Experiences using a multidisciplinary model for treating injection drug use associated infections: A qualitative study

Background: Over the past two decades, the United States has experienced a dramatic increase in the rate of injection drug use, injection associated infections, and overdose mortality. A hospital-based program for treating opioid use disorder in people who inject drugs presenting with invasive infections was initiated at an academic tertiary care center in 2020. The goal of this program was to improve care outcomes, enhance patient experiences, and facilitate transition from the hospital to longer term addiction care. The purpose of this study was to interview two cohorts of patients, those admitted before vs. after initiation of this program, to understand the program\u27s impact on care from the patient\u27s perspective and explore ways in which the program could be improved. Methods: Thirty patients admitted to the hospital with infectious complications of injection drug use were interviewed using a semi-structured format. Interviews were transcribed and coded. Emergent themes were reported. Limited descriptive statistics were reported based on chart review. Results: Thirty interviews were completed; 16 participants were part of the program (admitted after program implementation) while 14 were not participants (admitted prior to implementation). Common themes associated with hospitalization included inadequate pain control, access to medications for opioid use disorder (MOUD), loss of freedom, stigma from healthcare personnel, and benefits of having an interprofessional team. Participants in the program were more likely to report adequate pain control and access to MOUD and many cited benefits from receiving care from an interprofessional team. Conclusions: Patients with opioid use disorder admitted with injection related infections reported improved experiences when receiving care from an interprofessional team focused on their addiction. However, perceived stigma from healthcare personnel and loss of freedom related to hospitalization were continued barriers to care before and after implementation of this program

Expressions 2006

https://openspace.dmacc.edu/expressions/1041/thumbnail.jp

Geochemistry of hydrothermal fluids from the PACMANUS, Northeast Pual and Vienna Woods hydrothermal fields, Manus Basin, Papua New Guinea

Processes controlling the composition of seafloor hydrothermal fluids in silicic back-arc or near-arc crustal settings remain poorly constrained despite growing evidence for extensive magmatic–hydrothermal activity in such environments. We conducted a survey of vent fluid compositions from two contrasting sites in the Manus back-arc basin, Papua New Guinea, to examine the influence of variations in host rock composition and magmatic inputs (both a function of arc proximity) on hydrothermal fluid chemistry. Fluid samples were collected from felsic-hosted hydrothermal vent fields located on Pual Ridge (PACMANUS and Northeast (NE) Pual) near the active New Britain Arc and a basalt-hosted vent field (Vienna Woods) located farther from the arc on the Manus Spreading Center. Vienna Woods fluids were characterized by relatively uniform endmember temperatures (273–285 °C) and major element compositions, low dissolved CO2 concentrations (4.4 mmol/kg) and high measured pH (4.2–4.9 at 25 °C). Temperatures and compositions were highly variable at PACMANUS/NE Pual and a large, newly discovered vent area (Fenway) was observed to be vigorously venting boiling (358 °C) fluid. All PACMANUS fluids are characterized by negative δDH2O values, in contrast to positive values at Vienna Woods, suggesting substantial magmatic water input to circulating fluids at Pual Ridge. Low measured pH (25 °C) values (∼2.6–2.7), high endmember CO2 (up to 274 mmol/kg) and negative δ34SH2S values (down to −2.7‰) in some vent fluids are also consistent with degassing of acid-volatile species from evolved magma. Dissolved CO2 at PACMANUS is more enriched in 13C (−4.1‰ to −2.3‰) than Vienna Woods (−5.2‰ to −5.7‰), suggesting a contribution of slab-derived carbon. The mobile elements (e.g. Li, K, Rb, Cs and B) are also greatly enriched in PACMANUS fluids reflecting increased abundances in the crust there relative to the Manus Spreading Center. Variations in alkali and dissolved gas abundances with Cl at PACMANUS and NE Pual suggest that phase separation has affected fluid chemistry despite the low temperatures of many vents. In further contrast to Vienna Woods, substantial modification of PACMANUS/NE Pual fluids has taken place as a result of seawater ingress into the upflow zone. Consistently high measured Mg concentrations as well as trends of increasingly non-conservative SO4 behavior, decreasing endmember Ca/Cl and Sr/Cl ratios with increased Mg indicate extensive subsurface anhydrite deposition is occurring as a result of subsurface seawater entrainment. Decreased pH and endmember Fe/Mn ratios in higher Mg fluids indicate that the associated mixing/cooling gives rise to sulfide deposition and secondary acidity production. Several low temperature (⩽80 °C) fluids at PACMANUS/NE Pual also show evidence for anhydrite dissolution and water–rock interaction (fixation of B) subsequent to seawater entrainment. Hence, the evolution of fluid compositions at Pual Ridge reflects the cumulative effects of water/rock interaction, admixing and reaction of fluids exsolved from silicic magma, phase separation/segregation and seawater ingress into upflow zones

CRITERIOS DE SELECCIÓN FINANCIEROS APLICADOS EN EL SECTOR BANCARIO PERUANO A PARTIR DE LAS TASAS DE INTERÉS

En el presente artículo se muestra un análisis acerca de las tasas de interés activas en moneda nacional en el sector bancario peruano para las medianas y pequeñas empresas, porque este tipo de tasa es muy importante para que los empresarios al momento de adquirir un crédito bancario en las entidades financieras de Piura, sepan cuál de ellas les oferta un crédito con interés menos oneroso, teniendo en cuenta que la tasa de interés activa en el sistema bancario, es la lucro que el banco u otra entidad financiera obtiene por el crédito dinerario -u otros productos-que otorga a sus usuarios; para ello, se empleó la investigación cuantitativa, utilizando la entrevista a los empresarios de las pequeñas y medianas empresas – MYPES- que adquirieron crédito bancario. La población estuvo conformada por todas las entidades bancarias de la ciudad de Miguel Grau Seminario. (Tamayo, 1997, la población es estudiada porque todos sus elementos tienen por lo menos una característica común observable en un lugar y en un momento determinado, que se relaciona con el fenómeno objeto de estudios, lo que conlleva al origen de la obtención de los datos de la investigación); en tanto que la muestra estuvo constituida por las entidades bancarias del sector privado que operen sólo en la ciudad de Piura; que tienen como característica común el haber adquirido - alguna vez-, crédito bancario

Fragment-oriented synthesis: β-elaboration of cyclic amine fragments using enecarbamates as platform intermediates

A strategy for the β-sp3 functionalisation of cyclic amines is described. Regioselective conversion of protected amines to enecarbamates is achieved through electrochemical oxidation; these intermediates can be derivatised by functionalised alkyl halides under photoredox catalysis. The potential of the methods is highlighted by direct growth of a DCP2B-binding fragment

Sleeping with the Enemy: How Intracellular Pathogens Cope with a Macrophage Lifestyle

Sleeping with the Enemy: How Intracellular Pathogens Cope with a Macrophage Lifestyl

Different healthy habits between northern and southern Spanish school children

Aim: Healthy habits are influenced by several factors such as, geographical location. The aims of this study were to describe and compare healthy habits within two populations of sixth-grade primary school children (aged 11-12 years) from Northern and Southern Spain. Subject and Methods: A cross-sectional study using two representative samples of school children was conducted. Participants came from Logroño (n=329), in the North and Granada (n=284), in the South of Spain. Socio-demographic and anthropometric variables, adherence to the Mediterranean diet, aerobic fitness, and healthy lifestyles were recorded. Results: Boys reported higher level of physical activity and aerobic fitness than girls (p=0.000). Southern school children reported significantly higher adherence to the Mediterranean diet (♀: p=0.041; ♂: p=0.008), and lower aerobic fitness (♀: p=0.000; ♂: p=0.042) and hours of nightly sleep (♀: p=0.008, ♂: p=0.007) than Northern school children. Southern boys also reported lower levels of physical activity (p=0.013). There were slight or moderate correlations among all habits measured (physical activity, diet, screen and sleep time). Additionally, physical activity level was inversely related to body mass index in Northern boys (p=0.020) and Southern girls (p=0.024). Conclusions: Results showed differences in physical activity, eating and sleep habits, and aerobic fitness, according to geographical location. The relationships found among lifestyle habits indicate the need of health promotion interventions nationally and considering the differences discussed here