Recovery Support Research Articles

Short-term mechanical circulatory support in adults with congenital heart disease: indications and outcomes

Abstract Background An increasing number of adults with congenital heart disease (ACHD) present with heart failure (HF), which may require short- or long-term mechanical circulatory support (MCS), often around cardiac surgery or other interventions. Even though MCS has entered ACHD practice over the last few years, little is known on its indications and outcomes in this population. Purpose To assess the use and outcomes of short-term MCS in ACHD patients in a specialist centre, and assess the predictive power of the Survival After Veno-Arterial Extracorporeal Membrane Oxygenation (SAVE) score in this population. Methods Data on all ACHD patients who received MCS since 2008 in a single tertiary centre were collected. Immediate, short and longer-term outcomes were also collected, including death, complications, and weaning success. Logistic regression and ROC analysis were performed to identify predictors of in-hospital mortality. Result There were 65 episodes of MCS in 63 patients during the study period: age 36.9+-13.6 years, 61.5% male. Most patients had CHD of moderate or severe complexity (49.2% moderate and 10.8% severe according to ESC guidelines). The most common anatomical diagnoses were left outflow tract obstruction in 35.4%, Marfan syndrome in 20.0% and tetralogy of Fallot or pulmonary atresia in 10.8%. The most common indications for ECMO were perioperative support (not endocarditis) in 55.6%, HF in 14.3%, pneumonia in 12.7% and endocarditis-related surgery in 7.9%. A critical preoperative status was present in 26.8%; median PEACH score (a validated ACHD peri-operative risk score) was 1.0[1.0-3.0] and ACHS score was 0.6[0.6-1.0]. Median SAVE score was -4.0[-9.0–2.0], with 21(43.8%) in SAVE class 4 or 5. VA-ECMO was used in 69.2%, VV-ECMO in 21.5%, BiVAD-ECMO in 4.6% and RVAD support in 4.6% of patients. The median duration of ECMO support was 198.6[133.0-354.2] hours. Complications included ischemic stroke (15.4%), intracerebral bleeding (9.2%), and other thromboembolism (23.8%). Successful weaning was achieved in 56.2%, whereas 4.6% were switched to more definitive MCS. In-hospital mortality was 47.7%, and this was higher in patients receiving VA support (OR 4.92, 95%CI:1.32-23.93, p=0.03). For patients on VA-ECMO or BiVAD support, the presence of Marfan syndrome (OR 4.92, 95%CI:1.32-23.93, p=0.03) and a lower (worse) SAVE score (OR 1.3 per point reduction, 95%CI:1.11-1.59, p=0.004) were associated with in-hospital mortality. An adjusted SAVE score that accounted for the presence of heritable thoracic aortic diseases (HTAD, -3 points) performed well at predicting in-hospital mortality (AUC increasing from 0.73 to 0.8, Figure). Conclusions Short-term MCS is a useful temporary rescue intervention in patients with ACHD, as a bridge to recovery or durable support, with 1 in 2 patients surviving to hospital discharge. The SAVE score adjusted for HTAD can reliably predict outcomes in patients with VA-ECMO and requires external validation.Figure

Innovations in residential treatment that promote multi-drug addiction recovery

Abstract Background As the drug addiction crisis deepens in many countries across the globe, governments are rapidly expanding publicly funded treatment facilities. At the same time, the illicit drug market has evolved with many substances now containing multiple addictive drugs that complicate recovery. The evidence base for treatment remains primarily focused on single substances. The purpose of this study was to examine the lived experience of adults who attended in-patient treatment centres for multi-drug addiction in Canada. Methods This qualitative study was conducted in 2022 with 32 adults who voluntarily attended an in-patient treatment centre for drug addiction (44% female, 23-53 years). All had been addicted to multiple substances including opioids, crack and methamphetamines. Most (70%) were homeless before treatment. In 1-hour semi-structured interviews adults described the structures and programming that helped them recover in these facilities. Many tried multiple facilities and thus had a rich history of lived experience to draw from. Narrative inquiry was used to characterize qualitative themes across interviews using a phenomenological lens. Results Seven qualitative themes emerged from the data. Residential treatment centres that were effective at helping adults recover from multi-drug addiction: (1) provided flexible stays up to 100 days; (2) felt like a home not a prison; (3) permitted opioid replacement therapies; (4) provided a variety of recovery tools (e.g., cognitive behavioural therapy, Narcotics Anonymous, cultural supports); (5) helped adults reunite with family, find a safe place to stay, and find work before discharge; (6) provided transitional housing after discharge if needed; and (7) provided free long-term recovery support and check-ins after discharge. Conclusions The findings of this study highlight 7 actions that treatment facilities can adopt and test with their own clients in an effort to better support multi-drug addiction recovery. Key messages • A stronger evidence base is needed to inform in-patient multi-drug addiction treatment. • Findings underline 7 actions treatment facilities can take to promote multi-drug addiction recovery.

Recovery ecosystem: More than treatment

Andre L. Johnson, Psy.D., founder and CEO of the Detroit Recovery Project, shared his vision of a “recovery ecosystem” at the annual meeting of the Association of Addiction Professionals (NAADAC) in Washington, D.C. last week. “The world has changed, it's not the world of the 80s,” he said. Johnson, after he was sober for two years, went to Morehouse for an undergraduate psychology degree and went on to work at a hospital in Detroit, where he “sat down with CEOs and CFOs and learned how money is moved around and how programs are designed based on resources,” he said. After completing a clinical internship at Tarzana Treatment Center treating 12‐18‐year‐olds, he received a doctorate in clinical psychology from the Michigan School of Psychology. What he stressed at NAADAC was this: “we needed to develop a recovery support program.” Treatment alone wasn't working in the drug‐ravaged city. The time of 120 days in treatment was over.

Responding to location-based triggers of cravings to return to substance use: A qualitative study.

Individuals with substance use disorders face many challenges in establishing and maintaining recovery, most notably from contextual factors such as people, locations, events, emotions, and other triggers of cravings that could spark return to use. We sought to understand how individuals experience and cope with locations as triggers. We conducted 31 semi-structured in-depth interviews with individuals who had recently been in substance use treatment and reported problem levels of alcohol and opioid use according to screening instruments. Interviews were designed to explore how individuals experience location-based triggers. We coded these interviews according to concepts outlined in Marlatt and Gordon's cognitive behavioral model and used thematic analysis to generate themes in participant experiences. We found that participants described triggers as interrelated and associated with multiple people, locations, events, or emotions. Participants commonly identified 'home' as a trigger, one that is particularly difficult to cope with. Participants most commonly employed avoidance as a coping strategy. Finally, participants described an expectation that substance use was associated with more time spent outside of 'home' while recovery was associated with limited travel and more time spent at home. Location-based triggers represent a particularly challenging barrier to sustained substance use disorder recovery, partly due to the amorphous and interrelated nature of such triggers. The identification of 'home' as a primary trigger and common use of avoidance as a coping strategy suggest the need for additional recovery support and interventions. We plan to use these findings to develop and test an intervention promoting coping strategies.

The Role of Social Support in Substance Addiction Recovery: A Systematic Review

Recovery from substance addiction is a complex process that requires continuous physical and psychological support. Social support plays a crucial role in assisting individuals through the process of substance addiction recovery. This article presents a systematic review of the role of social support in substance addiction recovery by analyzing relevant studies from various academic sources. The findings indicate that social support, whether from family, friends, or community, significantly enhances individuals' motivation, resilience, and success in maintaining long-term recovery. Various forms of support, such as emotional, instrumental, and informational support, help individuals cope with the challenges of recovery. Additionally, participation in support groups and positive interpersonal relationships have been shown to accelerate the recovery process and prevent relapse. Therefore, social support is a key element not only in facilitating recovery but also in improving the quality of life for individuals dealing with substance addiction.

Supporting medication-assisted recovery in recovery residences: staff support, managing built environment threats, and building a supportive network

ABSTRACT Background: While medications for opioid use disorder (MOUD) are effective in reducing overdoses, widespread adoption and implementation of MOUD remains inadequate. Innovative approaches to promote MOUD use and to support people in their medication-assisted recovery (MAR) are needed. Recovery residences that serve people taking MOUD are steadily growing in number, yet little is known about how MOUD and the MAR pathway is promoted within the recovery residence setting. Objectives: The purpose of this qualitative analysis was to describe how recovery residences facilitate MOUD initiation and support residents’ MAR pathway. Methods: We conducted interviews with 93 residents (59.1% male; 38.7% female) living in recovery residences located in five Texas cities that served people taking medication for opioid use disorder. Results: We found that recovery residence staff addressed linkage to care gaps in their communities by connecting people who might benefit from MOUD to appropriate providers. Recovery residence staff also strengthened participants’ community of MAR-supportive peers by hosting or connecting residents to Medication-Assisted Recovery Anonymous meetings. Additionally, recovery residences helped some residents overcome common logistical barriers (e.g. transportation issues, housing instability, distance to providers) that hinder MOUD access. Conclusion: Recovery residences that serve people taking MOUD are a well-positioned recovery support service to promote MOUD initiation and the MAR pathway.

Opportunities and challenges in the development of artificial intelligence research in spinal surgery

Artificial intelligence has emerged as a game-changer in the field of spine surgery, offering transformative diagnostic and therapeutic approaches for spinal conditions. The application of AI in spine research encompasses a diverse range of diseases, with usage scenarios becoming increasingly widespread and technological integration going deeper. AI technology shows immense promise and value in the diagnosis of spinal diseases, the formulation of treatment strategies, surgical navigation, prognostic evaluation, and postoperative rehabilitation. Through deep learning and machine learning, AI can aid doctors in enhancing diagnostic accuracy, creating personalized treatment plans, and executing precise maneuvers during surgery, thus improving operational safety. Moreover, AI can provide intelligent support for patients' postoperative recovery, facilitating the restoration of their functions. However, current research is still in its nascent stage and confronts several challenges, such as the lack of standardized databases, the simplicity of algorithmic learning models, the inadequate fusion of multi-modal clinical information, and the limited clinical applicability. By developing open-source, standardized spine databases, incorporating innovative intelligent core algorithms, and establishing normalized screening, diagnostic, and predictive models for spinal conditions, we trust that we can drive the innovation and refinement of diagnostic and treatment technologies in spine surgery. This will realize an effective conjunction between technological provision and clinical demands, continuously elevating the intelligence level of spine surgery and offering safer, more effective medical services to a vast array of patients.

Process Mapping to Support the Implementation of a Regional Strategy to Address the Opioid Epidemic.

To address the opioid epidemic in Kansas City, Missouri, local health systems sought to implement a referral to peer recovery coaches (PRCs) for clients presenting with opioid use disorder. Client referrals were made primarily through health system emergency departments, where PRCs met clients to facilitate linkages to recovery support for up to twelve months. This study aimed to evaluate and improve program implementation with process mapping at three local health systems. Using a five-phase conceptual framework and three development and implementation domains, providers, administrators, and PRCs were interviewed to identify the process for recognizing clients with opioid use disorders and referring them to PRCs. Serial meetings were held to validate the process maps at three health systems and a distillation of key processes was created to guide future analyses and implementation efforts. A detailed process map for each health system was developed, from which a high-level process map was created to support future implementation efforts. Health system-specific process maps varied, although conceptually coherent elements were identified across each system to diagram a recovery ecosystem to support client referrals to PRCs. By systematically assessing the implementation of the same program across different health systems, critical steps, along with their barriers and facilitators, were identified that can be used to understand the processes of care associated with outcomes and to guide future implementation efforts.

“I feel like I'm always on edge”: Perceptions of parole supervision by parolees with substance use disorders

IntroductionWhile extant research has looked at parole and its various actors as an institution, few studies recount the parole experience from the perspective of parolees. Additionally, despite the prevalence of substance use disorders (SUDs) within the criminal justice system, research that assesses the additional challenges this population faces throughout parole supervision is even scarcer. MethodsTo address this gap, we analyze in-depth qualitative interviews (n = 51) conducted with reentering men with SUDs as they navigate parole in Pennsylvania. Three independent coders identified all narratives relating to a broad theme of “parole and probation experiences.” The authors then completed iterative rounds of more fine-grained independent coding within that theme. ResultsOur results emphasize that SUDs present a significant barrier to reentry success, and the tension of surveillance and revocation is amplified for those enduring simultaneous reentry and recovery. Importantly, our respondents regard parole officers more positively than they view parole as an institution, yet this perception of officers does not equate to provision of reintegration and recovery support. Respondents perceive that parole presents unnecessary additional hurdles to their reentry success, and their perceived risk level impacts their surveillance intensity. ConclusionsThe information gleaned through inclusion of perspectives from those enduring parole supervision calls for a critical assessment of current parole practices. Further, the current approach to SUDs within community supervision criminalizes relapse without provision of treatment resources or support.

Age and racial and ethnic disparities in filled buprenorphine prescriptions post-emergency department visit in Nevada.

We described age, gender, race, and ethnicity associations with filling buprenorphine prescriptions post-emergency department (post-ED) visits. We analyzed 1.5 years (July 1, 2020-December 31, 2021) of encounter-level Medicaid ED and retail pharmacy claims data obtained from the Nevada Department of Health and Human Services. We studied ED patients with an opioid use disorder (OUD) diagnosis who did not fill a prescription for OUD medications within 6 months before the ED encounter. Using logistic regression, we modeled the associations between the patient's demographic characteristics and the outcome, filling a buprenorphine prescription at a community pharmacy within 14 or 30 days of the ED encounter. Among 2781 ED visits, representing 2094 patients, the median age was 39 years, 54% were male, 18.5% were Black, 11.7% were Hispanic, and 62.3% were White. Only 4% of the ED visits were followed by a filled buprenorphine prescription. Increasing age (14-day window: adjusted odds ratio (aOR)=0.965, 95% confidence interval [CI]: 0.948-0.983) and being a Black patient (14-day window: aOR: 0.114, 95% CI 0.036-0.361) were both associated with lower odds of filled buprenorphine prescriptions. These results were similar within 30 days of an ED visit. Initiation of buprenorphine following an ED visit remains low among Nevadan Medicaid patients and is less likely with increasing age and among Black patients, despite strong evidence supporting its use. Overburdened EDs, lack of attention from managers, and substance use stigma are among possible explanations. When ED clinicians do write buprenorphine prescriptions, peer recovery support could increase the fill rates.

What happens after the funding ends?: A qualitative sustainability investigation of emergency department-based peer support programs implemented as part of Indiana's opioid state targeted response initiative

Introduction: In 2017, funding disseminated through the US Substance Abuse and Mental Health Services Administration's Opioid State Targeted Response (STR) program accelerated the expansion of peer recovery support services across several states to engage emergency department patients presenting with opioid use disorder. While there is some literature on the initial implementation of these programs, little is known about their sustainability after the STR funding's end. Identifying what happened to these programs is a key component of understanding their ultimate impact and can inform future activities to develop, fund, or sustain similar efforts. Methods: We collected qualitative data from six organizations that participated in Indiana's STR-funded Recovery Coaching and Peer Support Initiative (RCPSI). The semi-structured interview guide was designed to gather data related to eight domains of sustainability (i.e., environmental support, funding stability, partnerships, organizational capacity, program evaluation, program adaptation, program evaluation, communications, and strategic planning). The analysts followed a deductive-inductive analysis approach, using the eight domains as an a priori coding structure and developing higher-level inductive themes. Results: A total of ten individuals (roles included 4 Program Supervisors, 2 Nurse Administrators, a Psychiatric Social Worker, a Mobile Treatment Manager, a Grant Coordinator, and a Vice President of Planning) participated in six interviews. Two programs did not sustain services, primarily because they lacked a sufficient volume of eligible patients to justify services. Factors identified as supporting sustainability in the other four programs included (1) identification of alternate funding sources, (2) evolving internal support for ED-based opioid use disorder treatment, and (3) investment in internal and external relationships. Furthermore, these themes operated across multiple sustainability domains. Conclusions: The findings illustrate a dynamic interplay between program context and multiple theorized sustainability domains that impacted the viability of RCPSI programs after the end of STR funding. Results indicate a need for a better understanding of the factors influencing the sustainability of programs supported by federal funding to mitigate the opioid crisis, and such findings will likely apply to a broader range of grant-supported programs.

What We Know About the Peer Workforce and Economic Evaluation for Peer Recovery Support Services: A Systematic Review.

Peer recovery support services (PRSS) for substance use disorder (SUD) have expanded in the past 2 decades to be formally certified and reimbursed under Medicaid in almost every US state. This rapid expansion has been followed by a growth in research, but 2 persistent gaps remain: a lack of research on the peer workforce, and a lack of economic evaluation research. This systematic review examines the current literature on PRSS to summarize what is currently known about the SUD peer workforce and collect potential PRSS economic evaluation parameters, and clearly identify the current gaps in each category. PRISMA methods were followed and a PROSPERO protocol was registered (CRD42022323516). The search included a database search of peer-reviewed journal articles and dissertations, and also a hand-search of conference presentations and evaluation reports. Manuscripts were categorized as either workforce development-related and/or those containing potential economic evaluation parameters. Forty-two total manuscripts were included, with 22 related to the peer workforce and 26 containing potential economic evaluation parameters. Manuscripts with workforce-related findings covered peer worker characteristics, characteristics of PRSS delivery, or peer worker training-related outcomes. Economic evaluation parameters were primarily costs related to service utilization patters with some limited reporting on peer worker pay, as well as multiple sources that can be used to estimate averted medical costs. Effectiveness parameters were primarily substance use related, as virtually all quality of life and life functioning parameters are not readily convertible to estimating quality-adjusted life years. Future PRSS research can contribute to filling these gaps in the evidence base by addressing remaining questions about the interrelationship between peer worker job satisfaction, job tenure, and patient outcomes, as well as by using more consistent outcome measures, especially in the realm of quality of life and life functioning.

Efficient recovery of rare earth elements from ion-adsorption rare earth tailings: Based on the addition of pyrite calcination modification

Rare earth tailings constitute a significant amount of solid waste that remains after industrial (NH4)2SO4 leaching and typically contain rare earth elements (REEs), primarily Ce. This study aimed to fully recover REEs from rare earth tailings by calcination with pyrite under both air and N2 atmospheres, followed by dilute H2SO4 leaching or bioleaching. The results of XRD, SEM-EDS, TIMA, SEM-BSE, XPS, and ICP-MS analyses indicated that Ce and Mn were mainly present in the form of CeO2 and MnO2, respectively, whereas Fe existed in both Fe2O3 and Fe2(SO4)3 forms. Leaching experiments with dilute H2SO4 demonstrated that the co-calcination of rare earth tailings with pyrite significantly enhanced the recovery of REEs. Notably, calcination in air resulted in a significantly higher extraction rate of Ce (95.55 %) than that in N2 (83.82 %). This difference was attributed to the presence of O2, which promoted the oxidation of pyrite and facilitated the reduction of Ce(IV) to Ce(III). In contrast, incomplete oxidation of pyrite occurred in the N2 atmosphere, leading to a high residual Ce(IV) content in the tailings that could not be leached by the dilute acid. Subsequently, sufficient recovery of Ce (97.52 %) from the tailings calcined in the N2 atmosphere was achieved by bioleaching using Acidithiobacillus ferrooxidans and pyrite. Thus, this study provides theoretical support for the efficient recovery of REEs from mining tailings or secondary sources containing CeO2.

Advances in Phytochemical-Based Nanocarrier Approaches for Rheumatoid Arthritis: Challenges and Scope for Future-generation Formulations

The study aims to investigate and assess the effectiveness of current novel techniques for the preparation of an efficient nanocarrier system in resolving the drawbacks associated with the delivery of herbal bioactives to treat rheumatoid arthritis. Systematic utilization of various search engines like Science Direct, Pubmed, Shodhganga, Google Scholar, and Google Patent databases based on various sets of key phrases has been performed. All the findings from these data have been studied and briefed based on their relevant and irrelevant information. The current study summarizes the existing research and development of new nano-formulations with a focus on herbal bioactive compounds for treating rheumatoid arthritis. Physicochemical properties of phytoconstituents, such as low aqueous solubility, low permeation coefficient, and chemical instability, poor bioavailability, short plasma half-life, and ultimately sub-therapeutic efficacy, limit their clinical translation despite their great potency. The utilization of Phytochemical-Based Nanocarrier Approaches for rheumatoid arthritis can be a milestone as a major population is affected by this disease worldwide. The intensive study recapitulates that novel drug delivery systems can provide new opportunities to efficiently deliver herbal bioactives with improved pharmacokinetic and pharmacodynamic properties. The exhaustive study concluded that transferosomes, ethosomes, transethosomes, niosomes, phytosomes, Solid Lipid Nanoparticles (SLN), Nano Lipid Carriers (NLC), bilosomes and hylurosomes are some of the efficient nanocarrier systems that may impart numerous benefits to the delivery of herbal bioactives for treatment of RA. These nanocarrier systems fabricated with phytoconstituents flaunt the evident promising benefits of improved aqueous solubility, low first-pass metabolism with upgraded bioavailability, sustained release action, resistance to enzymatic degradation etc. providing support in rheumatoid arthritis recovery. This review discusses that the upgradation of the pharmacological action and other relevant issues of herbal bioactives are possible by utilizing novel drug delivery systems, resulting in successful development of nano-loaded herbal bioactives. It also focuses on highlighting the pioneering progression in the field of herbal bioactives-loaded nanocarrier systems for rheumatoid arthritis both in vitro and in vivo along with their advanced preparation methods and applications and discussing the opportunities for further prospects. This compiled informative review will enlighten various researchers in the field of delivering herbal bioactives for rheumatoid arthritis.

Understanding Socioeconomic Risk and Vulnerability to Climate Change–Induced Disasters: The Case of Informal Settlements in KwaZulu-Natal, South Africa

This study employs a qualitative research approach to spatially delineate the risk and vulnerability of informal settlements in KwaZulu-Natal, South Africa. This comes after devastating floods that occurred in KwaZulu-Natal, South Africa, in April 2022. This disaster emphasised the necessity for South Africa to proactively address natural hazards by implementing risk reduction strategies rather than attempting to mitigate the impact after the damage has occurred. Evidence indicates that the risk and vulnerability associated with climate-induced disasters, such as flooding, are exacerbated by socioeconomic factors, including housing shortages, which compel individuals to construct dwellings in flood-prone areas. Opportunities exist to enhance the understanding of disaster risk reduction in Africa, and South Africa in particular, through science-informed initiatives employing spatial techniques, including geographic information systems, hazard exposure mapping, and socioeconomic risk and vulnerability mapping. These techniques are crucial for humanitarian planning focused on long-term risk reduction, early recovery, shelter, reconstruction, and psychosocial support for climate change disaster recovery. Furthermore, an understanding of the nature and location of areas with high disaster risk, such as flooding, is essential for the formulation of disaster risk reduction strategies, including early warning systems.

Improving Engagement in Residential Treatment for Substance Use Disorders: An Integrated Care Quality Improvement Project for Individuals With Mental Health and Substance Use Disorders

Substance use disorder continues to pose significant challenges in the United States, with increasing opioid-related fatalities. Residential recovery treatment programs are effective; however, high attrition rates impact successful long-term outcomes. This quality improvement project aimed to enhance patient engagement in treatment for mental health and substance use disorder to improve retention rates. It also implemented an integrated care approach incorporating psychotherapy, psychopharmacologic interventions, and recovery support services. The project was conducted using a 2-group predesign and postdesign, analyzing 134 admissions. The approach resulted in a statistically significant increase in patient engagement in treatment from 24% to 92%. Substance use relapse rates significantly reduced from 25% to 12%, and a clinically meaningful increase in the 3-month retention rate was noted. Integrated care is a promising strategy to improve outcomes for individuals receiving care for co-occurring disorders via residential treatment settings. Future studies should explore integrative models of care, patient motivation, and retention in residential treatment centers.

Improving Treatment in Treatment Court: A Qualitative Interpretive Meta-Synthesis (QIMS) of the Drug Court Experience

Drug courts have played a key role in criminal justice reform, particularly in supporting substance use and mental health disorder recovery. Little is known, though, related to drug court participants’ views on the strengths of the program that support their recovery and what suggestions they have to improve programming. This qualitative interpretive meta-synthesis (QIMS) provides a behind-the-scenes perspective of drug court programming from the voices of participants (n = 183). Based on data extracted from a synthesis of nine qualitative studies, three new themes emerged related to the strengths of drug court that support recovery and suggestions to improve programming. The new themes are: (1) Improving treatment in treatment court; (2) The interplay between internal motivation for change and dignity and respect for all; and (3) Being future oriented: Developing a sustainable recovery support system. Implications for drug court practice, policy advocacy, and future research are discussed. Drug courts should revisit how clinical information is exchanged between treatment providers and the justice system, and potentially reduce this collaboration. Furthermore, recommendations are offered on how drug courts can support participants in developing internal motivation for recovery and in sustaining recovery post-drug court.

Optimizing sports performance in China: Investigating the influence of training, recovery, motivation, and environmental support within a moderation-mediation framework

The expansion of sports in China is astounding. Given the country's focus on athletic achievement, it is crucial to comprehend the different facets of sports. This research examines China's athletic success in training, recuperation, motivation, and environment. The moderation-mediation strategy is used to understand how these variables affect athletic performance. This study fills a gap in understanding Chinese players' on-field performance. The study examined 355 Chinese athletes from various regions and sports. The sample has a balanced gender distribution, diverse age distribution, and representation from various regions. Furthermore, training programs, recovery strategies, motivation, psychological well-being, support systems, and experience levels influence athletes' sports performance. The study reveals that the coefficients indicate that training, recuperation tactics, motivation, and support systems affect athletic performance. Psychological health emerges as a critical mediator in explaining the effects of these factors on performance outcomes. Additionally, athlete experience moderates the influence of these variables, highlighting nuanced differences. These findings offer crucial insights for enhancing the performance of Chinese athletes. By adopting a moderation-mediation approach, this research illuminates the interconnected dynamics among key components, enriching our understanding of avenues for athlete improvement. Specifically, the results underscore the interconnectedness of athletes' psychological well-being, on-field experience, and competitive performance, emphasizing the importance of tailored interventions. This study could help Chinese politicians, sports psychologists, and coaches enhance athletes' performance.

Scarce perinatal social support for women with OUD: Opportunities for doula services

ProblemPersons with opioid use disorder (OUD) often lack social support, which is associated with improved recovery outcomes. BackgroundIn the last two decades, the rate of opioid use disorder (OUD) among pregnant people has quadrupled. QuestionThis study aimed to describe the prenatal and postpartum social support networks and needs of persons with OUD and assess perceived acceptability of community-based social supports such as doulas. MethodsThis mixed methods study utilized quantitative and qualitative data to understand social support structures and needs. Data was collected through surveys –demographics and social mapping; Adverse Childhood Experiences (ACE) tool; Connor Davidson Resilience 25-item (CDRS-25) scale– and a semi-structured interview. A total of 34 participants from a single urban opioid treatment program consented to participate. FindingsParticipants were on average 34.9 years old, White (64.7%), and unemployed (91.2%). Participants described small perinatal social support networks, which decreased in size from the prenatal to postpartum period. Only half (52.9%) reported adequate prenatal and postpartum social support. Doulas and peer recovery support specialists were perceived as valuable in perinatal health, social support, and recovery domains, with interest in doulas seen particularly amongst those with fewer reported supports. Discussion: The scarcity of prenatal and postpartum social support among persons with OUD is critical to address, given the increased risk of relapse during the postpartum period which has implications for the maternal child dyad. Conclusion: Due to multiple disparities in prenatal and postpartum social support (small networks, inadequate support), doulas represent a trusted community-based support to be integrated into healthcare teams to address maternal morbidity/mortality associated with opioid use.

Effects of CO2-saturated brine imbibition on the mechanical and seepage characteristics of Longmaxi shale

Supercritical carbon dioxide (SC– CO2) serves as a promising anhydrous fracturing fluid that has the potential to simultaneously enhance shale gas recovery and accomplish CO2 sequestration within shale reservoirs. However, the hydromechanical properties of shale are considerably affected by CO2-brine-shale interaction. This study conducted shale imbibition experiments involving subcritical/supercritical CO2 saturated brine (Sub/SC-CO2+brine). Triaxial compressive strength tests were performed to evaluate the impact of Sub/SC-CO2+brine imbibition on the mechanical properties of shale, as well as the influence of SC-CO2+brine imbibition on shale permeability. The results indicate that, after SC-CO2 brine imbibition, noticeable macroscopic cracks are formed parallel to the bedding plane. The imbibition of Sub/SC-CO2+brine results in the reduction in axial stress and Young's modulus, while simultaneously increasing the axial strain of shales. Compared to Sub-CO2+brine, SC-CO2+brine exhibits a higher imbibition pressure and a more intense geochemical reaction with shale. Due to increased compressibility sensitivity, the averaged permeability after SC-CO2+brine imbibition shows a reduction of nearly 70 % compared to that before imbibition. The insights from this research are expected to provide theoretical support for shale gas recovery and CO2 geological sequestration.