A Qualitative Study on Pharmacy Policies toward Over-the-Counter Syringe Sales in a Rural Epicenter of US Drug-Related Epidemics

BACKGROUND: Expanding access to sterile syringes in rural areas is vital, as injection-related epidemics expand beyond metropolitan areas globally. While pharmacies have potential to be an easily accessible source of sterile syringes, research in cities has identified moral, legal and ethical barriers that preclude over-the-counter (OTC) sales to people who inject drugs (PWID). The current study builds on prior urban-based research by elucidating (1) pharmacy OTC policies and (2) pharmacists\u27 rationale for, and barriers and facilitators to, OTC syringe sales in a US rural area hard hit by drug-related epidemics. METHODS: We conducted 14 semi-structured interviews with pharmacists recruited from two Eastern Kentucky health districts. Interview domains included experiences with, and attitudes toward, selling OTC syringes to PWID. Constructivist grounded theory methods were used to analyze verbatim transcripts. RESULTS: Most pharmacists operated restrictive OTC pharmacies (n = 8), where patients were required to have a prescription or proof of medical need to purchase a syringe. The remainder (n = 6) operated open OTC pharmacies, which allowed OTC syringe sales to most patients. Both groups believed their pharmacy policies protected their community and pharmacy from further drug-related harm, but diverging policies emerged because of stigma toward PWID, perceptions of Kentucky law, and belief OTC syringe sales were harmful rather than protective to the community. CONCLUSION: Our results suggest that restrictive OTC pharmacy policies are rooted in stigmatizing views of PWID. Anti-stigma education about substance use disorder (SUD), human immunodeficiency virus (HIV), and Hepatitis C (HCV) is likely needed to truly shift restrictive pharmacy policy

Factors that Influence Enrollment in Syringe Services Programs in Rural Areas: A Qualitative Study among Program Clients in Appalachian Kentucky

BACKGROUND: Enrolling sufficient number of people who inject drugs (PWID) into syringe services programs (SSP) is important to curtail outbreaks of drug-related harms. Still, little is known about barriers and facilitators to SSP enrollment in rural areas with no history of such programs. This study\u27s purpose was to develop a grounded theory of the role of the risk environment and individual characteristics of PWID in shaping SSP enrollment in rural Kentucky. METHODS: We conducted one-on-one semi-structured interviews with 41 clients of 5 SSPs that were established in rural counties in Appalachian Kentucky in 2017-2018. Interviews covered PWID needs, the process of becoming aware of SSPs, and barriers and facilitators to SSP enrollment. Applying constructivist grounded theory methods and guided by the Intersectional Risk Environment Framework (IREF), we applied open, axial and selective coding to develop the grounded theory. RESULTS: Stigma, a feature of IREF\u27s meso-level social domain, is the main factor hampering SSP enrollment. PWID hesitated to visit SSPs because of internalized stigma and because of anticipated stigma from police, friends, family and healthcare providers. Fear of stigma was often mitigated or amplified by a constellation of meso-level environmental factors related to healthcare (e.g., SSPs) and social (PWID networks) domains and by PWID\u27s individual characteristics. SSPs mitigated stigma as a barrier to enrollment by providing low threshold services in a friendly atmosphere, and by offering their clients program IDs to protect them from paraphernalia charges. SSP clients spread positive information about the program within PWID networks and helped their hesitant peers to enroll by accompanying them to SSPs. Individual characteristics, including child custody, employment or high social status, made certain PWID more susceptible to drug-related stigma and hence more likely to delay SSP enrollment. CONCLUSIONS: Features of the social and healthcare environments operating at the meso-level, as well as PWID\u27s individual characteristics, appear to enhance or mitigate the effect of stigma as a barrier to SSP enrollment. SSPs opening in locations with high stigma against PWID need to ensure low threshold and friendly services, protect their clients from police and mobilize PWID networks to promote enrollment

Experimental and Theoretical Determination of the Stopping Power of ZrO2 Films for Protons and α-particles

Abstract. We report the results of an experimental-theoretical study on the stopping power of ZrO2 films for swift H and He ion beams. The experiments, using the Rutherford Backscattering technique, were done for protons with incident energies in the range 200-1500 keV and for α-particle beams with energies in the range 160-3000 keV. The theoretical calculations were done in the framework of the dielectric formalism using the MELF-GOS model to account for the ZrO2 target electronic response. It is shown that for both ion beams, the agreement between theory and experiment is quite remarkable

Compósito para a construção civil a partir de resíduos industriais

RESUMO Os estudos que visam à utilização dos resíduos industriais vêm se intensificando diante da pressão das organizações ambientais, escassez de recursos naturais, busca de certificações para ganho de mercado e minimização de impacto ambiental. O presente trabalho desenvolveu um novo compósito a base de resíduos industriais como cinzas de madeira, lodo de estação de tratamento de água (ETA) e resíduos de produção de cal com propriedades mecânicas que atendem às exigências da ASSOCIAÇÃO BRASILEIRA DE NORMAS TÉCNICAS - NBR 15270-1/2005, NBR 15270-2/2005 e NBR 5739/2007, objetivando a sua utilização na construção civil sem o acréscimo de cimento Portland. As resistências à compressão variaram de 2,35 a 16,48 MPa. O índice de absorção de água das amostras testadas também atendeu às normas aplicadas, demonstrando que ao longo do tempo de cura houve diminuição da porosidade com possível hidratação da cal. Os resultados do ensaio de resistência à compressão apresentaram variações durante o tempo de cura que podem ser justificadas pela presença de material orgânico no lodo de ETA e pelo tamanho das partículas de cinza de madeira que durante a homogeneização não foram destruídas completamente. Apesar das variações observadas nos resultados, as resistências dos compósitos se enquadram na classificação para blocos cilíndricos de concreto e blocos cerâmicos para alvenaria

Magnetic Reconnection inside a Flux Transfer Event‐like structure in Magnetopause Kelvin‐Helmholtz Waves

This is the final version. Available from the American Geophysical Union via the DOI in this recordMMS data are available from https://lasp.colorado.edu/mms/sdc/public/Magnetopause Kelvin‐Helmholtz (KH) waves are believed to mediate solar wind plasma transport via small‐scale mechanisms. Vortex‐induced reconnection (VIR) was predicted in simulations and recently observed using NASA's Magnetospheric Multiscale (MMS) mission data. Flux Transfer Events (FTEs) produced by VIR at multiple locations along the periphery of KH waves were also predicted in simulations but detailed observations were still lacking. Here we report MMS observations of an FTE‐type structure in a KH wave trailing edge during KH activity on 5 May 2017 on the dawnside flank magnetopause. The structure is characterised by (1) bipolar magnetic B Y variation with enhanced core field (B Z ) and (2) enhanced total pressure with dominant magnetic pressure. The cross‐section size of the FTE is found to be consistent with vortex‐induced flux ropes predicted in the simulations. Unexpectedly, we observe an ion jet (V Y ), electron parallel heating, ion and electron density enhancements, and other signatures that can be interpreted as a reconnection exhaust at the FTE central current sheet. Moreover, pitch angle distributions of suprathermal electrons on either side of the current sheet show different properties, indicating different magnetic connectivities. This FTE‐type structure may thus alternatively be interpreted as two interlaced flux tubes with reconnection at the interface as reported by Kacem et al. (2018) and Øieroset et al. (2019). The structure may be the result of interaction between two flux tubes, likely produced by multiple VIR at the KH wave trailing edge, and constitutes a new class of phenomenon induced by KH waves.Science and Technology Facilities Council (STFC)Thailand Science Research and InnovationNAS

Mele in grotta: via libera da Melinda al “modello sotterraneo”

Gli ultimi esiti della sperimentazione in corso e il progetto pilota per conservare le mele in modo ancora più sostenibil