Psychological wellbeing and sleep in human immunodeficiency virus (HIV): a retrospective analysis of assessment and interventions within HIV services in the UK and Ireland (UKI)

Background: People living with HIV are disproportionately affected by psychological wellbeing and sleep issues which can detrimentally impact their quality of life, adherence and health outcomes. Despite monitoring and assessment being imperative to improve long-term health;evidence indicates a variation in incidence of this and absence in guidance for sleep issues. To support generation of evidence in this field, a market research study was designed to gain insights into current interventions for psychological wellbeing and sleep assessment within HIV services in UKI. Method(s): The study was managed by a market research agency where an online survey link was disseminated to healthcare professionals (HCPs) in multiple HIV centres across UKI. To ensure accuracy of data, HCPs randomly selected a maximum 20 patient notes reviewed between 2020 to 2022. No identifiable patient information was recorded or shared with resulting data presented at an aggregate level. Result(s): 39 clinics participated contributing 665 patient notes with demographics reflective of UKI population. Since Covid- 19 77% of HCPs perceived an increasing demand for mental health support with 64% stating they routinely assess mental health;however, the majority express issues with capacity and resourcing to sufficiently support these patients. 33% of patients included were identified as experiencing a decline in psychological wellbeing, the majority of which self-reported during face to face (F2F) routine appointments;14% of these patients had a PHQ9. 78% received support with the majority signposted to external resources. For those who did not receive support, the primary driver was patient request. 46% of services state they do not routinely assess for sleep issues. A lower proportion of patients (17%) were identified as having such issues;however, of those identified the primary method was self-reporting during F2F routine appointments. 6% of these patients had a PSQI. Of those who did not receive sleep support, a lack of guidance was the main cited reason. Conclusion(s): This study indicates high variation between local management of psychological wellbeing and sleep in HIV, in addition to key gaps in clinical guidance, identifying, managing and ongoing monitoring which is required to ensure long term health.

A Report of Disseminated Histoplasmosis in an Immunocompromised Patient Following Covid-19 Infection

INTRODUCTION: Histoplasmosis results from spore inhalation of Histoplasma capsulatum, an endemic fungus in the soil of the Ohio and Mississippi River Valleys of the United States. While the majority of infections with H. capsulatum are asymptomatic and self-limited, immunosuppressed patients may develop severe, disseminated disease. Few reports have described disseminated histoplasmosis following SARS-CoV-2 (COVID-19) infection such as described in this case. DESCRIPTION: A 69-year-old female was evaluated for shortness of breath. Her medical history was significant for rheumatoid arthritis on methotrexate and recent COVID-19 infection treated with dexamethasone. Initial CT-angiography of the chest showed patchy bilateral ground glass opacities. She had leukopenia with white blood cell count of 1.3 K/uL and elevated procalcitonin of 5.88 ng/mL. Broad spectrum empiric antibiotics were initiated. On day 6, the patient decompensated and required ICU transfer. Urine histoplasma antigen, M and H precipitin bands, and serum galactomannan antigen returned positive. Amphotericin B was initiated. The patient underwent bronchoscopy with bronchoalveolar lavage showing atypical reactive macrophages with rare intracellular organisms suspicious for fungi. Repeat CT of the chest, abdomen, and pelvis showed extensive bilateral ground glass opacities, bilateral pulmonary calcifications consistent with granulomas, and calcifications in the spleen and liver. On hospital day 10, the patient required intubation due to hypoxemic respiratory failure. Despite appropriate antifungal therapy, she had worsening encephalopathy, leukocytosis, erythema nodosum, and renal failure. She passed away on day 19. DISCUSSION: This case highlights the development of disseminated histoplasmosis in an immunocompromised adult following COVID-19 infection. It was not until treatment with high dose glucocorticoids that the patient developed disseminated disease and declined. It is important to be aware of the impact that the COVID-19 pandemic has on the emergence of infectious disease and the role its treatment plays in immune suppression. Disseminated histoplasmosis is a consideration for immunocompromised patients in high risk, H. capsulatum endemic areas who are being treated for COVID-19 with high doses of steroids for prolonged periods.

Factors Influencing COVID-19 Vaccine Uptake among Reproductive-Aged Women in Jamaica

Background. Little is known about the factors which influence COVID-19 vaccine uptake among reproductive-aged women in Jamaica. Methods. We conducted a cross-sectional, web-based survey of 192 reproductive-aged women in Jamaica from February 1- 8, 2022. Participants were recruited from a convenience sample of women (patients, providers and staff) at a tertiary care hospital whose demographic characteristics are shown in Table 1. We assessed self-reported COVID-19 vaccination status, vaccine confidence (defined as confidence in the safety and efficacy of vaccines and the system that delivers them) and medical mistrust beliefs (e.g., "I don't trust the COVID-19 vaccine"). We conducted exploratory factor analysis using principal axis factoring and oblique equamax rotation on 22 survey items. Three factors were extracted which conceptually aligned with three subscales: lack of vaccine confidence, government-related COVID-19 medical mistrust, and race-based COVID-19 medical mistrust;we retained items with factor loadings > 0.40. The final subscale variables and their descriptive statistics are shown in Table 2. In addition, we used multivariable modified Poisson regression to calculate adjusted prevalence ratios (aPR) and 95% confidence intervals (CI) for the association between vaccine uptake and pregnancy status adjusting for education and factors scores. Variables with a p value < 0.1 were retained in the final regression model. Results. Of 192 respondents, 72(38%) were pregnant and 120 (62%) were nonpregnant. Pregnancy was negatively associated with vaccine uptake (aPR=0.70, 95% CI=0.51 - 0.96;p=0.029). Women with higher scores on the lack of vaccine confidence subscale (i.e., less confident in vaccine) were less likely to be vaccinated (aPR=0.72, 95%CI=0.61 - 0.86;p< 0.001). Government-related COVID-19 medical mistrust and race-based COVID-19 medical mistrust were not significantly associated with vaccine uptake (see Table 3). Conclusion. Findings suggest that pregnancy and lack of vaccine confidence are factors associated with lower vaccine uptake among reproductive-aged women in Jamaica. Bolstering vaccine confidence, through the use of evidence-based interventions, may help to increase COVID-19 vaccine uptake in this population.

Perceived barriers to client-choice conversion among Arkansas food pantries

Food insecurity continues to be a problem in the U.S., especially in Arkansas, which ranked second in the nation in food-insecure households in 2020 (Arkansas Food Bank, n.d.). To help address this, community-based food pantries make food available directly to area residents. Food pantry demand has increased during COVID-19, which has exacerbated food insecurity, particularly in the southern U.S. In Arkansas, the Arkansas Food Bank (AFB) serves as the state's largest nongovernmental food aid provider, working with 310 pantries. Pantries typically distribute food to clients in one of two ways: by using a prefilled bag or box of items (the traditional model), or by allowing clients to select items (the client-choice model). Although research has shown that the client-choice model has a variety of benefits for client health and wellbeing, pantries using the traditional model remain the norm in Arkansas, accounting for 87% of total pantries. Currently, there is limited research that identifies perceived barriers to converting to a client-choice model among pantry managers, and that identifies whether perceived barriers and localized concerns contribute to different operation styles among pantries. To address this, we examined perceived barriers to client-choice conversion using a mixed-method survey conducted with 187 Arkansas food pantry managers. We used common factor analysis to identify four barriers perceived by pantries to converting their traditional pantry to a client-choice pantry: (1) food supply concerns, (2) having limited nonfood resources, (3) food waste concerns, and (4) confusion from clients and nutritional concerns. A cluster analysis of pantry respondents was also used, based on their level of concern for the four identified perceived barriers. Clusters we identified are Potential Converters (18.2%), Confusion Concerned pantries (56.7%), and pantries who are Skeptics (25.1%). Our findings suggest that food pantry stakeholders may need additional outreach and education concerning the various ways that client choice can be implemented. Our results provide valuable information for those involved in distributing food aid to food-insecure households.

MAGNETOFLUIDICS-ENABLED POINT-OF-CARE SARS-COV-2 DIAGNOSTICS

As the SARS-CoV-2 virus continues to mutate, global eradication of infections is unlikely, and COVID-19 is predicted to become a seasonal or endemic disease like influenza. Widespread detection of variant strains will be critical to inform policy decisions to mitigate further spread, and post-pandemic multiplexed screening of respiratory viruses will be necessary to properly manage patients presenting with similar respiratory symptoms. We have developed a portable, magnetofluidic platform for multiplexed PCR testing in <30 min. Cartridges were designed for multiplexed detection of SARS-CoV-2 with either distinctive variant mutations or with Influenza A and B and tested with clinical samples. © 2021 MicroTAS 2021 - 25th International Conference on Miniaturized Systems for Chemistry and Life Sciences. All rights reserved.

HIGHER RATES OF LONG COVID SYMPTOMS IN PATIENTS WITH MILD COVID-19

BACKGROUND: The Coronavirus Disease 2019 (COVID-19) pandemic has affected over 61 million U.S. citizens, and up to 30-80% of COVID-19 survivors may go on to develop post-acute sequelae of SARS-CoV-2 (PASC). These sequelae can be debilitating and often impair quality of life and daily function. Although it has been suggested that severity of acute COVID-19 infection is directly related to PASC development, this association remains unclear. METHODS: This prospective cohort study was conducted through consecutive recruitment of confirmed and probable COVID-19 patients with persistent symptoms lasting ≥3 weeks from disease onset or positive SARS-CoV-2 test from academic PASC clinics at Emory University and Grady Memorial Hospital in Atlanta, GA during January-December 2021. Sociodemographic, comorbidity, and acute COVID-19 data were collected. Severe acute COVID- 19 was defined as requiring hospitalization, and critical acute COVID-19 required intensive care. New or worsening symptoms persisting ≥3 weeks from COVID-19 onset were collected using a standardized review of systems, and confirmed by clinician interview. Differences in PASC symptom type were assessed by calculating risk ratios (RR) and 95% confidence intervals (CI) using the Taylor series, and difference in PASC duration was assessed using student's t-test. Two-tailed p-values ≤0.05 were considered significant. RESULTS: Of 269 enrollees, median age was 52 years (range 18-93) and there were more women (74%) than men (26%). There were 152 (57%) African American, 76 (28%) White, and 21 (8%) Hispanic. Among PASC patients, the most common symptoms were dyspnea (68%), fatigue (63%), brain fog (48%), dizziness (27%), chest pain (25%), cough (23%) and headache (23%) with a median PASC duration of 132 days (range 21-523). Acute COVID-19 severity was asymptomatic in one participant, mild in 149 (55%), severe in 95 (35%), and critical in 23 (9%). Asymptomatic- mild acute COVID-19 patients had more persistent dyspnea (RR: 1.33, 95%, CI: 1.09- 1.61), fatigue (RR: 1.53, 95%CI: 1.22-1.91), brain fog (RR: 2.00, 95%CI: 1.44-2.67), dizziness (RR: 2.03, 95%CI: 1.27-3.25), and headache (RR: 2.07, 95%CI: 1.22-3.48) compared with severe-critical acute disease, who had a non-significant trend towards more cough and chest pain. Asymptomatic-mild participants were further from incident infection (153 days) compared to severe-critical participants (110 days) (p=0.04). CONCLUSIONS: Contrary to previous observations, COVID-19 survivors who experienced asymptomatic-mild infections may develop higher rates of prevalent PASC symptoms compared to those with severe- critical antecedent infections. These findings are not attributable to PASC duration, as longer PASC duration has been previously associated with fewer symptoms. To ensure early identification and linkage to specialized care, clinicians should be aware of PASC in patients with antecedent asymptomatic-mild acute COVID-19 infections.

MASTERING THE CHEST X-RAY: A NOVEL REMOTE LEARNING CURRICULUM FOR FIRST-YEAR RESIDENTS

SETTING AND PARTICIPANTS: 66 first-year internal medicine residents at Northwestern Memorial Hospital were randomized to Group A or Group B. Curriculum participation was mandatory for all first-year internal medicine residents, but participants were given the option to exclude their answers from the study. DESCRIPTION: Prior to 2020, there was no formal radiographic curriculum for internal medicine residents at our institution. Additionally, the COVID pandemic necessitated a paradigm shift in medical education from in-person teaching to remote learning. Accordingly, we created a novel virtual learning curriculum to teach common CXR findings to first-year residents. Objectives of the curriculum include 1) providing first-year residents with a systematic approach to reading and interpreting CXRs, and 2) prompting pattern recognition via proper identification of common CXR findings. We created a randomized cohort study with cross-over design to evaluate the efficacy of our curriculum. First-year internal medicine residents at McGaw Medical Center of Northwestern University were randomized into two groups (Group A/B). In phase I, only Group A was administered the 11-week curriculum. Learners received 2-4 weekly CXRs focusing on a modified ”ABCDE” approach. Each weekly lesson was designed to be completed in 15 mins via smartphone or laptop. Multiple choice standardized assessments were administered before (Pre-Test) and after (Post- Test #1) administration. In phase II, Group B, but not Group A, was given the curriculum;both groups then completed Post-Test #2. This phase assessed curriculum efficacy (Group B) and learning retention (Group A). EVALUATION: Independent and paired-sample T tests were used to compare scores between and within groups. Group A scored higher on Post-Test #1 following curriculum administration, compared to on the Pre-Test (pre: 44 ± 15%;post: 59 ± 17 %;p= 0.005). Group B scored similarly on the Pre-test and Post-Test #1 (pre: 50 ± 14%;post: 44 ± 17%;p= 0.25), but higher on Post-Test #2, following their curriculum administration (60 ± 17%) than on Post-Test #1 (p= 0.04). There was no statistically significant difference in Post-Test #2 scores between Groups A and B (55 ± 17% and 60 ± 17%, respectively). In Group A, self-assessed confidence with CXR reading was higher at the time of Post- Test #1 than Pre-Test (72 ± 13%;55 ± 12%;p= <0.01). DISCUSSION / REFLECTION / LESSONS LEARNED: This study suggests that our novel remote learning curriculum is a practical, effective adjunct to standard residency education for reading CXRs. Notably, residents who received the curriculum demonstrated higher scores and had improved confidence with reading CXRs. Study limitations include small sample size and participant attrition. Future studies include applying our remote learning framework to other imaging studies.

Research update: Arkansas food pantries and perceived barriers to client-choice conversion

To address food insecurity, community-based food pantries typically distribute food to area residents using a prefilled bag/box of items (traditional method), or by allowing clients to select items (client-choice method). Prior efforts have found client-choice pantries are often preferred by clients, allowing them more control and dignity over their food choices. However, limited research exists examining barriers to client-choice conversion that pantries may face. Many pantries continue to follow the traditional model. This is especially true in Arkansas, which frequently ranks high in the nation in food-insecure households. The Arkansas Foodbank (AFB) serves as the state's largest nongovernmental provider of food aid, working with over 400 pantries. Despite efforts by the AFB to promote client-choice conversion, in 2020 only 13% of Arkansas pantries offered client-choice. To identify perceived barriers to client-choice conversion, we conducted a mixed-methods survey sent to 366 Arkansas pantry managers during spring 2021. The survey featured questions concerning the feasibility of and potential barriers to offering the client-choice option and had a response rate of 36%. Following grounded theory, a thematic analysis approach was used to code and analyze responses to the open-ended, qualitative survey questions. Preliminary results uncovered five primary themes and six sub-themes, indicating perceived barriers to client-choice conversion. These included concerns related to pantry space and location (37%), volunteer and staffing needs (35%), lack of awareness concerning client-choice options (28%), COVID-19 concerns (27%), and perceived client greed and client distrust (12%). Our preliminary findings suggest food pantry stakeholders may need additional outreach and education concerning the various ways that the client-choice method can be implemented. Our results have important implications for those involved in distributing food aid to food-insecure households.

COVID-19 vaccine hesitancy among metroatlanta healthcare worker

Purpose of Study Vaccine hesitancy is a complex and controversial issue that undermines current efforts at ending the COVID-19 pandemic. Vaccine hesitancy in healthcare workers further complicates these issues as healthcare workers interact, educate and influence their peers and community members at large.We sought to understand vaccine hesitancy among HCW in four large healthcare systems in the metro- Atlanta region. Methods Used We conducted a cross-sectional multicenter 12 question anonymous survey sent via email to HCWs in four healthcare systems in metropolitan Atlanta over a seven week period from May to June 2021 using Qualtrics XM. We defined vaccine hesitancy as those who had not received the vaccine or planned to get it later. Demographics, employment information, history of COVID-19 diagnosis, vaccination status, and reasons for vaccine hesitancy were assessed. Descriptive variables including HCW demographics, clinical role, and self/family member with previous diagnosis of COVID were compared using chi-square and t-tests. A multivariate logistic regression model controlling for age, sex, race, ethnicity, and education was used to estimate adjusted measures of association analyzed with SAS 9.4. COVID vaccine perceptions were further explored using a five point Likert scale. Summary of Results Of the 5,329 completed responses from HCW, the largest group of respondents comprised of nurses (35%), followed by physicians (18%). Of the 551 (10%) vaccine hesitant HCW, 43% of them were black and 39% were white. 16% of the vaccine hesitant identified as working in the Emergency Department and 14% in the Intensive Care Unit. In the multivariate analysis, HCW aged 18-35 were more likely to be vaccine hesitant then other age groups with vaccine hesitancy decreasing as age increased. Non-Hispanics were more likely to be vaccine hesitant than Hispanics. Those with education levels of less than a Bachelor's degree were more likely to be vaccine hesitant than those with bachelor's degree or higher. There were no differences observed between the black and white races for vaccine hesitancy. Having a family member with COVID or caring for COVID patients did not have a significant impact on vaccine hesitancy. The main reasons for vaccine hesitancy were fear of side effects followed by concerns about safety and inadequate research Conclusions Ten percent of HCW in the four health systems studied were found to be vaccine hesitant. Increased vaccine hesitancy was associated with the younger age group of 18- 35, Non-Hispanic ethnicity, and education less than a bachelor's degree. The main reasons for vaccine hesitancy were fear of side effects followed by safety and inadequate research concerns. As vaccine mandates begin, the threat of workforce losses is imminent creating a strain on healthcare systems. Booster/third dose vaccine hesitancy also remains a significant concern. It is critical to identify and develop strategic interventions to reduce vaccine hesitancy among HCW.

Re-thinking historical consciousness in a pandemic: From commemoration to contestability

The paper critiques the curriculum construction of historical consciousness within Australian school systems. National and trans-national discourses about identity, culture, gender, race and class influence the development of historical consciousness in Australian classrooms. During this unprecedented period of shared grief and global trauma, re-interpreting historical narratives that build children's concepts of social justice, equity and global inclusivity is important epistemological work for the future. This paper uses survey data and interviews from Australian school children and teachers as the COVID-19 pandemic emerged to examine what are the key narratives about Indigenous stories, resilience, adversity, global migration, and national identity, and how these narratives distort present realities. The analysis considers how historical consciousness is enacted within the current Australian school curriculum with stories from commemoration to contestability. Survey data from students from school years 6-12 is analysed in terms of how personal agency and empathy is formed through historical practices and inquiry in the classroom. This is supported by interviews about teaching practices. This paper reveals how globalized experiences can bridge historic boundaries of racism, prejudice and exclusion and how curriculum frameworks can develop critical historical consciousness for the future.

Severity of seasonal coronavirus acute respiratory illness during infancy associated with respiratory viral co-infection

Background: There are limited data on the clinical characteristics of acute respiratory illness (ARI) in infants due to seasonal coronaviruses (CoV), long-term respiratory outcomes, and how CoV compare to other common viruses. Methods: Prospective cohort study of previously healthy term infants enrolled during hospitalization or acute care outpatient visits (emergency and clinic visits) for ARI from 2004-2008. ARI severity was determined using a 12-point respiratory severity score (RSS), and dichotomous LRTI or URI. ARI viral etiology was determined using real-time PCR for a panel of common respiratory viruses including seasonal CoV NL63, 229E, and OC43. In an exploratory analysis, proportions who subsequently developed childhood asthma were estimated by infection status in infancy. Clinical presentation of infant seasonal CoV infections was compared with published data on SARS-CoV-2 clinical characteristics in infants. Results: Among 665 infants, 28 (4%) had CoV detected. NL63, 229E, and OC43 comprised 25%, 25%, and 61% of detections, respectively, which included mixed-CoV infections. CoV exhibited winter seasonality. Among 28 CoV infections, 19 (68%) infants had co-infection with other viruses (RSV, HRV, influenza). Of 9 CoV-only detections, 2 (22%) were hospitalizations, 7 (78%) were outpatient, 8 (89%) were URI, 0 were bronchiolitis, and 1 (11%) was other diagnosis. Among CoV co-infections, 9 (47%) were hospitalizations, 10 (53%) were outpatient, 6 (32%) were URI, 11 (58%) were bronchiolitis, and 2 (11%) were other diagnoses. Average RSS was higher in infants with CoV co-infection than CoV-only infection (figure). Most common seasonal CoV symptoms were fever, cough, and rhinorrhea. Among those with long-term follow-up, childhood asthma (4-6 years) appeared more prevalent in RSV-only (62/152, 41%) and HRV-only infection groups (33/61, 54%) versus CoV-only (2/6, 33%);however, infants with CoV infection comprised a small proportion. Conclusions: Seasonal CoV represented the fourth most common viral etiology of ARI among infants seeking unscheduled medical care. CoV infection was less severe compared to RSV or HRV. This mild disease presentation is similar to current published reports of SARS-CoV-2 infection in infants. Greater illness severity was associated with CoV coinfection compared to CoV alone;however, CoV-only detection were few. Infants with seasonal CoV were less likely than infants with RSV or HRV to have later childhood long-term respiratory morbidity. These findings highlight the potential influence that respiratory co-pathogens may have in infant SARS-CoV-2 infection severity, and underscore the importance of identifying co-infecting pathogens.

Targeted rapid testing for SARS-CoV-2 in the emergency department is associated with large reductions in uninfected patient exposure time.

Opportunity exists to decrease healthcare-related exposure to severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), preserve infection control resources, and increase care capacity by reducing the time to diagnosis of coronavirus disease 2019 (COVID-19). A retrospective cohort analysis was undertaken to measure the effect of targeted rapid molecular testing for SARS-CoV-2 on these outcomes. In comparison with standard platform testing, rapid testing was associated with a 65.6% reduction (12.6 h) in the median time to removal from the isolation cohort for patients with negative diagnostic results. This translated to an increase in COVID-19 treatment capacity of 3028 bed-hours and 7500 fewer patient interactions that required the use of personal protective equipment per week.