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<h2>Abstract</h2><h3>Background</h3> Patients presenting to the emergency department (ED) following nonfatal opioid overdose represent a high-risk population with 5 % of patients dying within a year of the index visit. <h3>Objective</h3> To evaluate subsequent overdose and death before and after the implementation of an ED discharge naloxone program. <h3>Methods</h3> This was a retrospective cohort study of ED patients who presented at the Virginia Commonwealth University Health ED with an Opioid Use Disorder (OUD) chief complaint before and after a discharge naloxone program. The pre-naloxone cohort was consecutive ED OUD patients from August 15, 2021, to August 14, 2022, and the post-naloxone cohort from August 15, 2022, to August 14, 2023. The outcomes were subsequent overdose, ED visit to same hospital (VCU), and death within six months of the index visit. <h3>Results</h3> In total, 1,053 patients were included, of which 529 were in the pre-naloxone cohort and 524 patients in the post-naloxone cohort. The mean age was 44.2 years (SD = 14.0) and 69 % were males. There was a reduction in overdose requiring ED visiting (subsequent ED overdose) and death (4.6 % vs 9.2 % p = 0.03 and 2.0 % vs 5.6 % p = 0.02 respectively) in the post-naloxone cohort compared to the pre-naloxone cohort. After adjusting for sociodemographic and clinical factors, there was a 48 % reduction in the risk of subsequent ED overdose (RR = 0.52, 95 % CI: 0.27, 1.02) and a 63 % reduction in the risk of death (RR = 0.37, 95 % CI: 0.14, 0.95). <h3>Conclusion</h3> Implementing an ED take-home naloxone program was associated with a reduction in subsequent overdose and death at six months.

In the United States (US) kindergarten through twelfth-grade public school system, the classroom library has come to be a critical part of literacy instruction within the language arts classroom. This fact is especially true in the middle school grade levels (grades five through eight), where reading volume begins to rapidly increase. Additionally, a developmental norm for students within this age range includes a growing sense of independence and choice, as well as a desire to share and voice opinions. Classroom libraries have come to be tools that are used regularly and are heavily influential on the way that students grow to perceive themselves, the world around them, and the way they fit into that world. However, classroom libraries have remained stagnant and underrepresent the diverse populations of the students in those classrooms. This article aims to connect deep reflective thinking with anti-oppressive and transformative learning theories, exploring how these frameworks can be used to problematize current practices in classroom libraries. Through a content analysis of what is seen as deep and critical thinking practices and reflective thinking practices, anti-oppressive and transformative learning theories can be linked to foster a social justice classroom culture within US public middle school language arts classrooms. © 2025 Common Ground Research Networks. All rights reserved.

We present an investigation into the rotation and stellar activity of four fully convective M dwarf “twin” wide binaries. Components in each pair have (1) astrometry confirming they are common-proper-motion binaries, (2) Gaia BP, RP, and 2MASS J, H, and K s magnitudes matching within 0.10 mag, and (3) presumably the same age and composition. We report long-term photometry, rotation periods, multiepoch Hα equivalent widths, X-ray luminosities, time series radial velocities, and speckle observations for all components. Although it might be expected for the twin components to have matching magnetic attributes, this is not the case. Decade-long photometry of GJ 1183 AB indicates consistently higher spot activity on A than B, a trend matched by A appearing 58% ± 9% stronger in L X and 26% ± 9% stronger in Hα on average—this is despite similar rotation periods of A = 0.86 day and B = 0.68 day, thereby informing the range in activity for otherwise identical and similarly rotating M dwarfs. The young β Pic Moving Group member 2MA 0201+0117 AB displays a consistently more active B component that is 3.6 ± 0.5 times stronger in L X and 52% ± 19% stronger in Hα on average, with distinct rotation at A = 6.01 days and B = 3.30 days. Finally, NLTT 44989 AB displays remarkable differences with implications for spindown evolution—B has sustained Hα emission while A shows absorption, and B is ≥39 ± 4 times stronger in L X, presumably stemming from the surprisingly different rotation periods of A = 38 days and B = 6.55 days. The last system, KX Com, has an unresolved radial velocity companion, and is therefore not a twin system.

Shallow mantle processes such as edge-driven convection are thought to play an important role in shaping the passive margin setting. Previous geophysical investigations of northern New England suggest this process is likely operating beneath this portion of the eastern North American margin today. In western Vermont and eastern New York, USA, Early Cretaceous magmatism dated at ca. 140–130 Ma in the Burlington lobe and at ca. 110–100 Ma in the Taconic lobe of the New England–Quebec igneous province may represent the upper crustal expression of edge-driven convection operating beneath the eastern North American margin in the geologic past. This investigation addresses the potential relationship between these two episodes of magmatism and upper crustal deformation in northern New England through paleostress analysis of Early Cretaceous sheet intrusions and mesoscale normal faults, and geochemical analysis of sheet intrusions. The two episodes of magmatism are geochemically similar, display typical characteristics of intraplate alkaline magmatism, and are likely the product of a common source. Paleostress analysis and crosscutting relationships indicate that Burlington lobe magmatism was associated with a subhorizontal N–S extensional stress field, and Taconic lobe magmatism was associated with a subhorizontal NW–SE extensional stress field. Both stress fields represent short-term perturbations to the regional Early Cretaceous subhorizontal NE–SW extensional stress field. Each perturbation coincided with and likely continued following magmatism. The magmatism, geographic and temporal scale of the stress field changes, and return to regional subhorizontal NE–SW extension following these events are consistent with the periodic nature of edge-driven convection and associated small-scale delamination events. This field-based documentation of intraplate magmatism and its association with short-term changes in the stress field improves our understanding of the upper crustal expression of edge-driven convection at passive margins.

Constructing a personal narrative&nbsp;and&nbsp;consolidating identity is an ongoing process that becomes pressing in the face of mortality.&nbsp;The current pilot study examined the process of life review in a sample of older people, specifically examining the effects of participation in a memoir course on wisdom, identity, and well-being. We hypothesized that wisdom, identity fidelity and coherence, and subjective well-being would increase for those in the memoir group compared to a control. Eighteen elderly individuals from two senior retirement communities were randomly assigned to participate in weekly classes, for four weeks, either to work on a memoir or discuss films (control group).&nbsp;After engaging in the process of organizing their life story and writing about important memories, the nine individuals in the memoir group scored significantly higher on self-report measures of wise reminiscence, identity fidelity, and subjective well-being compared to those in the control group. Furthermore, exploratory analyses found that wise reminiscence statistically mediated relationships between the memoir condition and the outcome measures of identity&nbsp;fidelity, identity coherence, and subjective well-being. These findings point to the benefits of memoir writing for positive aging as well as potential mechanisms underlying its effectiveness.

Do not walk away from this burgeoning hope of heat and dryness.

From a snowbank I watched the squirrel run.

Grey Sparrow Press, in this landmark book, cherishes the voices of national writing treasures published over ten years; Robert Bly, Robert Wexelblatt, Michael C. Keith, Jules Nyquist, Khem Aryal, Marie Sheppard Williams [posthumously,] Doug Holder, Momila Joshi, William Woolfitt, Thomas R. Smith, M.J. Iuppa, LB Chhetri, John Roche, and Bhisma Upreti to name a few. Grey Sparrow Press was formed as a non-profit 501[c]3 on May 11, 2009.

Stock market forecasting is an essential factor in the daily operations of many companies and individuals. However, the complex and nonlinear nature of the stock market and the unpredictable variations in factors affecting stock prices present significant challenges in accurate forecasting. To address this, we employ four model-based metaheuristic search algorithms (MHs), namely the Crow Search Algorithm (CSA), Particle Swarm Optimizer (PSO), Gray Wolf Optimizer (GWO), and Dandelion Optimizer (DO), to estimate the parameters of stock market prices models. The data utilized in our experiments are extracted from the widely recognized stock index of Standard & Poor's 500 (S&P 500), that serves as a representative benchmark for the United States stock market. Our findings demonstrate that the CSA outperforms other MHs by providing the best combination of parameters for modeling stock market prices. The optimized parameters for the CSA model yielded Variance-Account-For (VAF) values of 97.846% in the training set and 93.483% in the testing set. This suggests that CSA offers promising capabilities for enhancing the accuracy and effectiveness of stock market forecasting models. © (2024), (Research Institute of Intelligent Computer Systems). All rights reserved.

Background: Social determinants of health account for racial inequities in breastfeeding rates in the United States. There is a gap in the role of neighborhood socioeconomic status (NSES) as it relates to breastfeeding disparities. Methods: Using longitudinal data from the Black Women’s Health Study, we assessed associations of NSES with breastfeeding initiation and duration in a cohort of primiparous U.S. Black women. We also explored associations within strata of important economic indicators, including education, occupation, and marital status. Results: Breastfeeding initiation ( n = 2,705) increased with NSES quartile, from 75.2% in the lowest quartile to 88.3% in the highest quartile ( p &lt; 0.0001). Compared with women living in the highest NSES quartile, those in the lowest quartile had a 41% (odds ratio: 0.59 [95% confidence interval: 0.43, 0.81]) decreased odds of initiating breastfeeding. For breastfeeding duration ( n = 2,172), women residing in NSES quartiles 1–3 were significantly less likely ( p &lt; 0.0001) to breastfeed (44.4%) for 6+ months compared with those living in the highest quartile (62.8%). Adjusted relative risks for those in quartiles 1–3 compared with 4 (highest) were 0.63 (0.45, 0.87), 0.50 (0.37, 0.68), and 0.64 (0.47, 0.86), respectively ( p = 0.0001). There was no statistically significant evidence of effect modification by education, occupation, marital status, and region ( P interaction = &gt;0.05). Conclusion: Living in a lower NSES environment was associated with reduced breastfeeding initiation and duration compared with a higher NSES environment. Research is needed to understand the mechanisms by which neighborhood-level factors influence breastfeeding initiation and duration for Black women in the United States.

Diabetes, affecting more than 500 million individuals worldwide, is the most widespread non-communicable disease, globally. The early identification and effective management of diabetes are crucial for controlling its spread. Currently, the HbA1c test is the gold standard for the detection of diabetes with high confidence. But this is an invasive, expensive pathology test. Therefore, alternative non-invasive and inexpensive methods have been proposed in the literature for the early detection of diabetes.

Epidermolysis bullosa acquisita (EBA) represents a big challenge as a rare skin disorder, with no established markers for early detection for patients. Moreover, as a rare disease, it is extremely difficult to acquire good number of patient sample to diagnose accurately with high confidence. EBA has many biomarkers very similar to other bullosa diseases and needs specific clinical expertise to detect it using immunofluorescence microscopy. In this study, we introduce a deep learningbased method, EBAnet, that leveraged Convolutional Neural Network (CNN) based model for the detection of EBA based on Direct immunofluorescence (DIF) microscopy image. The proposed EfficientNet-based model achieved 97.3% sensitivity, 96.1% precision, and 96.7% accuracy in distinguishing EBA from other class and outperformed the existing model for the same purpose. GradCAM based class activation map also highlighted the important region of the DIF images that was focused by the proposed model leveraging the explainability of the model. We believe, EBAnet will add value in the early and accurate detection of EBA, addressing a critical need in clinical practice.