Exploring the contextual factors and decision-making process of risky sexual behavior among homeless adults in Louisville, Kentucky.

Homelessness is a complex public health issue; individuals who experience homelessness are said to engage in risky sexual behaviors at an increased rate and experience a higher prevalence of sexually transmitted infection (STI). While the sexual behaviors of homeless adolescents are commonly studied, little is known about the sexual behaviors of the growing population of older adults, or how they make decisions to engage in sex. Three aims guided this research: 1) to describe the sexual behaviors and sexual decision-making process of homeless older adults, 2) to examine how homeless older adults evaluate the outcomes associated with engaging in risky sexual behaviors, and 3) to identify the predictors of sexual behaviors in which homeless older adults engage. This study used a qualitative approach, which included five key informant interviews with providers of homeless services and twenty interviews with the target population. A purposive sampling method was employed by utilizing an indirect facilitation approach, relying on a partnership with local service providers to identify and refer individuals who they believed met the eligibility criteria. Results of the study reflect that while homelessness presents barriers to healthy relationships, older adults experiencing homelessness engage in sex for personal benefits, including the ability to meet their basic needs through transactional opportunities and the need for interpersonal connection. As noted in other studies on homelessness, living in shelters and on the streets presents inherent risks to physical and emotional safety, with increased risk of vulnerability and victimization. Homeless individuals identify STIs/HIV and physical harm as results of sexual encounters, and although these risks can be mitigated, they do not motivate individuals to apply discretion and safer sex practices. In fact, participants expressed confidence in their ability to use safer sex practices and noted the accessibility of condoms, yet did not perceive themselves to be at risk at the time of the sexual encounter. One primary barrier to implementing safer sex practices while experiencing homelessness is the use of substances. The population experiences negative interpersonal relationships, with reports of social disconnection and unfavorable influences of substances on relationships

Health Profiles of Newly Arriving Refugees in Kentucky, 2016: Data from the University of Louisville Global Health Program

Objectives: Refugees resettling in the United States bring with them a number of health conditions, the majority chronic. These health conditions may impact their ability to be successful with disease self-management and employment, and acculturate and thrive in their new communities. Knowledge of health conditions present in individual refugee populations can be of benefit to healthcare providers in the community and public health. The objective of this manuscript is to describe the state of health among refugees newly arriving in the US and resettling in Kentucky during 2016. Methods: Using data from the domestic health screens, immunization clinics, and the Centers for Disease Control and Prevention Electronic Disease Notification, a database entitled Arriving Refugee Informatics Surveillance and Epidemiology (ARIVE) was developed and the Research Electronic Data Capture (REDCap) system used as the platform. Results: A total of 1495 adult and pediatric refugees were screened during January-June 2016 in Louisville, Lexington, Owensboro, and Bowling Green, Kentucky and data entered into ARIVE. Results from those domestic health screenings identified dental abnormalities (60%), obesity (23%), decreased visual acuity (14%), hyperlipidemia (14%), and elevated blood lead levels in child refugees (12%). Latent tuberculosis infection was identified in 13% and more than 32% had evidence of at least one intestinal parasite. Conditions of social importance included tobacco use among 16%. Mental health issues were evident as 15% had a positive Refugee Health Screener (RHS-15) result and more than 13% indicated they had witnessed or experienced torture. Conclusions: This analysis shows that the main health conditions facing refugees after arriving in the US are chronic conditions that require long‐term medical management and support services. Upon review of these results, a systematic approach to solving the problem of long‐term follow‐up needs to be established for refugees in order to address and decrease the impact of chronic health conditions. Using information from this Kentucky assessment may promote interest in a national refugee health database as a means of developing population-based and population-specific interventions to improve overall health

Level of Recall Bias Regarding Pneumococcal Vaccination History among Adults Hospitalized with Community-Acquired Pneumonia: Results from the University of Louisville Pneumonia Study

Background: Recall bias is likely to occur in vaccine effectiveness studies using self-reported vaccination history. The validity of patient-reported vaccination status for adults is not well defined. The objective of this study was to evaluate the validity of self-reported pneumococcal vaccination history among patients hospitalized with community-acquired pneumonia (CAP). Methods: Prospective ancillary study of a population-based observational study of hospitalized patients with CAP in the city of Louisville. To be included in the analysis, patients had to (i) be reached by phone 30-days after discharge from the hospital and (ii) report that they remembered whether or not they received a pneumococcal vaccine in the past five years. The vaccination history was classified as 1) Subjective: patient recollection, or 2) Objective: vaccination records from insurance companies or primary care physicians. Results: A total of 2,787 patients who recalled their vaccination history were included in the analysis. Subjective vaccination history was documented to be inaccurate in 1,023 (37%) patients. Conclusions: Our study indicates that in adult patients, self-reported data regarding pneumococcal vaccination is likely to be inaccurate in one out of three patients. This level of recall bias may incorporate a fatal flaw in vaccine effectiveness studies

Shear stress induces endothelial-to-mesenchymal transition via the transcription factor Snail

Blood flow influences atherosclerosis by generating wall shear stress, which alters endothelial cell (EC) physiology. Low shear stress induces dedifferentiation of EC through a process termed endothelial-to-mesenchymal transition (EndMT). The mechanisms underlying shear stress-regulation of EndMT are uncertain. Here we investigated the role of the transcription factor Snail in low shear stress-induced EndMT. Studies of cultured EC exposed to flow revealed that low shear stress induced Snail expression. Using gene silencing it was demonstrated that Snail positively regulated the expression of EndMT markers (Slug, N-cadherin, α-SMA) in EC exposed to low shear stress. Gene silencing also revealed that Snail enhanced the permeability of endothelial monolayers to macromolecules by promoting EC proliferation and migration. En face staining of the murine aorta or carotid arteries modified with flow-altering cuffs demonstrated that Snail was expressed preferentially at low shear stress sites that are predisposed to atherosclerosis. Snail was also expressed in EC overlying atherosclerotic plaques in coronary arteries from patients with ischemic heart disease implying a role in human arterial disease. We conclude that Snail is an essential driver of EndMT under low shear stress conditions and may promote early atherogenesis by enhancing vascular permeability

Real-time monitoring shows substantial excess all-cause mortality during second wave of COVID-19 in Europe, October to December 2020.

The European monitoring of excess mortality for public health action (EuroMOMO) network monitors weekly excess all-cause mortality in 27 European countries or subnational areas. During the first wave of the coronavirus disease (COVID-19) pandemic in Europe in spring 2020, several countries experienced extraordinarily high levels of excess mortality. Europe is currently seeing another upsurge in COVID-19 cases, and EuroMOMO is again witnessing a substantial excess all-cause mortality attributable to COVID-19.Funding statement: The EuroMOMO network hub at Statens Serum Institut receives funding from European Centre for Disease Prevention and Control, Solna, Sweden, through a framework contract 2017-2020.S

Early mobilisation in critically ill COVID-19 patients: a subanalysis of the ESICM-initiated UNITE-COVID observational study

Background Early mobilisation (EM) is an intervention that may improve the outcome of critically ill patients. There is limited data on EM in COVID-19 patients and its use during the first pandemic wave. Methods This is a pre-planned subanalysis of the ESICM UNITE-COVID, an international multicenter observational study involving critically ill COVID-19 patients in the ICU between February 15th and May 15th, 2020. We analysed variables associated with the initiation of EM (within 72 h of ICU admission) and explored the impact of EM on mortality, ICU and hospital length of stay, as well as discharge location. Statistical analyses were done using (generalised) linear mixed-effect models and ANOVAs. Results Mobilisation data from 4190 patients from 280 ICUs in 45 countries were analysed. 1114 (26.6%) of these patients received mobilisation within 72 h after ICU admission; 3076 (73.4%) did not. In our analysis of factors associated with EM, mechanical ventilation at admission (OR 0.29; 95% CI 0.25, 0.35; p = 0.001), higher age (OR 0.99; 95% CI 0.98, 1.00; p ≤ 0.001), pre-existing asthma (OR 0.84; 95% CI 0.73, 0.98; p = 0.028), and pre-existing kidney disease (OR 0.84; 95% CI 0.71, 0.99; p = 0.036) were negatively associated with the initiation of EM. EM was associated with a higher chance of being discharged home (OR 1.31; 95% CI 1.08, 1.58; p = 0.007) but was not associated with length of stay in ICU (adj. difference 0.91 days; 95% CI − 0.47, 1.37, p = 0.34) and hospital (adj. difference 1.4 days; 95% CI − 0.62, 2.35, p = 0.24) or mortality (OR 0.88; 95% CI 0.7, 1.09, p = 0.24) when adjusted for covariates. Conclusions Our findings demonstrate that a quarter of COVID-19 patients received EM. There was no association found between EM in COVID-19 patients' ICU and hospital length of stay or mortality. However, EM in COVID-19 patients was associated with increased odds of being discharged home rather than to a care facility. Trial registration ClinicalTrials.gov: NCT04836065 (retrospectively registered April 8th 2021)

Advancing the Use of Passive Sampling in Risk Assessment and Management of Sediments Contaminated with Hydrophobic Organic Chemicals: Results of an International Ex Situ Passive Sampling Interlaboratory Comparison Michiel T. O. Jonker*† , Stephan A. van der He

This work presents the results of an international interlaboratory comparison on ex situ passive sampling in sediments. The main objectives were to map the state of the science in passively sampling sediments, identify sources of variability, provide recommendations and practical guidance for standardized passive sampling, and advance the use of passive sampling in regulatory decision making by increasing confidence in the use of the technique. The study was performed by a consortium of 11 laboratories and included experiments with 14 passive sampling formats on 3 sediments for 25 target chemicals (PAHs and PCBs). The resulting overall interlaboratory variability was large (a factor of ∼10), but standardization of methods halved this variability. The remaining variability was primarily due to factors not related to passive sampling itself, i.e., sediment heterogeneity and analytical chemistry. Excluding the latter source of variability, by performing all analyses in one laboratory, showed that passive sampling results can have a high precision and a very low intermethod variability (Advancing the Use of Passive Sampling in Risk Assessment and Management of Sediments Contaminated with Hydrophobic Organic Chemicals: Results of an International Ex Situ Passive Sampling Interlaboratory Comparison Michiel T. O. Jonker*† , Stephan A. van der HepublishedVersio