The dynamics of heroin and illicit opioid use disorder, casual use, treatment, and recovery: A mathematical modeling analysis.

A leading crisis in the United States is the opioid use disorder (OUD) epidemic. Opioid overdose deaths have been increasing, with over 100,000 deaths due to overdose from April 2020 to April 2021. This paper presents a mathematical model to address illicit OUD (IOUD), initiation, casual use, treatment, relapse, recovery, and opioid overdose deaths within an epidemiological framework. Within this model, individuals remain in the recovery class unless they relapse back to use and due to the limited availability of specialty treatment facilities for individuals with OUD, a saturation treatment function was incorporated. Additionally, a casual user class and its corresponding specialty treatment class were incorporated. We use both heroin and all-illicit opioids datasets to find parameter estimates for our models. Bistability of equilibrium solutions was found for realistic parameter values for the heroin-only dataset. This result implies that it would be beneficial to increase the availability of treatment. An alarming effect was discovered about the high overdose death rate: by 2046, the disorder-free equilibrium would be the only stable equilibrium. This consequence is concerning because it means the epidemic would end due to high overdose death rates. The IOUD model with a casual user class, its sensitivity results, and the comparison of parameters for both datasets, showed the importance of not overlooking the influence that casual users have in driving the all-illicit opioid epidemic. Casual users stay in the casual user class longer and are not going to treatment as quickly as the users of the heroin epidemic. Another result was that the users of the all-illicit opioids were going to the recovered class by means other than specialty treatment. However, the change in the relapse rate has more of an influence for those individuals than in the heroin-only epidemic. The results above from analyzing this model may inform health and policy officials, leading to more effective treatment options and prevention efforts.

Type III Popliteal Artery Entrapment Syndrome with Concurrent Chronic Exertional Compartment Syndrome: A Case Report.

CASE: The patient, a 21-year-old female Division I track and field athlete, presents with bilateral calf pain, tightness, numbness, and swelling during activity. Initially diagnosed with chronic exertional compartment syndrome (CECS), she underwent bilateral four-compartment fasciotomies. After 4 months, she experienced persistence of some of her prefasciotomy symptoms and was referred to vascular surgery. A fibrous band was compressing the popliteal artery, making the diagnosis of popliteal artery entrapment syndrome (PAES). She underwent bilateral popliteal artery decompressions. She had a successful recovery with no recurrence of numbness, weakness, or pain. CONCLUSION: Recognize that structural PAES may coexist with CECS.

Modeling the Dynamics of Heroin and Illicit Opioid Use Disorder, Treatment, and Recovery.

Opioid use disorder (OUD) has become a serious leading health issue in the USA leading to addiction, disability, or death by overdose. Research has shown that OUD can lead to a chronic lifelong disorder with greater risk for relapse and accidental overdose deaths. While the prescription opioid epidemic is a relatively new phenomenon, illicit opioid use via heroin has been around for decades. Recently, additional illicit opioids such as fentanyl have become increasingly available and problematic. We propose a mathematical model that focuses on illicit OUD and includes a class for recovered users but allows for individuals to either remain in or relapse back to the illicit OUD class. Therefore, in our model, individuals may cycle in and out of three different classes: illicit OUD, treatment, and recovered. We additionally include a treatment function with saturation, as it has been shown there is limited accessibility to specialty treatment facilities. We used 2002-2019 SAMHSA and CDC data for the US population, scaled to a medium-sized city, to obtain parameter estimates for the specific case of heroin. We found that the overdose death rate has been increasing linearly since around 2011, likely due to the increased presence of fentanyl in the heroin supply. Extrapolation of this overdose death rate, together with the obtained parameter estimates, predict that by 2038 no endemic equilibrium will exist and the only stable equilibrium will correspond to the absence of heroin use disorder in the population. There is a range of parameter values that will give rise to a backward bifurcation above a critical saturation of treatment availability. We show this for a range of overdose death rate values, thus illustrating the critical role played by the availability of specialty treatment facilities. Sensitivity analysis consistently shows the significant role of people entering treatment on their own accord, which suggests the importance of removing two of the most prevalent SAMHSA-determined reasons that individuals do not enter treatment: financial constraints and the stigma of seeking treatment for heroin use disorder.

Evaluation and control of waste anesthetic gases in the postanesthesia care unit.

BACKGROUND: Few studies have addressed waste anesthetic gases (WAGs) in the postanesthesia care unit (PACU) related to exhaled sevoflurane and nitrous oxide. PURPOSE: To evaluate the effectiveness of a new scavenging system to control WAGs in the PACU. DESIGN: Comparative and descriptive study. METHODS: This pilot study compared exposure to WAGs with and without a scavenging system using infrared technology to visualize and quantify exposure to these gases in the PACU. FINDING: The results showed a significant reduction (P < .05) in both nitrous oxide and sevoflurane at both six inches and three feet from the patient's breathing zone, as well as in the work area of the perianesthesia nurses in the PACU. CONCLUSIONS: WAG exposure may be more easily managed through the use of this new scavenging system to better control occupational exposures to these gases among PACU personnel.

Job satisfaction in rural public health nurses.

OBJECTIVE: The purpose of this study was to determine whether nurse managers and staff nurses in rural public health offices were satisfied with their jobs, whether managers were more satisfied than staff nurses, and whether their achieved educational level impacted their job satisfaction. DESIGN: A nonexperimental comparative study was conducted of currently employed public health nurses (PHNs) to determine job satisfaction levels by using Stember's Web-based 80-question job satisfaction survey. SAMPLE: The sample consisted of 88 PHNs employed as either managers or staff nurses in county public health office settings during April 2006. RESULTS: In general, both nurse managers and staff nurses reported high job satisfaction. No significant differences existed between the composite job satisfaction scores of the managers and staff nurses. Significant differences existed between managers' and staff nurses' job satisfaction in the categories of "influence" and "interpersonal relationships" with managers less satisfied than staff nurses. CONCLUSIONS: Both staff nurses and managers in public health were satisfied with their jobs. Managers attributed any sense of decreased job satisfaction in the areas of influence and interpersonal relationships. Further study is needed to determine what contributes to satisfaction of PHNs in order to promote positive work environments conducive to retention and recruitment.

Ergonomics case study: revised NIOSH lifting equation instruction issues for students.

This case study investigated the effectiveness of formal instruction of the Revised NIOSH Lifting Equation for university students who may use the equation in their future work. Their successes and challenges were examined through a class exercise and two exams, all of which followed the classroom instruction in applying the Lifting Equation. Results showed students (1) had difficulty determining relevant values for task variables from reading a job description, and (2) generally were able to calculate the Recommended Weight Limit (RWL) and Lifting Index (LI) when task variables were such that the associated multipliers were less than or equal to 1. However, when the multiplier was calculated to be greater than 1, students had difficulty interpreting the result. The task variable and multiplier (consistently the greatest challenge) were the asymmetry task variable, A, and the asymmetric multiplier, AM. Results indicate that the layout of the Job Analysis Worksheet for Step 1 may make it easy to make arithmetic errors when calculating multipliers. It is recommended that the worksheet be redesigned to help individuals decrease the probability of making an arithmetic error when calculating the task variables, multipliers, RWL, and LI. It is also recommended that the redesigned worksheet be tested to determine whether fewer arithmetic errors are made and if the worksheet is less confusing for an inexperienced user to use.