Restrictive Policies Research Articles

Using hybrid automata to model mitigation of global disease spread via travel restriction

<abstract><p>Inspired by the COVID-19 pandemic, we build a large-scale epidemiological model that accounts for coordination between regions, each using travel restrictions in order to attempt to mitigate the spread of disease. There is currently a need for simulations of countries cooperating since travel restriction policies are typically taken without global considerations. It is possible, for instance, that a strategy which appears unfavorable to a region at some point during a pandemic might be best for containing the global spread, or that only by coordinating policies among several regions can a restriction strategy be truly effective. We use the formalism of hybrid automata to model the global disease spread among the coordinating regions. We model a connected network of coupled Susceptible-Exposed-Infected-Recovered (SEIR) models by considering a weighted directed graph with each node corresponding to a single region's disease model. The SEIR dynamics for each region admit terms for inter-regional travel determined by the graph's Laplacian that additionally accounts for travel restrictions between regions. The existence of an edge may change according to so-called guard conditions, which are triggered when the proportion of symptomatic infected individuals in a region reaches a critical value. Lastly, we run simulations in MATLAB of a global disease spreading among regions using automated travel restrictions and analyze the results.</p></abstract>

Fundamental analysis of the firm on stock returns in the uncertainty caused by the COVID-19 pandemic: The case of emerging economy

This paper refers to a previous study of Barua (2020), which shows the impact of the pandemic on aggregate demand and supply. The novelty and the purpose of this study is to examine the fundamental impact arising from the uncertainties created by the COVID-19 pandemic caused by the Indonesian government restrictions policy (spectrum) on stock returns of the sample companies listed on the Indonesia Stock Exchange (IDX) with a minimum of 200 trading days in 2020 from 2016 to 2020. This study used multiple regression analysis and cross-sectional for the cumulative abnormal return (CAR). The result shows that the fundamentals tested had no significant effect on cumulative abnormal returns. On the other hand, only the current ratio showed a significant effect on Spectrum 1 and 4; Spectrum 1 had a positive effect while Spectrum 4 had a negative effect, and the debt service coverage ratio (DSCR) had a slightly significant effect on Spectrum 1. The study results indicate that each spectrum had different levels of uncertainty, which gave rise to different perspectives for each investor. This study provides a perspective for investors to see different levels of uncertainty on the current ratio (CR) and DSCR as determinants of fundamentals for investment consideration.

ЧТО ПОВЛИЯЛО НА УРОВЕНЬ СМЕРТНОСТИ ОТ COVID-19 В ИНДОНЕЗИИ?

This paper systematically identifies the determinants of COVID-19 death rates at the initial stages of the outbreak in Indonesia by considering configurations of government conditions (responsiveness, ability to control case rate, and capacity to cure infected people) and societal conditions (vulnerability and compliance). Configurational analysis using crisp-set QCA was employed to analyze these sets of conditions and outcomes in 34 provinces throughout Indonesia. The results show that the high ability of local government to control the spread of the disease is a necessary and sufficient condition for a low death rate. However, the opposite condition (the low ability of government) is only necessary but not sufficient for a high fatality rate. To create sufficient conditions for a high death rate, the low ability of local governments to restrain the spread of the virus requires other specific conditions, particularly a low level of community obedience to the restriction policy. The present study highlights that the institutionalization of a new normal life during the pandemic through regulative, normative and cultural-cognitive mechanisms is of paramount importance.

The Effect of Supply Uncertainty on Dynamic Procurement and Pricing Strategies Under Lost Sales

The uncertainty in the supplier’s material flows has become a norm rather than an exception in supply chains. The supply uncertainty can result in unexpected inventory shortfall, amplifying lost sales. However, the design of inventory replenishment and product pricing policy to mitigate both supply uncertainty and demand loss remains unexplored. This is because the resulting dynamic planning problem is highly nonconcave and thus intractable. To address this challenge, we propose an approach that focuses on a class of intuitively appealing and practically plausible policies. Specifically, as the level of on-hand inventory increases, we expect an increased amount of demand fulfillment and a decreased product price. Applying the notions of stochastic functions, we show that, under general conditions of the stochastic supply and demand functions, the dynamic planning problem becomes a concave optimization problem over the restricted policy class. We further reduce the set of candidate policies to a refined class by excluding the dominated policies. A refined policy can be easily computed, and appropriately selected refined policies produce close-to-optimal profits. These developments allow us to evaluate the consequences of demand loss. In particular, demand retention through backordering can be beneficial when overstocking is costly in relation to understocking, but the benefit is insensitive to supply and demand uncertainties. Moreover, inventory-based dynamic pricing is more valuable in mitigating supply risk under lost sales than under backordering.

Experiences of delay-causing obstacles and mental health at the time of abortion seeking

ObjectivesThe delays and challenges people encounter when seeking abortion are well-documented, but their psychological implications are understudied. Aiming to fill this gap, we explored the associations between experiences of delay-causing obstacles to abortion care and adverse mental health symptoms among individuals seeking abortion care. Study designIn 2019, we surveyed 784 people (of 1092 approached) ages 15–45 accessing abortion care in four clinics in abortion-supportive states: California, Illinois, and New Mexico. We conducted multivariable Poisson regressions to examine associations between experiencing delay-causing obstacles to abortion care and stress, anxiety, and depression at the abortion appointment. We also used Poisson regression to examine whether some individuals are more likely to experience delay-causing obstacles than others. ResultsThree in five participants (58%) experienced delay-causing obstacles when accessing abortion care. The most prevalent obstacles were cost-related (45%), followed by access-related (43%), and travel time-related (35%) delays. In adjusted analyses, experiencing any type of delay-causing obstacle to abortion care was significantly associated with more symptoms of stress, anxiety, and depression and higher risk of anxiety and depressive disorders. Participants were more likely to experience delay-causing obstacles if they traveled from another state or over 100 miles to reach the clinic, sought abortion beyond 13 weeks gestation, lacked money for unexpected expenses, and found it difficult to pay for the abortion. ConclusionAbortion is a time-sensitive healthcare, but most individuals are forced to delay care due to various obstacles that may have a negative impact on their psychological well-being. ImplicationsObstacles causing delays in accessing abortion care may contribute to elevated symptoms of stress, anxiety, and depression and higher risk of anxiety and depressive disorders for abortion patients. As restrictive policies increase, delays are likely to worsen, potentially leading to psychological harm for people seeking abortion.

Pandemic Patient Engagement Success: Maintaining Family Presence Through Partnership

This presentation is relevant for patients of hospitals and residents of long-term care facilities, their loved ones and essential partners in care, and staff and leadership of healthcare facilities.
 A painful pandemic challenge for patients, families and staff in hospitals was the absence of loved ones or essential care partners through Family Presence/Visitor Policy restrictions. Leadership at Kingston Health Sciences Centre (KHSC) worked proactively with the Patient and Family Advisory Council and a small, diverse group of Patient Experience Advisors to plan for possible restrictions and consider how best to approach ongoing changes and challenges to the policy expected in the face of the pandemic. The group continues to work together at this time of uncertainty.
 An initial meeting of eight advisors and leaders took place prior to the World Health Organization’s official announcement of the pandemic. Due to growing concern about hospital infections, the meeting venue was a local coffee shop, hence the group became known throughout the hospital as The Balzac’s Group. Synchronous virtual meetings and asynchronous communication were employed by the group to address concerns and create family presence opportunities on a rapid response basis. Group collaboration remains evident as new concerns arise with the ongoing ebb and flow of COVID-19 hospitalizations, staff shortages and less restrictive family presence policies. This partnership has been pivotal to the organization’s pandemic planning and response, enabling family presence while respecting government directives, organizational challenges, and patient/family priorities.
 This collaboration informed several new and sustained initiatives including: a virtual visits process, ePostcards, a Care Partner Program, expanded cell phone use in restricted areas, resources for loved ones traveling distances, careful and measured increases in family presence and a family presence policy Exceptions Committee.
 An unexpected outcome was an increased level of respect and strengthened patient engagement. Factors influencing this success were transparency and trust in sharing sensitive or confidential information, mutual decision-making, frank and honest sharing of both personal and professional perspectives, and active listening. Many KHSC advisors increased their patient partnership activities during the pandemic and felt an enhanced sense of agency in their efforts to improve the patient experience in healthcare.
 
 This initiative may be a source of new ideas, inspiration, and encouragement for patient partners and hospital leaders to actively partner in co-design and delivery of compassionate person-centred policies and care, especially during times of crisis.
 The group continues to be the “go-to” group for family presence policy questions. The strengthened relationship with Patient Advisors has had a spillover effect more broadly into other hospital initiatives and increased awareness of the value of their input. We hope to continue to share this success story broadly to encourage other healthcare facilities to partner with the precious resource of patients, families, and patient advisors, at all levels of health care. We are considering a Patient Advisor led publication in the future.

Unveiling the emergence of multidrug-resistant pathogens in exotic pets from France: a comprehensive study (2017-2019)

Aim: This study intends to assess the occurrence of multi-drug resistant (MDR) resistant pathogens among exotic pets from France (2017-2019). Methods: Isolates were identified using MALDI-TOF-MS. Antimicrobial susceptibility testing was conducted for 21 antimicrobials and was assayed by disk diffusion methods. Statistical analyses were carried out using GraphPad Prism® (version 9.4.1.). Results: Isolates (n = 2,100) recovered from samples of 10 small mammals (n = 1,555), 23 birds (n = 287), and 18 reptiles (n = 208) species were identified as Enterobacterales (n = 634), Pseudomonadaceae (n = 176), Pasteurellacea (n = 276), Staphylococcaceae (n = 563) , Streptococcaceae (n = 259), and Enterococcaceae (n = 186). Consistent high resistance rates were observed among diverse genera and/or species to beta-lactams, tetracyclines, and macrolides. Notably, a significant prevalence of MDR bacteria was identified, with 22.8% (n = 479/2,100, P < 0.05). Furthermore, 23.5% (P < 0.05) of these MDR bacteria displayed resistance to all tested antimicrobials: E. faecalis (n = 47/49; 95.0%), E. coli (n = 19/52; 36.5%), Klebsiella spp. (n = 12/32; 37.5%), S. epidermidis (n = 7/25; 28%), Streptococcus spp. (n = 6/68; 8.8%), Enterococcus spp. (n = 6/23; 26%), Staphylococcus spp. (n = 4/51; 7.8%), Lactococcus spp. (n = 4/8; 50%), Citrobacter spp. (n = 3/7; 42.8%), Raoultella spp. (n = 2/3; 66.6%), Serratia spp. (n = 1/9; 11.1%), Pasteurella spp. (n = 1/14; 7.1%), and S. xylosus (n = 1/28; 3.5%). Conclusions: This study emphasizes exotic pets as an emergent reservoir of MDR bacteria, focusing on E. faecalis as a potential route of transmission of MDR bacteria to humans, other animal species and environment. Urgent measures, including the establishment of mandatory monitoring for antimicrobial resistance (AMR) and the enforcement of restrictive antibiotic use policies in exotic pets, should be implemented to mitigate the risk of further spread and safeguard public and animal health.

Relationships Between Alcohol and Cannabis Policies in U.S. States, 1999-2019.

A crucial question regarding the public health impacts of cannabis legalization is its impact on alcohol consumption and alcohol-related harm. However, little is known about whether these changing cannabis policies are occurring in liberal or in restrictive alcohol policy environments, either of which likely affect public health outcomes. We constructed comprehensive state-level alcohol and cannabis policy indices and explored relationships between them. We assessed relationships between the Alcohol Policy Scale (APS) and the Cannabis Policy Scale (CPS) from 1999 to 2019. The APS and CPS were based on 29 and 17 state-level policies, respectively, and each policy was weighted for its relative efficacy and degree of state-year implementation. From 1999 to 2019, average state APS scores increased modestly (became more restrictive) by 4.11 points (2019 M = 43.23, range: 24.44-66.31) and average CPS scores decreased (became less restrictive) by 15.33 points (2019 M = 76.40, range: 29.40-95.74) on a 100-point scale. In 2019, average APS scores were similar among states that prohibited (criminalized) possession of cannabis (42.00), decriminalized possession (41.33), legalized medical cannabis (44.36), and legalized recreational cannabis (43.32). Across states, there was no correlation between the restrictiveness of state-level alcohol and cannabis policies (r = .03, p = .37) in unadjusted models, although there was some variation by time, geographic region, and political party, with a weak negative correlation in state fixed-effects models. Although cannabis policies liberalized rapidly from 1999 to 2019, alcohol policies stayed relatively stable and did not differ by degree of cannabis policy liberalization. In general, there were weak associations between cannabis and alcohol policies among states; however, there was some temporal, regional, and political variation.

Analysis of nickel export restriction and downstream policy in Indonesia

With 21 million metric tons of nickel deposits, or ? of global reserves, Indonesia possesses an abundance of the metal. The purpose of this study is to evaluate the export and processing policies of the Indonesian government regarding nickel and how they relate to global nickel requirements in light of future energy estimates. This study's methodology, which gathers information from official websites, government papers, mass media, and literature, is based on qualitative assumption analysis. The findings indicate that a revision is necessary to ESDM Ministerial Regulation Number 11 of 2019. This policy has a negative effect since the government failed to consider a number of factors while drafting it, including the effects on the environment, the disparity in benefits between China and Indonesia, and the distribution of social implications. Since this policy fosters future national economic progress, it can be deemed appropriate. Impacts on social, environmental, and national resilience still need to be taken into account. The study's findings indicate that, although expert assumptions and a number of other factors on social and environmental issues vary, the government's assumptions, which give priority to the economic sector, do not. The notion of nickel's added value is currently the sole issue that the government views as a major concern, despite the fact that downstream nickel applications can have a good societal impact.

Antimicrobial Sales Comparison before and after the Implementation of Nationwide Restriction Policy in Saudi Arabia.

Antimicrobial dispensing without a prescription has been identified as a significant contributor to the burgeoning crisis of antimicrobial resistance. To combat this, the Saudi Ministry of Health introduced a stringent antimicrobial restriction policy in mid-2018, mandating prescriptions for all antimicrobial drug dispensations at pharmacies. Therefore, this study aimed to assess the immediate impact of this policy on retail antimicrobial sales. To do so, we analyzed annual sales data from 2017 to 2019 sourced from the IQVIA-MIDAS® database, which included a range of antimicrobials, such as antibiotics, antifungals, and other related agents. The analysis revealed a notable reduction in overall antimicrobial sales by 23.2%, decreasing from 818.9 million SAR in 2017 to 648.4 million SAR in 2019. While the Wilcoxon signed-rank test indicated a statistically significant median reduction in total antimicrobial sales post-policy implementation (p = 0.0397), it is important to acknowledge that the long-term effects and adherence to the policy require further investigation. Notably, sales of amoxicillin dropped by 70% in 2019 compared to 2017, contributing largely to the decline. Conversely, a continuous increase in sales of some antimicrobial drugs following the restriction policy was observed, led by amoxicillin/clavulanic acid. Our data support the implementation of antimicrobial restriction measures as an effective means of controlling excessive antimicrobial sales and dispensing without prescriptions.

Unlocking Insights: Analysing COVID-19 Lockdown Policies and Mobility Data in Victoria, Australia, through a Data-Driven Machine Learning Approach

The state of Victoria, Australia, implemented one of the world’s most prolonged cumulative lockdowns in 2020 and 2021. Although lockdowns have proven effective in managing COVID-19 worldwide, this approach faced challenges in containing the rising infection in Victoria. This study evaluates the effects of short-term (less than 60 days) and long-term (more than 60 days) lockdowns on public mobility and the effectiveness of various social restriction measures within these periods. The aim is to understand the complexities of pandemic management by examining various measures over different lockdown durations, thereby contributing to more effective COVID-19 containment methods. Using restriction policy, community mobility, and COVID-19 data, a machine-learning-based simulation model was proposed, incorporating analysis of correlation, infection doubling time, and effective lockdown date. The model result highlights the significant impact of public event cancellations in preventing COVID-19 infection during short- and long-term lockdowns and the importance of international travel controls in long-term lockdowns. The effectiveness of social restriction was found to decrease significantly with the transition from short to long lockdowns, characterised by increased visits to public places and increased use of public transport, which may be associated with an increase in the effective reproduction number (Rt) and infected cases.

Differences in buprenorphine prescribing readiness among primary care professionals with and without X-waiver training in the US

BackgroundMedications for opioid use disorder (OUD) are effective at preventing overdose and infectious disease but are vastly under-prescribed in the US. For decades, prescribers faced additional training and regulation to prescribe buprenorphine which stigmatized the medication and lessened support for a harm reduction approach to treating opioid use disorder. The Drug Enforcement Administration removed the X-waiver requirement for prescribing buprenorphine in late 2022, which removed stigma and lessened important barriers to prescribing but also left training at the discretion of individual organizations. Our study aimed to assess differences in knowledge, confidence, and stigma regarding buprenorphine between those who went through the X-waiver training and those who did not, among practicing primary care providers (PCPs).MethodsWe assessed buprenorphine prescribing readiness among primary care aligned outpatient providers in Ohio, USA. Using survey data, we conducted bivariate and regression analyses predicting primary prescribing outcomes. Primary outcomes measured knowledge of and confidence in buprenorphine, as well as perceived adequacy of one’s training. Secondary outcomes were attitudes toward patients with OUD, including bias toward OUD patients, stress when working with them, and empathy toward them. Participants (n = 403) included physicians, nurse practitioners, and physician assistants practicing in primary care aligned disciplines.ResultsSurvey data showed that PCPs who received X-waiver training were more likely to understand and have confidence in the mechanism of buprenorphine, and consider their training on treating OUD to be adequate. PCPs with an X-waiver showed more empathy, less negative bias, and experienced less stress when working with patients with OUD.ConclusionRemoving restrictive policies for prescribing buprenorphine is an important step to expanding access and reducing the stigma associated with opioid use disorder treatment. Yet, our findings suggest that the training received alongside regulation may be important for improving prescribing confidence and reducing stigma. Strategies to increase buprenorphine prescribing are unlikely to be effective without also expanding access to prescribing support for primary care providers across the career course.

The Infiltration of Necropolitics: the Case of Turkey’s Holocaust Narratives

Some memories are more actively cultivated than others, manifesting the obsessive and slippery theaters of contested histories. This may encourage us to explore the ways in which representations of the past are conveyed. While Holocaust awareness has grown globally, its presence in Turkish academia has been limited since the millennium. Recent studies predominantly frame how Turkey integrates the Holocaust within the settled narratives. However, public perception has been shaped by narratives of Turkish consulates saving numerous Turkish Jews from Nazi oppression. This prevalent life-saver theme has become a cornerstone in Holocaust Memory, strengthened by various publications and documentaries. This research mainly investigates Turkey’s restrictive border policy and rescuing activities concerning the Jewish migration during the Second World War and its present-day recollections in today’s Turkey. Through a detailed case analysis, the study contends that popular historical beliefs differ from the facts. Ultimately it reads these accounts in relation to necropolitics that dictates which memories are allowed to live and which are rendered, emphasizing how even in remembrance, a politics of life and death exists.

MENTAL HEALTH, PROTECTIVE MEASURES, COVID-19: A STUDY ABOUT HEALTHCARE WORKERS IN BRAZIL

During the COVID-19 pandemic, health workers’ occupational stress increased due to the amount of medicine needed by patients. Aims: This research aims to evaluate the fear generated by the risk of contracting COVID-19 among health professionals working in the intensive care unit of a Brazilian philanthropic hospital. Methods: This cross-sectional study adopted a quantitative approach. We collected data through questionnaires completed by a multi-professional team from an adult intensive care unit. The survey included questions on the professionals’ sociodemographic data and items from the adapted Information Related to the Health Unit and Patient Care questionnaire, the Fear of COVID-19 Scale, and the Patient Health Questionnaire-9. In addition, participants were asked about use of personal protective equipment (PPE) post-vaccination. Results: In total, 108 employees responded. There was an association between the PHQ-9 and the FCV-19S in terms of those respondents do not felt prepared to face COVID-19 and had feelings of insecurity for themselves and their family members due to the pandemic. Besides that, there was an apparent discrepancy between the respondents’ answers and the hospital’s protocol about the reused PPE. Conclusion: This lack of alignment, about protocol and reused PPE, generates more health costs because public resources finance the hospital through the Unified Health System. The use of PPE must continue after vaccination. Restriction policies, such as presenting a vaccination card when entering closed places (which in practice is not happening in most cities in Brazil) and approaching individuals when not using PPE are essential for infection control.

Varying mobility adaptation to COVID-19 of residents in urban villages and commodity housing communities: A quasi-experimental analysis in Shenzhen, China

Although studies have explored the travel behavior of residents in informal housing communities in recent years, few have been conducted in the context of a time series before and after the outbreak of COVID-19. This paper tracks individual-level daily mobility response for three months, using an interrupted time series (ITS) quasi-experimental design to infer daily causal effects of COVID-19 and community close-off management on individuals' daily travel distances. This study compares the mobility response to COVID-19 between people living in urban villages and commodity housing communities in Shenzhen, China. The results reveal that urban village residents reduced their travel less, with slower response and recovery rates after the COVID-19 outbreak. The community close-off management was less effective for urban village residents, with a smaller abrupt reduction in mobility and their recovery rate increasing faster during the post-lockdown period. Therefore, urban village residents may have experienced greater limitations in adjusting travel with higher exposure risks during the pandemic, compared with commodity housing residents. The variations in mobility change are significantly affected by some inherent differences between these two groups, even after controlling for their socioeconomic and built environment features. These results provide important insights for designing mobility restriction policies for different housing groups and planning more resilient neighborhoods in the post-COVID era.

Qualitative exploration of the early experiences of opioid use disorder patients from private clinics after Russia's invasion of Ukraine in five major cities in Ukraine.

Following the full-scale invasion of Ukraine by the Russian Federation on 24 February 2022, over 6,000 patients were at risk of potential disruptions in treatment with medications for opioid use disorder (MOUD) in Ukraine. Before 2022, privatized MOUD clinics had emerged, partly driven by restrictive governmental policies and practices in state-funded facilities. Nevertheless, scant information exists regarding their operation and the patient's experiences, especially during crises. This study seeks to elucidate the initial lived experiences of patients utilizing private MOUD clinics, integrating these insights with an analysis of the responding health system during war. The findings are derived from 20 qualitative semi-structured interviews conducted between March and June 2022, engaging participants from five major Ukrainian cities: Kharkiv, Kyiv, Odesa, Poltava, and Zaporizhzhya. Employing a rapid analysis procedure, we examined the data through descriptive and analytical summaries aligned with the domains of the data collection instrument. Emergent themes encompassed stress and uncertainty following the invasion's onset, challenges accessing MOUD, and consequent perceptions concerning state-funded versus private clinics. The study identified disruptions in the operation of private MOUD clinics across most cities examined. Issues pertaining to MOUD medication availability were linked to dosage reductions at state-funded clinics or pharmacy medication shortages or closures. Despite varied experiences at different MOUD clinics and cities, most participants continued their treatment. This qualitative exploration provides a perspective on lived experiences with MOUD treatment at private clinics amidst the initial months of the invasion, illuminating how the early days' stress, access challenges, varied responses from private MOUD clinics, and precarious conditions informed or altered preferences regarding MOUD treatment options. Moreover, these findings corroborate previously documented efforts by myriad stakeholders to mitigate war-related disruptions to MOUD delivery. These insights contribute to the international understanding of health system navigation and resilience during major crises, offering valuable lessons for preparedness development.

Updates on syringe coverage and service uptake among needle and syringe programs in the United States, 2019–2020

BackgroundAs injection drug use has increased in the US, so too has the prevalence of receptive syringe sharing. Since the 1980s, Needle and Syringe Programs (NSPs) have been an important source of clean injection equipment and disposal of used syringes. This study reports national syringe coverage and examines the impact of program attributes on organizational-level service uptake, defined as number of syringes distributed per participant contact per year. MethodsIn 2019 and 2020, we administered an annual cross-sectional survey to NSPs operating in the US (n = 260). A national estimate of coverage was calculated by dividing the total number of syringes distributed by the 2019 and 2020 population estimate of people who inject drugs (PWID). Frequency distributions and percentages were calculated for categorical variables (e.g., funding, census region, distribution policy/modality), and median and interquartile ranges (IQR) were calculated for continuous variables (e.g., participant contacts, syringes distributed). Bivariate and multivariable mixed effects logistic regression models were used to estimate the odds ratio associated with organizational characteristics on increasing service uptake at the NSP level. ResultsFrom 2019 to 2020, the total number of participant contacts by NSPs increased from 871,976 to 898,891, and the number of syringes distributed increased from 92,648,529 to 113,071,748. The national coverage estimate increased from 29.5 (95 % CI = 15.0, 58.2) to 35.8 (95 % CI = 18.2, 70.6) syringes per PWID. Fifty-eight percent of NSPs increased service uptake in 2020 as compared to the previous year. NSPs that received government funding and NSPs that changed to a less restrictive syringe distribution policy were more likely to increase service uptake (aOR 1.80, 95 % CI = 1.01, 3.22 and aOR 3.33, 95 % CI = 1.11, 9.94, respectively). Syringe distribution modalities also diversified, with more NSPs reaching participants via backpacking/outreach, fixed site pop-ups, mobile delivery, mail-based delivery, leaving supplies out, and secondary distribution. ConclusionBoth governmental investment in harm reduction programming and needs-based distribution of syringes increased service uptake and thus should be expanded and sustained to reduce harms associated with injection drug use.

Part II: Blood Transfusion and Donor Exposure in the Surgical Management of Trigonocephaly Patients: A Protocol From Alder Hey Craniofacial Unit.

Trigonocephaly is a craniofacial malformation caused by premature fusion of the metopic suture. Surgical correction frequently results in the need for blood transfusion. Transfusion complications include transfusion-transmitted infections (TTIs), immune-mediated reactions, and volume overload. Donor exposure (DE) describes the number of blood products from unique donors with increasing DE equating to an increased risk of TTI. We evaluate data on 204 trigonocephaly patients covering 20 years of practice with respect to blood transfusions and DE. This represents the largest series from a single unit to date. A protocol based on our experiences has been devised that summarizes the key interventions we recommend to minimize blood transfusions and DE in craniofacial surgery. Patients operated on between 2000 and 2020 were included. DE and a range of values were calculated including estimated red cell loss (ERCL) and estimated red cell volume transfused (ERCVT). Groups were established by relevant interventions and compared using the Mann-Whitney U test. Mean DE fell from 1.46 at baseline to 0.85 ( P <0.05). Median allogenic transfusion volume fell from 350mL at baseline to 250mL ( P <0.05). Median ERCL fell from 15.05mL/kg at baseline to 12.39mL/kg and median ERCVT fell from 20.85 to 15.98mL/kg. Changes in ERCL and ERCVT did not reach statistical significance. DE can be minimized with the introduction of key interventions such as a restrictive transfusion policy, preoperative iron, cell saver, tranexamic acid, and use of a matchstick burr for osteotomies.

Industrial Hog Operation Workers' Perspectives on Occupational Exposure to Zoonotic Pathogens: A Qualitative Pilot Study in North Carolina, USA.

Industrial hog operation (IHO) workers face a range of occupational hazards, including exposure to zoonotic pathogens such as livestock-associated antimicrobial-resistant Staphylococcus aureus and swine-origin influenza viruses with epidemic or pandemic potential. To better understand this population's occupational exposure to zoonotic pathogens, we conducted a community-driven qualitative research study in eastern North Carolina. We completed in-depth interviews with ten IHO workers and used thematic analysis to identify and analyze patterns of responses. Workers described direct and indirect occupational contact with hogs, with accompanying potential for dermal, ingestion, and inhalation exposures to zoonotic pathogens. Workers also described potential take-home pathways, wherein they could transfer livestock-associated pathogens and other contaminants from IHOs to their families and communities. Findings warrant future research, and suggest that more restrictive policies on antimicrobials, stronger health and safety regulations, and better policies and practices across all IHOs could afford greater protection against worker and take-home zoonotic pathogen exposures.

The impact of hostile abortion legislation on the United States maternal mortality crisis: a call for increased abortion education.

The growing restrictive abortion policies nationwide and the Supreme Court decision on Dobbs v. Jackson Women's Health Organization place increasing barriers to abortion access in the United States. These restrictions disproportionately affect low-income people of color, immigrants, and non-English speakers, and have the potential to exacerbate already existing racial inequities in maternal and neonatal outcomes. The United States is facing a Black maternal health crisis where Black birthing people are more than twice as likely to experience maternal mortality and severe maternal morbidity compared to White birthing people. Restrictions creating geographic, transportation, and financial barriers to obtaining an abortion can result in increased rates of maternal death and adverse outcomes across all groups but especially among Black birthing people. Restrictive abortion laws in certain states will decrease already limited training opportunities in abortion care for medical professionals, despite the existing abortion provider shortage. There is an immediate need for federal legislation codifying broad abortion care access into law and expanding access to abortion training across medical education. This commentary explores the impact of restrictive abortion laws on the Black maternal health crisis through multiple pathways in a logic model. By identifying current barriers to abortion education in medical school and residency, we created a list of action items to expand abortion education and access.