Homelessness and Public Health in Los Angeles

Los Angeles faces a housing crisis of unprecedented scale. After years of underinvestment, in 2016/2017 LA County voters approved Measures H and HHH, which provided an infusion of resources for homeless services, permanent housing, and integrated outreach through the LA County Homeless Initiative (HI). An estimated 58,936 individuals in LA County remain homeless as of January 2019, 75% of them unsheltered and living on streets, in tents, or encampments. Our best estimates suggest that the homeless population has grown since 2017.HI takes a Housing First approach to homelessness, with the largest amount of total funds allocated to housing solutions. However, rehousing is often subject to delays in construction and case management. These delays, combined with persistent market forces driving new homelessness, have left the county well short of its targets. While no forecasts were issued, the initial gap analysis for HI had assumed a 34% reduction in the total homeless count from 2016 to 2019. The count has in fact increased by 26% over that period, meaning 28,000 more homeless clients than anticipated on any night. Whereas cities with comparable homeless crises such as New York have focused on increasing the availability of emergency shelters and safe havens in addition to permanent housing, LA County’s relatively low investment in transitional options has resulted in persistent levels of unsheltered homelessness.Research has shown that homelessness has severe health consequences. Homeless individuals have a high risk of mortality, with a recent LA County Medical Examiner report finding an average age of death of 48 for women and 51 for men. Homeless individuals have much higher risks of mental illness, substance abuse, infectious disease, chronic illness, violence, and reproductive health risks than the general population. Much less is known about the health burdens associated with being unsheltered, but most evidence points to substantially greater health risks given the more intense exposures to violence, weather, pollution, poor sanitation, and behavioral risk. Research is just beginning to quantify the burdens of living on the streets.Our analysis of the LA County homelessness response drew on expert interviews, data analysis, and document review. Beyond the growing numerical gap between HI’s targets and actual trends, we identified five critical service gaps that require immediate attention: Taking a person-centered approach that recognizes both the diversity of client needs and the limitations of existing resources, yet honors the principle that everyone deserves housing; Improving access to emergency shelters by reducing legal and political barriers to construction and adopting “low barrier shelters” that facilitate entry; Delivering comprehensive street medicine and other services to unsheltered homeless populations using evidence-based models that support the path to housing and recovery Adopting more extensive outreach models that engage citizens, empower homeless clients and leverage mobile technology so that case workers can focus on clients most in need; Strengthening data collection and research methods to understand the consequences of unsheltered homelessness, pilot new service models, and evaluate rehousing efforts

Comparative evaluation of Polymerase Chain Reaction - Restriction Enzyme Analysis (PRA) and Sequencing of Heat shock protein 65 (hsp65) gene for identification of aquatic mycobacteria

Traditional identification of mycobacteria based on cultural and biochemical tests can take several weeks and may fail to provide a precise identification. Polymerase Chain Reaction-restriction analysis (PRA) of the gene encoding heat shock protein 65kDA (hsp65) gene has been proposed as a rapid and inexpensive alternative approach. Despite being widely used for differentiation of mammalian mycobacteria, this method has only been applied in the identification of a small number of aquatic mycobacteria. The present study aimed to evaluate the potential use of PRA of hsp65 for the identification of aquatic mycobacteria compared with sequence analysis. Seventy one mycobaterial isolates including, 10 type/reference strains and the remainder field isolates, were subjected to PRA of a 441 bp fragment of this gene. For 68 representative isolates, sequence analysis was performed. All rapidly and slow growing mycobacteria had best matches with 99.3% to 100% similarity with their corresponding species in the databanks. PRA proved to be a simple and rapid method for identifying aquatic mycobacteria. However, the incidence of similar or identical restriction patterns for some species of mycobacteria, and in particular, identification of new species of mycobacteria is a major problem using such a method. In contrast, the nucleic acid sequencing of the hsp65 gene yielded unambiguous results

Patient partner compensation in research and health care: the patient perspective on why and how

As patient and family engagement activity broadens across the continuum of care and expands around the world, the question of compensation for an increasingly competent advisory community continues to come up. The authors are 4 patients who are highly active in patient and public involvement initiatives internationally. Through our exclusive patient perspective, we provide insight into the reasoning and motivation that many patients are now awakening to as to why lived experience is a value that organizations need to recognize and support in concrete ways. We explore the core principles that an organization needs to consider and adopt when developing compensation policies for their engagement practices with patients and family members. Organizations face an ongoing challenge to achieve diversity among their patient advisors so that all segments of the community they serve are represented. In particular, marginalized populations are confronted with financial and social determinants that are often barriers to full inclusion. Comprehensive compensation policies overcome these barriers. While there is some guidance available from organizations like PCORI, the predominant culture in health care resists the notion of compensation. In addition to defining core principles behind compensation, we outline how to put those principles into practice in a valid, credible manner that honours and values the contributions of patients and families whether in quality improvement or health research. Experience Framework This article is associated with the Patient, Family & Community Engagement lens of The Beryl Institute Experience Framework. (http://bit.ly/ExperienceFramework) Access other PXJ articles related to this lens. Access other resources related to this lens

Neuron-Derived Extracellular Vesicles Modulate Microglia Activation and Function

Microglia act as the immune cells of the central nervous system (CNS). They play an important role in maintaining brain homeostasis but also in mediating neuroimmune responses to insult. The interactions between neurons and microglia represent a key process for neuroimmune regulation and subsequent effects on CNS integrity. However, the molecular mechanisms of neuron-glia communication in regulating microglia function are not fully understood. One recently described means of this intercellular communication is via nano-sized extracellular vesicles (EVs) that transfer a large diversity of molecules between neurons and microglia, such as proteins, lipids, and nucleic acids. To determine the effects of neuron-derived EVs (NDEVs) on microglia, NDEVs were isolated from the culture supernatant of rat cortical neurons. When NDEVs were added to primary cultured rat microglia, we found significantly improved microglia viability via inhibition of apoptosis. Additionally, application of NDEVs to cultured microglia also inhibited the expression of activation surface markers on microglia. Furthermore, NDEVs reduced the LPS-induced proinflammatory response in microglia according to reduced gene expression of proinflammatory cytokines (TNF-α, IL-6, MCP-1) and iNOS, but increased expression of the anti-inflammatory cytokine, IL-10. These findings support that neurons critically regulate microglia activity and control inflammation via EV-mediated neuron–glia communication. (Supported by R21AA025563 and R01AA025591)

Storytelling at board meetings: A case study of co-developing recommendations

In healthcare, stories shared by patients often provide details and insights into experiences of illness and care. Stories are a way to educate healthcare providers and others to improve care and systems to become more patient and family centred and to better meet patients’ needs and priorities. Telling stories may bring benefits to both storytellers and audience members but also presents risks of harm. A reflective storytelling practice aims to honor stories and storytellers by ensuring there is time to prepare, reflect, learn, ask questions, and engage in dialogue with the storyteller to explore what went well and where there are learning and improvement opportunities. Healthcare Excellence Canada (HEC) is a pan-Canadian health organization focused on improving the quality and safety of care in Canada. HEC commits to engage patients, caregivers, and communities and aims to develop practices and structures to enable engagement activities. At the request of the HEC Board, the Patient Engagement and Partnerships team co-developed recommendations on the process for how best to meaningfully share stories at Board meetings, including stories from those leading, providing, and receiving care. This Case Study outlines the process HEC used to co-develop storytelling recommendations, focusing on a trauma-informed approach to create safe spaces for preparing, learning from and reflecting on stories, to clearly articulate their purpose, and to ensure the locus of control for storytelling rests with the storytellers. This Case Study shares these recommendations and invites other organizations to use these recommendations and/or adapt them within their own context. Experience Framework This article is associated with the Infrastructure & Governance lens of The Beryl Institute Experience Framework (https://www.theberylinstitute.org/ExperienceFramework). Access other PXJ articles related to this lens. Access other resources related to this lens

Phosphorylation of pRb: mechanism for RB pathway inactivation in MYCN-amplified retinoblastoma.

A small, but unique subgroup of retinoblastoma has been identified with no detectable mutation in the retinoblastoma gene (RB1) and with high levels of MYCN gene amplification. This manuscript investigated alternate pathways of inactivating pRb, the encoded protein in these tumors. We analyzed the mutation status of the RB1 gene and MYCN copy number in a series of 245 unilateral retinoblastomas, and the phosphorylation status of pRb in a subset of five tumors using immunohistochemistry. There were 203 tumors with two mutations in RB1 (RB1(-/-) , 83%), 29 with one (RB1(+/-) , 12%) and 13 with no detectable mutations (RB1(+/+) , 5%). Eighteen tumors carried MYCN amplification between 29 and 110 copies: 12 had two (RB1(-/-) ) or one RB1 (RB1(+/-) ) mutations, while six had no mutations (RB1(+/+) ). Immunohistochemical staining of tumor sections with antibodies against pRb and phosphorylated Rb (ppRb) displayed high levels of pRb and ppRb in both RB1(+/+) and RB1(+/-) tumors with MYCN amplification compared to no expression of these proteins in a classic RB1(-/-) , MYCN-low tumor. These results establish that high MYCN amplification can be present in retinoblastoma with or without coding sequence mutations in the RB1 gene. The functional state of pRb is inferred to be inactive due to phosphorylation of pRb in the MYCN-amplified retinoblastoma without coding sequence mutations. This makes inactivation of RB1 by gene mutation or its protein product, pRb, by protein phosphorylation, a necessary condition for initiating retinoblastoma tumorigenesis, independent of MYCN amplification

Zimbabwean counselors' knowledge of and attitudes toward HIV/AIDS

Acquired Immune Deficiency Syndrome (AIDS) has become the world's foremost health threat and is the number one killer in Zimbabwe. Acquired Immune Deficiency Syndrome impacts not only the individual who has AIDS, but on nuclear and extended families, and all aspects of society in Zimbabwe. Since studies have indicated that counseling could be an effective tool in preventing the spread of Human Immuno Deficiency Virus (HIV) and helping those who are already impacted by the virus, it would be important for counselors to be knowledgeable about HIV/AIDS and have positive attitudes towards people with HIV/AIDS. Therefore, the main purpose of this study was to investigate eight practicing Zimbabwean counselors' attitudes towards and knowledge of HIV/AIDS. Additionally, the study explored the emotions the counselors experienced while counseling HI V/AIDS clients, their beliefs about the origin of HI V/AIDS, and their perceptions about HI V/AIDS counseling in Zimbabwe. Eight practicing counselors in Zimbabwe participated in this study. A mixed method Model III with a sequential exploratory design was used amid phenomenological underpinnings. The counselors provided information through a mailed (electronic mail) questionnaire and telephone interviews. Follow-ups to the interviews were carried out through the electronic mail. Results indicated that the counselors in the study were generally knowledgeable about HIV/AIDS, had positive attitudes toward people with HIV/AIDS, and did not think that the origin of HIV/AIDS was important and that it was better to focus on the solutions to the problem. The counselors experienced a wide variety of feelings while counseling HIV/AIDS clients. The counselors reported more negative than positive feelings, but most of the feelings were not directed toward the client. The counselors revealed that HIV/AIDS counseling was complex and difficult. The counselors thought counselor training in Zimbabwe was too limited and that counselors in Zimbabwe in general lacked both support and supervision services. Despite the difficulties of, and the lack of support and supervision, the counselors found meaning in counseling HIV/AIDS clients

Alternative cell line for the isolation of salmonid alphavirus-1

Salmonid alphavirus (SAV) has recently become an economically important pathogen in salmonid aquaculture in Europe. Subtype SAV-1 causes salmon pancreas disease (SPD) in Atlantic salmon in Scotland and Ireland, and was first isolated on Chinook salmon embryo-214 (CHSE-214) cells in 1995 in Ireland; several established cell lines have since been tested for viral growth, although the ability of these cell lines to support primary virus isolation has not being examined. In the present study, CHSE-214, Chum salmon heart -1 (CHH-1) and Salmon head kidney -1 (SHK-1) cell lines were evaluated for isolation of SAV-1 from kidney samples of experimentally infected Atlantic salmon (Salmo salar). The presence of infection in these samples was confirmed both by cell culture and reverse transcription polymerase chain reaction (RT-PCR). Homogenates of kidney from fish 3 days post-infection (p.i.) were inoculated onto the three cell lines and the development of a cytopathic effect (CPE) recorded. The CHH-1 cells produced a rapid CPE from Day 6 p.i., while the CHSE-214 cells showed the presence of a CPE from Day 10 p.i. In comparison, a CPE developed much later in the SHK-1 cells, from Day 20 p.i. The virus was successfully isolated on all three cell lines in subsequent passages, indicating that CHSE-214, CHH-1, and SHK-1 cells can be used for the isolation and culture of SAV-1. The CHH-1 cell line, however, has proven the most useful, since the CPE developed the quickest in this cell line

Integrating Human Factors into Space Vehicle Processing for Risk Management

This presentation will discuss the multiple projects performed in United Space Alliance's Human Engineering Modeling and Performance (HEMAP) Lab, improvements that resulted from analysis, and the future applications of the HEMAP Lab for risk assessment by evaluating human/machine interaction and ergonomic designs