Challenges and opportunities in using wastewater analysis to measure drug use in a small prison facility

Introduction and Aims Wastewater analysis (WWA) is intended to be a direct and objective method of measuring substance use in large urban populations. It has also been used to measure prison substance use in two previous studies. The application of WWA in this context has raised questions as to how best it might be used to measure illicit drug use in prisons, and whether it can also be used to measure prescription misuse. We applied WWA to a small regional prison to measure the use of 12 licit and illicit substances. We attempted to measure the non-medical use of methadone and buprenorphine and to compare our findings with the results of the prison's mandatory drug testing (MDT). Design and Methods Representative daily composite samples were collected for two periods of 12 consecutive days in May to July 2013 and analysed for 18 drug metabolites. Prescription data and MDT results were obtained from the prison and compared with the substance use estimates calculated from WWA data. Results Daily use of methamphetamine, methadone, buprenorphine and codeine was detected, while sporadic detection of ketamine and methylone was also observed. Overall buprenorphine misuse appeared to be greater than methadone misuse. Discussion and Conclusions Compared with MDT, WWA provides a more comprehensive picture of prison substance use. WWA also has the potential to measure the misuse of medically prescribed substances. However, a great deal of care must be exercised in quantifying the usage of any substance in small populations, such as in prisons.

Systematic and Day-to-Day Effects of Chemical-Derived Population Estimates on Wastewater-Based Drug Epidemiology

Population size is crucial when estimating population-normalized drug consumption (PNDC) from wastewater-based drug epidemiology (WBDE). Three conceptually different population estimates can be used: de jure (common census, residence), de facto (all persons within a sewer catchment), and chemical loads (contributors to the sampled wastewater). De facto and chemical loads will be the same where all households contribute to a central sewer system without wastewater loss. This study explored the feasibility of determining a de facto population and its effect on estimating PNDC in an urban community over an extended period. Drugs and other chemicals were analyzed in 311 daily composite wastewater samples. The daily estimated de facto population (using chemical loads) was on average 32% higher than the de jure population. Consequently, using the latter would systemically overestimate PNDC by 22%. However, the relative day-to-day pattern of drug consumption was similar regardless of the type of normalization as daily illicit drug loads appeared to vary substantially more than the population. Using chemical loads population, we objectively quantified the total methodological uncertainty of PNDC and reduced it by a factor of 2. Our study illustrated the potential benefits of using chemical loads population for obtaining more robust PNDC data in WBDE.

A Model to Estimate the Population Contributing to the Wastewater Using Samples Collected on Census Day

An important uncertainty when estimating per capita consumption of, for example, illicit drugs by means of wastewater analysis (sometimes referred to as “sewage epidemiology”) relates to the size and variability of the de facto population in the catchment of interest. In the absence of a day-specific direct population count any indirect surrogate model to estimate population size lacks a standard to assess associated uncertainties. Therefore, the objective of this study was to collect wastewater samples at a unique opportunity, that is, on a census day, as a basis for a model to estimate the number of people contributing to a given wastewater sample. Mass loads for a wide range of pharmaceuticals and personal care products were quantified in influents of ten sewage treatment plants (STP) serving populations ranging from approximately 3500 to 500 000 people. Separate linear models for population size were estimated with the mass loads of the different chemical as the explanatory variable: 14 chemicals showed good, linear relationships, with highest correlations for acesulfame and gabapentin. De facto population was then estimated through Bayesian inference, by updating the population size provided by STP staff (prior knowledge) with measured chemical mass loads. Cross validation showed that large populations can be estimated fairly accurately with a few chemical mass loads quantified from 24-h composite samples. In contrast, the prior knowledge for small population sizes cannot be improved substantially despite the information of multiple chemical mass loads. In the future, observations other than chemical mass loads may improve this deficit, since Bayesian inference allows including any kind of information relating to population size.

Estimating daily and diurnal variations of illicit drug use in Hong Kong: A pilot study of using wastewater analysis in an Asian metropolitan city

The measurement of illicit drug metabolites in raw wastewater is increasingly being adopted as an approach to objectively monitor population-level drug use, and is an effective complement to traditional epidemiological methods. As such, it has been widely applied in western countries. In this study, we utilised this approach to assess drug use patterns over nine days during April 2011 in Hong Kong. Raw wastewater samples were collected from the largest wastewater treatment plant serving a community of approximately 3.5 million people and analysed for excreted drug residues including cocaine, ketamine, methamphetamine, 3,4-methylenedioxymethamphetamine (MDMA) and key metabolites using liquid chromatography coupled with tandem mass spectrometry. The overall drug use pattern determined by wastewater analysis was consistent with that have seen amongst people coming into contact with services in relation to substance use; among our target drugs, ketamine (estimated consumption: 1400–1600 mg/day/1000 people) was the predominant drug followed by methamphetamine (180–200 mg/day/1000 people), cocaine (160–180 mg/day/1000 people) and MDMA (not detected). The levels of these drugs were relatively steady throughout the monitoring period. Analysing samples at higher temporal resolution provided data on diurnal variations of drug residue loads. Elevated ratios of cocaine to benzoylecgonine were identified unexpectedly in three samples during the evening and night, providing evidence for potential dumping events of cocaine. This study provides the first application of wastewater analysis to quantitatively evaluate daily drug use in an Asian metropolitan community. Our data reinforces the benefit of wastewater monitoring to health and law enforcement authorities for strategic planning and evaluation of drug intervention strategies.

Monitoring substance use in prisons: Assessing the potential value of wastewater analysis

Prison substance use is a major concern for prison authorities and the wider community. Australia has responded to this problem by implementing the National Corrections Drug Strategy. Across Australia, the true extent of prison substance use cannot be determined. As a result, the effectiveness of the interventions employed as part of this strategy cannot be properly assessed. This has important implications for the allocation of corrective services resources and future policy development. This article explores the benefits and limitations, as well as the ethical and practical issues in using wastewater analysis (WWA) to measure levels of substance use in prisons. It reports results from the first application of WWA to an Australian prison, which supports the use of WWA in this context. Given the increasing concern for prescription misuse in prisons, we also highlight the novel use of WWA to measure the extent of prescription misuse by prisoners. The article concludes that as a result of its objectivity, sensitivity and cost-effectiveness, the use of WWA in prisons warrants further consideration in Australia.

Measuring drug use patterns in Queensland through wastewater analysis

Estimating the use of illicit drugs in the general community is an important task with ramifications for law enforcement agencies, as well as health portfolios. Australia has four ongoing drug monitoring systems, including the AIC’s DUMA program, the National Drug Strategy Household Survey, the Illicit Drug Reporting System and the Ecstasy and Related Drug Reporting System. The systems vary in methods, but broadly they are reliant upon self-report data and may be subject to selection biases. The present study employed a completely different method. By chemically analysing sewerage water, the study produced daily estimates of consumption of methamphetamine, MDMA and cocaine. Samples were collected in November 2009 and November 2010 from a municipality in Queensland, with an population of over 150,000 people. Estimates were made of the average daily dose and average daily street value per 1,000 people. On the basis of estimated dose and price, the methamphetamine market appeared considerably stronger than either MDMA or cocaine. This paper explains the strengths and weaknesses of wastewater analysis. It considers the potential value of wastewater analysis in measuring net consumption of illicit drugs and the effectiveness of law enforcement agency strategies.

Acceptability of a rice-based oral rehydration solution in Port Moresby General Hospital's Children's Outpatient Department

The guardians of children brought to the Port Moresby General Hospital's Children's Outpatient Department with a chief complaint of diarrhoeal disease were questioned regarding their preference of glucose-based vs rice-based oral rehydration solution (ORS) in order to determine the acceptability of a rice-based ORS. Of the 93 guardians interviewed, greater than 60% preferred the glucose-based solution in its mixability, appearance and taste, and 65% initially reported that their children preferred the taste of the glucose solution. However, after a 30-minute trial, only 58% of children still preferred the glucose solution. In a country where diarrhoeal disease is a leading cause of child death and guardians are the primary health care providers, the acceptability of an ORS is critical to the morbidity and mortality of Papua New Guinea's children. Killing an estimated 2.9 million children annually, diarrheal disease is the second leading cause of child mortality worldwide. Diarrheal disease is also the second leading cause of child mortality in Papua New Guinea (PNG), killing an average 193 inpatient children per year over the period 1984-90. However, despite the high level of diarrhea-related mortality and the proven efficacy of oral rehydration therapy (ORT) in managing diarrhea-related dehydration, standardized ORT has been underutilized in PNG. The current glucose-based oral rehydration solution (ORS) does not reduce the frequency or volume of a child's diarrhea, the most immediate concern of caregivers during episodes of illness. Cereal-based ORS, made from cereals which are commonly available as food staples in most countries, better address the short-term concerns of caregivers while offering a superior nutritional profile. A sample of guardians of children brought to the Port Moresby General Hospital's Children's Outpatient Department complaining of child diarrhea were asked about their preferences on glucose-based versus rice-based ORS in order to determine the acceptability of a rice-based ORS. More than 60% of the 93 guardians interviewed preferred the glucose-based solution for its mixability, appearance, and taste. 65% initially reported that their children preferred the taste of the glucose solution. However, after a 30-minute trial, only 58% of children still preferred the glucose solution.

"Kirjailijoiden tapaus" Venäjällä vuonna 1997

In the autumn of 1997, Russian government was faced with media pressure when owners of the TV channels ORT and NTV joined forces against it. This study is based on media sources from October 1997 to December 1997. It shows clearly how the enormous power of the media was able to dictate what happened in Russia. In the mid-1990s Russians started to talk about political technology, which became a commonly used term by professionals, journalists, politicians and intelligence services. As a result of this action, two leading reformers in the government, Anatoliy Chubais and Boris Nemtsov, were dismissed from their highly influential posts as finance and energy ministers respectively, but retained their power as first deputy prime ministers. According to the correspondents, the real reason was to resolve a conflict within the parliament, which had demanded the dismissal of Mr. Chubais. This demand was presented after Chubais had accepted $90,000 as a reward for co-writing a book on privatization. Chubais was considered to be Russia’s “business card” towards the west – the"Authors’ case" (Delo avtorov) was only solved after President Boris Yeltsin took part in the public debate. According to the research, the media owned by powerful businessmen Boris Berezovsky and Vladimir Gusinski, was able to use its own security services to expose sensitive material (Russian term ‘kompromat’), if necessary, concerning any given person. The so-called Authors’ case can be considered as a part of the battle and the tip of the iceberg in arrangements designed to organize the funding of the Russian presidential election campaign in 2000. The reason why this particular incident was so widely covered on television was because several programs aimed to reveal to the public "hidden bribes" that, as they claimed, government officials had received. The political aspect, however, was quite mild, when the concrete issues of possible dismissals of Ministers were debated in the Parliament. Everything was dealt with as a “family matter” inside Kremlin. Yeltsin's "family" consisted of practically anybody from oligarch Berezovsky to Chubais, the father of Russia's privatization policy. Methods of critical history implementation analysis has been used in this research in determining the use of the source material. Literature and interviews have also provided a good base for the study. The study proves that any literature dealing with the subject has not paid enough attention to how the dismissal of Alexander Kazakov, deputy of President’s administration, was linked directly with Gazprom, the state gas monopoly. Kazakov had to leave Gazprom and lose his position as Chubais' ally when the influential ORT television company was deteriorated.

Nutritional intake of opioid replacement therapy patients in community pharmacies: A pilot study

Aim: Opioid replacement therapy (ORT) is an established therapy for a patient group that has been associated with nutrition-related comorbidities. This paper aims to assess the nutritional intake and supplementation in ORT patients, determine the extent of nutritional/dietary advice supplied to ORT patients and to briefly examine patients' perception of pharmacists' provision of nutritional advice. Methods: The nutritional intake of ORT patients receiving treatment in community pharmacies within the Australian Capital Territory was assessed via a 24-hour recall survey. Food intake data were analysed via nutrient analysis software and compared with Australian Nutrition Reference Values and the nutrient intakes of the Australian population. Patients were surveyed to determine supplement use and perceptions of nutritional advice gained by pharmacists. Results: Potential insufficient intake of various macronutrients and micronutrients was observed in both sexes. Less than 25 of patients recorded supplement use. Fifteen percent of males and 21 of females stated that they had approached a pharmacist with a nutrition-related query. All patients who received nutritional advice followed the advice. Conclusions: ORT patients dosing at community pharmacies appear to have poor nutritional intake. ORT patients appear to be receptive to pharmacist's advice. Community pharmacists can potentially increase the beneficial health outcomes in this population through the proactive supply of accurate nutritional advice.

Critical review on the stability of illicit drugs in sewers and wastewater samples

Wastewater-based epidemiology (WBE) applies advanced analytical methods to quantify drug residues in wastewater with the aim to estimate illicit drug use at the population level. Transformation processes during transport in sewers (chemical and biological reactors) and storage of wastewater samples before analysis are expected to change concentrations of different drugs to varying degrees. Ignoring transformation for drugs with low to medium stability will lead to an unknown degree of systematic under- or overestimation of drug use, which should be avoided. This review aims to summarize the current knowledge related to the stability of commonly investigated drugs and, furthermore, suggest a more effective approach to future experiments. From over 100 WBE studies, around 50 mentioned the importance of stability and 24 included tests in wastewater. Most focused on in-sample stability (i.e., sample preparation, preservation and storage) and some extrapolated to in-sewer stability (i.e., during transport in real sewers). While consistent results were reported for rather stable compounds (e.g., MDMA and methamphetamine), a varying range of stability under different or similar conditions was observed for other compounds (e.g., cocaine, amphetamine and morphine). Wastewater composition can vary considerably over time, and different conditions prevail in different sewer systems. In summary, this indicates that more systematic studies are needed to: i) cover the range of possible conditions in sewers and ii) compare results more objectively. To facilitate the latter, we propose a set of parameters that should be reported for in-sewer stability experiments. Finally, a best practice of sample collection, preservation, and preparation before analysis is suggested in order to minimize transformation during these steps.

Shanghai Collection 1924 - 1950

The collection relates to life in the ghetto and includes materials on: founding of the ghetto; relief groups such as JDC, ORT, HIAS, and SACRA (Shanghai Ashkenazic Collaborating Relief Association); political organizations such as Zionist groups, the Bund; the rabbinate; the sick and benevolent society; kitchen fund; commercial establishments; religious schools , secular schools; professional associations; art, theater and music activities; Jewish press; emigration from Shanghai after World War II. There are also manuscript histories of the Shanghai Ghetto.

Herman Bernstein 1897-1935

Correspondence, clippings, manuscripts, notes, reports, relating to Bernstein's journalistic, literary and diplomatic careers. Correspondence with well-known literary, political and communal, society personalities, 1908-1935. Includes Cyrus Adler, Viscount Allenby, Joseph Barondess, Bernard Baruch, Henri Bergson, Hayyim Nahman Bialik, Jacob Billikopf, Vladimir Bourtzeff, Louis Brandeis, Robert Cecil, Fyodor Chaliapin, Jacob de Haas, Albert Einstein, Henry Ford, Felix Frankfurter, Herbert Hoover, Vladimir Jabotinsky, Horace M. Kallen, Peretz Hirschbein, Peter Kropotkin, Herbert Lehman, Louis Lipsky, Judah L. Magnes, Louis Marshall, Henry Morgenthau, Max Nordau, Adolph Simon Ochs, David de Sola Pool, Bernard G. Richards, Theodore Roosevelt, Julius Rosenwald, Jacob Schiff, Harry Schneiderman, Maurice Schwartz, George Bernard Shaw, Sholem Aleichem, Nathan Straus, Henrietta Szold, Chaim Tchernowitz, Leo Tolstoy, Samuel Untermyer, Henry Van Dyke, Lillian Wald, Felix Warburg, Chaim Weizman n, Jefferson Williams, Stephen Wise, Israel Zangwill. Correspondence and other materials relating to Bernstein's post as U.S. ambassador to Albania. Materials pertaining to Bernstein's editorial work at *The Day*, *Jewish Tribune*, *New York Herald*, *Jewish Daily Bulletin*. Materials pertaining to Bernstein's involvement with the American Jewish Committee. Correspondence with organizations including American Jewish Congress, *American Hebrew*, HIAS, *Jewish Chronicle* (London), Jewish Community of New York, *Menorah Journal*, *New York American*, *New York Times*, ORT, U.S. Dept. of State, Yiddish Art Theater, Zionist Organization of America. Articles, clippings, correspondence and court materials relating to the Ford libel suit. Miscellaneous documents and reports relating to the Paris Peace Conference, the Jewish situation in Russia, 1917-1920, Russian revolutionary events of 1917. News dispatches from Russia, 1917-1920s. Translations by Bernstein of Russian wri Andre yev,

Lucien Wolf and David Mowshowitch papers, [ca. 1869-1959]

Correspondence, reports, minutes, manuscripts, and clippings relating to the activities of Wolf, Mowshowitch, and the Joint Foreign Committee, as well as to the political situation of Jews in various countries and to the Paris Peace Conference. Papers of Lucien Wolf include his diary, lectures on English-German relations and English-Russian relations; bibliography of Wolf's works on Jewish themes; clippings of Wolf's articles; congratulations on his seventieth birthday; article on his last interview with Chamberlain; and correspondence with parents, 1869-1882, A. Abrahams, 1914-1925, Chief Rabbi Dr. J.H. Hertz, 1892-1923, Clara Melchior, 1913-1929, Jacob Schiff, 1910, Maxim Vinawer, 1917, Mark Wischnitzer, 1926-1928, Lord Robert Cecil, 1916-1919, Lord Rothschild, 1906, Cyrus Adler, Count J. Bernstorff, Szymon Ashkenazy, Solomon Dingol, Louis Marshall, Claude G. Montefiore, Sir Edward Sassoon, Jacob Schiff, Lord William Selborne, Nakhum Sokolow, Oscar Straus, Chaim Weizmann, the American Jewish Congress, 1916-1923, Hilfsverein der Deutschen Juden, 1913, and Jewish Historical Society of England.

Graenum Berger papers, undated, (1825)-2002

Contains correspondence, minutes, reports, clippings, manuscripts, research materials, journal articles, photographs and publications; primarily relating to Berger's involvement with Ethiopian Jewry and his efforts to bring about their rescue through the organization he formed, the American Association for Ethiopian Jews. Also contains material from Berger's other interests- his writings, travels through the world and to Israel and Ethiopia, community affiliations, research in Black American Jews, profession as a Jewish social work executive, his commitment to Jewish causes and to Israel. There are also many personal and biographical materials from the numerous long-term friendships and associations he established.

A Probabilistic Approach to the Primary Visual Cortex

What can the statistical structure of natural images teach us about the human brain? Even though the visual cortex is one of the most studied parts of the brain, surprisingly little is known about how exactly images are processed to leave us with a coherent percept of the world around us, so we can recognize a friend or drive on a crowded street without any effort. By constructing probabilistic models of natural images, the goal of this thesis is to understand the structure of the stimulus that is the raison d etre for the visual system. Following the hypothesis that the optimal processing has to be matched to the structure of that stimulus, we attempt to derive computational principles, features that the visual system should compute, and properties that cells in the visual system should have. Starting from machine learning techniques such as principal component analysis and independent component analysis we construct a variety of sta- tistical models to discover structure in natural images that can be linked to receptive field properties of neurons in primary visual cortex such as simple and complex cells. We show that by representing images with phase invariant, complex cell-like units, a better statistical description of the vi- sual environment is obtained than with linear simple cell units, and that complex cell pooling can be learned by estimating both layers of a two-layer model of natural images. We investigate how a simplified model of the processing in the retina, where adaptation and contrast normalization take place, is connected to the nat- ural stimulus statistics. Analyzing the effect that retinal gain control has on later cortical processing, we propose a novel method to perform gain control in a data-driven way. Finally we show how models like those pre- sented here can be extended to capture whole visual scenes rather than just small image patches. By using a Markov random field approach we can model images of arbitrary size, while still being able to estimate the model parameters from the data.