Getting Out of the Ghetto: Harm Reduction, Drug User Health, and the Transformation of Social Policy in New York

This dissertation is a qualitative study of the emergence and evolution of harm reduction drug policies in New York City. It examines harm reduction as a case of the institutionalization of a public health policy movement. Harm reduction seeks to treat the medical and social consequences of drug use without requiring abstinence. The dissertation examines the process by which harm reduction has managed, in the words of one informant, to \u27get out of the ghetto\u27 and become increasingly integrated into New York\u27s public health establishment. Harm reduction has undergone three stages of institutionalization. It began as an activist policy movement. This was followed by a period of partial institutionalization, characterized by grant funding, organizational autonomy and limited state support. Finally, with harm reduction\u27s integration into Medicaid as well as the widespread adoption of naloxone overdose prevention strategies, it has assumed a mainstream position within the health system. This dissertation argues that institutionalization has changed harm reduction at the grassroots level and also contributed to wider changes in the design and delivery of public health in New York State. While some activists remain skeptical of what they see as harm reduction\u27s co-optation, the process has created new relationships between marginalized communities and the state, and led to new forms of social and political inclusion for drug users. This research demonstrates the effectiveness of social movements as policy actors and provides a case study of progressive policy change during a period marked by the privatization and restructuring of social welfare provision. The harm reduction approach, pioneered by drug users and public health activists, is now being applied to the health system more broadly

Functional Connectivity of the Raphe Nuclei: Link to Tobacco Withdrawal in Smokers.

BackgroundAlthough nicotine alters serotonergic neurochemistry, clinical trials of serotonergic medications for smoking cessation have provided mixed results. Understanding the role of serotonergic dysfunction in tobacco use disorder may advance development of novel pharmacotherapies.MethodsFunctional magnetic resonance imaging was used to measure resting-state functional connectivity of the raphe nuclei as an indicator of serotonergic function. Connectivity of the dorsal and median raphe nuclei was compared between 18 young smokers (briefly abstinent, ~40 minutes post-smoking) and 19 young nonsmokers (16-21 years old); connectivity was also examined in a separate sample of overnight-abstinent smokers (18-25 years old), before and after smoking the first cigarette of the day. Relationships between connectivity of the raphe nuclei with psychological withdrawal and craving were tested in smokers.ResultsConnectivity of the median raphe nucleus with the right hippocampal complex was weaker in smokers than in nonsmokers and was negatively correlated with psychological withdrawal in smokers. In overnight-abstinent smokers, smoking increased connectivity of the median raphe nucleus with the right hippocampal complex, and the increase was positively correlated with the decrease in psychological withdrawal.ConclusionsRelief of withdrawal due to smoking is potentially linked to the serotonergic pathway that includes the median raphe nucleus and hippocampal complex. These results suggest that serotonergic medications may be especially beneficial for smokers who endorse strong psychological withdrawal during abstinence from smoking

Hate or glory: a categorical and experimental consideration of Bronze Age halberds in Scotland in relation to MBA weaponry

Despite being one of the largest collections of their type in Europe, the Early Bronze Age halberds in Scotland have not been catalogued or analysed since Coles’ 1968-9 work. Accordingly, every halberd in Scotland was recorded and catalogued to assess the size and level of preservation of the assemblage. Experimental work using a replica halberd was designed to determine the combat capabilities and limitations of the weapon, and to determine the extent of damage inflicted on the blades during interpersonal combat. Prior to this, experiments using a replica Middle Bronze Age dirk from Friarton, Perthshire were designed to establish the methodology and experimental protocol. During the creation of the experimental protocols, parameters considered included the design and manufacture of the replica, the human tissue analogue used, the layout and audience for the experiment, and the subsequent data analysis. The experimentally derived data on the dirk were compared with extant catalogue data to investigate whether the damage inflicted on the replica blade could be observed on the prehistoric dirks. Following the methodology and experimental protocol refined following the investigations with the replica dirk, the replica halberd experiments were then undertaken, first using SynboneTM as a skeletal tissue proxy, and secondly a pig carcass as a soft tissue proxy. The damage to the replica halberd blades observed following the experiments was analysed and compared to the newly-catalogued prehistoric halberd assemblage An interpretative model synthesising all the halberd data was then derived as one possible interpretation as to the uses and distribution of the halberds; the halberds were shown experimentally to be functional combat weapons, able to be used effectively with no great amount of training or mobility, and the mending and conservation evidence in the prehistoric assemblage is hypothesised to be linked to their role as combat and political power proxies in long-distance communication networks across northern Europe

The social logic of naloxone: peer administration, harm reduction, and the transformation of social policy

This paper examines overdose prevention programs based on peer administration of the opioid antagonist naloxone. The data for this study consist of 40 interviews and participant observation of 10 overdose prevention training sessions at harm reduction agencies in the Bronx, New York, conducted between 2010 and 2012. This paper contends that the social logic of peer administration is as central to the success of overdose prevention as is naloxone's pharmacological potency. Whereas prohibitionist drug policies seek to isolate drug users from the spaces and cultures of drug use, harm reduction strategies like peer-administered naloxone treat the social contexts of drug use as crucial resources for intervention. Such programs utilize the expertise, experience, and social connections gained by users in their careers as users. In revaluing the experience of drug users, naloxone facilitates a number of harm reduction goals. But it also raises complex questions about responsibility and risk. This paper concludes with a discussion of how naloxone's social logic illustrates the contradictions within broader neoliberal trends in social policy

The Impact of Interactive Shared Book Reading on Children's Language Skills: A Randomized Controlled Trial.

Purpose Research has indicated that interactive shared book reading can support a wide range of early language skills and that children who are read to regularly in the early years learn language faster, enter school with a larger vocabulary, and become more successful readers at school. Despite the large volume of research suggesting interactive shared reading is beneficial for language development, two fundamental issues remain outstanding: whether shared book reading interventions are equally effective (a) for children from all socioeconomic backgrounds and (b) for a range of language skills. Method To address these issues, we conducted a randomized controlled trial to investigate the effects of two 6-week interactive shared reading interventions on a range of language skills in children across the socioeconomic spectrum. One hundred and fifty children aged between 2;6 and 3;0 (years;months) were randomly assigned to one of three conditions: a pause reading, a dialogic reading, or an active shared reading control condition. Results The findings indicated that the interventions were effective at changing caregiver reading behaviors. However, the interventions did not boost children's language skills over and above the effect of an active reading control condition. There were also no effects of socioeconomic status. Conclusion This randomized controlled trial showed that caregivers from all socioeconomic backgrounds successfully adopted an interactive shared reading style. However, while the interventions were effective at increasing caregivers' use of interactive shared book reading behaviors, this did not have a significant impact on the children's language skills. The findings are discussed in terms of practical implications and future research. Supplemental Material https://doi.org/10.23641/asha.12420539

Abnormal neuromuscular transmission in an infantile myasthenic syndrome

A term infant required intubation for respiratory depression. Examination revealed hypotonia and areflexia with intact extraocular movements. Electrodiagnostic studies demonstrated defective neuromuscular transmission characterized by borderline low motor evoked amplitudes, profound decremental responses at all stimulation rates, and moderate facilitation (50 to 740%) 15 seconds after 5 seconds of 50 Hz stimulation. Repetitive muscle action potential responses were not recorded following stimulation of nerves by single shocks. Sensory evoked responses and needle electromyographic findings were normal, as were acetylcholine receptor antibody levels. Results of muscle histochemical analyses, including acetylcholinesterase stains, were normal. End-plate histometric analyses demonstrated only a slight reduction in mean synaptic vesicle diameter compared with that in an adult control subject. In vitro muscle contractile properties, stimulating the muscle directly, were normal. Anticholinesterase medications were ineffective. Guanidine produced clinical deterioration. The amplitude of motor evoked responses progressively declined, whereas the percentage of decrement and amount of post-tetanic facilitation increased. Although the nature of the transmission defect was not identified, the data are consistent with abnormal acetylcholine resynthesis, mobilization, or storage without abnormality of release or receptors.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/50308/1/410160107_ftp.pd

Recovery-focused care planning and coordination in England and Wales: a cross-national mixed methods comparative case study

Background In the UK, concerns about safety and fragmented community mental health care led to the development of the care programme approach in England and care and treatment planning in Wales. These systems require service users to have a care coordinator, written care plan and regular reviews of their care. Processes are required to be collaborative, recovery-focused and personalised but have rarely been researched. We aimed to obtain the views and experiences of stakeholders involved in community mental health care and identify factors that facilitate or act as barriers to personalised, collaborative, recovery-focused care. Methods We conducted a cross-national comparative study employing a concurrent transformative mixed-methods approach with embedded case studies across six service provider sites in England and Wales. The study included a survey of views on recovery, empowerment and therapeutic relationships in service users (n = 448) and recovery in care coordinators (n = 201); embedded case studies involving interviews with service providers, service users and carers (n = 117) and a review of care plans (n = 33). Quantitative and qualitative data were analysed within and across sites using inferential statistics, correlations and framework method. Results Significant differences were found across sites for scores on therapeutic relationships. Variation within sites and participant groups was reported in experiences of care planning and understandings of recovery and personalisation. Care plans were described as administratively burdensome and were rarely consulted. Carers reported varying levels of involvement. Risk assessments were central to clinical concerns but were rarely discussed with service users. Service users valued therapeutic relationships with care coordinators and others, and saw these as central to recovery. Conclusions Administrative elements of care coordination reduce opportunities for recovery-focused and personalised work. There were few common understandings of recovery which may limit shared goals. Conversations on risk appeared to be neglected and assessments kept from service users. A reluctance to engage in dialogue about risk management may work against opportunities for positive risk-taking as part of recovery-focused work. Research to investigate innovative approaches to maximise staff contact time with service users and carers, shared decision-making in risk assessments, and training designed to enable personalised, recovery-focused care coordination is indicated

Injuries in Quidditch:A Prospective Study from a Complete UK Season

Background : Quidditch is a mixed-gender, full-contact sport founded in the USA in 2005, played worldwide by an estimated 25,000 players. It is one of the few mixed-gender full-contact sports, yet there remain few published studies regarding injury rates and patterns. A previous study suggested that the overall rate of injury in quidditch is in line with other contact sports, however raised concerns that female players were sustaining a higher rate of concussion when compared to male players. Purpose : To examine injury rates and injury patterns in UK quidditch athletes over the course of a single season. Study design: Prospective epidemiological study. Methods : Data were prospectively collected by professional first aid staff for the 2017-18 season spanning all major UK tournaments, involving 699 athletes. Anonymized player demographics were collected by an online survey. Time loss injury rates were measured per 1000 athletic exposures (AEs) and hours of play. Results: The overall time loss injury rate was 20.5 per 1000 hours or 8.0 per 1000 AEs. The combined rate of concussion was 7.3 per 1000 hours or 2.8 per 1000 AEs. There was no statistical difference between time loss injuries in males (20.9/1000 hours and 8.1/1000 AEs) and females (13.9/1000 hours and 5.4/1000 AEs) (p=0.30) and no statistical difference between concussion rates in males (n=7) and females (n=4) (p=0.60). Conclusions : Total time loss injury rates in quidditch appear to be comparable with other full-contact sports such as football. The rate of concussions for both males and females appear higher when compared to other contact sports. Level of evidence : 3Publisher PDFPeer reviewe