Search

ObjectiveDescribe trends in opioid plus high-risk medication coprescribing in the USA.DesignAnalyses of serial, cross-sectional, nationally representative data of the National Ambulatory Medical Care Survey (NAMCS) over 2007–2016 and the National Hospital Ambulatory Medical Care Survey (NHAMCS) over 2007–2018.SettingUS ambulatory (NAMCS) and emergency department (ED, NHAMCS) settings.ParticipantsPatient visits in which the patient was 18 years and older with an opioid prescription in the NAMCS or NHAMCS databases.Primary and secondary outcome measuresFrequency of opioid plus high-risk medication coprescribing.ResultsFrom a combined sample of 700 499 visits over 2007–2018, there were 105 720 visits (15.1%) where opioids were prescribed. n=31 825 were from NAMCS and n=73 895 were from NHAMCS. The mean prevalence of coprescription of opioids and high-risk medications for the combined NAMCS and NHAMCS sample was 18.4% in 2007, peaked at 33.2% in 2014 and declined to 23.8% in 2016. Compared with adults receiving opioid prescriptions alone, those coprescribed opioids and high-risk medications were older, more likely female, white and using private or Medicare insurance (pConclusionsCoprescribing is more common in ambulatory than ED settings and has been declining, yet one in four patient visits where opioids were prescribed resulted in coprescribed, high-risk medications in 2016. Efforts and research to help lower the rates of high-risk prescribing are needed.

Solid waste management is often perceived as one of the most pressing environmental problems facing local governments in urban India and elsewhere in the global south. However, solid waste is not simply a managerial problem but is in many ways a highly political issue that involves diverse political actors at different scales. Particularly at the local level, solid waste management can also be a key part of broader political strategies, acting through its unique materiality as an environmental artefact and social relic. In this paper, we use an urban political ecology approach to examine a recent segregation-at-source project in a small town in West Bengal as a lens to understand more general multi-scalar, socio-political urban processes. Drawing primarily upon qualitative field research, the paper shows how diffuse forms of power and different governmentalities were applied between and within state-level government agents, municipal authorities, local waste workers and local communities to implement and (re)shape this project. The research points to the complexity of urban environmental governance and everyday politics in which action repertoires ranging from threats, the creation of environmental and hygienic subjects, moral appeals and economic rationality, underpinned by the harmful character of waste and by socio-cultural imaginaries thereof, (re)produced uneven political ecologies of waste between and within different neighbourhoods of the city.

While researchers in the growing field of urban political ecology have given significant attention to the fragmented hydroscape that characterizes access to drinking water in the global South, so far the (re)production of other urban waters and its related power relations have been underexplored. This article seeks to contribute to filling this gap by exploring the everyday negotiations over access to urban water bodies, in particular ponds. These are understood as a composite resource that is simultaneously water, land and public space. This analysis draws on a case study from a small city in West Bengal, India, and is based primarily on data from open interviews with different actors with a stake in urban ponds. The article demonstrates that in a context of ambiguity of the statutory governance regime and fragmented control, the (re)production of the pondscape is embedded within complex relationships of power whereby social marginalization can be offset at least momentarily by local institutions such as neighbourhood clubs and political parties.

In the overall context of the Millennium Development Goals, Pakistan recently embarked on an effort to collect data regarding crucial issues of human development, such as health, poverty, and education. For their effective use in policy formulation, however, governments need to find ways of making the data easily accessible. It is argued that Geographical Information Systems (GIS) can play a major role here. The data compiled by the Federal Bureau of Statistics at district level are used in this article to develop maps on child health in the province of Punjab. Correlation allows identification of major determinants of the health status of children. For Punjab, these appeared to be mother literacy, vaccination coverage, and the incidence of poverty. Interpolation (here using Inverse Distant Weighting) and variable aggregation allow for easy identification of areas of concern at sub-district level. For Punjab, the areas most affected by negative health conditions are in the southwest. It is argued that health disparities can be addressed more effectively with the help of the presented methods because they help to close the information gap in the health system and contribute toward more precise allocation of funds and infrastructure.

Urban political ecology (UPE) has mainly evolved within the discipline of geography to examine the power relations that produce uneven urban spaces (infrastructures and natures) and unequal access to resources in cities. Its increasingly poststructuralist orientation demands the questioning of received categories and concepts, including those of (neoliberal) governance, government, and of the state. This paper attempts to open this black box by referring to the mostly anthropological literature on everyday governance and the everyday state. We argue that UPE could benefit from ethnographic governance studies to unveil multiple state and non-state actors that influence the local environment, their diverse rationalities, normative registers, and interactions across scales. This would also to enrich and nuance geographical UPE accounts of neoliberal environmental governance and potentially render the framework more policy relevant.

The integration of the human rights framework in water policy and management is slowly gaining strength. What is too often overlooked, though, is the ‘other’ side of the water cycle: wastewater governance. What do human rights have to do with sewage, sludge, and septage? What are the links between human rights and water contamination? The article starts by explaining the concept of wastewater, outlining the impact of water pollution on the realization of human rights, exploring the interface between access to sanitation and wastewater governance, and presenting the relevant human rights framework. It goes on to describe how households, agriculture, and industry contribute to water pollution. Its main contribution lies in demonstrating the value of integrating human rights into wastewater governance and water pollution control to address challenges in the legislative and regulatory frameworks, institutional settings, appropriate technology choices, financing and pricing, and strengthening accountability an...

This special issue of SAMAJ, composed of six empirical papers and this introduction seeks to throw light on environmental politics in contemporary urban India. Adopting a deliberately broad understanding of the environment, to include environmental amenities, urban natural resources and the built environment, the diverse case studies within this issue contribute to an interlinked set of discussions on the politicization of India’s urban environment. In doing so they engage with the ways that the environment is entwined with questions of urban citizenship; the role environmental knowledge(s) play(s) in urban environmental politics; and the situated character of urban political ecologies. While these papers employ diverse entry points into the environmental politics of Leh, Puri, Chennai, Bangalore and Delhi they all pay close attention to everyday practices and situated dynamics. As this perspective is applied across various city sizes the results demonstrate on the one hand the heterogeneity of India’s urban environments and on the other the pervasiveness of similar environmental politics across diverse sites. The insights from these papers aptly highlight the analytical challenge of considering issues of temporality and intersectionality whilst also recognizing the multi-scalar political-economic and social factors that shape contemporary urban power dynamics and the reproduction of particular urban environments.

The notion of waterscape has been proposed by urban political ecology (UPE) scholars as a conceptual lens for understanding urban hydro-social flows. So far, however, there has been little attention by UPE scholars to the importance of wastewater in urban waterscapes. This study demonstrates how wastewater is embedded in an arena of social relations of power, defined in this article as the wastewaterscape. Drawing on research conducted in Delhi, the aim of the study is to examine re-occurring problems of wastewater disposal and mismanagement through the lens of knowledge; and the different ways of knowing about wastewater which exist amongst inhabitants of an informal settlement, scientific experts and municipal workers in Delhi. On the basis of our analysis, we argue that the systemic exposure of poorer urban citizens to untreated wastewater cannot be attributed to the shortcomings of service delivery alone, but is more fundamentally associated with how legitimacy is awarded to competing systems of knowledge about wastewater in the urban sphere.

Delhi’s slums face recurrent and disturbing waste water-related problems: overflowing drains, stagnation of sewerage near or within houses, and subsequent mosquito breeding cause difficulties for everyday life and serious health hazards. The question arises for the affected people as well as administration, how to deal with this tremendous challenge? Governance is defined as ‘exercise of authority, control, management, power of government’ (World Bank, 1992, p. 3) and is used to explain differential outcomes of development interventions. It is widely recognized to be the task of the state, the private sector and civil society conjunctly (UNDP, 1997). Yet, the development debate is suggestive of a rather organized process of governance; of negotiations that lead to the identification of a common goal; and of a rational, technical, and somewhat apolitical management of means of reaching this goal. From this perspective, the waste water situation in Delhi’s slums presents a clear case of governance failure. This article aims at shedding these assumptions and the conclusion they point at, and rather expose the scattered, piece-meal and conflict-ridden character of governance practices and outcomes in the urban everyday. It therefore takes a bottom-up perspective on governance, starting from the empirical evidence of waste water governance in one slum cluster in west Delhi.

The wastewater crisis in megacities of the Global South is increasingly recognised. However, sector‐driven approaches (of river pollution, sewerage, or city‐wide drainage) have had limited success in tackling this multifaceted problem. This article seeks to dynamise debates by positioning the current crisis in relation to contests of knowledge. Focusing on wastewater governance in Delhi, the article explores the question which different knowledges about wastewater exist in scientific communities, governments, and amongst citizens. What is frequently understood as ‘expert’ knowledge of the Central Pollution Control Board, is juxtaposed with the ‘lay’ experiences of citizens residing in one unauthorised colony in East Delhi. Exploring both, the article provides insights on the mechanisms through which community experiences are excluded from policy deliberations, leading to major wastewater‐related problems being overlooked. The article then calls for enhanced attention to knowledge integration, thus strengthening the participation of citizens in formulation and implementation of wastewater programmes.

Lipid implants prepared by melting and casting offer a great potential for advanced drug delivery. However, care must be taken with respect to the solid state of the lipid(s) and potential changes thereof during storage. Generally, a thermal aftertreatment is required. However, little is known about the impact of the curing time and temperature on drug release. The aim of this study was to better understand the importance of these parameters for different types of implants containing propranolol hydrochloride. Hydrogenated cottonseed oil and hydrogenated soybean oil were used as matrix formers. The implants were characterized with respect to their in vitro release kinetics, water uptake, thermal properties, and morphology. On the basis of these experimental results, a mechanistic mathematical model was used to gain further insight into the underlying mass transport mechanisms. Both the curing time and the temperature strongly affected the resulting drug release patterns. Importantly, in most cases, these effects could not be attributed to polymorph transformations but to changes in the implants' microstructure. The size of the lipid particles depended on both the curing time and the temperature, and determined the size of the pores/channels through which water and drug diffuse. The importance of this aspect is often underestimated.

The Segura basin in southeast Spain is characterised by massive over-use of its water resources. Groundwater resources are being depleted, desertification risk is high and the river ecosystem is near to collapse with merely 4% of its original runoff reaching the mouth. Meanwhile, the water cycle has been deeply technologized to meet the needs of an irrigated agriculture that has been growing since the beginning of the twentieth century. Today, the introduction of new water uses for the irrigation of green spaces in gated communities priding themselves on their first-class golf courses is putting further pressure on water resources. These developments are provoking conflicts between sections of society as well as between levels of state administration. This article investigates why reactions to gated communities are so different. To do so, an approach that highlights actors' differing perceptions of the state of Murcia's waterscape and subsequent attitudes towards water management is used.

Study design This is a prospective, randomized, and controlled study, approved by the local ethical committee of Saarland (Germany), no. 209/06. Objective The aim of this study was to compare clinical results, segmental motility, magnetic resonance imaging (MRI) compatibility, and change of the bone density of a cervical spine segment that was treated with either bioresorbable or titanium plates in single level. Summary and background data Anterior cervical discectomy and fusion including plate fixation is an accepted technique for treatment of symptomatic degenerative disc disease. Titanium plates have been used but cause imaging artifacts. Radiolucent bioresorbable plates and screws were developed to reduce the imaging artifacts associated with titanium. Methods Forty patients with single level cervical radiculopathy were randomized to anterior discectomy and fusion with bioresorbable plate (19 patients, study group) or titanium plate (18 patients, control group). Follow-up used a visual analog scale (VAS) with regard to brachial pain and Neck Disability Index (NDI) for neck pain. Radiostereometry was performed immediately postoperative and after 6 weeks, 3, and 6 months. MRI of the cervical spine was obtained immediately postoperatively at 3 and 6 months to assess hematoma, infection, and swelling. Computed tomography of the operated cervical spine segment was performed to assess bone density, expressed in Hounsfield units. Results Three-dimensional analysis of segmental motion (medio-lateral, cranio-caudal and anterior-posterior) did not reveal any statistical difference between both groups at any time postoperatively (P>0.05). Fusion rate and speed evaluated on Radiostereometric analysis and computed tomography of cervical spine segment were similar in both groups. MRI of cervical spine did not show any pathology, especially hematoma and infection. The VAS and NDI did not differ between both groups after 6 months (P>0.05). Conclusions Anterior plate fixation by using a bioresorbable plate has the same fusion progress and stability as titanium. During the study, no complications like soft tissue swelling and infection occurred.

Megacities in Asia face tremendous environmental challenges. One of these is the drainage and treatment of waste water—a problem which ironically grows when access to water supply and water-borne toilets improves, leading to increasing per capita water consumption as well as water pollution. In Delhi, the overall waste water problem is huge with an estimated 1,800 million litres per day being disposed of without treatment in the Yamuna river. However, the various residential areas differ greatly in the magnitude of related problems they face. This inequality leads to a situation where mostly informal settlements have to bear the brunt of exposure to waste water. Against this background, this chapter investigates which waste water-related services informal settlements receive, who is providing them, and how residents struggle on a daily basis to obtain them. The case discussed here is of an informal residential area, or JJ cluster, in West Delhi. To study the presented problematic the approach of Urban Political Ecology (UPE) is introduced. This approach looks at environmental problems in their relationships with social, political as well as economic dynamics and processes. In the last years, UPE has started opening up to a more thorough investigation of the role of everyday practices in the production of uneven urban environments. Looking into the day to day interactions of residents with different state actors in the attempt to solve waste water-related problems allows furthering this avenue. By doing so, the chapter aims to contribute to a better understanding of how unequal urban environments are produced in today’s megacities.

Objective: Advantages of telemetric devices for long-term ICP measurement have been mentioned several times in the literature. However, descriptions of associated complications are lacking. Therefore, this observational study focuses on clinical and radiological findings after the insertion of an [for full text, please go to the a.m. URL], 65. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)

Ipilimumab is an anti-CTLA-4 antibody that is approved for the treatment of metastatic malignant melanoma. Side-effects are mostly immune-mediated and in many cases the lack of specific symptoms leads to delayed diagnosis and treatment of adverse events. We present the case of a female patient who experienced an uncommon combination of adverse reactions while undergoing therapy with ipilimumab and where the absence of specificity of the symptoms led to late diagnosis and treatment of side effects. Autoimmune disease was neither associated with tumor response nor with prolonged survival.

The aim of this study was to use lipid:lipid blends as matrix formers in controlled release implants. The systems were prepared by melting and casting and thoroughly characterized before and after exposure to the release medium. Based on the experimental results, a mechanistic realistic mathematical model was used to get further insight into the underlying drug release mechanisms. Importantly, broad spectra of drug release patterns could be obtained by simply varying the lipid:lipid blend ratio in implants based on Precirol ATO 5 (glyceryl palmitostearate):Dynasan 120 (hardened soybean oil) mixtures loaded with propranolol hydrochloride. Release periods ranging from a few days up to several months could be provided. Interestingly, the drug release rate monotonically decreased with increasing Dynasan 120 content, except for implants containing about 20–25% Precirol, which exhibited surprisingly high release rates. This could be attributed to the incomplete miscibility of the two lipids at these blend ratios: DSC thermograms showed phase separation in these systems. This is likely to cause differences in the implants’ microstructure, which determines the mobility of water and dissolved drug as well as the mechanical stability of the systems. Purely diffusion controlled drug release was only observed at Precirol ATO 5 contents around 5–10%. In all other cases, limited drug solubility effects or matrix former erosion are also expected to play a major role. Thus, lipid:lipid blends are very interesting matrix formers in controlled release implants. However, care must be taken with respect to the mutual miscibility of the compounds: in case of phase separation, surprisingly high drug release rates might be observed.