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Background People who are homeless experience an increased prevalence of traumatic events, including childhood trauma, trauma related to being homeless, and structural trauma. It is important to consider trauma in the delivery of health services for this population. Using a trauma-informed care approach is one way to ensure that a service or program takes into consideration the effects of trauma. The aims of this study are to describe how best to design a service to engage people experiencing homelessness in a trauma-focused therapy as well as detail what trauma-informed care would look like in this setting. Methods We conducted a series of qualitative interviews about how to design a trauma-informed trauma therapy for people experiencing homelessness and their perspectives on different principles of trauma-informed care. Thematic analysis was used to identify, analyze and report themes identified in the data. Results We conducted 12 in-depth interviews (8 women, 4 men) with people who were currently peer support workers with lived experience of trauma and homelessness. We identified themes to design a trauma-informed service including low-barrier access, communication strategies, meeting people’s needs, and how to engage and retain people in the service. We also identified themes related to how people with lived experience understand the principles of trauma informed care. Discussion The findings from this study provide insight and practical recommendations for designing and implementing a trauma-informed therapy tailored for people experiencing homelessness. The findings here shed light on the lived experience perspective of trauma-informed care principles, adding nuance to our understanding of what it means to be trauma-informed.

First responders (police, firefighters, and paramedics) are routinely exposed to potentially psychologically traumatic events (PPTE). While the prevalence of mental disorders is difficult to estimate, research has demonstrated that first responders report higher rates of mental health disorders than the general population. They also report significant barriers to accessing mental healthcare, including concerns about the confidentiality of mental health services and stigma by co-workers and organizational leadership. One way to address these barriers to seeking care is through the establishment of a first responder specific mental health clinic. The objective of this qualitative study was to assess how to best implement such a service for first responders in Ottawa, Canada. We conducted 14 in-depth semi-structured qualitative interviews with key interest holders from first responder services, unions/associations, and the Workplace Safety and Insurance Board (WSIB) which explored elements of service delivery and organizational barriers and facilitators to implementing the clinic. Interviews were analyzed and coded using thematic analysis by two independent coders. Four main themes were identified: implementation context (perceived need, workplace culture), design of the clinic (service delivery, confidentiality, cost, and communication about the clinic), the implementation process (barriers and facilitators to implementation), and the broader impact of the implementation of the clinic. Findings show that it is the right time to implement first responder specific clinical services as services begin to prioritize the mental health needs of their members. To increase uptake by first responders, confidentiality and cultural competency of care providers is paramount.

Background Diagnosed PTSD rates in people who are homeless are more than double that of the general population, ranging between 21 and 53%. Complex PTSD (cPTSD) also appears to be more common than PTSD. One treatment option is Narrative Exposure Therapy (NET), a brief trauma-focused psychotherapy which attempts to place trauma within a narrative of the person’s life. Our primary aim was to assess the feasibility and acceptability of recruiting people to a randomized controlled trial (RCT) of NET alone compared to NET augmented by a genealogical assessment. We hypothesized that incorporating a genealogical assessment may be more effective than NET alone in a population with predominately complex PTSD. Methods This pilot RCT enrolled participants who were 18 years of age or older, currently homeless or vulnerably housed, and with active symptoms of PTSD. Participants were randomized to NET alone or NET plus a genealogical assessment. Rates of referral, consent, and retention were examined as part of feasibility. Demographic and clinical data were collected at baseline. Symptoms of PTSD, drug use, and housing status were re-assessed at follow-up visits. We conducted a thematic analysis of qualitative interviews of service providers involved in the study which explored barriers and facilitators of study participation. Results Twenty-two potential participants were referred to the study, with 15 consenting to participate. Of these, one was a screen failure and 14 were randomized equally to the treatment arms. One randomized participant was withdrawn for safety. Attrition occurred primarily prior to starting therapy. Once therapy began, retention was high with 80% of participants completing all six sessions. Seven participants completed all follow-up sessions. Service providers identified a clear need for the treatment and emphasized the importance of trauma-informed care, a desire to know more about NET, and more communication about the process of referral. Conclusion Recruiting participants who were vulnerably housed to an RCT of a trauma-based therapy was possible. Once therapy had started, participants were likely to stay engaged. We will incorporate the results of this trial into a conceptual model which we will test in a factorial study as part of the optimization phase of MOST. Trial registration ClinicalTrials.gov NCT03781297 . Registered: December 19, 2018

First responders, such as police officers, paramedics, and firefighters are at an increased risk of experiencing negative mental health outcomes compared to the general population. This predisposition can partially be attributed to common occupational stressors, which may provoke strong feelings of betrayal and humiliation. The Workplace Assessment Scale (WAS) was developed as there is currently no appropriate measure to assess such feelings in the first responder population. Initial development of the WAS included a Betrayal Subscale and the Humiliation Subscale, each comprised of 5 Likert scale questions which ask participants to report the frequency at which they experience specific feelings associated with their workplace. This pilot validation study was conducted to determine if there is preliminary evidence to support a large-scale validation study. To determine this, we assessed the internal structure and the convergent, concurrent, and predictive validity of the WAS. Based on 21/22 (95%) participant responses, a factor analysis did not support the two-factor model we anticipated, with only one factor and seven items retained from the original version of the scale. However, the internal consistency of the remaining items was strong. The validity analysis found moderate convergent validity and weak predictive validity based on correlations between the WAS and other psychometric scales. Minimal concurrent validity was noted. Additional research is needed for further analysis and validation of the WAS.

We aimed to determine the mental health and cognitive outcomes at six months in people who had not been hospitalized with COVID-19 and who had tested positive or negative for COVID-19 in Eastern Ontario, Canada. Participants were matched 1:1 six months following their COVID-19 polymerase chain reaction test. X2, t-test, and Mann–Whitney U tests were conducted to compare self-report and observer-rated mental health and cognitive outcomes between the two groups. We also conducted an age and gender-adjusted logistic regression analysis to explore risk factors associated with depression, anxiety, and cognitive impairment among those who had tested positive for COVID-19. A total of 324 participants were enrolled (n = 162 per arm). Overall, 40.7% of those in the COVID-positive group were men, with an average age of 37.9 (SD 13.2) years. In the COVID-negative group, 41.4% were men, with an average age of 36.7 (SD 12.8). There were no statistically significant differences in mental health outcomes between the groups. On cognitive testing, while 21% of the COVID-positive participants and 14% of the COVID-negative participants had scores indicating significant cognitive impairment, the difference between groups was not significant, though this warrants further investigation in future research. In non-hospitalized patients who have tested positive for COVID-19, there is no evidence of an increase in mental health disorders compared to people who tested negative. Any increases in mental health disorders during the pandemic may be the effect of social changes rather than an effect of the virus itself. The exception may be the cognitive changes in those who tested positive.

Service dogs, trained to assist people with disabilities, are known to impact their human partners’ social experiences. While service dogs can act as a “social bridge,” facilitating greater social connection under certain circumstances, many service dog partners also encounter challenges in social settings because of the presence of their service dog – despite legal protections. Among the most common challenges reported are experiences of stigma, discrimination, and access or service denials. This preregistered integrative review sought to synthesize empirical, theoretical, and legal literature to understand better the social experiences reported by service dog partners in the United States, including (1) civil rights experiences; (2) experiences of stigma and discrimination; and (3) broader social experiences. Following database searches and article screening, a total of N = 43 articles met the eligibility criteria for inclusion. Analyses were conducted in two stages: first, synthesizing quantitative and qualitative findings to explore the magnitude of social experiences reported by empirical articles and second, narrative synthesis to integrate findings across all article types. Analyses identified three themes: Adverse Social Experiences , Contributing Factors , and Proposed Solutions . Overall, we found consistent reports of stigma, discrimination, and access denials for service dog handlers. Additionally, these adverse experiences may be more common for service dog partners with disabilities not externally visible (i.e., invisible disabilities such as diabetes or substantially limiting mental health conditions). This integrative review highlights a pattern of social marginalization and stigmatization for some service dog partners, exacerbated by inadequate legal protection and widespread service dog fraud. These findings have implications for the individual well-being of people with disabilities partnered with service dogs and highlight a need for collective efforts to increase inclusion and access. Effective solutions likely require a multi-component approach operating at various socio-ecological levels.

Genetic analysis involving 2035 patients with a myeloproliferative disorder identified eight genomic subgroups with distinct clinical phenotypes, risk of leukemic transformation, and event-free survival.

Transmission of SARS-CoV-2 is uncontrolled in many parts of the world; control is compounded in some areas by the higher transmission potential of the B.1.1.7 variant 1 , which has now been reported in 94 countries. It is unclear whether the response of the virus to vaccines against SARS-CoV-2 on the basis of the prototypic strain will be affected by the mutations found in B.1.1.7. Here we assess the immune responses of individuals after vaccination with the mRNA-based vaccine BNT162b2 2 . We measured neutralizing antibody responses after the first and second immunizations using pseudoviruses that expressed the wild-type spike protein or a mutated spike protein that contained the eight amino acid changes found in the B.1.1.7 variant. The sera from individuals who received the vaccine exhibited a broad range of neutralizing titres against the wild-type pseudoviruses that were modestly reduced against the B.1.1.7 variant. This reduction was also evident in sera from some patients who had recovered from COVID-19. Decreased neutralization of the B.1.1.7 variant was also observed for monoclonal antibodies that target the N-terminal domain (9 out of 10) and the receptor-binding motif (5 out of 31), but not for monoclonal antibodies that recognize the receptor-binding domain that bind outside the receptor-binding motif. Introduction of the mutation that encodes the E484K substitution in the B.1.1.7 background to reflect a newly emerged variant of concern (VOC 202102/02) led to a more-substantial loss of neutralizing activity by vaccine-elicited antibodies and monoclonal antibodies (19 out of 31) compared with the loss of neutralizing activity conferred by the mutations in B.1.1.7 alone. The emergence of the E484K substitution in a B.1.1.7 background represents a threat to the efficacy of the BNT162b2 vaccine. Sera from vaccinated individuals and some monoclonal antibodies show a modest reduction in neutralizing activity against the B.1.1.7 variant of SARS-CoV-2; but the E484K substitution leads to a considerable loss of neutralizing activity.

Background and Objective Determination of isocitrate dehydrogenase (IDH) 1/2 mutational status is crucial for a glioma diagnosis. It is common for IDH mutational status to be determined via a two-step algorithm that utilizes immunohistochemistry studies for IDH1 R132H, the most frequent variant, followed by next-generation sequencing studies for immunohistochemistry-negative or immunohistochemistry-equivocal cases. The objective of this study was to evaluate adding a rapid real-time polymerase chain reaction (RT-PCR) assay to the testing algorithm. Methods We validated a modified, commercial, qualitative, RT-PCR assay with the ability to detect 14 variants in IDH1/2 in formalin-fixed paraffin-embedded glioma tumor specimens. The assay was validated using 51 tumor formalin-fixed paraffinembedded specimens. During clinical implementation of this assay, 48 brain tumor specimens were assessed for IDH result concordance and turnaround time to result. Results Concordance between the RT-PCR and sequencing and IHC studies was 100%. This RT-PCR assay also showed concordant results with IHC for IDH1 R132H for 11 of the 12 (92%) tumor specimens with IDH mutations. The RT-PCR assay yielded faster results (average 2.6 days turnaround time) in comparison to sequencing studies (17.9 days), with complete concordance. Conclusions In summary, we report that this RT-PCR assay can reliably be performed on formalin-fixed paraffin-embedded specimens and has a faster turnaround time than sequencing assays and can be clinically implemented for determination of IDH mutation status for patients with glioma.

Background Cognitive behavioral therapy for chronic pain (CBT-CP) has a strong evidence base, but little is known about when treatment benefits are achieved. The present study is a secondary analysis of individuals with chronic back pain recruited for a noninferiority trial comparing interactive voice response (IVR) CBT-CP with in-person CBT-CP. Methods On the basis of data from daily IVR surveys, a clinically meaningful change was defined as a 30% reduction in pain intensity (n = 108) or a 45% increase in daily steps (n = 104) compared with the baseline week. We identified individuals who achieved a meaningful change at any point during treatment, and then we compared those who maintained a meaningful change in their final treatment week (i.e., responders) with those who did not or who achieved a meaningful change but lapsed (i.e., nonresponders). Results During treatment, 46% of participants achieved a clinically meaningful decrease in pain intensity, and 66% achieved a clinically significant increase in number of steps per day. A total of 54% of patients were classified as responders in terms of decreases in pain intensity, and 70% were responders in terms of increases in step count. Survival analyses found that 50% of responders first achieved a clinically meaningful change by week 4 for pain intensity and week 2 for daily steps. Dropout and demographic variables were unrelated to responder status, and there was low agreement between the two measures of treatment response. Conclusions Collectively, results suggest that most responders improve within 4 weeks. Evaluating treatment response is highly specific to the outcome measure, with little correlation across outcomes.