Doing community-based research during dual public health emergencies (COVID and overdose).

Meaningful engagement and partnerships with people who use drugs are essential to conducting research that is relevant and impactful in supporting desired outcomes of drug consumption as well as reducing drug-related harms of overdose and COVID-19. Community-based participatory research is a key strategy for engaging communities in research that directly affects their lives. While there are growing descriptions of community-based participatory research with people who use drugs and identification of key principles for conducting research, there is a gap in relation to models and frameworks to guide research partnerships with people who use drugs. The purpose of this paper is to provide a framework for research partnerships between people who use drugs and academic researchers, collaboratively developed and implemented as part of an evaluation of a provincial prescribed safer supply initiative introduced during dual public health emergencies (overdose and COVID-19) in British Columbia, Canada. The framework shifts from having researchers choose among multiple models (advisory, partnership and employment) to incorporating multiple roles within an overall community-based participatory research approach. Advocacy by and for drug users was identified as a key role and reason for engaging in research. Overall, both academic researchers and Peer Research Associates benefited within this collaborative partnerships approach. Each offered their expertise, creating opportunities for omni-directional learning and enhancing the research. The shift from fixed models to flexible roles allows for a range of involvement that accommodates varying time, energy and resources. Facilitators of involvement include development of trust and partnering with networks of people who use drugs, equitable pay, a graduate-level research assistant dedicated to ongoing orientation and communication, technical supports as well as fluidity in roles and opportunities. Key challenges included working in geographically dispersed locations, maintaining contact and connection over the course of the project and ensuring ongoing sustainable but flexible employment.

Identification of goat milk powder by manufacturer using multiple chemical parameters.

Concentrations of multiple elements and ratios of stable isotopes of carbon and nitrogen were measured and combined to create a chemical fingerprint of production batches of goat whole milk powder (WMP) produced by different manufacturers. Our objectives were to determine whether or not differences exist in the chemical fingerprint among samples of goat WMP produced at different sites, and assess temporal changes in the chemical fingerprint in product manufactured at one site. In total, 58 samples of goat WMP were analyzed by inductively coupled plasma-mass spectrometry as well as isotope ratio mass spectrometry and a suite of 13 elements (Li, Na, Mg, K, Ca, Mn, Cu, Zn, Rb, Sr, Mo, Cs, and Ba), δ(13)C, and δ(15)N selected to create the chemical fingerprint. Differences in the chemical fingerprint of samples between sites and over time were assessed using principal components analysis and canonical analysis of principal coordinates. Differences in the chemical fingerprints of samples between production sites provided a classification success rate (leave-one-out classification) of 98.1%, providing a basis for using the approach to test the authenticity of product manufactured at a site. Within one site, the chemical fingerprint of samples produced at the beginning of the production season differed from those produced in the middle and late season, driven predominantly by lower concentrations of Na, Mg, K, Mn, and Rb, and higher concentrations of Ba and Cu. This observed temporal variability highlights the importance of obtaining samples from throughout the season to ensure a representative chemical fingerprint is obtained for goat WMP from a single manufacturing site. The reconstitution and spray drying of samples from one manufacturer by the other manufacturer enabled the relative influence of the manufacturing process on the chemical fingerprint to be examined. It was found that such reprocessing altered the chemical fingerprint, although the degree of alteration varied among samples and individual elements. The findings of this study support the use of trace elements and stable isotope ratios to test the authenticity of goat WMP, which can likely be applied to other dairy goat products. This approach could be used test to the factory of origin (and potentially batch of origin) of products in the supply chain, thus providing the ability to audit the supply chain and monitor for fraudulent activity.

Does self-management for return to work increase the effectiveness of vocational rehabilitation for chronic compensated musculoskeletal disorders? Protocol for a randomised controlled trial.

BACKGROUND: Musculoskeletal disorders are common and costly disorders to workers compensation and motor accident insurance systems and are a leading contributor to the burden of ill-health. In Australia, vocational rehabilitation is provided to workers to assist them to stay in, or return to work. Self-management training may be an innovative addition to improve health and employment outcomes from vocational rehabilitation. METHODS/DESIGN: The research plan contains mixed methodology consisting of a single blind randomised controlled trial, an economic evaluation and qualitative research. Participants (n = 366) are volunteers with compensated musculoskeletal disorders of 3 months to 3 years in duration who were working at the time of the injury/onset of the chronic disorder. The trial tests the effectiveness of usual vocational rehabilitation plus the Chronic Disease Self-Management Program (CDSMP) to which two additional and newly-developed modules have been added, against vocational rehabilitation alone (control) The modules added to the CDSMP focus on how to navigate through compensation systems and manage the return to work process, and aim to be relevant to those in a vocational rehabilitation setting.The primary outcome of this study is readiness for return to work which will be evaluated using the Readiness for Return-to-Work scale. Secondary outcomes include return to work status, health efficacy (heiQ questionnaire) and general health status (SF-12v2(R) Health Survey). Measures will be taken at baseline, immediately post-intervention and at 6- and 12- months post-intervention by an independent assessor. An economic evaluation will compare the costs and outcomes between the intervention and control groups in terms of cost-effectiveness and a partial cost-benefit or cost analysis. The impact of the intervention will also be evaluated qualitatively, in terms of its acceptability to stakeholders. DISCUSSION: This article describes the protocol for a single blind randomised controlled trial with a one year follow-up. The results will provide evidence for the addition or not of self-management training within vocational rehabilitation for chronic compensated musculoskeletal disorders. TRIAL REGISTRATION: Australia and New Zealand Clinical Trials Registry ACTRN12609000843257.

In my car the brake is on the right: pedal errors among older drivers.

PURPOSE: To assess to what extent specific cognitive functions contribute to pedal errors among older drivers. METHODS: 180 subjects aged 65 and older completed a 30 min driving evaluation on a simulator as well as three cognitive tests, the Mini-Mental State Exam (MMSE), the Clock Drawing Test, and Trailmaking Part A and B. Analyses based on logistic regressions were performed using age, gender, MMSE, Trailmaking Part A and B, and Clock Drawing Test as independent variables. RESULTS: Results indicate that Clock Drawing is the best predictor of pedal errors (odds ratio=10.04, p<.0001, 95% CI: 3.80, 26.63) followed by age > or =84 (odds ratio 6.10, p<.05, 95% CI: 1.77, 21.03). In contrast, Trailmaking Part A and B, gender, and the MMSE were not significantly related to pedal errors. CONCLUSION: Executive dysfunction may be an important contributor to pedal errors and thus unsafe driving. Practitioners may wish to consider measures of executive function when evaluating patients for driving safety.

Hagfish in the New Zealand fjords are supported by chemoautotrophy of forest carbon.

Forest litter is often considered to be a minor energy source to marine communities due to its refractory nature. Large volumes of forest litter are deposited in the New Zealand fjords, and likely recycled into available energy by microbial activity. In this study we used evidence from stable isotope analyses to test whether recycled carbon from chemoautotrophs was an important contributor to the diet of hagfish (Eptatretus cirrhatus). We then analyzed fatty acid biomarkers from the chemoautotrophic clam Solemya parkinsoni and E. cirrhatus to further discriminate the contribution of marine, terrestrial, and chemoautotrophic sources. Bulk isotopic signatures of E. cirrhatus varied considerably (delta13C, from -29.2 per thousand to -16.7 per thousand; delta15N, from -2.8 per thousand to +15.5 per thousand; delta34S, from -21.7 per thousand to +16.7 per thousand) and indicated that a significant percentage of organic matter (38-51%) originated from chemoautotrophs (delta13C, -31.3 per thousand +/- 0.1 per thousand [mean +/- SE]; delta15N, -5.7 per thousand +/- 0.2 per thousand; delta34S, -32.per thousand +/- 3.8 per thousand). Fatty acid biomarkers were depleted in 13C, particularly cis-vaccenic acid (18:1omega7: delta13C, -39.0 per thousand) indicating specific microbial origins of carbon. A high proportion of forest litter in sediments, coupled with isotopic and fatty acid biomarker results, indicates that terrestrial organic matter is a dominant contributor to this marine benthic system. This study demonstrates a clear linkage between terrestrial and marine ecological processes.

Self-rated driving performance among elderly drivers referred for driving evaluation.

PURPOSE: To explore whether elderly drivers of varying driving skill levels (1) differ in their perception of their driving evaluation performance and (2) determine if self-rated driving evaluation performance is related to cognitive ability. METHODS: One hundred and fifty-two drivers aged 65 years or older and referred for a driving evaluation were enrolled into the study. Subjects were asked the question, "how well do you think you will perform today on your driving evaluation compared to others your own age?" Subjects also completed the Mini-Mental State Exam and a 30-min drive on a STISIM Drivetrade mark simulation (Systems Technology, Inc., Hawthorne, CA). Only 47 subjects completed both the simulated drive and self-rated item. RESULTS: Sixty-five percent of drivers rated themselves as performing better on a driving test than others of their age. Another 31.9% felt they would perform the same as others of their age on a driving test. A 50.0% of those considering themselves "a little better" and 52.9% of those considering themselves "a lot better" had an unsafe driving performance. As self-rated driving evaluation performance increased, there was a significantly increased risk of unsafe driving (p=0.02) in the study population. Drivers who considered themselves at least a little better than others of their age were over four times more likely to be unsafe drivers compared to others who believed they were comparable to or worse than other drivers of their age (RR=4.13, 95% CI=1.08-15.78). There was no significant difference in MMSE between self-rating groups (p=0.76). CONCLUSION: Older drivers assign high ratings to their driving performance, even in the presence of suspected skill decline. Cognitive ability was not related to self-rated driving evaluation performance.

Mechanisms and ecological role of carbon transfer within coastal seascapes.

Worldwide, coastal systems provide some of the most productive habitats, which potentially influence a range of marine and terrestrial ecosystems through the transfer of nutrients and energy. Several reviews have examined aspects of connectivity within coastal seascapes, but the scope of those reviews has been limited to single systems or single vectors. We use the transfer of carbon to examine the processes of connectivity through multiple vectors in multiple ecosystems using four coastal seascapes as case studies. We discuss and compare the main vectors of carbon connecting different ecosystems, and then the natural and human-induced factors that influence the magnitude of effect for those vectors on recipient systems. Vectors of carbon transfer can be grouped into two main categories: detrital particulate organic carbon (POC) and its associated dissolved organic and inorganic carbon (DOC/DIC) that are transported passively; and mobile consumers that transport carbon actively. High proportions of net primary production can be exported over meters to hundreds of kilometers from seagrass beds, algal reefs and mangroves as POC, with its export dependent on wind-generated currents in the first two of these systems and tidal currents for the last. By contrast, saltmarshes export large quantities of DOC through tidal movement, while land run-off plays a critical role in the transport of terrestrial POC and DOC into temperate fjords. Nekton actively transfers carbon across ecosystem boundaries through foraging movements, ontogenetic migrations, or 'trophic relays', into and out of seagrass beds, mangroves or saltmarshes. The magnitude of these vectors is influenced by: the hydrodynamics and geomorphology of the region; the characteristics of the carbon vector, such as their particle size and buoyancy; and for nekton, the extent and frequency of migrations between ecosystems. Through a risk-assessment process, we have identified the most significant human disturbances that affect the integrity of connectivity among ecosystems. Loss of habitat, net primary production (NPP) and overfishing pose the greatest risks to carbon transfer in temperate saltmarsh and tropical estuaries, particularly through their effects on nekton abundance and movement. In comparison, habitat/NPP loss and climate change are likely to be the major risks to carbon transfer in temperate fjords and temperate open coasts through alteration in the amount of POC and/or DOC/DIC being transported. While we have highlighted the importance of these vectors in coastal seascapes, there is limited quantitative data on the effects of these vectors on recipient systems. It is only through quantifying those subsidies that we can effectively incorporate complex interactions into the management of the marine environment and its resources.