Patient Perceptions of Access to Chronic Pain Medications

AbstractThe 2014 Drug Enforcement Administration’s reclassification of hydrocodone combination products caused significant unintentional consequences to patients with chronic pain. Although a few researchers have looked at the problems that resulted immediately following the reclassification, none have as yet repeated their studies, creating a knowledge gap. Additionally, previous researchers have shown that most of the current opioid restricting policies in place today were not created using a strong evidence-based or ethically inclusive approach. The purpose of this study was to assess whether common factors identified as issues impacting care for these patients immediately following the reclassification continue to affect care standards. The study also addressed the need for evidence-based and ethical approaches to the creation of opioid policies. Using a qualitative, phenomenological approach, 12 individual interviews were conducted and analyzed using Giorgi’s phenomenological method, interpretive constructionism, and narrative-based bioethics. Results indicated that new restrictions and heightened provider vigilance associated with the reclassification made appropriate care more difficult to access and subjected participants to shame, stigma, and a reduced quality of life. This study promotes positive social change by providing crucial evidentiary data that may be used in the development of opioid policies that are both more effective and ethically responsible

Process-Based Statistical Models Predict Dynamic Estuarine Salinity

Climate change is increasing variation in freshwater input and the intensity of this variation in estuarine systems throughout the world. Estuarine salinity responds to dynamic meteorological and hydrological processes with important consequences to physical features, such as vertical stratification, as well as living resources, such as the distribution, abundance and diversity of species. We developed and evaluated two space-time statistical models to predict bottom salinity in Pamlico Sound, NC: (i) process and (ii) time models. Both models used 20-years of observed salinity and contained a deterministic component designed to represent four key processes that affect salinity: (1) recent and long-term fresh water influx (FWI) from four rivers, (2) mixing with the ocean through inlets, (3) hurricane incidence, and (4) interactions among these variables. Freshwater discharge and distance from an inlet to the Atlantic Ocean explained the most variance in dynamic salinity. The final process model explained 89% of spatiotemporal variability in salinity in a withheld dataset, whereas the final time model explained 87% of the variability within the same withheld data set. This study provides a methodological template for modeling salinity and other normally-distributed abiotic variables in this lagoonal estuary

Let’s talk about seagrasses! A front-end evaluation to improve messaging strategies for seagrass conservation in Indian River Lagoon visitor centers

In the most recent decades, there has been extensive loss of seagrasses within the Indian River Lagoon estuary on the eastern coast of Florida. This decline poses a significant threat to the ecological function of the ecosystem, as well as to the social and economic wellbeing of the surrounding communities. Stakeholder buy-in and engagement with conservation initiatives is a critical component of lagoon-wide seagrass restoration and management efforts. Visitor centers, such as zoos, aquarium, and nature centers, can play a key role in increasing knowledge of environmental issues and facilitating behavior change among stakeholders. This capstone project included a 2-phase front-end evaluation to provide recommendations for the network of visitor centers within the region to increase messaging impact and buy-in for seagrass conservation efforts. The first phase involved a content analysis conducted at 11 facilities to understand current messaging strategies. The second phase was a visitor survey conducted at Brevard Zoo in Melbourne, Florida that sought to understand visitors’ beliefs and prior knowledge about seagrasses, as well as conduct a pilot-study to compare the impact of various messaging approaches. Combined, these two evaluation efforts helped to inform a set of recommendations to improve future messaging. While this project served as an important first step in improving messaging impact, continued and on-going evaluation efforts will undoubtedly be needed to help leverage the impact of visitor centers in their efforts to help secure a more sustainable future for seagrasses in the Indian River Lagoon

Visualization of lithium-ion transport and phase evolution within and between manganese oxide nanorods.

Multiple lithium-ion transport pathways and local phase changes upon lithiation in silver hollandite are revealed via in situ microscopy including electron diffraction, imaging and spectroscopy, coupled with density functional theory and phase field calculations. We report unexpected inter-nanorod lithium-ion transport, where the reaction fronts and kinetics are maintained within the neighbouring nanorod. Notably, this is the first time-resolved visualization of lithium-ion transport within and between individual nanorods, where the impact of oxygen deficiencies is delineated. Initially, fast lithium-ion transport is observed along the long axis with small net volume change, resulting in two lithiated silver hollandite phases distinguishable by orthorhombic distortion. Subsequently, a slower reaction front is observed, with formation of polyphase lithiated silver hollandite and face-centred-cubic silver metal with substantial volume expansion. These results indicate lithium-ion transport is not confined within a single nanorod and may provide a paradigm shift for one-dimensional tunnelled materials, particularly towards achieving high-rate capability

Targeting fibroblast activation protein in tumor stroma with chimeric antigen receptor T cells can inhibit tumor growth and augment host immunity without severe toxicity.

The majority of chimeric antigen receptor (CAR) T-cell research has focused on attacking cancer cells. Here, we show that targeting the tumor-promoting, nontransformed stromal cells using CAR T cells may offer several advantages. We developed a retroviral CAR construct specific for the mouse fibroblast activation protein (FAP), comprising a single-chain Fv FAP [monoclonal antibody (mAb) 73.3] with the CD8α hinge and transmembrane regions, and the human CD3ζ and 4-1BB activation domains. The transduced muFAP-CAR mouse T cells secreted IFN-γ and killed FAP-expressing 3T3 target cells specifically. Adoptively transferred 73.3-FAP-CAR mouse T cells selectively reduced FAP(hi) stromal cells and inhibited the growth of multiple types of subcutaneously transplanted tumors in wild-type, but not FAP-null immune-competent syngeneic mice. The antitumor effects could be augmented by multiple injections of the CAR T cells, by using CAR T cells with a deficiency in diacylglycerol kinase, or by combination with a vaccine. A major mechanism of action of the muFAP-CAR T cells was the augmentation of the endogenous CD8(+) T-cell antitumor responses. Off-tumor toxicity in our models was minimal following muFAP-CAR T-cell therapy. In summary, inhibiting tumor growth by targeting tumor stroma with adoptively transferred CAR T cells directed to FAP can be safe and effective, suggesting that further clinical development of anti-human FAP-CAR is warranted

Analysis of a STEM Education Professional Development Conference for Pre-service Educators

Science, technology, engineering, and mathematics (STEM) disciplines are attracting increased attention in education. The iSTEM 2017 conference was a professional development program designed to acquaint pre-service teachers with interdisciplinary, research-based STEM instructional strategies that can transform traditional classroom instruction into dynamic learning environments. The STEM Education Scholars (STEMES) is a Learning Community of Practice, housed in the College of Education, at a midsized mid-western public research university. The program of study focused on designing a professional development program for future Pre-K12 teachers. The iSTEM 2017 conference presented by the STEMES Community of Practice sought to inform pre-service teachers of STEM pedagogy, and focused on innovative classroom resources, hands-on learning and increasing content confidence when incorporating STEM into classroom instruction. iSTEM 2017 was held in February, 2017, and offered twenty refereed presentations and workshop sessions, a keynote address, and a closing session to over 200 pre-service teachers. Conference participants chose sessions, participated in game-like experiences and shared their learning with each other as well as with conference organizers. Results from participant self-reported surveys were analyzed to measure the impact of the conference on improving participants’ confidence in teaching STEM topics, and their attitudes about the instructional methods. These results were added to the conference proceedings, which also contain documentation of each iSTEM 2017 session. Findings suggest that the iSTEM 2017 conference had an overall positive impact on participants’ familiarity with STEM education, their belief in the importance of STEM education, and their confidence to integrate STEM education into future instructional practices

The natural history of thin melanoma and the utility of sentinel lymph node biopsy

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/141184/1/jso24765_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/141184/2/jso24765.pd

Strategies for Recruiting Migrants to Participate in a Sexual Health Survey: Methods, Results, and Lessons

In this article, we describe the approaches taken to recruit adult migrants living in Australia for a sexual health and blood-borne virus survey (paper and online) and present data detailing the outcomes of these approaches. The purpose was to offer guidance to redress the under-representation of migrants in public health research. Methods of recruitment included directly contacting people in individual/organizational networks, social media posts/advertising, promotion on websites, and face-to-face recruitment at public events/venues. Search query strings were used to provide information about an online referral source, and project officers kept records of activities and outcomes. Descriptive statistical analyses were used to determine respondent demographic characteristics, proportions recruited to complete the paper and online surveys, and sources of referral. Logistic regression analyses were run to predict online participation according to demographic characteristics. The total sample comprised 1454 African and Asian migrants, with 59% identifying as female. Most respondents (72%) were recruited to complete the paper version of the survey. Face-to-face invitations resulted in the highest number of completions. Facebook advertising did not recruit large numbers of respondents. Same-sex attraction and age (40–49 years) were statistically significant predictors of online completion. We encourage more researchers to build the evidence base on ways to produce research that reflects the needs and perspectives of minority populations who often bear the greatest burden of disease

Clinical efficacy and immune regulation with peanut oral immunotherapy

Background Oral immunotherapy (OIT) has been thought to induce clinical desensitization to allergenic foods, but trials coupling the clinical response and immunologic effects of peanut OIT have not been reported. Objective The study objective was to investigate the clinical efficacy and immunologic changes associated with OIT. Methods Children with peanut allergy underwent an OIT protocol including initial day escalation, buildup, and maintenance phases, and then oral food challenge. Clinical response and immunologic changes were evaluated. Results Of 29 subjects who completed the protocol, 27 ingested 3.9 g peanut protein during food challenge. Most symptoms noted during OIT resolved spontaneously or with antihistamines. By 6 months, titrated skin prick tests and activation of basophils significantly declined. Peanut-specific IgE decreased by 12 to 18 months, whereas IgG4 increased significantly. Serum factors inhibited IgE–peanut complex formation in an IgE-facilitated allergen binding assay. Secretion of IL-10, IL-5, IFN-γ, and TNF-α from PBMCs increased over a period of 6 to 12 months. Peanut-specific forkhead box protein 3 T cells increased until 12 months and decreased thereafter. In addition, T-cell microarrays showed downregulation of genes in apoptotic pathways. Conclusion Oral immunotherapy induces clinical desensitization to peanut, with significant longer-term humoral and cellular changes. Microarray data suggest a novel role for apoptosis in OIT

ER Stress Induces Anabolic Resistance in Muscle Cells through PKB-Induced Blockade of mTORC1

Anabolic resistance is the inability to increase protein synthesis in response to an increase in amino acids following a meal. One potential mediator of anabolic resistance is endoplasmic reticulum (ER) stress. The purpose of the present study was to test whether ER stress impairs the response to growth factors and leucine in muscle cells