An approach leveraging radiomics and model checking for the automatic early diagnosis of adhesive capsulitis.

Adhesive Capsulitis of the shoulder is a painful pathology limiting shoulder movements, commonly known as "Frozen Shoulder". Since this pathology limits movement, it is important to make an early diagnosis. Diagnosing capsulitis relies on clinical assessment, although diagnostic imaging, such as Magnetic Resonance Imaging, can provide predictive or supportive information for specific characteristic signs. However, its diagnosis is not so simple nor so immediate, indeed it remains a difficult topic for many general radiologists and expert musculoskeletal radiologists. This study aims to investigate whether it is possible to use disease signs within a medical image to automatically diagnose Adhesive Capsulitis. To this purpose, we propose an automatic Model Checking-based approach to quickly diagnose the Adhesive Capsulitis taking as input the radiomic feature values from the medical images. Furthermore, we compare the performance achieved by our method with diagnostic results obtained by professional radiologists with different levels of experience. To the best of our knowledge, this is the first method for the automatic diagnosis of Adhesive Capsulitis of the Shoulder.

An individual-based dynamic model to assess interventions to mitigate opioid overdose risk.

BACKGROUND: Illicit opioid overdose continues to rise in North America and is a leading cause of death. Mathematical modeling is a valuable tool to investigate the epidemiology of this public health issue, as it can characterize key features of population outcomes and quantify the broader effect of structural and interventional changes on overdose mortality. The aim of this study is to quantify and predict the impact of key harm reduction strategies at differing levels of scale-up on fatal and nonfatal overdose among a population of people engaging in unregulated opioid use in Toronto. METHODS: An individual-based model for opioid overdose was built featuring demographic and behavioural variation among members of the population. Key individual attributes known to scale the risk of fatal and nonfatal overdose were identified and incorporated into a dynamic modeling framework, wherein every member of the simulated population encompasses a set of distinct characteristics that govern demographics, intervention usage, and overdose incidence. The model was parametrized to fatal and nonfatal overdose events reported in Toronto in 2019. The interventions considered were opioid agonist therapy (OAT), supervised consumption sites (SCS), take-home naloxone (THN), drug-checking, and reducing fentanyl in the drug supply. Harm reduction scenarios were explored relative to a baseline model to examine the impact of each intervention being scaled from 0% use to 100% use on overdose events. RESULTS: Model simulations resulted in 3690.6 nonfatal and 295.4 fatal overdoses, coinciding with 2019 data from Toronto. From this baseline, at full scale-up, 290 deaths were averted by THN, 248 from eliminating fentanyl from the drug supply, 124 from SCS use, 173 from OAT, and 100 by drug-checking services. Drug-checking and reducing fentanyl in the drug supply were the only harm reduction strategies that reduced the number of nonfatal overdoses. CONCLUSIONS: Within a multi-faceted harm reduction approach, scaling up take-home naloxone, and reducing fentanyl in the drug supply led to the largest reduction in opioid overdose fatality in Toronto. Detailed model simulation studies provide an additional tool to assess and inform public health policy on harm reduction.

Preventing overdoses involving stimulants: the POINTS study protocol.

BACKGROUND: In recent years, overdoses involving illicit cocaine, methamphetamine, and other stimulants have increased in the U.S. The unintentional consumption of stimulants containing illicit fentanyl is a major risk factor for overdoses, particularly in Massachusetts and Rhode Island. Understanding the drug use patterns and strategies used by people who use stimulants (PWUS) to prevent overdose is necessary to identify risk and protective factors for stimulant and opioid-involved overdoses. Mixed-methods research with people who distribute drugs (PWDD) can also provide critical information into the mechanisms through which fentanyl may enter the stimulant supply, and the testing of drug samples can further triangulate PWUS and PWDD perspectives regarding the potency and adulteration of the drug supply. These epidemiological methods can inform collaborative intervention development efforts with community leaders to identify feasible, acceptable, and scalable strategies to prevent fatal and non-fatal overdoses in high-risk communities. METHODS: Our overall objective is to reduce stimulant and opioid-involved overdoses in regions disproportionately affected by the overdose epidemic. To meet this long-term objective, we employ a multi-pronged approach to identify risk and protective factors for unintentional stimulant and opioid-involved overdoses among PWUS and use these findings to develop a package of locally tailored intervention strategies that can be swiftly implemented to prevent overdoses. Specifically, this study aims to [1] Carry out mixed-methods research with incarcerated and non-incarcerated people who use or distribute illicit stimulants to identify risk and protective factors for stimulant and opioid-involved overdoses; [2] Conduct drug checking to examine the presence and relative quantity of fentanyl and other adulterants in the stimulant supply; and [3] Convene a series of working groups with community stakeholders involved in primary and secondary overdose prevention in Massachusetts and Rhode Island to contextualize our mixed-methods findings and identify multilevel intervention strategies to prevent stimulant-involved overdoses. DISCUSSION: Completion of this study will yield a rich understanding of the social epidemiology of stimulant and opioid-involved overdoses in addition to community-derived intervention strategies that can be readily implemented and scaled to prevent such overdoses in two states disproportionately impacted by the opioid and overdose crises: Massachusetts and Rhode Island.

"The compounds for females are really commonly faked!": Women's challenges in anabolic steroid acquisition and the place of drug checking interventions.

INTRODUCTION: Women who use drugs, particularly those using anabolic-androgenic steroids (AAS), encounter heightened social risks influenced by the legal status of AAS, varying regionally. In jurisdictions where AAS are legal, medical guidance and prescription are common, while in illegal regions, there are challenges associated with acquisition and safer usage. Therefore, we aimed to explore the experiences of women who use AAS in Australia, where these substances are criminalised, with a focus on the challenges they encounter in acquiring and using these drugs. METHODS: We focused on data from six women in a broader study interviewing 15 AAS users. The data were subjected to iterative inductive analysis, resulting in two theme-categories. RESULTS: Women who use AAS face distinct challenges in accessing reliable suppliers, with men seemingly having 'easier' access. Women experience this disparity as increasing their vulnerability to unsafe products, further compounded by their lack of knowledge regarding these substances. Moreover, mislabelling and counterfeiting of female-specific AAS substances is described to further compound these risks, reflecting the participants' expressed need for enhanced intervention and quality control in the AAS market. DISCUSSION AND CONCLUSIONS: Ensuring product reliability, transparency and accountability are perceived as essential for the health and safety of women who use AAS. To address these issues, interventions should provide women with comprehensive drug checking services tailored to their health needs. 'Steroid literacy' must be an integral component, equipping women with knowledge to make informed decisions in the gendered AAS market.

The role of on-site drug analysis within supervised injecting facilities: A case presentation of an adverse event highlighting need.

INTRODUCTION: The Sydney Medically Supervised Injecting Centre provides a safe, non-judgemental space where people can inject pre-obtained substances under the supervision of trained staff. This article describes an unusual incident occurring at the Medically Supervised Injecting Centre in January 2023. CASE PRESENTATION: Two regular male clients attending the Medically Supervised Injecting Centre injected a substance they believed to be cocaine. Both clients experienced adverse reactions; one was transported to hospital, while the other became extremely distressed and agitated. Paraphernalia sent for testing returned a result of tiletamine (a dissociative used in veterinary medicine) and no cocaine, 30 h after the incident. DISCUSSION AND CONCLUSIONS: Where substances are novel or unknown, adverse events are often unexpected and may be more difficult to prepare for. Substance-induced acute agitation can be alarming and hazardous for people consuming drugs and those around them and may pose challenges for staff. There is a substantial evidence base for the benefits of on-site drug analysis and drug checking in reducing harms related to drug use, and in enhancing drug market monitoring. This incident was successfully managed by Medically Supervised Injecting Centre and hospital staff, with no major consequence, however clinical management could have been improved using point of care drug testing.

Community notes increase trust in fact-checking on social media.

Community-based fact-checking is a promising approach to fact-check social media content at scale. However, an understanding of whether users trust community fact-checks is missing. Here, we presented n = 1,810 Americans with 36 misleading and nonmisleading social media posts and assessed their trust in different types of fact-checking interventions. Participants were randomly assigned to treatments where misleading content was either accompanied by simple (i.e. context-free) misinformation flags in different formats (expert flags or community flags), or by textual "community notes" explaining why the fact-checked post was misleading. Across both sides of the political spectrum, community notes were perceived as significantly more trustworthy than simple misinformation flags. Our results further suggest that the higher trustworthiness primarily stemmed from the context provided in community notes (i.e. fact-checking explanations) rather than generally higher trust towards community fact-checkers. Community notes also improved the identification of misleading posts. In sum, our work implies that context matters in fact-checking and that community notes might be an effective approach to mitigate trust issues with simple misinformation flags.

Barriers to, and Facilitators of, Checking Drugs for Adulterants in the Era of Fentanyl and Xylazine: Qualitative Study.

BACKGROUND: Overdose deaths continue to reach new records in New York City and nationwide, largely driven by adulterants such as fentanyl and xylazine in the illicit drug supply. Unknowingly consuming adulterated substances dramatically increases risks of overdose and other health problems, especially when individuals consume multiple adulterants and are exposed to a combination of drugs they did not intend to take. Although test strips and more sophisticated devices enable people to check drugs for adulterants including fentanyl and xylazine prior to consumption and are often available free of charge, many people who use drugs decline to use them. OBJECTIVE: We sought to better understand why people in the New York City area do or do not check drugs before use. We plan to use study findings to inform the development of technology-based interventions to encourage consistent drug checking. METHODS: In summer 2023, team members who have experience working with people who use drugs conducted 22 semistructured qualitative interviews with a convenience sample of people who reported illicit drug use within the past 90 days. An interview guide examined participants' knowledge of and experience with adulterants including fentanyl, xylazine, and benzodiazepines; using drug testing strips; and whether they had ever received harm reduction services. All interviews were audio recorded, transcribed, and analyzed for emerging themes. RESULTS: Most participants lacked knowledge of adulterants, and only a few reported regularly checking drugs. Reasons for not checking included lacking convenient access to test supplies, or a place to check samples out of the public's view, as well as time considerations. Some participants also reported a strong belief that they were not at risk from fentanyl, xylazine, or other adulterants because they exclusively used cocaine or crack, or that they were confident the people they bought drugs from would not sell them adulterated substances. Those who did report testing their drugs described positive interactions with harm reduction agency staff. CONCLUSIONS: New forms of outreach are needed not only to increase people's knowledge of adulterated substances and awareness of the increasing risks they pose but also to encourage people who use drugs to regularly check their substances prior to use. This includes new intervention messages that highlight the importance of drug checking in the context of a rapidly changing and volatile drug supply. This messaging can potentially help normalize drug checking as an easily enacted behavior that benefits public health. To increase effectiveness, messages can be developed with, and outreach can be conducted by, trusted community members including people who use drugs and, potentially, people who sell drugs. Pairing this messaging with access to no-cost drug-checking supplies and equipment may help address the ongoing spiral of increased overdose deaths nationwide.

Does responsibility for potential harm attenuate the effects of repeated checking on metamemory and automatization?

BACKGROUND AND OBJECTIVES: Repeated checking results in large reductions in metamemory variables (confidence, details, and vividness). It has been suggested that the underlying mechanism is gradual automatization. At the same time, individuals with obsessive-compulsive disorder (OCD) are reluctant to automatize routine processes. The aim was to investigate whether high responsibility for potential harm, typical of OCD, would attenuate the effects of repeated checking on metamemory variables and automatization. METHODS: One hundred seventy-five participants were initially provided with a cover story that put the subsequent virtual checking task in a context of potential harm for not checking properly. Participants were randomly allocated to four experimental groups (varying high and low responsibility, relevant and irrelevant checking) and performed a virtual checking task repeatedly, using either identical stimuli (relevant checking) or different stimuli (irrelevant checking) between the first and final checking trial. Metamemory variables were rated on visual analogue scales, and response latencies were assessed to establish automatization. RESULTS: Larger reductions in metamemory variables following relevant checking compared to irrelevant checking replicated previous findings. High responsibility did not affect these results. Large reductions in response latencies across the checking trials (automatization) were also independent of the perceived responsibility. LIMITATIONS: We did not include individuals with OCD. CONCLUSIONS: Since responsibility did not influence the effects of repeated checking on metamemory variables, findings are consistent with the idea that automatization remains a plausible explanation of the effects of repeated checking on metamemory variables in individuals with OCD.

Symbolic model checking quantum circuits in Maude.

This article presents a symbolic approach to model checking quantum circuits using a set of laws from quantum mechanics and basic matrix operations with Dirac notation. We use Maude, a high-level specification/programming language based on rewriting logic, to implement our symbolic approach. As case studies, we use the approach to formally specify several quantum communication protocols in the early work of quantum communication and formally verify their correctness: Superdense Coding, Quantum Teleportation, Quantum Secret Sharing, Entanglement Swapping, Quantum Gate Teleportation, Two Mirror-image Teleportation, and Quantum Network Coding. We demonstrate that our approach/implementation can be a first step toward a general framework to formally specify and verify quantum circuits in Maude. The proposed way to formally specify a quantum circuit makes it possible to describe the quantum circuit in Maude such that the formal specification can be regarded as a series of quantum gate/measurement applications. Once a quantum circuit has been formally specified in the proposed way together with an initial state and a desired property expressed in linear temporal logic (LTL), the proposed model checking technique utilizes a built-in Maude LTL model checker to automatically conduct formal verification that the quantum circuit enjoys the property starting from the initial state.

Aversatile MOF as an electrochemical/fluorescence/colorimetric signal probe for the tri-modal detection of MMP-9 secretion in the extracellular matrix to identify the efficacy of chemotherapeutic drugs.

BACKGROUND: MMP-9 plays a crucial role in regulating the degradation of proteins within the extracellular matrix (ECM). This process closely correlates with the occurrence, development, invasion, and metastasis of various tumors, each exhibiting diverse levels of MMP-9 expression. However, the accuracy of detection results using the single-mode method is compromised due to the coexistence of multiple biologically active substances in the ECM. RESULTS: Therefore, in this study, a tri-modal detection system is proposed to obtain more accurate information by cross-verifying the results. Herein, we developed a tri-modal assay using the ZIF-8@Au NPs@S QDs composite as a multifunctional signal probe, decorated with DNA for the specific capture of MMP9. Notably, the probe demonstrated high conductivity, fluorescence response and mimicked enzyme catalytic activity. The capture segments of hybrid DNA specifically bind to MMP9 in the presence of MMP9, causing the signal probe to effortlessly detach the sensor interface onto the sample solution. Consequently, the sensor current performance is weakened, with the colorimetric and fluorescent signals becoming stronger with increasing MMP9 concentration. Notably, the detection range of the tri-modal sensor platform spans over 10 orders of magnitude, verifying notable observations of MMP-9 secretion in four tumor cell lines with chemotherapeutic drugs. Furthermore, the reliability of the detection results can be enhanced by employing pairwise comparative analysis. SIGNIFICANCE: This paper presents an effective strategy for detecting MMP9, which can be utilized for both the assessment of MMP-9 in cell lines and for analyzing the activity and mechanisms involved in various tumors.

Body checking and avoidance among dancers.

Dancers are at heightened risk for eating disorders (EDs) and have job and training demands that obscure ED assessment and likely impede treatment. Two behavioral manifestations of ED psychopathology that may present uniquely in a dance environment are body checking and body avoidance. The current study sought to provide a foundational understanding of the phenomenology of body checking and avoidance among dancers by assessing the reliability (i.e., internal consistency) of existing body checking and avoidance measures and the relationships, or convergent validity, between measures of body checking and avoidance and measures of related constructs. Eighty professional and pre-professional (i.e., conservatory level) dancers (78.8 % female) from seven dance genres completed self-report measures of body checking and avoidance, ED pathology, clinical perfectionism, depression, and anxiety. Across the dancer sample, body checking and avoidance measures demonstrated adequate internal consistency. More frequent body checking and body avoidance was strongly related to higher levels of ED pathology. There were moderate to strong correlations between body checking and body avoidance and clinical perfectionism, depression, and anxiety such that higher body checking and body avoidance was related to higher clinical perfectionism, depression, and anxiety. Exploratory analyses found no significant differences between ballet dancers and dancers of other dance genres; professional dancers scored in the normative range on measures of body checking and body avoidance. Dancers' qualitative descriptions of body checking and avoidance revealed behaviors not included in existing questionnaires, such as unique mirror use behaviors, technology-assisted body checking, and the checking and avoidance of body parts relevant to the dance-specific body ideal. Results support the inclusion of body checking and avoidance interventions in ED treatments for dancers (particularly pre-professional dancers) and emphasize the need for dancer-specific ED assessment methods.

Protocols versus practice: unravelling clinical checking variations in community pharmacies in England-a multi-method study.

BACKGROUND: Standardisation, a widely accepted concept for risk management, entails designing and implementing task-specific operating procedures. In community pharmacies, Standardised Operating Procedures (SOPs) are a mandatory requirement and are recognised as essential for upholding safety and quality. AIM: This study aimed to investigate community pharmacists' (CPs) compliance with SOPs when checking prescriptions, and the reasons for variations between standardised protocols and practice. METHOD: Eight sets of SOPs underwent hierarchical task analysis (HTA) to generate a normative description of clinical checking execution as per protocols. Subsequently, twelve CPs were engaged in a simulated clinical checking exercise, verbalising their thoughts while checking virtual prescriptions. Transcribed data underwent content analysis, aligned with a descriptive model to uncover engagement patterns, and disparities between SOPs and CPs' practices. Finally, a focus group discussion took place to contextualise the observed variations. RESULTS: HTA aided in constructing a clinical checking model with six primary subtasks and 28 lower subtasks. CPs often omitted subtasks during checks, diverging from prescribed protocols. These deviations, observed in controlled environment, reveal an ingrained aspect within the professional culture of pharmacists, where there may be a tendency not to strictly adhere to protocols, despite variations in work conditions. Contributing factors to this culture include the exercise of professional judgment, reliance on others, and prioritisation of patient preferences. CONCLUSION: This study highlights ongoing deviations from SOPs during clinical prescription checks in community pharmacies, suggesting a cultural tendency. Future research should delve into risk management strategies for these deviations and address the delicate balance between flexibility and stringent compliance.

How do we understand the value of drug checking as a component of harm reduction services? A qualitative exploration of client and provider perspectives.

BACKGROUND: Mortality related to opioid overdose in the U.S. has risen sharply in the past decade. In California, opioid overdose death rates more than tripled from 2018 to 2021, and deaths from synthetic opioids such as fentanyl increased more than seven times in those three years alone. Heightened attention to this crisis has attracted funding and programming opportunities for prevention and harm reduction interventions. Drug checking services offer people who use drugs the opportunity to test the chemical content of their own supply, but are not widely used in North America. We report on qualitative data from providers and clients of harm reduction and drug checking services, to explore how these services are used, experienced, and considered. METHODS: We conducted in-depth semi-structured key informant interviews across two samples of drug checking stakeholders: "clients" (individuals who use drugs and receive harm reduction services) and "providers" (subject matter experts and those providing clinical and harm reduction services to people who use drugs). Provider interviews were conducted via Zoom from June-November, 2022. Client interviews were conducted in person in San Francisco over a one-week period in November 2022. Data were analyzed following the tenets of thematic analysis. RESULTS: We found that the value of drug checking includes but extends well beyond overdose prevention. Participants discussed ways that drug checking can fill a regulatory vacuum, serve as a tool of informal market regulation at the community level, and empower public health surveillance systems and clinical response. We present our findings within three key themes: (1) the role of drug checking in overdose prevention; (2) benefits to the overall agency, health, and wellbeing of people who use drugs; and (3) impacts of drug checking services at the community and systems levels. CONCLUSION: This study contributes to growing evidence of the effectiveness of drug checking services in mitigating risks associated with substance use, including overdose, through enabling people who use and sell drugs to test their own supply. It further contributes to discussions around the utility of drug checking and harm reduction, in order to inform legislation and funding allocation.

Implementation opportunities and challenges to piloting a community-based drug-checking intervention for sexual and gender minority men in Vancouver, Canada: a qualitative study.

BACKGROUND: In response to the overdose crisis, a collaborative group of two community-based organizations, a health authority and a research institute in Vancouver, Canada, implemented a pilot community-based drug checking (CBDC) intervention for sexual and gender minority (SGM) men. This study identified key factors that influenced the implementation of the CBDC intervention, including opportunities and challenges. METHODS: We conducted semi-structured interviews with seven pertinent parties involved in the CBDC, including policymakers, researchers and representatives from community-based organizations. These interviews were coded and analyzed using domains and constructs of the Consolidated Framework for Implementation Research. RESULTS: While drug-related stigma was identified as a challenge to deliver drug checking services, participants described the context of the overdose crisis as a key facilitator to engage collaboration between relevant organizations (e.g., health authorities, medical health officers, community organizations) to design, resource and implement the CBDC intervention. The implementation of the CBDC intervention was also influenced by SGM-specific needs and resources (e.g., lack of information about the drug supply). The high level of interest of SGM organizations in providing harm reduction services combined with the need to expand drug checking into community spaces represented two key opportunities for the CBDC intervention. Here, SGM organizations were recognized as valued partners that fostered a broader culture of harm reduction. Participants' emphasis that knowing the composition of one's drugs is a "right to know", particularly in the context of a highly contaminated illicit drug market, emerged as a key implementation factor. Lastly, participants emphasized the importance of involving SGM community groups at all stages of the implementation process to ensure that the CBDC intervention is appropriately tailored to SGM men. CONCLUSIONS: The context of the overdose crisis and the involvement of SGM organizations were key facilitators to the implementation of a drug checking intervention in SGM community spaces. This study offers contextualized understandings about how SGM knowledge and experiences can contribute to implement tailored drug checking interventions.

Preventing Overdoses Involving Stimulants: The POINTS Study Protocol.

Background: In recent years, overdoses involving illicit cocaine, methamphetamine, and other stimulants have increased in the U.S. The unintentional consumption of stimulants containing illicit fentanyl is a major risk factor for overdoses, particularly in Massachusetts and Rhode Island. Understanding the drug use patterns and strategies used by people who use stimulants (PWUS) to prevent overdose is necessary to identify risk and protective factors for stimulant-involved overdoses. Mixed-methods research with people who distribute drugs (PWDD) can also provide critical information into the mechanisms through which fentanyl may enter the stimulant supply, and the testing of drug samples can further triangulate PWUS and PWDD perspectives regarding the potency and adulteration of the drug supply. These epidemiological methods can inform collaborative intervention development efforts with community leaders to identify feasible, acceptable, and scalable strategies to prevent fatal and non-fatal overdoses in high-risk communities. Methods: Our overall objective is to reduce stimulant and opioid-involved overdoses in regions disproportionately affected by the overdose epidemic. To meet this long-term objective, we employ a multi-pronged approach to identify risk and protective factors for unintentional stimulant and opioid-involved overdoses among PWUS, and use these findings to develop a package of locally tailored intervention strategies that can be swiftly implemented to prevent overdoses. Specifically, this study aims to [1] Carry out mixed-methods research with incarcerated and non-incarcerated people who use or distribute illicit stimulants to identify risk and protective factors for stimulant and opioid-involved overdoses; [2] Conduct drug checking to examine the presence and relative quantity of fentanyl and other adulterants in the stimulant supply; and [3] Convene a series of working groups with community stakeholders involved in primary and secondary overdose prevention in Massachusetts and Rhode Island to contextualize our mixed-methods findings and identify multilevel intervention strategies to prevent stimulant-involved overdoses. Discussion: Completion of this study will yield a rich understanding of the social epidemiology of stimulant and opioid-involved overdoses in addition to community-derived intervention strategies that can be readily implemented and scaled to prevent such overdoses in two states disproportionately impacted by the opioid and overdose crises: Massachusetts and Rhode Island.

In pursuit of credibility: Evaluating the divergence between member-checking and hermeneutic phenomenology.

Credibility refers to the trustworthiness, genuineness, and plausibility of the research findings and has always been a contentious issue in qualitative research, particularly for those conducting studies on the hermeneutic phenomenology paradigm. The relationship between credibility and high qualitative research is noted by many qualitative scholars. Member checking, also known as participant or respondent validation, is a technique for exploring the credibility of results where data or results are returned to participants to check for accuracy and resonance with their experiences. Although member-checking has long been accepted as the gold standard in quantitative research, research shows that it is not the pinnacle for expressing rigor in Heideggerian hermeneutic phenomenology because it contradicts many of the underpinning philosophies. Within this article the author explores how member checking has been used in published research and presents a brief overview of the various discourses on member checking in qualitative research. The author discusses the importance of evaluating whether the method fits with the theoretical position of a study and the importance to consider how member checking was undertaken and for what purpose. It is essential that researchers are transparent about what they hope to achieve with the method and how their claims about credibility and validity fit with their epistemological stance.

Broad evidence of xylazine in the UK illicit drug market beyond heroin supplies: Triangulating from toxicology, drug-testing and law enforcement.

BACKGROUND AND AIMS: Xylazine is a non-opioid sedative which has spread rapidly throughout the US illicit drug supply. This study aimed to describe the spread of xylazine throughout the UK illicit drug supply. METHODS: Xylazine detections in human biological samples were collated from toxicology laboratories operating in the United Kingdom with the date, location, case type, xylazine concentration and co-detected drugs (with quantifications where performed) detailed, where permitted, by the corresponding coroner. Drug-testing cases positive for xylazine were collated from the Welsh Emerging Drugs and Identification of Novel Substances (WEDINOS) drug-testing postal service with the date, location, purchase intent and co-detected drugs detailed. Drug seizures made by UK law enforcement were communicated by the Office for Health Improvement and Disparities with the date and location detailed. RESULTS: By the end of August 2023, xylazine was detected in 35 cases from throughout toxicology, drug-testing and drug seizure sources covering England, Scotland and Wales. There were no cases reported from Northern Ireland. Xylazine was detected in biological samples from 16 people. In most cases where full toxicology results were provided, xylazine was detected with heroin and/or a strong opioid (n = nine of 11), but this polydrug use pattern was not evident in all cases (n = two of 11), suggesting a wider circulation of xylazine in the UK illicit drug market beyond heroin supplies. Evidence from WEDINOS supports this claim, as all 14 drug samples (100%) submitted from across the UK contained xylazine; however, in none of these cases was heroin the purchase intent but rather counterfeit prescription medication tablets (n = 11 of 14), tetrahydrocannabinol (THC) vapes (n = two of 14) or white powder (n = one of 14). Additional evidence for the spread of illicit xylazine comes from five drug seizures made by law enforcement. CONCLUSIONS: Xylazine has penetrated the UK illicit drug market and is not limited to heroin supplies.

The Accuracy of Pulse Oxygen Saturation, Heart Rate, Blood Pressure, and Respiratory Rate Raised by a Contactless Telehealth Portal: Validation Study.

BACKGROUND: The traditional measurement of heart rate (HR), oxygen saturation (SpO2), blood pressure (BP), and respiratory rate (RR) via physical examination can be challenging, and the recent pandemic has accelerated trends toward telehealth and remote monitoring. Instead of going to the physician to check these vital signs, measuring them at home would be more convenient. Vital sign monitors, also known as physiological parameter monitors, are electronic devices that measure and display biological information about patients under constant monitoring. OBJECTIVE: The purpose of this study was to validate the accuracy of the pulse SpO2, HR, BP, and RR raised by Docsun Telehealth Portal by comparing it with approved medical devices. METHODS: This is a noninvasive, self-check, system-based study conducted to validate the detection of vital signs (SpO2, HR, BP, and RR) raised by Docsun Telehealth Portal. The input for software processing involves facial screening without any accessories on the face, scanning directly through the software application portal. The participant's facial features are detected and screened for the extraction of necessary readings. RESULTS: For the validation of HR, SpO2, BP, and RR measurements, the main outcomes were the mean of the absolute difference between the respective investigational devices and the reference values as well as the absolute percentage difference between the respective investigational devices and the reference values. If the HR was within ±10% of the reference standard or 5 beats per minute, it was considered acceptable for clinical purposes. The average absolute difference between the Docsun Telehealth Portal and the reference values was 1.41 (SD 1.14) beats per minute. The mean absolute percentage difference was 1.69% (SD 1.37). Therefore, the Docsun Telehealth Portal met the predefined accuracy cutoff for HR measurements. If the RR was within ±10% of the reference standard or 3 breaths per minute, it was considered acceptable for clinical purposes. The average absolute difference between the Docsun Telehealth Portal and the reference values was 0.86 breaths per minute. The mean absolute percentage difference was 4.72%. Therefore, the Docsun Telehealth Portal met the predefined accuracy cutoff for RR measurements. SpO2 levels were considered acceptable if the average absolute difference between the Docsun Telehealth Portal and the reference values was ±3%. The mean absolute percentage difference was 0.59%. Therefore, the Docsun Telehealth Portal met the predefined accuracy cutoff for SpO2 measurements. The Docsun Telehealth Portal predicted systolic BP with an accuracy of 94.81% and diastolic BP with an accuracy of 95.71%. CONCLUSIONS: The results of the study show that the accuracy of the HR, BP, SpO2, and RR values raised by the Docsun Telehealth Portal, compared against the clinically approved medical devices, proved to be accurate by meeting predefined accuracy guidelines.

Containing misinformation: Modeling spatial games of fake news.

The spread of fake news on social media is a pressing issue. Here, we develop a mathematical model on social networks in which news sharing is modeled as a coordination game. We use this model to study the effect of adding designated individuals who sanction fake news sharers (representing, for example, correction of false claims or public shaming of those who share such claims). By simulating our model on synthetic square lattices and small-world networks, we demonstrate that social network structure allows fake news spreaders to form echo chambers and more than doubles fake news' resistance to distributed sanctioning efforts. We confirm our results are robust to a wide range of coordination and sanctioning payoff parameters as well as initial conditions. Using a Twitter network dataset, we show that sanctioners can help contain fake news when placed strategically. Furthermore, we analytically determine the conditions required for peer sanctioning to be effective, including prevalence and enforcement levels. Our findings have implications for developing mitigation strategies to control misinformation and preserve the integrity of public discourse.