Multipronged Approach Research Articles

Microscopic study of proteins, starch and cell walls in potato trimmings

Potato trimmings are an undervalued food industry by-product and represent a potential source of valuable nutrients such as potato proteins. Cryo-scanning electron microscopy, atomic force microscopy, fluorescence microscopy and Raman microscopy were used to define the structural organisation of the protein fraction in this food side stream. The complementarity of the techniques allowed to localise the proteins in potato trimmings but also revealed the microstructure of these proteins, which were mainly present as aggregates in the cytoplasm, near starch granules and within gelatinised starch. Globules in the aggregates ranged in size from 0.1 to 0.25 μm. Upon acid-based stabilisation, differences in the microstructure of both gelatinised starch and cell walls were observed. These were most apparent in samples stabilised by steered fermentation, and it is suggested that these changes have caused the improved protein extractability (+41%) observed in these samples. A multipronged microscopy approach helps to elucidate the impact of acid-based stabilisation techniques and might explain the positive effect of the stabilisations on protein extractability.

Mineralocorticoid Receptor Antagonists in Diabetic Kidney Disease: Clinical Evidence and Potential Adverse Events

Diabetic kidney disease (DKD) is the leading cause of chronic kidney disease (CKD) globally and is associated with an increased risk of developing cardiovascular disease (CVD). DKD management requires a multipronged approach to decrease the progression of CKD and CVD. Mineralocorticoid receptor antagonists (MRAs) added to renin-angiotensin-aldosterone system blockade and sodium–glucose cotransporter 2 inhibitor therapy reduce the incidence of cardiovascular outcomes and progression of CKD. This review examines the cardiorenal benefits of MRAs and summarizes evidence on potential risks for acute kidney injury, hyperkalemia, and sexual dysfunction for steroidal and nonsteroidal MRAs.

The complexity of immune evasion mechanisms throughout the metastatic cascade.

Metastasis, the spread of cancer from a primary site to distant organs, is an important challenge in oncology. This Review explores the complexities of immune escape mechanisms used throughout the metastatic cascade to promote tumor cell dissemination and affect organotropism. Specifically, we focus on adaptive plasticity of disseminated epithelial tumor cells to understand how they undergo phenotypic transitions to survive microenvironmental conditions encountered during metastasis. The interaction of tumor cells and their microenvironment is analyzed, highlighting the local and systemic effects that innate and adaptive immune systems have in shaping an immunosuppressive milieu to foster aggressive metastatic tumors. Effectively managing metastatic disease demands a multipronged approach to target the parallel and sequential mechanisms that suppress anti-tumor immunity. This management necessitates a deep understanding of the complex interplay between tumor cells, their microenvironment and immune responses that we provide with this Review.

Measuring spontaneous episodic future thinking in children: Challenges and opportunities.

The "Spoon task" is a common measure of episodic future thinking (i.e., ability to imagine hypothetical future events) in children. However, by providing items and prompting children to choose one, this task might not require deliberate and goal-driven episodic future thinking. In contrast, "spontaneous" Spoon tasks may better reflect Tulving's original conception as they minimize environmental cues and verbal prompts. We identify challenges in designing such tasks, including removing the scaffolded intention to act and giving children permission and sufficient motivation to act. Drawing on the comparative literature, we propose methods to overcome these obstacles when designing spontaneous Spoon tasks. Furthermore, sampling from the work of Clayton and colleagues, we advocate for a multipronged approach including two or more of the following methods in order to capture spontaneous behavior: naturalistic observation, virtually administered tasks within the child's home, laboratory experiments, and questionnaires. Our review highlights the importance of spontaneous episodic future thinking and establishes a foundation for future methodologies to study this complex cognitive process.

Exploring the therapeutic and prophylactic potential of bedaquiline in leprosy.

Leprosy remains a significant public health concern despite major strides in treatment and control efforts. The Global Leprosy Strategy 2021-2030 and the National Strategic Plan for Leprosy 2023-2027 majorly focus on facilitating action to reach the goal of zero leprosy. Exploration of new treatment regimens is emphasized as one of the verticals of the multipronged approach for reaching the aforementioned goals. This becomes particularly pertinent in the wake of growing evidence for resistance to the drugs currently being used in the management of leprosy. Repurposed molecules present a very good approach in this direction. The present review aims to explore the potential of bedaquiline, a drug used for multidrug-resistant tuberculosis, as a potential addition to the therapeutic armamentarium of leprosy. Through this narrative review, the authors attempt to look into the available proof of concept, clinical evidence, potential risks, and possible ways forward with bedaquiline in leprosy.

Biopsychosocial Associates of Psychological Distress and Post-Traumatic Growth among Canadian Cancer Patients during the COVID-19 Pandemic.

Understanding both the positive and negative psychological outcomes among cancer patients during the pandemic is critical for planning post-pandemic cancer care. This study (1) examined levels of psychological distress and post-traumatic growth (PTG) among Canadian cancer patients during the COVID-19 pandemic and (2) explored variables that were associated with psychological distress and PTG during the pandemic using a biopsychosocial framework. A cross-section survey was undertaken of patients receiving ongoing care at a regional cancer centre in Ontario, Canada, between February and December 2021. Self-reported questionnaires assessing sociodemographic information, social difficulties, psychological distress (depression, anxiety fear of recurrence, and emotional distress), PTG, illness perceptions, and behavioural responses to the pandemic were administered. Disease-related information was extracted from patient health records. Prevalences of moderate to severe levels of depression, anxiety, fear of recurrence and emotional distress were reported by 26.0%, 21.2%, 44.2%, and 50.0% of the sample (N = 104), respectively. Approximately 43% of the sample reported experiencing high PTG, and these positive experiences were not associated with levels of distress. Social factors, including social difficulties, being female, lower education, and unemployment status were prominent associative factors of patient distress. Perceptions of the pandemic as threatening, adopting more health safety behaviours, and not being on active treatment also increased patient likelihood to experience severe psychological distress. Younger age and adopting more health safety behaviours increased the likelihood of experiencing high PTG. The discriminatory power of the predictive models was strong, with a C-statistic > 0.80. Examining both the positive and negative psychological patient outcomes during the pandemic has highlighted the complex range of coping responses. Interventions that adopt a multi-pronged approach to screen and address social distress, as well as to leverage health safety behaviours, may improve the adjustments in the pandemic aftermath.

Built environment and childhood obesity.

Childhood obesity, an escalating global health challenge, is intricately linked to the built environment in which children live, learn, and play. This review and perspective examined the multifaceted relationship between the built environment and childhood obesity, offering insights into potential interventions for prevention. Factors such as urbanization, access to unhealthy food options, sedentary behaviors, and socioeconomic disparities are critical contributors to this complex epidemic. Built environment encompasses the human-modified spaces such as homes, schools, workplaces, and urban areas. These settings can influence children's physical activity levels, dietary habits, and overall health. The built environment can be modified to prevent childhood obesity by enhancing active transportation through the development of safe walking and cycling routes, creating accessible and inviting green spaces and play areas, and promoting healthy food environments by regulating fast-food outlet density. School design is another area for intervention, with a focus on integrating outdoor spaces and facilities that promote physical activity and healthy eating. Community engagement and education in reinforcing healthy behaviors is necessary, alongside the potential of technology and innovation in encouraging physical activity among children. Policy and legislative support are crucial for sustaining these efforts. In conclusion, addressing the built environment in the fight against childhood obesity requires the need for a comprehensive, multipronged approach that leverages the built environment as a tool for promoting healthier lifestyles among children, ultimately paving the way for a healthier, more active future generation.

Impact of Interventions on Medication Adherence in Patients With Coexisting Diabetes and Hypertension.

The coexistence of diabetes and hypertension is prevalent due to shared risk factors. Pharmacological treatment has been reported to be effective in managing both conditions. However, treatment effectiveness depends on the extent to which a patient adheres to their treatment. Poor adherence to long-term treatment for chronic diseases is a growing global problem of significant magnitude. Several interventions have been developed to help improve medication adherence in patients with coexisting diabetes and hypertension. This review aimed to determine the characteristics of these interventions and their impact on medication adherence. A systematic review of the literature was conducted using the PRISMA guidelines and registered in the PROSPERO International Registry of Systematic Reviews. Studies were searched in the databases CINAHL, Embase and Medline to identify relevant articles published during 2012-2023. The search concepts included 'medication adherence', 'hypertension', 'diabetes' and 'intervention'. Studies were included if they were in English and evaluated the impact of an intervention aimed at promoting adherence to medications for both diabetes and hypertension. Seven studies met the inclusion criteria, with five demonstrating a statistically significant improvement in medication adherence. Of the five studies that improved medication adherence, four were multifaceted and one was a single-component intervention. All successful interventions addressed at least two factors influencing non-adherence. Patient education was the foundation of most of the successful interventions, supported by other strategies, such as follow-ups and reminders. Multifaceted interventions that also included patient education had a positive impact on medication adherence in patients with coexisting diabetes and hypertension. Improving adherence in patients with coexisting diabetes and hypertension requires a multipronged approach that considers the range of factors impacting medication-taking. This systematic review provides comprehensive insights into the benefits of patient-centred approaches in intervention development and strengthening. Such patient involvement ensures that medication adherence interventions are more relevant, acceptable and effective, ultimately leading to better health outcomes and more meaningful patient engagement in healthcare research.

Prevalence and associated factors of non-adherence to antihyperlipidemic medication: a nationwide cross sectional survey in Pakistan

Hyperlipidemia significantly contributes to the risk of developing cardiovascular diseases. However, about half of the patients do not adhere to their antihyperlipidemic medications, leading to healthcare costs and premature mortality. This study's objective was to determine the prevalence and associated factors of non-adherence to antihyperlipidemic medications. The study covered hypertensive patients (21,451) aged 21–75 years, presenting to the primary and secondary healthcare facilities across Pakistan (covering 21 divisions) from January 2022 to April 2023. The outcome intended was non-adherence to antihyperlipidemic medication, which was assessed by SEAMS and pill-counting methods (non-adherence < 80%). The study found overall non-adherence to antihyperlipidemic medication of 60.6% across Pakistan, with the highest non-adherence rates found in Azad Jammu and Kashmir (71.9%) and the lowest in Islamabad (47.7%). Multivariable logistic regression analysis revealed that female, no health card (Sehat Sahulat Program government insurance), < 5 years of illness, < 5 daily medications, and dose frequency of twice daily revealed a positively significant association with non-adherence. While monthly income 51,000–100,000, graduation level of education, Muhajir, and hyperlipidemia with one comorbid condition had a significant negative association with the non-adherence. Antihyperlipidemic non-adherence is a multifaceted, multifactorial, profound problem requiring a multipronged approach.

Deaths Related to Domestic Violence in Washington State.

Domestic violence (DV; including intimate partner and family violence) is associated with heightened lethality risks, yet limited research has comprehensively assessed the connection between DV and fatal violence considering both homicides and suicides. Understanding the fatal consequences of DV can point to missed opportunities to support individuals and their families. To assess the proportion of violent deaths that were connected to DV and describe contacts with the legal system or social services prior to each DV-related fatality. This cross-sectional study used quantitative and qualitative data from the National Violent Death Reporting System (NVDRS) for all individuals who died by homicide or suicide in Washington from January 1, 2015, to December 31, 2020. Analyses were conducted from August 1, 2022, to September 30, 2023. A multipronged approach was used to assess DV history using existing NVDRS variables, leveraging data from prior review of NVDRS death narratives, applying a validated natural language processing tool, and linking related deaths. Domestic violence was recorded as yes or no, but the decedent's role in the abusive relationship (ie, experiencing or enacting DV) could not be differentiated. To describe system involvement prior to each death, keyword searching and hand review of NVDRS death narratives were used. A total of 7352 intentional violent deaths (1192 homicides [16.2%]; 6160 suicides [83.8%]) with known circumstances were recorded in Washington during the study period. Of these, 948 deaths (12.9%) were connected to DV (624 [65.8%] among males; mean [SD] age at death, 45.3 [19.2] years), including 588 suicides (62.0%) and 360 homicides (38.0%). For 420 DV-related deaths (44.3%), there was evidence to suggest that the person who died or their intimate partner(s), family, or cohabitants had prior contacts with the legal system or social services. Specifically, 318 records (33.5%) mentioned prior contacts with law enforcement or the criminal legal system (eg, prior 9-1-1 calls, criminal convictions), and 225 (23.7%) described engagement with social services or the civil legal system (eg, civil protection order, divorce, or child custody problems). In this cross-sectional study, 12.9% of violent deaths in Washington were connected to DV. The findings suggest that more resources are needed to support law enforcement, court professionals, and social services specialists to proactively identify and refer families to wraparound supports before the situation can escalate to a fatality.

Advancing Antibiotic-Resistant Microbe Combat: Nanocarrier-Based Systems in Combination Therapy Targeting Quorum Sensing.

The increase in antibiotic-resistant bacteria presents a significant risk to worldwide public health, emphasizing the necessity of novel approaches to address infections. Quorum sensing, an essential method of communication among bacteria, controls activities like the formation of biofilms, the production of virulence factors, and the synthesis of secondary metabolites according to the number of individuals in the population. Quorum quenching, which interferes with these processes, emerges as a vital approach to diminish bacterial virulence and prevent biofilm formation. Nanocarriers, characterized by their small size, high surface-area-to-volume ratio, and modifiable surface chemistry, offer a versatile platform for the disruption of bacterial communication by targeting various stages within the quorum sensing pathway. These features allow nanocarriers to infiltrate biofilms, disrupt cell membranes, and inhibit bacterial proliferation, presenting a promising alternative to traditional antibiotics. Integrating nanocarrier-based systems into combination therapies provides a multi-pronged approach to infection control, enhancing both the efficacy and specificity of treatment regimens. Nonetheless, challenges related to the stability, safety, and clinical effectiveness of nanomaterial-based antimicrobial treatments remain. Continued research and development are essential to overcoming these obstacles and fully harnessing the potential of nano-antimicrobial therapies. This review emphasizes the importance of quorum sensing in bacterial behavior and highlights the transformative potential of nanotechnology in advancing antimicrobial treatments, offering innovative solutions to combat antibiotic-resistant pathogens.

Reaching Youth Smokers Through a Multipronged Approach: Comparison of Three Recruitment Methods of a Youth Quitline in Hong Kong

PurposeUsing multipronged recruitment strategies is crucial for reaching diverse smokers, yet research specifically focusing on youths is lacking. This prospective study compared the characteristics and abstinence outcomes of youth smokers enrolled in a youth-centered cessation service by three different methods. MethodsFrom December 2016 to February 2022, the Youth Quitline enrolled 1,197 smokers aged 10–25 (mean = 19.4) years through traditional method (incoming calls or referrals, n = 276), proactive outreach (n = 735), and online method (website or social media platforms, n = 186). Logistic regression was used to calculate the odds ratio (OR) of biochemically validated tobacco abstinence at 6 months by recruitment methods. ResultsProportionally more participants recruited via online method than traditional method and outreach had moderate to heavy nicotine dependence (53.2% vs. 40.9% vs. 27.6%, p < .001), poor self-rated health (27.6% vs. 21.9% vs. 12.3%, p < .001), and risk of depression (51.4% vs. 42.5% vs. 37.4%, p = .003). More participants recruited by outreach (71.6%) had no intention to quit in 30 days than traditional (58.3%) and online (59.7%) methods (p < .001). Compared with traditional method, the 6-month validated abstinence rate was similar in smokers recruited by online method (crude OR 0.77, 95% confidence interval 0.44–1.34) but significantly lower in those recruited by outreach (crude OR 0.44, 95% confidence interval 0.28–0.67). Results were similar after adjusting for sociodemographic and baseline predictors of abstinence. DiscussionOnline recruitment can attract youth smokers with greater nicotine dependence and poorer health, whereas outreach can engage those with less motivation to quit. The lower quit rate in outreach-recruited participants indicated the need for more effective interventions.

Identification and Management of Dental Anxiety by New Zealand Dentists.

More than 1 in 8 New Zealand (NZ) adults are dentally anxious, which can lead to avoiding dental care and a higher risk of poor oral health. However, little is known about how dentally anxious patients are identified and managed by NZ general dentists. This survey aimed to investigate how NZ dentists identify and manage dentally anxious patients. We conducted an email survey of NZ dentists in 2022, obtaining 212 responses. Along with demographic information, respondents were queried about whether they ask patients about past/current dental fears and their likely origin, how they assessed those fears, their usual management of dentally anxious patients, and how the management of dentally anxious patients could be improved. Almost three-quarters reported personally asking patients about past and/or current dental fears, and half enquired about bad life experiences that had led to those fears. Only 6 respondents (2.8%) reported using a formal dental anxiety/phobia assessment tool prior to treatment. For managing severely anxious adult dental patients, all dentists used at least 1 pharmacologic or psychological technique or referral to a colleague. The study identified several weaknesses among NZ dentists in identifying and managing dental anxiety patients. The use of formal dental anxiety/phobia assessment tools prior to treatment needs improvement. Addressing dental anxiety is a complex issue that requires a multipronged approach involving improved education, the development and implementation of better assessment tools, and a greater understanding of how dentists' current assessment and management of dental anxiety can be improved.

Moving Sustainability from the Periphery to the Core in Your Organization

Abstract: This article presents a holistic, multi-pronged approach to effectively implementing sustainability initiatives within an organization. The article argues that sustainability efforts often fail without establishing a solid foundation, including gaining executive commitment by emphasizing the business case and defining clear, measurable goals. Next, internal and external stakeholders must be educated and engaged to build understanding and support. Sustainability should then be systematically integrated into core operations through practices like sustainable procurement and facilities management. Regular measurement and reporting of progress indicators keeps sustainability visible and ensures accountability. Ultimately, the author asserts that sustainability must be cultivated as an enduring part of organizational culture through ongoing communication, recognition of champions, and incentive structures to survive changes in priorities over time. With persistent, strategic work establishing these foundational elements, the article concludes that organizations can meaningfully advance their sustainability performance.

Advancing culturally responsive-sustaining computer science through K-12 teacher professional development strategies

To address racial and gender inequality in K-12 computer science (CS) education, there needs to be a multi-pronged approach. In addition to curricula that are culturally responsive and sustaining inclusive, K-12 CS teachers need to be equipped to implement the curriculum, pedagogy, and instruction to mitigate the racial and gender gaps in classrooms. Key results showed significant improvements in teachers’ confidence in carrying out culturally responsive-sustaining practices upon the completion of PD to improve teachers’ pedagogy within K-12 classrooms. A three-month follow-up showed that teachers integrated the CRCS practices to different degrees. Furthermore, examples of how the framework was integrated are shared. The PD and associated findings were made available as proposed scalable and replicable models for in-service CS teacher PD across the nation.

Interpretable machine learning tools to analyze PM2.5 sensor network data so as to quantify local source impacts and long-range transport

Sensor networks provide spatially resolved information about the time variation of PM2.5 concentrations in urban areas around the world. With relatively simple improvements to the control of the temperature and humidity of incoming air, and with proper quality assurance and calibration protocols, a low cost monitor was developed that provides measurements that were highly correlated with a reference PM2.5 monitor. These have sufficient resolution and reliability to quantify small differences within an urban area. Nevertheless, many sites report similar concentrations and it can be difficult to interpret the results or distinguish local from regional effects. Generalized Additive Models are an effective Machine Learning method to distinguish the impact of factors across very different scales. As a type of Interpretable Machine Learning / eXplainable Artificial Intelligence, they provide direct information on the link between specific factors and PM2.5 concentrations. GAM simulations were developed for sensors located around Dhaka, Bangladesh, for both the dry and the wet seasons. The simulations show that the largest contributor to high PM2.5 concentration variations across both urban and peri-urban sites is the boundary layer height which represent the vertical mixing of the urban plume. Using Trajectory Cluster Concentration Impacts, the simulations showed that robust estimates of long-range transport could be obtained from measurements located within a polluted environment, and the model further showed that enhancements of more than 40μg/m3 were associated with air transport from the Indo-Gangetic Plain in the dry season. Finally, interaction maps of the effect of horizontal wind speed and direction showed that these could be associated with up to +/−20 % variation in PM2.5 from site to site. Most of the enhancements are related to very calm winds and appear to be more strongly associated with road emissions than with point sources. Overall, the sensor network shows that air is polluted throughout the Dhaka area and into the peripheries, and that a multipronged approach will be needed to improve air quality for its inhabitants.

Pattern of anxiety, depression, and suicidality among in-school adolescents in Bauchi, North-East Nigeria

Background: Adolescence is a crucial period of development resulting in significant changes in physical appearance, and psychological functioning. Globally, mental health disorders account for 16% of the global burden of disease and injury in adolescents. The study aims to provide baseline information on adolescents' mental health in Bauchi State. Methods: A cross-sectional study design was employed in this study. Using systematic sampling technique, 672 in-school adolescents aged 10-19 who gave assent/consent were selected. SPSS was used to analyze the data. Results: The mean age of the respondents was 15±2.0, more respondents had no or minimal depression (65.0). However, 0.7% were moderately severely depressed. Most respondents (88.7%) had minimal anxiety, while 1.5% and 0.3% had moderate and severe anxiety respectively. Almost one-quarter of the respondents (23.2%) had thought of ending their life in the past month before the survey with up to 4.2% attempting suicide. Adolescents from polygamous settings were up to 70% less likely to attempt suicide compared to those in a monogamous setting and this was statistically significant with a p-value of 0.039 and CI (0.167-0.785). Furthermore, those whose parents were not in a marital union were 2.9 times more likely to attempt suicide compared to those whose parents were still in union and living together. This was statistically significant with a p-value of 0.018 and CI (1.203-7.060). Conclusions: Early intervention and a multi-pronged public health approach are crucial to safeguard this vulnerable population's mental well-being to enable them to thrive and reach their full potential.

A multi-pronged approach to assessing antimicrobial resistance risks in coastal waters and aquaculture systems

Antimicrobial resistance (AMR) is a global challenge that has impacted aquaculture and surrounding marine environments. In this study, a year-long monitoring program was implemented to evaluate AMR in two different aquaculture settings (i.e., open cage farming, recirculating aquaculture system (RAS)) and surrounding marine environment within a tropical coastal region. The objectives of this study are to (i) investigate the prevalence and co-occurrence of antibiotic-resistant bacteria (ARB), antibiotic resistance genes (ARGs), antibiotics (AB) and various associated chemical compounds at these study sites; (ii) explore the contributing factors to development and propagation of AMR in the coastal environment; and (iii) assess the AMR risks from different perspectives based on the three AMR determinants (i.e., ARB, ARGs and AB). Key findings revealed a distinct pattern of AMR across the different aquaculture settings, notably a higher prevalence of antibiotic-resistant Vibrio at RAS outfalls, suggesting a potential accumulation of microorganisms within the treatment system. Despite the relative uniform distribution of ARGs across marine sites, specific genes such as qepA, blaCTX−M and bacA, were found to be abundant in fish samples, especially from the RAS. Variations in chemical contaminant prevalence across sites highlighted possible anthropogenic impacts. Moreover, environmental and seasonal variations were found to significantly influence the distribution of ARGs and chemical compounds in the coastal waters. Hierarchical cluster analysis that was based on ARGs, chemical compounds and environmental data, categorized the sites into three distinct clusters which reflected strong association with location, seasonality and aquaculture activities. The observed weak correlations between ARGs and chemical compounds imply that low environmental concentrations may be insufficient for resistance selection. A comprehensive risk assessment using methodologies such as the multiple antibiotic resistance (MAR) index, comparative AMR risk index (CAMRI) and Risk quotient (RQ) underscored the complexity of AMR risks. This research significantly contributes to the understanding of AMR dynamics in natural aquatic systems and provides valuable insights for managing and mitigating AMR risks in coastal environments.

Preventing overdoses involving stimulants: the POINTS study protocol

BackgroundIn 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.MethodsOur 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.DiscussionCompletion 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.

Challenges to the adoption of biomimicry as a sustainable approach in the Nigerian construction industry

ABSTRACT Nigeria's construction industry, which mirrors a global trend, actively seeks methods to ensure a sustainable future. Sustainable construction practices have become a focal point for research and development, and biomimicry presents significant potential in achieving this goal. However, despite its advantages, challenges impede its widespread adoption. This study employed a multi-pronged approach, combining an in-depth literature review with descriptive and exploratory factor analysis (EFA) of data collected through well-structured questionnaires administered to construction professionals. The study of 243 responses, alongside existing literature, suggests that a lack of awareness regarding biomimicry principles presents the primary barrier to its adoption. Furthermore, the identified challenges were categorised into three distinct groups: regulatory, institutional, and attitudinal. To address the challenges of biomimicry adoption in the construction industry, the paper proposes a three-pronged solution: implementing regulatory measures, improving professional practices, and prioritising stakeholder education.