Emergency Department Clinicians’ Attitudes Toward Opioid Use Disorder and Emergency Department-initiated Buprenorphine Treatment: A Mixed-Methods Study

Introduction: Emergency department (ED) visits related to opioid use disorder (OUD) have increased nearly twofold over the last decade. Treatment with buprenorphine has been demonstrated to decrease opioid-related overdose deaths. In this study, we aimed to better understand ED clinicians’ attitudes toward the initiation of buprenorphine treatment in the ED.Methods: We performed a mixed-methods study consisting of a survey of 174 ED clinicians (attending physicians, residents, and physician assistants) and semi-structured interviews with 17 attending emergency physicians at a tertiary-care academic hospital.Results: A total of 93 ED clinicians (53% of those contacted) completed the survey. While 80% of respondents agreed that buprenorphine should be administered in the ED for patients requesting treatment, only 44% felt that they were prepared to discuss medication for addiction treatment. Compared to clinicians with fewer than five years of practice, those with greater experience were less likely to approve of ED-initiated buprenorphine. In our qualitative analysis, physicians had differing perspectives on the role that the ED should play in treating OUD. Most physicians felt that a buprenorphine-based intervention in the ED would be feasible with institutional support, including training opportunities, protocol support within the electronic health record, counseling and support staff, and a robust referral system for outpatient follow-up.Conclusion: ED clinicians’ perception of buprenorphine varied by years of practice and training level. Most ED clinicians did not feel prepared to initiate buprenorphine in the ED. Qualitative interviews identified several addressable barriers to ED-initiated buprenorphine

Focusing and Compression of Ultrashort Pulses through Scattering Media

Light scattering in inhomogeneous media induces wavefront distortions which pose an inherent limitation in many optical applications. Examples range from microscopy and nanosurgery to astronomy. In recent years, ongoing efforts have made the correction of spatial distortions possible by wavefront shaping techniques. However, when ultrashort pulses are employed scattering induces temporal distortions which hinder their use in nonlinear processes such as in multiphoton microscopy and quantum control experiments. Here we show that correction of both spatial and temporal distortions can be attained by manipulating only the spatial degrees of freedom of the incident wavefront. Moreover, by optimizing a nonlinear signal the refocused pulse can be shorter than the input pulse. We demonstrate focusing of 100fs pulses through a 1mm thick brain tissue, and 1000-fold enhancement of a localized two-photon fluorescence signal. Our results open up new possibilities for optical manipulation and nonlinear imaging in scattering media

Differential transcriptomic and metabolic profiles of M. africanum- and M. tuberculosis-infected patients after, but not before, drug treatment.

The epidemiology of Mycobacterium tuberculosis (Mtb) and M. africanum (Maf) suggests differences in their virulence, but the host immune profile to better understand the pathogenesis of tuberculosis (TB) have not been studied. We compared the transcriptomic and metabolic profiles between Mtb- and Maf-infected TB cases to identify host biomarkers associated with lineages-specific pathogenesis and response to anti-TB chemotherapy. Venous blood samples from Mtb- and Maf-infected patients obtained before and after anti-TB treatment were analyzed for cell composition, gene expression and metabolic profiles. Prior to treatment, similar transcriptomic profiles were seen in Maf- and Mtb-infected patients. In contrast, post treatment, over 1600 genes related to immune responses and metabolic diseases were differentially expressed between the groups. Notably, the upstream regulator hepatocyte nuclear factor 4-alpha (HNF4α), which regulated 15% of these genes, was markedly enriched. Serum metabolic profiles were similar in both group pre-treatment, but the decline in pro-inflammatory metabolites post treatment were most pronounced in Mtb-infected patients. Together, the differences in both peripheral blood transcriptomic and serum metabolic profiles between Maf- and Mtb-infected patients observed over the treatment period, might be indicative of intrinsic host factors related to susceptibility to TB and/or differential efficacy of the standard anti-TB treatment on the two lineages

The DEEP2 Galaxy Redshift Survey: Design, Observations, Data Reduction, and Redshifts

We describe the design and data sample from the DEEP2 Galaxy Redshift Survey, the densest and largest precision-redshift survey of galaxies at z ~ 1 completed to date. The survey has conducted a comprehensive census of massive galaxies, their properties, environments, and large-scale structure down to absolute magnitude M_B = -20 at z ~ 1 via ~90 nights of observation on the DEIMOS spectrograph at Keck Observatory. DEEP2 covers an area of 2.8 deg^2 divided into four separate fields, observed to a limiting apparent magnitude of R_AB=24.1. Objects with z < 0.7 are rejected based on BRI photometry in three of the four DEEP2 fields, allowing galaxies with z > 0.7 to be targeted ~2.5 times more efficiently than in a purely magnitude-limited sample. Approximately sixty percent of eligible targets are chosen for spectroscopy, yielding nearly 53,000 spectra and more than 38,000 reliable redshift measurements. Most of the targets which fail to yield secure redshifts are blue objects that lie beyond z ~ 1.45. The DEIMOS 1200-line/mm grating used for the survey delivers high spectral resolution (R~6000), accurate and secure redshifts, and unique internal kinematic information. Extensive ancillary data are available in the DEEP2 fields, particularly in the Extended Groth Strip, which has evolved into one of the richest multiwavelength regions on the sky. DEEP2 surpasses other deep precision-redshift surveys at z ~ 1 in terms of galaxy numbers, redshift accuracy, sample number density, and amount of spectral information. We also provide an overview of the scientific highlights of the DEEP2 survey thus far. This paper is intended as a handbook for users of the DEEP2 Data Release 4, which includes all DEEP2 spectra and redshifts, as well as for the publicly-available DEEP2 DEIMOS data reduction pipelines. [Abridged]Comment: submitted to ApJS; data products available for download at http://deep.berkeley.edu/DR4

The DEEP Groth Strip Galaxy Redshift Survey. III. Redshift Catalog and Properties of Galaxies

The Deep Extragalactic Evolutionary Probe (DEEP) is a series of spectroscopic surveys of faint galaxies, targeted at the properties and clustering of galaxies at redshifts z ~ 1. We present the redshift catalog of the DEEP 1 GSS pilot phase of this project, a Keck/LRIS survey in the HST/WFPC2 Groth Survey Strip. The redshift catalog and data, including reduced spectra, are publicly available through a Web-accessible database. The catalog contains 658 secure galaxy redshifts with a median z=0.65, and shows large-scale structure walls to z = 1. We find a bimodal distribution in the galaxy color-magnitude diagram which persists to z = 1. A similar color division has been seen locally by the SDSS and to z ~ 1 by COMBO-17. For red galaxies, we find a reddening of only 0.11 mag from z ~ 0.8 to now, about half the color evolution measured by COMBO-17. We measure structural properties of the galaxies from the HST imaging, and find that the color division corresponds generally to a structural division. Most red galaxies, ~ 75%, are centrally concentrated, with a red bulge or spheroid, while blue galaxies usually have exponential profiles. However, there are two subclasses of red galaxies that are not bulge-dominated: edge-on disks and a second category which we term diffuse red galaxies (DIFRGs). The distant edge-on disks are similar in appearance and frequency to those at low redshift, but analogs of DIFRGs are rare among local red galaxies. DIFRGs have significant emission lines, indicating that they are reddened mainly by dust rather than age. The DIFRGs in our sample are all at z>0.64, suggesting that DIFRGs are more prevalent at high redshifts; they may be related to the dusty or irregular extremely red objects (EROs) beyond z>1.2 that have been found in deep K-selected surveys. (abridged)Comment: ApJ in press. 24 pages, 17 figures (12 color). The DEEP public database is available at http://saci.ucolick.org

Galaxy Luminosity Functions to z~1: DEEP2 vs. COMBO-17 and Implications for Red Galaxy Formation

The DEEP2 and COMBO-17 surveys are used to study the evolution of the luminosity function of red and blue galaxies to $z \sim 1$. Schechter function fits show that, since $z = 1$, $M^*_B$ dims by $\sim$ 1.3 mag per unit redshift for both color classes, $\phi^*$ of blue galaxies shows little change, while $\phi^*$ for red galaxies has formally nearly quadrupled. At face value, the number density of blue galaxies has remained roughly constant since $z = 1$, whereas that of red galaxies has been rising. Luminosity densities support both conclusions, but we note that most red-galaxy evolution occurs between our data and local surveys and in our highest redshift bin, where the data are weakest. We discuss the implications of having most red galaxies emerge after $z = 1$ from precursors among the blue population, taking into account the properties of local and distant E/S0s. We suggest a ``mixed'' scenario in which some blue galaxies have their star-formation quenched in gas-rich mergers, migrate to the red sequence with a variety of masses, and merge further on the red sequence in one or more purely stellar mergers. E/S0s of a given mass today will have formed via different routes, in a manner that may help to explain the fundamental plane and other local scaling laws.Comment: Submitted to ApJ. 73 pages, 12 figures. Part II of a two-paper series. The entire paper is available as a single postscript file at: http://www.ucolick.org/~cnaw/paper2_submitted.ps.g

The Rise of Massive Red Galaxies: the color-magnitude and color-stellar mass diagrams for z < ~2 from the MUltiwavelength Survey by Yale-Chile (MUSYC)

We present the color-magnitude and color-stellar mass diagrams for galaxies with z_phot < ~2, based on a K < 22 (AB) catalog of the Extended Chandra Deep Field South (ECDFS) from the MUltiwavelength Survey by Yale-Chile (MUSYC). Our main sample of 7840 galaxies contains 1297 M_* > 10^11 M_Sol galaxies in the range 0.2 < z_phot < 1.8. We show empirically that this catalog is approximately complete for M_* > 10^11 M_Sol galaxies for z_phot < 1.8. For this mass-limited sample, we show that the locus of the red sequence color-stellar mass relation evolves as Del(u-r) ~ (-0.44+/-0.02) z_phot for z_phot ~1.3, however, we are no longer able to reliably distinguish red and blue subpopulations from the observed color distribution; we show that this would require much deeper near infrared data. At 1.5 < z_phot 10^11 M_Sol galaxies is ~50% of the local value, with a red fraction of ~33%. Making a parametric fit to the observed evolution, we find n_tot(z) ~ (1+z_phot)^(-0.52+/-0.12(+/-0.20)). We find stronger evolution in the red fraction: f_red(z) ~ (1+z_phot)^(-1.17+/-0.18(+/-0.21)). Through a series of sensitivity analyses, we show that the most important sources of systematic error are: 1. systematic differences in the analysis of the z~0 and z>>0 samples; 2. systematic effects associated with details of the photometric redshift calculation; and 3. uncertainties in the photometric calibration. With this in mind, we show that our results based on photometric redshifts are consistent with a completely independent analysis which does not require redshift information for individual galaxies. Our results suggest that, at most, 1/5 of local red sequence galaxies with M_* >10^11 M_Sol were already in place at z ~ 2.Comment: Accepted for publication in ApJ. 31 pages in emulateapj format; 18 figues (14 in main text). Additional online data available through http://www.strw.leidenuniv.nl/~ent

The morphologies and masses of extremely red galaxies in the Groth Strip survey

We present a new cataloge of EROs from the Groth strip and study the relation between their morphology and mass. We find 102 EROs (F814W-K=>4, K<=21.0), over a survey area of 155 arcmin^2. The photometric data include U,B,F606W,F814W,J,K bands. Morphologies are based on a by eye classification and we distinguish between 3 basic classes: compact objects, targets with a disc and/or a bulge component and irregular or merger candidates. The majority of our targets has either a very compact morphology (33+-6%), or show more or less distinct disc components (41+-6%). 14+-4% are merger or irregulars and 7 objects could not be classified. We also study the dependence of structural parameters on morphological appearance. EROs that are either compact or show a distinct bulge component have smaller median effective radii (1.22+-0.14 kpc and 3.31+-0.53 kpc) than disc dominated (5.50+-0.51 kpc) or possible irregular galaxies or merger candidates (4.92+-0.14 kpc). The Sersic index changes from 2.30+-0.34 and 3.24+-0.55, to 1.03+-0.24 and 1.54+-0.40 respectively. Most the EROs in our sample have redshifts between z=1 and z=2; however, compact EROs in our sample are found at redshifts as low as z=0.4 and as high as z=2.8; the latter qualify as well as DRGs. Disc-like EROs are also found up to z=2.8; however those with a bulge-disc structure are only seen at z<1.5. For each of these EROs we determined the stellar mass and mean population age by fitting synthetic Bruzual (2007) spectra to the SED. Mass estimates were obtained by assuming an exponentially declining star formation rate. Total stellar masses are in the range 9.1<log(M/M_sun)<11.6. We cannot detect significant differences between the stellar mass distribution of the morphological classes. EROs with masses of log(M/M_sun)>11.0 dominantly show compact morphologies, but also include a significant number of sources with a disc morphology.Comment: 21 pages, 17 figures, accepted for publication in MNRA

Automated Morphological Classification of SDSS Red Sequence Galaxies

(abridged) In the last decade, the advent of enormous galaxy surveys has motivated the development of automated morphological classification schemes to deal with large data volumes. Existing automated schemes can successfully distinguish between early and late type galaxies and identify merger candidates, but are inadequate for studying detailed morphologies of red sequence galaxies. To fill this need, we present a new automated classification scheme that focuses on making finer distinctions between early types roughly corresponding to Hubble types E, S0, and Sa. We visually classify a sample of 984 non-starforming SDSS galaxies with apparent sizes >14". We then develop an automated method to closely reproduce the visual classifications, which both provides a check on the visual results and makes it possible to extend morphological analysis to much larger samples. We visually classify the galaxies into three bulge classes (BC) by the shape of the light profile in the outer regions: discs have sharp edges and bulges do not, while some galaxies are intermediate. We separately identify galaxies with features: spiral arms, bars, clumps, rings, and dust. We find general agreement between BC and the bulge fraction B/T measured by the galaxy modeling package GIM2D, but many visual discs have B/T>0.5. Three additional automated parameters -- smoothness, axis ratio, and concentration -- can identify many of these high-B/T discs to yield automated classifications that agree ~70% with the visual classifications (>90% within one BC). Both methods are used to study the bulge vs. disc frequency as a function of four measures of galaxy 'size': luminosity, stellar mass, velocity dispersion, and radius. All size indicators show a fall in disc fraction and a rise in bulge fraction among larger galaxies.Comment: 24 pages, 20 figures, MNRAS accepte

The DEEP Groth Strip Survey IX: Evolution of the Fundamental Plane of Field Galaxies

Fundamental Plane studies provide an excellent means of understanding the evolutionary history of early-type galaxies. Using the Low Resolution Imaging Spectrograph on the Keck telescope, we obtained internal stellar kinematic information for 36 field galaxies in the Groth Strip--21 early-type and 15 disk galaxies. Their redshifts range from 0.3--1.0, with a median redshift 0.8. The slope of the relation shows no difference compared with the local slope. However, there is significant evolution in the zero-point offset; an offset due to evolution in magnitude requires a 2.4 magnitude luminosity brightening at z=1. We see little differences of the offset with bulge fraction, which is a good surrogate for galaxy type. Correcting for the luminosity evolution reduces the orthogonal scatter in the Fundamental Plane to 8%, consistent with the local scatter. This scatter is measured for our sample, and does not include results from other studies which may have different selection effects. The difference in the degree of evolution between our field sample and published cluster galaxies suggests a more recent formation epoch--around z=1.5 for field galaxies compared to z>2.0 for cluster galaxies. The magnitude difference implies that the field early-type galaxies are about 2 Gyr younger than the cluster ellipticals using standard single-burst models. However, the same models imply a significant change in the rest-frame U-B color from then to present, which is not seen in our sample. Continuous low-level star formation, however, would serve to explain the constant colors over this large magnitude change. A consistent model has 7% of the stellar mass created after the initial burst, using an exponentially decaying star formation rate with an e-folding time of 5 Gyr.Comment: 25 pages, accepted for publication in the Astrophysical Journal, high resolution version at http://hoku.as.utexas.edu/~gebhardt/FPpaper.p