Supervised injection services : what has been demonstrated? : a systematic literature review

BACKGROUND: Supervised injection services (SISs) have been developed to promote safer drug injection practices, enhance health-related behaviors among people who inject drugs (PWID), and connect PWID with external health and social services. Nevertheless, SISs have also been accused of fostering drug use and drug trafficking. AIMS: To systematically collect and synthesize the currently available evidence regarding SIS-induced benefits and harm. METHODS: A systematic review was performed via the PubMed, Web of Science, and ScienceDirect databases using the keyword algorithm [("SUPERVISED" OR "SAFER") AND ("INJECTION" OR "INJECTING" OR "SHOOTING" OR "CONSUMPTION") AND ("FACILITY" OR "FACILITIES" OR "ROOM" OR "GALLERY" OR "CENTRE" OR "SITE")]. RESULTS: Seventy-five relevant articles were found. All studies converged to find that SISs were efficacious in attracting the most marginalized PWID, promoting safer injection conditions, enhancing access to primary health care, and reducing the overdose frequency. SISs were not found to increase drug injecting, drug trafficking or crime in the surrounding environments. SISs were found to be associated with reduced levels of public drug injections and dropped syringes. Of the articles, 85% originated from Vancouver or Sydney. CONCLUSION: SISs have largely fulfilled their initial objectives without enhancing drug use or drug trafficking. Almost all of the studies found in this review were performed in Canada or Australia, whereas the majority of SISs are located in Europe. The implementation of new SISs in places with high rates of injection drug use and associated harms appears to be supported by evidence.

Cooperatives and Contracting in Agriculture: The Case of West Liberty Foods, October 2005

The West Liberty Foods turkey cooperative was formed in 1996 to purchase the assets and assume operations of Louis Rich Foods (an investor-owned processing rm), which, at the time, announced the imminent shutdown of its West Liberty, Iowa, processing facility. We study the creation and performance of this �new generation� cooperative using eld interviews with grower members and company management. We describe changes, before and after the buyout, in the contractual apparatus used for procuring live turkeys, and in the communication requirements, work expectations, and nancial positions of growers. During the private ownership period, most of the inputs (except labor and facilities) were provided by the rm; there was substantial supervision of the growers' actions; growers faced little price and production risk; and growers' equity was due largely to ownership of land and other farm assets. Our interviews reveal that, after cooperative formation, growers were exposed to considerable additional risk; monitoring of growers by the rm was less intensive; grower time and effort commitments to turkey production increased substantially; and a signicant fraction of rm (cooperative) equity came from growers' willingness to leverage their farm and personal assets (and hence indirectly their existing relationships with local lenders). We argue that some of these changes are consistent with a nancial contract where asset pledging and its corollary risk generate higher work effort by growers and a reduction in agency rents. These economies likely compensate for an organizational deadweight loss traditionally associated with cooperative governance.

Ilmanvaihtokoneen ohjauksen taloudellisuusvaikutukset

Tämän insinöörityön tarkoituksena oli luoda Insinööritoimisto Olof Granlund Oy:lle malliprojekti ilmanvaihtokoneen ohjauksen mahdollisesta sähköenergian säästöpotentiaalista. Insinöörityötä voidaan myöhemmin käyttää referenssinä tarjottaessa yrityksen palvelua asiakkaille energiakatselmointityössä kiinteistöihin, joissa on suuria ilmanvaihtokone-yksiköitä. Ensin työssä esitellään käytössä olevat, tutkittavat ilmanvaihtokoneet ja niiden toiminta. Sitten selvitetään ilmanvaihtolaitteiden ja niiden ohjauksen eri osien toiminta, sekä ohjausinformaatio, joka välittyy eri laitteiden välillä. Seuraavaksi työssä tutkitaan rakennusautomaation osuutta, sen hyötyä ja rakennetta kiinteistössä. Tämän jälkeen selvitetään hankkeen viranomaismääräykset. Sitten selvitetään, mistä koostuvat kustannukset ilmanvaihtokoneen ohjauksen uusimisessa. Lopuksi vielä tutkitaan, kuinka pitkä on tehtävän investoinnin takaisinmaksuaika, sekä mitkä ovat saneerauksen hiilidioksidi-päästövaikutukset. insinöörityön Lopputuloksena syntyi yrityksen sisäinen kansio. Kansion esimerkkilaskelmia ja laskentamenetelmiä on tarkoitus käyttää jatkossa referenssinä kiinteistönpito-osastolla sähkö- ja lvi-ryhmissä, niiden henkilöiden käytössä, jotka ovat tekemisissä energiakatselmointien kanssa.

Yksittäistuotannon ohjattavuusanalyysi

Tässä työssä tutkitaan Merima Oy:n tuotantolaitoksen toimintaa ohjattavuusanalyysillä. Työn tarkoituksena on etsiä potentiaalisia kehityskohteita yrityksen tuotannosta. Yrityksen tuotanto on muutospaineessa ja se tarvitsee kvantitatiivista informaatiota kehityksen suunnannäyttäjäksi. Työ aloitettiin jalostamalla yrityksen tuotannonohjausjärjestelmästä saatava data analysoitavaan muotoon. Tämän jälkeen päätettiin analyysityypeistä, joita työssä käytetään. Analyysivaiheessa jalostettu data saatettiin informoivaan muotoon, jonka jälkeen voitiin analysoida tuloksia ja tehdä johtopäätöksiä. Työn tuloksena saadaan joukko kehityskohteita, joihin kehityspanos tulisi fokusoida. Lisäksi raportin lopussa pohditaan keinoja kehityskohteiden parantamiseksi.

Evaluation of a Bridge Constructed using High Performance Steel, May 2006

Of the approximately 25,000 bridges in Iowa, 28% are classified as structurally deficient, functionally obsolete, or both. Because many Iowa bridges require repair or replacement with a relatively limited funding base, there is a need to develop new bridge materials that may lead to longer life spans and reduced life-cycle costs. In addition, new and effective methods for determining the condition of structures are needed to identify when the useful life has expired or other maintenance is needed. Due to its unique alloy blend, high-performance steel (HPS) has been shown to have improved weldability, weathering capabilities, and fracture toughness than conventional structural steels. Since the development of HPS in the mid-1990s, numerous bridges using HPS girders have been constructed, and many have been economically built. The East 12th Street Bridge, which replaced a deteriorated box girder bridge, is Iowa’s first bridge constructed using HPS girders. The new structure is a two-span bridge that crosses I-235 in Des Moines, Iowa, providing one lane of traffic in each direction. A remote, continuous, fiber-optic based structural health monitoring (SHM) system for the bridge was developed using off-the-shelf technologies. In the system, sensors strategically located on the bridge collect raw strain data and then transfer the data via wireless communication to a gateway system at a nearby secure facility. The data are integrated and converted to text files before being uploaded automatically to a website that provides live strain data and a live video stream. A data storage/processing system at the Bridge Engineering Center in Ames, Iowa, permanently stores and processes the data files. Several processes are performed to check the overall system’s operation, eliminate temperature effects from the complete strain record, compute the global behavior of the bridge, and count strain cycles at the various sensor locations.

The postmortem diagnosis of alcoholic ketoacidosis.

AIMS: The aim of this article is to review the forensic literature covering the postmortem investigations that are associated with alcoholic ketoacidosis fatalities and report the results of our own analyses. METHODS: Eight cases of suspected alcoholic ketoacidosis that had undergone medico-legal investigations in our facility from 2011 to 2013 were retrospectively selected. A series of laboratory parameters were measured in whole femoral blood, postmortem serum from femoral blood, urine and vitreous humor in order to obtain a more general overview on the biochemical and metabolic changes that occur during alcoholic ketoacidosis. Most of the tested parameters were chosen among those that had been described in clinical and forensic literature associated with alcoholic ketoacidosis and its complications. RESULTS: Ketone bodies and carbohydrate-deficient transferrin levels were increased in all cases. Biochemical markers of generalized inflammation, volume depletion and undernourishment showed higher levels. Adaptive endocrine reactions involving insulin, glucagon, cortisol and triiodothyronine were also observed. CONCLUSIONS: Metabolic and biochemical disturbances characterizing alcoholic ketoacidosis can be reliably identified in the postmortem setting. The correlation of medical history, autopsy findings and biochemical results proves therefore decisive in identifying pre-existing disorders, excluding alternative causes of death and diagnosing alcoholic ketoacidosis as the cause of death.

Urinary incontinence related to perineal muscle strength in the first trimester of pregnancy: cross-sectional study

Objective To analyze pelvic floor muscle strength (PFMS), urinary continence and quality of life related to urinary incontinence (UI) of women in the first trimester of pregnancy. Method Cross-sectional study with a sample of 500 women who started prenatal care in a complementary healthcare facility in Guarulhos, state of São Paulo, from 2012 and 2013. Pelvic floor muscle strength was evaluated through perineometry. The pregnant women who presented UI answered the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF). Results It was found that maternal age (OR=1.06; CI95% 1.02-1.11) and prior UI (OR=15.12; 95%CI 8.19-27.92) are the variables that, in tandem, best explain the occurrence of UI at the beginning of pregnancy. The mean score on the ICIQ-SF was 8.2 (SD=3.9), considered a moderate impact on quality of life. Conclusion Older pregnant women with prior UI are more likely to have UI in the first trimester of pregnancy.


Accidental intoxication of the infant-juvenile population in households: profiles of emergency care

OBJECTIVE Analyzing profiles of intoxication and accidental poisoning of infant-juvenile population (0-24 years) in the household, treated at a reference facility for Emergency and Primary Care, during the year 2013. METHOD A descriptive, cross-sectional study. Data were analyzed using Epi-Info, by way of simple and bivariate analyzes. The project was approved by the Research Ethics Committee (protocol 405.578). RESULTS There were 45 intoxications, with a prevalence of males (60.0%), aged 1-4 years (71.1%). Among children under one, there was a higher frequency of pesticide poisoning (66.6%), between the ages of 1-4 by cleaning products (34.4%), and between 5-9 years of age by pharmacological substances (66.6%). The primary assistance was provided only at health institutions, with hospital admissions in 24.4% of the cases. CONCLUSION The importance of prevention through legislation is evident, in order to ensure greater safety in packaging of various products, and community awareness to eliminate risks in the household environment.

Cultural singularities: indigenous elderly access to Public Health Service

OBJECTIVEDescribing how Kaingang seniors and their primary caregivers experience access to public health services.METHODA qualitative study guided by ethnography, conducted with 28 elderly and 19 caregivers. Data were collected between November 2010 and February 2013 through interviews and participative observation analyzed by ethnography.RESULTSThe study revealed the benefits and difficulties of the elderly access to health services, the facility to obtain health care resources such as appointments, medications and routine procedures, and the difficulties such as special assistance service problems and delays in the dispatching process between reference services.CONCLUSIONThe importance of knowing and understanding the cultural specificities of the group in order to offer greater opportunities for the elderly access to health services was reinforced.

Lane Closure Policy Development, Enforcement, and Exceptions: A Survey of Seven State Transportation Agencies, February 2007

Traffic volume increases and an aging infrastructure create the need for reconstruction, rehabilitation, and maintenance of existing facilities. As more motorists feel that delays should be minimal during highway renewal projects, lane closures that reduce capacity through the work zone should not create unreasonable delays. In order to facilitate the determination of when a lane closure is permitted during the day, some state transportation agencies (STAs) have developed lane closure policies, or strategies, that they use as guidance in determining daily permitted lane closure times. Permitted lane closure times define what times of the day, week, or season a lane closure is allowed on a facility and at a specific location or segment. This research addresses the lane closure policies of several STAs that were reputed to have good lane closures policies or strategies and that were selected by the project advisory committee for further research.

Emerging Biofuels: Outlook of Effects on U.S. Grain, Oilseed, and Livestock Markets, 2007

Projections of U.S. ethanol production and its impacts on planted acreage, crop prices, livestock production and prices, trade, and retail food costs are presented under the assumption that current tax credits and trade policies are maintained. The projections were made using a multi-product, multi-country deterministic partial equilibrium model. The impacts of higher oil prices, a drought combined with an ethanol mandate, and removal of land from the Conservation Reserve Program (CRP) relative to baseline projections are also presented. The results indicate that expanded U.S. ethanol production will cause long-run crop prices to increase. In response to higher feed costs, livestock farmgate prices will increase enough to cover the feed cost increases. Retail meat, egg, and dairy prices will also increase. If oil prices are permanently $10-per-barrel higher than assumed in the baseline projections, U.S. ethanol will expand significantly. The magnitude of the expansion will depend on the future makeup of the U.S. automobile fleet. If sufficient demand for E-85 from flex-fuel vehicles is available, corn-based ethanol production is projected to increase to over 30 billion gallons per year with the higher oil prices. The direct effect of higher feed costs is that U.S. food prices would increase by a minimum of 1.1% over baseline levels. Results of a model of a 1988-type drought combined with a large mandate for continued ethanol production show sharply higher crop prices, a drop in livestock production, and higher food prices. Corn exports would drop significantly, and feed costs would rise. Wheat feed use would rise sharply. Taking additional land out of the CRP would lower crop prices in the short run. But because long-run corn prices are determined by ethanol prices and not by corn acreage, the long-run impacts on commodity prices and food prices of a smaller CRP are modest. Cellulosic ethanol from switchgrass and biodiesel from soybeans do not become economically viable in the Corn Belt under any of the scenarios. This is so because high energy costs that increase the prices of biodiesel and switchgrass ethanol also increase the price of cornbased ethanol. So long as producers can choose between soybeans for biodiesel, switchgrass for ethanol, and corn for ethanol, they will choose to grow corn. Cellulosic ethanol from corn stover does not enter into any scenario because of the high cost of collecting and transporting corn stover over the large distances required to supply a commercial-sized ethanol facility.

Terceiro Relatório Nacional sobre o Estado da Biodiversidade em Cabo Verde

INFORMAÇÕES SOBRE A PREPARAÇÃO DO RELATÓRIO Com a ratificação da Convenção das Nações Unidas sobre a Biodiversidade, em Março de 1995, Cabo Verde comprometeu-se perante o mundo em apresentar periodicamente à Conferência das Partes, o balanço da implementação da Convenção, com particular destaque sobre o estado de conservação da biodiversidade, a nível nacional. O primeiro relatório foi elaborado em 1999 e o segundo em 2002. Este terceiro relatório foi elaborado com base em informações existentes e disponíveis nas instituições ligadas directa ou indirectamente à gestão da biodiversidade, nomeadamente o Instituto Nacional de Investigação e Desenvolvimento Agrário (INIDA), o Instituto Nacional do Desenvolvimento das Pescas (INDP), a Direcção-Geral da Agricultura, Silvicultura e Pecuária, a Direcção-Geral das Pescas, a Direcção-Geral do Ambiente, para além da consulta de documentos como o Livro Branco sobre o Estado do Ambiente em CABO Verde, o Perfil Ambiental de Cabo Verde, etc. Em termos de uma percepção geral sobre o estado de evolução dos diferentes elementos que constituem a biodiversidade de Cabo verde, apresenta-se a situação seguinte: (i) a flora indígena de Cabo Verde é formada por 224 espécies, das quais 85 são endémicas e as restantes são espécies espontâneas naturalizadas; (ii) a fauna indígena de Cabo Verde engloba espécies de recifes de corais, moluscos (bivalves, gastrópodes e cefalópodes), artrópodes (insectos, crustáceos e aracnídeos), peixes (grandes pelágicos, pequenos pelágicos e demersais), répteis e aves e, provavelmente, algumas espécies de mamíferos marinhos. Apesar dessa riqueza biótica dos ecossistemas cabo-verdianos e dos esforços de conservação dos recursos naturais, assiste-se, nos últimos tempos, a uma certa disfunção ambiental de origens e causas várias, e que vêm ameaçando a saúde dos nossos recursos vivos, e que urge por cobro a todo o custo. Aliás, a percepção do estado de degradação dos recursos biológicos fez com que o Governo tomasse algumas medidas, nomeadamente a publicação do Decreto nº 1/2005, de 21 de Março, que aprova a Convenção Internacional sobre Comércio Internacional das Espécies de Fauna e Flora selvagens ameaçadas de Extinção (CITES) e a Emenda ao artigo XXI adoptada em Gabão-1983; o Decreto-Lei nº 3/2003, de 24 de Fevereiro, sobre o regime jurídico da Rede nacional de áreas protegidas; a ratificação da Convenção sobre as zonas húmidas de importância internacional (RAMSAR); o Decreto-Lei n.º 7/2002, de 30 de Dezembro, que estabelece as medidas de conservação e protecção das espécies vegetais e animais ameaçadas de extinção. Não obstante as medidas acima mencionadas, a degradação da biodiversidade cabo-verdiana continua de forma preocupante. Esse grau de degradação está, aliás, evidenciado em diversos documentos produzidos, nomeadamente a “Primeira Lista Vermelha de Cabo Verde". De acordo com esse documento, encontram-se ameaçadas mais de 26% das angiospérmicas, mais de 40% das briófitas, mais de 65% das pteridófitas e mais de 29% dos líquenes” mais de 47% das aves, 25% dos répteis terrestres, 64% dos coleópteros, mais de 57% dos aracnídeos e mais de 59% dos moluscos terrestres. Esta situação considerada alarmante em 1996, vem-se agravando para as espécies Alauda razae (Calhandra-do-Ilhéu-Raso), cujo efectivo populacional sofreu uma redução de 250 exemplares em 1992 para 92 exemplares em 1998, Himantopus himantopus (Perna-longa), cuja população, avaliada em 75 exemplares em 1990, sofreu no período de 5 anos uma redução de cerca de 70% (Hazevoet, 1999). De uma forma geral, a redução dos efectivos populacionais das componentes da biodiversidade deve-se principalmente à depredação, destruição de habitats e à introdução de espécies exóticas. A vulnerabilidade das espécies marinhas cabo-verdianas, sobretudo as das costeira, tem aumentado, não obstante a existência de medidas legislativas no sentido de se minimizar a pressão sobre elas e os seus habitats. Apesar da adopção dessas medidas, o meio marinho tem experimentado mudanças comprometedoras, como resultado do aumento de pressão das capturas dos peixes comerciais, da extracção de areias nas praias e no mar (dragagem), da deposição de sedimentos nas zonas litorais como resultado das actividades realizadas no interior das ilhas. Os planos ambientais inter-sectoriais da biodiversidade e das pescas, elaborados de forma participativa, e os planos estratégicos de gestão dos recursos da pesca e de desenvolvimento da agricultura, são, por excelência, os instrumentos de gestão da biodiversidade, capazes de contribuírem para uma gestão sustentável dos recursos biológicos em Cabo Verde Os Governo de Cabo Verde não vêm poupando esforços no sentido de honrar os compromissos assumidos com a ratificação da Convenção sobre a Biodiversidade. Daí que, estrategicamente, atribui o nível de prioridade em média alta, à aplicação aos vários artigos da Convenção. Em termos de nível de dificuldades encontradas na aplicação dos dispositivos dos artigos da Convenção, ele situa-se em 70% Médio, 18,5% Baixo, 7,4% Alto e 3,7 Zero.

Quarterly Report of the Building Project for the Motor Vehicle Division

Pursuant to Section 1 of House File 466 of the 81st General Assembly, the Iowa Department of Transportation is required to make quarterly reports to the Legislative Council regarding the progress of the building project for the Motor Vehicle Division. During the quarter ending June 30, 2007, the project was delayed by two weeks. The Motor Vehicle Division moved into the new Ankeny facility on June 22 and was operational Monday, June 25. The driver's license stations reopened as scheduled Tuesday, June 26, at the Ankeny facility as well as the Oliver Plaza renewal location.

Locating emergency services with priority rules: The priority queuing covering location problem

One of the assumptions of the Capacitated Facility Location Problem (CFLP) is thatdemand is known and fixed. Most often, this is not the case when managers take somestrategic decisions such as locating facilities and assigning demand points to thosefacilities. In this paper we consider demand as stochastic and we model each of thefacilities as an independent queue. Stochastic models of manufacturing systems anddeterministic location models are put together in order to obtain a formula for thebacklogging probability at a potential facility location.Several solution techniques have been proposed to solve the CFLP. One of the mostrecently proposed heuristics, a Reactive Greedy Adaptive Search Procedure, isimplemented in order to solve the model formulated. We present some computationalexperiments in order to evaluate the heuristics performance and to illustrate the use ofthis new formulation for the CFLP. The paper finishes with a simple simulationexercise.

Median problems in networks

The P-median problem is a classical location model par excellence . In this paper we, firstexamine the early origins of the problem, formulated independently by Louis Hakimi andCharles ReVelle, two of the fathers of the burgeoning multidisciplinary field of researchknown today as Facility Location Theory and Modelling. We then examine some of thetraditional heuristic and exact methods developed to solve the problem. In the third sectionwe analyze the impact of the model in the field. We end the paper by proposing new lines ofresearch related to such a classical problem.