County Resource Research Articles

Sustainability of Treatment Programs Utilizing Medications for Opioid Use Disorders in Incarcerated Young Adults.

The epidemic of opioid overdose brought a major health crisis to the front line of public health in the United States. Early efforts have focused on the prevention of production, distribution, and consumption of the drugs. However, there is little information about youth populations at risk for opioid overdose and their response to targeted treatment plans. The San Bernardino County Youth Opioid Response (SBCYOR) coalition in collaboration with the San Bernadino County (SBC) Probation Department organized a safety net system for at-risk youth by improving communication among county resources. This program mainly focused on individuals aged 12 to 24 years in the county's detention centers along with educational and prevention projects such as naloxone programs for first responders in the region. To describe the impact of the SBCYOR program on at-risk youth, we compare the frequencies of patients referred and treated with medications for opioid use disorder (MOUD) at the SBC Probation Department, which was responsible for individuals from age 12 to less than 18 years, with those from the West Valley Detention Center (WVDC), which was responsible for adults (18 to 24 years of age), from September 2020 through June 2022. Similar proportions of youths were referred for treatment of opioid use disorder (OUD) at the respective sites (3.7% SBC Probation Department, 3.6% WVDC). Of these, however, 78.0% were treated with MOUD at SBC Probation Department compared with only 7.1% at WVDC. SBCYOR coalition partners were able to transform their services into a comprehensive medical and behavioral health program for the incarcerated youth population at risk for OUD.

The Relationship Between Citizen Perceptions on Government Transparency and Economic Development: A Case of Thika Town Sub-County, in Kiambu County, Kenya

This study examined the relationship between citizens' perception of government transparency and economic development in Thika Town Sub-County, Kiambu County, Kenya. The data collected on the first objective are explained in this section. Financial constraints were found to hinder citizens' ability and willingness to access resource allocation information, limiting their capacity to travel to county offices, access the internet, or purchase materials containing the relevant information. Despite this, respondents agreed to a great extent that the county government is transparent about how funds are spent in different sectors (mean = 3.7597, std. deviation = 0.69095), that the process for county resource allocation is clearly communicated to citizens (mean = 3.5581, std. deviation = 0.83128), and that information about how resources are allocated is easily accessible to the public (mean = 3.5116, std. deviation = 0.91101). The study’s third objective was to assess whether openness and transparency of the county's contracting and procurement practices influence economic development in Thika Town Sub-County in Kiambu County, Kenya. The findings were as follows. Concerning openness and transparency of county contracting and procurement practices, 63% of respondents indicated that information about county contracts and procurements is private, while 22% said it is available, and 15% were unsure. The majority of respondents (61%) indicated that the county's contracting and procurement processes are somewhat transparent, while 24% said they are very transparent, and 15% said they are not transparent at all. Even when information on county contracts and procurements is available, it may not be easily accessible due to bureaucratic hurdles, outdated or incomplete online resources, and the need for personal visits to county offices. Despite these challenges, respondents greatly agreed that the procurement and tendering process is open and transparent (mean = 3.7907, std. deviation = 0.78735), that increased transparency in contracting/procurement has benefited local businesses (mean = 3.7054, std. deviation = 0.80314), and that award criteria and selection methods are clearly defined and available (mean = 3.6419, std. deviation = 0.93763). The study concludes that while efforts exist to promote transparency in resource allocation, there are still gaps in the adequacy and accessibility of information. Financial constraints can be a barrier to citizens' engagement with government processes and access to information, potentially hindering their ability to hold the government accountable and contribute to economic development. The study concludes that addressing financial barriers and improving the accessibility and comprehensibility of resource allocation information could enhance citizens' participation and, consequently, economic development. The findings provide valuable insights for policymakers, civil society organizations, and citizens in Thika Town Sub-County and beyond, highlighting the need for a comprehensive and balanced approach to transparency reforms that prioritizes both information disclosure and citizen empowerment. The study concludes that by addressing the identified challenges and strengthening transparency and participation mechanisms, local governments can create a more conducive environment for sustainable economic growth and improve the lives of their citizens.

Has China’s Pilot Policy of Farmland Management Right Mortgage Loan Promoted County Agricultural Economic Growth?

Farmland mortgages are expected to drive county agricultural economic growth (CAEG) as a crucial component of furthering the reform of the rural land system and the reform of the rural financial system against the new backdrop of the new era. This study gathers panel data from 2045 Chinese counties from 2011 to 2020 and uses the difference-in-differences method and the synthetic control method to systematically examine the effects of China’s farmland management right mortgage loan (FMRML) pilot program on CAEG. The FMRML pilot program was implemented in 2016, and this research is presented as a quasi-natural experiment. The findings indicate that there is a “policy trap” and that CAEG has not been successfully promoted by the FMRML pilot program. The reason for this is because the pilot program has made county resource mismatch worse, making it unable to fully realize the promotional effect on CAEG, rather than significantly activating the three key drivers of agricultural economic growth: people, land, and money. The impact of the FMRML pilot policy on CAEG is not uniform, according to the results of the heterogeneity study, with a substantial “blocking” effect only in the central region and no significant influence in the western, northeastern, or eastern regions. The findings propose that in order to optimize agricultural mortgage policy and advance CAEG, China and other emerging nations can benefit greatly from the insights this study offers.

Electoral contestation, goods provision, and construction of devolved government in Northern Kenya

ABSTRACT Upon election in 2013, the first governors of the 47 counties created by Kenya’s 2010 constitution assumed responsibility for the construction – in some cases, especially in the historically marginalized north of the country, essentially from scratch – of the local administrative apparatuses needed to perform devolved government functions and manage county budgets. In this article, I draw on government, news media, and interview data to examine the local electoral drivers of the substantial variation in the new county administrations' capacity and performance. A paired comparison of Turkana and West Pokot counties in Northern Kenya shows that threats to political survival posed by electoral opponents incentivize vertically accountable local leaders to substitute clientelism for state-building. To secure reelection in 2017, the governors of both counties needed to satisfy constituent demands for improved access to state resources. Faced with weak electoral rivals, the Turkana leader did so by extending public service delivery, which required the construction of a capable county government. In contrast, his West Pokot counterpart’s vulnerability to electoral competition prompted reallocation of county resources to clients at the expense of investment in administrative capacity and public goods provision.

Race-ethnicity and sex differences in 1-year survival following percutaneous coronary intervention among Medicare fee-for-service beneficiaries.

Existing literature describing differences in survival following percutaneous coronary intervention (PCI)by patient sex, race-ethnicity and the role of socioeconomic characteristics (SEC)is limited. Evaluate differences in 1-year survival after PCI by sex and race-ethnicity, and explore the contribution of SEC to observed differences. Using a 20% sample of Medicare claims data for beneficiaries aged 65+, we identified fee-for-service patients who received PCI from 2007 to 2015. We performed logistic regression to assess how sex and race-ethnicity relate to procedural indication, inpatient versus outpatient setting, and 1-year mortality. We evaluated whether these relationships are moderated by sequentially controlling for factors including age, comorbidities, presence of acute myocardial infarction (AMI),county SEC, medical resource availabilityand inpatient versus outpatient procedural status. We identified 300,491 PCI procedures, of which 94,863 (31.6%) were outpatient. There was a significant transition to outpatient PCI during the study period, especially for men compared with women and White patients compared with Black patients. Black patients were 3.50 percentage points (p < 0.001) and women were 3.41 percentage points (p < 0.001) more likely than White and male patients to undergo PCI at the time of AMI, which typically occurs in the inpatient setting. Controlling for age and calendar year, Black patients were 2.87 percentage points more likely than non-Hispanic White patients to die within 1 year after PCI. After controlling for Black-White differences in comorbidities, the differences in 1-year mortality decreased to 0.95 percentage points, which then became nonsignificant when further controlling for county resources and state of residence. Women were more likely to experience PCI in the setting of AMI and had less transition to outpatient care during the period. Black patients experienced higher 1-year mortality following PCI, which is explained by differences in baseline comorbidities, county medical resources, and state of residence.

CARE NETWORKS OF RURAL APPALACHIAN FAMILY CAREGIVERS AND PERSONS LIVING WITH DEMENTIA

Abstract Dementia care research typically focuses on primary family caregivers with limited consideration of their engagement with a broader care network and the geographic area in which they reside. Using a mixed-methods approach, we analyzed care networks of 163 primary caregivers and their relative living with dementia in rural Virginia. Six distinct care network types emerged based on the primary caregiver's gender, relationship to the person living with dementia, and presence of other informal caregivers. Networks differed by the caregiver’s emotional connectivity with family/friends and feelings of caregiver strain, role overload, and loneliness. Caregivers’ service use attitudes and support service utilization varied across network types and across divergent economic resources of the rural counties in which families resided. Findings establish a framework for understanding the types and influences of care networks and tailoring services to support dementia family caregivers in diverse rural areas.

Development of forest industry of Northern Bukovyna and Khotyn region in the interwar period

Forest resources of Northern Bukovyna and Khotyn County have long played an important role in the life of the local population. During 1918–1940, the forest branch of the region occupied one of the leading positions in all industry. In particular, during the investigated period there was an expansion of production and an increase in the number of enterprises (from 32 to 48).Among the most important enterprises in the logging, sawmilling, furniture, pulp and paper subsectors of Northern Bukovyna and Khotyn region, which operated between the two world wars were: Joint-Stock Company f. Wood Industry «Goetz», «Forestiera», E.H. Friedmann, Engel &amp; Glasberg Sawmill, a furniture factory «Ant», «Nikolaus Zajacskowski &amp; Sons, Barrels Factory with Electric Power», a factory for the production of wooden nails «Astra», a paper factory «Biedermann and Kindler», Wallpaper and Paper Bags Factory «Tapa» Limited Liability Company in Chernivtsi.

1344. Predicting Measles Outbreaks in the United States: Application of Different Modeling Approaches

Abstract Background Although measles is still rare in the United States (U.S.), there have been recent resurgent outbreaks in the U.S. To improve the accuracy of prediction given the rarity of measles events, we used machine learning (ML) algorithms to model measles case predictions at the U.S. county level. Methods The main outcome was occurrence of ≥1 measles case at the U.S. county level. Two ML prediction models were developed (HDBSCAN, a clustering algorithm, and XGBoost, a gradient boosting algorithm) and compared with traditional logistic regression. We included 28 predictors in the following categories: sociodemographics, population statistics, measles vaccination coverage, healthcare access, and exposure to measles via international air travel. The models were trained on 2014 case data and validated on 2018 case data. Models were compared using area under the receiver operating curve (AUC), sensitivity, specificity, positive predictive value (PPV), and F2 score (combined measure of sensitivity and PPV). Results There were 667 measles cases in 2014 and 375 in 2018 in the U.S. We identified U.S. counties for 635 (95.2%) cases in 2014 and 366 (97.6%) cases in 2018 through published sources, corresponding to 81/3143 (2.6%) counties in 2014 and 64/3143 (2.0%) counties in 2018 with ≥1 measles case. HDBSCAN had the highest sensitivity (0.92), but lowest AUC (0.68) and PPV (0.04) (Table). XGBoost had the highest F2 score (0.49), best balance of sensitivity (0.72) and specificity (0.94), and AUC = 0.92. Logistic regression had high AUC (0.91) and specificity (1.00) but the lowest sensitivity (0.16). Conclusion Machine learning approaches outperformed logistic regression by maximizing sensitivity to predict counties with measles cases, an important criterion to consider to prevent or prepare for future outbreaks. XGBoost or logistic regression could be considered to maximize specificity. Prioritizing sensitivity versus specificity may depend on county resources, priorities, and measles risk. Different modeling approaches could be considered to optimize surveillance efforts and develop effective interventions for timely response. Disclosures Stephanie Kujawski, PhD MPH, Merck &amp; Co., Inc. (Employee, Shareholder) Boshu Ru, Ph.D., Merck &amp; Co. Kenilworth, NJ (NYSE: MRK) (Employee, Shareholder) Amar K. Das, MD, PhD, Merck (Employee) richard baumgartner, PhD, Merck (Employee) Shuang Lu, MBA, MS, Merck (Employee) Matthew Pillsbury, PhD, Merck &amp; CO. (Employee, Shareholder) Joseph Lewnard, PhD, Merck (Consultant, Grant/Research Support) James H. Conway, MD, FAAP, GSK (Advisor or Review Panel member)Merck (Advisor or Review Panel member)Moderna (Advisor or Review Panel member)Pfizer (Advisor or Review Panel member)Sanofi Pasteur (Research Grant or Support) Manjiri D. Pawaskar, PhD, Merck &amp; Co., Inc. (Employee, Shareholder)

Effect of Accountability Practices on County Government Performance in Kenya: A Case Study in Makueni and Marsabit County Governments

With devolution, it is expected that enhanced public involvement through participation and incorporation of other good governances’ practices would enhance accountability and performance of county (sub-national) governments in terms of timely delivery of services and accountability in resource utilization.However, previous studies indicate that counties are experiencing inefficient utilization of resources and poor timely delivery of services. About 41 percent of Kenyans were unsatisfied with performances of their counties in 2016, according to Transparency International Survey. This hinders effective performance. Conversely, some counties have performed well according to rating done by Policy Tracking Impact Public Affairs Consulting 2018, which ranked Makueni county government as the best performing county based on development projects and policies implied by counties.Therefore, the study sought to compare the effects of corporate governance practices on performances in Makueni and Marsabit counties. Marsabit County was chosen because despite Makueni being ranked the best, both counties experience almost similar challenges in their governance. The issues of low human capital development, cross-border community level conflicts, and low level of investment in infrastructure, high level of poverty, food insecurity, land degradations and poor health system are the common challenges that affect performance of the two county governments. Therefore, this study sought to examine the effects of accountability governance practices on the selected counties in Kenya. To accomplish the objectives, correlational research design and interpretivism research philosophy was adopted by the study. The target population consisted of county officials and heads of groups and the community leaders in the two counties. Primary data was collected and analyzed using a linear model to estimate the coefficients. The findings indicated that accountability had significant positive effect of 55.8 percent on county government performance. In this regard, the study recommended the need for counties to strengthen county resource management systems to boost accountability and ultimately its performance.

Profile of vision function amongst learners with low vision attending inclusive schools in Kakamega County, Kenya

Background: The quality of vision function of low vision (LV) children determines their ease and success in performing activities of daily living including academic activities undertaken whilst at school.Aim: The aim of this study was to determine the vision function of LV learners attending inclusive schools in Kakamega County, Kenya.Setting: This study was designed at public primary inclusive schools in Kakamega County, with LV placements by the County Educational Assessment and Resource Center.Methods: This was a school-based cross-sectional study. A census survey identified 21 LV learners, who met the World Health Organization (WHO) classification of LV and had been assessed and placed in 11 public primary inclusive schools in Kakamega County. Participants underwent standard LV assessment tests. Data were entered into Statistical Package for the Social Sciences (SPSS) version 25 software and analysed using descriptive and inferential statistics. Data were summarised and presented using tables, figures and percentages.Results: Out of the 21 LV learners who were selected, 19 (90.5%) were assessed. The best recorded visual acuity (VA) was 0.33 decimal notation at far and 0.02 and 0.01 in the right eye and the left eye, respectively, at near. The vast majority, 94.7%, had reduction in stereopsis, whilst 42.1% had defects in colour vision, 20.0% reduced contrast sensitivity (CS) and 15.8% had visual field impairment within the central 20 degrees.Conclusion: There is an overall decrease in vision function amongst LV learners attending inclusive schools in Kakamega County. The most affected parts of vision function are VA and stereopsis.

MISMANAGEMENT OF COUNTY RESOURCES: A CASE OF TRANS NZOIA COUNTY

The purpose of the study was to investigate mismanagement of county resources in Trans Nzoia County. The objective of the study is to determine the causes of mismanagement of resources for service delivery in Trans Nzoia County, establish the effects of redundancy in growth and development in county government on service delivery. Organization and management theory (Fredrick Taylor, 1961), was applied by researcher. The theory states that resources are to be managed effectively and efficiently. The researcher employed mixed research method that included qualitative and quantitative methods that led to triangulation design. The target population was 3000 people which gave a sample size of 900 people after the application of Greg and Morgan 1979 formula. The researcher employed purposive sampling technique and simple random sampling technique. Data collection was done by use of questionnaires and document analysis. The researcher also applied purposive sampling technique where data was collected from the people who had knowledge on what the researcher was conducting the study on. The researcher conducted a pre test and a post test of the research instruments to establish the validity and reliability of the instrument in the collection of data. Data was collected using questionnaires and document analysis. The findings indicated that the county resources were not well utilized and recommended that the people to handle finances should have the right qualifications and experiences.

Effects of Capacity Building on Management of County Resources in Machakos County, Kenya

Effects of Capacity Building on Management of County Resources in Machakos County, Kenya

Drivers of Clan Conflicts: A Perspective of the Role of Al-Shabaab in Garissa County, Kenya

The purpose of the study was to investigate the relationship between the drivers of intra-clan-based conflicts and the involvement of external actors that has remained indefinable in Garissa County. The three sub-counties: Garissa Township, Ijara and Fafi were purposively selected for the study because of prolonged and unresolved intra-clan conflicts coupled with militia group of Al-Shabaab attacks over the past years. Qualitative approach was used to seek understanding of drivers of intra-clan conflicts and involvement of violent extremism. The study involves primarily 35 Key Informants drawn from security agencies, Clan elders, Religious leaders and Civil societies across the three sub-counties. The study established that competition over natural resources: water; pasture and land are the main causes of intra-clan conflicts. The respondents attest that intra-clan conflicts have been accelerated by clan identity politics, poverty, illiteracy, unemployment and Al-Shabaab infiltration. The devolution has elevated competition for political leadership due to sharing of county resources and employment along the sub-clans. The study found some respondents attributing Kenya’s military operation in Somalia to reciprocal attacks by Al-Shabaab in the county. The research established that over the years, Somali clan conflicts and hostility have spilled over into North Eastern Kenya, creating security threat and undermining community peace and cohesion. The porous border of Kenya-Somali has made it easy for some sub-clans to communicate with their kinsmen’s counterparts and obtain guns that are readily available in Somalia. The perception of injustices and sense of marginalization amongst the Muslims have provided fertile ground for Al-Shabaab which has diverted attention of security agencies to violent extremism rather than clan conflicts. The study recommends enhancement of inclusive peace committee and collaboration of community with administration and security agencies to tie together peace. There is also a need for openness of politicians to advocate for impartiality, clan conflicts resolution and countering violent extremism through policy framework in the county assembly.

Drivers of Clan Conflicts: A Perspective of the Role of Al-Shabaab in Garissa County, Kenya

The purpose of the study was to investigate the relationship between the drivers of intra-clan-based conflicts and the involvement of external actors that has remained indefinable in Garissa County. The three sub-counties: Garissa Township, Ijara and Fafi were purposively selected for the study because of prolonged and unresolved intra-clan conflicts coupled with militia group of Al-Shabaab attacks over the past years. Qualitative approach was used to seek understanding of drivers of intra-clan conflicts and involvement of violent extremism. The study involves primarily 35 Key Informants drawn from security agencies, Clan elders, Religious leaders and Civil societies across the three sub-counties. The study established that competition over natural resources: water; pasture and land are the main causes of intra-clan conflicts. The respondents attest that intra-clan conflicts have been accelerated by clan identity politics, poverty, illiteracy, unemployment and Al-Shabaab infiltration. The devolution has elevated competition for political leadership due to sharing of county resources and employment along the sub-clans. The study found some respondents attributing Kenya’s military operation in Somalia to reciprocal attacks by Al-Shabaab in the county. The research established that over the years, Somali clan conflicts and hostility have spilled over into North Eastern Kenya, creating security threat and undermining community peace and cohesion. The porous border of Kenya-Somali has made it easy for some sub-clans to communicate with their kinsmen’s counterparts and obtain guns that are readily available in Somalia. The perception of injustices and sense of marginalization amongst the Muslims have provided fertile ground for Al-Shabaab which has diverted attention of security agencies to violent extremism rather than clan conflicts. The study recommends enhancement of inclusive peace committee and collaboration of community with administration and security agencies to tie together peace. There is also a need for openness of politicians to advocate for impartiality, clan conflicts resolution and countering violent extremism through policy framework in the county assembly.

Dynamics of Clan Based Conflicts in Wajir County, Kenya

Clannism is one of the key drivers of violent attacks in Northern Kenya. The causes of the persistent clan-based conflicts in Northern Kenya are not well known and ascertained. The rising incidents of violent attacks which clan-based conflict can be partially blamed, which this study attempted to explore. This underpins the need to conduct research in order to explore the drivers of clan-based conflict in Wajir county. The specific objective of the study was to assess the drivers of inter-clan and intra-clan-based conflicts in Wajir county, Kenya. The study adopted an exploratory research design. The study involved qualitative approach of data collection. The target population comprised of clan elders (Degodia, Ogaden and Ajuran), security agents, religious leaders and civil society organizations. A total of 31 respondents were interviewed who were selected using purposive and snowball approach. Interview guides were administered to the various respondents. The information obtained in the study was thematically analyzed according to the research questions. The study found that some of the key drivers of clan conflict in Wajir County include political influence, constituency boundaries, unequal sharing of county resources and competition over water and pasture. Findings from this study will be published to aid in disseminating information on the best ways to mitigate the clan-based conflict.

Association of county perinatal resources and gestational weight gain in West Virginia, United States

BackgroundInappropriate (inadequate or excessive) gestational weight gain (GWG) is of great concern to maternal, fetal and infant health. Different maternal and fetal risk factors are associated with GWG, but little is known about a more distal risk factor: inadequate county-level perinatal resources. Therefore, the study aim was to investigate GWG in women living in counties with below average perinatal resources in comparison with their counterparts living in counties with above average perinatal resources.MethodsRetrospective study of 406,792,010–2011 West Virginia births in 55 counties. The outcome was GWG and the main predictor was county perinatal resources. Hierarchical linear mixed model was used to investigate the association of county perinatal resources and GWG.ResultsCounty perinatal resources was associated with GWG (p = 0.009), controlling for important covariates. Below average county perinatal resources was not significantly associated with a decrease in mean GWG (M: − 5.29 lbs., 95% CI: − 13.94, 3.35, p = 0.2086), in comparison with counties with above average county perinatal resources. There was significant difference between average, and above average county perinatal resources (M: − 17.20 lbs., 95% CI: − 22.94, − 11.47, p < 0.0001), controlling for smoking during pregnancy and other covariates.ConclusionsAverage county perinatal resources was associated with reduced mean GWG relative to above average county perinatal resources, but not below average county perinatal resources. However, this could be due to the small number of counties with above average resources as the effect was in the hypothesized direction. This highlights one of the challenges in county perinatal resource studies.

Factors Influencing Health Service Provision In Pastoral Communities In Kenya: A Case Study Of Wajir County

The study seeks to find out factors affecting health service provision in pastoral communities, it is focusing Wajir County. The County Government is mandated to provide services including the health services which have been enabled by devolution functions such as transfer of funds. However, Counties especially within the patrol communities have been faced with myriad of challenges in obtaining the standard services from the County offices such as medical and education services. Some of the mentioned causes of poor services to the community from the literature has been leaders who are not objective in practicing the best human resource practices, poor communication facilities in the County thus community are not able to access the needed services in timely manner and lot of corruptions in the County offices. In addition, there is lack of proper structures or systems put in place to account for the resources allocated. From the past studies in the related fielded also present a methodological gap where most analysis is based on County reports lacking quantitative analysis while others uses only descriptive statistics to analyze the data. This study thus, fills the gap by looking at broad construct which give a broader picture of the health service provision. In addition, this study combines both descriptive and inferential statistics to determine the relationships between the study variables. The study therefore hypothesizes that: There is no relationship between devolved resource allocation and quality of health services provision (H01) and there is no relationship between human resource practices and quality of health services provision (H02); Research study was anchored on institutional theory. Descriptive survey was used; The findings of the research will be used by other researcher’s as a reference to what they will do in future not forgetting that it was used as a source of literature review to their studies. 65 respondents were chosen through random sampling that was stratified. The research questionnaires were administered by the researcher himself to the respondents. Focus group discussion was also done to the community members. Data was analyzed through f(n) and descriptive statistics and presented using tables and graphs. The research study established that resource allocation and human resource practices have a great influence in the provision of health services. The study recommends that Governor of Wajir County should develop and formulate guidelines, governing structure and strategic plans for effective implementation of county resources and revenue that will enable provision of quality healthcare.

21st Century Approach: Using data and novel technologies to address the opioid crisis

ObjectiveTo use novel technologies to develop a rapid response framework to reach opioid overdose patients in an area which is challenging from both a geography and population distribution standpoint.IntroductionClark County, Indiana is geographically located in between the urban area of Louisville, Kentucky and Scott County, Indiana. Scott County is the site for the largest HIV outbreak in the history of the United States, directly related to high rates of IV drug abuse. The unique geographic location of Clark County in combination with the recent HIV and Hepatitis C outbreaks in Clark and neighboring counties has greatly informed the development of an effective response to overdoses and the opioid epidemic in general. Furthermore, Clark County has a unique population distribution, with a population of over 125,000 and a land area of over 300 square miles. Despite this large area, over 80% of the population lives within 9 miles of the southern border of the county. This leads to a mix of both urban and rural challenges. There are several areas of the county that have greater than 15 minute emergency response times, which is often the difference between life and death in an overdose situation. These factors led to the development of the Clark County Rapid Response Project. The rapid response project is a community-based, multidisciplinary framework to address the opioid addicted patient, from initial use to successful recovery. The project uses data driven technology to initiate the care of opiate overdose patients and administer lifesaving interventions.MethodsClark County has partnered with the Indiana State Department of Health utilizing the early notification system that monitors statewide overdose activity. Once an alert is sent out, the response involves the use of two early notification systems. Everbridge is a one touch notification system that allows rapid dissemination of information to various community partners to allow them to initiate the appropriate response. Pulse Point is a smart phone application that allows CPR and trained community laypeople to respond to a cardiac arrest or overdose patient in a public place. It provides directions to the patient as well as to the nearest AED. Clark County has also simultaneously instituted a county-wide CPR training initiative and offered Narcan training as well. This is a major paradigm shift, as prior methods of deployment of trained laypeople essentially relied on the chance that an overdose will be reached by a first responder.ResultsEverbridge has allowed for the rapid notification of county entities and deployment of resources to overdose ‘hot spot’ areas. The Pulse Point initiative has dramatically increased the number of CPR and Narcan trained responders and provided means of delivering them to the appropriate patient population in a timely manner. Both these technologies have dramatically increased the delivery of resources to the overdose patient and decreased response times to the delivery of care.ConclusionsUsing data driven technology to inform how Clark County Health Department and first responders collectively address the opioid crisis is a novel approach. Since January 2018, Clark County Health Department has used ESSENCE (Electronic Surveillance System for the Early Notification of Community-based Epidemics) to determine where and when an increase of drug overdose activity is occurring throughout the county. This affords county health officials the ability to inform in “near real-time” first responders, the emergency department and other community stakeholders, relevant information thus allowing for the rapid deployment of county resources to the areas most affected. Our collective efforts to save lives is further enhanced by the county using of novel technologies like Pulse Point which is used to deploy both CPR and Narcan trained laypersons directly to sites in the community where overdoses are occurring. In a community, which is in large part considered rural and, in many places, has a greater than 15 minute emergency response time, using Pulse Point and Everbridge technologies has uniquely positioned Clark County to be on the cutting edge of saving lives as we leverage data and technology to address the opioid epidemic in our communities. This has markedly improved access to treatment and response times to overdose patients in Clark County, Indiana.

Should plastics be a source of energy?

In Rahway, N.J., near Route 1&9, looming cooling towers and a huge white smokestack dwarf the nearby car dealerships, fast-food joints, and motels. The installation is visible for miles and is a familiar landmark to the highway’s regulars, but likely few of them know what is going on inside. The structure is the Union County Resource Recovery Facility, a waste-to-energy facility that Covanta operates on behalf of the local government. Instead of the usual coal or natural gas, it burns garbage to make electricity. Inside, a parade of garbage trucks from all around the county tilt their loads onto the facility’s floor. What comes in is the assorted dross the local citizenry throws out that isn’t suited for paper, metal, and plastics recycling bins. Workers bulldoze unwanted toys, old pillows, broken furniture, and heaps of plastic garbage bags into a 10-meter-deep pit. Two steel claws the size of delivery vans

Worldwide Fracture Prediction

The substantial increase in the burden of non-communicable diseases in general and osteoporosis in particular, necessitates the establishment of efficient and targeted diagnosis and treatment strategies. This chapter reviews and compares different tools for osteoporosis screening and diagnosis; it also provides an overview of different treatment guidelines adopted by countries worldwide. While access to dual-energy X-ray absorptiometry to measure bone mineral density (BMD) is limited in most areas in the world, the introduction of risk calculators that combine risk factors, with or without BMD, have resulted in a paradigm shift in osteoporosis screening and management. To-date, forty eight risk assessment tools that allow risk stratification of patients are available, however only few are externally validated and tested in a population-based setting. These include Osteoporosis Self-Assessment Tool; Osteoporosis Risk Assessment Instrument; Simple Calculated Osteoporosis Risk Estimation; Canadian Association of Radiologists and Osteoporosis Canada calculator; Fracture Risk Assessment Calculator (FRAX); Garvan; and QFracture. These tools vary in the number of risk factors incorporated. We present a detailed analysis of the development, characteristics, validation, performance, advantages and limitations of these tools. The World Health Organization proposes a dual-energy X-ray absorptiometry-BMD T-score ≤ -2.5 as an operational diagnostic threshold for osteoporosis, and many countries have also adopted this cut-off as an intervention threshold in their treatment guidelines. With the introduction of the new fracture assessment calculators, many countries chose to include fracture risk as one of the major criteria to initiate osteoporosis treatment. Of the 52 national guidelines identified in 36 countries, 30 included FRAX derived risk in their intervention threshold and 22 were non-FRAX based. No universal tool or guideline approach will address the needs of all countries worldwide. Osteoporosis screening and management guidelines are best tailored according to the needs and resources of individual counties. While few countries have succeeded in generating valuable epidemiological data on osteoporotic fractures, to validate their risk calculators and base their guidelines, many have yet to find the resources to assess variations and secular trends in fractures, the performance of various calculators, and ultimately adopt the most convenient care pathway algorithms.