Consider these medications to help patients stay sober

Naltrexone can help prevent relapse in recently detoxified patients with alcohol use disorder. The evidence for acamprosate is not quite as strong. Practice changer: Consider prescribing oral naltrexone (50 mg/d) for patients with alcohol use disorder who wish to maintain abstinence after a brief period of detoxification

Are community health agents the link to integrating care? Lesson from Brazil

PurposeThis viewpoint piece will highlight the contribution of trained lay community health workers to the integrated workforce in rural, remote and island settings, drawing on experience from a system strengthening project involving community health agents (CHAs) in four municipalities in Litoral Norte, a remote coastal and island region in the state of São Paulo, Brazil.Design/methodology/approachThis viewpoint reflects on experiential learning from a unique north–south collaboration that spanned the period of a global pandemic. It adds to the international literature on the value of community health workers in public health and chronic disease management and highlights their potential pivotal role as integrators at point of care.FindingsCHAs took forward actions that touched the lives of thousands of vulnerable families with low income and complex needs in communities with high levels of social and health inequalities. They acted as a bridge between patients and families at home, primary healthcare professionals and wider community partners and services. Their valuable insight into the healthcare issues and social challenges experienced by the community informed and supported family centred practice and population health goals. The CHAs rapidly pivoted to became an essential public health workforce during the Covid-19 pandemic.Practical implicationsAs the authors establish integrated care systems and embrace proactive care and population health, the conditions are favourable for introducing a similar role in the UK. For psychological safety and avoidance of burnout people in such new roles will require training, supervision and full integration within community teams.Originality/valueThis viewpoint reflects experiential learning from a unique north–south collaboration that spanned the period of a global pandemic. It adds to the international literature on the value of community health workers in public health and chronic disease management and highlights their potential pivotal role as integrators at point of care.<br/

‘Flex Your Power’: Energy crises and the shifting rhetoric of the grid

In response to widespread power outages, rolling blackouts, and ubiquitous energy debates, this essay considers our relation to energy and the grid that produces it. First, we investigate California\u27s multimedia Flex Your Power campaign, which defines consumers as nodes of the grid to emphasize their responsibility to maintain a stable energy supply. Second, we examine state and national responses to the 2003 blackout in the Northeastern United States, attending to three strategies through which grid administrators sought to impose order, enact hierarchy, and deindividuate power. We propose that the grid invokes personalization at the local level and abstraction at the national level. These contradictory (but overlapping) narratives show a complex, nuanced set of relations between human society and mechanized processes of power distribution

Movement quantity and quality: How do they relate to pain and disability in dancers?

Objective This field-based study aimed to determine the association between pre-professional student dancers’ movement quantity and quality with (i) pain severity and (ii) pain related disability. Methods Pre-professional female ballet and contemporary dance students (n = 52) participated in 4 time points of data collection over a 12-week university semester. At each time point dancers provided self-reported pain outcomes (Numerical Rating Scale as a measure of pain severity and Patient Specific Functional Scale as a measure of pain related disability) and wore a wearable sensor system. This system combined wearable sensors with previously developed machine learning models capable of capturing movement quantity and quality outcomes. A series of linear mixed models were applied to determine if there was an association between dancers’ movement quantity and quality over the 4 time points with pain severity and pain related disability. Results Almost all dancers (n = 50) experienced pain, and half of the dancers experienced disabling pain (n = 26). Significant associations were evident for pain related disability and movement quantity and quality variables. Specifically, greater pain related disability was associated with more light activity, fewer leg lifts to the front, a shorter average duration of leg lifts to the front and fewer total leg lifts. Greater pain related disability was also associated with higher thigh elevation angles to the side. There was no evidence for associations between movement quantity and quality variables and pain severity. Discussion Despite a high prevalence of musculoskeletal pain, dancers’ levels of pain severity and disability were generally low. Between-person level associations were identified between dancers’ movement quantity and quality, and pain related disability. These findings may reflect dancers’ adaptations to pain related disability, while they continue to dance. This proof-of-concept research provides a compelling model for future work exploring dancers’ pain using field-based, serial data collection

Formation of Topological Defects in a Second Order Phase Transition

The classical evolution equations of the Abelian Higgs model are studied at temperatures below the Ginsburg temperature of a phase transition which is assumed to be second order. It is shown that the initial thermal fluctuations provide a domain structure which is stable against late time fluctuations. This result lends support to the Kibble mechanism for the formation of topological defects.Comment: Brown preprint BROWN-HET-934 (March 1994), 12 pages, uses phyzz