Engaging Opioid Overdose Survivors: Impact of Peer Recovery Specialists on Patient Utilization and Cost

Peer recovery specialists play a key role in addressing the current opioid crisis. The Opioid Survivor Outreach Program (OSOP) peer recovery specialist intervention was designed to support opioid overdose survivors. In this program, patients are connected with a peer recovery specialist and are provided connection to treatment, support services, and harm reduction tools. This study was a quasi-experimental, mixed-methods approach to evaluate the impact of OSOP on opioid-related and all-cause hospital visits and acute care cost avoidance. Chapter 1 focuses in on evaluating impact of OSOP on hospital visits while Chapter 2 evaluates the impact on cost avoidance through the assessment of hospital charges. The third chapter leverages in-depth interviews from OSOP peer recovery specialists, nurses, and physicians to allow for a more comprehensive understanding of the program’s efficacy. Narrative content analysis was used to analyze the interview data from 11 participants. A historical control group was selected through propensity score matching to compare hospital visit and charges data with a study population at four study setting hospitals. A negative binomial regression was used to assess the differences in hospital visits among the groups while two sample t-test was used to analyze differences in hospital charges. OSOP was found to reduce expected opioid-related visits by 32.5% in the pre and post-enrollment OSOP study group, as well as all-cause hospital visits. Opioid-related hospital visits result in $703 more in charges when compared to non-opioid related visits. When analyzing gross charges and programmatic costs, the OSOP program allows the healthcare system to avoid$1.1M in opioid-related hospital charges over one year and $770K in all-cause hospital charges. The findings suggest that the OSOP program is an intervention that assists patients in seeking substance use and supportive services while reducing acute hospital utilization and cost. Interviews from participants confirmed that a peer recovery specialist lived experiences encourage patients to enroll in OSOP. Peers have a command of the treatment ecosystem to effectively advocate and link patients to care. Further, insights from providers give other health institutions considerations on how to build a successful OSOP program in the emergency department environment

Public Evidence from Secret Ballots

Elections seem simple---aren't they just counting? But they have a unique, challenging combination of security and privacy requirements. The stakes are high; the context is adversarial; the electorate needs to be convinced that the results are correct; and the secrecy of the ballot must be ensured. And they have practical constraints: time is of the essence, and voting systems need to be affordable and maintainable, and usable by voters, election officials, and pollworkers. It is thus not surprising that voting is a rich research area spanning theory, applied cryptography, practical systems analysis, usable security, and statistics. Election integrity involves two key concepts: convincing evidence that outcomes are correct and privacy, which amounts to convincing assurance that there is no evidence about how any given person voted. These are obviously in tension. We examine how current systems walk this tightrope.Comment: To appear in E-Vote-Id '1

Transcriptional Changes Underlying Elemental Stoichiometry Shifts in a Marine Heterotrophic Bacterium

Marine bacteria drive the biogeochemical processing of oceanic dissolved organic carbon (DOC), a 750-Tg C reservoir that is a critical component of the global C cycle. Catabolism of DOC is thought to be regulated by the biomass composition of heterotrophic bacteria, as cells maintain a C:N:P ratio of ∼50:10:1 during DOC processing. Yet a complicating factor in stoichiometry-based analyses is that bacteria can change the C:N:P ratio of their biomass in response to resource composition. We investigated the physiological mechanisms of resource-driven shifts in biomass stoichiometry in continuous cultures of the marine heterotrophic bacterium Ruegeria pomeroyi (a member of the Roseobacter clade) under four element limitation regimes (C, N, P, and S). Microarray analysis indicated that the bacterium scavenged for alternate sources of the scarce element when cells were C-, N-, or P-limited; reworked the ratios of biomolecules when C- and P- limited; and exerted tighter control over import/export and cytoplasmic pools when N-limited. Under S limitation, a scenario not existing naturally for surface ocean microbes, stress responses dominated transcriptional changes. Resource-driven changes in C:N ratios of up to 2.5-fold and in C:P ratios of up to sixfold were measured in R. pomeroyi biomass. These changes were best explained if the C and P content of the cells was flexible in the face of shifting resources but N content was not, achieved through the net balance of different transcriptional strategies. The cellular-level metabolic trade-offs that govern biomass stoichiometry in R. pomeroyi may have implications for global carbon cycling if extendable to other heterotrophic bacteria. Strong homeostatic responses to N limitation by marine bacteria would intensify competition with autotrophs. Modification of cellular inventories in C- and P-limited heterotrophs would vary the elemental ratio of particulate organic matter sequestered in the deep ocean

Thank you to our 2017 peer reviewers

Author Posting. © American Geophysical Union, 2018. This article is posted here by permission of American Geophysical Union for personal use, not for redistribution. The definitive version was published in Journal of Geophysical Research: Oceans 123 (2018): 6042-6052, doi:10.1029/2018JC014410.Similar to the construction of physical ships and laboratory buildings, scientific knowledge is built incrementally and requires solid components of data, theory, and methodology at each phase of the “construction.” The peer‐review process provides the necessary “inspection” and the assurance that every step of the construction is solid, particularly in regard to the proper use of the scientific method. The peer‐review process helps improve the published work by providing constructive suggestions and by safeguarding against scientific work that could later be found to be built on shaky foundations. Because no single scientist has intimate knowledge of today's many aspects of the Ocean Sciences, we rely on each other's expertise to serve as unbiased “inspectors” of published articles. Your considerable time and effort, spent reviewing JGR‐Oceans manuscript(s) during 2017, are sincerely appreciated by our editorial board and by the Ocean Science community at large. We thank you for rising to this professional challenge and for your wisdom, commitment, skill, and service.2019-03-1

A typology of modifications to peer support work for adults with mental health problems:systematic review

© The Authors 2020. Background Peer support work roles are being implemented internationally, and increasingly in lower-resource settings. However, there is no framework to inform what types of modifications are needed to address local contextual and cultural aspects. Aims To conduct a systematic review identifying a typology of modifications to peer support work for adults with mental health problems. Method We systematically reviewed the peer support literature following PRISMA guidelines for systematic reviews (registered on PROSPERO (International Prospective Register of Systematic Reviews) on 24 July 2018: CRD42018094832). All study designs were eligible and studies were selected according to the stated eligibility criteria and analysed with standardised critical appraisal tools. A narrative synthesis was conducted to identify types of, and rationales for modifications. Results A total of 15 300 unique studies were identified, from which 39 studies were included with only one from a low-resource setting. Six types of modifications were identified: role expectations; initial training; type of contact; role extension; workplace support for peer support workers; and recruitment. Five rationales for modifications were identified: to provide best possible peer support; to best meet service user needs; to meet organisational needs, to maximise role clarity; and to address socioeconomic issues. Conclusions Peer support work is modified in both pre-planned and unplanned ways when implemented. Considering each identified modification as a candidate change will lead to a more systematic consideration of whether and how to modify peer support in different settings. Future evaluative research of modifiable versus non-modifiable components of peer support work is needed to understand the modifications needed for implementation among different mental health systems and cultural settings. Declaration of interest None

Belenios: a simple private and verifiable electronic voting system

International audienceWe present the electronic voting protocol Belenios together with its associated voting platform. Belenios guarantees vote privacy and full verifiability, even against a compromised voting server. While the core of the voting protocol was already described and formally proved secure, we detail here the complete voting system from the setup to the tally and the recovery procedures. We comment on the use of Belenios in practice. In particular, we discuss the security choices made by election administrators w.r.t. the decryption key and the delegation of some setup tasks to the voting platform

Inhibitors of Foot and Mouth Disease Virus Targeting a Novel Pocket of the RNA-Dependent RNA Polymerase

Foot-and-Mouth Disease Virus (FMDV) is a picornavirus that infects cloven-hoofed animals and leads to severe losses in livestock production. In the case of an FMD outbreak, emergency vaccination requires at least 7 days to trigger an effective immune response. There are currently no approved inhibitors for the treatment or prevention of FMDV infections.Using a luciferase-based assay we screened a library of compounds and identified seven novel inhibitors of 3Dpol, the RNA-dependent RNA polymerase of FMDV. The compounds inhibited specifically 3Dpol (IC(50)s from 2-17 µM) and not other viral or bacterial polymerases. Enzyme kinetic studies on the inhibition mechanism by compounds 5D9 and 7F8 showed that they are non-competitive inhibitors with respect to NTP and nucleic acid substrates. Molecular modeling and docking studies into the 3Dpol structure revealed an inhibitor binding pocket proximal to, but distinct from the 3Dpol catalytic site. Residues surrounding this pocket are conserved among all 60 FMDV subtypes. Site directed mutagenesis of two residues located at either side of the pocket caused distinct resistance to the compounds, demonstrating that they indeed bind at this site. Several compounds inhibited viral replication with 5D9 suppressing virus production in FMDV-infected cells with EC(50) = 12 µM and EC(90) = 20 µM).We identified several non-competitive inhibitors of FMDV 3Dpol that target a novel binding pocket, which can be used for future structure-based drug design studies. Such studies can lead to the discovery of even more potent antivirals that could provide alternative or supplementary options to contain future outbreaks of FMD

JWST/NIRCam Transmission Spectroscopy of the Nearby Sub-Earth GJ 341b

We present a JWST/NIRCam transmission spectrum from $3.9-5.0$ $\mu$m of the recently-validated sub-Earth GJ 341b ($\mathrm{R_P} = 0.92$ $\mathrm{R_{\oplus}}$, $\mathrm{T_{eq}} = 540$ K) orbiting a nearby bright M1 star ($\mathrm{d} = 10.4$ pc, $\mathrm{K_{mag}}=5.6$). We use three independent pipelines to reduce the data from the three JWST visits and perform several tests to check for the significance of an atmosphere. Overall, our analysis does not uncover evidence of an atmosphere. Our null hypothesis tests find that none of our pipelines' transmission spectra can rule out a flat line, although there is weak evidence for a Gaussian feature in two spectra from different pipelines (at 2.3 and $2.9\sigma$). However, the candidate features are seen at different wavelengths (4.3 $\mu$m vs 4.7 $\mu$m), and our retrieval analysis finds that different gas species can explain these features in the two reductions (CO$_2$ at $3.1\sigma$ compared to O$_3$ at $2.9\sigma$), suggesting that they are not real astrophysical signals. Our forward model analysis rules out a low mean molecular weight atmosphere ($< 350\times$ solar metallicity) to at least $3\sigma$, and disfavors CH$_4$-dominated atmospheres at $1-3\sigma$, depending on the reduction. Instead, the forward models find our transmission spectra are consistent with no atmosphere, a hazy atmosphere, or an atmosphere containing a species that does not have prominent molecular bands across the NIRCam/F444W bandpass, such as a water-dominated atmosphere. Our results demonstrate the unequivocal need for two or more transit observations analyzed with multiple reduction pipelines, alongside rigorous statistical tests, to determine the robustness of molecular detections for small exoplanet atmospheres.Comment: 25 pages, 18 figures, 6 tables. Accepted for publication in A

Double Trouble: Two Transits of the Super-Earth GJ 1132 b Observed with JWST NIRSpec G395H

The search for rocky planet atmospheres with JWST has focused on planets transiting M dwarfs. Such planets have favorable planet-to-star size ratios, enhancing the amplitude of atmospheric features. Since the expected signal strength of atmospheric features is similar to the single-transit performance of JWST, multiple observations are required to confirm any detection. Here, we present two transit observations of the rocky planet GJ 1132 b with JWST NIRSpec G395H, covering 2.8-5.2 $\mu$m. Previous HST WFC3 observations of GJ 1132 b were inconclusive, with evidence reported for either an atmosphere or a featureless spectrum based on analyses of the same dataset. Our JWST data exhibit substantial differences between the two visits. One transit is consistent with either a H$_2$O-dominated atmosphere containing ~1% CH$_4$ and trace N$_2$O ($\chi^{2}_{\nu}$ = 1.13) or stellar contamination from unocculted starspots ($\chi^{2}_{\nu}$ = 1.36). However, the second transit is consistent with a featureless spectrum. Neither visit is consistent with a previous report of HCN. Atmospheric variability is unlikely to explain the scale of the observed differences between the visits. Similarly, our out-of-transit stellar spectra show no evidence of changing stellar inhomogeneity between the two visits - observed 8 days apart, only 6.5% of the stellar rotation rate. We further find no evidence of differing instrumental systematic effects between visits. The most plausible explanation is an unlucky random noise draw leading to two significantly discrepant transmission spectra. Our results highlight the importance of multi-visit repeatability with JWST prior to claiming atmospheric detections for these small, enigmatic planets.Comment: 22 pages, 10 figures, 2 tables. Accepted for publication in ApJ Letters. Co-First Authors. Bonus materials and spectral data: https://doi.org/10.5281/zenodo.1000208