Stakeholder Analysis: Medicare Diabetes Prevention Program Awareness and Implementation

Study Design: We conducted a qualitative stakeholder analysis project with suppliers of the MDPP and health care providers. Am J Manag Care. 2023;29(6):In Press _____ Takeaway Points More than 5 years after CMS enacted coverage of the CDC-approved Medicare Diabetes Prevention Program (MDPP) in 2018, little is known about why MDPP uptake is so limited. * Findings of our stakeholder analysis with program suppliers and health care providers reinforced existing evidence on insufficient reimbursement and low awareness of the program. * Newer insights include recommendations about lagged payments, ongoing virtual delivery, and formally diagnosing prediabetes among MDPP participants. * Our findings on barriers and facilitators can inform policy to refine the MDPP and research on the MDPP, particularly within the field of implementation science. _____ Population-level strategies to prevent type 2 diabetes are urgently needed for the more than 24 million older adults with prediabetes in the United States.1 Evidence-based lifestyle interventions can prevent diabetes onset, per evidence from the landmark Diabetes Prevention Program trial.2 Thus, the CDC launched the National Diabetes Prevention Program (NDPP) in 2010.3 Significant reductions in weight and medical spending were observed among Medicare beneficiaries who participated in the NDPP,4 prompting CMS to fully cover the Medicare Diabetes Prevention Program (MDPP) starting in 2018.5 Despite unprecedented Medicare coverage for a disease prevention program, MDPP uptake is limited. Regarding awareness, national guidelines recommend referral to lifestyle intervention for adults aged 40 to 70 years with prediabetes.9 Yet less than 5% of adults eligible for a NDPP reported receiving a referral,10 which may stem from limited awareness among health care providers.11 Thus, we conducted a qualitative stakeholder analysis to learn about regional awareness of, referral to, facilitators of, and barriers to the MDPP. The 8 interviewees included 5 program directors (3 from YMCAs, 1 from a private organization, and 1 from a hospital system) and 3 health care providers (2 family physicians and 1 dietitian).

Covid-19: Trump fumes as adviser speaks out against lifting of US lockdowns

Tension between the Trump administration and its public health officials burst into the open this week, as President Donald Trump openly criticised his top infectious disease specialist, Anthony Fauci, for testifying in Congress against the reopening of states that have not met the administration's published criteria for ending their lockdowns.1 Dozens of mostly Republican controlled states are lifting restrictions despite failing grades on metrics such as new daily infections and percentage of positive test results. Maskless revellers filled bars across Wisconsin on the night of 13 May, as the state's conservative dominated Supreme Court struck down a lockdown imposed by Democratic governor Tony Evers. White House, April 16, 2020. https://www.whitehouse.gov/openingamerica/ 2 Dyer O. Covid-19: Trump says added deaths are necessary price for reopening US businesses.

Exploring Prenatal Care Quality and Access During the COVID-19 Pandemic Among Pregnant Immigrants in Philadelphia Through the Lens of Community-Based Organizations.

Background: The peak of the COVID-19 pandemic led to decreased maternal and child health care engagement, especially among marginalized populations. Existing disparities in prenatal care access and quality faced by pregnant immigrant people are likely to be amplified by the pandemic. Materials and Methods: We conducted a study with direct service providers (DSPs) at community-based organizations (CBOs) serving pregnant immigrant families in the Philadelphia region. Semistructured interviews addressed barriers and facilitators to prenatal health care access and engagement among immigrant families both before and then after the onset of the pandemic in March 2020. Additional questions elicited context about the demographics of service populations, organizational connectedness to health care providers, and pandemic-related operational changes. Results: Between June and November 2021, 10 interviews were conducted in English and Spanish with DSPs at 5 CBOs. Primary themes included diminished access and quality of care received due to decreased language accessibility, increased restrictions around support persons, shifts to telemedicine, and changes to appointment scheduling. Additional themes included heightened hesitancy engaging with services due to documentation status, confusion around legal rights, financial strain, and health insurance status. Interviewees provided suggestions for improving service access during and postpandemic for immigrant pregnant people, including implementation of culturally responsive group prenatal care, institutional policies to improve understanding of legal rights, and increased financial supports. Conclusions: Understanding emergent and exacerbated barriers to prenatal care access and quality during the COVID-19 pandemic provides context for how to improve health equity for immigrant pregnant people through public health and health care policies as the pandemic continues, and once it has subsided.

Vitamin D Levels in Hospitalized COVID-19 Patients

Background: Several studies suggest an association between serum Vitamin D levels and outcomes in patients diagnosed with COVID-19. Prevention measures for COVID-19 continue to be one of the best strategies to combat the virus but identification of individuals at high risk will help clinician's direct preventative care to reduce infections and improve outcomes. This work assesses the vitamin D levels of hospitalized COVID-19 patients at one community hospital in central Pennsylvania. Method(s): This prospective study, conducted on adult, hospitalized patients under the care of clinical nutrition services between April 2021 and April 2022. Inclusion criteria included age >18 years, COVID-19 positive by polymerase chain reaction (PCR) test with associated symptoms, and not receiving vitamin D supplementation prior to or during hospital admission (N = 122). Vitamin D 25 hydroxy laboratory values were obtained, and values were interpreted utilizing the recommended range categories: 25(OH)D level >= 30 ng/ml was representative of adequate vitamin D stores, while values between 21-29 ng/ml signified vitamin D insufficiency. A 25(OH)D value <20 ng/ml is indicative of vitamin D deficiency. Result(s): Over 77% (n = 95) of all patients included in study had vitamin D values below the recommended levels, with one half (n = 61) demonstrating vitamin D deficiency. Only 22.1% (n = 27) were found to have values consistent with a blood level deemed adequate. Conclusion(s): Many hospitalized patients with COVID-19 demonstrate vitamin D levels below acceptable ranges, many with vitamin D deficiencies. Identification of these individuals in the community will allow clinicians an opportunity to treat the vitamin insufficiency or deficiency with the goal of preventing infections and potential morbidity or mortality associated with the disease. (Figure Presented).

Infectious: Pathogens and How We Fight Them

Pennsylvania Department of Health, Harrisburg, Pennsylvania, USA;Pennsylvania State University College of Agriculture, University Park, Pennsylvania, USA Dobson AP, Carper ER. Infectious diseases and human population history: throughout history the establishment of disease has been a side effect of the growth of civilization. Nkuchia M. M'ikanatha Pennsylvania Department of Health, Harrisburg, Pennsylvania, USA;Pennsylvania State University College of Agriculture, University Park, Pennsylvania, USA

Changes in Service Access among People Who Inject Drugs in Philadelphia, 2018-2022

Background: The COVID-19 pandemic disrupted HIV prevention and treatment services, especially for structurally vulnerable individuals like many people who inject drugs (PWID). We sought to compare present levels of access to these services to their levels before the pandemic. Method(s): We used data from 2018 and 2022 collected through the National HIV Behavioral Surveillance (NHBS) survey among PWID in Philadelphia. Using generalized linear regression models, we estimated the associations between our exposure (year) and self-reported HIV testing, medical care, SSP access, PrEP use, and drug treatment in the year prior to interview. We calculated adjusted prevalence ratios (aPR) using multivariable models adjusted for age, race/ ethnicity, housing stability, and primary injecting drug. Result(s): There were 620 participants in 2018 and 604 in 2022 included in analyses. Compared to the 2018 sample, the 2022 sample was significantly older, non-Hispanic Black, and primarily injected drugs other than heroin. A significantly smaller proportion of participants in 2022 had a recent HIV test (57% vs. 71%), visited a health care provider (77% vs 82%), received sterile needles from an SSP (69% vs 75%), or participated in a drug treatment program (47% vs 54%). Between 2018 and 2022, PrEP awareness increased significantly (39% vs 54%) but PrEP use did not (3% vs 3%). In adjusted models, an 18% decrease in recent HIV testing was observed between 2018 and 2022 (aPR: 0.82;95% CI: 0.70-0.96). Among those who reported a recent HIV test, there was an 18% increase in testing in clinical settings observed between 2018 and 2022 (aPR: 1.18;95% CI: 1.10-1.26). Recent medical care, SSP access, PrEP use, and drug treatment were not associated with year in adjusted models. Conclusion(s): Access to a full range of social services is necessary for Ending the HIV Epidemic. These findings indicate that HIV prevention services, particularly HIV testing, among PWID have not rebound fully from the pandemic. Considering this and ongoing outbreaks of HIV among PWID, public health practitioners should closely monitor HIV testing frequency among PWID and prioritize expanding access to low-barrier HIV prevention and care services, especially in non-clinical settings.

Clinical Trials of Covid-19 Vaccines: Overcoming the Challenges

The COVID-19 pandemic has presented huge challenges to health care systems, the research community, and regulatory authorities worldwide. In recognition of the urgent need for safe and effective vaccines against this new coronavirus, the National Institutes of Health (NIH) worked with 5 manufacturers of promising vaccine candidates to mount the studies required to evaluate these vaccines and potentially support their deployment. The outcomes of the studies reported thus far have been far more successful than anyone would have imagined. In this session, perspectives on the issues raised in the COVID-19 vaccine development process under Operation Warp Speed will be shared by individuals playing a major role in the design, conduct, and analysis of these studies. We will hear from the lead company investigator of the Moderna trial, the first Operation Warp Speed trial to receive Emergency Use Authorization from the US Food and Drug Administration (FDA);from the NIH coordinator of the Data and Safety Monitoring Board (DSMB) convened to oversee all 5 trials;and from a member of that DSMB. SPEAKERS: Dr. Jacqueline Miller, Moderna, Inc., Lead company investigator for Moderna COVID-19 vaccine trial. Working title: Managing the evaluation of the data of a COVID-19 clinical trial: the manufacturer's perspective Dr. Sally Hunsberger, National Institute of Allergy & Infectious Diseases, NIH Coordinator of Data and Safety Monitoring Board for NIAO-sponsored trials of COVID-19 vaccines. Working title: Managing the evaluation of the data of a COVID-19 clinical trial: the NIH perspective Dr. Steven Joffe Department of Medical Ethics and Health Policy Perelman School of Medicine, University of Pennsylvania Member, NIAID COVID-19 vaccine trials Data and Safety Monitoring Board. Working title: Managing the evaluation of the data of a COVID- 19 clinical trial: a DSMB member's perspective.

Grisel's Syndrome and Covid Infection in Children: Report of Two Cases

Introduction: Grisel syndrome is a rare condition of rotator subluxation of the atlantoaxial joint that is not associated with trauma or bone lesion. It is characterized by acute and painful torticollis with fever, which is a consequence of complicated pharyngitis and tonsillitis. Material(s) and Method(s): We present two girls, aged 5 and 6 years, who developed atlantoaxial subluxation and torticollis during or after infection with COVID. As part of this, a pararetropharyngeal abscess developed. Based on clinical signs, radiological findings, and the course of the disease, Grisel's syndrome was confirmed. One patient had an asymptomatic COVID infection, before the development of Grisel's syndrome, and the other patient had an active COVID infection, during which Grisel's syndrome developed. Result(s): Both patients were treated multidisciplinary: conservatively with antibiotics and surgically, and then physical therapy was introduced along with the Philadelphia orthosis. Both were in constant clinical improvement and did not develop further complications. According to the literature, the Fielding-Hawkins classification describes 4 degrees of this subluxation, and our patients had type 3 at the time of diagnosis. Conclusion(s): Grisel's syndrome is a rare condition and should be suspected in children with painful torticollis after infections or head and neck surgery. The importance of this syndrome for maxillofacial surgeons is in early differential diagnosis, to avoid early and late consequences of undiagnosed pararetropharyngeal abscess and atlantoaxial subluxation and compression of vital structures. Grisel's syndrome needs to be treated multidisciplinary and immediately.

Differences in COVID-19-triggered pediatric asthma exacerbations across variant waves

Background: SARS-CoV-2 variants have differed in severity, but whether they are more or less likely to trigger asthma symptoms in children is unknown. Aim(s): To assess the likelihood of pediatric asthma exacerbations in the setting of COVID-19 across variant waves. Method(s): Using data from the UPMC Children's Hospital of Pittsburgh Emergency Department (ED) and the Western Pennsylvania COVID-19 Registry (WPACR), we compared outcomes among children with asthma in the pre-delta (01Jul20-30Jun21), delta (01Aug21-14Dec21), and omicron (15Dec21-15Jan22) waves. Result(s): Among 372 patients with asthma presenting with COVID-19 (pre-delta=202, delta=125, omicron=45), acute asthma exacerbations increased during omicron (respectively 24%, 31%, 91%;p<.001), including in subgroup analyses of children presenting to the ED (n=66, 67%, 87%, 100%;p=.02) and those followed by an asthma specialist (n=74, 29%, 50%, 75%;p=.003). COVID+ children with asthma were more likely to receive systemic steroids during omicron (12%, 20%, 42%;p<.001), including in subgroup analyses of those with an exacerbation (52%, 65%, 95%;p=.004). Among hospitalized COVID-positive children with asthma (n=49), hypoxia was more common during omicron (26%, 17%, 43%;p=.04). In addition, among 2150 ED encounters for asthma (predelta=1038, delta=949, omicron=163), a COVID+ test was significantly more frequent during omicron (3%, 2%, 12%;p<.001). Patients during delta were younger, with no other differences in sex or age across waves. Conclusion(s): The omicron variant is more likely to trigger pediatric asthma exacerbations than prior variants, supporting the need for ongoing surveillance of children with asthma who develop COVID-19.

Lympho-no: a happy ending to a mediastinal mass

Case Report: Mediastinal masses are rare with an incidence of 1 in 100 000 [1]. While the differential is broad, the risk of malignancy is higher in the pediatric population. Lymphomas account for about 50% of mediastinal masses [2].We present a patient with superior vena cava (SVC) syndrome from a mediastinal mass, concerning for lymphoma. After extensive work up, the mass was determined to be reactive. Case Presentation: A 5-year-old male, presented with one day of left sided face and neck swelling. Review of systemswas positive for a fewweeks of cough but notably negative for night sweats, fatigue, fever, or weight loss. Computed tomography (CT) scan (Figure 1, left) showed a heterogeneous mass, most concerning for lymphoma. Blood work was notable for lymphopenia (640 x 103/uL), elevated lactate dehydrogenase and uric acid (549 U/L and 7.1 mg/dL respectively). He tested positive for SARs- CoV2 RNA on nasopharyngeal PCR. Upon admission, he was started on methylprednisolone and allopurinol. A bone marrow biopsy and a lumbar puncture were unrevealing for immunophenotypic evidence of lymphoid neoplasm. A mediastinal biopsy showed fibrosis with patchy inflammation and inadequate number of viable cells to allow for flow cytometric analysis. A post-biopsy echocardiogram revealed a moderate sized pericardial effusion which eventually resolved. He was discharged with infectious disease and oncology follow up. Later, histoplasma and bartonella antibodies, and T spot were negative. A CT (Figure 1, right), ten days after initial presentation showed significant decrease in size of the mediastinal mass. At one month follow up, he remained clinically well with a normal chest x-ray. [Figure presented] Fig 1: A CT ten days after initial presentation showed significant decrease in size of the mediastinal mass Conclusion(s): This patient presented with SVC syndrome from a mediastinal mass that resolved with 3 days of intravenous steroids. The initial presumed diagnosis of lymphoma was ultimately inconsistent with the extensive workup, and the mass was ultimately deemed reactive. COVID-19 related mediastinal mass is not described in the literature, and although possible, remains unlikely. This case represents the importance of avoiding premature closure and keeping a broad differential diagnosis. 1. Park DR, Vallieres E. The mediastinal mass. Murray and Nadel's Textbook of Respiratory Medicine. 5th edn. Philadelphia, PA: Saunders;2010. pp. 1814-35. 2. Glick R. D., & La Quaglia M. P. (1999). Lymphomas of the anterior mediastinum. Seminars in Pediatric Surgery, 8(2),69-77.Copyright © 2023 Southern Society for Clinical Investigation.

The correlation of screen time with sleep quality: A cross-sectional study on undergraduate medical students

[5] Longer usage of mobile phones resulted in poorer sleep quality (delayed sleep phase, sleep duration, altered sleeping patterns, chronotype, and sleep quality), increased fatigue, and insomnia which, in turn, results in several mental health issues. [...]melatonin offers an alternative treatment to the currently available pharmaceutical therapies for sleep disorders with fewer side effects. The individuals who were undergoing medical treatment for any mental health disorders were excluded from the study. [...]sleep in multiple ways restores both normal levels of brain activity and normal "balance" among the different functions of the central nervous system.

Disputing Epidemics, Public Health, and Alternative Therapies in Latin American History

Villella reviews The Gray Zones of Medicine: Healers and History in Latin America edited by Diego Armus and Pablo F. Gomez, Compound Remedies: Galenic Pharmacy from the Ancient Mediterranean to New Spain by Paula S. De Vos and For All of Humanity: Mesoamerican and Colonial Medicine in Enlightenment Guatemala by Martha Few.

Objective screening for olfactory and gustatory dysfunction during the COVID-19 pandemic: a prospective study in healthcare workers using self-administered testing.

BACKGROUND: Smell and taste loss are highly prevalent symptoms in coronavirus disease 2019 (COVID-19), although few studies have employed objective measures to quantify these symptoms, especially dysgeusia. Reports of unrecognized anosmia in COVID-19 patients suggests that self-reported measures are insufficient for capturing patients with chemosensory dysfunction. OBJECTIVES: The purpose of this study was to quantify the impact of recent COVID-19 infection on chemosensory function and demonstrate the use of at-home objective smell and taste testing in an at-risk population of healthcare workers. METHODS: Two hundred and fifty healthcare workers were screened for possible loss of smell and taste using online surveys. Self-administered smell and taste tests were mailed to respondents meeting criteria for elevated risk of infection, and one-month follow-up surveys were completed. RESULTS: Among subjects with prior SARS-CoV-2 infection, 73% reported symptoms of olfactory and/or gustatory dysfunction. Self-reported smell and taste loss were both strong predictors of COVID-19 positivity. Subjects with evidence of recent SARS-CoV-2 infection (<45 days) had significantly lower olfactory scores but equivalent gustatory scores compared to other subjects. There was a time-dependent increase in smell scores but not in taste scores among subjects with prior infection and chemosensory symptoms. The overall infection rate was 4.4%, with 2.5% reported by PCR swab. CONCLUSION: Healthcare workers with recent SARS-CoV-2 infection had reduced olfaction and normal gustation on self-administered objective testing compared to those without infection. Rates of infection and chemosensory symptoms in our cohort of healthcare workers reflect those of the general public.

De‐prosecution and death: A reply to an imprecise and ideological critique

In an original article, I analyzed a potential causal link between the policy of de‐prosecution in Philadelphia and an increase in homicides. Utilizing the traditional synthetic control method with extensive descriptive data and a donor pool of the other 99 largest cities in the United States, the results demonstrated a statistically significant increase of over 74 homicides per year in Philadelphia during 2015‐19 associated with de‐prosecution (p<.05). A reaction essay addressing the original article on de‐prosecution has been submitted. In this reply, I correct inaccuracies in the reaction essay, explain the validity of methodological choices, discuss the reaction's misunderstanding of certain quantitative issues, and expose the ideological purposes of the reaction. In addition, I have included updated parallel research addressing the issue of de‐prosecution and examine the theoretical impact of the Covid‐19 pandemic on the interaction between de‐prosecution and homicides.

Establishing a Breastfeeding Consortium for Clinicians in Pediatric Outpatient Care

Creating a supportive environment for breastfeeding mothers in the primary care setting has been shown to improve breastfeeding rates and duration. An important aspect of establishing a breastfeeding-friendly practice is to engage and educate health care providers. To increase consistency of breastfeeding care and interventions across a large primary care network, we established an Ambulatory Breastfeeding Consortium (ABC) focused on information sharing and discussion centered on care of breastfeeding and lactating families. The COVID-19 pandemic further highlighted the need to share up-to-date education and guidance, and the importance of the role of primary care providers in breastfeeding support. The ABC has been effective in engaging primary care nurses and other clinicians and disseminating information while encouraging discussion on the importance of providing informed care to breastfeeding families. Although more breastfeeding-specific education is recommended for clinicians, the ABC serves as a model for primary care clinicians to improve their knowledge and provide support for families through education, shared experience, and awareness across many pediatric primary care network sites. Development of a breastfeeding consortium for ambulatory care clinics in the Children's Hospital of Philadephia primary care network including 31 sites across Pennsylvania and New Jersey is presented. Virtual monthly meetings and education facililtated clinicians knowledge on various breastfeeding topics. The consortium has been especially helpful during the COVID-19 pandemic as birthing hospitals discharge new mothers ealier than usual and often without full assessment of the breastfeeding couplet. Ongoing updates of information from the government and professional organizations were able to be shared with members of the interdisciplinary team.

Acupuncture for olfactory dysfunction in infected COVID-19 patients: Study protocol for a randomized, sham-controlled clinical trial

Background: Olfactory dysfunction (OD) is a common symptom of Corona Virus Disease 2019 (COVID-19). It is defined as the reduced or distorted ability to smell during sniffing (orthonasal olfaction) and represents one of the early symptoms in the clinical course of COVID-19 infection. A large online questionnaire-based survey has shown that some post-COVID-19 patients had no improvement 1 month after discharge from the hospital. Objective: To explore the efficacy of acupuncture for OD in COVID-19 infected patients and to determine whether acupuncture could have benefits over sham acupuncture for OD in post-COVID-19 patients. Methods: This is a single-blind, randomized controlled, cross-over trial. We plan to recruit 40 post-COVID-19 patients with smell loss or smell distortions lasting for more than 1 month. Qualified patients will be randomly allocated to the intervention group (real acupuncture) or the control group (sham acupuncture) at a 1:1 ratio. Each patient will receive 8 sessions of treatment over 4 weeks (Cycle 1) and a 2-week follow-up. After the follow-up, the control group will be subjected to real acupuncture for another 4 weeks (Cycle 2), and the real acupuncture group will undergo the 4-week sham acupuncture. The primary outcomes will be the score changes on the questionnaire of olfactory functioning and olfaction-related quality of life at week 6, 8, 12, and 14 from the baseline. The secondary outcomes will be the changes in the olfactory test score at week 6 and 12 from the baseline measured by using the Traditional Chinese version of the University of Pennsylvania Smell Identification Test (UPSIT-TC). Discussion: The results of this trial will help to determine the effectiveness of acupuncture for OD in post-COVID-19 patients. This may provide a new treatment option for patients.

Alcohol, nicotine, and COVID-19: A retrospective study of health outcomes in central Pennsylvania.

Individuals with substance abuse disorder are at increased risk for the development of severe disease following COVID-19 infection. Furthermore, individuals in rural populations where access to healthcare is limited and rates of substance abuse tend to be higher are at increased risk compared to other regions. The Penn State Health Network serves 29 counties in central Pennsylvania that are largely rural. The current study assessed the electronic medical records for individuals in this population that were reported as having alcohol dependence, nicotine dependence or both (co-users) in addition to individuals with no history of drug use and the rate of developing primary and secondary health outcomes following COVID-19 infection. All patients in this study were determined to be COVID+ while in care. We found that overall, risk for requiring ventilation, developing pneumonia, and mortality within 30 days of diagnosis all increased with any substance use history, across both males and females and across all age groups. Moreover, rates of these outcomes were considerably higher in patients that were both alcohol and nicotine dependent suggesting additive effects of co-use. Rates of secondary effects also increased substantially across all use categories with these patients showing greater risk of developing liver, kidney, and pancreas maladies compared to patients with no history of substance use. Taken together, these findings reinforce previous studies showing that substance use increases the risks of significant disease following COVID-19 infection, giving insights into the health disparities that exist in rural populations.

Geographic variations in opioid overdose patterns in Pennsylvania during the COVID-19 pandemic.

The convergence of the opioid epidemic and the COVID-19 pandemic has created new health challenges throughout the United States. Since the onset of the pandemic, media attention and scholarly research have drawn attention to the intersections of addiction and COVID-19. However, there remain few empirical studies that examine the direct impacts of the COVID-19 pandemic for opioid overdose patterns. Even fewer have integrated quantitative and qualitative methods to detail the place-specific dynamics shaping opioid overdose and addiction treatment during the COVID-19 pandemic. This article measures and maps change in the age-adjusted rate of opioid-related overdose incidents at the county level from 2018 to 2020. These analyses are combined with interviews conducted since December 2020 with public health providers in the state of Pennsylvania to identify the key factors influencing opioid misuse and transformations in addiction treatment practices.

Pandemic effects on social capital and loneliness in residents and non-residents of Chinese immigrant enclaves in Philadelphia

The COVID-19 pandemic profoundly affected cancer prevention behaviors and cancer care. Social capital is also thought to affect cancer prevention and care, with some observed improvements in well being and survival among cancer patients. Residents of immigrant enclaves are thought to have more social capital than non-residents, potentially buffering against negative effects of the pandemic. We compared residents and non-residents of Chinese immigrant enclaves in Philadelphia with respect to their social capital and loneliness and change in these factors from before to during the pandemic. Participants were 520 Chinese immigrant men and women aged 3565 y. Baseline interviews conducted 9/18-01/20 included questions on residence and demographics, structural and cognitive social capital (short version of the Adapted Social Capital Assessment Tool (SASCAT)), and a validated 3-item loneliness scale. The SASCAT includes questions on membership in neighborhood groups, receiving support from specific individuals (e.g., family, neighbors, friends), and cognitive social capital representing perceived levels of trust and belonging in the neighborhood. In May-July 2020, 419 participants completed a follow-up interview that included the SASCAT and loneliness scales. Participants were categorized as residing in a traditional, emerging, or non-enclave neighborhood depending on the ethnic density of their census tract and adjacent tracts. At baseline there were no significant differences in social capital or loneliness across neighborhood types. During the pandemic, participants regardless of neighborhood type reported declines in group membership (18% baseline vs. 11% pandemic) and loneliness (25% vs. 12%), and increases in cognitive social capital (85% vs. 99%) and receiving support from individuals (35% vs. 69%) (all p<0.001). However, extent of change differed by neighborhood, resulting in significantly less loneliness among residents of traditional enclaves (5%) than in emerging (14%) and non-enclave (16%) residents (p=0.02) during the pandemic. Multivariate analyses using generalized estimating equation models indicated that residents of traditional enclaves experienced a larger decrease in loneliness than other participants (interaction p=0.009), and that residents of traditional and emerging enclaves experienced a larger increase in cognitive social capital than residents of non-enclaves (interaction p=0.03). Our findings provide evidence that while the pandemic may have effected declines in group membership in this sample of Chinese immigrants, it was associated with increases in other forms of social capital and with a decrease in loneliness, particularly among enclave residents. These findings suggest the importance of clarifying how social capital derived from interacting within an immigrant enclave might be leveraged to counter the effects of a community stressor such as the COVID-19 pandemic, and used towards positive cancer outcomes in these communities.

The Advocacy Efforts for School Library Staffing during the Pandemic

Amid the ongoing pandemic, school librarians across the country have been facing a different kind of battle, one that has been going on for years in some cases: the fight for every student to benefit from the instruction and carefully curated resources a certified school librarian can provide. Several states are working to introduce or retain legislation that requires a certified school librarian in every school building. States across the country have seen a decrease in certified school librarian staffing. In some districts, positions have been reduced dramatically or cut entirely despite research showing the benefits students, staff, and the entire school community receive from these specifically trained educators. State school library associations are working diligently with lawmakers, fellow state-level education organizations, and national-level partners to advocate on behalf of their students. This article are the stories from Arizona, Michigan, Nebraska, New Jersey, and Pennsylvania about their states' fights for the right of every student to receive the services provided by a certified school librarian.