Design of a Virtual Reality Software to Promote the Learning of Students with Dyslexia

The research conducted is part of the European project Erasmus+ FORDYSVAR, whose main objective is to contribute to the educational inclusion of students with dyslexia, aged between 10 and 16 years old, through the use of technology, specifically virtual reality (VR), to improve the access, participation, and educational achievement of students with this learning difficulty. This is a qualitative and interpretative study with a descriptive character. The objective of this work is to design a VR application that contributes to the learning of students with dyslexia based on user-centered design as a methodology. The developmental lines to be addressed in the application have been defined, the features to be included have been determined, and the activities that make up the software have been designed. All this is based on the analysis of the needs and interests of the end users (students with dyslexia) as well as the vision of professionals (teachers and dyslexia intervention specialists). The results obtained allow us to conclude that VR technology is an interesting avenue of treatment, as it offers a ludic, safe, controlled, and motivating environment for students with dyslexia.

Sustained Transmission of Neisseria gonorrhoeae with High-Level Resistance to Azithromycin, in Indianapolis, Indiana, 2017–2018

Background Since 2014, Neisseria gonorrhoeae azithromycin (AZM) susceptibility has declined in the United States, but high-level AZM resistance (HL-AZMR) has been infrequent and sporadic. We describe a cluster of 14 N. gonorrhoeae isolates with HL-AZMR identified in Indianapolis over 13 months. Methods N. gonorrhoeae culture specimens (genital and extragenital) were collected from attendees of the Bell Flower Clinic. Isolates underwent antimicrobial susceptibility testing (AST) using Etest. AZM minimum inhibitory concentrations ≥256 µg/mL were classified as HL-AZMR. Local disease intervention specialists interviewed patients whose isolates demonstrated HL-AZMR and conducted partner services. Relatedness of isolates was investigated by genomic analyses. Results During 2017–2018, AST was performed in 1016 N. gonorrhoeae isolates collected at the Bell Flower Clinic. Fourteen isolates (1.4%) from 12 men collected over 13 months demonstrated HL-AZMR; all were cephalosporin susceptible. Of the 12 men, 9 were white and reported male sex partners. Nine of the men were able to be retested; all were cured with 250-mg ceftriaxone plus 1-g AZM. Two men named each other as partners; no other partners in common were reported. Genomic analysis demonstrated close relatedness of the HL-AZMR isolates and a novel combination of a mosaic-mtrR promoter along with 23S ribosomal RNA mutations that appear to have emerged from circulating strains. Conclusions The close genetic relatedness with limited epidemiologic linkages between patients highlights the challenges of gonorrhea partner investigations and suggests undetected local transmission. Local AST, rapid public health action, and epidemiologic investigations combined with genomic analysis provides a multipronged approach to understanding an outbreak of sexually transmitted disease.

Identification of an HIV-1 and Neurosyphilis Cluster in Vermont

Background Rates of syphilis in the U.S. have more than doubled over the last several decades, largely among men who have sex with men (MSM). Our study characterizes a cluster of neurosyphilis cases among HIV-1-infected individuals in Vermont in 2017-2018. Methods Vermont Department of Health disease intervention specialists conduct interviews with all newly diagnosed HIV-1 cases and pursued sexual networking analyses. Phylogenetic and network analyses of available Vermont HIV-1 polymerase (pol) sequences identified clusters of infection. Fishers-exact and independent t-tests were used to compare HIV-1-infected individuals within or outside an identified cluster. Results Between January 1, 2017 and December 31, 2018, 38 Vermont residents were newly diagnosed with HIV-1 infection. The mean age was 35.5 years, 79% were male and 82% were white. Risk factors for HIV-1 acquisition included MSM status (79%) and methamphetamine use (21%). Eighteen cases (49%) had HIV-1 viral loads (VLs) >100,000 copies/mL and 47% had CD4 cell counts <200/mm 3. Eleven of the 38 (29%) cases had positive syphilis serology, including four (36%) with neurosyphilis. Sexual networking analysis revealed a ten-person cluster with higher VLs at diagnosis (90% with VLs > 100,000 copies/mL vs. 33%, p=0.015). Phylogenetic analysis of pol sequences showed a cluster of 14 cases with sequences that shared 98-100% HIV-1 nucleotide identity. Conclusions This investigation of newly infected HIV-1 cases in Vermont led to identification of a cluster that appeared more likely to have advanced HIV-1 disease and neurosyphilis. Identification of a cluster was strongly supported by both phylogenetic and network analyses of HIV-1 pol sequences.

957. Efficacy of Using Disease Intervention Specialists (DIS) to Re-engage Out of Care HIV/HCV Co-Infected Persons into HCV Treatment

Background Published treatment cascades for HIV/HCV co-infection show WHO goals for HCV micro-elimination are not being met. Barriers include entry to care, access to DAA, treatment adherence, and out of care (OOC) patients. A Data to Care approach used to define persons with HIV (PWH) who are OOC, together with DPH-employed DIS to promote re-engagement has been successful for re-engaging OOC PWH. We modified this approach to re-engage OOC HIV/HCV coinfected persons. Methods Surveillance databases used: CTEDSS (CT Electronic Disease Surveillance System used for HCV) and eHARS (electronic HIV/AIDS Reporting System). Two OOC cohorts studied: HIV OOC for 12 months (no HIV lab 10/2018-10/2019) and 18 months (no HIV lab 12/2017-6/2019). Lists generated for the 2 cohorts matched to CTEDSS to determine the coinfected OOC. DIS supervisor performed pre-work/case conferencing on lists to assess DIS intervention eligibility. DIS success was defined as those who reengaged (made/kept appointment) out of those successfully contacted. Analysis: tests of homogeneity performed between those OOC and not OOC; evaluation of cases at each level of the intervention; measures of dispersion/central tendency performed illustrating reengagement workload. Project Flow Chart Results 12-month OOC: Non-baby boomers (p-value 0.05) and those with detectable HIV VLs (0.04) were more likely to be OOC; 53.7% were DIS-eligible; DIS initiation to client contact, 7 days average (range 4-11); 75 calls and 31 field visits for those successfully contacted; reengagement success rate, 39%. 18-month OOC: Non-baby boomers (0.017), Hispanic and Black race/ethnicity (0.043), and those with detectable HIV viral loads (0.002) were more likely to be OOC; 44% were DIS-eligible; DIS initiation to client contact, 12 days average (range 8-18); 74 calls and 36 field visits for those successfully contacted; reengagement success rate, 43%. Results for the Two Cohorts Out of Care and Workload Results Conclusion A data-to-care approach successfully identified, characterized, connected OOC HIV/HCV coinfected patients. DIS provided patient education, facilitating reengagement to care. DIS Success rates are encouraging but small; efforts were labor intensive. Additional strategies focused on preventing non-baby boomers, persons of color, and those with detectable HIV VLs from becoming OOC should be studied. Disclosures All Authors: No reported disclosures

HIV Outbreak Control With Effective Access to Care and Harm Reduction in North Carolina, 2017–2018

Objectives. To assess and control a potential outbreak of HIV among people who inject drugs in Western North Carolina. Methods. Disease intervention specialists offered testing for hepatitis B and hepatitis C, harm reduction materials, and linkage to care to 7 linked people recently diagnosed with HIV who also injected drugs. Contacts were offered the same services and HIV testing. HIV genotype analysis was used to characterize HIV spread. We assessed testing and care outcomes by using state surveillance information. Results. Disease intervention specialists contacted 6 of 7 linked group members and received information on 177 contacts; among 96 prioritized contacts, 42 of 96 (44%) were exposed to or diagnosed with hepatitis C, 4 of 96 (4%) had hepatitis B, and 14 of 96 (15%) had HIV (2 newly diagnosed during the investigation). HIV genotype analysis suggested recent transmission to linked group members and 1 contact. Eleven of 14 with HIV were virally suppressed following the outbreak response. Conclusions. North Carolina identified and rapidly responded to an HIV outbreak among people reporting injecting drugs. Effective HIV care, the availability of syringe exchange services, and the rapid response likely contributed to controlling this outbreak.

PSYCHOLOGICAL MECHANISMS THAT UNDERLIE GOAL EXPECTANCY AMONG RETIREES

The way individuals envision, formulate, and strive to meet retirement goals is poorly understood. In particular, few studies have focused on the goal setting process of individuals who have already retired. In this investigation, the authors replicate and extend Hershey and Jacobs-Lawson’s (2009) model of retirement goal expectancy across five retirement resource domains. Their (path) model posits individuals’ perceptions of the consequence of failing to achieve a goal determines the perceived importance of the goal. Perceived goal importance, in turn, determines the effort individuals allocate toward achieving the goal (goal striving). And goal striving, in turn, predicts the perceived likelihood the goal will be achieved (goal expectancy). This basic model was empirically tested across five key retirement resource domains (health, physical, social, cognitive and emotional) identified by Wang and Shi (2013). The sample of 698 American retirees (Mage=77.14 years, SD=6.00) was divided into four subgroups: males and females, aged 66-77 and 78-94. Twenty theoretically-driven path analysis models were tested using AMOS (i.e., four subgroup models across five retirement domains). Differences were observed across subgroups and domains in terms of the magnitude of path coefficients and the amount of accounted variance in goal expectancy criterion measures (R2 values ranged from .26-.67). Overall, the path model was effective at capturing variability in retirement goal expectancy. Findings not only provide a synthesis of the 2009 goal model with Wang and Shi’s Dynamic Resource Theory, but they also suggest areas in which retirement intervention specialists can intercede to increase the likelihood of goal attainment.