A New Look at Vertebral Body Tethering (VBT): Through the Modified Clavien-Dindo-Sink (mCDS) Classification.

INTRODUCTION: Anterior vertebral body tethering (AVBT) is increasingly popular as an option for surgical treatment of idiopathic scoliosis (IS). While the technology remains new, it is important for families and patients to be able to compare it to the current standard of care, posterior spinal fusion (PSF). The purpose of this study is to describe the complication rate of AVBT in IS using the mCDS and to compare it to the recently reported complication rate of PSF in IS. METHODS: A multicenter pediatric spine deformity database was queried for all idiopathic scoliosis patients who underwent vertebral body tethering. There were 171 patients with a minimum 9-month follow-up included in this study. Complications were retrospectively graded by 2 attending pediatric spine surgeons using the mCDS classification system. RESULTS: Data from 171 patients with idiopathic scoliosis was available for analysis, with 156/171 (91%) of patients being female and an average age of 12.2 years old at surgery. There were 156 thoracic tethers (1 with an LIV below L2), 5 lumbar tethers, 9 staged double tethers, and only 1 patient with same-day double tether. Fifty-five (55) (32%) patients experienced a total of 69 complications. The most common complication type for VBT by mCDS was Grade IIIb, encompassing 29/69 (42%) of complications. The second most frequent complication grade was Grade I at 23/69 (33%). Thirty-four (34) out of 69 (49%) of the VBT complications reported required either procedural/surgical intervention or admission to the ICU. CONCLUSIONS: This is the first study to directly compare the complication profile of VBT to PSF using the mCDS. Forty-nine percent (49%) of the VBT complications reported were at least Grade III, while only 7% of complications in the control PSF cohort from the literature were Grade III or higher. The mCDS complication classification brings light to the early learning experience of a new technique compared to the widely accepted standard of PSF for IS. LEVEL OF EVIDENCE: III - Retrospective comparative study.

Predicted Health Literacy Disparities Between Immigrant and US-Born Racial/Ethnic Minorities: a Nationwide Study.

BACKGROUND: Racial/ethnic minorities in the USA exhibit reduced health literacy (HL) proficiency, leading to increased health disparities. It is unclear how the effect of birth status (immigrant/US-born) affects HL proficiency among racial/ethnic minorities. OBJECTIVE: To identify the direct, indirect, and total effects of birth status on HL proficiency among a nationally representative population of racial/ethnic minority adults in the USA. DESIGN: A cross-sectional study of 2019 data from the Medial Expenditure Panel Survey. PARTICIPANTS: Participants aged 18 or older reporting as racial/ethnic minorities (Black, Asian, or Hispanic) with non-missing data. MAIN MEASURES: We predicted HL proficiency for each participant using a previously published model. Path analysis was used to estimate the direct, indirect, and total effects of birth status on HL proficiency, accounting for several other covariates. Prevalence ratios were estimated using adjusted Poisson regression to evaluate differences in the "Below Basic" HL category. KEY RESULTS: An estimated weighted 81,092,505 participants were included (57.5% US-born, 42.5% immigrant). More racial/ethnic minority immigrant participants fell into the lowest category of HL proficiency, "Below Basic" (14.3% vs 5.5%, p < 0.05). Results of the path analysis indicated a significant, negative direct effect of birth status on HL proficiency (standardized coefficient = - 0.24, SE = 0.01, 95%CI: - 0.26, - 0.23) in addition to an indirect effect mediated through insurance status, health-system resource use, and English proficiency. The total effect of birth status on HL proficiency was found to be - 0.29. The immigrant participant group had 81% higher prevalence of falling into the "Below Basic" HL category compared to US-born participants (prevalence ratio = 1.81, 95%CI: 1.52, 2.16). CONCLUSIONS: Immigrant status has a strong, negative, direct effect on HL proficiency among racial/ethnic minorities in the USA. This may be a result of barriers that prevent equitable access to resources that improve proper HL proficiency. US policymakers may consider several methods to reduce this disparity at the health-system-, provider-, and patient-levels.

HPV vaccine delay and refusal among unvaccinated Mexican American young adult women: a qualitative investigation of Mexican-born and US-born HPV vaccine decision narratives.

Low HPV vaccination rates among Latina young adults perpetuate HPV-associated cancer disparities. Using qualitative methods, this study explored individual, interpersonal, and community factors that influence HPV vaccine delay and refusal among Mexican- and U.S.-born Mexican American young adult women. Participants (N = 30) between 18 and 26 years old were purposively sampled from two federally qualified health centers in Orange County, California. The National Institute on Minority Health and Health Disparities research framework and narrative engagement theory guided semi-structured phone interviews coded inductively and deductively. Participants primarily attributed vaccine status to individual and interpersonal reasons. Emerging themes included low HPV vaccine knowledge, insufficient provider communication, negative perceptions about HPV and the vaccine, motherhood responsibilities, mother's communication about HPV, cultural family norms, health care access, and misinformation. Compared to U.S.-born Latinas, Mexican-born participants more frequently expressed avoiding health care discussions with family. HPV vaccine recommendations for young Mexican American women should include socioculturally tailored messages that may improve HPV vaccination acceptance and uptake.

Sociopolitical stressors are associated with psychological distress in a cohort of Latina women during early pregnancy.

Research suggests that the 2016 US election was a potential stressor among Latinos residing in the United States. Sociopolitical stressors targeted toward ethnic minority communities and become embodied through psychosocial distress. The current study investigates if and how sociopolitical stressors related to the 45th President, Donald Trump, and his administration are associated with psychological distress in early pregnancy of Latina women living in Southern California during the second half of his term. This cross-sectional analysis uses data from the Mothers' Cultural Experiences study (n = 90) collected from December 2018 to March 2020. Psychological distress was assessed in three domains: depression, state anxiety, and pregnancy-related anxiety. Sociopolitical stressors were measured through questionnaires about sociopolitical feelings and concerns. Multiple linear regression models examined the relationship between sociopolitical stressors and mental health scores, adjusting for multiple testing. Negative feelings and a greater number of sociopolitical concerns were associated with elevated pregnancy-related anxiety and depressive symptoms. The most frequently endorsed concern was about issues of racism (72.3%) and women's rights (62.4%); women endorsing these particular concerns also had higher scores on depression and pregnancy-related anxiety. No significant associations were detected with state anxiety after correction for multiple testing. This analysis is cross-sectional and cannot assess causality in the associations between sociopolitical stressors and distress. These results are consistent with the hypothesis that the 2016 election, the subsequent political environment, and the anti-immigrant rhetoric and policies of former President Trump and his administration were sources of stress for Latinos residing in the United States.

A Modern Day Timeline for In-Hospital Monitoring in Perfused, Pulseless Pediatric Supracondylar Humerus Fractures.

BACKGROUND: The perfused, pulseless supracondylar humerus fracture (ppSCHF) remains a consistent topic of discussion in the literature. Inpatient observation of these patients postoperatively for worsening vascular exam or compartment syndrome is frequently recommended but not well studied. The purpose of this study was to evaluate the postoperative complications in a cohort of ppSCHF patients and their timeline to discharge. METHODS: This study is a retrospective review of a prospectively maintained database of all operatively treated supracondylar humerus fractures from a tertiary pediatric hospital from 2013 to 2019. All patients without a palpable pulse were included. We excluded patients with <4 weeks follow-up. Demographic, operative, and postoperative data were collected, including time from presentation to operating room (OR), time from OR to discharge, and incidence of postoperative complications, including return to OR, compartment syndrome, new neurovascular deficits, and Volkmann contractures. The descriptive statistics were used to summarize the data. RESULTS: Among 1371 operatively treated supracondylar humerus fractures, 39 (2.8%) presented with a ppSCHF. Five (15%) had a signal on doppler ultrasound, whereas 34 (85%) had no signal. Thirty-seven (95%) patients had a Gartland type III fracture and 2 (5%) had type IV fractures. Twenty-two (56%) patients had a neurological deficit, of which 14 had an anterior interosseous nerve deficit. The average time to OR was 6.9 (range 2.2 to 15) hours; 6 (15%) required open reduction. At the time of discharge, 85% of patients had a palpable pulse and 13% had a dopplerable signal. Postoperatively, no patients were returned to the OR for any secondary procedures. The average length of stay after the operation was 25 (range 8.5 to 40) hours, with 92% of patients being discharged by 36 hours postoperatively. No patients developed compartment syndrome, new neurological deficits, or Volkmann contractures at a mean follow-up of 112 (range 34 to 310) days. CONCLUSIONS: In our study of 39 patients presenting with ppSCHF, no patient required an unexpected return to the OR, or developed post-treatment compartment syndrome, neurological deficits, or Volkmann contractures. The average time from OR to discharge for ppSCHF was 25 hours. LEVEL OF EVIDENCE: Level II.

BLK and BANK1 variants and interactions are associated with susceptibility for primary Sjögren's syndrome and with some clinical features.

BLK and BANK1 in primary Sjögren's syndrome (pSS) have scarcely been evaluated and the results are inconclusive. The aim of our study was to determine whether single nucleotide variants (SNVs) located within BLK or BANK1 are associated with susceptibility, clinical and serological features, and smoking in pSS. BLK rs13277113A/G, BANK1 rs10516487G/A and rs3733197G/A were genotyped in 203 cases and 424 controls using a TaqMan® SNP genotyping assay. The BLK rs13277113A allele showed association with pSS under the allelic (OR 1.35, p = 0.02), and recessive (OR 1.83, p = 0.003) model, while, BANK1 rs3733197G/A showed association under the dominant model (OR 2.90, p = 0.043). Interactions between BANK1 and BLK genotypes also showed association (OR 2.36, p < 0.0001). In addition, BLK rs13277113A/G was associated with protection against arthritis and BANK1 rs10516487G/A with both arthritis and keratoconjunctivitis sicca, meanwhile, BANK1 rs3733197G/A was associated with smoking in patients with pSS. This is the first study to describe an association between BLK and susceptibility to pSS in a Latin-American population. Our data also shows a first evidence of association between interactions of BLK and BANK1 in pSS, and association of BLK and BANK1with arthritis, keratoconjunctivitis sicca and smoking in patients with pSS.

Health Information Source Characteristics Matter: Adapting the Dissemination of an HPV Vaccine Intervention to Reach Latina and Vietnamese Women.

Latina and Vietnamese women are disproportionately burdened by human papillomavirus (HPV)-associated cervical cancer and underutilize the HPV vaccine, which is an effective cancer prevention measure. To inform the adaptation of a National Cancer Institute's evidence-based cancer control program, HPV Vaccine Decision Narratives, and because of the rapidly changing information concerning consumption patterns of young adults, we elicited preferences and characteristics associated with women's interest in various health information sources, specifically for HPV vaccination. We conducted 50 interviews with young Latina and Vietnamese women at two Planned Parenthood health centers in Southern California. Interview questions were guided by the Channel Complementarity Theory and focused on understanding the multiple communication channels women turn to for health, and the characteristics that motivate their use. Our results showed that Latina and Vietnamese women turn to many sources, from online and social media to school health classes, mothers, and doctors. Specific characteristics that motivate women's online use of health information included immediacy and access, convenience and credibility. When receiving HPV vaccine information, privacy, avoiding information overload, interpersonal engagement, and receiving health information from trusted sources was important. Our study advances the prevention literature by elevating the role of platform delivery considerations and emphasizing preferences to effectively reach Latina and Vietnamese women, who are disproportionately burdened by HPV cancers and are less aware of HPV vaccine prevention. These results can be used to further inform the dissemination of this cancer control program. Adaptation of the program should include changes to its delivery, such that trusted sources are used, and dissemination is coordinated to send a consistent message across multiple communication methods.

Type 1 Immune Mechanisms Driven by the Response to Infection with Attenuated Rabies Virus Result in Changes in the Immune Bias of the Tumor Microenvironment and Necrosis of Mouse GL261 Brain Tumors.

Immunotherapeutic strategies for malignant glioma have to overcome the immunomodulatory activities of M2 monocytes that appear in the circulation and as tumor-associated macrophages (TAMs). M2 cell products contribute to the growth-promoting attributes of the tumor microenvironment (TME) and bias immunity toward type 2, away from the type 1 mechanisms with antitumor properties. To drive type 1 immunity in CNS tissues, we infected GL261 tumor-bearing mice with attenuated rabies virus (RABV). These neurotropic viruses spread to CNS tissues trans-axonally, where they induce a strong type 1 immune response that involves Th1, CD8, and B cell entry across the blood-brain barrier and virus clearance in the absence of overt sequelae. Intranasal infection with attenuated RABV prolonged the survival of mice bearing established GL261 brain tumors. Despite the failure of virus spread to the tumor, infection resulted in significantly enhanced tumor necrosis, extensive CD4 T cell accumulation, and high levels of the proinflammatory factors IFN-γ, TNF-α, and inducible NO synthase in the TME merely 4 d postinfection, before significant virus spread or the appearance of RABV-specific immune mechanisms in CNS tissues. Although the majority of infiltrating CD4 cells appeared functionally inactive, the proinflammatory changes in the TME later resulted in the loss of accumulating M2 and increased M1 TAMs. Mice deficient in the Th1 transcription factor T-bet did not gain any survival advantage from RABV infection, exhibiting only limited tumor necrosis and no change in TME cytokines or TAM phenotype and highlighting the importance of type 1 mechanisms in this process.

Clearance of attenuated rabies virus from brain tissues is required for long-term protection against CNS challenge with a pathogenic variant.

Rabies virus is a neurotropic lyssavirus which is 100% fatal in its pathogenic form when reaching unprotected CNS tissues. Death can be prevented by mechanisms delivering appropriate immune effectors across the blood-brain barrier which normally remains intact during pathogenic rabies virus infection. One therapeutic approach is to superinfect CNS tissues with attenuated rabies virus which induces blood-brain barrier permeability and immune cell entry. Current thinking is that peripheral rabies immunization is sufficient to protect against a challenge with pathogenic rabies virus. While this is undoubtedly the case if the virus is confined to the periphery, what happens if the virus reaches the CNS is less well-understood. In the current study, we find that peripheral immunization does not fully protect mice long-term against an intranasal challenge with pathogenic rabies virus. Protection is significantly better in mice that have cleared attenuated virus from the CNS and is associated with a more robust CNS recall response evidently due to the presence in CNS tissues of elevated numbers of lymphocytes phenotypically resembling long-term resident immune cells. Adoptive transfer of cells from rabies-immune mice fails to protect against CNS challenge with pathogenic rabies virus further supporting the concept that long-term resident immune cell populations must be established in brain tissues to protect against a subsequent CNS challenge with pathogenic rabies virus.

Video-Based Grocery Shopping Intervention Effect on Purchasing Behaviors Among Latina Shoppers.

OBJECTIVES: To compare changes in food-purchasing knowledge, self-efficacy, and behavior after viewing nutrition education videos among Los Angeles, California Latinas responsible for household grocery shopping. METHODS: From February to May 2015, a convenience sample of 113 Latinas watched 1 video (El Carrito Saludable) featuring MyPlate guidelines applied to grocery shopping (1-video intervention) and another convenience sample of 105 Latinas watched 2 videos (El Carrito Saludable and Ser Consciente), the latter featuring mindfulness to support attention and overcome distractions while grocery shopping (2-video intervention). We administered questionnaires before and after intervention. A preselected sample in each intervention condition (n = 72) completed questionnaires at 2-months after intervention and provided grocery receipts (before and 2-months after intervention). RESULTS: Knowledge improved in both intervention groups (P < .001). The 2-video group improved more in self-efficacy and use of a shopping list (both P < .05) and purchased more healthy foods (d = 0.60; P < .05) at 2 months than did the 1-video group. CONCLUSIONS: Culturally tailored videos that model food-purchasing behavior and mindfulness show promise for improving the quality of foods that Latinas bring into the home.

Expression of interferon gamma by a recombinant rabies virus strongly attenuates the pathogenicity of the virus via induction of type I interferon.

UNLABELLED: Previous animal model experiments have shown a correlation between interferon gamma (IFN-γ) expression and both survival from infection with attenuated rabies virus (RABV) and reduction of neurological sequelae. Therefore, we hypothesized that rapid production of murine IFN-γ by the rabies virus itself would induce a more robust antiviral response than would occur naturally in mice. To test this hypothesis, we used reverse engineering to clone the mouse IFN-γ gene into a pathogenic rabies virus backbone, SPBN, to produce the recombinant rabies virus designated SPBNγ. Morbidity and mortality were monitored in mice infected intranasally with SPBNγ or SPBN(-) control virus to determine the degree of attenuation caused by the expression of IFN-γ. Incorporation of IFN-γ into the rabies virus genome highly attenuated the virus. SPBNγ has a 50% lethal dose (LD50) more than 100-fold greater than SPBN(-). In vitro and in vivo mouse experiments show that SPBNγ infection enhances the production of type I interferons. Furthermore, knockout mice lacking the ability to signal through the type I interferon receptor (IFNAR(-/-)) cannot control the SPBNγ infection and rapidly die. These data suggest that IFN-γ production has antiviral effects in rabies, largely due to the induction of type I interferons. IMPORTANCE: Survival from rabies is dependent upon the early control of virus replication and spread. Once the virus reaches the central nervous system (CNS), this becomes highly problematic. Studies of CNS immunity to RABV have shown that control of replication begins at the onset of T cell entry and IFN-γ production in the CNS prior to the appearance of virus-neutralizing antibodies. Moreover, antibody-deficient mice are able to control but not clear attenuated RABV from the CNS. We find here that IFN-γ triggers the early production of type I interferons with the expected antiviral effects. We also show that engineering a lethal rabies virus to express IFN-γ directly in the infected tissue reduces rabies virus replication and spread, limiting its pathogenicity in normal and immunocompromised mice. Therefore, vector delivery of IFN-γ to the brain may have the potential to treat individuals who would otherwise succumb to infection with rabies virus.

Failure to lengthen consensus for the magnetically controlled growing rod (MCGR).

INTRODUCTION: MCGR lengthening has become an important innovation in treating patients with EOS. An alternative to traditional growing instrumentation, a single surgical procedure is necessary for insertion of the construct, followed by non-invasive lengthening in the outpatient setting. With every new technology emanates a new complication to troubleshoot. Failure to lengthen in the MCGR is a significant cause of revision surgery. Currently, no consensus exists on how to define a MCGR lengthening failure, what steps are necessary after a failure to lengthen, and what factors determine these next steps. The primary goal of this study was to establish a consensus on how to define and navigate a MCGR that fails to lengthen. METHODS: A series of 3 surveys were distributed to 49 early onset scoliosis surgeons with 37 responses between December 2021 and April 2022. Consensus was defined as at least 70% agreement. RESULTS: 37 of 49 surgeons (75%) responded to the first survey, and all 37 surgeons responded to the following two surveys (100%). Consensus statements were reached on 25% of questions (3/12) from survey 1, 40% of questions (4/10) on survey 2, and 100% of questions (5/5) on survey 3. The questions that reached consensus are detailed in Table 1. Consensus steps to navigate a rod that fails to lengthen 1 mm (97%) in the office include retrying during the same visit (78%), changing technique in the office (88%), and not adjusting the interval between lengthening appointments (78%). Table 1 Items that reached consensus from each survey (12 total) Survey Question Response, Consensus Percentage 1 If a rod does not lengthen, do you try again in that office visit?​ Yes, 78% 1 All modes of XR are equivalent when determining failure to lengthen? Yes, 70% 1 If you are unsuccessful at lengthening, you should change the lengthening interval? No, 78% 2 Re-lengthening a rod following a failure to lengthen one should change their technique? Yes, 88% Reposition patient, 100% Alternate rods, 90% No traction in OR, 92.6% 2 Is a MCGR non-operational following 3 consecutive visits where the rod failed lengthening? Yes, 100% 2 Considerations when determining next steps with a non-operational rod? Skeletal Age, 100% Curve Progression, 97% Curve Stiffness, 93.8% Family Convenience, 83% Chronologic Age, 77% Time from Last Lengthening, 70% 2 Can an APP follow your protocol for a rod that has failed to lengthen? Yes, 81% 3 Are you comfortable using either clunk or stall to describe the phenomena of the internal clutch failing within the actuator when lengthening? Yes, 97.3% 3 Clunk/stall try again before an adjustment? Yes, 81% 3 Define failure to lengthen? Less than 1 mm length achieved, 97% 3 After two failure to lengthen events do you discuss next surgical steps?​ Yes, 97% 3 Once a rod had been classified as non-operational (no longer lengthening despite interventions) do you consider the underlying diagnosis when making next step decisions? Yes, 97% CONCLUSION: Best clinical practice guidelines using a Delphi method established a consensus on defining failure to lengthen in a MCGR (less than 1 mm), appropriate responses to failure to lengthen (re-attempt to lengthen and re-position patient) and a definition for a non-functional MCGR (failure to lengthen 3 consecutive times). This consensus will help standardize research on this important problem. LEVEL OF EVIDENCE: V-expert opinion.

Use of concept mapping to inform a participatory engagement approach for implementation of evidence-based HPV vaccination strategies in safety-net clinics.

BACKGROUND: Multiple evidence-based strategies (EBS) for promoting HPV vaccination exist. However, adolescent HPV vaccination rates remain below target levels in communities at high risk for HPV-associated cancers and served by safety-net clinics. Participatory engaged approaches are needed to leverage the expertise of community and clinical partners in selecting EBS relevant to their local context. We engaged concept mapping as a method to inform the adoption and adaptation of EBS that seeks to empower implementation partners to prioritize, select, and ultimately implement context-relevant EBS for HPV vaccination. METHODS: Using 38 EBS statements generated from qualitative interviews and national HPV vaccine advocacy sources, we conducted a modified concept mapping activity with partners internal to safety-net clinics and external community members in two study sites of a larger implementation study (Greater Los Angeles and New Jersey), to sort EBS into clusters and rate each EBS by importance and feasibility for increasing HPV vaccination within safety-net clinics. Concept mapping findings (EBS statement ratings, ladder graphs and go-zones) were shared with leaders from a large federally qualified health center (FQHC) system (focusing on three clinic sites), to select and implement EBS over 12 months. RESULTS: Concept mapping participants (n=23) sorted and rated statements, resulting in an eight-cluster solution: 1) Community education and outreach; 2) Advocacy and policy; 3) Data access/quality improvement monitoring; 4) Provider tracking/audit and feedback; 5) Provider recommendation/communication; 6) Expanding vaccine access; 7) Reducing missed opportunities; and 8) Nurse/staff workflow and training. The FQHC partner then selected to intervene on eight of 17 EBS statements in the "go-zone" for action, with three from "reducing missed opportunities," two from "nurse/staff workflow and training," and one each from "provider tracking/audit and feedback," "provider recommendation/communication," and "expanding vaccine access," which the research team addressed through the implementation of three multi-level intervention strategies (e.g., physician communication training, staff training and workflow assessment, audit and feedback of clinic processes). CONCLUSIONS: Concept mapping provided a powerful participatory approach to identify multilevel EBS for HPV vaccination relevant to the local safety-net clinic context, particularly when several strategies exist, and prioritization is necessary. This study demonstrates how a clinic system benefited directly from the ratings and prioritization of EBS by multilevel clinic and community partners within the broader safety-net clinic context to identify and adapt prioritized solutions needed to advance HPV vaccine equity.

Identifying the intersection of parental HPV and COVID-19 vaccine hesitancy to inform health messaging interventions in community-based settings.

PURPOSE: Parental human papillomavirus (HPV) vaccine hesitancy contributes to delays or refusals in adolescent uptake. It is unclear if COVID-19 vaccine hesitancy has further impacted the low HPV vaccine uptake trends among underrepresented minorities. This study examines the relationship between COVID-19 vaccine intent and HPV vaccine hesitancy among parents for their adolescents in communities with low vaccine uptake in Los Angeles County. METHODS: Parents from a school-based academic enrichment program serving low-income, first-generation immigrant families completed an online cross-sectional survey to understand parental HPV vaccine hesitancy, adolescent HPV vaccine behavior, and attitudes towards other vaccines, including intent to receive COVID-19 vaccines. In March 2021, parents with children ages 9-17 years completed online surveys. Using multivariate logistic regression models, we examined whether low parent intent to vaccinate their adolescent against COVID-19 was associated with hesitancy to vaccinate against HPV. RESULTS: A total of 291 surveys were completed. Among parents with high HPV vaccine hesitancy for their adolescent, 33 % did not intend to vaccinate their adolescent against COVID-19 compared to 7 % among parents with low HPV vaccine hesitancy. Low parent intention to vaccinate adolescent against COVID-19 was associated with higher HPV vaccine hesitancy (p < 0.01) after controlling for parent nativity status, medical mistrust, receiving the flu vaccination and negative HPV information. DISCUSSION: Our findings indicate associations between low parental COVID-19 vaccine intent and higher HPV vaccine hesitancy for their adolescent. Identifying community-relevant health interventions to address parental vaccine hesitancy across multiple child and adolescent vaccines may help to achieve equitable vaccine uptake.

A validation study for measuring Asian- and Hispanic-serving sociocultural institutions in neighborhoods using business listing data and potential implications for health.

Ethnic enclaves influence the health of Asian American and Hispanic or Latinx/a/o populations, likely via neighborhood social, economic, and built environments. To facilitate studies aiming to disentangle these specific neighborhood mechanisms, we describe the creation and validation of two novel measures-Asian-serving and Hispanic-serving sociocultural institutions (SCIs)-to estimate the social, cultural, and economic character of ethnic enclaves in California. Business listing data were used to identify SCIs or businesses that promote cultural and social identity, including arts, civic, historical, religious, social service, and membership organizations. Keyword searches of business names were used to identify potential Asian- or Hispanic-serving SCIs. An online audit of 1,627 businesses within 12 cities confirmed the validity of using keyword searches to assess whether census tracts were high or low in Asian- or Hispanic-serving SCIs (sensitivity: 63%-100%, specificity: 86%-95%; positive predictive value: 63%-89%). In exploratory regression analyses, high presence of SCIs (compared to low presence) may be associated with neighborhood-level health indicators, including greater percentages of residents who had an annual checkup in majority Asian census tracts and lower percentages of residents who were current smokers in majority Asian and Hispanic census tracts. This approach advances methodology in measurement of neighborhood sociocultural environments.

Disruptions to and Innovations in HPV Vaccination Strategies within Safety-Net Healthcare Settings Resulting from the COVID-19 Pandemic.

The COVID-19 pandemic disrupted healthcare delivery within safety-net settings. Barriers to and facilitators of human papillomavirus (HPV) vaccination during the pandemic can inform future HPV vaccine strategies for underserved communities. Qualitative interviews (n = 52) between December 2020 and January 2022 in Los Angeles and New Jersey were conducted with providers, clinic leaders, clinic staff, advocates, payers, and policy-level representatives involved in the HPV vaccine process. Using the updated Consolidated Framework for Implementation Research we identified (1) outer setting barriers (i.e., vaccine hesitancy driven by social media, political views during the pandemic) and facilitators (e.g., partnerships); (2) inner setting clinic facilitators (i.e., motivation-driven clinic metrics, patient outreach, vaccine outreach events); (3) individual characteristics such as patient barriers (i.e., less likely to utilize clinic services during the pandemic and therefore, additional outreach to address missed vaccine doses are needed); (4) innovations in HPV vaccination strategies (i.e., clinic workflow changes to minimize exposure to COVID-19, leveraging new community partnerships (e.g., with local schools)); and (5) implementation strategies (i.e., multisectoral commitment to HPV goals). Pandemic setbacks forced safety-net settings to develop new vaccine approaches and partnerships that may translate to new implementation strategies for HPV vaccination within local contexts and communities.

Multilevel perspectives on school-based opportunities to improve HPV vaccination among medically underserved adolescents: Beyond school entry mandates.

School-based HPV vaccination programs have improved vaccine uptake among adolescents globally. However, school-based HPV vaccination strategies in the United States (US) have mainly focused on school-entry mandates for vaccination, which have passed in only five states/jurisdictions. Many schools and school-based health centers (SBHCs) already provide health services to medically underserved adolescents and opportunities to improve disparities in HPV vaccine education and uptake are underexplored. This qualitative study of clinic and community members assessed potential opportunities within and outside schools to increase HPV vaccination. Data were generated from a larger mixed-methods study designed to understand experiences with HPV vaccination evidence-based strategies in medically underserved communities. The parent study included interviews and focus groups conducted with clinic (providers, clinic leaders, staff) and community (racial/ethnic minority parents, advocates, payers, policy representatives) members in Los Angeles and New Jersey between December 2020-January 2022. We created a reduced dataset of text related to schools/SBHCs (30 in-depth interviews, 7 focus groups) and conducted a directed content analysis. Participants indicated that schools and SBHCs are ideal venues for reaching medically underserved adolescents experiencing barriers to primary care access. Parents/providers expressed mutual interest in HPV vaccine administration/education in schools, but some advocates/policy participants experienced challenges due to increasing politicization of vaccines. Participants highlighted policies for expanding HPV vaccine education and administration in schools, including minor consent and increasing SBHC funding for HPV vaccines. More research is needed to explore existing infrastructure, partner motivation, and opportunities to improve HPV vaccination among medically underserved adolescents within schools beyond vaccine mandates.

"The curriculum brings equity to the forefront": Pediatric residents' perspectives and experiences in a longitudinal EDI curriculum.

BACKGROUND: The Accreditation Council for Graduate Medical Education (ACGME) Common Program Requirements include training in caring for diverse populations and understanding social determinants of health. Our large pediatric residency program implemented a longitudinal equity, diversity and inclusion (EDI) curriculum. OBJECTIVE: To explore pediatric residents' perspectives and experiences in our longitudinal EDI curriculum. METHODS: We applied the holistic framework by Haji et al. to characterize the effect of our EDI curriculum. We conducted 4 focus groups from November 2019 to September 2020 with trained facilitators using a structured question guide. We approached all eligible senior residents (n = 87) via email to participate. Project members coded written notes and transcripts and analyzed data using inductive thematic analysis. RESULTS: 26 pediatric senior residents participated either in person (n = 13) or online (n = 13). Themes emerged from domains of knowledge, attitudes and behavioral change. These included having: (1) increased knowledge surrounding EDI issues, (2) a framework and language to better engage in EDI efforts and (3) increased confidence interrupting bias and microaggressions. Additional themes demonstrated: an increased need for EDI education at the institutional level, the unique experiences of Black, Indigenous, People of Color (BIPOC) trainees, and systemic barriers to equitable care. CONCLUSION: A longitudinal EDI curriculum has the potential to influence individual trainees, their work, and perceptions of the broader institutions in which they operate. Residents recognized and valued the curriculum and felt driven to use this knowledge to ensure that institutional policies and practices led to equitable clinical care.

Associations between Coronavirus Crisis Perception, Perceived Economic Risk of Coronavirus, General Self-Efficacy, and Coronavirus Anxiety at the Start of the Pandemic: Differences by Gender and Race.

The coronavirus pandemic has escalated rates of anxiety in the general U.S. population. Understanding how factors associated with coronavirus anxiety at the start of the pandemic differed among populations hardest impacted by coronavirus anxiety is key to effectively remediating negatively associated health outcomes and to better understand how to address concerns of the public at the start of a global pandemic. This study was a secondary analysis of data from a cross-sectional online survey of 1165 Prolific users between 13 and 15 March 2020. Data were collected from a stratified sample of U.S. adults aged 20 or older and currently living in the United States. The sample was stratified for age, gender, and race. Coronavirus anxiety was assessed as the dependent variable, alongside three independent variables: coronavirus crisis perception, perceived economic risk of coronavirus, and general self-efficacy. Multiple linear regression assessed the associations between the independent variables and coronavirus anxiety. Interactions between independent variables and two sociodemographic variables (i.e., gender, race) were also explored. The models were adjusted for age, gender, race, education, employment, and income. The average age of participants was 45.6 ± 15.7. The majority (76%) identified as White, approximately half identified as female and reported obtaining a bachelor's degree or higher. Coronavirus crisis perception and perceived economic risk of coronavirus were positively associated with coronavirus anxiety (ß = 0.46, 95% CI = 0.41, 1.00; ß = 0.14, 95% CI = 0.09, 1.00, respectively). General self-efficacy was negatively associated with coronavirus anxiety (ß = -0.15, 95% CI = -1.00, -0.11). Gender and race both moderated the association between coronavirus crisis perception and anxiety. Race moderated the association between perceived economic risk and coronavirus crisis perception. These results provide a foundation to further explore cognitive factors in subgroups disproportionately affected by anxiety during the pandemic.

Challenges and Opportunities for Immunotherapeutic Intervention against Myeloid Immunosuppression in Glioblastoma.

Glioblastoma multiforme (GBM), the most common and deadly brain cancer, exemplifies the paradigm that cancers grow with help from an immunosuppressive tumor microenvironment (TME). In general, TME includes a large contribution from various myeloid lineage-derived cell types, including (in the brain) altered pathogenic microglia as well as monocyte-macrophages (Macs), myeloid-derived suppressor cells (MDSC) and dendritic cell (DC) populations. Each can have protective roles, but has, by definition, been coopted by the tumor in patients with progressive disease. However, evidence demonstrates that myeloid immunosuppressive activities can be reversed in different ways, leading to enthusiasm for this therapeutic approach, both alone and in combination with potentially synergistic immunotherapeutic and other strategies. Here, we review the current understanding of myeloid cell immunosuppression of anti-tumor responses as well as potential targets, challenges, and developing means to reverse immunosuppression with various therapeutics and their status. Targets include myeloid cell colony stimulating factors (CSFs), insulin-like growth factor 1 (IGF1), several cytokines and chemokines, as well as CD40 activation and COX2 inhibition. Approaches in clinical development include antibodies, antisense RNA-based drugs, cell-based combinations, polarizing cytokines, and utilizing Macs as a platform for Chimeric Antigen Receptors (CAR)-based tumor targeting, like with CAR-T cells. To date, promising clinical results have been reported with several of these approaches.