scholarly journals Shifting North American drug markets and challenges for the system of care

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
R. Michael Krausz ◽  
Jean N. Westenberg ◽  
Nickie Mathew ◽  
George Budd ◽  
James S. H. Wong ◽  
...  
Keyword(s):  
North America ◽  
Healthcare System ◽  
Large Scale ◽  
Drug Market ◽  
System Of Care ◽  
Morbidity And Mortality ◽  
People Who Use Drugs ◽  
Drug Markets ◽  
Individual Substance ◽  
Stimulant Use

AbstractDrug markets are dynamic systems which change based on demand, competition, legislation and revenue. Shifts that are not met with immediate and appropriate responses from the healthcare system can lead to public health crises with tragic levels of morbidity and mortality, as experienced Europe in the early 1990s and as is the case in North America currently. The major feature of the current drug market shift in North America is towards highly potent synthetic opioids such as fentanyl and fentanyl analogues. An additional spike in stimulant use further complicates this issue. Without understanding the ever-changing dynamics of drug markets and consequent patterns of drug use, the healthcare system will continue to be ineffective in its response, and morbidity and mortality will continue to increase. Economic perspectives are largely neglected in research and clinical contexts, but better treatment alternatives need to consider the large-scale macroeconomic conditions of drug markets as well as the behavioural economics of individual substance use. It is important for policy makers, health authorities, first responders and medical providers to be aware of the clinical implications of drug market changes in order to best serve people who use drugs. Only with significant clinical research, a comprehensive reorganization of the system of care across all sectors, and an evidence-driven governance, will we be successful in addressing the challenges brought on by the recent shifts in drug markets.

The relationship between the regulation of licit medications containing pseudoephedrine and the illicit methamphetamine market in Czechia and neighbouring countries

2019 ◽  
Vol 20 (1) ◽  
pp. 6-16 ◽  
Author(s):  
Benjamin Petruzelka
Keyword(s):  
Czech Republic ◽  
Supply Chains ◽  
Large Scale ◽  
Drug Market ◽  
Illegal Drug ◽  
Drug Markets ◽  
The Czech Republic ◽  
Content Type ◽  
The Relationship

Purpose The purpose of this paper is to improve the understanding of the relationship between region-specific regulations of medications used in the manufacture of illegal drugs and illegal drug markets. Design/methodology/approach This paper examines a case study of the relationship between the regulation of medications containing pseudoephedrine in Czechia and neighbouring countries and the illegal drug market for methamphetamine in Czechia between 2006 and 2018. The description of this case is based on a review of the literature and a review of publicly available data sources. Findings The tightening of the regulation of medications containing pseudoephedrine in the Czech Republic led, in the years under study, to a gradual decrease in the number of packages sold and simultaneously to the illegal import of such medications from neighbouring countries with less strict regulations. At the same time, shifts in the drug market could be observed: the internationalisation of previously primarily domestic supply chains, the increased involvement of Vietnamese organised crime groups, the emergence of large-scale methamphetamine labs and a shift in production to countries with less strict regulations. The subsequent application of stricter controls in neighbouring countries was accompanied by further shifts in supply chains and increased imports from non-European countries. Practical implications The tightening of regulations of medications within a single country or single region might lead to significant and undesirable changes in drug markets and supply chains. Originality/value This paper provides a novel case study of the development of region-specific regulations of medications and their influence on illegal drug markets and supply chains in the Czech Republic and in the European context.

An Internet-based health gateway device for interactive communication and automatic data uploading: Clinical efficacy for type 2 diabetes in a multi-centre trial

2016 ◽  
Vol 23 (6) ◽  
pp. 595-604 ◽  
Author(s):  
Jae Hyoung Cho ◽  
Hun-Sung Kim ◽  
Seung Hyun Yoo ◽  
Chang Hee Jung ◽  
Woo Je Lee ◽  
...  
Keyword(s):  
Adverse Events ◽  
Healthcare System ◽  
Glucose Control ◽  
Large Scale ◽  
Diabetes Management ◽  
Intervention Group ◽  
Diabetes Control ◽  
Control Group ◽  
Anthropometric Parameters ◽  
Automatic Data

Introduction The aim of this study was to improve the quality of diabetes control and evaluate the efficacy of an Internet-based integrated healthcare system for diabetes management and safety. Methods We conducted a large-scale, multi-centre, randomized clinical trial involving 484 patients. Patients in the intervention group ( n = 244) were treated with the Internet-based system for six months, while the control group ( n = 240) received the usual outpatient management over the same period. HbA1c, blood chemistries, anthropometric parameters, and adverse events were assessed at the beginning of the study, after three months, and the end of the study. Results There were no initial significant differences between the groups with respect to demographics and clinical parameters. Upon six-month follow-up, HbA1c levels were significantly decreased from 7.86 ± 0.69% to 7.55 ± 0.86% within the intervention group ( p < 0.001) compared to 7.81 ± 0.66% to 7.70 ± 0.88% within the control group. Postprandial glucose reduction was predominant. A subgroup with baseline HbA1c higher than 8% and good compliance achieved a reduction of HbA1c by 0.8 ± 1.05%. Glucose control and waist circumference reduction were more effective in females and subjects older than 40 years of age. There were no adverse events associated with the intervention. Discussion This e-healthcare system was effective for glucose control and body composition improvement without associated adverse events in a multi-centre trial. This system may be effective in improving diabetes control in the general population.

Auras of Detection: Power and Knowledge in Drug Prohibition

2021 ◽  
pp. 009145092110354
Author(s):  
Jennifer J. Carroll
Keyword(s):  
Law Enforcement ◽  
Knowledge Production ◽  
Illicit Drug ◽  
Drug Market ◽  
Epistemic Authority ◽  
People Who Use Drugs ◽  
Drug Supply ◽  
Political Implications ◽  
Starting Point ◽  
Drug Checking

Drug checking is an evidence-based strategy for overdose prevention that continues to operate (where it operates) in a legal “gray zone” due to the legal classification of some drug checking tools as drug paraphernalia—the purview of law enforcement, not public health. This article takes the emergence of fentanyl in the U.S. drug supply as a starting point for examining two closely related questions about drug checking and drug market expertise. First, how is the epistemic authority of law enforcement over the material realities of the drug market produced? Second, in the context of that authority, what are the socio-political implications of technologically advanced drug checking instruments in the hands of people who use drugs? The expertise that people who use drugs maintain about the nature of illicit drug market and how to navigate the illicit drug supply has long been discounted as untrustworthy, irrational, or otherwise invalid. Yet, increased access to drug checking tools has the potential to afford the knowledge produced by people who use drugs a technological validity it has never before enjoyed. In this article, I engage with theories of knowledge production and ontological standpoint from the field of science, technology, and society studies to examine how law enforcement produces and maintains epistemic authority over the illicit drug market and to explore how drug checking technologies enable new forms of knowledge production. I argue that drug checking be viewed as a form of social resistance against law enforcement’s epistemological authority and as a refuge against the harms produced by drug criminalization.

Interannual Variability of North American Winter Temperature Extremes and Its Associated Circulation Anomalies in Observations and CMIP5 Simulations

2020 ◽  
Vol 33 (3) ◽  
pp. 847-865 ◽  
Author(s):  
B. Yu ◽  
H. Lin ◽  
V. V. Kharin ◽  
X. L. Wang
Keyword(s):  
North America ◽  
Surface Temperature ◽  
Atmospheric Circulation ◽  
North American ◽  
North Pacific ◽  
Large Scale ◽  
Temperature Extremes ◽  
Temperature Extreme ◽  
Central Canada ◽  
Leading Mode

AbstractThe interannual variability of wintertime North American surface temperature extremes and its generation and maintenance are analyzed in this study. The leading mode of the temperature extreme anomalies, revealed by empirical orthogonal function (EOF) analyses of December–February mean temperature extreme indices over North America, is characterized by an anomalous center of action over western-central Canada. In association with the leading mode of temperature extreme variability, the large-scale atmospheric circulation features an anomalous Pacific–North American (PNA)-like pattern from the preceding fall to winter, which has important implications for seasonal prediction of North American temperature extremes. A positive PNA pattern leads to more warm and fewer cold extremes over western-central Canada. The anomalous circulation over the PNA sector drives thermal advection that contributes to temperature anomalies over North America, as well as a Pacific decadal oscillation (PDO)-like sea surface temperature (SST) anomaly pattern in the midlatitude North Pacific. The PNA-like circulation anomaly tends to be supported by SST warming in the tropical central-eastern Pacific and a positive synoptic-scale eddy vorticity forcing feedback on the large-scale circulation over the PNA sector. The leading extreme mode–associated atmospheric circulation patterns obtained from the observational and reanalysis data, together with the anomalous SST and synoptic eddy activities, are reasonably well simulated in most CMIP5 models and in the multimodel mean. For most models considered, the simulated patterns of atmospheric circulation, SST, and synoptic eddy activities have lower spatial variances than the corresponding observational and reanalysis patterns over the PNA sector, especially over the North Pacific.

scholarly journals Atmospheric Conditions Associated with Labrador Sea Deep Convection: New Insights from a Case Study of the 2006/07 and 2007/08 Winters

2016 ◽  
Vol 29 (14) ◽  
pp. 5281-5297 ◽  
Author(s):  
Who M. Kim ◽  
Stephen Yeager ◽  
Ping Chang ◽  
Gokhan Danabasoglu
Keyword(s):  
North America ◽  
North Atlantic ◽  
Large Scale ◽  
Initial Conditions ◽  
Deep Convection ◽  
La Niña ◽  
Labrador Sea ◽  
Atmospheric Conditions ◽  
Circulation Anomaly ◽  
La Nina

Abstract Deep convection in the Labrador Sea (LS) resumed in the winter of 2007/08 under a moderately positive North Atlantic Oscillation (NAO) state. This is in sharp contrast with the previous winter with weak convection, despite a similar positive NAO state. This disparity is explored here by analyzing reanalysis data and forced-ocean simulations. It is found that the difference in deep convection is primarily due to differences in large-scale atmospheric conditions that are not accounted for by the conventional NAO definition. Specifically, the 2007/08 winter was characterized by an atmospheric circulation anomaly centered in the western North Atlantic, rather than the eastern North Atlantic that the conventional NAO emphasizes. This anomalous circulation was also accompanied by anomalously cold conditions over northern North America. The controlling influence of these atmospheric conditions on LS deep convection in the 2008 winter is confirmed by sensitivity experiments where surface forcing and/or initial conditions are modified. An extended analysis for the 1949–2009 period shows that about half of the winters with strong heat losses in the LS are associated with such a west-centered circulation anomaly and cold conditions over northern North America. These are found to be accompanied by La Niña–like conditions in the tropical Pacific, suggesting that the atmospheric response to La Niña may have a strong influence on LS deep convection.

Wildfires in the southern Canadian Rocky Mountains and their relationship to mid-tropospheric anomalies

1993 ◽  
Vol 23 (6) ◽  
pp. 1213-1222 ◽  
Author(s):  
E.A. Johnson ◽  
D.R. Wowchuk
Keyword(s):  
North America ◽  
Rocky Mountains ◽  
Large Scale ◽  
Fire Frequency ◽  
Fuel Moisture ◽  
Large Fire ◽  
Canadian Rocky Mountains ◽  
Area Burned ◽  
Upper Level ◽  
Moisture Conditions

In this paper we present evidence for a large-scale (synoptic-scale) meteorological mechanism controlling the fire frequency in the southern Canadian Rocky Mountains. This large-scale control may explain the similarity in average fire frequencies and timing of change in average fire frequencies for the southern Canadian Rocky Mountains. Over the last 86 years the size distribution of fires (annual area burned) in the southern Canadian Rockies was distinctly bimodal, with a separation between small- and large-fire years at approximately 10–25 ha annual area burned. During the last 35 years, large-fire years had significantly lower fuel moisture conditions and many mid-tropospheric surface-blocking events (high-pressure upper level ridges) during July and August (the period of greatest fire activity). Small-fire years in this period exhibited significantly higher fuel moisture conditions and fewer persistent mid-tropospheric surface-blocking events during July and August. Mid-tropospheric surface-blocking events during large-fire years were teleconnected (spatially and temporally correlated in 50 kPa heights) to upper level troughs in the North Pacific and eastern North America. This relationship takes the form of the positive mode of the Pacific North America pattern.

scholarly journals Observed decrease in atmospheric mercury explained by global decline in anthropogenic emissions

2016 ◽  
Vol 113 (3) ◽  
pp. 526-531 ◽  
Author(s):  
Yanxu Zhang ◽  
Daniel J. Jacob ◽  
Hannah M. Horowitz ◽  
Long Chen ◽  
Helen M. Amos ◽  
...  
Keyword(s):  
North America ◽  
Large Scale ◽  
Elemental Mercury ◽  
Atmospheric Mercury ◽  
Small Scale ◽  
Commercial Products ◽  
Earth Observing System ◽  
Global Emission ◽  
Emission Controls ◽  
Phase Out

Observations of elemental mercury (Hg0) at sites in North America and Europe show large decreases (∼1–2% y−1) from 1990 to present. Observations in background northern hemisphere air, including Mauna Loa Observatory (Hawaii) and CARIBIC (Civil Aircraft for the Regular Investigation of the atmosphere Based on an Instrument Container) aircraft flights, show weaker decreases (<1% y−1). These decreases are inconsistent with current global emission inventories indicating flat or increasing emissions over that period. However, the inventories have three major flaws: (i) they do not account for the decline in atmospheric release of Hg from commercial products; (ii) they are biased in their estimate of artisanal and small-scale gold mining emissions; and (iii) they do not properly account for the change in Hg0/HgII speciation of emissions from coal-fired utilities after implementation of emission controls targeted at SO2 and NOx. We construct an improved global emission inventory for the period 1990 to 2010 accounting for the above factors and find a 20% decrease in total Hg emissions and a 30% decrease in anthropogenic Hg0 emissions, with much larger decreases in North America and Europe offsetting the effect of increasing emissions in Asia. Implementation of our inventory in a global 3D atmospheric Hg simulation [GEOS-Chem (Goddard Earth Observing System-Chemistry)] coupled to land and ocean reservoirs reproduces the observed large-scale trends in atmospheric Hg0 concentrations and in HgII wet deposition. The large trends observed in North America and Europe reflect the phase-out of Hg from commercial products as well as the cobenefit from SO2 and NOx emission controls on coal-fired utilities.

Aquaculture in North America: An Assessment of Future Prospects

1982 ◽  
Vol 39 (1) ◽  
pp. 151-154 ◽  
Author(s):  
P. A. Larkin
Keyword(s):  
North America ◽  
Large Scale ◽  
Geographical Location ◽  
Aquatic Environments ◽  
Future Prospects ◽  
Growing Period ◽  
Close Proximity ◽  
Cheap Alternative ◽  
Alternative Sources ◽  
Simple Technology

The farming of aquatic environments is already a large-scale world enterprise involving relatively simple technology, but aquacultural production in North America is only a small part of the world total. Aquaculture is only economically rewarding where high rates of production over a long growing period can be coupled with close proximity to large markets in which there are few cheap alternative sources of protein. Much of North American aquaculture is aimed at meeting demands of recreational fishermen rather than as a way of producing food. There are many opportunities for development of aquaculture in North America and it seems reasonable to project substantial increases in production in the next two decades.Key words: aquaculture, geographical location, North America, future prospects, economics

scholarly journals Charcoal in soils of the Allerød-Younger Dryas transition were the result of natural fires and not necessarily the effect of an extra-terrestrial impact

2008 ◽  
Vol 87 (4) ◽  
pp. 359-361 ◽  
Author(s):  
T. van der Hammen ◽  
B. van Geel
Keyword(s):  
North America ◽  
Large Scale ◽  
Sand Dunes ◽  
Younger Dryas ◽  
Natural Fires ◽  
Water Tables ◽  
Pine Trees ◽  
Climate Cooling ◽  
Fossil Records ◽  
Terrestrial Material

AbstractDuring the warm Bølling-Allerød interstadial, tree species migrated from their refugia in southern Europe northwards into the area within the present temperate climatic zone. It is evident from high levels of charcoal in fossil records in this region that, especially during the later part of the Bølling-Allerød interstadial, many fires occurred. The start of the Younger Dryas was characterised by rapid and intense cooling and rising water tables, with catastrophic effects on the vegetation. Thermophilous pine trees could not survive the cold Younger Dryas climate. Dead wood provided an abundant source of fuel for intense, large-scale fires seen in many records as a concentration of charcoal particles in so-called ’Usselo-soils’ dated to ca 10,95014C BP. A similar trend in increased charcoal indicating increased burning is seen at many sites across North America at this time and it has been suggested by Firestone et al. (2007) that this was caused by an explosion of extra-terrestrial material over northern North America, causing the Younger Dryas climate cooling and Megafaunal extinction. We argue that there is no need to invoke an extraterrestrial cause to explain the charcoal in the fossilized soils. The volume of forest trees that died as a result of the cold Younger Dryas climate would easily have supplied sufficient fuel for intense, large-scale fires and can be used to account for the concentration of charcoal particles. As soils were no longer covered by dense vegetation, much erosion occurred during the Younger Dryas and therefore, at many places, Usselo soils, rich in charcoal, were preserved under aeolian sand dunes.

Invasive Cereal Aphids of North America: Ecology and Pest Management

2019 ◽  
Vol 64 (1) ◽  
pp. 73-93 ◽  
Author(s):  
Michael J. Brewer ◽  
Frank B. Peairs ◽  
Norman C. Elliott
Keyword(s):  
North America ◽  
Pest Management ◽  
Great Plains ◽  
Large Scale ◽  
Production Systems ◽  
Cereal Crops ◽  
Cereal Aphids ◽  
Sugarcane Aphid ◽  
Cereal Production ◽  
Abundance And Diversity

Aphid invasions of North American cereal crops generally have started with colonization of a new region or crop, followed by range expansion and outbreaks that vary in frequency and scale owing to geographically variable influences. To improve understanding of this process and management, we compare the invasion ecology of and management response to three cereal aphids: sugarcane aphid, Russian wheat aphid, and greenbug. The region exploited is determined primarily by climate and host plant availability. Once an area is permanently or annually colonized, outbreak intensity is also affected by natural enemies and managed inputs, such as aphid-resistant cultivars and insecticides. Over time, increases in natural enemy abundance and diversity, improved compatibility among management tactics, and limited threshold-based insecticide use have likely increased resilience of aphid regulation. Application of pest management foundational practices followed by a focus on compatible strategies are relevant worldwide. Area-wide pest management is most appropriate to large-scale cereal production systems, as exemplified in the Great Plains of North America.

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