Toward a New Understanding: The California Statewide Study of People Experiencing Homelessness

This report outlines the largest representative study of homelessness in the United States since the mid-1990s. The study provides a comprehensive look at the causes and consequences of homelessness in California and recommends policy changes to shape programs in response.Designed to be representative of all adults 18 years and older experiencing homelessness in California, CASPEH includes nearly 3,200 administered questionnaires and 365 in-depth interviews with adults experiencing homelessness in eight regions of the state, representing urban, rural, and suburban areas. Interviews were conducted in English and Spanish, with interpreters for other languages. In partnership with a wide array of community stakeholders, the UCSF BHHI team collected data between October 2021 and November 2022. CASPEH was funded by UCSF BHHI, the California Health Care Foundation, and Blue Shield of California Foundation

Residential Mobility, Neighborhood Contexts, and Development from Birth to Adolescence

While a single residential move is a common experience for many families with children, residential moves that occur in higher frequency may serve as disruptive events in a child’s life. The present study draws upon data from the Fragile Families and Child Wellbeing Study of children from birth to 15 years of age to examine associations between residential moves and five measures of health and cognition: emergency room utilization, body mass index, incidence of asthma attack or asthma episode, repeated school grades, and scores on the Peabody Picture Vocabulary Test. Age-dependent, cumulative, and differential associations by sex and race are explored. Finally, the present study examines potential moderation of these associations by neighborhood context of a child’s city of birth. Cumulative analyses from the present study suggest that residential mobility is significantly associated with increased emergency room utilization over time, decreased body mass index over time, and a higher likelihood of a experiencing a repeated grade over time, and an increase in PPVT score over time. Age-dependent analyses of all children suggest that mobility in early childhood is significantly associated with emergency room usage and body mass index outcomes, while moves later in life are associated with increased body mass index and higher odds of repeating a school grade. The study further reveals significant sex and racial differences in both age-dependent and cumulative analyses. Evidence for age-dependent and cumulative associations between mobility and odds of an asthma attack emerged only when sex differences were examined. Several racial differences were observed in analyses. Notably, mobility was not a significant predictor of emergency room utilization for Black children at any time point examined nor in longitudinal analyses. Finally, evidence of consistent moderation effects by a child’s birth city neighborhood context was not found; however, significant moderation effects by neighborhood context were found for associations between mobility and emergency room utilization at age 1, BMI at age 3 and BMI at age 5. A central aim of the present study is to contribute to the growing body of empirical research about housing mobility and correlates to developmental outcomes for children. Results from the present study’s analysis can help inform housing-centered strategies to mitigate adverse outcomes for children from families experiencing housing hardship

Talking about Race in Puerto Rico: Four Descendants of the Transatlantic African Diaspora Share their Experiences

Puerto Ricans are racially characterized by a mix of three races (Spaniard, Taíno, and African). In fact, this statement dominates any other version of the Puerto Rican racial identity, which has limited the discussions about racial issues such as blanqueamiento and racism. In an effort to better understand racial dynamics and the Puerto Rican’s perception of race, four descendants of the African Diaspora engaged in a self-reflective process using a roundtable approach to analyze their experiences in Puerto Rico. The roundtable approach is based in an ethnographic method of the qualitative approach. Each individual journaled each moment from their own perspective, then as a group they came together to discuss the themes, experiences, and impressions of the journey. They did this by attending the Latin American Studies Association Conference that was held in San Juan in 2015.  While visiting the conference, the attending researchers made efforts to learn as much as they could through experiences such as visiting historical sites and engaging with residents. The investigators discussed the themes they observed in Puerto Rico that related to the overarching question, “What does Blackness mean in Puerto Rico?” and the impact of this meaning on the well-being of Black Puerto-Ricans.  These roundtable discussions took place over a year with multiple 2-3 hour meetings. In discussing the themes, the researchers created a space where each author had an equal voice and expertise. This roundtable process not only expanded the authors’ understanding of how Blackness is understood in the diaspora, but also their very own personal understanding of Blackness. The findings from each author were compared to develop a broader and deeper understanding of how each viewed the research questions.  If the themes from the different authors arrived at the same resolution, then their confidence in the themes was strengthened. This process resulted in the team identifying four major themes; the romanticization of belonging to the three races, psychological sense of belonging and resiliencies, tension points in Loíza: resiliency, resistance and social exclusion and the rehabilitation of each individual’s cultural identity as descendants of the Transatlantic African Diaspora. Each individual reproduced their own experiences in this process into these four themes. In regards to the romanticization of belonging to the three races, one member wrote   On my way home I couldn’t believe the day we had. I saw discrimination and racism with my own eyes.  I saw it here in a place I always believed was filled with no racism. In a place, I consider was innocent to color differences and that respected and valued the power of differences. I discover that as Puerto-Ricans we are so used to the fantasy of diversity that we do not see that, for some, diversity is unrealistic; especially when you can’t even acknowledge the basic rights of others.   Using their individual reflections as data, the four researchers were able to identify the resiliency factors that have helped to strengthen their and others’ racial identity. In this process, the researchers were able to have a deeper understanding of their African ancestry and develop a more inclusive Puerto Rican identity.  This process included the researchers examining ways that anti-blackness and colorism are displayed in the Puerto Rican culture, and also detecting areas of racial justice and resiliency throughout their community. The ultimate goal is to determine how transgenerational transmission of resiliency could better inform interventions and strategies targeting racial adversities for all descendants of the Transatlantic African Diaspora while considering its impact on cultural identity development and formation. Collectively, as a result of this project, there is a higher sense of connectedness to African roots.  In team discussions, it was found that a limitation of this paper is not having a person who identifies as Black Puerto-Rican as an author and how this would have added greatly to the roundtable discussions and findings. The authors recognize that there may be tension points that exist for Puerto-Ricans to fully accept their African heritage. The objective of this paper is to start a dialogue to open up spaces and opportunities to engage in this difficult conversation. It is the authors’ hope that this paper can spark conversations and strategies to address the historical and contemporary impact of how Blackness is socially constructed in Puerto Rican Society.  Finally, it is with hopes that this can connect the experiences of Black Puerto Ricans’ historical/contemporary resiliencies to the larger knowledge base of strategies that can help address racial adversities of all people from the Transatlantic African Diaspora

Talking about Race in Puerto Rico: Four Descendants of the Transatlantic African Diaspora Share their Experiences

Puerto Ricans are racially characterized by a mix of three races (Spaniard, Taíno, and African). In fact, this statement dominates any other version of the Puerto Rican racial identity, which has limited the discussions about racial issues such as blanqueamiento and racism. In an effort to better understand racial dynamics and the Puerto Rican’s perception of race, four descendants of the African Diaspora engaged in a self-reflective process using a roundtable approach to analyze their experiences in Puerto Rico. The roundtable approach is based in an ethnographic method of the qualitative approach. Each individual journaled each moment from their own perspective, then as a group they came together to discuss the themes, experiences, and impressions of the journey. They did this by attending the Latin American Studies Association Conference that was held in San Juan in 2015.  While visiting the conference, the attending researchers made efforts to learn as much as they could through experiences such as visiting historical sites and engaging with residents. The investigators discussed the themes they observed in Puerto Rico that related to the overarching question, “What does Blackness mean in Puerto Rico?” and the impact of this meaning on the well-being of Black Puerto-Ricans.  These roundtable discussions took place over a year with multiple 2-3 hour meetings. In discussing the themes, the researchers created a space where each author had an equal voice and expertise. This roundtable process not only expanded the authors’ understanding of how Blackness is understood in the diaspora, but also their very own personal understanding of Blackness. The findings from each author were compared to develop a broader and deeper understanding of how each viewed the research questions.  If the themes from the different authors arrived at the same resolution, then their confidence in the themes was strengthened. This process resulted in the team identifying four major themes; the romanticization of belonging to the three races, psychological sense of belonging and resiliencies, tension points in Loíza: resiliency, resistance and social exclusion and the rehabilitation of each individual’s cultural identity as descendants of the Transatlantic African Diaspora. Each individual reproduced their own experiences in this process into these four themes. In regards to the romanticization of belonging to the three races, one member wrote   On my way home I couldn’t believe the day we had. I saw discrimination and racism with my own eyes.  I saw it here in a place I always believed was filled with no racism. In a place, I consider was innocent to color differences and that respected and valued the power of differences. I discover that as Puerto-Ricans we are so used to the fantasy of diversity that we do not see that, for some, diversity is unrealistic; especially when you can’t even acknowledge the basic rights of others.   Using their individual reflections as data, the four researchers were able to identify the resiliency factors that have helped to strengthen their and others’ racial identity. In this process, the researchers were able to have a deeper understanding of their African ancestry and develop a more inclusive Puerto Rican identity.  This process included the researchers examining ways that anti-blackness and colorism are displayed in the Puerto Rican culture, and also detecting areas of racial justice and resiliency throughout their community. The ultimate goal is to determine how transgenerational transmission of resiliency could better inform interventions and strategies targeting racial adversities for all descendants of the Transatlantic African Diaspora while considering its impact on cultural identity development and formation. Collectively, as a result of this project, there is a higher sense of connectedness to African roots.  In team discussions, it was found that a limitation of this paper is not having a person who identifies as Black Puerto-Rican as an author and how this would have added greatly to the roundtable discussions and findings. The authors recognize that there may be tension points that exist for Puerto-Ricans to fully accept their African heritage. The objective of this paper is to start a dialogue to open up spaces and opportunities to engage in this difficult conversation. It is the authors’ hope that this paper can spark conversations and strategies to address the historical and contemporary impact of how Blackness is socially constructed in Puerto Rican Society.  Finally, it is with hopes that this can connect the experiences of Black Puerto Ricans’ historical/contemporary resiliencies to the larger knowledge base of strategies that can help address racial adversities of all people from the Transatlantic African Diaspora

Process evaluation of complex interventions in non-communicable and neglected tropical diseases in low- and middle-income countries: a scoping review

Objectives: The aim of this review is to map out the use of process evaluation (PE) in complex interventions that address non-communicable diseases (NCDs) and neglected tropical diseases (NTDs) to identify gaps in the design and conduct, as well as strengths, limitations and implications, of this type of research in low- and middle-income countries (LMICs). Design: Scoping review of PE studies of complex interventions implemented in LMICs. Six databases were searched focused on studies published since 2008. Data sources: Embase, PubMed, EbscoHost, Web of Science (WOS), Virtual Health Library (VHL) Regional Portal and Global Index Medicus: Regional Indexes AIM (AFRO), LILACS (AMRO/PAHO), IMEMR (EMRO), IMSEAR (SEARO), WPRIM (WPRO) Global Index Regional Indexes, MEDLINE, SciELO. Eligibility criteria: Studies conducted in LMICs on PEs of randomised controlled trials (RCTs) and non-RCTs published between January 2008 and January 2020. Other criteria were studies of interventions for people at risk or having physical and mental NCDs, and/or NTDs, and/or their healthcare providers and/or others related to achieve better health for these two disease groups. Studies were excluded if they were not reported in English or Spanish or Portuguese or French, not peer-reviewed articles, not empirical research and not human research. Data extraction and synthesis: Data extracted to be evaluated were: available evidence in the utilisation of PE in the areas of NCDs and NTDs, including frameworks and theories used; methods applied to conduct PEs; and in a subsample, the barriers and facilitators to implement complex interventions identified through the PE. Variables were extracted and categorised. The information was synthesised through quantitative analysis by reporting frequencies and percentages. Qualitative analysis was also performed to understand facilitators and barriers presented in these studies. The implications for PEs, and how the information from the PE was used by researchers or other stakeholders were also assessed in this approach. Results: 303 studies were identified, 79% were for NCDs, 12% used the label ‘PE’, 27% described a theory or framework for the PE, and 42% used mixed methods to analyse their findings. Acceptability, barriers and facilitators to implement the interventions, experiences and perceptions, and feasibility were the outcomes most frequently evaluated as part of the PEs. Barriers and facilitators themes identified were contextual factors, health system factors, human resources, attitudes and policy factors. Conclusions: PEs in NCDs and NTDs are used in LMICs with a wide variety of methods. This review identified many PEs that were not labelled by the authors as such, as well as a limited application of PE-related theories and frameworks, and heterogeneous reporting of this type of study

Impact of Production Variability on Balanced Mix Designs in Virginia

116425The objective of this study was to evaluate the influence of production variability on performance test results to determine if mixtures balanced during design could become unbalanced during production. Fourteen currently accepted mixture designs, 10 BMD mixtures and 4 Superpave mixtures (to serve as a comparison between current standards and BMD designs), were recreated in the laboratory. Additionally, the mixes were adjusted to produce coarse and fine gradations and high and low binder contents according to currently accepted tolerance limits to simulate production variability. Two interaction mixtures assessing changes in gradation and binder content were evaluated as well as two critically aged mixtures

Defining the genotypic and phenotypic spectrum of X-linked MSL3-related disorder

Purpose We sought to delineate the genotypic and phenotypic spectrum of female and male individuals with X-linked, MSL3-related disorder (Basilicata-Akhtar syndrome). Methods Twenty-five individuals (15 males, 10 females) with causative variants in MSL3 were ascertained through exome or genome sequencing at ten different sequencing centers. Results We identified multiple variant types in MSL3 (ten nonsense, six frameshift, four splice site, three missense, one in-frame-deletion, one multi-exon deletion), most proven to be de novo, and clustering in the terminal eight exons suggesting that truncating variants in the first five exons might be compensated by an alternative MSL3 transcript. Three-dimensional modeling of missense and splice variants indicated that these have a deleterious effect. The main clinical findings comprised developmental delay and intellectual disability ranging from mild to severe. Autism spectrum disorder, muscle tone abnormalities, and macrocephaly were common as well as hearing impairment and gastrointestinal problems. Hypoplasia of the cerebellar vermis emerged as a consistent magnetic resonance image (MRI) finding. Females and males were equally affected. Using facial analysis technology, a recognizable facial gestalt was determined. Conclusion Our aggregated data illustrate the genotypic and phenotypic spectrum of X-linked, MSL3-related disorder (Basilicata-Akhtar syndrome). Our cohort improves the understanding of disease related morbidity and allows us to propose detailed surveillance guidelines for affected individuals

Defining the genotypic and phenotypic spectrum of X-linked MSL3-related disorder

PURPOSE: We sought to delineate the genotypic and phenotypic spectrum of female and male individuals with X-linked, MSL3-related disorder (Basilicata-Akhtar syndrome). METHODS: Twenty-five individuals (15 males, 10 females) with causative variants in MSL3 were ascertained through exome or genome sequencing at ten different sequencing centers. RESULTS: We identified multiple variant types in MSL3 (ten nonsense, six frameshift, four splice site, three missense, one in-frame-deletion, one multi-exon deletion), most proven to be de novo, and clustering in the terminal eight exons suggesting that truncating variants in the first five exons might be compensated by an alternative MSL3 transcript. Three-dimensional modeling of missense and splice variants indicated that these have a deleterious effect. The main clinical findings comprised developmental delay and intellectual disability ranging from mild to severe. Autism spectrum disorder, muscle tone abnormalities, and macrocephaly were common as well as hearing impairment and gastrointestinal problems. Hypoplasia of the cerebellar vermis emerged as a consistent magnetic resonance image (MRI) finding. Females and males were equally affected. Using facial analysis technology, a recognizable facial gestalt was determined. CONCLUSION: Our aggregated data illustrate the genotypic and phenotypic spectrum of X-linked, MSL3-related disorder (Basilicata-Akhtar syndrome). Our cohort improves the understanding of disease related morbidity and allows us to propose detailed surveillance guidelines for affected individuals