Changes in Confidence, Feelings, and Perceived Necessity Concerning COVID-19 Booster.

The COVID-19 booster first became available to all adults in the U.S. in November 2021 and a bivalent version in September 2022, but a large population remains booster-hesitant; only 17% of Americans have obtained the updated vaccine as of June 2023. We conducted two cross-sectional surveys in 2021 and 2022 (n = 1889 and 1319) to determine whether changes in booster-related feelings or perceptions had occurred and whether they altered vaccination rates over time. We found that both positive and negative emotions had grown stronger between the two years, with the prevalence of annoyance increasing the most (21.5% to 39.7%). The impact of trust on booster intention more than doubled (OR = 7.46 to 16.04). Although perceived risk of infection decreased, more participants in 2022 indicated uncertainty or unwillingness to obtain a new booster than in 2021, while the proportion refusing a booster remained constant at 22.5%. Confidence in the COVID-19 vaccine and feelings of hope from the booster motivated acceptance; both were stronger predictors of booster receptivity than prior vaccination history. Our findings signal a need to rebuild trust by informing people of their continued risk and appealing to positive, especially optimistic emotions to encourage booster uptake. Future research should explore longitudinal trends in behavior and feelings toward new booster doses and the impact of prolonged vaccine hesitancy on infection rates.

Vaccinated Yet Booster-Hesitant: Perspectives from Boosted, Non-Boosted, and Unvaccinated Individuals.

Though available for all age groups in the US, only about half of those vaccinated have obtained a COVID-19 booster. Similar to the unvaccinated, those vaccinated-but-not-boosted may reduce the effectiveness of widespread viral protection. Booster hesitancy differs from general vaccine hesitancy yet remains less researched. We examined booster perceptions across vaccination status using qualitative methodologies. Four focus groups and 11 individual interviews (total n = 32) revealed nuanced changes and differences compared to the first-dose decision. Booster hesitancy stemmed from questions and surprises. Most vaccinated participants accepted the booster, though to varying degrees: enthusiastically with feelings of appreciation and added confidence, passively as an intuitive next step, indifferently following recommendation-"primed" by the yearly flu shot, and reluctantly with worries. The vaccinated-but-not-boosted group expressed confusion about the need for a new shot and discontentment as to why it was not communicated from the start, which coincided with their uncertainty about ending the pandemic. Inadvertently, booster recommendations further polarized non-vaccinated participants, augmenting their skepticism of the original dosages' efficacy or necessity and intensifying their distrust of the government. The findings illuminate the need for adjusting vaccination promotions to better tailor communications (e.g., distinguishing its benefits from the first vaccine and emphasizing the continued risk of COVID-19 spread). Future researchers should further explore the vaccine-accepting-yet-booster-hesitant groups' motivations and risk perceptions to reduce booster rejection.

Teaching quality essentials: the effectiveness of a team-based quality improvement curriculum in a tertiary health care institution.

A unique quality improvement (QI) curriculum was implemented within the Division of General Internal Medicine to improve QI knowledge through multidisciplinary, team-based education, which also met the QI requirement for the American Board of Internal Medicine (ABIM) Maintenance of Certification (MOC) and the Mayo Quality Fellows program. Participants completed up to 4 QI learning modules, including pretest and posttest assessments. A participant who successfully completed all 4 modules received certification as a Silver Quality Fellow and credit toward the quality requirement for ABIM MOC. Of 62 individuals invited to participate, 33 (53%) completed all 4 modules and corresponding pretests and posttests. Participants substantially improved knowledge in all 4 quality modules. Study group participants' pretest scores averaged 71.0%, and their posttest scores averaged 92.7%. Posttest scores of reference group participants compared favorably, averaging 89.2%. Initial assessments showed substantial knowledge improvements and successful implementation of staff-developed QI projects.

Induction of CD56 and TCR-independent activation of T cells with aging.

Degeneration of the thymus and severe contraction of the T cell repertoire with aging suggest that immune homeostasis in old age could be mediated by distinct effectors. Therefore, receptors expressed on T cells as they undergo senescence in vitro, as well as those displayed by circulating T cells during normal chronologic aging, were examined. Monitoring of T cells driven to senescence showed de novo induction of CD56, the prototypic receptor of NK cells. Analysis of fresh T cells in peripheral blood showed an age-dependent induction of CD56. These unusual T cells expressed high levels of Bcl2, p16, and p53, and had limited, or completely lost, ability to undergo cell division, properties consistent with senescence. CD56 cross-linking without TCR ligation on CD56(+) T cells resulted in extensive protein phosphorylation, NF-kappaB activation, and Bax down-regulation. CD56 cross-linking was also sufficient to drive production of various humoral factors. These data suggest that the immunologic environment in old age is functionally distinct, rather than being a dysfunctional version of that seen at a young age. CD56(+) T cells are unique effectors capable of mediating TCR-independent immune cascades that could be harnessed to enhance protective immunity in the elderly.

Drug-induced meningitis.

Preview Drug-induced aseptic meningitis is an unusual adverse reaction associated with a number of medications. In this report, the authors present a case related to use of trimethoprim- sulfamethoxazole and summarize the available data regarding various proposed mechanisms of drug-induced meningitis. The usual clinical presentation and course of the disorder are discussed.