BARRIERS TO AND FACILITATORS OF CARE: EXPLORING HOW LOW-INCOME WOMEN ACCESS REPRODUCTIVE HEALTHCARE IN A RURAL COMMUNITY

The purpose of this research study was to gain a comprehensive understanding of the experiences of low-income women living in a rural community when accessing reproductive care and bring awareness to the barriers and facilitating factors they encounter. The present study adopted a post positivism paradigm and was conducted in a rural county in Northern California. A combination of quantitative and qualitative data was gathered through demographic surveys and individual interviews with twenty-two participants. A bottom-up approach was utilized for the phases of qualitative data analysis, which included open coding, axial coding and selective coding. Data analysis revealed thirteen open codes and various connections between those codes. These codes were broken down into three broader categories: the power of personal experiences at the micro level, the community environment in which services are provided and received, and the broader systemic issues at a macro level. The researcher identified the deeply interpersonal nature of reproductive healthcare, which is often directly related to a cultural or societal stigma, as a core issue among low-income women living in rural areas. This core issue is further explored along with actions that can be taken to help mitigate this issue including but not limited to helping clients process core beliefs and emotions around care, teaching clients how to advocate for themselves in a medical setting and collaborating with healthcare agencies to provide relevant training for medical professionals. This research addresses a gap in the existing literature and contributes to both micro and macro social work by offering insight to the barriers that low-income women face, which can guide both clinical practice and policy development. Understanding the experiences of low-income women can be especially helpful to social workers in healthcare settings and better equip them to work with clients

Addressing Knowledge Deficit around Narcan Administration in Unhoused Youth in the Greater Seattle Area

Introduction For our project we worked with a non profit organization in downtown Seattle that serves houseless youth ages 18-25 with a day center and overnight shelter. Their day center has health clinics, serves lunches, and provides creative activities for the houseless to enjoy. Their overnight shelters are open every night for the houseless, providing 30 beds. The goal of the facility is to end homelessness among youth by partnering with them on their journey towards housing and sustainability. Recently, the center was approved to become a Narcan (naloxone) distribution site. When assessing the needs of the facility we identified the following nursing diagnosis; a knowledge deficit related to the need for Narcan and how to utilize it. Narcan is a drug used as a rescue medication for someone who is experiencing drug overdose. We wanted to encourage the young adults at the shelter to carry Narcan with them and feel inspired to utilize the distribution site. We created two posters, one with information on what Narcan is, how to use it, and why it is important. Our second poster included resources for getting help with drug abuse. We also created a small card for people to carry with Narcan including the steps to take if they ever have to use it. Background A majority of the young adults the facility serves are either experiencing addiction themselves or are surrounded by people who are experiencing addiction. There are more than 40,000 people in King County who are experiencing homelessness (Point in Time Count, 2022). Many of the drugs individuals can purchase off the streets are being mixed with fentanyl since it is cheaper to produce, which is leading to a rise of fentanyl overdose cases (U.S. Department of Health and Human Services, 2023). Fentanyl is being mixed into pills and powders and is unregulated, therefore, it is impossible to know the amount going into each dose (Laced & Lethal, 2021). Drug overdose cases are more common amongst the houseless population, and the addition of fentanyl to street drugs is making the risk of overdose more likely. In King County, fentanyl-related overdose deaths increased by 164% between 2018 and 2020. Fentanyl is up to 50 times stronger than heroin, tasteless, and odorless, making it all the more dangerous (Laced & Lethal, 2021). Naloxone (Narcan) is the only known treatment to counteract the effects of opioid overdose. Narcan works by blocking the effects of opiates on the brain, which in turn also restores breathing (Charles, 2022). Due to the rise in use and overuse of fentanyl, Narcan is becoming more and more important for everyone to carry. The young adults that this facility targets have a higher likelihood of either needing Narcan for themselves, or being around someone who needs to be rescued with it, because they are at risk youth. According to a study done by the Center for Disease Control (CDC), in nearly forty percent of overdose deaths, someone else was present (2023). Having Narcan available allows bystanders to potentially help save a life during an overdose. Narcan can not harm a person who does not need it, only save a person who does. Since Narcan is available to everyone, it is important for houseless individuals to feel comfortable administering and carrying Narcan as it can save their own lives and the lives around them. Activities with Rationale Based on the needs assessment, we identified knowledge deficits surrounding the topics of Narcan use, drug overdose, and drug safety. For our project we created three resources that target a different need of the organization. Our first resource was directed towards the specific population the site serves. For the houseless young adults we created a wallet-sized card that includes condensed information on how to respond during an overdose. We created the small sized card so that it is easy for people to carry it with them. On the card we included signs and symptoms of overdose, how to administer naloxone, and a directive to call 911. In our literature review, we found that fear of arrest and/or prosecution was a barrier to calling for help, therefore, we also emphasized The Good Samaritan Law so that people do not shy away from calling for help. The literature demonstrates that having access to and using Narcan appropriately can help save lives during an overdose (CDC, 2023). The cards address potential knowledge deficits around Narcan for unhoused youth. In addition, the literature demonstrates easy access to information through products like a badge card can improve both process and outcomes. The other two resources we created were educational posters to be hung on the walls of the facility and serve both the staff and clientele. The first poster provided education about overdose signs and symptoms, facts and figures regarding drug use among the houseless population, information on Narcan and how to administer it, the Good Samaritan Law, and resources outside of the facility that can be utilized by people seeking recovery help. The purpose of this poster was to educate clients on how to identify an overdose and take action so they are able to help save lives. Long term opioid abuse and homelessness has a 25% mortality rate (Fine, n.d.) and we aimed to reduce the incidence of drug-overdose related deaths with this poster. The second poster was an infographic that provided a list of resources to their clients such as, addiction help, needle exchange, and detox programs.This poster was meant to condense the resources the site offers to one place. We chose to do this in an appealing, clear, and concise way so that people felt drawn to look at the poster and utilize the resources. All of the elements of our project were meant to reduce overdose mortality within the houseless population, which we identified to be a major issue within our target population. The literature demonstrates that health posters are an effective strategy for transferring knowledge when attempting to reach a wide audience (Hasanica, 2020). Outcomes After meeting with the staff at the facility and deliberating as a group we identified a knowledge deficit requiring narcan administration education, drug overdose education, and drug safety education. The goal of addressing this deficit is to reduce the mortality rate among houseless individuals. An outcome we identified was for clients to be able to recognize the signs and symptoms of opioid overdose. We believe this outcome was achieved by giving our wallet sized card and poster to the site. Another outcome we identified was the need for the population to feel comfortable administering Narcan. Again, giving our poster and wallet sized card on how to administer Narcan to the site allowed us to achieve this outcome. The goal of this was to offer clients easy access to the information, thus reducing a potential barrier, i.e. having to ask for these resources. We achieved this outcome by creating this list in the form of a poster and displaying it in the day center and overnight shelter. Conclusion Our goal was to create a project that would address the knowledge deficit related to Narcan use/opioid overdose/etc as evidenced by our needs assessment, that would continue to be utilized by the facility beyond the project term. During our needs assessment at the site, we identified that the houseless population served is at high risk for drug misuse. Our research led us to discover that many drugs are being laced with fentanyl, a dangerous substance which is leading to an increase in fentanyl overdose and death. Our research also led us to discover that there are often bystanders present when a person overdoses. Therefore, we identified the nursing diagnosis of knowledge deficit. The clients of the site needed more information on drug overdose, drug safety, and Narcan use. The facility recently becoming a Narcan distribution site set up the perfect opportunity for us to create resources that would address these needs. We created a wallet-sized card with step-by-step instructions on what to do when administering Narcan. When clients or employees administer Narcan, the card will be an easy resource for them to reference in the event that they need to give Narcan to someone. The use of cards for rapid access to health literature is evidence-based practice. We also made a poster with overdose signs and symptoms, facts about drug overdose, Narcan administration instructions, and emphasized the good samaritan law. We created this poster to educate clientele on what overdose looks like, how they can help, and how to take action. Health information posters are demonstrated in the literature as an effective educational tool for large audiences. Lastly, we created a simple and colorful poster with helplines and addiction recovery services resources so participants have access, a need identified by the site. All program outcomes were accomplished. Future recommendations are to continue educating the clientele on the importance of carrying Narcan and updated information on drug overdose in the city of Seattle. References Centers for Disease Control and Prevention. (2023, January 25). Lifesaving naloxone. Centers for Disease Control and Prevention. Retrieved February 1, 2023, from https://www.cdc.gov/stopoverdose/naloxone/index.html Charles, Dowd. (2022, July 25). Naloxone: Frequently asked questions. Anne Arundel County Department of Health. Retrieved February 22, 2023, from https://www.aahealth.org/naloxone-frequently-asked-questions/ Fine, D. R., Dickins, K. A., & Adams, L. D. (n.d.). Drug Overdose Mortality Among People Experiencing Homelessness, 2003 to 2018. Jama Network. Retrieved February 1, 2023, from https://jamanetwork.com/journals/jamanetworkopen/article-abstract/2787711 Hasanica, N., Ramic-Catak, A., Mujezinovic, A., Begagic, S., Galijasevic, K., & Oruc, M. (2020). The Effectiveness of Leaflets and Posters as a Health Education Method. Materia socio-medica, 32(2), 135–139. https://doi.org/10.5455/msm.2020.32.135-139 Point in time count. KCRHA. (2022, June 29). Retrieved February 22, 2023, from https://kcrha.org/data-overview/king-county-point-in-time-count/ The risk is real:fentanyl 101. Laced & Lethal ❘ See Why Fentanyl Is So Dangerous. (2021). Retrieved February 1, 2023, from https://www.lacedandlethal.com/fentanyl-101/ U.S. Department of Health and Human Services. (2023, January 9). Fentanyl drugfacts. National Institutes of Health. Retrieved February 1, 2023, from https://nida.nih.gov/publications/drugfacts/fentany

Children\u27s Perceptions of Parent-Child Relationships: A Narrative, Inductive Approach

Background: Narrative methods can allow researchers to gather rich data from children regarding their perceptions of their relationship with parents that may not otherwise be captured using tasks, questionnaires, or structured interviews; however, existing coding systems have been established with samples that are largely White and middle class. The current study sought to establish child-inspired codes that would better reflect the sample. Methods: Children aged 5-12 years (M=8.82, 48.9% female) and their caregivers were recruited from high-poverty urban US areas. All participants identified as Black or African American. Children were audiotaped while speaking, uninterrupted, for three minutes about their relationship with their primary caregiver (TMSS; Marshall et al., 1990). A team of five researchers - diverse in race, ethnicity, and background - established a codebook using in-vivo methods, dually coded N=51 transcripts via thematic analysis, and analyzed codes for emergent themes (Braun & Clarke, 2006). Results: Coders identified N=671 codes from the transcripts, of which 332 (49.5%) were unique codeable units. Five themes emerged from the data: interactions, feelings about caregiver, emotional closeness, reciprocity, and insight. Conclusions: The use of open-ended speech sampling coupled with qualitative coding allowed cataloging of Black children’s own perceptions of the parent-child relationship. Children emphasized time spent together, mutual understanding, & reciprocity. Many children also showed insight into parents’ perspectives and motivations, including financial awareness. Previous work indicates this dyadic reciprocity may be one way families protect themselves against the negative consequences of financial difficulties (Wilhoit et al., 2021). References: Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3, 77–101. https://doi.org/10.1191/1478088706qp063oa Marshall, V.G., Longwell, L., Goldstein, M.J., & Swanson, J.M. (1990). Family factors associated with aggressive symptomatology in boys with Attention Deficit Hyperactivity Disorder: A research note. J. Child Psychol. Psychiat., 31(4), 629-636. https://doi.org/10.1111/j.1469-7610.1990.tb00802.x Wilhoit, S.A., Trentacosta, C.J., Beeghly, M., Boeve, J.L., Lewis, T.L. and Thomason, M.E. (2021). Household chaos and early childhood behavior problems: The moderating role of mother–child reciprocity in lower-income families. Fam Relat, 70, 1040-1054. https://doi.org/10.1111/fare.12560https://scholarscompass.vcu.edu/gradposters/1174/thumbnail.jp

Investigating the growing population of massive quiescent galaxies at cosmic noon

We explore the build-up of quiescent galaxies using a sample of 28 469 massive (M⋆ ≥ 1011 M☉) galaxies at redshifts 1.5 < zz < 3.0, drawn from a 17.5 deg2 area (0.33 Gpc3 comoving volume at these redshifts). This allows for a robust study of the quiescent fraction as a function of mass at 1.5 < zz < 3.0 with a sample ∼40 times larger at log(M⋆/ M⊙)≥11.5M⊙)≥11.5 than previous studies. We derive the quiescent fraction using three methods: specific star formation rate, distance from the main sequence, and UVJ colour-colour selection. All three methods give similar values at 1.5 < zz < 2.0, however the results differ by up to a factor of 2 at 2.0 < zz < 3.0. At redshifts 1.5 < zz < 3.0, the quiescent fraction increases as a function of stellar mass. By zz = 2, only 3.3 Gyr after the big bang, the universe has quenched ∼25 per cent of M⋆ = 1011 M☉ galaxies and ∼45 per cent of M⋆ = 1012 M☉ galaxies. We discuss physical mechanisms across a range of epochs and environments that could explain our results. We compare our results with predictions from hydrodynamical simulations SIMBA and IllustrisTNG and semi-analytic models (SAMs) SAG, SAGE, and Galacticus. The quiescent fraction from IllustrisTNG is higher than our empirical result by a factor of 2-5, while those from SIMBA and the three SAMs are lower by a factor of 1.5-10 at 1.5 < zz < 3.0Fil: Sherman, Sydney. Department Of Astronomy; Estados UnidosFil: Jogee, Shardha. Department Of Astronomy; Estados UnidosFil: Florez, Jonathan. Department Of Astronomy; Estados UnidosFil: Stevans, Matthew L. Department Of Astronomy; Estados UnidosFil: Kawinwanichakij, Lalitwadee. Kavli Institute For The Physics And Mathematics Of The; JapónFil: Wold, Isak. Nasa Goddard Space Flight Center; Estados UnidosFil: Finkelstein, Steven L. Department Of Astronomy; Estados UnidosFil: Papovich, Casey. Department Of Physics And Astronomy; Estados UnidosFil: Ciardullo, Robin. Department Of Astronomy And Astrophysics; Estados UnidosFil: Gronwall, Caryl. Department Of Astronomy And Astrophysics; Estados UnidosFil: Cora, Sofia Alejandra. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - La Plata. Instituto de Astrofísica La Plata. Universidad Nacional de La Plata. Facultad de Ciencias Astronómicas y Geofísicas. Instituto de Astrofísica La Plata; ArgentinaFil: Hough, Tomas. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - La Plata. Instituto de Astrofísica La Plata. Universidad Nacional de La Plata. Facultad de Ciencias Astronómicas y Geofísicas. Instituto de Astrofísica La Plata; ArgentinaFil: Vega Martínez, Cristian Antonio. Instituto de Investigación Multidisciplinar En Ciencia; Chil

Effect of Hydrocortisone on Mortality and Organ Support in Patients With Severe COVID-19: The REMAP-CAP COVID-19 Corticosteroid Domain Randomized Clinical Trial.

Importance: Evidence regarding corticosteroid use for severe coronavirus disease 2019 (COVID-19) is limited. Objective: To determine whether hydrocortisone improves outcome for patients with severe COVID-19. Design, Setting, and Participants: An ongoing adaptive platform trial testing multiple interventions within multiple therapeutic domains, for example, antiviral agents, corticosteroids, or immunoglobulin. Between March 9 and June 17, 2020, 614 adult patients with suspected or confirmed COVID-19 were enrolled and randomized within at least 1 domain following admission to an intensive care unit (ICU) for respiratory or cardiovascular organ support at 121 sites in 8 countries. Of these, 403 were randomized to open-label interventions within the corticosteroid domain. The domain was halted after results from another trial were released. Follow-up ended August 12, 2020. Interventions: The corticosteroid domain randomized participants to a fixed 7-day course of intravenous hydrocortisone (50 mg or 100 mg every 6 hours) (n = 143), a shock-dependent course (50 mg every 6 hours when shock was clinically evident) (n = 152), or no hydrocortisone (n = 108). Main Outcomes and Measures: The primary end point was organ support-free days (days alive and free of ICU-based respiratory or cardiovascular support) within 21 days, where patients who died were assigned -1 day. The primary analysis was a bayesian cumulative logistic model that included all patients enrolled with severe COVID-19, adjusting for age, sex, site, region, time, assignment to interventions within other domains, and domain and intervention eligibility. Superiority was defined as the posterior probability of an odds ratio greater than 1 (threshold for trial conclusion of superiority >99%). Results: After excluding 19 participants who withdrew consent, there were 384 patients (mean age, 60 years; 29% female) randomized to the fixed-dose (n = 137), shock-dependent (n = 146), and no (n = 101) hydrocortisone groups; 379 (99%) completed the study and were included in the analysis. The mean age for the 3 groups ranged between 59.5 and 60.4 years; most patients were male (range, 70.6%-71.5%); mean body mass index ranged between 29.7 and 30.9; and patients receiving mechanical ventilation ranged between 50.0% and 63.5%. For the fixed-dose, shock-dependent, and no hydrocortisone groups, respectively, the median organ support-free days were 0 (IQR, -1 to 15), 0 (IQR, -1 to 13), and 0 (-1 to 11) days (composed of 30%, 26%, and 33% mortality rates and 11.5, 9.5, and 6 median organ support-free days among survivors). The median adjusted odds ratio and bayesian probability of superiority were 1.43 (95% credible interval, 0.91-2.27) and 93% for fixed-dose hydrocortisone, respectively, and were 1.22 (95% credible interval, 0.76-1.94) and 80% for shock-dependent hydrocortisone compared with no hydrocortisone. Serious adverse events were reported in 4 (3%), 5 (3%), and 1 (1%) patients in the fixed-dose, shock-dependent, and no hydrocortisone groups, respectively. Conclusions and Relevance: Among patients with severe COVID-19, treatment with a 7-day fixed-dose course of hydrocortisone or shock-dependent dosing of hydrocortisone, compared with no hydrocortisone, resulted in 93% and 80% probabilities of superiority with regard to the odds of improvement in organ support-free days within 21 days. However, the trial was stopped early and no treatment strategy met prespecified criteria for statistical superiority, precluding definitive conclusions. Trial Registration: ClinicalTrials.gov Identifier: NCT02735707