Reduction Program Research Articles

Stochastic assessment of 3‐D tunnels in near‐fault ground motion using modified domain reduction method

AbstractA robust assessment of tunnels due to uncertainties present in soil and ground motion properties can affect the dynamic response of these structures. In this paper, a stochastic analysis considering an aleatory variability in shear velocity Vs by performing Monte Carlo simulations and assessing its influence on underground tunnels. To numerically assess the response of the soil‐tunnel system to near‐fault earthquake ground motion, the required computational domain usually spans multiple kilometers including both earthquake fault and the structure. Thus, these simulations are computationally expensive. An efficient alternative method, that is, the Domain Reduction Method (DRM), in which a modular two‐step methodology for reducing the computational costs in the large domain analysis is employed. A 3‐D soil‐tunnel structure interaction is modeled to simulate the response of tunnel subjected to an inclined earthquake fault. The numerical simulation of the soil‐tunnel‐fault system is conducted in an open‐source FE package called Multi‐hazard Analysis for STOchastic time DOmaiN phenomena (MASTODON) based on MOOSE framework. The interactive analyses are carried out for three distinct types of soils based on National Earthquake Hazards Reduction Program (NEHRP) provision, that is, soft, medium, and hard, by generating 130 realizations. The results provide many insights into the influence of local site effects, that is, frequency shift for the peak response and the importance of input ground motion characteristics that govern the response of underground structures. The dynamic response of the structure is very sensitive to the uncertainty in rock material properties, especially, the stiffness of the rock sample and the shear wave velocity.

Exploring differences in substance use behaviours among gender minority and non-gender minority youth: a cross-sectional analysis of the COMPASS study.

Research characterizing substance use disparities between gender minority youth (GMY) and non-GMY (i.e. girls and boys) is limited. The aim of this study was to examine the differences in substance use behaviours among gender identity (GI) groups and identify associated risk and protective factors. Cross-sectional data from Canadian secondary school students (n = 42 107) that participated in Year 8 (2019/20) or Year 9 (2020/21) of the COMPASS study were used. Hierarchal logistic regression models estimated current substance use (cigarettes, e-cigarettes, binge drinking, cannabis and nonmedical prescription opioids [NMPOs]). Predictor variables included sociodemographics, other substances, mental health outcomes, school connectedness, bullying and happy home life. Interaction terms were used to test mental health measures as moderators in the association between GI and substance use. Compared to non-GMY, GMY reported a higher prevalence for all substance use outcomes. In the adjusted analyses, GMY had higher odds of cigarette, cannabis and NMPO use and lower odds for e-cigarette use relative to non-GMY. The likelihood of using any given substance was higher among individuals who were involved with other substances. School connectedness and happy home life had a protective effect for all substances except binge drinking. Bullying victimization was associated with greater odds of cigarette, e-cigarette use and NMPOs. Significant interactions between GI and all mental health measures were detected. Findings highlight the importance of collecting a GI measure in youth population surveys and prioritizing GMY in substance use-related prevention, treatment and harm reduction programs. Future studies should investigate the effects of GI status on substance use onset and progression among Canadian adolescents over time.

A Guideline for Greenhouse Gas Emission Reduction and Carbon Sequestration in Forest Sector Based on Thailand Voluntary Emission Reduction Programme

Currently climate change and global warming have significant impact on the environment toward biodiversity and human quality of life. Major cause derives from human activities that produce greenhouse gas emission especially the diffusion of carbon dioxide to the atmosphere. One way to address global warming is to increase the absorption potential of greenhouse gases, especially carbon dioxide. The best natural method is forest adsorption whereby trees absorb carbon dioxide and store it in the form of biomass through photosynthesis. Therefore, forests are a highly efficient source of carbon sinks. The main objective of this research was to implement a methodology for greenhouse gas reduction and carbon sequestration assessments in forest sector according to Thailand's standards known as the Thailand Voluntary Emission Reduction Program (T-VER). According to climate change, reduction of greenhouse gas process will use methodology of T-VER-METH-FOR-01 Version 2 (Sustainable Forestation)andT-VER-TOOL-FOR/AGR-01 Version 2(Calculation for Carbon Sequestration). The Baseline Sequestration/Emissionand Project Sequestration/ Emission as well as plant diversity assessment in project area as greenhouse gas activity will be used for the calculation. The results of this development of prototype project could be used for concluding content of greenhouse gas from 134.72 ha of the research area and it was shown that Baseline Sequestration was 19,618.95 tCO2e. When calculating Project Sequestration for 10 years, carbon content could be increased by 27,617.95tCO2e calculated to be 800.61tCO2e/yr. Therefore, total Project Sequestration was 8,006.13tCO2e.

Composición de la microbiota intestinal en población pediátrica con obesidad: una revisión sistemática

The increasing prevalence of obesity among children and adolescent’s wide is a public health problem, resulting from the interaction of genetic, environmental and lifestyle factors. Obesity can lead to dysbiosis of the gut microbiota. This systematic review aims to gather scientific information available on the composition of gut microbiota in children/ adolescents with overweight/obesity. Research studies were identified through a scientific database (PubMed). The key words used were “Obese” OR “Overweight” AND “adolescent” OR “children” AND “microbiota”. Observational and intervention studies in children/adolescents having either overweight or obesity were included in this review, belonging to the last ten years – from December 2012 to October 2022. The initial search resulted in 409 references, 379 of them were excluded because the participants had major pathologies other than obesity or overweight. From the remaining articles, others were excluded due to not providing information on the number of participants, or not including data on microbiota composition. A total of 16 articles were selected: 12 observational studies and 4 intervention studies. Among the observational studies that compared overweight/obesity vs. normal weight or metabolically unhealthy obese vs. metabolically healthy obese children/adolescents, at least two studies found higher levels of Firmicutes, Proteobacteria, Bacteroidales, Adlercreutzia, Bifidobacterium, Escherichia coli, and Clostridium. Moreover, lower abundances of Bacteroidetes, Verrucomicrobia, Bacteroides, and Akkermansia were observed. Regarding intervention studies consisting of supplementation of oligofructose- enriched inulin and a weight reduction program, higher proportions of Actinobacteria were observed after the intervention. Clostridia was also found in higher abundances after interventions that used a combined strength and endurance training program and a weight reduction program. The findings suggest that obesity decreased microbiota diversity and increases species associated with inflammation. The results are consistent with previous studies in adults. This information will be useful for designing dietary interventions to prevent or reverse dysbiosis in individuals with obesity. Keywords: Obese; Overweight; Adolescents; Children; Microbiota; Intervention studies; Observational studies

INTERVENTIONS TO REDUCE MENOPAUSE SIGNS AND SYMPTOMS IN MENOPAUSE WOMEN A NARRATIVE REVIEW

Introduction: Women who experience menopause will experience a decrease in the hormones estrogen and progesterone that occurs before menopause caused by ovarian atrophy, so it needs to be overcome with pharmacological and non-pharmacological therapy. One type of non-pharmacological therapy is complementary therapy. Objective: This study aims to identify interventions that can be taken to reduce menopausal signs and symptoms. Methods: CINAHL, PubMed, and Sage Journal databases were used for searching articles with sample inclusion criteria of menopausal women, Randomized Controlled Trials or quasi experimental study design, published in 2017-2022, in English, and full text. The exclusion criteria used were the focus of articles discussing interventions to reduce menopausal signs and symptoms with pharmacological therapy, protocol study articles, and pre-proof articles. Results: The search results for 14 matching articles were found. Interventions that can be done to reduce menopausal signs and symptoms are grouped into 4 approaches, namely psychological approaches (self hypnosis and mindfulness stress reduction programs), physical approaches (foot soaking and physical activity), nutritional approaches (herbal medicine, administration of magnesium, fluid nutrition, administration of isoflavones), and combined approaches (electroacupuncture, combined diet guidance and anti-resistance exercises). Conclusions: From the 14 articles obtained, it can be concluded that there are 4 categories of therapeutic approaches that can be taken to reduce menopausal symptoms.It is recommended that further research focus on interventions that are effective in reducing menopausal symptoms.

Systematic Review and Meta-Analysis of the Financial Impact of 30-Day Readmissions for Selected Medical Conditions: A Focus on Hospital Quality Performance.

The Patient Protection and Affordable Care Act (ACA) established the Hospital Quality Initiative in 2010 to enhance patient safety, reduce hospital readmissions, improve quality, and minimize healthcare costs. In response, this study aims to systematically review the literature and conduct a meta-analysis to estimate the average cost of procedure-specific 30-day risk-standardized unplanned readmissions for Acute Myocardial Infarction (AMI), Heart Failure (HF), Pneumonia, Coronary Artery Bypass Graft (CABG), and Total Hip Arthroplasty and/or Total Knee Arthroplasty (THA/TKA). Eligibility Criteria: This study included English language original research papers from the USA, encompassing various study designs. Exclusion criteria comprise studies lacking empirical evidence on hospital financial performance. A comprehensive search using relevant keywords was conducted across databases from January 1990 to December 2019 (updated in March 2021), covering peer-reviewed articles and gray literature. Risk of Bias: Bias in the included studies was assessed considering study design, adjustment for confounding factors, and potential effect modifiers. The review adhered to PRISMA guidelines. Employing Monte Carlo simulations, a meta-analysis was conducted with 100,000 simulated samples. Results indicated mean 30-day readmission costs: USD 16,037.08 (95% CI, USD 15,196.01-16,870.06) overall, USD 6852.97 (95% CI, USD 6684.44-7021.08) for AMI, USD 9817.42 (95% CI, USD 9575.82-10,060.43) for HF, and USD 21,346.50 (95% CI, USD 20,818.14-21,871.85) for THA/TKA. Despite the financial challenges that hospitals face due to the ACA and the Hospital Readmissions Reduction Program, this meta-analysis contributes valuable insights into the consistent cost trends associated with 30-day readmissions. This systematic review and meta-analysis provide comprehensive insights into the financial implications of 30-day readmissions for specific medical conditions, enhancing our understanding of the nexus between healthcare quality and financial performance.

THE EXTENT OF UNDERSTANDING AND IMPLEMENTATION OF DISASTER RISK MANAGEMENT PROGRAMS OF SAN MARIANO NATIONAL HIGH SCHOOL

This study aimed to determine the extent of understanding and implementing disaster risk management at San Mariano National High School. The Participatory School Disaster Management Toolkit, created by Save the Children as a contribution to the implementation of Comprehensive School Safety Pillar 2—School Disaster Management—was the data source for quantitative research, which employed the descriptive-evaluative method. The San Mariano National High School's understanding and implementation of disaster risk management were examined using the mean and standard deviation. A Likert scale was employed to gauge the level of understanding and implementation. Considering the results, although the faculty and staff of San Mariano National High School do not belong to the disaster risk reduction management council, programs and activities for disaster risk reduction are executed successfully. The results also showed that faculty and staff understand and participate in disaster risk reduction, response, and preparedness. However, many faculty members and staff encountered difficulties putting these programs into practice, so they were advised to develop a more comprehensive disaster risk reduction management plan that would meet the needs of the school, maintain and upgrade DRR programs, add more members to the DRR organization, purchase and identify facilities and equipment for emergencies, and finally regularly review and assess the implementation of disaster risk reduction programs to achieve very well-implemented DRRM programs.

Implementation of The Convergence Program to Accelerate Stunting Reduction in Sibolga City

<div><table cellspacing="0" cellpadding="0" align="left"><tbody><tr><td align="left" valign="top"><p><em>Sibolga City is one of the priority cities in the effort to accelerate stunting reduction. Sibolga City implements an accelerated stunting prevalence reduction program that involves cross-sectors, better known as the convergence action to accelerate stunting reduction. The purpose of the study was to evaluate the implementation of the convergence program to accelerate stunting reduction in Sibolga City. This research is a qualitative study involving 18 informants from </em> <em>Regional Work U</em><em>nits</em><em> that are members of the Sibolga City </em> <em>S</em><em>tunting Reduction Acceleration Team. This research was conducted in November 2023 in Sibolga City, which consists of 4 sub-districts and 17 villages. Data were collected by conducting Focus Group Discussions and in-depth interviews. Furthermore, Data is analyzed through triangulation of methods, sources, and between researchers. The results of the analysis of the effectiveness of the program show that the quality of human resources and financing sources is good enough to reduce the stunting rate in the kelurahan which is the locus of stunting. Likewise, the results of the analysis of the program implementation process. The program planning that was prepared was in accordance with the problems obtained in the situation analysis and had targeted the locus villages determined in the situation analysis. The implementation and evaluation process has also been carried out well, which ultimately has an impact on reducing the stunting prevalence rate by 11.3%. As an effort to encourage a greater reduction in stunting prevalence, we recommend that the Sibolga City Government increase human resource capacity and funding, encourage the involvement of various parties including the private sector in accelerating stunting reduction programs in Sibolga City, improve coordination between </em><em>Regional Work Units</em><em> in the planning, implementation and evaluation processes and encourage the availability of a quality and sustainable data management system in each village</em></p></td></tr></tbody></table></div><strong><em>Keywords:</em></strong><em> <strong>Accelerate, Convergence, Reduction, </strong><strong>Prevalence, Stunting</strong></em>

Continuing Low Awareness and Use of Pre-exposure Prophylaxis (PrEP) for HIV among People Who Inject Drugs (PWID), San Francisco, 2022.

Clinical trials provide evidence that pre-exposure prophylaxis (PrEP) prevents HIV acquisition including through sharing of injection equipment among people who inject drugs (PWID). However, uptake among many populations at risk for HIV has been slow, particularly among PWID. We examined data from the National HIV Behavioral Surveillance (NHBS) from San Francisco in 2022 to measure PrEP uptake and identify factors associated with PrEP awareness among PWID. Of 479 PWID with HIV-negative or unknown HIV status, 54.9% were aware of PrEP, 5.9% had discussed PrEP with a healthcare provider, and 1.5% had used PrEP in the past year. Lack of PrEP awareness was associated with being age 50 years and older (adjusted odds ratio [aOR] 0.40, 95% CI 0.27-0.60), being men who have sex with women (vs. men who have sex with men, aOR 0.47, 95% CI 0.24-0.92), having a disability (aOR 0.58, 95% CI 0.35-0.95), using heroin as their most frequently injected drug (aOR 0.51, 95% CI, 0.34-0.78), not having tested for HIV, HCV, or an STD in the past year (aOR 0.43, 95% CI 0.28-0.64), and not having access to new sterile needles in the past year (aOR 0.28, 95%CI 0.08-1.00). We found negligible change in the awareness and uptake of PrEP among PWID since previously measured in NHBS in 2018. Low PrEP use among PWID may be addressed by increasing provider discussion of PrEP with their PWID patients and clients during routine care, expanding testing for injection-related infections among PWID, and integrating PrEP access into harm reduction programs.

High-efficiency prediction method for helicopter global/ground noise based on near-field acoustic holography

Noise reduction program design is an effective approach that relies on efficient noise prediction for reducing ground noise during flight. The existing noise prediction methods have the limitations of being computationally expensive or only applicable to far-fields. In this paper, a High-Efficiency Prediction Method (HEPM) for helicopter global/ground noise based on near-field acoustic holography is proposed. The HEPM can predict the global noise based on acoustic modal analysis and has the advantages of high prediction accuracy and low time cost. The process is given as follows: firstly, the rotor noise on the holographic surface in the specified flight is obtained by simulations or experiments. Secondly, the global noise model, which maps time-domain noise to acoustic modes, is established based on near-field acoustic holography and Fourier acoustic analysis methods. Finally, combined with acoustic modal amplitude, the model established enables efficiently predicting the global/ground noise in the corresponding flight state. To verify the accuracy of the prediction method, a simulation study is conducted in hovering and forward flight states using a model helicopter with a 2-meter rotor and Rotor Body Interaction (ROBIN) fuselage. The comparison of HEPM with numerical results shows that the average prediction errors of the global and ground noise are less than 0.3 dB and 0.2 dB, respectively. For a region containing 100000 observers, the computation time of the HEPM is only one-fifth of that of the acoustic hemisphere method, demonstrating the rapidity of the proposed method.

Making waves: Wastewater-based surveillance of cannabis use

Monitoring cannabis consumption holds great interest due to the increasing trend towards its legalization for both medicinal and recreational purposes, despite the potential risks and harms involved. Wastewater-based surveillance (WBS) offers a valuable tool for assessing shifts and patterns in drug consumption and to evaluate law enforcement strategies and harm reduction programs. However, WBS-derived cannabis use estimates have been linked to greater uncertainties compared to other drugs, in part due to the many different routes of administration and a substantial excretion of metabolites in faecal matter. Therefore, the usual approach for estimating consumed amounts and scaling consumption compared to other problem drugs requires a rethink. This viewpoint highlights the progress made in this area and describes the current existing barriers related to in-sewer and in-sample behaviour (e.g., adsorption/desorption mechanisms), analytical procedures used (e.g., sample preparation), and pharmacokinetic aspects (e.g., administration route) linked to cannabis biomarkers in influent wastewater. These need to be addressed to improve the estimation of cannabis use and reflect spatial and temporal trends in the same way as for other drugs. Until then, we recommend being cautious when interpreting wastewater-based cannabis consumption estimates.

The Role of Indonesian Muslim Millennials in Reducing Food Waste towards Sustainable Development Goals: Empirical Analysis PLS-SEM

Food waste is a critical concern under SDGs 12 due to its global welfare implications. Islam, with its substantial following worldwide, can play a role in addressing this issue, particularly through the involvement of Muslim millennials. This study aims to explore the impact of religiosity, product usage efficiency, and intention to reduce food waste, with da’wah, Instagram, and Muslim eating manners as mediators. Quantitative research was conducted through an online survey of Indonesian millennials using purposive sampling. The research model, consisting of five hypotheses, was analyzed using the PLS-SEM analysis method. Results indicate that individual religiosity significantly influences Instagram proselytizing and eating behavior among Muslim millennials. Instagram proselytizing strongly affects millennial Muslim consumer behavior, particularly in terms of food consumption efficiency. Additionally, Muslim millennials’ eating etiquette impacts food consumption efficiency and environmental awareness. The efficiency of food consumption can shape millennials’ intention to reduce food waste. Implications of this study include promoting millennial involvement in food waste reduction, sustainable agricultural practices, improving literacy on food consumption efficiency, incorporating food waste education in Islamic religious curricula, and fostering collaboration among Muslim millennial organizations in Indonesia’s food waste reduction programs.

Adequate iodine nutrition and higher salt intake in Chinese adults aged 18–59 years recommended by international organizations

Iodine deficiency and excessive salt intake have adverse health effects. This study evaluated the iodine level and salt intake in Chinese adults aged 18–59 years after implementing the salt reduction program and compared with both the World Health Organization (WHO) and Chinese recommendations. Adults aged 18–59 years were randomly selected using multi-stage stratified random sampling in coastal urban area (CUA), non-coastal urban area (Non-CUA), coastal rural area (CRA), and non-coastal rural area (Non-CRA) of Fujian Province, China. Iodine, sodium, and creatinine concentrations in spot urine samples were measured. Knudsen equation was used to determine 24-h urinary iodine and sodium excretion. The median urinary iodine concentration (mUIC) and urinary sodium concentration (mUNaC) among adults (n = 3513) were 132.0 μg/L and 4.0 g/d, respectively. The mUIC and median daily iodine intake in CUA, Non-CUA, CRA and Non-CRA were 112.1, 127.5, 128.5, 167.5 μg/L and 189.6, 182.5, 199.4, 236.0 μg/d, respectively. The mUNaC and median daily salt intake (mDSI) in these four areas were 2.4, 2.8, 2.9, 2.9 g/L and 9.8, 10.4, 10.4, 10.6 g/d, respectively. The mUIC and DII of residents were higher in the Non-CRA than in the other three areas (P < 0.05). The UNaC and DSI of residents were lower in the CUA than in the other three areas (P < 0.05). The logistic regression demonstrated that the people living in CUA and Non-CUA consumed less salt compared with those in Non-CRA. Except for Non-CUA, the DII was lower (< 150 μg/d) among women of childbearing age in the low–salt intake group (< 5 g/d) compared with the high–salt intake group (≥ 5 g/d) (P < 0.05). Iodine nutrition in Chinese adults aged 18–59 years was sufficient, but the salt intake was substantially higher than the WHO and Chinese recommendations. Further policy implementation is needed to reduce salt intake and improve the monitoring of iodine levels in Chinese adults, especially in women of childbearing age.

Malnutrition in children under five years in a squatter settlement of Karachi: a case-control study

BackgroundMultidimensional factors such as socioeconomic or environmental factors influence malnutrition. Several studies have strongly linked malnutrition to poverty. Some international studies point to the worse nutritional status of urban slum children than rural children. Limited data is available regarding the nutritional status of slum children in Karachi. This study aimed to determine characteristics of malnourished children in an urban squatter settlement in Karachi, Pakistan.MethodsA case- control study was carried out at the primary healthcare center of a squatter settlement in Karachi, Pakistan. All children under five years of age visiting the primary healthcare center were recruited consecutively. Cases were defined as children with z scores < -2 SD of WHO reference measurements of WFA, HFA, WFH and OFC. The controls were similar in terms of age group but had z scores between − 2SD and + 2SD. A self- structured risk factor questionnaire that included information about sociodemographic, economic and environmental factors as well as child- related characteristics was researcher administered via face-to-face interviews with the mothers of children. Univariate and multivariate logistic regression analyses were conducted. Crude and adjusted odds ratios were calculated with 95% confidence interval.ResultsA total of 280 participants including 140 cases and 140 controls participated in the study. A larger proportion of the sample originated from individuals with low household income. After adjusting for the confounders, childhood malnutrition was significantly associated with a low education level of father (aOR 4.86, 95% CI 2.23–10.60), a monthly income less than 25,000 PKR (89 USD) per month (aOR 7.13, 95% CI 1.67–30.54), pour pit latrine type of toilet (aOR 4.41, 95% CI 2.67–7.3), less than six months of exclusive breast feeding (aOR 3.578, CI 1.58–8.08), inappropriate weaning age (aOR 3.71, 95% CI 1.53-9).ConclusionMalnutrition in children under five years of age in the community is associated with low family income, low paternal education, poor toilet facilities, lack of exclusive breastfeeding and inappropriate weaning age. The implementation of poverty reduction programs, sanitation provision at affordable rates, community-based breast feeding and weaning education intervention are urgently required to efficiently improve children’s nutritional status.

First-hand accounts of structural stigma toward people who use opioids on Reddit

People who use opioids face multilevel stigma that negatively affects their health and well-being and drives opioid-related overdose. Little research has focused on lived experience of the structural levels of stigma toward opioid use. This study identified and qualitatively analyzed Reddit content about structural stigma toward opioid use. Iterative, human-in-the-loop natural language processing methods were used to identify relevant posts and comments from an opioid-related subforum. Ultimately, 273 posts and comments were qualitatively analyzed via directed content analysis guided by a prominent conceptualization of stigma. Redditors described how structures—including governmental programs and policies, the pharmaceutical industry, and healthcare systems—stigmatize people who use opioids. Structures were reported to stigmatize through labeling (i.e., particularly in medical settings), perpetuating negative stereotypes, separating people who use opioids into those who use opioids “legitimately” versus “illegitimately,” and engendering status loss and discrimination (e.g., denial of healthcare, loss of employment). Redditors also posted robust formulations of structural stigma, mostly describing how it manifests in the criminalization of substance use, is often driven by profit motive, and leads to the pervasiveness of fentanyl in the drug supply and the current state of the overdose crisis. Some posts and comments highlighted interpersonal and structural resources (e.g., other people who use opioids, harm reduction programs, telemedicine) leveraged to navigate structural stigma and its effects. These findings reveal key ways by which structural stigma can pervade the lives of people who use opioids and show the value of social media data for investigating complex social processes. Particularly, this study's findings related to structural separation may help encourage efforts to promote solidarity among people who use opioids. Attending to first-hand accounts of structural stigma can help interventions aiming to reduce opioid-related stigma be more responsive to these stigmatizing structural forces and their felt effects.

Factors Associated With Self-Reported Overdose Reversals Using Naloxone in Little Rock, Arkansas: Implications for Harm Reduction Service Delivery in the US South

Background. The Central Arkansas Harm Reduction Project (CAHR) is located in Little Rock, Arkansas, and is the only harm reduction service provider in the city. This quality improvement study was conducted to inform harm reduction programming decisions. Methods. We used CAHR data among clients who reported methamphetamine and/or opioid use (2021-2022; N = 459). We used an explanatory mixed methods design to identify factors associated with self-reported overdose reversals using naloxone. Results. The average number of reversals was 3.27. Nearly all clients (95%) reported methamphetamine use. The use of both methamphetamine and opioids (vs. opioids only; [Formula: see text] = 0.26, p = .04) was positively associated with a higher number of reversals. Our qualitative analysis provided additional context around methamphetamine and overdose, including leveraging community members connected to large networks of people who use drugs. Conclusion. Future CAHR initiatives will focus on expanding public health education around naloxone and fentanyl for a population increasingly using methamphetamine.

Innovation and deadlock in governing disasters and climate change collaboratively - Lessons from the Northern Rivers region of New South Wales, Australia

Both scholars and global policy point to the need for, and effectiveness of, locally-led and collaborative disaster and climate change practices. However, there is a need for analysing how these collaborative approaches are developed and used in practice in different contexts. This paper outlines the use of collaborative approaches by a climate change and disaster community of practice across seven local government areas in the Northern Rivers region, New South Wales, Australia. The region has experienced multiple large-scale flood and bushfire disasters since 2017. This ethnographic study uses established collaborative governance and adaptive governance theoretical frameworks to draw findings from: lived experiences of researchers, 22 interviews with diverse stakeholder groups, in-person and online events and the first author's research diary. The findings indicate that collaborative practice in response to disasters and climate change has resulted in both effective outcomes and multi-dimensional challenges, which have lasting implications for communities across the Northern Rivers region. Three critical leverage points for enhanced collaboration and effectiveness were identified. First, improved use and flow of information such as climate projections and place- and needs-based information. Second, mindset shifts that value community knowledge and contributions, and improved practice through enhancing skills in community development and community-led recovery in disaster and climate change practitioners. Lastly, collectively moving from reactive to proactive responses to climate change and disasters. These insights provide an opportunity for improving the design of community-based risk reduction programs and multi-stakeholder governance arrangements into the future, in the state of New South Wales and beyond.

Cognitive-Motor Dual-Task Performance of the Landing Error Scoring System.

The Landing Error Scoring System (LESS) is a common assessment used to determine biomechanical landing errors. However, this assessment is completed as a single motor task, which does not require additional attentional resources. It is unclear if the LESS can be used to detect cognitive-motor interference (i.e., dual-task cost) in biomechanical errors associated with lower extremity injury. To determine if the LESS is a suitable clinical assessment of dual-task performance in uninjured females and to evaluate whether specific landing criteria are more affected by an additional cognitive load than others. Observational Cross-Sectional Design. Setting: University research laboratory. Twenty uninjured, physically active females participated. Intervention(s): Participants performed the LESS under three different conditions: baseline landing with no cognitive distraction (Single), a visual-based dual-task (Visual), and a number-based dual-task (Number). Mean sagittal, frontal, and total LESS scores were compared between conditions using a one-way repeated measures analysis of variance with Tukey post hoc corrections. Cohen's d effect sizes with 95% confidence intervals were used to determine the magnitude of differences. The frequency of errors for each individual LESS item under the three conditions were compared using Chi-Squared analyses. Participants exhibited greater sagittal plane (P=.013, d=0.91 [0.26, 1.56]) and total (P=.008, d=1.03 [0.37, 1.69]) errors during the Visual condition compared to the Single condition. Frontal plane errors were significantly greater during the Number condition compared to the Single condition (P=.008, d=1.03 [0.37, 1.69]). The frequency of errors observed for each LESS item did not statistically differ between conditions (all P>.05). The LESS was able to detect a dual-task cost in landing errors during both the Visual and Number conditions. We recommend developing clinically-oriented solutions to incorporate similar dual- task paradigms in traditional injury risk reduction programs.

Cannabis donation as a harm reduction strategy: a case study

BackgroundThe United States (US) continues to experience unprecedented rates of overdose mortality and there is increased need to identify effective harm reduction practices. Research from Canada describes cannabis donation through harm reduction agencies as an adjunctive strategy to mitigate the negative consequences of more harmful drugs. This case study describes the operational logistics, feasibility, and potential benefits of a cannabis donation program that was operated through a harm reduction program in rural Michigan.Case presentationWe applied a community driven research approach to gather information from harm reduction program staff about the implementation and evolution of cannabis donation efforts in Michigan. We also examined 20-months (September 2021 through May 2023) of administrative data from a cannabis company to compare the sale and donation of cannabis products. Ten cannabis-experienced harm reduction clients received cannabis donations, with clinical staff determining client interest and appropriateness, and providing weekly pick-up or delivery. To expand product availability and sustainability, we examined administrative data from a commercialcannabis company that volunteered to provide donations. This administrative data suggests that while flower products constitute most of the adult and medical sales, edible, oil, and topical products predominated donations. Further, cost analysis suggests that donations represent only 1% of total gross sales and account for much less than the expected yearly donation amount.ConclusionsResearch suggests there is potential to reduce alcohol and drug use related harms of more dangerous substances through substitution with cannabis. This case study is the first to document cannabis donation as a harm reduction practice in the US and suggests potential for sustainability dependent on state laws. Findings from this case study provide a starting point for inquiry into cannabis donation as a harm reduction strategy in the US; future research is needed to fully understand the individual-level outcomes, public health impacts, necessary legal regulations, and best practices for cannabis donation programs through harm reduction organizations.

Accidental substance-related acute toxicity deaths among youth in Canada: a descriptive analysis of a national chart review study of coroner and medical examiner data.

Substance-related acute toxicity deaths (ATDs) are a public health crisis in Canada. Youth are often at higher risk for substance use due to social, environmental and structural factors. The objectives of this study were to understand the characteristics of youth (aged 12-24 years) dying of accidental acute toxicity in Canada and examine the substances contributing to and circumstances surrounding youth ATDs. Data from a national chart review study of coroner and medical examiner data on ATDs that occurred in Canada between 2016 and 2017 were used to conduct descriptive analyses with proportions, mortality rates and proportionate mortality rates. Where possible, youth in the chart review study were compared with youth in the general population and youth who died of all causes, using census data. Of the 732 youth who died of accidental acute toxicity in 2016-2017, most (94%) were aged 18 to 24 years. Youth aged 20 to 24 who were unemployed, unhoused or living in collective housing were overrepresented among accidental ATDs. Many of the youth aged 12 to 24 who died of accidental acute toxicity had a documented history of substance use. Fentanyl, cocaine and methamphetamine were the most common substances contributing to death, and 38% of the deaths were witnessed or potentially witnessed. The findings of this study point to the need for early prevention and harm reduction strategies and programs that address mental health, exposure to trauma, unemployment and housing instability to reduce the harms of substance use on Canadian youth.