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Background Opioid-related harms, including fatal and non-fatal overdoses, rose dramatically during the COVID-19 pandemic and presented unique challenges during outbreaks in congregate settings such as shelters. People who are deprived of permanent housing have a high prevalence of substance use and substance use disorders, and need nimble, rapid, and portable harm reduction interventions to address the harms of criminalized substance use in an evidence-based manner. Case study In February 2021, a COVID-19 outbreak was declared at an emergency men’s shelter in Hamilton, Ontario, Canada. Building on pre-existing relationships, community and hospital-based addictions medicine providers and a local harm reduction group collaborated to establish a shelter-based opioid agonist treatment and safer supply program, and a volunteer run safer drug use space that also distributed harm reduction supplies. In the 4 weeks preceding the program, the rate of non-fatal overdoses was 0.93 per 100 nights of shelter bed occupancy. During the 26 days of program operation, there were no overdoses in the safer use space and the rate of non-fatal overdoses in the shelter was 0.17 per 100 nights of shelter bed occupancy. The odds ratio of non-fatal overdose pre-intervention to during intervention was 5.5 (95% CI 1.63–18.55, p  = 0.0059). We were not able to evaluate the impact of providing harm reduction supplies and did not evaluate the impact of the program on facilitating adherence to public health isolation and quarantine orders. The program ended as the outbreak waned, as per the direction from the shelter operator. Conclusions There was a significant reduction in the non-fatal overdose rate after the safer drug use and safer supply harm reduction program was introduced. Pre-existing relationships between shelter providers, harm reduction groups, and healthcare providers were critical to implementing the program. This is a promising approach to reducing harms from the criminalization of substance use in congregate settings, particularly in populations with a higher prevalence of substance use and substance use disorders.

The Ontario Government, in an attempt to address escalating costs of the Ontario Disability Support Program (ODSP), announced its intention to align the program's definition of disability to that of the federal government. The goal of this article was to use data collected in a multisite population-based program to provide an estimate of homeless persons with disabilities who may currently be excluded from ODSP and the rate of those who would no longer be eligible for ODSP if the narrower Disability Tax Credit (DTC) definition was adopted. Frontline shelter staff were asked to assess shelter users on their caseload using the Rapid Assessment of Residential Supports to help triage clients needing psychological services. A total of 1,872 client profiles from 25 shelters in Toronto, Ottawa, and the York region were analysed. Up to 14% of those with a suspected severe mental illness (SMI) or a neurocognitive disorder (NCD) likely eligible for ODSP were not being supported by the program. Conversely, up to 23% of those with an SMI or NCD currently on ODSP would be at risk of losing their income support if the DTC definition were enacted. Public Significance Statement Changing the definition of disability may negatively impact persons with disabilities experiencing homelessness. Disability programs such as ODSP act as a last line of support for persons with disabilities without income. Restricting access to such program can cause significant hardship, negatively impact health outcomes, and contribute to premature death. Le gouvernement de l'Ontario, dans le but de régler les coûts croissants du Programme ontarien de soutien aux personnes handicapées (ODSP), a annoncé son intention d'harmoniser la définition d'invalidité du programme avec celle du gouvernement fédéral. L'objectif de cet article était d'utiliser les données recueillies dans le cadre d'un programme multisite basé sur la population pour fournir une estimation des personnes handicapées sans-abri qui peuvent actuellement être exclues de l'ODSP et et le taux de celles qui ne seraient plus admissibles à l'ODSP si la définition plus étroite du crédit d'impôt pour personnes handicapées (DTC) était adoptée. On a demandé au personnel de première ligne des centres d'hébergement d'évaluer les usagers dont ils ont la charge à l'aide de l'évaluation rapide des soutiens en hébergement (Rapid Assessment of Residential Supports) pour aider à trier les clients ayant besoin de services psychologiques. Au total, 1 872 profils de clients provenant de 25 centres d'hébergement à Toronto, à Ottawa et dans la région de York ont été analysés. Jusqu'à 14 % des personnes soupçonnées de souffrir d'une maladie mentale grave (SMI) ou d'un trouble neurocognitif (NCD) susceptibles d'être admissibles à l'ODSP n'étaient pas soutenues par le programme. À l'inverse, jusqu'à 23 % des personnes qui ont une SMI ou un NCD bénéficiant actuellement de l'ODSP risqueraient de perdre leur soutien du revenu si la définition du DTC était adoptée.

Since its first reported case in December 2019, COVID-19 disease, caused by severe acute respiratory coronavirus 2 (SARS-CoV-2), evolved into a major pandemic throughout the world. Although COVID-19 is most often characterized as a respiratory pathology, there are also extensive reports of renal complications, such as glomerulonephritis (GN). However, the precise nature of COVID-associated glomerulonephritis (COVID-GN) has yet to be fully understood. This review seeks to elucidate COVID-GN pathophysiology by conducting an exhaustive systematic review. Herein, we compare the different GN subtypes associated with COVID-19 in the literature. We also review the cytokines, antibodies, and genes most implicated in COVID-GN. The GN subtype with the highest number of cases associated with COVID-19 infection was focal segmental glomerulosclerosis, specifically the collapsing morphology. Meanwhile, the highest number of cases associated with COVID-19 vaccination was IgA nephropathy. The most prevalent mechanism in the literature for COVID-GN involves a cytokine storm, which may be accompanied by immune complex deposition. Both infection and vaccination from SARS-CoV-2 can induce robust CD4+ T cell responses promoted by an IL-6 amplifier loop of inflammation. This immune response is likely further enhanced by interactions with complement systems and the renin-angiotensin-aldosterone system (RAAS). SARS-CoV-2-mediated pathways of both direct cytotoxicity and stimulation of polyclonal immunoglobulin may converge to cause glomerular inflammation and injury. Further investigation of these inflammatory pathways may provide insight into COVID-19 pathophysiology, treatment, and long-term outcomes.

We present the highest fidelity spectrum to date of a planetary-mass object. VHS 1256 b is a \\(<\\)20 M\\(_\\mathrm{Jup}\\) widely separated (\\(\\sim\\)8\\arcsec, a = 150 au), young, planetary-mass companion that shares photometric colors and spectroscopic features with the directly imaged exoplanets HR 8799 c, d, and e. As an L-to-T transition object, VHS 1256 b exists along the region of the color-magnitude diagram where substellar atmospheres transition from cloudy to clear. We observed VHS 1256~b with \\textit{JWST}'s NIRSpec IFU and MIRI MRS modes for coverage from 1 \\(\\mu\\)m to 20 \\(\\mu\\)m at resolutions of \\(\\sim\\)1,000 - 3,700. Water, methane, carbon monoxide, carbon dioxide, sodium, and potassium are observed in several portions of the \\textit{JWST} spectrum based on comparisons from template brown dwarf spectra, molecular opacities, and atmospheric models. The spectral shape of VHS 1256 b is influenced by disequilibrium chemistry and clouds. We directly detect silicate clouds, the first such detection reported for a planetary-mass companion.