Rapid Analysis of Drugs: A Pilot Surveillance System To Detect Changes in the Illicit Drug Supply To Guide Timely Harm Reduction Responses - Eight Syringe Services Programs, Maryland, November 2021-August 2022.

A record number of 2,912 drug overdose deaths occurred in Maryland during the 12-month period July 1, 2020-June 30, 2021. Illicitly manufactured fentanyl, fentanyl analogs, or both* were involved in 84% of these deaths. Timely identification of illicit drug market changes (e.

Greenhouse Gas Emissions and Management Practices that Affect Emissions in US Rice Systems.

Previous reviews have quantified factors affecting greenhouse gas (GHG) emissions from Asian rice ( L.) systems, but not from rice systems typical for the United States, which often vary considerably particularly in practices (i.e.

Identification of Aboriginal and Torres Strait Islander status by general practice registrars: Confidence and associations.

Background: Identification of Aboriginal and Torres Strait Islander status in healthcare settings is essential for the delivery of culturally appropriate care. Under-identification is common and practitioner confidence is a known barrier.

Objective: The objective of this research was to document the self-reported confidence of general practice registrars in identifying the Aboriginal and Torres Strait Islander status of their patients, and associations of this confidence.

Continuity of care in general practice vocational training: prevalence, associations and implications for training.

Continuity of care is a defining characteristic of general practice. Practice structures may limit continuity of care experience for general practice registrars (trainees). This study sought to establish prevalence and associations of registrars' continuity of care.

Clinical encounters of Australian general practice registrars with Aboriginal and Torres Strait Islander patients.

Objective: General practice is central to Aboriginal and Torres Strait Islander health care, and this area is a core element of Australian general practice (GP) training. We aimed to describe the prevalence, nature and associations of GP registrar encounters with Aboriginal and Torres Strait Islander patients.

Methods: A cross-sectional analysis from a cohort study of GP registrars' clinical consultations 2010-2013.

Investigation of fatigue by Australian general practice registrars: a cross-sectional study.

Introduction: Fatigue is the most common undifferentiated problem presenting in general practice. Previous studies have shown that this presentation leads to multiple investigations. There is no published literature describing the management of patients with fatigue by general practice (GP) registrars.

The recording of Aboriginal and Torres Strait Islander status in general practice clinical records: a cross-sectional study.

Objectives: To document the frequency of recording of Aboriginal and Torres Strait Islander status in general practice (GP) clinical records and to establish associations of this recording.

Methods: Cross-sectional analysis of recording of patients' Aboriginal and Torres Strait Islander status in GP clinical records from GP training practices in four Australian states.

Results: Of the 9,704 clinical records examined, the patients' Aboriginal and Torres Strait Islander status had been documented in 5,165 (53.

Test ordering in an evidence free zone: Rates and associations of Australian general practice trainees' vitamin D test ordering.

Rationale, Aims And Objectives: Indiscriminate health screening is increasingly seen as being problematic. In particular, vitamin D testing rates are increasing rapidly despite recommendations against population screening. The purpose of this study was to determine the level of vitamin D testing among family practice/general practitioner (GP) trainees and to establish associations of this testing.

Anticholinergic burden in older women: not seeing the wood for the trees?

Objectives: To identify medicines contributing to and describe predictors of anticholinergic burden among community-dwelling older Australian women.

Design, Setting And Participants: Retrospective longitudinal analysis of data from the Australian Longitudinal Study on Women's Health linked to Pharmaceutical Benefits Scheme medicines data from 1 January 2008 to 30 December 2010; for 3694 women born in 1921-1926.

Main Outcome Measures: Anticholinergic burden calculated from Anticholinergic Drug Scale (ADS) scores derived from ADS levels (0 to 3) for all medicines used by each woman, summed over each 6-month period (semester), medicines commonly used by women with high semester ADS scores (defined as 75th percentile of scores).

Family medicine trainees' clinical experience of chronic disease during training: a cross-sectional analysis from the registrars' clinical encounters in training study.

Background: A broad case-mix in family physicians' (general practitioners', GPs') vocational trainee experience is deemed essential in producing competent independent practitioners. It is suggested that the patient-mix should include common and significant conditions and be similar to that of established GPs. But the content of contemporary GP trainees' clinical experience in training is not well-documented.

How we use patient encounter data for reflective learning in family medicine training.

Introduction: Consulting with patients is the core learning activity of Australian family medicine (general practice/GP) training, providing a rich source of reflective learning for trainees. We have developed a reflective learning program for postgraduate vocational trainees based on clinical encounters.

Methods: The Registrar Clinical Encounters in Training (ReCEnT) program is an educational program documenting GP trainees' consultations in five Australian GP training providers.

Testing and screening for chlamydia in general practice: a cross-sectional analysis.

Objectives: Chlamydia screening is widely advocated. General practice registrars are an important stage of clinical behaviour development. This study aimed to determine rates of, and factors associated with, registrars' chlamydia testing including asymptomatic screening.

Problems managed by Australian general practice trainees: results from the ReCenT (Registrar Clinical Encounters in Training) study.

Unlabelled: BACKGROUND Previous studies have found that general practitioner (GP) trainees (registrars) see a different spectrum of clinical problems compared to trainers, including less chronic disease and more acute minor illness. Our aim was to describe the case mix of first-term Australian GP trainees.

Methods: This was a cross-sectional analysis of trainee consultations.

Multi-scale geospatial agroecosystem modeling: a case study on the influence of soil data resolution on carbon budget estimates.

The development of effective measures to stabilize atmospheric CO2 concentration and mitigate negative impacts of climate change requires accurate quantification of the spatial variation and magnitude of the terrestrial carbon (C) flux. However, the spatial pattern and strength of terrestrial C sinks and sources remain uncertain. In this study, we designed a spatially-explicit agroecosystem modeling system by integrating the Environmental Policy Integrated Climate (EPIC) model with multiple sources of geospatial and surveyed datasets (including crop type map, elevation, climate forcing, fertilizer application, tillage type and distribution, and crop planting and harvesting date), and applied it to examine the sensitivity of cropland C flux simulations to two widely used soil databases (i.

Evaluation of three field-based methods for quantifying soil carbon.

Three advanced technologies to measure soil carbon (C) density (g C m(-2)) are deployed in the field and the results compared against those obtained by the dry combustion (DC) method. The advanced methods are: a) Laser Induced Breakdown Spectroscopy (LIBS), b) Diffuse Reflectance Fourier Transform Infrared Spectroscopy (DRIFTS), and c) Inelastic Neutron Scattering (INS). The measurements and soil samples were acquired at Beltsville, MD, USA and at Centro International para el Mejoramiento del Maíz y el Trigo (CIMMYT) at El Batán, Mexico.

Multi-year lags between forest browning and soil respiration at high northern latitudes.

High-latitude northern ecosystems are experiencing rapid climate changes, and represent a large potential climate feedback because of their high soil carbon densities and shifting disturbance regimes. A significant carbon flow from these ecosystems is soil respiration (R(S), the flow of carbon dioxide, generated by plant roots and soil fauna, from the soil surface to atmosphere), and any change in the high-latitude carbon cycle might thus be reflected in R(S) observed in the field. This study used two variants of a machine-learning algorithm and least squares regression to examine how remotely-sensed canopy greenness (NDVI), climate, and other variables are coupled to annual R(S) based on 105 observations from 64 circumpolar sites in a global database.

Climate mitigation and the future of tropical landscapes.

Land-use change to meet 21st-century demands for food, fuel, and fiber will depend on many interactive factors, including global policies limiting anthropogenic climate change and realized improvements in agricultural productivity. Climate-change mitigation policies will alter the decision-making environment for land management, and changes in agricultural productivity will influence cultivated land expansion. We explore to what extent future increases in agricultural productivity might offset conversion of tropical forest lands to crop lands under a climate mitigation policy and a contrasting no-policy scenario in a global integrated assessment model.

Temperature-associated increases in the global soil respiration record.

Soil respiration, R(S), the flux of microbially and plant-respired carbon dioxide (CO(2)) from the soil surface to the atmosphere, is the second-largest terrestrial carbon flux. However, the dynamics of R(S) are not well understood and the global flux remains poorly constrained. Ecosystem warming experiments, modelling analyses and fundamental biokinetics all suggest that R(S) should change with climate.

The next generation of scenarios for climate change research and assessment.

Advances in the science and observation of climate change are providing a clearer understanding of the inherent variability of Earth's climate system and its likely response to human and natural influences. The implications of climate change for the environment and society will depend not only on the response of the Earth system to changes in radiative forcings, but also on how humankind responds through changes in technology, economies, lifestyle and policy. Extensive uncertainties exist in future forcings of and responses to climate change, necessitating the use of scenarios of the future to explore the potential consequences of different response options.

Implications of limiting CO2 concentrations for land use and energy.

Limiting atmospheric carbon dioxide (CO2) concentrations to low levels requires strategies to manage anthropogenic carbon emissions from terrestrial systems as well as fossil fuel and industrial sources. We explore the implications of fully integrating terrestrial systems and the energy system into a comprehensive mitigation regime that limits atmospheric CO2 concentrations. We find that this comprehensive approach lowers the cost of meeting environmental goals but also carries with it profound implications for agriculture: Unmanaged ecosystems and forests expand, and food crop and livestock prices rise.