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Purpose: Families of children in pediatric acute care offered ultra-rapid genomic sequencing are making complex decisions in a high stress period. To reduce complexity for families and clinicians, we offered genomic screening for the child and parents after completion of diagnostic testing. We evaluated uptake, understanding and service delivery preferences., Methods: A cohort of 235 families who had completed ultra-rapid diagnostic genomic sequencing at 17 Australian hospitals were offered up to three screens on their genomic data: pediatric-onset, adult-onset, expanded couple carrier screening. We investigated decision-making, understanding and service delivery preferences using surveys at three timepoints (pre-counseling, post-counseling, post-result) and performed inductive content analysis of pre-test genetic counseling transcripts., Results: 119 families (51%) attended genetic counseling with 115 (49%) accepting genomic screening. Survey respondents were more likely to find decisions about couple carrier screening 'easy' (87%) than adult (68%; p=0.002) or pediatric (71%; p=0.01) screening decisions. All respondents with newly detected pathogenic variants accurately recalled this one month later. A delayed offer of screening was acceptable to most respondents (78%)., Conclusion: Separating genomic screening from the stressful diagnostic period is supported by families who demonstrate good knowledge and recall. Our results suggest delaying genomic screening should be trialed more widely., (Copyright © 2024. Published by Elsevier Inc.)

High dose and long-acting opioid overdose reversal drugs can precipitate withdrawal in people who are opioid dependent. Products recently brought to market for community use in the United States (US) have drawn international concern because of their increased risk of withdrawal. At the March 18-19, 2024, Compassionate Overdose Response Summit & Naloxone Dosing Meeting, a panel of harm reduction experts issued the following call to action: 1) people who use drugs should be directly involved in decisions regarding the research, development, selection, and distribution of opioid overdose reversal products; 2) regulatory agencies and pharmaceutical manufacturers should carefully consider and communicate the risk and duration of withdrawal associated with higher dose and longer-acting opioid antagonists; 3) take-home naloxone kits should include at least two doses of an intramuscular (IM) product containing 0.4 mg or an intranasal (IN) product containing ≤4 mg; 4) At this time, high dose and long-acting opioid antagonists have no use in acute opioid overdose response; and, 5) overdose response educational materials, instructions on overdose response, and training should emphasize the restoration of breathing, avoiding withdrawal, and compassionate post-overdose support and care. High dose and long-acting opioid overdose reversal drugs were approved without testing for withdrawal and are often aggressively marketed despite decades of evidence from naloxone distribution programs worldwide that the ideal dose of naloxone is one that restores breathing without inducing withdrawal. Government agencies should direct resources to harm reduction programs to make standard dose take-home naloxone products widely available among people who use drugs. Lay bystanders, people who use drugs, their families, and professional first responders can learn and apply a compassionate approach to opioid overdose response., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: 1. Erin Russell discloses that Harm Reduction Therapeutics is a client of Health Management Associates. HRT is a nonprofit organization based in the United States that manufactures a 3 mg naloxone nasal spray product. 2. In the last three years, Joanne Neale has secured, through her university, research funding from Mundipharma Research Ltd (for research on naloxone) and Camurus AB (for research on long-acting injectable buprenorphine). She has also received honoraria from Indivior and Camurus AB for presentations and from Figure 8 Consultancy Ltd for research advice on a study of residential rehabilitation., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

This article presents a case where the issue was to determine who was the driver and who was the passenger at the time of a fatal car accident involving two persons, one of whom died in the accident. The presence of the two persons in the car was not contested, only the mechanisms that led to the deposition of the DNA (i.e., the activities) were. To our knowledge, few cases are evaluated considering the alleged activities. The reasons for this include the lack of knowledge, and data, as well as the difficulties encountered for the formulation of conclusions. In this case report, we present the architecture of the Bayesian Network (BN) used to evaluate the DNA results of the traces recovered from the steering wheel, driver's and passenger's airbags. The following propositions were considered: "The person of interest (POI) was driving the car and the alternative person (AP) was the passenger at the time of the accident" or vice versa. We discuss the assumptions that were made and how data from the literature was used to parametrize into the BN. A likelihood ratio of the order of 90 was finally assigned. The statement proposed to the mandating authority indicated that, given the information that was made available to us, our observations were of the order of 90 times more probable if the POI was driving the car at the time of the accident rather than if the AP was. A sensitivity analysis was performed (5000 simulations): this shows that our likelihood ratio is robust., Competing Interests: Declaration of Competing Interest No conflict of interest., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Research Question: What are the perspectives of preimplantation genetic testing (PGT) patients in Belgium on the ethics of PGT for polygenic risk scoring (PGT-P)?, Design: In-depth interviews (18 in total, 10 couples, 8 women, n = 28) were performed with patients who had undergone treatment with PGT for monogenic/single-gene defects (PGT-M) or chromosomal structural rearrangements (PGT-SR) between 2017 and 2019 in Belgium. Participants were asked about their own experiences with PGT-M/SR and about their viewpoints on PGT-P, including their own interest and their ideas on its desirability, scope and consequences. Inductive content analysis was used to analyse the interviews., Results: Participants stated that their experiences with PGT-M/SR had been physically, psychologically and practically difficult. Most participants stated that, partly because of these difficulties, they did not see the added value of knowing the risk scores of embryos via PGT-P. Many participants worried that PGT-P could lead to additional anxieties, responsibilities and complex choices in reproduction and parenthood. They argued that not everything should be controlled and felt that PGT-P, especially non-medical and broad screening, was going too far. With regards to the clinical implementation of PGT-P, participants in general preferred PGT-P to be limited to people with a serious polygenic family history and wanted embryo selection decisions to be made by healthcare professionals., Conclusions: This study shows that individuals with experience of PGT-M/SR saw PGT-P as different from PGT-M/SR. They had various ethical concerns with regards to PGT-P, especially regarding broadly offering PGT-P. These stakeholder viewpoints need to be considered regarding potential PGT-P implementation and guidelines., (Copyright © 2024 Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.)

The surge in non-grain production on farmland (NGPF) poses significant threats to food security and land sustainability, particularly in hilly regions. However, there remains a lack of clarity on how to effectively balance grain and non-grain production in relation to land remediation. Using Wannian County as a case study, we investigate the evolution of this by leveraging high-precision land surveys and satellite imagery. Through the application of bootstrapped partial linear regression models, we identify key influencers behind each type of NGPF. In proposing land remediation solutions, we integrate the results of NGPF and land quality evaluations to identify mismatches between non-grain production and land attributes (i.e., topography, geology, soil, and land use). Our findings reveal a substantial growth in NGPF, expanding from 3838.72 ha to 5659.64 ha (2010-2020), and predominantly occurring on farmland with favorable natural conditions and connected locations such as proximity to roads, town centers, and industrial plants. Surprisingly, the basic farmland protection policy shows limited effectiveness in curbing NGPF, except for garden operations. We identify 1674 NGPF patches suitable for conversion to grain production and provide land remediation suggestions tailored to low-quality farmland with specific natural barriers, thus complementing the demand for regional non-grain production. This study thereby innovatively proposes nature-based land remediation strategies to address the non-grain production dilemma by tailoring NGPF and land quality, offering valuable insights for sustainable farmland management in China and beyond., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Drought and floods seriously affect agriculture across the world. It is of great importance to lower down the agricultural vulnerability to disasters to build climate-resilient agriculture. The paper aims to investigate the spatio-temporal changes of agricultural vulnerability to drought and floods in the world in the period 2003-2019. Research results show that (1) the agricultural vulnerability to drought and floods is at a low level across the globe owning to the dual effects of decreasing exposure and increasing adaptability; (2) the northern parts of United States, northeastern parts of China, and the border between Russia and Kazakhstan are identified as most vulnerable areas to drought and floods; and (3) spatio-temporal mismatch of precipitation is the main factor to cause floods and drought while better adaption is beneficial to minimize the adverse effects of disasters. Based on analysis on the drivers and spatial patterns of drought and floods risk in all dimensions, tailored measures and policies are put forwards to make adaptive strategies of agriculture to climate change., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier B.V.)

Objectives: To improve access, the VA Maintaining Internal Systems and Strengthening Integrated Outside Networks (MISSION) Act of 2018 mandated a 2-year study of medical scribes in Veterans Health Administration specialty clinics and emergency departments. Medical scribes are employed in clinical settings with the goals of increasing provider productivity and satisfaction by minimizing physicians' documentation burden. Our objective is to quantify the economic outcomes of the MISSION Act scribes trial., Methods: A cluster-randomized trial was designed with 12 Department of Veterans Affairs (VA) medical centers randomized into the intervention. We estimated the total cost of the trial, cost per scribe-year, and projected cost of hiring additional physicians to achieve the observed scribe productivity benefits in relative value units and visits per full-time-equivalent over the 2-year intervention period (June 30, 2020 to July 1, 2022)., Results: The estimated cost of the trial was $4.6 million, below the Congressional Budget Office estimate of $5 million. A full-time scribe-year cost approximately $74 600 through contracting and $62 900 through VA hiring. Randomization into the trial led to an approximate 30% increase in productivity in cardiology and 20% in orthopedics. The projected incremental cost of using additional physicians instead of scribes to achieve the same productivity benefits was nearly $1.7 million more, or 75% higher, than the observed cost of scribes in cardiology and orthopedics., Conclusions: As the largest randomized trial of scribes to date, the MISSION Act scribes trial provides important evidence on the costs and benefits of scribes. Improving productivity enhances access and scribes may give VA a new tool to improve productivity in specialty care at a lower cost than hiring additional providers., Competing Interests: Author Disclosures Author disclosure forms can be accessed below in the Supplemental Material section., (Copyright © 2024. Published by Elsevier Inc.)

Objectives: This study investigates the effect of e-cigarette-related harm and addiction perceptions on e-cigarette initiation among US tobacco-naïve adolescents., Study Design: This is a longitudinal study., Methods: Using data from five waves (2013-2019) of the Population Assessment of Tobacco and Health Study, we created a longitudinal data set for 2775 youth aged 12-17 years who had no prior use of tobacco products at Wave 1. E-cigarette initiation was defined as transitioning from non-use at Wave 1 to ever use in subsequent waves. Kaplan-Meier survival and Cox proportional hazard regression models were used to assess the impact of harm and addiction perceptions on e-cigarette initiation., Results: Our analytic sample comprised 63.1% of youth who had never used tobacco products at Wave 1 and consequently initiated e-cigarette use in subsequent waves. Over time, fewer individuals perceived e-cigarettes as harmless (14.1%-2.1%), whereas more perceived them as likely to cause addiction (53.7%-76.6%). Compared with perceiving e-cigarettes as a lot of harm, those perceiving some harm (adjusted hazard ratio [aHR] = 1.30, 95% confidence interval [CI]: 1.12-1.52), little harm (aHR = 1.42, 95% CI: 1.20-1.68), or no harm (aHR = 2.09, 95% CI: 1.64-2.65) were more likely to initiate e-cigarette use. Demographic factors for initiation included being Black or Hispanic ethnicity (vs White), younger age (12-14 vs15-17 years), and receiving over $20 per week (vs $0) in pocket money, with P-values <0.05. However, in adjusted results, addiction perceptions did not significantly impact e-cigarette initiation (P-values >0.05)., Conclusions: Among youth without prior tobacco/nicotine use, perceiving e-cigarettes as having low harm significantly predicted initiation over time. Effective prevention strategies, including targeted risk communication interventions, are essential for discouraging e-cigarette use among youth., (Copyright © 2024 The Royal Society for Public Health. All rights reserved.)

Child marriage has continued to rear its ugly head in Nigerian society. This study aimed to evaluate the impact of storytelling and multimedia music interventions in improving knowledge of the Child Rights Act and reducing the propensity to engage in child marriage. The researchers applied a quasi-experimental design and collected data using a structured questionnaire. The children were assigned into three groups (control, storytelling and multimedia music) of 173 participants. It was found that the interventions were effective. In particular, while storytelling contributed more to reducing the propensity to engage in child marriage, multimedia music contributed more to improving knowledge of the Child Rights Act. These results suggest that storytelling and multimedia music interventions can be effective approaches for addressing the lingering problem of child marriage in Nigeria., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

The COVID-19 pandemic was an unexpected event with far-reaching long-term economic, political, and social consequences, entailing disruptive changes with potentially existence- and livelihood threatening consequences. Lessons in resilience from illegal economies such as the illegal wildlife trade could help society better cope with harms and risk from global environmental change. We critically review the Frictions and Flows framework and the case of the illegal wildlife trade-a globally distributed form of nature crime-in South Africa, Tanzania, and Zambia-countries with different responses to the COVID-19 pandemic. Diverse frictions and flows were, and continue to be, documented in the illegal wildlife economies of each country through and after pandemic lockdowns, demonstrating resilience, adaptability, and innovation. We point to market features and characteristics prevalent in the anthroposphere that appear to render actors and markets more resilient, shock-resistant, and flexible. Without advocating for operating outside the rule of law and with overt recognition for the destructive impacts of illicit trades on sustainable development, political stability, and global security, we identify three observations relevant to resilience and global environmental change that scientists of the total environment may be critically missing., Competing Interests: Declaration of competing interest The authors declare no conflict of interest., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Purpose: Accidental death is a leading cause of mortality among military members and Veterans; however, knowledge is limited regarding time-dependent risk following deployment and if there are differences by type of accidental death., Methods: Longitudinal cohort study (N = 860,930) of soldiers returning from Afghanistan/Iraq deployments in fiscal years 2008-2014. Accidental deaths (i.e., motor vehicle accidents [MVA], accidental overdose, other accidental deaths), were identified through 2018. Crude and age-adjusted mortality rates, rate ratios, time-dependent hazard rates and trends postdeployment were compared across demographic and military characteristics., Results: During the postdeployment observation period, over one-third of deaths were accidental; most were MVA (46.0 %) or overdoses (37.9 %). Across accidental mortality categories (all, MVA, overdose), younger soldiers (18-24, 25-29) were at higher risk compared to older soldiers (40+), and females at lower risk than males. MVA death rates were highest immediately postdeployment, with a significant decreasing hazard rate over time (annual percent change [APC]: -6.5 %). Conversely, accidental overdose death rates were lowest immediately following deployment, with a significant increasing hazard rate over time (APC: 9.9 %)., Conclusions: Observed divergent trends in risk for the most common types of accidental deaths provide essential information to inform prevention and intervention planning for the immediate postdeployment transition and long-term., Competing Interests: Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Rachel Sayko Adams, PhD, MPH reports financial support was provided by grants from NIH, Henry Jackson Foundation, and a VA IPA. Jeri Forster, PhD reports financial support was provided by grants from the VA, DoD and NIH. Claire Hoffmire, PhD reports financial support was provided by grants from the VA and NIH. Colin Walsh, MD reports financial support was provided by grants from NIH, and US Food and Drug Admin. Mary Jo Larson, PhD reports financial support was provided by grants from the NIH, USU and DoD. Jaimie Gradus, PhD reports financial support was provided by grants from the VA, DoD, and NIH. Lisa A. Brenner, PhD reports financial support was provided by VA, DoD, NIH, and the State of Colorado. Colin Walsh MD reports financial support was provided by the Military Suicide Research Consortium, Wellcome Leap, Selby Stead Fund, Vanderbilt Univ. Medical Center, TN Department of Health, Southeastern Home Office Underwriters Ass., Hannover Re., and holding equity in Sage AI outside the submitted work. Lisa Brenner, PhD reports financial support was provided by Editorial renumeration from Wolters Kluwer, royalties from the American Psychological Association and Oxford Unv., and financial support was provided by Consults with sports leagues via her university affiliation., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Cigarette packages are potent marketing tools. Following guidance from the WHO Framework Convention on Tobacco Control, many countries have sought to diminish this marketing power by mandating that (1) large graphic health warnings be affixed to the packages (i.e., text warnings combined with graphic images of the health consequences of smoking) and (2) all packages be fully "plain" in their design (i.e., all packages use the same drab/bland color and font type; no brand logos, other colors, or designs are permitted). Yet, the United States lags other countries in implementing regulations designed to blunt the marketing power of cigarette packages. This is not because of a lack of effort on the part of the Food and Drug Administration, the main governmental body charged with regulating tobacco products in the United States. Rather, it is because the regulatory options that that have been advanced in the country (e.g., graphic health warnings) have not been found - yet - to be legally feasible by its courts. This commentary works through some of the conceptual, practical, and legal issues regarding packaging regulations in the United States. It considers the political and bureaucratic risks involved with issuing new regulations. The overall intent is to prompt our field to think creatively about what is realistic in this regulatory space and to offer a novel perspective that may help move the United States tobacco control community forward in its efforts to reduce the promotional power of cigarette packages., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023. Published by Elsevier B.V.)

This paper performed as a frontier try to investigate the effect of high temperatures on entrepreneurship, assessed from an urban perspective. This paper estimated the impact of high temperatures on urban entrepreneurship levels using data from 281 prefecture cities in China, during the period 2000-2017. This paper found that a single day with a temperature of above 30 °C led to a decrease of 0.47 % in urban entrepreneurship levels, compared with a single day recording comfortable temperatures. Following a series of robustness tests, the results were found to be significant. Next, this paper conducted a series of heterogeneity analyses and discovered that cities with advanced industrial structures, larger sizes and more essential hierarchies were less affected by high temperatures. Finally, this paper further analyzed the potential influence mechanisms of high temperatures on entrepreneurship. This paper found that high temperature affects urban entrepreneurship levels by worsening the entrepreneurial environment, especially by reducing human capital, hindering innovation, decreasing the financial support available to enterprises, and hindering economic development. The results of our study have thus enriched the literature on entrepreneurship by exploring the impact of climate change on entrepreneurship., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Background: Evidence for the effectiveness of menthol cigarette bans comes mostly from studies of adults that smoke. This experiment evaluated whether the absence of menthol products from a convenience store influenced young people's susceptibility to cigarette smoking after they shopped in the store., Methods: This experiment took place in the RAND StoreLab (RSL), a life-sized research convenience store. A three-group, between-subjects design was used. Study conditions differed in the mix of flavored tobacco products the RSL displayed: 1) All tobacco-, sweet-, and menthol-flavors displayed; 2) only tobacco- and menthol-flavors displayed; and 3) only tobacco-flavors displayed. Participants were randomly assigned to shop in the RSL under one of these conditions and after shopping, completed measures of their susceptibility to cigarette smoking, one measure for menthol cigarettes and one for unflavored cigarettes (scores on each susceptibility measure was dichotomized: 0 = not susceptible; 1 = susceptible)., Results: Multivariable logistic regression assessed the main effects of condition on susceptibility to smoking menthol and unflavored cigarettes. There was no condition effect on susceptibility to smoking unflavored cigarettes. However, removing menthol-flavored products significantly increased participants' susceptibility to smoking menthol cigarettes compared to when all flavored products were available (OR = 3.66, 95% CI [1.33, 10.03]). This significant effect was only found among young people with some pre-existing risk of cigarette smoking (OR = 5.92, 95% CI [1.81, 19.39])., Conclusion: Results suggest the need to consider that menthol bans could unintentionally increase the appeal of menthol cigarettes among youth already at risk of smoking., Competing Interests: Declaration of Competing Interest No conflicts declared., (Copyright © 2023 Elsevier B.V. All rights reserved.)

The process of vaccine production, manufacturing, is time-intensive, complex, expensive, and highly technical, requiring close coordination and collaboration among multiple companies with different inputs, from active pharmaceutical ingredients to glass, and specializations, and with the supply chains spread across many countries. Covid-19 pandemic highlighted that neglecting and ignoring the need for a global effort in vaccine manufacturing and delivery can have alarming, and devastating, repercussions, especially when the world needs a robust healthcare ecosystem to make sure that all of us are safe. So, the natural question is: what does the world need to be well-prepared for the next virus; what does it take to have the manufacturing of vaccines become less concentrated in a few countries and centers and diversified to more countries so that distribution can be more universal, so that all of us are safe? First will need to be the political recognition, and the acceptance, that no country can do or supply everything alone in the pharmaceutical sector - no country can be an island -and that binding international agreements will need to be adopted to make access to medicine more equitable and secure around the world. Furthermore, and critically so, significant long-term sustained investment in human resources must be adopted to fill major gaps in expertise, starting with a robust educational system whose graduates have the knowledge, ability, and capacity to work in this technical industry. Only then, with a professional-educated labor force, can resilient pharma-manufacturing clusters be successfully built throughout the world, which can, and will, give life to the new health code: "No one is safe, until everyone is safe.", Competing Interests: Declaration of Competing Interest I have served as attorney for Vetter Pharma (for the period 1983 to about 2015), which is a German manufacturer of prefilled syringes, and have, and still do, serve as attorney for other pharma companies, all of which are start-up companies, or, in one case, a small medical equipment company. Furthermore, I was trustee–executor of Vetter Pharma from February 1999 to December 31, 2007. In addition, I serve as an advisor to an angel fund that invests in biotech and digital health companies, although I am not an investor in that fund, while my daughter is an investor., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Background: In the United States, methadone treatment for opioid use disorder is only available at opioid treatment programs (OTPs). In addition to federal regulations, states can enact laws which shape access to OTPs. We aimed to define classes of states according to restrictiveness of state OTP laws and examine population characteristics associated with class membership., Methods: A set of laws was extracted from a database of statutes and regulations governing OTPs in 49 states and the District of Columbia as of June 2021. Latent class analysis of laws was used to estimate the probability of class membership for each state. Class-weighted multinomial logistic regression analysis assessed state-level correlates of class membership and adjusted Relative Risk Ratio (aRRR) and 95% confidence intervals (95%CI) were generated., Results: States (n = 50) were assigned to three classes; Class 1) High restrictiveness on patient experience, low restrictiveness on access to service (n = 13); Class 2) Medium restrictiveness on patient experience, high restrictiveness on access to service (n = 14); Class 3) Low restrictiveness on patient experience, low restrictiveness on access to service (n = 23). States with a higher probability of membership in Classes with higher restrictiveness had higher rates of unemployment (Class 1 vs Class 3, aRRR:1.24; 95%CI:1.06-1.45), and Black residents (Class 2 vs Class 3, aRRR:1.10; 95%CI:1.04-1.15), and lower likelihood of Medicaid coverage of methadone (Class 1 vs Class 3, aRRR:0.25; 95%CI:0.07-0.88). States with a higher probability of membership in Classes with higher restrictiveness also had higher rates of potential indicators for opioid use disorder treatment need, including rates of opioid dispensing (Class 1 vs Class 3, aRRR:1.06; 95%CI:1.02-1.10, Class 2 vs Class 3, aRRR:1.07; 95%CI:1.03-1.11) and HIV diagnoses attributed to injection (Class 1 vs Class 3, aRRR:3.92; 95%CI:1.25-12.22)., Conclusions: States with indicators of greater potential need for opioid use disorder treatment have the most restrictions, raising concerns about unmet treatment need., Competing Interests: Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: CT has received speaker fees from Abbvie and Gilead and has received a research grant from Merck outside the submitted work. JG is a consultant/advisor and has received research grants from Abbvie, bioLytical, Camurus, Cepheid, Gilead Sciences, Hologic, and Indivior. NK provides testimony for ongoing opioid litigation. AC, FM, SD, VB, ADM, CSD, SC and MC have nothing to disclose., (Copyright © 2023 The Author(s). Published by Elsevier B.V. All rights reserved.)

Background: Despite evidence that the U.S. "War on Drugs" is associated with increases in drug-related harm and other negative outcomes, all U.S. states have long criminalized most drug possession. In early 2021, both Oregon and Washington became exceptions to this rule when they fully (Oregon) or partially (Washington) decriminalized possession of small amounts of all drugs., Methods: We obtained arrest data for 2019 to 2021 for intervention states (Oregon and Washington) and control states (Colorado, Idaho, Montana, and Nevada). We calculated monthly rates for arrests overall and for violent crimes, drug possession, equipment possession, non-drug crimes, and a set of low-level crimes termed displaced arrests. Using an interrupted time series analysis, we examined changes in monthly arrest rates after the implementation of policy change in Oregon and Washington compared to control states., Results: In Oregon, there were 3 fewer drug possession arrests per 100,000 in the month after the policy change; the rate decreased throughout the post-implementation period. In Washington, there were almost 5 fewer drug possession arrests per 100,000 in the month following policy change, and the rate remained stable thereafter. Both declines were significantly greater than in comparison states. There were also statistically significant reductions in arrests for possession of drug equipment in Washington and a significant increase in displaced arrests in Oregon. There were no significant changes in overall arrests, non-drug arrests or arrests for violent crime in either state, relative to controls., Conclusion: This analysis demonstrates that it is possible for state drug decriminalization policies to dramatically reduce arrests for drug possession without increasing arrests for violent crimes, potentially reducing harm to people who use drugs and their communities. Additional research is needed to determine whether these legal reforms were associated with changes in overdose rates and other drug-related harms., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 The Author(s). Published by Elsevier B.V. All rights reserved.)

Background: Drug overdose deaths continue to rise, and considerable racial inequities have emerged. Overdose Good Samaritan laws (GSLs) are intended to encourage overdose witnesses to seek emergency assistance. However, evidence of their effectiveness is mixed, and little is known regarding racial disparities in their implementation. This study examined GSL impact by assessing racial differences in awareness of and trust in New York state's GSL., Methods: Using a sequential mixed methods design, Black and white participants were recruited from an existing longitudinal cohort study of people who use illicit opioids in New York City to participate in a quantitative survey and qualitative interviews. Racially stratified survey responses were analyzed using chi-squared tests, Fisher exact tests, or t-tests. Qualitative interviews were analyzed using a hybrid inductive-deductive approach., Results: Participants (n=128) were 56% male and predominantly aged 50 years or older. Most met criteria for severe opioid use disorder (81%). Fifty-seven percent reported that the New York GSL makes them more likely to call 911 even though 42% reported not trusting law enforcement to abide by the GSL; neither differed by race. Black people were less likely to have heard of the GSL (36.1% vs 60%) and were less likely to have accurate information regarding its protections (40.4% vs 49.6%)., Conclusions: Though GSLs may reduce negative impacts of the criminalization of people who use drugs, their implementation may exacerbate existing racial disparities. Resources should be directed towards harm reduction strategies that do not rely on trust in law enforcement., Competing Interests: Declaration of Competing Interest No conflicts declared., (Copyright © 2023. Published by Elsevier B.V.)

Conventional composting is a viable method treating agricultural solid waste, and microorganisms and nitrogen transformation are the two major components of this proces. Unfortunately, conventional composting is time-consuming and laborious, and limited efforts have been made to mitigate these problems. Herein, a novel static aerobic composting technology (NSACT) was developed and employed for the composting of cow manure and rice straw mixtures. During the composting process, physicochemical parameters were analyzed to evaluate the quality of compost products, and microbial abundance dynamics were determined using high-throughput sequencing technique. The results showed that NSACT achieved compost maturity within 17 days as the thermophilic stage (≥55 °C) lasted for 11 days. GI, pH, and C/N were 98.71 %, 8.38, and 19.67 in the top layer, 92.32 %, 8.24, and 22.38 in the middle layer, 102.08 %, 8.33, and 19.95 in the bottom layer. These observations indicate compost products maturated and met the requirements of current legislation. Compared with fungi, bacterial communities dominated NSACT composting system. Based on the stepwise verification interaction analysis (SVIA), the novel combination utilization of multiple statistical analyses (Spearman, RDA/CCA, Network modularity, and Path analyses), bacterial genera Norank Anaerolineaceae (-0.9279*), norank Gemmatimonadetes (1.1959*), norank Acidobacteria (0.6137**) and unclassified Proteobacteria (-0.7998*), and fungi genera Myriococcum thermophilum (-0.0445), unclassified Sordariales (-0.0828*), unclassified Lasiosphaeriaceae (-0.4174**), and Coprinopsis calospora (-0.3453*) were the identified key microbial taxa affecting NH 4 + -N, NO 3 - -N, TKN and C/N transformation in the NSACT composting matrix respectively. This work revealed that NSACT successfully managed cow manure-rice straw wastes and significantly shorten the composting period. Interestingly, most microorganisms observed in this composting matrix acted in a synergistic manner, promoting nitrogen transformation., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Background: The United States continues to experience unprecedented rates of overdose mortality. Addressing the overdose epidemic has been challenging for policy makers given the lack of effectiveness of existing drug control policy measures. More recently, the implementation of harm reduction-based policies such as Good Samaritan Laws has led to increasing scholarly attention aimed at evaluating their effectiveness at reducing the likelihood of criminal justice-related sanctions for individuals following an overdose incident. The results of these studies, however, have been mixed., Methods: This study utilizes data from a nationally representative survey of law enforcement agencies designed to provide national information on services, policies, practices, operations, and resources of law enforcement drug response around overdoses to assess whether state Good Samaritan Laws reduce the likelihood of overdose victims being cited or being jailed following an overdose incident., Results: In general, findings indicate that although most agencies reported that overdose victims were not incarcerated or cited following an overdose incident, that this did not vary by whether agencies were in a state that had a GSL arrest protection for possession of controlled substances., Conclusions: GSLs are often written in complex and confusing language that officers and people who use drugs do not fully understand, which may deter their being used for their intended purpose. Although GSLs are well-intentioned, these findings highlight the need for training and education for law enforcement and people who use drugs around the scope of these laws., Competing Interests: Declaration of Competing Interest The authors have no conflicts of interest to declare., (Copyright © 2023 Elsevier B.V. All rights reserved.)

The implementation of the European Food Regulation in the German military started in 2003 and was fully implemented in 2006. In addition, in 2003 the German military introduced the concept of using convenience-based foods targeted to improve the safety of food served to the troops. The aim of this study was to evaluate the impact of these changes on food safety and the occurrence of food-borne disease outbreaks in the German military. For this purpose, data from a total of 517 food-borne outbreaks that occurred between 1995 and 2019 in the responsible areas of the German military both within the country and abroad were subjected to a retrospective analysis. As a result, a significant decrease (p = 2.47 × 10 -5 ) in the number of the food-borne outbreak was observed in the second observation period (2003-2019) compared to the first period (1995-2002). Food groups often found contaminated with pathogens were desserts and prepared dishes (first period), fresh produce, soups, and sauces (second period). Bacillus cereus, Enterobacteriaceae, Salmonella spp., and Staphylococcus aureus were dominant pathogens isolated from suspected foods during disease outbreaks in both periods, however, the absolute number of isolates reduced significantly in the second period. Therefore it can be concluded that the implementation of European food hygiene regulations together with the introduction of convenience-based foods had a significant positive impact on food safety in the German military., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 The Author(s). Published by Elsevier Inc. All rights reserved.)

Background: Naloxone distribution is central to ongoing efforts to address the opioid overdose crisis. Some critics contend that naloxone expansion may inadvertently promote high-risk substance use behaviors among adolescents, but this question has not been directly investigated., Methods: We examined relationships between naloxone access laws and pharmacy naloxone distribution with lifetime heroin and injection drug use (IDU), 2007-2019. Models generating adjusted odds ratios (aOR) and 95% confidence intervals (CI) included year and state fixed effects, controlled for demographics and sources of variation in opioid environments (e.g., fentanyl penetration), as well as additional policies expected to impact substance use (e.g., prescription drug monitoring). Exploratory and sensitivity analyses further examined naloxone law provisions (e.g., third-party prescribing) and applied e-value testing to assess vulnerability to unmeasured confounding., Results: Adoption of any naloxone law was not associated with changes in adolescent lifetime heroin or IDU. For pharmacy dispensing, we observed a small decrease in heroin use (aOR: 0.95 [CI: 0.92, 0.99]) and a small increase in IDU (aOR: 1.07 [CI: 1.02, 1.11]). Exploratory analyses of law provisions suggested that third-party prescribing (aOR: 0.80, [CI: 0.66, 0.96]) and non-patient-specific dispensing models (aOR: 0.78, [CI: 0.61, 0.99]) were associated with decreased heroin use but not decreased IDU. Small e-values associated with the pharmacy dispensing and provision estimates indicate that unmeasured confounding may explain observed findings., Conclusion: Naloxone access laws and pharmacy naloxone distribution were more consistently associated with decreases rather than increases in lifetime heroin and IDU among adolescents. Our findings therefore do not support concerns that naloxone access promotes high-risk adolescent substance use behaviors. As of 2019, all US states have adopted legislation to improve naloxone access and facilitate use. However, further removal of adolescent naloxone access barriers is an important priority given that the opioid epidemic continues to affect people of all ages., Competing Interests: Declarations of Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: D. Hasin has received funding from Syneos Health for an unrelated project. K. Keyes has received personal fees related to expert work in litigation. H. Samples has received consulting fees from the American Society of Addiction Medicine., (Copyright © 2023. Published by Elsevier B.V.)

Several studies have demonstrated that DNA can be indirectly transferred from an individual onto a surface. Therefore, the presence of DNA that is compatible with a given person does not necessarily mean that this person has touched the surface on which the DNA was recovered. The present work simulates cases, where DNA is recovered on a door handle and compared to several reference DNA profiles. The DNA profile of the trace shares DNA components with a person of interest (POI). When asked about the DNA results, the POI says he has nothing to do with the incident and has never been at the scene. However, a possibility would be that the DNA came from his recently stolen gloves. Someone else, the alternative offender (AO), could have opened the door wearing his gloves (POI's gloves), and transferred his DNA (POI's DNA). Based on the above-mentioned scenario, 60 burglary simulations experiments were carried out to generate data to assess DNA results given these allegations. The quantity and quality of DNA profiles (NGM SElect) recovered when the POI opened/closed the door bare-handed or when someone else performed the same activity but using POI's gloves, were compared. The gloves were regularly worn during at least three months by their owner during the winter. On the contrary, the AO wore them only for two minutes. Among the traces collected on the door handles, less than 50% of the traces led to interpretable DNA profiles. In 30% of the cases (3/10), when the door was opened/closed with bare hands, the DNA found on the door handle led to a mixed DNA profile with the POI's DNA aligning with the major contributor. For the experiments where the AO opened/closed the door with the POI's gloves, the POI's DNA was compatible with 22% (11/50) of the mixed DNA profile, aligning with the major in 8% of the cases (4/50). The DNA profiles of the offices' occupants were observed on the door handles, but not the AO's. In addition to the results of the experiments, we show two examples of how one can assess results observed in casework. Given the possibility of indirect transfer of minute DNA quantities, this research emphasizes the need to evaluate DNA results given the activities when the POI has a legitimate reason that can explain the presence of their DNA., Competing Interests: Conflicts of interest The authors have no conflicts of interest to declare., (Copyright © 2022 The Authors. Published by Elsevier B.V. All rights reserved.)

In recent years, scholars have levied multiple criticisms against traditional proficiency testing procedures in forensic laboratories. Consequently, on several occasions, authorities have formally recommended that laboratories implement blind proficiency testing procedures. Implementation has been slow, but laboratory management has increasingly expressed interest in initiating blind testing in at least some forensic disciplines, with some laboratories conducting blind testing in almost all disciplines. However, little is known about how a key population perceives blind proficiency testing, i.e., forensic examiners. We surveyed active latent print examiners (N = 338) to explore perceptions of blind proficiency testing and determine whether beliefs varied between examiners who work for laboratories with and without blind proficiency testing. Results suggest that examiners do not hold particularly strong beliefs about such procedures, but that examiners who work in laboratories with blind proficiency testing procedures view them significantly more positively than those who do not. Further, examiner responses provide insight into potential obstacles to continued implementation., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 The Chartered Society of Forensic Sciences. Published by Elsevier B.V. All rights reserved.)

Purpose: Since 2012 fentanyl-detected fatal overdoses have risen from 4% of all fatal overdoses in Connecticut to 82% in 2019. We aimed to investigate the geographic and temporal trends in fentanyl-detected deaths in Connecticut during 2009-2019., Methods: Data on the dates and locations of accidental/undetermined opioid-detected fatalities were obtained from Connecticut Office of the Chief Medical Examiner. Using a Bayesian space-time binomial model, we estimated spatiotemporal trends in the proportion of fentanyl-detected deaths., Results: During 2009-2019, a total of 6,632 opioid deaths were identified. Among these, 3234 (49%) were fentanyl-detected. The modeled spatial patterns suggested that opioid deaths in northeastern Connecticut had higher probability of being fentanyl-detected, while New Haven and its neighboring towns and the southwestern region of Connecticut, primarily Greenwich, had a lower risk. Model estimates also suggested fentanyl-detected deaths gradually overtook the preceding non-fentanyl opioid-detected deaths across Connecticut. The estimated temporal trend showed the probability of fentanyl involvement increased substantially since 2014., Conclusions: Our findings suggest that geographic variation exists in the probability of fentanyl-detected deaths, and areas at heightened risk are identified. Further studies are warranted to explore potential factors contributing to the geographic heterogeneity and continuing dispersion of fentanyl-detected deaths in Connecticut., (Copyright © 2023 The Author(s). Published by Elsevier Inc. All rights reserved.)

Background: The increase in alcohol consumption among young women has been the most striking change in drinking culture in Spain in recent years. This study sets out to examine how images and stories about alcohol consumption are presented on Instagram, the strategies for constructing them, and the impact of social norms, including gender norms, on the strategies of making alcohol consumption visible., Methods: We have carried out a digital ethnography study in which different research techniques have been applied. We held 13 discussion groups, conducted a three-month period of observation on Instagram, and 38 in-depth interviews of young Spanish men and women between the ages of 15 and 24 (N = 118)., Results: The representation of alcohol consumption on Instagram by young people shows fashionable party spaces for shared disinhibition, fun and youth gatherings. This social network permits different types of alcohol advertising and promotion of the image associated with its consumption, and is thus a space that brands and influencers exploit. Young people avoid the diffusion on Instagram of images related to their heavy use of alcohol through particular strategies. They untag, delete or avoid using their smartphone; and they choose the audience to whom images are directed, and the areas of publication. The desire to be posting and exhibiting constantly converges with embarrassment and precaution with (un)known audiences. Gender is a key element for understanding the differences in the way in which posts on Instagram related to drinking and drunkenness affect young people., Conclusions: Our data show that Instagram fosters the spreading of an ideal model of "alcohol consumption" online that tends to conceal the adverse effects of the substance, and that the online diffusion of behaviour concerning drinking is not gender-neutral., Competing Interests: Declarations of Interest The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (Copyright © 2022. Published by Elsevier B.V.)

Field research within latent print comparison has remained sparse in the context of an otherwise growing body of literature examining the discipline. Studies examining how ACE-V procedures are implemented within active crime laboratories are especially lacking in light of research suggesting significant variability in examiner practices despite standardized ACE-V procedures. To date, no studies have examined a potentially important aspect of the Analysis phase: digital image editing. We provide information on the prevalence and types of latent print image editing within one laboratory (i.e., Houston Forensic Science Center), examine the potential effect of image editing on objective print quality and clarity (i.e., LQMetrics scores), and explore potential examiner differences in editing effectiveness. Results indicate that most latent prints are edited in some manner, and that image editing improves the quality and clarity of print images as defined by an objective quality metric, although examiners varied in their ability to improve the clarity of print images. Findings suggest that formal guidance or documentation of standard editing procedures would likely improve the reliability of examiner conclusions early in the latent print comparison process., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 The Chartered Society of Forensic Sciences. Published by Elsevier B.V. All rights reserved.)

Research Question: How do Dutch heterosexual parents who achieved parenthood through donor conception navigate non-genetic parenthood and kinship?, Design: A qualitative in-depth semi-structured interview study was performed between September 2018 and January 2019 with both partners of 13 Dutch heterosexual couples where the male partner suffered from infertility and who conceived a child with the help of a sperm donor. Interview questions were based on literature and clinical experiences of experts in the field of donor conception. Interviews were transcribed and analysed using thematic analysis., Results: All parents navigated non-genetic parenthood through 'doing' kinship: they negotiated the importance of nature versus nurture with regards to donor conception and non-genetic parenthood. Most parents perceived genetics as irrelevant for experiencing parenthood, bonding with their children and the preferred role of the donor in their future lives. Yet most of them found genetics relevant for generating similarities between the father and the child, and for wanting the same donor for all their children to ensure a full genetic relation among them. Additionally, based on the donor's genetic bond with the child, some men were anxious about the donor's role in the child's future life and the consequences for their position as a non-genetic father. A few women perceived genetics as relevant in terms of possible inherited illnesses from the donor., Conclusions: Parents experienced several ambiguities regarding the role of genetics in donor conception and navigated 'doing' kinship in various ways. These aspects need to be taken into consideration during the counselling of prospective parents planning to conceive with donor conception., (Copyright © 2022 Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.)

When poor mental health impairs a doctor's ability to safely practise medicine, poor patient outcomes can result. Medical regulators play a critical role in protecting the public from impaired doctors, by requiring monitoring and treatment. However, regulatory processes may paradoxically harm doctors, with potential adverse implications for the community. There is little prior research examining the experiences of doctors with prior mental health or substance use challenges who are subject to regulatory notifications and processes relating to their health. Therefore, we explored this issue through the thematic analysis of semi-structured qualitative interviews. Participants reported that mandated treatment improved aspects of their health, but that fear of regulatory processes delayed them seeking treatment. Participants recognised being significantly unwell at the time of regulatory notification. Participants told us that regulatory processes triggered psychological distress, symptom relapse, and adverse financial and vocational implications. They also told us that these processes eroded their trust in regulators and regulatory processes. To improve health outcomes for unwell doctors and to create safer healthcare for the community, we propose: 1) greater awareness and education of the medical profession about the thresholds and requirements for mandatory reporting of health impairment; 2) better integrating specialised doctors' health services into existing regulatory pathways; and 3) adoption of a more therapeutic approach to regulation by medical regulators., Competing Interests: Declaration of Competing Interest OB was previously employed by Avant Insurance and is currently employed by the MIPS. While MIPS, Avant and MDA National were involved in facilitating the recruitment of potential participants, they did not have access to study data and had no input into the analysis or interpretation of results., (Copyright © 2022 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Diagnostic genomic sequencing generates unprecedented amounts of data. In addition to its primary use, this data could be used for a wide range of secondary purposes, including research and informing future healthcare for the data donor. These opportunities may require data to be shared with third parties. Although effective data sharing relies on public support, there are barriers which may prevent people from choosing to donate their genomic data and surprisingly few studies explore these barriers in depth. To address this need, this study aimed to qualitatively explore the Australian public's views and preferences for storing and sharing genomic data. Online focus groups were recorded, transcribed, and analysed using inductive content analysis. A total of 7 focus groups were conducted with 39 members of the Australian public ranging from 18 to 67 years of age. Participants were mostly supportive of genomic data being stored and shared for secondary purposes, recognising the potential benefits for individual health and wider medical research. However, some concerns were identified. Participants felt genomic data was particularly sensitive information, and raised the potential for discrimination, stigma, and other malicious uses of such data. Concerns for privacy and security of the data were also prevalent. Trustworthiness of data users was important when considering who genomic data should be shared with. Although participants were supportive of data being freely available to health professionals and researchers, they were opposed to insurance companies and employers accessing the data. There was greater controversy around sharing data with law enforcement and pharmaceutical companies. Participants recognised both benefits and harms to sharing with law enforcement. They were also cognizant of the dual purpose of pharmaceutical companies as both research and profit-driven organisations. Finally, participants expressed varying perspectives about sharing genomic data with family members, yet most agreed that explicit consent from the data donor should be required to share their information with relatives. This study highlighted several of the Australian public's perceived barriers and motivators for the storage and sharing of genomic data. Participants recognised both the benefits of collecting, storing and sharing such data widely but also the potential for harm from data misuse. While public acceptance of such endeavours is required to maximise the volume of data made available, the concerns around data access and security need to be addressed before this can occur. These findings also highlight the nuance and ethical complexity of decisions about who we should allow to access donated genomic data. These perspectives will be essential in helping to shape the way large-scale genomic data storage and sharing is developed and implemented in Australia, and internationally., Competing Interests: Declaration of competing interest Yan Meng is an associate at Analysis Group, Ltd. Research for this article was undertaken when she was working at the University of Melbourne. Julian Savulescu is a Partner Investigator on an Australian Research Council Linkage award (LP190100841, Oct 2020–2023) which involves industry partnership from Illumina. He does not personally receive any funds from Illumina. Julian Savulescu presented at a Genomic Prediction-organised webinar (2021), but received no payment or other benefits from Genomic Prediction Ltd. Julian Savulescu is a Bioethics Committee consultant for Bayer. The remaining authors declare no conflict of interest., (Copyright © 2022 Elsevier Masson SAS. All rights reserved.)

Intensive human activities caused massive socio-economic and land-use changes that directly or indirectly resulted in excessive accumulation of heavy metals in agricultural soils. The goal of our study was to explore the spatial determinants of heavy metals pollution for agricultural soil environment in Sunan economic region of China. We applied geographically weighted regressions (GWR) to measure the spatially varying relationship as well as conducted principal component analysis (PCA) to incorporate multiple variables. The results indicated that our GWR models performed well to identify the determinants of heavy metal pollution in different agricultural soils with relatively high values of local R 2 . Heavy metal pollution in Sunan economic region was crucially determined by accessibility, varying agricultural inputs as well as the composition and configuration of agricultural landscape, and such impacts exhibited significantly heterogeneity over space and farming practices. For the both agricultural soils, the major variance proportion for our determinants can be grouped into the first four factors (82.64 % for cash-crop soils and 73.065 for cereal-crop soils), indicating the incorporation and interactions between variables determining agricultural soil environment. Our findings yielded valuable insights into understanding the spatially varying 'human-land interrelationship' in rapidly developing areas. Methodologically, our study highlighted the applicability of geographically weighted regression to explore the spatial determinants associated with unwanted environmental outcomes in large areas., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationship that could have appeared to influence the work reported in this paper., (Copyright © 2022 Elsevier B.V. All rights reserved.)