Surveillance, Self-Governance, and Mortality: The Impact of Prescription Drug Monitoring Programs on U.S. Overdose Mortality, 2000–2016

Policy mechanisms shaping population health take numerous forms, from behavioral prohibitions to mandates for action to surveillance. Rising drug overdoses undermined the state’s ability to promote population-level health. Using the case of prescription drug monitoring programs (PDMPs), we contend that PDMP implementation highlights state biopower operating via mechanisms of surveillance, whereby prescribers, pharmacists, and patients perceive agency despite choices being constrained. We consider whether such surveillance mechanisms are sufficient or if prescriber/dispenser access or requirements for use are necessary for population health impact. We test whether PDMPs reduced overdose mortality while considering that surveillance may require time to reach effectiveness. PDMPs reduced opioid overdose mortality 2 years postimplementation and sustained effects, with similar effects for prescription opioids, benzodiazepines, and psychostimulants. Access or mandates for action do not reduce mortality beyond surveillance. Overall, PDMP effects on overdose mortality are likely due to self-regulation under surveillance rather than mandated action.

First Survey about Current Practices of Environmental Monitoring Programs within French Agri-Food Industries

Food safety is a constant challenge for stakeholders in the food industry. To manage the likelihood of microbiological contamination, food safety management systems must be robust, including food and environmental testing. Environmental monitoring programs (EMP) have emerged this last decade aiming to validate cleaning–sanitation procedures and other environmental pathogen control programs. The need to monitor production environments has become evident because of recent foodborne outbreaks. However, the boundaries of environmental monitoring are not only limited to the management of pathogens but also extend to spoilage and hygiene indicators, microorganisms, allergens, and other hygiene monitoring. Surfaces in production environments can be a source of contamination, either through ineffective cleaning and disinfection procedures or through contamination during production by flows or operators. This study analyses the current practices of 37 French agri-food industries (small, medium, or large), reporting their objectives for EMPs, microbial targets, types, numbers and frequency of sampling, analysis of results, and types of corrective actions.

Worst-case Execution Time Calculation for Query-based Monitors by Witness Generation

Runtime monitoring plays a key role in the assurance of modern intelligent cyber-physical systems, which are frequently data-intensive and safety-critical. While graph queries can serve as an expressive yet formally precise specification language to capture the safety properties of interest, there are no timeliness guarantees for such auto-generated runtime monitoring programs, which prevents their use in a real-time setting. While worst-case execution time (WCET) bounds derived by existing static WCET estimation techniques are safe, they may not be tight as they are unable to exploit domain-specific (semantic) information about the input models. This article presents a semantic-aware WCET analysis method for data-driven monitoring programs derived from graph queries. The method incorporates results obtained from low-level timing analysis into the objective function of a modern graph solver. This allows the systematic generation of input graph models up to a specified size (referred to as witness models ) for which the monitor is expected to take the most time to complete. Hence, the estimated execution time of the monitors on these graphs can be considered as safe and tight WCET. Additionally, we perform a set of experiments with query-based programs running on a real-time platform over a set of generated models to investigate the relationship between execution times and their estimates, and we compare WCET estimates produced by our approach with results from two well-known timing analyzers, aiT and OTAWA.

Calcite Scale Mitigation in a Very Low Watercut, Low Salinity, HPHT Environment: Lessons Learned in Surveillance, Mitigation and Scale Inhibitor Performance Monitoring for an Onshore Field

A prolific Southeast Asia onshore oilfield has enjoyed scale free production for many years before recently experiencing a series of unexpected and harsh calcite scaling events. Well watercuts were barely measurable, yet mineral scale deposits accumulated quickly across topside wellhead chokes and within downstream flowlines. This paper describes the scale management experience, and the specific challenges presented by this extraordinarily low well water cut, low pH, calcium carbonate scaling environment. To the knowledge of the authors, no previous literature works have been published regarding such an unusual and aggressive mineral scale control scenario. A detailed analysis of the scaling experience is provided, including plant layout, scaling locations, scale surveillance and monitoring programs, laboratory testing, product selection and implementation, and scale inhibitor efficacy surveillance and monitoring programs. The surveillance and application techniques themselves are notable, and feature important lessons learned for addressing similar very low water cut and moderate pH calcium carbonate scaling scenarios. For example, under ultra-low watercut high temperature well production conditions, it was found that a heavily diluted scale inhibitor was necessary to achieve optimum scale control, and a detailed laboratory and field implementation process is described that led to this key learning lesson. The sudden and immediate nature of the occurrence demanded a fast-track laboratory testing approach to rapidly identify a suitable scale inhibitor for the high temperature topside calcium carbonate scaling scenario. The streamlined selection program is detailed, however what could not be readily tested for via conventional laboratory testing was the effect of <1% water cut, and how the product would perform in that environment. A risk-managed field surveillance program was initiated to determine field efficiency of the identified polymeric scale inhibitor and involved field-trialing on a single well using a temporary restriction orifice plate (ROP) to modify the residence time of the injected chemical. The technique proved very successful and identifed that product dispersibility was important, and that dilution of the active scale inhibitor had a positive effect on dispersibility for optimum inhibitor action. The lessons learned were rolled out to all at-risk field producers with positive results. The ongoing success of this program continues and will be detailed in the manuscript and presentation. This paper demonstrates a unique situation of calcium carbonate scale formation and control that utilized a previously unreported and analytical surveillance approach. The cumulative performance derived by improving not only chemical selection, but the way the wells were managed via surveillance and chemical management decision making processes is compelling and of value to other production chemists working in the scaling arena.

Isotopic evidence of increasing water abundance and lake hydrological change in Old Crow Flats, Yukon, Canada

Lake-rich northern permafrost landscapes are sensitive to changing climate conditions, but ability to track real-time and potentially multiple hydrological responses (e.g. lake expansion, drawdown, drainage) is challenging due to absence of long-term, sustainable monitoring programs in these remote locations. Old Crow Flats (OCF), Yukon, is a Ramsar Wetland of International Importance where concerns about low water levels and their consequences for wildlife habitat and traditional ways of life prompted multidisciplinary studies during the International Polar Year (2007–2008) and led to the establishment of an aquatic ecosystem monitoring program. Here, we report water isotope data from 14 representative thermokarst lakes in OCF, the foundation of the monitoring program, and time-series of derived metrics including the isotope composition of input waters and evaporation-to-inflow ratios for a 13 year period (2007–2019). Although the lakes spanned multiple hydrological categories (i.e. rainfall-, snowmelt- and evaporation-dominated) based on initial surveys, well-defined trends from application of generalized additive models and meteorological records reveal that lakes have become increasingly influenced by rainfall, and potentially waters from thawing permafrost. These sources of input have led to more positive lake water balances. Given the documented role of rainfall in causing thermokarst lake drainage events in OCF and elsewhere, we anticipate increased vulnerability of lateral water export from OCF. This study demonstrates the value of long-term isotope-based monitoring programs for identifying hydrological consequences of climate change in lake-rich permafrost landscapes.

Advance of soy commodity in the southern Amazonia with deforestation via PRODES and ImazonGeo: a moratorium-based approach

The guidance on decision-making regarding deforestation in Amazonia has been efficient as a result of monitoring programs using remote sensing techniques. Thus, the objective of this study was to identify the expansion of soybean farming in disagreement with the Soy Moratorium (SoyM) in the Amazonia biome of Mato Grosso from 2008 to 2019. Deforestation data provided by two Amazonia monitoring programs were used: PRODES (Program for Calculating Deforestation in Amazonia) and ImazonGeo (Geoinformation Program on Amazonia). For the identification of soybean areas, the Perpendicular Crop Enhancement Index (PCEI) spectral model was calculated using a cloud platform. To verify areas (polygons) of largest converted forest-soybean occurrences, the Kernel Density (KD) estimator was applied. Mann–Kendall and Pettitt tests were used to identify trends over the time series. Our findings reveal that 1,387,288 ha were deforested from August 2008 to October 2019 according to PRODES data, of which 108,411 ha (7.81%) were converted into soybean. The ImazonGeo data showed 729,204 hectares deforested and 46,182 hectares (6.33%) converted into soybean areas. Based on the deforestation polygons of the two databases, the KD estimator indicated that the municipalities of Feliz Natal, Tabaporã, Nova Ubiratã, and União do Sul presented higher occurrences of soybean fields in disagreement with the SoyM. The results indicate that the PRODES system presents higher data variability and means statistically superior to ImazonGeo.

Remote Monitoring Programs for Cardiac Conditions

These recommendations were developed by the CADTH Health Technology Expert Review Panel (HTERP) to address the implementation of remote monitoring or remote management programs for patients with chronic cardiac conditions. The recommendations were developed following HTERP deliberations over multidisciplinary evidence reviewed in a CADTH Health Technology Assessment (HTA) report. The HTA included a realist review conducted to identify key perceived or actual mechanisms of remote monitoring programs, patients’ and caregivers’ expectations and experiences of engaging with remote monitoring programs, and ethical issues raised by the use of remote monitoring for patients with chronic cardiac conditions. HTERP recommends that the design and implementation of remote monitoring programs include a broad range of stakeholder voices with considerations across several key domains. In particular, HTERP recommends that: remote monitoring programs for chronic cardiac conditions be flexible and adaptable to a diverse range of patient circumstances if implemented, remote monitoring should be an integral part of the care pathway for chronic cardiac conditions, with processes and policies to support it jurisdictions understand and be transparent about information flow, and keep patient data use and privacy at the forefront of service contract negotiations remote monitoring programs for cardiac conditions avoid creating or exacerbating inequities in health care remote monitoring programs include an evaluation component to ensure program aims are met.