Peer ambassador stories: formative qualitative research to enhance the reach of PrEP, HIV testing, and behavioral health treatments to LMSM in South Florida.

Existing HIV prevention interventions, such as pre-exposure prophylaxis (PrEP), and behavioral health treatments inadequately reach Latino men who have sex with men (LMSM) in the US. This study involved formative research to inform the content, design, and implementation of a scalable, low resource implementation strategy - peer ambassador stories - stories from peers to normalize using PrEP, HIV testing, and behavioral health treatment. We conducted semi-structured interviews with 20 LMSM to elucidate their content, design, and implementation preferences for peer ambassador stories. Men were asked about story prompts, story contributor characteristics, story platform features, design preferences, and recommendations for enhancing the adoption and use of the peer ambassador technology platform among LMSM. Interviews were transcribed and analyzed via rapid qualitative analysis. Qualitative analyses identified 14 themes within 4 pre-specified domains. Collectively, the themes unified around the central concept that technology-delivered peer ambassador stories require a personalized, relational, culturally relevant touch to be acceptable and appropriate for LMSM. This study suggests that disseminating peer ambassador stories using electronic platforms and audio/video formats may enhance the reach of services and if they are personalized, relational, and culturally relevant. Findings have broad implications for informing other peer-based strategies to mitigate HIV disparities among LMSM.

Societal Costs of Dementia: 204 Countries, 2000-2019.

Background: Dementia prevalence is expected to increase as populations grow and age. Therefore, additional resources will be needed to meet the global demand for care for Alzheimer's disease and related dementias (ADRD). Objective: Estimate global and country-level health care spending attributable to ADRD and the cost of informal care for people living with ADRD. Methods: We gathered data from three systematic literature reviews and the Global Burden of Disease 2019 study. We used spatiotemporal Gaussian process regression to impute estimates for the many countries without underlying data. We projected future costs to 2050 based on past trends in costs, diagnosis rates, and institutionalization rate. Results: We estimated that in 2019, the direct health care spending attributable to ADRD across 204 countries reached $260.6 billion (95% uncertainty interval [UI] 131.6-420.4) and the cost of informal ADRD care was $354.1 billion (95% UI 190.0-544.1). On average, informal care represents 57% (95% UI 38-75%) of the total cost of care. We estimated that direct health care spending attributable to ADRD will reach $1.6 trillion (95% UI 0.6-3.3) in 2050, or 9.4% (95% UI 3.9-19.6%) of projected health spending worldwide. We estimated the cost of informal care will reach $0.9 trillion (95% UI 0.3-1.7) in 2050. Conclusions: These cost estimates underscore the magnitude of resources needed to ensure sufficient resources for people living with ADRD and highlight the role that informal care plays in provision of their care. Incorporating informal care cost estimates is critical to capture the social cost of ADRD.

Field-based body temperatures reveal behavioral thermoregulation strategies of the Atlantic marsh fiddler crab Minuca pugnax.

Behavioral thermoregulation is an important defense against the negative impacts of climate change for ectotherms. In this study we examined the use of burrows by a common intertidal crab, Minuca pugnax, to control body temperature. To understand how body temperatures respond to changes in the surface temperature and explore how efficiently crabs exploit the cooling potential of burrows to thermoregulate, we measured body, surface, and burrow temperatures during low tide on Sapelo Island, GA in March, May, August, and September of 2019. We found that an increase in 1°C in the surface temperature led to a 0.70-0.71°C increase in body temperature for females and an increase in 0.75-0.77°C in body temperature for males. Body temperatures of small females were 0.3°C warmer than large females for the same surface temperature. Female crabs used burrows more efficiently for thermoregulation compared to the males. Specifically, an increase of 1°C in the cooling capacity (the difference between the burrow temperature and the surface temperature) led to an increase of 0.42-0.50°C for females and 0.34-0.35°C for males in the thermoregulation capacity (the difference between body temperature and surface temperature). The body temperature that crabs began to use burrows to thermoregulate was estimated to be around 24°C, which is far below the critical body temperatures that could lead to death. Many crabs experience body temperatures of 24°C early in the reproductive season, several months before the hottest days of the year. Because the use of burrows involves fitness trade-offs, these results suggest that warming temperatures could begin to impact crabs far earlier in the year than expected.