On-site Services Research Articles

An Introduction to the Papers – Child Analysts in the Community – Daycare and Preschool Consultation and On-Site Services

ABSTRACT Psychoanalysts have increasingly sought opportunities to move beyond their consultation rooms to find ways to provide service from a psychoanalytic point of view where it could be well utilized. While there is a long tradition of these endeavors, such as Freud’s free clinics, for child analysts searching for ways to provide service and support for young children and for those who care for them has long been an ideal. This section introduction strives to provide context and rationale for this important work. Support for the child’s development of improved verbalization of affect and social and emotional development more broadly are noted. As well, a brief (and necessarily incomplete) review of the history of such efforts and reference to attempts to undertake research regarding efficacy and efforts to establish best practices is provided.

1210 PROVISION OF EYE CARE SERVICES AND INTERVENTIONS IN CARE HOMES - A NARRATIVE SYNTHESIS REVIEW

Abstract Introduction The prevalence of eye disease and visual impairment in care home residents is disproportionately higher compared to the general population. Access to eye care services and treatment can be variable for this vulnerable population. Objective This narrative synthesis reviews the available evidence of services and interventions for delivering eye care to care home residents. The key review questions: Methods Literature search of EMBASE/MEDLINE for original papers published since 1995. Two reviewers independently reviewed abstracts/papers. Data was extracted and evaluated using narrative synthesis. Results 13 original papers met the inclusion criteria. On-site optometrist-led services improved diagnosis and management of eye conditions, with one study showing 53% of residents benefited from direct ophthalmology intervention. Provision of interventions such as cataract surgery, refractive error correction and low vision rehabilitation improved visual acuity and vision-related quality of life but did not improve cognitive or physical function, depression or health-related quality of life. There was little UK-based literature to inform eye service design or interventions to improve outcomes. Conclusion Care home-based eye assessments improve the management of eye conditions. Interventions improve visual acuity and vision-related quality of life. Further research and/or clinical service scoping is needed to better understand current UK services, access difficulties or examples of good practice as well as to identify and test cost-effective service models for this vulnerable group.

Community health workers perspective on the COVID-19 impact on primary health care in Northeastern Brazil.

This article evaluates the COVID-19 pandemic impacts on the Family Health Strategy (FHS) team's work routines across a range of northeast Brazilian cities as perceived by community health workers (CHW). Data on COVID-19, CHW activities, and FHS teams were collected in 2021 by a structured questionnaire. A total of 1,935 CHWs from four state capitals (Fortaleza - Ceará State, João Pessoa - Paraíba State, Recife - Pernambuco State, Teresina - Piauí State) and four hinterland cities (Crato, Juazeiro do Norte, Barbalha, Sobral - Ceará State) participated in the study. Most CHWs were women (82.42%), with mean age 46.25±8.54 years. Many (39.92%) were infected with COVID-19, of which 70.78% believed they were infected in the workplace. A total of 77.82% defined their role as frontline in the fight against COVID-19, 16.07% reported receiving training for COVID-19, and 13.74% had access to sufficient protective equipment. Most (90.27%) believed their work routines were modified by the pandemic, either strengthening (41.46%) or weakening (44.41%) the team spirit. Home visits (60.55%), health promotion actions in schools (75.66%) and in specific community groups (93.96%), and other on-site community services (66.01%) showed a reduction in frequency. The sampled cities revealed a significant heterogeneity regarding responses to the COVID-19 pandemic, possibly associated with a lack of coordination by the Federal Government. Regardless of context, the pandemic led to a reconfiguration of local health systems, workflows, and primary care protocols for FHS teams. The importance of the Brazilian Unified National Health System (SUS) and its potential for reorganization during crisis should be acknowledged while preserving the headway made thus far.

Improving Equitable Access to Imaging: Developing an On-Site Ultrasound Service at a Student-Run Free Clinic

Background: Student-run free clinics (SRFC) provide comprehensive primary care for uninsured populations throughout the country. However, imaging remains a barrier to care for underserved communities that experience inequitable access to healthcare. In this study, we describe the establishment of a radiology specialty clinic (RSC) that served as an in-house ultrasound imaging service at our institution's SRFC.
 Methods: Between September 2019 and March 2020, patients were scheduled for imaging at the free clinic site, and studies were performed and read by institutional radiologists. Patient data were reviewed to assess patient demographics, study indication, ultrasound type, and time between referral and appointment. Lastly, imaging utilization was examined seven months prior to and seven months after implementing the free ultrasound clinic to assess any changes in usage, wait time, or referral patterns using Fischer’s exact test and unpaired student t-tests.
 Results: A total of 10 patients were seen during the clinic’s operation, with 11 studies being performed. Overall, usage patterns stayed consistent pre and post-implementation. There was no significant difference in wait times between referral and appointment (pre-RSC 15 days vs. post-RSC 18.5 days, p=0.91) and the RSC demonstrated a total cost savings of $770 to the clinic.
 Conclusions: We describe the implementation of an in-house ultrasound imaging service at our SRFC. The RSC provided increased access to imaging, demonstrated cost-savings to the SRFC, and had no negative effects on ultrasound usage or wait times between referrals and appointments.

Green vehicle routing and dynamic pricing for scheduling on-site services

In this paper, we study a problem where a company sends engineers with vehicles to customer sites to provide services. Customers request the service through a website or by calling a call centre and the company needs to allocate the service tasks to time windows and decide on how to schedule these jobs to their vehicles. We propose a new approach to this problem which applies low-emission vehicle routing techniques with dynamic pricing to reduce CO 2 emissions and maximise profit. When a customer requests a service, the company will provide the customer with different service time-window options and their corresponding prices. Prices are differentiated to influence the customer's choice. To help the company in determining the prices, our approach solves the problem in two phases. The first phase solves a time-dependent vehicle routing model with the objective of minimising CO 2 emissions for each of the time window options and the second phase solves a dynamic pricing model to determine the service prices for these options to maximise profit. Metaheuristic methods are applied for real-life business applications which enable the solution framework to be applied online where shorter computational time is required. The approach is tested through numerical experiments. Results show that dynamic pricing leads to a reduction in CO 2 emissions and an improvement in profit.

Evaluation and improvement of a miniature mass spectrometry system for quantitative harm reduction drug checking

The increasing variability of the illicit drug market has imposed serious health risks for people who use drugs (PWUD), particularly due to the increasing co-occurrence of opioids and etizolam (or other benzodiazepines) in some jurisdictions. A miniature mass spectrometer (MS) equipped with paper capillary spray ionization was evaluated for its ability to quantify fentanyl, fluorofentanyl, carfentanil, and etizolam in illicit drug samples. Prior to testing actual drug samples, inter- and intra-day reproducibility, calibration linearity, and analytical sensitivity were assessed. The development of a continuous spray solvent delivery system improved MS/MS quantitation by prolonging ionization stability. A simple, rapid and quantitative tandem mass spectrometry method was developed and employed for the analysis of real-world illicit drug samples provided by PWUD at a harm reduction site in Victoria, British Columbia, Canada. Limits of detection ranged from 0.001 to 0.24% w/w of illicit analyte in the original solid drug samples. Target analytes were detected and quantified via the miniature MS system for samples where conventional on-site drug checking technologies were not always effective. These promising results demonstrate the potential role for miniature mass spectrometer systems for on-site drug checking services that can be both sensitive to trace, toxic levels as well as adaptable/selective for new drug threats as they appear in the illicit drug supply.

The impact of maternal depression on child mental health treatment and models for integrating care: a systematic review.

Maternal depression negatively impacts child mental health and is a well-known risk factor for child psychopathology. However, maternal depression treatment and child mental health treatment are rarely integrated. The purpose of this review was to assess the impact of maternal depression on child mental health treatment, including (1) how treatment of maternal depression affects child mental health outcomes, (2) the impact of maternal depression on children receiving mental health care, and (3) emerging models that address maternal depression in primary-care pediatrics and child mental health settings. A systematic literature review was conducted using PubMed and PsycInfo. Initial search yielded 224 records, and after exclusion, 29 papers were reviewed. Effective treatment of maternal depression is associated with a significant decrease in child psychiatric symptoms. Maternal depression negatively affects child mental health treatment in that there is a high rate of untreated mental illness among mothers of psychiatrically ill children, and maternal depression impedes effective child mental health treatment. Current models to address maternal depression in child settings include screening in pediatric primary care, psychotherapy for depressed mothers of psychiatrically ill children, and emerging models that integrate maternal and child mental health treatment. Effective treatment of maternal depression significantly improves child mental health and should be better integrated into child treatment. Opportunities to improve care include more robust screening for parental mental illness, supports to refer parents to psychiatric care, and on-site services for parents. Such interventions hold promise, but require significant support from a multidisciplinary team.

Research on the Emission Reduction Decision of Cost-Sharing Logistics Service Supply Chain in the O2O Model

As an effective way to realize energy savings and environmental protection, cost sharing is gradually becoming an important measure to reduce emissions in the logistics service supply chain under O2O mode in recent years. How to conduct contract selection and design optimization under the cost-sharing situation, and then improve the operational efficiency of the logistics service supply chain is an important issue that needs to be addressed. Firstly, based on the initial market demand for logistics, this paper involves the influence of both online logistics service integrators and onsite functional logistics service providers on logistics market demand in terms of emission reduction and platform brand image and develops a model based on the logistics service demand function in the O2O mode. Secondly, for the role of online and onsite emission reduction services in multi-cycle continuous cooperation to enhance the platform integrator’s brand image, a cost-sharing differential game model between online and onsite services is developed to facilitate providers’ adoption of high-quality emission reduction services. Finally, the HJB equation is used to compare the non-cooperative Nash game, the cost-sharing Stackelberg game, and the cooperative game to make the optimal abatement decision, the optimal benefit, and the cost-sharing ratio of the abatement service supply chain in the non-cooperative Nash game, the cost-sharing Stackelberg game, and the cooperative game. By comparing the results of the three games, we find that the optimal onsite and online abatement service decision is related to the cost, marginal revenue, and the impact of the service on demand; the abatement cost-sharing contract and cooperation are both better than the non-cooperative independent decision state, which can effectively guide the provision of high-quality onsite abatement service and improve the revenue of both parties involved in the logistics service supply chain and the total system’s revenue in the O2O mode. Compared with the cooperative game model, the cost-sharing contract can more effectively facilitate close cooperation between the actors, and the relationship between onsite and online marginal revenue affects the improvement of both parties’ revenue. The findings of the study can provide useful managerial insights for the selection and design optimization of abatement contracts for logistics service supply chains considering cost-sharing via the O2O model.

Quantitative tools for maintenance planning for in-situ service entities

The company under study is dedicated to providing in-situ maintenance services, its objective is to provide comprehensive security technical goods and services to national and foreign entities, according to current standards; with professionalism and advanced technologies, guaranteeing the primacy in the national market and promoting exports. These services involve moving employees and equipment to the physical locations of customers. The companies that are dedicated to guaranteeing Security Systems, need to always keep the equipment installed available to the clients, so it is essential for them to periodically restore the capacities of these systems. The objective of this work is to propose the use of a set of quantitative tools that allow to increase the efficiency and effectiveness in the planning of on-site maintenance services. The security and protection company under study for the application of the proposal, improved considerably in terms of availability of the systems installed to customers and in the use of the resources. The work includes tools for the planning phases: long-term, which will be carried out annually, short-term, to decide on a monthly basis which clients will be served and the daily one in which it is determined on a daily basis which clients will be served.

The impact of geography on receipt of cancer treatment in Montana.

140 Background: The challenges of cancer patients in rural areas are well-documented. Most rural hospitals do not deliver on-site cancer care services and lack infrastructure, specialty physicians and oncology-trained support personnel (i.e., nurses, advanced practice providers, and pharmacists) to deliver infusion services. Because of this, cancer patients travel long distances to receive treatment. Travel distance is associated with an increased financial burden and worse outcomes with cancer, including later stage at diagnosis, less timely receipt of chemotherapy, and delay or declination of treatment. According to America’s Health Rankings, high geographic disparity within the state of Montana remains a significant challenge to overall health. Chronic understaffing of oncologists further exacerbates the geographic barrier to cancer care. Methods: To assess the impact of these combined access barriers to cancer treatment, we utilized 5 year cumulative data (2014-2018) from the Montana tumor registry database to assess the impact of geographic disparity on cancer care for patients in Montana. Results: Overall 19.2% of Montanans did not receive treatment following a cancer diagnosis. This is similar to the percentage of cancer patients in Delaware that did not receive treatment (19.1%). Although the population of Delaware is similar to Montana, it is 1.3% of the size. While this suggests that distance may not impact the receipt of treatment for cancer, further analysis of treatment data for Montana by county demonstrated broad discrepancies in the receipt of treatment: No treatment ranged from 12.5% to 30.3%. When mapped geographically the counties with the highest percentage of “no treatment” were distant from the 8 Commission on Cancer-approved cancer centers within the state. A similar county-by-county analysis demonstrated no apparent relationship of “no treatment” with either socioeconomic deprivation or lack of insurance. Distance from Commission on Cancer-approved centers also correlated with traveling out of state to receive care. Conclusions: This analysis provides insight into the impact of geographic barriers on cancer treatment in Montana and identifies remote sites that could benefit from robust outreach and care services to improve cancer care delivery.

Barriers to cancer prevention among women experiencing homelessness who receive onsite mammography, patient navigation, and education (HOPE).

111 Background: While incidence rates of cancer are lower among women experiencing homelessness (WEH), cancer mortality remains higher. Barriers to screening include economic, transportation, housing, childcare and other barriers. This study evaluates barriers to mammographic screening as part of a prospective program that provides onsite mammography services to WEH. Methods: Cleveland Clinic partnered with shelters to provide breast health education, patient navigation, and mobile mammograms onsite at shelters. Also, participants received a meal, a bra, and hygiene items. 75 women and persons of other genders completed a mammogram. 55 WEH participated in the study by completing a survey for a response rate of 73.3%. The survey included questions about barriers and demographics. We conducted a preliminary analysis to improve study quality and plan for a follow up study. Results: Participants were 40-75 years old and identified as American Indian/Alaska Native (5.5%), Black/African American (60%), and White (40%). 16% of participants received their first ever mammogram. 34% noted a family history of breast cancer and 22% had previously been advised to return for additional imaging. One participant was a breast cancer survivor. On average, participants’ last mammogram was four years prior with the greatest screening lapse being 18 years prior. A majority (n = 39, 70.9%) disagreed or strongly disagreed with the statement, “I’m afraid the mammogram will be painful.” Likewise, a majority (n = 46, 83.7%) disagreed or strongly disagreed with the statement, “I’m embarrassed about having a mammogram.” A majority (n = 44, 80.0%) also disagreed or strongly disagreed with the statement, “I’m busy and do not have time.” Almost all participants (n = 51, 96.2%) responded “yes” to the statement, “I believe in preventative care screenings.” However, participants’ responses to the statement, “I’m afraid of finding breast cancer” varied widely from strongly disagree (n = 7, 13.0%) and disagree (n = 10, 18.5%), to neutral (n = 15, 27.8%), to agree (n = 12, 22.2%) and strongly agree (n = 10, 18.5%). Conclusions: Our preliminary data shows that most participants believe in preventative screening, showing that novel services such as onsite mammography may address the lack of screening in this population. 40.7% of participants stated they are afraid of finding breast cancer, indicating this is a barrier to screening in the WEH population. Future research should explore reasons for fear (financial burden, mortality, lack of access to care, etc.) and why this may result in a lack of screening.

Differences in the utilization of palliative care support services among patients with metastatic solid tumor cancer in a community oncology setting: A retrospective review.

82 Background: Palliative care has been underutilized in the setting of advanced cancer despite its established benefit in improving the quality of life in cancer patients. Few studies have evaluated socioeconomic disparities in receiving palliative care in the outpatient oncology setting. We aimed to evaluate for disparities in utilization of palliative care among patients with metastatic solid tumor malignancies at Tennessee Oncology, a large outpatient community oncology practice with an established palliative care program. Methods: We completed a retrospective review of medical records of 1513 patients that were seen in Tennessee Oncology clinics from 12/2020 to 12/2021. We compared the baseline characteristics of patients with metastatic solid tumor malignancies who did and did not receive palliative care. Chi-square and two-sample t-tests were used for data analysis with the 5% significance level using R statistical software. Results: Male patients utilized palliative care less often than female patients (17% versus 24% for females, p =.0002; 95% CI,.05-1.0). Of payer types, Medicare had the least palliative care utilization (14%) compared to commercial (25%) and other payers (23%). Utilization also varied by cancer type, with melanoma (9%), lung cancer (15%) and renal cancer (21%) being least likely to receive palliative care (p <.00005; 95% CI,.19-1.0). We did examine racial differences in palliative care utilization, but those did not reach statistical significance. Conclusions: There are multiple disparities in the utilization of on-site palliative care support services among patients with metastatic solid tumor cancer in this outpatient community oncology setting. Further research is needed to gain insight into why this is, including an in-depth analysis of both patient and provider utilization/referral practices.[Table: see text]

Implementation of an innovative multidisciplinary survivorship clinic: The OWLS (Oncology, Wellness, Lifestyle and Survivorship) experience.

34 Background: Cancer survivors have complex medical and psychosocial needs and report difficulty accessing specialty care for short and long-term effects of treatment. We created an innovative multi-specialty survivorship clinic to address the medical and psychosocial consequences of cancer and to promote wellness and healthy lifestyle changes. Methods: The “Oncology, Wellness, Lifestyle and Survivorship” (OWLS) clinic was implemented 12/2020 for breast and gyn cancer survivors and extended to all cancer types in 111/2021. Patients complete pre and post-clinic survey to their medical and psychosocial concerns. OWLS is led by an internist and NP expert in survivorship with nurse navigator, physical activity coach, massage therapist on-site. A multidisciplinary team of providers experienced in survivorship care from hem/onc, cardiology, pulmonary, rheumatology, nephrology, dermatology, endocrinology, neurology, psychiatry, sexual health, physical therapy, nutrition, and lifestyle medicine meet monthly to create a comprehensive care management plan presented to survivors at their follow up visit and shared with their PCP and oncologist. Results: The OWLS team has seen 91 patients as of May 2022 and had 12 MDC meetings. Mean survivor age was 50 and the majority were white (80%) had breast cancer(76%) with non-metastatic disease 80%. Most frequent referrals were nutrition, physical therapy, gastroenterology and sexual health. At 6 mos f/u survey almost all were v.satisfied/satisfied with care. All OWLS MDC providers rated it as valuable. Conclusions: The OWLS clinic is an innovate, multi-specialty program that provides a comprehensive survivorship plan for cancer survivors at any stage of their disease. Areas for future growth include extending onsite services, expanding the number of male survivors serviced, and increasing outreach to non-white, non-commercially insured patients.[Table: see text]

Differences in trauma-informed care implementation by clinic-level factors across Ryan White HIV clinics in the Southeastern United States

ABSTRACT Trauma is common among people with HIV (PWH) and associated with low HIV care engagement, thus trauma-informed care (TIC) integration within HIV services is critical. From December 2019 to April 2020, we conducted surveys with 321 administrators, providers, and staff of 46 Ryan White HIV clinics (RWCs) in 8 Southeastern U.S. states to assess level of TIC implementation and clinic-level factors associated with TIC adoption. The mean score for TIC implementation was highest for the Physical Environment domain (μ = 4.08, SE = 0.07), followed by Screening, Assessment, and Treatment Services (μ = 3.96, SE = 0.07), Cross-sector Collaboration (μ = 3.75, SE = 0.08), Engagement and Involvement (μ = 3.92, SE = 0.09); and Training and Workforce Development (μ = 3.54, SE = 0.12). Greatest gaps were in staff TIC training, staff support, presence of onsite legal, spiritual, and housing services, and seeking patients’ definitions of safety and developing their individualized crisis/safety plans. Across most TIC implementation domains, clinic type, urbanicity, academic affiliation, and presence of onsite psychosocial support services were associated with level of TIC adoption. Thus, RWCs have the necessary foundation to integrate TIC practices, but further progress will require addressing identified gaps. The overall lack of significant difference in TIC implementation across domains by clinic-level factors suggests that a RW network-wide approach to enhancing TIC integration is feasible.

Rapid COVID-19 Testing and On-site Case Investigation and Contact Tracing in an Underresourced Area of Salt Lake City, Utah, December 2020-April 2021.

This case study describes how we paired free SARS-CoV-2 rapid antigen testing with on-site case investigation and contact tracing at a drive-through site in an underresourced area of Salt Lake City. Residents of this area had lower rates of employment and health insurance and higher rates of poverty than in the Utah general population. People were given an option to remain on-site and wait until their test results were ready. If a vehicle occupant received a positive test result, the case investigation occurred on-site; contact tracing with the other vehicle occupants was also initiated. People were provided resources to support isolation and quarantine. Bilingual staff who spoke Spanish were incorporated into the workflow. From December 2020 through April 2021, public health staff administered 39 587 rapid tests; 4094 people received a positive test result and 1133 stayed for on-site case investigation. More than half (60.5%) of people with a positive test result who agreed to stay for on-site case investigation were Hispanic or self-reported belonging to a non-Hispanic racial minority group (American Indian/Alaska Native, Asian, Black or African American, Native Hawaiian or Other Pacific Islander, or other racial identities). Pairing rapid antigen testing with on-site case investigation and contact tracing is feasible and improved the timeliness of case investigation by ≥1 day. On-site vaccination services were later integrated. Future emergency responses might consider assisting underresourced communities with on-site services that provide convenient and accessible public health interventions. By providing dependable and reliable services, we were able to achieve buy-in and become a consistent resource for those in the community.

Attenuation of bacterial hazard indicators in the subsurface of an informal settlement and their application in quantitative microbial risk assessment.

Pit latrines provide essential onsite sanitation services to over a billion people, but there are concerns about their role in infectious disease transmission, and impacts on groundwater resources. We conducted fieldwork in an informal settlement in Dar es Salaam, where cholera is endemic. We combined plate counting with portable MinION sequencing and quantitative polymerase chain reaction (qPCR) methods for characterization of bacteria in pit latrine sludge, leachate, shallow and deep groundwater resources. Pit latrine sludge was characterized by log10 marker gene concentrations per 100mL of 11.2±0.2, 9.9±0.9, 6.0±0.3, and 4.4±0.8, for total bacteria (16S rRNA), E. coli (rodA), human-host-associated Bacteroides (HF183), and Vibrio cholerae (ompW), respectively. The ompW gene observations suggested 5% asymptomatic Vibrio cholerae carriers amongst pit latrine users. Pit leachate percolation through one-meter-thick sand beds attenuated bacterial hazard indicators by 1 to 4 log10 units. But first-order removal rates derived from these data substantially overestimated the longer-range hazard attenuation in the sand aquifers. Cooccurrence of human sewage marker gene HF183 in all shallow groundwater samples testing positive for ompW genes demonstrated the human origin of Vibrio cholerae hazards in the subsurface. All borehole water samples tested negative for ompW and HF183 genes, but 16S rRNA gene sequencing data suggested ingress of faecal pollution into boreholes at the peak of the "long rainy season". Quantitative microbial risk assessment (QMRA) predicted a gastrointestinal disease burden of 0.05 DALY per person per year for the community, well above WHO targets of 10-4-10-6 DALY for disease related to drinking water.

Evaluation of Online Grocery Platform Alternatives Using Fuzzy ZNumbers

Bacground: Retail management has evolved into a new business model with the development of online shopping habits. There may be significant differences between onsite service and online service in terms of customer expectations. Introduction: In this study, companies providing online grocery services in Turkey are evaluated by examining the services they provide from the perspective of customers. Fuzzy Z numbers, which also add the reliability of linguistic assessments to the analysis, are used in order to better describe the uncertainty. Methods: Fuzzy Z-analytic hierarchy method (FZ-AHP) is used to weight the decision criteria, and fuzzy Z-Grey relational analysis (FZ-GRA) method is used to find the best online market company. Results: As a result of the analysis, it is revealed that the most important criteria for online grocery shopping are minimum order amount and brand diversity. The results are also compared with ordinary fuzzy methods. Conclusion: The comparison of the methods used in the study shows that although the ranks of the criteria and alternatives are the same, using fuzzy Z linguistic scale results in a wider interval for the weights and the scores of the alternatives, which could change the ordering, especially in cases where criterion weights or alternative scores are very close to each other.

Sexual and Gender Minority Individuals' Interest in Sexual Health Services at Collective Sex Venues in New York City.

Sexual and gender minority individuals who attend collective sex venues (CSVs; establishments where people can have sex in groups or the presence of others) are at elevated risk for HIV and STIs. On-site sexual health interventions have been attempted at CSVs, but attendees’ interest in receiving such services is under-investigated. This paper presents results from a 2020 online cross-sectional survey completed by 342 sexual and gender minority individuals who attended CSVs in New York City. Interest in services such as on-site testing for STIs, testing vans near CSVs, and informational referrals was overall high, particularly among younger participants. Among participants who reported being HIV negative, those of younger age and those who were not using PrEP reported being more likely to take an HIV test if it would be offered at CSVs. In open-text survey responses, participants expressed interest in CSVs providing free prevention services such as HIV/STI testing, PEP, PrEP, and STI medications or vaccination, as well as in ways to improve norms surrounding condom use and consent at these venues. Some participants expressed barriers to on-site services such as privacy concerns, preexisting access to health services, an emphasis on personal responsibility, and negative reactions to the presence of service providers. However, some participants also felt that these services could be delivered in a positive, acceptable, and non-judgmental way, especially by involving CSV organizers and attendees in their implementation. Findings from this study can inform future initiatives to develop sexual health interventions at CSVs.

"Nobody Wants to Talk About It, Especially in This Building": A Qualitative Study of How People Living in Permanent Supportive Housing Approach End-Of-Life Care.

Permanent supportive housing (PSH) is long-term affordable housing with onsite social services. End-of-life care (EOLC) involves a discussion about the type of medical care an individual hopes to receive at the end of their life. This qualitative study examines the goals, desires, and expectations for EOLC for people living in PSH. Semi-structured interviews were conducted with 17 formerly homeless residents in four PSH facilities in San Francisco, California and analyzed using the framework method. The interviews reveal how an individual's experience with housing precarity and with the PSH setting shape their preferences and expectations for the end of life. While PSH residents value social support in their final days, social isolation in PSH serves as a barrier to receiving such support. Results from this work can inform policies and programs to support people living in PSH in achieving their desired death.

Sudden cardiac arrest in commercial airports: Incidence, responses, and implications

Billions of travelers pass through airports around the world every year. Airports are a relatively common location for sudden cardiac arrest when compared with other public venues. An increased incidence of cardiac arrest in airports may be due to the large volume of movement, the stress of travel, or adverse effects related to the physiological environment of airplanes. Having said that, airports are associated with extremely high rates of witnessed arrests, bystander interventions (eg. CPR and AED use), shockable arrest rhythms, and survival to hospital discharge. Large numbers of people, a high density of public-access AEDs, and on-site emergency medical services (EMS) resources are probably the major reasons why cardiac arrest outcomes are so favorable at airports. The success of the chain of survival found at airports may imply that applying similar practices to other public venues will translate to improvements in cardiac arrest survival. Airports might, therefore, be one model of cardiac arrest preparedness that other public areas should emulate.