Causes of death among people who used illicit opioids in England, 2001–18: a matched cohort study

Background: In many countries, the average age of people who use illicit opioids, such as heroin, is increasing. This has been suggested to be a reason for increasing numbers of opioid-related deaths seen in surveillance data. We aimed to describe causes of death among people who use illicit opioids in England, how causes of death have changed over time, and how they change with age. Methods: In this matched cohort study, we studied patients in the Clinical Practice Research Datalink with recorded illicit opioid use (defined as aged 18–64 years, with prescriptions or clinical observations that indicate use of illicit opioids) in England between Jan 1, 2001, and Oct 30, 2018. We also included a comparison group, matched (1:3) for age, sex, and general practice with no records of illicit opioid use before cohort entry. Dates and causes of death were obtained from the UK Office for National Statistics. The cohort exit date was the earliest of date of death or Oct 30, 2018. We described rates of death and calculated cause-specific standardised mortality ratios. We used Poisson regression to estimate associations between age, calendar year, and cause-specific death. Findings: We collected data for 106 789 participants with a history of illicit opioid use, with a median follow-up of 8·7 years (IQR 4·3–13·5), and 320 367 matched controls with a median follow-up of 9·5 years (5·0–14·4). 13 209 (12·4%) of 106 789 participants in the exposed cohort had died, with a standardised mortality ratio of 7·72 (95% CI 7·47–7·97). The most common causes of death were drug poisoning (4375 [33·1%] of 13 209), liver disease (1272 [9·6%]), chronic obstructive pulmonary disease (COPD; 681 [5·2%]), and suicide (645 [4·9%]). Participants with a history of illicit opioid use had higher mortality rates than the comparison group for all causes of death analysed, with highest standardised mortality ratios being seen for viral hepatitis (103·5 [95% CI 61·7–242·6]), HIV (16·7 [9·5–34·9]), and COPD (14·8 [12·6–17·6]). In the exposed cohort, at age 20 years, the rate of fatal drug poisonings was 271 (95% CI 230–313) per 100 000 person-years, accounting for 59·9% of deaths at this age, whereas the mortality rate due to non-communicable diseases was 31 (16–45) per 100 000 person-years, accounting for 6·8% of deaths at this age. Deaths due to non-communicable diseases increased more rapidly with age (1155 [95% CI 880–1431] deaths per 100 000 person-years at age 50 years; accounting for 52·0% of deaths at this age) than did deaths due to drug poisoning (507 (95% CI 452–562) per 100 000 person-years at age 50 years; accounting for 22·8% of deaths at this age). Mirroring national surveillance data, the rate of fatal drug poisonings in the exposed cohort increased from 345 (95% CI 299–391) deaths per 100 000 person-years in 2010–12 to 534 (468–600) per 100 000 person-years in 2016–18; an increase of 55%, a trend that was not explained by ageing of participants. Interpretation: People who use illicit opioids have excess risk of death across all major causes of death we analysed. Our findings suggest that population ageing is unlikely to explain the increasing number of fatal drug poisonings seen in surveillance data, but is associated with many more deaths due to non-communicable diseases

Review of magnetic gear technologies and their applications in marine energy

The marine energy industry is in its early stages but has a large potential for growth. One of the most significant challenges is the reduction of operation and maintenance costs. Magnetic gears (MGs) offer the potential for long periods between maintenance intervals due to their frictionless torque transmission which could reduce these costs. This study presents a summary of the state of the art in MG technology and then investigates its potential for marine energy applications. A brief overview is given of the state of the marine energy industry and the environment in which marine energy converters (MECs) operate. A short history of MG development over the past century is then presented followed by a discussion of the leading MG technologies and their relative advantages. In order to demonstrate the potential of MGs in marine applications, the current technologies, i.e. mechanically geared and direct drive machines, are examined in terms of sizing, reliability and economic value using previous studies on a similar technology, namely wind. MGs are applied to four types of MECs to demonstrate how the technology can be incorporated. The potential to deploy at scale and potential obstacles to this are then discussed

The feasibility of a role for community health workers in integrated mental health care for perinatal depression: a qualitative study from Surabaya, Indonesia.

BACKGROUND: Indonesian maternal health policies state that community health workers (CHWs) are responsible for detection and referral of pregnant women and postpartum mothers who might suffer from mental health problems (task-sharing). The documents have been published for a while, however reports on the implementation are hardly found which possibly resulted from feasibility issue within the health system. AIMS: To examine the feasibility of task-sharing in integrated mental health care to identify perinatal depression in Surabaya, Indonesia. METHODS: Semi-structured interviews were conducted with 62 participants representing four stakeholder groups in primary health care: program managers from the health office and the community, health workers and CHWs, mental health specialists, and service users. Questions on the feasibility were supported by vignettes about perinatal depression. WHO's health systems framework was applied to analyse the data using framework analysis. RESULTS: Findings indicated the policy initiative is feasible to the district health system. A strong basis within the health system for task-sharing in maternal mental health rests on health leadership and governance that open an opportunity for training and supervision, financing, and intersectoral collaboration. The infrastructure and resources in the city provide potential for a continuity of care. Nevertheless, feasibility is challenged by gaps between policy and practices, inadequate support system in technologies and information system, assigning the workforce and strategies to be applied, and the lack of practical guidelines to guide the implementation. CONCLUSION: The health system and resources in Surabaya provide opportunities for task-sharing to detect and refer cases of perinatal depression in an integrated mental health care system. Participation of informal workforce might facilitate in closing the gap in the provision of information on perinatal mental health

Multifunctional Nickel Phosphate Nano/Microflakes 3D Electrode for Electrochemical Energy Storage, Nonenzymatic Glucose, and Sweat pH Sensors

Multifunctional, low-cost electrodes and catalysts are desirable for next-generation electrochemical energy-storage and sensor applications. In this study, we demonstrate the fabrication of Ni₃(PO₄)₂·8H₂O nano/microflakes layer on nickel foam (NF) by a facile one-pot hydrothermal approach and investigate this electrode for multiple applications, including sweat-based glucose and pH sensor as well as hybrid energy-storage device, e.g., supercapattery. The electrode displays a specific capacity of 301.8 mAh g^–1 (1552 F g^–1) at an applied current of 5 mA cm^–2 and can retain 84% of its initial capacity after 10 000 cycles. Furthermore, the supercapattery composed of Ni₃(PO₄)₂·8H₂O/NF as positive electrode and activated carbon as negative electrode can offer a high specific energy of 33.4 Wh kg^–1 with the power of 165.5 W kg^–1. As an electrocatalyst for nonenzymatic glucose sensor, Ni₃(PO₄)₂·8H₂O/NF shows an exceptional sensitivity (24.39 mA mM^–1cm^–2) with a low detection limit of 97 nM (S/N = 3). Moreover, as a sweat-based pH sensor, the electrode is capable of detecting human sweat pH values ranging from 4 to 7. Therefore, this three-dimensional nanoporous Ni₃(PO₄)₂·8H₂O/NF electrode, due to its excellent electrochemical performance, can be successfully applied in electrochemical energy-storage and biosensor applications

Influence of Te-Incorporated LaCoO₃ on Structural, Morphology and Magnetic Properties for Multifunctional Device Applications

A high perovskite activity is sought for use in magnetic applications. In this paper, we present the simple synthesis of (2.5% and 5%) Tellurium-impregnated-LaCoO3 (Te-LCO), Te and LaCoO3 (LCO) by using a ball mill, chemical reduction, and hydrothermal synthesis, respectively. We also explored the structure stability along with the magnetic properties of Te-LCO. Te has a rhombohedral crystal structure, whereas Te-LCO has a hexagonal crystal system. The reconstructed Te was imbued with LCO that was produced by hydrothermal synthesis; as the concentration of the imbuing agent grew, the material became magnetically preferred. According to the X-ray photoelectron spectra, the oxidation state of the cobaltite is one that is magnetically advantageous. As a result of the fact that the creation of oxygen-deficient perovskites has been shown to influence the mixed (Te4+/2−) valence state of the incorporated samples, it is abundantly obvious that this process is of utmost significance. The TEM image confirms the inclusion of Te in LCO. The samples start out in a paramagnetic state (LCO), but when Te is added to the mixture, the magnetic state shifts to a weak ferromagnetic one. It is at this point that hysteresis occurs due to the presence of Te. Despite being doped with Mn in our prior study, rhombohedral LCO retains its paramagnetic characteristic at room temperature (RT). As a result, the purpose of this study was to determine the impacts of RT field dependency of magnetization (M-H) for Te-impregnated LCO in order to improve the magnetic properties of RT because it is a low-cost material for advanced multi-functional and energy applications

A fully automated measurement system for the characterization of micro thermoelectric devices near room temperature

 In this work, we report the customized design and development of a fully automated measurement system to  characterize the temperature-dependent properties of microscale thermoelectric devices. The featured system  can characterize the devices up to a dimension of 8.79 × 8.79 mm2 in an atmospheric environment. Commercially available bismuth telluride-based thermoelectric modules (both thermoelectric generator and thermoelectric cooler) are used to validate the feasibility and accuracy of the developed system. Their performance data  is analysed and compared with the available manufacturer datasheet. The measured data from these devices are  found to be in good agreement with the anticipated values and showed an acceptable deviation of less than 4% in  the output performances. The developed setup is simple to operate and suitable for performance evaluation of  both macro and micro-thermoelectric devices. The system accurately reproduces application conditions the  module may be subjected to in a real-world environment.  </p

NiFe2O4 / rGO nanocomposites produced by soft bubble assembly for energy storage and environmental remediation

Environmental concerns regarding the use of potentially harmful chemicals and fossil fuels stimulate research efforts on the multifunctional hybrid nanocomposites produced from biowastes via simple environmentally friendly processes. Such nanomaterials could help to combat the escalating environmental issues related to environmental remediation and energy storage, as a step to the renewable energy technology of the future. This work discusses the synthesis of novel nickel-based reduced graphene oxide (rGO) nanostructured composites with superior energy storage and photocatalytic properties. Using a facile hydrothermal method, rGO nanoflakes were synthesized from the negative value coconut coir biowaste and then decorated with functional NiO and NiFe2O4 nanoparticles to produce hierarchical functional nanocomposites. Benefiting from the synergies arising from the concomitant use of NiFe2O4 nanoparticles and rGO nanoflakes, the resultant nanocomposites yielded excellent specific capacitance of 599.9 F/g at current density of 1 Ag-1 and retention rate of 86.5% even after 2000 cycles. Moreover, the composite exhibited excellent efficiency of visible light driven photocatalytic degradation of 96.5%. Thus, our material is essentially multifunctional and importantly, it demonstrates quite pronounced electrochemical and photocatalytic activities when produced in a simple, single technological route. These findings confirm that the developed multifunctional nanostructured composite is a strong candidate material for energy and environmental remediation applications.</p