The impact of civil commitment laws for substance use disorder on opioid overdose deaths.

Objective: Our study analyzed the impact of civil commitment (CC) laws for substance use disorder (SUD) on opioid overdose death rates (OODR) in the U.S. from 2010-21. Methods: We used a retrospective study design using the CDC Wide-ranging Online Data for Epidemiologic Research (WONDER) dataset to analyze overdose death rates from any opioid during 2010-21 using ICD-10 codes. We used t-tests and two-way ANOVA to compare the OODR between the U.S. states with the law as compared to those without by using GraphPad Prism 10.0. Results: We found no significant difference in the annual mean age-adjusted OODR from 2010-21 between U.S. states with and without CC SUD laws. During the pre-COVID era (2010-19), the presence or absence of CC SUD law had no difference in age-adjusted OODR. However, in the post-COVID era (2020-21), there was a significant increase in OODR in states with a CC SUD law compared to states without the law (p = 0.032). We also found that OODR increased at a faster rate post-COVID among both the states with CC SUD laws (p < 0.001) and the states without the law (p = 0.019). Conclusion: We found higher age-adjusted OODR in states with a CC SUD law which could be due to the laws being enacted in response to the opioid crisis or physicians' opposition to or unawareness of the law's existence leading to underutilization. Recent enactment of CC SUD law(s), a lack of a central database for recording relapse rates, and disparities in opioid overdose rate reductions uncovers multiple variables potentially influencing OODR. Thus, further investigation is needed to analyze the factors influencing OODRs and long-term effects of the CC SUD laws.

The emergence of Urban Community Resilience Initiatives During the COVID-19 Pandemic: An International Exploratory Study.

All over the world, urban communities take initiative in order to cope with the COVID-19 pandemic. This study conducts a literature review and an international exploratory study in order to identify pathways within which Community Resilience Initiatives (CRIs) emerge within different governance contexts. The CRIs target vulnerable communities, which are hard to reach. Our study results identify four pathways: (1) informal bottom-up community initiatives; (2) formal community initiatives emerging out of existing community-based initiatives; (3) initiatives of external actors, often NGOs, universities or governments and (4) networks of organisations whom together initiate action in response to COVID-19. The pathways lead to different types, scales and complexities of the initiatives. However, all face similar barriers related to funding, weak networks and limited cooperation. CRIs often perceive the government agencies to be unreliable and unsupportive which in turn also hampers CRI's emergence.

Partout dans le monde, les communautés urbaines prennent des initiatives pour faire face à la pandémie de COVID-19. Cette étude mène une revue de la littérature et une étude exploratoire internationale afin d'identifier les voies par lesquelles les initiatives de résilience communautaire (IRC) émergent dans différents contextes de gouvernance. Les IRC ciblent les communautés vulnérables, qui sont difficiles à atteindre. Les résultats de notre étude identifient quatre voies: (1) les initiatives communautaires informelles ascendantes; (2) les initiatives communautaires formelles issues d'initiatives communautaires pré-existantes; (3) les initiatives d'acteurs externes, souvent des ONG, des universités ou des gouvernements; et (4) les réseaux d'organisations qui, ensemble, entreprennent des actions en réponse à la COVID-19. Ces voies mènent à des initiatives de type, d'échelle et de niveaux de complexité différents. Cependant, elles sont toutes confrontées à des obstacles similaires liés au financement, à la faiblesse des réseaux et à une collaboration limitée. Les IRC perçoivent souvent les agences gouvernementales comme étant peu fiables et peu sources de soutien, ce qui freine également l'émergence du CRI.

Bilirubin and Ischemic Stroke: Rendering the Current Paradigm to Better Understand the Protective Effects of Bilirubin.

Novel and innovative methods are critical in fostering new treatments and improving clinical outcomes in patients who suffer from ischemic stroke. Bilirubin has long been considered metabolic waste that can be harmful to the body; however, it is now becoming recognized as one of the body's most potent antioxidant, anti-inflammatory, and neuroprotective molecules. These properties facilitate bilirubin's anti-atherogenic effects to impede and prevent the formation of thrombi in ischemic stroke. These functions allow for protection from neuronal injury during an ischemic state and suggest that elevated bilirubin levels may be linked to a lower rate of morbidity and mortality. Therefore, here we discuss the pathophysiology of stroke and the molecular properties of bilirubin to better understand their beneficial relationship. We outline clinical studies looking at the relationship between serum bilirubin levels and ischemic stroke prevalence. At this time, few studies have rigorously looked at the relationship between bilirubin and ischemic stroke, whether it is positive or negative. Thus, rigorous research is needed to provide evidence supporting the current studies, expand on these studies, and facilitate their translation to bedside therapy for patients who suffer from ischemic stroke.

The learning evaluation: a theoretical and empirical exploration.

In this article, the authors theoretically and empirically explore the concept of learning evaluation. They shed light on the positioning of the learning evaluation amid scholarly work on evaluations. Moreover, they describe the learning evaluation in practice in the Netherlands by going into a specific project called the Stimulation Program on Citizen and Environment. The theoretical and empirical quest gives insights into the problems with and possibilities of the learning evaluation. They think that their experiences can help the further development of theory about learning evaluation as well as aid in the practice of such evaluations.