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Background Healthcare disparities hinder the goal of ending the HIV pandemic by 2030. This review aimed to understand the status of healthcare disparities among people living with HIV (PLWH) in China and summarize driving factors. Methods We searched six databases: PubMed, Web of Science, Cochrane Library, Scopus, China National Knowledge Infrastructure (CNKI), and China Wanfang. English or Chinese articles published between January 2000 and July 2022 were included if they focused on any disparities in access to and utilization of healthcare among PLWH in China. Grey literature, reviews, conferences, and commentaries were excluded. A random effects model was used to calculate the pooled estimates of data on healthcare access/utilization and identified the driving factors of healthcare disparities based on a socio-ecological framework. Results A total of 8728 articles were identified in the initial search. Fifty-one articles met the inclusion criteria. Of these studies, 37 studies reported HIV-focused care, and 14 focused on non-HIV-focused care. PLWH aged ≥ 45 years, female, ethnic minority, and infected with HIV through sexual transmission had a higher rate of receiving antiretroviral therapy (ART). Females living with HIV have higher adherence to ART than males. Notably, 20% (95% CI, 9–43%, I2 = 96%) of PLWH with illness in two weeks did not seek treatment, and 30% (95% CI, 12–74%, I2 = 90%) refused hospitalization when needed. Barriers to HIV-focused care included the lack of knowledge of HIV/ART and treatment side effects at the individual level, and social discrimination and physician-patient relationships at the community/social level. Structural barriers included out-of-pocket medical costs, and distance and transportation issues. The most frequently reported barriers to non-HIV-focused care were financial constraints and the perceived need for medical services at individual-level factors; and discrimination from healthcare providers, distrust of healthcare services at the community/social level. Conclusion This review suggests disparities in ART access, adherence, and utilization of non-HIV-focused care among PLWH. Financial issues and social discrimination were prominent reasons for healthcare disparities in PLWH care. Creating a supportive social environment and expanding insurance policies, like covering more medical services and increasing reimbursement rates could be considered to promote healthcare equity.

Background: Proximal interphalangeal joint (PIPJ) osteoarthritis is a common condition that results in pain, stiffness, and loss of function in the affected hand. Proximal interphalangeal joint arthroplasty is an effective treatment option when conservative methods have failed. The wide-awake local anesthesia no tourniquet (WALANT) technique to perform surgery carries advantages such as lack of tourniquet discomfort, reduces the staffing and costs associated with anesthesia and sedation, and allows faster recovery. We aimed to determine whether the WALANT technique was safe and effective in the context of PIPJ arthroplasty. Methods: Patients were enrolled retrospectively from January 2015 to October 2020 by examining operating theater records and surgeon logbooks. Electronic patient records were examined to obtain patient data. Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaires and Visual Analog Scale (VAS) for pain were sent by post to patients—with a separate DASH and VAS for each digit operated on. Results: Twenty-nine PIPJ arthroplasties were carried out using WALANT technique by 3 different surgeons all using the dorsal approach. All cases were successfully carried out as day-case procedures. There was a significant correlation with increasing VAS and increasing DASH score. Proximal interphalangeal joint arthroplasty improved range of motion from 28.9 ± 5.5° to 79.4 ± 13.3° ( P < .0001). Two cases developed complications related to surgery. Conclusions: Our study is the first to report the use of WALANT to perform PIPJ arthroplasty, and shows comparable results with traditional methods. Larger, multicenter prospective trials are required to determine the efficacy of this technique and to quantify its economical benefit.

Hepatitis B virus (HBV) and hepatitis C virus (HCV) testing rates remain low in China, especially among men who have sex with men (MSM). Pay-it-forward involves having a person receive a free test with community-generated messages and then asks if those who received a free test would like to donate money or test to support subsequent other people to also receive free testing. This study aimed to evaluate the capacity of a pay-it-forward strategy with active community participation to promote HBV and HCV testing among MSM in China. We undertook a two-arm superiority cluster-randomized trial led by MSM community-based organizations in two cities in the Jiangsu Province, China. As part of the intervention, MSM peers were actively involved in planning and leading the trial. Enrolled MSM were randomized to the pay-it-forward (intervention) and standard-of-care (control) arms in groups of ten. Men randomized to the pay-it-forward arm received free HBV and HCV testing and were offered a chance to pay-it-forward by donating money to support the testing of another anonymous person. In the standard-of-care arm, each participant paid for their HCV and HBsAg antibody rapid test at US $7.7/test. Only the staff who performed data analyses were blinded. The primary outcome was the proportion of men tested for HBV and HCV. We pre-specified sub-analyses based on substance use, risky sexual behaviors, and people older than 30 years. The trial was registered in the China Clinical Trial Registry (ChiCTR 2100046140). Between March and October 2021, 322 MSM were randomized to the pay-it-forward (n=160) and standard-of-care (n=162) arms. HBV and HCV rapid testing was notably higher in the pay-it-forward arm (59.4%) than in the standard-of-care arm (25.3%) (proportion difference (PD) 34.4%, 95% CI lower bound 26.9%). Sub-analyses demonstrated that the pay-it-forward intervention was effective among people who use substances, people with risky sexual behaviors, and older individuals. Among men in the pay-it-forward arm, 101/160 (63%) donated some amount to future participants, and the total donation amount covered over half (68%) of the test cost in the pay-it-forward arm. Economic evaluation found that the pay-it-forward model was cheaper than the standard of care, considering economic or financial costs per person tested. The pay-it-forward approach improved HBV and HCV testing among an at-risk populations in a resource-constrained environment. Pay-it-forward model appeared to be managed successfully in a real-world setting, especially as a part of community-led efforts to reach higher-risk populations.

Introduction Narcolepsy is a chronic sleep disorder that can greatly inhibit sleep quality, daytime functioning, and health-related quality of life. Although medication is the first-line treatment to manage narcolepsy symptoms, behavioral interventions may provide additional benefits. We examined the impact of varying lengths of a group mindfulness-based intervention on symptoms of hypersomnia among participants diagnosed with narcolepsy. Methods We randomized 60 participants to 3 versions of a mindfulness-based intervention: brief (4 weeks), standard (8 weeks), or extended (12 weeks). Groups of four participants met weekly or biweekly with a trained instructor via videoconference. Participants completed the Hypersomnia Severity Index (HSI) at baseline, 4 weeks, 8 weeks, and 12 weeks to assess hypersomnolence severity and related impairment. Paired samples t-tests were conducted to examine differences from baseline to post-treatment for the HSI total score, symptoms subfactor, and impairment subfactor. Linear mixed models (LMM) were conducted on the HSI total score to examine changes in the three groups across each assessment time point. Analyses were conducted using an intent-to-treat approach with the last observation carried forward for participants who had missing data after the baseline assessment (brief, n = 1; standard, n = 5; extended, n = 3). Results There were no significant group differences on the HSI total score or subfactor scores at baseline. Analyses revealed a significant decrease in HSI total scores from baseline to post-treatment (d=.533, p Conclusion This preliminary report suggest that mindfulness programs can reduce hypersomnia symptoms for individuals with narcolepsy over a 12-week period, regardless of the duration of treatment. Additional analyses are being examined to determine ideal treatment duration to maximize benefits and minimize costs. Support (if any) This research was supported by a grant from NCCIH (R34AT009551)

BACKGROUND Mobile health (mhealth) interventions among Adolescents and Young Adults (AYA) are increasingly available in African Low- and Middle-Income Countries (LMIC). Its use in overcoming the challenge of verification of HIV self-testing (HIVST) results has improved the scale-up of HIVST services among AYAs. However, there is a challenge in reaching AYAs without access to smartphones. OBJECTIVE The study, therefore, described the creation of an Unstructured Supplementary Service Data (USSD) platform and determined its feasibility and usability to promote HIVST among AYA in Nigeria. METHODS Through a user-centered approach, we developed, assessed usability, and implemented an Unstructured Supplementary Service Data (USSD) platform to verify HIVST results. We used a mixed method study to assess the usability of the platform through a process of quantitative heuristic assessment, qualitative think-aloud method, and exit interview. USSD platform guided AYA in performing HIVST, interpreting the result, and providing linkage to care. Descriptive statistics of quantitative data and inductive thematic analysis of qualitative variables were done. RESULTS A total of 19 AYA participated in the usability test with a median age of 19 years (Range 16-23 years). There were 11 women, eight men, and no non-binary individuals. They were out-of-school AYAs. A total of seven of the 10 Nielsen usability heuristics yielded positive results. The participants found the USSD platform easy to use, preferred the simplicity of the system, felt no need for a major improvement, and were happy the system provided linkage to care following the interpretation of the HIVST result. The pilot field test of the platform enrolled 164 out-of-school AYAs, with females in the majority(61.6%). The mean age of 17.53.18 years, and 92.1% of the participants reported that they were heterosexual, while 7.9% reported that they were gay. A total of 13/164 (7.9%) youth had positive HIV results (reactive to OraQuik kit). However, none of the 13 reactive persons were confirmed HIV positive. CONCLUSIONS This study demonstrated the usability and feasibility of using a USSD system as an alternative to mobile phone applications to verify HIVST results among Nigerian youth without access to smartphones. It, therefore, recommends the scale-up of this system to promote HIVST among young persons in Nigeria

Impairments in neurocognitive functioning domains like memory, or attention can have a significant impact on quality of life or safety of the individual. Sleep disturbances like those seen in insomnia or obstructive sleep apnea, can lead to impairments. In patients with both sleep disorders (comorbid insomnia and sleep apnea, or COMISA), the impact may be further exacerbated, however studies documenting functioning in the COMISA are sparse. Treatments such as Positive Airway Pressure Therapy (PAP) or Cognitive Behavioural Therapeutics for insomnia (CBT-I) may be beneficial in reversing the negative sequelae, however no such research study exists. This is the first study to document both baseline neurocognitive functioning of COMISA patients and the impact of CBT-I, PAP therapy and combined treatment approaches.

Background To inform policy and implementation that can enhance prevention and improve tuberculosis (TB) care cascade outcomes, this review aimed to summarize the impact of various interventions on care cascade outcomes for active TB. Methods and findings In this systematic review and meta-analysis, we retrieved English articles with comparator arms (like randomized controlled trials (RCTs) and before and after intervention studies) that evaluated TB interventions published from January 1970 to September 30, 2022, from Embase, CINAHL, PubMed, and the Cochrane library. Commentaries, qualitative studies, conference abstracts, studies without standard of care comparator arms, and studies that did not report quantitative results for TB care cascade outcomes were excluded. Data from studies with similar comparator arms were pooled in a random effects model, and outcomes were reported as odds ratio (OR) with 95% confidence interval (CI) and number of studies (k). The quality of evidence was appraised using GRADE, and the study was registered on PROSPERO (CRD42018103331). Of 21,548 deduplicated studies, 144 eligible studies were included. Of 144 studies, 128 were from low/middle-income countries, 84 were RCTs, and 25 integrated TB and HIV care. Counselling and education was significantly associated with testing (OR = 8.82, 95% CI:1.71 to 45.43; I2 = 99.9%, k = 7), diagnosis (OR = 1.44, 95% CI:1.08 to 1.92; I2 = 97.6%, k = 9), linkage to care (OR = 3.10, 95% CI = 1.97 to 4.86; I2 = 0%, k = 1), cure (OR = 2.08, 95% CI:1.11 to 3.88; I2 = 76.7%, k = 4), treatment completion (OR = 1.48, 95% CI: 1.07 to 2.03; I2 = 73.1%, k = 8), and treatment success (OR = 3.24, 95% CI: 1.88 to 5.55; I2 = 75.9%, k = 5) outcomes compared to standard-of-care. Incentives, multisector collaborations, and community-based interventions were associated with at least three TB care cascade outcomes; digital interventions and mixed interventions were associated with an increased likelihood of two cascade outcomes each. These findings remained salient when studies were limited to RCTs only. Also, our study does not cover the entire care cascade as we did not measure gaps in pre-testing, pretreatment, and post-treatment outcomes (like loss to follow-up and TB recurrence). Conclusions Among TB interventions, education and counseling, incentives, community-based interventions, and mixed interventions were associated with multiple active TB care cascade outcomes. However, cost-effectiveness and local-setting contexts should be considered when choosing such strategies due to their high heterogeneity.

Introduction Cognitive behavioral therapy for insomnia (CBTI) improves sleep in pregnancy, but its therapeutic benefits may be diminished in pregnancy due to undertreatment of cognitive arousal (i.e., heightened cognitive activity, especially at night). A recent proof-of-concept, single-arm trial suggested that combining behavioral sleep strategies with mindfulness components produced large reductions in prenatal insomnia, depression, and cognitive arousal. The present study was a randomized controlled trial evaluating the effectiveness of this mindfulness-based intervention and CBTI relative to a control condition. Methods Sixty-four pregnant women with clinically significant insomnia symptoms were randomized to a mindfulness-based intervention, CBTI, or control. The mindfulness intervention was Perinatal Understanding of Mindful Awareness for Sleep (PUMAS), which places behavioral sleep strategies within a mindfulness framework and tailors all components to pregnancy. PUMAS and CBTI were delivered via six telemedicine sessions, whereas control patients electronically received six weekly information sheets on perinatal sleep health. Treatment outcomes were assessed before and after treatment, which included the insomnia severity index (ISI), Edinburgh postnatal depression scale (EPDS), and pre-sleep arousal scale’s cognitive factor (PSASC; nocturnal cognitive arousal). Treatment outcomes were analyzed via general linear models, and the PRODCLIN method tested mediation models in evaluation of treatment mechanisms. Results Intent-to-treat analyses revealed significant ISI reductions in the PUMAS (-11.05±3.84) and CBTI (-11.20±6.87) conditions relative to control (-4.27±1.96). Insomnia remission rates were highest among PUMAS patients (81.8%), whereas 65.0% of CBTI patients and 13.6% of controls remitted. PUMAS significantly alleviated depression relative to control (EPDS: -3.77±3.88 vs -0.59±2.84, p=.017), whereas CBTI did not differ from either group (EPDS: -2.55±4.25, p-values ≥ .271). Similarly, PUMAS alleviated cognitive arousal relative to control (PSASC: -8.82±4.99 vs -3.45±4.53, p=.009), whereas CBTI did not differ from either group (PSASC: -7.30±7.49, p-values ≥ .104). Mediation analyses estimated that reductions in cognitive arousal mediated 26.6% and 40.6% of PUMAS effects on insomnia and depression. Conclusion PUMAS alleviated insomnia, depression, and cognitive arousal relative to control. Reducing cognitive arousal was a significant treatment mechanism by which PUMAS alleviated insomnia and depression. By comparison, CBTI significantly alleviated insomnia relative to control, but yielded no significant effects on depression or cognitive arousal. Support (if any)

Introduction Significant challenges exist in access to high-quality care for insomnia disorder. After the recent publication of clinical practice guidelines on behavioral/psychological treatments for insomnia in adults, the American Academy of Sleep Medicine (AASM) hosted a virtual one-day summit in September 2022 to discuss improving care for patients with insomnia disorder. Methods Fifty attendees representing a variety of organizations (e.g., medical, psychological, and nursing associations; patient advocacy groups; and federal institutions) participated in the Summit. Videos highlighting patient perspectives and an overview of current insomnia disorder treatment guidelines were followed by thematic sessions: (1) barriers to care, (2) facilitators of high-quality care, and (3) future directions and innovations. After 3-4 brief topical presentations by content experts, summit participants divided into seven breakout groups to brainstorm and prioritize issues. Each breakout highlighted 3-5 priorities and reported back to the broader group following each thematic session. Results The top barriers to care for insomnia disorder identified by summit participants included (1) limited access to care, (2) limited awareness of insomnia treatment options, (3) limited treatment formats, (4) low perceived value of insomnia treatment, and (5) insufficient number of trained clinicians to provide care. The top facilitators of care included (1) increased education and awareness, (2) novel models to increase access to care, (3) developing and expanding the insomnia patient care workforce, (4) incorporating research into practice, and (5) increasing reimbursement. Top priorities for future directions included (1) increasing awareness among patients and healthcare providers, (2) increasing the number of skilled behavioral sleep medicine providers, (3) increasing advocacy efforts to address insurance issues (e.g., billing, reimbursement, and performance measures), and (4) working collaboratively with multidisciplinary organizations to achieve common goals for insomnia disorder care. Conclusion The AASM and participants from partnering organizations successfully engaged in a summit and identified prioritized strategies to improve access to high-quality care for insomnia disorder across diverse clinical settings (e.g., private practice, academic institutions, and rural areas). The priorities are to improve access to care for insomnia disorder, which require advocacy efforts to increase awareness of treatment options, improve reimbursement, and grow the skilled workforce for treating insomnia disorder. Support (if any) AASM

Introduction Cognitive behavioral therapy for insomnia (CBTI) improves sleep in pregnancy, but its therapeutic benefits may be diminished in pregnancy due to undertreatment of cognitive arousal (i.e., heightened cognitive activity, especially at night). Growing evidence indicates that mindfulness-based interventions produce large reductions in cognitive arousal, which may enhance insomnia therapy outcomes. The present study was a proof-of-concept, single-arm trial of Perinatal Understanding of Mindful Awareness for Sleep (PUMAS), which places behavioral sleep strategies within a mindfulness intervention framework and tailors sleep and mindfulness components to pregnancy. We evaluated patient engagement, treatment outcomes, and patient feedback from 12 pregnant women with insomnia who received PUMAS treatment. Methods Twelve pregnant women with DSM-5 insomnia disorder were treated with six weekly telemedicine sessions of PUMAS. Patient engagement was operationalized as session attendance. Treatment outcomes were assessed before and after PUMAS, which included the insomnia severity index (ISI), Edinburgh postnatal depression scale (EPDS), pre-sleep arousal scale’s cognitive factor (PSASC), and Glasgow sleep effort scale (GSES). Patients completed the Consumer’s report treatment satisfaction scale and provided treatment feedback. Results Eleven of 12 patients completed all six sessions (91.7%). Intent-to-treat analyses revealed very large reductions in ISI (ISI: 14.50±2.50 to 3.67±3.11; p Conclusion Pregnant women with DSM-5 insomnia disorder are engaged in PUMAS, which produced large reductions in insomnia, depression, cognitive arousal, and sleep effort. Patients reported high satisfaction across several domains of functioning. This trial supports testing PUMAS in a randomized controlled trial. Support (if any)

The nuclear factor erythroid 2-related factor 2 (Nrf2) pathway upregulates key cellular defenses. Clinical trials are utilizing pharmacologic Nrf2 inducers such as bardoxolone methyl to treat chronic kidney disease, but Nrf2 activation has been linked to a paradoxical increase in proteinuria. To understand this effect, we examined genetically engineered mice with elevated Nrf2 signaling due to reduced expression of the Nrf2 inhibitor, Kelch-like ECH-associated protein 1 (Keap1). These Keap1FA/FA mice lacked baseline proteinuria but exhibited increased proteinuria in experimental models evoked by adriamycin, angiotensin II, or protein overload. After injury, Keap1FA/FA mice had increased glomerulosclerosis, nephrin disruption and shedding, podocyte injury, foot process effacement, and interstitial fibrosis. Keap1FA/FA mice also had higher daytime blood pressures and lower heart rates measured by radiotelemetry. Conversely, Nrf2 knockout mice were protected from proteinuria. We also examined the pharmacologic Nrf2 inducer CDDO-Im. Compared to angiotensin II alone, the combination of angiotensin II and CDDO-Im significantly increased proteinuria, a phenomenon not observed in Nrf2 knockout mice. This effect was not accompanied by additional increases in blood pressure. Finally, Nrf2 was found to be upregulated in the glomeruli of patients with focal segmental glomerulosclerosis, diabetic nephropathy, fibrillary glomerulonephritis, and membranous nephropathy. Thus, our studies demonstrate that Nrf2 induction in mice may exacerbate proteinuria in chronic kidney disease.

The study examined the relationship between self-compassion and sleep quality. We also investigated whether the relationship was mediated by brooding, perceived stress, sleep hygiene, and anxiety about sleep and whether self-compassion was associated with anxiety, depression, and mental well-being indirectly through sleep quality. A sample of 468 adults completed measures of demographics, health, sleep quality, self-compassion, predisposing (arousability, brooding, perfectionism, interpersonal problems), precipitating (perceived stress, presence of life-changing events) and perpetuating (sleep hygiene, anxiety about sleep) factors of insomnia, depression, anxiety and mental well-being. The results of the hierarchical multiple regression analysis revealed that low self-compassion was significantly associated with poorer sleep quality when controlling for socio-demographic variables, health-related factors and predisposing factors of insomnia. The association, however, became non-significant when precipitating and perpetuating factors of insomnia were added to the model. Structural equation modelling showed that the relationship between self-compassion and sleep quality was mediated by anxiety about sleep and through sequential mediations involving anxiety about sleep and then sleep hygiene; or anxiety about sleep, perceived stress and then sleep hygiene; or perceived stress and then sleep hygiene. Poor sleep in turn was associated with anxiety and depression, which had a negative effect on mental well-being. This study provided cross-sectional evidence that low self-compassion is a potential risk factor for poor sleep quality, and consequently, poor mental well-being. These findings provide insights into possible mechanisms underlying the relationship between self-compassion and sleep quality that could inform etiological models of insomnia.

BACKGROUND Extensive use of geosocial networking (GSN) apps has substantially changed the behaviors and HIV risk among men who have sex with men (MSM). OBJECTIVE We aim to examine the HIV prevalence and risky behaviors among GSN app-using MSM. METHODS We conducted a cross-sectional study among MSM users of Blued (a GSN app) from July 2017 to December 2018. Sociodemographic and behavioural data in the preceding six months were collected through an app-assistant questionnaire, and blood samples were also obtained to test for HIV. HIV prevalence was calculated, and multivariable logistic regression models were constructed to explore the correlates of HIV infection RESULTS A total of 7252 app-using MSM in Beijing were included. The HIV prevalence was 4.7% (95%CI 4.2%-5.2%). In the last six months, nearly half (49.0%) had multiple sexual partners, 3.3% reported having HIV-positive partners, 50.9% were not sure about their current partners’ HIV status. The majority (62.3%) of participants reported consistent condom use, 6.1% had engaged in group sex, and 19.1% had used recreational drug in the past six months. Having college or undergraduate (AOR=0.35, 95%CI 0.16-0.75), or postgraduate (AOR=0.22, 95%CI 0.06-0.78) education, being exclusively insertive in anal intercourse (AOR=0.18, 95%CI 0.07-0.48) were correlated with decreased odds of HIV infection. However, having anal sex (AOR=4.74, 95%CI 1.17-19.19), having 2 to 5 (ORa=1.47 95%CI 1.17-1.86) or six and more (AOR=2.18, 95%CI 1.34-3.55) male sex partners, not consistently using condoms during anal sex (AOR=1.93, 95%CI 1.06-3.52), and being diagnosed with STIs (AOR=3.02, 95%CI 0.95-9.56) in the preceding six months were associated with greater odds of HIV infection. CONCLUSIONS HIV risky behaviors were prevalent among app-using MSM, suggesting more targeted interventions are needed among this population.

Background The COVID-19 pandemic has negatively impacted psychological health. Mindfulness training, which helps individuals attend to the present moment with a nonjudgmental attitude, improves sleep and reduces stress during regular times. Mindfulness training may also be relevant to the mitigation of harmful health consequences during acute crises. However, certain restrictions may necessitate the web-based delivery of mindfulness training (ie, rather than in-person group training settings). Objective The objective of our study was to examine the effects of mindfulness interventions during the COVID-19 pandemic and to evaluate the effectiveness of web-based interventions. Methods Data from an ongoing study were used for this retrospective equivalence analysis. Recruited participants were enrollees from mindfulness courses at a local charity organization that promoted mental wellness. This study had no exclusion criteria. We created three groups; two groups received their training during the COVID-19 pandemic (in-person training group: n=36; videoconferencing group: n=38), and a second control group included participants who were trained before the pandemic (n=86). Our primary outcomes were self-reported stress and sleep quality. Baseline levels and changes in these variables due to mindfulness training were compared among the groups via an analysis of covariance test and two one-tailed t tests. Results Baseline perceived stress (P=.50) and sleep quality (P=.22) did not differ significantly among the three groups. Mindfulness training significantly reduced stress in all three groups (P Conclusions Web-based mindfulness training via videoconferencing may be a useful intervention for reducing stress during times when traditional, in-person training is not feasible. However, it may not be useful for improving sleep quality.

ObjectivesAntimicrobial resistance (AMR) is a significant threat to global public health. Many medical curricula have limited clinical cases and materials focused on AMR. Enhanced AMR education and training are needed to support antimicrobial stewardship programmes. We used crowdsourcing methods to develop open-access, learner-centred AMR resources. Crowdsourcing is the process of having a large group, including experts and non-experts, solve a problem and then share solutions with the public.MethodsWe organised a global crowdsourcing contest soliciting AMR-related multiple-choice questions, infographics, and images. First, we convened a diverse steering committee group to finalise a call for entries. Second, we launched the contest and disseminated the call for entries using social media, blog posts, email, and an in-person event. Partner institutions included two digital healthcare platforms: Fig. 1® and Ding Xiang Yuan. Both organizations serve as online communities for healthcare specialists and professionals to report and comment on clinical information. At the end of the call, solicited entries were screened for eligibility and judged on merit and relevance to AMR learning and education. Exceptional entries were recognised, awarded prizes, and further reviewed for sharing with the public via open-access platforms.ResultsWe received 59 entries from nine countries. These included 54 multiple-choice questions, four infographics, and one image. Eligible entries (n = 56) were reviewed and assigned a score on a 1–10 scale. Eight entries received mean scores greater than 6.0 and were selected as finalists. The eight finalist entries consisted of three infographics and five multiple-choice questions. They were disseminated through open-access publications and online medical communities.ConclusionsWe demonstrate that crowdsourcing challenge contests can be used to identify infectious disease teaching materials. Medical educators and curriculum developers can adapt this method to solicit additional teaching content for medical students.

BACKGROUND The COVID-19 pandemic has negatively impacted psychological health. Mindfulness training, which helps individuals attend to the present moment with a nonjudgmental attitude, improves sleep and reduces stress during regular times. Mindfulness training may also be relevant to the mitigation of harmful health consequences during acute crises. However, certain restrictions may necessitate the web-based delivery of mindfulness training (ie, rather than in-person group training settings). OBJECTIVE The objective of our study was to examine the effects of mindfulness interventions during the COVID-19 pandemic and to evaluate the effectiveness of web-based interventions. METHODS Data from an ongoing study were used for this retrospective equivalence analysis. Recruited participants were enrollees from mindfulness courses at a local charity organization that promoted mental wellness. This study had no exclusion criteria. We created three groups; two groups received their training during the COVID-19 pandemic (in-person training group: n=36; videoconferencing group: n=38), and a second control group included participants who were trained before the pandemic (n=86). Our primary outcomes were self-reported stress and sleep quality. Baseline levels and changes in these variables due to mindfulness training were compared among the groups via an analysis of covariance test and two one-tailed t tests. RESULTS Baseline perceived stress (P=.50) and sleep quality (P=.22) did not differ significantly among the three groups. Mindfulness training significantly reduced stress in all three groups (PP=.002). Sleep quality improved significantly in the prepandemic training group (PPP=.02), and participants in the videoconferencing group engaged in marginally more daily practice than the in-person training group. CONCLUSIONS Web-based mindfulness training via videoconferencing may be a useful intervention for reducing stress during times when traditional, in-person training is not feasible. However, it may not be useful for improving sleep quality.

BACKGROUND: HIV testing for marginalized populations is critical to controlling the HIV epidemic. However, the HIV testing rate among men who have sex with men (MSM) in China remains low. Crowdsourcing, the process of shifting individual tasks to a group, has been increasingly adopted in public health programs and may be a useful tool for spurring innovation in HIV testing campaigns. We designed a multi-site study to develop a crowdsourced HIV test promotion campaign and evaluate its effectiveness against conventional campaigns among MSM in China.METHODS: This study will use an adaptation of the stepped wedge, randomized controlled trial design. A total of eight major metropolitan cities in China will be randomized to sequentially initiate interventions at 3-month intervals. The intervention uses crowdsourcing at multiple steps to sustain crowd contribution. Approximately 1280 MSM, who are 16 years of age or over, live in the intervention city, have not been tested for HIV in the past 3 months, and are not living with HIV, will be recruited. Recruitment will take place through banner advertisements on a large gay dating app along with other social media platforms. Participants will complete one follow-up survey every 3 months for 12 months to evaluate their HIV testing uptake in the past 3 months and secondary outcomes including syphilis testing, sex without condoms, community engagement, testing stigma, and other related outcomes.DISCUSSION: MSM HIV testing rates remain poor in China. Innovative methods to promote HIV testing are urgently needed. With a large-scale, stepped wedge, randomized controlled trial our study can improve understanding of crowdsourcing's long-term effectiveness in public health campaigns, expand HIV testing coverage among a key population, and inform intervention design in related public health fields.TRIAL REGISTRATION: ClinicalTrials.gov, NCT02796963 . Registered on 23 May 2016.

Renal denervation lowers arterial blood pressure (ABP) in multiple clinical trials and some experimental models of hypertension. These antihypertensive effects have been attributed to the removal of renal afferent nerves. The purpose of the present study was to determine whether renal sensory nerves contributed to the 2-Kidney-1-Clip (2K1C) model of hypertension. 2K1C hypertension was produced in male C57Bl6 mice (12-14 weeks, Jackson Laboratories) by placement of a 0.5mm length of PTFE tubing (ID: 0.008” x OD: 0.014”) around the left renal artery. 2K1C mice (n=6) displayed an elevated ABP measured via telemetry (Day 0: 96±4mmHg vs Day 14: 115±3mmHg, P