Statewide Longitudinal Trends in Transmitted HIV-1 Drug Resistance in Rhode Island, USA

Background HIV-1 transmitted drug resistance (TDR) remains a global challenge that can impact care, yet its comprehensive assessment is limited and heterogenous. We longitudinally characterized statewide TDR in Rhode Island. Methods Demographic and clinical data from treatment-naïve individuals were linked to protease, reverse transcriptase and integrase sequences, routinely obtained over 2004–2020. TDR extent, trends, impact on 1 st-line regimens, and association with transmission networks were assessed using Stanford Database, Mann-Kendall statistic, and phylogenetic tools. Results In 1,123 individuals, TDR to any antiretroviral increased from 8% (2004) to 26% (2020), driven by NNRTI (5-18%), and less NRTI TDR (2-8%). Dual- and triple-class TDR were low and major InSTI resistance was absent. Predicted intermediate-high resistance was in 77% of those with TDR, with differential suppression patterns. Among all individuals, 34% were in molecular clusters, some only with members with TDR who shared mutations. Among clustered individuals, people with TDR were more likely in small clusters. Conclusions In a unique (statewide) assessment over 2004–2020, TDR increased, primarily, but not solely, driven by NNRTIs, impacting antiretroviral regimens. Limited TDR to multi-class regimens and PrEP are encouraging, however, surveillance and its integration with molecular epidemiology should continue, to potentially improve care and prevention interventions.

Instructionally Embedded Assessment: Theory of Action for an Innovative System

Policy shifts in the United States are beginning to reduce the emphasis on using statewide assessment results primarily for accountability and teacher evaluation. Increasingly, there are calls for and interest in innovative and flexible assessments that shift the purposes of assessment and use of results toward instructional planning and student learning. Under the Innovative Assessment Demonstration Authority, some states are exploring options for replacing traditional large-scale summative assessments with innovative measures. However, many of these programs are still in early phases of planning and research and have not yet fully articulated how the innovative system achieves desired outcomes. This conceptual paper presents an argument in the form of a theory of action for a flexible and innovative assessment system already in operational use. The system replaces traditional summative assessments with large-scale through-year Instructionally Embedded assessments. We describe the components of the theory of action, detailing the theoretical model and supporting literature that illustrate how system design, delivery, and scoring contribute to the intended outcomes of teachers using assessment results to inform instruction and having higher expectations for student achievement, in addition to accountability uses. We share considerations for others developing innovative assessment systems to meet stakeholders’ needs.

Workplace Health in Kentucky: A Statewide Comparison

The objectives of this study were to assess the state of Kentucky’s workplace health promotion and occupational safety and health programs, to ensure the ability to comprehend any possible trends over the past six years in the state’s progress in offering workplace health promotion and health protection programs, to compare the results of this survey with the 2013 Kentucky state-wide assessment, and to identify gaps in Kentucky’s workplace health promotion and occupational safety and health based on Total Worker Health® (TWH) concepts. Using Qualtrics research software, the Workplace Health in America assessment was sent to companies located in Kentucky and having 10 or more employees. Participants were identified using Dun and Bradstreet’s Hoover’s database. The results showed that, as with the 2013 survey, larger workplaces significantly were more likely to offer workplace health promotion programs than smaller companies (X2 = 24.30; p < 0.001). However, more companies (78%) reported offering programs compared to the 2013 assessment (49%). Given the results of the current study as compared to the statewide assessment conducted in 2013, Kentucky’s WHP is moving in a positive direction; yet, there is still much to be done. There remains a strong need to provide cost-effective and accessible resources for all elements of TWH to small workplaces.

A 15 Year Evaluation of West Nile Virus in Wisconsin: Effects on Wildlife and Human Health

West Nile virus (WNV) is the most important and widespread mosquito-borne virus in the United States (U.S.). WNV has the ability to spread rapidly and effectively, infecting more than 320 bird and mammalian species. An examination of environmental conditions and the health of keystone species may help predict the susceptibility of various habitats to WNV and reveal key risk factors, annual trends, and vulnerable regions. Since 2002, WNV outbreaks in Wisconsin varied by species, place, and time, significantly affected by unique climatic, environmental, and geographical factors. During a 15 year period, WNV was detected in 71 of 72 counties, resulting in 239 human and 1397 wildlife cases. Controlling for population and sampling efforts in Wisconsin, rates of WNV are highest in the western and northwestern rural regions of the state. WNV incidence rates were highest in counties with low human population densities, predominantly wetland, and at elevations greater than 1000 feet. Resources for surveillance, prevention, and detection of WNV were lowest in rural counties, likely resulting in underestimation of cases. Overall, increasing mean temperature and decreasing precipitation showed positive influence on WNV transmission in Wisconsin. This study incorporates the first statewide assessment of WNV in Wisconsin.

“Sincerely Held Principles” or Prejudice? The Tennessee Counseling Discrimination Law

In 2016, Tennessee became the first state to allow counselors and therapists in private practice to deny services to any client based on the therapist’s sincerely held principles. The law’s proponents framed mental health care ethics as infringing on counselors’ religious liberties; its critics denounced the bill because it apparently targeted LGBT+ individuals. This exploratory study is the first statewide assessment of LGBT+ Tennesseans’ ( N = 346) perceptions of the law and how it may affect their help-seeking attitudes and behaviors. Evidence suggests widespread awareness of the law among our respondents and deep skepticism toward mental health care. Further, most respondents view the law as cover for discrimination. We stress the need for broader research on conscience clauses and call for advocacy against these laws, which have the potential to engender widespread harm to multiple minority groups.