Opioid overdose deaths have increased exponentially in the United States. Bystander response to opioid overdose ideally involves administering naloxone, providing rescue breathing, and calling 911 to ...summon emergency medical assistance. Recently in the US, public health and public safety agencies have begun seeking to use 911 calls as a method to identify and deliver post-overdose interventions to opioid overdose patients. Little is known about the opinions of PWUDs about the barriers, benefits, or potential harms of post-overdose interventions linked to the 911 system. We sought to understand the perspectives of PWUDs about a method for using 911 data to identify opioid overdose cases and trigger a post-overdose intervention.
We conducted three focus groups with 11 PWUDs in 2018. Results are organized into 4 categories: willingness to call 911 (benefits and risks of calling), thoughts about a technique to identify opioid overdoses in 911 data (benefits and concerns), thoughts about the proposed post-overdose intervention (benefits and concerns), and recommendations for developing an ideal post-overdose intervention. For most participants, calling 911 was synonymous with "calling the police" and law enforcement-related fears were pervasive, limiting willingness to engage with the 911 system. The technique to identify opioid overdoses and the proposed post-overdose intervention were identified as potentially lifesaving, but the benefits were balanced by concerns related to law enforcement involvement, intervention timing, and risks to privacy/reputation. Nearly universally, participants wished for a way to summon emergency medical assistance without triggering a law enforcement response.
The fact that the 911 system in the US inextricably links emergency medical assistance with law enforcement response inherently problematizes calling 911 for PWUDs, and has implications for surveillance and intervention. It is imperative to center the perspectives of PWUDs when designing and implementing interventions that rely on the 911 system for activation.
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Many shorebird species undertake long-distance migrations punctuated by brief stays at food-rich, estuarine stopover locations. Understanding use of these food resources helps guide conservation and ...responsible development decisions. We determined the extent and degree to which Western Sandpiper (Calidris mauri) utilized biofilm as a food resource across a large and variable stopover location during northward (spring) migration. We investigated the spatial heterogeneity in diet composition, to determine whether shorebirds were consistently feeding on biofilm or whether diet varied between naturally and anthropogenically delineated sites. We used stable isotope analysis to estimate that biofilm conservatively comprised 22% to 53% of Western Sandpiper droppings across all sampling sites and that prey composition differed significantly between areas within the stopover location. Widespread biofilm consumption demonstrates the importance of biofilm as a dietary component. Variable diet composition suggests that habitat heterogeneity may be an important component of high quality stopover locations in the context of "state-dependant trade-offs" of Western Sandpiper population sub-groups. Future management decisions must consider and address potential impacts on the biofilm community throughout a stopover location, as single site studies of diet composition may not be adequate to develop effective management strategies for entire stopover sites.
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We review the recent progress in our understanding of the large scales in homogeneous (but anisotropic) turbulence. We focus on turbulence which emerges from Saffman-like initial conditions, in which ...the vortices possess a finite linear impulse. Such turbulence supports long-range velocity correlations of the form uiu′j=O(r−3), where u and u′ are separated by a distance r, and these long-range interactions dominate the dynamics of large eddies. We show that, for axisymmetric turbulence, the energy and integral scales evolve as u⊥2~u//2~t−6/5 and l⊥~l//~t2/5, where ⊥ and // indicate directions that are perpendicular and parallel to the symmetry axis, respectively. These predictions are consistent with the evidence of direct numerical simulations. Similar results are obtained for the passive scalar variance, where we find that θ2~t−6/5. The primary point of novelty in our discussion of passive scalar decay is that it is based in real (rather than spectral) space, making use of an integral invariant which is a generalization of the isotropic Corrsin integral.
There are two recurring themes in astrophysical and geophysical fluid mechanics: waves and turbulence. This book investigates how turbulence responds to rotation, stratification or magnetic fields, ...identifying common themes, where they exist, as well as the essential differences which inevitably arise between different classes of flow. The discussion is developed from first principles, making the book suitable for graduate students as well as professional researchers. The author focuses first on the fundamentals and then progresses to such topics as the atmospheric boundary layer, turbulence in the upper atmosphere, turbulence in the core of the earth, zonal winds in the giant planets, turbulence within the interior of the sun, the solar wind, and turbulent flows in accretion discs. The book will appeal to engineers, geophysicists, astrophysicists and applied mathematicians who are interested in naturally occurring turbulent flows.
A younger and protracted emplacement of the Ontong Java Plateau Davidson, Peter C; Koppers, Anthony A P; Sano, Takashi ...
Science (American Association for the Advancement of Science),
2023-Jun-16, 2023-06-16, 20230616, Volume:
380, Issue:
6650
Journal Article
Peer reviewed
The submarine volcanic emplacement of the Ontong Java Plateau (OJP) is the suggested cause of Ocean Anoxic Event 1a (OAE 1a). However, no precise timing and duration exists for the formation of OJP, ...and its connection to OAE1a relies mainly on proxies in the sedimentary record. We provide high-precision
Ar/
Ar data from OJP drill and dredge sites that considerably improve OJP's eruptive history. The ages determined from this work are as much as 10 million years younger than previous dates and indicate a protracted formation over at least 6 million years. OJP now appears too young to have caused OAE1a, but we suggest that it may have had a role in the later OAE1b. The protracted eruptive sequence has implications for the emplacement dynamics of OJP and other large igneous provinces.
Evaluates prospectively a clinical pathway for investigation of haematuria that involves an initial screening using a urinary biomarker of bladder cancer (Cxbladder Triage™ (CxbT)) in combination ...with either a renal ultrasound or a computed tomography imaging. Source: National Library of New Zealand Te Puna Matauranga o Aotearoa, licensed by the Department of Internal Affairs for re-use under the Creative Commons Attribution 3.0 New Zealand Licence.
•The number of injections decreased precipitously among people who inject drugs in San Francisco from 2018 to 2020.•Concomitantly, we found that among people who inject drugs that use fentanyl, the ...number of days they smoke fentanyl increased.•Qualitative interviews revealed that people who inject drugs’ main motivation for switching from injecting tar heroin to smoking fentanyl was related to their difficulties finding easily accessible veins.•After switching to smoking fentanyl, people noticed many benefits including how the drug felt, improved health, fewer financial constraints, and reduced stigma.
The introduction of illicitly made fentanyl in the United States has slowly replaced heroin. New illicit drugs are often associated with changes in frequency and modes of administration. We assessed changes in injection frequency and smoking fentanyl in the new era of fentanyl availability in San Francisco.
We used targeted sampling to recruit 395 people who inject drugs (PWID) into an observational cohort study in San Francisco 2018–2020. We assessed changes in injection frequency, opioid injection frequency and fentanyl smoking frequency in four six-month periods. We also conducted qualitative interviews with PWID asking about motivations for injecting and smoking opioids.
The median number of past-month injections steadily decreased by semi-annual calendar year from 92 injections in July to December 2018 to 17 injections in January to June 2020. The rate of opioid injections reduced by half (Adjusted Incidence Rate Ratio = 0.41; 95 % Confidence Interval = 0.25, 0.70; p < 0.01). The number of days smoking fentanyl was associated with fewer number of injections (X2(2) = 11.0; p < 0.01). Qualitative interviews revealed that PWID’s motivation for switching from injecting tar heroin to smoking fentanyl was related to difficulties accessing veins. After switching to smoking fentanyl, they noticed many benefits including how the drug felt, improved health, fewer financial constraints, and reduced stigma.
Between 2018 and 2020, there was a shift from injecting tar heroin to smoking fentanyl in San Francisco. Reductions in injection of illicit drugs may offer public health benefit if it reduces risk of blood-borne viruses, abscesses and soft-tissue infections, and infective endocarditis.
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Examines prospectively the impact of adding a urinary biomarker of bladder cancer (Cxbladder TriageTM, CxbT) to a clinical pathway for investigating haematuria, as a way to improve risk ...stratification of patients who may require cystoscopy and imaging. Source: National Library of New Zealand Te Puna Matauranga o Aotearoa, licensed by the Department of Internal Affairs for re-use under the Creative Commons Attribution 3.0 New Zealand Licence.
Abstract
Background
Opioid use and opioid overdose deaths are at an all-time high and evidence-based treatments for people with opioid use disorder (OUD) are underutilized. Therefore, we sought to ...understand experiences and perceptions of abuses in the for-profit substance use disorder treatment industry that could potentially put people with OUD at an increased risk for an overdose.
Methods
One-on-one semi-structured interviews were conducted from November 2018 to May 2019 in Southern California with 20 people with OUD and 20 professionals who work in the substance use disorder (SUD) treatment field. A grounded theory approach was conducted to discover emerging patterns from the data.
Results
Three major themes emerged:1) financial and material enticements, 2) encouraging substance use in the for-profit treatment sector, and 3) contributors to overdose risk. Participants reported that patient brokers would pay for plane tickets and offer financial incentives (e.g., money) to attract individuals to SUD treatment, capitalizing on insurance profits despite initial expenses. Participants reported being encouraged to use drugs before treatment to meet insurance conditions, thus jeopardizing genuine recovery efforts and adding to the temptation of drug use. Many participants linked patient brokering to increased overdose deaths, emphasizing the dangerous practices of brokers providing drugs, promoting relapse, and creating a revolving door of treatment, which compounds the overdose risk after periods of abstinence.
Conclusions
Patient brokering and unethical abuses in the for-profit treatment industry have caused some people with OUD to seek treatment for money and housing instead of seeking treatment to stop opioid use. The harmful treatment environment was seen as a barrier to care and an unwanted obstacle to overcome on the path to recovery.
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Highlights • Law enforcement officers are being trained to respond to opioid overdoses with naloxone. • Brief trainings can improve competency and confidence in overdose response. • Improved ...community relations could impact willingness to call 911 for overdose victims.
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