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Background: The U.S. relies far too heavily on punitive criminal justice strategies to address problems that are better prevented and resolved through social and health services. The resulting harms are especially large and longstanding for people trapped in the failed War on Drugs. Philadelphia launched a Police Assisted Diversion (PAD) program to address the highest rates of poverty, incarceration, and fatal overdose among large cities in the U.S. PAD enables police officers to connect people with supportive services in many instances that would otherwise result in arrest or through outreach when no crime is suspected., Methods: We conducted semi-structured interviews with 30 clients, 15 police officers, and 12 other personnel involved with the program. Data were gathered in 2019 and 2020 and analyzed using standard qualitative methods., Results: PAD represents a new less-punitive model for responding to illegal purchasing of drugs, possession of drugs, prostitution, and retail theft in Philadelphia. Clients reported mostly positive experiences with the program, identifying the primary benefits as avoided arrest and relational support from affiliated service providers. Police officers expressed support for the program in principle but skepticism about its effects in practice, questioning the quality of available services. Program personnel and police officers described multi-sectoral collaboration as essential to addressing frequent and diverse logistical challenges, including overly restrictive eligibility criteria, mistrust between police and service providers, and coordination across different neighborhoods. Finally, all three groups suggested that people can only benefit from service linkages when they are ready to engage and that inadequate access to resources like housing limits program effectiveness., Conclusions: The PAD program is a promising public health intervention for diverting people away from punishment and towards services to address unmet social and health needs. But increasing investments in training and in other supportive services is essential to sustainable and transformational change., Competing Interests: Declarations of Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2021. Published by Elsevier B.V.)

The intrarenal injection of contrast media results in a transient fall in renal blood flow (RBF) and a decrease in glomerular filtration rate (GFR). These effects are enhanced by dietary sodium restriction and attenuated by sodium loading. A similar sodium-dependent response of RBF and GFR occurs with the intrarenal injection of adenosine. In view of these similarities, we sought to determine whether endogenous adenosine is involved in the renal hemodynamic response to contrast media. The intrarenal injection of contrast media (meglumine-Na diatrizoate, 76%) in six sodium-depleted, anesthetized dogs resulted in a 17% +/- 4% decrease in RBF and a 31% +/- 5% decrease in GFR. The infusion of the adenosine receptor antagonist, theophylline (5 mumol/min), reduced the decrease in RBF to 6% +/- 2% and in GFR to 12% +/- 3% of control values. During the intrarenal infusion of dipyridamole (24 micrograms/kg/min), a potentiator of adenosine through its action to inhibit the cellular uptake of nucleosides, the hemodynamic response to contrast media was greater; RBF fell 25% +/- 4% and GFR fell 44% +/- 7%. In addition, the urinary excretion of endogenous adenosine increased after the injection of contrast media (388 +/- 79 vs. 830 +/- 231 nmol/min). In summary, the contrast media-induced fall in RBF and GFR was attenuated by theophylline and augmented by dipyridamole, and the administration of contrast media resulted in an increase in the excretion of endogenous adenosine. These results support the hypothesis that endogenous adenosine is involved in the renal hemodynamic response to contrast media.