Associations of alternative cannabis product use and poly-use with subsequent illicit drug use initiation during adolescence.

RATIONALE: Specific cannabis products may differentially increase risk of initiating non-cannabis illicit drug use during adolescence. OBJECTIVE: To determine whether ever- and poly-use of smoked, vaporized, edible, concentrate, or blunt cannabis products are associated with subsequent initiation of non-cannabis illicit drug use. METHODS: High school students from Los Angeles completed in-classroom surveys. The analytic sample (N = 2163; 53.9% female; 43.5% Hispanic/Latino; baseline M age = 17.1 years) included students who reported never using illicit drugs at baseline (spring, 11th grade) and provided data at follow-up (fall and spring, 12th grade). Logistic regression models assessed associations between use of smoked, vaporized, edible, concentrate, and blunt cannabis at baseline (yes/no for each product) and any non-cannabis illicit drug use initiation-including cocaine, methamphetamine, psychedelics, ecstasy, heroin, prescription opioids, or benzodiazepines-at follow-up. RESULTS: Among those who never used non-cannabis illicit drugs at baseline, ever cannabis use varied by cannabis product (smoked = 25.8%, edible = 17.5%, vaporized = 8.4%, concentrates = 3.9%, and blunts = 18.2%) and patterns of use (single product use = 8.2% and poly-product use = 21.8%). After adjustment for baseline covariates, odds of illicit drug use at follow-up were largest for baseline ever users of concentrates (aOR [95% CI] = 5.74[3.16-10.43]), followed by vaporized (aOR [95% CI] = 3.11 [2.41-4.01]), edibles (aOR [95% CI] = 3.43 [2.32-5.08]), blunts (aOR [95% CI] = 2.66[1.60-4.41]), and smoked (aOR [95% CI] = 2.57 [1.64-4.02]) cannabis. Ever use of a single product (aOR [95% CI] = 2.34 [1.26-4.34]) or 2 + products (aOR [95% CI] = 3.82 [2.73-5.35]) were also associated with greater odds of illicit drug initiation. CONCLUSIONS: For each of five different cannabis products, cannabis use was associated with greater odds of subsequent illicit drug use initiation, especially for cannabis concentrate and poly-product use.

Rapid fluoroquinolone resistance detection in Pseudomonas aeruginosa using mismatch amplification mutation assay-based real-time PCR.

Background. Antimicrobial resistance (AMR) is an ever-increasing global health concern. One crucial facet in tackling the AMR epidemic is earlier and more accurate AMR diagnosis, particularly in the dangerous and highly multi-drug-resistant ESKAPE pathogen, Pseudomonas aeruginosa.Objectives. We aimed to develop two SYBR Green-based mismatch amplification mutation assays (SYBR-MAMAs) targeting GyrA T83I (gyrA248) and GyrA D87N, D87Y and D87H (gyrA259). Together, these variants cause the majority of fluoroquinolone (FQ) AMR in P. aeruginosa.Methods. Following assay validation, the gyrA248 and gyrA259 SYBR-MAMAs were tested on 84 Australian clinical P. aeruginosa isolates, 46 of which demonstrated intermediate/full ciprofloxacin resistance according to antimicrobial susceptibility testing.Results. Our two SYBR-MAMAs correctly predicted an AMR phenotype in the majority (83%) of isolates with intermediate/full FQ resistance. All FQ-sensitive strains were predicted to have a sensitive phenotype. Whole-genome sequencing confirmed 100 % concordance with SYBR-MAMA genotypes.Conclusions. Our GyrA SYBR-MAMAs provide a rapid and cost-effective method for same-day identification of FQ AMR in P. aeruginosa. An additional SYBR-MAMA targeting the GyrB S466Y/S466F variants would increase FQ AMR prediction to 91 %. Clinical implementation of our assays will permit more timely treatment alterations in cases where decreased FQ susceptibility is identified, leading to improved patient outcomes and antimicrobial stewardship.

Health Care Needs of Young Adults Who Have Experienced Homelessness.

INTRODUCTION: Young adults experiencing homelessness have poorer overall health compared with the general population. However, not much is known about how health care needs may change in the transition from homelessness to supportive housing. This study utilizes the Gelberg-Andersen Behavioral Model for Vulnerable Populations to examine unmet health care needs among young adults currently experiencing homelessness and formerly homeless young adults living in supportive housing. METHODS: This study includes data from 192 young adults who were either residing in a supportive housing program (n=103) or were "unhoused" (eg, residing on the street, staying in emergency shelters; n=89) in Los Angeles, CA, between 2017 and 2019. Hierarchical modeling examined unmet health care needs and factors that may enable those needs to be met, controlling for predisposing and other need factors. RESULTS: Controlling for predisposing and other need characteristics, this study identified increased enabling factors among those residing in supportive housing, the most widely applied intervention for homelessness. Participants who resided in supportive housing were more likely to report at least 1 type of unmet need than youth who did not have access to housing. Additional findings regarding the association of enabling factors and unmet need yield mixed results based on the type of unmet need. DISCUSSION: The acknowledgment of unmet needs may, in fact, be a byproduct of shifting priorities, which often occurs in the transition from homelessness to housing. Understanding the unmet need and health implications of this transition has relevance for practice as we work to better support formerly homeless young adults in meeting the needs that they identify.

Drinking with Friends: Measuring the Two-week Ecology of Drinking Behaviors.

Objectives: Despite the substantial influence these acute alcohol-related problems cause globally, past research has failed historically to capture the dynamic nature of drinking events, including how multiple factors (ie, individual, group, and environmental) interact to affect event-level intoxication. Fortunately, technology (eg, transdermal alcohol monitors) and smartphone surveys have provided researchers with new avenues to measure the complex nature of alcohol consumption. This paper presents the methods of a pilot study that sought to measure event-level alcohol consumption in a natural drinking group of college students. Methods: Ten groups of friends (N=49) were followed for 2 weeks with daily diary surveys, continuous activity trackers, hourly geographic ecological momentary assessments (EMAs) on 4 separate drinking occasions, and a transdermal alcohol monitor during one group-based social event. Results: On average, participants responded to > 75% of both daily diaries and EMAs and were compliant with activity trackers on 96% of monitoring days. Over 90% of the sample had usable transdermal data and after smoothing, peak transdermal alcohol contents ranged from 0.13 to 0.395 during the observation evening. Conclusion: The lessons learned during this pilot study can provide a building block for future work in this area, especially as data collection in alcohol research rapidly advances.

Express Yourself: Quantitative Real-Time PCR Assays for Rapid Chromosomal Antimicrobial Resistance Detection in Pseudomonas aeruginosa.

The rise of antimicrobial-resistant (AMR) bacteria is a global health emergency. One critical facet of tackling this epidemic is more rapid AMR diagnosis in serious multidrug-resistant pathogens like Pseudomonas aeruginosa. Here, we designed and then validated two multiplex quantitative real-time PCR (qPCR) assays to simultaneously detect differential expression of the resistance-nodulation-division efflux pumps MexAB-OprM, MexCD-OprJ, MexEF-OprN, and MexXY-OprM, the AmpC ß-lactamase, and the porin OprD, which are commonly associated with chromosomally encoded AMR. Next, qPCRs were tested on 15 sputa from 11 participants with P. aeruginosa respiratory infections to determine AMR profiles in vivo. We confirmed multiplex qPCR testing feasibility directly on sputa, representing a key advancement in in vivo AMR diagnosis. Notably, comparison of sputa with their derived isolates grown in Luria-Bertani broth (±2.5% NaCl) or a 5-antibiotic cocktail showed marked expression differences, illustrating the difficulty in replicating in vivo expression profiles in vitro. Cystic fibrosis sputa showed significantly reduced mexE and mexY expression compared with chronic obstructive pulmonary disease sputa, despite harboring fluoroquinolone- and aminoglycoside-resistant strains, indicating that these loci do not contribute to AMR in vivo. oprD was also significantly downregulated in cystic fibrosis sputa, even in the absence of contemporaneous carbapenem use, suggesting a common adaptive trait in chronic infections that may affect carbapenem efficacy. Sputum ampC expression was highest in participants receiving carbapenems (6.7 to 15×), some of whom were simultaneously receiving cephalosporins, the latter of which would be rendered ineffective by the upregulated ampC. Our qPCR assays provide valuable insights into the P. aeruginosa resistome, and their use on clinical specimens will permit timely treatment alterations that will improve patient outcomes and antimicrobial stewardship measures.

The Effect of Momentary Affect on Substance Use among Young Adults Who Experience Homelessness.

IntroductionLittle is known about the momentary patterns and predictors of substance use among young adults who experience homelessness. To enhance understanding of substance use patterns, smartphone-based ecological momentary assessment (EMA) was utilized to examine the real-time association between affect and substance use. Methods: 251 young adults (aged 18-27) with history of homelessness were recruited from supportive housing programs and drop-in facilities in Los Angeles. Exploratory factor analysis was used to examine the latent structure of positive and negative affective states and mixed-effects logistic regression models were completed separately for both the full remaining sample (n = 227) and a subsample of alcohol or cannabis users (n = 145) to evaluate whether positive or negative affect predicted lead, recent, or lagged substance use. Results: Greater positive affect within-person was associated with greater odds of alcohol or cannabis use within the past two hours, and participants who reported feeling more negative than their peers experienced greater odds of reporting use within the past 4 h and the following two hours. Conclusion: Results suggest that individuals experience a heightened positive mood compared to their own average mood, concurrently or immediately after engaging in alcohol or cannabis use. Heightened positive mood might be an anticipatory effect of drinking or cannabis use. Future research should consider a longer study period to capture multiple drinking or drug use events over a longer period and consider more environmental exposures that may influence the frequency or intensity of substance use.

Housing interventions for emerging adults experiencing homelessness: A scoping review.

INTRODUCTION: This review aims to identify and synthesize literature focused on housing interventions for young adults experiencing homelessness. METHODS: Following a five-stage approach to scoping reviews, a computerized search was conducted between February 4-8, 2019 to include peer-reviewed articles from a total of eight electronic databases: PsychINFO, Google Scholar, PubMed, Web of Science, Social Work Abstracts, Cochrane, Clinicaltrials.gov, and CINAHL. The search was limited to include literature published between January 1, 1987 and December 31, 2018. Search parameters included three domains: homelessness, housing intervention, and age. RESULTS: Of the initial 7,344 sources identified, 29 articles met the search criteria and were included in the final sample. Housing models discussed in the reviewed literature include Permanent Supportive Housing, Transitional and Independent Housing and Living Programs, the Foyer model, Housing First, and general Supportive Housing. Housing models were discussed in the context of outcome domains including quality of life, education, employment, housing tenure, cost of intervention, systems and service use, HIV, and social network and relationships. DISCUSSION: Housing interventions for young adults experiencing homelessness remains a relatively new intervention to combat homelessness among younger demographics. While the evidence base continues to grow, there remains a need for quality research to generate empirical evidence in this area, though studies included in this review showed promise for the development of best housing practices with this population.

Factors associated with condom and contraceptive use among currently and formerly homeless young adults: Does housing matter?

BACKGROUND: Young adults that experience homelessness (YAEH) are at heightened risk of unplanned pregnancy and contracting STIs, including HIV than their housed counterparts. It is unclear how exiting homelessness into Supportive Housing (SH), the most prominent intervention in homelessness, may shape sexual risk-taking. OBJECTIVE: The goal of this study is to explore associations of condom and contraception use with particular interest in the role of partner type (i.e., casual and/or serious) and housing status. METHODS: This study includes 143 sexually active YAEH (ages 18-27) who reported engaging in vaginal sex during the past three months: 67 "unhoused" (i.e., street-based, couch-surfers, or staying in emergency shelter), and 76 "housed" from SH programs. Multiple logistic regression examined the relationship of housing status and partner type with condom and contraceptive use. RESULTS: Being a parent was associated with higher odds of contraceptive use regardless of housing status, while partner type (i.e., serious or casual partner) was differently associated with condom use by housing status. DISCUSSION: Despite documented differences in condom-using behaviors by housing status, findings revealed similar patterns in contraceptive use between the two groups, indicating a possible need for enhanced and targeted service planning for YAEH, particularly among those transitioning to and residing in SH, regarding contraceptive use and prevention.

Examining HIV Risk and Exchange Sex Among Current and Formerly Homeless Young Adults.

This study investigated HIV risk among homeless and formerly homeless young adults by examining risky sex behaviors (e.g., condomless sex, exchange sex, and sex with multiple persons) using 90-day and daily recall methods. Data came from a sample of young adults (aged 18-27) with current (n = 101) or past (n = 109) homelessness experience in Los Angeles, California, recruited between 2017 and 2019. Baseline surveys queried demographics and sexual history. Daily retrospective surveys queried sexual events. Multiple logistic regressions were used to test the effects of demographic characteristics including homelessness history, relationship status, substance use, and sexual history on risky sex outcomes. In this sample, 26% reported never using a condom during anal or vaginal sex in the past 90 days, 5% reported testing positive for HIV, 82% had limited to no knowledge of preexposure prophylaxis, and 8% reported having had exchange sex during a 7-day measurement period, with those experiencing homelessness more likely to report. The study suggests supportive housing can reduce the occurrence of exchange sex but that HIV prevention services are still needed in homeless and housing programs to promote safe sexual practices.

Conceptualizing stigma in contexts of pregnancy and opioid misuse: A qualitative study with women and healthcare providers in Ohio.

BACKGROUND: Women with histories of opioid misuse face drug-related stigma, which can be amplified during pregnancy. While women are often blamed for their drug use and urged to change, the social contexts that create and reinforce stigma are largely unchallenged. Drawing on a multidimensional model of stigma, we examine how stigma manifested across women's pregnancy journeys to shape access and quality of care. METHODS: We triangulate in-depth interviews with 28 women with histories of opioid misuse who were pregnant or recently gave birth and 18 healthcare providers in Ohio. Thematic analysis examined how stigma operates across contexts of care. RESULTS: Providers represented physicians, nurses, social workers, counselors, and healthcare administrators. Among 28 women, average age was 30 (range: 22-41) and 79 % were White. Most women used prenatal medication-assisted treatment (MAT), including Suboxone (n = 19) or methadone (n = 8), and 15 were pregnant. Evidence of stigma emerged across healthcare contexts. Structural stigma encoded barriers to care in insurance practices and punitive drug treatment, while enacted stigma manifested as mistreatment and judgment from providers. Unpredictability of an infant diagnosis of neonatal abstinence syndrome (NAS), even when women were "doing everything right" by using MAT, perpetuated anticipated stigma from fear of loss of custody and internalized stigma among women who felt guilty about the diagnosis. Providers recognized the harmful effects of these stigmas and many actively addressed it. CONCLUSIONS: We recommend harm reduction approaches to address the multiplicity of stigmas that women navigate in opioid misuse and pregnancy to improve healthcare experiences.

Examining Sleep Disturbance Among Sheltered and Unsheltered Transition Age Youth Experiencing Homelessness.

BACKGROUND: The estimated 3.5-million transition age youth (TAY) who experience homelessness in the United States annually are routinely exposed to inadequate sleep environments and other psychosocial risk factors for deficient sleep. Although staying in a shelter versus being unsheltered may facilitate sleep, research suggests that perceived safety wherever one sleeps may be just as important. In this study, which is the first known study to investigate sleep disturbances among TAY experiencing homelessness, we examine associations of sleep disturbances with sheltered status and perceived safety of usual sleep environment. METHODS: We surveyed TAY (aged 18-25) experiencing homelessness in Los Angeles, CA about their sleep, psychosocial health, and living situations. Participants (n=103; 60% sheltered) self-reported sleep disturbances using the Patient-Reported Outcomes Measurement Information System Sleep Disturbance short form, while individual items assessed sheltered status and perceived safety where they usually slept. Regression analyses examined associations of sheltered status and perceived sleep environment safety with sleep disturbance, adjusting for age, sex, race, self-rated health, depression symptoms, serious mental illness, high-risk drinking, and severe food insecurity. RESULTS: Twenty-six percent of participants reported moderate-severe sleep disturbances. Sleep disturbance was not associated with sheltered status, but was positively associated with feeling unsafe in one's sleep environment, depression symptoms, severe food insecurity, and decreased age. CONCLUSIONS: Our findings suggest that sleep disturbances among TAY experiencing homelessness are associated more closely with how safe one feels rather than one's sheltered status. This highlights the importance of providing safe places to live for sheltered and unsheltered TAY.

Investigating Sleep Disturbance and Its Correlates Among Formerly Homeless Adults in Permanent Supportive Housing.

BACKGROUND: Adults experiencing homelessness have a high burden of sleep disturbance, which may be reduced by accessing permanent supportive housing. OBJECTIVES: To assess sleep disturbances and their correlates, including demographics, activity level, health status, age-related health issues (eg, functionality and cognitive impairment), substance use, and homelessness history in a sample of permanent supportive housing (PSH) tenants. RESEARCH DESIGN: Cross-sectional survey design. SUBJECTS: A total of 237 formerly homeless adults between 45 and 80 years old. MEASURES: The Patient-Reported Outcomes Measurement Information System (PROMIS) Sleep Disturbance short form was used to measure sleep disturbance. RESULTS: Twenty-eight percent of our sample had PROMIS scores indicative of a moderate or severe sleep disturbance. Functional impairment, pain, and mental health comorbidities were associated with increased sleep disturbance in multivariable linear regression analyses. The number of years a person experienced homelessness was inversely associated with sleep disturbance. CONCLUSIONS: This study supports the need to screen for sleep disturbances among PSH tenants. The findings suggest that supportive services in PSH may need to include integrated physical and behavioral health care, pain management, and interventions designed to address activities of daily livings to improve tenant sleep. They also suggest that improved sleep may help reduce PSH tenant pain, impairment, and mental health symptoms among PSH tenants.

Effect of Exposure to e-Cigarettes With Salt vs Free-Base Nicotine on the Appeal and Sensory Experience of Vaping: A Randomized Clinical Trial.

Importance: Alkaline free-base nicotine is bitter and a respiratory irritant. High-nicotine electronic cigarette (e-cigarette) products contain acid additives that change nicotine from a free-base to a protonated salt chemical form, which could improve the sensory experience of vaping, particularly among never smokers unaccustomed to inhaling free-base nicotine. Objective: To determine whether exposure to e-cigarettes with salt vs free-base nicotine formulations improves the appeal and sensory experience of vaping e-cigarettes and whether nicotine formulation effects differ by e-cigarette flavor and ever combustible cigarette smoking status. Design, Setting, and Participants: Single-visit double-blind within-participant randomized clinical trial was conducted in an academic medical center outpatient clinical research facility in Southern California. Participants were 119 individuals with past 30-day e-cigarette or combustible cigarette use aged 21 years or older recruited from November 2019 to March 2020. Interventions: Participants self-administered standardized puffs of each 10 differently flavored e-cigarette solutions using a pod-style device. Each flavor was administered in salt (benzoic acid added) and free-base (no benzoic acid) nicotine formulations with commensurate nicotine concentrations (mean, 23.6 mg/mL). The 20 solutions were administered in randomly assigned sequences. Immediately after puffing each solution, participants rated appeal and sensory attributes. Main Outcomes and Measures: Self-reported appeal (mean of like, dislike [reverse-scored], and willingness to use again ratings) and 4 sensory attributes (sweetness, smoothness, bitterness, and harshness; analyzed individually) on visual analog scales with not at all and extremely anchors (range, 0-100). Results: Of the 119 participants; 39 (32.8%) were female. The mean (SD) age was 42.1 (14.4) years; 105 (88.2%) were ever combustible cigarette smokers, and 66 (55.5%) were current e-cigarette users. Salt vs free-base nicotine formulations produced higher ratings of appeal (salt vs free-base mean difference effect estimate: b = 12.0; 95% CI, 9.9-14.1; P < .001), sweetness (b = 9.3; 95% CI, 7.1-11.4; P < .001), and smoothness (b = 17.4; 95% CI, 15.2-19.6; P < .001) and lower ratings of bitterness (b = -13.3; 95% CI, -15.4 to -11.2; P < .001) and harshness (b = -21.0; 95% CI, -23.2 to -18.7; P < .001). Nicotine formulation effects largely generalized across different flavors and the smoothness-enhancing and harshness-reducing effects of nicotine salt were stronger in never vs ever cigarette smokers. Conclusions and Relevance: In this randomized clinical trial of adult current nicotine or tobacco product users, controlled exposure to e-cigarette puffs with salt vs free-base nicotine formulations appeared to increase product appeal and improve the sensory experience of vaping, particularly among never smokers. Regulatory policies limiting acid additives in e-cigarettes might reduce the appeal of high-nicotine e-cigarettes among populations deterred from vaping e-cigarettes that emit harsh aerosol. Trial Registration: ClinicalTrials.gov Identifier: NCT04399031.

Taking the next-gen step: Comprehensive antimicrobial resistance detection from Burkholderia pseudomallei.

BACKGROUND: Antimicrobial resistance (AMR) poses a major threat to human health. Whole-genome sequencing holds great potential for AMR identification; however, there remain major gaps in accurately and comprehensively detecting AMR across the spectrum of AMR-conferring determinants and pathogens. METHODS: Using 16 wild-type Burkholderia pseudomallei and 25 with acquired AMR, we first assessed the performance of existing AMR software (ARIBA, CARD, ResFinder, and AMRFinderPlus) for detecting clinically relevant AMR in this pathogen. B. pseudomallei was chosen due to limited treatment options, high fatality rate, and AMR caused exclusively by chromosomal mutation (i.e. single-nucleotide polymorphisms [SNPs], insertions-deletions [indels], copy-number variations [CNVs], inversions, and functional gene loss). Due to poor performance with existing tools, we developed ARDaP (Antimicrobial Resistance Detection and Prediction) to identify the spectrum of AMR-conferring determinants in B. pseudomallei. FINDINGS: CARD, ResFinder, and AMRFinderPlus failed to identify any clinically-relevant AMR in B. pseudomallei; ARIBA identified AMR encoded by SNPs and indels that were manually added to its database. However, none of these tools identified CNV, inversion, or gene loss determinants, and ARIBA could not differentiate AMR determinants from natural genetic variation. In contrast, ARDaP accurately detected all SNP, indel, CNV, inversion, and gene loss AMR determinants described in B. pseudomallei (n≈50). Additionally, ARDaP accurately predicted three previously undescribed determinants. In mixed strain data, ARDaP identified AMR to as low as ~5% allelic frequency. INTERPRETATION: Existing AMR software packages are inadequate for chromosomal AMR detection due to an inability to detect resistance conferred by CNVs, inversions, and functional gene loss. ARDaP overcomes these major shortcomings. Further, ARDaP enables AMR prediction from mixed sequence data down to 5% allelic frequency, and can differentiate natural genetic variation from AMR determinants. ARDaP databases can be constructed for any microbial species of interest for comprehensive AMR detection. FUNDING: National Health and Medical Research Council (BJC, EPP, DSS); Australian Government (DEM, ES); Advance Queensland (EPP, DSS).

Real-Time Data Collection to Examine Relations Between Physical Activity and Affect in Adults With Mental Illness.

Adults with serious mental illness engage in limited physical activity, which contributes to significant health disparities. This study explored the use of both ecological momentary assessments (EMAs) and activity trackers in adults with serious mental illness to examine the bidirectional relationship between activity and affect with multilevel modeling. Affective states were assessed up to seven times per day using EMA across 4 days. The participants (n = 20) were equipped with a waist-worn accelerometer to measure moderate to vigorous physical activity. The participants had a mean EMA compliance rate of 88.3%, and over 90% of completed EMAs were matched with 30-min windows of accelerometer wear. The participants who reported more positive affect than others had a higher probability of engaging in moderate to vigorous physical activity. Engaging in more moderate to vigorous physical activity than one's usual was associated with more negative affect. This study begins to address the effect of momentary mood on physical activity in a population of adults that is typically difficult to reach.

Longitudinal effects of permanent supportive housing on insomnia for homeless adults.

OBJECTIVES: To examine the longitudinal change in insomnia as adults transition from homelessness to permanent supportive housing (PSH) and whether additional factors may moderate this relationship. METHODS: Standardized interviews were conducted with 331 homeless participants in Los Angeles prior to moving into PSH. Outcomes were measured 3, 6, and 12 months after move-in. Insomnia was assessed using the Sleep Condition Indicator, which is a 2-item validated short-form inventory that is intended to be used in clinical settings as a brief screening instrument for insomnia. Mixed-effects models were used to examine insomnia across all 4 measurement points and to test for interactions between time and covariates. RESULTS: Participants were on average approximately 55 years old and had spent an average of 5.6 years homeless in their lifetime, with approximately 70% identifying as male. Sixty-two percent of the sample screened positive for insomnia disorder at baseline. There was a significantly reduced likelihood of insomnia at each measurement period compared to baseline, but no differences were found between 3, 6, and 12 months. Mental health symptoms, physical health comorbidities, tobacco consumption, and female gender were associated with an increased likelihood of insomnia. CONCLUSION: Findings indicate a significant decrease in insomnia after moving into PSH, regardless of time spent homeless.

Identification of A Novel Picorna-Like Virus, Burpengary Virus, that is Negatively Associated with Chlamydial Disease in the Koala.

Koalas (Phascolarctos cinereus) are native Australian marsupials whose populations are in decline from a range of threats. Infectious diseases caused by the bacterium Chlamydia pecorum and other pathogens are of particular concern. We analysed 26 poly-A selected RNA-sequencing libraries from a data set designed to study the immune response of koalas to ocular chlamydial infection. Using virus discovery techniques, we identified the coding-complete genome sequence of a novel picorna-like virus, denoted Burpengary virus, that was most common in south-east Queensland. Notably, abundance measurements of the virus across all 26 libraries revealed an inverse relationship between abundance and ocular disease in koalas, suggesting that the co-infection of Burpengary virus and Chlamydia pecorum is inhibited.

Investigating Health Risk Environments in Housing Programs for Young Adults: Protocol for a Geographically Explicit Ecological Momentary Assessment Study.

BACKGROUND: Young adults who experience homelessness are exposed to environments that contribute to risk behavior. However, few studies have examined how access to housing may affect the health risk behaviors of young adults experiencing homelessness. OBJECTIVE: This paper describes the Log My Life study that uses an innovative, mixed-methods approach based on geographically explicit ecological momentary assessment (EMA) through cell phone technology to understand the risk environment of young adults who have either enrolled in housing programs or are currently homeless. METHODS: For the quantitative arm, study participants age 18-27 respond to momentary surveys via a smartphone app that collects geospatial information repeatedly during a 1-week period. Both EMAs (up to 8 per day) and daily diaries are prompted to explore within-day and daily variations in emotional affect, context, and health risk behavior, while also capturing infrequent risk behaviors such as sex in exchange for goods or services. For the qualitative arm, a purposive subsample of participants who indicated engaging in risky behaviors are asked to complete an in-depth qualitative interview using an interactive, personalized geospatial map rendering of EMA responses. RESULTS: Recruitment began in June of 2017. To date, 170 participants enrolled in the study. Compliance with EMA and daily diary surveys was generally high. In-depth qualitative follow-ups have been conducted with 15 participants. We expect to recruit 50 additional participants and complete analyses by September of 2019. CONCLUSIONS: Mixing the quantitative and qualitative arms in this study will provide a more complete understanding of differences in risk environments between homeless and housed young adults. Furthermore, this approach can improve recall bias and enhance ecological validity. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/12112.

A Control-Theoretic Assessment of Interventions During Drinking Events.

This paper employs control-theoretic tools to provide guidelines for in-situ interventions aimed at reducing high-risk alcohol consumption at drinking events. A dynamical directed network model of a drinking event with external intervention, suitable for mathematical analysis and parameter estimation using field data is proposed, with insights from pharmacokinetics and psychology. Later, a characterization of a bound on blood alcohol content (BAC) trajectories is obtained via Lyapunov stability analysis, and structural controllability guarantees are obtained via a graph-theoretic method. We use the degree of controllability, given to be the trace of the system's controllability Gramian, as a metric to compare the viability of network nodes for intervention based on theoretic and heuristic centrality measures. Results of numerical examples of bars and parties, informed by field data, and the stability and controllability results, suggest that intervening in the environment in wet bars, while targeting influential individuals with high alcohol consumption motivations in private parties efficiently yield lower peak BAC levels in individuals at the drinking events.

The event-level impact of one's typical alcohol expectancies, drinking motivations, and use of protective behavioral strategies.

INTRODUCTION: Much of the past research on the excessive consumption of alcohol by college students has focused on the interplay of individual factors and typical drinking patterns, but this is not adequate to understand behavior as it occurs. The need to understand drinking at the event-level is critical in order to develop event-level prevention. To this end, this study examined a conceptual model of college students' drinking events in order to determine the potential mediating effect of drinking motives and protective behavioral strategies (PBS) in the relationship between alcohol expectancies and event-level alcohol use and consequences. METHODS: An existing data set containing information about 2279 college student drinking events were analyzed for this study. Students completed surveys during the administration of a commercial online alcohol course during 2010 and 2011. A theoretical model was analyzed with structural equation modeling. RESULTS: Both typical use of PBS and drinking motives mediated the relationship between expectancies and event-level alcohol use and problems. Positive expectancies were associated with greater positive motives, greater motives were associated with less use of PBS, and less PBS use was then, in turn, associated with higher event-level intoxication. Lastly, higher intoxication was associated with more serious consequences during the event. CONCLUSION: This is the first study to simultaneously explore the relationship between these factors and event-level drinking. There is a great need to continue to further explore the dynamic nature of drinking at the event-level to illuminate potential leverage points amendable to change.