The Apollo project manager, anomalies and ambiguities

Problems of Apollo project managers in decision making and production engineerin

The Professional and Technical Qualifications of Apollo Project Managers

Qualifications of Apollo project manager personne

Health outcomes in patients using no-prescription online pharmacies to purchase prescription drugs

BACKGROUND: Many prescription drugs are freely available for purchase on the Internet without a legitimate prescription from a physician. OBJECTIVE: This study focused on the motivations for using no-prescription online pharmacies (NPOPs) to purchase prescription drugs rather than using the traditional doctor-patient-pharmacy model. We also studied whether users of NPOP-purchased drugs had poorer health outcomes than those who obtain the same drug through legitimate health care channels. METHODS: We selected tramadol as a representative drug to address our objective because it is widely prescribed as an unscheduled opioid analgesic and can easily be purchased from NPOPs. Using search engine marketing (SEM), we placed advertisements on search result pages stemming from the keyword “tramadol” and related terms and phrases. Participants, who either used the traditional doctor-patient-pharmacy model to obtain tramadol (traditional users, n=349) or purchased it on the Web without a prescription from their local doctor (ie, nontraditional users, n=96), were then asked to complete an online survey. RESULTS: Respondents in both groups were primarily white, female, and in their mid-forties (nontraditional users) to upper forties (traditional users). Nearly all nontraditional users indicated that their tramadol use was motivated by a need to treat pain (95%, 91/96) that they perceived was not managed appropriately through legitimate health care channels. A majority of nontraditional users (55%, 41/75) indicated they used NPOPs because they did not have access to sufficient doses of tramadol to relieve pain. In addition, 29% (22/75) of nontraditional users indicated that the NPOPs were a far cheaper alternative than seeing a physician, paying for an office visit, and filling a prescription at a local pharmacy, which is often at noninsured rates for those who lack medical insurance (37%, 35/96, of NPOP users). The remainder of participants (16%, 12/96) cited other motivations (eg, anonymity) for using NPOPs. In terms of health outcomes, nontraditional users experienced a significantly (P<.01) greater number and severity of adverse events, including life-threatening seizures: 7% (7/96) of nontraditional users reported seizures, while none of the traditional users reported seizures. CONCLUSIONS: Although online pharmacies can offer distinct advantages in terms of convenience and cost, users of these “rogue” pharmacies that offer drugs with no prescription or doctor supervision do so at great risk to their health, as evidenced by much higher rates of adverse events. The most logical explanation for these findings is that the lack of physician oversight of dosage schedules, contraindicated conditions, and concomitant medications, were responsible for the increased intensity and frequency of adverse events in the nontraditional users. Although we only examined tramadol, it is logical to postulate that similar results would be observed with dozens of equally accessible prescription drugs. As such, the geometric growth in the use of online pharmacies around the world should prompt intense medical and regulatory discussion about their role in the provision of medical care

Theoretical investigations of a highly mismatched interface: the case of SiC/Si(001)

Using first principles, classical potentials, and elasticity theory, we investigated the structure of a semiconductor/semiconductor interface with a high lattice mismatch, SiC/Si(001). Among several tested possible configurations, a heterostructure with (i) a misfit dislocation network pinned at the interface and (ii) reconstructed dislocation cores with a carbon substoichiometry is found to be the most stable one. The importance of the slab approximation in first-principles calculations is discussed and estimated by combining classical potential techniques and elasticity theory. For the most stable configuration, an estimate of the interface energy is given. Finally, the electronic structure is investigated and discussed in relation with the dislocation array structure. Interface states, localized in the heterostructure gap and located on dislocation cores, are identified

Alternate Routes of Administration and Risk for HIV Among Prescription Opioid Abusers

Route of administration is an important contributor to the adverse health consequences of prescription medication abuse. The current study examines characteristics associated with non-oral routes of administration among a large sample of prescription opioid abusers and explores needle-related human immunodeficiency virus (HIV) risk behaviors as well. In the study, 791 opioid abusers completed a one-time structured interview, including complete histories of illicit and prescription drug abuse and route of drug administration. The most common method of pill use was oral (91%), followed by intranasal (53.1%), injection (23.8%), and smoking (14.5%). The youngest prescription opioid abusers, ages 18-24, displayed significantly higher odds of using alternate routes of administration and of reusing nonsterile needles for injection. HIV prevention programming should be developed for young prescription opioid injectors

Factors Contributing to the Rise of Buprenorphine Misuse: 2008-2013

OBJECTIVE: The purpose of the present study was to examine the motivations underlying the use of buprenorphine outside of therapeutic channels and the factors that might account for the reported rapid increase in buprenorphine misuse in recent years. METHODS: This study used: (1) a mixed methods approach consisting of a structured, self-administered survey (N=10,568) and reflexive, qualitative interviews (N=208) among patients entering substance abuse treatment programs for opioid dependence across the country, centered on opioid misuse patterns and related behaviors; and (2) interviews with 30 law enforcement agencies nationwide about primary diverted drugs in their jurisdictions. RESULTS: Our results demonstrate that the misuse of buprenorphine has increased substantially in the last 5 years, particularly amongst past month heroin users. Our quantitative and qualitative data suggest that the recent increases in buprenorphine misuse are due primarily to the fact that it serves a variety of functions for the opioid-abusing population: to get high, manage withdrawal sickness, as a substitute for more preferred drugs, to treat pain, manage psychiatric issues and as a self-directed effort to wean themselves off opioids. CONCLUSION: The non-therapeutic use of buprenorphinehas risen dramatically in the past five years, particularly in those who also use heroin. However, it appears that buprenorphine is rarely preferred for its inherent euphorigenic properties, but rather serves as a substitute for other drugs, particularly heroin, or as a drug used, preferable to methadone, to self-medicate withdrawal sickness or wean off opioids

The Changing Face of Heroin Use in the United States: A Retrospective Analysis of the Past 50 Years

IMPORTANCE: Over the past several years, there have been a number of mainstream media reports that the abuse of heroin has migrated from low-income urban areas with large minority populations to more affluent suburban and rural areas with primarily white populations. OBJECTIVE: To examine the veracity of these anecdotal reports and define the relationship between the abuse of prescription opioids and the abuse of heroin. DESIGN, SETTING, AND PARTICIPANTS: Using a mixed-methods approach, we analyzed (1) data from an ongoing study that uses structured, self-administered surveys to gather retrospective data on past drug use patterns among patients entering substance abuse treatment programs across the country who received a primary (DSM-IV) diagnosis of heroin use/dependence (n = 2797) and (2) data from unstructured qualitative interviews with a subset of patients (n = 54) who completed the structured interview. MAIN OUTCOMES AND MEASURES: In addition to data on population demographics and current residential location, we used cross-tabulations to assess prevalence rates as a function of the decade of the initiation of abuse for (1) first opioid used (prescription opioid or heroin), (2) sex, (3) race/ethnicity, and (4) age at first use. Respondents indicated in an open-ended format why they chose heroin as their primary drug and the interrelationship between their use of heroin and their use of prescription opioids. RESULTS: Approximately 85% of treatment-seeking patients approached to complete the Survey of Key Informants\u27 Patients Program did so. Respondents who began using heroin in the 1960s were predominantly young men (82.8%; mean age, 16.5 years) whose first opioid of abuse was heroin (80%). However, more recent users were older (mean age, 22.9 years) men and women living in less urban areas (75.2%) who were introduced to opioids through prescription drugs (75.0%). Whites and nonwhites were equally represented in those initiating use prior to the 1980s, but nearly 90% of respondents who began use in the last decade were white. Although the high produced by heroin was described as a significant factor in its selection, it was often used because it was more readily accessible and much less expensive than prescription opioids. CONCLUSION AND RELEVANCE: Our data show that the demographic composition of heroin users entering treatment has shifted over the last 50 years such that heroin use has changed from an inner-city, minority-centered problem to one that has a more widespread geographical distribution, involving primarily white men and women in their late 20s living outside of large urban areas

Development and Initial Validation of the Beliefs About Sexual Functioning Scale: A Gender Invariant Measure

The work was financially supported by the BIAL Foundation Fellowship (167/12) and by the Portuguese Science Foundation (CPUP UID/PSI/00050/2013; FEDER/COMPETE2020 POCI-01-0145-FEDER-007294).Background: Past research on cognitive models of sexual functioning has focused on sexual beliefs as an important vulnerability factor for sexual dysfunction. However, the existing measurements of sexual beliefs are lengthy and entangle beliefs about sexual functioning with moral beliefs and ideas about sexuality. Furthermore, they have female and male versions, which does not allow for sex comparisons or dyadic research with heterosexual couples. Aim: To describe the development and validation of the Beliefs About Sexual Functioning Scale (BASEF), which assesses beliefs about sexual functioning in men and women. Methods: This study included two cross-sectional online studies with adults in heterosexual dyadic committed and exclusive relationships. In study 1 (sample A, n ¼ 274, mean age ¼ 32.27 years; sample B, n ¼ 114, mean age ¼ 30.6 years), the factorial validity of the BASEF was analyzed through an exploratory factor analysis with an initial poll of 51 items, followed by a test of its structure in a confirmatory factor analysis. In study 2 (n ¼ 426, mean age ¼ 31.5 years), the factorial equivalence of the BASEF was tested across sexes and its association with total scores of sexual functioning was analyzed. Outcome: The main outcome was a new instrument for measurement of beliefs about sexual functioning. Results: In study 1, 15 items indicating 5 factors were retained. The structure was confirmed by confirmatory factor analysis, establishing its factorial validity with the five factors aggregated in a second-order latent variable. In study 2, the equivalence of the BASEF was demonstrated across sexes and its association with theoretically related measurements, the International Index of Erectile Function and the Female Sexual Function Index, was supported. Clinical Implications: This new measurement could be useful to evaluate clients and design interventions that take into account similarity and discrepancy in sexual beliefs in couples, such as those interventions framed in cognitive and systemic clinical models. Strengths and Limitations: This study presents a new measurement of beliefs about sexual functioning suited to address an equivalent set of beliefs for men and women. In future studies, the scale will be useful to compare the unique role of these same beliefs in the sexual outcomes of men and women. One major limitation is the lack of examination of the BASEF criterion validity with a clinical sample. Conclusions: Results are indicative of a brief, valid, and reliable sex-invariant measurement of beliefs about sexual functioning that enables testing of cognitive models of sexual functioning in men and women in clinical and research settings.info:eu-repo/semantics/publishedVersio

Mechanisms of Prescription Drug Diversion among Drug-Involved Club and Street-Based Populations

OBJECTIVE: Prescription drug diversion involves the unlawful channeling of regulated pharmaceuticals from legal sources to the illicit marketplace, and can occur along all points in the drug delivery process, from the original manufacturing site to the wholesale distributor, the physician\u27s office, the retail pharmacy, or the patient. However, empirical data on diversion are limited. METHOD: In an attempt to develop a better understanding of how specific drug-using populations are diverting prescription opioids and other medications, or obtaining controlled drugs that have already been diverted, qualitative interviews and focus group data were collected on four separate populations of prescription drug abusers in Miami, Florida--club drug users, street-based illicit drug users, methadone maintenance patients, and HIV positive individuals who abuse and/or divert drugs. RESULTS: Sources of abused prescription drugs cited by focus group participants were extremely diverse, including their physicians and pharmacists; parents and relatives; doctor shopping ; leftover supplies following an illness or injury; personal visits to Mexico, South America and the Caribbean; prescriptions intended for the treatment of mental illness; direct sales on the street and in nightclubs; pharmacy and hospital theft; through friends or acquaintances; under-the-door apartment flyers advertising telephone numbers to call; and stealing from grandma\u27s medicine cabinet. CONCLUSION: While doctor shoppers, physicians and the Internet receive much of the attention regarding diversion, the data reported in this paper suggest that there are numerous active street markets involving patients, Medicaid recipients and pharmacies as well. In addition, there are other data which suggest that the contributions of residential burglaries, pharmacy robberies and thefts, and sneak thefts to the diversion problem may be understated