Health and Housing Trends of Single Homeless Adults in Chittenden County, Vermont

Introduction. Homeless individuals are at an increased risk for both physical and mental health comorbidities compared to those with stable housing. Prior studies have demonstrated that many of these individuals do not seek or receive proper medical care. This study provides a landscape analysis of health characteristics in the single adult homeless population in Chittenden County, Vermont. Methods. Interviews were conducted using a modified version of the Vulnerability Index – Service Prioritization Decision Assistance Tool to determine vulnerability indices across a range of different health and social wellness domains. Single home- less adults were sampled from community self-help clinics and transitional living and homeless shelters from September to November 2017. Results. 56 in-person surveys were conducted. Mean age of participants was 45.3 years and over half were male (63%). Extended periods or multiple episodes of homelessness were experienced most by those who reported sleeping outdoors (89%); this group also reported the highest use of emergency services (47%). The highest incidence of abuse/trauma as a contributing factor for homelessness was reported most in the 18-30 age group (71%) and least in the above 51 age group (35%). Nearly all participants owned a cell phone (86%). Conclusions. Single homeless adults self-reported a variety of health and social is- sues, including substance abuse, increased emergency department use, and in- creased abuse, trauma, and deteriorated social relationships. This study highlights different risk factors that contribute to homelessness in this select population. Future research should evaluate how to individually address these vulnerabilities to optimize health care and well-being.https://scholarworks.uvm.edu/comphp_gallery/1255/thumbnail.jp

Healthcare Barriers of Residents at a Subsidized Housing Community

Introduction: Despite expanded healthcare programs, the low income and elderly lack coverage of vision, hearing, and dental services. Community services are often asked to fill these gaps. To evaluate the situation in Burlington, VT, we surveyed staff and residents in Burlington Housing Authority (BHA) subsidized housing to (1) identify gaps in healthcare coverage and (2) assess barriers to accessing those services in this population.https://scholarworks.uvm.edu/comphp_gallery/1207/thumbnail.jp

Characterization of Hypertension Risk Factors at the Committee on Temporary Shelter

Introduction: The health of homeless populations is at risk due to a high prevalence of undiagnosed hypertension (HTN) and cardiovascular disease (CVD). The interaction of housing and socioeconomic status with the risk factors for HTN and CVD remains unclear. Prevention of HTN through a healthy diet, exercise, adequate sleep, and avoidance of tobacco has been well described, but financial limitations and competing priorities for shelter and food make blood pressure (BP) control difficult for this population. By characterizing the risk factors and awareness of hypertension within the homeless population at the Committee on Temporary Shelter Daystation (COTS) in Burlington, Vermont, we may be able to identify promising avenues for therapeutic intervention.https://scholarworks.uvm.edu/comphp_gallery/1226/thumbnail.jp

Association of Urine Findings with Metabolic Syndrome Traits in a Population of Patients with Nephrolithiasis

Background The odds of nephrolithiasis increase with more metabolic syndrome (MetS) traits. We evaluated associations of metabolic and dietary factors from urine studies and stone composition with MetS traits in a large cohort of stone-forming patients. Methods Patients .18 years old who were evaluated for stones with 24-hour urine collections between July 2009 and December 2018 had their records reviewed retrospectively. Patient factors, laboratory values, and diagnoses were identified within 6 months of urine collection and stone composition within 1 year. Four groups with none, one, two, and three or four MetS traits (hypertension, obesity, dyslipidemia, and diabetes) were evaluated. Trends across groups were tested using linear contrasts in analysis of variance and analysis of covariance. Results A total of 1473 patients met the inclusion criteria (835 with stone composition). MetS groups were 684 with no traits, 425 with one trait, 211 with two traits, and 153 with three or four traits. There were no differences among groups for urine volume, calcium, or ammonium excretion. There was a significant trend (P,0.001) for more MetS traits being associated with decreasing urine pH, increasing age, calculated dietary protein, urine uric acid (UA), oxalate, citrate, titratable acid phosphate, net acid excretion, and UA supersaturation. The ratio of ammonium to net acid excretion did not differ among the groups. After adjustment for protein intake, the fall in urine pH remained strong, while the upward trend in acid excretion was lost. Calcium oxalate stones were most common, but there was a trend for more UA (P,0.001) and fewer calcium phosphate (P50.09) and calcium oxalate stones (P50.01) with more MetS traits. Conclusions Stone-forming patients with MetS have a defined pattern of metabolic and dietary risk factors that contribute to an increased risk of stone formation, including higher acid excretion, largely the result of greater protein intake, and lower urine pH

What You Don’t Know Can Hurt You: Communicating Health Law with Vermont Physicians

Background: Physicians today need a working knowledge of pertinent medical law. With an increased focus on patients’ rights in health care, states are encouraged to set specific laws protecting patients. The additional medical legislation places a challenge on physicians to continually update their medical-legal acumen such as disease reporting, malpractice issues, and medical information access.Little research has been conducted on physicians’ knowledge of the law and medicine. In an effort to expand upon these topics and to find an efficient way to make information about the law and medicine accessible to Vermont physicians, the University of Vermont College of Medicine partnered with the Vermont Board of Medical Practice to answer the following questions: • How well do Vermont physicians understand laws that relate to the practice of medicine? • How do Vermont physicians access nformation on law and medicine? • What topics are most relevant and important to Vermont physicians? • What educational methods willbe effective and how can the Vermont Board of Medial Practice best serve such education needs?https://scholarworks.uvm.edu/comphp_gallery/1018/thumbnail.jp

Are Mandates the Answer? Improving Palliative Care and Pain Management in Vermont

Background: The Vermont legislature (bill H.435, Sec. 19) has tasked the Vermont Board of Medical Practice (VBMP) with making a formal recommendation on improving Vermont health professionals’ knowledge and practice of Palliative Care and Pain Management (PC/PM). In collaboration with the VBMP, our group set out to answer the following questions: • How confident/competent are VT physicians in the practice of PC/PM? • What are the barriers to achieving optimal patient care in PC/PM? • Do VT physicians believe mandatory CME would improve the overall quality of care in PC/PM? • What are the best methods of providing Continuing Medical Education (CME)?https://scholarworks.uvm.edu/comphp_gallery/1040/thumbnail.jp

Serving as Trusted Messengers about COVID-19 Vaccines and Therapeutics

This article is made available for unrestricted research re-use and secondary analysis in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic

VgrG and PAAR Proteins Define Distinct Versions of a Functional Type VI Secretion System

The Type VI secretion system (T6SS) is widespread among bacterial pathogens and acts as an effective weapon against competitor bacteria and eukaryotic hosts by delivering toxic effector proteins directly into target cells. The T6SS utilises a bacteriophage-like contractile machinery to expel a puncturing device based on a tube of Hcp topped with a VgrG spike, which can be extended by a final tip from a PAAR domain-containing protein. Effector proteins are believed to be delivered by specifically associating with particular Hcp, VgrG or PAAR proteins, either covalently ('specialised') or non-covalently ('cargo' effectors). Here we used the T6SS of the opportunistic pathogen Serratia marcescens, together with integratecd genetic, proteomic and biochemical approaches, to elucidate the role of specific VgrG and PAAR homologues in T6SS function and effector specificity, revealing new aspects and unexpected subtleties in effector delivery by the T6SS. We identified effectors, both cargo and specialised, absolutely dependent on a particular VgrG for delivery to target cells, and discovered that other cargo effectors can show a preference for a particular VgrG. The presence of at least one PAAR protein was found to be essential for T6SS function, consistent with designation as a 'core' T6SS component. We showed that specific VgrG-PAAR combinations are required to assemble a functional T6SS and that the three distinct VgrG-PAAR assemblies in S. marcescens exhibit distinct effector specificity and efficiency. Unexpectedly, we discovered that two different PAAR-containing Rhs proteins can functionally pair with the same VgrG protein. Showing that accessory EagR proteins are involved in these interactions, native VgrG-Rhs-EagR complexes were isolated and specific interactions between EagR and cognate Rhs proteins identified. This study defines an essential yet flexible role for PAAR proteins in the T6SS and highlights the existence of distinct versions of the machinery with differential effector specificity and efficiency of target cell delivery

Seminatural areas act as reservoirs of genetic diversity for crop pollinators and natural enemies across Europe

Despite increasing recognition of the importance of the multiple dimensions of biodiversity, including functional or genetic diversity as well as species diversity, most conservation studies on ecosystem service-providing insects focus on simple diversity measures such as species richness and abundance. In contrast, relatively little is known about the genetic diversity and resilience of pollinators or natural enemies of crop pests to population fragmentation and local extinction. The genetic diversity and demographic dynamics of remnant populations of beneficial insects in agricultural areas can be a useful indicator proving additional insights into their conservation status, but this is rarely evaluated. Although gene flow between agricultural and seminatural areas is key to maintaining genetic diversity, its extent and directionality remain largely unexplored. Here, we apply a pan-European sampling protocol to quantify genetic diversity and structure and assess gene flow between agricultural and nearby seminatural landscapes in populations of two key ecosystem service-providing insect species, the lady beetle Coccinella septempunctata, an important predator of aphids and other crop pests, and the bee pollinator Andrena flavipes. We show that A. flavipes populations are genetically structured at the European level, whereas populations of C. septempunctata experience widespread gene flow across the continent and lack any defined genetic structure. In both species, we found that there is high genetic connectivity between populations established in croplands and nearby seminatural areas and, as a consequence, they harbor similar levels of genetic diversity. Interestingly, demographic models for some regions support asymmetric gene flow from seminatural areas to nearby agricultural landscapes. Collectively, our study demonstrates how seminatural areas can serve as genetic reservoirs of both pollinators and natural enemies for nearby agricultural landscapes, acting as sources for recurrent recolonization and, potentially, contributing to enhancing ecosystem service and crop production resilience in the longer term