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Abstract Fibrosis is a common outcome of numerous pathologies, including chronic kidney disease (CKD), a progressive renal function deterioration. Current approaches to target activated fibroblasts, key effector contributors to fibrotic tissue remodeling, lack specificity. Here, we report Gucy1α1 as a specific kidney fibroblast marker. Gucy1α1 levels significantly increased over the course of two clinically relevant murine CKD models and directly correlated with established fibrosis markers. Immunofluorescent (IF) imaging showed that Gucy1α1 comprehensively labelled cortical and medullary quiescent and activated fibroblasts in the control kidney and throughout injury progression, respectively. Unlike traditionally used markers platelet derived growth factor receptor beta (Pdgfrβ) and vimentin (Vim), Gucy1α1 did not overlap with off-target populations such as podocytes. Notably, Gucy1α1 labelled kidney fibroblasts in both male and female mice. Furthermore, we observed elevated GUCY1α1 expression in the human fibrotic kidney and lung. Studies in the murine models of cardiac and liver fibrosis revealed Gucy1α1 elevation in activated Pdgfrβ-, Vim- and alpha smooth muscle actin (αSma)-expressing fibroblasts paralleling injury progression and resolution. Overall, we demonstrate Gucy1α1 as an exclusive fibroblast marker in both sexes. Due to its multiorgan translational potential, GUCY1α1 might provide a novel promising strategy to specifically target and mechanistically examine fibroblasts.

Abstract Environmental risk assessment (ERA) is critical for protecting life by predicting population responses to contaminants. However, routine toxicity testing often examines only one genotype from surrogate species, potentially leading to inaccurate risk assessments, as natural populations typically consist of genetically diverse individuals. To evaluate the importance of intraspecific variation in translating toxicity testing to natural populations, we quantified the magnitude of phenotypic variation between 20 Daphnia magna clones exposed to two levels of microcystins, a cosmopolitan cyanobacterial toxin. We observed significant genetic variation in survival, growth, and reproduction, which increased under microcystins exposure. Simulations of survival showed that using a single genotype for toxicity tolerance estimates on average failed to produce accurate predictions within the 95% confidence interval over half of the time. Whole genome sequencing of the 20 clones tested for correlations between toxicological responses and genomic divergence, including candidate loci from prior gene expression studies. We found no overall correlations, indicating that clonal variation, rather than variation at candidate genes, predicts population-level responses to toxins. These results highlight the importance of incorporating broad intraspecific genetic variation, without focusing specifically on variation in candidate genes, into ERAs to more reliably predict how local populations will respond to contaminants.

Abstract Background Procrastination is common among university students and associated with adverse outcomes such as physical and mental health problems. According to the Temporal motivation theory procrastination may vary over time depending on the temporal proximity to goals and deadlines. Aims To determine if mean procrastination levels among university students varies over an academic year, and if trajectories of procrastination are moderated by gender identity, perfectionistic strivings, and/or perfectionistic concerns. Sample Swedish university students (n = 1410). Methods The cohort was followed with web-surveys at four time-points over one academic year (Late semester, Mid semester, After semester, and Early semester). Generalized Estimating Equations were used to estimate mean levels of self-rated procrastination at the different time-points. Results We found only small fluctuations in mean procrastination levels over the academic year. Participants with high perfectionistic concerns demonstrated higher mean procrastination levels at all time-points, but neither gender identity, perfectionistic concerns nor perfectionistic strivings affected the slope of the mean procrastination trajectories. Conclusions In this cohort of Swedish university students, self-rated procrastination levels were stable over the academic year. Perfectionistic concerns, but not gender identity or perfectionistic strivings, was associated with higher levels of procrastination.

Participatory action research (PAR) is an effective means of collaborating with older adults to support community change. Limited PAR literature exists in which older adults catalyse social change within neighbourhoods, particularly using virtual methods. In this paper, we discuss a virtual PAR process with older adults that occurred during the COVID-19 pandemic, and the results of inquiry into our application of PAR principles. We conducted PAR in a collective involving university researchers, older adult residents and community partners in an urban core neighbourhood in a mid-sized Canadian city and focused on enhancing daily life for older adults. The PAR project emerged through reflection on previous ethnographic findings regarding older adults’ daily life in neighbourhoods. Our PAR collective collaboratively identified a need among older adults for more accessible information about community resources. To support older adults’ participation and access to community information, the PAR collective created and distributed a free neighbourhood resource booklet, in print and digital formats, to promote equitable access. We evaluated the impact of the booklet through a survey and discussions with community partners. During our PAR process we found challenges and solutions related to using technology, engaging in discussion during virtual meetings, and making collaborative decisions. A combination of in-person, remote and online interactions seemed to facilitate relationship development amongst co-researchers and completion of the project. Future PAR projects would benefit from incorporating in-person, remote and online methods from the outset, as well as ways to support older adults in using and accessing technology. We further noted the value of a local resource booklet, in print and digital formats, in promoting neighbourhood information sharing.

Background: The COVID-19 pandemic contributed to increased pressure on healthcare systems. During periods when the demands exceed the capacity of healthcare organizations, adaptive strategies are used to meet these demands. During the COVID-19 pandemic, working hours for nursing staff were reorganized and extended. This has posed challenges for recovery, which may be a key factor for maintaining health and safety under such conditions. Objectives: The aim of the study was to bring insights into how nursing staff perceived their working hours and recovery during the COVID-19 pandemic, and if they experienced any changes in their sleep and well-being. Design: A qualitative descriptive design was chosen, as it is suitable for gaining insight into perceptions and experiences. Methods: Qualitative semi-structured interviews were conducted using an interview guide. The interviews were analyzed using thematic analysis. Sixteen registered nurses and six certified nursing assistants from four Swedish hospitals participated in the study. Results: The organization of working hours during the COVID-19 pandemic was considered suboptimal and resulted in more demanding working hours and poor recovery. Nursing staff experienced loss of control as they lost influence over working hours, working hours became more unpredictable and the boundaries between work and leisure became blurred. Nursing staff also experienced a decline in their health and well-being, including extreme fatigue, impaired sleep and physical/mental changes. Conclusion: The strategies used by healthcare organizations to meet increasing demands during the COVID-19 pandemic contributed to impaired recovery and well-being of nursing staff, which could generate negative feedback loops contributing to depletion of resources at the organizational level.

This paper illustrates the importance of critical reflexivity in guiding socially and ethically responsible participatory research through an analysis of reflexive notes pertaining to the process of a participatory filmmaking research project with children with disabilities. Within this process, numerous ethical tensions emerged in the field regarding the participation of children with disabilities, authenticity of stories shared, navigating facilitator’s voice, issues of representation of child co-researchers, safety and risks associated with sharing everyday realities within the film, and limits to immediate action. The practice of individual and shared critical reflexivity among researchers, and inclusivity of child co-researchers, was central in navigating ethical tensions. This paper makes transparent the process of critical reflexivity within a participatory action research project by highlighting the ethical tensions faced, contextualizing them within cultural practices and power relations, and sharing strategies used to address ‘ethics in practice.’ We end by proposing practical strategies to enhance reflexive research practices in participatory work.

Abstract Aim To explore Finnish paramedics' perceptions of work‐related performance expectations in relation to work experience, and understand how organizational socialization contributes to understanding paramedics' performance expectations. Design A qualitative design with a deductive‐inductive approach utilizing a social constructivist framework. The organizational socialization framework by Wanberg was used as the theoretical basis. Methods Data were collected between May and August 2023, using group and individual interviews of newly graduated (n = 9) and experienced paramedics (n = 13). Participants were recruited via social media channels. Data were first analyzed deductively, according to constructs of the organizational socialization framework (role clarity, task mastery, and social acceptance), then inductively, using codes not utilized in the deductive phase. Data Sources Interviewed Finnish paramedics (N = 22), both newly graduated paramedics (n = 9) and experienced paramedics (n = 13). The interviews were performed remotely and then transcribed into text. Results Our findings showed comparable performance expectations between newly graduated and experienced paramedics, mismatches in role clarity of paramedic work, challenges in both learning and upholding professional competence, and difficulties of social acceptance into the paramedic community. There were variations in how expectations were perceived between groups, indicating that experience might partly affect how paramedics identify and manage performance expectations. The organizational socialization framework enables the contextualization of these performance expectations. Conclusions and Implications Paramedic work involves challenges to upholding clinical competence, aligning to a professional role, and social integration into the professional community. Our research contributes to understanding how paramedics perceive these challenges as performance expectations in different stages of their careers and how they could be managed utilizing a framework for organizational socialization. The socialization of paramedics into the workforce needs to account for these performance expectations, especially considering the changing paradigm of paramedic work, role, and societal expectations. Patient or Public Contribution No Patient or Public Contribution.

Fifty years after the coup d`état in Chile, cities such as Amsterdam, Frankfurt, Leeds, Milan, Belgrade, Los Angeles, and Chicago, still display traces of Chilean exile on the walls of cultural centres, universities, theatres and other buildings. These are the remains of hundreds of murals, painted by brigades created by Chileans in exile to encourage their host countries to show solidarity with their resistance to the Pinochet dictatorship. The complex experience of Chilean exile and its long-lasting and intergenerational repercussions have only slowly been integrated into research and memory practices. This article examines three case studies of Chilean murals in exile as atypical forms of testimonial sources, with the aim of gaining insights into the multi-layered network of actors behind them, in particular into the testimonies of Chilean exiles and actors of international solidarity. It also explores the memorial dimensions of postephemeral murals and how these can function as carriers of a collective, transnational memory of Chilean exile.

Abstract Examining kidney fibrosis is crucial for mechanistic understanding and developing targeted strategies against chronic kidney disease (CKD). Persistent fibroblast activation and tubular epithelial cell (TEC) injury are key CKD contributors. However, cellular and transcriptional landscapes of CKD and specific activated kidney fibroblast clusters remain elusive. Here, we analyzed single cell transcriptomic profiles of two clinically relevant kidney fibrosis models which induced robust kidney parenchymal remodeling. We dissected the molecular and cellular landscapes of kidney stroma and newly identified three distinctive fibroblast clusters with “secretory”, “contractile” and “vascular” transcriptional enrichments. Also, both injuries generated failed repair TECs (frTECs) characterized by decline of mature epithelial markers and elevation of stromal and injury markers. Notably, frTECs shared transcriptional identity with distal nephron segments of the embryonic kidney. Moreover, we identified that both models exhibited robust and previously unrecognized distal spatial pattern of TEC injury, outlined by persistent elevation of renal TEC injury markers including Krt8 and Vcam1, while the surviving proximal tubules (PTs) showed restored transcriptional signature. We also found that long-term kidney injuries activated a prominent nephrogenic signature, including Sox4 and Hox gene elevation, which prevailed in the distal tubular segments. Our findings might advance understanding of and targeted intervention in fibrotic kidney disease.

Background: Registered nurses working on the frontline during the COVID-19 pandemic encountered significant challenges, including exposure to critical incidents. Critical incidents refer to sudden unexpected clinical events that surpass an individual's ability to cope, leading to considerable psychological distress, which could potentially result in the development of post-traumatic stress disorder symptoms. Research has shown a high prevalence of post-traumatic stress disorder symptoms among healthcare workers, particularly those in close contact with COVID-19 patients. Objective: To assess the levels of post-traumatic stress symptoms among registered nurses in relation to exposure to working conditions during the COVID-19 pandemic, such as how much their work was affected by the pandemic, re-deployment, working hours hindering sufficient recovery between shifts and critical incidents. Design: Cross sectional study. Setting(s): The registered nurses working in multiple health care services covering all 21 geographic regions in Sweden. Participants: A total of 1,923 registered nurses, who are part of a Swedish national cohort and have been followed since their nursing education, were invited to participate in a survey in late September 2021 (15 to 19 years post graduation). Methods: The data were analyzed using descriptive statistics, unpaired t-tests, and one-way analysis of variance. Cohen's d was employed to quantify differences in mean levels between subgroups. Results: The response rate were 56.5 %. Over 50 % of experienced registered nurses reported significant disruptions to their work environments. In total, 85 % of registered nurses were exposed to at least one critical incident in their work during the pandemic, with 60 % facing organisational changes and nearly 50 % experiencing emotionally distressing situations. The exposure to work situations involving critical incidents consistently demonstrated strong associations with higher levels of post-traumatic stress disorder symptoms compared to those not exposed, with effect sizes ranging from moderate to high. Conclusions: This study underscores the profound impact that working conditions, such as redeployment and exposure to critical incidents, have on the mental health of registered nurses. We offer valuable insights into registered nurses’ pandemic-related challenges, highlighting the need for support and interventions to prevent and manage critical incidents, ultimately promoting their well-being. We also highlight the significance of thorough workforce readiness planning for future pandemics and other challenging health care scenarios, such as staff shortage.

BACKGROUND: Immunotherapy is promising as an efficacious treatment for food allergy. Other food allergy treatments are also under development. However, adverse allergic events during treatment, as well as during oral food challenges, are common and reporting is not standardized. OBJECTIVE: A more nuanced grading scale is needed to create a comprehensive and universal system to categorize adverse events and their severity for food allergy clinical trials. METHODS: Starting with the 2012 Consortium for Food Allergy Research (CoFAR) Grading Scale and the World Allergy Organization Grading System, we developed the CoFAR Grading Scale for Systemic Allergic Reactions, Version 3.0, in collaboration with industry partners with expert opinion. RESULTS: The revised CoFAR Grading Scale for Systemic Allergic Reactions has 5 levels of increasing severity, ranging from generalized urticaria, localized angioedema, rhinitis, and abdominal pain (grade 1) to death (grade 5). Systemic reactions are further categorized within each grade by relevant organ system. Mild, single-system reactions are differentiated from mild, multisystem reactions. Lower respiratory tract symptoms are graded on the basis of response to therapy; those that are refractory to standard treatment (eg, requiring >3 doses of intramuscular epinephrine, continuous intravenous epinephrine infusion, and continuous albuterol nebulization) and respiratory compromise requiring mechanical ventilation are classified as grade 4, life-threatening reactions. CONCLUSIONS: Universal and consistent use of the revised CoFAR Grading Scale beyond the CoFAR centers would allow for better data aggregation and safety comparisons in clinical trials for food allergy.

Direct observation of evolution in response to natural environmental change can resolve fundamental questions about adaptation, including its pace, temporal dynamics, and underlying phenotypic and genomic architecture. We tracked the evolution of fitness-associated phenotypes and allele frequencies genome-wide in 10 replicate field populations of Drosophila melanogaster over 10 generations from summer to late fall. Adaptation was evident over each sampling interval (one to four generations), with exceptionally rapid phenotypic adaptation and large allele frequency shifts at many independent loci. The direction and basis of the adaptive response shifted repeatedly over time, consistent with the action of strong and rapidly fluctuating selection. Overall, we found clear phenotypic and genomic evidence of adaptive tracking occurring contemporaneously with environmental change, thus demonstrating the temporally dynamic nature of adaptation.

BACKGROUND: Outbreaks of SARS-CoV-2 in long-term care facilities (LTCFs) cause significant morbidity and mortality. Mapping viral transmission within and between facilities by combining genomic sequencing with epidemiologic investigations enables targeting infection-control interventions. METHODS: We conducted weekly surveillance of residents and staff in LTCFs in Santa Clara County, California, with ≥1 confirmed COVID-19 case between March and July 2020. Positive samples were referred for whole-genome sequencing. Epidemiological investigations and phylogenetic analyses of the largest outbreaks (>30 cases) were carried out in 6 LTCFs (Facilities A through F). RESULTS: Among the 61 LTCFs in the county, 41 had ≥1 confirmed case during the study period, triggering weekly SARS-CoV-2 testing. The 6 largest outbreaks accounted for 60% of cases and 90% of deaths in LTCFs, although the bed capacity of these facilities represents only 11% of the LTCF beds in the county. Phylogenetic analysis of 196 whole-genome sequences recovered from those facilities showed that each outbreak was monophyletic, with staff and residents sharing a common viral lineage. Outbreak investigations revealed that infected staff members often worked at multiple facilities, and in 1 instance, a staff member infected while working in 1 facility was the likely index case in another. CONCLUSIONS: We detected a pattern of rapid and sustained transmission after a single introduction of SARS-CoV-2 in 6 large LTCF outbreaks, with staff playing a key role in transmission within and between facilities. Infection control, testing, and occupational policies to reduce exposure and transmission risk for staff are essential components to keeping facility residents safe.

The COVID-19 pandemic put pressure on healthcare organizations, making them dependent on sufficient resources and employees’ performance. Recovery is a key factor in maintaining safe operations, employee health, and retention. However, during the pandemic, working hours became more demanding, which limited time for recovery between shifts. The responsibility to ensure employee recovery in relation to working hours lies at the organizational level. The aim of this study was to examine how working hours, staffing, and recovery were managed at the organizational level during the COVID-19 pandemic in Swedish health care, studied from the perspective of HR representatives. Qualitative interview data based on 19 HR representatives from 16 Swedish regions was analyzed using thematic analysis. The results showed that during the COVID-19 pandemic, organizations maximized working hours and reorganized employees, care, and HR. Actions were taken to buffer job demands, including providing support and identifying employees who were not feeling well. Inadequate staffing and skill mix influenced the management of working hours, staffing, and recovery. Our findings highlight the use of short-term solutions to manage the situation at hand, which could lead to exhaustion of human capital long-term and subsequent effects on safety, performance, and employee retention. We term this phenomenon the organizational recovery paradox.

Abstract Aim To examine registered nurses' individual strengths (psychological capital and grit) and an organizational resource (organizational justice) as well as associated work‐related outcomes. In a time of a global nursing shortage, there is an urgent need to identify strengths and resources that can have a positive impact on the health, well‐being and retention of registered nurses. Design A cross‐sectional survey. Methods A nationwide convenience sample of 514 registered nurses responded to a survey. Data were collected using a self‐reported questionnaire between March and May 2018. Data were analysed using descriptive statistics and multivariate path analysis. Results Participants rated their psychological capital and grit moderately high. Grit and organizational justice were found to have significant direct effects on psychological capital. Furthermore, psychological capital had positive direct effects on engagement and the perception of well‐conducted everyday nursing as well as negative direct effects on burnout, the stress of conscience and the intent to leave the profession. Conclusion The results suggest that nurse leaders and managers could consider improving registered nurses' well‐being with two complementary approaches. It might be useful to reinforce positive, individual strengths, such as psychological capital, and at the same time create more favourable nursing work environments, for example by strengthening organizational justice. Implications for the Profession Psychological capital and grit are emerging concepts in nursing workforce research. Identifying registered nurses' positive strengths and resources is important for inventing interventions that enhance nurses' engagement and well‐being as well as reduce turnover intentions. Impact Nurse leaders and managers play crucial roles in managing and developing registered nurses' individual strengths and organizational resources. This has gained even more importance now as the COVID‐19 pandemic could have a long‐term negative impact on nurses' well‐being. Reporting Method The study is reported following STROBE guidelines. Patient or Public Contribution No patient or public contribution.

PurposeThe Graham Roberts Study was initiated in 2018 and is the first Trials Within Cohorts (TwiCs) study for bladder cancer. Its purpose is to provide an infrastructure for answering a breadth of research questions, including clinical, mechanistic, and supportive care centred questions for bladder cancer patients.ParticipantsAll consented patients are those aged 18 or older, able to provide signed informedconsent and have a diagnosis of new or recurrent bladder cancer. All patients are required to have completed a series of baseline questionnaires. The questionnaires are then sent out every 12 months and include information on demographics and medical history as well as questionnaires to collect information on quality of life, fatigue, depression, overall health, physical activity, and dietary habits. Clinical information such as tumor stage, grade and treatment has also been extracted for each patient.Findings to dateTo date, a total of 125 bladder cancer patients have been consented onto the study with 106 filling in the baseline questionnaire. The cohort is made up of 75% newly diagnosed bladder cancer patients and 66% non-muscle invasive bladder cancer cases. At present, there is 1-year follow-up information for 70 patients, 2-year follow-up for 57 patients, 3-year follow-up for 47 patients and 4-year follow-up for 19 patients.Future plansWe plan to continue recruiting further patients into the cohort study. Using the data collected within the study, we hope to carry out independent research studies with a focus on quality of life. We are also committed to utilizing the Roberts Study Cohort to set up and commence an intervention. The future studies and trials carried out using the Roberts Cohort have the potential to identify and develop interventions that could improve the prevention, diagnosis, and treatment of bladder cancer.

We combined viral genome sequencing with contact tracing to investigate introduction and evolution of severe acute respiratory syndrome coronavirus 2 lineages in Santa Clara County, California, from 27 January to 21 March 2020. From 558 persons with coronavirus disease 2019, 101 genomes from 143 available clinical samples comprised 17 lineages, including SCC1 (n = 41), WA1 (n = 9; including the first 2 reported deaths in the United States, with postmortem diagnosis), D614G (n = 4), ancestral Wuhan Hu-1 (n = 21), and 13 others (n = 26). Public health intervention may have curtailed the persistence of lineages that appeared transiently during February and March. By August, only D614G lineages introduced after 21 March were circulating in Santa Clara County.

Staphylococcus aureus colonizes patients with atopic dermatitis (AD) and exacerbates disease by promoting inflammation. The present study investigated the safety and mechanisms of action of Staphylococcus hominis A9 (ShA9), a bacterium isolated from healthy human skin, as a topical therapy for AD. ShA9 killed S. aureus on the skin of mice and inhibited expression of a toxin from S. aureus (psmα) that promotes inflammation. A first-in-human, phase 1, double-blinded, randomized 1-week trial of topical ShA9 or vehicle on the forearm skin of 54 adults with S. aureus-positive AD (NCT03151148) met its primary endpoint of safety, and participants receiving ShA9 had fewer adverse events associated with AD. Eczema severity was not significantly different when evaluated in all participants treated with ShA9 but a significant decrease in S. aureus and increased ShA9 DNA were seen and met secondary endpoints. Some S. aureus strains on participants were not directly killed by ShA9, but expression of mRNA for psmα was inhibited in all strains. Improvement in local eczema severity was suggested by post-hoc analysis of participants with S. aureus directly killed by ShA9. These observations demonstrate the safety and potential benefits of bacteriotherapy for AD.

This meta-analysis evaluated theoretical predictions from balanced identity theory (BIT) and evaluated the validity of zero points of Implicit Association Test (IAT) and self-report measures used to test these predictions. Twenty-one researchers contributed individual subject data from 36 experiments (total N = 12,773) that used both explicit and implicit measures of the social-cognitive constructs. The meta-analysis confirmed predictions of BIT's balance-congruity principle and simultaneously validated interpretation of the IAT's zero point as indicating absence of preference between two attitude objects. Statistical power afforded by the sample size enabled the first confirmations of balance-congruity predictions with self-report measures. Beyond these empirical results, the meta-analysis introduced a within-study statistical test of the balance-congruity principle, finding that it had greater efficiency than the previous best method. The meta-analysis's full data set has been publicly archived to enable further studies of interrelations among attitudes, stereotypes, and identities.

Despite the existence of policies aimed at ensuring equitable opportunities for individuals with disabilities, at the postsecondary level, students with learning disabilities and/or attention deficit/hyperactivity disorder have lower enrollment and completion rates than those without disabilities. To optimize policies and practices to support students with learning disabilities, it is crucial to incorporate the perspectives and experiences of such students. This paper presents the results of a scoping review of research based in the United States and Canada that addressed the perspectives and experiences of students with learning disabilities and/or attention deficit/hyperactivity disorder regarding postsecondary education. The five-step process for scoping reviews outlined by Arksey and O'Malley (2005) was used. A search of 10 databases resulted in 44 articles meeting the inclusion criteria, with most studies conducted in the United States (n = 35) and using qualitative designs (n = 37). Six themes were identified using an inductive analysis process: (1) supportive and non-supportive experiences with professors, faculty and counselors; (2) experiences of negotiating and receiving formal accommodations; (3) intrinsic factors affecting success; (4) influence of variability in timing and understanding of diagnosis; (5) stigmatization of disability status; and (6) social factors affecting success. Findings support the need for inclusive learning environments, better access to accommodations, collaboration between all stakeholders, and educational initiatives to combat negative attitudes and beliefs regarding students with learning disabilities among peers and faculty. Future research directions are also identified.

Summary: In the face of scarce public health resources, it is critical to understand which disease surveillance strategies are effective, yet such validation has historically been difficult. From May 1 to December 31, 2021, a cohort study was carried out in Santa Clara County, California, in which 10,131 high-quality genomic sequences from COVID-19 polymerase chain reaction tests were merged with disease surveillance data. We measured the informational value, the fraction of sequenced links surfaced that are biologically plausible according to genomic sequence data, of different disease surveillance strategies. Contact tracing appeared more effective than spatiotemporal methods at uncovering nonresidential spread settings, school reporting appeared more fruitful than workplace reporting, and passively retrieved links through survey information presented some promise. Given the rapidly dwindling cost of sequencing, the informational value metric may enable near real-time, readily available evaluation of strategies by public health authorities to fight viral diseases beyond COVID-19.

Purpose Strategies for preventing and ending homelessness are frequently measured by their effectiveness on indices of tenancy sustainment. To shift this narrative, we conducted research to identify what is needed to “thrive” following homelessness from the perspectives of persons with lived experience in Ontario, Canada. Methods Conducted in the context of a community-based participatory research study aimed at informing the development of intervention strategies, we interviewed 46 persons living with mental illness and/or substance use disorder [n = 25 (54.3%) unhoused; n = 21 (45.7%) housed following homelessness] using qualitative interviews. A subsample of 14 participants agreed to engage in photovoice interviews. We analysed these data abductively using thematic analysis informed by health equity and social justice. Results Participants described experiences of “living in a state of lack” following homelessness. This essence was expressed through four themes: 1) housing as part one of the journey to home; 2) finding and keeping “my people”; 3) meaningful activity as critical for thriving following homelessness; and 4) struggling to access mental health supports in the context of challenging circumstances. Conclusions Individuals struggle to thrive following homelessness in the context of insufficient resources. There is a need to build on existing interventions to address outcomes beyond tenancy sustainment.

Despite the attention drawn to the plastic crisis by the media and environmental campaigns, much of the practice around single-use plastic has remained unchanged. It appears that, although many know the correct position to assume regarding the issue, the 'talk' does not necessarily translate into action. This incongruity can be explained with reference to Heidegger's theory on the everydayness of discourse which suggests that a lack of authenticity underlies our everyday interactions and that what is needed is a different kind of encounter with the world. In the light of this we consider Ranciere's theory on the potential of a political artwork to disrupt the everyday and prompt a different response. Within the framework of these theories, this paper discusses a performance artwork protesting plastic pollution -- namely 12 "Plastic Monsters" by Luke Rudman -- as an alternative strategy to prompt a fresh engagement with the issue.