Quantifying Syringe Exchange Program Operational Space in the District of Columbia.

Syringe exchange programs (SEPs) are effective structural interventions for HIV prevention among persons who inject drugs. In 2000, a buffer zone policy (the 1000 Foot Rule) was implemented in Washington, DC, that prohibited SEP operations within 1000 feet of schools. We examined changes in the amount of legal SEP operational space over time. We used data pertaining to school operations and their approximate physical property boundaries to quantify the impact of the 1000 Foot Rule on legal SEP operational space from its implementation in 2000-2013. Adherence to the 1000 Foot Rule reduced SEP operational space by more than 50 % annually since its implementation. These findings demonstrate the significant restrictions on the amount of legal SEP operational space in Washington, DC, that are imposed by the 1000 Foot Rule. Changing this policy could have a significant impact on SEP service delivery among injectors

Assessing syringe exchange program access among persons who inject drugs (PWID) in the District of Columbia

Prior research has explored spatial access to syringe exchange programs (SEPs) among persons who inject drugs (PWID), but these studies have been based on limited data from short periods of time. No research has explored changes in spatial access to SEPs among PWID longitudinally. The purpose of this research is to examine spatial access to SEPs among PWID who accessed services at a SEP in Washington, District of Columbia (DC), from 1996 to 2010. The geometric point distance estimation technique was used to calculate the mean walking distance PWID traveled from the centroid point of their zip code of home residence to the mobile exchange site where they accessed SEP services. Analysis of variance (ANOVA) was used to examine differences in walking distance measures by year. The results of this research suggest that the distance DC PWID traveled to access SEP services remained relatively constant (approximately 2.75 mi) from 2003 to 2008, but increased to just over 4 mi in 2010. This research provides support for expanding SEP operations such that PWID have increased access to their services. Increasing SEP accessibility may help resolve unmet needs among injectors

Impact Evaluation of a Policy Intervention for HIV Prevention in Washington, DC

Syringe exchange programs (SEPs) lower HIV risk. From 1998 to 2007, Congress prohibited Washington, DC, from using municipal revenue for SEPs. We examined the impact of policy change on IDU-associated HIV cases. We used surveillance data for new IDU-associated HIV cases between September 1996 and December 2011 to build an ARIMA model and forecasted the expected number of IDU-associated cases in the 24 months following policy change. Interrupted time series analyses (ITSA) were used to assess epidemic impact of policy change. There were 176 IDU-associated HIV cases in the 2 years post-policy change; our model predicted 296 IDU-associated HIV cases had the policy remained in place, yielding a difference of 120 averted HIV cases. ITSA identified significant immediate (B = −6.0355, p = .0005) and slope changes (B = −.1241, p = .0427) attributed to policy change. Policy change is an effective structural intervention for HIV prevention when it facilitates the implementation of services needed by vulnerable populations

Using Capture-Recapture Methods to Estimate the Population of People Who Inject Drugs in Washington, DC

No current estimates exist for the size of the population of people who inject drugs (PWID) in the District of Columbia (DC). The WHO/UNAIDS Guidelines on Estimating the Size of Populations Most at Risk to HIV was used as the methodological framework to estimate the DC PWID population. The capture phase recruited harm reduction agency clients; the recapture phase recruited community-based PWID. The 951 participants were predominantly Black (83.9 %), male (69.8 %), and 40+ years of age (68.2 %). Approximately 50.3 % reported injecting drugs in the past 30 days. We estimate approximately 8829 (95 % CI 4899 and 12,759) PWID in DC. When adjusted for possible missed sub-populations of PWID, the estimate increases to 12,000; thus, the original estimate of approximately 9000 should be viewed in the context of the 95 % confidence interval. These evidence-based estimations should be used to determine program delivery needs and resource allocation for PWID in Washington, DC

Assessing seasonality of travel distance to harm reduction service providers among persons who inject drugs.

BACKGROUND: Prior research has examined access to syringe exchange program (SEP) services among persons who inject drugs (PWID), but no research has been conducted to evaluate variations in SEP access based on season. This is an important gap in the literature given that seasonal weather patterns and inclement weather may affect SEP service utilization. The purpose of this research is to examine differences in access to SEPs by season among PWID in the District of Columbia (DC). FINDINGS: A geometric point distance estimation technique was applied to records from a DC SEP that operated from 1996 to 2011. We calculated the walking distance (via sidewalks) from the centroid point of zip code of home residence to the exchange site where PWID presented for services. Analysis of variance (ANOVA) was used to examine differences in walking distance measures by season. Differences in mean walking distance measures were statistically significant between winter and spring with PWID traveling approximately 2.88 and 2.77 miles, respectively, to access the SEP during these seasons. CONCLUSIONS: The results of this study suggest that seasonal differences in SEP accessibility may exist between winter and spring. PWID may benefit from harm reduction providers adapting their SEP operations to provide a greater diversity of exchange locations during seasons in which inclement weather may negatively influence engagement with SEPs. Increasing the number of exchange locations based on season may help resolve unmet needs among injectors

Legal space for syringe exchange programs in hot spots of injection drug use-related crime.

BACKGROUND: Copious evidence indicates that syringe exchange programs (SEPs) are effective structural interventions for HIV prevention among persons who inject drugs (PWID). The efficacy of SEPs in supporting the public health needs of PWID populations is partially dependent on their accessibility and consistent utilization among injectors. Research has shown that SEP access is an important predictor of PWID retention at SEPs, yet policies exist that may limit the geographic areas where SEP operations may legally occur. Since 2000 in the District of Columbia (DC), SEP operations have been subject to the 1000 Foot Rule (§48-1121), a policy that prohibits the distribution of any needle or syringe for the hypodermic injection of any illegal drug in any area of the District of Columbia which is within 1000 feet of a public or private elementary or secondary school (including a public charter school). The 1000 Foot Rule may impede SEP services in areas that are in urgent need for harm reduction services, such as locations where injections are happening in real time or where drugs are purchased or exchanged. We examined the effects of the 1000 Foot Rule on SEP operational space in injection drug use (IDU)-related crime (i.e., heroin possession or distribution) hot spots from 2000 to 2010. METHODS: Data from the DC Metropolitan Police Department were used to identify IDU-related crime hot spots. School operation data were matched to a dataset that described the approximate physical property boundaries of land parcels. A 1000-ft buffer was applied to all school property boundaries. The overlap between the IDU-related crime hot spots and the school buffer zones was calculated by academic year. RESULTS: When overlaying the land space associated with IDU-related crime hot spots on the maps of school boundaries per the 1000-ft buffer zone stipulation, we found that the majority of land space in these locations was ineligible for legal SEP operations. More specifically, the ineligible space in the identified hot spots in each academic year ranged from 51.93 to 88.29 % of the total hot spot area. CONCLUSIONS: The removal of the 1000 Foot Rule could significantly improve the public health of PWID via increased access to harm reduction services. Buffer zone policies that restrict SEP operational space negatively affect the provision of harm reduction services to PWID

EFFECTS OF ORTHODONTIC MINI-IMPLANT DIAMETER ON MICRODAMAGE.

POSTER ABSTRACTMicrodamage reduces bone mechanical properties and thus could possi-bly contribute to implant failure. The objective of this study was to investi-gate whether the diameter of mini-implants (MI) affects microdamage gen-eration and whether this differs between the mandible and maxilla due to their contrasting cortical thicknesses. Methods: Maxillary and mandibular quadrants of 5 dogs were randomly assigned to receive, in situ, no interven-tion (control), pilot drilling only, or pilot drilling plus one of three diameters of MI: 1.4 (n=18), 1.6 (n=18), and 2.0 mm (n=18). Microdamage was as-sessed on basic fuchsin stained sections using epifluorescence microscopy. Results: No microdamage was found in the non-drilling controls. Pilot drill-ing produced only minimal microdamage in the maxilla but more microdamage in the mandible. There was significantly higher microdamage generated in the mandible, compared to the maxilla (p<0.05). In the maxil-la, although insertion of all implants produced higher microdamage than the control and pilot drilling, there were no differences between the 3 MI diame-ters. In the mandible, insertion of implants generated significantly higher microdamage than the control, but it did not produce higher microdamage than pilot drilling. Similarly, no differences in microdamage were found be-tween 3 MI diameters. Conclusion: Insertion of MIs in the mandible pro-duced higher microdamage than in the maxilla, which may explain that the higher MI failure rate in the mandible. Implant diameter did not affect over-all microdamage burden in either jaw. Microdamage was mostly generated by pilot drilling through the cortex in the mandible, while microdamage in the maxilla was mainly produced when manual inserting MIs after pilot drill-ing

Energy non-equipartition in systems of inelastic, rough spheres

We calculate and verify with simulations the ratio between the average translational and rotational energies of systems with rough, inelastic particles, either forced or freely cooling. The ratio shows non-equipartition of energy. In stationary flows, this ratio depends mainly on the particle roughness, but in nonstationary flows, such as freely cooling granular media, it also depends strongly on the normal dissipation. The approach presented here unifies and simplifies different results obtained by more elaborate kinetic theories. We observe that the boundary induced energy flux plays an important role.Comment: 4 pages latex, 4 embedded eps figures, accepted by Phys Rev

Postnatal β2 adrenergic treatment improves insulin sensitivity in lambs with IUGR but not persistent defects in pancreatic islets or skeletal muscle

Placental insufficiency causes intrauterine growth restriction (IUGR) and disturbances in glucose homeostasis with associated β adrenergic receptor (ADRβ) desensitization. Our objectives were to measure insulin-sensitive glucose metabolism in neonatal lambs with IUGR and to determine whether daily treatment with ADRβ2 agonist and ADRβ1/β3 antagonists for 1 month normalizes their glucose metabolism. Growth, glucose-stimulated insulin secretion (GSIS) and glucose utilization rates (GURs) were measured in control lambs, IUGR lambs and IUGR lambs treated with adrenergic receptor modifiers: clenbuterol atenolol and SR59230A (IUGR-AR). In IUGR lambs, islet insulin content and GSIS were less than in controls; however, insulin sensitivity and whole-bodyGUR were not different from controls.Of importance, ADRβ2 stimulation with β1/β3 inhibition increases both insulin sensitivity and whole-body glucose utilization in IUGR lambs. In IUGR and IUGR-AR lambs, hindlimb GURs were greater but fractional glucose oxidation rates and ex vivo skeletal muscle glucose oxidation rates were lower than controls. Glucose transporter 4 (GLUT4) was lower in IUGR and IUGR-AR skeletal muscle than in controls but GLUT1 was greater in IUGR-AR. ADRβ2, insulin receptor, glycogen content and citrate synthase activity were similar among groups. In IUGR and IUGR-AR lambs heart rates were greater, which was independent of cardiac ADRβ1 activation. We conclude that targeted ADRβ2 stimulation improved whole-body insulin sensitivity but minimally affected defects in GSIS and skeletal muscle glucose oxidation. We show that risk factors for developing diabetes are independent of postnatal catch-up growth in IUGR lambs as early as 1 month of age and are inherent to the islets and myocytes