Stigma is a known barrier to treating substance use disorders and dramatically diminishes the quality of life of people who use drugs (PWUD) nonmedically. Stigma against PWUD may be especially ...pronounced in rural areas due to their decreased anonymity and residents' limited access, or resistance, to “neutralizing” information on factors associated with drug use. Stigma often manifests in the attitudes of professionals whom stigmatized individuals regularly interact with and often materially impact. We analyzed interviews conducted between July 2018 and February 2019 with professional stakeholders in rural southern Illinois who interact with PWUD, specifically those who use opioids nonmedically or who inject drugs (n = 30). We further analyzed interview data from a complementary PWUD sample (n = 22). Interviews addressed perspectives around nonmedical drug use and treatment/harm reduction, with analysis centered around the Framework Integrating Normative Influences on Stigma and its focus on micro, meso and macro level stigmatization processes. Stakeholder participants included professionals from local law enforcement, courts, healthcare organizations, emergency management services, and faith-based and social services organizations. Most stakeholders, particularly law enforcement, negatively perceived PWUD and nonmedical drug use in general, questioned the character, agency and extrinsic value of PWUD, and used labels (e.g. “addict,” “abuser,” etc.) that may be regarded as stigmatizing. Further, most respondents, including PWUD, characterized their communities as largely unaware or dismissive of the bio-medical and sociocultural explanations for opioid use, drug injection and towards harm reduction services (e.g., syringe exchanges) and naloxone, which were frequently framed as undeserved usages of taxpayer funds. In conclusion, rural stigma against PWUD manifested and was framed as a substantial issue, notably activating at micro, meso and macro levels. Stigma prevention efforts in these communities should aim to improve public knowledge on the intricate factors contributing to opioid use and drug injection and harm reduction programming's moral and fiscal value.
•Antagonism for treatment and prevention arises from perceived taxpayer cost burden.•Stakeholders often contest the character and agency of PWUD.•Stakeholders commonly use potentially stigmatizing terms on drug use/user milieu.•Perceived class traits—e.g., appearance/behavior—may activate negative PWUD views.•Rural public viewed as unaware of/unsympathetic to PWUD general challenges.
The COVID‐19 pandemic is an unprecedented event in modern American history. It has the potential to impact nearly every American community significantly regardless of its size. As of this writing (1 ...PM CST; 31 March 2020), the United States has had 174,467 confirmed cases and 3,461 deaths associated with COVID‐19.1 A majority of the states are in some form of “lockdown” to increase social isolation in order to flatten the infection curve and forestall health care system breakdown. Although rural areas may have more geographic space per person, which may facilitate social isolation and slow the spread of COVID‐19, rural contexts may sometimes facilitate its spread. For example, rural health care barriers may be more pronounced than urban ones since rurality is generally characterized by lower incomes, limited economic and educational opportunities, increased rates of alcohol and tobacco use, and health care shortages.Further, the United States is still wrestling with the opioid epidemic, widely noted to disproportionately impact some rural areas.2 The inequalities described above are particularly pronounced for rural persons who use drugs (PWUD), who face multiple barriers to seeking and obtaining health care, including both stigma (which negatively impacts their ability to self‐function and seek care) and drug‐use‐associated illness and injury.3, 4 Before COVID‐19, we saw a marked increase in opioid and amphetamine use in rural areas, and thus an increase in overdoses.5-8 Research has demonstrated that big events such as economic decline and disease outbreaks can lead to an increase in deaths, especially among disadvantaged populations, such as PWUD. Given that rural PWUD may face disproportionate negative impacts across several fronts, we should focus some efforts on PWUD, tracking how COVID‐19 impacts them, and working to make prevention and treatment accessible. While our materials described below stem from our research and outreach in rural southern Illinois, we believe they are relevant to many other rural areas.
Drug overdose rates in the United States have been steadily increasing, particularly in rural areas. The COVID-19 pandemic and associated mitigation strategies may have increased overdose risk for ...people who use drugs by impacting social, community, and structural factors.
The study included a quantitative survey focused on COVID-19 administered to 50 people who use drugs and semi-structured qualitative interviews with 17 people who use drugs, 12 of whom also participated in the quantitative survey. Descriptive statistics were run for the quantitative data. Qualitative coding was line-by-line then grouped thematically. Quantitative and qualitative data were integrated during analysis.
Findings demonstrate how COVID-19 disruptions at the structural and community level affected outcomes related to mental health and drug use at the individual level. Themes that emerged from the qualitative interviews were (1) lack of employment opportunities, (2) food and housing insecurity, (3) community stigma impacting health service use, (4) mental health strains, and (5) drug market disruptions. Structural and community changes increased anxiety, depression, and loneliness on the individual level, as well as changes in drug use patterns, all of which are likely to increase overdose risk.
The COVID-19 pandemic, and mitigation strategies aimed at curbing infection, disrupted communities and lives of people who use drugs. These disruptions altered individual drug use and mental health outcomes, which could increase risk for overdose. We recommend addressing structural and community factors, including developing multi-level interventions, to combat overdose. Trial registration Clinicaltrails.gov: NCT04427202. Registered June 11, 2020: https://clinicaltrials.gov/ct2/show/NCT04427202?term=pho+mai&draw=2&rank=3.
Successful intervention in rural opioid misuse requires a better understanding of how local social norms and networks, and employment and medical care access, combine to facilitate or hinder ...individual use.
Abstract
Prescription and illicit opioids were involved in over 42,000 deaths in the USA in 2016. Rural counties experience higher rates of opioid prescribing and, although opioid prescribing rates have fallen in recent years, the rate of decline is less in rural areas. The sociocultural context of rural life may impact opioid misuse in important ways; however, little research directly explores this possibility. We performed a systematic review of English-language manuscripts in U.S. context to determine what is known about social networks, norms, and stigma in relation to rural opioid misuse. Of nine articles identified and reviewed, two had only primary findings associated with social networks, norms, or stigma, five had only secondary findings, and two had both primary and secondary findings. The normalization of prescription opioid use along with environmental factors likely impacts the prevalence of opioid misuse in rural communities. Discordant findings exist regarding the extent to which social networks facilitate or protect against nonmedical opioid use. Lastly, isolation, lack of treatment options, social norms, and stigma create barriers to substance use treatment for rural residents. Although we were able to identify important themes across multiple studies, discordant findings exist and, in some cases, findings rely on single studies. The paucity of research examining the role of social networks, norms, and stigma in relation to nonmedical opioid use in rural communities is evident in this review. Scholarship aimed at exploring the relationship and impact of rurality on nonmedical opioid use is warranted.
•The Rural Risk Environment Framework focuses on macro forces of disease risk.•The production of hepatitis C risk operates at the economic, physical, policy, and social levels.•Individual hepatitis C ...risk is related to vulnerabilities produced structurally.•Hepatitis C interventions need to move beyond individual behavioral modification.
Hepatitis C virus (HCV) infection has increased among persons who inject drugs (PWID) in the United States with disproportionate burden in rural areas. We use the Risk Environment framework to explore potential economic, physical, social, and political determinants of hepatitis C in rural southern Illinois.
Nineteen in-depth semi-structured interviews were conducted with PWID from August 2019 through February 2020 (i.e., pre-COVID-19 pandemic) and four with key informants who professionally worked with PWID. Interviews were recorded, professionally transcribed, and coded using qualitative software. We followed a grounded theory approach for coding and analyses.
We identify economic, physical, policy, and social factors that may influence HCV transmission risk and serve as barriers to HCV care. Economic instability and lack of economic opportunities, a lack of physically available HCV prevention and treatment services, structural stigma such as policies that criminalize drug use, and social stigma emerged in interviews as potential risks for transmission and barriers to care.
The rural risk environment framework acknowledges the importance of community and structural factors that influence HCV infection and other disease transmission and care. We find that larger structural factors produce vulnerabilities and reduce access to resources, which negatively impact hepatitis C disease outcomes.
Overdose is a leading cause of morbidity and mortality among people who inject drugs. Illicitly manufactured fentanyl is now a major driver of opioid overdose deaths.
Semi-structured interviews were ...conducted with 23 participants (19 persons who inject drugs and 4 service providers) from rural southern Illinois. Data were analyzed using constant comparison and theoretical sampling methods.
Participants were concerned about the growing presence of fentanyl in both opioids and stimulants, and many disclosed overdose experiences. Strategies participants reported using to lower overdose risk included purchasing drugs from trusted sellers and modifying drug use practices by partially injecting and/or changing the route of transmission. Approximately half of persons who inject drugs sampled had heard of fentanyl test strips, however fentanyl test strip use was low. To reverse overdoses, participants reported using cold water baths. Use of naloxone to reverse overdose was low. Barriers to naloxone access and use included fear of arrest and opioid withdrawal.
People who inject drugs understood fentanyl to be a potential contaminant in their drug supply and actively engaged in harm reduction techniques to try to prevent overdose. Interventions to increase harm reduction education and information about and access to fentanyl test strips and naloxone would be beneficial.
People who use drugs (PWUD) continue to be at risk of HIV infection, but the frequency and distribution of transmission-associated behaviors within various rural communities is poorly understood.
To ...examine the association of characteristics of rural PWUD with HIV transmission behaviors.
In this cross-sectional study, surveys of PWUD in rural communities in 10 states (Illinois, Kentucky, New Hampshire, Massachusetts, North Carolina, Ohio, Oregon, Vermont, West Virginia, and Wisconsin) were collected January 2018 through March 2020 and analyzed August through December 2022. A chain-referral sampling strategy identified convenience sample seeds who referred others who used drugs. Rural PWUD who reported any past 30-day injection drug use or noninjection opioid use "to get high" were included.
Individual characteristics, including age, race, gender identity, sexual orientation, partnership status, drug of choice, and location, were collected.
Past 30-day frequency of behaviors associated with HIV transmission, including drug injection, syringe sharing, opposite- and same-gender partners, transactional sex, and condomless sex, was assessed.
Of 3048 rural PWUD (mean SD age, 36.1 10.3 years; 225 American Indian 7.4%, 96 Black 3.2%, and 2576 White 84.5% among 3045 with responses; and 1737 men 57.0% among 3046 with responses), most participants were heterosexual (1771 individuals 86.8% among 2040 with responses) and single (1974 individuals 68.6% among 2879 with responses). Opioids and stimulants were reported as drug of choice by 1636 individuals (53.9%) and 1258 individuals (41.5%), respectively, among 3033 individuals with responses. Most participants reported recent injection (2587 of 3046 individuals 84.9% with responses) and condomless sex (1406 of 1757 individuals 80.0% with responses), among whom 904 of 1391 individuals (65.0%) with responses indicated that it occurred with people who inject drugs. Syringe sharing (1016 of 2433 individuals 41.8% with responses) and transactional sex (230 of 1799 individuals 12.8% with responses) were reported less frequently. All characteristics and behaviors, except the number of men partners reported by women, varied significantly across locations (eg, mean SD age ranged from 34.5 10.0 years in Wisconsin to 39.7 11.0 years in Illinois; P < .001). In multivariable modeling, younger age (adjusted odds ratio aOR for ages 15-33 vs ≥34 years, 1.36; 95% CI, 1.08-1.72) and being single (aOR, 1.37; 95% CI, 1.08-1.74) were associated with recent injection; younger age (aOR, 1.49; 95% CI, 1.20-1.85) and bisexual orientation (aOR vs heterosexual orientation, 2.27; 95% CI, 1.60-3.23) with syringe sharing; gender identity as a woman (aOR vs gender identity as a man, 1.46; 95% CI, 1.01-2.12), bisexual orientation (aOR vs heterosexual orientation, 2.59; 95% CI, 1.67-4.03), and being single (aOR, 1.71; 95% CI, 1.15-2.55) with transactional sex; and bisexual orientation (aOR vs heterosexual orientation, 1.60; 95% CI, 1.04-2.46) and stimulants as the drug of choice (aOR vs opioids, 1.45; 95 CI, 1.09-1.93) with condomless sex with someone who injects drugs.
This study found that behaviors associated with HIV transmission were common and varied across communities. These findings suggest that interventions to reduce HIV risk among rural PWUD may need to be tailored to locally relevant factors.
The MESSENGER Spacecraft Leary, James C; Conde, Richard F; Dakermanji, George ...
Space science reviews,
8/2007, Letnik:
131, Številka:
1-4
Journal Article
Recenzirano
The MErcury Surface, Space ENvironment, GEochemistry, and Ranging (MESSENGER) spacecraft was designed and constructed to withstand the harsh environments associated with achieving and operating in ...Mercury orbit. The system can be divided into eight subsystems: structures and mechanisms (e.g., the composite core structure, aluminum launch vehicle adapter, and deployables), propulsion (e.g., the state-of-the-art titanium fuel tanks, thruster modules, and associated plumbing), thermal (e.g., the ceramic-cloth sunshade, heaters, and radiators), power (e.g., solar arrays, battery, and controlling electronics), avionics (e.g., the processors, solid-state recorder, and data handling electronics), software (e.g., processor-supported code that performs commanding, data handling, and spacecraft control), guidance and control (e.g., attitude sensors including star cameras and Sun sensors integrated with controllers including reaction wheels), radio frequency telecommunications (e.g., the spacecraft antenna suites and supporting electronics), and payload (e.g., the science instruments and supporting processors). This system architecture went through an extensive (nearly four-year) development and testing effort that provided the team with confidence that all mission goals will be achieved.
A Mercury orbiter mission is challenging from thermal and mass perspectives. The Mercury Surface, Space Environment, Geochemistry, and Ranging (MESSENGER) mission overcomes these challenges while ...avoiding esoteric technologies by using an innovative approach with commonly available materials, minimal moving parts, and maximum heritage. This approach yields a spacecraft with good margins in all categories and low technical risk. The key concepts are a ceramic-cloth sunshade, an integrated lightweight structure and high- performance propulsion system, and a solar array incorporating optical solar reflectors (OSRs). The sunshade maintains the spacecraft at room temperature. The integrated structure and propulsion system provides ample mass margin. The solar array with OSRs, which has already undergone significant testing, provides thermal margin even if the panels are inadvertently pointed directly at the Sun at 0.3 AU.
0.3
AU
.
The only how-to guide offering a unified, systemic approach to acquiring, cleaning, and managing data in REvery experienced practitioner knows that preparing data for modeling is a painstaking, ...time-consuming process. Adding to the difficulty is that most modelers learn the steps involved in cleaning and managing data piecemeal, often on the fly, or they develop their own ad hoc methods. This book helps simplify their task by providing a unified, systematic approach to acquiring, modeling, manipulating, cleaning, and maintaining data in R. Starting with the very basics, data scientists Samuel E. Buttrey and Lyn R. Whitaker walk readers through the entire process. From what data looks like and what it should look like, they progress through all the steps involved in getting data ready for modeling. They describe best practices for acquiring data from numerous sources; explore key issues in data handling, including text/regular expressions, big data, parallel processing, merging, matching, and checking for duplicates; and outline highly efficient and reliable techniques for documenting data and recordkeeping, including audit trails, getting data back out of R, and more.The only single-source guide to R data and its preparation, it describes best practices for acquiring, manipulating, cleaning, and maintaining dataBegins with the basics and walks readers through all the steps necessary to get data ready for the modeling processProvides expert guidance on how to document the processes described so that they are reproducibleWritten by seasoned professionals, it provides both introductory and advanced techniquesFeatures case studies with supporting data and R code, hosted on a companion websiteA Data Scientist's Guide to Acquiring, Cleaning and Managing Data in R is a valuable working resource/bench manual for practitioners who collect and analyze data, lab scientists and research associates of all levels of experience, and graduate-level data mining students.
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