The peer to career pipeline: An observational study of peer worker trainee characteristics and training completion likelihood.

INTRODUCTION: Peer recovery support services (PRSS) for substance use disorder (SUD) are a flexible and evidence-based intervention employed across multiple settings and for a variety of populations. These services have expanded over the past two decades, but there is little research on recruitment and training of prospective peer workers - the peer to career pipeline. This study observed training outcomes for applicants to a peer worker scholarship program in Texas. METHODS: A total of 448 participants provided baseline personal history information, and a subset of participants (n = 239) completed optional psychosocial surveys. Logistic regression analysis tested associations of personal history and psychosocial variables with three training stage completion outcomes: classroom training completion, placement at an internship site, and full certification. RESULTS: The greatest decline in advancement between stages occurred in the transition between classroom training (78.1 % of participants completed) and internship placement (43.3 % of participants completed). Participants were diverse in terms of race/ethnicity and life experiences salient to the peer worker role, but Hispanic/Latinx peer workers were under-represented. Past work with a SUD peer worker, age, and having a bachelor's degree were each positively associated with training stage completion across multiple models, while having basic technological access, being a woman, and veteran status were each positively associated with training stage completion in only one model. Years since recovery initiation date, non-monosexual orientation, White race, and quality of life were each negatively associated with training stage completion in only one model. CONCLUSIONS: The existing peer workforce may be a key source of recruitment for new peer workers; thus retention of existing workers is key to ensuring continued expansion of these services. Additional support may be required to recruit and retain younger peer worker trainees, men trainees, Hispanic/Latinx trainees, trainees who lack basic technological access, or trainees without bachelor's degrees. Unanswered questions about the peer workforce remain and must be addressed to ensure that an appropriately diverse workforce is recruited, that disparities in training outcomes are minimized or prevented, and that existing peer workers are well-supported.

Mapping COVID vulnerability in relation to drug and alcohol recovery residence availability across the United States.

Recovery housing is an important resource for those in recovery from substance use disorders. Unfortunately, we know little about its relationship to key community health risk and protective factors, potentially limiting the role it could play as a broader health resource. Leveraging county-level data on recovery residences from the National Study of Treatment and Addiction Recovery Residences (NSTARR), this study used multilevel modeling to examine Community COVID Vulnerability Index (CCVI) scores as well as availability of COVID testing and vaccination sites in relation to recovery housing. CCVI composite scores were positively associated with recovery housing availability. Analyses using CCVI thematic sub-scores found that population density and number of churches were positively associated with recovery housing availability, while epidemiological factors and healthcare system factors were negatively associated with recovery housing availability. In counties with recovery housing, there also was a positive association between CCVI and both COVID testing and vaccination availability. Recovery residences tend to be located in areas of high COVID vulnerability, reflecting effective targeting in areas with higher population density, more housing risk factors, and other high-risk environments and signaling a key point of contact to address broader health issues among those in recovery from substance use disorders.

Social Model Recovery and Recovery Housing.

Recovery housing is an important resource for many in their recovery from alcohol and other drug use disorders. Yet providers of recovery housing face a number of challenges. Many of these challenges are rooted in stigma and bias about recovery housing. The ability to describe the service and purported mechanisms of action vis-a-vis an overarching framework, approach, or orientation could also go a long way in adding credence to recovery housing as a service delivery mechanism. Several aspects of social model recovery are often explicitly built or organically reflected in how recovery housing operates, yet describing recovery housing in these terms often does little to demystify key features of recovery housing. To more fully cement social model recovery as the organizing framework for recovery housing this article aims to: review the history, current status, and evidence base for social model recovery; comment on challenges to implementing the social model in recovery housing; and delineate steps to overcome these challenges and establish an evidence base for social model recovery housing.

Air Quality Dispersion Modelling to Evaluate CIPP Installation Styrene Emissions.

Cured-in-place pipe (CIPP) is one of the most popular in situ rehabilitation techniques to repair sewer and water pipes. While there are multiple approaches to curing CIPP, steam-curing of styrene-based resins has been found to be associated with air-borne chemical emissions. Health officials, utilities and industry representatives have recognized the need to know more about these emissions, especially styrene. Such concern has led to multiple studies investigating the concentrations of volatile organic compounds on CIPP installation sites. This study expands upon previous effort by modeling worst-case, steam-cured CIPP emissions over a 5-year weather record. The effort also includes calibration of the model to emissions averages over the work day rather than instantaneous field measurements. Dispersion modelling software, AERMOD, was utilized to model the styrene component of CIPP emissions on two CIPP installation sites in the US. Based on the analysis results, it was found that the styrene emitted from stacks dissipates rapidly with styrene concentrations only exceeding minimum health and safety threshold levels at distances close to the stack (2 m or less). The values predicted by the model analysis are comparable with the field measured styrene concentrations from other studies. Current safety guidelines in the US recommend a 4.6-m (15-ft) safety perimeter for stack emission points. The results of this study indicate that significant and lasting health impacts are unlikely outside recommended safety perimeter. The results also validate the importance of enforcing recommended safety guidance on steam-cured CIPP sites.

Identifying the availability of recovery housing in the U.S.: The NSTARR project.

BACKGROUND: Home is essential to recovery, and recovery housing can play an important role for individuals seeking a supportive environment. The National Study of Treatment and Addiction Recovery Residences (NSTARR) Project constitutes the largest and most diverse study of recovery housing to date. We describe the development of a national sampling frame to study recovery housing, as well as findings on availability and distribution of recovery housing across the U.S. METHODS: Data from publicly available sources and lists maintained by entities tracking recovery housing were compiled. Residences for which locating information was available were geocoded and linked with U.S. Census data and drug and alcohol mortality data. We used hot spot analysis and multilevel models to describe the geographic distribution of recovery residences and assess whether residences are located in areas of high need. RESULTS: The NSTARR database contains information on 10,358 residences operated by 3628 providers in all 50 states. Residences were more likely (p < 0.05) to be in urban areas and in counties with higher substance use mortality; they were less likely to be in economically disadvantaged areas. Recovery housing density also was greater in urban areas and areas with a greater proportion of non-White residents, but lower in economically disadvantaged areas. CONCLUSIONS: Despite a wealth of research on some types of recovery housing, critical gaps in the field's understanding about the nature of recovery housing remain. The NSTARR Project represents an important first step to expand research on recovery housing across the country.

Sheltering in place and social distancing when the services provided are housing and social support: The COVID-19 health crisis and recovery housing.

Recovery housing is a vital service for individuals with substance use disorders who need both recovery support and safe housing. Recovery housing is a residential service, and it relies heavily on social support provided by peers both within the residence and in outside mutual help groups. As such, efforts to keep residents safe from SARS CoV-2, the virus that causes the illness COVID-19, pose a number of challenges to social distancing. Further, residents are some of the more vulnerable individuals in recovery. They are more likely to have co-occurring health conditions that place them at risk for COVID-19, and they often have risk factors such as employment in low-wage jobs that increase their potential for negative economic impacts of the pandemic. Since most recovery housing operates outside formal substance use treatment, residents who pay out-of-pocket for services largely support these residences. Comprehensive support for those using, as well as those providing and ensuring the quality of recovery housing, is needed to ensure the viability of recovery housing.

Supporting individuals using medications for opioid use disorder in recovery residences: challenges and opportunities for addressing the opioid epidemic.

Full and partial opioid agonists and opioid antagonist medications play an important role in containing the opioid epidemic. However, these medications have not been used to their full extent. Recovery support services, such as recovery residences (RRs), also play a key role. RRs may increase an individual's recovery capital, facilitate social support for abstinence, and foster a sense of community among residents. These processes may be critical for individuals with opioid use disorder (OUD). In combination these two recovery pathways have the potential to enhance one another and improve outcomes among residents with OUD. Barriers to doing so have resulted in a limited supply of residences that can support residents using opioid agonist and antagonist medications. This perspective describes key interpersonal and structural barriers to medication use among individuals with an OUD seeking support from a recovery residence and discusses measures for reducing these barriers. These measures include workforce development to address stigma and attitudinal barriers and enhancing residence capability to ensure resident safety and reduce potential diversion. The perspective also highlights the need for additional research to facilitate the identification of best practices to improve outcomes among residents treated with medications living in recovery residences.

A paradigm for information needed to protect at-risk species: northern pine snake (Pituophis melanoleucus) in the pine barrens as a case study.

New methods of examining the risk to endangered, threatened and rare species are required to identify vulnerability. A paradigm for examining risk is presented that describes anthropogenic threats, species activities, and vulnerabilities, and uses Northern pine snakes (Pituophis melanoleucus) in the New Jersey Pine Barrens as a case study. The paradigm includes (1) conceptual model of natural, anthropogenic, and interactive stressors, (2) template of the functional attributes of threats from human activities, and (3) template of effects from different human activities. Pine snake behavior throughout the year was used to examine the temporal overlap in high snake vulnerability periods and desired human activities in a shared habitat. New data on autumn behavior of pine snakes are also provided. Passive integrated transponders (PIT tag) tracking technology indicated that the fall basking activity period is both longer in duration, and at a higher intensity than previously presumed. During the autumn, individual snakes moved in and out of dens an average of 6 times over a two-month period. Younger snakes at a small hibernaculum were more active than those at hibernacula with larger and older snakes. The high activity period of pine snakes overlaps with the timing of preferred off-road-vehicle (ORV) use, controlled burns, and other human activities, increasing snake vulnerability, potentially causing behavioral disruptions, injury, and death. The conceptual model illustrating relationships between attributes of human activity and effects may be utilized to determine risks to other listed species, and those of special concern in different habitats. This paradigm also provides managers with template tools to assess risks to species that may also be used to provide information to the public.

A Functional Approach to Solubility Parameter Computations.

The determination of solubility parameters for solutes represents a challenging mathematical problem of locating the central tendency of solvent affinity based on a limited set of data taken from experimental observations. At present, the most commonly used methods for computing solubility parameters of a solute require a binary classification of solvent affinity for the solute and employ a spherical/ellipsoidal compatibility region in the three-dimensional Hansen solubility parameter space. Utilizing a binary classification requires an arbitrary solubility threshold, and an ellipsoidal fitting model imposes a symmetry on the intermolecular forces that is rarely reflected by the experimental data. To overcome these issues, an approach that makes use of accurate solubility data to describe a three-dimensional solubility function, f, is introduced. The principles of the approach are discussed in detail and the procedures for constructing the solubility function and computing solubility parameters are described. An example using PCBM solubility data available in the literature demonstrates the new method. Lastly, a method that employs f as a predictor of solubility in arbitrary solvents with a proposed measure of reliability is presented.

Solubility Characteristics of PCBM and C60.

Empirical data indicate that several good solvents for C60 and [6,6]-phenyl-C61-butyric acid methyl ester (PCBM) have substantial polar and hydrogen-bonding components, which are not intrinsic to the structure of the C60 and PCBM molecules themselves. Functional solubility parameter (FSP) and convex solubility parameter (CSP) computations are performed on C60 and PCBM using solubility data available in the literature. The CSP and FSP results are compared to previously reported Hansen solubility parameters (HSPs) and to the parameters calculated using additive functional group contribution methods. The CSP and FSP methods confirm the anomalously large polar and hydrogen-bonding parameters, δP and δH, obtained experimentally for C60 and PCBM. This behavior, which is quite irregular given the structure of the molecules, is due to the fact that several good solvents have high δP and δH values. Thus, these irregularities are highlighted by the CSP and FSP calculations. Additional contradictory solubility characteristics are disclosed by comparing the experimental solubility parameters to a linear solvation energy relationship (LSER) model, additive functional group calculations, and COSMO-RS computations. The FSP solubility function strongly suggests that the solubility parameters do not accurately represent the cohesive energy density properties of C60 and PCBM, as intended, but rather they manifest the properties of the solvents, e.g., high δP and δH values, that are necessary to accommodate these molecules in the liquid phase.

Maximizing social model principles in residential recovery settings.

Peer support is integral to a variety of approaches to alcohol and drug problems. However, there is limited information about the best ways to facilitate it. The "social model" approach developed in California offers useful suggestions for facilitating peer support in residential recovery settings. Key principles include using 12-step or other mutual-help group strategies to create and facilitate a recovery environment, involving program participants in decision making and facility governance, using personal recovery experience as a way to help others, and emphasizing recovery as an interaction between the individual and their environment. Although limited in number, studies have shown favorable outcomes for social model programs. Knowledge about social model recovery and how to use it to facilitate peer support in residential recovery homes varies among providers. This article presents specific, practical suggestions for enhancing social model principles in ways that facilitate peer support in a range of recovery residences.

Maximum daily 6 minutes of activity: an index of functional capacity derived from actigraphy and its application to older adults with heart failure.

OBJECTIVES: To compare the correlation between the maximum 6 minutes of daily activity (M6min) and standard measures of functional capacity in older adults with heart failure (HF) with that in younger subjects and its prognostic utility. DESIGN: Prospective, cohort study. SETTING: Tertiary care, academic HF center. PARTICIPANTS: Sixty, ambulatory, adults, New York Heart Association (NYHA) Class I to III, stratified into young (50.9 +/- 9.4) and older cohorts (76.8 +/- 8.0). MEASUREMENTS: Correlation between M6min and measures of functional capacity (6-minute walk test; 6MWT) and peak oxygen consumption (VO(2)) according to cardiopulmonary exercise testing in a subset of subjects. Survival analysis was employed to evaluate the association between M6min and adverse events. RESULTS: Adherence to actigraphy was high (90%) and did not differ according to age. The correlation between M6min and 6MWT was higher in subjects aged 65 and older than in those younger than 65 (correlation coefficient (r=0.702, P<.001 vs r=0.490, P=.002). M6min was also significantly associated with peak VO(2) (r=0.612, P=.006). During the study, 26 events occurred (2 deaths, 10 hospitalizations, 8 emergency department visits, and 6 intercurrent illnesses). The M6min was significantly associated with subsequent events (hazard ratio=2.728, 95% confidence interval=1.10-6.77, P=.03), independent of age, sex, ejection fraction, NYHA class, brain natriuretic peptide, and 6MWT. CONCLUSION: The high adherence to actigraphy and association with standard measures of functional capacity and independent association with subsequent morbid events suggest that it may be useful for monitoring older adults with HF.

The prevalence and impact of anergia (lack of energy) in subjects with heart failure and its associations with actigraphy.

BACKGROUND: Anergia (lack of energy) is a newly delineated, criterion-based geriatric syndrome. Because heart failure (HF) is a common chronic condition among older adults and a because a cardinal symptom of HF is reduced energy, we characterized the degree of anergia in subjects with HF and evaluated its relevance to disease severity, functional performance, and quality of life. METHODS AND RESULTS: Prospective 3-month cohort study among a convenience sample of 61 subjects (61 +/- 15 years, 48% women, ejection fraction 41 +/- 16%) with New York Heart Association (NYHA) Class I-III HF were studied. The criterion for anergia was based on the major criterion "sits around for lack of energy" and any 2 of 6 minor criteria. Principal measures in addition to demographic and clinical characteristics included functional performance (NYHA class, 6-minute walk, cardiopulmonary exercise testing), plasma B-type natriuretic peptide, and quality of life (SF-12 and Minnesota Living with Heart Failure Questionnaire). To evaluate the relevance of anergia to daily function, each subject wore an Actigraph, a watch-like wrist device that continuously and automatically monitors patient activity levels and energy expenditure, for 3 months. Anergia was prevalent in 39% of this population. Anergia was associated with decrements in functional capacity (higher NYHA Class and lower 6-minute walk distance) as well as reduction in quality of life, but was not associated with ejection fraction. Actigraphy data demonstrated that HF subjects with anergia spent significantly less time performing moderate physical activity and the peak activity counts per day were significantly lower than HF subjects without anergia. Additionally, the amplitude of circadian rhythm was lower, suggesting altered sleep and activity patterns in HF subjects with anergia compared with those without anergia. Over the 3 months of follow-up, there was a significant association between anergia and intercurrent hospitalization. CONCLUSIONS: Anergia is significantly associated with several of the cardinal domains of HF. Its presence is associated with demonstrable differences in both physical activity and circadian rhythm as measured by actigraphy and an increased risk of hospitalizations. Accordingly, anergia may be a target for intervention among HF subjects.