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Introduction Unpaid carers are an increasing proportion of the UK population. One of the many ways in which they help those they care for is assisting with medication adherence. Many older adults have medicines dispensed in pharmacy-filled multi-compartment medication compliance aids (pMCAs). However, evidence suggests that pMCAs may increase medication-related harm, and little is known about the interaction between the user, medication adherence systems and the carer. Aim To explore the views of carers supporting older adults to manage their medications with and without a pMCA. Method A researcher-administered questionnaire survey of carers supporting older adults to manage their medicines with or without a pMCA. Participants were recruited from inpatient wards, outpatient clinics and community services in central London. Responses were analysed by two independent researchers to identify overarching themes. Results Eighty-eight unpaid carers were interviewed and responses were categorised according to the medication adherence method used; 47 supported a user with a pMCA and 41 supported without a pMCA. The main themes were: Time, Responsibility and Mistakes, Waste and Sustainability, and Polypharmacy, with sub-themes of design of multi-compartment medication compliance aids, organisation and reassurance. Conclusion Supporting medication adherence puts considerable burden on carers regardless of whether a self- or pharmacy-filled medication compliance aid is used or not. Prescribers could alleviate this burden through regular medication review by considering the prescribing frequency and duration and medication rationalisation. Redesign of both pMCAs and systems surrounding their use could also help reduce carer's burden and environmental burden. [ABSTRACT FROM AUTHOR]

Objective: Adverse respiratory outcomes in post-9/11 veterans with elevated urinary metal measures and enrolled in the VA's Toxic Embedded Fragment registrywere compared to thosewithout elevated urinary metals. Methods: Veterans completed questionnaires, underwent pulmonary physiology tests (pulmonary function and oscillometry), and provided urine samples for analysis of 13 metals. Respiratory symptoms, diagnoses, and physiology measures were compared in veterans with ≥1 urine metal elevation to those without metal elevations, adjusted for covariates, including smoking. Results: Among 402 study participants, 24% had elevated urinemetals, often just exceeding upper limits of reference values. Compared to veterans without elevated metals, those with elevated metals had had higher FEV1 values but similar frequencies of respiratory symptoms and diagnoses and abnormalities on pulmonary physiology tests. Conclusions: Mild systemic metal elevations in post-9/11 veterans are not associated with adverse respiratory health outcomes. [ABSTRACT FROM AUTHOR]

Biogas is a renewable energy fuel that can be treated to increase purity so that the resulting "biomethane" can be injected into the natural gas pipeline grid. The trace contaminants in biogas and biomethane make up a small fraction of the total gas but they still have the potential to cause adverse health effects and pipeline corrosion. This study investigates the statistical distributions of 17 trace metals, six mercaptans, hydrogen sulfide, ammonia, and six additional trace organic compounds. Twelve of these 31 trace contaminants have been previously identified as constituents of concern based on their toxicity profiles and through health risk assessment studies. Untreated and treated samples of biogas were collected from 12 different biogas production facilities using diverse feedstocks throughout California. Results show that most biogas trace contaminants follow a single log-normal distribution or a bi-modal lognormal distribution depending on the type of production facility. Treatment of biogas demonstrates some removal for all trace contaminants, but four constituents of concern (copper, lead, hydrogen sulfide, and methyl mercaptan) are predicted to have a >1% probability of exceeding trigger levels even after common treatments. This finding suggests that enhanced monitoring may be warranted for these contaminants. Several trace metals and volatile organic compounds (VOCs) were found to have seasonal trends with greater concentrations in the summer and lower concentrations in the winter suggesting that seasonal variation should be considered in future monitoring plans. Unlabelled Image • Concentrations for most trace contaminants followed a log-normal profile. • Some contaminant concentrations had >1% chance of exceeding safe levels. • Biogas treatment reduced concentrations of many trace contaminants. • Concentrations for some contaminants were greater in summer than in winter. [ABSTRACT FROM AUTHOR]

Migrant Asian massage workers in North America first experienced the impacts of COVID-19 in the final weeks of January 2020, when business dropped drastically due to widespread xenophobic fears that the virus was concentrated in Chinese diasporic communities. The sustained economic devastation, which began at least 8 weeks prior to the first social distancing and shelter in place orders issued in the U.S. and Canada, has been further complicated by a history of aggressive policing of migrant massage workers in the wake of the war against human trafficking. Migrant Asian massage businesses are increasingly policed as locales of potential illicit sex work and human trafficking, as police and anti-trafficking initiatives target migrant Asian massage workers despite the fact that most do not provide sexual services. The scapegoating of migrant Asian massage workers and criminalization of sex work have led to devastating systemic and interpersonal violence, including numerous deportations, arrests, and deaths, most notably the recent murder of eight people at three Atlanta-based spas. The policing of sex workers has historically been mobilized along fears of sexually transmitted disease and infection, and more recently, within the past two decades, around a moral panic against sex trafficking. New racial anxieties around the coronavirus as an Asian disease have been mobilized by the state to further cement the justification of policing Asian migrant workers along the axes of health, migration, and sexual labor. These justifications also solidify discriminatory social welfare regimes that exclude Asian migrant massage workers from accessing services on the basis of the informality and illegality of their work mixed with their precarious citizenship status. This paper draws from ethnographic participant observation and survey data collected by two sex worker organizations that work primarily with massage workers in Toronto and New York City to examine the double-edged sword of policing during the pandemic in the name of anti-trafficking coupled with exclusionary policies regarding emergency relief and social welfare, and its effects on migrant Asian massage workers in North America. Although not all migrant Asian massage workers, including those surveyed in this paper, provide sexual services, they are conflated, targeted, and treated as such by the state and therefore face similar barriers of criminalization, discrimination, and exclusion. This paper recognizes that most migrant Asian massage workers do not identify as sex workers and does not intend to label them as such or reproduce the scapegoating rhetoric used by law enforcement. Rather, it seeks to analyze how exclusionary attitudes and policies towards sex workers are transferred onto migrant Asian massage workers as well whether or not they provide sexual services. [ABSTRACT FROM AUTHOR]

Background: Many critically ill patients receive ketamine for adjunct sedation despite a paucity of evidence on its use, dosing, and monitoring in this setting. Objective: To describe the dosing and safety considerations of ketamine for adjunct sedation in a population of mechanically ventilated critically ill patients targeting light sedation. Methods: We conducted a retrospective review of mechanically ventilated patients receiving continuous ketamine infusion between January 2012 and April 2016. Data included dosing, effect of ketamine on other sedatives, total sedative use, Riker Sedation‐Agitation Scale (SAS) scores, adverse drug reactions (ADRs), and hemodynamic variables. Results: Ninety‐one patients were included in the analysis. Ketamine was infused at a median dosage of 0.41 mg/kg/hour (range 0.04–2.5 mg/kg/hr) for up to 14.7 days (median 2.8 days). Concomitant sedatives were reduced or discontinued, without the initiation of an additional sedative, in 57 patients (63%) within 24 hours of initiating ketamine. Propofol was most commonly discontinued (16 patients, 36%), followed by benzodiazepines (12 patients, 27%). There was an increase in the number of SAS scores documented in goal in the 24‐hour period after ketamine initiation compared with the immediate 24 hours before (61% vs 55%, p=0.001). Patients were less frequently agitated, defined as SAS >4, after the initiation of ketamine (27% vs 33%, p=0.005). Seven patients (7.7%) required discontinuation of ketamine infusion for an ADR. There were no significant changes in hemodynamic variables after the initiation of ketamine. Conclusions: Continuous ketamine infusion for adjunct light sedation was well tolerated in a cohort of critically ill adults, with an acceptable safety profile. Prospective studies of ketamine infusion are warranted to further establish its efficacy as a sedative in this population. [ABSTRACT FROM AUTHOR]