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

The Impact of Medical Management on Quality of Life in Brugada Syndrome Patients

PURPOSE: Brugada syndrome is an inherited cardiac arrhythmia disorder characterized by ST segment elevation in leads V1-V3 on an electrocardiogram (ECG). The main symptoms of this condition are syncope and sudden cardiac death. Medical management for symptomatic patients is an implantable cardioverter defibrillator (ICD). Research has shown that cardiac patients who have an ICD experience a decreased quality of life. However, limited studies have been done on the impact of Brugada syndrome on patient quality of life let alone the impact of medical management in this patient population. The purpose of this study was to understand how Brugada syndrome affects quality of life and if there is any difference between those with an ICD and those without one. The public health significance of this project is to further the understanding of the impacts of medical management in a specific patient population. METHODS: Participants were recruited from a multigenerational family with Brugada syndrome where a mutation has been identified in the gene GPD1L. A questionnaire was developed to ascertain medical management decisions. Additionally, the 36-Item Short Form Health Survey (SF-36v2) was used to assess quality of life. RESULTS: A total of 17 participants agreed to enroll in the study with an age range of 36-89 years. Ten of the seventeen had the family mutation in GPD1L with seven of these ten displaying the Brugada phenotype on an ECG. Only three participants had an ICD and one participant was considering the option in the near future. The main reasons for choosing an ICD were either due to a sense of inevitability and necessity or for family benefit. There was no difference in quality of life between those with the familial mutation and those without. There was also no difference observed between asymptomatic and symptomatic individuals with the mutation. Those with an ICD had a lower MCS than those without an ICD (p-value 0.013) with no other significant differences observed. CONCLUSION: Reasons underlying ICD decision-making are similar to those seen in other studies, indicating that Brugada patients’ experiences are similar to other patient groups with an ICD. There was no statistical difference in quality of life between those with and those without a genetic diagnosis or those with and without symptoms. The difference between those with and without an ICD indicates that medical management does impact quality of life, adding more evidence to support there is a significant psychosocial aspect to Brugada syndrome management. Additional research is needed to better address the specific needs of this patient population

Mathematical problem-solving strategies and group dynamics of a small group of high school students

The goal of this experiment was to find out how a small group of students at Annapolis High School would respond to a series of 3-4 problems per week. The problems required both knowledge of commonly covered secondary level problem-solving strategies and an understanding of where the strategies could be applied. The students worked individually on problem sets during the first four weeks and had a break for two weeks. They were allowed to work as a group on the last set which was comprised of previously worked problems which had been difficult for all of the students

Mai 68 : L’Evolution de la mémoire culturelle et des icônes à travers la photographie

Abstract/Résumé Mai 68 : L’évolution de la mémoire culturelle, des mythes et des icônes à travers la photographie Ariane Sarah Richards, Durham University This thesis investigates the evolution of the cultural memory of May 68 within French society, through a study of the effect of photography on the building and transmission of myths and icons over a period of 40 years. It begins with an examination of the role of photography in documenting the events of May 68, before moving on to consider the reproduction of these images at each ten-year anniversary of the event. A chronological study of the publication of photographs in dedicated collections and in media coverage of the movement follows this broad contextualisation and theoretical positioning, focusing in particular, although not exclusively, on the visual coverage afforded by Paris Match. This study of each ten-year anniversary and its significance permits the underlining of dominant and recurring myths linked especially to urban space and its visual representation; the masculine hegemony in visual representations of May 68, and finally the mythologisation of Daniel Cohn-Bendit. Following this, a study of the myths identified and their continued modification across the 40 years between the event and its latest anniversary is carried out, in which the creation of icons both in a photographic and human sense is interrogated. The methodological approach of this thesis derives from a range of studies on cultural memory and on the evolving role of photography in the formation of cultural memory in the twentieth century both universally and as a mode of representation that responds to the characteristics of contemporary French society. Overall, these analytical steps underline the heterogeneity of representations of May 68 and enable the formulation of conclusions regarding the importance of photography as a vector for the transmission of cultural memory not only in the French context of May 68 but in modern society at large

Volume 18. Article 2. The demersal fish population of Long Island Sound.

https://elischolar.library.yale.edu/bulletin_yale_bingham_oceanographic_collection/1163/thumbnail.jp

Polymer-stabilized sialylated nanoparticles : synthesis, optimization, and differential binding to influenza hemagglutinins

During influenza infection, hemagglutinins (HAs) on the viral surface bind to sialic acids on the host cell's surface. While all HAs bind sialic acids, human influenza targets terminal α2,6 sialic acids and avian influenza targets α2,3 sialic acids. For interspecies transmission (zoonosis), HA must mutate to adapt to these differences. Here, multivalent gold nanoparticles bearing either α2,6- or α2,3-sialyllactosamine have been developed to interrogate a panel of HAs from pathogenic human, low pathogenic avian, and other species' influenza. This method exploits the benefits of multivalent glycan presentation compared to monovalent presentation to increase affinity and investigate how multivalency affects selectivity. Using a library-orientated approach, parameters including polymer coating and core diameter were optimized for maximal binding and specificity were probed using galactosylated particles and a panel of biophysical techniques [ultraviolet-visible spectroscopy, dynamic light scattering, and biolayer interferometry]. The optimized particles were then functionalized with sialyllactosamine and their binding analyzed against a panel of HAs derived from pathogenic influenza strains including low pathogenic avian strains. This showed significant specificity crossover, which is not observed in monovalent formats, with binding of avian HAs to human sialic acids and in agreement with alternate assay formats. These results demonstrate that precise multivalent presentation is essential to dissect the interactions of HAs and may aid the discovery of tools for disease and zoonosis transmission

Research with Disabled Children: Tracing the Past, Present, and Future

This chapter does not provide a toolkit or a ‘how to guide’ for conducting research with disabled children. Rather here the trajectory of disability research in relation to children and childhood is examined within the complex and dynamic social structures in which such research is situated. We trace the general direction of travel that has taken this research out of the institution and the domain of the medical profession into the field of social science, interpretivism and rights. Wider methodological trends, the emerging interest of the social sciences in children’s lives and social agency along with the progression of disability rights and activism has transformed the landscape of contemporary research. We therefore take readers from the imposed passivity of disabled children to their agentic participation in research and highlight the ways that these ideas have been, and can continue to be, applied and interrogated. An exploration of the ways in which disability research is facilitated, conducted and published cannot be extricated from the social context in which ‘disability’ and ‘childhood’ sit. Therefore this chapter does not shy away from the ongoing debates which research in this field generate. We consider here not only changing methodologies and the positioning of participants in research but touch upon ongoing, unresolved social and political debates about who can research, what can they seek to know and what purpose such knowledge should serve. To that effect disability studies is similar to other academic disciplines that interrogate the ways in which social research is conducted. As such, readers (as well as the authors) of this chapter enter an ongoing debate about the characteristics of research with disabled children and at its end should not seek simple and complete answers to what constitutes ‘good’ research. Rather readers should aim to recognise some of the dynamic complexities and opposing positions that influence social research in this field