“It’s called overamping”: experiences of overdose among people who use methamphetamine

Background The USA is experiencing increases in methamphetamine use and methamphetamine-related or attributed deaths. In the current study, we explore qualitative narratives of methamphetamine overdose and strategies used by people who use drugs to reduce the undesirable effects associated with methamphetamine use. Methods We conducted 21 qualitative interviews with people over the age of 18 who reported using methamphetamine in the previous 3 months in Nevada and New Mexico. Interviews were recorded, transcribed, and analyzed using qualitative thematic analysis. Results Respondents described a constellation of psychological and physical symptoms that they characterized as “overamping,” experienced on a continuum from less to more severe. Reports of acute, fatal methamphetamine overdose were rare. Few reported seeking medical attention for undesirable effects (usually related to psychological effects). General self-care strategies such as sleeping and staying hydrated were discussed. Conclusions When asked directly, our respondents claimed that acute, fatal methamphetamine overdose is rare or even impossible. However, they described a number of undesirable symptoms associated with overconsumption of methamphetamine and had few clinical or harm reduction strategies at their disposal. Addressing this current wave of drug-related deaths will require attention to the multiple factors that structure experiences of methamphetamine “overdose,” and a collaborative effort with PWUDs to devise effective harm reduction and treatment strategies.

A Relaxed and Bound Algorithm Based on Auxiliary Variables for Quadratically Constrained Quadratic Programming Problem

Quadratically constrained quadratic programs (QCQP), which often appear in engineering practice and management science, and other fields, are investigated in this paper. By introducing appropriate auxiliary variables, QCQP can be transformed into its equivalent problem (EP) with non-linear equality constraints. After these equality constraints are relaxed, a series of linear relaxation subproblems with auxiliary variables and bound constraints are generated, which can determine the effective lower bound of the global optimal value of QCQP. To enhance the compactness of sub-rectangles and improve the ability to remove sub-rectangles, two rectangle-reduction strategies are employed. Besides, two ϵ-subproblem deletion rules are introduced to improve the convergence speed of the algorithm. Therefore, a relaxation and bound algorithm based on auxiliary variables are proposed to solve QCQP. Numerical experiments show that this algorithm is effective and feasible.

Opioid reduction for patients with chronic pain in primary care: systematic review

Background: Long-term opioid treatment in patients with chronic pain is often ineffective and possibly harmful. These patients are often managed by general practitioners, who are calling for a clear overview of effective opioid reduction strategies for primary care. Aim: Evaluate effectiveness of opioid reduction strategies applicable in primary care for patients with chronic pain on long-term opioid treatment. Design: Systematic review of controlled trials and cohort studies. Method Literature search conducted in Embase, Medline, Web of Science, Cochrane CENTRAL register of trials, CINAHL, Google Scholar and PsychInfo. Studies evaluating opioid reduction interventions applicable in primary care among adults with long-term opioid treatment for chronic non-cancer pain were included. Risk of bias was assessed using Cochrane risk of bias (RoB) 2.0 tool or Risk-of-Bias in Non-randomized studies of Interventions (ROBINS-I) tool. Narrative synthesis was performed due to clinical heterogeneity in study designs and types of interventions. Results: Five RCTs and five cohort studies were included (total n= 1717, range 35-985) exploring various opioid reduction strategies. Six studies had high RoB, three moderate RoB, and one low RoB. Three cohort studies investigating a GP supervised opioid taper (critical ROBINS-I), an integrative pain treatment (moderate ROBINS-I) and group medical visits (critical ROBINS-I) demonstrated significant between-group opioid reduction. Conclusion: Results carefully point in the direction of a GP supervised tapering and multidisciplinary group therapeutic sessions to reduce long term opioid treatment. However, due to high risk of bias and small sample sizes, no firm conclusions can be made demonstrating need for more high-quality research.

Impact of Surgical Smoke on the Surgical Team and Operating Room Nurses and its Reduction Strategies: A Systematic Review

Background: Surgical smoke is an integral part of surgical operations that the surgical team has been exposed to for so long. This study aimed to investigate the effects of smoke, on members of the surgical team. Methods: A systematic review was conducted focusing on the complexity of surgical smoke. PubMed, Scopus and web of science databases were searched until May 2020 without any time or language limitation. All documents were reviewed by title or abstract according to the search strategy. The screening process of articles was performed by two independent authors. The articles were selected according to the inclusion and exclusion criteria. Results: Overall, 37 studies in this systematic study were investigated. The effects of many surgical smokes were found in a nutshell including complications such as carcinogenic, toxicity, mutation, irritant, transmission of tumor cells, virus transmission, headaches, dizziness, sleepiness, headache, the bad odor in head hair, the tearing of the eye on the surgical team and staff. Conclusion: Surgical smoke, produced during surgical operations, is one of the risks and threats to which the surgical team and operating room staff are at risk then can affect the organs of different bodies from the body of all operating room staff and surgical team.

A Proposed Uncertainty Reduction Criterion of Renewable Energy Sources for Optimal Operation of Distribution Systems

Power system operation and planning studies face many challenges with increasing of renewable energy sources (RESs) penetration. These challenges revolve around the RESs uncertainty and its applications on probabilistic forecasting, power system operation optimization and power system planning. This paper proposes a novel and effective criterion for uncertainties modeling of the RESs as well as system loads. Four sorting stages are applied for the proposed uncertainty cases reduction. Added to that, it proposes three different uncertainty reduction strategies for obtaining different accuracy and speed options. The proposed reduction strategies are tested on medium and large scale distribution systems; IEEE 69-bus and 118-bus systems. The obtained results verify the effectiveness of the proposed criterion in uncertainties modeling in distribution systems with acceptable level of accuracy.

A Machine Learning Framework for Multi-Hazard Risk Assessment at the Regional Scale in Earthquake and Flood-Prone Areas

Communities are confronted with the rapidly growing impact of disasters, due to many factors that cause an increase in the vulnerability of society combined with an increase in hazardous events such as earthquakes and floods. The possible impacts of such events are large, also in developed countries, and governments and stakeholders must adopt risk reduction strategies at different levels of management stages of the communities. This study is aimed at proposing a sound qualitative multi-hazard risk analysis methodology for the assessment of combined seismic and hydraulic risk at the regional scale, which can assist governments and stakeholders in decision making and prioritization of interventions. The method is based on the use of machine learning techniques to aggregate large datasets made of many variables different in nature each of which carries information related to specific risk components and clusterize observations. The framework is applied to the case study of the Emilia Romagna region, for which the different municipalities are grouped into four homogeneous clusters ranked in terms of relative levels of combined risk. The proposed approach proves to be robust and delivers a very useful tool for hazard management and disaster mitigation, particularly for multi-hazard modeling at the regional scale.

Odor and Constituent Odorants of HDPE–Lignin Blends of Different Lignin Origin

The still-rising global demand for plastics warrants the substitution of non-renewable mineral oil-based resources with natural products as a decisive step towards sustainability. Lignin is one of the most abundant natural polymers and represents an ideal but hitherto highly underutilized raw material to replace petroleum-based resources. In particular, the use of lignin composites, especially polyolefin–lignin blends, is currently on the rise. In addition to specific mechanical property requirements, a challenge of implementing these alternative polymers is their heavy odor load. This is especially relevant for lignin, which exhibits an intrinsic odor that limits its use as an ingredient in blends intended for high quality applications. The present study addressed this issue by undertaking a systematic evaluation of the odor properties and constituent odorants of commercially available lignins and related high-density polyethylene (HDPE) blends. The potent odors of the investigated samples could be attributed to the presence of 71 individual odorous constituents that originated primarily from the structurally complex lignin. The majority of them was assignable to six main substance classes: carboxylic acids, aldehydes, phenols, furan compounds, alkylated 2-cyclopenten-1-ones, and sulfur compounds. The odors were strongly related to both the lignin raw materials and the different processes of their extraction, while the production of the blends had a lower but also significant influence. Especially the investigated soda lignin with hay- and honey-like odors was highly different in its odorant composition compared to lignins resulting from the sulfurous kraft process predominantly characterized by smoky and burnt odors. These observations highlight the importance of sufficient purification of the lignin raw material and the need for odor abatement procedures during the compounding process. The molecular elucidation of the odorants causing the strong odor represents an important procedure to develop odor reduction strategies.

Greater Reduction of Blood Pressure with Exercise Intervention Than Standard Care After Recent Ischaemic Atroke: A Randomized Clinical Trial

Context and Objectives: Ischaemic stroke (IS) causes disability and uses massive public health resources. Cumulative disability from recurrence may be reduced with cardiometabolic risk reduction strategies e.g., lowering blood pressure (BP). We hypothesized that intensive exercise plus best available care in adults with recent IS improves fitness, glucose metabolism, muscle protein synthesis in paretic limbs compared to controls. BP changes were compared between intervention (INT) and controls (CON). Research Design and Setting: A randomised, interventional clinical trial conducted in Jamaican adults subjects: We investigate 103 adults with recent IS and residual weakness. Forty-nine subjects (24 women: mean age 61.5; 25 men: mean age 63.8) received task-oriented exercise training (TEXT) plus best available care. Fifty-four subjects (23 women: mean age 60.2; 31 men: mean age 61.3) received best care, including exercise advice. Measurements: We measured baseline, 3-month and 6-month BP. Results: After recent IS, TEXT plus best available care reduced systolic BP by 21 mmHg and diastolic by 12 mmHg compared to controls, independent of medication adherence, body composition; stroke severity. Men in the TEXT group had increased lean mass (P < 0.007), VO2 max (P = 0.03); 6-minute walk distance (P = 0.003). Leg press on paretic (P = 0.004) and non-paretic (P < 0.001) increased with TEXT vs CON over 6 months, in both sexes (P-values for sex difference > 0.2). Time-to-chair-rise decreased in both sexes who received intervention vs controls (P <0.04) Conclusions: TEXT results in significant blood pressure reduction in adults with recent ischaemic stroke and residual weakness when compared with best available medical care only.

Sustainable Rural Livelihood and Poverty Reduction Strategies

This chapter presents the framework of sustainable livelihoods. The interests of this chapter derive from three issues: (1) How can one determine who in the population achieves a sustainable livelihood and who does not? That is, how does sustainable livelihood assist in eliminating poverty and reduce deprivation in rural communities? (2) What livelihood resources and institutional processes are necessary for enabling or constraining sustainable livelihoods for different groups? That is, does household livelihood help individuals or families to escape poverty? (3) What are the practical, operational, and policy implications of adopting a sustainable livelihood approach to poverty reduction? Namely, what constitutes a satisfactory basis for adopting a livelihood framework?

Why Study Sustainable Livelihood and Poverty Reduction?

This introductory chapter utilizes a framework of inquiry on why people are poor based on sustainable livelihood and poverty reduction. A livelihood is sustainable when it copes with and can recover from stress and shocks, maintain or enhance its capabilities and assets, and provide sustainable livelihood opportunities for the next generation. This book examines the core issues, namely (1) the links between sustainable rural livelihoods and why people are poor; (2) the multilateral policy contexts of poverty; (3) poverty reduction within the context of globalizing world economy; (4) the economic and moral interdependence of humans and nature; and (5) the assessment of poverty among vulnerable groups, for instance, the elderly, the young, the ill, and the disabled. The themes of this volume orbit around characteristics and challenges of sustainable development, marginalization, social empowerment, social development theory, and poverty reduction strategies advocated by the 17 United Nations Sustainable Development Goals worldwide.