Factors associated with gaps in naloxone knowledge: evidence from a 2022 great plains survey

Background The rising prevalence of fast-acting opioids in the USA suggests the increased need for non-professional first responder administration of naloxone. Effective administration of naloxone during an overdose requires that bystanders are familiar with, have access to, and know how to use naloxone. Methods Drawing on a statewide, address-based sample of Nebraskan adults, we used logistic regression to predict the likelihood of respondents’ familiarity with, access to, and competency to administer naloxone. Our independent variables included measures indicating proximity to drug use, perceived community stigma toward people who use drugs, and demographic data. Results There were significant gaps in naloxone knowledge in Nebraska. Although 74.8% of respondents were familiar with naloxone, only 18.2% knew how to access it and 18.0% knew how to use it. Being close to an overdose experience, lifetime illicit opioid use, being close to a person who uses opioids, and having access to illicit opioids were not significantly associated with naloxone familiarity, access, or competency among respondents in Nebraska’s two largest cities, Omaha and Lincoln. Outside of these cities, being close to a past overdose experience and access to illicit opioids was associated with higher odds of naloxone access and competency, but lifetime opioid use and being close to a person who uses opioids were not. Finally, among those familiar with naloxone, a higher perception of community stigma toward people who use opioids generally was associated with lower odds of naloxone access and competency. Higher perception of community stigma toward people who use heroin, methamphetamines, and cocaine, however, was associated with higher odds of naloxone access. Conclusions Our findings highlight the continued need for education on naloxone with a specific focus on access and competency to further reduce opioid-related overdose deaths. Specific focus should be placed on promoting naloxone knowledge among people with a higher likelihood of needing to administer naloxone to reduce otherwise avoidable deaths. Further work is needed to understand differences in the relationship between substance-specific perceived stigma and its association with naloxone access

The potential for material circularity and independence in the U.S. steel sector

Achieving a U.S. circular economy would reduce environmental impacts and increase material independence. This article calculates maximum recycled contents (RCs) and recycling rates (RRs) in an independent U.S. steel sector, and estimates the potential to displace current imports with recycled scrap that is currently destined for landfill, hibernating stocks, or export (LHSE). A U.S. dynamic material flow analysis (1880–2100) is conducted to estimate annual steel consumption and scrap generation. The results are coupled with a linear optimization model that minimizes primary steel demand while satisfying the volumetric and compositional demands of new consumption. The compositional analysis examines only copper content because it is of greatest concern to recyclers.The best estimate is that the maximum independent RR is already constrained by copper contamination. Without interventions, this maximum RR will gradually decline throughout the century. The annual consumption to scrap availability ratio (C2SR) will decrease from around 1.4 today. Concurrently, the maximum RC rises but then plateaus below 75% as the RR falls. This highlights a conflict in the conditions for a circular economy: a C2SR approaching unity is a necessary condition for a high RC but leads to fewer opportunities for scrap contaminant dilution, which decreases the RR. Improved product design for recycling and deployment of scrap refining technologies will be needed to reach higher RCs. In 2017, the mass of U.S. scrap destined for LHSE exceeded direct steel imports. Domestic recycling of scrap exports alone could have displaced 36% of direct steel imports, reducing the U.S. deficit by $5.5 billion.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/156151/3/jiec12971-sup-0001-SuppMatS1.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/156151/2/jiec12971_am.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/156151/1/jiec12971.pd

Interventions to improve the appropriate use of polypharmacy in older people: a Cochrane systematic review

OBJECTIVE: To summarise the findings of an updated Cochrane review of interventions aimed at improving the appropriate use of polypharmacy in older people. DESIGN: Cochrane systematic review. Multiple electronic databases were searched including MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials (from inception to November 2013). Hand searching of references was also performed. Randomised controlled trials (RCTs), controlled clinical trials, controlled before-and-after studies and interrupted time series analyses reporting on interventions targeting appropriate polypharmacy in older people in any healthcare setting were included if they used a validated measure of prescribing appropriateness. Evidence quality was assessed using the Cochrane risk of bias tool and GRADE (Grades of Recommendation, Assessment, Development and Evaluation). SETTING: All healthcare settings. PARTICIPANTS: Older people (≥65 years) with ≥1 long-term condition who were receiving polypharmacy (≥4 regular medicines). PRIMARY AND SECONDARY OUTCOME MEASURES: Primary outcomes were the change in prevalence of appropriate polypharmacy and hospital admissions. Medication-related problems (eg, adverse drug reactions), medication adherence and quality of life were included as secondary outcomes. RESULTS: 12 studies were included: 8 RCTs, 2 cluster RCTs and 2 controlled before-and-after studies. 1 study involved computerised decision support and 11 comprised pharmaceutical care approaches across various settings. Appropriateness was measured using validated tools, including the Medication Appropriateness Index, Beers’ criteria and Screening Tool of Older Person's Prescriptions (STOPP)/ Screening Tool to Alert doctors to Right Treatment (START). The interventions demonstrated a reduction in inappropriate prescribing. Evidence of effect on hospital admissions and medication-related problems was conflicting. No differences in health-related quality of life were reported. CONCLUSIONS: The included interventions demonstrated improvements in appropriate polypharmacy based on reductions in inappropriate prescribing. However, it remains unclear if interventions resulted in clinically significant improvements (eg, in terms of hospital admissions). Future intervention studies would benefit from available guidance on intervention development, evaluation and reporting to facilitate replication in clinical practice

Space Plasma Interactions with Spacecraft Materials

Spacecraft materials on orbit are subjected to the harsh weather of space. In particular, high-energy electrons alter the chemical structure of polymers and cause charge accumulation. Understanding the mechanisms of damage and charge dissipation is critical to spacecraft construction and operational anomaly resolution. Energetic particles in space plasma break molecular bonds in polymers and create radicals that can act as space charge traps. These electron-induced chemical changes also result in changes to the spectral absorption profile of polymers on orbit. Radicals react over time, either recreating identical bonds to those in the pristine material, leading to material recovery, or creating new bonds, resulting in a new material with new physical properties. Lack of knowledge about this dynamic aging is a major impediment to accurate modeling of spacecraft behavior over its mission life. This chapter first presents an investigation of the chemical and physical properties of polyimide films (PI, Kapton-H®) during and after irradiation with high-energy (90 keV) electrons. Second, the deleterious effects of space plasma on a spacecraft component level are presented. The results of this physical/chemical collaboration demonstrate the correlation of chemical changes in PI with the dynamic nature of spacecraft material aging

Medium-Energy Gamma-Ray Astrophysics with the 3-DTI Gamma-Ray Telescope

Gamma-ray observations in the medium energy range (0.50-50.0 MeV) are central to unfolding many outstanding questions in astrophysics. The challenges of medium-energy gamma-ray observations, however, are the low photon statistics and large backgrounds. We review these questions, address the telescope technology requirements, and describe our development of the 3-Dimensional Track Imaging (3-DTI) Compton telescope and its performance for a new mediumenergy gamma-ray mission. The 3-DTI is a large-volume time projection chamber (TPC) with a 2-dimensional gas micro-well detector (MWD) readout

Spatially structured brown-headed cowbird control measures and their effects on Kirtland’s warbler long-term population sustainability

Context: Brown-headed cowbirds (Molothrus ater), through brood parasitism, can exert extrinsic population growth pressures on North American songbirds. Cowbird removal programs may reduce parasitism rates on host species but can be expensive and difficult to implement throughout a host species’ breeding range. Aim: We estimated cowbird abundance and nest parasitism rates within Kirtland’s warbler (Setophaga kirtlandii) primary breeding range in Michigan, USA, and determined the maximum sustainable parasitism rate for Kirtland’s warblers under several spatially structured cowbird removal designs. Methods: We conducted point counts to estimate cowbird abundance and monitored nests to quantify nest parasitism rates during 2019–2021. We used the modelling software STELLA to determine the maximum sustainable parasitism rate for Kirtland’s warblers under different spatially structured cowbird removal scenarios (complete, core-only, and no removal). Key results: Cowbird abundance and parasitism rates remained low following cowbird trap closures in 2018. In the simulation study, complete removal was the most robust scenario with no replications having \u3c1000 Kirtland’s warbler males. The core-only removal scenario had a substantially higher sustainable parasitism rate in the peripheral breeding area than the no removal scenario. Assumed hatch-year dispersal distance had the greatest impact on the maximum sustainable parasitism rate in the core-only scenario. Conclusions: Low cowbird abundance and nest parasitism following suspension of cowbird removal efforts showed resuming the removal program may not be required in the short-term. If cowbird abundance increases, however, adaptive cowbird removal programs can be used to sustain Kirtland’s warbler populations long-term. Implications: Our results indicate that incorporating spatial structure of host species’ habitat into designing cowbird removal programs may minimise costs of cowbird management while sustaining populations of Kirtland’s warbler and possibly other host species that are affected by brood parasitism

Pool boiling on modified surfaces using R-123

This article has been made available through the Brunel Open Access Publishing Fund.Saturated pool boiling of R-123 was investigated for five horizontal copper surfaces modified by different treatments, namely, an emery-polished surface, a fine sandblasted surface, a rough sandblasted surface, an electron beam-enhanced surface, and a sintered surface. Each 40-mm-diameter heating surface formed the upper face of an oxygen-free copper block, electrically heated by embedded cartridge heaters. The experiments were performed from the natural convection regime through nucleate boiling up to the critical heat flux, with both increasing and decreasing heat flux, at 1.01 bar, and additionally at 2 bar and 4 bar for the emery-polished surface. Significant enhancement of heat transfer with increasing surface modification was demonstrated, particularly for the electron beam-enhanced and sintered surfaces. The emery-polished and sandblasted surface results are compared with nucleate boiling correlations and other published data. © 2014 Syed W. Ahmad, John S. Lewis, Ryan J. McGlen, and Tassos G. Karayiannis Published with license by Taylor & Francis