Patient Perspectives on Medication Assisted Therapy in Vermont

Introduction. Medication-Assisted Therapy (MAT) for opioid addiction has dramatically increased in Vermont, supported by a novel statewide system that integrates specialty treatment centers ( Hubs ) with primary care office-based opioid therapy ( Spokes ). In 2010, Vermont had the highest per capita buprenorphine use in the US. Previous studies of patient perspectives of MAT have identified social barriers, rigid program rules, and concerns about withdrawal and relapse as common causes of treatment failure. Our goal was to elicit patient perspectives on barriers and enablers of successful MAT to further inform system refinement. Methods. An interview guide was developed based on previous literature as well as discussions with program leadership, staff and clinicians, and community stakeholders. Responses were organized using thematic content analysis with consensus across seven interviewers and two analysts. The interviews were conducted with 44 patients enrolled in MAT at two Hub sites in Burlington, VT in October 2016. Results. The median age of subjects was 34 years, 34% were employed at least part-time, and 72% were female. Half reported a mental health condition and 20% reported chronic pain. Barriers included transportation (25%), lack of stable housing, and stigma (41%). Enablers included feeling supported (82% felt well-supported; 52% felt supported by healthcare professionals). Subjects expressed high confidence in the treatment system and high self-efficacy for sobriety. Conclusions. Patients in MAT have complex medical, mental health, social, personal, and work lives. A comprehensive system that addresses this wide range of domains is critical to achieving optimal outcomes.https://scholarworks.uvm.edu/comphp_gallery/1245/thumbnail.jp

Examining the Relationship Between Markers of Emergency Department Crowding and Physician Wellbeing

Objectives- Explore changes to EP wellbeing over time. Evaluate the relationships between markers of ED crowding and boarding and EP wellbeinghttps://knowledgeconnection.mainehealth.org/lambrew-retreat-2021/1013/thumbnail.jp

Escaping the pushpin paradigm in geographic information science: (re)presenting national crime data

In 2011 the Home Office released the police.uk website, which provided a high-resolution map of recent crime data for the national extents of England, Wales and Northern Ireland. Through this free service, crimes were represented as points plotted on top of a Google map, visible down to a street level of resolution. However, in order to maintain confidentiality and to comply with data disclosure legislation, individual-level crimes were aggregated into points that represented clusters of events that were located over a series of streets. However, with aggregation the representation of crimes as points becomes problematic, engendering spurious precision over where crimes occurred. Given obvious public sensitivity to such information, there are social imperatives for appropriate representation of crime data, and as such, in this paper we present a method of translating the ‘point’ crime events into a new representational form that is tied to street network geography; presenting these results in an alternate national crime mapping portal http://www.policestreets.co.u

A robust sequential hypothesis testing method for brake squeal localisation

This contribution deals with the in situ detection and localisation of brake squeal in an automobile. As brake squeal is emitted from regions known a priori, i.e., near the wheels, the localisation is treated as a hypothesis testing problem. Distributed microphone arrays, situated under the automobile, are used to capture the directional properties of the sound field generated by a squealing brake. The spatial characteristics of the sampled sound field is then used to formulate the hypothesis tests. However, in contrast to standard hypothesis testing approaches of this kind, the propagation environment is complex and time-varying. Coupled with inaccuracies in the knowledge of the sensor and source positions as well as sensor gain mismatches, modelling the sound field is difficult and standard approaches fail in this case. A previously proposed approach implicitly tried to account for such incomplete system knowledge and was based on ad hoc likelihood formulations. The current paper builds upon this approach and proposes a second approach, based on more solid theoretical foundations, that can systematically account for the model uncertainties. Results from tests in a real setting show that the proposed approach is more consistent than the prior state-of-the-art. In both approaches, the tasks of detection and localisation are decoupled for complexity reasons. The localisation (hypothesis testing) is subject to a prior detection of brake squeal and identification of the squeal frequencies. The approaches used for the detection and identification of squeal frequencies are also presented. The paper, further, briefly addresses some practical issues related to array design and placement. (C) 2019 Author(s)

Systems-based Practice in Burn Care: Prevention, Management, and Economic Impact of Health Care–associated Infections

Health care–associated infections in burn patients, from ventilator-associated pneumonia to skin and soft tissue infections, can substantially compromise outcomes, because these complications are associated with longer lengths of stay, increased morbidity and mortality, and greater direct medical costs. Health care–associated infections are largely preventable, through surveillance, education, appropriate hand hygiene, and culture change, especially for device-related infections. Systems-based practice, which allows individuals and clinical microsystems to navigate and improve the macro health care system, may be one of the most powerful skill sets to effect change, permitting a shift in culture toward patient safety and quality improvement

Timeline of health care–associated infections and pathogens after burn injuries

Infections are an important cause of morbidity and mortality after burn injuries. Here, we describe the timeline of infections and pathogens after burns

Fast Photon Detection for Particle Identification with COMPASS RICH-1

Particle identification at high rates is an important challenge for many current and future high-energy physics experiments. The upgrade of the COMPASS RICH-1 detector requires a new technique for Cherenkov photon detection at count rates of several $10^6$ per channel in the central detector region, and a read-out system allowing for trigger rates of up to 100 kHz. To cope with these requirements, the photon detectors in the central region have been replaced with the detection system described in this paper. In the peripheral regions, the existing multi-wire proportional chambers with CsI photocathode are now read out via a new system employing APV pre-amplifiers and flash ADC chips. The new detection system consists of multi-anode photomultiplier tubes (MAPMT) and fast read-out electronics based on the MAD4 discriminator and the F1-TDC chip. The RICH-1 is in operation in its upgraded version for the 2006 CERN SPS run. We present the photon detection design, constructive aspects and the first Cherenkov light in the detector.Comment: Proceedings of the Imaging 2006 conference, Stockholm, Sweden, 27-30 June 2006, 5 pages, 6 figures, to appear in NIM A; corrected typo in caption of Fig.

Fast photon detection for the COMPASS RICH detector

The COMPASS experiment at the SPS accelerator at CERN uses a large scale Ring Imaging CHerenkov detector (RICH) to identify pions, kaons and protons in a wide momentum range. For the data taking in 2006, the COMPASS RICH has been upgraded in the central photon detection area (25% of the surface) with a new technology to detect Cherenkov photons at very high count rates of several 10^6 per second and channel and a new dead-time free read-out system, which allows trigger rates up to 100 kHz. The Cherenkov photons are detected by an array of 576 visible and ultra-violet sensitive multi-anode photomultipliers with 16 channels each. The upgraded detector showed an excellent performance during the 2006 data taking.Comment: Proceeding of the IPRD06 conference (Siena, Okt. 06

Testing fluvial erosion models using the transient response of bedrock rivers to tectonic forcing in the Apennines, Italy

The transient response of bedrock rivers to a drop in base level can be used to discriminate between competing fluvial erosion models. However, some recent studies of bedrock erosion conclude that transient river long profiles can be approximately characterized by a transport‐limited erosion model, while other authors suggest that a detachment‐limited model best explains their field data. The difference is thought to be due to the relative volume of sediment being fluxed through the fluvial system. Using a pragmatic approach, we address this debate by testing the ability of end‐member fluvial erosion models to reproduce the well‐documented evolution of three catchments in the central Apennines (Italy) which have been perturbed to various extents by an independently constrained increase in relative uplift rate. The transport‐limited model is unable to account for the catchments’response to the increase in uplift rate, consistent with the observed low rates of sediment supply to the channels. Instead, a detachment‐limited model with a threshold corresponding to the field‐derived median grain size of the sediment plus a slope‐dependent channel width satisfactorily reproduces the overall convex long profiles along the studied rivers. Importantly, we find that the prefactor in the hydraulic scaling relationship is uplift dependent, leading to landscapes responding faster the higher the uplift rate, consistent with field observations. We conclude that a slope‐ dependent channel width and an entrainment/erosion threshold are necessary ingredients when modeling landscape evolution or mapping the distribution of fluvial erosion rates in areas where the rate of sediment supply to channels is low

The Fast Read-out System for the MAPMTs of COMPASS RICH-1

A fast readout system for the upgrade of the COMPASS RICH detector has been developed and successfully used for data taking in 2006 and 2007. The new readout system for the multi-anode PMTs in the central part of the photon detector of the RICH is based on the high-sensitivity MAD4 preamplifier-discriminator and the dead-time free F1-TDC chip characterized by high-resolution. The readout electronics has been designed taking into account the high photon flux in the central part of the detector and the requirement to run at high trigger rates of up to 100 kHz with negligible dead-time. The system is designed as a very compact setup and is mounted directly behind the multi-anode photomultipliers. The data are digitized on the frontend boards and transferred via optical links to the readout system. The read-out electronics system is described in detail together with its measured performances.Comment: Proceeding of RICH2007 Conference, Trieste, Oct. 2007. v2: minor change