Housing Settings Research Articles

Housing-based syringe services programs to improve access to safer injecting equipment for people who inject drugs in Vancouver, Canada: a spatially oriented qualitative study

BackgroundHousing environments shape injection drug-related risks and harms and thus represent a critical implementation setting for syringe services programs (SSPs). As critical harm reduction measures, SSPs provide safe injecting equipment to people who inject drugs (PWID). Vancouver, Canada, has well-established syringe distribution programs through which PWID have low-threshold access to unlimited syringes and related injecting equipment, including through non-profit operated supportive housing and single-room occupancy hotels. This study examines the role of housing-based SSPs in distributing injecting equipment to PWID in Vancouver.MethodsBetween January and March 2020, semi-structured, in-depth interviews were conducted in Vancouver with 26 PWID. Interviews were audio-recorded, transcribed, and coded. Salient themes were identified using inductive and deductive approaches.ResultsMany participants accessed SSPs in housing facilities and expressed preference for these programs over those offered at other locations and through other health and social services. Three major themes emerged to explain this preference. First, most participants injected in the buildings where they resided, and housing-based SSPs made injecting equipment available when and where it was most needed. Second, many participants preferred to avoid carrying syringes outside of the places where they inject due to fears that syringe possession may lead to criminal charges or confiscation of syringes and/or illicit drugs by police. Third, for some participants, anti-drug user stigma and concerns over unwillingly disclosing their drug use hindered access to SSPs outside of housing settings. Programs operated within housing facilities often offered greater client anonymity along with more supportive and less stigmatizing environments, particularly in the presence of peer staff.ConclusionThe current study advances understanding of access to injecting equipment in a setting with city-wide syringe distribution programs. Our findings underscore the benefits of housing-based SSPs and encourage the expansion of such services to maximize access to harm reduction supports for PWID.

Understanding why racial/ethnic inequities along the HIV care continuum persist in the United States: a qualitative exploration of systemic barriers from the perspectives of African American/Black and Latino persons living with HIV

BackgroundRacial/ethnic inequities along the HIV care continuum persist in the United States despite substantial federal investment. Numerous studies highlight individual and social-level impediments in HIV, but fewer foreground systemic barriers. The present qualitative study sought to uncover and describe systemic barriers to the HIV care continuum from the perspectives of African American/Black and Latino persons living with HIV (PLWH) with unsuppressed HIV viral load, including how barriers operated and their effects.MethodsParticipants were African American/Black and Latino PLWH with unsuppressed HIV viral load (N = 41). They were purposively sampled for maximum variability on key indices from a larger study. They engaged in semi-structured in-depth interviews that were audio-recorded and professionally transcribed. Data were analyzed using directed content analysis.ResultsParticipants were 49 years old, on average (SD = 9), 76% were assigned male sex at birth, 83% were African American/Black and 17% Latino, 34% were sexual minorities (i.e., non-heterosexual), and 22% were transgender/gender-nonbinary. All had indications of chronic poverty. Participants had been diagnosed with HIV 19 years prior to the study, on average (SD = 9). The majority (76%) had taken HIV medication in the six weeks before enrollment, but at levels insufficient to reach HIV viral suppression. Findings underscored a primary theme describing chronic poverty as a fundamental cause of poor engagement. Related subthemes were: negative aspects of congregate versus private housing settings (e.g., triggering substance use and social isolation); generally positive experiences with health care providers, although structural and cultural competency appeared insufficient and managing health care systems was difficult; pharmacies illegally purchased HIV medication from PLWH; and COVID-19 exacerbated barriers. Participants described mitigation strategies and evidenced resilience.ConclusionsTo reduce racial/ethnic inequities and end the HIV epidemic, it is necessary to understand African American/Black and Latino PLWH’s perspectives on the systemic impediments they experience throughout the HIV care continuum. This study uncovers and describes a number of salient barriers and how they operate, including unexpected findings regarding drug diversion and negative aspects of congregate housing. There is growing awareness that systemic racism is a core determinant of systemic barriers to HIV care continuum engagement. Findings are interpreted in this context.

What are important ingredients for Intensive Home Support for people with severe mental illness according to experts? A concept mapping approach

BackgroundDeinstitutionalization in mental health care has been an ongoing process for decades. More and more people with severe mental illness (SMI), who previously lived in residential supported housing settings and were formerly homeless, are now living independently in the community but need intensive support to enable independent living. The support provided by regular outpatient teams is inadequate for this target group. This study explored the ingredients for an alternative form of outpatient support: intensive home support (IHS).MethodsConcept mapping was used, following five steps: (1) brainstorming, (2) sorting, (3) rating, (4) statistical analysis & visual representation, and (5) interpretation. Purposive sampling was used to represent several perspectives, including researchers, professionals, peer workers, and policy makers.ResultsExperts (n = 17) participated in the brainstorming step and the sorting and rating steps (n = 14). The 84 generated statements were grouped into 10 clusters:. (1) housing rights; (2) informal collaboration; (3) reciprocity in the community; (4) normalization and citizenship; (5) recovery; (6) sustainable funding; (7) equivalence; (8) flexible, proactive 24/7 support; (9) public health and positive health; and (10) integrated cooperation in support at home.ConclusionsGiven the diversity of the ingredients contained in the clusters, it seems that IHS should be designed according to a holistic approach in collaboration with several sectors. Additionally, IHS is not only the responsibility of care organizations but also the responsibility of national and local governments. Further research about collaboration and integrated care is needed to determine how to implement all of the ingredients in practice.

#4894 EFFICIENCY AND SAFETY OF AN ASSISTED HOME HEMODIALYSIS PROGRAM IN THE STATE OF QATAR: A RETROSPECTIVE STUDY

Abstract Background and Aims Home hemodialysis (HHD) usually done as self-care by patient themselves through a portable haemodialysis (HD) machine under training and monitoring by dialysis team. HHD offers greater patient autonomy, cost benefits, treatment-related flexibility, and improved quality of life compared to traditional in-centre HD. Uptake of HHD is limited by patient motivation, cognitive and/or physical barriers, as well as lack of support of family and community. Assisted HHD (AHHD) is a new concept where dialysis team provides HD at home. Usually, it is done by a visiting dialysis nurse using mobile HD machine. Its use is limited due to financial and logistical restriction. We like to present our unique experience in providing AHHD in the State of Qatar. Planning for our AHHD program started in July 2020. Because of COVID-19 pandemic, it faced many challenges and delays. We started first patient in July of 2021. In our program, we use traditional HD machine (not portable) with connection set up in the house in a dedicated room. Special training was provided to AHHD staff regarding the special care needed for home setting (including social, complication of home dialysis settings, decision making, follow up of protocols and policies, etc.) Method We performed a retrospective study between July 1st, 2021 - December 31st, 2022. Our primary objectives were efficiency and safety of AHHD, and secondary objective was cost effectiveness. We included adult chronic HD patients (on HD >3 months) using ambulance (or eligible for it) with functional dialysis access. We excluded patients who are not suitable for home environment (psychiatric illness, aggressive behaviour, etc.). Data were collected from our national electronic health record system. Results 946 patients screened for the program. 237 were eligible (exclusion mostly due to lack of national insurance coverage or not meeting mobility/transport criteria). 121 patients refused to participate (mostly for feeling safer in the clinic setting or improper home environment), 40 patients were undecided, and 76 patients accepted and started AHHD. Age was 73+/-11 years. We had 32 males and 44 females. Mean follow up period were 7 months. 12 patients died and 2 patients returned to dialysis centre during follow up period. Only 15 out of the total 126 hospitalizations were related to dialysis (mostly due to volume overload and non-compliance with dialysis schedule and time). We had 55 patients with permcath and 21 with AV fistulas. We had 8 incidents of dialysis catheter malfunction (6 required tissue plasminogen activator installation in the house setting and only two needed catheter exchange (one had catheter related infection)). No reported significant access bleeding or hypotension episodes. We had 20 technical incidents during the study related to electricity or water supply failures. All incidents were resolved without much interruption of treatment. The program overall was cost effective and reduced cost by over 25% (mostly related to saving of ambulance cost). Patients and their families were very satisfied with the program overall. Conclusion We present a unique successful program related to providing AHHD. Targeting certain dialysis population showed great care, safety, cost saving, better QOL and satisfaction.

The POP (Permanent Supportive Housing Overdose Prevention) Study: protocol for a hybrid type 3 stepped-wedge cluster randomized controlled trial

BackgroundPermanent supportive housing (PSH)—subsidized housing paired with support services such as case management—is a key part of national strategic plans to end homelessness. PSH tenants face high overdose risk due to a confluence of individual and environmental risk factors, yet little research has examined overdose prevention in PSH.MethodsWe describe the protocol for a hybrid type 3 stepped-wedge cluster randomized controlled trial (RCT) of overdose prevention practice implementation in PSH. We adapted evidence-based overdose prevention practices and implementation strategies for PSH using input from stakeholder focus groups. The trial will include 20 PSH buildings (with building size ranging from 20 to over 150 tenants) across New York City and New York’s Capital Region. Buildings will be randomized to one of four 6-month intervention waves during which they will receive a package of implementation support including training in using a PSH Overdose Prevention (POP) Toolkit, time-limited practice facilitation, and learning collaboratives delivered to staff and tenant implementation champions appointed by each building. The primary outcome is building-level fidelity to a defined list of overdose prevention practices. Secondary and exploratory implementation and effectiveness outcomes will be examined using PSH staff and tenant survey questionnaires, and analysis of tenant Medicaid data. We will explore factors related to implementation success, including barriers and facilitators, using qualitative interviews with key stakeholders. The project is being conducted through an academic-community partnership, and an Advisory Board including PSH tenants and other key stakeholders will be engaged in all stages of the project.DiscussionWe describe the protocol for a hybrid type 3 stepped-wedge cluster RCT of overdose prevention practice implementation in PSH. This study will be the first controlled trial of overdose prevention implementation in PSH settings. The research will make a significant impact by testing and informing future implementation strategies to prevent overdose for a population at particularly high risk for overdose mortality. Findings from this PSH-focused research are expected to be broadly applicable to other housing settings and settings serving people experiencing homelessness.Trial registrationClinicalTrials.gov, NCT05786222, registered 27 March 2023.

Automatic Detection of Cage-Free Dead Hens with Deep Learning Methods

Poultry farming plays a significant role in ensuring food security and economic growth in many countries. However, various factors such as feeding management practices, environmental conditions, and diseases lead to poultry mortality (dead birds). Therefore, regular monitoring of flocks and timely veterinary assistance is crucial for maintaining poultry health, well-being, and the success of poultry farming operations. However, the current monitoring method relies on manual inspection by farm workers, which is time-consuming. Therefore, developing an automatic early mortality detection (MD) model with higher accuracy is necessary to prevent the spread of infectious diseases in poultry. This study aimed to develop, evaluate, and test the performance of YOLOv5-MD and YOLOv6-MD models in detecting poultry mortality under various cage-free (CF) housing settings, including camera height, litter condition, and feather coverage. The results demonstrated that the YOLOv5s-MD model performed exceptionally well, achieving a high mAP@0.50 score of 99.5%, a high FPS of 55.6, low GPU usage of 1.04 GB, and a fast-processing time of 0.4 h. Furthermore, this study also evaluated the models’ performances under different CF housing settings, including different levels of feather coverage, litter coverage, and camera height. The YOLOv5s-MD model with 0% feathered covering achieved the best overall performance in object detection, with the highest mAP@0.50 score of 99.4% and a high precision rate of 98.4%. However, 80% litter covering resulted in higher MD. Additionally, the model achieved 100% precision and recall in detecting hens’ mortality at the camera height of 0.5 m but faced challenges at greater heights such as 2 m. These findings suggest that YOLOv5s-MD can detect poultry mortality more accurately than other models, and its performance can be optimized by adjusting various CF housing settings. Therefore, the developed model can assist farmers in promptly responding to mortality events by isolating affected birds, implementing disease prevention measures, and seeking veterinary assistance, thereby helping to reduce the impact of poultry mortality on the industry, ensuring the well-being of poultry and the overall success of poultry farming operations.

Social network and mental health of Chinese immigrants in affordable senior housing during the COVID-19 pandemic: a mixed-methods study

Objective Chinese immigrant older adults who live in affordable housing are at high risk of experiencing social isolation during the COVID-19 pandemic, which can affect their mental health. Using a triangulation mixed-methods approach, this study describes Chinese immigrant older adults’ social network, mental health status, and their associations during the pandemic. Methods Semi-structured in-depth interviews were conducted with 26 Chinese immigrant older adults from June to August 2021. The structure and characteristics of participants’ social networks were assessed with a name-generating approach. Mental health status was self-reported with Geriatric Depression Scale and UCLA loneliness scale. Results This sample (mean age = 78.12, 69.23% female), on average, had 5.08 social ties in their network, and 58% were family ties. Participants reported decreased social contact, family and friends interaction patterns specific to immigrants, and constantly being in a low mood and bored. Having closer relationships with others and maintaining the same or higher contact frequency after COVID-19 onset was associated with fewer depressive symptoms. Resilience from religious beliefs, neighbors as role models, and wisdom learned from past experiences were reported. Conclusion Knowledge built in this study can inform respondence to future crises like the COVID-19 pandemic in affordable housing settings serving older immigrant populations.

Developing a peer-led intervention to promote COVID-19 testing in low-income housing settings.

The Housing Collaborative project at Eastern Virginia Medical School has developed a method of adapting public health guidance from public housing communities, which face tremendous health challenges in cardiometabolic health, cancer, and other major health conditions. In this paper, we describe how academic and community partners in the Housing Collaborative came together to do this work with a focus on COVID-19 testing in the context of the emerging pandemic. The academic team used virtual community engagement methods to interact with the Housing Collaborative Community Advisory Board (HCCAB) and a separate cohort of research participants (N = 102) recruited into a study of distrust in COVID-19 guidance. We conducted a series of 44 focus group interviews with participants on related topics. Results from these interviews were discussed with the HCCAB. We used the collaborative intervention planning framework to inform adaptation of public health guidance on COVID-19 testing delivered in low-income housing settings by including all relevant perspectives. Participants reported several important barriers to COVID-19 testing related to distrust in the tests and those administering them. Distrust in housing authorities and how they might misuse positive test results seemed to further undermine decision making about COVID-19 testing. Pain associated with testing was also a concern. To address these concerns, a peer-led testing intervention was proposed by the Housing Collaborative. A second round of focus group interviews was then conducted, in which participants reported their approval of the proposed intervention. Although the COVID-19 pandemic was not our initial focus, we were able to identify a number of barriers to COVID-19 testing in low-income housing settings that can be addressed with adapted public health guidance. We struck a balance between community input and scientific rigor and obtained high quality, honest feedback to inform evidence-based recommendations to guide decisions about health.

Immunizations in a Senior Housing Setting

Immunizations in a Senior Housing Setting

The Lake House by Sarah Beth Durst

Reviewed by: The Lake House by Sarah Beth Durst Natalie Berglind Durst, Sarah Beth The Lake House. HarperTeen, 2023 [368p] Trade ed. ISBN 9780063214071 $19.99 E-book ed. ISBN 9780063214101 $10.99 Reviewed from digital galleys R Gr. 7-10 Claire tends to imagine the worst-case, life-ending scenario in any situation, so she's not exactly thrilled when her parents force her to go to summer camp—the outdoors are filled with potential ways to die—but they insist the Lake House will be a "formative experience." Bad weather has already forced her to arrive late with two strangers—Mariana, a preppy girl from LA, and Reyva, a pessimistic girl who keeps to herself. Things go from mildly bad to pretty horrifying when, after they're dropped off by boat and left alone, the three teens find the Lake House itself burned to the ground and the body of an instructor dead in the woods by gunshot. The girls debate what to do: should they find food and shelter, try to get help, or hide from the possible murderer? And perhaps more pressingly, what on earth is that human-sized underground cage, and what was it holding that's no longer there? The harrowing experience of going from living a relatively comfortable life to suddenly needing to make fire, source freshwater, and scour for resources just to stay alive will be a familiar and satisfying element to fans of survival shows (which, thankfully, Claire is). That urgency is further heightened by the possibility of a murderer (possibly more than one) running around, and the Lake House setting is more than it seems in a variety of ways, not all of them of this world. Claire's anxiety, a source of tension in her friendships and her relationship to her parents, is treated with sensitivity from both Mariana and Reyva; in fact, thinking of the worst thing that could happen often comes in handy in this life-or-death situation. The slower moments where the trio bond are some of the book's strongest scenes, as the teens discuss their greatest fears, pressures from their parents and society to be and act a certain way, and how much they miss pizza. Fans of the televisions shows The Wilds or Yellowjackets will relish this thriller about friendship and the sheer power of teenage girls to overcome any odds. Copyright © 2023 The Board of Trustees of the University of Illinois

A SWOT Analysis of AWH Project Implementation in the Brazilian Amazon as Perceived by Affordable Housing Stakeholders

In Brazil, affordable housing programs aimed at low-income populations reach a limited number of people. In the northern region, conventional bricklaying is the preferred method of building affordable single-family houses, which are essentially sets of tiny houses on the outskirts of cities. Conventional bricklaying can damage the environment. This study, started in July 2019, aimed to understand the perception of using timber to build affordable houses by housing program stakeholders and determine why the beneficiaries of housing programs prefer brick houses to wooden houses in locations with building permits. We applied a SWOT analysis to a group of 60 individuals comprising government agents and wooden and brick house residents of cities located in the northern region of Brazil. Subsequently, we devised relevant strategies, validated by stakeholders involved in public policy, for the provision of wooden housing for low-income populations. We used R software to analyze the data, and the results showed that the beneficiaries of affordable housing programs were unaware of wooden architectural projects and their durability, despite the regional abundance of wood and its environmental benefits. We suggest using strategies based on the SWOT analysis and validated by a group of experts to include the Affordable Wooden Housing (AWH) Project in the National Rural Housing Program (PNHR) and Harvest Plan.

Potus by Selina Fillinger, and: For Colored Girls … by Ntozake Shange (review)

Reviewed by: Potus by Selina Fillinger, and: For Colored Girls … by Ntozake Shange Sonja Arsham Kuftinec POTUS. By Selina Fillinger. Directed by Susan Stroman. Shubert Theatre, New York. May 7, 2022. for COLORED GIRLS… By Ntozake Shange. Directed and Choreographed by Camille A. Brown. Booth Theatre, New York. May 8, 2022. How does feminism perform on Broadway in the wake of Covid cautions, Supreme Court throw-downs, and challenges to “White American Theatre?” Two plays staged in neighboring theatres [End Page 89] offer some insights: the premiere of 28-year-old Selina Fillinger’s comedy POTUS, or Behind Every Great Dumbass Are Seven Women Trying to Keep Him Alive, and a revival of Ntozake Shange’s 1976 choreopoem for colored girls who have considered suicide / when the rainbow is enuf. Both productions featured seven-woman ensembles helmed by Tony-nominated director-choreographers. But where POTUS worked within the conventions of farce to critique the narcissistic and obtuse dimensions of presidential power and illuminate its less visible networks of female support, for colored girls reanimated a radical-spirituality-infused poetics that centered Black and brown women’s bodies supporting each other. Click for larger view View full resolution POTUS cast featuring (left to right) Vanessa Williams (Margaret), (Chris) Lili Cooper, Rachel Dratch (Stephanie), Julie White (Harriet), Julianna Hough (Dusty), and Suzy Nakamura (Jean). Photo: Paul Kolnik. The Shubert production of POTUS connected to a Girl Boss energy in which “Bitch” playlists and power poses both animated and punctured the idea of empowerment. Mask requirements for audiences could not stifle the exuberance prompted by preshow pop songs featuring Annie Lennox and Pat Benatar, establishing a sonically energetic rather than visually specific orientation to the production. The curtain then rose on a White House setting (delightfully designed by Beowulf Boritt) that felt masculine and patriarchal: heavy wooden furniture and gold drapes flanked by portraits of a uniformed General Eisenhower and Roosevelt Rough Riders on dusty horseback. Executive power represented as sturdy warrior energy. Press Secretary Jean (Suzy Nakamura) punctured that energy linguistically with a four-letter word for female anatomy—launching the play’s action through a high-stakes exchange with harried Chief of Staff Harriet (a sneaker-clad Julie White). The linguistic transgression also set in motion one of many crisis-driven plot points. In this case, the President had publicly used the derogatory term to reference First Lady Margaret (a gutsy stiletto-Croc-clad Vanessa Williams). Opening the play with a shocking slur also launched a dynamic of rule-bending within the rule-keeping conventions of farce: bawdy bodies breaking boundaries of restraint while ultimately sustaining the status quo. And Fillinger’s script crafts these women’s bodies as excessive. They leak breast milk in the Press Room (Lilli Cooper’s Chris, a journalist hunting for a scoop), smuggle drugs into the White House (Lea Delaria’s deliciously grungy Bernadette, the President’s sister), and vomit blue slushies into a vase (Julianne Hough’s Dusty, the President’s pregnant girlfriend). In the most memorable sustained performance of excess, former SNL star Rachel Dratch’s buttoned-up secretary character, Stephanie, lets loose after consuming hallucinogenic pills she [End Page 90] thought were Tums. The accidental ingestion led to a second act unraveling that concluded with a bloodied Stephanie surfing scenes in a pink plastic pool ring, clad only in granny panties, silken tank top, and Post-It notes. This liberatory energy of excess pressed against a dramaturgy of containment—of crises, secrets and gaffes, as well as pregnant, criminal, and possibly dead bodies. The plot also details the daily labor of propping up this unnamed POTUS “dumbass.” As Harriet intones, “Today began with calling his wife ‘cunty’ while in the Diplomatic Room.” Indeed, as the women’s capacity for problem-solving unfolded several characters remarked to others, “You should be president!” An intriguing dynamic emerged with the production illuminating the hidden details of manipulated narratives required to prop up this problematic president. The private becomes public and support figures take center stage. At the same time, even characters who function as agents of chaos emerge as savvier than they at first appeared. Defined initially by her status as the pregnant, rural, slushy...

Conceptualizing New Materialism in Geographical Studies of the Rural Realm

Geographic analysis in rural areas has been dominated in recent decades by socio-economic and socio-political perspectives. The new materialism can constitute a way of progress in rural geographical studies that involve the material and the human in the form of hybrid experiences. Materiality can be expressed in three ways: (1) the surface matter that corresponds to the traditional elements of the material rural space, (2) the materiality that would be associated with a joint and undifferentiated vision of human artefacts in a village, mainly the set of rural houses and (3) the experimental materiality that has an individual dimension, the result of the multiple processes of destruction, revival and reconstruction that simultaneously happen in one place. The experimental materiality is of the most interest for geographic analysis since it is where the materiality of the rural house and the individual are hybridized in the process of recovery of the traditional rural house. In the process of recovery of materialities, binary oppositions built in the rigid framework of modernity can be dissolved and established fluid postmodern alternatives co-produced between people and materiality. The new materialism in rural geography can be an alternative path that allows analyzing heterogeneous realities in a hybrid way and contributing in a practical context to the development of new rural policies.

Quality of Life among the Parents of Saudi Arabian children with Autistic Spectrum Disorder, Riyadh, KSA

Objective: To assess the factors influencing the quality-of-life differences between families caring for a child with Autistic Spectrum disorder diagnosis. Methods: Cross-sectional study of either parent of ASD child aged 1 to 14 years following up at the OPD setting in Riyadh, KSA from June 2019 through to the end of January 2020 at the Division of Developmental Pediatrics at King Saud medical city in Riyadh, Saudi Arabia via a structured questionnaire, (The World Health Organization Quality of Life Assessment-BREF (WHOQOL-BREF). Inclusion criteria: Parent of child with ASD who has been diagnosed by a developmental pediatrician at least 6 months prior to the commencement of this study, parent of child with ASD who receives follow-up treatment at the King Saud medical city children’s Hospital. Parent should be the primary caregiver of the child with ASD. (For the purposes of this study, “primary caregiver” is defined as the individual in the family whose main responsibility is to provide care to the ASD child). Parent who has no history of previous psychological, psychiatric disorder or physical disability. Parents who have been residing in Saudi Arabia for at least 6 months prior to the commencement of this study. Parent who has offered informed consent. Exclusion criteria: parent of any child who has dysmorphic features or a diagnosed genetic syndrome, parent of child with ASD who has sibling diagnosed with ASD, or parents of child with ASD who has sibling diagnosed with other chronic medical illness. Results: Marital status, housing settings, total household income, current employment, being part of support groups and associated illness in the ASD child significantly impacted at least one domain of WHOQOL-BREF. Conclusion: Modifiable factors that have the ability to elevate the quality of life for parents of ASD children are marital status, housing settings, total household income, current employment, being part of support groups and overall care of ASD children. Key words: ASD, Quality of Life, Autism Spectrum disorder, WHOQOL-BREF

Association Between Buprenorphine Dose and the Urine "Norbuprenorphine" to "Creatinine" Ratio: Revised.

Utilizing a 1-year chart review as the data, Furo et al. conducted a research study on an association between buprenorphine dose and the urine "norbuprenorphine" to "creatinine" ratio and found significant differences in the ratio among 8-, 12-, and 16-mg/day groups with an analysis of variance (ANOVA) test. This study expands the data for a 2-year chart review and is intended to delineate an association between buprenorphine dose and the urine "norbuprenorphine" to "creatinine" ratio with a higher statistical power. This study performed a 2-year chart review of data for the patients living in a halfway house setting, where their drug administration was closely monitored. The patients were on buprenorphine prescribed at an outpatient clinic for opioid use disorder (OUD), and their buprenorphine prescription and dispensing information were confirmed by the New York Prescription Drug Monitoring Program (PDMP). Urine test results in the electronic health record (EHR) were reviewed, focusing on the "buprenorphine," "norbuprenorphine," and "creatinine" levels. The Kruskal-Wallis H and Mann-Whitney U tests were performed to examine an association between buprenorphine dose and the "norbuprenorphine" to "creatinine" ratio. This study included 371 urine samples from 61 consecutive patients and analyzed the data in a manner similar to that described in the study by Furo et al. This study had similar findings with the following exceptions: (1) a mean buprenorphine dose of 11.0 ± 3.8 mg/day with a range of 2 to 20 mg/day; (2) exclusion of 6 urine samples with "creatinine" level <20 mg/dL; (3) minimum "norbuprenorphine" to "creatinine" ratios in the 8-, 12-, and 16-mg/day groups of 0.44 × 10-4 (n = 68), 0.1 × 10-4 (n = 133), and 1.37 × 10-4 (n = 82), respectively; however, after removing the 2 lowest outliers, the minimum "norbuprenorphine" to "creatinine" ratio in the 12-mg/day group was 1.6 × 10-4, similar to the findings in the previous study; and (4) a significant association between buprenorphine dose and the urine "norbuprenorphine" to "creatinine" ratios from the Kruskal-Wallis test (P < .01). In addition, the median "norbuprenorphine" to "creatinine" ratio had a strong association with buprenorphine dose, and this association could be formulated as: [y = 2.266 ln(x) + 0.8211]. In other words, the median ratios in 8-, 12-, and 16-mg/day groups were 5.53 × 10-4, 6.45 × 10-4, and 7.10 × 10-4, respectively. Therefore, any of the following features should alert providers to further investigate patient treatment compliance: (1) inappropriate substance(s) in urine sample; (2) "creatinine" level <20 mg/dL; (3) "buprenorphine" to "norbuprenorphine" ratio >50:1; (4) buprenorphine dose >24 mg/day; or (5) "norbuprenorphine" to "creatinine" ratios <0.5 × 10-4 in patients who are on 8 mg/day or <1.5 × 10-4 in patients who are on 12 mg/day or more. The results of the present study confirmed those of the previous study regarding an association between buprenorphine dose and the "norbuprenorphine" to "creatinine" ratio, using an expanded data set. Additionally, this study delineated a clearer relationship, focusing on the median "norbuprenorphine" to "creatinine" ratios in different buprenorphine dose groups. These results could help providers interpret urine test results more accurately and apply them to outpatient opioid treatment programs for optimal treatment outcomes.

Residential design for adults on the autism spectrum: a scoping review

PurposeThis scoping review aims to (1) summarize research and design writings on residential design for adults on the autism spectrum in peer-reviewed and grey literature, (2) identify research gaps in this field and (3) understand the concept of independent living based on this literature.Design/methodology/approachA systematic search was conducted in seven databases using 47 search terms related to residence, design and autism. It was supplemented with a manual search for recommended authors and architectural websites.FindingsA final review of 37 sources highlighted that existing residential design guidelines are supported by weak evidence due to the lack of methods for involving and limited direct contact with autistic adults. Moreover, the needs of people living or working with them tend to be overlooked. Finally, the role of independent living has received little attention in the literature on residential design for adults on the spectrum.Research limitations/implicationsThe findings show a need for taking on board autistic people's understanding of independent living. Future research about residential design for autistic adults should be conducted with them, in diverse housing settings, providing nuanced insight into their housing needs and those of the people around them.Originality/valueThis scoping review is the first to provide an overview of what is known about residential design for autistic adults with a focus on the concept of independent living.

An integrated home energy management system by the load aggregator in a microgrid using the internet of things infrastructure

&lt;span lang="EN-US"&gt;Smart technologies enable the significant participation of consumers in demand-side management programs. In this paper, the management of electrical energy consumption for a set of residential houses in a microgrid by a load aggregator for a 24-h planning horizon is studied. In this study, consumption management programs are implemented on controllable equipment by sending binary codes by the load aggregator via the internet of things (IoT) infrastructure to residential sockets. To increase the level of customer convenience and provide more flexibility for consumers to participate in demand response programs, a parameter called the value of lost load (VOLL) has been introduced. According to the results, in addition to no need to use the energy management system for each residential house, only by moving shiftable loads to off-peak hours, 18.34% of energy consumption costs are saved daily. Also, from the load aggregator’s viewpoint for every 10% change in status from normal to the scheduled priority, there is a reduction of about 3.4% in the consumer’s peak-load cost. If solar arrays and storage resources are used, more than 18% of the total consumption cost can be saved.&lt;/span&gt;

STUDI KOMPARATIF KONDISI LINGKUNGAN RUMAH DAN PENGENDALIAN VEKTOR ANTARA PENDERITA DAN NON PENDERITA DBD (Studi Kasus di Wilayah Kerja Puskesmas Kedung I Kabupaten Jepara Tahun 2021)

In 2021, dengue cases in the working area of Kedung I Public Health Center, Jepara Regency, showed an increasing trend of cases. A total of 59 cases of DHF were reported throughout 2021. This figure has increased from the previous year, which was 34 cases. Poor of home environmental conditions and vector control are risk factors for the transmission of DHF. The purpose of this study was to determine differences in home environmental factors and vector control between patients and non-patients of DHF in the working area of Kedung I Public Health Center, Jepara Regency. This research uses quantitative with retrospective design, comparative study method. The samples were 59 samples of patient group with total sampling technique and 59 samples of non-patient group with purposive sampling technique. The instruments used are questionnaires and observation sheets. Data analysis used is mann whitney statistical test. The results showed that there were differences in the conditions of TPA (p=0,038), use of mosquito repellent (p=0,035) and physical/mechanical control (p=0,009) between patients and non-patients of DHF. While the variables of presence of used goods (p=0,064), presence of hanging clothes (p=0,433), biological control (p=0,151) and chemical control (p=0,524) did not show a significant difference. The suggestion of this research is that every house sets one jumantik, and so that people are more aware to increase awareness of dengue disease by always implementing 3M plus.

Neighbourhood trajectories in Stockholm: Investigating the role of mobility and in situ change

This paper studies the dynamics of neighbourhood change and neighbourhood stability, using the case of Stockholm during the period 1990–2015. We employ Swedish register data and a three-step methodology to investigate to what extent and how neighbourhoods’ characteristics change over time and the factors driving those changes. Firstly, we apply k-means clustering to a set of socioeconomic, housing and demographic characteristics at the neighbourhood level, and identify a typology of neighbourhood states. Secondly, we build neighbourhood trajectories out of the states over time and use sequence analysis to obtain ideal-typical neighbourhood trajectories. Finally, we decompose the neighbourhood change into selective mobility, i.e., the differences in the characteristics of in- and out-movers, and in situ change of sitting residents. Our results reveal a mixed picture, with the role of selective mobility and in situ change varying depending on the type of neighbourhood transition and the variable under consideration. Trajectories of neighbourhood upgrading towards elite status in the Stockholm city-centre and downward trajectories ending in vulnerability in the periphery are mainly driven by selective mobility. Other typical trajectories comprise the emergence of newly built elite areas and the ageing of certain middle-class areas, the latter mostly driven by ageing of sitting residents.

Community Houses to Increase Access to Home Dialysis.

Community Houses to Increase Access to Home Dialysis.