The Evergreen Challenges of Healing: an Evaluation of Urban Green Space in Harambee

Urban green space initiatives have emerged in low- and middle-income cities as a solution to disinvestment, the production of more positive public health metrics, and a tool of community engagement. While the production of urban greening provides ample room for applause, The City of Milwaukee’s Healing Spaces Initiative model regarding the ongoing construction of green space and the implementation of maintenance creates challenges that perpetuate racist capitalistic notions of the neoliberal project. This paper presents reports from participant observation, document analysis, and 17 qualitative interviews with representatives of the City of Milwaukee, community partners, garden leaders, and residents. The data suggest that the needs of the residents are beyond what the City of Milwaukee can provide. Therefore, they use collaborative community partnerships and outside funding to piece together the social support to serve residents while maintaining control over decision-making, even when outside vendors do the work. The result of this is disjointed service and confused residents. Through the tenacity of individual actors and residents, Healing Spaces Initiative remains a success despite various challenges. Resolving these issues by engaging in a new strategic direction for neighborhood beautification is essential to preserving the right to green space

A novel mhealth application for improving HIV and Hepatitis C knowledge in individuals with opioid use disorder

Aims: Untreated opioid use disorder (OUD) is associated with overdose, premature death and infectious disease, including human immunodeficiency virus (HIV) and Hepatitis C (HCV). While prior studies have shown that educational interventions are associated with improvements in HIV and HCV knowledge and reductions in risk behaviors, those examined to date have typically been time- and resource-intensive. We recently developed an HIV+HCV Education intervention which aims to improve HIV and HCV knowledge in a single visit using an automated iPad platform. In this project, we examined its ability, using a within-subject evaluation, to improve knowledge of HIV and HCV transmission and risks among adults with OUD. Methods: Participants were 25 adults with OUD who were enrolled in a 12-week randomized trial evaluating the efficacy of an Interim Buprenorphine Treatment (IBT) for reducing illicit opioid use while awaiting entry into community-based opioid treatment. Participants completed a baseline HIV+HCV knowledge assessment (Pre-Test) followed by corrective feedback, both administered via iPad. They then completed an interactive HIV flipbook and animated HCV video, also on iPad, followed by a second administration of the knowledge assessment (Post-Test). Finally, to evaluate whether any changes in knowledge persisted over time, the HIV+HCV assessment was administered again at 4 and 12 weeks following study intake. Results: At baseline (Pre-Test), participants answered 69% and 65% of items correctly on the HIV and HCV assessments, respectively. After completing the educational intervention, participants answered 86% of items correctly on both the HIV and HCV assessments (p’s\u3c.001). These improvements in knowledge also persisted throughout the three-month study, with scores at Week 4 and 12 timepoints significantly greater than baseline (p’s\u3c.001). Conclusion: An HIV+Hepatitis Education intervention delivered via a portable, automated iPad platform may produce significant and persistent improvements in HIV and HCV knowledge among adults with OUD. These data provide additional support for the use of mobile educational interventions for enhancing HIV and HCV knowledge in individuals at elevated risk for infectious disease. Support: This trial was supported by NIDA R34 DA3730385 (Sigmon) with additional support by NIDA T32 DA007242 (Higgins)

Accounting for health opportunity costs in key decisions in healthcare resource allocation in low- and middle-income countries

The concept of opportunity cost is fundamental to economic analysis. Opportunity costs exist because resources are scarce, and so their use in one way means they are not available for use in other ways. Economic evaluation methods that enable opportunity costs to be accounted for in decision-making in healthcare in high-income countries (HICs) are well-developed. However, methods are less well-developed to inform decisions in low- and middle-income countries (LMICs) despite the fact that it is in these countries where healthcare resources are most constrained and the potential health gains per additional resource spent on healthcare are greatest. This thesis provides methods to answer key policy questions for healthcare resource allocation in LMICs by extending existing frameworks and estimating key parameters required to inform them to enable health opportunity costs to be accounted for. It begins by providing empirical estimates of the marginal cost per unit of health produced by the healthcare system for LMICs, which were previously unavailable. How calculations of value founded on such estimates can be used to inform international guidelines about whether specific healthcare interventions should be provided in countries, whether and the extent to which these should be externally supported, and how to prioritise the development of new healthcare interventions for provision in LMICs is demonstrated. Next, the sources for empirical evidence to inform key parameter estimates for a framework of economic evaluation that accounts for the timing of costs and effects in a more appropriate way are identified, and the assumptions implicit in existing guidelines for economic evaluation are exposed and compared. Finally, a framework is developed to inform health benefits package (HBP) design that takes account of health opportunity costs and can analytically consider dimensions pertaining to equity, financing and implementation, while explicitly assessing key trade-offs in package design

Generation of Cholinergic and Dopaminergic Interneurons from Human Pluripotent Stem Cells as a Relevant Tool for In Vitro Modeling of Neurological Disorders Pathology and Therapy

The cellular and molecular bases of neurological diseases have been studied for decades; however, the underlying mechanisms are not yet fully elucidated. Compared with other disorders, diseases of the nervous system have been very difficult to study mainly due to the inaccessibility of the human brain and live neurons in vivo or in vitro and difficulties in examination of human postmortem brain tissue. Despite the availability of various genetically engineered animal models, these systems are still not adequate enough due to species variation and differences in genetic background. Human induced pluripotent stem cells (hiPSCs) reprogrammed from patient somatic cells possess the potential to differentiate into any cell type, including neural progenitor cells and postmitotic neurons; thus, they open a new area to in vitro modeling of neurological diseases and their potential treatment. Currently, many protocols for generation of various neuronal subtypes are being developed; however, most of them still require further optimization. Here, we highlight accomplishments made in the generation of dopaminergic and cholinergic neurons, the two subtypes most affected in Alzheimer's and Parkinson's diseases and indirectly affected in Huntington's disease. Furthermore, we discuss the potential role of hiPSC-derived neurons in the modeling and treatment of neurological diseases related to dopaminergic and cholinergic system dysfunction

Examining sucrose subjective response among individuals with opioid use disorder

Aims: Opioid use disorder (OUD) is associated with significant morbidity and mortality, and opioid agonist treatment (OAT) with methadone or buprenorphine represents the most efficacious treatment. However, data suggest that chronic administration of opioids may be associated with significant weight gain, possibly by altering an organism’s perception of and preference for sweet foods. The primary aim of this laboratory study was to rigorously examine sucrose subjective response among adults receiving OAT and a comparison sample without OUD. As secondary outcomes, we also sought to compare the groups on additional baseline characteristics that may influence subjective sucrose response and weight gain during treatment. Methods: Participants were 40 adults receiving treatment for OUD (OUD+) and a comparison sample of 40 adults without OUD (OUD-). All participants completed an initial screening visit that included questionnaires on eating behaviors, diet and nutrition, recent substance use, and measurement of body mass index. Eligible participants completed two, same-day outpatient laboratory sessions during which they sampled six experimenter-administered concentrations of sucrose solution (0, 0.1, 0.25, 0.5, 0.75, and 1.0M in distilled water) each three times under double-blind counterbalanced conditions. Following each exposure, participants rated the pleasantness and intensity of each sample using 100-point visual analog scales. Results: OUD+ participants rated sucrose solutions as less pleasant than OUD- participants (p\u3c0.001). However, this effect was limited to the three lowest sucrose concentrations (0, 0.1, 0.25M), and at higher concentrations there were no group differences. There were no between-group differences on ratings of intensity (p=0.35). Given these baseline group differences in placebo (0M) responding, sucrose response was also examined in terms of change from baseline. In this analysis, there was a significant group effect, with a higher magnitude of change in pleasantness ratings and a lower magnitude of change in intensity ratings from 0M in OUD+ vs. OUD- participants (p’s\u3c0.05). With regard to baseline characteristics that may influence sucrose response and eating behavior more generally, the OUD+ group had a higher prevalence of obesity, food insecurity, unhealthy eating behaviors, high sugar consumption, and nutrition knowledge deficits compared to the OUD- group (p’s\u3c0.05). Conclusion: Data from preclinical and clinical research have suggested that opioid agonist medications may enhance subjective response to sweet flavors. In the present study, OUD+ participants exhibited a higher magnitude of change in pleasantness ratings from placebo compared to OUD- participants. However, this effect was largely driven by pronounced group differences in perceived pleasantness of essentially unsweet solutions. On the outcome of sucrose intensity, findings were more mixed with no consistent differences between OUD+ and OUD- participants. In contrast, group differences were far more pronounced in participants’ daily eating behaviors and nutrition knowledge, with OUD+ participants presenting with a consistently more severe profile. These data highlight the significant risk factors experienced by OUD+ individuals that extend beyond drug-related risks and may inform future scientific and clinical efforts to improve health outcomes in this vulnerable population

Assessing the value of human papillomavirus vaccination in Gavi-eligible low-income and middle-income countries.

INTRODUCTION: Estimating the value of providing effective healthcare interventions in a country requires an assessment of whether the improvement in health outcomes they offer exceeds the improvement in health that would have been possible if the resources required had, instead, been made available for other healthcare activities in that country. This potential alternative use of the same resources represents the health opportunity cost of providing the intervention. Without such assessments, there is a danger that blanket recommendations made by international organisations will lead to the adoption of healthcare interventions that are not cost effective in some countries, even given existing donor mechanisms intended to support their affordability. METHODS: We assessed the net health impact to 46 Gavi-eligible countries of achieving one of the WHO's proposed 90-70-90 targets for cervical cancer elimination, which includes 90% coverage of human papillomavirus (HPV) vaccination among girls by 15 years of age, using published estimates of the expected additional benefits and costs in each country and estimates of the marginal productivity of each healthcare system. We calculated the maximum price each country could afford to pay for HPV vaccination to be cost effective by assessing the net health impact that would be expected to be generated at different potential prices. RESULTS: At Gavi negotiated prices, HPV vaccination offers net health benefits across most Gavi-eligible countries included in this study. However, if Gavi-eligible countries faced the average price faced by non-Gavi eligible countries, providing HPV vaccination would result in reduced overall population health in most countries. CONCLUSION: Estimates of the net health impact of providing a healthcare intervention can be used to assess the benefit (or lack of) to countries of adhering to global guidance, inform negotiations with donors, as well as pricing negotiations and the value of developing new healthcare interventions

Decision Problem of Instrumentation in a Company involved in ISO 50001

International audience—In the context of performance management and the involvement of companies in sustainable development, energy management is a new challenge. Managing energy is a complex problem as it can potentially impact the whole company and if mishandled could be harmful for its added value. In order to assist companies in this challenge, the ISO 50001 proposes a standard for the creation of Energy Management Systems (EnMS). Such systems bring the recurring problem of decision about the choice of the actions necessary into their deployments. Notably, they rely heavily on the data related to the consumptions of energy and its usage in a given company. Hence the problem of decision, at an audit stage, can concern the choice of a sound instrumentation. This paper deals with the interest of the company adixen Vacuum Products in a standard for decision aiding in this situation. The idea is to build the model of preference of the Decision Maker and to establish a generic procedure about decision supported by a MCDA tool. Our proposition is to use the ACUTA method in order to elicit this model of preference

Effects of eccentric exercise on anaerobic power, starting speed and anaerobic endurance

The aim of this study was to evaluate the effects of eccentric exercise on anaerobic power, starting speed and anaerobic endurance. The participants performed the maximum cycling sprint test (MCST) prior to eccentric exercise (ECC), 10 minutes after, as well as one hour, 24 hours, 48 hours, and one week after ECC. The peak and mean power, time to attain peak power, time of maintaining peak power and power decrease were measured in the MCST. Before and after ECC, the myoglobin concentration (Mb) in the blood plasma was measured. After ECC, a significant (p<.05) increase in Mb was observed. A significant (p<.05) decrease was noted in peak (-.92±0.42 W.kg-1) as well as in mean power (-.57±0.36 W.kg-1) immediately after ECC. A significant (p<.05) decrement of these indicators lasted for at least 24 hours after ECC. Eccentric exercise did not affect starting speed (time to attain peak power) and anaerobic endurance (time of maintaining peak power and power decrease during MCST)