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BackgroundOverdose deaths continue to reach new records in New York City and nationwide, largely driven by adulterants such as fentanyl and xylazine in the illicit drug supply. Unknowingly consuming adulterated substances dramatically increases risks of overdose and other health problems, especially when individuals consume multiple adulterants and are exposed to a combination of drugs they did not intend to take. Although test strips and more sophisticated devices enable people to check drugs for adulterants including fentanyl and xylazine prior to consumption and are often available free of charge, many people who use drugs decline to use them. ObjectiveWe sought to better understand why people in the New York City area do or do not check drugs before use. We plan to use study findings to inform the development of technology-based interventions to encourage consistent drug checking. MethodsIn summer 2023, team members who have experience working with people who use drugs conducted 22 semistructured qualitative interviews with a convenience sample of people who reported illicit drug use within the past 90 days. An interview guide examined participants’ knowledge of and experience with adulterants including fentanyl, xylazine, and benzodiazepines; using drug testing strips; and whether they had ever received harm reduction services. All interviews were audio recorded, transcribed, and analyzed for emerging themes. ResultsMost participants lacked knowledge of adulterants, and only a few reported regularly checking drugs. Reasons for not checking included lacking convenient access to test supplies, or a place to check samples out of the public’s view, as well as time considerations. Some participants also reported a strong belief that they were not at risk from fentanyl, xylazine, or other adulterants because they exclusively used cocaine or crack, or that they were confident the people they bought drugs from would not sell them adulterated substances. Those who did report testing their drugs described positive interactions with harm reduction agency staff. ConclusionsNew forms of outreach are needed not only to increase people’s knowledge of adulterated substances and awareness of the increasing risks they pose but also to encourage people who use drugs to regularly check their substances prior to use. This includes new intervention messages that highlight the importance of drug checking in the context of a rapidly changing and volatile drug supply. This messaging can potentially help normalize drug checking as an easily enacted behavior that benefits public health. To increase effectiveness, messages can be developed with, and outreach can be conducted by, trusted community members including people who use drugs and, potentially, people who sell drugs. Pairing this messaging with access to no-cost drug-checking supplies and equipment may help address the ongoing spiral of increased overdose deaths nationwide.

Following an archaeological diagnosis made in 2009 under the responsibility of J. Grasso for the National Institute for Preventive Archaeology (INRAP), an excavation was carried out in May 2014 by the Lyon Archaeology Service (SAVL) on a section of the Brevenne aqueduct at Limonest, located on a ridge line between two valleys. Two straight ditches were revealed, running perpendicular to the trunk of the aqueduct pipe and on both sides of a slight bend formed by the pipeline.Observed over a distance of 16 m (in the case of the longest ditch), but probably longer in all, these ditches have a U-shaped profile with a flat bottom and vertical sides, measuring approximately 37 cm in width. Both widen as they approach the pipeline and dip slightly towards the slope. Their similar fillings contained many fragments of architectural terracota. An imbrex, two fragments of which came from both ditches, is evidence of the contemporaneity of the fillings. These can be compared with other ditches discovered upstream on the route of the aqueduct, in the neighbouring plot, at Limonest during a dig led by M. Monin for SAVL in 2010-2011, at Lentilly during a dig led by C. Coquide for INRAP in 2014, and at Dardilly during a rescue archaeology dig led by B. Rostaing-Taillard, R. Saby and D. Gerboud for AFAN (now INRAP) in 1991.All these ditches share common features. The ditches found at Limonest in 2014 and in the neighbouring plot in 2010-2011 have parallel trajectories. If we had a hypothetical ditch discovered in this same excavation, the four ditches would be evenly spaced between 15 and 20 m apart. At Dardilly and Lentilly, the fillings are close and in the latter case, the width in contact with the aqueduct is the same as that observed at Limonest. At Dardilly and Lentilly, the ditches are intersected by the pipeline’s installation trench. The dating of ceramics and of a complete tegula discovered at Limonest corroborates the likelihood that they were dug prior to or contemporary with the construction of the aqueduct.The similarity of these ditches, their repetition at regular intervals and their location on several sections of the aqueduct route suggest a global strategy relating to the construction of the aqueduct rather than to occasional repairs. The absence of similar ditches on Lyon’s three other aqueducts and, to our knowledge, on any other aqueduct, prevents us from reaching a robust conclusion. In the current state of our excavations and knowledge, we suggest that they should be identified as standardised structures or storage areas or as drains for evacuating rainwater during the construction of the aqueduct in somewhat clayey soils.

Background: Health information-seeking behavior (HISB) of college students is of importance due to health information inconsistencies at a time when personal independence and concurrent personal health decision making may be increased. Currently, there is a dearth of research about the HISB of college students, especially from diverse backgrounds. Therefore, the purpose of this study was to identify and describe the sources college students use when engaging in HISB; and to explore associations between HISB and demographic factors. Methods: This cross-sectional study was conducted with undergraduate students at a diverse, public institution in New York City. The sample was drawn from an institutional social science research pool and asked to complete a survey on HISB. A total of 226 respondents completed the survey. Results: The believed accuracy of the information found online was positively correlated with related behaviors and beliefs. The number of followers on Instagram proved to be an important mediator of HISB of college students. The number of followers a health information provider has was fittingly positively correlated with the belief that social media is a helpful resource for health information r(233)=0.18, P=0.01. Students from families with two or more generations living in the United States accessed health professionals more frequently than students from one or less generation (χ2=8.107(2), P=0.017). Conclusion: Targeted educational programs designed to increase health information seeking skills, including discernment of information quality should be a priority for college students.

BackgroundRoutine use of patient-reported outcome measures (PROMs) and computerized adaptive tests (CATs) may improve care in a range of surgical conditions. However, most available CATs are neither condition-specific nor coproduced with patients and lack clinically relevant score interpretation. Recently, a PROM called the CLEFT-Q has been developed for use in the treatment of cleft lip or palate (CL/P), but the assessment burden may be limiting its uptake into clinical practice. ObjectiveWe aimed to develop a CAT for the CLEFT-Q, which could facilitate the uptake of the CLEFT-Q PROM internationally. We aimed to conduct this work with a novel patient-centered approach and make source code available as an open-source framework for CAT development in other surgical conditions. MethodsCATs were developed with the Rasch measurement theory, using full-length CLEFT-Q responses collected during the CLEFT-Q field test (this included 2434 patients across 12 countries). These algorithms were validated in Monte Carlo simulations involving full-length CLEFT-Q responses collected from 536 patients. In these simulations, the CAT algorithms approximated full-length CLEFT-Q scores iteratively, using progressively fewer items from the full-length PROM. Agreement between full-length CLEFT-Q score and CAT score at different assessment lengths was measured using the Pearson correlation coefficient, root-mean-square error (RMSE), and 95% limits of agreement. CAT settings, including the number of items to be included in the final assessments, were determined in a multistakeholder workshop that included patients and health care professionals. A user interface was developed for the platform, and it was prospectively piloted in the United Kingdom and the Netherlands. Interviews were conducted with 6 patients and 4 clinicians to explore end-user experience. ResultsThe length of all 8 CLEFT-Q scales in the International Consortium for Health Outcomes Measurement (ICHOM) Standard Set combined was reduced from 76 to 59 items, and at this length, CAT assessments reproduced full-length CLEFT-Q scores accurately (with correlations between full-length CLEFT-Q score and CAT score exceeding 0.97, and the RMSE ranging from 2 to 5 out of 100). Workshop stakeholders considered this the optimal balance between accuracy and assessment burden. The platform was perceived to improve clinical communication and facilitate shared decision-making. ConclusionsOur platform is likely to facilitate routine CLEFT-Q uptake, and this may have a positive impact on clinical care. Our free source code enables other researchers to rapidly and economically reproduce this work for other PROMs.

Technology-based behavioral health interventions offer potentially limitless opportunities to localize content and target specific populations. However, this ability to customize requires developers to make a wide range of decisions not only about who should appear on screen, but how each message should be refined to most effectively reach a particular group of intervention recipients. These issues become especially salient as interventions are scaled for delivery to multiple populations in different geographical locations or settings (e.g., a hospital emergency department versus the drop-in center of a community-based clinic), and in more than one language. To facilitate evidence-based development of customized, targeted intervention content, our team created a multi-step methodology over a series of NIH-funded research projects. The resulting Participatory Education and Research into Lived Experience (PEARLE) Methodology entails formative qualitative interviews to examine why members of a given population do not enact a specific health behavior such as HIV/HCV testing or vaccinating against COVID-19 (this step includes identifying potential gaps in related health literacy), followed by iterative evaluations of draft content designed to address these barriers, and extensive discussions with a Community Advisory Board. The final step is a clinical trial. PEARLE is designed to be highly flexible, adaptable to a variety of behavioral outcomes in clinical and community settings, and to create content in more than one language depending on the needs or preferences of a population. The current paper discusses how our team employed PEARLE to develop content in English and Spanish for our latest project, which is intended to increase COVID-19 vaccination uptake among people who inject drugs.

BackgroundPeople who inject drugs are disproportionately impacted by SARS-CoV-2 and COVID-19, yet they do not frequently accept vaccination against SARS-CoV-2 when offered. ObjectiveThis study aimed to explore why people who inject drugs decline free vaccines against SARS-CoV-2 and how barriers to vaccination can potentially be addressed. MethodsWe conducted semistructured qualitative interviews with 17 unvaccinated adult persons who inject drugs during August and September 2021 at a New York City syringe service program, where approximately three-fourth of participants identified as Latino (55%) or African American (22%). Interviews lasted roughly 20 minutes. The interview guide examined reasons for declining vaccination, participants’ understanding of COVID-19 risks, and how messages could be developed to encourage vaccine uptake among people who inject drugs. ResultsParticipants acknowledged that they faced increased risk from SARS-CoV-2 owing to their injection drug use but feared that long-term substance use may have weakened their health, making them especially vulnerable to side effects. Fears of possible side effects, compounded by widespread medical mistrust and questions about the overall value of vaccination contributed to marked ambivalence among our sample. The desire to protect children and older family members emerged as key potential facilitators of vaccination. ConclusionsCommunity-developed messages are needed in outreach efforts to explain the importance of vaccination, including the far greater dangers of COVID-19 compared to possible unintended side effects. Messages that emphasize vaccines’ ability to prevent inadvertently infecting loved ones, may help increase uptake. Community-focused messaging strategies, such as those used to increase HIV and hepatitis C virus testing and overdose prevention among people who inject drugs, may prove similarly effective.

Abstract Background Patients with cancer admitted for an acute coronary syndrome (ACS) and/or percutaneous coronary intervention (PCI) represent a growing and high-risk population. The influence of co-existing cancer on mortality remains unclear in such patients. We aimed to assess the impact of cancer on early and late, all-cause and cardiac mortality in the setting of ACS and/or PCI. Methods We performed a systematic review and meta-analysis of studies comparing outcomes of patients with and without a history of cancer admitted for ACS and/or PCI. Results Six studies including 294,528 ACS patients and three studies including 39,973 PCI patients were selected for our meta-analysis. Patients with cancer had increased rates of in-hospital all-cause death (RR 1.74 [1.22; 2.47]), cardiac death (RR 2.44 [1.73; 3.44]) and bleeding (RR 1.64 [1.35; 1.98]) as well as one-year all-cause death (RR 2.62 [1.2; 5.73]) and cardiac death (RR 1.89 [1.25; 2.86]) in ACS studies. Rates of long term all-cause (RR 1.96 [1.52; 2.53]) but not cardiac death were higher in cancer patients admitted for PCI. Conclusion Cancer patients represent a high-risk population both in the acute phase and at long-term after an ACS or PCI. The magnitude of the risk of mortality should however be tempered by the heterogeneity among studies. Early and long term optimal management of such patients should be promoted in clinical practice.

This report describes the case of a 48-year-old man whose electrocardiogram after cardiopulmonary resuscitation showed up-sloping ST-segment depression at the J point in precordial leads combined with tall symmetrical T waves. This electrocardiographic pattern corresponded to de Winter syndrome and is related to proximal left anterior descending coronary artery occlusion. (Level of Difficulty: Beginner.)

Objectives. We aimed to assess the quality of optical frequency domain imaging (OFDI) of the left main (LM) arterial wall and describe and analyse potential artefacts in this setting. Background. OFDI is increasingly used to assess ambiguous lesions and optimize LM percutaneous coronary intervention. However, its ability to provide artefact-free high-quality images of coronary ostia and large segments such as the LM remains uncertain. Methods. We included 42 consecutive patients who underwent OFDI, including LM imaging. Each OFDI frame was subdivided into four quadrants and analysed. The number of quadrants with artifacts was calculated within the proximal, mid, and distal LM and the first 5 mm of the left anterior descending artery (LAD) and/or left circumflex artery (LCX). Results. The quadrants analysis showed an overall artifact rate of 8.9%, mostly out-of-field (45.1%) or residual blood (44.7%) artefacts. Most artifacts were located in the proximal LM (18.6%) with a stepwise reduction of artifact rates towards distal segments (mid LM 5.8%; distal LM 3.6%, ostial LAD 2.6%, and ostial LCX 0%; p90% of the quadrants of the LM and the ostia of its bifurcation branches. However, artifacts mainly located in the proximal LM and decreasing distally in a stepwise fashion should be considered in the interpretation of OFDI in this setting.

Numerous Merovingian funerary steles have been excavated in Île-de-France, most notably in the North-Western part of this region, in an area encompassing the dioceses of Rouen, Paris, Evreux and Chartres. Inherited from an antique tradition, the Merovingian exemples are however more numerous. Most of them are bare of any inscription, though they are frequently ingraved with symbols, which vary from one grave site to the other. Numerous cross figures are found, variable in shapes and forms, alluding to Christian symbols, sometimes in a definitive way. Some of the motifs are more geometric, similar to the patterns found on plaster sarcophagi from Île-de-France. Dated from the 6th and 7th c. and often found in a different context than their original purpose, these steles are some of the earliest traces linked to the first rural Christian communities of the area, along with a few inscriptions and remaining vestige of buildings.

The preventive archaeological survey and excavation conducted on the site of Lyon’s former Hôtel-Dieu recently unearthed a whole chapter of the history of the Jewish population established in this French city at the end of the early modern period. Presumed sites of community cemeteries are of particular interest, as they allow for a study of both the emergence of the Jewish urban diaspora, and the search and management of a communal burial ground.

The risk and benefit of GP-IIb/IIIa Inhibition (GPI) in combination with recent antiplatelet regimens in acute coronary syndromes (ACS) remain unassessed. The advent of fast-acting highly active oral P2Y12 inhibitors questions the additional value and risk of their association with GPI. We studied the effect of GPI in combination with prasugrel and ticagrelor, compared to clopidogrel on major bleeding in pivotal randomized controlled trials in the setting of ACS, using a meta-analytic approach. A similar analysis, further including the comparison of a double versus standard dose clopidogrel regimen, was performed for the risk of the primary efficacy endpoint. The combination of GPI and recent P2Y12 inhibitors was associated with a similar risk of bleeding as compared with GPI and the standard clopidogrel regimen (RR 0.92 [0.74; 1.13]). The benefit of recent regimens, including double dose clopidogrel, in reducing the primary ischemic endpoint (RR 0.86 [0.78; 0.94]) persisted in those treated with GPI. Although GPI use was associated with a consistent increase in the risk of bleeding in both recent (RR 1.27 [1.05–1.55]) and standard regimens (RR 2.01 [1.64–2.47]), the relative magnitude of such an increase was lower in association with prasugrel or ticagrelor as compared with clopidogrel. The risk of bleeding using a combination of GPI and oral antiplatelet regimens is mainly related to the use of GPI and not the oral antiplatelet regimen. Considering the absence of increased risk of bleeding and the persistence of the benefit of recent P2Y12 regimens in combination with GPI as compared with the standard clopidogrel regimen, the use of such a combination within the guidelines is supported by our findings.

Many connected devices are expected to be deployed during the next few years. Energy harvesting appears to be a good solution to power these devices but is not a reliable power source due to the time-varying nature of most energy sources. It is possible to harvest energy from multiple energy sources to tackle this problem, thus increasing the amount and the consistency of harvested energy. Additionally, a power management system can be implemented to compute how much energy can be consumed and to allocate this energy to multiple tasks, thus adapting the device quality of service to its energy capabilities. The goal is to maximize the amount of measured and transmitted data while avoiding power failures as much as possible. For this purpose, an industrial sensor node platform was extended with a multi-source energy-harvesting circuit and programmed with a novel energy-allocation system for multi-task devices. In this paper, a multi-source energy-harvesting LoRaWAN node is proposed and optimal energy allocation is proposed when the node runs different sensing tasks. The presented hardware platform was built with off-the-shelf components, and the proposed power management system was implemented on this platform. An experimental validation on a real LoRaWAN network shows that a gain of 51% transmitted messages and 62% executed sensing tasks can be achieved with the multi-source energy-harvesting and power-management system, compared to a single-source system.

Noise pollution reduction in the environment is a major challenge from a societal and health point of view. To implement strategies to improve sound environments, experts need information on existing noise. The first source of information is based on the elaboration of noise maps using software, but with limitations on the realism of the maps obtained, due to numerous calculation assumptions. The second is based on the use of measured data, in particular through professional measurement observatories, but in limited numbers for practical and financial reasons. More recently, numerous technical developments, such as the miniaturization of electronic components, the accessibility of low-cost computing processors and the improved performance of electric batteries, have opened up new prospects for the deployment of low-cost sensor networks for the assessment of sound environments. Over the past fifteen years, the literature has presented numerous experiments in this field, ranging from proof of concept to operational implementation. The purpose of this article is firstly to review the literature, and secondly, to identify the expected technical characteristics of the sensors to address the problem of noise pollution assessment. Lastly, the article will also put forward the challenges that are needed to respond to a massive deployment of low-cost noise sensors.

This paper presents some of the key findings from a 2013 survey achieved with a representative sample of 101 independent trainers-consultants, members of a French trade union. These results highlight more particularly their socio-demographic characteristics, their core activities and four main career pathways identified. This survey was part of a two years action research, conducted in a partnership between this professional trade union and university laboratories in the field of adult education. The aim was to improve the understanding of this specific professional group, of its ongoing professionalization process and its visibility as one of the actors of the continuing education and vocational training (CVET) system in France.

Over the near-ultraviolet (UV) and visible spectrum the reflectance from mineral compounds and vegetation is predominantly due to absorption and scattering in the bulk material. Except for a factor of scale, the radiative transfer mechanism is similar to that seen in murky optically complex waters. We therefore adapted a semi-empirical algebraic irradiance model developed by Albert and Mobley to calculate the irradiance reflectance from both mineral compounds and vegetation commonly found on the sea bottom. This approach can be used to accurately predict the immersed reflectance spectra given the reflectance measured in air. When applied to mineral-based compounds or various types of marine vegetation, we obtain a simple two-parameter fit that accurately describes the key features of the reflectance spectra. The non-linear spectral combination effect as a function of the thickness of vegetation growing on a mineral substrate is then accounted for by a third parameter.

The principle of lifelong training seems overtly prescriptive and risks damaging the concept of ongoing education and its humanist, cultural and social development objectives. In this paper, the authors firstly clarify and situate the principal concepts in question--lifelong education, ongoing education, initial professional education (all schooling before entry into the working world), professional training and continuing professional training--in order to bring out the similarities, but above all to show their particularities in relation to lifelong education and training. Secondly, after presenting their method of analysis, they reveal what seems to be an evolution of practice in France and question the notion of lifelong training within this evolution: is professional training still within the scope of lifelong education? In further analysis they examine several countries in the European Union. They seek to clarify how well the aims and purposes of professional training are being met and its relationship to the larger concept of education.

Objetivo: Demostrar si existe correlación entre el ángulo denominado de Inclinación Mediocarpiana y el tipo de semilunar. Material y Método: Se estudiaron dos poblaciones: La primera fue de 100 pacientes con radiografías en posición póstero-anterior (PA) neutra. La segunda fue de 60 pacientes con radiografías PA en máxima desviación radial y cubital. Para cada una se determinó el tipo de semilunar por dos observadores independientes. Se propone un nuevo parámetro de análisis morfológico del carpo: el Ángulo de Inclinación Mediocarpiana. Resultados: En la primera población, 40 casos fueron clasificados como semilunar tipo I, 47 casos como tipo II. El promedio del ángulo de inclinación mediocarpiana fue de 56,3° (± 3,8) para el semilunar tipo I y de 67,5° (± 4,2) para el tipo II (p < 0.0001). En la segunda población, 23 casos fueron clasificados como semilunar tipo I, 19 casos como tipo II. El promedio de este ángulo, en las radiografías en máxima desviación radial fue de 59,5° (DS ± 6,4) para el semilunar de tipo I y de 69,4° (± 6) para el tipo II (p< 0,0001). En las radiografías en máxima desviación cubital el promedio fue de 51° (± 7,6) para en semilunar de tipo I y de 58,3° (± 7,4) para el tipo II (p= 0,003). Conclusiones: Este nuevo ángulo de inclinación mediocarpiana ofrece una herramienta más para determinar radiológicamente el tipo de semilunar, independientemente de la posición de la muñeca en el momento de obtener la radiografía.

The 19th century drawing of the panel of a decorated plaster sarcophagus from the church of Saint-Christophe de Créteil has recently been rediscovered. Analysis of the ornamentation allows us to identify a Merovingian sarcophagus made from the same mould as another Parisian example found during the 19th century, in the Saint-Germain-des-Prés cemetery. The church, the oldest parts of which date back to the twelfth century, is mentioned for the first time in the early 10th century, and comprises a crypt housing relics of martyrs cited in the 9th century. The Créteil cemetery has been in use since the end of the early 6th century. The presence of this sarcophagus with a Parisian decoration within a Medieval church could suggest the existence of an earlier edifice, dating to the Merovingian period.

This paper discusses the complexity in the field of adult training by presenting and displaying a constructivist, psychosocial and multi referential posture. If adult training is part of education, it is incorporated into a plurality of areas, approaches, statutes, actors and publics that should be characterized. Training is interacting with the spheres of education, work and society constituting many "social worlds of training". Adult training is subject to certain paradoxes as logical operational training and people development, personal development and the development of the society. Training must take into account these tensions while keeping its humanistic foundations.