Healthcare workers' experiences protecting themselves and their families during the COVID-19 pandemic in 2020-2021.

We characterized experiences and strategies used by frontline healthcare workers to prevent severe-acute-respiratory-syndrome-related coronavirus transmission at work and to household members during the coronavirus disease pandemic. Alongside an online questionnaire (n = 234), remote semi-structured interviews (n = 23: 15 clinicians, 8 non-clinicians) were conducted in 2021. Mitigation challenges and facilitators were identified from data to represent experiences as a process considering the before, during, and after work shifts. Journey mapping was utilized to visually describe how healthcare workers experienced the stages of the work environment, leaving work, commuting home, and the home environment, and strategies implemented to stay safe. Major facilitators included the uptake of coronavirus disease vaccines and testing, information regarding virus transmission, and adequate personal protective equipment. The most critical challenges identified included a lack of designated areas for end-of-day disinfection, changing rooms, showers, and lockers in the leaving work stage. Psychosocial and environmental factors must be considered in future hospital pandemic preparations.

Impact of Irpex lenis and Schizophyllum commune endophytic fungi on Perilla frutescens: enhancing nutritional uptake, phytochemicals, and antioxidant potential.

BACKGROUND: Endophytic fungi (EF) reside within plants without causing harm and provide benefits such as enhancing nutrients and producing bioactive compounds, which improve the medicinal properties of host plants. Selecting plants with established medicinal properties for studying EF is important, as it allows a deeper understanding of their influence. Therefore, the study aimed to investigate the impact of EF after inoculating the medicinal plant Perilla frutescens, specifically focusing on their role in enhancing medicinal properties. RESULTS: In the current study, the impact of two EF i.e., Irpex lenis and Schizophyllum commune isolated from A. bracteosa was observed on plant Perilla frutescens leaves after inoculation. Plants were divided into four groups i.e., group A: the control group, group B: inoculated with I. lenis; group C: inoculated with S. commune and group D: inoculated with both the EF. Inoculation impact of I. lenis showed an increase in the concentration of chlorophyll a (5.32 mg/g), chlorophyll b (4.46 mg/g), total chlorophyll content (9.78 mg/g), protein (68.517 ± 0.77 mg/g), carbohydrates (137.886 ± 13.71 mg/g), and crude fiber (3.333 ± 0.37%). Furthermore, the plants inoculated with I. lenis showed the highest concentrations of P (14605 mg/kg), Mg (4964.320 mg/kg), Ca (27389.400 mg/kg), and Mn (86.883 mg/kg). The results of the phytochemical analysis also indicated an increased content of total flavonoids (2.347 mg/g), phenols (3.086 mg/g), tannins (3.902 mg/g), and alkaloids (1.037 mg/g) in the leaf extract of P. frutescens inoculated with I. lenis. Thus, overall the best results of inoculation were observed in Group B i.e. inoculated with I. lenis. GC-MS analysis of methanol leaf extract showed ten bioactive constituents, including 9-Octadecenoic acid (Z)-, methyl ester, and hexadecanoic acid, methyl ester as major constituents found in all the groups of P. frutescens leaves. The phenol (gallic acid) and flavonoids (rutin, kaempferol, and quercetin) were also observed to increase after inoculation by HPTLC analysis. The enhancement in the phytochemical content was co-related with improved anti-oxidant potential which was analyzed by DPPH (% Inhibition: 83.45 µg/ml) and FRAP (2.980 µM Fe (II) equivalent) assay as compared with the control group. CONCLUSION: Inoculation with I. lenis significantly enhances the uptake of nutritional constituents, phytochemicals, and antioxidant properties in P. frutescens, suggesting its potential to boost the therapeutic properties of host plants.

Revolutionizing SIEM Security: An Innovative Correlation Engine Design for Multi-Layered Attack Detection.

Advances in connectivity, communication, computation, and algorithms are driving a revolution that will bring economic and social benefits through smart technologies of the Industry 4.0 era. At the same time, attackers are targeting this expanded cyberspace to exploit it. Therefore, many cyberattacks are reported each year at an increasing rate. Traditional security devices such as firewalls, intrusion detection systems (IDSs), intrusion prevention systems (IPSs), anti-viruses, and the like, often cannot detect sophisticated cyberattacks. The security information and event management (SIEM) system has proven to be a very effective security tool for detecting and mitigating such cyberattacks. A SIEM system provides a holistic view of the security status of a corporate network by analyzing log data from various network devices. The correlation engine is the most important module of the SIEM system. In this study, we propose the optimized correlator (OC), a novel correlation engine that replaces the traditional regex matching sub-module with a novel high-performance multiple regex matching library called "Hyperscan" for parallel log data scanning to improve the performance of the SIEM system. Log files of 102 MB, 256 MB, 512 MB, and 1024 MB, generated from log data received from various devices in the network, are input into the OC and simple event correlator (SEC) for applying correlation rules. The results indicate that OC is 21 times faster than SEC in real-time response and 2.5 times more efficient in execution time. Furthermore, OC can detect multi-layered attacks successfully.

Modelling take-off moment arms in an ornithocheiraean pterosaur.

Take-off is a vital part of powered flight which likely constrains the size of birds, yet extinct pterosaurs are known to have reached far larger sizes. Three different hypothesised take-off motions (bipedal burst launching, bipedal countermotion launching, and quadrupedal launching) have been proposed as explanations for how pterosaurs became airborne and circumvented this proposed morphological limit. We have constructed a computational musculoskeletal model of a 5 m wingspan ornithocheiraean pterosaur, reconstructing thirty-four key muscles to estimate the muscle moment arms throughout the three hypothesised take-off motions. Range of motion constrained hypothetical kinematic sequences for bipedal and quadrupedal take-off motions were modelled after extant flying vertebrates. Across our simulations we did not find higher hindlimb moment arms for bipedal take-off motions or noticeably higher forelimb moment arms in the forelimb for quadrupedal take-off motions. Despite this, in all our models we found the muscles utilised in the quadrupedal take-off have the largest total launch applicable moment arms throughout the entire take-off sequences and for the take-off pose. This indicates the potential availability of higher leverage for a quadrupedal take-off than hypothesised bipedal motions in pterosaurs pending further examination of muscle forces.

Methadone Take-Home Policies and Associated Mortality: Permitting versus Non-Permitting States.

To mitigate COVID-19 exposure risks in methadone clinics, the Substance Abuse and Mental Health Services Administration (SAMHSA) issued a temporary modification of regulations in March 2020 to permit, with state concurrence, extended take-home methadone doses. The modification allowed for up to 28 days of take-home methadone for stable patients and 14 days for those less stable. Using both interrupted time series and difference-in-differences methods, this study examined the association between the policy change and fatal methadone overdoses, comparing states that permitted the expansion of take-home doses with states that did not. The findings suggest the pandemic emergency take-home policy did not increase methadone-involved mortality.

In-person learning during the pandemic: Student take-up and school-level effects of remote and hybrid instruction on student outcomes.

While studies have examined the effects of schools offering in-person learning during the pandemic, this study provides analysis of student enrollment decisions (remote versus in-person) in response to schools providing in-person learning opportunities. In Connecticut during the 2020-21 school year, we find that student take-up of in-person learning opportunities was low with students on average enrolled in-person for only half of the days offered, and take-up was even lower in schools with larger shares of disadvantaged students. The provision of in-person learning opportunities has been previously shown to mitigate pandemic learning losses. By exploiting data on actual enrollment, we show that the protective benefits of in-person learning are twice as large as previously estimated once we account for the low rates of student take-up. Finally, we provide evidence suggesting that a key mechanism behind the benefits of in-person learning is alleviating the burden faced by schools and teachers in delivering remote education. First, we show that the benefits to individual students of their in-person learning are substantially smaller than the overall benefits a student receives from their school average level of in-person enrollment. Second, we show that a combination of remote and in-person learning (hybrid) with a full-time on-line presence of students when at home was worse than hybrid learning with students never or only partially online. This second finding is consistent with qualitative evidence showing that teachers found hybrid learning especially challenging when having to manage both in-person and remote students for the entire class period.

Dual-loop control and state prediction analysis of QUAV trajectory tracking based on biological swarm intelligent optimization algorithm.

Quadrotor unmanned aerial vehicles (QUAVs) have attracted significant research focus due to their outstanding Vertical Take-Off and Landing (VTOL) capabilities. This research addresses the challenge of maintaining precise trajectory tracking in QUAV systems when faced with external disturbances by introducing a robust, two-tier control system based on sliding mode technology. For position control, this approach utilizes a virtual sliding mode control signal to enhance tracking precision and includes adaptive mechanisms to adjust for changes in mass and external disruptions. In controlling the attitude subsystem, the method employs a sliding mode control framework that secures system stability and compliance with intermediate commands, eliminating the reliance on precise models of the inertia matrix. Furthermore, this study incorporates a deep learning approach that combines Particle Swarm Optimization (PSO) with the Long Short-Term Memory (LSTM) network to foresee and mitigate trajectory tracking errors, thereby significantly enhancing the reliability and safety of mission operations. The robustness and effectiveness of this innovative control strategy are validated through comprehensive numerical simulations.

Graft take outcomes of burn patients transplanted with CEA derived from a modified composite culture technique: A case series.

Low-cost and efficient culture environments comparable to standard techniques would undoubtedly improve burn outcomes in under-resourced settings. The aim of this case series was to report on the CEA graft-take using a modified composite culture technique. CEA transplants, following emergency ethical approval, occurred for burn patients (n=25) with low survival prognosis and/or exhausted donor sites. Keratinocytes were retrieved from skin biopsies, seeded centrally on routinely-used dressing gauze and incubated at 37 °C in pediatric incubators. Fresh autogenous plasma was applied daily and hydrogel every third or fourth day. After confluence, the CEA was transplanted onto debrided wound beds. Xenografts were used for temporary cover during the culture period. Final graft take assessment (21 days) was assessed and calculated as a graft take percentage for total CEA area transplanted. Central indices were described as mean (95% CI) and frequency (%) for age, total body surface area, abbreviated burn severity index scores, survival prognosis and graft take. Eleven patients survived with a mean age of 36.1 years (95% CI 25.8-46.4), 45.0 %TBSA burns (95% CI 35.1-54.9), 9.7 ABSI scores (95% CI 8.6-10.8) and 79.5% graft take (95% CI 62.9-96.0). Reduced graft take (61.2%) was observed in patients with perineum burns and increased graft take (97%) in uncomplicated burns. The average CEA graft take was 79.5% using a low-cost culture technique and comparable to the largest case series in literature. The survival of the major burn cases was highly favourable considering injury severity, expected outcomes without CEA and the observed challenges.

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.

CRY1 is involved in the take-off behaviour of migratory Cnaphalocrocis medinalis individuals.

BACKGROUND: Numerous insect species undertake long-distance migrations on an enormous scale, with great implications for ecosystems. Given that take-off is the point where it all starts, whether and how the external light and internal circadian rhythm are involved in regulating the take-off behaviour remains largely unknown. Herein, we explore this issue in a migratory pest, Cnaphalocrocis medinalis, via behavioural observations and RNAi experiments. RESULTS: The results showed that C. medinalis moths took off under conditions where the light intensity gradually weakened to 0.1 lx during the afternoon or evening, and the take-off proportions under full spectrum or blue light were significantly higher than that under red and green light. The ultraviolet-A/blue light-sensitive type 1 cryptochrome gene (Cmedcry1) was significantly higher in take-off moths than that of non-take-off moths. In contrast, the expression of the light-insensitive CRY2 (Cmedcry2) and circadian genes (Cmedtim and Cmedper) showed no significant differences. After silencing Cmedcry1, the take-off proportion significantly decreased. Thus, Cmedcry1 is involved in the decrease in light intensity induced take-off behaviour in C. medinalis. CONCLUSIONS: This study can help further explain the molecular mechanisms behind insect migration, especially light perception and signal transmission during take-off phases.

High Reimplantation of Coronary Arteries After the Switch Procedure and Associated Stenoses.

Surgical repair through the arterial switch operation (ASO) is the only definitive treatment in patients with dextro-transposition of the great arteries (d-TGA). A crucial step during the reimplantation process is transfer of coronary arteries (CA) to the neo-aorta. A potential cause of CA stenosis is the presence of a high implantation of CA (HICA), defined by the presence of coronary ostium located above the sinotubular junction (STJ) of the aorta. We conducted a retrospective study on 157 patients (82 had digitally preserved angiograms) with d-TGA between 2010 and 2018 in a tertiary pediatric hospital in Canada. Of the 82 cases, 56 (68%) had HICA above the STJ. The mean distance from the STJ was + 7.1 ± 3.4 mm for the RCA, and + 6.8 ± 3.1 mm for the LMCA. Out of the 56 patients with HICA, 4 patients (7%) had stenosis, and out of 26 patients with in-sinus reimplanted CA, one patient (4%) had stenosis (p = 0.16). Patients in the HICA group with stenosis had a lower height of reimplantation of the CA compared to those without stenosis (+ 4.5 ± 1.3 mm vs. + 6.8 ± 3.1 mm, respectively; p < 0.05). This is a rare study assessing the rates of stenosis in the context of in-sinus versus HICA in the ASO. Reimplanting the coronary ostia at a higher level than the expected natural level does not seem to be associated with a significant risk in compromising CA perfusion.

[Challenges in the treatment of opioid dependence]. / Aktuelle Herausforderungen in der Behandlung der Opioidabhängigkeit.

BACKGROUND: The number of persons using opioids has increased worldwide in the last decade, particularly the use of opioid analgesics in North America and Africa. In Germany, the prevalence of heroin addiction has remained relatively stable. METHOD: Narrative review of the literature. RESULTS: Opioid-assisted maintenance treatment (OMT) with the established substances methadone, levomethadone, slow-release morphine and buprenorphine is recommended as the first-line treatment for heroin dependence. The OMT reduces the use of heroin, mortality and individual suffering and improves the quality of life and physical health. A diamorphine and heroine-assisted treatment is an option for people who do not benefit from conventional OMT. An alternative to the use of diamorphine could be treatment with hydromorphone hydrochloride. The regulations on carrying out maintenance treatment in the Controlled Substances Prescription Act and the guidelines of the Federal Medical Association in Germany have been loosened based on the experiences of the COVID-19 pandemic, for example with respect to take-home prescriptions. There is an ongoing intensive discussion on how to deal with the decreasing number of outpatient clinics offering OMT. CONCLUSION: The first-line treatment for opioid addiction is opioid-assisted substitution treatment, including diamorphine and heroin-assisted treatment. Long-acting depot medications and implants still play a subordinate role.

Improving the estimation of countermovement jump height from force plate recordings by considering the interaction between multiple procedural steps: An optimisation approach.

Force plates are used as standalone measurement systems in research and practice to evaluate metrics such as jump height. Calculating jump height involves multiple procedural steps, but previous investigations aiming to improve calculation procedures have only considered the influence of a single procedural step in isolation. The purpose of this study was to investigate if considering the interacting influence of multiple procedural steps in conjunction would impact the accuracy of jump height calculated from force plate recordings. An optimisation procedure was used to determine the combination of filter type, filter order, filter cut-off, integration start point and instant of take-off, that would minimize the root mean squared difference between force plate calculated jump height and a kinematic criterion. The best filter approach was a fifth order Butterworth filter with a 6 Hz cut-off frequency or a third order Chebyshev filter with a 5 Hz cut-off frequency. The best starting point for integration was approximately 0.25 s prior to the onset of the jump and the instant of take-off was best identified by finding the first instant that the force-time signal decreased by the magnitude of system weight. The presented optimisation technique provides an improved quantitative approach to develop standard procedures.

Development and evaluation of two educational sessions on take-home lead exposure prevention for construction workers and their families.

Take-home exposures occur when workers accidentally bring workplace contaminants home. Regular job responsibilities may expose construction workers to lead, which extends to their households via the take-home pathway. The present study aimed to develop and evaluate 2 educational sessions addressing take-home lead exposure tailored to construction workers and their families. Educational materials on take-home lead exposure and prevention strategies were designed following guidance from US government institutions and experts on construction work, lead exposure, and educational interventions. The educational materials were pilot-tested with construction workers and their family members during in-person or online sessions in English or Spanish. Changes in knowledge of take-home lead exposure were assessed through pre- and post-testing and open-ended feedback was collected from both participants and session facilitators. The study sample comprised 44 participants, including 33 workers and 11 family members. Among all participants, 81% were male, 46% were Hispanic or Latino, and the average age was 29 years. Post-test scores (µ = 93%, SD = 10%) were higher than pre-test scores (µ = 82%, SD = 19%), and younger participants (<30 years) were more likely to have a lower pre-test score compared to older participants (≥30 years). Overall, feedback from participants and facilitators was positive, indicating appropriate duration, appealing visuals, and ease of engagement through the training activities. Effective public health education for lead-exposed construction workers and their families is needed to reduce lead exposure disparities, especially among children of workers. Interventions must recognize that take-home exposures are not isolated to occupational or home environments.

[Study on determination methods and analysis of micronutrients in take-away meals].

OBJECTIVE: To comprehensively analyze the trace nutrient contents in take-away meals, the simultaneous detection method of common vitamins in take-away meals were explored based on the samples' matrix, and the content of trace nutrients in take-away meals was analyzed combined with inductively coupled plasma-mass spectrometry(ICP-MS) detection of common elements. METHODS: Fifty-seven take-away meals were collected randomly and analyzed. Vitamins were determined by high performance liquid chromatography-ultraviolet detector tandem fluorescence detector after pretreatment of samples including enzymatic digestion, hydrolysis and extraction. The separation was performed on a C_(18) column(250 mm×4.6 mm, 5 µm) with ion-pair acid reagents as the mobile phase for water-soluble vitamins and methanol for fat-soluble vitamins. Vitamin B_1, vitamin B_2, nicotinic acid, nicotinamide and vitamin A were detected by ultraviolet detector(UVD), while vitamin B_6 and E by fluorescence detector(FLD). Elemental analysis of calcium, magnesium, sodium, potassium, zinc, selenium and copper in the take-away meals was carried out according to GB 5009.268-2016 by ICP-MS to comprehensively evaluate the contents of micronutrients. RESULTS: Through optimization of chromatography and sample pretreatment conditions, the sensitivity of the established detection method can meet the needs of micronutrient evaluation with the detection limits and quantification limits of vitamins in the range of 0.002-0.098 mg/100 g and 0.007-0.327 mg/100 g, respectively. Good precision was obtained(<10%). The spiked recovery rates were 80.5%-103.8%(n=6). The result showed that the contents of micronutrients in take-away meals were generally low. The detection rates of vitamins ranged from 21.1% to 98.2%. CONCLUSION: The proposed method is simple and sensitive, and the contents of vitamins and elements determined were low in the collected take-away meals.

A decade of submersible observations revealed temporal trends in elasmobranchs in a remote island of the Eastern Tropical Pacific Ocean.

No-take marine protected areas (MPAs) can mitigate the effects of overfishing, climate change and habitat degradation, which are leading causes of an unprecedented global biodiversity crisis. However, assessing the effectiveness of MPAs, especially in remote oceanic islands, can be logistically challenging and often restricted to relatively shallow and accessible environments. Here, we used a long-term dataset (2010-2019) collected by the DeepSee submersible of the Undersea Hunter Group that operates in Isla del Coco National Park, Costa Rica, to (1) determine the frequency of occurrence of elasmobranch species at two depth intervals (50-100 m; 300-400 m), and (2) investigate temporal trends in the occurrence of common elasmobranch species between 2010 and 2019, as well as potential drivers of the observed changes. Overall, we observed 17 elasmobranch species, 15 of which were recorded on shallow dives (50-100 m) and 11 on deep dives (300-400 m). We found a decreasing trend in the probability of occurrence of Carcharhinus falciformis over time (2010-2019), while other species (e.g. Taeniurops meyeni, Sphyrna lewini, Carcharhinus galapagensis, Triaenodon obesus, and Galeocerdo cuvier) showed an increasing trend. Our study suggests that some species like S. lewini may be shifting their distributions towards deeper waters in response to ocean warming but may also be sensitive to low oxygen levels at greater depths. These findings highlight the need for regional 3D environmental information and long-term deepwater surveys to understand the extent of shark and ray population declines in the ETP and other regions, as most fishery-independent surveys from data-poor countries have been limited to relatively shallow waters.

The impact of emergency guidance to the COVID-19 pandemic on treatment entry, retention and mortality among patients on methadone in Ukraine.

BACKGROUND AND AIMS: Ukraine's Ministry of Health released urgent COVID-19 guidelines, allowing for early implementation of take-home dosing (THD) for opioid agonist therapies (OAT) such as methadone. Enrollment in OAT and retention in the program are the most effective HIV prevention strategies for people who inject drugs (PWID). This study aimed to evaluate the impact of Ukraine's COVID-19 emergency guidance on OAT treatment enrollment, retention on treatment and mortality. DESIGN AND SETTING: Using Ukraine's national OAT registry for 252 governmental clinics across 25 regions, we conducted a 12-month comparative prospective cohort survival analysis. This study compared newly enrolled methadone patients within the initial 6 months following the COVID-19 guidance (COVID) with patients from the preceding year (pre-COVID) in a country with high adult HIV prevalence (1.2%) that is concentrated in PWID. PARTICIPANTS: In the nation-wide sample of newly enrolled PWID in Ukraine, comprising 2798 individuals, 1423 were in the COVID cohort and 1375 were in the pre-COVID cohort. The majority were male (86.7%), with an average age of 39.3 years. MEASUREMENTS: Primary outcomes were average monthly enrollment per cohort, treatment retention and mortality, with internal time-dependent predictors, including THD and optimal (> 85 mg) methadone dosing. RESULTS: Relative to the pre-COVID period, the monthly average patient enrollment was statistically significantly higher during the COVID period (283.7 versus 236.0; P < 0.0001), where patients were more likely to transition to THD and achieve optimal dosing earlier. Significant differences were observed in the proportions of person-months on THD (41 versus 13%, P < 0.0001) and optimal dosing (38 versus 31%, P < 0.0001) between the COVID and pre-COVID cohorts. Predictors of treatment retention, expressed as adjusted hazard ratios (aHR), included early THD [aHR = 1.90, 95% confidence interval (CI) = 1.47-2.45], early optimal dosing (aHR = 1.71, 95% CI = 1.37-2.13) and prior methadone treatment (aHR = 1.39, 95% CI = 1.15-1.68). These factors persisted, respectively, in the pre-COVID (aHR = 2.28, 95% CI = 1.41-3.70; aHR = 1.84, 95% CI = 1.32-2.56; and aHR = 1.36, 95% CI = 1.06-1.74) and COVID (aHR = 1.91, 95% CI = 1.40-2.59; aHR = 1.61, 95% CI = 1.20-2.16; and aHR = 1.49, 95% CI = 1.08-1.94) cohorts. Survival did not differ significantly between the two prospective cohorts. CONCLUSION: Ukraine's prompt adoption of early take-home dosing for opioid agonist therapies, such as methadone, following the emergency COVID-19 guidance appears to have increased enrollment into methadone and improved treatment retention for people who inject drugs without adverse effects on patient survival.

A multisectoral approach to medication safety in Kuwait using the take-back campaign.

Background: The take-back campaign, which focuses on enhancing public awareness, safe medication disposal practices, stakeholder engagement and patient participation was used to promote medication safety in Kuwait. Aim: To evaluate the effectiveness of the take-back campaign in promoting medication safety in Kuwait. Methods: The campaign was implemented systematically through several stages of planning, communication and coordination among several stakeholders. This social media campaign encouraged individuals from the participating healthy cities to bring unwanted medications to designated collection centres. Returned medications were categorized based on the British National Formulary and data analysis was conducted using Excel. Consultations were held at the collection sites to increase patient confidence in medication compliance and safety. The medications were sorted and disposed safely. Results: The take-back campaign lasted 56 hours over a period of one month. It successfully engaged 405 households and collected 1005 kg of medication, comprising 7648 items, over a period 6 working days. Fifty-seven percent of the medications collected through the campaign originated from the Ministry of Health and 43% from the private sector. Fifty-two percent had expired and 59% were in solid dosage form. Painkillers comprised the largest group (18%) among the returned medications. Conclusion: The take-back campaign effectively raised awareness about medication safety and provided a safe disposal mechanism for unused and expired medications. This campaign has provided a foundation for future initiatives and contributed significantly to improving medication safety and public health outcomes in Kuwait.

Risk compensation after COVID-19 vaccination: Evidence from vaccine rollout by exact birth date in South Korea.

We utilize the phased rollout of COVID-19 vaccines by exact birth date in South Korea as a natural experiment for testing risk compensation. People may resume face-to-face social activities following vaccination because they perceive lower risk of infection. Applying a regression discontinuity design based on birth date cutoffs for vaccine eligibility, we find no evidence of risk-compensating behaviors, as measured by large, high-frequency data from credit card and airline companies as well as survey data. We find some evidence of self-selection into vaccine take-up based on perception toward vaccine effectiveness and side effects, but the treatment effects do not differ between compliers and never-takers.

Estimating the total utilization of take home naloxone during an unregulated drug toxicity crisis: A Bayesian modeling approach.

BACKGROUND: British Columbia (BC) Canada has a large take-home naloxone (THN) program, implemented as part of the provincial response to the ongoing toxic unregulated drug supply emergency. Ascertaining the rate of use of THN kits is vital to understanding the full impact of the program. However, this is a challenging problem due to under-reporting of kit distribution. This study aims to estimate the total number of THN kits used based on the number of THN kits shipped, the number of THN kits reported as distributed, and the number of THN kits reported as used. METHODS: We used BC THN shipment and distribution records (February 2015 to August 2023) to inform a simple Bayesian model of naloxone kit distribution and use. A logistic regression term by health region and distribution site type was incorporated to account for variable under-reporting, and a convolution term was incorporated to account for kit distribution. RESULTS: We find the number of THN kits reported as used, and the number of total THN kits distributed, are largely under-reported. An estimated 1,500 (95 % CrI: 1,430 - 1,590) THN kits per 10,000 BC population were used, of which 288 per 10,000 had been reported as used. Of all the THN kits shipped, the model estimated that 43 % (95 % CrI: 41-45 %) of kits were used. We also found variation in both distribution and use by distribution site type, with kits distributed from overdose prevention sites having the highest rate of use (56 %; 95 % CrI: 53-59 %). CONCLUSION: Across all sites, kit use is approximately five times higher than has been reported. Our framework can also be applied to other localities where THN programs operate, in order to better estimate the true reach and impact of take home naloxone distribution.