Evaluating the Impact of Strategies for Tuberculosis Prevention and Control in High-Burden, Low-Resource Settings: Data for Evidence-Based Decision-Making in Local Contexts

Background: While incidence rates of tuberculosis (TB) are on the decline globally, the TB burden in sub-Saharan Africa and Southeast Asia remains high. If the goal of reducing the global TB incidence rate to < 10/100,000 population per year is to be achieved by 2035, additional TB control interventions will need to be deployed in high burden settings. Research is needed to identify effective, efficient interventions that prevent additional TB cases, identify and properly diagnose incident cases, as well as to provide timely, appropriate treatment and ensure treatment completion. We sought to evaluate several TB control interventions as implemented in local contexts, including a household contact tracing in rural South Africa, a cost-effectiveness analysis of interferon-γ release assays (IGRAs) in India, and predictors of isoniazid preventive therapy (IPT) completion in rural Malawi. This research aims to provide data for policy-makers and government officials tasked with the deployment of scarce TB control resources in local contexts, with the goal of identifying strategies to integrate TB case finding and prevention activities into programs with limited resources. Methods: We recruited 130 newly diagnosed TB patients (“index cases”) from public clinics in Vhembe District, Limpopo Province, South Africa, and visited their homes to test their household contacts for TB via sputum smear microscopy and culture. Clinical and demographic characteristics, including HIV status, were assessed via self-report. We calculated the yield of previously undiagnosed TB disease among household contacts (defined as the number of new TB cases identified for every 100 index cases traced) and evaluated risk factors for TB disease among household contacts using multilevel logistic regression. Next we evaluated the incremental cost-effectiveness of IGRAs compared to a base-case scenario of empirical diagnosis (without microbiological testing), as well as sputum smear microscopy and Xpert MTB/RIF. We performed our analysis from the perspective of the Indian TB Control Program, and evaluated the cost, disability-adjusted life years, deaths, and secondary cases averted, and false positive diagnoses resulting from the use of these diagnostics in a hypothetical cohort of 1 million adult Indian TB suspects. We performed one-way sensitivity analyses, as well as a probabilistic sensitivity analysis to generate uncertainty ranges around our estimates. Finally we evaluated factors associated with IPT completion in a cohort of 974 newly diagnosed adult HIV patients in Malawi who were started on IPT after active TB disease was excluded. Participants were recruited as part of a larger cluster randomized trial of TB screening being conducted in 12 clinics across rural Malawi. IPT completion was defined as receipt of ≥150 doses of isoniazid during routine clinical visits. We assessed factors associated with IPT completion using a multilevel logistic regression model adjusted for patient clinical and demographic characteristics. Results: A total of 282 household contacts were enrolled in our household contact tracing study between December 1, 2013 and September 30, 2014. A total of 11 individuals tested positive for TB disease, for a household TB disease prevalence of 3.9% (95% CI: 2.0-6.9%) and a yield of 8.5 cases per 100 index cases traced (95% CI: 4.2-15.1). The majority of TB cases identified by the study (10/11, 90.9%) were smear-negative/culture-positive. The presence of TB symptoms was not significantly associated with increased odds of active TB disease in our population (aOR: 0.3, 95% CI: 0.1-1.4). Our cost-effectiveness analysis found that IGRAs were less cost-effective than sputum smear microscopy or Xpert MTB/RIF when diagnosing active TB in India. This was largely due to the poor specificity of IGRAs for active TB in a setting with high background rates of latent TB infection. Relative to sputum smear microscopy, IGRAs resulted in 315,700 (95% uncertainty range [UR]: 118,300 – 388,400) false-positive TB diagnoses, at an incremental cost of US$49.3 million (95$34.9 - $58.0 million) per 1 million population tested. Relative to Xpert MTB/RIF (including the cost of treating drug resistant TB), IGRAs averted 70,400 (95$14.6 million (95% UR: [-$7.2] -$28.7 million) more. In Malawi, 732 of the 974 (75%) individuals who started IPT completed their course of therapy. Individuals completing IPT were significantly older than non-completers (34 vs. 31, p2 months (7.1% vs. 80%, p=0.01). After controlling for potential confounders, participants younger than 25 years (compared to those over 45 years, aOR: 0.33, 95% CI: 0.18-0.60) and males (compared to non-pregnant women, aOR: 0.57, 95% CI: 0.37-0.88) had significantly lower odds of IPT completion. Concomitant receipt of ART drugs, being a current or former smoker, and self-reported alcohol use were not significantly associated with IPT completion in our study. Discussion: Identification of effective and cost-effective interventions operationalizing case finding and prevention of TB will be vital in controlling TB and meeting ambitious global targets by 2035, especially in high-burden settings. We evaluated potential prevention and case-finding interventions in local settings, providing data useful to TB control programs and governments in sub-Saharan Africa and Southeast Asia, where high TB burdens and scarce resources present substantial challenges to meeting global TB control targets

Keeping PACE With 21st Century Healthcare: A Framework for Telehealth Research, Practice, and Program Evaluation in Occupational Therapy

The use of telehealth to deliver occupational therapy services rapidly expanded during the COVID-19 pandemic. There are frameworks to evaluate services delivered through telehealth; however, none are specific to occupational therapy. Therefore, occupational therapy would benefit from a framework to systematically evaluate components of telehealth service delivery and build evidence to demonstrate the distinct value of occupational therapy.&nbsp; The PACE Framework outlines four priority domains to address areas of need: (1) Population and Health Outcomes; (2) Access for All Clients; (3) Costs and Cost Effectiveness; and (4) Experiences of Clients and Occupational Therapy Practitioners. This article describes the development and expert reviewer evaluation of the PACE Framework. In addition, the PACE Framework’s domains, subdomains, and outcome measure examples are described along with future directions for implementation in occupational therapy research, practice, and program evaluation.&nbsp

Unionists prefer dominant leaders

Kristen K. Knowles - ORCID 0000-0001-9664-9055 https://orcid.org/0000-0001-9664-9055Voters rely on many cues to make decisions about who to vote for, and the appearance of a potential leader can play an important part in this decision-making process. When choosing leaders, it is thought that voters make “fit-to-task” voting decisions, for example, exhibiting a preference for masculine-looking leaders in hypothetical wartime scenarios, when masculine behavioural characteristics would be most valued. Here, we examine face preferences within a sample of Scottish voters during the campaign for the 2014 Scottish independence referendum. Subjects were presented with masculinised and feminised versions of faces in a forced-choice experimental task to select their preferred face in a hypothetical national election. No voters (those who voted to maintain the Union) chose more masculine-faced hypothetical leaders than Yes voters (those who voted in favour of an independent Scotland); effect sizes observed were medium. Within Yes voters, economic concern was related to a preference for masculine faces, but for No voters, economic outlook did not relate to face preferences. These findings underscore the importance of real-world socio-political contexts in psychology research, particularly that concerning the public perception of different leadership prototypes. Implications in the current Scottish context are discussed.https://doi.org/10.3366/scot.2019.029728pubpub

Physical activity and social connectedness interventions in outdoor spaces among children and youth: A rapid review

Introduction: The rise in sedentary behaviour, coupled with the decline in overall mental health among Canadian children and youth in recent decades, demonstrates a clear need for applied research that focusses on developing and evaluating cross-disciplinary interventions. Outdoor spaces provide opportunities for physical activity and social connectedness, making them an ideal setting to address these critical health concerns among children and youth. Methods: We conducted a rapid review of peer-reviewed (n = 3096) and grey literature (n = 7) to identify physical activity and/or social connectedness outdoor space interventions targeted at children and youth (19 years and under) in Australia and New Zealand, Canada, Europe and the United States. We determined if interventions were effective by analyzing their research design, confidence intervals and reported limitations, and then conducted a narrative synthesis of the effective interventions. Results: We found 104 unique studies, of which 70 (67%) were determined to be effective. Overall, 55 interventions targeted physical activity outcomes, 10 targeted social connectedness outcomes and 5 targeted both. Play (n = 47) and contact with nature (n = 25) were dominant themes across interventions, with most taking place in a school or park. We report on the identifying features, limitations and implications of these interventions. Conclusion: The incorporation of natural and play-focussed elements into outdoor spaces may be effective ways to improve physical activity and social connectedness. There is a considerable need for more Canadian-specific research. Novel methods, such as incorporating smartphone technology into the design and evaluation of these interventions, warrant consideration

Safety, tolerability, and pharmacokinetics of l‐ornithine phenylacetate in patients with acute liver injury/failure and hyperammonemia

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/142428/1/hep29621.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/142428/2/hep29621-sup-0001-suppinfo1.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/142428/3/hep29621_am.pd

A Call to Action: Taking the Untenable out of Women Professors’ Pregnancy, Postpartum, and Caregiving Demands

Despite becoming increasingly represented in academic departments, women scholars face a critical lack of support as they navigate demands pertaining to pregnancy, motherhood, and child caregiving. In addition, cultural norms surrounding how faculty and academic leaders discuss and talk about tenure, promotion, and career success have created pressure for women who wish to grow their family and care for their children, leading to questions about whether it is possible for these women to have a family and an academic career. The current paper is a call to action for academia to build structures that support women professors as they navigate the complexities of pregnancy, the postpartum period, and the caregiving demands of their children. We specifically call on those of us in I-O psychology, management, and related departments to lead the way. In making this call, we first present the realistic, moral, and financial cases for why this issue needs to be at the forefront of discussions surrounding success in the academy. We then discuss how in the U.S. and elsewhere, an absence of policies supporting women places two groups of academics—department heads (as the leaders of departments who have discretion outside of formal policies to make work better for women) and other faculty members (as potential allies both in the department and within our professional organizations)—in a critical position to enact support and change. We conclude with our boldest call—to make a cultural shift that shatters the assumption that having a family is not compatible with academic success. Combined, we seek to launch a discussion that leads directly to necessary and overdue changes in how women scholars are supported in academia

Use of Objective Structured Clinical Examination (OSCE) in a hybrid digital / in-person training for hormonal IUD in Nigeria: findings and applications of the approach [version 1; peer review: 2 approved]

Background: The hormonal intrauterine device, a long-acting reversible contraceptive method, is being introduced to pilot sites in the private and public sector in Nigeria by the Nigerian Federal Ministry of Health since 2019. To inform training of health care providers, a study was conducted on a hybrid digital and in-person training which utilized Objective Structured Clinical Examination (OSCE) to assess competency of provider trainees. This study represents one of few documented experiences using OSCE to assess the effectiveness of a digital training. Methods: From September – October 2021, in Enugu, Kano and Oyo states of Nigeria, 62 health care providers from public and private sector health facilities were trained in hormonal IUD service provision using a hybrid digital / in-person training approach. Providers, who were skilled in provision of copper IUD, underwent a didactic component using digital modules, followed by an in-person practicum, and finally supervised service provision in the provider trainee’s workplace. Skills were assessed using OSCE during the one-day practicum.  Results: Use of the OSCE to assess skills provided valuable information to study team. The performance of provider trainees was high (average 94% correct completion of steps in the OSCE).  Conclusions: OSCE was used as a research methodology as part of this pilot study; to date, OSCE has not been integrated into the training approach to be scaled up by FMOH. Uniformly high performance of provider trainees was seen on the OSCE, unsurprising since provider trainees were experienced in providing copper IUD. If and when training is rolled out to providers inexperienced with copper IUD, OSCE may have a more important role to assess skills before service provision. The role of OSCE in design of hybrid digital / in-person training approaches should be further explored in rollout of hormonal IUD and other contraceptive technologies

Advancing HIV research with pregnant women: navigating challenges and opportunities

Concerns about including pregnant women in research have led to a dearth of evidence to guide safe and effective treatment and prevention of HIV in pregnancy. To better understand why these evidence gaps persist and inform guidance for responsible inclusion of pregnant women in the HIV research agenda, we aimed to learn what HIV experts perceive as barriers and constraints to conducting this research

Prophylactic evaluation of verubecestat on disease- and symptom-modifying effects in 5XFAD mice.

Introduction: Alzheimer\u27s disease (AD) is the most common form of dementia. Beta-secretase (BACE) inhibitors have been proposed as potential therapeutic interventions; however, initiating treatment once disease has significantly progressed has failed to effectively stop or treat disease. Whether BACE inhibition may have efficacy when administered prophylactically in the early stages of AD has been under-investigated. The present studies aimed to evaluate prophylactic treatment of the BACE inhibitor verubecestat in an AD mouse model using the National Institute on Aging (NIA) resources of the Model Organism Development for Late-Onset Alzheimer\u27s Disease (MODEL-AD) Preclinical Testing Core (PTC) Drug Screening Pipeline. Methods: 5XFAD mice were administered verubecestat ad libitum in chow from 3 to 6 months of age, prior to the onset of significant disease pathology. Following treatment (6 months of age), in vivo imaging was conducted with 18F-florbetapir (AV-45/Amyvid) (18F-AV45) and 18-FDG (fluorodeoxyglucose)-PET (positron emission tomography)/MRI (magnetic resonance imaging), brain and plasma amyloid beta (Aβ) were measured, and the clinical and behavioral characteristics of the mice were assessed and correlated with the pharmacokinetic data. Results: Prophylactic verubecestat treatment resulted in dose- and region-dependent attenuations of 18F-AV45 uptake in male and female 5XFAD mice. Plasma Aβ40 and Aβ42 were also dose-dependently attenuated with treatment. Across the dose range evaluated, side effects including coat color changes and motor alterations were reported, in the absence of cognitive improvement or changes in 18F-FDG uptake. Discussion: Prophylactic treatment with verubecestat resulted in attenuated amyloid plaque deposition when treatment was initiated prior to significant pathology in 5XFAD mice. At the same dose range effective at attenuating Aβ levels, verubecestat produced side effects in the absence of improvements in cognitive function. Taken together these data demonstrate the rigorous translational approaches of the MODEL-AD PTC for interrogating potential therapeutics and provide insight into the limitations of verubecestat as a prophylactic intervention for early-stage AD

Student Compostiton Recital

Kennesaw State University School of Music presents Student Composition Recital.https://digitalcommons.kennesaw.edu/musicprograms/1390/thumbnail.jp