Somewhere to Go: Implementing Medication-Based Treatment for Opioid Use Disorders in Rural Maryland and beyond

Treatment for opioid use disorders is highly effective yet unavailable in many rural areas. “Somewhere to Go: Ensuring Access to Medication-Assisted Treatment in Rural Maryland” is a Robert Wood Johnson Funded Clinical Scholars project intended to expand the use of tele-health medication-based treatment for opioid use disorders services directly to rural areas in need. We demonstrated that a University-based substance use treatment team can successfully collaborate with a geographically distant rural substance use treatment clinic to provide medication-based treatment for opioid use disorders using a HIPPA compliant telehealth strategy. We provide an overview of the implementation strategies our team used to expand overall access in different locales throughout the State of Maryland and beyond. We describe implementation results of a tele-health medication-based treatment program for opioid use disorders that focuses on implementation successes and how to identify and overcome implementation challenges and barriers. Implementation of a telemedicine approach can be challenging, but careful consideration and forethought can map a successful path to program development, operation and sustainability

The effect of age on outcomes of coronary artery bypass surgery compared with balloon angioplasty or bare-metal stent implantation among patients with multivessel coronary disease. A collaborative analysis of individual patient data from 10 randomized trials.

OBJECTIVES: This study sought to assess whether patient age modifies the comparative effectiveness of coronary artery bypass graft (CABG) surgery and percutaneous coronary intervention (PCI). BACKGROUND: Increasingly, CABG and PCI are performed in older patients to treat multivessel disease, but their comparative effectiveness is uncertain. METHODS: Individual data from 7,812 patients randomized in 1 of 10 clinical trials of CABG or PCI were pooled. Age was analyzed as a continuous variable in the primary analysis and was divided into tertiles for descriptive purposes (≤56.2 years, 56.3 to 65.1 years, ≥65.2 years). The outcomes assessed were death, myocardial infarction and repeat revascularization over complete follow-up, and angina at 1 year. RESULTS: Older patients were more likely to have hypertension, diabetes, and 3-vessel disease compared with younger patients (p < 0.001 for trend). Over a median follow-up of 5.9 years, the effect of CABG versus PCI on mortality varied according to age (interaction p < 0.01), with adjusted CABG-to-PCI hazard ratios and 95% confidence intervals (CI) of 1.23 (95% CI: 0.95 to 1.59) in the youngest tertile; 0.89 (95% CI: 0.73 to 1.10) in the middle tertile; and 0.79 (95% CI: 0.67 to 0.94) in the oldest tertile. The CABG-to-PCI hazard ratio of less than 1 for patients 59 years of age and older. A similar interaction of age with treatment was present for the composite outcome of death or myocardial infarction. In contrast, patient age did not alter the comparative effectiveness of CABG and PCI on the outcomes of repeat revascularization or angina. CONCLUSIONS: Patient age modifies the comparative effectiveness of CABG and PCI on hard cardiac events, with CABG favored at older ages and PCI favored at younger ages

Effectiveness of Interventions to Reduce Contact Rates during a Simulated Influenza Pandemic

Measures to decrease contact between persons during an influenza pandemic have been included in pandemic response plans. We used stochastic simulation models to explore the effects of school closings, voluntary confinements of ill persons and their household contacts, and reductions in contacts among long-term care facility (LTCF) residents on pandemic-related illness and deaths. Our findings suggest that school closings would not have a substantial effect on pandemic-related outcomes in the absence of measures to reduce out-of-school contacts. However, if persons with influenzalike symptoms and their household contacts were encouraged to stay home, then rates of illness and death might be reduced by ≈50%. By preventing ill LTCF residents from making contact with other residents, illness and deaths in this vulnerable population might be reduced by ≈60%. Restricting the activities of infected persons early in a pandemic could decrease negative health impact

The Enigmatic Young Low-Mass Variable TWA 30

TWA 30 is a remarkable young (7+/-3 Myr), low-mass (0.12+/-0.04 Msun), late-type star (M5+/-1) residing 42+/-2 pc away from the sun in the TW Hydrae Association. It shows strong outflow spectral signatures such as [S II], [O I], [O II], [O III], and Mg I], while exhibiting weak Halpha emission (-6.8+/-1.2 Angstroms). Emission lines of [S II] and [O I] are common to T Tauri stars still residing in their natal molecular clouds, while [O III] and Mg I] emission lines are incredibly rare in this same population; in the case of TWA 30, these latter lines may arise from new outflow material colliding into older outflow fronts. The weak Halpha emission and small radial velocity shifts of line emission relative to the stellar frame of rest (generally <=10 km/s) suggest that the disk is viewed close to edge-on and that the stellar axis may be inclined to the disk, similar to the AA Tau system, based on its temporal changes in emission/absorption line strengths/profiles and variable reddening (A_V=1.5-9.0). The strong Li absorption (0.61+/-0.13 Angstroms) and common kinematics with members of the TWA confirm its age and membership to the association. Given the properties of this system such as its proximity, low mass, remarkable outflow signatures, variability, and edge-on configuration, this system is a unique case study at a critical time in disk evolution and planet-building processes.Comment: ApJ in press, 51 pages, 8 tables, 12 figures; converted to preprint style since emulateapj version cut off Tables 4-

Human Proteome Project Mass Spectrometry Data Interpretation Guidelines 3.0

The Human Proteome Organization’s (HUPO) Human Proteome Project (HPP) developed Mass Spectrometry (MS) Data Interpretation Guidelines that have been applied since 2016. These guidelines have helped ensure that the emerging draft of the complete human proteome is highly accurate and with low numbers of false-positive protein identifications. Here, we describe an update to these guidelines based on consensus-reaching discussions with the wider HPP community over the past year. The revised 3.0 guidelines address several major and minor identified gaps. We have added guidelines for emerging data independent acquisition (DIA) MS workflows and for use of the new Universal Spectrum Identifier (USI) system being developed by the HUPO Proteomics Standards Initiative (PSI). In addition, we discuss updates to the standard HPP pipeline for collecting MS evidence for all proteins in the HPP, including refinements to minimum evidence. We present a new plan for incorporating MassIVE-KB into the HPP pipeline for the next (HPP 2020) cycle in order to obtain more comprehensive coverage of public MS data sets. The main checklist has been reorganized under headings and subitems, and related guidelines have been grouped. In sum, Version 2.1 of the HPP MS Data Interpretation Guidelines has served well, and this timely update to version 3.0 will aid the HPP as it approaches its goal of collecting and curating MS evidence of translation and expression for all predicted ∼20 000 human proteins encoded by the human genome.This work was funded in part by the National Institutes of Health grants R01GM087221 (EWD/RLM), R24GM127667 (EWD), U54EB020406 (EWD), R01HL133135 (RLM), U19AG02312 (RLM), U54ES017885 (GSO), U24CA210967-01 (GSO), R01LM013115 (NB) and P41GM103484 (NB); National Science Foundation grants ABI-1759980 (NB), DBI-1933311 (EWD), and IOS-1922871 (EWD); Canadian Institutes of Health Research 148408 (CMO); Korean Ministry of Health and Welfare HI13C2098 (YKP); French Ministry of Higher Education, Research and Innovation, ProFI project, ANR-10-INBS-08 (YV); also in part by the National Eye Institute (NEI), National Human Genome Research Institute (NHGRI), National Heart, Lung, and Blood Institute (NHLBI), National Institute of Allergy and Infectious Diseases (NIAID), National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institute of General Medical Sciences (NIGMS), and National Institute of Mental Health (NIMH) of the National Institutes of Health under Award Number U24HG007822 (SO) (the content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health)

Guillain-Barré Syndrome, Influenza Vaccination, and Antecedent Respiratory and Gastrointestinal Infections: A Case-Centered Analysis in the Vaccine Safety Datalink, 2009–2011

Background: Guillain-Barré Syndrome (GBS) can be triggered by gastrointestinal or respiratory infections, including influenza. During the 2009 influenza A (H1N1) pandemic in the United States, monovalent inactivated influenza vaccine (MIV) availability coincided with high rates of wildtype influenza infections. Several prior studies suggested an elevated GBS risk following MIV, but adjustment for antecedent infection was limited. Methods: We identified patients enrolled in health plans participating in the Vaccine Safety Datalink and diagnosed with GBS from July 2009 through June 2011. Medical records of GBS cases with 2009–10 MIV, 2010–11 trivalent inactivated influenza vaccine (TIV), and/or a medically-attended respiratory or gastrointestinal infection in the 1 through 141 days prior to GBS diagnosis were reviewed and classified according to Brighton Collaboration criteria for diagnostic certainty. Using a case-centered design, logistic regression models adjusted for patient-level time-varying sources of confounding, including seasonal vaccinations and infections in GBS cases and population-level controls. Results: Eighteen confirmed GBS cases received vaccination in the 6 weeks preceding onset, among 1.27 million 2009–10 MIV recipients and 2.80 million 2010–11 TIV recipients. Forty-four confirmed GBS cases had infection in the 6 weeks preceding onset, among 3.77 million patients diagnosed with medically-attended infection. The observed-versus-expected odds that 2009–10 MIV/2010–11 TIV was received in the 6 weeks preceding GBS onset was odds ratio = 1.54, 95% confidence interval (CI), 0.59–3.99; risk difference = 0.93 per million doses, 95% CI, −0.71–5.16. The association between GBS and medically-attended infection was: odds ratio = 7.73, 95% CI, 3.60–16.61; risk difference = 11.62 per million infected patients, 95% CI, 4.49–26.94. These findings were consistent in sensitivity analyses using alternative infection definitions and risk intervals for prior vaccination shorter than 6 weeks. Conclusions: After adjusting for antecedent infections, we found no evidence for an elevated GBS risk following 2009–10 MIV/2010–11 TIV influenza vaccines. However, the association between GBS and antecedent infection was strongly elevated

Inducing behavioural change in society through communication and education in sustainable manufacturing

The United Nations considers the mobilization of the broad public to be the essential requirement for achieving a shift towards a more sustainable development. Science can play a vital role in Education for Sustainable Development (ESD) by contributing to ESD-related research and development on the one hand, and by becoming active awareness raisers themselves in education and multiplier networks. Specifically, the use of special Learnstruments, and investment inOpen Educationformats among other educational tools, may pave the way for accelerated apprehension and appreciation of sustainable manufacturing topics among the greater populace