Search Results (777)

Background: The Pharm2Home Initiative’s Community Health Arm adopts a health-equitable approach to chronic disease education and medication therapy management (MTM). We serve senior residents of Solano County, California, who live in affordable housing and have limited financial resources. Aim: This evaluation assesses the uptake of chronic disease management recommendations provided by clinical pharmacists during MTM sessions at community events. Methods: The program engaged clinical pharmacists to provide tailored education and healthcare interventions in senior housing facilities. The goal was to empower seniors to manage their health effectively. The sessions covered various topics, including expired or duplicated medications, incorrect medication use, consultations on medication management, immunizations, and lifestyle adjustments. Results: Over an 18-month period, from January 2022 to August 2023, the program involved 65 participants across ten community health events. These events provided approximately 65 h of direct intervention. Many participants reported significant improvements in understanding their treatment plans and navigating their health needs more confidently. Feedback from 60 seniors after the sessions indicated that 88% felt much better informed about their medications, and 75% expressed that their concerns were addressed extremely well. Conclusions: These outcomes demonstrate the importance of clinical pharmacist-led interventions in improving seniors’ medication use and chronic disease management. The initiative’s approach advocates for integrating clinical pharmacists into community health settings, suggesting a scalable model for enhancing person-centered care. However, further studies are necessary to assess the long-term impacts of these interventions and explore their effectiveness across diverse age groups and more complex conditions. Full article

Despite an abundance of available research, calf mortality persists as a multifaceted phenomenon that presents ongoing challenges in practical management. This historical single-cohort study was conducted to provide a more comprehensive layer of knowledge to the existing information pool on calf mortality risk factors by using multiblock partial least squares analysis. The method reveals the contribution of several variables aggregated into thematic blocks and allows to include multiple outcome variables describing the same phenomenon. Such an analysis of the data provides valuable information to farmers, veterinarians, and advisors alike, not only about single risk factors, but also about management areas to prioritize when tackling calf mortality. Data was gathered from 118 Estonian dairy herds, each comprising ≥100 cows, via questionnaire, sample collection, and on-farm scoring and measurements. The final dataset included 147 questions divided into 13 meaningful blocks. The outcome variables were annual herd-level calf mortality risk during the first 21 days (MR21) and 22–90 days (MR90) using farm records and the national cattle database, respectively. The average MR21 was 5.9% (median 4.4%, range 0.0–26.8%) and the average MR90 was 2.7% (median 2.3%, range 0.0–12.7%). Of the 13 thematic variable blocks, the most important blocks explaining calf mortality were ‘Routine stress-inducing activities’, ‘Herd characteristics’, ‘Calving management’, ‘Calf housing during 5–21 days’, and ’External biosecurity’. The most influential single variables associated with higher overall calf on-farm mortality during the preweaning period were poorer cleanliness scores of calving animals and calves having access to an outdoor area during the first 21 days of life. Detected risk factors for MR21 were calf barn age > 20 years, allowing the calves to suckle the first colostrum, bucket feeding calves during the first three weeks, disbudding all calves (compared to only heifer calves), and disbudding at 21–29 days of age. Risk factors for MR90 included the use of automatic milk feeders and feeding waste milk during the first three weeks, early introduction of calves to large group pens and higher in-pen age differences, absence of forced ventilation during the first three weeks, opportunity for feces to spread between calf pens, and use of calving pens for sick animals. Washing and disinfection of newborn calves’ pens and testing colostrum quality were protective factors against both MR21 and MR90. Other protective practices for MR21 were related to proper colostrum feeding routines, whereas lower MR90 was mostly associated with efficient external biosecurity practices and vaccination programs. The multiblock model proved to be beneficial in providing a broader understanding of the importance of different management areas on calf mortality. Full article

Soaring housing prices worldwide are compromising housing affordability, potentially leading to significant economic, social, and health repercussions. Understanding the price discovery process within the real estate market is therefore crucial for policymakers. While the relationship between land and housing prices in urban residential markets has been widely examined in the literature, the results are often context-specific, leaving the question of whether the land market leads the housing market or vice versa open to debate. Saudi Arabia, with its rapidly growing real estate market, evolving demographics and urbanization trends, and transformative regulatory reforms, presents a compelling context for revisiting the land–housing nexus. This study examines the long-term relationship between land and housing markets and investigates the short-term price dynamics with the ultimate goal of understanding the price formation in the housing market. The study dataset comprises quarterly time-series price indices published by the General Authority for Statistics (GASTAT) in Saudi, representing the nation-wide price movements of residential lands and villas from 2014Q1 to 2025Q1. The study employs the Johansen cointegration method and the Granger causality testing. The results of cointegration analysis confirm a significant long-run equilibrium relationship between the two markets, while the error correction model reveals that both land and housing prices adjust to restore this equilibrium. Granger causality test results show a unidirectional relationship, where land prices predict future housing prices, consistent with the neoclassical rent theory. These findings reinforce the long-term, intrinsic link between land and housing markets observed in prior studies. The dynamics in the Saudi market are likely shaped by rapid urbanization that intensified speculation in the land market, and also the prevalence of self-building enabled by government-supported financing. This study underscores the importance of striking a delicate balance between supply and demand side policies in the real estate market while monitoring the impact of these policies on housing affordability. Full article

Jordan’s aging population faces a critical challenge: a strong cultural preference for aging at home, rooted in Islamic ethics of familial care (birr al-wālidayn), conflicts with housing stock that is largely unsafe and inaccessible. This first national mixed-methods study examines the intersection of home modifications, socio-economic barriers, and cultural constraints to aging in place. Data from 587 surveys and 35 interviews across seven governorates were analyzed using chi-square tests, linear regression, and thematic coding. Results indicate that while physical modifications significantly improve accessibility to key spaces like kitchens and reception areas (majlis) (χ² = 341.86, p < 0.001), their adoption is severely limited. Socio-economic barriers are paramount, with 34% of households unable to afford the median modification cost of over $1500. Cultural resistance is equally critical; 22% of widows avoid modifications like grab bars to prevent the ‘medicalization’ of their home, prioritizing aesthetic and symbolic integrity over safety. The study reveals a significant gendered decision-making dynamic, with men controlling 72% of structural modifications (β = 0.27, p < 0.001). We conclude that effective policy must integrate universal design with Islamic care ethics. We propose three actionable recommendations: (1) mandating universal design in building codes (aligned with SDG 11), (2) establishing means-tested subsidy programs (aligned with SDG 10), and (3) launching public awareness campaigns co-led by faith leaders to reframe modifications as preserving dignity (karama) (aligned with SDG 3). This approach provides a model for other rapidly aging Middle Eastern societies facing similar cultural-infrastructural tensions. Full article

Background: Major geopolitical events and structural shocks are thought to play a significant role in shaping HIV epidemics by influencing individual behaviours, reshaping social networks, and impacting HIV prevention and treatment programs. Here, we describe individual-level measures of estimated time since HIV infection (ETI) from viral next-generation sequencing data among female sex workers and their clients in relation to significant geopolitical events in Ukraine. Methods: The Dynamics Study is a cross-sectional integrated biological and behavioural survey conducted among female sex workers and their clients in Dnipro, Ukraine (December 2017 to March 2018). We were able to successfully sequence a portion of the HIV pol gene on dried blood spot specimens among n = 5/9 clients and n = 5/16 female sex workers who tested positive for HIV (total n = 10/25) using an in-house drug resistance genotyping assay. The “HIV EVO” Intrapatient HIV Evolution web-based tool was used to infer ETI from viral diversity. Results: The median ETIs for female sex workers and their clients were 5.4 years (IQR = 2.9, 6.6) and 6.5 years (IQR = 5.4, 10.8), respectively. Nearly all HIV acquisition events (n = 7/10; 70%) were estimated to have occurred between the Great Recession (2008–2009) and the War in Donbas (May 2014–February 2022). In general, ETI suggests that HIV acquisition occurred earlier among clients (2012 [IQR = 2007, 2013]) compared to sex workers (2013 [IQR = 2012, 2016]). Conclusion: Our findings suggest that most HIV acquisition in this small subset of female sex workers and clients living with HIV occurred during periods of economic decline. Molecular studies on timing of HIV acquisition against timing of major geopolitical events offer a novel way to contextualize how such events may shape transmission patterns. Full article

This study investigated how county- and state-level socioeconomic factors influence racial differences in placement stability outcomes for children in foster care. Using a sample drawn from the Adoption and Foster Care Analysis and Reporting System (AFCARS) covering 2012–2020, we employed linear mixed modeling (LMMs) to nest individual- and case-level data within counties and states. Our analysis focused on Black and White children, examining how variables such as poverty, unemployment, public welfare expenditures, residential mobility, and family structure affect the number of placement moves experienced by children. The findings indicated that Black children experience higher rates of placement instability compared to White children, although the gap narrows over time. Key factors associated with improved stability included county-administered child welfare systems and higher rates of multigenerational households and owner-occupied housing, particularly benefiting Black children. In contrast, higher levels of Supplemental Nutrition Assistance Program (SNAP) participation and increased residential mobility were linked to greater instability. The implementation of program improvement plans (PIPs) during the third round of the Child and Family Services Reviews (CFSR-3) produced mixed outcomes, with PIPs contributing to a reduction in the racial gap primarily by increasing placement moves for White children. These findings underscore the importance of analyzing data by race and incorporating broader socioeconomic contexts into child welfare improvement strategies, while also emphasizing the need for localized, context-sensitive approaches to improve placement stability. Full article

Objectives: We investigated the performance of a slow computed tomography (CT) protocol to reduce alignment errors arising from motion when using CT-on-rail (CTOR) for image guidance for patients receiving thoracic stereotactic body radiation therapy (SBRT). Methods: A Quasar lung phantom with a moving tumor was programmed with three breathing rates and three motion amplitudes. MIP and average 4DCT images were used for contouring and alignment, respectively. Ten CTOR images were obtained for each of the breathing rates and amplitudes, under both CT protocols. We used in-house CAT software for image guidance, centering the tumor in the lung window within the gross tumor volume contour. Longitudinal coordinate reproducibility was compared between the two protocols. We also retrospectively analyzed CBCT SBRT image guidance alignment data from 31 patients to evaluate the systematic error in the longitudinal direction between simulation and daily treatments. Results: The mean (standard deviation) alignments (mm) for the standard and slow CT protocol ranged from 0.7 (0.68) and 1.0 (0.0), respectively, for the 28 BPM breathing rate and 5 mm amplitude combination to 5.2 (2.0) and 1.6 (0.52) for the 8 BPM breathing rate and 15 mm amplitude combination. Our retrospective analysis of patient alignment data showed a notable systematic difference in the relative bone and gross tumor volume alignment between the simulation and daily cone beam CT datasets. The mean longitudinal difference was −0.19 cm (standard deviation, 0.17 cm; range, 0.28 cm to −1.14 cm). Therefore, the position of the vertebral body cannot be used as a surrogate for mean tumor position in the longitudinal direction. Longitudinal position must be accurately determined for each patient using multiple CT images. Conclusions: A slow CT protocol improved the alignment with slower breathing rates being more challenging. A 5 mm PTV is not sufficient for tumor motion greater than 9 mm. Averaging the coordinates from multiple CTOR images is recommended. Full article

This study examines whether and how community schools’ integrated student support services (academic, socioemotional, health, and family support) contributed to improving whole-child/youth development and reducing systemic inequalities of students’ learning/wellness outcomes across New York State under the Every Student Succeeds Act (ESSA). Applying a quasi-experimental method with propensity score matching to the state’s 2018–2023 school survey and report card databases, it provides new evidence on the efficacy of community school programs on average and by subgroups (race/ethnicity, poverty, disability, English language learner, and housing status). The results of matched comparisons between community schools and non-community schools are mixed, after considering their differences in terms of student demographics and baseline conditions. Overall, community schools showed policy implementation fidelity with more state funding, policy-aligned practices, and school-based health centers/clinics. However, community schools had no discernable impacts on academic achievement and chronic absenteeism overall, except that the operation of school-based health centers was associated with a reduction in absenteeism. In contrast, community schools had more positive impacts on high school graduation rates, particularly among disadvantaged minority students; the impacts are attributable to policy-aligned practices, set-aside funding, and school-based health center dental programs. Educational policy and research implications are discussed. Full article

Background/Objectives: Private hosting arrangements have emerged as community-driven alternatives to institutional refugee housing, offering personalized support and opportunities for enhanced social integration. However, clarity around care practices and service delivery models remains underdeveloped. Methods: This paper presents the findings of a scoping review aimed at mapping evidence on service delivery and care practices in private hosting contexts for refugee families. Following an overview of the background and methodology, we present key themes, propose a conceptual model, and conclude with implications for policy, practice, and future research. This scoping review maps existing literature on care practices; it does not assess the effectiveness of interventions or establish best practices. The review synthesizes empirical and gray literature on service delivery and care practices supporting refugee and displaced families in private hosting contexts. Following the Joanna Briggs Institute (JBI) methodology, six academic databases and multiple gray literature sources were systematically searched, resulting in the inclusion of 28 studies. Results: The analysis identified four conceptual dimensions of care described in the literature: relational care and trust-building, program structure and policy integration, holistic integration pathways, and embedded equity and protection. While private hosting facilitates emotional connection and psychosocial integration, the review highlights key challenges, including variability in host preparedness, emotional labor disparities, and limited formal oversight. Conclusions: The findings underscore the need for evidence-informed guidelines, standardized host training, trauma-informed approaches, and coordinated policy frameworks. The resulting model offers a foundation to inform future research, guide policy development, and strengthen private hosting practices to ensure equitable, inclusive, and sustainable outcomes for refugee and displaced families. Full article

Millions of puppies are welcomed into the homes of families around the world each year. However, understanding the ways in which puppies are bred and raised by their breeders, as well as the perspectives and perceptions underpinning these practices, is still in its infancy. The current study administered an online survey to 200 Australian dog breeders to investigate their breeding program characteristics, breeding dog selection, understanding of the importance of early experiences in puppyhood, and the extent and diversity of their puppy rearing and socialisation practices. Results indicated that breeders were motivated by breed improvement and producing dogs for themselves rather than providing companion dogs, despite most of their puppies being placed in companionship roles. The participating breeders also acknowledged the important role they play in shaping puppies’ behaviour and temperament, which was reflected in both their breeding dog selection and in their rearing and socialisation practices. The majority of breeders housed their litters within their residence for the initial weeks of life but the socialisation experiences they provided were variable in type and frequency. Longer-term breeders and those with larger, more intensive programs reported providing human-focused socialisation experiences less frequently, though the correlational nature of these findings require cautious interpretation. Whilst future research should endeavor to explore these results more comprehensively among a more diverse sample, these findings provide valuable insight into the breeding, rearing, and socialisation process undertaken by dog breeders in Australia. Full article

To solve the present housing crisis, the Support for Access to Housing Program, in the context of PRR, mainly focuses on social housing to be built or on housing of social interest to be regenerated. To approach this problem, a research question was raised: “What is the significance of the existing cooperative housing in solving the current housing crisis?” To analyze this issue, a multiple case study was adopted, comparing a collective dwelling of cooperative promotion at controlled costs in Caselas (1980s–1990s) with Expo Urbe (2000–2007) in Parque das Nações, a symbol of the new sustainable cooperative housing, which targets a population with a higher standard of living and thus is excluded from the PRR plan. These cases revealed the discrepancy created by the Cooperative Code of 1998 and its consequences for the urban regeneration of this heritage. They show that Caselas, built in a residential urban neighborhood, is strongly attached to a community, provides good social inclusion for vulnerable groups at more affordable prices, and it is eligible for urban regeneration and reuse (for renting or buying). However, the reuse of Caselcoop’s edifices cannot compromise their cultural and residential values or threaten the individual integrity. Full article

This article describes the design, methods, and baseline characteristics of the social needs assessment (SNA) of participants enrolled in an ongoing randomized clinical trial implementing a comprehensive approach to improving diabetes self-management and providing an intensive Diabetes Self-Management Education and Support (iDSMES) Program at St. Vincent’s House Clinic, a primary care practice serving resource-challenged diverse populations in Galveston, Texas. Standardized SNA was conducted to collect information on financial needs, psychosocial well-being, and other chronic health conditions. Based on their identified needs, participants were referred to non-medical existing community resources. A series of in-depth interviews were conducted with a subset of participants. A team member independently categorized these SNA narratives and aggregated them into two overarching groups: medical and social needs. Fifty-nine participants (with a mean age of 53 years and equal representation of men and women) completed an SNA. Most (71%) did not have health insurance. Among 12 potential social needs surveyed, the most frequently requested resources were occupational therapy (78%), utility assistance (73%), and food pantry services (71%). SNA provided data with the potential to address barriers that may hinder participation, retention, and outcomes in diabetes self-management. SNA findings may serve as tertiary prevention to mitigate diabetes-related complications and disparities. Full article

Coyaima is a town in the department of Tolima, Colombia, that was prioritized in a pilot program under Colombia’s National Plan for the Control of the Taeniasis/Cysticercosis Complex, focusing on this neglected health issue. The project engaged local indigenous communities, promoting education and outreach within the One Health framework. The study included 444 randomly selected volunteers, who filled a Knowledge, Attitudes, and Practices (KAP) survey on the taeniasis/cysticercosis complex. The baseline study found no Taenia spp. eggs via microscopy on 383 stool samples examined, and no T. solium DNA was detected on human stool and soil samples by Copro-qPCR. However, seroprevalence was 8.5% for human cysticercosis and 14% for porcine cysticercosis, as detected by in-house ELISA testing for T. solium. Moreover, 57.9% of participants who provided a stool sample were positive for at least one parasite. Following the sampling and characterization activities, local health workers implemented mass treatment with Niclosamide, based on evidence of ongoing transmission, high porcine seroprevalence, poor basic sanitation, and the presence of free-roaming pigs reported in the KAP survey. These findings provide scientific evidence to apply national public health policies for controlling taeniasis/cysticercosis complex in Coyaima. Full article

Housing sustainability is a cornerstone element of sustainable economic and social development. This is particularly true for China, where high-rise residential buildings are the primary form of housing. In recent years, China has experienced frequent housing-related accidents, resulting in a significant loss of life and property damage. This study aims to identify the key factors influencing housing sustainability and provide a basis for the prevention and control of housing-related safety risks. This study has developed a housing sustainability evaluation indicator system comprising three primary indicators and 16 secondary indicators. This system is based on an analysis of the causes of over 500 typical housing accidents that occurred in China over the past 10 years, employing research methods such as literature reviews and expert consultations, and drawing on the analytical frameworks of risk management theory and system safety theory. Subsequently, the NK-SNA model, which significantly outperforms traditional models in terms of adaptive learning and optimization, as well as the explicit modeling of complex nonlinear relationships, was used to identify the key risk factors affecting housing sustainability. The empirical results indicate that the risk coupling value is correlated with the number of risk coupling factors; the greater the number of risk coupling factors, the larger the coupling value. Human misconduct is prone to forming two-factor risk coupling with housing, and the physical risk factors are prone to coupling with other factors. The environmental factors easily trigger ‘physical–environmental’ two-factor risk coupling. The key factors influencing housing sustainability are poor supervision, building facilities, the main structure, the housing height, foundation settlement, and natural disasters. On this basis, recommendations are made to make full use of modern information technologies such as the Internet of Things, big data, and artificial intelligence to strengthen the supervision of housing safety and avoid multi-factor coupling, and to improve upon early warnings of natural disasters and the design of emergency response programs to control the coupling between physical and environmental factors. Full article

Background/Objectives: Myelofibrosis (MF) is a myeloproliferative neoplasm characterized by the replacement of healthy bone marrow (BM) with malignant and fibrotic tissue. In a healthy state, bone marrow is composed of approximately 60–70% fat cells, which are replaced as disease progresses. Proton density fat fraction (PDFF), a non-invasive and quantitative MRI metric, enables analysis of BM architecture by measuring the percentage of fat versus cells in the environment. Our objective is to investigate variance in quantitative PDFF-MRI values over time as a marker of disease progression and response to treatment. Methods: We analyzed existing data from three cohorts of mice: two groups with MF that failed to respond to therapy with approved drugs for MF (ruxolitinib, fedratinib), investigational compounds (navitoclax, balixafortide), or vehicle and monitored over time by MRI; the third group consisted of healthy controls imaged at a single time point. Using in-house MATLAB programs, we performed a voxel-wise analysis of PDFF values in lower extremity bone marrow, specifically comparing the variance of each voxel within and among mice. Results: Our findings revealed a significant difference in PDFF values between healthy and diseased BM. With progressive disease non-responsive to therapy, the expansion of hematopoietic cells in BM nearly completely replaced normal fat, as determined by a markedly reduced PDFF and notable reduction in the variance in PDFF values in bone marrow over time. Conclusions: This study validated our hypothesis that the variance in PDFF in BM decreases with disease progression, indicating pathologic expansion of hematopoietic cells. We can conclude that disease progression can be tracked by a decrease in PDFF values. Analyzing variance in PDFF may improve the assessment of disease progression in pre-clinical models and ultimately patients with MF. Full article