Role of community drug and alcohol services in physical healthcare for people who use illicit opioids: a qualitative study of clinical staff in the UK

Objectives: To understand how clinicians working in addiction services perceive their responsibilities for physical healthcare of clients who use opioids, and how physical healthcare could be improved for this group. Design: Qualitative study comprising semistructured interviews. Participants: 16 clinicians, including nurses and nurse practitioners, nurse consultants, addiction psychiatrists, specialist general practitioners and psychiatry specialty registrars. Setting Community-based drug and alcohol treatment services in the UK, with services including outpatient opioid agonist therapy. Results: We identified three overarching themes. First, clients have unmet physical health needs that are often first identified in community drug and alcohol services. Participants reported attempts to improve their clients’ access to healthcare by liaising directly with health services and undertaking other forms of health advocacy, but report limited success, with many referrals ending in non-attendance. Second, most participants saw their role as supporting access to mainstream health services rather than providing physical healthcare directly, though sometimes reported frustration at being unable to provide certain treatments such as antibiotics for a respiratory infection. A minority of participants felt that people who use illicit opioids would be best served by an integrated ‘one-stop-shop’ model, but felt this model is currently unlikely to receive funding. Third, participants felt isolated from other health services, in part due to commissioning arrangements in which funding is provided through local government rather than the National Health Service. Conclusions: Clinicians participating in this study serve a patient group with unmet physical health needs, but lack the resources to respond effectively to these needs

Upper Limits on the Extragalactic Background Light from the Gamma-Ray Spectra of Blazars

The direct measurement of the extragalactic background light (EBL) is difficult at optical to infrared wavelengths because of the strong foreground radiation originating in the Solar System. Very high energy (VHE, E$>$100 GeV) gamma rays interact with EBL photons of these wavelengths through pair production. In this work, the available VHE spectra from six blazars are used to place upper limits on the EBL. These blazars have been detected over a range of redshifts and a steepening of the spectral index is observed with increasing source distance. This can be interpreted as absorption by the EBL. In general, knowledge of the intrinsic source spectrum is necessary to determine the density of the intervening EBL. Motivated by the observed spectral steepening with redshift, upper limits on the EBL are derived by assuming that the intrinsic spectra of the six blazars are $\propto E^{-1.8}$. Upper limits are then placed on the EBL flux at discrete energies without assuming a specific spectral shape for the EBL. This is an advantage over other methods since the EBL spectrum is uncertain.Comment: 33 pages, 14 figures, accepted by Ap

Echolocation detections and digital video surveys provide reliable estimates of the relative density of harbour porpoises

Acknowledgements We would like to thank Erik Rexstad and Rob Williams for useful reviews of this manuscript. The collection of visual and acoustic data was funded by the UK Department of Energy & Climate Change, the Scottish Government, Collaborative Offshore Wind Research into the Environment (COWRIE) and Oil & Gas UK. Digital aerial surveys were funded by Moray Offshore Renewables Ltd and additional funding for analysis of the combined datasets was provided by Marine Scotland. Collaboration between the University of Aberdeen and Marine Scotland was supported by MarCRF. We thank colleagues at the University of Aberdeen, Moray First Marine, NERI, Hi-Def Aerial Surveying Ltd and Ravenair for essential support in the field, particularly Tim Barton, Bill Ruck, Rasmus Nielson and Dave Rutter. Thanks also to Andy Webb, David Borchers, Len Thomas, Kelly McLeod, David L. Miller, Dinara Sadykova and Thomas Cornulier for advice on survey design and statistical approache. Data Accessibility Data are available from the Dryad Digital Repository: http://dx.doi.org/10.5061/dryad.cf04gPeer reviewedPublisher PD

Multiwavelength Observations of a Flare from Markarian 501

We present multiwavelength observations of the BL Lacertae object Markarian 501 (Mrk 501) in 1997 between April 8 and April 19. Evidence of correlated variability is seen in very high energy (VHE, E > 350 GeV) gamma-ray observations taken with the Whipple Observatory gamma-ray telescope, data from the Oriented Scintillation Spectrometer Experiment of the Compton Gamma-Ray Observatory, and quicklook results from the All-Sky Monitor of the Rossi X-ray Timing Explorer while the Energetic Gamma-Ray Experiment Telescope did not detect Mrk 501. Short term optical correlations are not conclusive but the U-band flux observed with the 1.2m telescope of the Whipple Observatory was 10% higher than in March. The average energy output of Mrk 501 appears to peak in the 2 keV to 100 keV range suggesting an extension of the synchrotron emission to at least 100 keV, the highest observed in a blazar and ~100 times higher than that seen in the other TeV-emitting BL Lac object, Mrk 421. The VHE gamma-ray flux observed during this period is the highest ever detected from this object. The VHE gamma-ray energy output is somewhat lower than the 2-100 keV range but the variability amplitude is larger. The correlations seen here do not require relativistic beaming of the emission unless the VHE spectrum extends to >5 TeV.Comment: 10 pages, 2 figures, accepted for publication in ApJ Letter