanced WeChat mini program. The enhanced mini program covered all the information in the standard mini program. In addition, the enhanced mini program assessed users' behaviors and invited users to watch different web-based videos on reducing nonmarital sexual contacts and promoting HIV testing based on their behavioral characteristics at months 0 and 1. The videos were developed based on in-depth interviews with male factory workers. Intention-to-treat analysis was used for outcome analyses. Multiple imputation was used to replace missing outcome values at T1 and T2. At T1, fewer participants in the intervention group reported sexual intercourse with a nonregular female sex partner in the past 6 months compared with the control group (1/125, 0.8% vs 8/122, 6.6%; relative risk=0.12, 95% CI 0.02-0.96; P=.02). However, there were no between-group differences in sexual intercourse with a nonregular female sex partner at T2 (10/125, 8% vs 14/122, 11.5%; P=.36) or sexual intercourse with a female sex worker at T1 (2/125, 1.6% vs 2/122, 1.6%; P=.98) or T2 (8/125, 6.4% vs 8/122, 6.6%; P=.96). The enhanced WeChat mini program was more effective than the standard WeChat mini program in reducing sexual intercourse with nonregular female sex partners among male factory workers in the short term but not in the longer term. Improvements should be made to the WeChat mini program before implementation. ClinicalTrials.gov NCT05811611; https://clinicaltrials.gov/study/NCT05811611.