A qualitative assessment of an abstinence-oriented therapeutic community for prisoners with substance use disorders in Kyrgyzstan.

BACKGROUND: Kyrgyzstan, where HIV is concentrated in prisons and driven by injection drug use, provides a prison-based methadone maintenance therapy program as well as abstinence-oriented therapeutic community based on the 12-step model called the "Clean Zone." We aimed to qualitatively assess how prisoners navigate between these treatment options to understand the persistence of the Clean Zone despite a lack of evidence to support its effectiveness in treating opioid use disorders. METHODS: We conducted an analysis of policy documents and over 60 h of participant observation in February 2016, which included focus groups with a convenience sample of 20 therapeutic community staff members, 110 prisoners across three male and one female prisons, and qualitative interviews with two former Clean Zone participants. Field notes containing verbatim quotes from participants were analyzed through iterative reading and discussion to understand how participants generally perceive the program, barriers to entry and retention, and implications for future treatment within prisons. RESULTS: Our analyses discerned three themes: pride in the mission of the Clean Zone, idealism regarding addiction treatment outcomes against all odds, and the demonization of methadone. CONCLUSION: Despite low enrollment and lack of an evidence base, the therapeutic community is buttressed by the strong support of the prison administration and its clients as an "ordered" alternative to what is seen as chaotic life outside of the Clean Zone. The lack of services for Clean Zone patients after release likely contributes to high rates of relapse to drug use. The Clean Zone would benefit from integration of stabilized methadone patients combined with a post-release program

Charge-coupled devices with fast timing for astrophysics and space physics research

A charge coupled device is under development with fast timing capability (15 millisecond full frame readout, 30 microsecond resolution for measuring the time of individual pixel hits). The fast timing CCD will be used in conjunction with a CsI microfiber array or segmented scintillator matrix detector to detect x rays and gamma rays with submillimeter position resolution. The initial application will be in conjunction with a coded aperture hard x ray/gamma ray astronomy instrument. We describe the concept and the readout architecture of the device

MARGIE: A gamma-ray burst ultra-long duration balloon mission

We are designing MARGIE as a 100 day ULDB mission to: a) detect and localize gamma-ray bursts; and b) survey the hard X-ray sky. MARGIE will consist of one small field-of-view (FOV) and four large FOV coded mask modules mounted on a balloon gondola. The burst position will be calculated onboard and disseminated in near-real time, while information about every count will be telemetered to the ground for further analysis. In a 100-day mission we will localize ∼40 bursts with peak photon fluxes from 0.14 to ∼5 ph cm−2 s−1 using 1 s integrations; the typical localization resolution will be better than ∼2 arcminutes

Absence of antiretroviral therapy and other risk factors for morbidity and mortality in Malaysian compulsory drug detention and rehabilitation centers

Background: Throughout Asia, people who use drugs are confined in facilities referred to as compulsory drug detention and rehabilitation centers. The limited transparency and accessibility of these centers has posed a significant challenge to evaluating detainees and detention conditions directly.Despite HIV being highly prevalent in this type of confined setting, direct evaluation of detainees with HIV and their access to medical care has yet to be reported in the literature. Methods: We evaluated the health status of 100 adult male detainees with HIV and their access to medical care in the two largest Malaysian compulsory drug detention and rehabilitation centers holding HIV-infected individuals.Results: Approximately 80% of all detainees with HIV were surveyed in each detention center. Most participants reported multiple untreated medical conditions. None reported being able to access antiretroviral therapy during detention and only 9% reported receiving any HIV-related clinical assessment or care. Nearly a quarter screened positive for symptoms indicative of active tuberculosis, yet none reported having been evaluated for tuberculosis.Although 95% of participants met criteria for opioid dependence prior to detention, none reported being able to access opioid substitution therapy during detention, with 86% reporting current cravings for opioids and 87% anticipating relapsing to drug use after release.Fourteen percent of participants reported suicidal ideation over the previous two weeks.Conclusion: We identified a lack of access to antiretroviral therapy in two of the six compulsory drug detention and rehabilitation centers in Malaysia designated to hold HIV-infected individuals and found significant, unmet health needs among detainees with HIV. Individuals confined under such conditions are placed at considerably high risk for morbidity and mortality.Our findings underscore the urgent need for evidence-based drug policies that respect the rights of people who use drugs and seek to improve, rather than undermine, their health

Balloon-borne coded aperture telescope for arc-minute angular resolution at hard x-ray energies

We are working on the development of a new balloon-borne telescope, MARGIE (minute-of-arc resolution gamma ray imaging experiment). It will be a coded aperture telescope designed to image hard x-rays (in various configurations) over the 20 - 600 keV range with an angular resolution approaching one arc minute. MARGIE will use one (or both) of two different detection plane technologies, each of which is capable of providing event locations with sub-mm accuracies. One such technology involves the use of cadmium zinc telluride (CZT) strip detectors. We have successfully completed a series of laboratory measurements using a prototype CZT detector with 375 micron pitch. Spatial location accuracies of better than 375 microns have been demonstrated. A second type of detection plane would be based on CsI microfiber arrays coupled to a large area silicon CCD readout array. This approach would provide spatial resolutions comparable to that of the CZT prototype. In one possible configuration, the coded mask would be 0.5 mm thick tungsten, with 0.5 mm pixels at a distance of 1.5 m from the central detector giving an angular resolution of 1 arc-minute and a fully coded field of view of 12 degrees. We review the capabilities of the MARGIE telescope and report on the status of our development efforts and our plans for a first balloon flight

Directly observed antiretroviral therapy: a systematic review and meta-analysis of randomised clinical trials.

BACKGROUND: Directly observed therapy has been recommended to improve adherence for patients with HIV infection who are on highly active antiretroviral therapy, but the benefit and cost-effectiveness of this approach has not been established conclusively. We did a systematic review and meta-analysis of randomised trials of directly observed versus self-administered antiretroviral treatment. METHODS: We did duplicate searches of databases (from inception to July 27, 2009), searchable websites of major HIV conferences (up to July, 2009), and lay publications and websites (March-July, 2009) to identify randomised trials assessing directly observed therapy to promote adherence to antiretroviral therapy in adults. Our primary outcome was virological suppression at study completion. We calculated relative risks (95% CIs), and pooled estimates using a random-effects method. FINDINGS: 12 studies met our inclusion criteria; four of these were done in groups that were judged to be at high risk of poor adherence (drug users and homeless people). Ten studies reported on the primary outcome (n=1862 participants); we calculated a pooled relative risk of 1.04 (95% CI 0.91-1.20, p=0.55), and noted moderate heterogeneity between the studies (I(2)= 53.8%, 95% CI 0-75.7, p=0.0247) for directly observed versus self-administered treatment. INTERPRETATION: Directly observed antiretroviral therapy seems to offer no benefit over self-administered treatment, which calls into question the use of such an approach to support adherence in the general patient population. FUNDING: None

Measurements of Compton Scattered Transition Radiation at High Lorentz Factors

X-ray transition radiation can be used to measure the Lorentz factor of relativistic particles. Standard transition radiation detectors (TRDs) typically incorporate thin plastic foil radiators and gas-filled x-ray detectors, and are sensitive up to \gamma ~ 10^4. To reach higher Lorentz factors (up to \gamma ~ 10^5), thicker, denser radiators can be used, which consequently produce x-rays of harder energies (>100 keV). At these energies, scintillator detectors are more efficient in detecting the hard x-rays, and Compton scattering of the x-rays out of the path of the particle becomes an important effect. The Compton scattering can be utilized to separate the transition radiation from the ionization background spatially. The use of conducting metal foils is predicted to yield enhanced signals compared to standard nonconducting plastic foils of the same dimensions. We have designed and built a Compton Scatter TRD optimized for high Lorentz factors and exposed it to high energy electrons at the CERN SPS. We present the results of the accelerator tests and comparisons to simulations, demonstrating 1) the effectiveness of the Compton Scatter TRD approach; 2) the performance of conducting aluminum foils; and 3) the ability of a TRD to measure energies approximately an order of magnitude higher than previously used in very high energy cosmic ray studies.X-ray transition radiation can be used to measure the Lorentz factor of relativistic particles. Standard transition radiation detectors (TRDs) typically incorporate thin plastic foil radiators and gas-filled x-ray detectors, and are sensitive up to \gamma ~ 10^4. To reach higher Lorentz factors (up to \gamma ~ 10^5), thicker, denser radiators can be used, which consequently produce x-rays of harder energies (>100 keV). At these energies, scintillator detectors are more efficient in detecting the hard x-rays, and Compton scattering of the x-rays out of the path of the particle becomes an important effect. The Compton scattering can be utilized to separate the transition radiation from the ionization background spatially. The use of conducting metal foils is predicted to yield enhanced signals compared to standard nonconducting plastic foils of the same dimensions. We have designed and built a Compton Scatter TRD optimized for high Lorentz factors and exposed it to high energy electrons at the CERN SPS. We present the results of the accelerator tests and comparisons to simulations, demonstrating 1) the effectiveness of the Compton Scatter TRD approach: 2) the performance of conducting aluminum foils: and 3) the ability of a TRD to measure energies approximately an order of magnitude higher than previously used in very high energy cosmic ray studies

Relapse to opioid use in opioid-dependent individuals released from compulsory drug detention centres compared with those from voluntary methadone treatment centres in Malaysia: a two-arm, prospective observational study

Background Detention of people who use drugs into compulsory drug detention centres (CDDCs) is common throughout East and Southeast Asia. Evidence-based pharmacological therapies for treating substance use disorders, such as opioid agonist treatments with methadone, are generally unavailable in these settings. We used a unique opportunity where CDDCs coexisted with voluntary drug treatment centres (VTCs) providing methadone in Malaysia to compare the timing and occurrence of opioid relapse (measured using urine drug testing) in individuals transitioning from CDDCs versus methadone maintenance in VTCs. Methods We did a parallel, two-arm, prospective observational study of opioid-dependent individuals aged 18 years and older who were treated in Malaysia in the Klang Valley in two settings: CDDCs and VTCs. We used sequential sampling to recruit individuals. Assessed individuals in CDDCs were required to participate in services such as counselling sessions and manual labour. Assessed individuals in VTCs could voluntarily access many of the components available in CDDCs, in addition to methadone therapy. We undertook urinary drug tests and behavioural interviews to assess individuals at baseline and at 1, 3, 6, 9, and 12 months post-release. The primary outcome was time to opioid relapse post-release in the community confi rmed by urinary drug testing in individuals who had undergone baseline interviewing and at least one urine drug test (our analytic sample). Relapse rates between the groups were compared using time-to-event methods. This study is registered at ClinicalTrials.gov (NCT02698098). Findings Between July 17, 2012, and August 21, 2014, we screened 168 CDDC attendees and 113 VTC inpatients; of these, 89 from CDDCs and 95 from VTCs were included in our analytic sample. The baseline characteristics of the two groups were similar. In unadjusted analyses, CDDC participants had signifi cantly more rapid relapse to opioid use post-release compared with VTC participants (median time to relapse 31 days [IQR 26–32] vs 352 days [256–unestimable], log rank test, p<0·0001). VTC participants had an 84% (95% CI 75–90) decreased risk of opioid relapse after adjustment for control variables and inverse propensity of treatment weights. Time-varying eff ect modelling revealed the largest hazard ratio reduction, at 91% (95% CI 83–96), occurs during the fi rst 50 days in the community. Interpretation Opioid-dependent individuals in CDDCs are signifi cantly more likely to relapse to opioid use after release, and sooner, than those treated with evidence-based treatments such as methadone, suggesting that CDDCs have no role in the treatment of opioid-use disorders

I Am Error

I Am Error is a platform study of the Nintendo Family Computer (or Famicom), a videogame console first released in Japan in July 1983 and later exported to the rest of the world as the Nintendo Entertainment System (or NES). The book investigates the underlying computational architecture of the console and its effects on the creative works (e.g. videogames) produced for the platform. I Am Error advances the concept of platform as a shifting configuration of hardware and software that extends even beyond its ‘native’ material construction. The book provides a deep technical understanding of how the platform was programmed and engineered, from code to silicon, including the design decisions that shaped both the expressive capabilities of the machine and the perception of videogames in general. The book also considers the platform beyond the console proper, including cartridges, controllers, peripherals, packaging, marketing, licensing, and play environments. Likewise, it analyzes the NES’s extension and afterlife in emulation and hacking, birthing new genres of creative expression such as ROM hacks and tool-assisted speed runs. I Am Error considers videogames and their platforms to be important objects of cultural expression, alongside cinema, dance, painting, theater and other media. It joins the discussion taking place in similar burgeoning disciplines—code studies, game studies, computational theory—that engage digital media with critical rigor and descriptive depth. But platform studies is not simply a technical discussion—it also keeps a keen eye on the cultural, social, and economic forces that influence videogames. No platform exists in a vacuum: circuits, code, and console alike are shaped by the currents of history, politics, economics, and culture—just as those currents are shaped in kind