Evaluation of a Peer Mentor Program on Adult Heroin Overdose Patients in the Emergency Department

Abstract PURPOSE: According to the Centers for Disease Control and Prevention (CDC), the rate of heroin use and heroin overdoses has greatly increased in the last decade, regardless of sex, age, race or income. The emergency department (ED) is a common place heroin users present, often as an overdose or due to a complication from their drug use. To address the current opioid epidemic, the CDC calls for increased access to substance abuse treatment services. Peer Mentors placed in the ED serve as a link for the patient to recovery services. The purpose of this study is to evaluate the effectiveness of a Peer Mentor Program on adult patients who overdosed on or admitted to using heroin at the time of ED presentation. METHODS: This descriptive single-center study used convenience sampling and a retrospective chart review of patients who consulted with a Peer Mentor. Data were obtained through the Peer Mentor Documentation Sheet, electronic health record chart review, and data extraction from the healthcare system’s data analytics team. RESULTS: Nine patients were seen by Peer Mentors from June through September 2018, two of whom met all inclusion criteria. No patients went directly from the ED to the treatment service center. The healthcare system’s data analytics team compared the patient population of heroin-related ED visits from the same time period; no statistically significant difference (p\u3c0.05) was noted among patient demographics, date and time of ED arrival, ED disposition, and 30-day ED readmit. CONCLUSION: Clinically significant outcomes include identification of the patient population demographics and recognition of the most common days and times where Peer Mentors should be available to engage the majority of patients. Further research is needed to determine the most optimal location and time to present options for substance abuse treatment services

Embracing Social Media for Stakeholder Management within NPOs – A Case Study

Social media became highly popular over the last fifteen years since the introduction of Web 2.0 and is now used as a successful marketing and communication tool by many companies. The benefits include the cheap, easy and instantaneous posting of messages and the incomparable coverage of various platforms as well as smart features, like the promotion of events on Facebook. Hence, the embedding of social media into the overall business strategy is a great chance to achieve a better performance in terms of stakeholder management. This is especially promising for small- and medium-sized non-profit organizations (NPOs), who do not have the resources to invest in more expensive forms of marketing or stakeholder management. Nevertheless, companies often struggle with the implementation of social media strategies, especially due to the spread of diverse platforms and the lack of resources to maintain the accounts. This paper asks how small- and medium-sized NPOs can use social media to achieve stakeholder commitment. A study using a mixed-method approach was conducted in cooperation with a voluntary organization of the Catholic Church sector in Germany, called KjG Diözesanverband Essen. The study captured information on KjG’s stakeholders’ use and preferences of popular social media platforms. Interviews were conducted with the organization’s key stakeholders to examine the existing social media and stakeholder strategy. The results of 139 questionnaires and five interviews revealed important stakeholders’ usage patterns of social media platforms and the top-ranked ones for receiving information, which makes them highly interesting for stakeholder communication. A framework was designed to support NPOs with the strategic use of social media for stakeholder management

Concurrent whole brain radiotherapy and bortezomib for brain metastasis

Abstract Background Survival of patients with brain metastasis particularly from historically more radio-resistant malignancies remains dismal. A phase I study of concurrent bortezomib and whole brain radiotherapy was conducted to determine the tolerance and safety of this approach in patients with previously untreated brain metastasis. Methods A phase I dose escalation study evaluated the safety of bortezomib (0.9, 1.1, 1.3, 1.5, and 1.7 mg/m2) given on days 1, 4, 8 and 11 of whole brain radiotherapy. Patients with confirmed brain metastasis were recruited for participation. The primary endpoint was the dose-limiting toxicity, defined as any ≥ grade 3 non-hematologic toxicity or grade ≥ 4 hematologic toxicity from the start of treatment to one month post irradiation. Time-to-Event Continual Reassessment Method (TITE-CRM) was used to determine dose escalation. A companion study of brain diffusion tensor imaging MRI was conducted on a subset of patients to assess changes in the brain that might predict delayed cognitive effects. Results Twenty-four patients were recruited and completed the planned therapy. Patients with melanoma accounted for 83% of all participants. The bortezomib dose was escalated as planned to the highest dose of 1.7 mg/m2/dose. No grade 4/5 toxicities related to treatment were observed. Two patients had grade 3 dose-limiting toxicities (hyponatremia and encephalopathy). A partial or minor response was observed in 38% of patients. Bortezomib showed greater demyelination in hippocampus-associated white matter structures on MRI one month after radiotherapy compared to patients not treated with bortezomib (increase in radial diffusivity +16.8% versus 4.8%; p = 0.0023). Conclusions Concurrent bortezomib and whole brain irradiation for brain metastasis is well tolerated at one month follow-up, but MRI changes that have been shown to predict delayed cognitive function can be detected within one month of treatment.http://deepblue.lib.umich.edu/bitstream/2027.42/112849/1/13014_2013_Article_928.pd

Early phase clinical trials extension to the guidelines for the content of statistical analysis plans

This paper reports guidelines for the content of statistical analysis plans for early phase clinical trials, ensuring specification of the minimum reporting analysis requirements, by detailing extensions (11 new items) and modifications (25 items) to existing guidance after a review by various stakeholders

Genomic diversity of the human pathogen Paracoccidioides across the South American continent

Paracoccidioidomycosis (PCM) is a life-threatening systemic mycosis widely reported in the Gran Chaco ecosystem. The disease is caused by different species from the genus Paracoccidioides, which are all endemic to South and Central America. Here, we sequenced and analyzed 31 isolates of Paracoccidioides across South America, with particular focus on isolates from Argentina and Paraguay. The de novo sequenced isolates were compared with publicly available genomes. Phylogenetics and population genomics revealed that PCM in Argentina and Paraguay is caused by three distinct Paracoccidioides genotypes, P. brasiliensis (S1a and S1b) and P. restrepiensis (PS3). P. brasiliensis S1a isolates from Argentina are frequently associated with chronic forms of the disease. Our results suggest the existence of extensive molecular polymorphism among Paracoccidioides species, and provide a framework to begin to dissect the connection between genotypic differences in the pathogen and the clinical outcomes of the disease.Fil: Teixeira, Marcus de Melo. Universidade do Brasília; BrasilFil: Cattana, Maria Emilia. Universidad Nacional del Nordeste. Instituto de Medicina Regional; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Nordeste; ArgentinaFil: Matute, Daniel R.. University of North Carolina; Estados UnidosFil: Muñoz, José F.. Broad Institute Of Mit And Harvard; Estados UnidosFil: Arechavala, Alicia. Hospital Francisco J Muñiz; ArgentinaFil: Isbell, Kristin. University of North Carolina; Estados UnidosFil: Schipper, Rafael. Universidade do Brasília; BrasilFil: Santiso, Gabriela Maria. Gobierno de la Ciudad de Buenos Aires. Hospital de Infecciosas "Dr. Francisco Javier Muñiz"; ArgentinaFil: Tracogna, Fernanda. Gobierno de la Provincia de Chaco. Hospital Julio Cecilio Perrando.; ArgentinaFil: Sosa, María de los Ángeles. Universidad Nacional del Nordeste. Instituto de Medicina Regional; ArgentinaFil: Cech, Norma. Hospital 4 de Junio; ArgentinaFil: Alvarado, Primavera. Instituto de Biomedicina Dr. Jacinto Convit; VenezuelaFil: Barreto, Laura. Instituto Superior de Formación Docente Salome Ureña; República DominicanaFil: Chacón, Yone. Provincia de Salta. Ministerio de Salud Pública. Hospital del Milagro; ArgentinaFil: Ortellado, Juana. Universidad Nacional de Asunción; ParaguayFil: Lima, Cleoni Mendes de. Universidade Federal de Rondonia; BrasilFil: Chang, Marilene Rodrigues. Universidade Federal do Mato Grosso do Sul; BrasilFil: Niño Vega, Gustavo. Universidad de Guanajuato; MéxicoFil: Yasuda, Maria Aparecida Shikanai. Universidade de Sao Paulo; BrasilFil: Felipe, Maria Sueli Soares. Universidade Catolica de Brasilia; BrasilFil: Negroni, Ricardo. Gobierno de la Ciudad de Buenos Aires. Hospital de Infecciosas "Dr. Francisco Javier Muñiz"; ArgentinaFil: Cuomo, Christina A.. Broad Institute of MIT And Harvard; Estados UnidosFil: Barker, Bridget. Tgen Northern Arizona University; Estados UnidosFil: Giusiano, Gustavo Emilio. Universidad Nacional del Nordeste. Instituto de Medicina Regional; Argentina. Universidad Nacional del Nordeste. Facultad de Medicina; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Nordeste; Argentin

A Novel Metagenomic Short-Chain Dehydrogenase/Reductase Attenuates Pseudomonas aeruginosa Biofilm Formation and Virulence on Caenorhabditis elegans

In Pseudomonas aeruginosa, the expression of a number of virulence factors, as well as biofilm formation, are controlled by quorum sensing (QS). N-Acylhomoserine lactones (AHLs) are an important class of signaling molecules involved in bacterial QS and in many pathogenic bacteria infection and host colonization are AHL-dependent. The AHL signaling molecules are subject to inactivation mainly by hydrolases (Enzyme Commission class number EC 3) (i.e. N-acyl-homoserine lactonases and N-acyl-homoserine-lactone acylases). Only little is known on quorum quenching mechanisms of oxidoreductases (EC 1). Here we report on the identification and structural characterization of the first NADP-dependent short-chain dehydrogenase/reductase (SDR) involved in inactivation of N-(3-oxo-dodecanoyl)-L-homoserine lactone (3-oxo-C12-HSL) and derived from a metagenome library. The corresponding gene was isolated from a soil metagenome and designated bpiB09. Heterologous expression and crystallographic studies established BpiB09 as an NADP-dependent reductase. Although AHLs are probably not the native substrate of this metagenome-derived enzyme, its expression in P. aeruginosa PAO1 resulted in significantly reduced pyocyanin production, decreased motility, poor biofilm formation and absent paralysis of Caenorhabditis elegans. Furthermore, a genome-wide transcriptome study suggested that the level of lasI and rhlI transcription together with 36 well known QS regulated genes was significantly (≥10-fold) affected in P. aeruginosa strains expressing the bpiB09 gene in pBBR1MCS-5. Thus AHL oxidoreductases could be considered as potent tools for the development of quorum quenching strategies

Sporangiospore Size Dimorphism Is Linked to Virulence of Mucor circinelloides

Mucor circinelloides is a zygomycete fungus and an emerging opportunistic pathogen in immunocompromised patients, especially transplant recipients and in some cases otherwise healthy individuals. We have discovered a novel example of size dimorphism linked to virulence. M. circinelloides is a heterothallic fungus: (+) sex allele encodes SexP and (−) sex allele SexM, both of which are HMG domain protein sex determinants. M. circinelloides f. lusitanicus (Mcl) (−) mating type isolates produce larger asexual sporangiospores that are more virulent in the wax moth host compared to (+) isolates that produce smaller less virulent sporangiospores. The larger sporangiospores germinate inside and lyse macrophages, whereas the smaller sporangiospores do not. sexMΔ mutants are sterile and still produce larger virulent sporangiospores, suggesting that either the sex locus is not involved in virulence/spore size or the sexP allele plays an inhibitory role. Phylogenetic analysis supports that at least three extant subspecies populate the M. circinelloides complex in nature: Mcl, M. circinelloides f. griseocyanus, and M. circinelloides f. circinelloides (Mcc). Mcc was found to be more prevalent among clinical Mucor isolates, and more virulent than Mcl in a diabetic murine model in contrast to the wax moth host. The M. circinelloides sex locus encodes an HMG domain protein (SexP for plus and SexM for minus mating types) flanked by genes encoding triose phosphate transporter (TPT) and RNA helicase homologs. The borders of the sex locus between the three subspecies differ: the Mcg sex locus includes the promoters of both the TPT and the RNA helicase genes, whereas the Mcl and Mcc sex locus includes only the TPT gene promoter. Mating between subspecies was restricted compared to mating within subspecies. These findings demonstrate that spore size dimorphism is linked to virulence of M. circinelloides species and that plasticity of the sex locus and adaptations in pathogenicity have occurred during speciation of the M. circinelloides complex

Evaluating expert-based habitat suitability information of terrestrial mammals with GPS-tracking data

Aim Macroecological studies that require habitat suitability data for many species often derive this information from expert opinion. However, expert-based information is inherently subjective and thus prone to errors. The increasing availability of GPS tracking data offers opportunities to evaluate and supplement expert-based information with detailed empirical evidence. Here, we compared expert-based habitat suitability information from the International Union for Conservation of Nature (IUCN) with habitat suitability information derived from GPS-tracking data of 1,498 individuals from 49 mammal species. Location Worldwide. Time period 1998-2021. Major taxa studied Forty-nine terrestrial mammal species. Methods Using GPS data, we estimated two measures of habitat suitability for each individual animal: proportional habitat use (proportion of GPS locations within a habitat type), and selection ratio (habitat use relative to its availability). For each individual we then evaluated whether the GPS-based habitat suitability measures were in agreement with the IUCN data. To that end, we calculated the probability that the ranking of empirical habitat suitability measures was in agreement with IUCN's classification into suitable, marginal and unsuitable habitat types. Results IUCN habitat suitability data were in accordance with the GPS data (> 95% probability of agreement) for 33 out of 49 species based on proportional habitat use estimates and for 25 out of 49 species based on selection ratios. In addition, 37 and 34 species had a > 50% probability of agreement based on proportional habitat use and selection ratios, respectively. Main conclusions We show how GPS-tracking data can be used to evaluate IUCN habitat suitability data. Our findings indicate that for the majority of species included in this study, it is appropriate to use IUCN habitat suitability data in macroecological studies. Furthermore, we show that GPS-tracking data can be used to identify and prioritize species and habitat types for re-evaluation of IUCN habitat suitability data