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Maternal cardiac arrest (MCA) requires a multidisciplinary team well versed in the cascade of steps involved during resuscitation. Historically, maternal outcomes were poor, primarily because cardiac arrest management in pregnant women was neither optimum nor standardized. However, current evidence has shown better maternal survival given the young age and reversible causes of death. There are specific interventions such as manual left uterine displacement (MLUD) for relief of aortocaval compression that, if not performed, may undermine the success of resuscitation. The team should simultaneously explore the etiology of MCA, which could be a combination of pregnancy-related causes and comorbid conditions. Resuscitative Hysterotomy or Resuscitative Uterine Interventions (RUI) should be considered if there is no return of spontaneous circulation following 4–5 min of cardiopulmonary resuscitation. Teamwork is critical to success in the high-stakes environment of MCA. This consensus statement was prepared by the experts after reviewing evidence-based literature on maternal resuscitation during MCA.

Objective To assess the implementation of a mobile dispensing service to improve opioid users' access to methadone maintenance therapy. Methods In March 2019, we started mobile methadone dispensing in an urban underprivileged locality in Delhi, India. The doctor was available only at the main community drug treatment clinic for clinical services, while the nurse dispensed methadone from a converted ambulance. We involved patients in identifying community leaders for sensitization and in deciding the location and timings for dispensing. We conducted a retrospective chart review of the programme data collected during delivery of clinical services. We compared the numbers of patients registered for methadone therapy and their retention and adherence to therapy in the 12-month periods before and after implementation of the mobile service. Findings The number of patients registered for therapy at the clinic increased from 167 in the year before implementation to 671 in the year after. A significantly higher proportion of patients were retained in therapy at 3, 6 and 9 months after enrolment; 9- month retention rates were 19% (32/167 patients) and 45% (44/97 patients) in the year before and after implementation, respectively. There was no significant difference in patients' adherence to therapy between the two periods. Challenges included providing suitable dispensing hours for patients in employment and concerns of local community near to the dispensing sites. Conclusion It is feasible to dispense methadone by a mobile team in an urban setting, with better retention rates in therapy compared with dispensing through a stationary clinic. Distribution mobile de methadone a Delhi, en Inde: etude de la mise en oeuvre Objectif Analyser la mise en oeuvre d'un service de distribution mobile destine a ameliorer l'acces des consommateurs d'opiaces au traitement de maintien a la methadone. Methodes En mars 2019, nous avons commence la distribution mobile de methadone dans une agglomeration urbaine defavorisee a Delhi, en Inde. Le medecin restait au centre communautaire de prise en charge de la toxicomanie pour assurer les services cliniques, tandis que l'infirmiere circulait dans une ambulance reconvertie pour fournir de la methadone. Nous avons demande aux patients d'identifier les responsables au sein de la communaute, afin de les inclure dans le processus de sensibilisation et de determiner quand et ou organiser la distribution. Nous avons mene un examen retrospectif des dossiers regroupant les donnees du programme, recoltees lors de la prestation des services cliniques. Enfin, nous avons compare le nombre de patients enregistres pour le traitement a la methadone, leur maintien et leur adhesion au traitement sur des periodes de 12 mois, avant et apres la mise en oeuvre de la distribution mobile. Resultats Le nombre de patients inscrits a la clinique en vue de recevoir un traitement est passe de 167 durant l'annee precedant la mise en oeuvre a 671 l'annee suivante. Un pourcentage nettement plus eleve de patients ont maintenu leur traitement 3, 6 et 9 mois apres l'avoir entame; le taux de maintien apres 9 mois etait de 19% (32/167 patients) avant la mise en oeuvre, et de 45% (44/97 patients) apres celle-ci. Aucune difference notable n'a ete constatee entre les deux periodes au niveau de l'adhesion des patients au traitement. Plusieurs defis se sont presentes: proposer des heures de distribution qui conviennent aux patients exercant un emploi, et apaiser les inquietudes de la communaute locale installee a proximite des lieux de distribution. Conclusion Il est possible de distribuer de la methadone par l'intermediaire d'une equipe mobile dans un environnement urbain, et les taux de maintien du traitement sont meilleurs que ceux observes dans une clinique fixe. Distribucion movil de metadona en Delhi (India): investigacion sobre su implementacion Objetivo Evaluar la implementacion de un servicio de distribucion movil para mejorar el acceso de los usuarios de opioides a la terapia de mantenimiento con metadona. Metodos En marzo de 2019, iniciamos la distribucion movil de metadona en una localidad urbana desfavorecida de Delhi (India). El medico solo estaba disponible en la clinica principal de tratamiento de medicamentos de la comunidad para los servicios clinicos, mientras que la enfermera dispensaba la metadona desde una ambulancia transformada. Involucramos a los pacientes en la identificacion de los lideres de la comunidad para la sensibilizacion y en la decision del lugar y los horarios de distribucion. Realizamos una revision retrospectiva de los datos del programa recogidos durante la prestacion de los servicios clinicos. Se comparo el numero de pacientes registrados para la terapia con metadona y su retencion y adherencia al tratamiento en periodos de 12 meses antes y despues de la implementacion del servicio movil. Resultados El numero de pacientes registrados para recibir tratamiento en la clinica aumento de 167 en el ano anterior a la implementacion a 671 en el ano posterior. Una proporcion significativamente mayor de pacientes siguio con el tratamiento a los 3, 6 y 9 meses de su inscripcion; las tasas de retencion a los 9 meses fueron del 19% (32/167 pacientes) y del 45% (44/97 pacientes) en el ano anterior y posterior a la implantacion, respectivamente. No hubo diferencias significativas en el cumplimiento terapeutico de los pacientes entre los dos periodos. Los desafios incluyeron la provision de un horario de distribucion adecuado para los pacientes con empleo y las preocupaciones de la comunidad local cercana a los lugares de distribucion. Conclusion Es factible la distribucion de metadona por un equipo movil en un entorno urbano, con mejores tasas de retencion en el tratamiento en comparacion con la distribucion a traves de una clinica fija., Introduction Although opioids are the second most commonly used group of illicit drugs worldwide, they cause the most harm to the health of users. Opioids account for 66% of the [...]

Background: About one-fourth of individuals who are dependent on opioids use opioids through injecting route. Most of such individuals start using opioids through noninjecting route much earlier before they transition to injecting opioids. It is important to identify important factors that delineate individuals who inject opioids from those who use opioids through other routes, which was the objective of the present study. Methods: This was a cross-sectional study design. Four hundred treatment-naïve opioid users with opioid dependence were selected using a snowballing sampling technique. The drug use details, family relations, social and occupational functioning, and peer network history were assessed using a self-developed questionnaire and the use of structured instruments such as the Leeds Dependence Questionnaire Scale, High-Risk Behavior Scale, and Functional Status Questionnaire Scale. Comorbid psychiatric symptoms were assessed using the Generalized Anxiety Disorder-7 and Patient Health Questionnaire-9. The Ask Suicide-Screening Questions was used for assessing different domains of suicidality. Results: The mean age of the participants was 26 (standard deviation = 6) years. One-third (n = 136) of these were injecting opioid users (injecting drug users [IDUs]) and the remaining were taking opioids through other routes (non-IDUs). In multivariate analysis, IDUs (as compared to non-IDUs) had higher rates of family history of opioid use (odds ratio [OR] =3.53, 95% confidence interval: 1.17–8.69), incarceration history (OR = 2.16, 1.78–3.11), lower employment (OR = 0.53, 0.31–0.84), more people with <5 years of education (OR = 4.31, 2.60–12.73), lower age of starting opioid use (OR = 0.44, 0.26–0.69), more concurrent sedative use (OR = 5.60, 4.34–7), more self-harm attempts history (OR = 1.88, 1.16–3.2), larger peer groups (OR = 1.89, 1.11–2.63), and greater involvement in selling illegal drugs (OR = 1.81, 1.49–3.67). Conclusions: Various factors are significantly associated with using opioids through injecting route in individuals with opioid dependence. These factors can help identify individuals with opioid dependence who are likely to transition to injecting opioids. [ABSTRACT FROM AUTHOR]

Rockfill dams are hydraulic structures of major importance. They can be exposed to extreme flood events, in turn leading to overtopping. These phenomena erode and affect structural and geotechnical integrity, which in turn can cause dam breach. Ripraps are broadly used for rockfill dam protection against such erosion processes. For steep slopes, as the one considered in this study (S = 1:1.5, vertical: horizontal), understanding the riprap behavior during overtopping is an important issue to improve dam design and reinforcement techniques. In this work, datasets are obtained from five experimental models of placed riprap built on a rock filter layer in a flume, at the hydraulic laboratory of the Norwegian University of Science and Technology, Trondheim. The riprap stones were placed in an interlocking pattern with a metallic support at the toe. The models were subjected to successive and incremental overtopping discharges until their complete failure. A laser traverse system was used to measure the coordinates (3D) of individual marked riprap stones between each discharge increase. Six load cells located at the toe measured the imposed loads during the entire procedure. From the total load values, two different types of load contributions could be distinguished: the self-weight of the stones and the hydraulic load depending on the discharge level of the overflow. This article highlights the strong relation in each of the five tests between riprap stone displacements, axial reaction load values measured at the toe and overtopping discharges. Moreover, as demonstrated in previous works, a buckling deformation of the riprap layer was observed and described. The results demonstrate that as the hydraulic load induces 2D deformations of the riprap, a larger part of the riprap weight is supported at the toe. Thus, the measured axial load during overtopping arises both from the hydraulic load and from the load imparted due to the compaction of the riprap layer. This compaction effect induces an even greater load than the one imposed due to the hydraulic contribution. The results from this study are finally put into perspective with the Norwegian Water Resources and Energy Directorate recommendations for full scale dams and suggest the great resistance of supported riprap at the toe.

Background: Integrating mobile technologies in healthcare (mHealth) is helpful to manage various medical conditions. mHealth applications can bridge the gap in the management of patients with opioid use disorder (OUD). Research evaluating the feasibility of mHealth to address OUD is limited in developing countries. We aimed to assess the digital capacity and interest in mHealth interventions in patients maintained on opioid agonist treatment (OAT). Methods: 150 patients on OAT from a community drug treatment clinic in New Delhi, India, were included. We assessed the participants on their pattern of mobile and Internet use and their willingness to use mHealth technology to access health information and services related to OUD. Results: 88% of participants (n = 132) owned a mobile phone at assessment; 2.7% (n = 4) had never used a mobile phone in their lifetime. 70% (n = 105) participants had Internet access. 80% (n = 120) of participants showed interest in receiving text messages related to the management of OUD. 60% of participants showed a willingness to download and use applications for monitoring their substance use. Conclusions: In India, there is an interest among people on OAT to use mHealth interventions to manage their substance use. This population also has access to mobile phones and the necessary knowledge to install and run applications needed for various mHealth interventions. [ABSTRACT FROM AUTHOR]

Maternal cardiac arrest (MCA) requires a multidisciplinary team well versed in the cascade of steps involved during resuscitation. Historically, maternal outcomes were poor, primarily because cardiac arrest management in pregnant women was neither optimum nor standardized. However, current evidence has shown better maternal survival given the young age and reversible causes of death. There are specific interventions such as manual left uterine displacement (MLUD) for relief of aortocaval compression that, if not performed, may undermine the success of resuscitation. The team should simultaneously explore the etiology of MCA, which could be a combination of pregnancy-related causes and comorbid conditions. Resuscitative Hysterotomy or Resuscitative Uterine Interventions (RUI) should be considered if there is no return of spontaneous circulation following 4–5 min of cardiopulmonary resuscitation. Teamwork is critical to success in the high-stakes environment of MCA. This consensus statement was prepared by the experts after reviewing evidence-based literature on maternal resuscitation during MCA. [ABSTRACT FROM AUTHOR]

An estimated 6.5 to 13.2 million people with opioid dependence, representing more than half of the world's estimated number, live in Asia. (1) Although most people in Asia who are [...]

Background: Opioid-dependent patients undergoing opioid substitution therapy (OST) consume alcohol in a hazardous pattern which adversely affects their treatment outcome. This study aims to measure alcohol biomarkers to screen for secondary alcohol use in OST patients. Methods: A pilot study was planned to measure alcohol biomarkers (AST, ALT, GGT, and CDT) to assess alcohol use in OST patients from three community clinics. The biomarkers were categorized based on the reported frequency of alcohol use. The association of the biomarkers with the frequency of alcohol consumption was determined using the post hoc (Mann-Whitney) test. Results: Forty-five patients with a mean (SD) age of 37.04 (10.7) years were included in the study. Alcohol intake was reported in daily, weekly, and monthly patterns by 22, 63, and 16% of the patients, respectively. High levels of ALT, GGT, and CDT were measured in patients with daily use of alcohol. Serum CDT levels significantly differentiate daily and weekly use from monthly consumption of alcohol. Conclusions: Alcohol biomarkers significantly predict the pattern of alcohol use among OST patients. These results can be prudent in low-resource community clinics to improve the overall outcomes of OST in India. [ABSTRACT FROM AUTHOR]