Autonomous medical evaluation for guideline adherence of large language models.

Autonomous Medical Evaluation for Guideline Adherence (AMEGA) is a comprehensive benchmark designed to evaluate large language models' adherence to medical guidelines across 20 diagnostic scenarios spanning 13 specialties. It includes an evaluation framework and methodology to assess models' capabilities in medical reasoning, differential diagnosis, treatment planning, and guideline adherence, using open-ended questions that mirror real-world clinical interactions. It includes 135 questions and 1337 weighted scoring elements designed to assess comprehensive medical knowledge.

2S/LGBTQ+ youth substance use and pathways to homelessness: A photovoice study.

Background: Studies have posited that substance use is associated with, or contributes to, homelessness for 2S/LGBTQ+ youth. However, interconnections between these issues are poorly articulated.

Methods: This community-based photovoice study describes the narratives used by 2S/LGBTQ+ youth about how substance use featured in their pathways to homelessness.

A Scoping Review of Evidence-Based Interventions and Health-Related Services for Youth Who Use Nonmedical Opioids in Canada and the United States.

Purpose: This scoping review synthesizes the characteristics and outcomes of recent evidence-based treatments and services for youth with nonmedical opioid use/opioid use disorder in the context of the ongoing opioid crisis in Canada and the United States.

Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses - Extension for Scoping Reviews guidelines, empirical health databases were searched for literature describing treatments or health-related services for nonmedical opioid use/opioid use disorder among youth (ages 12-25). Two independent reviewers conducted study screening, selection, and data extraction.

Homes of substance: Drugs and the making of home/lessness for 2S/LGBTQ+ youth.

Two-Spirit, lesbian, gay, bisexual, transgender, queer, and other sexual minority (2S/LGBTQ+) youth between the ages of 14 and 29 experience inequities in homelessness and substance use. Research in this area has explored substance use as a determinant of homelessness and/or as a coping mechanism, yet far less attention has been directed to the potentially generative role of drugs in this marginalizing context. This community-based photovoice study leverages data from 61 semi-structured interviews with 32 2S/LGBTQ+ youth experiencing homelessness and unstable housing to examine how drugs shape their practices and contexts of homemaking.

Road to Recovery: protocol for a mixed-methods prospective cohort study evaluating the impact of a new model of substance use care in a Canadian setting.

Introduction: The Road to Recovery (R2R) Initiative is an innovative model of substance use care that seeks to increase treatment capacity by creating approximately 100 new addiction treatment beds to provide on-demand addiction care in Vancouver, British Columbia, for patients with substance use disorders. The new model also coordinates the region's existing clinical substance use services to support patients across a care continuum that includes traditional office-based addiction treatment and harm reduction services, early withdrawal management and more intensive abstinence-based treatment programming. To understand the impact of offering on-demand and coordinated substance use care, an observational cohort of individuals who access any R2R clinical service will be created to examine health and social outcomes over time.

The war on drugs is a war on us: young people who use drugs and the fight for harm reduction in the Global South.

In the Global South, young people who use drugs (YPWUD) are exposed to multiple interconnected social and health harms, with many low- and middle-income countries enforcing racist, prohibitionist-based drug policies that generate physical and structural violence. While harm reduction coverage for YPWUD is suboptimal globally, in low- and middle-income countries youth-focused harm reduction programs are particularly lacking. Those that do exist are often powerfully shaped by global health funding regimes that restrict progressive approaches and reach.

"They are always focusing on the person who is doing the worst": Exploring how crisis shapes young people's pathways in and out of supportive housing in Vancouver, Canada.

Housing instability, homelessness, and mental health among young people who use drugs in Vancouver, Canada, and elsewhere have increasingly been framed through a language of crisis. The declaration of overlapping housing, mental health, and addictions crises in our own setting has prompted a wide range of interventions, including the rapid expansion of supportive housing programs that include integrated housing-based substance use and mental health care. There is growing evidence demonstrating that these models are effective at stabilizing people who are experiencing protracted housing instability, mental health, and substance use related health concerns.

Positive Psychological Intervention Delivered Using Virtual Reality in Patients on Hemodialysis With Comorbid Depression: Protocol and Design for the Joviality Randomized Controlled Trial.

Background: Depression is highly prevalent in individuals on hemodialysis, but it is infrequently identified and remains undertreated. In this paper, we present details of the methodology of a randomized controlled trial (RCT) aimed at testing the feasibility and preliminary efficacy of a 5-week positive psychological intervention in individuals on hemodialysis with comorbid depression delivered using immersive virtual reality (VR) technology.

Objective: We aim to describe the protocol and design of the Joviality trial whose main objectives are 2-fold: determine the feasibility of the Joviality VR software through metrics capturing rates of recruitment, refusal, retention, noncompliance, and adherence, as well as end-user feedback; and assess preliminary efficacy for outcomes measures of depressive symptoms, psychological well-being and distress, quality of life, treatment adherence, clinical biomarkers, and all-cause hospitalizations.

Risk mitigation guidance and safer supply prescribing among young people who use drugs in the context of COVID-19 and overdose emergencies.

Across North America, overlapping overdose and COVID-19 emergencies have had a substantial impact on young people who use drugs (YPWUD). New risk mitigation guidance (RMG) prescribing practices were introduced in British Columbia, Canada, in 2020 to allow people to decrease risk of overdose and withdrawal and better self-isolate. We examined how the prescribing of hydromorphone tablets specifically impacted YPWUD's substance use and care trajectories.

Bismuth-Polyoxocation Coordination Networks: Controlling Nuclearity and Dimension-Dependent Photocatalysis.

Bismuth-oxocluster nodes for metal-organic frameworks (MOFs) and coordination networks/polymers are less prolific than other families featuring zinc, zirconium, titanium, lanthanides, etc. However, Bi is non-toxic, it readily forms polyoxocations, and its oxides are exploited in photocatalysis. This family of compounds provides opportunity in medicinal and energy applications.

Interest in using buprenorphine-naloxone among a prospective cohort of street-involved young people in Vancouver, Canada.

Introduction: Limited research examines buprenorphine-naloxone interest among adolescents and young adults (AYA). This longitudinal study examined factors associated with initial buprenorphine-naloxone interest and the time to a positive change in buprenorphine-naloxone interest or enrollment, in addition to identifying reasons for buprenorphine-naloxone disinterest.

Methods: The study derived data from a cohort of street-involved AYA in Vancouver, Canada between December 2014 and June 2018.

'I turn to my closest friends for support': queer youth navigating mental health during COVID-19.

The objectives of this in-depth qualitative study were to identify how COVID-19 impacted the mental health experiences of queer youth in Vancouver, Canada. Between November 2020 and June 2021, fifteen queer youth aged 15 to 25 were enrolled in the study. They participated in semi-weekly, solicited digital diary entries and semi-structured intake and follow-up interviews about COVID-19, social distancing protocols, and mental health.

Staying Together No Matter What: Becoming Young Parents on the Streets of Vancouver.

Among young people who use drugs in the context of entrenched poverty and homelessness, pregnancy is often viewed as an event that can meaningfully change the trajectory of their lives. However, youth's desires and decision-making do not always align with the perspectives of various professionals and systems regarding how best to intervene during pregnancies and early parenting. Drawing on longitudinal interviews and fieldwork with young people in Vancouver, Canada, we explore how their romantic relationships powerfully shaped understandings of what was right and wrong and which actions to take during pregnancy and early parenting, and how these moral worlds frequently clashed with the imperatives of healthcare, criminal justice, and child protection systems.

Photoactive Organo-Sulfur Polymers for Hydrogen Generation.

Herein, we report the synthesis of photoactive polymeric organo-sulfur (POS) materials. These polymers absorb light in the ultraviolet/visible and near-infrared region of the solar spectrum, and upon irradiation, they reduce water to hydrogen (H ). The decoration of POS materials with nitrile (-CN) groups is found to be the critical factor for enhanced interactions with the co-catalyst, Ni P, leading to greater H evolution rates compared to the nitrile-free POS material.

Orientation and Mobility During COVID-19 and the Effect on Psychosocial Functioning.

This research explored the psychosocial effects observed during the COVID-19 pandemic as it relates to orientation and mobility (O&M) services for children with visual impairments. The survey asked professionals to identify what were their experiences in providing O&M instruction in-person and online and to describe their interactions with students and families during the fall of 2020. The online survey results included open-ended responses from 166 O&M specialists.

Methadone Maintenance Treatment Discontinuation Among Young People who use Opioids in Vancouver, Canada.

Objective: Retaining adolescents and young adults (AYA) in medications for opioid use disorder (MOUD), like methadone maintenance treatment (MMT), is critical to reducing toxic drug fatalities. This analysis sought to identify factors associated with MMT discontinuation among AYA.

Method: Data were derived from the At-Risk Youth Study, a prospective cohort study of street-involved AYA in Vancouver, Canada, between December 2005 and June 2018.

I'm just trying to stay: Experiences of temporal uncertainty in modular and supportive housing among young people who use drugs in Vancouver.

Over the past decades the city of Vancouver has attempted to address a lack of affordable housing for it most marginalized citizens, including young people who use drugs (YPWUD), by expanding access to temporary modular and supportive housing. These projects are guided by a Housing First philosophy that recognizes housing as a key social determinant of health. In this commentary, we draw attention to how, rather than providing a clear pathway to greater stability, modular and supportive housing have become part of broader "institutional circuits" that reinforce residential transience and what we call "temporal uncertainty.

Navigating Opioid Agonist Therapy among Young People who use Illicit Opioids in Vancouver, Canada.

Background: Opioid agonist therapy (OAT) has been shown to reduce opioid use and related harms. However, many young people are not accessing OAT. This study sought to explore how young people navigated OAT over time, including periods of engagement, disengagement, and avoidance.

Using photovoice to understand experiences of opioid use among sexual and gender minority youth in Vancouver, Canada.

In Canada, sexual and gender minority youth use opioids at disproportionately high rates. Yet, little is known about the distinct contexts of opioid use within this group, challenging capacity to develop well founded policy and practice supports. This case study aims to examine - in depth - the experiences and contexts of opioid use among a sample of four sexual and gender minority youth in Vancouver, Canada.

Interventions to Reduce Opioid Use in Youth At-Risk and in Treatment for Substance Use Disorders: A Scoping Review.

Background: Youth and young adults have been significantly impacted by the opioid overdose and health crisis in North America. There is evidence of increasing morbidity and mortality due to opioids among those aged 15-29. Our review of key international reports indicates there are few youth-focused interventions and treatments for opioid use.

Harm reduction calls to action from young people who use drugs on the streets of Vancouver and Lisbon.

Vancouver, Canada, and Lisbon, Portugal, are both celebrated for their world-leading harm reduction policies and programs and regarded as models for other cities contending with the effects of increasing levels of drug use in the context of growing urban poverty. However, we challenge the notion that internationally celebrated places like Lisbon and Vancouver are meeting the harm reduction needs of young people who use drugs (YPWUD; referring here to individuals between the ages of 14 and 29). In particular, the needs of YPWUD in the context of unstable housing, homelessness, and ongoing poverty-a context which we summarize here as "street involvement"-are not being adequately met.

Initiation of opioid agonist treatment and subsequent substance use and other patterns among adolescents and young adults in Vancouver, Canada.

Background: Opioid agonist treatments (OAT) are effective interventions for reducing illicit opioid use; however, less is known about OAT among adolescents and young adults (AYA). This study sought to examine OAT retention and discontinuation among AYA.

Methods: Data were derived from the At-Risk Youth Study, a prospective cohort of street-involved AYA in Vancouver, Canada, between September 2005 and December 2018.

The generative potential of mess in community-based participatory research with young people who use(d) drugs in Vancouver.

Community-based participatory research (CBPR) is increasingly standard practice for critical qualitative health research with young people who use(d) drugs in Vancouver, Canada. One aim of CBPR in this context is to redress the essentialization, erasure, and exploitation of people who use(d) drugs in health research. In this paper, we reflect on a partnership that began in 2018 between three university researchers and roughly ten young people (ages 17-28) who have current or past experience with drug use and homelessness in Greater Vancouver.