Illicit Psychoactive Medication Use: Experiences of Medicalization and Normalization

This dissertation explores illicit psychoactive medication use among young adults. Overwhelmingly, the literature on this drug trend, particularly among this population, is grounded in a study of pathology. However, my research demonstrates that this obscures a significant portion of how youth practice and make meaning of their consumption of these controversial medications. The following phenomenologically based dissertation presents and unpacks the experiences, practices, and perspectives of young adults who illicitly consume psychoactive medications. Through analyzing 162 interviews of 18-29 year olds who report recent misuse of a prescription stimulant, tranquilizer, sedative, and/or opioid, I present the ways youth medicalize and normalize particular consumption practices and context. By taking seriously the ways youth experience these drugs in day to day life this phenomenological study highlights how youth construct socially responsible practices of illicit drug use. The focus and timing of this research is significant as it relates to gaining a more comprehensive social and cultural understanding of a well-known drug trend ubiquitously framed as one of today’s major social problems in U.S. society

Global Assimilation of Loon Stratospheric Balloon Observations

Project Loon has an overall goal of providing worldwide internet coverage using a network of long-durationsuper-pressure balloons. Since 2013, Loon has launched over 1600 balloons from multiple tropical and middlelatitude locations. These GPS tracked balloon trajectories provide lower stratospheric wind information overthe oceans and remote land areas where traditional radiosonde soundings are sparse, thus providing uniquecoverage of lower stratospheric winds. To fully investigate these Loon winds we: 1) compare the Loon windsto winds produced by a global data assimilation system (DAS: NASA GEOS) and 2) assimilate the Loon windsinto the same comprehensive DAS. Results show that in middle latitudes the Loon winds and DAS winds agreewell, and the Loon wind assimilation has only a minor impact on the forecasts. However, in the Tropics, thereis often a substantial difference between the assimilated winds and the observed Loon winds, of 8 m/s or morein magnitude. In these cases, assimilating the Loon winds significantly improves the meteorological analysesand subsequently the forecasts of the Loon winds. By highlighting cases where the Loon and DAS winds differ,these results can lead to improved understanding of stratospheric winds, especially in the tropics, as well asaiding analyses of the representation of dynamical forcing mechanisms in the GEOS model

Lipid Profiles, Glycated Hemoglobin, and Diabetes in People Living at High Altitude in Nepal.

This study aimed to describe lipid profiles and the distribution of glycated hemoglobin (HbA1c) in a sample of a high altitude population of Nepal and to explore associations between these metabolic risk variables and altitude. A cross-sectional survey of cardiovascular disease and associated risk factors was conducted among 521 people living at four different altitude levels, all above 2800 m, in the Mustang and Humla districts of Nepal. Urban participants (residents at 2800 m and 3620 m) had higher total cholesterol (TC) and triglyceride (TG) than rural participants. A high ratio of TC to high-density lipoprotein-cholesterol (HDL) (TC/HDL ≥ 5.0) was found in 23.7% (95% CI 19.6, 28.2) and high TG (≥1.7 mmol/L) in 43.3% (95% CI 38.4, 48.3) of participants overall. Mean HbA1c levels were similar at all altitude levels although urban participants had a higher prevalence of diabetes. Overall, 6.9% (95% CI 4.7, 9.8) of participants had diabetes or were on hypoglycaemic treatment. There was no clear association between lipid profiles or HbA1c and altitude in a multivariate analysis adjusted for possible confounding variables. Residential settings and associated lifestyle practices are more strongly associated with lipid profiles and HbA1c than altitude amongst high altitude residents in Nepal

Stakeholder perspectives on new ways of delivering unscheduled health care: the role of ownership and organisational identity

<b>Rationale, aims and objectives</b>: To explore stakeholder perspectives of the implementation of a new, national integrated nurse-led telephone advice and consultation service (NHS 24), comparing the views of stakeholders from different health care organisations. <b>Methods</b>: Semi-structured interviews with 26 stakeholders including partner organisations located in primary and secondary unscheduled care settings (general practitioner (GP) out-of-hours co-operative; accident and emergency department; national ambulance service), members of NHS 24 and national policymakers. Attendance at key meetings, documentary review and email implementation diaries provided a contextual history of events with which interview data could be compared. <b>Results</b>: The contextual history of events highlighted a fast-paced implementation process, with little time for reflection. Key areas of partner concern were increasing workload, the clinical safety of nurse triage and the lack of communication across the organisations. Concerns were most apparent within the GP out-of-hours co-operative, leading to calls for the dissolution of the partnership. Accident and emergency and ambulance service responses were more conciliatory, suggesting that such problems were to be expected within the developmental phase of a new organisation. Further exploration of these responses highlighted the sense of ownership within the GP co-operative, with GPs having both financial and philosophical ownership of the co-operative. This was not apparent within the other two partner organisations, in particular the ambulance service, which operated on a regional model very similar to that of NHS 24. <b>Conclusions</b>: As the delivery of unscheduled primary health care crosses professional boundaries and locations, different organisations and professional groups must develop new ways of partnership working, developing trust and confidence in each other. The results of this study highlight, for the first time, the key importance of understanding the professional ownership and identity of individual organisations, in order to facilitate the most effective mechanisms to enable that partnership working

A role for intracellular calcium downstream of G-protein signaling in undifferentiated human embryonic stem cell culture

AbstractMultiple signalling pathways maintain human embryonic stem cells (hESC) in an undifferentiated state. Here we sought to define the significance of G protein signal transduction in the preservation of this state distinct from other cellular processes. Continuous treatment with drugs targeting Gαs-, Gα-i/o- and Gα-q/11-subunit signalling mediators were assessed in independent hESC lines after 7days to discern effects on normalised alkaline phosphatase positive colony frequency vs total cell content. This identified PLCβ, intracellular free calcium and CAMKII kinase activity downstream of Gα-q/11 as of particular importance to the former. To confirm the significance of this finding we generated an agonist-responsive hESC line transgenic for a Gα-q/11 subunit-coupled receptor and demonstrated that an undifferentiated state could be promoted in the presence of an agonist without exogenously supplied bFGF and that this correlated with elevated intracellular calcium. Similarly, treatment of unmodified hESCs with a range of intracellular free calcium-modulating drugs in biologically defined mTESR culture system lacking exogenous bFGF promoted an hESC phenotype after 1week of continuous culture as defined by co-expression of OCT4 and NANOG. At least one of these drugs, lysophosphatidic acid significantly elevates phosphorylation of calmodulin and STAT3 in this culture system (p<0.05). These findings substantiate a role for G-protein and calcium signalling in undifferentiated hESC culture

Assessing the effectiveness of business support services in England: evidence from a theory based evaluation

In England, publicly supported advisory services for small firms are organised primarily through the Business Link (BL) network. Based on the programme theory underlying this business support services we develop four propositions and test these empirically using data from a new survey of over 3,000 English small firms. Our empirical results provide a broad validation of the programme theory underlying BL assistance for small firms in England during 2003, and more limited support for its effectiveness. More specifically, we find strong support for the value of BL operators maintaining a high profile as a way of boosting take-up. We also find some support for the approach to market segmentation adopted by BL allowing more intensive assistance to be targeted on younger firms and those with limited liability status. In terms of the outcomes of BL support, and allowing for issues of sample selection, we find no significant effects on growth from ‘other’ assistance but do find positive and significant employment growth effects from intensive assistance. This provides partial support for the programme theory assertion that BL support will lead to improvements in business growth performance and stronger support for the proposition that there would be differential outcomes from intensive and other assistance. The positive employment growth outcomes identified here from intensive assistance, even allowing for sample selection, suggest something of an improvement in the effectiveness of the BL network since the late 1990s

Recent Decline in Extratropical Lower Stratospheric Ozone Attributed to Circulation Changes

1998-2016 ozone trends in the lower stratosphere (LS) are examined using the Modern-Era Retrospective Analysis for Research and Applications Version 2 (MERRA-2) and related NASA products. After removing biases resulting from step-changes in the MERRA-2 ozone observations, a discernible negative trend of -1.67+/-0.54 Dobson units per decade (DU/decade) is found in the 10-km layer above the tropopause between 20 deg N and 60 deg N. A weaker but statistically significant trend of -1.17+/-0.33 DU/decade exists between 50 deg S and 20 deg S. In the Tropics, a positive trend is seen in a 5-km layer above the tropopause. Analysis of an idealized tracer in a model simulation constrained by MERRA-2 meteorological fields provides strong evidence that these trends are driven by enhanced isentropic transport between the tropical (20 deg S20 deg N) and extratropical LS in the past two decades. This is the first time that a reanalysis dataset has been used to detect and attribute trends in lower stratospheric ozone. Plain Language Summary. Stratospheric ozone shields the biosphere from harmful ultraviolet radiation and affects the Earths radiative budget. Observational data show evidence that concentrations of ozone in the upper stratosphere have increased in the last 15 years. This is an expected result of the implementation of the Montreal Protocol and its amendments banning emissions of ozone depleting substances into the atmosphere. The evolution of stratospheric ozone is also impacted by climate change through its dependence on temperature and circulation, which can be different at different altitudes. These effects are less well understood. This study uses NASAs data and computer models to analyze the long-term changes in ozone since 1998. It is shown that the increase in the upper stratospheric ozone has been partially offset by a small but discernible decline of ozone concentrations in the lowermost stratosphere, in qualitative agreement with one recent study. A chemistry model simulation forced by meteorological data provides strong evidence that the primary mechanism driving this negative trend is an intensification of transport of ozone-poor air from the tropics into the extratropics, indicative of a systematic change in the lower-stratospheric circulation between 1998 and 2016

The Global Structure of UTLS Ozone in GEOS-5: A Multi-Year Assimilation of EOS Aura Data

Eight years of ozone measurements retrieved from the Ozone Monitoring Instrument (OMI) and the Microwave Limb Sounder, both on the EOS Aura satellite, have been assimilated into the Goddard Earth Observing System version 5 (GEOS-5) data assimilation system. This study thoroughly evaluates this assimilated product, highlighting its potential for science. The impact of observations on the GEOS-5 system is explored by examining the spatial distribution of the observation-minus-forecast statistics. Independent data are used for product validation. The correlation coefficient of the lower-stratospheric ozone column with ozonesondes is 0.99 and the bias is 0.5%, indicating the success of the assimilation in reproducing the ozone variability in that layer. The upper-tropospheric assimilated ozone column is about 10% lower than the ozonesonde column but the correlation is still high (0.87). The assimilation is shown to realistically capture the sharp cross-tropopause gradient in ozone mixing ratio. Occurrence of transport-driven low ozone laminae in the assimilation system is similar to that obtained from the High Resolution Dynamics Limb Sounder (HIRDLS) above the 400 K potential temperature surface but the assimilation produces fewer laminae than seen by HIRDLS below that surface. Although the assimilation produces 5 - 8 fewer occurrences per day (up to approximately 20%) during the three years of HIRDLS data, the interannual variability is captured correctly. This data-driven assimilated product is complementary to ozone fields generated from chemistry and transport models. Applications include study of the radiative forcing by ozone and tracer transport near the tropopause