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BackgroundHomeless-experienced populations are at increased risk of exposure to SARS-CoV-2 due to their living environments and face an increased risk of severe COVID-19 disease due to underlying health conditions. Little is known about COVID-19 testing and vaccination acceptability among homeless-experienced populations.ObjectiveTo understand the facilitators and barriers to COVID-19 testing and vaccine acceptability among homeless-experienced adults.DesignWe conducted in-depth interviews with participants from July to October 2020. We purposively recruited participants from (1) a longitudinal cohort of homeless-experienced older adults in Oakland, CA (n=37) and (2) a convenience sample of people (n=57) during a mobile outreach COVID-19 testing event in San Francisco.ParticipantsAdults with current or past experience of homelessness.ApproachWe asked participants about their experiences with and attitudes towards COVID-19 testing and their perceptions of COVID-19 vaccinations. We used participant observation techniques to document the interactions between testing teams and those approached for testing. We audio-recorded, transcribed, and content analyzed all interviews and identified major themes and subthemes.Key resultsParticipants found incentivized COVID-19 testing administered in unsheltered settings and supported by community health outreach workers (CHOWs) to be acceptable. The majority of participants expressed a positive inclination toward vaccine acceptability, citing a desire to return to routine life and civic responsibility. Those who expressed hesitancy cited a desire to see trial data, concerns that vaccines included infectious materials, and mistrust of the government.ConclusionsParticipants expressed positive evaluations of the incentivized, mobile COVID-19 testing supported by CHOWs in unsheltered settings. The majority of participants expressed a positive inclination toward vaccination. Vaccine hesitancy concerns must be addressed when designing vaccine delivery strategies that overcome access challenges. Based on the successful implementation of COVID-19 testing, we recommend mobile delivery of vaccines using trusted CHOWs to address concerns and facilitate wider access to and uptake of the COVID vaccine.

We report the public health response to a coronavirus disease 2019 (COVID-19) outbreak in a San Francisco shelter where 67% of residents and 17% of staff tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We describe the limited utility of case investigation, person-based contact tracing and symptom screening, and the benefits of mass testing in outbreak response.

ObjectiveHomelessness is the greatest risk factor for HIV viremia in San Francisco. Innovative care models for people with HIV (PWH) with homelessness or unstable housing (HUH) are needed to address this inequity. We developed a novel low-barrier clinic-based program for PWH-HUH in an urban safety-net clinic ('POP-UP') and report outcomes on care engagement and viral suppression.DesignA prospective cohort study.SettingSan Francisco General Hospital HIV Clinic (Ward 86).ParticipantsWe enrolled PWH who are HUH, viraemic and for whom usual care is not working (at least one missed primary care appointment and at least two drop-in visits at Ward 86 in the last year).InterventionPOP-UP provides drop-in comprehensive primary care, housing assistance and case management, financial incentives and patient navigation with frequent contact.Main outcome measuresWe describe uptake of eligible patients into POP-UP, and cumulative incidence of antiretroviral therapy (ART) initiation, return to care and virologic suppression 6 months post-enrolment, estimated via Kaplan--Meier.ResultsOut of 192 referred patients, 152 were eligible, and 75 enrolled. All 75 were off ART and viraemic; 100% had a substance use disorder; and 77% had a mental health diagnosis. Over three-quarters restarted ART within 7 days of enrolment, and 91% returned for follow-up within 90 days. The cumulative incidence of viral suppression at 6 months was 55% (95% confidence interval 43-68).ConclusionA novel care model for PWH-HUH demonstrates early success in engaging viraemic patients in care and improving viral suppression. Low-barrier, high-contact primary care programmes offering comprehensive services and incentives may improve outcomes for this vulnerable population.

Precise characterization of detector time resolution is of crucial importance for next-generation cryogenic-bolometer experiments searching for neutrinoless double-beta decay, such as CUPID, in order to reject background due to pileup of two-neutrino double-beta decay events. In this paper, we describe a technique developed to study the pileup rejection capability of cryogenic bolometers. Our approach, which consists of producing controlled pileup events with a programmable wave-form generator, has the benefit that we can reliably and reproducibly control the time separation and relative energy of the individual components of the generated pileup events. The resulting data allow us to optimize and benchmark analysis strategies to discriminate between individual and pileup pulses. We describe a test of this technique performed with a small array of detectors at the Laboratori Nazionali del Gran Sasso, in Italy; we obtain a 90% rejection efficiency against pulser-generated pileup events with rise time of ∼15ms down to time separation between the individual events of about 2ms.

Job loss and evictions tied to the Coronavirus Disease 2019 (COVID-19) pandemic are expected to increase homelessness significantly in the coming months. Reciprocally, homelessness and the many vulnerabilities that inevitably accompany it are driving COVID-19 outbreaks in US shelters and other congregate living situations. Unless we intervene to address homelessness, these co-existing and synergistic situations will make the current public health crisis even worse. Preventing homelessness and providing permanent affordable housing has reduced the ravages of the HIV epidemic. We must take the lessons learned in 40 years of fighting HIV to respond effectively to the COVID-19 crisis. Housing is an investment that will curb the spread of COVID-19 and help protect all of us from future pandemics.

Importance  Several jurisdictions in the United States have secured hotels to temporarily house people experiencing homelessness who require isolation or quarantine for confirmed or suspected coronavirus disease 2019 (COVID-19). To our knowledge, little is known about how these programs serve this vulnerable population outside the hospital setting.Objective  To assess the safety of a hotel-based isolation and quarantine (I/Q) care system and its association with inpatient hospital capacity.Design, Setting, and Participants  This retrospective cohort study of a hotel-based I/Q care system for homeless and unstably housed individuals in San Francisco, California, was conducted from March 19 to May 31, 2020. Individuals unable to safely isolate or quarantine at home with mild to moderate COVID-19, persons under investigation, or close contacts were referred from hospitals, outpatient settings, and public health surveillance to 5 I/Q hotels. Of 1009 I/Q hotel guests, 346 were transferred from a large county public hospital serving patients experiencing homelessness.Exposure  A physician-supervised team of nurses and health workers provided around-the-clock support, including symptom monitoring, wellness checks, meals, harm-reduction services, and medications for opioid use disorder.Main Outcomes and Measures  Characteristics of I/Q hotel guests, program retention, county hospital readmissions, and mean length of stay.Results  Overall, the 1009 I/Q hotel guests had a median age of 44 years (interquartile range, 33-55 years), 756 (75%) were men, 454 (45%) were Latinx, and 501 (50%) were persons experiencing sheltered (n = 295) or unsheltered (n = 206) homelessness. Overall, 463 (46%) received a diagnosis of COVID-19; 303 of 907 (33%) had comorbid medical disorders, 225 of 907 (25%) had comorbid mental health disorders, and 236 of 907 (26%) had comorbid substance use disorders. A total of 776 of 955 guests (81%) completed their I/Q hotel stay; factors most strongly associated with premature discontinuation were unsheltered homelessness (adjusted odds ratio, 4.5; 95% CI, 2.3-8.6; P

Coronavirus disease-2019 (COVID-19) threatens to further worsen HIV outcomes among people experiencing homelessness. We conducted an interrupted time-series analysis of care engagement and viral suppression among unhoused individuals in the 'POP-UP' low-barrier, high-intensity HIV primary care program during COVID-19. Among 85 patients, care engagement and viral suppression did not decrease in the 5 months following implementation of San Francisco's 'shelter-in-place' ordinance. Low-barrier, in-person HIV care for homeless individuals may be important for maintaining HIV outcomes during COVID-19.

A scintillating bolometer based on a large cubic Li$_{2}$$^{100}$MoO$_4$crystal (45 mm side) and a Ge wafer (scintillation detector) has been operatedin the CROSS cryogenic facility at the Canfranc underground laboratory inSpain. The dual-readout detector is a prototype of the technology that will beused in the next-generation $0\nu2\beta$ experiment CUPID. The measurementswere performed at 18 and 12 mK temperature in a pulse tube dilutionrefrigerator. This setup utilizes the same technology as the CUORE cryostatthat will host CUPID and so represents an accurate estimation of the expectedperformance. The Li$_{2}$$^{100}$MoO$_4$ bolometer shows a high energyresolution of 6 keV FWHM at the 2615 keV $\gamma$ line. The detection ofscintillation light for each event triggered by the Li$_{2}$$^{100}$MoO$_4$bolometer allowed for a full separation ($\sim$8$\sigma$) between$\gamma$($\beta$) and $\alpha$ events above 2 MeV. The Li$_{2}$$^{100}$MoO$_4$crystal also shows a high internal radiopurity with $^{228}$Th and $^{226}$Raactivities of less than 3 and 8 $\mu$Bq/kg, respectively. Taking also intoaccount the advantage of a more compact and massive detector array, which canbe made of cubic-shaped crystals (compared to the cylindrical ones), this testdemonstrates the great potential of cubic Li$_{2}$$^{100}$MoO$_4$ scintillatingbolometers for high-sensitivity searches for the $^{100}$Mo $0\nu2\beta$ decayin CROSS and CUPID projects.

A scintillating bolometer based on a large cubic Li$_{2}$$^{100}$MoO$_4$crystal (45 mm side) and a Ge wafer (scintillation detector) has been operatedin the CROSS cryogenic facility at the Canfranc underground laboratory inSpain. The dual-readout detector is a prototype of the technology that will beused in the next-generation $0u2\beta$ experiment CUPID. The measurementswere performed at 18 and 12 mK temperature in a pulse tube dilutionrefrigerator. This setup utilizes the same technology as the CUORE cryostatthat will host CUPID and so represents an accurate estimation of the expectedperformance. The Li$_{2}$$^{100}$MoO$_4$ bolometer shows a high energyresolution of 6 keV FWHM at the 2615 keV $\gamma$ line. The detection ofscintillation light for each event triggered by the Li$_{2}$$^{100}$MoO$_4$bolometer allowed for a full separation ($\sim$8$\sigma$) between$\gamma$($\beta$) and $\alpha$ events above 2 MeV. The Li$_{2}$$^{100}$MoO$_4$crystal also shows a high internal radiopurity with $^{228}$Th and $^{226}$Raactivities of less than 3 and 8 $\mu$Bq/kg, respectively. Taking also intoaccount the advantage of a more compact and massive detector array, which canbe made of cubic-shaped crystals (compared to the cylindrical ones), this testdemonstrates the great potential of cubic Li$_{2}$$^{100}$MoO$_4$ scintillatingbolometers for high-sensitivity searches for the $^{100}$Mo $0u2\beta$ decayin CROSS and CUPID projects.

A scintillating bolometer based on a large cubic Li2100MoO4 crystal (45 mm side) and a Ge wafer (scintillation detector) has been operated in the CROSS cryogenic facility at the Canfranc underground laboratory in Spain. The dual-readout detector is a prototype of the technology that will be used in the next-generation 0ν2β experiment CUPID . The measurements were performed at 18 and 12 mK temperature in a pulse tube dilution refrigerator. This setup utilizes the same technology as the CUORE cryostat that will host CUPID and so represents an accurate estimation of the expected performance. The Li2100MoO4 bolometer shows a high energy resolution of 6 keV FWHM at the 2615 keV γ line. The detection of scintillation light for each event triggered by the Li2100MoO4 bolometer allowed for a full separation (∼8σ) between γ(β) and α events above 2 MeV . The Li2100MoO4 crystal also shows a high internal radiopurity with 228Th and 226Ra activities of less than 3 and 8 μBq/kg, respectively. Taking also into account the advantage of a more compact and massive detector array, which can be made of cubic-shaped crystals (compared to the cylindrical ones), this test demonstrates the great potential of cubic Li2100MoO4 scintillating bolometers for high-sensitivity searches for the 100Mo 0ν2β decay in CROSS and CUPID projects.

The CUPID Collaboration is designing a tonne-scale, background-free detector to search for double beta decay with sufficient sensitivity to fully explore the parameter space corresponding to the inverted neutrino mass hierarchy scenario. One of the CUPID demonstrators, CUPID-Mo, has proved the potential of enriched Li2100MoO4 crystals as suitable detectors for neutrinoless double beta decay search. In this work, we characterised cubic crystals that, compared to the cylindrical crystals used by CUPID-Mo, are more appealing for the construction of tightly packed arrays. We measured an average energy resolution of (6.7 ± 0.6) keV FWHM in the region of interest, approaching the CUPID target of 5 keV FWHM. We assessed the identification of α particles with and without a reflecting foil that enhances the scintillation light collection efficiency, proving that the baseline design of CUPID already ensures a complete suppression of this α-induced background contribution. We also used the collected data to validate a Monte Carlo simulation modelling the light collection efficiency, which will enable further optimisations of the detector.

The CUPID Collaboration is designing a tonne-scale, background-free detector to search for double beta decay with sufficient sensitivity to fully explore the parameter space corresponding to the inverted neutrino mass hierarchy scenario. One of the CUPID demonstrators, CUPID-Mo, has proved the potential of enriched Li2100MoO4 crystals as suitable detectors for neutrinoless double beta decay search. In this work, we characterised cubic crystals that, compared to the cylindrical crystals used by CUPID-Mo, are more appealing for the construction of tightly packed arrays. We measured an average energy resolution of (6.7 ± 0.6) keV FWHM in the region of interest, approaching the CUPID target of 5 keV FWHM. We assessed the identification of α particles with and without a reflecting foil that enhances the scintillation light collection efficiency, proving that the baseline design of CUPID already ensures a complete suppression of this α-induced background contribution. We also used the collected data to validate a Monte Carlo simulation modelling the light collection efficiency, which will enable further optimisations of the detector.

ProblemMedical students often feel unprepared to care for patients whose cultural backgrounds differ from their own. Programs in medical schools have begun to address health: inequities; however, interventions vary in intensity, effectiveness, and student experience.InterventionThe authors describe an intensive 2-day diversity, equity, and inclusion curriculum for medical students in their orientation week prior to starting formal classes. Rather than using solely a knowledge-based "cultural competence" or a reflective "cultural humility" approach, an experiential curriculum was employed that links directly to fundamental communication skills vital to interactions with patients and teams, and critically important to addressing interpersonal disparities. Specifically, personal narratives were incorporated to promote individuation and decrease implicit bias, relationship-centered skills practice to improve communication across differences, and mindfulness skills to help respond to bias when it occurs. Brief didactics highlighting student and faculty narratives of difference were followed by small group sessions run by faculty trained to facilitate sessions on equity and inclusion.ContextOrientation week for matriculating first-year students at a US medical school.ImpactMatriculating students highly regarded an innovative 2-day diversity, equity, and inclusion orientation curriculum that emphasized significant relationship-building with peers, in addition to core concepts and skills in diversity, equity, and inclusion.Lessons learnedThis orientation represented an important primer to concepts, skills, and literature that reinforce the necessity of training in diversity, equity, and inclusion. The design team found that intensive faculty development and incorporating diversity concepts into fundamental communication skills training were necessary to perpetuate this learning. Two areas of further work emerged: (1) the emphasis on addressing racism and racial equity as paradigmatic belies further essential understanding of intersectionality, and (2) uncomfortable conversations about privilege and marginalization arose, requiring expert facilitation.

BACKGROUND:Homelessness and unstable housing (HUH) negatively impact care outcomes for people living with HIV (PLWH). To inform design of a clinic program for PLWH experiencing HUH, we quantified patient preferences and trade-offs across multiple HIV-service domains using a discrete choice experiment (DCE). METHODS:We sequentially sampled PLWH experiencing HUH presenting at an urban HIV clinic with missed primary care visit and viremia in the last year to conduct a DCE. Participants chose between two hypothetical clinics varying across five service attributes: care team "get to know me as a person" versus not; receiving $10, $15 or $20 gift cards for clinic visits; drop-in versus scheduled visits; direct phone communication to care team versus front-desk staff; staying 2 versus 20 blocks from the clinic. We estimated attribute relative utility (i.e., preference) using mixed-effects logistic regression and calculated the monetary trade-off of preferred options. RESULTS:Among 65 individuals interviewed, 61% were >40 years-old; 45% white; 77% male; 25% heterosexual; 56% lived outdoors/emergency housing, and 44% in temporary housing. Strongest preferences were for patient-centered care team (β = 3.80; 95%CI 2.57-5.02) and drop-in clinic appointments (β = 1.33; 95%CI 0.85-1.80), with a willingness to trade $32.79 (95%CI 14.75-50.81) and $11.45 (95%CI 2.95-19.95) in gift cards/visit, respectively. CONCLUSION:In this DCE, PLWH-HUH were willing to trade significant financial gain to have a personal relationship with and drop-in access to their care team rather than clinic proximity and gift cards. These findings informed Ward 86's "POP-UP" program for PLWH-HUH and can inform "Ending the HIV Epidemic" efforts.

Precise characterization of detector time resolution is of crucial importancefor next-generation cryogenic-bolometer experiments searching for neutrinolessdouble-beta decay, such as CUPID, in order to reject background due to pile-upof two-neutrino double-beta decay events. In this paper, we describe atechnique developed to study the pile-up rejection capability of cryogenicbolometers. Our approach, which consists of producing controlled pile-up eventswith a programmable waveform generator, has the benefit that we can reliablyand reproducibly control the time separation and relative energy of theindividual components of the generated pile-up events. The resulting data allowus to optimize and benchmark analysis strategies to discriminate betweenindividual and pile-up pulses. We describe a test of this technique performedwith a small array of detectors at the Laboratori Nazionali del Gran Sasso, inItaly; we obtain a 90% rejection efficiency against pulser-generated pile-upevents with rise time of ~15ms down to time separation between the individualevents of about 2ms.

Background COVID-19 outbreaks have occurred in homeless shelters across the US, highlighting an urgent need to identify the most effective infection control strategy to prevent future outbreaks. Methods We developed a microsimulation model of SARS-CoV-2 transmission in a homeless shelter and calibrated it to data from cross-sectional polymerase-chain-reaction (PCR) surveys conducted during COVID-19 outbreaks in five shelters in three US cities from March 28 to April 10, 2020. We estimated the probability of averting a COVID-19 outbreak when an exposed individual is introduced into a representative homeless shelter of 250 residents and 50 staff over 30 days under different infection control strategies, including daily symptom-based screening, twice-weekly PCR testing and universal mask wearing. Results The proportion of PCR-positive residents and staff at the shelters with observed outbreaks ranged from 2.6% to 51.6%, which translated to basic reproduction number ( R 0 ) estimates of 2.9–6.2. The probability of averting an outbreak diminished with higher transmissibility ( R 0 ) within the simulated shelter and increasing incidence in the local community. With moderate community incidence (~30 confirmed cases/1,000,000 people/day), the estimated probabilities of averting an outbreak in a low-risk ( R 0 =1.5), moderate-risk ( R 0 =2.9), and high-risk ( R 0 =6.2) shelter were, respectively: 0.35, 0.13 and 0.04 for daily symptom-based screening; 0.53, 0.20, and 0.09 for twice-weekly PCR testing; 0.62, 0.27 and 0.08 for universal masking; and 0.74, 0.42 and 0.19 for these strategies combined. Conclusions In high-risk homeless shelter environments and locations with high community incidence of COVID-19, even intensive infection control strategies (incorporating daily symptom-screening, frequent PCR testing and universal mask wearing) are unlikely to prevent outbreaks, suggesting a need for non-congregate housing arrangements for people experiencing homelessness. In lower-risk environments, combined interventions should be employed to reduce outbreak risk.

BackgroundHigh consumption of red and processed meat is commonly associated with increased cancer risk, particularly colorectal cancer. Antibodies against the red meat-derived carbohydrate N-glycolylneuraminic acid (Neu5Gc) exacerbate cancer in "human-like" mice. Human anti-Neu5Gc IgG and red meat are both independently proposed to increase cancer risk, yet how diet affects these antibodies is largely unknown.MethodsWe used world global data to demonstrate that colorectal cancer incidence and mortality are associated with increased national meat consumption. In a well-defined large cohort, we used glycomics to measure daily Neu5Gc intake from red meat and dairy, and investigated serum as well as affinity-purified anti-Neu5Gc antibodies. Based on 24-h dietary records, daily Neu5Gc intake was calculated for 19,621 subjects aged ≥ 18 years of the NutriNet-Santé study. Serum and affinity-purified anti-Neu5Gc antibodies were evaluated by ELISA and glycan microarrays in representative 120 individuals, each with at least eighteen 24-h dietary records (aged 45-60, Q1-Q4; aged > 60, Q1 and Q4; 10 men/women per quartile).ResultsWe found that high-Neu5Gc diet, gender, and age affect the specificity, levels, and repertoires of anti-Neu5Gc IgG immune responses, but not their affinity. Men consumed more Neu5Gc than women, mostly from red meat (p = 0.0015), and exhibited higher overall serum anti-Neu5Gc IgG levels by ELISA (3.94 ng/μl versus 2.22 ng/μl, respectively; p = 0.039). Detailed glycan microarray analysis against 56 different glycans revealed high Neu5Gc-specificity with increased anti-Neu5Gc IgG and altered repertoires, associated with higher consumption of Neu5Gc from red meat and cow dairy. Affinity purification of serum anti-Neu5Gc antibodies revealed increased levels and biased array repertoire patterns, without an increase in antibody affinity, in individuals consuming higher Neu5Gc levels. Furthermore, in a high-meat diet, antibody diversity patterns on glycan microarrays shifted towards Neu5Gcα3-linked glycans, increasing the α3/α6-glycans ratio score.ConclusionsWe found a clear link between the levels and repertoire of serum anti-Neu5Gc IgG and Neu5Gc intake from red meat and dairy. These precise rational methodologies allowed to develop a Gcemic index to simplify the assessment of Neu5Gc in foods that could potentially be adapted for dietary recommendations to reduce cancer risk.

Purpose of reviewSingular interventions targeting vulnerable populations of people living with HIV (PLWH) are necessary for reducing new infections and optimizing individual-level outcomes, but extant literature for PLWH who experience homelessness and unstable housing (HUH) has not been compiled. To inform implementation of clinic-based programs that improve care outcomes in this population, we present a synthetic review of key studies examining clinic-based interventions, specifically case management, patient navigation, financial incentives, and the use of mobile technology.Recent findingsResults from unimodal interventions are mixed or descriptive, are limited by inability to address related multi-modal barriers to care, and do not address major challenges to implementation. Multi-component interventions are needed, but gaps in our knowledge base may limit widespread uptake of such interventions before further data are compiled. Future research evaluating interventions for PLWH experiencing HUH should include implementation outcomes in order to facilitate adaptation across diverse clinical settings.

• We show that the rotation ellipse parameters a, b and c are responsible for the appearance of a giant and negative spatial GH and IF shifts in the elliptical polarization. • We can see that there are two giant and opposite spatial IF shifts near the Brewster angle for p -polarized beam. • Analytical solutions and numerical simulations almost coincide for the GH and IF shifts. We introduce a theoretical research of the Goos-Hänchen (GH) and Imbert-Fedorov (IF) shifts for the rotating elliptical Gaussian beams (REGBs) incidencing on a weakly absorbing semi-infinite medium. We show that the rotation ellipse parameters a, b and c are related to the occurance of giant spatial GH and IF shifts in the elliptical polarization. A comparison with the IF shift for p -polarization is also discussed. Analytical solutions and numerical simulations almost coincide for the GH and IF shifts. [ABSTRACT FROM AUTHOR]