Implementation costs of a multi-component program to increase human papillomavirus (HPV) vaccination in a network of pediatric clinics

Introduction: HPV vaccination is both a clinically and cost-effective way to prevent HPV-related cancers. Increased focus on preventing HPV infection and HPV-related cancers has motivated development of strategies to increase adolescent vaccination rates. This analysis estimates the average cost associated with implementing programs aimed at increasing HPV vaccination from the perspective of the clinic decision makers. As providers and healthcare organizations consider vaccination initiatives, it is important for them to understand the costs associated with implementing these programs. Methods: Healthcare provider assessment and feedback, reminders, and education; and parent education/reminder strategies were implemented in a large pediatric clinic network between October 2015 and February 2018 to improve HPV vaccination rates. A micro-costing method was used in 2018 to prospectively estimate program implementation costs with the clinic as the unit of analysis. A sensitivity analysis assessed the effects of variability in levels of participation. Results: Assessment and feedback reports and provider education were implemented among 51 clinics at average per clinic cost of $786 and$368 respectively. Electronic vaccination reminders were delivered to providers and parents at a per clinic cost of $824. The parent education implementation cost was$2,126 per clinic. Conclusion: The four complimentary HPV evidence-based strategies were delivered at a total cost of $157,534 or$4,749 per clinic, including staff training and participant recruitment, reaching 155,000 HPV vaccine eligible adolescents

Does Positive Psychology Coaching Improve Trainee Well-Being? Evidence from a Longitudinal Professional Development Coaching Program in a Cohort of Pediatric Trainees

Introduction: Trainee burnout is common and evidence supporting the effectiveness of well-being interventions for this population is limited. We studied the effect of a longitudinal coaching program grounded in positive psychology on measures of pediatric trainee well-being. Methods: Pediatric interns and fellows (n = 67) were enrolled in a positive psychology coaching program in 2017-2019. Pediatric faculty (n = 23) underwent training and were paired with trainees outside their field of interest. Trainees were surveyed at the beginning and end of the program to assess burnout and well-being, and key skills necessary to achieve well-being. Results: Thirty-one trainees completed the baseline survey and 30 completed the end of program survey. Professional fulfillment, as measured by the Professional Fulfillment Index, improved after participating in the coaching program (Cohen’s d = 0.33, p = 0.03). On bivariate analysis, ability to cope was positively correlated with gratitude (r = 0.49, p = 0.01), PERMA (r = 0.61, p = 0.001), and self-valuation (r = 0.46, p = 0.01), and negatively correlated with intolerance of uncertainty (r = -0.46, p = 0.01). Burnout was negatively correlated with professional fulfillment (r = -0.65, p \u3c 0.001) and self-valuation (r = -0.75, p \u3c 0.001). There was no deterioration in scores for trainees who participated in the coaching program. Conclusion: Our longitudinal coaching program was associated with improvement in pediatric trainees’ professional fulfillment, identified possible drivers of well-being on bivariate analysis, and may serve as a roadmap for development of well-being curricula. Our findings suggest that well-being is not merely the absence of burnout, and maintenance of well-being during training may be just as critical as improvement

An isoform of Dicer protects mammalian stem cells against multiple RNA viruses

In mammals, early resistance to viruses relies on interferons, which protect differentiated cells but not stem cells from viral replication. Many other organisms rely instead on RNA interference (RNAi) mediated by a specialized Dicer protein that cleaves viral double-stranded RNA. Whether RNAi also contributes to mammalian antiviral immunity remains controversial. We identified an isoform of Dicer, named antiviral Dicer (aviD), that protects tissue stem cells from RNA viruses—including Zika virus and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)—by dicing viral double-stranded RNA to orchestrate antiviral RNAi. Our work sheds light on the molecular regulation of antiviral RNAi in mammalian innate immunity, in which different cell-intrinsic antiviral pathways can be tailored to the differentiation status of cells