Fatal drug use in the COVID-19 pandemic response: Changing trends in drug-involved deaths before and after stay-at-home orders in Louisiana.

The effect of disaster events on increasing drug-involved deaths has been clearly shown in previous literature. As the COVID-19 pandemic led to stay-at-home orders throughout the United States, there was a simultaneous spike in drug-involved deaths around the country. The landscape of a preexisting epidemic of drug-involved deaths in the United States is one which is not geographically homogenous. Given this unequal distribution of mortality, state-specific analysis of changing trends in drug use and drug-involved deaths is vital to inform both care for people who use drugs and local policy. An analysis of public health surveillance data from the state of Louisiana, both before and after the initial stay-at-home order of the COVID-19 pandemic, was used to determine the effect the pandemic may have had on the drug-involved deaths within this state. Using the linear regression analysis of total drug-involved deaths, as well as drug-specific subgroups, trends were measured based on quarterly (Qly) deaths. With the initial stay-at-home order as the change point, trends measured through quarter 1 (Q1) of 2020 were compared to trends measured from quarter 2 (Q2) of 2020 through quarter 3 (Q3) of 2021. The significantly increased rate of change in Qly drug-involved deaths, synthetic opioid-involved deaths, stimulant-involved deaths, and psychostimulant-involved deaths indicates a long-term change following the initial response to the COVID-19 pandemic. Changes in the delivery of mental health services, harm reduction services, medication for opioid use disorder (MOUD), treatment services, withdrawal management services, addiction counseling, shelters, housing, and food supplies further limited drug-involved prevention support, all of which were exacerbated by the new stress of living in a pandemic and economic uncertainty.

A quantitative assessment of institutions of higher education disaster preparedness and resilience.

OBJECTIVE: Assess levels of disaster preparedness in institutions of higher education (IHEs) in the United States. DESIGN: An anonymous, 57-question survey targeted individuals responsible for emergency management at IHEs across the US descriptive statistics and bivariate chi-square analysis were reported. Using the established threshold score of the initial Cities Readiness Initiative from the CDC, an individual respondent's composite score of 70 percent or higher across 23 specific questions within the 57-question survey was labeled as "prepared." RESULTS: Chi-square analysis identified variables associated with lower preparedness levels at IHEs not achieving the minimum 70 percent score. Having a campus law enforcement officer serve the additional role of emergency manager had a negative association with being prepared [χ2 (1) = 10.18, p < 0.001]. Having emergency management as a separate university function from campus law enforcement had a positive relationship with being prepared [χ2 (1) = 18.55, p < 0.001]. Staffing the emergency management function with a professional having less than 3 years of emergency management experience had a negative association with being prepared. CONCLUSIONS: Our results indicate that minimizing the mission of emergency management by simply tasking a campus law enforcement officer with the extra responsibility of emergency management or entertaining less professionally qualified personnel to lead emergency management's complex mission can lead to disastrous results. Not only is preparedness impacted, but also resilience when facing disaster situations. Our nation continues to strive to become more resilient when facing such adverse events, as formally embraced and emphasized in the 2017 National Security Strategy. Research continues to offer best practices and unfortunately continues to highlight gaps. While the higher education community is not one of the 16 federal critical infrastructure sectors, identified gaps such as those presented in our findings as well as those published by the National Academies of Sciences are cause for alarm. Not only are higher education campuses generating invaluable contributions to society in general, bio-innovation, public health, and medicine, to name a few, they are a core stakeholder in resilience research and implementation. Yet, research continues to indicate preparedness and therefore resilience gaps in this sector. The authors propose implications for practice, policy, and research to assist IHEs in achieving a more comprehensive, sustainable level of resilience.

Persistent low avian malaria in a tropical species despite high community prevalence.

Malarial and other haemosporidian parasites are widespread; however, their temporal dynamics are ill-understood. Longitudinal sampling of a threatened riparian bird revealed a consistently very low prevalence over 13 years (∼5%) despite infections persisting and prevalence increasing with age. In contrast, three key species within this tropical community were highly infected (∼20-75% prevalence) and these differences were stable. Although we found novel lineages and phylogenetic structure at the local level, there was little geographic structuring within Australasia. This study suggests that malarial parasite susceptibility is determined by host factors and that species can maintain low levels despite high community prevalence.

Examining the influence of professional emergency management coordinators driving preparedness and resilience on university campuses.

OBJECTIVE: To characterize the compliance with disaster management recommendations of ensuring a full-time, dedicated professional is responsible for coordinating disaster management programs. This research targets a subset of institutions of higher education (IHEs) in the United States at risk of annual hurricane threats or having experienced an active shooter incident near campus. DESIGN: A comprehensive Web-based assessment was conducted to determine the Web presence of emergency management of 265 IHEs with student enrollment greater than 2,000 in coastal states at risk of annual Atlantic Hurricane landfalls. Results were displayed spatially using ArcGIS. RESULTS: Although the Web sites of 91 percent of IHEs with enrollment greater than 20,000 displayed easily accessible information on a dedicated professional leading emergency management, only 42 percent of the Web sites of those IHEs with enrollment between 10,000 and 20,000 did so. As enrollment declined, the compliance rate declined. Compliance rates for IHEs with different enrollments were as follows: 6,001-9,999, 30 percent; 3,001-6,000, 23 percent; 2,000-3,000, 13 percent. CONCLUSIONS: A full-time, dedicated professional coordinating emergency preparedness is a best practice as evidenced by various accrediting bodies, but this practice is not mandated for IHEs. Our results suggest that proximity to significant annual hurricane threats does not influence the adoption of this recommendation. Despite IHEs being core stakeholders in assuring disaster resilience, gaps exist in preparedness practice.

Predicting end-of-life in patients with an exacerbation of COPD by routine clinical assessment.

UNLABELLED: The purpose of this study was to determine if routine clinical assessment could reliably predict in-hospital death in patients admitted with acute exacerbation of COPD (AECOPD). METHODS: In a case-crossover study the case records of AECOPD related deaths were reviewed. Clinical and laboratory variables including performance status (WHO-PS) and a composite physiological score (early warning score, EWS) at initial clinical assessment on final admission (FA) and penultimate admission (PA) for AECOPD were compared. RESULTS: Sixty patients included in study, female 60%, mean age (SD) 75 (8.7) years. 98% had ≥2 admissions for AECOPD. On univariate analysis variables associated with death were: Charlson score, WHO-PS, EWS, pH<7.35, Urea and CRP. On multivariate analysis predictors of mortality were: WHO-PS (OR 95% CI: 4.9 (1.06-22.61); p=0.04) and EWS (OR 95% CI: 3.39 (1.56-7.41); p=0.002). ROC analysis of relationship between combined WHO-PS/EWS score and death gave AUC 0.86; a total score≥6 had sensitivity 78% and specificity 86.2% and on multivariate analysis OR (95% CI) for death was 19.3 (4.3-86.2); p<0.0005. CONCLUSION: In-hospital deaths from AECOPD may be predicted by assessment of WHO-PS and EWS on admission to hospital.