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Opioid overdose deaths in the United States are increasing. Time to restoration of ventilation is critical. Rapid bystander administration of opioid antidote (naloxone) is an effective interim response but is historically constrained by legal restrictions.
To review and contextualize development of legislation facilitating layperson administration of naloxone across the United States.
Publicly accessible databases (1,2) were searched for legislation relevant to naloxone administration between January 2001 and July 2017.
All 51 jurisdictions implemented naloxone access laws between 2001 and 2017; 45 of these between 2012 and 2017. Nationwide mortality from opioid overdose increased from 3.3 per 100,000 population in 2001 to 13.3 in 2016, 42, and 35 jurisdictions enacted laws giving prescribers immunity from criminal prosecution, civil liability, and professional sanctions, respectively. 36, 41, and 35 jurisdictions implemented laws allowing dispensers immunity in the same domains. 38 and 46 jurisdictions gave laypeople administering naloxone immunity from criminal and civil liability. Forty-seven jurisdictions implemented laws allowing prescription of naloxone to third parties. All jurisdictions except Nebraska allowed pharmacists to dispense naloxone without a patient-specific prescription. Fifteen jurisdictions removed criminal liability for possession of non-prescribed naloxone. The 10 states with highest average rates of opioid overdose-related mortality had not legislated in a higher number of domains compared to the 10 lowest states and the average of all jurisdictions (3.4 vs 2.9 vs 2.7, respectively).
Effective involvement of bystanders in early recognition and reversal of opioid overdose requires removal of legal deterrents to prescription, dispensing, distribution, and administration of naloxone. Jurisdictions have varied in degree and speed of creating this legal environment. Understanding the integration of legislation into epidemic response may inform the response to this and future public health crises.
Human Stampedes (HS) occur at religious mass gatherings. Religious events have a higher rate of morbidity and mortality than other events that experience HS. This study is a subset analysis of religious event HS data regarding the physics principles involved in HS, and the associated event morbidity and mortality.
To analyze reports of religious HS to determine the initiating physics principles and associated morbidity and mortality.
Thirty-four reports of religious HS were analyzed to find shared variables. Thirty-three (97.1%) were written media reports with photographic, drawn, or video documentation. 29 (85.3%) cited footage/photographs and 1 (2.9%) was not associated with visual evidence. Descriptive phrases associated with physics principles contributing to the onset of HS and morbidity data were extracted and analyzed to evaluate frequency before, during, and after events.
34 (39.1%) reports of HS found in the literature review were associated with religious HS. Of these, 83% were found to take place in an open space, and 82.3% were associated with population density changes. 82.3% of events were associated with architectural nozzles (small streets, alleys, etc). 100% were found to have loss of XY-axis motion and 89% reached an average velocity of zero. 100% had loss of proxemics and 91% had associated Z-axis displacement (falls). Minimum reported attendance for a religious HS was 3000. 100% of religious HS had reported mortality at the event and 56% with further associated morbidity.
HS are deadly events at religious mass gatherings. Religious events are often recurring, planned gatherings in specific geographic locations. They are frequently associated with an increase in population density, loss of proxemics and velocity, followed by Z-axis displacements, leading to injury and death. This is frequently due to architectural nozzles, which those organizing religious mass gatherings can predict and utilize to mitigate future events.
To describe treatment and referral patterns and National Health Service resource use in patients with chronic pain associated with low back pain or osteoarthritis, from a Primary Care perspective.
Osteoarthritis and low back pain are the two commonest debilitating causes of chronic pain, with high health and social costs, and particularly important in primary care. Understanding current practice and resource use in their management will inform health service and educational requirements and the design and optimisation of future care.
Multi-centre, retrospective, descriptive study of adults (⩾18 years) with chronic pain arising from low back pain or osteoarthritis, identified through primary care records. Five general practices in Scotland, England (two), Northern Ireland and Wales. All patients with a diagnosis of low back pain or osteoarthritis made on or before 01/09/2006 who had received three or more prescriptions for pain medication were identified and a sub-sample randomly selected then consented to an in-depth review of their medical records (n=264). Data on management of chronic pain were collected retrospectively from patients’ records for three years from diagnosis (‘newly diagnosed’ patients) or for the most recent three years (‘established’ patients).
Patients received a wide variety of pain medications with no overall common prescribing pattern. GP visits represented the majority of the resource use and ‘newly diagnosed’ patients were significantly more likely to visit their GP for pain management than ‘established’ patients. Although ‘newly diagnosed’ patients had more referrals outside the GP practice, the number of visits to secondary care for pain management was similar for both groups.
This retrospective study confirmed the complexity of managing these causes of chronic pain and the associated high resource use. It provides an in-depth picture of prescribing and referral patterns and of resource use.
In this study, men and women were surveyed about their attitudes toward the use of white lies and other forms of benevolent deception in their romantic relationships. We predicted that people would be more accepting of telling lies than of having lies told to them. Furthermore, we predicted that women would be more accepting than men of benevolent deception in their romantic relationships. We found that people were more tolerant of telling benevolent lies than they were of being told such lies. However, we found that men, not women, were more accepting of benevolent deception in their relationships.
This study focuses on managing cotton production and marketing risks using combinations of irrigation levels, put options (as price insurance), and crop insurance. Stochastic cotton yields and prices are used to simulate a whole-farm financial statement for a 1,000 acre furrow-irrigated cotton farm in the Texas Lower Rio Grande Valley under 16 combinations of risk management strategies. Analyses for risk-averse decision makers indicate that multiple irrigations are preferred. The benefits to purchasing put options increase with yields, as they are more beneficial when higher yields are expected from applying more irrigation applications. Crop insurance is strongly preferred at lower irrigation levels.
Fenoxaprop effectively controls crabgrass in tall fescue turf, but antagonism with growth-regulating herbicides reduces potential to apply fenoxaprop in combination with many herbicides registered for broadleaf weed control. Aminocyclopyrachlor is a new broadleaf weed control herbicide that has not been evaluated in combination with fenoxaprop. Field experiments were conducted in Georgia, New Jersey, and Tennessee to investigate tank mixtures of fenoxaprop with aminocyclopyrachlor for smooth crabgrass and white clover control. Fenoxaprop alone exhibited substantial activity on smooth crabgrass but control was greater with fenoxaprop + aminocyclopyrachlor treatments. By 4 and 6 wk after treatment (WAT), approximately 22 and 44% less fenoxaprop was required to achieve 80% smooth crabgrass control when the herbicide was tank-mixed with aminocyclopyrachlor at 52.5 and 79 g ai ha−1, respectively. Fenoxaprop did not reduce white clover control with aminocyclopyrachlor because 97% control was achieved by 4 WAT for all aminocyclopyrachlor + fenoxaprop treatments. Tall fescue was not injured by any treatment. Results suggest aminocyclopyrachlor enhances fenoxaprop efficacy for smooth crabgrass control in tall fescue.
The Long Parliament which convened in November 1640 has always been seen as being of central importance to the broader narrative of English history. Its notoriety derives, in the first instance, from the critical role it played in the onset – and subsequent conduct – of the English Civil War and Revolution. But it is also seen to be critically important to the history of the institution itself and to Parliament's evolving sense of its own role and responsibilities. The collapse of the king's government in 1640, the resulting (and immediate) need to fill the administrative vacuum and the eventual demands of governing in wartime all worked inevitably to bring about a fundamental transformation during the ensuing decade. Traditionally (and certainly through the parliaments of the 1620s) Parliament had been called primarily to do ‘the king's business’ and it did so in three clearly defined ways: by offering advice and counsel to the king's government on contemporary problems; by joining the king in passing legislation to correct those problems and any others which they or the king's ministers might have identified; and (rather less conspicuously) by enforcing the king's laws through the judicial process of impeachment or through appellate review in the House of Lords. Parliament's functions were advisory, legislative and judicial. They were not, and until 1640 were not presumed to be, either administrative or executive in nature.