Opioid Overdose Prevention in Family Medicine Clerkships: A CERA Study

BACKGROUND AND OBJECTIVES: The national opioid crisis requires medical education to develop a proactive response centering on prevention and treatment. Primary care providers (PCPs)—many of whom are family medicine physicians—commonly treat patients on opiates, and write nearly 50% of opioid prescriptions. Despite linkages between PCP opioid prescribing patterns and the associated potential for overdose, little is known about how family medicine clerkship students are trained to prevent opioid overdose, including training on the use of naloxone. This study describes the presence of opioid overdose education at the national level and barriers to inclusion. It also discusses implementation strategies along with instructional methodology and learner evaluation. METHODS: Data were collected as part of a cross-sectional survey administered electronically by the Council of Academic Family Medicine Educational Research Alliance to 139 family medicine clerkship directors. RESULTS: A total of 99 clerkship directors (71.2% response rate) responded to the survey. A large majority (86.4%) agreed that it is important to offer opioid overdose prevention education in the clerkship, yet only 25.8% include this topic. Of these, only 50.0% address naloxone use. The most common barriers to including opioid overdose prevention education were prioritization of educational topics (82.1%) followed by lack of available faculty with sufficient experience/expertise (67.7%). CONCLUSIONS: Findings point to a disparity between perceived importance of opioid overdose prevention education and inclusion of this topic in family medicine clerkship-level medical education. Innovative use of online education and partnering with community resources may address barriers related to curricular prioritization while supporting interprofessional education principles

Willingness to Use a Wearable Device Capable of Detecting and Reversing Overdose Among People Who Use Opioids in Philadelphia

Background: The incidence of opioid-related overdose deaths has been rising for 30 years and has been further exacerbated amidst the COVID-19 pandemic. Naloxone can reverse opioid overdose, lower death rates, and enable a transition to medication for opioid use disorder. Though current formulations for community use of naloxone have been shown to be safe and effective public health interventions, they rely on bystander presence. We sought to understand the preferences and minimum necessary conditions for wearing a device capable of sensing and reversing opioid overdose among people who regularly use opioids. Methods: We conducted a combined cross-sectional survey and semi-structured interview at a respite center, shelter, and syringe exchange drop-in program in Philadelphia, Pennsylvania, USA during the COVID-19 pandemic in August and September 2020. The primary aim was to explore the proportion of participants who would use a wearable device to detect and reverse overdose. Preferences regarding designs and functionalities were collected via a questionnaire with items having Likert-based response options and a semi-structured interview intended to elicit feedback on prototype designs. Independent variables included demographics, opioid use habits, and previous experience with overdose. Results: A total of 97 adults with an opioid-use history of at least 3 months were interviewed. A majority of survey participants (76%) reported a willingness to use a device capable of detecting an overdose and automatically administering a reversal agent upon initial survey. When reflecting on the prototype, most respondents (75.5%) reported that they would wear the device always or most of the time. Respondents indicated discreetness and comfort as important factors that increased their chance of uptake. Respondents suggested that people experiencing homelessness and those with low tolerance for opioids would be in greatest need of the device. Conclusions: The majority of people sampled with a history of opioid use in an urban setting were interested in having access to a device capable of detecting and reversing an opioid overdose. Participants emphasized privacy and comfort as the most important factors influencing their willingness to use such a device. Trial Registration: NCT0453059

Rare meteorites common in the Ordovician period

© 2017 Macmillan Publishers Limited, part of Springer Nature. All rights reserved. Most meteorites that fall today are H and L type ordinary chondrites, yet the main belt asteroids best positioned to deliver meteorites are LL chondrites 1,2. This suggests that the current meteorite flux is dominated by fragments from recent asteroid breakup events 3,4 and therefore is not representative over longer (100-Myr) timescales. Here we present the first reconstruction of the composition of the background meteorite flux to Earth on such timescales. From limestone that formed about one million years before the breakup of the L-chondrite parent body 466 Myr ago, we have recovered relict minerals from coarse micrometeorites. By elemental and oxygen-isotopic analyses, we show that before 466 Myr ago, achondrites from different asteroidal sources had similar or higher abundances than ordinary chondrites. The primitive achondrites, such as lodranites and acapulcoites, together with related ungrouped achondrites, made up ∼15-34% of the flux compared with only ∼0.45% today. Another group of abundant achondrites may be linked to a 500-km cratering event on (4) Vesta that filled the inner main belt with basaltic fragments a billion years ago 5. Our data show that the meteorite flux has varied over geological time as asteroid disruptions create new fragment populations that then slowly fade away from collisional and dynamical evolution. The current flux favours disruption events that are larger, younger and/or highly efficient at delivering material to Earth

Сенсибилизация к аллергенам клещей домашней пыли у детей

ДЫХАТЕЛЬНАЯ ГИПЕРЧУВСТВИТЕЛЬНОСТЬАЛЛЕРГОЗЫ РЕСПИРАТОРНЫЕГИПЕРСЕНСИБИЛИЗАЦИЯ РЕСПИРАТОРНАЯРЕСПИРАТОРНАЯ АЛЛЕРГИЯАЛЛЕРГЕНЫКЛЕЩИ ПЫЛЕВЫЕ ДОМАШНИЕDERMATOPHAGOIDES PTERONYSSINUSDERMATOPHAGOIDES FARINAEСЕНСИБИЛИЗАЦИЯ БИОЛОГИЧЕСКАЯСЕНСИБИЛИЗАЦИЯ К АЛЛЕРГЕНАМДЕТИОБЗОР ЛИТЕРАТУРЫАллергические заболевания представляют серьезную проблему современной медицины. Сенсибилизация к ингаляционным аллергенам является одним из ключевых факторов формирования респираторных аллергозов. Среди аэроаллергенов важное значение играют аллергенные компоненты домашней пыли – клещи Dermatophagoides pteronyssinus и Dermatophagoides farinae, составляющие до 90% акарофауны жилых помещений. В формировании сенсибилизации к клещам домашней пыли также предполагается роль индивидуальных источников аллергенов. Сенсибилизация к мажорным компонентам аллергена клещей домашней пыли ассоциируется с риском развития бронхиальной астмы, к минорным (Der p 10) – риском развития перекрестных реакций с тропомиозином других беспозвоночных, тропомиозином человека. Аллергены клещей домашней пыли (Der p 2 и Der f 2) могут быть ответственны за симптомы оральной клещевой анафилаксии, а также способствовать развитию сенсибилизации к бактериальным антигенам Staphylococcus aureus и Escherichia coli. В 1 части статьи изложены биология и источники клеща домашней пыли. Представлена классификация аллергенов, пути сенсибилизации и распространенность сенсибилизации к клещу домашней пыли у детей.Allergic diseases are a serious problem in modern medicine. Sensitization to inhalation allergens is one of the key factors in the formation of respiratory allergoses. Among aeroallergens, allergenic components of domestic dust play an important role – mites Dermatophagoides pteronyssinus and Dermatophagoides farinae, that make up to 90% of the acarofauna of residential premises. In the formation of sensitization to domestic dust mites, the role of individual sources of allergens is also considered. Sensitization to the major components of the domestic dust mite allergens is associated with the risk of developing bronchial asthma, to minor ones (Der p 10) – the risk of cross-reactions with tropomyosin of other invertebrates, human tropomyosin. Domestic dust mite allergens (Der p 2 and Der f 2) may be responsible for the symptoms of oral tick-born anaphylaxis as well as for the development of sensitization to bacterial antigens of Staphylococcus aureus and Escherichia coli. Part 1 of this article outlines biology and sources of the domestic dust mite. The classification of allergens, sensitization pathways and the prevalence of sensitization to domestic dust mite in children are presented

Patient perceptions of glucocorticoids in anti-neutrophil cytoplasmic antibody-associated vasculitis

© 2017, The Author(s). Granulomatosis with polyangiitis (GPA), microscopic polyangiitis (MPA), and eosinophilic granulomatosis with polyangiitis (EGPA) are multisystem diseases of small blood vessels, collectively known as the anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitides (AAV). This study explores the patient’s perspective on the use of glucocorticoids, which are still a mainstay of treatment in AAV. Patients with AAV from the UK, USA, and Canada were interviewed, using purposive sampling to include a range of disease manifestations and demographics. The project steering committee, including patient partners, designed the interview prompts and cues about AAV, its treatment, and impact on health-related quality of life. Interviews were transcribed and analysed to establish themes grounded in the data. A treatment-related code was used to focus analysis of salient themes related to glucocorticoid therapy. Fifty interviews were conducted. Individual themes related to therapy with glucocorticoids emerged from the data and were analysed. Three overarching themes emerged: (1) Glucocorticoids are effective at the time of diagnosis and during relapse, and withdrawal can potentiate a flare, (2) glucocorticoids are associated with salient emotional, physical, and social effects (depression, anxiety, irritation, weight gain and change in appearance, diabetes mellitus, effect on family and work); and (3) patient perceptions of balancing the risks and benefits of glucocorticoids. Patients identified the positive aspects of treatment with glucocorticoids; they are fast-acting and effective, but, they voiced concerns about adverse effects and the uncertainty of the dose-reduction process. These results may be informative in the development of novel glucocorticoid-sparing regimens

Influence of dietary fats on pancreatic phospholipids of chronically ethanol-treated rats.

Male rats were given liquid diets by pair-feeding for 24-30 days, and phosphatidylinositols in pancreas were analyzed as derivatives of diacylglycerols and fatty acids. Addition of arachidonic acid or changing the fat component (35 energy %) in the liquid diet from olive oil/corn oil to oil from Borago officinalis, which contains 22% gamma-linolenic acid, increased the fraction of arachidonoyl-containing species. This fraction was decreased by more than 50% by substituting ethanol for 36 of the 47 energy% provided by carbohydrate. A smaller difference between ethanol-fed and control rats was seen in the composition of phosphatidylcholines and phosphatidylethanolamines. There was no difference in the composition of phosphatidylinositols when fat, instead of ethanol, was used to substitute the 36 energy % in the diet containing olive oil/corn oil. Substituting ethanol for 28 of 35 energy% provided by fat as corn oil in a liquid diet had no effect on the fraction of arachidonoyl-containing species. The results indicate that the effect of ethanol on phosphatidylinositols in pancreas is not due to a deficiency of arachidonic acid, and that the effect of the ethanol-containing diet is not due to the lowered carbohydrate content. However, high contents of fat or of ethanol appear to be necessary for the effect