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Background The Stay Safe Study is the first observational prospective cohort study investigating fentanyl test strip (FTS) use by people who use drugs (PWUD) and distribution by community organizations that provide harm reduction services (e.g., naloxone distribution) in three states (Kentucky, New York, and Ohio). The purpose of this paper is to describe the study design, along with implementation successes and challenges. A related goal is to provide recommendations and encourage researchers to undertake multi-state and multilevel studies of FTS use and distribution. Methods The Stay Safe Study has one primary, five secondary, and three exploratory objectives. From May-December 2023, we collected survey, interview, and oral fluid drug test data with the primary population of PWUD attending service locations of partner organizations that distribute FTS. We collected survey and interview data with a population of community organizations providing harm reduction services that have a distribution relationship to FTS. There was no intervention, and the study did not distribute FTS. Results A total of 1,156 PWUD participants were enrolled in the study and were invited to complete four weekly survey assessments. Of these, 732 PWUD participants (97.6% of the target) completed at least two of the four weekly surveys and reported drug use at least once during the 28-day observation period. A subset of enrolled participants completed a one-time oral fluid data collection visit (48-hour self-report survey and oral fluid specimen collection) ( n  = 267) and one-on-one semi-structured interviews ( n  = 120). From the population of 36 organizations providing harm reduction services, employees of 28 (78%) in 22 counties across 3 states completed a web-based survey and employees of 24 (66.7%) completed an interview. Study findings will be presented in subsequent publications [ 1 , 2 ]. Conclusion The research team successfully enrolled a large sample of PWUD participants and organizations that provide harm reduction services in three states, followed a cohort of PWUD participants, and generated rich data using three types of instruments. Factors contributing to implementation success include drawing on the community expertise of the parent HEALing Communities Study, selecting incentive amounts that acknowledged the time and expertise of PWUD participants, centralizing survey data collection, and tracking implementation challenges and solutions. Areas of implementation complexity included conducting research on site at the service locations of 14 partner organizations, facilitating timely incentive payments, overseeing research staff, and returning oral fluid results to PWUD participants.

A recent article in \"The Weekly Standard,\" \"Kenyon College Cancels Play About Immigration; Starts 'Whiteness Group,'\" describes a current call for censorship. Wendy MacLeod's play, \"The Good Samaritan,\" is about an immigrant family in the U.S. surviving \"without pay and living in dire conditions,\" according to the author. Based on a true story, MacLeod wanted to shine a light on this family and, apparently, used humor and satire in the process. The play was scheduled to be produced at Kenyon College but was met with protest by some students, faculty and administrators who called for its censure. Most people could take any novel, play, film, cartoon, essay, song, poem or story and find characters to object to, actions to condemn, ideas to despise, language to censor and portrayals to vilify as hurtful to a group, gender or country. One reason for the Kenyon College protest was because the play was written about a Guatemalan family, illegals, by a natural born U.S. citizen, a white woman. This line of logic, if followed to its ridiculous conclusion in literature, would posit that a writer can only create characters of his own gender, ethnicity, social and educational status within the framework of the environment in which he grew up. This view is completely debilitating for the majority of creative artists, who use their imaginations to enter into people and territories, eras and situations, histories and worlds that are totally alien to their personal day-to-day lives. In an open society, built upon the ideals of freedom, people must allow conflicting and diverse views to exist. If writers, artists, philosophers, or journalists are fearful of creating work because they might be attacked or censored, the result can only stifle creativity, originality, and truth-telling.

AbstractDispersal in tigers was studied in Royal Chitwan National Park, Nepal. Thirty six adult and young were studied to monitor movements and social interactions relative to dispersal. Fourteen subadults were followed from before their dispersal until they died or established post-dispersal territories. Subadult tigers became semi-independent of their mother when her next litter was born. They usually remained within her natal area until the subsequent litter began to move with her at about 2 mos of age. Animals dispersed between 19 and 28 mos. Males dispersed farther than females and settled in poorer habitat. Three of 4 females settled adjacent to their mothers; in two cases the mother shifted her territory allowing the daughter to take over a large portion of the mother's former territory. Wounds on young prior to dispersal indicated that aggression prompted dispersal. Fjghts were observed between dispersers and residents. After fights, dispersers always left the resident's area. All 4 dispersing females established breeding territories. Females settled next to their mothers tending to reduce the genetic variance of a male's offspring. Eight of 10 males became localized in temporary, post-dispersal territories; 4 of the 8 survived. Two males died of poisoning and 2 from intrasexual aggression. Surviving males either expanded temporary territories or shifted to new areas to establish breeding territories. The Chitwan tigers are an isolated remnant of a population once continuous across the lowlands of Nepal. Effective population size was estimated to be <30 animals. Tigers did not disperse across cultivated areas but did travel through degraded forest habitat. No animal dispersed outside the Chitwan region and there appear to be effective barriers separating Chitwan from the two nearest populations 150 and 250 kms distant. The Chitwan population is probably one of the largest tiger populations remaining in the world. Isolation and small size threaten these populations with stochastic events that may lead to further reduction in population size.

Evidence-based practices for reducing opioid-related overdose deaths include overdose education and naloxone distribution, the use of medications for the treatment of opioid use disorder, and prescription opioid safety. Data are needed on the effectiveness of a community-engaged intervention to reduce opioid-related overdose deaths through enhanced uptake of these practices. In this community-level, cluster-randomized trial, we randomly assigned 67 communities in Kentucky, Massachusetts, New York, and Ohio to receive the intervention (34 communities) or a wait-list control (33 communities), stratified according to state. The trial was conducted within the context of both the coronavirus disease 2019 (Covid-19) pandemic and a national surge in the number of fentanyl-related overdose deaths. The trial groups were balanced within states according to urban or rural classification, previous overdose rate, and community population. The primary outcome was the number of opioid-related overdose deaths among community adults. During the comparison period from July 2021 through June 2022, the population-averaged rates of opioid-related overdose deaths were similar in the intervention group and the control group (47.2 deaths per 100,000 population vs. 51.7 per 100,000 population), for an adjusted rate ratio of 0.91 (95% confidence interval, 0.76 to 1.09; P = 0.30). The effect of the intervention on the rate of opioid-related overdose deaths did not differ appreciably according to state, urban or rural category, age, sex, or race or ethnic group. Intervention communities implemented 615 evidence-based practice strategies from the 806 strategies selected by communities (254 involving overdose education and naloxone distribution, 256 involving the use of medications for opioid use disorder, and 105 involving prescription opioid safety). Of these evidence-based practice strategies, only 235 (38%) had been initiated by the start of the comparison year. In this 12-month multimodal intervention trial involving community coalitions in the deployment of evidence-based practices to reduce opioid overdose deaths, death rates were similar in the intervention group and the control group in the context of the Covid-19 pandemic and the fentanyl-related overdose epidemic. (Funded by the National Institutes of Health; HCS ClinicalTrials.gov number, NCT04111939.).

Wendy MacLeod's new play, The Good Samaritan, is about an immigrant family in the U.S. surviving \"without pay and living in dire conditions,\" according to the author. There are an infinite number of reasons why writers compose, but many would say they create work to delve into the depths of the human condition and explore emotional and psychological territory found in relationships, families, in the characters' search for meaning. Frederick, the Supreme Court upheld a school's ability to \"prohibit speech that can reasonably be interpreted as advocating illegal drug use,\" but they made it clear that they would not support \"any restriction of speech that can plausibly be interpreted as commenting on any political or social issue\" (Bethel School District No. 403 v. Fraser, 2013). When we feel offended or threatened by a work of art, we have a number of healthy options to consider: * to not support, read, or see the work in question; * to protest the artist while acknowledging his or her right to create the work; * to support creative alternative work in response; and * to try to learn from the work-to analyze why it seems offensive, why it threatens, why another person would view this work as legitimate and worthy.

Despite more than two decades of conservation efforts, only limited information is available on the metapopulation structure of the tiger (Panthera tigris). We report on the geographic distribution of tigers in Nepal in relation to habitat quality and describe an inventory and monitoring system that can be applied across the entire range of the species. Using information from previous studies, interviews with local people, and digital thematic mapper satellite data, we identified four populations of tigers; three occur primarily within the borders of Nepal, and a fourth is across the border in India. We estimate that there are 153 breeding tigers in these four populations. In the Chitwan population, 77% of breeding tigers live in three protected areas; the rest occupy national forests. Tigers in all four populations survive in isolated forest remnants of what was once a continuous subtropical forest zone lying south of the Himalayas. Within central Nepal the ratio of good‐ to poor‐quality tiger habitat ranged from 16% to 86% across seven forest districts. The four areas with the highest ratio of good‐quality habitat (>54%) supported breeding populations, one area with a marginal ratio of good‐quality habitat (46%) was used only occasionally, and the two areas with the lowest ratio of good‐quality habitat (<26%) were not used by tigers. We suggest that when the ratio of good to poor habitat drops below approximately 50%, tigers no longer breed; when it drops below 30%, tigers no longer occur in an area. Estimates of potential tiger habitat and data on habitat used by tigers demonstrate the need to expand current management beyond parks to encompass the entire land base supporting these fragmented populations so that small tiger populations can be managed as ecosystem or tiger management units rather than as portions of populations within protected areas. Análisis de Paisaje de la Distribución de Tigres y Calidad del Hábitat en Nepal A pesar de mas de dos décadas de esfuerzos de conservación, la información sobre la estructura metapoblacional del tigre Panthera tigris es viable únicamente en forma limitada. Reportamos la distribución geográfica de tigres del Nepal en relación a la calidad del hábitat y describimos un inventario y un sistema de monitoreo que puede ser aplicado a lo largo del rango de distribución total de la especie. Usando información de estudios previos, entrevistas con pobladores del lugar y datos de mapeadores digitales temáticos, identificamos cuatro poblaciones de tigres; tres de las cuales ocurren principalmente dentro de los límites de Nepal y una cuarta población se encuentra mas allá de la frontera con India. Estimamos que existen 153 tigres reproductores en estas cuatro poblaciones. En la población de Chitwan, 77% de los tigres reproductores viven en áreas protegidas; el resto ocupa bosques nacionales. Los tigres de las cuatro poblaciones sobreviven en bosques remanentes aislados de lo que alguna vez fué un bosque subtropical continuo del Sur de los Himalayas. Dentro de la región central de Nepal y a lo largo de siete distritos forestales, la proporción de tigres en buena y mala condición varía entre 16% y 86%. Las cuatro áreas con la tasa mas alta de calidad de hábitat (>54%) soporta poblaciones reproductoras; un área con una tasa marginal de buena calidad de hábitat (46%) fueron usadas por los tigres únicamente en ocasiones y las otras dos áreas con la tasa más baja (<26%) no fueron usadas. Sugerimos que los tigres no se reproducen si la tasa entre hábitat bueno y malo es más baja de un 50%; si baja más de un 30%, los tigres no se encuentran en el área. Estimaciones de hábitat potencial para tigres y datos de hábitat usado por tigres demuestran la necesidad de expander el manejo actual más allá de los parques y abarcar la totalidad de las tierras que soportan estas poblaciones fragmentadas, de tal manera que puedan ser manejadas como ecosistema o como unidades de manejo para tigres, y no como porciones de poblaciones dentro de áreas protegidas.

Creative writing has been the ugly stepsister in the English discipline for years. On one side, the literature scholars carry the torch for pure language, and, on the other side, the composition and rhetoric theorists approach writing like a science. Somewhere off in a dark corner, the creative writing staff loiters, getting paid to do nothing more than say what they think about student writing. The debate whether creativity can be taught smolders. Most creative writing teachers believe in the creative potential of all people, and that the right environment with prompts and encouragement can elicit creative work to a degree. Talent, motivation and desire always play an important role. Though creative writing involves innate talent, it is also a craft with tools, techniques, concepts. Any fledgling writer needs to learn the elements in order to practice, experiment, and perfect them. Though people argue that creative writing is subjective and personal in the end (and they are right), they are far less willing to argue that the elements of poetry, fiction, and drama are subjective. The elements are objective and should be a crucial part of the evaluation of creative writing coursework. This article presents an experiment which was devised to prove that students were learning about elements of poetry, fiction, and drama in a creative writing class. Since the evaluation of creative work is admittedly subjective, a parallel focus on writing elements was incorporated into class. In addition to writing prompts and helping-circle feedback, the poetry section involved figurative language, rhyme schemes, sound elements, images and forms of poetry. The fiction section covered character types, points of view, and innovative fiction. In playwriting, the concepts of tragedy, theatre of the absurd, and play format style were explored. (Contains 1 table.)