Whole fentanyl patch ingestion: a multi-center case series.

BACKGROUND: Fentanyl is a potent synthetic opioid with large abuse potential. A common preparation of fentanyl is a sustained-release transdermal patch. To our knowledge, there are only two published case reports of whole patch ingestion. A case series of 76 patients with a history of whole patch ingestion is reported. STUDY OBJECTIVES: To characterize whole fentanyl patch ingestion to develop a clinical guideline for management. METHODS: This was a retrospective review of all patients who ingested intact fentanyl patches as reported to three regional poison information centers (RPIC) from 2000 to 2008. The three RPIC medical record databases were queried for all exposures with a substance code matching the Micromedex® (Thomson Reuters, New York, NY) fentanyl product codes. Collected data included: age, gender, reason for the exposure, number of patches ingested, dose (μg/h), symptoms, symptom onset and duration, treatment hospital flow (level of care), and outcome. RESULTS: A total of 76 patients met the inclusion criteria. Two patients had both time of onset and symptom duration documented. In both patients, the signs and symptoms developed within 2 h of the exposure, and the patients were asymptomatic at 6½ and 9 h, respectively. Fifty-eight (78.3%) patients were admitted. Of those patients who were admitted, 56 (96.5%) were admitted to a critical care unit. Fourteen patients required intubation, and naloxone infusions were documented in eight cases. CONCLUSION: Ingestion of whole fentanyl patches may lead to prolonged and significant toxicity based on these poison center data

Fast Inhibition of Glutamate-Activated Currents by Caffeine

Background: Caffeine stimulates calcium-induced calcium release (CICR) in many cell types. In neurons, caffeine stimulates CICR presynaptically and thus modulates neurotransmitter release. Methodology/Principal Findings: Using the whole-cell patch-clamp technique we found that caffeine (20 mM) reversibly increased the frequency and decreased the amplitude of miniature excitatory postsynaptic currents (mEPSCs) in neocortical neurons. The increase in mEPSC frequency is consistent with a presynaptic mechanism. Caffeine also reduced exogenously applied glutamate-activated currents, confirming a separate postsynaptic action. This inhibition developed in tens of milliseconds, consistent with block of channel currents. Caffeine (20 mM) did not reduce currents activated by exogenous NMDA, indicating that caffeine block is specific to non-NMDA type glutamate receptors. Conclusions/Significance: Caffeine-induced inhibition of mEPSC amplitude occurs through postsynaptic block of non-NMDA type ionotropic glutamate receptors. Caffeine thus has both pre and postsynaptic sites of action at excitatory synapses

Proton Transfer, Hydrogen Bonding, and Disorder: Nitrogen Near-Edge X-ray Absorption Fine Structure and X-ray Photoelectron Spectroscopy of Bipyridine-Acid Salts and Co-crystals

The sensitivity of near-edge X-ray absorption fine structure (NEXAFS) spectroscopy to Brønsted donation and the protonation state of nitrogen in the solid state is investigated through a series of multicomponent bipyridine–acid systems alongside X-ray photoelectron spectroscopy (XPS) data. A large shift to high energy occurs for the 1s → 1π* resonance in the nitrogen K-edge NEXAFS with proton transfer from the acid to the bipyridine base molecule and allows assignment as a salt (C═NH+), with the peak ratio providing the stoichiometry of the types of nitrogen species present. A corresponding binding energy shift for C═NH+ is observed in the nitrogen XPS, clearly identifying protonation and formation of a salt. The similar magnitude shifts observed with both techniques relative to the unprotonated nitrogen of co-crystals (C═N) suggest that the chemical state (initial-state) effects dominate. Results from both techniques reveal the sensitivity to identify proton transfer, hydrogen bond disorder, and even the potential to distinguish variations in hydrogen bond length to nitrogen

Proliferation of Gig Platforms and Its Impacts on Labor in a Study of Uber and CarGo

In the context of widely contested arguments in favor and against rapidly emerging gig platforms, my study embraces direct workers’ perspective on labor conditions through three thematic sections. The first section inquires about the new forms of labor exploitation under ride-hailing platforms. The second section asks about alienation and connects economic aspects, exploitation, and control of the production relations, with psychological manifestations such as normlessness, powerlessness, and isolation among drivers. The third section explores how alienation affects collective mobilization. Theoretically, I discuss and analyze “social factory,” the power of technology, legal (de)regulations, and “integrating framework” that set the stage for studying exploitation, alienation, and mobilization. I use qualitative mixed-method approach and two case studies, one of Uber drivers in Tampa Bay (United States), and another of CarGo and taxi drivers in Belgrade (Serbia). I argue that platform owners re-conceptualize the status of ride-hailing drivers and their earnings to more efficiently extract profits and expand their operation. As a result of increased control and deprivation of workers’ rights, ride-hailing drivers experience high levels of alienation, which inherits positive and negative potential for labor mobilization. High levels of normlessness and powerlessness lead to collective mobilization. Simultaneously, isolation makes collective mobilization sporadic and short-lived and prevents the formation of “class for itself,” despite belonging to “class in itself.

Professional Ethics for College Health Services

College health services provide a crucial resource for campus communities in the United States, substantially affecting student health, safety, and wellbeing. The impact and quality of campus clinical services impact student life through varied approaches to the delivery of services, health innovations, and business models. The role that campus health services plays in dealing with risk mitigation is essential: well-established public health principles of disease prevention, health promotion, and health education are sustained and advanced by campus clinical health services. Despite the widely recognized importance of college health services, there is very little literature on the contribution of ethics related to them, especially from the perspective of professional responsibilities. This dissertation seeks to present an approach to Professional Ethics for College Health Services (CHS) through the relevance of prominent principles in healthcare ethics as a foundation for the development of an approach

Toxic Christmas and New Year Holiday Plants...or Are They?

Background: Poinsettia (Euphorbia pulcherrima), holly (Ilex opaca) and mistletoe (Phoradendron flavescens) adorn homes during the Christmas and New Year holiday season and create the potential for curious children to sample their colorful leaves and enticing berries. This study was aimed to review the American Association of Poison Control Centers National Poison Data System (AAPCC NPDS) to describe the epidemiologic profile of ingestion of these plants and to determine whether there was associated morbidity and mortality. Methods: All plant ingestion exposures reported to American poison centers (PCs) from 2000-2009 were analyzed to identify all exposures to E. pulcherrima, I. opaca and P. flavescens. The data analysis included ingestions by age, gender, patient management site, symptoms, intention and outcome. Results: The AAPCC NPDS database included 668,111 plant ingestions during 2000 to 2009. E. pulcherrima (19,862; 3.0%), I. opaca (5,432; 0.8%) and P. flavescens (1,138; 0.2%) exposures accounted for 26,632 (4.0%) of all plant ingestion exposures. Children younger than six years were responsible for majority of ingestions (88.0%). Ingestions were more likely to occur unintentionally (P < 0.001). Most cases (96.1%) were asymptomatic. When clinical effects developed (1,046 cases), the most frequent reported signs were gastrointestinal in nature (59.8%) including abdominal pain, diarrhea and/or vomiting. Moreover, the development of gastrointestinal signs was higher in patients who ingested P. flavescens compared to the other two species. Most exposures (96.1%) were managed at home with the guidance from PC experts. When the outcome was known, the majority of exposures (89.2%) experienced no adverse effects. Moderate effects occurred in only 28 ingestions (0.1%), and one major effect was recorded in a patient who ingested poinsettia. Conclusion: These holiday plants were associated with extremely low morbidity and no mortality. Home management along with expert guidance can be adequate intervention in the majority of these exposures