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Reducing the stigma and discrimination faced by men who have sex with men (MSM) and transgender women (TGW) in healthcare settings is key to improving health outcomes. Using a one-group pre- and post-test design, we tested the efficacy of a theory-informed, multi-level pilot intervention (“Harmony”) among 98 healthcare workers (HCWs) to reduce sexual orientation and gender identity (SOGI)-related stigma and discrimination faced by MSM and TGW in two public hospitals. The intervention contained group-level (a half-day workshop) and individual-level (four videos) components. Using multi-level modelling, we compared knowledge, attitudes, and comfort level among HCWs across three timepoints: pre-intervention, post-intervention, and follow-up (2 months after the intervention). Client surveys were conducted among 400 MSM/TGW (two independent samples of 200 MSM/TGW) attending the intervention hospitals, before the intervention among HCWs and three months after the intervention. Generalised estimating equations assessed service users’ satisfaction with hospital services, discrimination experiences, and positive interactions with HCWs. Significant changes were observed in primary outcomes: 30% increase in positive attitude scores (incidence rate ratio (IRR) = 1.30, 95% CI 1.13–1.49) and 23% increase in the proportion of HCWs reporting being comfortable in providing care to MSM/TGW (IRR = 1.23, 95% CI 0.03–1.68). Similarly, there was a significant improvement in secondary outcomes (scores): support for non-discriminatory hospital policies (IRR = 1.08, 95% CI 1.004–1.15), the importance of asking SOGI questions in clinical history (IRR = 1.17, 95% CI 1.06–1.29), and perceived self-efficacy in providing clinical care (IRR = 1.13, 95% CI 1.01–1.27). Service users’ data provided corroborative evidence for intervention efficacy: e.g., 14% increase in the proportion of MSM reporting overall satisfaction with hospital services and 6% and 15% increase in the scores of positive interactions with HCWs in the combined sample of MSM/TGW and TGW, respectively. The Harmony intervention showed preliminary evidence for improving positive attitudes, comfort level, and understanding of the healthcare issues of MSM/TGW among HCWs, warranting large-scale implementation research.

Transgender women (TGW) in India, especially those who engage in sex work, are at high risk for HIV. Guided by the information-motivation-behavioral skills model and qualitative formative research findings, Sakhi (girlfriend), a 3-week smartphone-based pilot intervention consisting of short videos (one/week) and text messages (two/week), was implemented using a one-group pre- and post-test design to test its efficacy in promoting condom use and HIV testing among TGW (n = 50) who engage in sex work in Chennai. Changes in outcomes were assessed by conducting multivariable analyses using generalized estimating equations. Participants’ mean age was 26 years, and the mean monthly income was INR 21700 (USD 292). About one-third completed college, and 96% were HIV-negative. Significant changes in the desired direction were observed in the primary outcomes: condom use – decrease in the engagement of condomless anal sex with male partners (12% to 2%, p < 0.05) and HIV testing – increase in intentions to undergo HIV testing every 6 months (34% to 86%, p < 0.001); and in some of the secondary outcomes: decrease in alcohol use before sex, increase in intentions to use condoms consistently and increase in the well-being score. This study demonstrated the feasibility, acceptability, and preliminary efficacy of the Sakhi intervention and warrants a larger randomized trial among diverse subgroups in diverse settings.

Background: Lung ultrasound (LUS) is increasingly used as an extension of physical examination, informing clinical diagnosis, and decision making. There is particular interest in the assessment of patients with pulmonary congestion and extravascular lung water, although gaps remain in the evidence base underpinning this practice as a result of the limited evaluation of its inter-rater reliability and comparison with more established radiologic tests. Methods: 30 patients undergoing haemodialysis were prospectively recruited to an observational cohort study (NCT01949402). Patients underwent standardised LUS assessment before, during and after haemodialysis; their total LUS B-line score was generated, alongside a binary label of whether appearances were consistent with an interstitial syndrome. LUS video clips were recorded and independently scored by two blinded expert clinician sonographers. Low-dose non-contrast thoracic CT, pre- and post dialysis, was used as a “gold standard” radiologic comparison. Results: LUS detected a progressive reduction in B-line scores in almost all patients undergoing haemodialysis, correlating with the volume of fluid removed once individuals with no or minimal B-lines upon pre-dialysis examination were discounted. When comparing CT scans pre- and post dialysis, radiologic evidence of the change in fluid status was only identified in a single patient. Conclusions: This is the first study to demonstrate that LUS detects changes in extravascular lung water caused by changing fluid status during haemodialysis using a blinded outcome assessment and that LUS appears to be more sensitive than CT for this purpose. Further research is needed to better understand the role of LUS in this and similar patient populations, with the aim of improving clinical care and outcomes.

Cost–volume–profit (CVP) analysis is a widely used decision tool across many business disciplines. The current literature on stochastic applications of the CVP model is limited in that the model is studied under the restrictive forms of the Gaussian and Lognormal distributions. In this paper we introduce the Mellin Transform as a methodology to generalize stochastic modeling of the CVP problem. We demonstrate the versatility of using the Mellin transform to model the CVP problem, and present a generalization of the CVP model when the contribution margin and sales volume are both defined by continuous random distributions.