Rhode Island Research Articles

Financing Thresholds for Sustainability of Community Health Worker Programs for Patients Receiving Medicaid Across the United States.

States have turned to novel Medicaid financing to pay for community health worker (CHW) programs, often through fee-for-service or capitated payments. We sought toestimate Medicaid payment rates to ensure CHW program sustainability. A microsimulation model was constructed toestimate CHW salaries, equipment, transportation, space, and benefits costs across the U.S. Fee-for-service rates per 30-min CHW visit (code 98960) and capitated rates were calculated for financial sustainability. The mean CHW hourly wage was $23.51, varying from $15.90 in Puerto Rico to $31.61 in Rhode Island. Overhead per work hour averaged $43.65 nationwide, and washighest for transportation among other overhead categories(65.1% of overhead). The minimum fee-for-service rate for a 30-min visit was $53.24 (95% CI $24.80, $91.11), varying from $40.44 in South Dakota to $70.89 in Washington D.C. The minimum capitated rate was $140.18 per member per month (95% CI $105.94, $260.90), varyingfrom $113.55 in South Dakota to $176.58 in Washington D.C. Rates varied minimally by metro status but more by panel size. Higher Medicaid fee-for-service and capitated rates than currently used may be needed to support financial viability of CHW programs. A revised payment estimation approach may help state officials, health systems and plans discussing CHW program sustainability.

Perceived parent and peer substance use disapproval and perceptions of harm among youth before and after COVID-19 lockdowns

ABSTRACT Background Changes in substance use among adolescence from before to after the COVID-19 lockdowns have been noted in the literature with mixed findings. Yet, no study has examined potential changes in risk or protective factors for substance use in that same period. This study assesses whether perceived parental/peer disapproval, and perceptions of substance harm among adolescents, changed from before to after COVID-19 lockdowns. Methods The Rhode Island Student Survey was administered to 17,751 middle and high school students from January 2020 – May 2021. Perceived parental/peer disapproval, as well as perception of harm, was measured for cigarettes, vaping, alcohol, marijuana, prescription drugs, and illegal drugs. Changes were assessed pre-post COVID-19 lockdown implementation using multivariable logistic regression. Results Perceptions of harm increased for all substances other than vaping, alcohol, and marijuana, and perceptions of peer and parental disapproval for all substances increased after COVID-19 lockdown implementation. Conclusion COVID-19 lockdown implementation may have led to greater perceptions of substance harm and peer/parental disapproval among adolescents. These shifts may have been associated with increased parental exposure and limited peer influence, which should be considered in future programming to prevent and treat adolescent substance use.

Analysis, evaluation and implications of Rhode Island’s “2021 Act on Climate” for response to climate change

The state of Rhode Island is responding appropriately to the climate crisis by enacting “the Resilient Rhode Island Act of 2014” and then preparing the revised “2021 Act on Climate.” Accordingly, Rhode Island strives to achieve carbon neutrality in 2050 by establishing and evaluating a climate change response plan and setting science-based climate goals through the Executive Climate Change Coordinating Council through consultation with the Advisory Board and the Science and Technical Advisory Board. Additionally, Rhode Island is committed to establishing industry support strategies to respond to climate change, considering future generations, including children, in the impacts of climate change, utilizing the knowledge of private experts at universities, and promoting public education on climate change response. However, matters that need to be supplemented and improved in the implementation of Rhode Island’s climate change-related legal policies include the fair and transparent selection of advisors from an organizational perspective and the securing of dedicated personnel and budget for practical work.

A qualitative study of reasons to use substances and substance use treatment experiences among transgender and gender diverse adults in Rhode Island

A qualitative study of reasons to use substances and substance use treatment experiences among transgender and gender diverse adults in Rhode Island

A preliminary characterization of cannabis oil use and vaporization among individuals who use for medical purposes: A pilot study.

Little is known about the naturalistic use of cannabis oil vaporization, a high-potency product with the ability to be administered discreetly. This pilot study evaluated the feasibility of utilizing a "smart" vaporizer and application to assess the timing, frequency, socioenvironmental factors, and substance use involved in cannabis oil vaporization. Adults with a medical cannabis registration card were recruited from a dispensary in Rhode Island and completed a 2-week study monitoring period using the Gram1 vaporizer, followed by a poststudy qualitative interview. The sample included nine adults who were predominantly male (89%), 100% White, and 100% non-Hispanic. The Gram1 collected topographical vaping data, and the cellphone application utilized ecological momentary assessment (EMA) to assess socioenvironmental factors and other substance use. Qualitative interview data were coded, and illustrative quotations were selected to support quantitative findings. A total of 224 vaping sessions were recorded reflecting 76.4% of the study monitoring period. There was an average of 1.79 vaping sessions per day across all days. Participants took 8.76 puffs on average (SD = 8.23) per vaping session, and the session lasted 2.59 min on average (SD = 4.19). Regular vaporization was exhibited across days of the week and hours of the day. EMA reports indicated that smoking cannabis flower was the most common additional mode of cannabis administration. This study utilized a naturalistic design with novel topographical data and EMA to characterize cannabis oil vaporization. These findings establish the feasibility of collecting objective, momentary data to better understand use behaviors which are critical to informing safe consumption. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Abstract WMP9: Comparative Analysis of Endovascular Treatment Outcomes in Acute Large Vessel Occlusion Strokes: Intracranial Atherosclerotic vs. Non- Intracranial Atherosclerotic Occlusions

Introduction: Intracranial atherosclerotic disease (ICAD) is a common cause of ischemic stroke worldwide. We assessed the clinical outcomes of endovascular treatment in acute large vessel occlusion (LVO) strokes caused by ICAD and compared them with large vessel occlusion strokes not associated with intracranial atherosclerosis (non-ICAD LVO). Methods: Our study comprised 1390 adult patients diagnosed with LVO stroke that underwent endovascular therapy at Rhode Island Hospital from July 2015 to March 2023 and data collected retrospectively. Among these, 68 patients exhibited Intracranial Atherosclerotic Disease Large Vessel Occlusion (ICADLVO), while 1322 individuals were categorized as non-ICADLVO. In the ICADLVO group, 23 out of 68 patients underwent angioplasty, whereas 38 patients received stenting. We aim to compare treatment outcomes, including recurrent in-hospital large vessel occlusion, disability, and mortality between these two distinct groups, while also assessing demographic characteristics and medical risk factors. T-Test, Chi square and fisher’s exact tests were used for the comparison of groups. Results: The study findings highlight significant differences between the ICADLVO group and the non-ICADLVO group. The ICADLVO group had younger age (mean 66.6 ± 12.64 vs. 71.92 ± 14.56, p < 0.001) , higher proportion of individuals with Asian ethnicity (5.2% vs. 0.8%, p = 0.019), higher incidence of prior strokes (43.3% vs. 23.9%, p=0.000), higher prevalence of smokers (35.6% vs. 22.7%, p = 0.022), and a lower association with known atrial fibrillation (23.9% vs. 42.3%, p=0.003) compared to the non-ICADLVO group. Additionally, the ICADLVO group had a higher occurrence of recurrent large vessel occlusion during hospitalization (11.8% vs. 4%, p = 0.008). This analysis finds no significant difference in good 90-dayfunctional outcome (mRS <= 2) between the ICADLVO and NON-ICADLVO groups (OR = 0.62, 95% CI 0.34-1.13, p=0.118). Conclusion: Our study showed a higher incidence of recurrent large vessel occlusion during hospitalization in the ICADLVO group following endovascular therapy. However, we did not observe any statistically significant differences in long-term outcomes, including measures of disability and mortality.

Abstract TP234: A Predictive Model for Early Neurologic Deterioration in Small Subcortical Infarcts

Introduction: Roughly a quarter of patients with an acute small subcortical infarct may develop early neurologic deterioration (END) hallmarked by progressive or stuttering neurologic deficits. Importantly, END results in worse short- and long-term functional outcomes. However, despite its importance, there is an inability to identify those at risk for END, thereby creating a barrier to designing future treatment and preventative trials. We aimed to generate a simple predictive scoring model for END in patients with an acute SSI. Methods: We performed a retrospective chart review of all adult patients admitted to Rhode Island Hospital with an acute SSI between 2015 and 2022. Clinical and demographic data were extracted. Radiographic variables included: 1)infarct signal intensity ratio ≤ 1.15 (analogous to the MR-WITNESS trial), 2) infarct morphology, and 3) infarct size. The primary outcome was END, defined as a ≥ 2-point increase in NIHSS or progressive disabling stroke-related deficits while hospitalized attributed to the index acute SSI. Standard descriptive statistical techniques were used. We then employed a backward stepwise logistic regression with a 0.05 threshold to discern factors associated with END, with each factor contributing one point to the model. An external validation cohort was ascertained from Columbia University. The area under the curve (AUC) was used to assess the utility of the predictive model. Results: A total of 252 patients met inclusion criteria. Demographic and clinical histories did not differ amongst the primary or validation cohorts. A signal intensity ratio ≤ 1.15, “finger-like” SSI morphology, and the presence of SSI on > 3 axial diffusion weighted imaging slices were predictive of END. Allocating one point for each domain (minimum 0, maximum 3) yielded an AUC of 0.88. A score of 2 points captured 91.6% of all END cases. Applying this model to the external validation cohort (n=43) yielded an AUC of 0.68. Conclusion: In sum, we found that a radiographic ordinal model including signal intensity ratio ≤ 1.15, “finger-like” SSI morphology, and infarct presence on > 3 axial diffusion weight imaging slices was helpful in predicting END. Future studies are needed to expand the external cohort size to test this model’s validity.

Abstract WP136: Impaired Venous Outflow Impacts Functional Outcomes in Acute Small Subcortical Infarcts: A Single-Center Retrospective Analysis

Introduction: Acute small subcortical infarcts (SSI), colloquially acute lacunar stroke, are a radiographic diagnosis representing a myriad of pathophysiologic processes. One such pathophysiologic subgroup is venous collagenosis which serves as a pathologic indicator that aberrant venous outflow may contribute to SSI development. We aimed to identify whether impaired venous outflow (IVO) impacted functional outcomes in individuals presenting with SSI. Methods: We performed a single-center retrospective study of individuals who presented to the Rhode Island Hospital Comprehensive Stroke Center. Included individuals were ≥ 18 years with the diagnosis of SSI, as defined per consensus criteria, on brain MRI diffusion weighted imaging. The primary exposure is the presence of impaired venous outflow (IVO) defined radiologically in accordance with prior studies, as hyperintensity of the jugular, sigmoid, or transverse sinuses along the skull base on MR angiogram time of flight, Figure. The primary outcome was a favorable function outcome at hospital discharge defined as a modified Rankin Scale (mRS) of ≤ 3. Standard descriptive and regression statistical techniques were used for data interpretation. Results: We identified 39 patients who met criteria with 12 (30.8%) with IVO. Age and vascular risk factors did not significantly differ amongst the cohort. Twenty-six (66.7%) had a favorable hospital discharge outcome favorable functional outcome with IVO being less common [IVO present: 5/26 (19.2%) versus LVO absent: 21/26, (80.8%), p = 0.034]]. After adjusting for age and hypertension, IVO was associated with an odds ratio of 8.33 (95%CI 1.41-49.3, p =0.019). Conclusion: We found that IVO may be an independent contributor to fewer favorable functional outcomes. This data highlights that not only the arterial vessels are of relevance in acute SSI.

Abstract TMP66: Ipsilateral Carotid Web is Associated With Higher Risk of Recurrent Stroke in Patients With Large Vessel Occlusion Undergoing Thrombectomy

Introduction: Carotid artery webs are a rare cause of embolic stroke of undetermined source, especially among the young without conventional risk factors. However, despite its detriment, the rate of stroke recurrence is not well studied. We aimed to understand the likelihood of stroke recurrence in patients with a confirmed symptomatic carotid web. Methods: We analyzed data from adult patients admitted with anterior large vessel occlusion at Rhode Island Hospital from July 2015 to March 2023. The assessment of carotid webs was conducted by a group of endovascular neurosurgeons and vascular neurologists by reviewing the vessel imaging. Any identified carotid webs on vascular imaging were reviewed by an independent vascular neurologist for adjudication. Chi square and fisher’s exact tests were used for the comparison of groups. After adjusting for age, admission NIHSS, known atrial fibrillation, and site of occlusion, multivariate logistic regression modeling was performed for in-hospital recurrence ischemic stroke. Results: Of the 1225 patients with anterior circulation large vessel occlusion, 22(1.80%) had ipsilateral carotid artery web. Patients with carotid web were younger than those without carotid web (73% <65 years). Patients with ipsilateral carotid web had a higher risk of recurrent stroke compared to those without ipsilateral carotid web (OR 3.35, 95% CI,1.043373-10.7041, p = 0.042). Conclusion: Carotid webs are an under recognized cause of acute large vessel occlusion and are associated with higher risk of early recurrence. Studies are needed to validate our findings and test early revascularization strategies in patients with symptomatic carotid artery webs.

Processes Driving Subseasonal Variations of Upper Ocean Heat Content in the Equatorial Indian Ocean

AbstractIn the equatorial Indian Ocean, the largest subseasonal temperature variations in the upper ocean are observed below the mixed layer. Subsurface processes can influence mixed layer temperature and consequently air‐sea coupling. However, the physical processes driving temperature variability at these depths are not well quantified. During the boreal winter, the Madden–Julian Oscillation (MJO) partly drives upper ocean heat content (OHC) variations. Therefore, to understand processes driving subseasonal OHC variability in the equatorial Indian Ocean, we use an observationally constrained, physically consistent ocean state estimate from the Estimating the Circulation and Climate of the Ocean (ECCO) Consortium. Using a heat budget analysis, we show that the main driver of subseasonal OHC variability in the ECCO ocean state estimate is horizontal advection. Along the equator, OHC variations are driven by zonal advection while the role of meridional advection becomes more important away from the equator. During the active phase of the MJO, net air‐sea heat fluxes damp OHC variability along the equator, while away from the equator net air‐sea heat fluxes partly drive OHC variability. Equatorial OHC variations are found to be associated with processes driven by Kelvin and Rossby waves consistent with previous studies. By quantifying the physical processes, we highlight the important role of ocean dynamics in contributing to the observed variations of subseasonal OHC in the equatorial Indian Ocean.

Cross-state Border Nicotine Vaping Products Purchase - Early Evidence from State Emergency Sales Restrictions in 2019.

While retail sales and retailer inspection studies generally indicate high compliance with state sales restrictions on Nicotine Vaping Products (NVPs) within the restricted area, studies using survey data generally indicate that most users could readily continue gaining access to restricted NVPs. Our study bridges a gap in the current literature and investigates the potential role of cross-state border purchases to evade state emergency NVP sales restrictions in 2019. The study sample was restricted to NVP sales from the states neighboring Massachusetts (MA), Rhode Island (RI), and Washington (WA), three states that implemented all NVP or flavored NVP sales restrictions in 2019. Among these neighboring states, the 2019 weekly county-level NVP sales by flavors (tobacco, mint/menthol, and other flavors) were compiled using Nielsen Scanner data. A quasi-experimental, comparison group pre-post study design was used to study the impacts of NVP sales restrictions on cross-state border NVP purchases. Weekly NVP sales for border counties significantly increased in response to the MA, RI, and WA bans for tobacco flavored (56%, 45%, 14%, respectively), menthol/mint flavored (51%, 2%, 41%, respectively), and other flavored (79%, 3%, 4%, respectively) products, compared to sales for non-border counties (all p-values <0.01). Our study identified significant cross-state border NVP purchases in all studied states to circumvent NVP emergency sales restrictions in response to the EVALI outbreak. Policymakers should factor in these purchasing behaviors to evade sales restrictions when evaluating any future potential policies at the state or local levels. While retail sales data and retailer inspections indicate high compliance with Nicotine Vaping Product (NVP) flavor sales restrictions from major retail outlets, survey data obtain mixed findings on the effects of sales restrictions on vaping behaviors. Our study identified a significant increase in cross-state border NVP purchases to circumvent NVP sales restrictions in 2019, consistent across all three settings of Massachusetts, Rhode Island, and Washington. Policymakers should factor in these cross-state border NVP purchases in response to sales restrictions when evaluating any future potential NVP sales restrictions.

Assessment of Climate Change Effects of Drought Conditions Using the Soil and Water Assessment Tool

A combination of annual peak water demand due to seasonal population spikes along with small and shallow aquifers has prompted an assessment of the region’s watersheds as operating at a net water deficit. This study uses the Soil and Water Assessment Tool (SWAT) to simulate historical drought conditions in the Chipuxet watershed in Rhode Island, USA. The calibrated and validated model uses the Soil Moisture Deficit Index (SMDI) and Evapotranspiration Deficit Index (ETDI) as well as an Indicators of Hydrological Alteration (IHA) calculation to determine the frequency and severity of historical droughts and to simulate climate change conditions developed through a downscaled climate model selection. The output data for the historical and climate change scenarios were analyzed for drought frequency and severity. Results indicate that water stress will increase in both low-emission (RCP4.5) and high-emission (RCP8.5) scenarios. Additionally, the SMDI and ETDI show that RCP8.5 climate scenarios will have more severe deficits. Finally, IHA data indicate that zero-flow days and low-flow durations increase under all climate scenarios.

The Impact and Relevance of Sensory Modulation-Related Occupational Therapy Interventions on Emotional Regulation in Preparation for Readiness to Change for Individuals Who Are Incarcerated and Have Experienced Trauma

This study investigated the effects that sensory modulation-related occupational therapy interventions can have on emotional regulation in preparation for readiness to change among individuals who are incarcerated. Assessments used included the PTSD Checklist (PCL-5), University of Rhode Island Change Assessment Scale 32-item (URICA), and a semi-structured interview. Results quantitatively demonstrated emotional regulation in relation to traumatic experiences was impacted through statistically significant changes in PCL-5 scores. The change in URICA scores was minimal, yet positive. Qualitative data supported positive effects on emotional regulation and readiness to change. This project provided evidence regarding sensory modulation-related occupational therapy interventions within justice-based settings.

A review of the Indian Ocean carbon dynamics, acidity, and productivity in a changing environment

The Indian Ocean dynamics is governed by the seasonal reversal of monsoon winds and the associated ocean currents. The relatively deep thermocline along the equator due to a lack of steady easterlies, low-latitude connection to the neighbouring Pacific, and a lack of northward heat export due to the position of the Asian continent are important factors in regulating the ocean state. These features make it a unique ecosystem among the world's tropical oceans and determine key features of potential air-sea interaction at different time scales. The pCO2 shows a large seasonal variation linked with monsoon circulation. The Indian Ocean’s northwestern part acts as an atmospheric CO2 source, whereas the northeastern part acts as a net atmospheric CO2 sink. The region between the latitudes of 15°S-50°S in the Indian Ocean is a major subduction zone because of positive wind stress curl. The subducted water masses are transported to the northern Indian Ocean by the cross-equatorial cell (a shallow meridional overturning circulation). Based on the regional studies carried out on the carbonate system in the Indian Ocean, the area north of 15°S is a source of atmospheric CO2, while the area between 15°S and 50°S is a sink. A recent synthesis of models (observational climatology) over different spatial scales provides an estimate of the mean value of CO2 in the north of 37.5°S of the Indian Ocean as − 0.19 ± 0.1 PgC/yr (−0.07 ± 0.14 PgC/yr) during 1985–2018. The estimated decrease in pH (acidification) using model outputs in the Indian Ocean basin is 0.0675 units during 1961–2010, in which the contribution of dissolved inorganic carbon and surface temperature is 69.3 % and 13.8 %, respectively. The range of the Indian Ocean’s annual primary production based on satellite estimates over the last two decades (1998–2018) is 7.72–8.70 Gt C/yr, whereas the climatological mean is 8.24 ± 0.30 Gt C/yr. This paper consolidates the current state of understanding of the Indian Ocean carbon fluxes, acidification, and productivity using available field and satellite-based measurements, model simulations, and re-constructed datasets. It provides an overview of the functioning of the Indian Ocean’s air-to-sea CO2 exchange and highlights its influence on global climate. Finally, it aims to highlight the grey areas of the Indian Ocean carbon cycle that need to be understood.

A STUDY OF COVID-19 EFFECTS ON THE IDENTITY THEFT LANDSCAPE

This research studies the impact of COVID-19 on the identity theft landscape using historical data published by the Federal Trade Commission. The data set included information about the number of identity theft reports for each state per year over a 6-year period, 2017 -2022. The dataset also included the number of reports for each identity theft category, providing a holistic view of the identity theft landscape. The data showed a significant increase in the number of identity thefts across all the states in 2020 compared to 2019; the percentage increase ranged from 45% to 1,801.1%. This coincided with the pandemic, which started in December 2019. The top 5 states that had the highest percent increase in 2020 are Kansas, Rhode Island, Maine, Washington, and Illinois. Moreover, in the year 2020, there was a dramatic increase across all the states in the number of identity theft reports related to government documents or benefits fraud, ranging from 207.7% to 33,236% increase compared to the year 2019. This was due to the sudden increase in available funds to help Americans during the pandemic, including unemployment benefits, stimulus checks, small business loans, etc., along with the expedited process to distribute the funds, which created ideal conditions for cybercriminals, especially identity thieves.

Rays in the Shadows: Batoid Diversity, Occurrence, and Conservation Status in Fiji.

Over recent decades, elasmobranchs (sharks, rays, and skates) have been increasingly recognized among the world's most threatened marine wildlife, leading to heightened scientific attention. However, batoids (rays and skates) are relatively understudied, especially in Large Ocean States of the Pacific. This synthesis compiles insights on batoid diversity and occurrence in Fiji's waters by integrating a literature review, participatory science programs such as the Great Fiji Shark Count (GFSC) Initiative, Projects Abroad Fiji (PA), Manta Project Fiji (MPF), and iNaturalist, along with environmental DNA. Nineteen batoid species from seven families were identified: 19 species from the literature, 12 from participatory science programs, and six from eDNA analysis. Notably, this study provides the first photographic evidence for the bentfin devil ray (Mobula thurstoni, Lloyd, 1908) in Fiji. GFSC data indicated the highest species diversity in the Western Division, with spotted eagle rays (Aetobatus ocellatus, Kuhl, 1823) and maskrays (Neotrygon sp.) being observed most. In-person interviews conducted by PA provided information on the occurrence of wedgefishes and potentially sawfishes. MPF records and iNaturalist uploads were dominated by reef manta rays (M. alfredi, Krefft, 1868), while the pink whipray (Pateobatis fai, Jordan and Seale, 1906) yielded the most DNA sequences. Overall, 68.4% of the species face an elevated extinction risk based on the International Union for the Conservation of Nature Red List criteria. Although caution is warranted with older literature-based records for the giant guitarfish (Glaucostegus typus, Anonymous [Bennett], 1830), giant stingaree (Plesiobatis daviesi, Wallace, 1967), and the lack of sawfish verification, this synthesis highlights the effectiveness of a combined methodological approach in establishing a reference point for the diversity and occurrence of this understudied taxon in Fiji.

Risk factors for pediatric intoxications in the prehospital setting. A geospatial survey.

Socioeconomic factors and the COVID-19 pandemic influence children's physical and mental health. We aimed to investigate the association between a census tract's median household income [MHI in United States Dollars ($)] and pediatric intoxications in Rhode Island, the smallest state in the United States of America. Geographical hotspots, as well as interactions with the COVID-19 pandemic, should be identified. This study is a retrospective analysis of ambulance calls for pediatric (<18 years) intoxication in Rhode Island between March 1st, 2018, and February 28th, 2022. March 1st, 2020 was considered the beginning of the COVID-19 pandemic. Prehospital data were joined with information from the United States Census Bureau. The census tracts' case counts and MHI were examined using Poisson regression. Geographical clusters were identified with the Global Moran's I and local indicators of spatial association tests in ArcGIS Pro (Esri Corporation, Redlands, CA). Inclusion criteria were met by 208 incidents (48% female, median age 16 (IQR 15 to 17) years). The regression model showed a 0.6% increase (IRR 1.006, 95% CI [1.002, 1.01], p = 0.003) in pediatric intoxications for every $ 1,000 increase in MHI. Interaction analysis showed that the effect of MHI was less pronounced during the pandemic (IRR 0.98, 95% CI [0.964, 0.997], p = 0.02). Thirty-four (14%) of the 244 census tracts contributed to geographical clusters, which changed after the onset of the pandemic. Higher median household income could be a risk factor for pediatric intoxications. Geographical hotspots changed with the pandemic.

More Frequent Abrupt Marine Environmental Changes Expected

AbstractWe quantify an elevated occurrence of abrupt changes in ocean environmental conditions under human‐induced climate forcing using Earth system model output through a novel analysis method that compares the temporal evolution of the forcings applied with the development of local ocean state changes for temperature, oxygen concentration, and carbonate ion concentration. Through a multi‐centennial Earth system model experiment, we show that such an increase is not fully reversible after excess greenhouse gas emissions go back to zero. The increase in occurrence of regional abrupt changes in marine environmental conditions has not yet been accounted for adequately in climate impact analyses that usually associate ecosystem shifts large‐scale variability or extreme events. Estimates for remaining greenhouse gas emission targets need thus to be more conservative.

Humid climate phases on the Island of Rhodes (Greece) during the late Pliocene at times of sapropel formation

The Island of Rhodes, located in the Eastern Mediterranean Sea, is affected by an active convergent plate boundary. In this context, marine sediments of Plio-Pleistocene age have been uplifted and are outcropping along the eastern coast of Rhodes. These archives provide an excellent opportunity to unravel the hydrological and climatic changes of the region during the late Pliocene. Our results provide new evidence for a more humid climate and an increased precipitation on the island during times of Northern Hemisphere summer insolation maxima and related sapropel formation in the Mediterranean deep sea. The periodic occurrence of eutrophic conditions at the shelf and upper slope off Rhodes is indicated by the recurrent dominance of eutrophic indicator species (of the genera Bolivina, Eubuliminella and Rectuvigerina), simultaneously with a decline in diversity and oligotrophic indicator species. These conditions resulted from higher primary productivity, triggered by local effects, such as enhanced precipitation and river run-off, which consequently favors the appearance of eutrophic taxa. The ∆δ13C records of the epibenthic foraminifera Cibicidoides pseudoungerianus and the shallow infaunal species Uvigerina peregrina indicate a slight productivity decrease towards younger times.

Characterizing opioid overdose hotspots for place-based overdose prevention and treatment interventions: A geo-spatial analysis of Rhode Island, USA

ObjectiveExamine differences in neighborhood characteristics and services between overdose hotspot and non-hotspot neighborhoods and identify neighborhood-level population factors associated with increased overdose incidence. MethodsWe conducted a population-based retrospective analysis of Rhode Island, USA residents who had a fatal or non-fatal overdose from 2016 to 2020 using an environmental scan and data from Rhode Island emergency medical services, State Unintentional Drug Overdose Reporting System, and the American Community Survey. We conducted a spatial scan via SaTScan to identify non-fatal and fatal overdose hotspots and compared the characteristics of hotspot and non-hotspot neighborhoods. We identified associations between census block group-level characteristics using a Besag-York-Mollié model specification with a conditional autoregressive spatial random effect. ResultsWe identified 7 non-fatal and 3 fatal overdose hotspots in Rhode Island during the study period. Hotspot neighborhoods had higher proportions of Black and Latino/a residents, renter-occupied housing, vacant housing, unemployment, and cost-burdened households. A higher proportion of hotspot neighborhoods had a religious organization, a health center, or a police station. Non-fatal overdose risk increased in a dose responsive manner with increasing proportions of residents living in poverty. There was increased relative risk of non-fatal and fatal overdoses in neighborhoods with crowded housing above the mean (RR 1.19 [95 % CI 1.05, 1.34]; RR 1.21 [95 % CI 1.18, 1.38], respectively). ConclusionNeighborhoods with increased prevalence of housing instability and poverty are at highest risk of overdose. The high availability of social services in overdose hotspots presents an opportunity to work with established organizations to prevent overdose deaths.