Implementation of mandatory opioid prescribing limits in North Carolina: healthcare administrator and prescriber perspectives

Background: Recent increases in state laws to reduce opioid prescribing have demonstrated a need to understand how they are interpreted and implemented in healthcare systems. The purpose of this study was to explore the systems, strategies, and resources that hospital administrators and prescribers used to implement the 2017 North Carolina Strengthen Opioid Prevention (STOP) Act opioid prescribing limits, which limited initial prescriptions to a five (for acute) or seven (for post-surgical) days’ supply. Methods: We interviewed 14 hospital administrators and 38 prescribers with degrees in medicine, nursing, pharmacy, business administration and public health working across North Carolina. Interview guides, informed by the Consolidated Framework for Implementation Research, explored barriers and facilitators to implementation. Interview topics included communication, resources, and hospital system support. Interviews were recorded and transcribed, then analyzed using flexible coding, integrating inductive and deductive coding, to inform analytic code development and identify themes. Results: We identified three main themes around implementation of STOP act mandated prescribing limits: organizational communication, prescriber education, and changes in the electronic medical record (EMR) systems. Administrators reflected on implementation in the context of raising awareness and providing reminders to facilitate changes in prescriber behavior, operationalized through email and in-person communications as well as dedicated resources to EMR changes. Prescribers noted administrative communications about prescribing limits often focused on legality, suggesting a directive of the organization’s policy rather than a passive reminder. Prescribers expressed a desire for more spaces to have their questions answered and resources for patient communications. While hospital administrators viewed compliance with the law as a priority, prescribers reflected on concerns for adequately managing their patients’ pain and limited time for clinical care. Conclusions: Hospital administrators and prescribers approached implementation of the STOP act prescribing limits with different mindsets. While administrators were focused on policy compliance, prescribers were focused on their patients’ needs. Strategies to implement the mandate then had to balance patient needs with policy compliance. As states continue to legislate to prevent opioid overdose deaths, understanding how laws are implemented by healthcare systems and prescribers will improve their effectiveness through tailoring and maximizing available resources

Epiphytic metazoans on emergent macrophytes in oxbow lakes of the Krapina River, Croatia: differences related to plant species and limnological conditions

This study investigated the structure of the epiphytic metazoans on emerged macrophytes in the littoral zone of two oxbow lakes with different trophic levels. Differences in the diversity and density of the epiphytic metazoans were analyzed in relation to plant architecture (simple or complex stems), food resources (algae and detritus) and water characteristics (transparency and derived trophic state index). Asignificant negative correlation was found between detritus on plants as food resource, and diversity and density of epiphytic metazoans, indicating grazing of microphagous species. Rotifers dominated in diversity and density in the epiphyton on all habitats. Total density of metazoans, rotifers and copepods in epiphyton were significantly higher on Mentha in mesotrophic lake than on Iris in a eutrophic lake.We presume that macrophyte belt width and trophic state governed biotic interactions and consequently epiphytic assemblages more strongly than macrophyte architecture. However, a Mentha habitat showed a slightly higher density and diversity of epiphytic metazoans in relation to Iris at the same site, but these differences were not significant

The monitoring of nitrogen and phosphorus content in without-flow lake after elimination of wastewater inflow

Przedstawiono wyniki badań koncentracji związków azotu i fosforu w jeziorze bezodpływowym, dokumentujące zmiany jakościowe po odcięciu dopływu ścieków. Uwzględniono zmiany, jakie nastąpiły w zbiorniku po pierwszej fazie rekultywacji (chemiczne strącanie fosforanów, biomanipulacja i natlenianie hypolimnionu). Obniżanie się poziomu wody jeziora zasilanego z poziomu wodonośnego wielkopolskiej doliny kopalnej spowodowało ustanie odpływu powierzchniowego. Redukcja wielkości zasilania przez wody podziemne w ciągu kilkudziesięciu lat spowodowała zmniejszenie powierzchni jeziora o ponad 3 ha, a głębokości średniej o 1 m. Jezioro było przez ponad 40 lat odbiornikiem ścieków bytowych z pobliskiego sanatorium. Eliminacja dopływu ścieków w końcu lat 80. XX wieku nie spowodowała oczekiwanej poprawy stanu jakościowego wód jeziora, lecz intensyfikację eutrofizacji. Cechą jeziora były obfite zakwity fitoplanktonu i wyczerpanie tlenu od głębokości 5-6 m. Analiza przyczyn pogarszającego się stanu jeziora oparta m.in. na gradientach głębokościowych form azotu i fosforanów rozpuszczonych wykazała znaczącą rolę wtórnego zasilania wewnętrznego z osadów dennych. Wydzielanie fosforanów z osadów dennych było stymulowane przez warunki silnie redukujące. W wyniku rekultywacji nastąpił wzrost przezroczystości wody, ale warunki tlenowe nie zmieniły się. Znacznie wzrosły stężenia fosforu całkowitego, a azotu zmniejszyły się.The results of study the concentrations of nitrogen and phosphorus content in the lake without outflow after elimination of wastewater inflow were presented. The effects of first phase of the lake restoration (by aeration of the hypolimnion, chemical phosphorus inactivation and biomanipulation) were also noted. Several dozen years ago in result the change of groundwater level in Wielkopolska buried valley from the lake the water outflow was stopped. Reduction of supplying the underground water caused a decrease of the lake area of more than 3 hectares and average depth about 1 m. For the water quality changes in the lake during last 20 years (after 1989) a great impact had the inflow of domestic sewage from nearby sanatorium. The analyses performed after closing of sanatorium revealed the constant increase the concentrations of mineral biogenic compounds in the lake water. The intensification of the lake eutrophication was stated. Characteristic feature of lake was abundant algal blooms and depletion of oxygen from 5-6 m depth. Analysis of the causes of the deteriorating condition of the lake (based on depth gradients of nitrogen forms and dissolved phosphates) a significant role of secondary supplying from bottom sediments showed. Release of phosphate was stimulated by strongly reducing conditions. The result of restoration was improvement of the light conditions, but without improving of oxygen content in water column. In water chemistry higher concentration of TP and smaller of TN were recorded

Gördes: a new early Miocene micromammal assemblage from western Anatolia

The mammal locality of Gördes is only known from its test sample, as it has been subsequently destroyed. This small sample yielded a surprisingly rich assemblage, with five rodent species, four species of insectivore and a bat. Based on the rodent contents, the assemblage is assigned to Anatolian mammal zone D, equivalent to MN 3. One of the rodent species, Eumyarion gordesensis nov. sp. is new. Both the cricetid Deperetomys and the glirid Glirudinus represent a hitherto unknown evolutionary stadium and have been assigned to D. aff. intermedius and G. aff. haramiensis, respectively. Based on the relatively high diversity of insectivores, the presence of a dimylid and the dominance of Eumyarion, the Gördes assemblage presumably represents a closed, humid environment. © 2018, Senckenberg Gesellschaft für Naturforschung and Springer-Verlag GmbH Germany, part of Springer Nature