Engaging Community-Based Organizations to Address Barriers in Public Health Programs: Lessons Learned From COVID-19 Vaccine Acceptance Programs in Diverse Rural Communities

Factors such as geography, community hesitancy, the political landscape, and legislative efforts to limit public health authority have contributed to a disproportionate number of COVID-19 infections and deaths in US rural communities. Community-based organizations are trusted entities that provide social and educational services in the communities where they live and have proven to be effective public health partners in response to the COVID-19 pandemic. Recognizing the unique challenges faced by rural communities, coupled with higher rates of vaccine hesitancy, the CDC Foundation awarded grants to 21 community-based organizations serving rural communities in 7 Midwest states to support the equitable uptake and distribution of COVID-19 vaccines. In this case study, 2 grantees, the Missouri Center for Public Health Excellence and the Hmong American Center, provide case studies that document their experiences, challenges, and strategies for overcoming barriers during the implementation of COVID-19 vaccine acceptance projects in diverse rural communities. These case studies provide key lessons learned that can be applied to future public health emergency and nonemergency responses to ensure that all members of communities are served well and protected.

Patient acceptability and usability of a self-administered electronic patient-reported outcome assessment in HIV care: relationship with health behaviors and outcomes

We assessed acceptability/usability of tablet-based patient-reported outcome (PRO) assessments among patients in HIV care, and relationships with health outcomes using a modified Acceptability E-Scale (AES) within a self-administered PRO assessment. Using multivariable linear regression, we measured associations between patient characteristics and continuous combined AES score. Among 786 patients (median age=48; 91% male; 49% white; 17% Spanish-speaking) overall mean score was 26/30 points (SD: 4.4). Mean scores per dimension (max 5, 1=lowest acceptability, 5=highest): ease of use 4.7, understandability 4.7, time burden 4.3, overall satisfaction 4.3, helpfulness describing symptoms/behaviors 4.2, and enjoyability 3.8. Higher overall score was associated with race/ethnicity (+1.3 points/African-American patients (95%CI:0.3-2.3); +1.6 points/Latino patients (95%CI:0.9-2.3) compared to white patients). Patients completing PROs in Spanish scored +2.4 points on average (95%CI:1.6-3.3). Higher acceptability was associated with better quality of life (0.3 points (95%CI:0.2-0.5)) and adherence (0.4 points (95%CI:0.2-0.6)). Lower acceptability was associated with: higher depression symptoms (-0.9 points (95%CI:-1.4 to -0.4)); recent illicit opioid use (-2.0 points (95%CI:-3.9 to -0.2)); multiple recent sex partners (-0.8 points (95%CI:-1.5 to -0.1)). While patients endorsing depression symptoms, recent opioid use, condomless sex, or multiple sex partners found PROs less acceptable, overall, patients found the assessments highly acceptable and easy to use.

Provider perceptions of the value of same-day, electronic patient-reported measures for use in clinical HIV care

Strong evidence suggests that patient-reported outcomes (PROs) aid in managing chronic conditions, reduce omissions in care, and improve patient-provider communication. However, provider acceptability of PROs and their use in clinical HIV care is not well known. We interviewed providers (n = 27) from four geographically diverse HIV and community care clinics in the US that have integrated PROs into routine HIV care, querying perceived value, challenges, and use of PRO data. Perceived benefits included the ability of PROs to identify less-observable behaviors and conditions, particularly suicidal ideation, depression, and substance use; usefulness in agenda setting prior to a visit; and reduction of social desirability bias in patient-provider communication. Challenges included initial flow integration issues and ease of interpretation of PRO feedback. Providers value same-day, electronic patient-reported measures for use in clinical HIV care with the condition that PROs are (1) tailored to be the most clinically relevant to their population; (2) well integrated into clinic flow; and (3) easy to interpret, highlighting chief patient concerns and changes over time.

Lessons learned from the design and implementation of myocardial infarction adjudication tailored for HIV clinical cohorts

We developed, implemented, and evaluated a myocardial infarction (MI) adjudication protocol for cohort research of human immunodeficiency virus. Potential events were identified through the centralized Centers for AIDS Research Network of Integrated Clinical Systems data repository using MI diagnoses and/or cardiac enzyme laboratory results (1995-2012). Sites assembled de-identified packets, including physician notes and results from electrocardiograms, procedures, and laboratory tests. Information pertaining to the specific antiretroviral medications used was redacted for blinded review. Two experts reviewed each packet, and a third review was conducted if discrepancies occurred. Reviewers categorized probable/definite MIs as primary or secondary and identified secondary causes of MIs. The positive predictive value and sensitivity for each identification/ascertainment method were calculated. Of the 1,119 potential events that were adjudicated, 294 (26%) were definite/probable MIs. Almost as many secondary (48%) as primary (52%) MIs occurred, often as the result of sepsis or cocaine use. Of the patients with adjudicated definite/probable MIs, 78% had elevated troponin concentrations (positive predictive value = 57%, 95% confidence interval: 52, 62); however, only 44% had clinical diagnoses of MI (positive predictive value = 45%, 95% confidence interval: 39, 51). We found that central adjudication is crucial and that clinical diagnoses alone are insufficient for ascertainment of MI. Over half of the events ultimately determined to be MIs were not identified by clinical diagnoses. Adjudication protocols used in traditional cardiovascular disease cohorts facilitate cross-cohort comparisons but do not address issues such as identifying secondary MIs that may be common in persons with human immunodeficiency virus.

Development and usability testing of a web-based cancer symptom and quality-of-life support intervention

The feasibility and acceptability of computerized screening and patient-reported outcome measures have been demonstrated in the literature. However, patient-centered management of health information entails two challenges: gathering and presenting data using "patient-tailored" methods and supporting "patient-control" of health information. The design and development of many symptom and quality-of-life information systems have not included opportunities for systematically collecting and analyzing user input. As part of a larger clinical trial, the Electronic Self-Report Assessment for Cancer-II project, participatory design approaches were used to build and test new features and interfaces for patient/caregiver users. The research questions centered on patient/caregiver preferences with regard to the following: (a) content, (b) user interface needs, (c) patient-oriented summary, and (d) patient-controlled sharing of information with family, caregivers, and clinicians. Mixed methods were used with an emphasis on qualitative approaches; focus groups and individual usability tests were the primary research methods. Focus group data were content analyzed, while individual usability sessions were assessed with both qualitative and quantitative methods. We identified 12 key patient/caregiver preferences through focus groups with 6 participants. We implemented seven of these preferences during the iterative design process. We deferred development for some of the preferences due to resource constraints. During individual usability testing (n = 8), we were able to identify 65 usability issues ranging from minor user confusion to critical errors that blocked task completion. The participatory development model that we used led to features and design revisions that were patient centered. We are currently evaluating new approaches for the application interface and for future research pathways. We encourage other researchers to adopt user-centered design approaches when building patient-centered technologies.

Pasteurization of chicken litter with steam and quicklime to reduce Salmonella Typhimurium

The nursery industry pasteurizes soil with steam and quicklime to reduce plant pathogens. The mechanism of action for quicklime is the resulting exothermic reaction that occurs when the chemical interacts with water and its ability to increase pH levels. These treatments may also reduce pathogens in a commercial poultry house. In this study, a steam sterilization cart simulated conditions used by the nursery industry to treat litter inoculated with Salmonella enterica serovar Typhimurium. A homogenized sample of litter was exposed to steam for 0, 5, 30, or 120 min. Quicklime was used at concentrations of 0 (control), 2.5, 5.0, or 10.0%. All steam treatments, with or without quicklime, significantly reduced Salmonella Typhimurium colonization by at least 3 orders of magnitude. Significant reductions were also observed in the treatments with quicklime alone. Both the steam and the quicklime treatments often reduced colonization to undetectable levels, even when samples were enriched. Therefore, we demonstrated 2 novel techniques for reducing Salmonella Typhimurium in poultry litter. Soil pasteurization potentially offers an environmentally sound means of reducing the pathogens present in used poultry litter.

Evaluation of Salmonella enteritidis in molting hens after administration of an experimental chlorate product (for nine days) in the drinking water and feeding an alfalfa molt diet

The method most commonly used to induce molting and stimulate multiple egg-laying cycles in laying hens for commercial egg production is to fast the hens. Unfortunately, increased risk of Salmonella enteritidis (SE) infection may result from the use of this method. Methods to stimulate multiple egg-laying cycles without increasing the risk of SE infection are needed. Hens over 50 wk of age were divided into 12 groups of 11 hens each and placed in individual laying cages. One week prior to dietary changes, hens were placed on an 8-h light and 16-h dark photoperiod that continued for the 9-d molt. All hens were challenged orally with 10(6) cfu of SE on the fourth day of the molt. Treatments were nonfed hens with distilled water (NFD), nonfed hens with the experimental chlorate product (ECP, which provided 15 mM chlorate ion) water (NFECP), alfalfa diets with distilled water (ALD), and alfalfa diets with ECP water (ALECP). In the NFD hens, 67% (log10 2.74) of the crops and 94% (log10 5.62) of the ceca were colonized, whereas for the NFECP hens significant reductions to 22% (log10 1.05) of the crops and 61% (log10 2.44) of the ceca were observed. In the ALD hens, 61% (log10 2.52) of the crops and 94% (log10 4.06) of the ceca were colonized. In the ALECP hens, highly significant reductions to 11% (log10 1.26) of the crops and 39% (log10 1.12) of the ceca were observed. When compared with the NFD hens, significant reductions in SE invasion of the ovary, liver, and spleen occurred in all other treatments, except the ovary in the ALD hens. The low alfalfa intake is probably a factor in our lowered protection against SE when compared with previous results. For several parameters, these results suggest that ECP or the combination of ECP and alfalfa may be a useful tool to reduce the risk of SE during an induced molt.

The bovine mimecan gene. Molecular cloning and characterization of two major RNA transcripts generated by alternative use of two splice acceptor sites in the third exon

Mimecan is a proteoglycan expressed by many connective tissues. It was originally isolated in a truncated form as a bone-associated glycoprotein, osteoglycin, and was considered an osteoinductive factor. Recently, we demonstrated that the full-length translation product of the cDNA encoding mimecan is a corneal keratan sulfate proteoglycan present in other tissues without keratan sulfate chains. We also described multiple mimecan mRNA transcripts generated by differential splicing and alternative polyadenylation. In this study, we isolated genomic clones and determined the genomic organization of the bovine mimecan gene. The gene is spread over >33 kilobases of continuous DNA sequence and contains eight exons. The newly discovered first exon, identified by 5'-rapid amplification of cDNA ends, consists of a 5'-untranslated region and is enriched in C+G nucleotides. Two transcription initiation sites starting at the first and at the second exons were determined by primer extension. Molecular characterization shows that alternatively spliced RNA isoforms are generated by the use of two distinct splice acceptor sites in the third exon situated 278 base pairs apart. We determined a partial genomic structure of the human mimecan gene and demonstrated two alternatively spliced RNA transcripts that are generated likewise. Despite the diversity of mimecan transcripts, the primary structure of the core protein is encoded from exons 3 to 8 and remains unchanged, indicating its functional importance. Using ribonuclease protection assay, we analyzed the patterns of spliced RNA expressed in cultured bovine keratocytes. We demonstrated that their expression is differentially modulated in a temporal manner by basic fibroblast growth factor.

The New York Angler Cohort Study: exposure characterization and reproductive and developmental health

The New York State Angler Study will evaluate the association between past and current consumption of contaminated fish from Lake Ontario and both short- and long-term health effects in a population-based cohort. It will measure fish consumption and reproductive and developmental health among 10,518 male anglers and 6,651 of their wives or partners, as well as among 913 female anglers. To characterize exposure among subgroups of the cohort, further analytical methods were developed and implemented to measure specific polychlorinated biphenyls (PCB) congeners, methylmercury, and other substances in biological samples. Exposure assessment has been completed for a stratified random sample of 321 anglers. In addition, analyses for 79 congeners of PCBs are complete for 177 anglers. A special study of duck and turtle consumers currently is underway. Telephone interviews have been completed with 2,454 of the 2,999 women who planned a pregnancy between 1991 and 1994. The entire cohort of male anglers, partners of male anglers, and female anglers has been submitted for matching with the New York State live birth and fetal death registries to obtain lifetime reproductive histories. A medical record abstraction study will assess perinatal and developmental outcomes among the 3,442 births that occurred between 1986 and 1991. Finally, a study of breast milk from currently lactating women is underway, and 215 breast milk samples have been collected from the planned pregnancy subcohort. Progress on each of the study components is discussed herein.

Effect of vanadate on renal hypertrophy and sorbitol accumulation in streptozotocin induced diabetes in rats

Vanadate has been previously shown to normalize blood glucose in streptozotocin-induced diabetic (STZ-DM) rats. The effect of a previously studied dose of vanadate (0.8 mg/ml) in drinking water on blood glucose, renal hypertrophy, and whole kidney polyol accumulation was studied in STZ-DM rats. Rats with diabetes of 5 weeks duration had higher blood glucose, greater urinary output, higher kidney weight, lower body weight, and higher kidney to body weight ratios than controls. Whole kidney sorbitol concentrations were significantly increased in diabetes but myo-inositol levels were unchanged vs control animals. After four weeks of oral vanadate treatment, blood glucose, urine volume, and kidney weights were similar to control values. Kidney to body weight ratios fell below that of the STZ-DM animals, but because body weights remained decreased, the kidney to body weight ratios were not normalized. Renal sorbitol levels returned to control values and renal myo-inositol levels remained unchanged in STZ-DM and normal animals treated with vanadate. These results provide evidence that vanadate therapy may result in regression of the hypertrophy and polyol accumulation characteristic of diabetic nephropathy in STZ-DM rats. This effect is most likely due to normalization of blood glucose by the insulin-mimetic activity of vanadate treatment.

Short-term potentiation of off-responses in turtle horizontal cells

Depolarizing responses to light off were studied in turtle horizontal cells using intracellular recording in the everted eyecup preparation. In many cells the off-response showed two components (fast and slow) which could overshoot beyond the steady-state dark level. The peak amplitudes of the fast and slow components increased with increasing duration of the light stimulus. A similar enhancement of the off-responses could also be produced by repetitive stimulation with brief flashes. However, the degree of enhancement produced by repetitive stimulation was greater than could be produced by increasing stimulus duration, and the latency of the onset of depolarization was longer, suggesting that the enhancement produced by repetitive stimulation involves an additional mechanism. Dramatic enhancement of the off-response by stimuli which did not affect the on-response during light indicates that the off-response may contain information not present in the on-response. The fast component of the off-response was suppressed to a greater degree than other components by reducing extracellular calcium or in the presence of 500 microM cobalt, suggesting that this component may involve a calcium current.

Effect of acute and chronic hypernatremia on myoinositol and sorbitol concentration in rat brain and kidney

In animal models of hypernatremia, increases in brain electrolyte content account for the entire increase in osmolality in acute but not chronic hypernatremia, suggesting that there is generation of additional intracellular solutes ("idiogenic osmoles") in chronic hypernatremic states. In the present study, the concentration of the polyols myoinositol and sorbitol and water content were determined in the brain and kidneys of rats made acutely (2 hours) and chronically (72 hours) hypernatremic by intraperitoneal injection of NaCl and water restriction. Both the brain and the kidney responded to chronic hypernatremia with increased levels of myoinositol. Sorbitol levels increased in the kidney in response to both acute and chronic hypernatremia. Water content dropped in acute hypernatremia, but remained unchanged during chronic hyperosmolar challenge. We conclude that the polyols, myoinositol and sorbitol, may play a significant role in cellular osmoregulation in brain and kidney during chronic hypernatremia in the rat.

Radiation chemistry of 2'-deoxycytidylyl-(3'-5')-2'-deoxyguanosine and its sequence isomer in N2O- and O2-saturated solutions

The radiation chemistry of the dinucleoside monophosphate d(CpG) and its sequence isomer, d(GpC), has been examined in aqueous solutions saturated with either N2O or O2. The products were isolated using HPLC, and the major products were identified using proton NMR spectroscopy and mass spectrometry. The major products include 5,6-dihydroxy-5,6-dihydrouracil (glycol) derivatives, 5- and 6-hydroxycytosine substitution products, 1-carbamoyl-2-oxo-4,5-dihydroxyimidazolidine products, and the 8-hydroxyguanine substitution product. Both trans stereoisomers of the imidazolidine derivatives are obtained from d(CpG) as well as from its sequence isomer. These are prominent products when the irradiation is carried out in the presence of oxygen, but they are not observed in the absence of oxygen.

Diagnosis of viral infections by multicomponent mass spectrometric analysis

Metabolic profiles of urine extracts of humans with viral infections, as well as of media of virus-infected human tissue cultures, have been analyzed by non-fragmenting mass spectrometry and compared with corresponding controls. The spectra were then subjected to several alternative computerized statistical procedures to detect diagnostic biochemical profiles. Controlled longitudinal studies on fully informed, consenting volunteers who received sandfly fever virus demonstrate the onset of a characteristic metabolic pattern that precedes the onset of symptoms and subsides when the patients overcome the infection. Longitudinal studies of human tissue cultures infected with poliomyelitis virus demonstrate characteristic metabolic patterns within a few hours after infection. Non-fragmenting mass spectrometry may thus provide the clinical laboratory with a sensitive, reliable test for viral infections significantly faster than attainable by current techniques.

Diagnosis of viral infections by multicomponent mass spectrometric analysis

Metabolic profiles of urine extracts of humans with viral infections, as well as of media of virus-infected human tissue cultures, have been analyzed by non-fragmenting mass spectrometry and compared with corresponding controls. The spectra were then subjected to several alternative computerized statistical procedures to detect diagnostic biochemical profiles. Controlled longitudinal studies on fully informed, consenting volunteers who received sandfly fever virus demonstrate the onset of a characteristic metabolic pattern that precedes the onset of symptoms and subsides when the patients overcome the infection. Longitudinal studies of human tissue cultures infected with poliomyelitis virus demonstrate characteristic metabolic patterns within a few hours after infection. Non-fragmenting mass spectrometry may thus provide the clinical laboratory with a sensitive, reliable test for viral infections significantly faster than attainable by current techniques.

Acute copper intoxication. Pathophysiology and therapy with a case report

We report a case of cupric sulfate intoxication in a child who had a serum copper level of 1,650 mug/100 ml. His course was accompanied by hemolytic anemia and renal tubular damage. We review the pathophysiology of copper metabolism and intoxication. We also review modes of therapy, with specific reference to the initial approach, using dimercaprol (BAL) and edetic acid rather than penicillamine.

Organogenic Elements and Compounds in Surface Samples from the Sea of Tranquillity

Organogenic elements, mainly carbon, nitrogen, phosphorus, and sulfur are present in the particulate material and in a breccia rock from Tranquillity Base in amounts ranging from 5 to 4200 parts per million. The major compounds of carbon released by heating are carbon monoxide and carbon dioxide; the former predominates. Small amounts of other compounds of carbon have also been observed. Sulfur can be released as hydrogen sulfide by treatment with acid. The carbon isotopic delta(13L)C values are definitely nonterrestrial (+ 13 to + 18.5 per mil).