Removing Barriers for Seniors at Transit Stops and Stations and the Potential for Transit Ridership Growth

The focus of this study was on the identification of barriers to transit use by older adults and on testing improvements and interventions that hold promise for increasing ridership. Baseline measurements of ridership and perceptions of transit use were gathered at two study sites in the San Francisco Bay Area. Among the challenges and barriers to transit use by older adults are lack of information about service and schedules; waiting outdoors in uncomfortable station areas; lack of security and perception of crime; inconvenient pedestrian access to stops; and lack of training for drivers in the needs of older riders. The report includes a summary of surveys of seniors' perspectives, results of two travel training interventions, and a handbook to be used by transit and senior services agencies

Non-Emergency Medical Transportation Needs of Middle-Aged and Older Adults: A Rural-Urban Comparison in Delaware, USA.

Background: Older adults in rural areas have unique transportation barriers to accessing medical care, which include a lack of mass transit options and considerable distances to health-related services. This study contrasts non-emergency medical transportation (NEMT) service utilization patterns and associated costs for Medicaid middle-aged and older adults in rural versus urban areas. Methods: Data were analyzed from 39,194 NEMT users of LogistiCare-brokered services in Delaware residing in rural (68.3%) and urban (30.9%) areas. Multivariable logistic analyses compared trip characteristics by rurality designation. Results: Rural (37.2%) and urban (41.2%) participants used services more frequently for dialysis than for any other medical concern. Older age and personal accompaniment were more common and wheel chair use was less common for rural trips. The mean cost per trip was greater for rural users (difference of $2910 per trip), which was attributed to the greater distance per trip in rural areas. Conclusions: Among a sample who were eligible for subsidized NEMT and who utilized this service, rural trips tended to be longer and, therefore, higher in cost. Over 50% of trips were made for dialysis highlighting the need to address prevention and, potentially, health service improvements for rural dialysis patients

Food Insecurity Among Homeless and Marginally Housed Individuals Living with HIV/AIDS in San Francisco

Food insecurity is a risk factor for both HIV transmission and worse HIV clinical outcomes. We examined the prevalence of and factors associated with food insecurity among homeless and marginally housed HIV-infected individuals in San Francisco recruited from the Research on Access to Care in the Homeless Cohort. We used multiple logistic regression to determine socio-demographic and behavioral factors associated with food insecurity, which was measured using the Household Food Insecurity Access Scale. Among 250 participants, over half (53.6%) were food insecure. Higher odds of food insecurity was associated with being white, low CD4 counts, recent crack use, lack of health insurance, and worse physical and mental health. Food insecurity is highly prevalent among HIV-infected marginally housed individuals in San Francisco, and is associated with poor physical and mental health and poor social functioning. Screening for and addressing food insecurity should be a critical component of HIV prevention and treatment programs

Geocoding police collision report data from California: a comprehensive approach

<p>Abstract</p> <p>Background</p> <p>Collision geocoding is the process of assigning geographic descriptors, usually latitude and longitude coordinates, to a traffic collision record. On California police reports, relative collision location is recorded using a highway postmile marker or a street intersection. The objective of this study was to create a geocoded database of all police-reported, fatal and severe injury collisions in the California Statewide Integrated Traffic Records System (SWITRS) for years 1997-2006 for use by public agencies.</p> <p>Results</p> <p>Geocoding was completed with a multi-step process. First, pre-processing was performed using a scripting language to clean and standardize street name information. A state highway network with postmile values was then created using a custom tool written in Visual Basic for Applications (VBA) in ArcGIS software. Custom VBA functionality was also used to incorporate the offset direction and distance. Intersection and address geocoding was performed using ArcGIS, StreetMap Pro 2003 digital street network, and Google Earth Pro. A total of 142,007 fatal and severe injury collisions were identified in SWITRS. The geocoding match rate was 99.8% for postmile-coded collisions and 86% for intersection-coded collisions. The overall match rate was 91%.</p> <p>Conclusions</p> <p>The availability of geocoded collision data will be beneficial to clinicians, researchers, policymakers, and practitioners in the fields of traffic safety and public health. Potential uses of the data include studies of collision clustering on the highway system, examinations of the associations between collision occurrence and a variety of variables on environmental and social characteristics, including housing and personal demographics, alcohol outlets, schools, and parks. The ability to build maps may be useful in research planning and conduct and in the delivery of information to both technical and non-technical audiences.</p

Slate Literary Magazine, 2012-2013

Trinity College\u27s Literary Magazine - student works.https://digitalrepository.trincoll.edu/slate/1000/thumbnail.jp

Food Insecurity Among Homeless and Marginally Housed Individuals Living With HIV/Aids in San Francisco

Food insecurity is a risk factor for both HIV transmission and worse HIV clinical outcomes. We examined the prevalence of and factors associated with food insecurity among homeless and marginally housed HIV-infected individuals in San Francisco recruited from the Research on Access to Care in the Homeless Cohort. We used multiple logistic regression to determine socio-demographic and behavioral factors associated with food insecurity, which was measured using the Household Food Insecurity Access Scale. Among 250 participants, over half (53.6%) were food insecure. Higher odds of food insecurity was associated with being white, low CD4 counts, recent crack use, lack of health insurance, and worse physical and mental health. Food insecurity is highly prevalent among HIV-infected marginally housed individuals in San Francisco, and is associated with poor physical and mental health and poor social functioning. Screening for and addressing food insecurity should be a critical component of HIV prevention and treatment programs

Analysis of Neptune's 2017 Bright Equatorial Storm

We report the discovery of a large ($\sim$8500 km diameter) infrared-bright storm at Neptune's equator in June 2017. We tracked the storm over a period of 7 months with high-cadence infrared snapshot imaging, carried out on 14 nights at the 10 meter Keck II telescope and 17 nights at the Shane 120 inch reflector at Lick Observatory. The cloud feature was larger and more persistent than any equatorial clouds seen before on Neptune, remaining intermittently active from at least 10 June to 31 December 2017. Our Keck and Lick observations were augmented by very high-cadence images from the amateur community, which permitted the determination of accurate drift rates for the cloud feature. Its zonal drift speed was variable from 10 June to at least 25 July, but remained a constant $237.4 \pm 0.2$ m s$^{-1}$ from 30 September until at least 15 November. The pressure of the cloud top was determined from radiative transfer calculations to be 0.3-0.6 bar; this value remained constant over the course of the observations. Multiple cloud break-up events, in which a bright cloud band wrapped around Neptune's equator, were observed over the course of our observations. No "dark spot" vortices were seen near the equator in HST imaging on 6 and 7 October. The size and pressure of the storm are consistent with moist convection or a planetary-scale wave as the energy source of convective upwelling, but more modeling is required to determine the driver of this equatorial disturbance as well as the triggers for and dynamics of the observed cloud break-up events.Comment: 42 pages, 14 figures, 6 tables; Accepted to Icaru

Multiple Measures Reveal Antiretroviral Adherence Successes and Challenges in HIV-Infected Ugandan Children

Background: Adherence to HIV antiretroviral therapy (ART) among children in developing settings is poorly understood. Methodology/Principal Findings: To understand the level, distribution, and correlates of ART adherence behavior, we prospectively determined monthly ART adherence through multiple measures and six-monthly HIV RNA levels among 121 Ugandan children aged 2–10 years for one year. Median adherence levels were 100% by three-day recall, 97.4% by 30-day visual analog scale, 97.3% by unannounced pill count/liquid formulation weights, and 96.3% by medication event monitors (MEMS). Interruptions in MEMS adherence of $\geq$48 hours were seen in 57.0% of children; 36.3% had detectable HIV RNA at one year. Only MEMS correlated significantly with HIV RNA levels (r = −0.25, p = 0.04). Multivariable regression found the following to be associated with <90% MEMS adherence: hospitalization of child (adjusted odds ratio [AOR] 3.0, 95% confidence interval [CI] 1.6–5.5; p = 0.001), liquid formulation use (AOR 1.4, 95%CI 1.0–2.0; p = 0.04), and caregiver’s alcohol use (AOR 3.1, 95%CI 1.8–5.2; p<0.0001). Child’s use of co-trimoxazole (AOR 0.5, 95%CI 0.4–0.9; p = 0.009), caregiver’s use of ART (AOR 0.6, 95%CI 0.4–0.9; p = 0.03), possible caregiver depression (AOR 0.6, 95%CI 0.4–0.8; p = 0.001), and caregiver feeling ashamed of child’s HIV status (AOR 0.5, 95%CI 0.3–0.6; p<0.0001) were protective against <90% MEMS adherence. Change in drug manufacturer (AOR 4.1, 95%CI 1.5–11.5; p = 0.009) and caregiver’s alcohol use (AOR 5.5, 95%CI 2.8–10.7; p<0.0001) were associated with $\geq$48-hour interruptions by MEMS, while second-line ART (AOR 0.3, 95%CI 0.1–0.99; p = 0.049) and increasing assets (AOR 0.7, 95%CI 0.6–0.9; p = 0.0007) were protective against these interruptions. Conclusions/Significance: Adherence success depends on a well-established medication taking routine, including caregiver support and adequate education on medication changes. Caregiver-reported depression and shame may reflect fear of poor outcomes, functioning as motivation for the child to adhere. Further research is needed to better understand and build on these key influential factors for adherence intervention development