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In recent years, police violence has amassed notable international attention from the public, practitioners, and academics alike. This paper explores experiences and perceptions of police violence in Canada, documenting the impacts of direct and vicarious experiences of police violence on inner-city residents. The study employed semi-structured interviews with 45 community members across three Toronto inner-city neighbourhoods. Using a general interview prompt guide, participants were asked a range of questions about their experiences with and perceptions of police, and particularly, of police violence in their community. The interviews were audio recorded, transcribed, thematically coded, and analyzed. All participants reported direct and/or vicarious experiences of police violence, and most described experiencing long-standing, and continual fear that police contact would result in harm to them. Further, participants described a variety of serious and negative outcomes associated with experiencing and/or witnessing police violence. Police violence in Canada is a public health issue that requires an integrated public health policy approach to address the negative outcomes associated with direct and vicarious police violence exposure.

Despite the plethora of research on inner-city policing, little is known about how women experience and make sense of involuntary police encounters. Based upon interviews with women who had their homes raided by police in Toronto’s inner-city, this paper explores how these marginalized women perceive, navigate, and resist normative gender expectations in their interactions with police officers during raids. Our findings demonstrate that women believed officers treated them according to gendered stereotypes, and in response, women strategically deployed gendered presentations in an effort to resist, negotiate, and temper anticipated raid related harms. However, participants’ positionality constrained their efforts.

When compared to studies examining racialized people’s perceptions of police in North America, studies of immigrants’ views of police are quite rare and they often conflate the views of immigrants with those of racialized people. Yet, we know racialized people are not necessarily immigrants and immigrants are not necessarily racialized. Research that distinguishes immigrant status from racialized status has found important differences based on immigrant vs. native-born status, country of origin, and length of settlement. This research builds on these findings by specifically considering the relative influence of universal and immigrant-specific factors that may shape within-group views of police. Using the 2014 General Social Survey, variations in views of police among South Asians – Canada’s largest racialized group – are explored by whether they were born in Canada, immigrated recently, or had long settled within Canada. Our findings suggest that traditional measures – or the universal factors – used to assess perceptions of police may not explain immigrants’ views in the same way that they do for native-born individuals, and that immigrants’ views of police may be shaped in ways that are, as of yet, unaccounted for in the literature.

Many inner-city neighbourhoods across North America are disproportionately subject to heightened and aggressive policing strategies. Consequently, many inner-city residents have developed strategies to limit their encounters with police. Research examining police–community relationships has traditionally examined how residents perceive and respond to ‘the police’. However, this homogenizes and over-simplifies nuanced processes. Based upon 48 interviews with Toronto inner-city residents, we demonstrate how narratives about allegedly ‘notorious’ officers reveal that residents differentiate between individual officers and modify their behaviours accordingly. This process of officer differentiation—‘cop clockin’—results in strategic responses to specific officers as residents attempt to hinder the potential harms of interactions with ‘notorious cops’. Furthermore, officer complacency raises questions about police legitimacy and strengthening police–community relationships.

A network of global respiratory disease surveillance systems and partnerships has been built over decades as a direct response to the persistent threat of seasonal, zoonotic, and pandemic influenza. These efforts have been spearheaded by the World Health Organization, country ministries of health, the US Centers for Disease Control and Prevention, nongovernmental organizations, academic groups, and others. During the COVID-19 pandemic, the US Centers for Disease Control and Prevention worked closely with ministries of health in partner countries and the World Health Organization to leverage influenza surveillance systems and programs to respond to SARS-CoV-2 transmission. Countries used existing surveillance systems for severe acute respiratory infection and influenza-like illness, respiratory virus laboratory resources, pandemic influenza preparedness plans, and ongoing population-based influenza studies to track, study, and respond to SARS-CoV-2 infections. The incorporation of COVID-19 surveillance into existing influenza sentinel surveillance systems can support continued global surveillance for respiratory viruses with pandemic potential.

Shifting political contexts can significantly alter drug policy approaches and available supports for People Who Use Drugs (PWUD). The purpose of this study was to explore how shifts in provincial drug policy approaches, specifically the replacement of a Safe Consumption Site (SCS) with a smaller mobile Overdose Prevention Site (OPS) in Lethbridge, Alberta Canada, impacted PWUD' access to and experiences with harm reduction services.We conducted semi-structured interviews with 50 PWUD in the City of Lethbridge, Canada. Through traditional fieldwork, we recruited participants within, and just outside of, downtown Lethbridge. Using a standardized general prompt guide to begin interviews, participants were asked a variety of questions about their experiences with and perceptions of SCS access and changes to SCS provisions. Interviews were audio recorded, then transcribed, coded, and analyzed.Participants reported regular and frequent access and overall positive experiences with the SCS, despite also noting certain operational barriers (e.g., long wait times). By contrast, participants reported more limited use of the new OPS compared to the SCS because of three main reasons: (1) concerns about location; (2) smoking room elimination; and (3) lack of social space and activities. Overall, changes to SCS provision produced a range of negative consequences for PWUD in Lethbridge. These relate to perceived increases in drug-related harms (e.g., increased overdoses) as well as negative social impacts (e.g., lack of place to meet other people).Findings from this study provide preliminary indications of the importance of understanding how contextual and locally-specific elements (location, limits on permitted route administration, and social aspects) can work together to facilitate SCS uptake and even overcome traditional SCS barriers. Conversely, the absence of such elements can hinder SCS uptake. Results show that the value of SCS might differ across locations, pointing to the need for further locally-grounded examinations of harm reduction service uptake and experience.

Barriers to accessing supervised consumption services are well documented in the literature. Police and security presence in the areas surrounding these sites are two such barriers. Yet, despite what we know about these autonomous social control actors, less is known about whether/how the convergence of actors within neighborhoods housing supervised consumption sites shapes service access. This paper examines how people who use drugs navigate police, security, and residents to access harm reduction services in Calgary, Canada. Based on qualitative interviews with persons who use drugs, our findings suggest that these public health services are undermined when police, security and area residents converge in their efforts to address social ‘disorder’. Participants reported displacement from the area surrounding these health services, resulting in greater public drug use and reduced service access. This research extends knowledge on supervised consumption site access barriers and social control of people who use drugs.

Relationships between police and minority groups have been shown to be strained with members of these groups often viewing police in a more negative light. Distinguishing between minority group and immigrant populations, more recent work has shown that foreign-born individuals are more likely to view the police in a more favourable light than native-born populations. Adding to this literature, we examine group-specific factors that shape foreign-born individuals’ views of the police. We find that country of origin and length of settlement are important factors in better understanding immigrants’ perceptions of the police. The study concludes with a discussion of trust in police and recommendations for future research.

BACKGROUND eHealth tools have the potential to meet the mental health needs of individuals who experience barriers to accessing in-person treatment. However, most users have less than optimal engagement with eHealth tools. Coaching from peer specialists may increase their engagement with eHealth. OBJECTIVE This pilot study aims to test the feasibility and acceptability of a novel, completely automated web-based system to recruit, screen, enroll, assess, randomize, and then deliver an intervention to a national sample of military veterans with unmet mental health needs; investigate whether phone-based peer support increases the use of web-based problem-solving training compared with self-directed use; and generate hypotheses about potential mechanisms of action for problem-solving and peer support for future full-scale research. METHODS Veterans (N=81) with unmet mental health needs were recruited via social media advertising and enrolled and randomized to the self-directed use of a web-based problem-solving training called Moving Forward (28/81, 35%), peer-supported Moving Forward (27/81, 33%), or waitlist control (26/81, 32%). The objective use of Moving Forward was measured with the number of log-ins. Participants completed pre- and poststudy measures of mental health symptoms and problem-solving confidence. Satisfaction was also assessed post treatment. RESULTS Automated recruitment, enrollment, and initial assessment methods were feasible and resulted in a diverse sample of veterans with unmet mental health needs from 38 states. Automated follow-up methods resulted in 46% (37/81) of participants completing follow-up assessments. Peer support was delivered with high fidelity and was associated with favorable participant satisfaction. Participants randomized to receive peer support had significantly more Moving Forward log-ins than those of self-directed Moving Forward participants, and those who received peer support had a greater decrease in depression. Problem-solving confidence was associated with greater Moving Forward use and improvements in mental health symptoms among participants both with and without peer support. CONCLUSIONS Enrolling and assessing individuals in eHealth studies without human contact is feasible; however, different methods or designs are necessary to achieve acceptable participant engagement and follow-up rates. Peer support shows potential for increasing engagement in web-based interventions and reducing symptoms. Future research should investigate when and for whom peer support for eHealth is helpful. Problem-solving confidence should be further investigated as a mechanism of action for web-based problem-solving training. CLINICALTRIAL ClinicalTrials.gov NCT03555435; http://clinicaltrials.gov/ct2/show/NCT03555435

Police presence near Supervised Consumption Services (SCS) and other harm reduction services has been shown to hamper access to these critical facilities for People Who Use Drugs (PWUD). However, few studies document the empirical nuances of these contextually dependant police-PWUD relationships, and how PWUD' experiences and perceptions of policing near harm reduction services shape SCS access. If the goal is to increase SCS uptake, understanding the complexities of PWUD-police relations near SCS is imperative for guiding both formal policy and informal best-practices.We report findings from a larger qualitative study on PWUD' experiences with SCS in two Canadian cities. Data were collected through 75 face-to-face interviews and observations with street-involved PWUD near local SCS in Edmonton and Calgary, Alberta.Participants' perceptions of and experiences with policing varied across jurisdictions. Participants in Calgary reported concentrated police presence in and near SCS, in addition to harassment, negative encounters, fears about getting arrested, and experiences of being displaced from the area. Participants in Edmonton, despite also reporting heavy police presence near SCS, reported feeling relatively safe from police intervention and harassment, within SCS and the surrounding area.Rather than the presence/absence and quantity of policing near SCS, our findings show that the quality of policing experienced in the community shapes PWUD' perceptions, experiences, and willingness to access SCS.

Empirical research has consistently demonstrated that residents of disadvantaged and racialized inner-city neighborhoods across North America are subjected to disproportionate and omnipresent policing. Consequently, relationships between law enforcement officials and marginalized community members are often strained. Whilst a robust body of literature has examined how citizens perceive “every day” policing practices such as “carding,” stop and search, etc., it remains unclear how citizens perceive more invasive policing encounters—such as police raids. Drawing upon 35 interviews with residents of Toronto’s inner-city, this paper explores how community members experience, make sense of, and talk about police raids. Our data uncover widespread perceptions of nefariously motivated police misconduct, raise questions about how residents anticipate and expect police to treat them, and highlight nuances in how these experiences shape police legitimacy views. We argue that how residents perceive police to behave during raids matters, as this can damage perceptions of police legitimacy for some residents, while merely reaffirming existing views for others.

Background and Aims While previous scholarship has documented barriers to Supervised Consumption Services (SCS) access, little is known about how Non-SCS-users perceive available, sanctioned SCS, and how such perceptions may hinder their SCS use. The objectives of this study were to examine: 1) barriers to accessing SCS for SCS-users and Non-SCS-users; and 2) the extent to which these barriers are consistent between groups. Methods We conducted semi-structured interviews with 75 PWUD in two cities in Western Canada, Edmonton and Calgary, who may or may not have accessed available SCS. Participants were recruited on the streets near SCS via traditional fieldwork and snowball sampling. We employed a generalized prompt guide and asked a range of questions about how PWUD perceived and/or experienced SCS in the area. All interviews were digitally recorded, transcribed, thematically coded, and analysed. Results Despite PWUD's generally positive perceptions of SCS, we identified several operational barriers to SCS access, including wait times and time limits, restrictions on injection assistance, and client bans from clinics. We also identified contextual barriers, including perceptions of the 'unnecessary' use of naloxone and police surveillance. Importantly, these barriers were consistent between SCS-users and Non-SCS-users, though some SCS-users actively worked to counter contextual barriers among peers. Conclusion Operational and contextual barriers to SCS use contribute to intermittent access for existing clients and preclude SCS access for others. Addressing such barriers may increase SCS uptake, thereby further extending the well-documented and critical reach of these harm reduction initiatives.

BACKGROUND A national priority at the US Department of Veterans Affairs (VA) is to increase the availability and accessibility of evidence-based psychotherapies (EBPs) across all VA medical facilities. Yet many veterans, particularly those who use remote outpatient VA clinics, still do not receive much needed evidence-based treatment. Strategies are needed for supporting mental health providers at rural VA community-based outpatient clinics (CBOCs) as they translate their clinical training to routine practice. The Coordinated Anxiety Learning Management (CALM) program is a computer-delivered program that supports the delivery of cognitive behavioral therapy (CBT) by providers in outpatient settings to patients with depression and anxiety, including posttraumatic stress disorder. OBJECTIVE The objectives of our study were to (1) adapt an existing computer-based program to rural VA CBOCs through feedback from key stakeholder focus groups; (2) develop a prototype of the adapted program; and (3) determine the adapted program’s acceptability and feasibility. Mental health stakeholders included VA leaders (n=4) in the implementation of EBPs, VA experts (n=4) in CBT, VA CBOC mental health providers (n=8), and veterans (n=8) diagnosed with a mental health condition treated using the CALM program and receiving treatment in a VA CBOC. METHODS An iterative approach comprising 3 waves of focus group discussions was used to develop a modified prototype of CALM. Following each wave of focus group discussions, template analysis was used to rapidly communicate stakeholder recommendations and feedback to the design team. The original program was first adapted through a process of data collection, design modification, and product development. Next, a prototype was developed. Finally, the redesigned program was tested for acceptability and feasibility through a live demonstration. RESULTS Key stakeholders suggested modifications to the original CALM program that altered its modules’ appearance by incorporating veteran-centric content. These modifications likely have no impact on the integrity of the original CALM program, but have altered its content to reflect better the demographic characteristics and experiences of rural veterans. Feedback from stakeholder groups indicates that changes will help VA patients identify with the program content, potentially enhancing their treatment engagement. CONCLUSIONS The development model was effective for economically gathering actionable recommendations from stakeholders to adapt a computer-based program, and it can result in the development of an acceptable and feasible computer-delivered intervention. Results have implications for developing computer-based programs targeting behavior change more broadly and enhancing engagement in EBP.

Background Pregnant women are at higher risk for complications from influenza infection. Nevertheless, seasonal influenza vaccination among pregnant women in China is low. A better understanding of perceptions of pregnant women and their physicians, and factors influencing decisions about receiving seasonal influenza vaccine could be used to develop effective strategies for improving seasonal influenza vaccine uptake during pregnancy. Methods We recruited pregnant women from 9 hospitals located in 5 cities across China to participate in focus group interviews. Obstetricians from the same hospitals were recruited for one on one in-depth interviews. We collected information about perceptions of barriers and motivating factors for utilizing seasonal influenza vaccine during pregnancy. We systematically analyzed the information using qualitative methods. Results We conducted 18 focus groups with 108 pregnant women and interviewed 18 obstetricians. Awareness about the use of influenza vaccine during pregnancy was minimal in both subject groups. None of the pregnant women had received influenza vaccine during pregnancy and none of the obstetricians had recommended influenza vaccine for their patients. Both groups noted insufficient knowledge about influenza infection and benefits of the vaccine, concerns about vaccine safety, and lack of local data related to vaccine use in Chinese pregnant women. Obstetricians cited the lack of a national policy as a major barrier to recommending seasonal influenza vaccine to pregnant women. Pregnant women cited not receiving a recommendation for vaccination from healthcare workers as an additional barrier. Conclusion Our findings highlight the immediate need to increase awareness and knowledge about the risks of influenza infection and the benefits and safety of seasonal influenza vaccination among both pregnant women and obstetricians in China. Obstetricians interviewed stated that the development and implementation of a national policy prioritizing pregnant women for seasonal influenza vaccination would facilitate their willingness to recommend seasonal influenza vaccine to pregnant women.

For those who are negotiating their way through court, there are potentially many aspects of the court-room atmosphere that can be perceived as unpleasant. Moreover, issues arising from general delays, confusion, and unprofessional conduct may be related to broader evaluations of the entire justice system, independently of how fairly people feel that they, personally, were treated by specific court actors. We explored this by interviewing youths after their first court appearance and by independently coding the overall atmosphere of the court-room. We found that, independently of how fairly youths felt they themselves had been treated, the atmosphere of the courtroom was significantly related to their overall assessments of the legitimacy of the criminal justice system. Those who experienced an atmosphere of confusion and unprofessionalism tended to view the entire justice system as less legitimate than did those who experienced better days.

It is assumed that legitimacy of the legal system is important, yet almost nothing is known about how young offenders view this institution. A sample of youths were interviewed at their first appearance in court and asked about their feelings regarding how they have been treated (procedural justice) by their lawyer, by the crown attorney, and by the judge, as well as their views on the overall legitimacy of the legal system. Youths were again interviewed at sentencing, using the same questionnaire, to explore changes in their views over time. Generally, it appears that how youths feel they have been treated— specifically, by their own lawyer and by the judge—affected broad views of legitimacy, even when controlling for their overall satisfaction of the outcome of their case.

We assessed the effect of daily cotrimoxazole, essential for HIV care, on development of antifolate-resistant Plasmodium falciparum, naso-pharyngeal Streptococcus pneumoniae (pneumococcus), and commensal Escherichia coli. HIV-positive subjects with CD4 cell count350 cells/muL (lower-CD4; N = 692) received cotrimoxazole; HIV-positive with CD4 cell countor = 350 cells/muL (higher-CD4; N = 336) and HIV-negative subjects (N = 132) received multivitamins. Specimens were collected at baseline, 2 weeks, monthly, and at sick visits during 6 months of follow-up to compare changes in resistance, with higher-CD4 as referent. P. falciparum parasitemia incidence density was 16 and 156/100 person-years in lower-CD4 and higher-CD4, respectively (adjusted rate ratio [ARR] = 0.11; 95% confidence interval [CI] = 0.06-0.15; P0.001) and 97/100 person-years in HIV-negative subjects (ARR = 0.62; 95% CI = 0.44-0.86; P = 005). Incidence density of triple and quintuple dihydrofolate-reductase/dihydropteroate-synthetase mutations was 90% reduced in lower-CD4 compared with referent. Overall, cotrimoxazole non-susceptibility was high among isolated pneumococcus (92%) and E. coli (76%) and increased significantly in lower-CD4 subjects by Week 2 (P0.005). Daily cotrimoxazole prevented malaria and reduced incidence of antifolate-resistant P. falciparum but contributed to increased pneumococcus and commensal Escherichia coli resistance.

Background : No previous studies have examined the extent to which correctional facilities in the United States screen for and treat hepatitis C (HCV) infection. Methods : Medical directors of state correctional facilities responded to a survey assessing the degree to which prisons screen for and treat hepatitis C. To estimate numbers of inmates eligible for interferon treatment and to examine costs associated with HCV management, we constructed a feasibility model that incorporated screening criteria used in California and Rhode Island. Results : Thirty-six states and Washington, DC, responded, resulting in a survey response rate of 73%, representing 77% of all inmates in state facilities nationwide. Colorado alone reported routine screening. Only California reported conducting a systematic sero-prevalence study, which found that 39.4% of male inmates were hepatitis C antibody positive in 1994. Seventy-three percent of the respondents sometimes consider treating with interferon. Four states follow a standard protocol. The feasibility model suggests that treating suitably screened inmates is a reasonable expenditure for correctional systems. Conclusion : Prison may be an appropriate setting for treatment of hepatitis C. If accompanying substance abuse issues are addressed, instituting HCV treatment for certain eligible incarcerated individuals may be a worthy target for public health dollars.

Enzymes of the glyoxylate cycle, isocitrate lyase and malate synthase, are active during the germination of spores of the fern Dryopteris filix-mas. Increases in activity of both enzymes are correlated with the breakdown of lipid reserves. The occurrence of these enzymes suggests that the microbodies previously described in these spores are glyoxysomes.

In chlorophyll-containing spores of Onoclea sensibilis, depletion of lipid reserves during germination is correlated with increases in the activity of the glyoxylate cycle enzymes isocitrate lyase and malate synthase. In Onoclea, the heterotrophic activity associated with lipid catabolism occurs at the same time that autotrophic activity is taking place. Increases in chlorophyll content and in the activity of glycolate oxidase were recorded during the earliest stages of spore germination. In this species, there is no temporal separation of heterotrophic and autotrophic reactions. Concurrent increases in glyoxylate and glycolate cycle activities appear to occur naturally.