Acceptability of prison-based take-home naloxone programmes among a cohort of incarcerated men with a history of regular injecting drug use

Background: Take-home naloxone (THN) programmes are an evidence-based opioid overdose prevention initiative. Elevated opioid overdose risk following prison release means release from custody provides an ideal opportunity for THN initiatives. However, whether Australian prisoners would utilise such programmes is unknown. We examined the acceptability of THN in a cohort of male prisoners with histories of regular injecting drug use (IDU) in Victoria, Australia. Methods: The sample comprised 380 men from the Prison and Transition Health (PATH) Cohort Study; all of whom reported regular IDU in the 6 months prior to incarceration. We asked four questions regarding THN during the pre-release baseline interview, including whether participants would be willing to participate in prison-based THN. We describe responses to these questions along with relationships between before- and during-incarceration factors and willingness to participate in THN training prior to release from prison. Results: Most participants (81%) reported willingness to undertake THN training prior to release. Most were willing to resuscitate a friend using THN if they were trained (94%) and to be revived by a trained peer (91%) using THN. More than 10 years since first injection (adjusted odds ratio [AOR] 2.22, 95%CI 1.03-4.77), having witnessed an opioid overdose in the last 5 years (AOR 2.53, 95%CI 1.32-4.82), having ever received alcohol or other drug treatment in prison (AOR 2.41, 95%CI 1.14-5.07) and injecting drugs during the current prison sentence (AOR 4.45, 95%CI 1.73-11.43) were significantly associated with increased odds of willingness to participate in a prison THN programme. Not specifying whether they had injected during their prison sentence (AOR 0.37, 95%CI 0.18-0.77) was associated with decreased odds of willingness to participate in a prison THN training. Conclusion: Our findings suggest that male prisoners in Victoria with a history of regular IDU are overwhelmingly willing to participate in THN training prior to release. Factors associated with willingness to participate in prison THN programmes offer insights to help support the implementation and uptake of THN programmes to reduce opioid-overdose deaths in the post-release period

The interaction between safety culture and degraded modes: a survey of national infrastructures for air traffic management

This paper presents the initial results from a study into the interaction between safety culture and degraded modes of operation in European Air Traffic Management (ATM). Degraded modes occur when operators struggle to maintain levels of service eventhough key elements of their infrastructure have failed. Safety culture can be simply described as ‘the way safety is done around here’ – emphasizing that it is concerned with the realities of safety, and not necessarily what people say should be done. Although safety culture therefore deals necessarily with attitudes, beliefs and even feelings – so-called ‘soft’ phenomena – it does not mean that these are any less important than more objective and visible safety management artifacts such as standards and procedures, and so on. Poor safety culture is often linked to the causes of major accidents and incidents. Recent initiatives in ATM, including the European Safety Programme and its precursor, the Strategic Safety Action Plan, have also recognized that degraded modes of operation played a significant role in previous adverse events. Operators often reveal a high degree of tolerance for degraded infrastructures. There is a ‘can do’ attitude, whereby staff struggle to maintain operations when it might be more prudent to reduce the level of service or even close airspace in order to maintain levels of safety. The high level objectives of this project are: (1) to identify safety cultural aspects that influence tolerance to degraded modes and (2) to identify ‘best practices’ that Air Navigation Service Providers can apply to deal with degraded mode of operations

Urine output on an intensive care unit: case-control study.

OBJECTIVE: To compare urine output between junior doctors in an intensive care unit and the patients for whom they are responsible. DESIGN: Case-control study. SETTING: General intensive care unit in a tertiary referral hospital. PARTICIPANTS: 18 junior doctors responsible for clerking patients on weekday day shifts in the unit from 23 March to 23 April 2009 volunteered as "cases." Controls were the patients in the unit clerked by those doctors. Exclusion criteria (for both groups) were pregnancy, baseline estimated glomerular filtration rate <15 ml/min/1.73 m(2), and renal replacement therapy. MAIN OUTCOME MEASURES: Oliguria (defined as mean urine output <0.5 ml/kg/hour over six or more hours of measurement) and urine output (in ml/kg/hour) as a continuous variable. RESULTS: Doctors were classed as oliguric and "at risk" of acute kidney injury on 19 (22%) of 87 shifts in which urine output was measured, and oliguric to the point of being "in injury" on one (1%) further shift. Data were available for 208 of 209 controls matched to cases in the data collection period; 13 of these were excluded because the control was receiving renal replacement therapy. Doctors were more likely to be oliguric than their patients (odds ratio 1.99, 95% confidence interval 1.08 to 3.68, P=0.03). For each additional 1 ml/kg/hour mean urine output, the odds ratio for being a case rather than a control was 0.27 (0.12 to 0.58, P=0.001). Mortality among doctors was astonishingly low, at 0% (0% to 18%). CONCLUSIONS: Managing our own fluid balance is more difficult than managing it in our patients. We should drink more water. Modifications to the criteria for acute kidney injury could be needed for the assessment of junior doctors in an intensive care unit

PRELIMINARY RESULTS FROM A EUROPEAN SAFETY R&amp;D PROGRAM

Eurocontrol is the Agency concerned with the safety of air navigation in European airspace. It works with most European countries to help improve Air Traffic Management (ATM) and harmonize best practices, including those relating to safety. The research arm of Eurocontrol is based in its Experimental Centre (the EEC) near Bretigny, South of Paris, where future ATM concepts, including new airspace designs and tools to help augment controller performance and ATM efficiency, are explored. Research there is coordinated with Eurocontrol Headquarters (EHQ) in Brussels, as well as the Eurocontrol training Institute in Luxembourg, and Eurocontrol’s operational ATM centre in Maastricht. Following two severe accidents which involve