Impact of a community-based naloxone distribution program on opioid overdose death rates

Background: In August 2013, a naloxone distribution program was implemented in North Carolina (NC). This study evaluated that program by quantifying the association between the program and county-level opioid overdose death (OOD) rates and conducting a cost-benefit analysis. Methods: One-group pre-post design. Data included annual county-level counts of naloxone kits distributed from 2013 to 2016 and mortality data from 2000-2016. We used generalized estimating equations to estimate the association between cumulative rates of naloxone kits distributed and annual OOD rates. Costs included naloxone kit purchases and distribution costs; benefits were quantified as OODs avoided and monetized using a conservative value of a life. Results: The rate of OOD in counties with 1–100 cumulative naloxone kits distributed per 100,000 population was 0.90 times (95% CI: 0.78, 1.04) that of counties that had not received kits. In counties that received >100 cumulative kits per 100,000 population, the OOD rate was 0.88 times (95% CI: 0.76, 1.02) that of counties that had not received kits. By December 2016, an estimated 352 NC deaths were avoided by naloxone distribution (95% CI: 189, 580). On average, for every dollar spent on the program, there was $2742 of benefit due to OODs avoided (95$1,237, $4882). Conclusions: Our estimates suggest that community-based naloxone distribution is associated with lower OOD rates. The program generated substantial societal benefits due to averted OODs. States and communities should continue to support efforts to increase naloxone access, which may include reducing legal, financial, and normative barriers

Heat and mass transfer in unsaturated porous media. Final report

A preliminary study of heat and water transport in unsaturated porous media is reported. The project provides background information regarding the feasibility of seasonal thermal energy storage in unconfined aquifers. A parametric analysis of the factors of importance, and an annotated bibliography of research findings pertinent to unconfined aquifer thermal energy storage (ATES) are presented. This analysis shows that heat and mass transfer of water vapor assume dominant importance in unsaturated porous media at elevated temperature. Although water vapor fluxes are seldom as large as saturated medium liquid water fluxes, they are important under unsaturated conditions. The major heat transport mechanism for unsaturated porous media at temperatures from 50 to 90/sup 0/C is latent heat flux. The mechanism is nonexistent under saturated conditions but may well control design of unconfined aquifer storage systems. The parametric analysis treats detailed physical phenomena which occur in the flow systems study and demonstrates the temperature and moisture dependence of the transport coefficients of importance. The question of design of an unconfined ATES site is also addressed by considering the effects of aquifer temperature, depth to water table, porous medium flow properties, and surface boundary conditions. Recommendations are made for continuation of this project in its second phase. Both scientific and engineering goals are considered and alternatives are presented

Subsurface monitoring of reservoir pressure, temperature, relative humidity, and water content at the CAES Field Experiment, Pittsfield, Illinois: system design

This subsurface-instrumentation design has been developed for the first Compressed Air Energy Storage (CAES) field experiment to be performed in porous media. Energy storage will be accomplished by alternating the injection and withdrawal of compressed air in a confined sandstone aquifer near Pittsfield, Illinois. The overall experiment objective is to characterize the reservoir's geochemical and thermohydraulic response to imposed CAES conditions. Specific experiment objectives require monitoring: air-bubble development; thermal development; cyclic pressure response; reservoir dehydration; and water coning. Supporting these objectives, four parameters will be continuously monitored at depth in the reservoir. They are: temperature; pressure; pore-air relative humidity; and pore-water content. Reservoir temperatures and pressures will range to maximum values approaching 200/sup 0/C and 300 psi, respectively. Both pore-air relative humidity and pore-water content will range from approx. 0 to 100%. This report discusses: instrumentation design; sensor and sensor system calibration; field installation and testing; and instrument-system operation. No comprehensive off-the-shelf instrument package exists to adequately monitor CAES reservoir parameters at depth. The best available sensors were selected and adapted for use under expected ranges of reservoir conditions. The instrumentation design criteria required: suitable sensor accuracy; continuous monitoring capability; redundancy; maximum sensor integrity; contingency planning; and minimum cost-information ratio. Three wells will be instrumented: the injection/withdrawal (I/W) well and the two instrument wells. Sensors will be deployed by wireline suspension in both open and backfilled (with sand) wellbores. The sensors deployed in the I/W well will be retrievable; the instrument-well sensors will not