In summarizing the proceedings of a longitudinal meeting of experts on substance use disorders among adolescents and young adults, we review 2 principles of care related to harm reduction for young ...adults with substance use disorders. The first is that harm reduction services are critical to keeping young adults alive and healthy and can offer opportunities for future engagement in treatment. Such services therefore should be offered at every opportunity, regardless of an individual's interest or ability to minimize use of substances. The second is that all evidence-based harm reduction strategies available to older adults should be available to young adults and that whenever possible, harm reduction programs should be tailored to young adults and be developmentally appropriate.
National efforts are underway to reduce hospital readmissions. Few studies have used administrative data to provide a global view of readmission among people experiencing homelessness, who often ...utilize multiple hospital systems.
To examine the 30-day hospital readmission rate and factors associated with readmission following discharge among homeless Medicaid members in Massachusetts.
We analyzed medical record and Medicaid administrative data for 1269 hospitalizations between 2013 and 2014 for 458 unique patients attributed to Boston Health Care for the Homeless Program. Generalized Estimating Equations were used to investigate factors associated with readmission.
Of all hospitalizations, 27% resulted in readmission, more than double the average national Medicaid readmission rate. Leaving against medical advice was associated with increased readmission, while having a Health Care for the Homeless primary care practitioner was associated with reduced readmission. Among the most frequently admitted individuals, being discharged to medical respite care was associated with reduced readmission.
To break the readmission cycle, health care providers serving homeless individuals could focus on assuring access to medical respite care and extending outreach efforts that increase primary care engagement. This may be especially important for accountable care systems, as safety net providers increasingly assume financial risk for patients' total cost and quality of care.
To analyse changes in trends in mortality due to chronic obstructive pulmonary disease (COPD) in Spain by Autonomous Community (AC) and sex during the period 1980-2021.
Data on population and COPD ...death records (International Classification of Diseases, 10
edition, codes J40â-"J44 and J47) were retrieved from the National Institute of Statistics for the study period. Age-standardised mortality rates by AC and sex were assessed using joinpoint regression models.
There were 562,668 deaths due to COPD (423,855 in men and 138,813 in women), with an average annual increase of 1.6%. COPD deaths in men increased in most ACs, except for Asturias (â-"0.5% per year). The Canary Islands (14% per year) and Madrid (6.5% per year) had the highest increases. In women, the figures show a wide range of values at the AC level (from a â-"1.4% decrease to 7.9% increase). Nationally, the sex ratio increased from 1980 to 2021. In men, six ACs showed a significant decrease, while in women only two ACs showed a significant decrease.
A steady decrease in COPD mortality was observed in most ACs for men, while a different trend was observed in women in several ACs. Despite past and ongoing tobacco control initiatives, this condition remains a leading cause of death.
Leucititic rocks, K-foiditic in composition are volumetrically important in the Colli Albani (also known as Alban Hills) volcanic district (Central Italy) especially during the most explosive phases ...of activity (>200 km3). The Colli Albani tephra in distal (>500 km) deposits indicates that K-foiditic magma chambers fed large explosive eruptions (i.e., tens of km3 of pyroclastic rocks). Major oxides, trace elements and Raman spectra were measured on the glasses and minerals occurring in the K-foiditic scoria clasts of the ~530 kyr-old Tufo del Palatino, erupted in the Colli Albani volcanic district. The Colli Albani pre-eruptive magmatic system is characterized by the aH2O < 1 and high CO2 activity in the melt, as testified by the CO3 in the clinopyroxene melt inclusions, by the early crystallization of CO3-bearing apatite and by the high CO2 activity in the free volatile phase that led to crystallization of calcium carbonate in the scoria clast vesicles. The K-foiditic magmas plot on the Cpx + Lc + melt divariant surface of the Ol-Cpx-Lc-Mel-H2O-CO2, P ≥ 0.2 GPa and T ≤ 1100 °C. The assimilation of cold carbonate by hot magmas is an important open-system process allowing the establishment of aH20 < 1 condition in the volatile-rich, Colli Albani magma chambers where the stability fields of the olivine and phlogopite are reduced in favor of clinopyroxene and leucite. Trace element modelling indicates large amount of carbonate assimilation (~12.4 wt%) involved in the differentiation process that origins the K-foiditic magmas starting from a K-rich, phonotephritic parental magma. The large amount of assimilate carbonate is consistent with the peculiar distribution of the latent heat across the crystallization interval of the phonotephritic parental magma. The isenthalpic assimilation process is very efficient in the phonotephritic magma because the crystallization of clinopyroxene and leucite in equilibrium with a K-foiditic melt proceeds over a relatively large temperature interval (>200 °C) and the K-foiditic melt shows low viscosity (104Pa·s at 1000 °C). Actually, the low melt viscosity, that increases the growth rate, and the large temperature interval of crystallization are intrinsic factors that increase the release of the latent heat of crystallization from the phonotephritic parental magma. Extrinsic factors enhancing the assimilation process efficiency are the thickness (>4 km) and the depth (down to 5–7 km) of the carbonate substrate in the Colli Albani volcanic district.
The large-scale experiments described herein were carried out at Forschungs-Zentrum Küste (FZK), Hannover (Germany) by a research team of the Universities of Bologna, Edinburgh, Southampton, ...Plymouth, HR Wallingford and the Coast and Harbor Engineering, Inc. (USA). Wave-induced loads on close-to-prototype jetties were measured. Experimental evidence indicates the presence of force peaks with a short space-time correlation structure, carried by convective processes with a velocity of the order of the wave celerity. The important limitations imposed by the imperfect spatial resolution of pressure transducers on the integrated force are discussed. The finding may be of interest to design laboratory tests involving rapidly-varied processes such as impact waves and the subsequent analysis phase, which may lead to gross errors in the evaluation of the integral process. A guideline to select the cutting frequency is provided.
Eruptive scenarios associated with the possible reactivation of maar-forming events in the Quaternary, ultrapotassic Colli Albani Volcanic District (CAVD) provides implications for volcanic hazard ...assessment in the densely populated area near Rome. Based on detailed stratigraphy, grain size, componentry, ash morphoscopy and petro-chemical analyses of maar eruption products, along with textural analysis of cored juvenile clasts, we attempt to reconstruct the eruptive dynamics of the Prata Porci and Albano maars, as related to pre- and syn-eruptive interactions between trachybasaltic to K-foiditic feeder magmas and carbonate–silicoclastic and subvolcanic country rocks. Magma volumes in the order of 0.5–3.1
×
10
8 m
3 were erupted during the monogenetic Prata Porci maar activity and the three eruptive cycles of the Albano multiple maar, originating loose to strongly lithified, wet and dry pyroclastic surge deposits, Strombolian scoria fall horizons and lithic-rich explosion breccias. These deposits contain a wide range of accessory and accidental lithic clasts, with significant vertical stratigraphic variations in the lithic types and abundances. The two maar study cases hold a record of repeated transitions between magmatic (i.e, Strombolian fallout) and hydromagmatic (wet and dry pyroclastic surges) activity styles. Evidence of phreatic explosions, a common precursor of explosive volcanic activity, is only found at the base of the Prata Porci eruptive succession. The quantitative evaluation of the proportions of the different eruptive styles in the stratigraphic record of the two maars, based on magma vs. lithic volume estimates, reveals a prevailing magmatic character in terms of erupted magma volumes despite the hydromagmatic footprint. Different degrees of explosive magma–water interaction were apparently controlled by the different hydrogeological and geological–structural settings. In the Prata Porci case, shifts in the depth of magma fragmentation are proposed to have accompanied eruption style changes. In the Albano case, a deeply dissected geothermal aquifer in peri-caldera setting and variable mass eruption rates were the main controlling factors of repeated shifts in the eruptive style. Finally, textural evidence from cored juvenile clasts and analytical modeling of melt–solid heat transfer indicate that the interacting substrate in the Prata Porci case was at low, uniform temperature (~ 100 °C) as compared to the highly variable temperatures (up to 700–800 °C) inferred for the geothermal system beneath Albano.
In the European Union three different health systems could be defined according to service delivery, financing, and economic policies: Beveridge, Bismarck and Mixed system. Although health systems ...are hardly to compare, various organizations are developing methods assessing performance. In the present work the performance of the three systems were evaluated using European Community Health Indicators according to Organization for Economic Cooperation and Development.
The study has been conducted among the 28 states of the European Union using the following indicators: Standardized death rate for diseases of the circulatory system, standardized death rate of malignant neoplasms, road traffic accidents with injury, life expectancy at birth, incidence of Human Immunodeficiency Virus (HIV), infant deaths, pure alcohol consumption, infants vaccinated against Diphtheria Tetanus Pertussis (DTP), public and total expenditure on health over the period 2001-2010.
The variation of health indicators over the observational time shows similar trend of circulatory system diseases and malignant neoplasms death rates, road accidents with injury, infant deaths, life expectancy at birth, public and total health expenditure. Some differences in the trend of HIV incidence, alcohol intake and DTP vaccination rates arise among systems. Grouping countries by health system paradigm and geographical area, resulted in a relevant heterogeneity (I
≥ 90%, Pvalue < 0.0001). No clear superiority of a given health delivery system was found with respect to other paradigms.
In accordance with the evidence of our study, it can be stated that best performances are more likely to be linked to country specific economic factors. In conclusion, it was not possible to identify the best health system model.
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