Naloxone Co-Prescribing Across a Large Health System: A Quality Improvement Project

Introduction: • Naloxone availability and administration saves lives • The CDC recommends naloxone co-prescribing for patients with OUD and other eligibility criteria • Maine Medical Center’s baseline was found to be 6% in one clinic. This held true across the entire MaineHealth system.https://knowledgeconnection.mainehealth.org/lambrew-retreat-2021/1033/thumbnail.jp

Invasion of Plant Communities

Due to numerous human activities, organisms have been transported and either accidentally or deliberately introduced all around the globe. Biological invasions are now considered to be one of the main drivers of global change because many invasive plants have severe ecological, economic, and health consequences. Thus, there is an ever-growing need to better understand invasions to determine how specific plant species are able to establish in communities and, in many cases, expand their range. Here, we describe the invasion process and how it contributes to the invasion of plant communities. We present an invasion-factor framework (IFF) model that uses three factors (climate dynamics, ecosystem resistance, and invader fitness) to explain how each plays a role in the introduction of plants and their ultimate failure or success (i.e., becoming invasive). The invasion of plant communities starts with the uptake of propagules from the native range, followed by their transport to and release into a new territory, where they become established and can spread or expand. Propagule pressure, prior adaptation, anthropogenically induced adaptation to invade, and post-introduction evolution are several theories that have been posed to explain the establishment of invasive plants. Further, traits of invasive plants, either before (existing) or after (developed) introduction, provide a mechanistic understanding with direct ties to the three factors of the IFF. The IFF is a general guide with which to study the invasion process based on specific factors for individual invaders and their target communities. The IFF combines (a) climatic dynamics, analogous to environmental filters; (b) ecosystem resistance, which prevents invasive plants from becoming established even if they are able to overcome the climate factor; and (c) invader fitness, relating to the genetic diversity of invasive plants, which allows them to become established after overcoming climate and ecosystem resistance factors. Case studies from the literature provide examples of research investigating each of the three factors of the IFF, but none exist that describe all the factors at once for any given invasive plant species. The application of the IFF for management is most appropriate once an invasive plant has become established, as preventative measures before this point rely only on accurate identification (detection) and removal (response). The IFF model should be considered as a tool to establish research priorities and identify components in the invasion process and inform restoration efforts. We advocate that the IFF should be integrated into management practices to help in the decision-making process that contributes to more effective practices that reduce the occurrence and impacts of invasive plants in a range of communities

Influence of Selected Surfactants and Water Quality Perameters on Surfactant-Enhanced Soil Flushing of Hydrophobic Hydrocarbon Contaminated Soil

Civil Engineerin

Increasing Naloxone Co-Prescribing Among At-Risk Individuals: Evaluation of a Quality Improvement Project in a Large Health System

Background: Naloxone availability and early administration is key in preventing death following opioid overdose. The CDC advises that naloxone should be made available to all at-risk individuals. In 2017, providers at Maine Medical Center noted that only 6% of at-risk patients had naloxone prescriptions Methods: Included in this study were all patients of MaineHealth, a health system comprising 9 hospitals and 30 primary care practices, serving approximately 1.1 million patients. Between 2017 and 2020, we implemented several system-wide quality improvement interventions to increase rates of naloxone co-prescribing among at-risk individuals. Risk factors included prescribed opioids ≥50 morphine milligram equivalents, concurrent prescriptions for opioids and benzodiazepines or sedative/hypnotics, a diagnosis of substance use disorder, or a history of opioid overdose. Our interventions included (1) a standing order for naloxone in the hospital pharmacy, (2) in-person naloxone trainings for all clinical and non-clinical primary care staff, (3) online training modules, (4) guidelines on naloxone co-prescribing sent via email, and (5) automated alerts in the electronic medical record (EMR). To evaluate these interventions, the EMR for, was queried for patients with one or more risk factors for opioid overdose, and whether they had naloxone on their medication list between 2017 and 2020. Results: Over the course of the study period, overall rate of naloxone co-prescribing system-wide increased from 0.4% to 26% of patients. Automatic EMR alerts were associated with an increase of 4.5%, the largest single-quarter increase. Online education modules and guideline dissemination were associated with smaller increases of 0.9% and 3% in the two quarters following their implementation. In-person trainings and making naloxone available without a prescription were followed by Conclusions: Our most effective intervention was automatic alerts in the EMR, while e online trainings and guidelines produced modest effects. A notable increase was also seen in one hospital system whose entire leadership and staff deliberately prioritized increasing naloxone access. Even with these gains, we have not yet achieved adequate co-prescribing across our system

Peripheral blood leukocyte response and macrophage function during Eimeria adenoeides infection in turkey poults

Intestinal coccidiosis, caused by various species of Eimeria, is an economically important disease of chickens and turkeys. The peripheral blood leukocyte response and macrophage functions during a coccidial infection in turkeys have not been defined. To examine these aspects of innate immunity during primary Eimeria infection in turkeys, 4-week-old poults were orally inoculated with either 50,000 E. adenoeides oocyst (24 infected poults) or water (24 control poults). To monitor the concentrations and proportions of white blood cells (WBC) throughout the course of infection, heparinized blood was collected from 12 infected and 12 control poults prior to inoculation (day 0), and on days 4, 7, and 11 post-inoculation (PI). To study macrophage function, Sephadex-elicited abdominal exudate cells (macrophages) were collected on day 7 PI from 12 infected and 12 control poults. Macrophages were used to study phagocytosis of unopsonized and antibody-opsonized sheep red blood cells (SRBC), production of nitric oxide, and production of cytotoxic factors. E. adenoeides infection was associated with alterations in the concentration of WBC, including a decrease in the numbers of circulating lymphocytes on day 4 and a rise in lymphocytes and heterophils on day 11. Although phagocytic activity was not different in macrophages from infected and control poults, macrophages from infected poults exhibited greater cytotoxic activity. Data from these studies strongly suggest that components of innate immunity were recruited and activated during this primary infection of turkey poults with E. adenoeides. Further investigations are needed to determine the role of these components in limiting primary infection by E. adenoeides

Rural community convenience centers

The Oklahoma Cooperative Extension Service periodically issues revisions to its publications. The most current edition is made available. For access to an earlier edition, if available for this title, please contact the Oklahoma State University Library Archives by email at [email protected] or by phone at 405-744-6311

Evolutionary Responses of Invasive Grass Species to Variation in Precipitation and Soil Nitrogen

1.Global climate models suggest that many ecosystems will experience reduced precipitation over the next century and the consequences for invasive plant performance are largely unknown. Annual invasive species may be able to quickly evolve traits associated with drought escape or tolerance through rapid genetic changes. 2.We investigated the influence of five years of water and nitrogen manipulations on trait values in a southern California grassland system. Seeds from two annual grass species (Avena barbata, Bromus madritensis) were collected from experimental plots and grown in a common environment over two generations. We measured 14 physiological, morphological, phenological, and reproductive traits. 3.Both species displayed phenotypic differences depending on the water treatment from which they were collected, but not depending on the nitrogen treatment. Both species displayed trait values characteristic of drought escape (e.g., earlier flowering in A. barbata and B. madritensis, lower water-use efficiency in B. madritensis) when grown from seeds collected from plots that experienced five years of reduced precipitation. Furthermore, A. barbata individuals grown from seeds collected from drought plots had higher reproductive output and higher photosynthetic performance than individuals grown from water addition plots, with individuals grown from ambient plots displaying intermediate trait values. Notably, we found no phenotypic variation among treatments for six root traits. 4.Synthesis. Trait differences were observed following two generations in a common garden, suggesting that treatment differences were genetically based. This suggests that populations were responding to selection over the five years of water manipulations, a remarkably short time period. The rapid evolutionary responses observed here may help these two widespread invasive grass species thrive under reduced precipitation scenarios, which could have important implications for fire dynamics, invasive species management, and native plant restoration in communities invaded by annual grasses

Community solid waste recycling systems

The Oklahoma Cooperative Extension Service periodically issues revisions to its publications. The most current edition is made available. For access to an earlier edition, if available for this title, please contact the Oklahoma State University Library Archives by email at [email protected] or by phone at 405-744-6311

Backyard composting in Oklahoma

The Oklahoma Cooperative Extension Service periodically issues revisions to its publications. The most current edition is made available. For access to an earlier edition, if available for this title, please contact the Oklahoma State University Library Archives by email at [email protected] or by phone at 405-744-6311.Biosystems and Agricultural Engineerin