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Those devices were installed alternatively on particular SDMs of interest. They record the time of every operation of the SDM by monitoring the movement of the SDM drawer block: used syringe insertion, coin collection, coin insertion and prevention kit collection. All data are recorded on a flash card. The data collection is done at regular interval via a card reader and processed using numerical analysis software. Kits and syringe distribution in SDMs were routinely recorded by SAFE staff during their daily or weekly distribution route using established reporting forms.

All forms were transcribed in an Excel spreadsheet, saved, stored and backed up on a local server. Counting device data were recorded using a card reader. The data was saved as a text file containing date, time and unit code. Those were converted into Excel spreadsheets, saved, stored and backed up. The analysis was performed using Excel analysis tools to obtain descriptive statistics, including mean and standard deviation SD.

Finally, user interaction data were recorded by SAFE social workers team on site on specifically design forms then recorded electronically at the office.

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We initiated our analysis by studying the historical processes that led to the establishment of this SEP and its evolution over a year period under different organizations and management with extensive material changes. Each one developed a specific strategy. MDM implemented dispensing machines within the drug consumption zones, coupling distributors and exchangers.

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This association decided to develop the program where access to syringes was still difficult or insufficient, especially near railway stations. In partnership with French authorities state, region and town representatives , SAFE has evaluated all the sites to define problems, inadequacies and technical difficulties.

First, dispensing machines distributing less than kits per year were moved to sites where they were expected to perform better. Secondly, SAFE improved the existing machines by replacing the coupling exchanger-distributor for a sturdier version, adding exchangers to distributors MSF implementations and moving some machines to better new location sites. A The numbers of implementations in B The status of the SEP in This approach allows easier access to harm reduction equipment even in less favored districts where users are hard to reach and less inclined to interact with dedicated harm reduction programs.

Interestingly, the original dispensing machines were replaced and moved to new locations, promoting the coupling of exchanger with distributor. Due to the large modification and reorganization of the implementations, we have divided our study in two parts. Firstly, we have followed up the overall performance of the entire SEP over time. On the other hand, we have analyzed specifically a number of sites that have been unchanged over time. However, site-specific activity is very variable, both in terms of distribution and rate of recovery. Site-to-site variation over time. Eight sites were followed for their distribution activity over 10 years blue: , red: and green: As mentioned above, the numbers of sites that have remained unchanged over time is limited.

As shown previously, there has been a steady and significant increase of kit distribution in the SAFE SEP; however, this is not an overall increase. Gare du Nord and Chevaleret show a correlated increase, but not the other six sites. Syringe distribution over time. Blue: syringe distribution, red: syringe recycled and black line: global syringe collection. However, three slight variations can be observed.

The lowest activity level occurred in December and January, while the highest activity level was in April and May. It is also interesting to notice that the 2 months of July and August are also among the highest months for distribution and the operation of the SAFE team especially at the Gare du Nord machine. This is essentially correlated with the closing down of a nearby SEP over summer. The dispensing machines can be used 24 h a day and 7 days a week but need to be refilled and looked after.

The follow-up of failures, repairs and refills is an important measure of the overall activity of such a large set-up. This requires the accurate recording of those events. We have been only able to obtain the records up to 5 years. The latter measure represents a lack of availability SEP related , while the former can reflect the machine mismanagement, age or vandalism technical related.

This is not simply related to the entire set-up development, since the data weighted to the number of devices or sites are increasing. In parallel, we recorded an important increase in the number of supply disruptions; they have more than doubled between and , despite an increase in refilling tours per day and the establishment of an everyday refilling tour. Eight sites were followed for their distribution activity over 5 years blue: failures, red: disruptions and green: out of order. To better understand the site-by-site variation, we have equipped distributors and exchangers with automatic counting devices to measure the distribution flux over time.

This non-invasive strategy invisible by the IDUs was designed to define the speed of the processes as well as their extent during the day or in between distribution or exchange actions. This allows a non-biased measure of the number of kits per user and their behaviour qualitatively and quantitavely. Additionally, this can be used to define the distribution window per day to understand supply disruption.

This first pilot study was primarily intended for syringe collection events. The syringe collection time in a syringe-distributing machine is 14 s coin against a new kit and 18 s in the case of an SDM coupled with an exchanging unit dirty syringe against a coin then for a new kit. They are very similar values.

The number of kits taken per IDU is 1. The use of counting devices on SDMs is a very useful tool that allows the follow-up of the distribution and recycling processes with limited biases. This is very efficient for defining limitations, understanding problems and solving them.

Our approach using large data collection on an entire SDM scheme over time using counting devices has been well received by the different players involved in harm reduction in France national drug initiatives, local authorities, etc. SAFE has been recognized as the main provider of information in relation to drug use and user profile within the Paris area. The steady increase in data available to the communities allows the different partners to find answers.

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SAFE is now regularly asked to provide data related to syringe distribution in order to answer critics. For example, the day and night monitoring of syringe exchange in various districts has clearly demonstrated the absence of activity at night time as well as a need to increase SDM capacities in some areas. Moreover, the 3. But most of all, the high exchange rate and recycling of used syringes demonstrate the carefulness of the IDUs for health and safety issues!

Also, this large dataset and its related possibilities have opened way to collaboration with several research groups, and new initiatives are being tested. The surveys of SEPs are usually indirect [ 8 ]. They are evaluated via large virus infection surveys that cannot distinguish between SEP users and non-users. Another approach is the use of questionnaire that requires not only a trained interviewer but also willing users.

This introduces a limitation as such.

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We took advantage of a large and well-defined SDM to test a different approach. We combined regular monitoring activities with counting devices to analyze the characteristics of such a SEP over a year period. Harm-reduction strategies are not constant over time, and the Parisian SEP is a clear illustration of the changes in activities and strategies of harm-reduction policy in the Paris area.

The increase in distribution as well as the recycling above the expected threshold is a positive result, but does not mean that the SAFE SEP is fully optimal. The variation per site is tremendous and is not fully understood. The introduction of counting device seems to provide a way to further understand the SEP and to hopefully provide optimal solutions. The initial point of this study was to understand the SAFE SEP and to provide an objective view of its results and limitations to answer local concerns.

Local authorities are regularly arguing against this SEP.

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However, most of their concerns could not be monitored previously and were based on observations or urban legends the SEP is used by a limited amount of users, the SEP promotes syringe disposal in public areas, etc. The mean kit uptake by users is 1. This clearly indicates that IDUs in the Paris area only take a limited amount of syringes. We could conclude that this is an indication of limited shared syringes based on the limited amount of syringes taken; however, our analysis cannot be stretched this far, and further investigation using spectrometry and DNA-based methods will be needed to further characterize recycled syringes in correlation with collection.

This could also be used to monitor addiction type per site. Furthermore, we observed a recycling activity of the SEP which is above the expected threshold. And this effect increases over time. We already observed in a previous study a direct improvement of the cleanliness of the SDM SEP environment when distributors are coupled with exchangers [ 11 ]. It seems obvious that IDU knows about safety and disposal and consciously recycled their used syringes even without counterparts coins.

This recycling ability is higher than diabetes patients [ 12 ] or HVC-treated patients [ 13 ]. This result indicates a clear understanding of the SEP by its target population and a positive outcome that needs to be further investigated in terms of syringe exchange in between IDUs [ 14 ]. The annual variations of syringe distribution are limited and show an almost constant distribution activity. Only three slight variations can be observed. December and January, the coldest months of the year, show the lowest activity level, and we hypothesized a correlation between the slight drop of activity and the weather that may block machines frozen drawers, etc.

The former increase in activity appears in a period with high number of public holidays 1st, 8th, 22nd, etc. Also, the higher number of music festivals especially the electronic and techno music scenes are well known to attract IDUS, and so planning of drug consumption outside urban areas could lead to a tendency to stock kits prior to the event.

Interestingly, the SAFE network data are slightly different from other national drug initiatives or local associations, which are probably in relation to the fact that the SDM set-up is a non-discriminatory system that attracts users outside the normal framework.

We believe this is a more representative vision of injection practice. Moreover, the SDM set-up generates very large datasets within the 1,count range and over and so significantly higher than questionnaire-based studies. This provides better statistics and larger cohort study with limited bias.

The use of counting devices to monitor a SEP is the first time in the world; we are aware this has been done. This objective and innovative approach gave clear results concerning distribution rate and also distribution time window. Moreover, it illustrates our strategy. We have already observed an increase of supply disruptions in several sites, and public concerns pointed out an extensive use of the SDM during the night. However, we observed by monitoring heavily used sites Gare du Nord and Barbes a limited time window of distribution that ends up before night fall 19 h and 19 h 30 min, respectively.

This disproves criticisms by local authorities that SDMs are heavily used at night and generate noise around machines, leading to neighbourhood complaints. But it can be seen as use of the SDMs by a population with a regular daily activity workers, civil servants, etc. Already, SAFE has implemented a number of corrective measures:.

Installation of dispensing machines of greater capacity in the Gare du Nord and Gare de l'Est. You get redirected while browsing : When you browse the internet, get into the habit of keeping your eyes on the URL bar, especially when the page is loading.

Sometimes, it can even impersonate the website you were visiting and collect any information you enter. The next time you check a sensitive account like your Paypal account, for example , make sure you know the correct URL. These include built-in firewalls, malware detectors, and other software that you might have installed from a reputable source or that came standard with your device.

Phone bill discrepancies : Some phone-specific malware acts by quietly sending SMS messages to expensive private numbers that charge exorbitant sums. So you think you have malware. Now what? Well, it depends on your device. The same accessibility that allows new app makers to flourish also makes it easy for hackers and scammers to push malicious apps that will do everything from selling your data to draining your bank account.

Google does make an effort to filter their app store, but malicious code still makes it in on a regular basis. Apps unsupported by the app store are even more dangerous. Do so at your own risk! This will prevent the malicious app from doing any more damage than it already has and give you time to do some research using another device.

While your phone is shut down, try to find out what you can. What exactly were the symptoms? Can you find any info about other users with the same issue? When did the problem start? Did the beginning of the symptoms coincide with the installation of a new app? If so, search the name of that app and see if it has been revealed to be malware. The safe mode instructions vary from device to device, so consider finding the instructions for your model online.

On most, you can start by pressing the power button as you would when turning your phone on regularly. Then, while the Google startup animation plays, hold the volume down button until the animation ends. You should then see an on-screen indication that your phone is running in safe mode. But what is safe mode and how will it help you? When your Android starts up in safe mode, it will only allow its default apps to run. This will allow you to eliminate the suspected malicious app without suffering any more damage to your system or your security than you already have.

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However, this is one of the most powerful tools in your arsenal against malware. To do a factory reset, follow these instructions from Google. If the app compromised your bank account, call your bank immediately for advice on how to secure your account. Change your passwords to any websites and services that the app might have accessed. Your work at this stage will vary depending on the type of malware, so use your common sense. No fortress is impenetrable, and even iPhones can be compromised by malware. Just like Android, the main way for hackers and scammers to compromise an iPhone is through innocent-looking apps that hide their malicious payloads Note: Jailbreaking your smartphone can open new vulnerabilities.

Turn off your iPhone. This is the most surefire way to prevent the malware from doing any more damage or communicating with its owner while you look for a solution using another device. Retrace your steps to figure out when you think you might have downloaded the offending app. When did the problems or irregularities start to appear? Does that time coincide with a specific new app you downloaded? Some apps might immediately start to cause problems while others are more subtle. Armed with that information, you can also do some research about whether the malware app is a known problem and whether anyone has discovered more about how it attacks its victims.

At this point, your malware is most likely gone. Figure out how the malicious code might have compromised you and use your common sense to secure yourself. Change your passwords. Contact your bank to check for suspicious transactions or notify them that someone else may have your data. Check to see if any suspicious messages have been sent on your behalf and contact the people who received them. What you do now will depend on the malware you contracted, but this would be a great opportunity to do a full security overhaul!

Removing malware from a Windows PC can be very simple or highly complicated depending on how deeply it has penetrated your system. The potential threats are also more diverse, as Windows machines have traditionally served as punching bags for hackers due to their ubiquity. For better or for worse, there are countless tools available to clean your Windows PC. Start by shutting down your PC and starting it up in safe mode. This will run your machine in its most basic settings.

If the malware symptoms persist when running in Safe Mode or Safe Mode with Networking , the malicious code has probably penetrated fairly deep into your system. If the problems began recently, then a recently installed program might be the culprit. Completely wiping your hard drive before reinstalling Windows 10 is beyond the scope of this guide, as this is a risky process that usually involves specialized software. We suggest looking for complete instructions online or bringing your computer to a local computer technician to wipe and reinstall your system for you.

The clues that tipped you off to the malware in the first place may give you an idea of what you have to do to minimize its effects. However, it does happen. It often comes hidden in apps or browser extensions that were dishonest about what they do or that are bundled with other software that you trusted when installing it.

You can use another device to do some research on whether or not other users have had similar issues. When you do start up your Mac, do so in safe mode. Safe mode will boot your computer with its most basic settings and block any third-party apps — malicious or not — from automatically running on startup. If the issue is gone, you might not have had malware at all — or safe mode has prevented it from operating. Follow these instructions to turn on safe mode on your Mac. Look for apps that you downloaded recently or whose appearance coincided with the beginning of your malware symptoms. Sometimes, trusted apps can be to blame. If the app publisher was hacked, they might have distributed malware without their knowledge. The instructions for this step may vary depending on what browser you use, so try to find instructions online.

A combination of these measures should remove any malware that made it to your computer. If not, your best bet will probably be to take your computer to a licensed Apple retailer for repair services! Change your passwords to any online accounts you have, starting from the most sensitive ones. Contact your bank to check for suspicious operations. Consider notifying them of the attack as well so they can flag your account for heightened monitoring. Use your common sense to figure out what you have to do. Hopefully, these steps will help you get rid of malware no matter which of your devices got infected.

As always, premium tools are the way to go. The best software packages are backed by dedicated teams of developers who monitor the latest threats and respond to them with updates as quickly as possible.