Latest Trends in the Heroin Epidemic and the Responsibility of the Pharmacist in Controlling Heroin Abuse

Over the last few years, there has been an exponential increase in morbidity and mortality associated with heroin abuse. The current rise in heroin abuse and overdose is attributed to widespread use and abuse of prescription opioids, which can produce significant euphoric effects in humans. In fact, reports suggest that heroin abusers initially become addicted to prescription opioids but subsequently switch to heroin because it is cheaper and more easily available than prescription opioids. Over the years, the purity of heroin available for illicit use has been on the decline. Smugglers and heroin vendors have started mixing heroin with other clandestinely prepared, potent, analgesic opioids such as fentanyl. Fentanyl is 30 to 50 times more potent than heroin, and the combination can be quite lethal to abusers due to the increased potency and effects on the body\u27s respiratory centers which may result in death. This review will mainly focus on some of the recent trends in heroin abuse and recent changes in laws with respect to dispensing and possession of naloxone, an effective antidote against heroin overdose. Finally, the role of the pharmacist in countering the current heroin epidemic by recognizing at-risk populations and providing the proper resources to addicts to prevent further heroin/opioid-related overdose fatalities will be discussed

High-Temperature Deformation During Continental-Margin Subduction & Exhumation: The Ultrahigh-Pressure Western Gneiss Region of Norway

A new dataset for the high-pressure to ultrahigh-pressure Western Gneiss Region allows the definition of distinct structural and petrological domains. Much of the study area is an E-dipping homocline with E-plunging lineations that exposes progressively deeper, more strongly deformed, more eclogite-rich structural levels westward. Although eclogites crop out across the WGR, Scandian deformation is weak and earlier structures are well preserved in the southeastern half of the study area. The Scandian reworking increases westward, culminating in strong Scandian fabrics with only isolated pockets of older structures; the dominant Scandian deformation was coaxial E–W stretching. The sinistrally sheared Møre–Trøndelag Fault Complex and Nordfjord Mylonitic Shear Zone bound these rocks to the north and south. There was moderate top-E, amphibolite-facies deformation associated with translation of the allochthons over the basement along its eastern edge, and the Nordfjord–Sogn Detachment Zone underwent strong lower amphibolite-facies to greenschist-facies top-W shearing. A northwestward increase in exhumation-related melting is indicated by leucosomes with hornblende, plagioclase, and Scandian sphene. In the western 2/3 of the study area, exhumation-related, amphibolite-facies symplectite formation in quartzofeldspathic gneiss postdated most Scandian deformation; further deformation was restricted to slip along biotite-rich foliation planes and minor local folding. That the Western Gneiss Region quartzofeldspathic gneiss exhibits a strong gradient in degree of deformation, implies that continental crust in general need not undergo pervasive deformation during subduction

Large variations in the prices of urologic procedures at academic medical centers 1 year after implementation of the Price Transparency Final Rule

IMPORTANCE: Patients with urologic diseases often experience financial toxicity, defined as high levels of financial burden and concern, after receiving care. The Price Transparency Final Rule, which requires hospitals to disclose both the commercial and cash prices for at least 300 services, was implemented to facilitate price shopping, decrease price dispersion, and lower health care costs. OBJECTIVE: To evaluate compliance with the Price Transparency Final Rule and to quantify variations in the price of urologic procedures among academic hospitals and by insurance class. DESIGN, SETTING, AND PARTICIPANTS: This was a cross-sectional study that determined the prices of 5 common urologic procedures among academic medical centers and by insurance class. Prices were obtained from the Turquoise Health Database on March 24, 2022. Academic hospitals were identified from the Association of American Medical Colleges website. The 5 most common urologic procedures were cystourethroscopy, prostate biopsy, laparoscopic radical prostatectomy, transurethral resection of the prostate, and ureteroscopy with laser lithotripsy. Using the corresponding Current Procedural Terminology codes, the Turquoise Health Database was queried to identify the cash price, Medicare price, Medicaid price, and commercial insurance price for these procedures. EXPOSURES: The Price Transparency Final Rule, which went into effect January 1, 2021. MAIN OUTCOMES AND MEASURES: Variability in procedure price among academic medical centers and by insurance class (Medicare, Medicaid, commercial, and cash price). RESULTS: Of 153 hospitals, only 20 (13%) listed a commercial price for all 5 procedures. The commercial price was reported most often for cystourethroscopy (86 hospitals [56%]) and least often for laparoscopic radical prostatectomy (45 hospitals [29%]). The cash price was lower than the Medicare, Medicaid, and commercial price at 24 hospitals (16%). Prices varied substantially across hospitals for all 5 procedures. There were significant variations in the prices of cystoscopy (χ23 = 85.9; P = .001), prostate biopsy (χ23 = 64.6; P = .001), prostatectomy (χ23 = 24.4; P = .001), transurethral resection of the prostate (χ23 = 51.3; P = .001), and ureteroscopy with laser lithotripsy (χ23 = 63.0; P = .001) by insurance type. CONCLUSIONS AND RELEVANCE: These findings suggest that, more than 1 year after the implementation of the Price Transparency Final Rule, there are still large variations in the prices of urologic procedures among academic hospitals and by insurance class. Currently, in certain situations, health care costs could be reduced if patients paid out of pocket. The Centers for Medicare & Medicaid Services may improve price transparency by better enforcing penalties for noncompliance, increasing penalties, and ensuring that hospitals report prices in a way that is easy for patients to access and understand

Use of optical mapping to sort uropathogenic Escherichia coli strains into distinct subgroups

Optical maps were generated for 33 uropathogenic Escherichia coli (UPEC) isolates. For individual genomes, the NcoI restriction fragments aligned into a unique chromosome map for each individual isolate, which was then compared with the in silico restriction maps of all of the sequenced E. coli and Shigella strains. All of the UPEC isolates clustered separately from the Shigella strains as well as the laboratory and enterohaemorrhagic E. coli strains. Moreover, the individual strains appeared to cluster into distinct subgroups based on the dendrogram analyses. Phylogenetic grouping of these 33 strains showed that 32/33 were the B2 subgroup and 1/33 was subgroup A. To further characterize the similarities and differences among the 33 isolates, pathogenicity island (PAI), haemolysin and virulence gene comparisons were performed. A strong correlation was observed between individual subgroups and virulence factor genes as well as haemolysis activity. Furthermore, there was considerable conservation of sequenced-strain PAIs in the specific subgroups. Strains with different antibiotic-resistance patterns also appeared to sort into separate subgroups. Thus, the optical maps distinguished the UPEC strains from other E. coli strains and further subdivided the strains into distinct subgroups. This optical mapping procedure holds promise as an alternative way to subgroup all E. coli strains, including those involved in infections outside of the intestinal tract and epidemic strains with distinct patterns of antibiotic resistance

Large expert-curated database for benchmarking document similarity detection in biomedical literature search

Document recommendation systems for locating relevant literature have mostly relied on methods developed a decade ago. This is largely due to the lack of a large offline gold-standard benchmark of relevant documents that cover a variety of research fields such that newly developed literature search techniques can be compared, improved and translated into practice. To overcome this bottleneck, we have established the RElevant LIterature SearcH consortium consisting of more than 1500 scientists from 84 countries, who have collectively annotated the relevance of over 180 000 PubMed-listed articles with regard to their respective seed (input) article/s. The majority of annotations were contributed by highly experienced, original authors of the seed articles. The collected data cover 76% of all unique PubMed Medical Subject Headings descriptors. No systematic biases were observed across different experience levels, research fields or time spent on annotations. More importantly, annotations of the same document pairs contributed by different scientists were highly concordant. We further show that the three representative baseline methods used to generate recommended articles for evaluation (Okapi Best Matching 25, Term Frequency-Inverse Document Frequency and PubMed Related Articles) had similar overall performances. Additionally, we found that these methods each tend to produce distinct collections of recommended articles, suggesting that a hybrid method may be required to completely capture all relevant articles. The established database server located at https://relishdb.ict.griffith.edu.au is freely available for the downloading of annotation data and the blind testing of new methods. We expect that this benchmark will be useful for stimulating the development of new powerful techniques for title and title/abstract-based search engines for relevant articles in biomedical research.Peer reviewe

Strain Within the Ultrahigh‐Pressure Western Gneiss Region of Norway Recorded by Quartz CPOs

Electron back‐scatter diffraction was used to measure the crystal preferred orientations (CPOs) from 101 samples across the ultrahigh‐pressure Western Gneiss Region of Norway to assess slip systems, sense of shear, CPO strength, and strain geometry. The CPOs suggest a dominance of prism slip, with lesser amounts of prism [c] slip and basal slip; there are few Type‐I and Type‐II girdles. The major structural feature in the study area—the high‐strain, top‐W, normal‐sense Nordfjord–Sogn Detachment Zone—is characterized by asymmetric and strong CPOs; an eastern domain with strong asymmetric CPOs shows top‐E shear. Strain throughout the study area was characterized by a mix of plane strain and constriction with no evidence of flattening. Adjacent gneiss and quartzite/vein samples have similar CPOs

Erucic acid, a nutritional PPAR delta-ligand may influence Huntington's disease pathogenesis

Increasing recent evidence suggests a key role of oligodendroglial injury and demyelination in the pathophysiology of Huntington's Disease (HD) and the transcription factor PPAR delta is critical for oligodendroglial regeneration and myelination. PPAR delta directly involves in the pathogenesis of HD and treatment with a brain-permeable PPAR delta-agonist (KD3010) alleviates its severity in mice. Erucic acid (EA) is also a PPAR delta-ligand omega 9 fatty acid which is highly consumed in Asian countries through ingesting cruciferous vegetables such as rapeseed (Brassica napus) and indian mustard (Brassica juncea). EA is also an ingredient of Lorenzo's oil employed in the medical treatment of adrenoleukodystrophy and can be converted to nervonic acid, a component of myelin. HD pathogenesis also involves oxidative and inflammatory injury and EA exerts antioxidative and antiinflammatory efficacies including inhibition of thrombin and elastase. Consumption of rapeseed, indian mustard, and Canola oils (containing EA) improves cognitive parameters in animal models, as well as treatment with pure EA. Moreover, erucamide, an endogenous EA-amide derivative regulating angiogenesis and water balance, exerts antidepressive and anxiolytic effects in mice. Hitherto, no study has investigated the therapeutic potential of EA in HD and we believe that it strongly merits to be studied in animal models of HD as a potential therapeutic.</p