The association of criminal justice supervision setting with overdose mortality: a longitudinal cohort study.

Background and aimsDespite the high prevalence of substance use among people in the US criminal justice system, little is known about the incidence of overdose mortality by use patterns, drug convictions and supervision setting. We examined the associations between these characteristics and overdose mortality.DesignRetrospective cohort study.Setting and participantsIndividuals sentenced to prison, jail, probation or jail plus probation for a felony conviction in Michigan, USA from 2003 to 2006.MeasurementsUsing the National Death Index, we assessed overdose mortality to December 2012. We calculated overdose mortality rates by pre-sentence opioid use, drug convictions and supervision setting. Multivariable analyses were conducted using competing risks regression with time-varying covariates.FindingsAmong 140 266 individuals followed over a mean of 7.84 years [standard deviation (SD) = 1.52], 14.9% of the 1131 deaths were due to overdose (102.8 per 100 000 person-years). Over the follow-up, more than half of overdose deaths occurred in the community (57.7%), nearly a third (28.8%) on probation and 12.8% on parole. The adjusted risk of overdose death was lower on probation [hazard ratio (HR) = 0.71, 95% confidence interval (CI) = 0.60, 0.85] than in the community without probation or parole (HR = 1.00) but not significantly different on parole (HR = 1.13, 95% CI = 0.87, 1.47). Pre-sentence daily opioid use (HR = 3.54, 95% CI = 3.24, 3.87) was associated with an increased risk. Drug possession (HR = 1.11, 95% CI = 0.93, 1.31) and delivery convictions (HR = 0.92, 95% CI = 0.77, 1.09) were not significantly associated with overdose mortality.ConclusionsBased on the absolute or relative risk, parole, probation and community settings are appropriate settings for enhanced overdose prevention interventions. Ensuring that individuals with pre-sentence opioid use have access to harm reduction and drug treatment services may help to prevent overdose among people involved with the criminal justice system

US and UK Routes to Employment: Strategies to Improve Integrated Service Delivery to People with Disabilities

In this report, the authors examine the experience of the United States and United Kingdom in developing effective strategies for providing integrated service delivery. The report examines what works and what doesn't work, and provides a roadmap to improving services for individuals with disabilities. While more research is needed, the report identifies 12 strategies to strengthen integrated service delivery systems, and to assist individuals with disabilities in gaining and maintaining productive employment. Implementing these strategies can benefit clients, who have the opportunity to realize their potential more fully; the taxpayer, who is paying less for disability assistance; and society at large, which gains the productive skill of talented individuals

Nonprofit governance: Improving performance in troubled economic times

Nonprofit management is currently pressured to perform effectively in a weak economy. Yet, nonprofit governance continues to suffer from unclear conceptions of the division of labor between board of directors and executive directors. This online survey of 114 executive directors aims to provide clarification and recommendations for social administration

Efficient transcription through an intron requires the binding of an Sm-type U1 snRNP with intact stem loop II to the splice donor

The mechanism behind the positive action of introns upon transcription and the biological significance of this positive feedback remains unclear. Functional ablation of splice sites within an HIV-derived env cDNA significantly reduced transcription that was rescued by a U1 snRNA modified to bind to the mutated splice donor (SD). Using this model we further characterized both the U1 and pre-mRNA structural requirements for transcriptional enhancement. U1 snRNA rescued as a mature Sm-type snRNP with an intact stem loop II. Position and sequence context for U1-binding is crucial because a promoter proximal intron placed upstream of the mutated SD failed to rescue transcription. Furthermore, U1-rescue was independent of promoter and exon sequence and is partially replaced by the transcription elongation activator Tat, pointing to an intron-localized block in transcriptional elongation. Thus, transcriptional coupling of U1 snRNA binding to the SD may licence the polymerase for transcription through the intron

Vitamin D status and supplementation in adult patients receiving extracorporeal membrane oxygenation

The prevalence of vitamin D deficiency in critical illness is known to be high and associated with adverse clinical outcomes. Patients receiving extracorporeal membrane oxygenation (ECMO) may be at increased risk of vitamin D deficiency due to high severity of acute illness. Challenges with drug dosing in ECMO patients are recognised due to increased volume of distribution and drug absorption to circuit components. To describe the prevalence of vitamin D deficiency in ECMO patients and the effect of intramuscular dosing of cholecalciferol on levels of vitamin D metabolites, and to compare these data with intensive care unit (ICU) patients not receiving ECMO, two prospective studies were performed sequentially: an observational study of 100 consecutive ICU patients and an interventional study assessing effects of intramuscular cholecalciferol in 50 ICU patients. The subgroup of patients who required ECMO support in each of these studies was analysed and compared to patients who did not receive ECMO. Twenty-four ECMO patients, 12 from the observational study and 12 from the interventional study (who received intramuscular cholecalciferol) were studied-21/24 (88%) ECMO patients were vitamin D deficient at baseline compared to 65/126 (52%) of non-ECMO patients (P=0.006). Of the 12 ECMO patients who received cholecalciferol, six patients (50%) achieved correction of deficiency compared to 36/38 (95%) non-ECMO patients (P=0.001). The prevalence of vitamin D deficiency is higher in ECMO patients compared to other critically ill adults. Correction of deficiency with single dose cholecalciferol is not reliable;higher or repeated doses should be considered to correct deficiency

Managing for change: October 11, 1989

Bi-weekly newsletter of University Hospital's Change Project, provided to managers at the hospital

Long-Term Trends in Phytoplankton Chlorophyll a and Size Structure in the Benguela Upwelling System

This is the final version. Available from American Geophysical Union (AGU) via the DOI in this record.The Benguela Upwelling System (BUS) is among the most productive ecosystems globally, supporting numerous fisheries and ecosystem services in Southern Africa. Sea-viewing Wide Field-of-view Sensor and Moderate-resolution Imaging Spectroradiometer-Aqua chlorophyll a (Chla) concentrations between September 1997 and February 2018 were used to investigate long-term trends in phytoplankton biomass and size structure (microphytoplankton [>20 μm], nanophytoplankton [2–20 μm], and picophytoplankton [<2 μm]) in the Northern Benguela, Southern Benguela (SB), and Agulhas Bank (AB) shelf and open ocean regions of the BUS. Trends in upwelling and correlations with Chla and size structure were examined. Increasing Chla and microphytoplankton trends occurred in the Northern Benguela shelf and open ocean, while decreases were evident on the SB shelf in all seasons. In the SB open ocean, small increases occurred during austral winter, with a decrease in spring. On the AB shelf, increases in Chla and microphytoplankton occurred in summer with decreases during the other seasons. Patterns differed in the AB open ocean, with increases in winter and spring and decreases in summer and autumn. Although R 2 values indicated that linear trends accounted for a reasonable portion of the variance, and most trends were statistically significant, they showed only small changes on the shelf domains and little to no change in the open ocean. Strong correlations between upwelling, Chla, and the size classes were observed, but distinct seasonal differences occurred in each region. This is the first 20-year analysis of phytoplankton biomass and community structure in the BUS and provides a baseline against which future changes can be monitored.NERC National Centre for Earth ObservationSouth African National Research Foundation (NRF)South African Department of Environmental Affair

The X-ray R Aquarii: A Two-sided Jet and Central Source

We report Chandra ACIS-S3 x-ray imaging and spectroscopy of the R Aquarii binary system that show a spatially resolved two-sided jet and an unresolved central source. This is the first published report of such an x-ray jet seen in an evolved stellar system comprised of ~2-3 solar masses. At E < 1 keV, the x-ray jet extends both to the northeast and southwest relative to the central binary system. At 1 < E < 7.1 keV, R Aqr is a point-like source centered on the star system. While both 3.5-cm radio continuum emission and x-ray emission appear coincident in projection and have maximum intensities at ~7.5" northeast of the central binary system, the next strongest x-ray component is located \~30" southwest of the central binary system and has no radio continuum counterpart. The x-ray jets are likely shock heated in the recent past, and are not in thermal equilibrium. The strongest southwest x-ray jet component may have been shocked recently since there is no relic radio emission as expected from an older shock. At the position of the central binary, we detect x-ray emission below 1.6 keV consistent with blackbody emission at T ~2 x 10^6 K. At the central star there is also a prominent 6.4 keV feature, a possible fluorescence or collisionally excited Fe K-alpha line from an accretion disk or from the wind of the giant star. For this excitation to occur, there must be an unseen hard source of x-rays or particles in the immediate vicinity of the hot star. Such a source would be hidden from view by the surrounding edge-on accretion disk.Comment: PS, 20 pages, including 3 figures PNG, JPG - accepted for publication in ApJ Letters. Subject headings: stars: individual (R Aquarii) -- binaries: symbiotic -- circumstellar matter -- stars: white dwarfs -- stars: winds, outflows -- radio continuum: stars -- x-rays: genera