Qualitative study of the quality of sleep in marginalized individuals living with HIV.

Sleep disturbances have been reported to be higher in human immunodeficiency virus (HIV)-infected individuals compared to the general population. Despite the consequences of poor quality of sleep (QOS), research regarding sleep disturbances in HIV infection is lacking and many questions regarding correlates of poor QOS, especially in marginalized populations, remain unanswered. We conducted one-on-one qualitative interviews with 14 marginalized HIV-infected individuals who reported poor QOS to examine self-reported correlates of sleep quality and explore the relationship between QOS and antiretroviral adherence. Findings suggest a complex and multidimensional impact of mental health issues, structural factors, and physical conditions on QOS of these individuals. Those reporting poor QOS as a barrier to antiretroviral adherence reported lower adherence due to falling asleep or feeling too tired to take medications in comparison to those who did not express this adherence barrier. These interviews underscore the importance of inquiries into a patient's QOS as an opportunity to discuss topics such as adherence, depression, suicidal ideation, and substance use

Solving the Yang-Baxter Matrix Equation

The Yang-Baxter equation is one that has been widely used and studied in areas such as statistical mechanics, braid groups, knot theory, and quantum mechanics. While many sets of solutions have been found for this equation, it is still an open problem. In this project, I solve the Yang-Baxter matrix equation that is similar in format to the Yang-Baxter equation. I try to solve the corresponding Yang-Baxter matrix equation, ������=������, where X is an unknown ������ matrix, and ��=[0����0] or [0−��−��0], by using the Jordan canonical form to find infinitely many solutions

Sheroes: Feasibility and Acceptability of a Community-Driven, Group-Level HIV Intervention Program for Transgender Women.

Transgender women experience disproportionate risk of HIV acquisition and transmission. We piloted 'Sheroes', a peer-led group-level intervention for transgender women of any HIV status emphasizing empowerment and gender affirmation to reduce HIV risk behaviors and increase social support. Participants (N = 77) were randomized to Sheroes (n = 39) or a time- and attention-matched control (n = 38). Sheroes is 5 weekly group sessions; topics include sexuality, communication, gender transition, and coping skills. Control participants attended 5 weekly group movie sessions. At 6-month follow up, HIV-negative and unknown status Sheroes participants reported reductions in condomless intercourse and improved social support compared to control. Among participants living with HIV, both the control and intervention groups reduced their total number of sex partners; this change was sustained at 6-month follow-up for Sheroes participants but not for control participants relative to baseline. Sheroes was deemed highly feasible and acceptable to participants; findings support preliminary efficacy of Sheroes

Novel methods to estimate antiretroviral adherence: protocol for a longitudinal study.

BackgroundThere is currently no gold standard for assessing antiretroviral (ARV) adherence, so researchers often resort to the most feasible and cost-effective methods possible (eg, self-report), which may be biased or inaccurate. The goal of our study was to evaluate the feasibility and acceptability of innovative and remote methods to estimate ARV adherence, which can potentially be conducted with less time and financial resources in a wide range of clinic and research settings. Here, we describe the research protocol for studying these novel methods and some lessons learned.MethodsThe 6-month pilot study aimed to examine the feasibility and acceptability of a remotely conducted study to evaluate the correlation between: 1) text-messaged photographs of pharmacy refill dates for refill-based adherence; 2) text-messaged photographs of pills for pill count-based adherence; and 3) home-collected hair sample measures of ARV concentration for pharmacologic-based adherence. Participants were sent monthly automated text messages to collect refill dates and pill counts that were taken and sent via mobile telephone photographs, and hair collection kits every 2 months by mail. At the study end, feasibility was calculated by specific metrics, such as the receipt of hair samples and responses to text messages. Participants completed a quantitative survey and qualitative exit interviews to examine the acceptability of these adherence evaluation methods. The relationship between the 3 novel metrics of adherence and self-reported adherence will be assessed.DiscussionInvestigators conducting adherence research are often limited to using either self-reported adherence, which is subjective, biased, and often overestimated, or other more complex methods. Here, we describe the protocol for evaluating the feasibility and acceptability of 3 novel and remote methods of estimating adherence, with the aim of evaluating the relationships between them. Additionally, we note the lessons learned from the protocol implementation to date. We expect that these novel measures will be feasible and acceptable. The implications of this research will be the identification and evaluation of innovative and accurate metrics of ARV adherence for future implementation

Technology-Based Self-Care Methods of Improving Antiretroviral Adherence: A Systematic Review

Background: As HIV infection has shifted to a chronic condition, self-care practices have emerged as an important topic for HIV-positive individuals in maintaining an optimal level of health. Self-care refers to activities that patients undertake to maintain and improve health, such as strategies to achieve and maintain high levels of antiretroviral adherence. Methodology/Principal Findings: Technology-based methods are increasingly used to enhance antiretroviral adherence; therefore, we systematically reviewed the literature to examine technology-based self-care methods that HIV-positive individuals utilize to improve adherence. Seven electronic databases were searched from 1/1/1980 through 12/31/2010. We included quantitative and qualitative studies. Among quantitative studies, the primary outcomes included ARV adherence, viral load, and CD4+ cell count and secondary outcomes consisted of quality of life, adverse effects, and feasibility/ acceptability data. For qualitative/descriptive studies, interview themes, reports of use, and perceptions of use were summarized. Thirty-six publications were included (24 quantitative and 12 qualitative/descriptive). Studies with exclusive utilization of medication reminder devices demonstrated less evidence of enhancing adherence in comparison to multicomponent methods. Conclusions/Significance: This systematic review offers support for self-care technology-based approaches that may result in improved antiretroviral adherence. There was a clear pattern of results that favored individually-tailored, multi-functio

If someone cares about you, you are more apt to come around: improving HIV care engagement by strengthening the patient-provider relationship.

Purpose:The patient-provider relationship is a central factor that can promote or hinder long-term engagement in care among people living with chronic illnesses. In this paper, we explore characteristics of the patient-provider relationship that facilitated or hindered engagement in care among patients receiving care at HIV specialty clinics. Patients and methods:We conducted 6 focus group discussions with a total of 43 well-retained and less well-retained HIV+ patients in San Francisco, Seattle, and Birmingham, to elicit a wide range of perspectives on engagement in HIV care. Borrowing from the field of psychotherapy, we examined patient-provider relationship characteristics through the lens of the therapeutic alliance, and with regard to their therapeutic efficacy and impact on patient engagement. Results:The majority of participants emphasized how a strong patient-provider relationship defined by trust, intimacy, and collaboration promoted engagement, while a weak patient-provider relationship impeded engagement. Conclusion:We discuss practical strategies and therapeutic techniques that may be helpful to providers in building strong patient-provider relationship and contend that a strong patient-provider relationship is crucial for patients to feel cared for during clinical encounters, which can promote long-term and sustained engagement in HIV care

Influenza Vaccination of the Health Care Workforce: A Literature Review

Since 1981, the Centers for Disease Control and Prevention (CDC) has recommended that all health care workers (HCWs) receive an annual influenza vaccination. The Healthy People objectives aimed for 60% coverage of HCW influenza vaccination by 2010 and 90% coverage by 2020. Although influenza vaccine uptake among HCWs has trended upward over the past several years, the percentage of immunized HCWs has remained approximately 40% between 2004 and 2008. In order to complete the literature review, researchers identified and analyzed peer reviewed literature, news articles, professional organization position statements, and institutional policies published between 1991 and 2011. In the absence of evidence from the United States experience, materials relevant to Canada, France and the United Kingdom were reviewed. Defining Health Care Workers and Settings: The healthcare workforce could be individuals who have direct exposure or have the potential for indirect exposure to patients or infectious materials including: body substances, contaminated medical supplies and equipment, environmental surfaces or air. They may be paid or unpaid, an employee, contractor, volunteer, visitor, or student. Health care workers work in a broad range of institutional and community settings. Health Care Workers Impact Patient Safety: HCWs who have direct contact with patients are the primary source of infectious disease outbreaks in health-care facilities. During an average season, 23% of HCWs are infected with the virus, show mild symptoms, and continue to work despite being infectious. Over the past 30 years, nosocomial influenza outbreaks have been documented throughout the United States and abroad. Strategies to Encourage Voluntary Vaccination Among HCWs: Healthcare facilities, and government and professional organizations have developed and supported various strategies to encourage voluntary influenza vaccination among HCWs, including: 1) educational and promotional campaigns, 2) increased access to the seasonal influenza vaccine, 3) declination statements, and 4) health programs that incorporate several strategies. State–Mandated School Immunization and Exemption Policies: State laws that require vaccination as a condition for school attendance translate national recommendations into immunization practice. These laws have proven to be the most effective mechanism to protect children and their families from the effects of vaccine-preventable disease. Historical and modern examination of school vaccination laws provides a context for understanding the benefits of compulsory vaccination policy when applied to the health workforce. All jurisdictions include opt-out or exemption provisions that permit parents to refuse immunizations for their children for one of three reasons: 1) medical contraindication, 2) religious beliefs, or 3) personal, moral, or philosophical beliefs. Two jurisdictions employ declination statements as a fourth option to allow refusal. 1 Mandatory Influenza Vaccination Policies in Healthcare Facilities: Beginning in 2004, healthcare facilities and local health departments began to require influenza vaccination as a condition of employment. Currently, 87 facilities in 30 states and the District of Columbia have implemented HCW mandatory influenza vaccination programs. Professional and Government Organizations Position Statements Related to Health Care Worker Influenza Vaccination: Several professional, government, non-profit organizations have indicated their support of mandatory influenza vaccination of HCWs as the most effective strategy to protect patients. However, the largest health care union, representing several categories of the health care workforce, opposes mandatory influenza vaccination. Health Care Workers’ Attitudes and Beliefs Related to Influenza Vaccination: The workforce continues to present several common arguments against influenza vaccination, including: 1) fear, 2) a belief in popular myths and misinformation, and 3) inconvenience. However, others accept the vaccination as an effective method to protect themselves, their families, and their patients

A Systematic Review of Black American Same-Sex Couples Research: Laying the Groundwork for Culturally-Specific Research and Interventions

This article presents the findings of a systematic review of the empirical literature related to Black American same-sex couples (BASCs). We found 16 articles that met inclusion criteria. Most articles were published in journals that focused on interdisciplinary studies, HIV/AIDS, and couples and families’ studies. Approximately 63% of the articles reported external funding support. However, only one of these grants was awarded to a Black investigator. Articles predominately focused on BASCs composed of Black sexual minority men residing in major U.S. cities. Only 25% of the articles focused on couples where both partners were Black. Most studies were cross-sectional, used convenience samples, and were reported without mention of a theoretical framework that explicated the philosophical assumptions that guided the research. The articles focused on a range of topics such as resilience, relationship dynamics, couple level social support, rituals with extended families, and partner-health associations. The implications of these findings for advancing culturally-specific behavioral and social science health research and interventions with BASCs are presented

Collegiate Leadership Competition: Deliberate Practice Leading to Expertise

Deliberate practice (Ericsson & Pool, 2016), the scientific process often attributed to developing expertise, requires a well-developed field and a teacher who can design, provide, and facilitate purposeful activities that target specific goals related to performance in that field. Components of purposeful practice include (a) well-defined goals, often related to skills that others have figured out how to do; (b) timely, continuous, and specific feedback; (c) deliberate practice outside of one’s comfort zone; and (d) developing previously acquired skills through continuous improvement. USM students’ participation in Collegiate Leadership Competition (CLC) practice sessions include components of deliberate practice aimed toward the goal of developing expert leaders. Through intentional learning activities grounded in applied leadership and specific performance outcomes, CLC practices include innovative strategies for leading and influencing high performing teams, solving complex problems, improving intergroup communication skills, and enhancing critical thinking skills; and each learning activity concludes with focused debriefing sessions that include feedback from the instructor and peer students. While 10,000 hours of deliberate practice in a leadership environment may be unrealistic for most college students, the CLC facilitates an accessible alternative