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OBJECTIVE To identify factors associated with referral and enrollment in early intervention (EI) for infants with neonatal abstinence syndrome (NAS). METHODS We conducted a retrospective cohort study of 256 infants born with NAS (2006-2013) at a tertiary care hospital in (Springfield), Massachusetts, linking maternal-infant birth hospitalization records with Department of Public Health EI records. We calculated the percent of infants retained at each step in the EI enrollment process over the first 3 years of life. We conducted separate multivariable logistic regression analyses to identify factors associated with EI referral and enrollment. RESULTS Among mothers, 82% received medication-assisted treatment at delivery, 36% endorsed illicit drug use during pregnancy, and 76% retained custody of their child at discharge. Among infants, 77% were referred to EI and 48% were enrolled in services. Of infants discharged to biological parents, 81% were referred to EI versus 66% of infants discharged to foster care (p ≤ 0.05); this difference persisted in multivariable analysis [adjusted odds ratio, 2.30; 95% confidence interval (CI), 1.09-4.86]. Infants in the highest tertile for length of stay had 2.70 times the odds of EI enrollment (95% CI, 1.37-5.31). CONCLUSION Fewer than half of the eligible infants with NAS were enrolled in EI services. Discharge to a biological parent and longer hospital stay had the strongest associations with EI referral and enrollment, respectively. Efforts to improve EI referral rates during the birth hospitalization, particularly among infants discharged into foster care, and close follow-up for infants with shorter hospital stays would enhance the developmental supports for this vulnerable population.

BACKGROUND: Increasing rates of maternal opioid use disorder has led to greater number of opioid exposed newborns (OENs). Maternal enrollment in medication for opioid use disorder (MOUD) program improves short term neonatal outcomes. This study aimed at assessing neurobehavioral outcomes for OENs. METHODS: Retrospective observational cohort study of OENs between Jul 2006 and Dec 2018. Two study groups were identified as initiation of medication for opioid use disorder (MOUD) prior to diagnoses of pregnancy or after. Primary outcome variables were enrollment in and duration of EI services. Secondary outcome variable was diagnoses of a behavioral and/or developmental disorder (BDD) during the study period. RESULTS: Of 242 infants, 113 were enrolled in EI and BDD diagnoses data was available for all infants [age range 6 to 12 years], 82% infants had exposure to maternal MOUD, while 18% were exposed to either maternal prescription non-MOUD opioids or illicit opioids. Maternal MOUD initiation prior to pregnancy was associated with improved short term outcomes for OENs. Almost a third of infants were diagnosed with a BDD with no differences between the two study groups. CONCLUSION: Early initiation of maternal MOUD improved short term outcomes and discharge disposition for OENs. Prolonged in-utero exposure to opioids presents a potential for negative impact on neurodevelopmental and behavioral outcomes. These risks must be considered to increase access and adherence to EI services, as well as to focus on non-opioid based maternal MOUD. Longitudinal studies assessing the safety of MOUD on short and long-term child health outcomes are needed.

Background Multiple births and first pregnancy are associated with higher preeclampsia risk. It is unknown if the transfer of multiple embryos or first embryo transfer with assisted reproductive technology (ART) is also associated with greater preeclampsia risk. Methods We performed a retrospective cohort study of IVF clinics and hospitals in Massachusetts. We used linked ART surveillance, birth certificate, and maternal hospitalization discharge data for 21,188 births, considering resident singleton (12,810) and twin (8378) live-births from autologous or donor eggs from 2005 to 2012. We used log binomial and Poisson regression to calculate adjusted relative risks (aRRs) and 95% confidence intervals (CI) for the association between preeclampsia and predictors of preeclampsia. Outcomes were stratified by singleton and twin birth, donor versus autologous cycles, and use of fresh versus cryopreserved embryos. Results Considering all singleton births, the transfer of multiple embryos increased the risk of preeclampsia [aRR = 1.10 (95% CI: 1.01–1.19)]. Relative risks were greatest for fresh non-donor cycles [aRR = 1.14 (95% CI: 1.03–1.26)]. Vanishing twin and number of prior ART cycles was not associated with preeclampsia among singleton births [aRR = 1.18 (95% CI: 0.91–1.53)], and aRR = 1.01 (95% CI: 0.96–1.05)], respectively. Considering all twin births, the transfer of > 2 embryos increased the risk of preeclampsia [aRR = 1.09 (95% CI: 1.001–1.19)]. Vanishing triplet and number of prior ART cycles were not associated with preeclampsia among twin births [aRR = 0.93 (95% CI: 0.69–1264), and aRR = 0.98 (CI: 0.95–1.02)], respectively. Conclusions Among ART births, the transfer of more than 1 embryo for singleton gestations and more than 2 embryos for twin gestations increased the risk for preeclampsia diagnosis.

Purpose: Patent ductus arteriosus (PDA) continues to be one of the most common complications associated with preterm birth. Up to 70% of infants born before 28 weeks gestational age may require som...

BACKGROUND: Buprenorphine is an effective medication for opioid use disorder (MOUD) when offered in community-based settings, but evidence is limited for incarcerated populations, particularly in relation to recidivism. In Massachusetts, Franklin County jail (FCSO) was among the first to provide buprenorphine; adjacent Hampshire County jail (HCHC) offered it more recently. These jails present a natural experiment to determine whether outcomes are different between individuals who did and did not have the opportunity to receive buprenorphine in jail. METHODS: We examined outcomes of all incarcerated adults with opioid use disorder (n=469) who did (FCSO n=197) and did not (HCHC n=272) have the opportunity to receive buprenorphine. The primary outcome was post-release recidivism, defined as time from jail exit to a recidivism event (incarceration, probation violation, arraignment). Using Cox proportional hazards models, we investigated site as a predictor, controlling for covariates. We also examined post-release deaths. RESULTS: Fewer FCSO than HCHC individuals recidivated (48.2% vs. 62.5%; p=0.001); fewer FCSO individuals were re-arraigned (36.0% vs. 47.1%; p=0.046) or re-incarcerated (21.3% vs. 39.0%; p

Peroral endoscopic myotomy (POEM) has become an acceptable incisionless treatment for achalasia based on encouraging outcomes in multiple series worldwide. This report reflects our early experience.Data were collected prospectively on all patients undergoing POEM between June 2011 and April 2016 under IRB approval. Diagnosis of achalasia was confirmed by standard preoperative work-up. Primary outcome was symptom relief, measured by Eckardt score. Secondary outcomes were operative time, length of stay (LOS), adverse events, failure, and recurrence.Fifty patients were included; 30 were female. Mean age was 55.7 ± 17.7 years. Mean BMI was 29.5 ± 9.2. Median OR time was 133.5 minutes (range 70-462); average myotomy was 13.1 ± 2.3 cm. One early case was converted to a laparoscopic Heller myotomy due to extensive submucosal fibrosis from a recent Botox injection. Two cases were aborted; one due to extensive submucosal fibrosis and the other to intraoperative capnopericardium. Median LOS was 1 day (range 0.8-8). Two major complications occurred: intraoperative cardiac arrest due to capnopericardium and postoperative submucosal hemorrhage. There were no deaths. Mean postoperative Eckardt score was 1.0 ± 1.9 (range 0-8) at 2-6 weeks (vs. preoperative score 7.7 ± 2.8; P .0001); mean dysphagia component 0.35 ± 0.28 (vs. preoperative score 2.6 ± 0.7; P .0001). Two recurrences were identified, both at 6 months.POEM is a safe and durable treatment for achalasia in the short term. We demonstrated marked improvement of symptoms in all completed cases. There was an acceptable serious adverse event rate of 4%, failure of 6% due to patient selection, and recurrences occurring in only 4% of cases.

Opioid use disorder is often treated with short term hospitalization and medically supervised withdrawal from opioids followed by counseling alone without medication assisted treatment (MAT). More evidence is needed to confirm the expectation that the rate of relapse would be high after short term inpatient treatment and withdrawal from opioids without follow-up MAT.To examine relapse to opioid use disorder in a randomized, multi-site effectiveness trial of extended-release injection naltrexone (XR-NTX) vs community-based treatment as usual (TAU) without medication, as a function of the type of clinical service where treatment was initiated-short-term inpatient (N=59), long-term inpatient (N=48), or outpatient (N=201). Inpatients typically were admitted to treatment actively using opioids and had completed withdrawal from opioids before study entry. Outpatients typically presented already abstinent for varying periods of time.One month after randomization, relapse rates on TAU by setting were: short-term inpatient: 63%; long term inpatient: 14%; outpatient: 28%. On XR-NTX relapse rates after one month were low (12%) across all three settings. At the end of the 6 month trial, relapse rates on TAU were high across all treatment-initiation settings (short term inpatient 77%; long term inpatient 59%; outpatient 61%), while XR-NTX exerted a modest protective effect against relapse across settings (short term inpatient: 59%; long term inpatient 46%; outpatient 38%).Short term inpatient treatment is associated with a high rate of relapse among patients with opioid use disorder. These findings support the recommendation that medically supervised withdrawal from opioids should be followed by medication assisted treatment.

Background Extended release naltrexone (XR-NTX) injected intramuscularly monthly has been shown to reduce relapse in persons with opioid use disorder. Baseline factors, including patients' demographics, comorbidities and lifestyle, may help identify patients who will benefit most or least from XR-NTX treatment. Methods Potential moderators of XR-NTX's effect were examined in the largest North American randomized open-label effectiveness trial of XR-NTX. Relapse status (Yes/No) at 6-month follow-up was regressed on treatment group (XR-NTX, N=153; or Treatment-as-Usual [TAU], N=155), baseline covariates, and their two-way interaction to identify moderator effects. Baseline covariates included age, gender, summary scores for depression, suicidal thoughts, drug abuse risk, substance use, medical, psychiatric and employment status, socialization, legal and family/social issues, history of abuse and quality of life measures. Results Alcohol use to intoxication in the 30days before randomization was a significant moderator: during the treatment phase, those who reported being recently intoxicated before randomization to XR-NTX relapsed to opioids at a rate (56%) similar to TAU (58%), while those without alcohol intoxication in the prior 30days had a lower rate of opioid relapse (41% vs. 65%, respectively, P Conclusions XR-NTX appeared to work equally well across subgroups with diverse demographic, addiction, mental health and environmental characteristics, with the possible exception of working better among those without recent alcohol intoxication. These findings should be reassuring to practitioners increasingly using XR-NTX as medical addiction therapy in diverse and often vulnerable populations.

Background Opioid use disorders have reached epidemic proportions, with overdose now the leading cause of accidental death in the United States. Extended release naltrexone (XR-NTX) has emerged as a medication treatment that reduces opioid use and craving. However, the effect of XR-NTX therapy on acute healthcare utilization, including emergency department visits and inpatient hospitalizations, remains uncertain. The objective of the current study is to evaluate hospital-based healthcare resource utilization in adults involved in the criminal justice system with a history of opioid use disorder randomized to XR-NTX therapy compared with treatment as usual (TAU) during a 6-month treatment phase and 12months post-treatment follow up. Methods This retrospective exploratory analysis uses data collected in a published randomized trial. Comparisons of the number of emergency department visits and hospital admissions (for drug detox, psychiatric care and other medical reasons) were performed using chi square tests for any admission and negative binomial models for number of admissions. Results Of the 308 participants randomized, 96% had utilization data (76% complete 6months, 67% complete follow up). No significant differences were seen in overall healthcare utilization (IRR=0.88, 95%CI 0.63–1.23, p =0.45), or substance use-related drug detox hospitalizations (IRR=0.83, 95%CI 0.32–2.16, p =0.71). Despite having more participants report chronic medical problems at baseline (43% vs. 32%, p =0.05), those receiving XR-NTX generally experienced equivalent or lower rates of healthcare utilization compared to TAU. The XR-NTX group had significantly lower medical/surgical related hospital admissions (IRR=0.55, 95%CI 0.30–1.00, p =0.05) during the course of the entire study. Conclusions XR-NTX did not significantly increase rates of healthcare utilization compared to TAU. Provider concerns regarding healthcare utilization should not preclude the consideration of XR-NTX as therapy for opioid use disorders.

Peritoneal closure during laparoscopic trans-abdominal preperitoneal (TAPP) inguinal hernia repair has been the standard of care to prevent bowel obstruction due to adhesions generated by contact with mesh. However, with newer coated meshes, leaving the peritoneal layer open may be safe. While many studies compare methods of peritoneal flap closure, there is a deficit of literature reporting the outcomes of non-closure. A retrospective comparison of peritoneal flap closure versus non-closure during primary laparoscopic TAPP inguinal hernia repair with coated mesh was performed for all patients at Baystate Medical Center meeting inclusion criteria between January 2005 and August 2016. Primary outcome was any procedure-related adverse outcome following repair. Secondary outcomes included operative time, resolution of pre-operative pain and/or gastrointestinal symptoms, and hernia recurrence. Of 231 patients, 55 (24%) underwent peritoneal flap closure and 176 (76%) underwent non-closure. Demographic, comorbidity, and hernia characteristics were comparable between groups with the exception of obesity (p = 0.01), current smoking status (p = 0.05) and hernia side [p = 0.04 (left), 0.0003 (right)]. Mean operative time was higher in the closure group than non-closure (98.1 ± 37.1 min vs. 76.8 ± 32.9, p

Climate change has led to concerns about increasing river floods resulting from the greater water-holding capacity of a warmer atmosphere1. These concerns are reinforced by evidence of increasing economic losses associated with flooding in many parts of the world, including Europe2. Any changes in river floods would have lasting implications for the design of flood protection measures and flood risk zoning. However, existing studies have been unable to identify a consistent continental-scale climatic-change signal in flood discharge observations in Europe3, because of the limited spatial coverage and number of hydrometric stations. Here we demonstrate clear regional patterns of both increases and decreases in observed river flood discharges in the past five decades in Europe, which are manifestations of a changing climate. Our results—arising from the most complete database of European flooding so far—suggest that: increasing autumn and winter rainfall has resulted in increasing floods in northwestern Europe; decreasing precipitation and increasing evaporation have led to decreasing floods in medium and large catchments in southern Europe; and decreasing snow cover and snowmelt, resulting from warmer temperatures, have led to decreasing floods in eastern Europe. Regional flood discharge trends in Europe range from an increase of about 11 per cent per decade to a decrease of 23 per cent. Notwithstanding the spatial and temporal heterogeneity of the observational record, the flood changes identified here are broadly consistent with climate model projections for the next century4,5, suggesting that climate-driven changes are already happening and supporting calls for the consideration of climate change in flood risk management. Analysis of a comprehensive European flood dataset reveals regional changes in river flood discharges in the past five decades that are consistent with models suggesting that climate-driven changes are already happening.

Molecular markers reported to be linked to extreme resistance (ER) against Potato virus Y (PVY) were evaluated in potato germplasm. YES3-3A and YES3-3B, markers linked to Rysto, were detected in ‘Barbara’ and its three descendants that exhibit ER to PVY; RYSC3, a marker linked to Ryadg, was detected in breeding clones NY121 and NY123. Assessment of RYSC3 as a marker for selection for Ryadg-mediated ER validated its efficacy in identification of selections with ER to PVY.

This paper presents the background, objectives, and preliminary outcomes from the first year of activities of the Polish–Norwegian project CHIHE (Climate Change Impact on Hydrological Extremes). The project aims to estimate the influence of climate changes on extreme river flows (low and high) and to evaluate the impact on the frequency of occurrence of hydrological extremes. Eight “twinned” catchments in Poland and Norway serve as case studies. We present the procedures of the catchment selection applied in Norway and Poland and a database consisting of near-natural ten Polish and eight Norwegian catchments constructed for the purpose of climate impact assessment. Climate projections for selected catchments are described and compared with observations of temperature and precipitation available for the reference period. Future changes based on those projections are analysed and assessed for two periods, the near future (2021–2050) and the far-future (2071–2100). The results indicate increases in precipitation and temperature in the periods and regions studied both in Poland and Norway.

Background Criminal justice involved (CJS) populations with opioid use disorder (OUD) have high rates of relapse, future arrests, and death upon release. While medication for OUD (MOUD) reduces opioid relapse, concerns regarding diversion and stigma limit treatment in CJS populations. Extended release naltrexone (XR-NTX), as an opioid antagonist, may be more acceptable to CJS administrators. However, the impact of XR-NTX on criminal recidivism remains unknown. Methods Arrest data from a published randomized trial comparing XR-NTX to treatment as usual (TAU) was captured by self-report and official state arrest records. Comparisons of future arrests, time to first arrest and total number of arrests were performed using chi square tests and multivariable generalized regression models. Secondary outcomes explored differences in arrests by type and severity of crime, use of opioid and other drugs, and study phase. Results Of 308 participants randomized, 300 had arrest data. The incidence of arrests did not differ between XR-NTX (47.6%) and TAU (42.5%) participants. (ChiSq p = 0.37). Additionally, there was no significant difference in time to first arrest (adjusted HR 1.35, CI 0.96–1.89) and number of arrests per participant (adjusted IR 1.33, CI 0.78–2.27). Controlling for gender, age, previous criminal activity, and use of non-opioid drugs, logistic regression demonstrated no significant difference in incidence of arrests between groups (adjusted OR 1.38, 95% CI 0.85–2.22). Conclusions We detected no significant difference in arrests between CJS participants with OUD randomized to XR-NTX or TAU. Despite its efficacy in reducing opioid use, XR-NTX alone may be insufficient to reduce criminal recidivism.

The Common Core State Standards emphasize higher-order thinking, problem solving, and the creation, retention, and application of knowledge. Achieving these standards creates greater cognitive demands on students. Recent research suggests that active play and regular exercise have a positive effect on brain regions associated with executive function, learning, and memory, thus increasing student achievement. Physical activity increases production of neurotransmitters that support learning readiness; oxygen flow, which facilitates healthy brain functioning, and the brain chemical BDNF, which enhances creation of neurons and synapses. The authors share practical pathways to increase the positive effect of physical activity for students of all ages.

Medication-assisted treatment (MAT) is effective for alcohol and opioid use disorders but it is stigmatized and underutilized in criminal justice settings.This study cluster-randomized 20 community corrections sites to determine whether an experimental implementation strategy of training and an organizational linkage intervention improved staff perceptions of MAT and referral intentions more than training alone. The 3-hour training was designed to address deficits in knowledge, perceptions and referral information, and the organizational linkage intervention brought together community corrections and addiction treatment agencies in an interagency strategic planning and implementation process over 12 months.Although training alone was associated with increases in familiarity with pharmacotherapy and knowledge of where to refer clients, the experimental intervention produced significantly greater improvements in functional attitudes (e.g. that MAT is helpful to clients) and referral intentions. Corrections staff demonstrated greater improvements in functional perceptions and intent to refer opioid dependent clients for MAT than did treatment staff.Knowledge, perceptions and information training plus interorganizational strategic planning intervention is an effective means to change attitudes and intent to refer clients for medication assisted treatment in community corrections settings, especially among corrections staff.

International audience; Concern over the potential impact of anthropogenic climate change on flooding has led to a proliferation of studies examining past flood trends. Many studies have analysed annual-maximum flow trends but few have quantified changes in major (25–100 year return period) floods, i.e. those that have the greatest societal impacts. Existing major-flood studies used a limited number of very large catchments affected to varying degrees by alterations such as reservoirs and urbanisation. In the current study, trends in major-flood occurrence from 1961 to 2010 and from 1931 to 2010 were assessed using a very large dataset (>1200 gauges) of diverse catchments from North America and Europe; only minimally altered catchments were used, to focus on climate-driven changes rather than changes due to catchment alterations. Trend testing of major floods was based on counting the number of exceedances of a given flood threshold within a group of gauges. Evidence for significant trends varied between groups of gauges that were defined by catchment size, location, climate, flood threshold and period of record, indicating that generalizations about flood trends across large domains or a diversity of catchment types are ungrounded. Overall, the number of significant trends in major-flood occurrence across North America and Europe was approximately the number expected due to chance alone. Changes over time in the occurrence of major floods were dominated by multidecadal variability rather than by long-term trends. There were more than three times as many significant relationships between major-flood occurrence and the Atlantic Multidecadal Oscillation than significant long-term trends.

Near-infrared array detectors, like the \JWST NIRSpec's Teledyne's H2RGs, often provide reference pixels and a reference output. These are used to remove correlated noise. Improved Reference Sampling and Subtraction (\IRSSquare, pronounced "IRS-square") is a statistical technique for using this reference information optimally in a least squares sense. Compared to "traditional" H2RG readout, \IRSSquare uses a different clocking pattern to interleave many more reference pixels into the data than is otherwise possible. Compared to standard reference correction techniques, \IRSSquare subtracts the reference pixels and reference output using a statistically optimized set of frequency dependent weights. The benefits include somewhat lower noise variance and much less obvious correlated noise. NIRSpec's \IRSSquare images are cosmetically clean, with less $1/f$ banding than in traditional data from the same system. This article describes the \IRSSquare clocking pattern and presents the equations that are needed to use \IRSSquare in systems other than NIRSpec. For NIRSpec, applying these equations is already an option in the calibration pipeline. As an aid to instrument builders, we provide our prototype \IRSSquare calibration software and sample \JWST NIRSpec data. The same techniques are applicable to other detector systems, including those based on Teledyne's H4RG arrays. The H4RG's "interleaved reference pixel readout" mode is effectively one \IRSSquare pattern.

Objective To determine whether assisted reproductive technology (ART) cycles involving cryopreserved-warmed embryos are associated with the development of preeclampsia. Design Retrospective cohort study. Setting IVF clinics and hospitals. Patient(s) A total of 15,937 births from ART: 9,417 singleton and 6,520 twin. Intervention(s) We used linked ART surveillance, birth certificate, and maternal hospitalization discharge data, considering resident singleton and twin births from autologous or donor eggs from 2005–2010. Main Outcome Measure(s) We compared the frequency of preeclampsia diagnosis for cryopreserved-warmed versus fresh ET and used multivariable logistic regression to adjust for confounders. Result(s) Among pregnancies conceived with autologous eggs resulting in singletons, preeclampsia was greater after cryopreserved-warmed versus fresh ET (7.51% vs. 4.29%, adjusted odds ratio=2.17 [95% CI 1.67–2.82]). Preeclampsia without and with severe features, preeclampsia with preterm delivery, and chronic hypertension with superimposed preeclampsia were more frequent after cryopreserved-warmed versus fresh ET (3.99% vs. 2.55%; 2.95% vs. 1.41%; 2.76 vs. 1.48%; and 0.95% vs. 0.43%, respectively). Among pregnancies from autologous eggs resulting in twins, the frequency of preeclampsia with severe features (9.26% vs. 5.70%) and preeclampsia with preterm delivery (14.81% vs. 11.74%) was higher after cryopreserved versus fresh transfers. Among donor egg pregnancies, rates of preeclampsia did not differ significantly between cryopreserved-warmed and fresh ET (10.78% vs. 12.13% for singletons and 28.0% vs. 25.15% for twins). Conclusion(s) Among ART pregnancies conceived using autologous eggs resulting in live births, those involving transfer of cryopreserved-warmed embryos, as compared with fresh ETs, had increased risk for preeclampsia with severe features and preeclampsia with preterm delivery.

Opioid use disorder is common in prison populations, and prison release is a high-risk time for relapse and overdose. Initiation of extended release injectable naltrexone (XR-NTX)) prior to prison release might decrease relapse among opioid-dependent persons.This pilot study examined the feasibility and acceptability of XR-NTX injection prior to prison release among adult inmates with opioid use disorder, followed by six months of community XR-NTX treatment. It sought to determine effects on treatment retention and abstinence compared to post-release XR-NTX initiation.Recruitment for the study took place at the RIDOC's Adult Correctional Institute (ACI). Volunteers with a history of opioid dependence and a release date scheduled within 1-2months were self-referred in response to recruitment fliers. Consented volunteers were randomized to XR-NTX treatment prior to release followed by 5 monthly treatments in the community (pre-release) or six XR-NTX treatments in the community (post-release).Of 26 volunteers consented, 15 were randomized (9 pre-release, 6 post-release). The pre-release group generally had better treatment retention: 100% received the first NTX injection (vs. 67% post-release), 78% received more than one injection (vs. 17%) and 22% received all 6 injections (vs. 0%). The pre-release group also had greater abstinence, with a higher proportion of self-reported opioid free days in the first month after release (83% vs. 46%, fewer positive urine drug tests in the 6months after release (22% vs. 33%), and more days of opioid receptor blockade during the first two weeks after release, a high risk time for overdose death.Initiation of XR-NTX injection prior to release from prison might be an effective approach to reduce relapse to opioids, but these findings require confirmation in a larger trial.

The OSIRIS-REx Visible and Infrared Spectrometer (OVIRS) is a point spectrometer covering the spectral range of 0.4 to 4.3 microns (25,000-2300 cm-1). Its primary purpose is to map the surface composition of the asteroid Bennu, the target asteroid of the OSIRIS-REx asteroid sample return mission. The information it returns will help guide the selection of the sample site. It will also provide global context for the sample and high spatial resolution spectra that can be related to spatially unresolved terrestrial observations of asteroids. It is a compact, low-mass (17.8 kg), power efficient (8.8 W average), and robust instrument with the sensitivity needed to detect a 5% spectral absorption feature on a very dark surface (3% reflectance) in the inner solar system (0.89-1.35 AU). It, in combination with the other instruments on the OSIRIS-REx Mission, will provide an unprecedented view of an asteroid's surface., 14 figures, 3 tables, Space Science Reviews, submitted

Extended-release naltrexone, a sustained-release monthly injectable formulation of the full mu-opioid receptor antagonist, is effective for the prevention of relapse to opioid dependence. Data supporting its effectiveness in U.S. criminal justice populations are limited.In this five-site, open-label, randomized trial, we compared a 24-week course of extended-release naltrexone (Vivitrol) with usual treatment, consisting of brief counseling and referrals for community treatment programs, for the prevention of opioid relapse among adult criminal justice offenders (i.e., persons involved in the U.S. criminal justice system) who had a history of opioid dependence and a preference for opioid-free rather than opioid maintenance treatments and who were abstinent from opioids at the time of randomization. The primary outcome was the time to an opioid-relapse event, which was defined as 10 or more days of opioid use in a 28-day period as assessed by self-report or by testing of urine samples obtained every 2 weeks; a positive or missing sample was computed as 5 days of opioid use. Post-treatment follow-up occurred at weeks 27, 52, and 78.A total of 153 participants were assigned to extended-release naltrexone and 155 to usual treatment. During the 24-week treatment phase, participants assigned to extended-release naltrexone had a longer median time to relapse than did those assigned to usual treatment (10.5 vs. 5.0 weeks, P0.001; hazard ratio, 0.49; 95% confidence interval [CI], 0.36 to 0.68), a lower rate of relapse (43% vs. 64% of participants, P0.001; odds ratio, 0.43; 95% CI, 0.28 to 0.65), and a higher rate of opioid-negative urine samples (74% vs. 56%, P0.001; odds ratio, 2.30; 95% CI, 1.48 to 3.54). At week 78 (approximately 1 year after the end of the treatment phase), rates of opioid-negative urine samples were equal (46% in each group, P=0.91). The rates of other prespecified secondary outcome measures--self-reported cocaine, alcohol, and intravenous drug use, unsafe sex, and reincarceration--were not significantly lower with extended-release naltrexone than with usual treatment. Over the total 78 weeks observed, there were no overdose events in the extended-release naltrexone group and seven in the usual-treatment group (P=0.02).In this trial involving criminal justice offenders, extended-release naltrexone was associated with a rate of opioid relapse that was lower than that with usual treatment. Opioid-use prevention effects waned after treatment discontinuation. (Funded by the National Institute on Drug Abuse; ClinicalTrials.gov number, NCT00781898.).

A novel flow regime classification scheme was applied to 141 river basins across western Europe, providing more robust analysis of space–time variability in regimes and their driving hydroclimatological processes. Regime shape (timing) and magnitude (size) were classified to regionalise long-term average flow regimes and to quantify year-to-year variation in regimes for each basin. Six long-term regime shape regions identified differences in seasonality related to latitude and altitude. Five long-term magnitude regions were linked to location plus average annual rainfall. Spatial distribution of long-term regimes reflected dominant climate and runoff generation processes. Regions were used to structure analysis of (relative) inter-annual regime dynamics. Six shape and five magnitude inter-annual regimes were identified; and regime stability (switching) assessed at pan-European, regional and basin scales. In some years, certain regime types were more prevalent, but never totally dominant. Regime shape was more stable at higher altitude due to buffering by frozen water storage-release (cf. more variable rainfall-runoff at lower altitudes). The lower inter-annual magnitude regimes persisted across larger domains (cf. higher magnitude) due to the more widespread climatic conditions generating low flow. Notably, there was limited spatio-temporal correspondence between regime shape and magnitude, suggesting variations in one attribute cannot be used to infer the other.

Explicit instruction on the skill of creating mental imagery from text supports reading comprehension and recall. This article shares a strategy for teaching students how to process what they read by comparing mental imagery to “brain movies.” It emphasizes choosing appropriate fiction and nonfiction texts to encourage readers to build the skill of creating mental imagery, and offers examples from two classrooms on how students use brain movies to make meaning from what they read.

A pan-Nordic dataset of 151 streamflow records was analysed to detect spatial and temporal changes in streamflow. Prior to undertaking analyses, all streamflow records with significant levels of autocorrelation were pre-whitened to remove the adverse effect of temporal autocorrelation on the test results. The Mann-Kendall trend test was applied to study changes in annual and seasonal streamflow as well as floods and droughts for three periods: 1920-2005, 1941-2005 and 1961-2000. Field significance was evaluated to determine the percentage of stations that are expected to show a trend due to the effect of cross-correlation. The period analysed and the selection of stations influenced the regional patterns found, but the overall picture was that trends of increased streamflow dominate annual values and the winter and spring seasons. Trends identified in summer flows differed between the three periods analysed, whereas no trend was found for the autumn season. In all three periods, a signal towards earlier snowmelt floods was clear, as was the tendency towards more severe summer droughts in southern and eastern Norway. These trends in streamflow result from changes in both temperature and precipitation, but the temperature induced signal is stronger than precipitation influences. This is evident because the observed trends in winter and spring, where snowmelt is the dominant process, are greater than the annual trends. A qualitative comparison of the findings with available streamflow projections for the region showed that the strongest trends found are generally consistent with future changes expected in the projection periods, for example increased winter discharge and earlier snowmelt floods. However, there are predicted changes that are not reflected in past trends, such as the expected increase in autumn discharge in Norway. Hence, the changes expected because of increased temperatures are reflected in the observed trends, whereas changes anticipated due to increases in precipitation are not.

One hundred twelve pregnant women who were diagnosed depressed were randomly assigned to a group who received group Interpersonal Psychotherapy or to a group who received both group Interpersonal Psychotherapy and massage therapy. The group Interpersonal Psychotherapy (one hour sessions) and massage therapy (30 minute sessions) were held once per week for six weeks. The data suggested that the group who received psychotherapy plus massage attended more sessions on average, and a greater percentage of that group completed the six-week program. The group who received both therapies also showed a greater decrease in depression, depressed affect and somatic-vegetative symptom scores on the Center for Epidemiological Studies Depression Scale (CES-D), a greater decrease in anxiety scale (STAI) scores and a greater decrease in cortisol levels. The group therapy process appeared to be effective for both groups as suggested by the increased expression of both positive and negative affect and relatedness during the group therapy sessions. Thus, the data highlight the effectiveness of group Interpersonal Psychotherapy and particularly when combined with massage therapy for reducing prenatal depression.

The risk of thrombosis related to peripherally inserted central catheters (PICCs) is a well-known complication. A study was conducted to compare thrombosis rates associated with the old technique of inserting PICCs by visualizing veins in the antecubital fossa, using anatomical landmarks and palpation versus using ultrasound guidance to locate veins in the upper arm. The findings from data collected on 538 patients included a significant decline in the thrombosis rates, as thrombosis decreased from 9.3% with the palpation method to 1.9% with the ultrasound method, and successful PICC placements by registered nurses increased from 76.9% when using the old method to 98.9% when using ultrasound guidance.

There is increasing evidence for recent changes in the intensity and frequency of heavy precipitation and in the number of days with snow cover in many parts of Norway. The question arises as to whether these changes are also discernable with respect to their impacts on the magnitude and frequency of flooding and on the processes producing high flows. In this study, we tested up to 211 catchments for trends in peak flow discharge series by applying the Mann-Kendall test and Poisson regression for three different time periods (1962-2012, 1972-2012, 1982-2012). Field-significance was tested using a bootstrap approach. Over threshold discharge events were classified into rainfall vs. snowmelt dominated floods, based on a simple water balance approach utilizing a nationwide 1 x 1 km(2) gridded data set with daily observed rainfall and simulated snowmelt data. Results suggest that trends in flood frequency are more pronounced than trends in flood magnitude and are more spatially consistent with observed changes in the hydrometeorological drivers. Increasing flood frequencies in southern and western Norway are mainly due to positive trends in the frequency of rainfall dominated events, while decreasing flood frequencies in northern Norway are mainly the result of negative trends in the frequency of snowmelt dominated floods. Negative trends in flood magnitude are found more often than positive trends, and the regional patterns of significant trends reflect differences in the flood generating processes (FGPs). The results illustrate the benefit of distinguishing FGPs rather than simply applying seasonal analyses. The results further suggest that rainfall has generally gained an increasing importance for the generation of floods in Norway, while the role of snowmelt has been decreasing and the timing of snowmelt dominated floods has become earlier. (C) 2016 Elsevier B.V. All rights reserved.

This study compiles a new dataset, consisting of the longest available flow series from across Europe, and uses it to study the spatial and temporal clustering of flood events across the continent. Hydrological series at 102 gauging stations were collected from 25 European countries. Five geographically distinct large-scale homogeneous regions are identified: (i) an Atlantic region, (ii) a Continental region, (iii) a Scandinavian region, (iv) an Alpine region, and (v) a Mediterranean region. The months with a higher likelihood of flooding were identified in each region. The analysis of the clustering of annual counts of floods revealed an over-dispersion in the Atlantic and Continental regions, forming flood-rich and flood-poor periods, as well as an under-dispersion in the Scandinavian region that points to a regular pattern of flood occurrences at the inter-annual scale. The detection of trends in flood series is attempted by basing it on the identified regions, interpreting the results at a regional scale and for various time periods: 1900-1999; 1920-1999; 1939-1998 and 1956-1995. The results indicate that a decreasing trend in the magnitude of floods was observed mainly in the Continental region in the period 1920-1999 with 22% of the catchments revealing such a trend, as well as a decreasing trend in the timing of floods in the Alpine region in the period 1900-1999 with 75% of the catchments revealing this trend. A mixed pattern of changes in the frequency of floods over a threshold and few significant changes in the timing of floods were detected. (C) 2015 Elsevier B.V. All rights reserved.

To meet their aims of managing population health to improve the quality and cost of health care in the United States, accountable care organizations (ACOs) will need to focus on coordinating care for individuals with substance abuse disorders. The prevalence of these disorders is high, and these individuals often suffer from comorbid chronic medical and social conditions. This article examines the extent to which the nation's fourteen thousand specialty substance abuse treatment (SAT) organizations, which have a daily census of more than 1 million patients, are contracting with ACOs across the country; we also examine factors associated with SAT organization involvement with ACOs. We draw on data from a recent (2014) nationally representative survey of executive directors and clinical supervisors from 635 SAT organizations. Results show that only 15 percent of these organizations had signed contracts with ACOs. Results from multivariate analyses show that directors' perceptions of market competition, organizational ownership, and geographic location are significantly related to SAT involvement with ACOs. We discuss implications for integrating the SAT specialty system with the mainstream health care system.

Proceedings of the First International Symposium on Places of Death: an Agenda for the 21st Century. Held in Sion, Switzerland, November 1 and 2, 2005, at the Institut Universitaire Kurt Bosch, with the support of Geneva University, WHO, and the Swiss Medical Academy.

Intensive care unit (ICU) core measures that target the prevention of catheter-related bloodstream infections (CRBSIs) and ventilator-associated pneumonia (VAP) in ventilated ICU patients are underway across the United States. Implementation often requires additional personnel to educate providers and collect the data. We hypothesized that use of our current computerized ICU flowsheet could provide timely, accurate data on ICU core measures without additional personnel dedicated to data capture.In a 10-bed, closed surgical ICU with existing protocols for deep vein thrombosis (DVT) prophylaxis, stress ulcer bleeding prophylaxis (SUP), ventilator weaning parameters, and glucose control, we created a reporting tool that would document daily weaning parameters, head of bed (HOB) at 30 degrees , glucose levels, DVT prophylaxis, and SUP. Our glucose protocol targeted150 mg/dL, with all daily glucose values reported rather than just the morning value. The results from the previous 12 am to 11:59 pm were available to the rounding team at 7 am. We examined compliance at the start and after education of medical staff (March/April for HOB up, DVT, and SUP; May/June for glucose control).During 2005, compliance with all protocols improved. Percent compliance for DVT prophylaxis, SUP, and HOB up rose from as low as 32% at the start of the documentation process to consistently higher than the target level of 95%. Compliance for glucose control increased after intensive education of nursing and physicians with the mean glucose falling from 144 to 122 mg/dL. There was increased nursing workload for checking glucose levels in which the mean number of glucose checks rose from a low of 1.5 per patient to as high as 8.2 per patient per day. CRBSI and VAP rates did not decrease during this period compared with the prior year. Length of stay and mortality were unchanged.Reporting of ICU core measures to treating staff can be done accurately and promptly with a computerized system. Education was effective in improving compliance levels. No additional personnel were required to create reports, capture data, or improve compliance after initial development and testing. Although compliance with core measures met target levels at the end of the year, we did not observe improved outcomes in terms of CRBSI, VAP, mortality, or length of stay.

Most if not all of end-of-life care for people living in long-term care facilities is provided within the facility. This type of care is likely to increase with population ageing. This paper presents a literature review of the published literature on end-of-life care in long-term care facilities such as nursing homes, aged care facilities, residential care homes and continuing care settings, published between 2000 and 2004. A subset of literature that focuses on the development of practice and the identification of interventions to promote the provision of end-of-life care in care homes is examined in detail. Twenty-five papers are identified and these address modes of service delivery, the introduction of ‘interventions’ that facilitate care for individuals, and the development of tools. This work remains largely descriptive. Small-scale work dominates, reflecting the initial stages of knowledge development in this area of work. Suggestions for ways to expand the scope of the end-of-life care development work in long-term care settings are presented, as it is time to expand the horizons of these initiatives to become more rigorous and responsive to the needs of older people and their families in this care setting.