Deaths of profound despair: A retrospective cohort study of mortality among people experiencing homelessness.

Introduction: The number of people dying while unhoused is increasing nationally. In Santa Clara County (SCC), deaths of unhoused people have almost tripled in 9 years. This is a retrospective cohort study examining mortality trends among unhoused people in SCC.

Invisibility as a structural determinant: Mortality outcomes of Asians and Pacific Islanders experiencing homelessness.

Introduction: Asians and Pacific Islanders (APIs) who are experiencing homelessness are situated in a social intersection that has rendered them unrecognized and therefore vulnerable. There has been increasing attention to racial disparities in homelessness, but research into API homelessness is exceedingly rare, despite rapidly growing populations. The purpose of this study is to examine the causes of death among APIs who died while homeless in Santa Clara County (SCC) and compare these causes to other racial groups.

Narratives of people who inject drugs on factors contributing to opioid overdose.

Background: In recent years, there has been increasing national and global attention to opioid overdoses. In San Francisco, it is estimated that the population of people who inject drugs (PWID) has more than doubled in the past ten years. The risk factors for opioid overdose have been examined closely, but firsthand accounts of PWID who have experienced overdoses are less documented.

Frequently asked questions about dabbing concentrates in online cannabis community discussion forums.

Background: "Dabbing" involves vaporizing a "dab" of cannabis concentrate on a heated "nail," passing the vapour through a water-pipe rig or portable pen device, and inhaling the vapour. While some cannabis industry media claims that this process is cleaner, safer, and more effective for getting high, medical and public health sources raise concerns about residual solvents and pesticides, unexpectedly intense effects, and rapid increases in tolerance. The aim of this study is to characterize the content of questions about dabbing posed in cannabis and dabbing-specific forums on the Reddit social media platform, as well as comment responses to these questions.

Perceived Causes of Personal versus Witnessed Overdoses among People who Inject Opioids.

Studies show that people who inject drugs (PWID) underestimate their overdose risk. We sought to explore this phenomenon by comparing how PWID perceive causes of personal overdoses compared to witnessed overdoses. We analyzed 40 interviews from participants enrolled in a randomized-controlled behavioral intervention to reduce overdose among at-risk PWID in San Francisco from 2014 to 2016.

Sources and Impact of Time Pressure on Opioid Management in the Safety-Net.

Purpose: This study sought to understand clinicians' and patients' experience managing chronic noncancer pain (CNCP) and opioids in safety-net primary care settings. This article explores the time requirements of safer opioid prescribing for medically and socially complex patients in the context of safety-net primary care.

Methods: We qualitatively interviewed 23 primary care clinicians and 46 of their patients with concurrent CNCP and substance use disorder (past or current).

Structural factors affecting Asians and Pacific Islanders in community-based substance use treatment: Treatment provider perspectives.

Asians and Pacific Islanders (API) have large disparities in utilization of substance use treatment compared to other racial groups. In this study, we analyzed factors that shape API experiences accessing and engaging in community-based treatment from the perspective of treatment providers. We conducted semi-structured interviews with 40 treatment providers who work with API clients in treatment programs in San Francisco and Los Angeles.

Fair hearing outcomes of patients recommended discharge from methadone maintenance.

A system known as fair hearings is a due process opportunity for patients who are involuntarily discharged from methadone maintenance treatment to challenge the discharge recommendation. We know very little about the processes and outcomes of fair hearings. For this study, we used a mixed methods approach to retrospectively analyze 73 fair hearing reports that were documented from a California methadone maintenance treatment program between 2000 and 2014.

Opioid pharmacovigilance: A clinical-social history of the changes in opioid prescribing for patients with co-occurring chronic non-cancer pain and substance use.

There is growing concern among US-based clinicians, patients, policy makers, and in the media about the personal and community health risks associated with opioids. Perceptions about the efficacy and appropriateness of opioids for the management of chronic non-cancer pain (CNCP) have dramatically transformed in recent decades. Yet, there is very little social scientific research identifying the factors that have informed this transformation from the perspectives of prescribing clinicians.

Health in the Tenderloin: A resident-guided study of substance use, treatment, and housing.

Substance use researchers recognize that environments - our homes, streets, communities, and neighborhoods - set the stage for substance use and treatment experiences by framing interactions, health options, and decision-making. The role of environment is particularly salient in places deemed disadvantaged or risky, such as parts of the Tenderloin neighborhood of San Francisco. Since risk is historically, socially, and structurally situated, an individual's social position in a neighborhood shapes how risk environments are experienced.

The Docent Method: A Grounded Theory Approach for Researching Place and Health.

To understand health, research needs to move outside of controlled research settings into the environments where health activities occur-homes, streets, and neighborhoods. I offer the docent method as a qualitative place-based approach for exploring health in a participant-driven, structured, and flexible way. The docent method is a participant-led, audiotaped, and photographed walking interview through broad "sites of interest" (SOIs).

Provider Experiences With the Identification, Management, and Treatment of Co-occurring Chronic Noncancer Pain and Substance Use in the Safety Net.

Background: In the United States and internationally, providers have adopted guidelines on the management of prescription opioids for chronic noncancer pain (CNCP). For "high-risk" patients with co-occurring CNCP and a history of substance use, guidelines advise that providers monitor patients using urine toxicology screening tests, develop opioid management plans, and refer patients to substance use treatment.

Objective: We report primary care provider experiences in the safety net interpreting and implementing prescription opioid guideline recommendations for patients with CNCP and substance use.

Cultural health capital and the interactional dynamics of patient-centered care.

As intuitive and inviting as it may appear, the concept of patient-centered care has been difficult to conceptualize, institutionalize and operationalize. Informed by Bourdieu's concepts of cultural capital and habitus, we employ the framework of cultural health capital to uncover the ways in which both patients' and providers' cultural resources, assets, and interactional styles influence their abilities to mutually achieve patient-centered care. Cultural health capital is defined as a specialized collection of cultural skills, attitudes, behaviors and interactional styles that are valued, leveraged, and exchanged by both patients and providers during clinical interactions.

Glioblastoma multiforme regional genetic and cellular expression patterns: influence on anatomic and physiologic MR imaging.

Purpose: To determine whether magnetic resonance (MR) imaging is influenced by genetic and cellular features of glioblastoma multiforme (GBM) aggressiveness.

Materials And Methods: In this HIPAA-compliant institutional review board-approved study, multiple enhancing and peritumoral nonenhancing stereotactic neurosurgical biopsy samples from treatment-naïve GBMs were collected prospectively, with guidance from cerebral blood volume (CBV) MR imaging measurements. By using monoclonal antibodies, tissue specimens were examined for microvascular expression, hypoxia, tumor and overall cellular density, and histopathologic features of GBM aggressiveness.

Differentiation of recurrent glioblastoma multiforme from radiation necrosis after external beam radiation therapy with dynamic susceptibility-weighted contrast-enhanced perfusion MR imaging.

Purpose: To investigate whether cerebral blood volume (CBV), peak height (PH), and percentage of signal intensity recovery (PSR) measurements derived from the results of T2-weighted dynamic susceptibility-weighted contrast material-enhanced (DSC) magnetic resonance (MR) imaging performed after external beam radiation therapy (EBRT) can be used to distinguish recurrent glioblastoma multiforme (GBM) from radiation necrosis.

Materials And Methods: Fifty-seven patients were enrolled in this HIPAA-compliant institutional review board-approved retrospective study after they received a diagnosis of GBM, underwent EBRT, and were examined with DSC MR imaging, which revealed progressive contrast enhancement within the radiation field. A definitive diagnosis was established at subsequent surgical resection or clinicoradiologic follow-up.