Integrating Evidence-Based Screening, Brief Intervention, and Referral to Treatment Into a Family Nurse Practitioner Program.

PROBLEM STATEMENT: Substance use disorder (SUD)-and more specifically opioid use disorder-is a national epidemic. With the increasing amounts of people suffering from SUD, all healthcare professionals should be educated to identify substance abuse, provide a brief intervention, and refer patients for treatment when indicated. PURPOSE: The purpose of this project is to integrate the SBIRT into the curriculum of a graduate-level family nurse practitioner (FNP) program in southeastern Pennsylvania and to determine if educating FNP students on the SBIRT process increases their knowledge of SUDs and their treatment and increases their motivation to work with patients with SUD. MEASUREMENTS: The measurements used were as follows: shortened Alcohol and Alcohol Problems Perception Questionnaire (S-AAPPQ), shortened Drug and Drug Problems Perception Questionnaire (S-DDPPQ), a 10-question knowledge test, and demographic data. RESULTS: All subscales of the S-DDPPQ, the S-AAPPQ, and the knowledge test showed a statistically significant change from the pretest score means and to posttest means. This evidence-based practice project supports the integration of SBIRT education into FNP programs to increase their ability to identify and treat individuals with SUDs.

An interview with Pennsylvania State representative Tarik Khan, PhD, FNP-BC.

ABSTRACT: Nurse practitioners (NPs) take on diverse and essential roles. In an exclusive interview, Representative Tarik Khan, PhD, FNP-BC, highlights the impact NPs can have in the political arena. Transitioning from an NP to a legislator in Pennsylvania, Dr. Khan's journey reflects his commitment to health care reform, driven by hospital closures, lack of patient care access, and the COVID-19 pandemic. Elected in 2022, Dr. Khan leverages his health care background to address a wide range of legislative issues, passing significant bills. He advocates for NPs to engage politically, emphasizing their unique perspective and problem-solving skills. Dr. Khan's story underscores the transformative potential of NPs in shaping public policy and advancing systemic change.

Blood Lead Testing and Follow-up Testing Among Children Hospitalized for Lead Poisoning.

BACKGROUND AND OBJECTIVES: US children experience lead poisoning, which has detrimental health effects and significant individual and societal costs. This study aimed to describe the sociodemographic and hospitalization characteristics of children hospitalized for lead poisoning and assess the proportion of inpatients who received blood lead testing and appropriate follow-up testing before hospitalization. METHODS: 2015-2021 hospital discharge data were linked to lead surveillance data for Pennsylvania children aged 0 to 5 years. Demographics, hospitalization characteristics, and lead testing data from children with a primary diagnosis code of lead poisoning were used. The number of hospitalizations, associated hospital length of stay and charges, and the proportion of inpatients who received lead testing and follow-up testing after identification of high blood lead levels before hospitalization were analyzed by selected characteristics. RESULTS: During the study period, there were 93 children hospitalized for lead poisoning, incurring 443 inpatient days and approximately 6 million dollars in inpatient charges. Of these inpatients, 69.9% were males, 36.6% were non-Hispanic Black, 67.7% were aged 0 to 2 years, 14% had repeated admissions, and 88.2% of admissions were paid by Medicaid. In addition, 20.4% did not have lead testing, and 34.4% had appropriate follow-up testing before hospitalization. Non-Hispanic whites and children with developmental, behavioral, and emotional disorders had relatively low proportions of having appropriate follow-up testing. CONCLUSIONS: Severe childhood lead poisoning is a significant health and economic burden, especially among children with Medicaid. Further improvements in blood lead testing and follow-up testing can help prevent childhood lead poisoning.

Sleep Is a Human Right, and Its Deprivation Is Torture.

Sleep is integral to human health and well-being; it is recognized as a fundamental right by international bodies. Nevertheless, deliberate sleep deprivation is frequently employed as a form of torture, violating the right to health. Legal cases such as LeMaire v Maass, Ireland v UK, and Huertas v Secretary Pennsylvania Dept of Corrections illustrate the varying interpretations of sleep deprivation as torture or cruel and unusual punishment. Ambiguity in domestic and international legal definitions underscores the need for collaboration between health and legal professionals. Clinicians can offer expertise about physiological and psychological consequences of sleep deprivation, which informs what legally counts as torture. This commentary explores the intersection of sleep deprivation, human rights, and the role of medical professionals in addressing, identifying, and preventing sleep deprivation as a means of coercion and abuse.

Racial disparities in Phase 1 COVID-19 vaccine shipments to Neighborhood sites in Pennsylvania by the Federal Retail Pharmacy Program.

Early racial disparities in COVID-19 vaccination rates have been attributed primarily to personal vaccine attitudes and behavior. Little attention has been paid to the possibility that inequitable vaccine distribution may have contributed to racial disparities in vaccine uptake when supplies were most scarce. We test the hypothesis that scarce vaccines were distributed inequitably using the shipping addresses of 385,930 COVID-19 vaccine doses distributed in the first 17 weeks of Pennsylvania's Phase 1 rollout (December 14, 2020 through April 12, 2021). All shipments we analyze were allocated via the Federal Retail Pharmacy Program, a public-private partnership coordinated by the Centers for Disease Control and Prevention.Overall, White people had an average of 81.4% more retail pharmacy program doses shipped to their neighborhoods than did Black people. Regression models reveal that weekly vaccine allocations determined by pharmacy chains-rather than initial shipment and administration site decisions requiring state and federal approval-drove these effects. All findings remained consistent after controlling for neighborhood differences in income, population density, insurance coverage, number of pharmacies, and other social determinants of health.Our findings suggest that the private distribution of scarce public resources should be assessed for racial impact, regulated as public resources, and monitored continuously.

Trichinella murrelli identified in red foxes (Vulpes vulpes) in Pennsylvania, USA.

Trichinella infections have been eliminated from pork where pigs are raised in biosecure facilities, but wildlife infections persist. Trichinella murrelli is the primary zoonotic species in wild carnivores in the United States, having been identified in several species of omnivores and carnivores. Here, we document its occurrence in seven of 21 (33.3%) red foxes (Vulpes vulpes) from six counties in Pennsylvania. Encysted Trichinella larvae were detected in muscle squashes (<5 g samples) of all seven foxes, and in histological sections of the tongue and limb muscle of three. Larvae from muscle squashes were pooled and tested in a multiplex PCR capable of differentiating all Trichinella species native to the USA; all samples contained only T. murrelli. This is the first identification of T. murrelli in red foxes from Pennsylvania, and the first such survey performed in the last three decades. Results indicate that Trichinella remains endemic in Pennsylvania wildlife and a threat to the health of those who consume wild game.

Temporal analysis of water chemistry and smallmouth bass (Micropterus dolomieu) health at two sites with divergent land use in the Susquehanna River watershed, Pennsylvania, USA.

Monitoring wild fish health and exposure effects in impacted rivers and streams with differing land use has become a valuable research tool. Smallmouth bass (Micropterus dolomieu) are a sensitive, indicator species that exhibit signs of immunosuppression and endocrine disruption in response to water quality changes and contaminant exposure. To determine the impact of agriculture and development on smallmouth bass health, two sites (a developed/agriculture site and a forested site) in the Susquehanna River watershed, Pennsylvania were selected where bass and water chemistry were sampled from 2015 to 2019. Smallmouth bass were sampled for histopathology to assess parasite and macrophage aggregate density in the liver and spleen, condition factor (Ktl), hepatic gene transcript abundance, hepatosomatic index (HSI), and a health assessment index (HAI). Land use at the developed/agriculture site included greater pesticide application rates and phytoestrogen crop cover and more detections and higher concentrations of pesticides, wastewater-associated contaminants, hormones, phytoestrogens, and mycotoxins than at the forested site. Additionally, at the developed/agriculture site, indicators of molecular changes, including oxidative stress, immune/inflammation, and lipid metabolism-related hepatic gene transcripts, were associated with more contaminants and land use variables. At both sites, there were multiple associations of contaminants with liver and/or spleen macrophage aggregate density, indicating that changes at the molecular level seemed to be a better indicator of exposures unique to each site. The findings illustrate the importance of timing for land management practices, the complex mixtures aquatic animals are exposed to, and the temporal changes in contaminant concentration. Agricultural practices that affect hepatic gene transcripts associated with immune function and disease resistance were demonstrated which could negatively affect smallmouth bass populations.

Lessons for future pandemics: Temporal evolution and rural-urban variations in the impacts of the COVID-19 on opioid use treatment.

The COVID-19 pandemic introduced imminent and lasting impacts on the opioid crisis in the U.S., including a significant increase in opioid overdose and deaths and in use of telehealth in treatment. What lessons can we learn from the treatment transition during the pandemic that could help tackle the opioid crisis when future pandemics strike? In this paper, we conducted a phone survey with opioid treatment facilities in Pennsylvania to examine the COVID-19's impacts on treatment facilities and individuals with opioid use disorder during the first year of the pandemic. We separated the lockdown period (Mid-March through Mid-May, 2020) from the reopening period that followed, and urban areas from rural areas, to explore temporal evolution and rural-urban variations in the COVID-19's impacts. We found rural-urban heterogeneity in facilities' adoption of telehealth in treatment and in challenges and risk factors faced by their clients during the lockdown period. During the reopening, telehealth was adopted by most facilities, and telehealth-related challenges became less salient; however, both rural and urban facilities reported higher relapse risks faced by their clients, citing factors more likely to be at clients' end and related to socioeconomic stressors and mental health. Our results highlight the vitality of addressing socioeconomic and mental health challenges faced by individuals with OUD, via government policies and community interventions, when future pandemics strike. The findings also indicate the importance of maintaining facilities' financial well-being to provide treatment services.

Priority screening of contaminants of emerging concern (CECs) in surface water: Comparing cell-based bioassays and exposure-activity ratios (EARs).

In this study, we compared a wide range of cell-based bioassays to the use of chemical analysis followed by exposure-activity ratio (EAR) and Toxicological Prioritization index (ToxPi) for prioritizing chemicals, sites, and hazard concerns in water samples. Surface water samples were collected from nine sites in three Central Pennsylvania streams and analyzed for a forty-six contaminants of emerging concern (CECs), including pesticides, personal care products, and pharmaceuticals. Cell-based reporter assays evaluated human and zebrafish molecular initiating events (MIEs) in endocrine and metabolic disruption, altered lipid metabolism, and oxidative stress. Bioassays showed that 12 out of 40 assays had at least one site with activity over the effect-based trigger (EBT) values. The receptors that exhibited the highest number of samples above the EBT that would be expected to cause toxicity were Aryl hydrocarbon receptor (AhR, human and zebrafish), Pregnane X Receptor (PXR), Estrogen Receptor-beta (ERB), and Androgen Receptor (AR). Characterizing the collection sites by their bioactivity aligned closely with the stream in which samples were collected. The sum of all EARs for each chemical indicated that the pharmaceutical Carbamazepine and the pesticides Carbaryl and Atrazine posed the greatest concern. However, predicted activity and site prioritization based on individual chemical analysis and calculated EAR were different than those measured by bioassay, indicating that biologically active chemicals are present in the samples that were not included in the targeted analytes. Taken together, these data show that chemical analysis and EAR analysis are beneficial for prioritization of chemicals, whereas mechanism-based bioassays are more inclusive of known as well as unknown chemical contaminants and thus of more use for overall water quality analysis and site prioritization.

Aversion to pragmatic randomised controlled trials: three survey experiments with clinicians and laypeople in the USA.

OBJECTIVES: Pragmatic randomised controlled trials (pRCTs) are essential for determining the real-world safety and effectiveness of healthcare interventions. However, both laypeople and clinicians often demonstrate experiment aversion: preferring to implement either of two interventions for everyone rather than comparing them to determine which is best. We studied whether clinician and layperson views of pRCTs for COVID-19, as well as non-COVID-19, interventions became more positive during the pandemic, which increased both the urgency and public discussion of pRCTs. DESIGN: Randomised survey experiments. SETTING: Geisinger, a network of hospitals and clinics in central and northeastern Pennsylvania, USA; Amazon Mechanical Turk, a research participant platform used to recruit online participants residing across the USA. Data were collected between August 2020 and February 2021. PARTICIPANTS: 2149 clinicians (the types of people who conduct or make decisions about conducting pRCTs) and 2909 laypeople (the types of people who are included in pRCTs as patients). The clinician sample was primarily female (81%), comprised doctors (15%), physician assistants (9%), registered nurses (54%) and other medical professionals, including other nurses, genetic counsellors and medical students (23%), and the majority of clinicians (62%) had more than 10 years of experience. The layperson sample ranges in age from 18 to 88 years old (mean=38, SD=13) and the majority were white (75%) and female (56%). OUTCOME MEASURES: Participants read vignettes in which a hypothetical decision-maker who sought to improve health could choose to implement intervention A for all, implement intervention B for all, or experimentally compare A and B and implement the superior intervention. Participants rated and ranked the appropriateness of each decision. Experiment aversion was defined as the degree to which a participant rated the experiment below their lowest-rated intervention. RESULTS: In a survey of laypeople administered during the pandemic, we found significant aversion to experiments involving catheterisation checklists and hypertension drugs unrelated to the treatment of COVID-19 (Cohen's d=0.25-0.46, p<0.001). Similarly, among both laypeople and clinicians, we found significant aversion to most (comparing different checklist, proning and mask protocols; Cohen's d=0.17-0.56, p<0.001) but not all (comparing school reopening protocols; Cohen's d=0.03, p=0.64) non-pharmaceutical COVID-19 experiments. Interestingly, we found the lowest experiment aversion to pharmaceutical COVID-19 experiments (comparing new drugs and new vaccine protocols for treating the novel coronavirus; Cohen's d=0.04-0.12, p=0.12-0.55). Across all vignettes and samples, 28%-57% of participants expressed experiment aversion, whereas only 6%-35% expressed experiment appreciation by rating the trial higher than their highest-rated intervention. CONCLUSIONS: Advancing evidence-based medicine through pRCTs will require anticipating and addressing experiment aversion among patients and healthcare professionals. STUDY REGISTRATION: http://osf.io/6p5c7/.

Community Asset Density and Past-Year Mental Health Symptoms Among Youths.

Importance: Many youths experience mental health challenges. Identifying which neighborhood and community factors may influence mental health may guide health policy and practice. Objective: To explore associations between community assets (eg, schools, parks, libraries, and barbershops) and past-year mental health symptoms among youths. Design, Setting, and Participants: This cross-sectional study leveraged 3 datasets, which were linked by 26 zip codes: the Western Pennsylvania Regional Data Center, the Child Opportunity Index 2.0 database, and the Allegheny County Youth Risk Behavior Survey (YRBS). The YRBS was administered during the study period in 2018 to youths across 13 high schools in Allegheny County, Pennsylvania; the study dates were from October 15 to October 19, 2018. Dates of analysis were from August 1, 2023, to July 15, 2024. Exposures: Asset density in each zip code across 8 asset categories (transportation, education, parks and recreation, faith-based entities, health services, food resources, personal care services, and social infrastructure) was calculated. Main Outcomes and Measures: The main outcomes were mental health measures included in the past 12 months, which comprised feelings of hopelessness (feeing so sad or hopeless that you stopped doing activities), nonsuicidal self-injury (hurt yourself on purpose without wanting to die), and suicidal ideation (seriously considered attempting suicide). All were operationalized to any or none. Data were analyzed using multivariable generalized linear mixed models and were adjusted for age, sex assigned at birth, race and ethnicity, and identification as sexually or gender diverse. Results: Among 6306 students who were eligible for the YRBS based on their enrollment in participating high schools, 4487 students completed surveys, and 2162 were included in the analytic sample (mean [SD] age, 15.8 [1.2] years; 1245 [57.6%] were assigned female sex at birth). Over one-third of the participants (811 [37.5%]) reported past-year feelings of hopelessness; 587 (27.2%), past-year nonsuicidal self-injury; and 450 (20.8%), past-year suicidal ideation. High total asset population density (adjusted odds ratio [AOR], 0.85 [95% CI, 0.75-0.97]; P = .01), as well as population density of transportation assets (AOR, 0.77 [95% CI, 0.66-0.90]; P < .001), educational resources (AOR, 0.78 [95% CI, 0.67-0.92]; P = .002), and health services (AOR, 0.74 [95% CI, 0.60-0.91]; P = .006), were associated with lower odds of past-year hopelessness after adjusting for covariates. There were no correlations between asset density, Child Opportunity Index, and other mental health measures. Conclusions and Relevance: The findings of this cross-sectional study suggest that access to certain community assets was associated with lower odds of feelings of hopelessness among youths. Ongoing work is needed to characterize other forms of social and cultural capital, which may mitigate negative mental health outcomes among adolescent youths.

Wastewaters Coproduced with Shale Gas Drive Slight Regional Salinization of Groundwater.

While unconventional oil and gas (UOG) development is changing the world economy, processes that are used during UOG development such as high-volume hydraulic fracturing ("fracking") have been linked with water contamination. Water quality risks include leaks of gas and salty fluids (brines) that are coproduced at wellpads. Identifying the cause of contamination is difficult, however, because UOG wells are often colocated with other contaminant sources. We investigated the world's largest shale gas play with publicly accessible groundwater data (Marcellus Shale in Pennsylvania, U.S.A. with ∼29,000 analyses) and discovered that concentrations of brine-associated barium ([Ba]) and strontium ([Sr]) show small regional increases within 1 km of UOG development. Higher concentrations in groundwaters are associated with greater proximity to and density of UOG wells. Concentration increases are even larger when considering associations with the locations of (i) spill-related violations and (ii) some wastewater impoundments. These statistically significant relationships persist even after correcting for other natural and anthropogenic sources of salts. The most likely explanation is that UOG development slightly increases salt concentrations in regional groundwaters not because of fracking but because of the ubiquity of wastewater management issues. These results emphasize the need for stringent wastewater management practices across oil and gas operations.

Thelazia callipaeda Eyeworms in American Black Bear, Pennsylvania, USA, 2023.

We identified a Thelazia callipaeda eyeworm in an American black bear in Pennsylvania, USA, on the basis of its morphological features and molecular analysis. Our finding highlights emergence of a T. callipaeda worm sylvatic transmission cycle in the United States.

Designing Retirement Strategies for Coal-Fired Power Plants To Mitigate Air Pollution and Health Impacts.

Retiring coal power plants can reduce air pollution and health damages. However, the spatial distribution of those impacts remains unclear due to complex power system operations and pollution chemistry and transport. Focusing on coal retirements in Pennsylvania (PA), we analyze six counterfactual scenarios for 2019 that differ in retirement targets (e.g., reducing 50% of coal-based installed capacity vs generation) and priorities (e.g., closing plants with higher cost, closer to Environmental Justice Areas, or with higher CO2 emissions). Using a power system model of the PJM Interconnection, we find that coal retirements in PA shift power generation across PA and Rest of PJM, leading to scenario-varying changes in the plant-level release of air pollutants. Considering pollution transport and the size of the exposed population, these emissions changes, in turn, give rise to a reduction of 6-136 PM2.5-attributable deaths in PJM across the six scenarios, with most reductions occurring in PA. Among our designed scenarios, those that reduce more coal power generation yield greater aggregate health benefits due to air quality improvements in PA and adjacent downwind regions. In addition, comparing across the six scenarios evaluated in this study, vulnerable populations─in both PA and Rest of PJM─benefit most in scenarios that prioritize plant closures near Environmental Justice Areas in PA. These results demonstrate the importance of considering cross-regional linkages and sociodemographics in designing equitable retirement strategies.

Punxsutawney, Pennsylvania Pamphlet Proselytizing Preventive Dentistry, by Drs. Morrison and Henry.

Advice on preventive dental care for children, prior to 1900 is scarce. In the 1890s, Drs. Morrison and Henry, two Punxsutawny, Pennsylvania dentists, cogently offered such advice in their promotional pamphlet, along with some lessons on life, as reflected by precious stones.

Appropriateness of Imaging for Low-Risk Prostate Cancer-Real World Data from the Pennsylvania Urologic Regional Collaboration (PURC).

Imaging for prostate cancer defines the extent of disease. Guidelines recommend against imaging low-risk prostate cancer patients with a computed tomography (CT) scan or bone scan due to the low probability of metastasis. We reviewed imaging performed for men diagnosed with low-risk prostate cancer across the Pennsylvania Urologic Regional Collaborative (PURC), a physician-led data sharing and quality improvement collaborative. The data of 10 practices were queried regarding the imaging performed in men diagnosed with prostate cancer from 2015 to 2022. The cohort included 13,122 patients with 3502 (27%) low-risk, 2364 (18%) favorable intermediate-risk, 3585 (27%) unfavorable intermediate-risk, and 3671 (28%) high-risk prostate cancer, based on the AUA guidelines. Amongst the low-risk patients, imaging utilization included pelvic MRI (59.7%), bone scan (17.8%), CT (16.0%), and PET-based imaging (0.5%). Redundant imaging occurred in 1022 patients (29.2%). There was variability among the PURC sites for imaging used in the low-risk patients, and iterative education reduced the need for CT and bone scans. Approximately 15% of low-risk patients had staging imaging performed using either a CT or bone scan, and redundant imaging occurred in almost one-third of men. Such data underscore the need for continued guideline-based education to optimize the stewardship of resources and reduce unnecessary costs to the healthcare system.

Self-Reported COVID-19 Vaccine and Booster Acceptance and Hesitancy Among Autistic Adults in Pennsylvania: Cross-Sectional Analysis of Survey Data.

BACKGROUND: The autistic population is rapidly increasing; meanwhile, autistic adults face disproportionate risks for adverse COVID-19 outcomes. Limited research indicates that autistic individuals have been accepting of initial vaccination, but research has yet to document this population's perceptions and acceptance of COVID-19 boosters. OBJECTIVE: This study aims to identify person-level and community characteristics associated with COVID-19 vaccination and booster acceptance among autistic adults, along with self-reported reasons for their stated preferences. Understanding this information is crucial in supporting this vulnerable population given evolving booster guidelines and the ending of the public health emergency for the COVID-19 pandemic. METHODS: Data are from a survey conducted in Pennsylvania from April 11 to September 12, 2022. Demographic characteristics, COVID-19 experiences, and COVID-19 vaccine decisions were compared across vaccination status groups. Chi-square analyses and 1-way ANOVA were conducted to test for significant differences. Vaccination reasons were ranked by frequency; co-occurrence was identified using phi coefficient correlation plots. RESULTS: Most autistic adults (193/266, 72.6%) intended to receive or received the vaccine and booster, 15% (40/266) did not receive or intend to receive any vaccine, and 12.4% (33/266) received or intended to receive the initial dose but were hesitant to accept booster doses. Reasons for vaccine acceptance or hesitancy varied by demographic factors and COVID-19 experiences. The most significant were previously contracting COVID-19, desire to access information about COVID-19, and discomfort with others not wearing a mask (all P=.001). County-level factors, including population density (P=.02) and percentage of the county that voted for President Biden (P=.001) were also significantly associated with differing vaccination acceptance levels. Reasons for accepting the initial COVID-19 vaccine differed among those who were or were not hesitant to accept a booster. Those who accepted a booster were more likely to endorse protecting others and trusting the vaccine as the basis for their acceptance, whereas those who were hesitant about the booster indicated that their initial vaccine acceptance came from encouragement from someone they trusted. Among the minority of those hesitant to any vaccination, believing that the vaccine was unsafe and would make them feel unwell were the most often reported reasons. CONCLUSIONS: Intention to receive or receiving the COVID-19 vaccination and booster was higher among autistic adults than the population that received vaccines in Pennsylvania. Autistic individuals who accepted vaccines prioritized protecting others, while autistic individuals who were vaccine hesitant had safety concerns about vaccines. These findings inform public health opportunities and strategies to further increase vaccination and booster rates among generally accepting autistic adults, to better support the already strained autism services and support system landscape. Vaccination uptake could be improved by leveraging passive information diffusion to combat vaccination misinformation among those not actively seeking COVID-19 information to better alleviate safety concerns.

Somebody to Lean on: Understanding Self-Stigma and Willingness to Disclose in the Context of Addiction.

Substance use self-stigma is a barrier to treatment and can negatively impact individuals' well-being and treatment engagement. Given the mixed findings in previous research and the limited specific investigation into the concept of self-stigma within the context of opioid misuse, examining factors associated with self-stigma in the context of opioid use disorder (OUD) is warranted. The current study examines the influence of individual-level factors (race, sex, urban/rural status, support group attendance) on self-stigma and willingness to disclose opioid use. Data for this study were from a larger study of OUD-related stigma among adults in Pennsylvania, U.S. The current study included participants who indicated a personal past or current history with OUD were included (n = 84). Exploratory factor analysis and multiple indicators, multiple causes (MIMIC) model were used to explore the associations between demographic factors (i.e., sex, age, race/ethnicity, urban/rural status), attendance at mutual support groups, and self-stigma factors. Results indicated that sex and attendance at mutual support groups significantly predicted levels of self-stigma. Women and individuals with no previous experience attending mutual support groups endorsed lower levels of self-stigma. Additionally, attendance at mutual support groups predicted willingness to self-disclose past and present opioid use. Individuals who reported no history of attending mutual support groups demonstrated less willingness to disclose past and present OUD use compared to participants who were support group attendees. The current research findings enhance the understanding of OUD-related self-stigma by examining its relationship with individual-level factors, disclosure, and attendance to mutual support groups. The results offer insights into the influence of sex and support group attendance on self-stigma and disclosure. These findings have significant clinical implications for developing future interventions and promoting health policy changes.

Comparison of Butorphanol-Azaperone-Medetomidine and Nalbuphine-Medetomidine-Azaperone in Free-Ranging Elk (Cervus canadensis) in Pennsylvania, USA.

Chemical immobilization is commonly used to capture and handle free-ranging elk (Cervus canadensis). Butorphanol-azaperone-medetomidine (BAM) and nalbuphine-medetomidine-azaperone (NalMed-A) are compounded drug combinations that are lower-scheduled in the US than drugs historically used for elk immobilizations. We compared BAM and NalMed-A for immobilization of free-ranging elk using free-darting and Clover trapping. From January 2020 to April 2022, 196 female elk were immobilized in Pennsylvania, USA. We report vital rates, induction and recovery times, and the need for supplemental drugs. We built mixed-effects logistic regression models to describe differences between drug choice based on induction and recovery times, capture method, and individual variation. Several models were competing, including our null model, which suggests that BAM and NalMed-A are comparable based on the parameters we evaluated. Supplemental drug administration was more frequently needed in NalMed-A immobilizations (21.2%) than in BAM immobilizations (9.0%). Overall, we found minor differences between BAM and NalMed-A, both of which appear to be effective for immobilizing elk in both free-darting and Clover trapping scenarios when performing moderately invasive, minimally painful procedures on free-ranging elk.

A negative binomial Lindley approach considering spatiotemporal effects for modeling traffic crash frequency with excess zeros.

Statistical analysis of traffic crash frequency is significant for figuring out the distribution pattern of crashes, predicting the development trend of crashes, formulating traffic crash prevention measures, and improving traffic safety planning systems. In recent years, the theory and practice for traffic safety management have shown that road crash data have characteristics such as spatial correlation, temporal correlation, and excess zeros. If these characteristics are ignored in the modeling process, it may seriously affect the fitting performance and prediction accuracy of traffic crash frequency models and even lead to incorrect conclusions. In this research, traffic crash data from rural two-way two-lane from four counties in Pennsylvania, USA was modeled considering the spatiotemporal effects of crashes. First, a negative binomial Lindley spatiotemporal effect model of crash frequency was constructed at the micro level; Simultaneously, the characteristics and problems of excess zeros and potential heterogeneity of the crash data were resolved; Finally, the effects of road characteristics on crash frequency were analyzed. The results indicate a significant spatial correlation between the crash frequency of adjacent road sections. Compared with the negative binomial model, the negative binomial Lindley model can better handle the excess zeros characteristics in traffic crash data. The model that considers both spatial correlation and temporal conditional autoregressive effects has the best fit for the observed data. In addition, for road sections that allow passing and have a speed limitation of not less than 50 miles per hour, the crash frequency corresponding to these sections is lower due to their good visibility and road conditions. The increase in average turning angle and intersection density on the horizontal curve of the road section corresponds to an increase in crash frequency.