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Annual Trends Among the Unsheltered in Three Los Angeles Neighborhoods: The Los Angeles Longitudinal Enumeration and Demographic Survey (LA LEADS) 2023 Annual Report. 洛杉矶三个社区无庇护者的年度趋势:洛杉矶纵向枚举和人口调查(LA LEADS) 2023年度报告。
Pub Date : 2024-12-30 eCollection Date: 2024-12-01
Jason M Ward, Rick Garvey, Sarah B Hunter

Since fall 2021, the authors of this study have conducted regular enumerations of the unsheltered populations in three Los Angeles neighborhoods known for having high concentrations of people experiencing unsheltered homelessness: Hollywood, Skid Row, and Venice. In addition to counts, the authors have conducted surveys of unsheltered residents in these same neighborhoods to better understand the characteristics, experiences, and needs of these populations. The results of the first year of this study, known as the Los Angeles Longitudinal Enumeration and Demographic Survey (LA LEADS), were presented in a report published by RAND in 2023. The authors continued their enumeration and survey efforts in these three neighborhoods throughout 2023 using an updated survey instrument that includes new questions about employment, income, experiences with service providers, health conditions, and substance use. This study presents their findings from the 2023 data collection period and includes comparisons with the previous year's effort and new information about unsheltered populations' experiences and needs across the same three Los Angeles neighborhoods.

自2021年秋季以来,这项研究的作者定期对洛杉矶三个社区的无庇护人口进行了统计,这些社区以高密度的无庇护无家可归者而闻名:好莱坞、Skid Row和威尼斯。除了统计外,作者还对这些社区的无家可归者进行了调查,以更好地了解这些人群的特征、经历和需求。这项研究第一年的结果被称为洛杉矶纵向枚举和人口调查(LA LEADS),在兰德公司2023年发布的一份报告中提出。作者在整个2023年使用更新的调查工具继续在这三个社区进行枚举和调查工作,其中包括有关就业,收入,服务提供者经验,健康状况和物质使用的新问题。这项研究展示了他们在2023年数据收集期的发现,包括与前一年的努力进行比较,以及关于洛杉矶三个相同社区中无家可归人口的经历和需求的新信息。
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引用次数: 0
Understanding the State and Local Policies Affecting Abortion Care Administration, Access, and Delivery: A Case Study in Virginia. 了解影响堕胎护理管理、获取和交付的州和地方政策:弗吉尼亚州的案例研究。
Pub Date : 2024-12-10 eCollection Date: 2024-12-01
Julia Rollison, Skye A Miner, Maya Buenaventura, Rachel Holzer, Yoony Lee, Mekdes Shiferaw

The patchwork of laws and regulations that affect abortion access in the United States has become increasingly complex since the 2022 Dobbs v. Jackson Women's Health Organization U.S. Supreme Court decision that gave states the right to enact and enforce policies facilitating or restricting abortion access. The authors examined state, local, and institutional policies in Virginia-which is one of the only remaining states in the South post-Dobbs with legal access to abortion care past 13 weeks gestational age-to better understand how the policy landscape is influencing provision of care in the state. The authors reviewed existing legislation, bills, and sources detailing the policy landscape in Virginia and interviewed a sample of clinicians and nonclinicians working at organizations providing or supporting abortion care. The study principally focused on state laws, local policies and actions, institutional policies, and reported implementation experiences affecting access to abortion care.

自2022年美国最高法院就多布斯诉杰克逊妇女健康组织案作出裁决以来,影响美国堕胎准入的法律法规的拼凑性变得越来越复杂,该裁决赋予各州制定和执行促进或限制堕胎准入的政策的权利。作者考察了弗吉尼亚州的州、地方和机构政策——该州是多布斯事件后南方仅有的几个可以合法获得胎龄超过13周的堕胎护理的州之一——以便更好地了解政策格局如何影响该州的护理服务。作者回顾了弗吉尼亚州现有的立法、法案和详细介绍政策前景的资料,并采访了在提供或支持堕胎护理的组织工作的临床医生和非临床医生的样本。该研究主要侧重于州法律、地方政策和行动、机构政策以及报告的影响获得堕胎护理的实施经验。
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引用次数: 0
Health and Social Services During Heat Events: Demand for Services in Los Angeles County. 高温事件期间的卫生和社会服务:洛杉矶县对服务的需求。
Pub Date : 2024-12-10 eCollection Date: 2024-12-01
Roland Sturm, Lawrence Baker, Avery Krovetz

The authors analyze the relationship between heat events in Los Angeles County and (1) emergency medical services, (2) emergency room visits, (3) deaths investigated by the medical examiner, and (4) bookings for violent offenses. Heat events are classified according to the National Weather Service HeatRisk system. Days classified as moderate, major, and severe HeatRisk days are associated with worse results for all these outcomes.

作者分析了洛杉矶县的高温事件与以下因素之间的关系:(1)紧急医疗服务,(2)急诊室就诊,(3)法医调查的死亡人数,以及(4)暴力犯罪预订。高温事件是根据国家气象局的高温风险系统进行分类的。被划分为中度、重度和重度热风险的日子与所有这些结果的较差结果相关。
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引用次数: 0
Process Evaluation of the Los Angeles County Rapid Diversion Program: A Pretrial Mental Health Diversion Program. 洛杉矶县快速分流项目的过程评价:审前心理健康分流项目。
Pub Date : 2024-12-10 eCollection Date: 2024-12-01
Stephanie Brooks Holliday, Elizabeth Marsolais, Samantha Matthews

The Los Angeles County Rapid Diversion Program (RDP) is a pretrial mental health diversion program operating in seven courthouses in Los Angeles County, California. Established in 2019 as a faster approach to pretrial mental health diversion compared with the traditional approach, RDP allows for the diversion of individuals who have a mental health diagnosis or substance use disorder and certain qualifying misdemeanor or felony charges. Individuals who complete the program have their case dismissed. In this study, the authors present findings from a formal assessment of program implementation to date. Using a mixed-methods evaluation, they explore current program operations, characteristics of and case outcomes for individuals who participate in RDP, and strengths and areas for improvement. Lessons learned from this evaluation have the potential to inform efforts to scale the program within Los Angeles County and to other counties interested in implementing a similar pretrial diversion program.

洛杉矶县快速分流项目(RDP)是一项审前心理健康分流项目,在加州洛杉矶县的七个法院开展。RDP成立于2019年,与传统方法相比,它是一种更快的审前心理健康转移方法,允许转移患有精神健康诊断或物质使用障碍以及某些合格轻罪或重罪指控的个人。完成该项目的个人的案件将被驳回。在这项研究中,作者介绍了迄今为止对项目实施的正式评估的结果。使用混合方法评估,他们探索当前的项目运作,参与RDP的个人的特征和案例结果,以及优势和需要改进的领域。从这次评估中吸取的经验教训有可能为在洛杉矶县和其他有兴趣实施类似审前转移计划的县扩大该计划的努力提供信息。
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引用次数: 0
An Assessment of Help Me Grow Western New York's Progress Toward Strengthening Early Childhood Systems. 《帮助我成长》对纽约西部加强早期儿童系统的进展的评估。
Pub Date : 2024-12-10 eCollection Date: 2024-12-01
Dana Schultz, Andrea Phillips, Anita Chandra, Emma Bianculli

Healthy child development is a key driver for better health and well-being throughout a person's life, and the early years set that important foundation. Early childhood development programs play a critical role in mitigating risks to the cognitive, social, behavioral, and physical development of children. Increasingly, there is recognition that early intervention to support child development requires more than separate programs and services. Instead, a full system transformation, such as the national Help Me Grow initiative, is necessary. Help Me Grow Western New York (HMG WNY), a regional effort, aims to build and strengthen a comprehensive and coordinated system of early childhood development services and care to support the development and well-being of children in this region. HMG WNY serves eight counties in western New York that form a diverse community whose socioeconomic composition varies but which all share at least some level of need for better coordination and provision of early childhood development programs and services. In this study, the authors assess how HMG WNY addresses this regional need. The authors focus on how HMG WNY is working to strengthen and expand the early childhood network in western New York and provide insights that will inform the next steps for HMG WNY.

健康的儿童发育是一个人一生中更好的健康和福祉的关键驱动力,而幼儿期奠定了这一重要基础。儿童早期发展项目在减轻儿童认知、社会、行为和身体发展风险方面发挥着关键作用。越来越多的人认识到,支持儿童发展的早期干预需要的不仅仅是单独的项目和服务。相反,有必要进行全面的系统转型,比如全国性的“帮助我成长”(Help Me Grow)倡议。“帮助我成长纽约西部”(HMG WNY)是一项区域性努力,旨在建立和加强一个全面和协调的儿童早期发展服务和护理系统,以支持该地区儿童的发展和福祉。HMG WNY服务于纽约西部的八个县,这些县形成了一个多元化的社区,其社会经济构成各不相同,但都至少在一定程度上需要更好的协调和提供早期儿童发展计划和服务。在这项研究中,作者评估了HMG WNY如何满足这一区域需求。作者关注HMG WNY如何努力加强和扩大纽约西部的幼儿网络,并提供将为HMG WNY下一步提供信息的见解。
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引用次数: 0
Addressing Adverse Childhood Experiences in Clinics Serving California Farmworker Communities: NACES Pilot Project Evaluation. 解决加州农场工人社区诊所的不良童年经历:NACES试点项目评估。
Pub Date : 2024-12-10 eCollection Date: 2024-12-01
Ingrid Estrada-Darley, Gabriela Alvarado, Alejandro Roa Contreras, Cristina Glave, Yoselin Mayoral, Peter Mendel, Nicole K Eberhart

The No More Adverse Childhood Experiences (NACES) pilot project addresses Adverse Childhood Experiences (ACEs) in rural farmworker communities in central California. Informed by engagement of farmworkers, the project included a clinic-based intervention that provided ACE education, screening, and response services during routine health visits with adult and pediatric patients. To understand the impact of the clinic-based intervention, the evaluation team developed a mixed-methods approach that collected and analyzed administrative data on ACE education and screening; clinic readiness for trauma informed health care self-assessments; staff training surveys; and interviews with staff, adult patients, and caregivers of pediatric patients. The evaluation found that clinic staff trained by NACES partners gained confidence in their ability to provide ACE education and screenings to the rural farmworker community they serve. In addition, adult patients and caregivers of pediatric patients said that ACE education was easy to understand and agreed that ACE education and screening was acceptable during routine visits with their or their child's doctor. Overall, results provide early evidence for the feasibility, acceptability, and potential for positive impact of an ACE education, screening, and response model that is informed by farmworker voices.

不再有不良的童年经历(NACES)试点项目解决了加州中部农村农场工人社区的不良童年经历(ace)。在农场工人的参与下,该项目包括一项基于诊所的干预措施,在成人和儿科患者的常规健康访问期间提供ACE教育、筛查和应对服务。为了了解临床干预的影响,评估小组开发了一种混合方法,收集和分析ACE教育和筛查的行政数据;临床创伤知情卫生保健自我评估准备情况;员工培训调查;并采访了工作人员,成年患者和儿科患者的护理人员。评估发现,接受NACES合作伙伴培训的诊所工作人员对他们所服务的农村农场工人社区提供ACE教育和筛查的能力有了信心。此外,成人患者和儿科患者的护理人员表示ACE教育很容易理解,并同意在他们或他们孩子的医生的常规就诊中接受ACE教育和筛查。总体而言,研究结果为以农场工人的声音为基础的ACE教育、筛查和应对模式的可行性、可接受性和潜在的积极影响提供了早期证据。
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引用次数: 0
Reimagining the Army Medical Corps: Five Ideas for Raising Recruitment, Restoring Retention, and Restructuring Requirements. 重塑陆军医疗队:提高招募、恢复保留和重组要求的五个想法。
Pub Date : 2024-12-10 eCollection Date: 2024-12-01
Edward W Chan, Michael G Mattock, Patricia K Tong, Lawrence M Hanser, Christina Panis, Sarah Baker

The Army Medical Corps comprises the physicians of the U.S. Army. In recent years, the Medical Corps' rate of recruitment has not been able to keep up with the pace of separations. Retention is down. A larger-than-expected proportion of Army physicians who have fulfilled their active-duty service obligation are separating rather than extending their careers and, possibly, serving until they are eligible for military retirement. This trend results in positions at military treatment facilities and other units being unfilled, compromising the Medical Corps' ability to fulfill its missions, whether in deployed operations or in caring for service members and other beneficiaries at home. In this study, the authors examine alternative strategies for the Army Medical Corps to ensure that it has access to the personnel it needs to support operational requirements. The authors consulted with subject-matter experts and gathered and analyzed data to help identify five courses of action (COAs) that could increase retention, increase accessions, or reduce the requirement for uniformed physicians.

陆军医疗队由美国陆军的医生组成。近年来,医疗队的招聘速度跟不上离职的速度。留存率下降。在完成了现役服务义务的陆军医生中,有比预期更大的比例选择离职,而不是延长他们的职业生涯,并可能一直服务到他们有资格参军退休。这一趋势导致军事治疗设施和其他单位的职位空缺,损害了医疗队履行其任务的能力,无论是在部署的行动中,还是在家中照顾服务人员和其他受益者。在本研究中,作者审查了陆军医疗队的备选战略,以确保它能够获得支持业务需求所需的人员。作者咨询了主题专家,并收集和分析了数据,以帮助确定五种行动方案(coa),这些方案可以增加保留率,增加入学率,或减少对穿制服的医生的要求。
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引用次数: 0
Respiratory Health Among U.S. Veterans Across Age and Over Time. 美国退伍军人的呼吸健康状况
Pub Date : 2024-12-10 eCollection Date: 2024-12-01
Robert Bozick, Roland Neil

Many veterans and their advocates are concerned that military service may cause impaired respiratory function resulting from occupational exposures to environmental hazards (e.g., Agent Orange in the Vietnam War, burn pits in the Global War on Terror) or infectious diseases (e.g., pneumonia). Such exposures occurring in service members' young adulthoods may not have immediately discernible effects on lung health; some symptoms may emerge in the immediate months or years after separation from the military, and diagnosable conditions may not manifest until decades later. Health care providers serving veteran populations must consider both the unique combat circumstances surrounding the time of veterans' service and the age-graded nature of health conditions that might result from military service. To characterize lung health across a broad age range of veterans, the authors analyzed data from two nationally representative surveys of health and well-being that include samples of veterans and their civilian peers. With these data, the authors compared respiratory health outcomes observed for the veteran and civilian populations who were of prime age for military service during different periods of national conflict: the Korean War, the Vietnam War, Operation Desert Shield/Storm, and the Global War on Terror. The authors estimated that differences in smoking behaviors-including differences prior to enlistment-account for at least half of the veteran-civilian disparities in respiratory outcomes. This suggests the need for military-based and post-transition smoking cessation efforts and further research into other factors that might contribute to these veteran and civilian disparities, such as environmental exposures during military service.

许多退伍军人及其支持者担心,服兵役可能会因职业接触环境危害(如越南战争中的橙剂、全球反恐战争中的烧伤坑)或传染病(如肺炎)而导致呼吸功能受损。这种暴露发生在服役人员的青年时期,可能不会对肺部健康产生立即可见的影响;一些症状可能会在离开军队后的几个月或几年内出现,而可诊断的疾病可能要到几十年后才会出现。为退伍军人提供服务的医疗保健提供者必须考虑退伍军人服役期间的独特战斗环境和服兵役可能导致的健康状况的年龄分级性质。为了描述广泛年龄范围内退伍军人的肺部健康状况,作者分析了两项具有全国代表性的健康和福祉调查的数据,其中包括退伍军人及其平民同龄人的样本。根据这些数据,作者比较了在不同的国家冲突时期(朝鲜战争、越南战争、沙漠盾牌/风暴行动和全球反恐战争)中观察到的退伍军人和适龄服兵役的平民的呼吸健康结果。作者估计,吸烟行为的差异——包括入伍前的差异——至少占退伍军人与平民呼吸结果差异的一半。这表明需要在军队和过渡期后努力戒烟,并进一步研究可能导致这些退伍军人和平民差异的其他因素,如服兵役期间的环境暴露。
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引用次数: 0
Securing Commercial Nucleic Acid Synthesis. 确保商业核酸合成。
Pub Date : 2024-12-10 eCollection Date: 2024-12-01
Forrest W Crawford, Kyle Webster, Gerald L Epstein, Derek Roberts, Joseph Fair, Sella Nevo

On-demand gene synthesis is a growing industry that has democratized access to customized synthetic deoxyribonucleic acid (DNA) and ribonucleic acid (RNA) products used in biological research. However, the increasing availability and decreasing cost of custom synthetic nucleic acids presents a risk of misuse that could allow nefarious actors to obtain sequences of dangerous organisms or novel-engineered pathogens to construct a biological weapon. Securing nucleic acid synthesis is a policy priority for the U.S. government and the synthetic biology industry. But there is currently no legal requirement that gene synthesis providers screen their customers or their orders to ensure that the requested synthetic DNA and RNA constructs are not used for harmful purposes. Many providers screen orders voluntarily, but there is currently no universally accepted standard for screening customers or orders. In this study, the authors review government screening guidelines, industry consortium requirements, legislative proposals, and the scientific literature to assess the current state of commercial gene synthesis screening; summarize proposals for strengthening screening; and contribute recommendations for implementing comprehensive screening policies to secure commercial nucleic acid synthesis. These recommendations expand on and strengthen government communications, industry consortium rules and best practices, and proposals developed by researchers and provider organizations.

按需基因合成是一个不断发展的行业,它使生物研究中使用的定制合成脱氧核糖核酸(DNA)和核糖核酸(RNA)产品变得更加大众化。然而,定制合成核酸的可获得性的增加和成本的降低带来了误用的风险,这可能使不法分子获得危险生物体的序列或新型工程病原体来构建生物武器。确保核酸合成是美国政府和合成生物学产业的一项优先政策。但是,目前没有法律要求基因合成供应商筛选他们的客户或他们的订单,以确保所要求的合成DNA和RNA结构不被用于有害目的。许多供应商自愿筛选订单,但目前还没有普遍接受的筛选客户或订单的标准。在本研究中,作者回顾了政府筛选指南、行业联盟要求、立法建议和科学文献,以评估商业基因合成筛选的现状;总结加强筛选的建议;并为实施全面筛查政策提供建议,以确保商业核酸合成。这些建议扩展并加强了政府沟通、行业联盟规则和最佳实践,以及研究人员和供应商组织提出的建议。
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引用次数: 0
The Science of Gun Policy: A Critical Synthesis of Research Evidence on the Effects of Gun Policies in the United States, Fourth Edition. 《枪支政策科学:美国枪支政策影响研究证据的关键综合》,第四版。
Pub Date : 2024-12-10 eCollection Date: 2024-12-01
Rosanna Smart, Andrew R Morral, James P Murphy, Rupa Jose, Amanda Charbonneau, Sierra Smucker

In this study, part of RAND's Gun Policy in America initiative, researchers seek objective information about what scientific literature reveals about the likely effects of various gun laws. In the fourth edition of this study, the authors incorporate more-recent research in their synthesis of the available scientific data regarding the effects of 18 state firearm policies on firearm injuries and deaths, violent crime, suicides, the gun industry, defensive gun use, and other outcomes. By highlighting where scientific evidence is accumulating, the authors hope to build consensus around a shared set of facts that have been established through a transparent, nonpartisan, and impartial review process. In so doing, they also illuminate areas in which more and better information could make important contributions to establishing fair and effective gun policies.

在这项研究中,作为兰德公司“美国枪支政策”倡议的一部分,研究人员寻求客观信息,了解科学文献揭示的各种枪支法律可能产生的影响。在本研究的第四版中,作者将最新的研究纳入了他们对18个州枪支政策对枪支伤害和死亡、暴力犯罪、自杀、枪支工业、防御性枪支使用和其他结果的影响的综合科学数据中。通过强调科学证据正在积累的地方,作者希望围绕一系列通过透明、无党派和公正的审查过程建立起来的共同事实建立共识。在这样做的过程中,它们也阐明了一些领域,在这些领域中,更多和更好的信息可以对制定公平和有效的枪支政策作出重要贡献。
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引用次数: 0
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Rand health quarterly
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