Methadone and Corrected QT Prolongation in Pain and Palliative Care Patients: A Case–Control Study

Background: Methadone (ME) is commonly used in pain and palliative care (PPC) patients with refractory pain or intolerable opioid adverse effects (AEs). A unique ME AE is its corrected QT (QTc) interval prolongation risk, but most evidence exists in methadone maintenance therapy patients. Objective: Our goal was to identify QTc interval prolongation risk factors in PPC patients receiving ME and other medications known to prolong the QTc interval and develop a risk stratification tool. Design: We performed a case–control study of adult inpatients receiving ME for pain management. Settings/Subjects: Adult inpatients receiving ME with a QTc \u3e470 msec (males) and \u3e480 msec (females) were matched 1:2 according to age, history of QTc prolongation, and gender with ME patients who did not have a prolonged QTc interval. QTc prolongation risk factors were collected for both groups. Covariates were analyzed using conditional logistic regression. Classification and regression tree analysis was used to identify the ME dose associated with QTc prolongation. Results: Predictors of QTc prolongation included congestive heart failure (CHF) (OR: 11.9; 95% CI: 3.7–38.2; p \u3c 0.00), peptic ulcer disease (PUD) (odds ratio [OR]: 8.3; 95% confidence interval [95% CI]: 2.4–28.9; p \u3c 0.00), hypokalemia (OR: 6.5; 95% CI: 1.5–28.2; p \u3c 0.01), rheumatologic diseases (OR: 4.7; 95% CI: 1.6–13.9; p \u3c 0.00), taking medications with a known torsades de pointes (TdP) risk (OR: 4.4; 95% CI: 1.8–10.7; p \u3c 0.01), malignancy (OR: 3.3; 95% CI: 1.2–9.3; p \u3c 0.03), hypocalcemia (OR: 2.1; 95% CI: 0.9–4.8; p \u3c 0.07), and ME doses \u3e45 mg per day (OR: 1.9; 95% CI: 0.8–4.8; p \u3c 0.16). Mild liver disease was protective against QTc prolongation (OR: 0.05; 95% CI: 0.0–0.46; p \u3c 0.01). Conclusions: Predictors of QTc prolongation in our multivariate conditional logistic regression model included CHF, PUD, hypokalemia, rheumatologic disorders, use of medications with a known TdP risk, malignancy, hypocalcemia, and ME doses \u3e45 mg per day

Where Land Meets Water

Inside every ocean, river and stream, lies a space where water meets land. In this space, the water and land interact in a way in which we are left behind a message to decipher. Special patterns and lines are paved, and they give us insight into how they were created. Were these patterns created in a dangerously rapid river during a storm? Were they created over millions of years in a motionless ocean? Understanding how these patterns and lines are created is crucial to our ability to reconstruct the past. In my research, I run trials where sediment interacts with the force of water, and I try to recreate the rock record, taking special note of patterns and shapes in the rock. With my experiments, I plan to use my own rock record as a key to unlocking and understanding the ancient spaces where land met water.Ope

The Effects of the Correspondent Banking Network on the Real Economy

There is a longstanding academic debate regarding the role of financial networks. There is a tradeoff between improving the flow of funds and acting as a channel for contagion. This paper investigates the impact of banking networks on the real economy during the Great Depression. Building permit values are used as a proxy for real economic activity as implemented in previous research. A simple linear regression model estimated by ordinary least squares is used such that locational networks are differentiated from networks links to money centers and non-money centers. The results demonstrate that financial networks have both positive and negative effects on real economic activity and building permits. Positive network effects are observed when linkages to money centers are supported by strong locational networks

London Calling Brexit: how the rest of the UK views the capital

London has been accused of dominating UK political, economic and cultural life for hundreds of years. However, the last decade has seen relations become increasingly strained, with a series of seismic events inflaming longstanding tensions between the capital and the rest of the nation. In the third of the London Calling Brexit series, Jack Brown (Centre for London) looks at how the rest of the UK view their capital city

Henri Temianka Correspondence; (jbrown)

This collection contains material pertaining to the life, career, and activities of Henri Temianka, violin virtuoso, conductor, music teacher, and author. Materials include correspondence, concert programs and flyers, music scores, photographs, and books.https://digitalcommons.chapman.edu/temianka_correspondence/1562/thumbnail.jp

The Relationship Between Prior Experiences in Mathematics and Pharmacy School Success

Objective. To assess students’ pre-pharmacy math experiences, confidence in math ability, and relationship between experiences, confidence, and grades in math-based pharmacy courses. Methods. A cross-sectional survey of first year to third year pharmacy students was conducted. Students reported type of pre-pharmacy math courses taken, when they were taken [high school (HS) vs. college] and year of HS and college graduation. Students rated their confidence in math ability using the previously validated 11-item Fogerty Math Confidence Scale (Cronbach alpha=0.92). Math grade point average (GPA), Pharmacy College Admission Test quantitative (PCAT quant) scores, and grades (calculations and kinetics) were obtained from transcripts and school records. Spearman correlation and multivariate linear regression were used to compare math experiences, confidence, and grades. Results. There were 198 students who reported taking math courses 7.1 years since HS graduation and 2.9 years since their last schooling prior to pharmacy school. Students who took math courses with more time since HS/last schooling had lower calculations and kinetics grades. Students reporting having taken more HS math courses had better calculations grades. Students with higher math GPA, and PCAT quant scores also had higher calculations and kinetics grades. Greater confidence in math ability was associated with higher calculations grades. In multivariate regressions, PCAT quant scores and years since HS independently predicted calculations grades, and PCAT quant scores independently predicted kinetics grades. Conclusion. The number of pre-pharmacy math courses and time elapsed since they were taken are important factors to consider when predicting a pharmacy student’s success in math-based pharmacy school courses

The Effects of Instant Visual Feedback of Congruence in Group Counseling

Problem The purpose of this study was to determine the effects of immediate feedback of congruence by subjects in group counseling. Measures of outcome included the Tennessee Self-Concept Scale (TSCS), Fundamental Interpersonal Relations Orientations-Behavior (FIRO-B), the Tentative Scale for the Measurement of Genuineness and a time measure of the relative amount of time that the focus of attention within the groups was perceived to be congruent, incongruent or neutral. Procedure There were two studies with twenty-three subjects in the first study and twenty-five subjects in the second study. The subjects were volunteer university students who were randomly assigned to one of four groups in their respective studies. The membership of the groups also included two facilitators who contributed on-light time and genuineness scale data. The use of a specially constructed instant feedback device constituted the independent variable in the experiment. Group A focused on congruence and received feedback from the device. Group B focused on congruence but did not receive feedback from the device. Group C did not use the feedback device in any way. Group D served as the control group and did not mean for group sessions. The subjects in groups A and B pressed green, white and red buttons in the instant feedback device which signified congruence, neutrality or incongruence. There were eight one and one-half hour sessions for groups A, B and C. Results The following significant findings resulted from the investigation: 1. There was a significant difference on one of the twenty-two TSCS variables when the subjects from both studies were combined into four groups on-the basis of treatment after pre-test differences were covaried out. The true/false ratio variable was significantly different at the .05 level. Dunn\u27s c demonstrated that group A was significantly higher than groups C and D on this variable. 2. There was a significant difference on one of the six FIRO-B variables in the first study. Expressed affection was significantly different at the .01 level after pre-test differences were covaried out. Dunn\u27s c demonstrated that group C was significantly higher than groups A and B at the .05 level. 3. There was a significant difference on one of the six FIRO-B variables in the second study. Wanted inclusion was significantly different at the .05 level after pre-test differences were covaried out. Utilizing Dunn\u27s c , group A was significantly higher than group C at the .05 level. 4. There was a significant difference at the .001 level when the groups from both studies were analyzed separately on the Tentative Scale for the Measurement of Genuineness. Dunn\u27s c demonstrated that group A from the first study was significantly higher than group B of the first study, group A from the first study was significantly higher than group C of the second study, group B from the first study was significantly higher than group C of the first study, group C from the first study was significantly higher than group C of the second study and group B from the second study was significantly higher than group C of the second study. 5. There was a significant difference for the Tentative Scale for the Measurement of Genuineness data from the second study. Group C was significantly higher than groups A and B in this study. 6. There was a significant difference for the amount of green light time when the four groups from both studies were analyzed separately. Group A from the first study was significantly higher than group A of the second study. 7. There was a significant difference on the white light times when the four groups from both studies were analyzed separately. Group A from the first study was significantly higher than group A of the second study and group B from the first study was significantly higher than group A of the second study

The coevolution of toxin and antitoxin genes drives the dynamics of bacterial addiction complexes and intragenomic conflict

Bacterial genomes commonly contain ‘addiction’ gene complexes that code for both a toxin and a corresponding antitoxin. As long as both genes are expressed, cells carrying the complex can remain healthy. However, loss of the complex (including segregational loss in daughter cells) can entail death of the cell. We develop a theoretical model to explore a number of evolutionary puzzles posed by toxin–antitoxin (TA) population biology. We first extend earlier results demonstrating that TA complexes can spread on plasmids, as an adaptation to plasmid competition in spatially structured environments, and highlight the role of kin selection. We then considered the emergence of TA complexes on plasmids from previously unlinked toxin and antitoxin genes. We find that one of these traits must offer at least initially a direct advantage in some but not all environments encountered by the evolving plasmid population. Finally, our study predicts non-transitive ‘rock-paper-scissors’ dynamics to be a feature of intragenomic conflict mediated by TA complexes. Intragenomic conflict could be sufficient to select deleterious genes on chromosomes and helps to explain the previously perplexing observation that many TA genes are found on bacterial chromosomes