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Archives November 2021

Naloxone shortage could lead to thousands of overdose deaths, experts warn

It was New Year’s Eve. Devin Lyall sat in the back bedroom of her drug dealer’s house.

Her thin fingers fumbled with the syringe. Her fingers weren’t the only frail thing about her—in the past few months she had lost about 40 pounds, leaving her practically skin and bones.

She was using Opana, a strong narcotic, melting the small, circular pills into a liquid that she could inject.

As the dregs of 2012 trickled into the New Year, Lyall didn’t have much hope. It was as if her life was ticking away as quickly as the seconds remaining before midnight.

She was shaking, chills running through her body, yet she was so hot she felt like she was on fire. She kept injecting, hoping it was the relief her body needed.

She woke up later, lying in a hospital bed. Her mother and father stood over her. She wasn’t sure when or how she had gotten there.

Lyall had overdosed.

The drug dealer had called her mother, who rushed her to Wilkes Medical Center. They made it in time for doctors to give Lyall the reversal drug naloxone, saving her life.

“I remember in that moment feeling very helpless, but relieved,” Lyall said. “I was so glad that I wasn’t in that house anymore and that maybe I had an opportunity to do something different. It was the first time in a long time that I thought maybe I can get help.”

She began the new year in the ICU for seven days, a regular room for 10 more, and detox for 14 after that.

The anti-overdose drug

Naloxone blocks the nervous system’s opiate receptors. It is most commonly used for drug overdoses—Narcan is a well-known brand name.

In August, Pfizer halted production of its single-dose injectable naloxone due to a manufacturing issue. This naloxone is used by many grassroots harm reduction coalitions across the state.

Dr. Nabarun Dasgupta, drug and infectious disease scientist at UNC Gillings School of Global Public Health, and others estimate the naloxone interruption could result in about 1 million fewer doses, which could lead to as many as 18,000 avoidable overdose deaths.

In 2012, the year Devin overdosed, naloxone and overdose kits weren’t common in clinics, harm reduction coalitions, or other local organizations. Hardly any individual had them on hand. In a way, Devin was fortunate. She had a dealer who called her mother, and her mother responded. Many who overdosed at the time weren’t as lucky.

Now, naloxone is more accessible—on pharmacy shelves, part of local syringe exchange programs, and often in first responders’ hands. This access is crucial, especially as opioid overdose deaths rose to an all-time high in North Carolina in 2020.

The change is largely a result of North Carolina’s 2016 naloxone standing order, which allows pharmacists to dispense naloxone to those who need it and for community distribution. But addiction recovery experts say the standing order is not doing enough to blunt the rapid rise of opioid addiction.

“There’s a third tier of programs around the state that rely on other programs to purchase naloxone for them,” Dasgupta says. “So, these are sponsored programs, programs run by people of color serving people of color, and they are ones that don’t have the official paperwork to buy and purchase naloxone—but have the really critical infrastructure to get it to where it needs to go.”

Getting naloxone to these local harm reduction groups is critical, because this is often where active users—who are most at risk—go for naloxone.

The standing order only covers distribution—not purchasing. Pharmaceutical companies producing naloxone require a prescription. This is where the nuances of the North Carolina order stand in the way of getting naloxone to the organizations where it is most effective.

“The standing order, it’s kind of a sham,” Dasgupta says. “Our legislature came up with a piecemeal, almost useless version of a law that created this standing order, then feel like they’ve done something and wash their hands of it. What would have really helped is for these smaller programs to be able to order naloxone directly from pharmaceutical distributors.”

With rising overdoses, a flawed standing order, and a shortage of Pfizer naloxone, North Carolina faces what could be a nightmare.

People die without naloxone

Louise Vincent is the executive director of the N.C. Urban Survivors Union, a grassroots Greensboro group working to support and assure safety for opioid users in the community through syringe exchanges and by providing naloxone.

“If I didn’t have naloxone I couldn’t go to work'” Vincent says. “I could not look someone in the face and tell them I don’t have naloxone and send them to die—because you’re literally sending someone off to die if you don’t have it.”

This reality landed on national consultant Robert Suarez’s doorstep at Urban Survivors just a few weeks ago. A young woman ran into the center screaming. Her friend was overdosing in her car right outside. Suarez grabbed two bottles of naloxone, ran outside, opened the passenger side door, climbed on top of the overdosing man, and administered the lifesaving drug.

After he injected the naloxone, Suarez said he gave him mouth-to-mouth during the four minutes it took the naloxone to work.

“Four minutes is an eternity when someone isn’t breathing on their own,” Suarez says.

A month into Pfizer’s naloxone shortage, the Urban Survivor’s Union supplies remain sufficient—for now.

But the fear of coming up short is pervasive.

“I’m acutely aware that there’s a shortage, and I want to be mindful,” Vincent says. “I cannot run out. I will not run out. Bottom line is I won’t run out. There’s expired naloxone that I’ve already figured out how to access. We’re pretty scrappy people, I’m going to find it.”

Alternate sources

Another way harm reduction groups are coping with this shortage is by getting naloxone from larger organizations across the state with the ability to purchase from other pharmaceutical distributors.

One of these groups helping provide naloxone is Project Lazarus in Wilkes County. They have a medical director able to order the drug.

“We’ve worked with what stock we have, and every time we have looked at getting naloxone it wasn’t just for ourselves,” says Fred Brason, executive director and founder. “I’ve given Louise Vincent naloxone, I’ve given it to Twin Cities Harm Reduction.”

Brason explains that studies show that people who go to a pharmacy for naloxone are usually family members or friends of users, rather than the users themselves.

“Within the harm reduction circle there is a huge concern—there never has been the full access that is necessary to make the difference naloxone can,” Brason says. “Any reduction from what was already not sufficient is going to create major problems.”

A waitress saves a life

Tracy Coins, a waitress in Greensboro, relies on the Urban Survivors Union for naloxone.

“The circle of people that I travel in wouldn’t go anywhere else but Urban Survivors,” Coins says. “They don’t want to walk into places like CVS or Walgreens because those people are so judgmental.”

In August, Coins saved someone overdosing right in front of her with the naloxone she had on hand.

She was with a group of people at a friend’s house, and they were all doing heroin. Suddenly, one man curled up, his body as tense as a rubber band stretched to its limits, his arms and legs locked up. Coins looked around the room and realized that no one had any idea how to help.

“I carry naloxone with me all the time if I can,” she said. “The only place I get it is through Urban Survivors.”

Coins gave him naloxone and mouth-to-mouth until he came to.

Local harm reduction agencies acknowledge that there are people who are going to use drugs. By providing naloxone, and hosting syringe exchanges, they give these people the option to have a safer experience.

From addict to recovery

After Lyall’s near-fatal New Year’s Eve, she got clean. She gradually got her life back—her house, her kids, and she reconnected with her family.

Today, she is the founder and executive director of Wilkes Recovery Revolution.

Wilkes Recovery focuses on helping people overcome addiction, and is a harm reduction center—working to assure users are safe, distributing Nnaloxone, and trying to decrease stigma.

“Syringe exchange programs are truly the people that are boots on the ground,” Lyall says. “We’re the ones intersecting with people who use drugs and serving them on a daily basis, yet we are the last to get naloxone, when I think it should probably the other way around, So, if there’s a shortage, then we’re definitely hurting at the grassroots level, as a syringe exchange.”

Pfizer expects its naloxone shortage to continue through February 2022, leaving harm reduction groups to continue relying on sources whose naloxone supplies are diminishing.

Lyall says she had a wonderful life before her addiction. A supportive, upper middle-class upbringing. A good job and a family of her own.

When she slipped down some icy stairs at a ski resort, shattering her ankle, she had no idea that the pain medicine she would be prescribed would be the start to a crippling addiction.

Now, Lyall reflects on pulling herself out of the depth of her addiction, how difficult this was, and how lucky she was to get naloxone in time to save her life.

At Wilkes Recovery Center, she wants to give people this same chance.

“When I moved back home, my mission was to give other people the opportunities that I had,” she says. “I understand that I was a privileged person and that not everybody gets those same options and opportunities and that I was very lucky to have.”

Tesla opens charging network to other EVs for the first time

Tesla Inc (TSLA.O) is opening its charging network to other electric cars for the first time with a pilot program in the Netherlands, as the world’s most valuable carmaker looks to bring electric vehicles into the mainstream.

The program will be tested at 10 locations in the Netherlands, the company said on Monday, adding that Dutch non-Tesla EV drivers can access the Tesla stations, or Superchargers, through the Tesla app.

Tesla drivers can continue to use these stations and the company will closely monitor each site for congestion.

Tesla operates more than 25,000 Superchargers worldwide, while other carmakers have formed alliances or invested in startups for networks as they rush new electric vehicles to market.

The Superchargers are open to cars with the Combined Charging System (CCS) favored by BMW (BMWG.DE), Mercedes-Benz maker Daimler (DAIGn.DE), Ford (F.N) and the Volkswagen (VOWG_p.DE), which includes Audi and Porsche.

Tesla uses the CCS standard in Europe, allowing a wide range of cars to charge in stations without an adapter that uses a similar connector.

Charging prices for non-Tesla drivers will include extra costs to support a broad range of vehicles and site adjustments to accommodate these vehicles, Tesla said. The price to charge can be lowered with a charging membership, it added.

“This move directly supports our mission to accelerate the world’s transition to sustainable energy,” the company said.

Tesla, which crossed $1 trillion in market capitalization for the first time last week, has defied supply chain issues and global chip shortages to mark a record quarter for car deliveries as demand ramps up and its investments in new factories pay off.

Certain Windows 11 built-in apps won’t work for some users

Early adopters of Microsoft’s Windows 11 operating system have had to contend with the usual collection of bugs and glitches, ranging from performance regressions to printing issues and everything between. Some people may even find they can’t use some built-in apps, but luckily there’s a fix for that.

Windows 11 is evolved from Windows 10, which is both a blessing and a curse. Microsoft has spent the past several years perfecting Windows 10, which means its successor is also based on a relatively mature core. At the same time, it has inherited various bugs and glitches that some early adopters have discovered in the past few weeks.

One notable issue is related to printers, which don’t seem to work in certain scenarios. Other issues are less visible to the average user, such as memory leaks in File Explorer when opening several windows on a daily basis, something that can lead to less RAM being available for any other apps you might use.

More recently, someone discovered that Windows 11 can flood your HDD or SSD with thousands of empty folders. This won’t impact performance or take any significant amount of space on your storage drive, but it’s a perfect example of old Windows 10 warts reappearing in Windows 11.

This week, some of you may have also found that you can no longer use or even open certain built-in apps such as Get Started, Tips, Snipping Tool, Touch Keyboard, Voice Typing, Emoji Panel, and Input Method Editor user interface (IME UI), as well as the accounts page and landing page in the Settings app for Windows 11 S users.

Microsoft says the issue only affects people that have not yet installed the KB5006746 update that was released on October 21, and S mode users are more likely to experience this problem.

The affected apps rely on a certificate that expired on October 31, and the best way to solve this problem is to manually install the latest update, as it will renew the expired certificate. KB5006746 is currently marked as an optional update, but it will soon be offered to everyone as part of the November Patch Tuesday update.

Heinz launches its first ever limited-edition Christmas Dinner Big Soup

The latest soup flavour from Heinz comes complete with turkey, pigs in blankets, stuffing and chunky potatoes – as new research finds that a quarter of brits would eat Christmas dinner every day if they could

Calling all Christmas dinner fanatics – as we have a new food item that you are going to want to get your hands on, pronto.

Heinz Big Soups do not mess around, especially when it comes to full-on ingredients and big-time flavour. And the latest festive addition to the Big Soup family is certainly no exception!

The new Heinz limited edition Christmas Dinner Big Soup is packed full of big chunks of all the festive feasting favourites, including turkey, stuffing balls, chunky potatoes, Brussels sprouts and even pigs in blankets – for no-nonsense seasonal satisfaction.

Luckily for those turkey, stuffing, roastie and pigs-in-blankets-loving Brits, Heinz Christmas Dinner Big Soup boasts big, delicious chunks of these festive favourites, takes just minutes to warm through in the microwave or on the hob.

Best of all? It’s a snip of the price of your full Christmas lunch at just £1.50 – perfect for those that would happily eat Christmas dinner every day.

You can buy it now from the Heinz website right here – but you’ll need to be quick as it won’t be around for long. So what are you waiting for?

Scottish roundup: Celtic squander late penalty in draw with Livingston

Giorgos Giakoumakis missed a stoppage-time penalty as Celtic squandered the chance to go top of the cinch Premiership in a goalless home draw with Livingston.

The Greek striker’s weak effort was saved by Max Stryjek after Abi Obileye had gifted the hosts a rare chance when he hit out at Kyogo Furuhashi in the box and received a red card.

Celtic took even longer to get going than their supporters after a 30-minute silent protest against the board and managed only one other shot on target – an Anthony Ralston effort that was cleared off the line just before half-time. The home side had 85 per cent of possession but failed to score against David Martindale’s side for the second time this season.

A win would have put Celtic top, at least until Rangers play Motherwell on Sunday, for the first time since they briefly hit the summit after beating St Mirren 6-0 on August.

The stalemate meant Hearts could have climbed to second, but instead they surrendered their unbeaten record in a 2-1 defeat at Aberdeen.

John Souttar gave the visitors the lead from the penalty spot after Joe Lewis brought down Josh Ginnelly. But Aberdeen equalised four minutes into the second half through a fierce Marley Watkins drive that gave Craig Gordon no chance.

In the 69th minute Lewis Ferguson rose above everyone else to meet a Dylan McGeouch corner and send a powerful header into the net to win it for the Dons. Hearts’ misery was compounded when Andrew Halliday was sent off a minute from the end.

Dundee United’s seven-game unbeaten run was ended by St Johnstone thanks to Ali Crawford’s first-half goal.

In the 28th minute Cammy MacPherson stole the ball from Jeando Fuchs and played in Crawford, who curled his shot into the bottom corner. United had plenty of chances to equalise but were denied time after time by Saints goalkeeper Zander Clark, who produced an inspirational display.

Dundee bounced back from their 5-0 midweek defeat to Ross County to claim a first league away win of the season at St Mirren. Max Anderson’s 11th-minute curler from the edge of the box was enough to give Dundee victory. The Dark Blues held firm throughout the second half as Jim Goodwin’s men chased an equaliser that never came.

The match between Ross County and Hibernian was postponed after a Covid-19 outbreak in the visitors’ camp.

Newly discovered skin cell may underlie inflammatory skin disease

The surprise discovery of a new type of cell explains how distress to the skin early in life may prime a person for inflammatory skin disease later, according to a new study by UC San Francisco researchers in the Oct. 27 issue of Nature. Knowledge of this new cell type will likely lead to greater insight on how to reverse autoimmune disorders such as scleroderma, and shed light on the nature of inflammatory disease in general, the researchers said.

“The results reinforce the idea that what you’re exposed to initially may have lasting ramifications,” said Michael Rosenblum, MD, Ph.D., principal investigator on the study. “It appears that early exposure to inflammation can, through these cells we discovered, imprint an ability for tissues to develop inflammatory disease later in life.”

The team learned about the new type of cell while investigating the effects of a set of actions known to evoke immune response in mice. One of these actions involved knocking out a group of skin cells that suppress the immune system. In the absence of that regulation, Rosenblum said, the researchers saw the presence of a unique cell that seemed to be acting as a shelter for pathogenic immune cells that aren’t usually seen in skin tissues.

“We had to knock out one cell population to see that they were controlling the growth and capacity of these other, unknown cells,” he said, noting that the new cells became apparent only in the tissue that had been exposed to inflammatory triggers. “What normally would be a deserted island on the skin was now inhabited by all these strangers,” he said.

The team dubbed the strangers “TIFFs” (Th2-interacting fascial fibroblasts) after the Th2 immune cells that they help to house. The location of TIFFs in the skin suggests that they belong to a group of cells that make up fascia, the fibrous connective tissue that surrounds and connects organs throughout the body, said lead author Ian Boothby, a graduate student in Rosenblum’s lab.

“Because most organs have fascia of some sort, what we’re learning about TIFFs in skin may well be widely applicable to the rest of the body, meaning that these cells may play a role in a huge number of inflammatory diseases,” he said.

‘Home for Immune Cells’ Opens Its Doors

Boothby and Rosenblum saw that when the skin lacking regulatory cells is subjected to inflammatory triggers, the population of TIFFs expands like wildfire, and the TIFFs become a sort of holding pen for the Th2 immune cells. Later in life, when even a small insult to the skin presents itself again, Rosenblum said, the TIFFs open their floodgates, letting the Th2 cells out.

“All you need to do is push the immune system just a little bit, with a wound or with stress, to unleash all the pathogenic cells living in these TIFFs and create an exaggerated inflammatory response,” he said.

That exaggerated response, the researchers hypothesize, may manifest as the creation of fibroses in the fascia, the driving force behind inflammatory skin diseases such as scleroderma, which affects about 50,000 Americans.

The team’s next move was to confirm the presence of TIFFs in human skin. They obtained samples from volunteers with eosinophilic fasciitis (EF), a rare inflammatory disorder in which white blood cells called eosinophils build up in the skin fascia, the fibrous tissue which lies between the skin and the muscles below it.

When they compared the EF samples to those of healthy skin, the researchers found TIFFs in both types of skin sample, but the two looked completely different. In healthy skin, the fascia forms a thin, spidery network between fat cells, while in the EF skin sample, the cells had expanded to form thick bands of fibrous tissue.

Solving the Mysteries Underlying Inflammation

It turns out that TIFFs are present in every organ of the body, said Rosenblum. They’re usually found in the fascia that surrounds our major organs and serve a role in maintaining structure. They’re also prone to interacting with immune cells. He postulates that TIFFs might have evolved as a sort of emergency brigade in case of injury, able to jump-start repair in the case of internal injury.

“In patients with scleroderma or other fibrosing diseases like EF, that repair program may be kind of co-opted, resulting in this chronic wound-healing response,” said Rosenblum. “If we can understand the biology of these cells, we can come in with drugs that revert them back to what they’re supposed to be doing.”

Taking that approach is vital to addressing the broad array of inflammatory diseases for which there are often no good treatments.

“There are lots of therapies that reduce inflammation, but we don’t have good ways of restoring the affected organs to full health,” he said. “So, learning about how cells like these TIFFs interact with immune cells to drive inflammatory disease is critical to developing treatments that address its cause, rather than its symptoms.”

Amazon seeks U.S. approval to launch two internet satellites by 2022

Amazon.com (AMZN.O) on Monday asked the U.S. Federal Communications Commission for approval to launch and operate two prototype internet satellites by the end of 2022 as part of the company’s effort to create a space-based satellite network.

Amazon, which has pledged to spend at least $10 billion to build 3,236 such satellites through its Project Kuiper program, said the testing and demonstration launch is “an important step toward Amazon’s goal of delivering high-capacity, low latency broadband communications services to tens of millions of unserved and underserved consumers and businesses.”

Amazon said on Monday it “continues to invest in Project Kuiper as we approach full production launches and prepare to serve tens of millions of customers around the world.”

In 2020, the FCC approved the Project Kuiper plan for the constellation of low-Earth orbit satellites to compete with the Starlink network being built out by Elon Musk’s SpaceX.

Amazon has sparred with Musk, recently accusing the billionaire of ignoring a variety of government-imposed rules, including several Federal Aviation Administration (FAA) requirements.

“The conduct of SpaceX and other Musk-led companies makes their view plain: rules are for other people, and those who insist upon or even simply request compliance are deserving of derision and ad hominem attacks,” Amazon wrote. “If the FCC regulated hypocrisy, SpaceX would be keeping the commission very busy.”

Amazon founder Jeff Bezos and Musk are rivals in the private space launch business. Bezos’ Blue Origin has challenged the National Aeronautics and Space Administration’s decision to award a $2.9 billion lunar lander contract to SpaceX.

SpaceX has accused Amazon in its own filing with the FCC of seeking to delay SpaceX’s plan: “While SpaceX has proceeded to deploy more than 1,700 satellites, Amazon has yet to even attempt to address the radiofrequency interference and orbital debris issues that must be resolved before Amazon can deploy its constellation.”

ZipCharge Go is a portable powerbank for your electric vehicle

UK startup ZipCharge has introduced a portable electric vehicle charger that could come in very handy in the right situation. I personally view this as a backup or emergency solution, but ZipCharge believes the best way to charge an EV is when you don’t need to – topping up wherever you park to avoid having to wait at a charging station later on. I’m not sure what would stop a would-be thief from helping themselves to your charger if left unattended in such a scenario, however.

The ZipCharge Go is essentially a portable battery pack like the kind you’d use for a smartphone, except it’s meant for an electric vehicle. The company describes it as a “smart charger on wheels” that’s no bigger than a compact suit case. According to InsideEVs, the Go weighs around 50 pounds.

ZipCharge says the unit is compatible with any plug-in hybrid or electric vehicle with a Type 2 socket, and can be charged from any standard household outlet. A full charge can provide 20 to 40 miles of range depending on your EV and can be delivered in 30 to 60 minutes, depending on capacity and temperature.

A companion smartphone app can be used to schedule charging at the lowest cost, provide status updates and more.

Full details are still pending but according to InsideEVs, units will be available to purchase or lease, with the latter starting around $67 per month. Look for the first examples to be available in Q4 2022.

Mum leaves sassy note on pavement for neighbour who moaned about son’s chalk art

Ashley Woodfolk hit back at her neighbour after they complained about seeing her son’s drawings on the pavement – by writing her a note in chalk in their courtyard

Many of us will have played with chalk when we were children and some of us will also remember using special pavement chalk to draw hopscotch lines and other fun doodles outside.

Pavement chalk is designed to wash away in the rain, but one person has been left so annoyed at the sight of the temporary drawings outside their flat that they contacted the building management.

Ashley Woodfolk, from New York, USA, took to Twitter (@AshWrites) to share her story after she allowed her son to draw with pavement chalk in their building’s courtyard, and was met with resistance from one of her neighbours.

And after building management listened to the neighbour’s complaints and stopped the use of chalk outside the property, the mum hit back – by writing a note to her disgruntled neighbour in chalk across the courtyard.

A picture of the note was shared on Twitter, which reads: “Good evening to everyone except the woman at my co-op who complained to the board about me and my toddler using sidewalk chalk in the courtyard.

“So I wrote her a little letter. In sidewalk chalk. In the courtyard.”

She continued to say: “This will be my last time using sidewalk chalk in the courtyard since it seems to be such a problem for you (and only for you).

“I’m sorry such harmless fun that brought my toddler joy (and has actually helped him learn all of his letters and most of his numbers – his favourites are E and 8) causes you so much distress that you have to complain to the board and waste everyone’s time when our building has much bigger real problems.

“I think you’re aware that we’re in a pandemic and while I’d love to take my kid to museums and the movies, I don’t feel doing that, and sometimes even local parks are more crowded than I’m comfortable with.

“The courtyard was a safe space but now there are limits on that too.

“There are only a few weeks of nice weather left, and I sincerely hope that you enjoy the use of the sidewalk-chalk free courtyard for the remainder of the fall. And I hope that every time it rains, rain that would have washed away any colourful ABC’s I wrote on the ground, you think of me.”

Ashley’s post has received more than 243,000 likes and many people can’t believe the cheek of the mum’s neighbour.

One person said: “I very much applaud your response to a ridiculous prohibition of your child’s creativity.”

While another wrote: “Before I became disabled, I would hop every single chalk hopscotch that I came across. Sidewalk chalk art is art for everyone and is so temporary that to get upset about it is a symptom of a sad existence. Chalk on, little one!”

Championship roundup: Cardiff’s quickfire treble saves point at Stoke

Managerless Cardiff pulled off a remarkable comeback at the Bet365 Stadium, as Stoke let slip a three‑goal lead to draw 3-3.

Jacob Brown put the hosts ahead after 10 minutes and Steven Fletcher grabbed a goal in each half to put them in control. But three goals in five minutes hauled Cardiff level. Rubin Colwill pulled one back in the 66th minute, Mark Harris added a second four minutes later and Kieffer Moore struck almost instantly to complete the fightback.

Victory would have taken Stoke into the top six but they are in ninth. Cardiff, who sacked Mick McCarthy last Saturday, are 21st.

Steve Morison, the Cardiff caretaker, was asked if he feared the worst and said: “Fear the worst? We had the worst, we were 3-0 down, it couldn’t have got much worse, could it? All credit goes to the players, I just told them that standard at 3-0 down wasn’t good enough but the performance after we went 3-0 down is good enough.

“At the minute, we’re not good enough to not be at it because if we aren’t at it then we’re 3-0 quite quickly. But if we perform at that level, we will win games of football.

At the summit Bournemouth continued their remarkable unbeaten start to the season with a 2-0 win at Reading. Dominic Solanke opened the scoring with a close-range header just before half-time, and Jamal Lowe added the second with a smart finish just before the hour. The win – their 11th from 15 league games this season – keeps the Cherries five points clear of second-placed Fulham and nine clear of West Brom in third.

Coventry strengthened their position in the play-off places with a 1-0 win at struggling Hull. Matty Godden’s ninth-minute header – helped on its way by poor goalkeeping – was enough to earn them three points.

Coventry are fourth in the table and deserved the victory against meek opposition, whose fans demanded at full-time the dismissal of Grant McCann. Hull have won two league games and remain in the relegation zone, having been promoted as champions.

Huddersfield climbed to fifth after Jonathan Hogg’s late header sank Millwall 1-0. The Huddersfield substitute Josh Koroma and Millwall’s Ryan Leonard were booked with five minutes remaining in a row over time-wasting.

Andreas Weimann’s first-half double ended Nigel Pearson’s Ashton Gate nightmare as Bristol City came from behind to beat Barnsley 2-1. The visitors took a 28th-minute lead through Aaron Leya Iseka. The home fans were becoming restless until Weimann thumped the equaliser past Brad Collins on 42 minutes . He then netted his second in first-half stoppage time.

City held on for a first home success in 18 games, stretching back to 26 January – 15 of them under Pearson.

First-half goals from Jake Bidwell, Joel Piroe and Olivier Ntcham handed Swansea a 3-0 win over Peterborough. Ben Brereton Díaz scored twice in the first 20 minutes as Blackburn beat Derby 2-1, Curtis Davies grabbing a late consolation.

Two goals in three second-half minutes from Marc Roberts and Scott Hogan gave Birmingham a 2-0 win at Middlesbrough, in Neil Warnock’s 1,601st match as a manager. Warnock said: “I will still be disappointed when I get home tonight. I will still be horrible to be with sat next to my missus.”

Emil Riis celebrated his new contract at Preston with both goals in the 2-0 defeat of Luton and Keshi Anderson’s late goal secured a 1-0 victory for Blackpool at Sheffield United.