Investigating transmission of SARS-CoV-2 using novel face mask sampling: a protocol for an observational prospective study of index cases and their contacts in a congregate setting.

INTRODUCTION: This study aims to measure how transmission of SARS-CoV-2 occurs in communities and to identify conditions that lend to increased transmission focusing on congregate situations. We will measure SARS-CoV-2 in exhaled breath of asymptomatic and symptomatic persons using face mask sampling-a non-invasive method for SARS-CoV-2 detection in exhaled air. We aim to detect transmission clusters and identify risk factors for SARS-CoV-2 transmission in presymptomatic, asymptomatic and symptomatic individuals. METHODS AND ANALYSIS: In this observational prospective study with daily follow-up, index cases and their respective contacts are identified at each participating institution. Contact definitions are based on Centers for Disease Control and Prevention and local health department guidelines. Participants will wear masks with polyvinyl alcohol test strips adhered to the inside for 2 hours daily. The strips are applied to all masks used over at least 7 days. In addition, self-administered nasal swabs and (optional) finger prick blood samples are performed by participants. Samples are tested by standard PCR protocols and by novel antigen tests. ETHICS AND DISSEMINATION: This study was approved by the Colorado Multiple Institutional Review Board and the WHO Ethics Review Committee. From the data generated, we will analyse transmission clusters and risk factors for transmission of SARS-CoV-2 in congregate settings. The kinetics of asymptomatic transmission and the evaluation of non-invasive tools for detection of transmissibility are of crucial importance for the development of more targeted control interventions-and ultimately to assist with keeping congregate settings open that are essential for our social fabric. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov (#NCT05145803).

An Innovative Academic-Practice Partnership Using Simulation to Provide End-of-Life Education for Undergraduate Nursing Students in Rural Settings.

ABSTRACT: Innovations that foster academic-practice partnerships can fill direct clinical care gaps and supplement faculty expertise, particularly in rural settings. An end-of-life simulation was cocreated by nursing faculty and regional certified hospice and palliative care nurses (CHPNs) as a course improvement project for traditional baccalaureate students who lacked direct care experience. Groups of students experienced skills-based pain management and end-of-life conversation-based scenarios using CHPNs as standardized patients. The simulation conformed to current standards in health care simulation, including prebriefing and debriefing components. Feedback from students and CHPNs supports the partnership as an effective teaching/learning strategy.

Nursing Considerations for Patients With HIV in Critical Care Settings.

Infection with HIV is a chronic condition that requires daily medication to suppress viral replication. With appropriate treatment, people living with HIV have a life expectancy approaching that of the general population. However, they are at increased risk for comorbidities including cardiovascular disease, renal disease, type 2 diabetes, neurologic conditions, and cancers, often with worse outcomes than in patients without HIV. When they are admitted to critical care settings, care considerations, particularly regarding antiretroviral therapy, must be addressed. Antiretroviral therapy is critical for successful management of HIV infection and should be continued when possible during intensive care unit stays. However, many antiretroviral regimens result in drug-drug interactions, adverse drug-related events, and secondary complications such as insulin resistance and prolonged QT intervals. Critical care nurses have unique opportunities to provide safe, unbiased, and compassionate care that promotes health for a population of people who have a history of being stigmatized.

The impact of logging roads on dung beetle assemblages in a tropical rainforest reserve.

The demand for timber products is facilitating the degradation and opening up of large areas of intact habitats rich in biodiversity. Logging creates an extensive network of access roads within the forest, yet these are commonly ignored or excluded when assessing impacts of logging on forest biodiversity. Here we determine the impact of these roads on the overall condition of selectively logged forests in Borneo, Southeast Asia. Focusing on dung beetles along > 40 km logging roads we determine: (i) the magnitude and extent of edge effects alongside logging roads; (ii) whether vegetation characteristics can explain patterns in dung beetle communities, and; (iii) how the inclusion of road edge forest impacts dung beetle assemblages within the overall logged landscape. We found that while vegetation structure was significantly affected up to 34 m from the road edge, impacts on dung beetle communities penetrated much further and were discernible up to 170 m into the forest interior. We found larger species and particularly tunnelling species responded more than other functional groups which were also influenced by micro-habitat variation. We provide important new insights into the long-term ecological impacts of tropical logging. We also support calls for improved logging road design both during and after timber extraction to conserve more effectively biodiversity in production forests, for instance, by considering the minimum volume of timber, per unit length of logging road needed to justify road construction. In particular, we suggest that governments and certification bodies need to highlight more clearly the biodiversity and environmental impacts of logging roads.

Screening, Brief Intervention, and Referral to Treatment in a rural Ryan White Part C HIV clinic.

About 24% of people living with HIV nationally are identified as needing treatment for alcohol or illicit drug use. Screening, Brief Intervention, and Referral to Treatment (SBIRT) has evolved as a strategy to assess and intervene with substance abuse behaviors in various clinical settings. However, less is known about the processes and outcomes of using the SBIRT intervention in outpatient HIV clinics. This paper presents a descriptive analysis of de-identified existing SBIRT results data from an outpatient HIV clinic located in western Colorado. From 2008 to 2013, a total of 1616 SBIRT evaluations were done, which included duplicate patients because some individual patients were screened more than once in a given year. Over this time period, 37-49% of encounters per year were notable for tobacco use, 8-21% for alcohol use, 6-16% for marijuana use, 3-9% for amphetamine use, and 0-2% for illicit opioid use. Unique, unduplicated patient data from 2013 revealed 40% of patients used tobacco, 16% used alcohol, and 11% used methamphetamine. Analyses highlighted that the majority of our patient population (58% in 2013) used and/or abused tobacco, alcohol, and/or illicit substances. An alarming finding was the increase in methamphetamine use over time with more than 50-fold prevalence of use in our population compared to national rates.

Integration of the interaction model of client health behavior and transactional model of stress and coping as a tool for understanding retention in HIV care across the lifespan.

Retaining people living with HIV (PLWH) in care over the lifespan is critical to quality and longevity of life. Individual health behavior decisions that affect care retention are complicated and multifactorial. Current health behavior theories are inadequate in isolation to guide retention in care research. Two existing models, Cox's Interaction Model of Client Health Behavior, and Lazarus and Folkman's Transactional Model of Stress and Coping have both guided research with PLWH, although not related to retention in care. Integration of these models may more comprehensively inform care retention research and practice across the lifespan as it incorporates not only intra- and inter-personal characteristics and relationships but also the stress and coping experiences inevitable when living with a chronic illness such as HIV.