Ingestible sensor system for measuring, monitoring and enhancing adherence to antiretroviral therapy: An open-label, usual care-controlled, randomised trial.

BACKGROUND: Co-encapsulated antiretrovirals (ARVs) with ingestible sensor (IS) has the capacity to monitor adherence in real-time using a sensor patch, a mobile device, and supporting software. We evaluated the acceptability, effectiveness, and sustainability of the IS system with real-time text reminders. METHODS: Participants were recruited from HIV clinics in Los Angeles and were randomised 1:1 to IS or usual care (UC) group. Adherence to ARVs (primary outcome) was measured by IS system (IS group only), plasma ARV concentration, and self-report. IS-measured adherence was clustered by group-based trajectory model and was validated by ARV concentration summarized by integrated pharmacokinetic adherence measure (IPAM) score. HIV RNA viral load (VL) was compared between IS and UC group. FINDINGS: A total of 112 (IS = 54, UC = 58) participants who completed baseline with at least one follow-up data collection were included in analyses. Overall satisfaction rate for the IS system was >90%. The IPAM score was higher (0.018, 95% CI: -0.098-0.134, p = 0.75) and VL decayed faster (-0.020, 95% CI: -0.042-0.002, p = 0.08) in the IS group compared with the UC group. The ingestible sensor system was well tolerated by study participants. INTERPRETATION: The IS system was well accepted by participants and its use was associated with improved adherence and lower HIV RNA VL. The findings provide a potentially effective strategy for improving adherence. FUNDING: This work was supported by grant R01-MH110056 from the National Institute of Mental Health (NIMH)/National Institutes of Health (NIH). Y. Wang was in part supported by the NIMH/NIH award T32MH080634. E. Daar was in part supported by the National Center for Advancing Translational Sciences through UCLACTSI Grant UL1TR001881. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

Social Cognitive Theory to Assess the Intention to Participate in the Facebook Metaverse by Citizens in Peru during the COVID-19 Pandemic

The current study aims to validate and apply an instrument to assess the relationship between institutional support, technological literacy, and self-efficacy on the intention to participate in the Facebook Metaverse using social cognitive theory. We performed a cross-sectional, analytical study of 410 citizens in Peru to assess the influence of institutional support, technological literacy, and self-efficacy on the intention to participate in the Facebook Metaverse during the COVID-19 pandemic. The research model was validated using partial least square structural equation modeling (PLS-SEM) to establish the influence of variables on the model. Institutional support and technological literacy were found to influence the self-efficacy of participating in the metaverse positively by correlations of 0.573 and 0.257, respectively. Self-efficacy of participating positively influenced the intention to participate in the Facebook Metaverse by 0.808. The model explained 65.4% of the intention to participate in the Facebook Metaverse. Bootstrapping demonstrated that the path coefficients of the research model were statistically significant. The research outcomes may help firms to develop planning and investment in the metaverse, as well as understanding the factors that influence a higher intention to participate in the Facebook Metaverse.

Understanding opportunities and challenges with telemedicine-delivered buprenorphine during the COVID-19 pandemic.

INTRODUCTION: Opioid use disorder (OUD) is a debilitating illness that remains a serious public health issue in the United States. Use of telemedicine to deliver medications for the treatment of OUD (MOUD) was limited until the confluence of the COVID-19 and opioid addiction epidemics in spring 2020. Starting in spring 2020, the Department of Veterans Health Affairs (VHA) transitioned from in-person to mostly telemedicine-delivered OUD care to reduce COVID-19 transmission among veterans and providers. To gain a nuanced understanding of provider perspectives on MOUD care delivery using telemedicine, we conducted semi-structured interviews with VHA providers who were using telehealth to deliver MOUD care. METHODS: We conducted semi-structed Zoom interviews with VA clinicians at nine VA Medical Centers (VAMCs) in eight states. Potential study participants were identified as providers who were involved in referrals and provision of buprenorphine treatment for chronic pain and opioid addiction. Audio-recordings of all interviews were transcribed and entered into Atlas. Ti qualitative analysis software. The study team analyzed the transcripts for major themes related to tele-prescribing practices for buprenorphine. RESULTS: Twenty-three VA providers participated in the study, representing 32% of all providers invited to participate in the study. The research team identified the following four themes: (1) COVID-19 spurred a seismic shift in OUD treatment; (2) Video calls provided a rare window into veterans' lives; (3) Providers experienced numerous challenges to virtual visits; and (4) Providers wrestled with paternalism and trust. CONCLUSIONS: The pandemic accelerated the movement toward harm reduction approaches. Prior to the pandemic, stringent requirements existed for patients receiving MOUD care. Providers in this study reflected on the need for these requirements (e.g., in-person visits, toxicology screens) and how reducing this monitoring implied more trust in patients' autonomous decisions. Providers' observation that videoconferencing offered them a window into patients' lives may offer some ways to improve rapport, and research should explore how best to incorporate the additional information conveyed in virtual visits.

Counseling Veterans with Chronic Pain During the COVID-19 Pandemic: A Secondary Analysis of a Randomized Controlled Trial.

INTRODUCTION: Veterans with chronic pain could be vulnerable during the COVID-19 pandemic. We qualitatively explored the impact of the COVID-19 pandemic on a sample of veterans receiving brief counseling focused on pain management in an ongoing clinical trial and discuss how the pandemic affected the process of motivating veterans with chronic pain to engage in interdisciplinary multimodal pain treatment at the Department of Veteran Affairs. METHODS: Segments of audio-recorded counseling sessions containing content about the pandemic were transcribed and coded to identify key concepts emerging from individual counselor-participant transactions. Themes that emerged were examined with constant comparison analysis. RESULTS: Three major themes emerged. 1) The pandemic caused a disruption in pain management service delivery, resulting in changes to the way veterans receive services or manage their pain symptoms. 2) The pandemic offered opportunities for resilience and personal growth as veterans with chronic pain reflected on their lives and personal goals. 3) The pandemic brought veterans' mental health issues to the forefront, and these should be addressed as part of a comprehensive pain management approach. DISCUSSION: Discussion of the COVID-19 pandemic during pain treatment counseling sessions highlighted negative and positive ways participants were affected by the pandemic. These discussions provided counselors with a unique opportunity to facilitate behavior change by focusing on characteristics of resilience to motivate individuals with chronic pain to adapt and adopt positive behaviors and outlooks to improve their pain experience and quality of life. CONCLUSIONS: Counselors can leverage feelings of resilience and personal growth to motivate veterans' use of adaptive coping skills and a wider array of pain management services.

Assessing the impact of the COVID-19 pandemic on pragmatic clinical trial participants.

Characterizing the impacts of disruption attributable to the COVID-19 pandemic on clinical research is important, especially in pain research where psychological, social, and economic stressors attributable to the COVID-19 pandemic may greatly impact treatment effects. The National Institutes of Health - Department of Defense - Department of Veterans Affairs Pain Management Collaboratory (PMC) is a collective effort supporting 11 pragmatic clinical trials studying nonpharmacological approaches and innovative integrated care models for pain management in veteran and military health systems. The PMC rapidly developed a brief pandemic impacts measure for use across its pragmatic trials studying pain while remaining broadly applicable to other areas of clinical research. Through open discussion and consensus building by the PMC's Phenotypes and Outcomes Work Group, the PMC Coronavirus Pandemic (COVID-19) Measure was iteratively developed. The measure assesses the following domains (one item/domain): access to healthcare, social support, finances, ability to meet basic needs, and mental or emotional health. Two additional items assess infection status (personal and household) and hospitalization. The measure uses structured responses with a three-point scale for COVID-19 infection status and four-point ordinal rank response for all other domains. We recommend individualized adaptation as appropriate by clinical research teams using this measure to survey the effects of the COVID-19 pandemic on study participants. This can also help maintain utility of the measure beyond the COVID-19 pandemic to characterize impacts during future public health emergencies that may require mitigation strategies such as periods of quarantine and isolation.

Optimizing the Impact of Pragmatic Clinical Trials for Veteran and Military Populations: Lessons From the Pain Management Collaboratory.

Pragmatic clinical trials (PCTs) are well-suited to address unmet healthcare needs, such as those arising from the dual public health crises of chronic pain and opioid misuse, recently exacerbated by the COVID-19 pandemic. These overlapping epidemics have complex, multifactorial etiologies, and PCTs can be used to investigate the effectiveness of integrated therapies that are currently available but underused. Yet individual pragmatic studies can be limited in their reach because of existing structural and cultural barriers to dissemination and implementation. The National Institutes of Health, Department of Defense, and Department of Veterans Affairs formed an interagency research partnership, the Pain Management Collaboratory. The partnership combines pragmatic trial design with collaborative tools and relationship building within a large network to advance the science and impact of nonpharmacological approaches and integrated models of care for the management of pain and common co-occurring conditions. The Pain Management Collaboratory team supports 11 large-scale, multisite PCTs in veteran and military health systems with a focus on team science with the shared aim that the "whole is greater than the sum of the parts." Herein, we describe this integrated approach and lessons learned, including incentivizing all parties; proactively offering frequent opportunities for problem-solving; engaging stakeholders during all stages of research; and navigating competing research priorities. We also articulate several specific strategies and their practical implications for advancing pain management in active clinical, "real-world," settings.

Coastal Cities Seen from Loyalty and Their Tourist Motivations: A Study in Lima, Peru

The objective of this empirical study is to determine: (a) the underlying variables of the travel motivations related to a coastal city;and (b) the motivational dimensions that predict return, recommendation, and saying positive things about a coastal city as loyalty variables. This project utilized an in situ investigation carried out in Lima, a coastal city located on the Pacific Ocean near Peru with important natural and cultural attractions. The researchers used 381 questionnaires that were analyzed through factor analysis, in addition to the stepwise multiple regression method. Reesults identified six underlying variables or motivational factors: “culture and nature”, “authentic coastal experience”, “novelty and social interaction”, “learning”, “sun and beach”, and “nightlife”. Regarding loyalty, the “novelty and social interaction” dimension is the most important predictor of return and the “authentic coastal experience” dimension is the most important predictor of recommending and saying positive things about a coastal city. To motivate a return, events could be created on the beach to motivate novelty, as well as increase recommendations and the amount of positive things said about the destination;educational and sports activities and workshops could also be created with the community and the coastal environment. Results can be used by firms for preparing information for new customers in order to increase trip intention and improve guides for destination marketing organizations (DMOs).

Factors for Implementation of Circular Economy in Firms in COVID-19 Pandemic Times: The Case of Peru

The circular economy can contribute to the eco-efficient use of resources. Firms can obtain relevant benefits if they implement a circular economy. In Peru, the circular economy would create benefits, but it is not fully clear what factors explain the acceptance of firms of implementing a circular economy. Following the theory of planned behavior, the current research assesses the influence of attitudes, subjective norms, perceived behavioral norms, intentions, and pressures on behaviors towards the circular economy. A total of 71 medium-size firms based in Peru participated in an online survey. Six questions were focused on general information, and forty-seven questions evaluated the circular economy behavior of firms. A partial least square structural equation modeling technical analysis was used. It was found that attitudes (0.144), subjective norms (0.133), and perceived behavioral control (0.578) had a positive influence on intentions;also, perceived behavioral control (0.461) had a positive influence on behaviors towards the circular economy. Finally, pressures had a positive influence (0.162) on behaviors towards the circular economy. The model explained 64.3% of the behaviors towards the circular economy. The outcomes of the bootstrapping test were used to evaluate if the path coefficients are significant. This study showed that attitudes, subjective norms, perceived behavioral norms, intentions, and pressures explained circular economy behaviors. This information can help firms develop strategies to move forward a circular economy and provide governments information about the current situation of circular economy implementation to generate new norms and strategies for more implementation of circular economy measures in enterprises. The novelty is based on using the PLS-SEM technique.

Influence of Technostress on Academic Performance of University Medicine Students in Peru during the COVID-19 Pandemic

The current study aims to validate and apply an instrument to assess the relationship between communication overload, social overload, technostress, exhaustion and academic performance. We performed a cross-sectional, analytical study of 2286 university medical students to assess the influence of technostress as a mediator of social media overload, communication overload and mental exhaustion and its detrimental effect on the academic performance of university students in Peru during the COVID-19 pandemic. The research model was validated using partial least square structural equation modeling (PLS-SEM) to establish the influence of variables on the model. Communication and social overload were found to positively influence technostress by correlations of 0.284 and 0.557, respectively. Technostress positively influenced exhaustion by 0.898, while exhaustion negatively influenced academic performance by -0.439. Bootstrapping demonstrated that the path coefficients of the research model were statistically significant. The research outcomes may help university managers understand students’ technostress and develop strategies to improve the balanced use of technology for their daily academic activities.

Prevalence, risk and protective factors of alcohol use disorder during the COVID-19 pandemic in U.S. military veterans.

BACKGROUND: There have been reports of increased alcohol consumption during the COVID-19 pandemic in the general population. However, little is known about the impact of the pandemic on the prevalence of alcohol use disorder (AUD), especially in high-risk samples such as U.S. military veterans. METHODS: Data were analyzed from the 2019-2020 National Health and Resilience in Veterans Study, which surveyed a nationally representative, prospective cohort of 3078 U.S. veterans. Pre-pandemic and 1-year peri-pandemic risk and protective factors associated with incident and chronic probable AUD were examined. RESULTS: A total of 6.9 % (n = 183) of veterans were classified as chronic probable AUD, 3.2 % (n = 85) as remitted from AUD, and 2.7 % (n = 71) as incident probable AUD during the pandemic; the prevalence of probable AUD in the full sample remained stable -10.1 % pre-pandemic and 9.6 % peri-pandemic. Younger age, greater pre-pandemic alcohol use severity, and COVID-related stressors were associated with incident AUD during the pandemic, whereas higher pre-pandemic household income was associated with lower risk of this outcome. Younger age, combat experience, lifetime substance use disorder, greater drug use severity, lower dispositional optimism, and more COVID-related worries and social restriction stress were associated with higher risk of chronic AUD. CONCLUSIONS: Nearly 1-in-10 US veterans screened positive for AUD 1-year into the pandemic; however, the pre- and 1-year peri-pandemic prevalence of probable AUD remained stable. Veterans who are younger, have served in combat roles, endorse more COVID-related stressors, and have fewer socioeconomic resources may be at higher risk for AUD during the pandemic.

Factors Affecting Green Entrepreneurship Intentions in Business University Students in COVID-19 Pandemic Times: Case of Ecuador

This research assesses the influence of education development support, conceptual development support, and country support through entrepreneurial self-efficacy over green entrepreneurial intentions. A total of 532 business students in Ecuador participated in an online survey. Eight questions were focused on demographic information, and twenty-seven questions evaluated the green entrepreneurship intentions of students. An SEM-PLS technical analysis was used. The results showed that educational support for developing entrepreneurship (0.296), conceptual support for developing entrepreneurship (0.123), and country support for entrepreneurship (0.188) had a positive influence on entrepreneurial self-efficacy, and that entrepreneurial self-efficacy had a positive influence (0.855) on gren entrepreneurial intentions. The model explained 73.1% of the green entrepreneurial intentions. Outcomes of the bootstrapping test were used to evaluate if the path coefficients are significant. This study showed the impacts of education development support, conceptual development support, and country support on the entrepreneur’s ability to carry out green entrepreneurship were positive. This information can help universities develop strategic plans to achieve ecological ventures and ensure students have the necessary skills to do so on campus. The research findings also may be helpful for the governments in establishing new norms to promote entrepreneurship. The novelty is based on using the partial least square structural equation modeling (PLS-SEM) technique.

The intertwined expansion of telehealth and buprenorphine access from a prescriber hub.

In this manuscript, we describe how efforts to increase access to buprenorphine for Opioid Use Disorder (OUD) through a telemedicine hub before and since the COVID-19 pandemic have played out in the Veterans Healthcare Administration (VHA) in New England. We look at how the COVID-19 pandemic and subsequent spike in opioid overdoses tilted the risk: benefit calculation for tele-prescribing a controlled substance such as buprenorphine toward expanding access to tele-buprenorphine. We conclude that there is a need for tele-buprenorphine hubs that can fill gaps in geographically dispersed healthcare systems.

Expectations and Interests of University Students in COVID-19 Times about Sustainable Development Goals: Evidence from Colombia, Ecuador, Mexico, and Peru

The coronavirus disease 2019 (COVID-19) pandemic has changed the world, creating the need for new actions from society, including universities and companies. The United Nations Sustainable Development Goals (SDGs) are part of a global agenda, but this priority is not significant to university students. Although some research has focused on SDGs and university students, there is a lack of evaluation and comparison in Latin American countries. The current study aims to evaluate student knowledge of the SDGs, the relation of student professional careers to the SDGs, the importance of the SDGs for economic development after the COVID-19 pandemic, and student interest research in SDG issues. The study is carried out with students in Colombia, Ecuador, Mexico, and Peru. The instrument was developed and validated. The highest score of level of knowledge was reported in Mexico and the lowest score in Colombia. This outcome can be explained by the availability of training programs in the universities about SDGs. The availability of programs created and promoted by the governments can also be a reason;however, students from Mexico are the ones who felt the most that the authorities are not making efforts to promote the SDGs. With research interests, interests in creating sustainable cities and communities, and responsible consumption and production were recognized for the four countries. The outcomes reveal several interesting insights through comparisons among the four countries considered according to descriptive analyses. Some SDGs were found to be more important for some countries than others. Interests were noted in research on some SDGs.

Screening, Brief Intervention, and Referral to Treatment for Pain Management for Veterans Seeking Service-Connection Payments for Musculoskeletal Disorders: SBIRT-PM Study Protocol.

BACKGROUND: Veterans with significant chronic pain from musculoskeletal disorders are at risk of substance misuse. Veterans whose condition is the result of military service may be eligible for a disability pension. Department of Veterans Affairs compensation examinations, which determine the degree of disability and whether it was connected to military service, represent an opportunity to engage Veterans in pain management and substance use treatments. A multisite randomized clinical trial is testing the effectiveness and cost-effectiveness of Screening, Brief Intervention, and Referral to Treatment for Pain Management (SBIRT-PM) for Veterans seeking compensation for musculoskeletal disorders. This telephone-based intervention is delivered through a hub-and-spoke configuration. DESIGN: This study is a two-arm, parallel-group, 36-week, multisite randomized controlled single-blind trial. It will randomize 1,100 Veterans experiencing pain and seeking service-connection for musculoskeletal disorders to either SBIRT-PM or usual care across eight New England VA medical centers. The study balances pragmatic with explanatory methodological features. Primary outcomes are pain severity and number of substances misused. Nonpharmacological pain management and substance use services utilization are tracked in the trial. SUMMARY: Early trial enrollment targets were met across sites. SBIRT-PM could help Veterans, at the time of their compensation claims, use multimodal pain treatments and reduce existing substance misuse. Strategies to address COVID-19 pandemic impacts on the SBIRT-PM protocol have been developed to maintain its pragmatic and exploratory integrity.