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ABSTRACT IMPACT: Identifying factors associated with opioid overdoses will enable better resource allocation in communities most impacted by the overdose epidemic. OBJECTIVES/GOALS: Opioid overdoses often occur in hotspots identified by geographic and temporal trends. This study uses principles of community engaged research to identify neighborhood and community-level factors associated with opioid overdose within overdose hotspots which can be targets for novel intervention design. METHODS/STUDY POPULATION: We conducted an environmental scan in three overdose hotspots’‘ two in an urban center and one in a small city’‘ identified by the Rhode Island Department of Health as having the highest opioid overdose burden in Rhode Island. We engaged hotspot community stakeholders to identify neighborhood factors to map within each hotspot. Locations of addiction treatment, public transportation, harm reduction programs, public facilities (i.e., libraries, parks), first responders, and social services agencies were converted to latitude and longitude and mapped in ArcGIS. Using Esri Service Areas, we will evaluate the service areas of stationary services. We will overlay overdose events and use logistic regression identify neighborhood factors associated with overdose by comparing hotspot and non-hotspot neighborhoods. RESULTS/ANTICIPATED RESULTS: We anticipate that there will be differing neighborhood characteristics associated with overdose events in the densely populated urban area and those in the smaller city. The urban area hotspots will have overlapping social services, addiction treatment, and transportation service areas, while the small city will have fewer community resources without overlapping service areas and reduced public transportation access. We anticipate that overdoses will occur during times of the day when services are not available. Overall, overdose hotspots will be associated with increased census block level unemployment, homelessness, vacant housing, and low food security. DISCUSSION/SIGNIFICANCE OF FINDINGS: Identifying factors associated with opioid overdoses will enable better resource allocation in communities most impacted by the overdose epidemic. Study results will be used for novel intervention design to prevent opioid overdose deaths in communities with high burden of opioid overdose.
Parts I through III of this paper will examine several, increasingly comprehensive forms of aggregation, ranging from insurance reimbursement “lock-in” programs to PDMPs to completely unified electronic medical records (EMRs). Each part will advocate for the adoption of these aggregation systems and provide suggestions for effective implementation in the fight against opioid misuse. All PDMPs are not made equal, however, and Part II will, therefore, focus on several elements — mandating prescriber usage, streamlining the user interface, ensuring timely data uploads, creating a national data repository, mitigating privacy concerns, and training doctors on how to respond to perceived doctor-shopping — that can make these systems more effective. In each part, we will also discuss the privacy concerns of aggregating data, ranging from minimal to significant, and highlight the unique role of stigma in motivating these concerns. In Part IV, we will conclude by suggesting remedial steps to offset this loss of privacy and to combat the stigma around SUDs and mental health disorders in general.
Atrazine has been the most widely used herbicide in North American
processing sweet corn for decades; however, increased restrictions in recent
years have reduced or eliminated atrazine use in certain production areas.
The objective of this study was to identify the best stakeholder-derived
weed management alternatives to atrazine in processing sweet corn. In field
trials throughout the major production areas of processing sweet corn,
including three states over 4 yr, 12 atrazine-free weed management
treatments were compared to three standard atrazine-containing treatments
and a weed-free check. Treatments varied with respect to herbicide mode of
action, herbicide application timing, and interrow cultivation. All
treatments included a PRE application of dimethenamid. No single weed
species occurred across all sites; however, weeds observed in two or more
sites included common lambsquarters, giant ragweed, morningglory species,
velvetleaf, and wild-proso millet. Standard treatments containing both
atrazine and mesotrione POST provided the most efficacious weed control
among treatments and resulted in crop yields comparable to the weed-free
check, thus demonstrating the value of atrazine in sweet corn production
systems. Timely interrow cultivation in atrazine-free treatments did not
consistently improve weed control. Only two atrazine-free treatments
consistently resulted in weed control and crop yield comparable to standard
treatments with atrazine POST: treatments with tembotrione POST either with
or without interrow cultivation. Additional atrazine-free treatments with
topramezone applied POST worked well in Oregon where small-seeded weed
species were prevalent. This work demonstrates that certain atrazine-free
weed management systems, based on input from the sweet corn growers and
processors who would adopt this technology, are comparable in performance to
standard atrazine-containing weed management systems.
Nearly 258 million ha (28%) of the United States is publicly owned land that is managed by federal government agencies. For example, the US Department of Agriculture's Forest Service (USFS) manages over 77 million ha of national forests and grasslands for the benefit of the American public. Given its legal directive to manage multiple uses, it is not surprising that conflicts arise among stakeholders over how this land should be used (Lansky, 1992). The USFS has much discretion in how land is managed, yet must often balance conflicting values of public use and benefit (Nie, 2004). As national priorities, social preferences and public awareness of national forest goods, services and values have changed over time, USFS managers have faced increased pressure to balance consumptive uses with the need for environmental protection. Competing stakeholder demands coupled with increased environmental risks (wildfires, tree diseases and insect epidemics) have resulted in an escalating conservation conflict that is manifested in administrative appeals, lawsuits and a growing distrust of the agency.
Over time, the USFS has embraced new directions and management paradigms to reduce conflict. Some of these have been ecosystem management, adaptive management and now collaborative management (e.g. Holling, 1978; Maser, 1988; Franklin, 1992; Boyce and Haney, 1997; Wondolleck and Yaffee, 2000; Brown et al., 2004). These approaches reflect changing societal values, political pressures and new scientific information.
A persistent conflict has been the logging of trees in national forests and related impacts on forest ecosystems (Lansky, 1992). The USFS’ timber sale programme has supported jobs and community stability through economic development. Logging has also been a mechanism to reduce the risk of wildfire by reducing tree density (fuel for fires) and vertical stand diversity (‘ladder’ fuels; North et al., 2009). However, logging can also negatively affect forest integrity, watershed quality, wildlife, aesthetic and spiritual values of forests (Satterfield, 2002; North et al., 2009).
To examine the use of vitamin D supplements during infancy among the participants in an international infant feeding trial.
Information about vitamin D supplementation was collected through a validated FFQ at the age of 2 weeks and monthly between the ages of 1 month and 6 months.
Infants (n 2159) with a biological family member affected by type 1 diabetes and with increased human leucocyte antigen-conferred susceptibility to type 1 diabetes from twelve European countries, the USA, Canada and Australia.
Daily use of vitamin D supplements was common during the first 6 months of life in Northern and Central Europe (>80 % of the infants), with somewhat lower rates observed in Southern Europe (>60 %). In Canada, vitamin D supplementation was more common among exclusively breast-fed than other infants (e.g. 71 % v. 44 % at 6 months of age). Less than 2 % of infants in the USA and Australia received any vitamin D supplementation. Higher gestational age, older maternal age and longer maternal education were study-wide associated with greater use of vitamin D supplements.
Most of the infants received vitamin D supplements during the first 6 months of life in the European countries, whereas in Canada only half and in the USA and Australia very few were given supplementation.
A literature search found no clinical trials or guidelines addressing the management of spontaneous intracranial hypotension (SIH). Based on the available literature and expert opinion, we have developed recommendations for the diagnosis and management of SIH. For typical cases, we recommend brain magnetic resonance (MR) imaging with gadolinium to confirm the diagnosis, and conservative measures for up to two weeks. If the patient remains symptomatic, up to three non-directed lumbar epidural blood patches (EBPs) should be considered. If these are unsuccessful, non-invasive MR myelography, radionuclide cisternography, MR myelography with intrathecal gadolinium, or computed tomography with myelography should be used to localize the leak. If the leak is localized, directed EPBs should be considered, followed by fibrin sealant or neurosurgery if necessary. Clinically atypical cases with normal brain MR imaging should be investigated to localize the leak. Directed EBPs can be used if the leak is localized; non-directed EBPs should be used only if there are indirect signs of SIH.
High quality single crystal boron-doped diamond films are deposited in a microwave plasma-assisted CVD reactor with feedgas mixtures including hydrogen, methane, diborane, and carbon dioxide at reactor pressures of 160 Torr. The effect of diborane levels and other growth parameters on the incorporated boron levels are investigated, and the doping efficiency is calculated over a wide range of boron concentrations. The boron level is investigated using infrared absorption, and compared to SIMS measurements, and defects are shown to affect the doping uniformity.
Mobile robotic manipulators can augment the strength and dexterity of human operators in unstructured environments. Here, the control system for a six degree-of-freedom heavy-lift mobile manipulator for lifting and inserting payloads on the deck of a ship is described. The robotic hardware and the application present several control challenges, including structural resonances, high joint friction that varies with time, limited sensors for measuring the joint friction, complex interaction with the environment, tight tolerances for the insertion tasks, lack of bilateral force feedback of the contact forces, and ship motions. The control system enables an operator to perform insertion tasks using feedback of tactile clues of the manipulator position, and reduces the effects of friction with a combination of sensor-based, adaptive, and model-based methods of friction compensation. The control architecture is validated in simulation and on a laboratory manipulator.
There is evidence that headache response rates may be higher if triptans are used early when a migraine attack is still mild, as compared to when it is treated after pain has reached moderate or severe intensity.
In this randomized, double blind, placebo controlled, parallel group clinical trial, 361 patients took either placebo, sumatriptan 50 mg, or sumatriptan 100 mg in a single attack study. The primary outcome measure was pain-free status at two hours.
In the intention to treat group, two hour pain free rates were 16%, 40%, and 50% in the placebo group, sumatriptan 50 mg group, and the sumatriptan 100 mg group respectively (p<0.001, active treatment groups vs. placebo).
Both sumatriptan 50 mg and 100 mg were significantly superior to placebo for the pain-free end point at two hours. The pain-free response rates in this trial where sumatriptan was taken while the headache was still mild were generally higher than in older clinical trials where headache was treated after reaching a moderate or severe intensity.
This is the first history of the Export-Import Bank of the United States (Ex-Im) based on archival sources. As the government's exports credit agency, Ex-Im promotes exports through loans, guarantees and insurance and has had an unusual history as a public institution shaped by market principles. Congress mandated that the Bank only provide credit with a reasonable assurance of repayment. But the rules of the market and the needs of the state conflicted at times. Ex-Im has played a part in all the major events that marked the growing involvement of the United States in the international economy. In the last two decades, the bank has carried on its congressionally mandated mission in an increasingly complicated environment brought on by changes in private capital markets; congressional constraints on its budgets; major financial crises in Latin America and South-East Asia; fast-moving developments in communications and information technology and the demands of non-governmental organisations devoted to environmental protection.
During World War II and in its aftermath, the Export-Import Bank showed itself to be a remarkably flexible and resilient institution. The volume, scope, and complexity of its activity increased rapidly in these years. When war broke out in Europe in 1939, the Bank to that point principally financed the export of surplus agricultural products and aided manufacturers to meet overseas competition. During World War II, the Bank's focus narrowed essentially to dealing with Latin America. But its activities there broadened. It helped Latin American countries to cope with the dislocations in world markets and finance brought about by the conflict. Ex-Im financed – in cooperation at times with other U.S. government agencies – equipment, facilities, and strategic materials for the war effort. The Bank embarked on a program of developmental lending to improve the export capabilities of Latin American countries. In doing so, it reoriented its financing from relatively simple transactions to complex project-type lending that involved literally hundreds or thousands of separate transactions.
Following the war, the U.S. government refocused the Bank on Europe instead of Latin America. In coping with the destruction in Europe, the Ex-Im became the first government agency to provide loans in the emergency reconstruction effort of the immediate postwar years. It was the only agency of the U.S. government still in business in 1945 with the experience to take up the task of extending and managing large credits overseas.