Too Much, Too Soon? Obergefell as Applied Equality Practice

Abrupt cultural change inevitably arouses anxieties, and often those fears provoke a retrograde reaction seeking to preserve the familiar status quo. When the world by which we define ourselves undergoes unexpected transitions, especially in directions that contradict the comfortable taken-for-granted assumptions that had been earlier enjoyed, we feel threatened. One needs only recall how the new standards of racial equality announced in Brown I and Brown II elicited virulent protests as some districts chose to shutter all public schools rather than have them become racially integrated. In the shadow of such traumas, it may seem an obvious lesson that progress should be slow and incremental, going only so far and as fast as the changes can be absorbed into the social habits. William Eskridge has offered a full-throated defense of modulating the rate of change in order to avoid these unintended consequences of modernization. Legal rights can be formally recognized, he says, but their enforcement should not outpace the acceptance of the new order. The prudence that Eskridge counsels appeals at an intuitive level, but is too abstract to provide useful guidance on how the real world should behave. This paper attempts to demonstrate an empirical means to distinguish situations when caution is prudent from moments when it is not by examining the context in which Eskridge himself frames his defense of incrementalism: same-sex marriage

The 2023 release of Cloudy

We describe the 2023 release of the spectral synthesis code Cloudy. Since the previous major release, migrations of our online services motivated us to adopt git as our version control system. This change alone led us to adopt an annual release scheme, accompanied by a short release paper, the present being the inaugural. Significant changes to our atomic and molecular data have improved the accuracy of Cloudy predictions: we have upgraded our instance of the Chianti database from version 7 to 10; our H- and He-like collisional rates to improved theoretical values; our molecular data to the most recent LAMDA database, and several chemical reaction rates to their most recent UDfA and KiDA values. Finally, we describe our progress on upgrading Cloudy's capabilities to meet the requirements of the X-ray microcalorimeters aboard the upcoming XRISM and Athena missions, and outline future development that will make Cloudy of use to the X-ray community.Comment: 18 pages, 10 figures, accepted for publication in RMxA

Substance abuse treatment and psychiatric comorbidity: do benefits spill over? analysis of data from a prospective trial among cocaine-dependent homeless persons

BACKGROUND: Comorbid psychiatric illness can undermine outcomes among homeless persons undergoing addiction treatment, and psychiatric specialty care is not always readily available. The prognosis for nonsubstance abuse psychiatric diagnoses among homeless persons receiving behaviorally-based addiction treatment, however, is little studied. RESULTS: Data from an addiction treatment trial for 95 cocaine-dependent homeless persons (1996–1998) were used to profile psychiatric diagnoses at baseline and 6 months, including mood-related disorders (e.g. depression) and anxiety-related disorders (e.g. post-traumatic stress disorder). Treatment interventions, including systematic reinforcement for goal attainment, were behavioral in orientation. There was a 32% reduction in the prevalence of comorbid non-addiction psychiatric disorder from baseline to 6 months, with similar reductions in the prevalence of mood (-32%) and anxiety-related disorders (-20%) (p = 0.12). CONCLUSION: Among cocaine-dependent homeless persons with psychiatric comorbidity undergoing behavioral addiction treatment, a reduction in comorbid psychiatric disorder prevalence was observed over 6 months. Not all participants improved, suggesting that even evidence-based addiction treatment will prove insufficient for a meaningful proportion of the dually diagnosed homeless population

Addiction Treatment and Stable Housing among a Cohort of Injection Drug Users

Background: Unstable housing and homelessness is prevalent among injection drug users (IDU). We sought to examine whether accessing addiction treatment was associated with attaining stable housing in a prospective cohort of IDU in Vancouver, Canada. Methods: We used data collected via the Vancouver Injection Drug User Study (VIDUS) between December 2005 and April 2010. Attaining stable housing was defined as two consecutive ‘‘stable housing’ ’ designations (i.e., living in an apartment or house) during the follow-up period. We assessed exposure to addiction treatment in the interview prior to the attainment of stable housing among participants who were homeless or living in single room occupancy (SRO) hotels at baseline. Bivariate and multivariate associations between the baseline and time-updated characteristics and attaining stable housing were examined using Cox proportional hazard regression models. Principal Findings: Of the 992 IDU eligible for this analysis, 495 (49.9%) reported being homeless, 497 (50.1%) resided in SRO hotels, and 380 (38.3%) were enrolled in addiction treatment at the baseline interview. Only 211 (21.3%) attained stable housing during the follow-up period and of this group, 69 (32.7%) had addiction treatment exposure prior to achieving stable housing. Addiction treatment was inversely associated with attaining stable housing in a multivariate model (adjusted hazard ratio [AHR] = 0.71; 95 % CI: 0.52–0.96). Being in a partnered relationship was positively associated with the primary outcom

Effectiveness of interventions to improve the health and housing status of homeless people: a rapid systematic review

Background: Research on interventions to positively impact health and housing status of people who are homeless has received substantially increased attention over the past 5 years. This rapid review examines recent evidence regarding interventions that have been shown to improve the health of homeless people, with particular focus on the effect of these interventions on housing status. Methods: A total of 1,546 articles were identified by a structured search of five electronic databases, a hand search of grey literature and relevant journals, and contact with experts. Two reviewers independently screened the first 10% of titles and abstracts for relevance. Inter-rater reliability was high and as a result only one reviewer screened the remaining titles and abstracts. Articles were included if they were published between January 2004 and December 2009 and examined the effectiveness of an intervention to improve the health or healthcare utilization of people who were homeless, marginally housed, or at risk of homelessness. Two reviewers independently scored all relevant articles for quality. Results: Eighty-four relevant studies were identified; none were of strong quality while ten were rated of moderate quality. For homeless people with mental illness, provision of housing upon hospital discharge was effective in improving sustained housing. For homeless people with substance abuse issues or concurrent disorders, provision of housing was associated with decreased substance use, relapses from periods of substance abstinence, and health services utilization, and increased housing tenure. Abstinent dependent housing was more effective in supporting housing status, substance abstinence, and improved psychiatric outcomes than non-abstinence dependent housing or no housing. Provision of housing also improved health outcomes among homeless populations with HIV. Health promotion programs can decrease risk behaviours among homeless populations. Conclusions: These studies provide important new evidence regarding interventions to improve health, housing status, and access to healthcare for homeless populations. The additional studies included in this current review provide further support for earlier evidence which found that coordinated treatment programs for homeless persons with concurrent mental illness and substance misuse issues usually result in better health and access to healthcare than usual care. This review also provides a synthesis of existing evidence regarding interventions that specifically support homeless populations with HIV.Partial funding for this paper was provided to the Effective Public Health Practice Project by the Region of Peel, Canada

Cost-Effectiveness of Peer-Delivered Interventions for Cocaine and Alcohol Abuse among Women: A Randomized Controlled Trial

<div><h3>Aims</h3><p>To determine whether the additional interventions to standard care are cost-effective in addressing cocaine and alcohol abuse at 4 months (4 M) and 12 months (12 M) from baseline.</p> <h3>Method</h3><p>We conducted a cost-effectiveness analysis of a randomized controlled trial with three arms: (1) NIDA's Standard intervention (SI); (2) SI plus a Well Woman Exam (WWE); and, (3) SI, WWE, plus four Educational Sessions (4ES).</p> <h3>Results</h3><p>To obtain an additional cocaine abstainer, WWE compared to SI cost $7,223 at 4 M and$3,611 at 12 M. Per additional alcohol abstainer, WWE compared to SI cost $3,611 and$7,223 at 4 M and 12 M, respectively. At 12 M, 4ES was dominated (more costly and less effective) by WWE for abstinence outcomes.</p> <h3>Conclusions</h3><p>To our knowledge, this is the first cost-effectiveness analysis simultaneously examining cocaine and alcohol abuse in women. Depending on primary outcomes sought and priorities of policy makers, peer-delivered interventions can be a cost-effective way to address the needs of this growing, underserved population.</p> <h3>Trial Registration</h3><p>ClinicalTrials.gov <a href="http://www.clinicaltrials.gov/ct2/show/NCT01235091">NCT01235091</a></p> </div

Raspodjela lindana u vodi, sedimentu i ribama iz rijeke Warri (Delta Nigera, Nigerija)

This paper is the first attempt to quantify the levels and the distribution pattern of lindane in the surface water, sediment and fish (Chrysichthys furcatus and Tilapia zilli). The samples were collected from three stations (Ovwian, Ekakpamre, and Ovu) of the Warri River in the western Niger Delta of Nigeria in 2006: during the dry (January-April) and wet seasons (May-August). The analysis included a total of 96 samples made up of 24 samples each for water, sediment, and fish. The pesticide levels were analysed using high performance liquid chromatography to elucidate its distribution in various environmental compartments. Residue levels in the matrices ranged from below the detection limit (BDL) to 1.37µg L-1 in water, BDL to 12.66 µg g-1 dry weight (dw) in sediment, BDL to 16.67 µg g-1dw in Chrysichthys furcatus, and BDL to 0.15 µg g-1dw in Tilapia zilli .The observed values were above the ecological benchmarks (0.01 µg L-1) recommended by the Nigerian Environmental Protection Agency and European Union. They were also relatively higher than in previous studies on the Nigerian environment, which calls for regular monitoring of the Niger Delta water bodies.Istražene su pojava i raspodjela lindana u površinskoj vodi, sedimentu i dvije vrste riba Chrysichthys furcatus i Tilapia zilli iz rijeke Warri u zapadnom dijelu delte Nigera (Nigerija). Uzorci su skupljeni 2006. godine na tri postaje (Ovwian, Ekakpamre i Ovu) tijekom sušne (siječanj - travanj) i vlažne sezone (svibanj - kolovoz). Analizirano je ukupno 96 uzoraka: po 24 uzorka vode, sedimenta i riba. Razine pesticida odre|ene su primjenom tekućinske kromatografije visoke djelotvornosti (HPLC) te je utvr|ivana njihova raspodjela u različitim dijelovima okoliša. Koncentracije rezidua u uzorcima vode bile su u rasponu: ispod granice detekcije (BDL) do 1,37 µg L-1, u sedimentu: BDL do 12,66 µg g-1 suhe tvari, u ribama Chrysichthys furcatus: BDL do 16,67 µg g-1 suhe tvari te Tilapia zilli: BDL do 0,15 µg g-1 suhe tvari. Određene vrijednosti bile su ispod graničnih vrijednosti (0,01 µg L-1) propisanih od Nigerijske uprave za zaštitu okoliša i Europske unije. Kako su dobivene vrijednosti bile relativno više u odnosu na podatke iz ranijih istraživanja okoliša u Nigeriji, istaknuta je potreba trajnog monitoringa vodotoka u delti Nigera