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Supermarkets receive criticism for irresponsible marketing practices, such as price promotions, that trigger over-purchasing and seemingly contribute to consumer waste. In the wake of this, retailers have abolished certain price promotions as part of an effort to meet corporate social responsibility (CSR) goals. We aim to investigate whether the underlying assumption that price promotions are positively related to consumer food waste needs to hold true. Through a review of the existing literature, we show that there is no scientific consensus on this assumption. Our findings show that half of the studies conclude that price promotions result in food waste by encouraging over-purchase, while the remaining conclude that consumers buying price-promoted food products show average or even lower levels of household food waste. Unraveling this inconsistency, we contribute by proposing a multi-level model of CSR behavior, where CSR actions at an institutional level (retailer) interact with individual characteristics at a micro (consumer) level leading to demonstrably different outcomes. We argue that the assumption that price promotions necessarily cause food waste has been overly simplistic, as it did not take into account the consumers' role. We conclude that the relationship between price promotions and consumer food waste is conditional on price consciousness, attitudes, values, household identities, and household roles. Thus, we illustrate that CSR problems are often wicked ones, where first-order solutions often lead to secondary problems that stymie the progress of institutions and policy makers in addressing social needs in business. We derive specific recommendations for retailers seeking to meet CSR goals. [ABSTRACT FROM AUTHOR]

Purpose: This pilot study aimed to develop a methodology characterising the urogenital microbiome as a predictive test in the IVF workup., Methods: Using unique custom qPCRs, we tested for the presence of specific microbial species from vaginal samples and First Catch Urines from the male. The test panel included a range of potential urogenital pathogens, STIs, 'favourable bacteria' (Lactobacillus spp.) and 'unfavourable bacteria' (anaerobes) reported to influence implantation rates. We tested couples attending Fertility Associates, Christchurch, New Zealand for their first round of IVF., Results: We found that some microbial species affected implantation. The qPCR result was interpreted qualitatively using the Z proportionality test. Samples from women at the time of Embryo Transfer who did not achieve implantation had significantly higher percent of samples that were positive for Prevotella bivia and Staphylococcus aureus compared to women who did achieve implantation., Discussion: The results provide evidence that most other microbial species chosen for testing had little functional effect on implantation rates. The addition of further microbial targets (yet to be determined) could be combined in this predictive test for vaginal preparedness on the day of embryo transfer. This methodology has a substantial advantage of being affordable and easily performed in any routine molecular laboratory. This methodology is most suitable as a foundation on which to develop a timely test of microbiome profiling. Using the indicators detected to have a significant influence, these results can be extrapolated., Conclusion: Using a rapid antigen test, a woman can self-sample prior to embryo transfer and obtain an indication of microbial species present which could influence implantation outcome., (© 2023. The Author(s).)

Introduction: Alongside the emergence of COVID-19 in the United States, several reports highlighted increasing rates of opioid overdose from preliminary data. Yet, little is known about how state-level opioid overdose death trends and decedent characteristics have evolved using official death records., Methods: We requested vital statistics data from 2018-2020 from all 50 states and the District of Columbia, receiving data from 14 states. Accounting for COVID-19, we excluded states without data past March 2020, leaving 11 states for analysis. We defined state-specific analysis periods from March 13 until the latest reliable date in each state's data, then conducted retrospective year-over-year analyses comparing opioid-related overdose death rates, the presence of specific opioids and other psychoactive substances, and decedents' sex, race, and age from 2020 to 2019 and 2019 to 2018 within each state's analysis period. We assessed whether significant changes in 2020 vs. 2019 in opioid overdose deaths were new or continuing trends using joinpoint regression., Results: We found significant increases in opioid-related overdose death rates in Alaska (55.3%), Colorado (80.2%), Indiana (40.1%), Nevada (50.0%), North Carolina (30.5%), Rhode Island (29.6%), and Virginia (66.4%) - all continuing previous trends. Increases in synthetic opioid-involved overdose deaths were new in Alaska (136.5%), Indiana (27.6%), and Virginia (16.5%), whilst continuing in Colorado (44.4%), Connecticut (3.6%), Nevada (75.0%), and North Carolina (14.6%). We found new increases in male decedents in Indiana (12.0%), and continuing increases in Colorado (15.2%). We also found continuing increases in Black non-Hispanic decedents in Massachusetts (43.9%) and Virginia (33.7%)., Conclusion: This research analyzes vital statistics data from 11 states, highlighting new trends in opioid overdose deaths and decedent characteristics across 10 of these states. These findings can inform state-specific public health interventions and highlight the need for timely and comprehensive fatal opioid overdose data, especially amidst concurrent crises such as COVID-19. Key messages:Our results highlight shifts in opioid overdose trends during the COVID-19 pandemic that cannot otherwise be extracted from aggregated or provisional opioid overdose death data such as those published by the Centres for Disease Control and Prevention.Fentanyl and other synthetic opioids continue to drive increases in fatal overdoses, making it difficult to separate these trends from any possible COVID-19-related factors.Black non-Hispanic people are making up an increasing proportion of opioid overdose deaths in some states.State-specific limitations and variations in data-reporting for vital statistics make it challenging to acquire and analyse up-to-date data on opioid-related overdose deaths. More timely and comprehensive data are needed to generate broader insights on the nature of the intersecting opioid and COVID-19 crises.

Importance: There is limited evaluation of the performance of Medicaid managed care (MMC) private plans in covering substance use disorder (SUD) treatment., Objective: To compare the performance of MMC plans across 19 indicators of access, quality, and outcomes of SUD treatment., Design Setting and Participants: This cross-sectional study used administrative claims and mandatory assignment to plans of up to 159 016 adult Medicaid recipients residing in 1 of the 5 counties (boroughs) of New York, New York, from January 2009 to December 2017 to identify differences in SUD treatment access, patterns, and outcomes among different types of MMC plans. Data from the latest years were received from the New York State Department of Health in October 2019, and analysis began soon thereafter. Approximately 17% did not make an active choice of plan, and a subset of these (approximately 4%) can be regarded as randomly assigned., Exposures: Plan assignment., Main Outcomes and Measures: Percentage of the enrollees achieving performance measures across 19 indicators of access, process, and outcomes of SUD treatment., Results: Medicaid claims data from 159 016 adults (mean [SD] age, 35.9 [12.7] years; 74 261 women [46.7%]; 8746 [5.5%] Asian, 73 783 [46.4%] Black, and 40 549 [25.5%] White individuals) who were auto assigned to an MMC plan were analyzed. Consistent with national patterns, all plans achieved less than 50% (range, 0%-62.1%) on most performance measures. Across all plans, there were low levels of treatment engagement for alcohol (range, 0%-0.4%) and tobacco treatment (range, 0.8%-7.2%), except for engagement for opioid disorder treatment (range, 41.5%-61.4%). For access measures, 4 of the 9 plans performed significantly higher than the mean on recognition of an SUD diagnosis, any service use for the first time, and tobacco use screening. Of the process measures, total monthly expenditures on SUD treatment was the only measure for which plans differed significantly from the mean. Outcome measures differed little across plans., Conclusions and Relevance: The results of this cross-sectional study suggest the need for progress in engaging patients in SUD treatment and improvement in the low performance of SUD care and limited variation in MMC plans in New York, New York. Improvement in the overall performance of SUD treatment in Medicaid potentially depends on general program improvements, not moving recipients among plans., Competing Interests: Conflict of Interest Disclosures: Drs Alegria, Falgas-Bague, and Rigotti and Ms Fukuda reported grants from National Institute on Drug Abuse (NIDA) during the conduct of the study. Ms O’Malley and Dr Stein reported grants from National Institutes of Health during the conduct of the study. Dr Layton reported personal fees from Greaylock McKinnon and Associates outside the submitted work. Dr Wallace reported grants from NIDA during the conduct of the study; additionally, his spouse is the Director of Medicaid Transformation and Financing at Aurrera Health Group. Dr Neighbors reported personal fees from Harvard University during the conduct of the study. Dr Wakeman reported personal fees from Celero Systems outside the submitted work. Dr Kane reported grants from the Health Resources and Services Administration outside the submitted work. No other disclosures were reported., (Copyright 2022 Alegría M et al. JAMA Health Forum.)

Background: Individuals with opioid use disorder (OUD) have a high prevalence of smoking and limited success quitting smoking with existing tools. There is ongoing debate about whether electronic cigarettes (e-cigarettes) may be a viable harm reduction strategy. We sought to determine the potential acceptability of e-cigarettes for cigarette harm reduction among individuals receiving medication treatment for opioid use disorder (MOUD) with buprenorphine. Among individuals receiving MOUD we investigated health harm perceptions of cigarettes, nicotine e-cigarettes, and nicotine replacement therapy (NRT), and perceptions of the helpfulness of e-cigarettes and NRT for quitting cigarettes., Methods: Cross-sectional telephone survey conducted among adults in buprenorphine treatment at five community health centers in the Boston, MA metropolitan area from February to July 2020., Results: 93% and 63% of participants rated cigarettes and e-cigarettes, respectively, as very or extremely harmful to health, and 62% rated NRT as not to slightly harmful to health. Over half (58%) rated cigarettes as more harmful than e-cigarettes; 65% and 83% perceived e-cigarettes and NRT, respectively, to be helpful for reducing/quitting cigarette use. In bivariate analyses, nicotine e-cigarette users, compared to nonusers, perceived e-cigarettes to be less harmful to health and more often rated e-cigarettes as helpful for reducing/quitting cigarette use (both p <0.05)., Conclusions: This study suggests that Massachusetts patients receiving MOUD with buprenorphine have concerns about the health harms of e-cigarettes yet rate them as helpful tools for reducing or quitting cigarette smoking. Future research is needed to test the efficacy of e-cigarettes for cigarette harm reduction., Competing Interests: Dr. Rigotti receives royalties from UpToDate, has consulted for Achieve Life Sciences, and consulted (without pay) for Pfizer. Dr. Kalkhoran received royalties from UpToDate. Dr. Wakeman receives royalties from UpToDate and has received salary support from OptumLabs, Celero Systems, and Alosa Health. No other authors have conflicts of interest to disclose., (© 2022 The Authors.)

Objectives: To determine the effect of one-click integration of a state's prescription drug monitoring program (PDMP) on the number of PDMP searches and opioid prescriptions, stratified by specialty., Methods: Our large health system worked with the state department of public health to integrate the PDMP with the electronic health record (EHR), which enabled providers to query the data with a single click inside the EHR environment. We evaluated Schedule II or III opioid prescriptions reported to the Massachusetts PDMP 6 months before (November 15, 2017-May 15, 2018) and 6 months after (May 16, 2018, to November 16, 2018) integration. Search counts, prescriptions, patients, morphine milligram equivalents, as well as prescriber specialty were compared., Results: There were 3,185 unique prescribers with a record of a Schedule II and/or III opioid prescription in both study periods that met inclusion criteria. After integration, the number of PDMP searches increased from 208,684 in the pre-integration phase to 298,478 searches in the post-integration phase (+43.0%). The number of opioid prescriptions dispensed decreased by 4.8%, the number of patients receiving a prescription decreased by 5.1%, and the mean morphine milligram equivalents (MMEs) per prescriber decreased by 5.4%. There were some notable specialty-specific differences in these measures., Conclusions: Integration of the PDMP into the EHR markedly increased the number of searches but was associated with modest decreases in opioids prescribed and patients receiving a prescription. Single click EHR integration of the PDMP, if implemented broadly, may be a way for states to significantly increase PDMP utilization., (© The Author(s) 2021. Published by Oxford University Press on behalf of the American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Recent evidence shows that emergency physicians (EP) can help patients obtain evidence-based treatment for Opioid Use Disorder by starting medication for addiction treatment (MAT) directly in the Emergency Department (ED). Many EDs struggle to provide options for maintenance treatment once patients are discharged from the ED. Health systems around the country are in need of a care delivery structure to link ED patients with OUD to care following initiation of buprenorphine. This paper reviews the three most common approaches to form effective partnerships between EDs and primary care/addiction medicine services: the Project Alcohol and Substance Abuse Services and Referral to Treatment (ASSERT) model, Bridge model, and ED-Bridge model.The ASSERT Model is characterized by peer educators or community workers in the ED directly referring patients suffering from OUD in the ED to local addiction treatment services. The Bridge model encourages prescribing physicians in an ED to screen patients for OUD, provide a short-term prescription for buprenorphine, and then refer the patient directly to an outpatient Bridge Clinic that is co-located in the same hospital but is a separate from the ED. This Bridge Clinic is staffed by addiction trained physicians and mid-level clinicians. The ED-Bridge model employs physicians trained in both emergency medicine and addiction medicine to serve within the ED as well as in the follow up addiction clinic.Distinct from the Bridge Clinic model above, EPs in the ED-Bridge model are both able to screen at-risk patients in the ED, often starting treatment, and to longitudinally follow patients in a regularly scheduled addiction clinic. This paper provides examples of these three models as well as implementation and logistical details to support a health system to better address OUD in their communities.

Competing Interests: Conflict-of-Interest Disclosures: Dr. Ostrovsky reports receiving personal fees from AppliedVR, Boulder Care, and FindLocalTreatment. com. Dr. Wakeman reports receiving research funding from OptumLabs.

Opioid use disorder (OUD) is an increasing public health problem. Transplant centers worldwide are being confronted with increasing numbers of patients with opioid use disorder and end stage organ disease. Opioid agonist therapy (OAT; ie, methadone, buprenorphine, and buprenorphine/naloxone) is a scientifically proven, effective, physician-prescribed treatment for OUD. Although data in transplant populations remain limited, studies suggest that OAT does not appear to negatively affect graft or patient survival. Policies that require discontinuation of OAT for purposes of listing or transplantation contradict the evidence base for efficacy of OAT. Additional prospective outcomes studies on OAT and transplantation are needed. In the meantime, centers should not be asking patients to come off these effective treatments., (© 2018 The American Society of Transplantation and the American Society of Transplant Surgeons.)

Objective: To compare uterine and ovarian blood flow, measured by Doppler ultrasound, in the follicular phase of the menstrual cycle, in women who conceived to women who did not conceive during that cycle., Design: A prospective study of 192 women looking at markers of ovarian reserve between August 2000 and September 2002., Setting: A fertility clinic., Patient(s): A cross-section of women attending for fertility advice and treatment., Intervention(s): Each woman was monitored during a natural cycle and then during a clomiphene challenge cycle (100 mg clomiphene given for 5 days from days 3-7 of the cycle). Doppler ultrasound scans were performed on days 3 and 12 of the natural cycle and day 11 of the clomiphene challenge cycle., Main Outcome Measure(s): Cycles in which women conceived were compared with those in which women did not conceive to see whether there were differences in uteroovarian blood flow parameters as measured by Doppler ultrasound scan in the follicular phase of the cycle., Result(s): In the 15 natural conception cycles there was an increased uterine artery peak systolic velocity at day 12 compared with 131 natural nonconception cycles (in which there was an opportunity to conceive). There were no differences in any uteroovarian blood flow parameters at day 3, and no differences in ovarian blood flow parameters (dominant follicle blood flow, dominant follicle pulsatility index), endometrial thickness or pulsatility at day 12. No differences were seen in any blood flow parameters in 10 clomiphene conception cycles compared with 116 clomiphene nonconception cycles., Conclusion(s): In the late follicular phase of natural conception cycles there is an increased uterine artery peak systolic velocity compared with nonconception cycles. This was not seen in clomiphene cycles in which conception occurred. There is very little in the literature comparing natural or clomiphene conception with nonconception cycles.