Heroin Adulterated with the Novel Synthetic Cannabinoid, 5F-MDMB-PINACA: A Case Series

Introduction: Heroin can be adulterated with various substances that may or may not have pharmacological effects. Here we report a case series of 8 patients who presented to the emergency department after overdose with intravenous heroin preparation adulterated with the synthetic cannabinoid methyl 2-(1-(5-fluoropentyl)-1H-indazole-3-carboxamido)-3,3-dimethylbutanoate (5F-MDMB-PINACA).Case Series: Except for one patient, all of them presented with a typical initial opioid toxidrome consisting of central nervous system and respiratory depression along with pinpoint pupils. Naloxone was given to them, triggering severe agitation and combative behavior along with overlapping features of anticholinergic and sympathomimetic toxidrome. All patients required multiple doses of benzodiazepines. Three were successfully treated with physostigmine.Discussion: 5F-MDMB-PINACA is a synthetic cannabinoid that was added to heroin in samples obtained from patients reported in this case series. Patients demonstrated significant agitation after receiving naloxone for opioid toxidrome, presumably because of the removal of the depressant effect of opioids, which unmasked the excitatory effects of the synthetic cannabinoids. Three patients required physostigmine along with the benzodiazepines for control of their agitation, urine retention and abnormal vitals, suggesting the possibility of an anticholinergic toxidrome to have developed in these patients.Conclusion: Heroin contaminated with 5F-MDMB-PINACA exhibits variable severities of anticholinergic effects, some on presentation and others only after opiate antagonism

Physics diagnostic test: an approach to qualify astronomy students

This study determines the learning outcomes measured by the physics diagnostic test, the performance of the incoming college freshman astronomy students in the physics diagnostic test, the suitability of the physics diagnostic test as entry requirement for the BS Astronomy Technology students, and the differences in the result of the physics diagnostic test. It deals with the analysis on the conceptualization that students may have difficulties pursuing the astronomy course if they have impediments in the result of their physics diagnostic test. In the past years, it casually occurs that students with low physics adaptation results to have lower to failing grades when they reach higher astronomy subjects.This study utilized a causal-comparative research design. A purposive sampling was used to the incoming freshmen students of BS Astronomy Technology during the first semester of school year 2014-2015 who took the 25 item validated basic introductory concepts in physics diagnostic test of the department.The findings showed that the physics diagnostic test measured and matched the prescribed learning outcomes set by the department. It also showed that most of the students have very satisfactorily understanding in physics. Therefore, it concludes that the physics diagnostic test match entry requirement for BS Astronomy Technology and that there is no significant difference in the physics diagnostic test between the BS Astronomy Technology college freshman students

Physician Empathy in Public and Private Internal Medicine Residency Training Programs in Pasig City

Research Question: What are the levels of patient-perceived and self-assessed physician empathy among internal medicine (IM) residents in two tertiary hospitals in Pasig City? Is there a significant difference in patient-perceived and self-assessed physician empathy levels between public and private tertiary hospitals? Background: Empathy is important because it has been speculated to have a positive effect on patient outcomes; it is a skill that can be learned and developed. Objectives: This study obtained quantitative measurements of patient-perceived and self-assessed physician empathy. Empathy levels between public and private tertiary hospitals were compared. General Study Design: This study utilized a quantitative cross-sectional design, with surveys as the strategy for data collection. Participants: 162 out-patient department patients aged 19-75, and 69 IM residents were sampled from one private and one public tertiary hospital. Outcome Measures: The Jefferson Scale of Patient Perceptions of Physician Empathy (JSPPPE) and the Jefferson Scale of Physician Empathy (JSE) were used to measure the empathy levels. Analysis: Sample size calculation was done using OpenEpi. An alpha level of .05 was used for computing the independent samples t-test. Results: Internal medicine patients from the private hospital rated the physicians with higher empathy scores (mean=31.23) compared to their public hospital counterparts (mean=29.01), which is significant (p=.0134). Residents from the private hospital also scored a higher self-assessed empathy score (mean=110.46) compared to physicians from the public hospital (mean=102.13), which is significant (p=.0147). Conclusion: This study provided preliminary information on the empathy levels of physicians in the Philippine setting between private and public hospitals, showing that physician empathy levels are consistently higher in the private hospital facility. The results can help hospitals incorporate or improve training in empathy in internal medicine residency programs, as empathy is known to affect patient health outcome

Freshwater microcrustaceans (Cladocera: Anomopoda and Ctenopoda, Copepoda: Cyclopoida and Calanoida) in the highly urbanized Metropolitan Manila area (Luzon, Philippines)

Despite the increasing interest in studying Cladocera and Copepoda in Philippine freshwaters, there is a need to update our knowledge on its taxonomy and distribution in highly urbanized areas, such as Metropolitan Manila. This paper presents an updated listing of freshwater microcrustaceans and their distribution in Metropolitan Manila, considering the continued deterioration of water quality and increased urbanization in many areas since the last comprehensive study on these taxa in 1950s. We collected water samples from 33 freshwater sites in Metropolitan Manila and 23 of which were found to contain microcrustacean zooplankton. A total of 13 species were identified including two new locality records for C. cornuta and D. dubium in Pasig River. All 8 cladocerans, we identified have already recorded in previous studies while 3 cyclopoid copepods are new records for Metropolitan Manila. Furthermore, 16% of all known freshwater microcrustacean zooplankton species in the Philippines are found in Metropolitan Manila, including the Luzon-endemic Filipinodiaptomus insulanus collected from man-made reservoirs in less-disturbed habitats (an urban wildlife park, golf course and eco-park). Other identified species such as Thermocyclops taihokuensis may serve as indicator for high levels of nutrient. These results point to the importance of monitoring urban aquatic biodiversity for their potential in determining aquatic ecosystem health and of maintaining urban aquatic sanctuaries which may serve as alternative habitat for flora and fauna in rapidly developing urban centers such as Metropolitan Manila

Factors Affecting Students, Faculties and Industry Partners Readiness in Virtual Internship: Input for Institutional Planning and Development in the Age of Pandemic

This study is about to stand on the brink of a technological revolution that will fundamentally alter the way we live, work, and relate to one another. In its scale, scope, and complexity, the transformation will be unlike anything humankind has experienced before. We do not yet know just how it will unfold, but one thing is clear: the response to it must be integrated and comprehensive, involving all stakeholders of the global polity, from the public and private sectors to academia and civil society.The institute of Technology and College of Education come up with a research to assess the factors affecting students and faculty readiness in online internship. The output of this study will serve as an input for the Institutional planning and development of the Polytechnic University of the Philippines in order to address the gap that will hamper the services provided by the university to all its stakeholders.The study cannot be over emphasized because of the fact that the preparedness of online internship transmission have become an essential element in every aspect of human society in today’s globalized world, its contribution in enhancement of the teaching – learning process to individuals, groups, society and to educational institutions have been overwhelming. It is believed that the tools available used  in the teaching of online  would greatly increase the learning activity of the students

Endothelial adhesion molecules and multiple organ failure in patients with severe sepsis

Objective To determine if serum levels of endothelial adhesion molecules were associated with the development of multiple organ failure (MOF) and in-hospital mortality in adult patients with severe sepsis. Design This study was a secondary data analysis of a prospective cohort study. Setting Patients were admitted to two tertiary intensive care units in San Antonio, TX, between 2007 and 2012. Patients Patients with severe sepsis at the time of intensive care unit (ICU) admission were enrolled. Inclusion criteria were consistent with previously published criteria for severe sepsis or septic shock in adults. Exclusion criteria included immunosuppressive medications or conditions. Interventions None. Measurements Baseline serum levels of the following endothelial cell adhesion molecules were measured within the first 72\ua0h of ICU admission: Intracellular Adhesion Molecule 1 (ICAM-1), Vascular Cell Adhesion Molecule-1 (VCAM-1), and Vascular Endothelial Growth Factor (VEGF). The primary and secondary outcomes were development of MOF (\u2a7e2 organ dysfunction) and in-hospital mortality, respectively. Main results Forty-eight patients were enrolled in this study, of which 29 (60%) developed MOF. Patients that developed MOF had higher levels of VCAM-1 (p\ua0=\ua00.01) and ICAM-1 (p\ua0=\ua00.01), but not VEGF (p\ua0=\ua00.70) compared with patients without MOF (single organ failure only). The area under the curve (AUC) to predict MOF according to VCAM-1, ICAM-1 and VEGF was 0.71, 0.73, and 0.54, respectively. Only increased VCAM-1 levels were associated with in-hospital mortality (p\ua0=\ua00.03). These associations were maintained even after adjusting for APACHE and SOFA scores using logistic regression. Conclusions High levels of serum ICAM-1 was associated with the development of MOF. High levels of VCAM-1 was associated with both MOF and in-hospital mortality

Genetic mechanisms of critical illness in COVID-19.

Host-mediated lung inflammation is present1, and drives mortality2, in the critical illness caused by coronavirus disease 2019 (COVID-19). Host genetic variants associated with critical illness may identify mechanistic targets for therapeutic development3. Here we report the results of the GenOMICC (Genetics Of Mortality In Critical Care) genome-wide association study in 2,244 critically ill patients with COVID-19 from 208 UK intensive care units. We have identified and replicated the following new genome-wide significant associations: on chromosome 12q24.13 (rs10735079, P = 1.65 × 10-8) in a gene cluster that encodes antiviral restriction enzyme activators (OAS1, OAS2 and OAS3); on chromosome 19p13.2 (rs74956615, P = 2.3 × 10-8) near the gene that encodes tyrosine kinase 2 (TYK2); on chromosome 19p13.3 (rs2109069, P = 3.98 ×  10-12) within the gene that encodes dipeptidyl peptidase 9 (DPP9); and on chromosome 21q22.1 (rs2236757, P = 4.99 × 10-8) in the interferon receptor gene IFNAR2. We identified potential targets for repurposing of licensed medications: using Mendelian randomization, we found evidence that low expression of IFNAR2, or high expression of TYK2, are associated with life-threatening disease; and transcriptome-wide association in lung tissue revealed that high expression of the monocyte-macrophage chemotactic receptor CCR2 is associated with severe COVID-19. Our results identify robust genetic signals relating to key host antiviral defence mechanisms and mediators of inflammatory organ damage in COVID-19. Both mechanisms may be amenable to targeted treatment with existing drugs. However, large-scale randomized clinical trials will be essential before any change to clinical practice

A realist analysis of hospital patient safety in Wales:Applied learning for alternative contexts from a multisite case study

Background: Hospital patient safety is a major social problem. In the UK, policy responses focus on the introduction of improvement programmes that seek to implement evidence-based clinical practices using the Model for Improvement, Plan-Do-Study-Act cycle. Empirical evidence that the outcomes of such programmes vary across hospitals demonstrates that the context of their implementation matters. However, the relationships between features of context and the implementation of safety programmes are both undertheorised and poorly understood in empirical terms. Objectives: This study is designed to address gaps in conceptual, methodological and empirical knowledge about the influence of context on the local implementation of patient safety programmes. Design: We used concepts from critical realism and institutional analysis to conduct a qualitative comparative-intensive case study involving 21 hospitals across all seven Welsh health boards. We focused on the local implementation of three focal interventions from the 1000 Lives+ patient safety programme: Improving Leadership for Quality Improvement, Reducing Surgical Complications and Reducing Health-care Associated Infection. Our main sources of data were 160 semistructured interviews, observation and 1700 health policy and organisational documents. These data were analysed using the realist approaches of abstraction, abduction and retroduction. Setting: Welsh Government and NHS Wales. Participants: Interviews were conducted with 160 participants including government policy leads, health managers and professionals, partner agencies with strategic oversight of patient safety, advocacy groups and academics with expertise in patient safety. Main outcome measures: Identification of the contextual factors pertinent to the local implementation of the 1000 Lives+ patient safety programme in Welsh NHS hospitals. Results: An innovative conceptual framework harnessing realist social theory and institutional theory was produced to address challenges identified within previous applications of realist inquiry in patient safety research. This involved the development and use of an explanatory intervention–context–mechanism–agency–outcome (I-CMAO) configuration to illustrate the processes behind implementation of a change programme. Our findings, illustrated by multiple nested I-CMAO configurations, show how local implementation of patient safety interventions are impacted and modified by particular aspects of context: specifically, isomorphism, by which an intervention becomes adapted to the environment in which it is implemented; institutional logics, the beliefs and values underpinning the intervention and its source, and their perceived legitimacy among different groups of health-care professionals; and the relational structure and power dynamics of the functional group, that is, those tasked with implementing the initiative. This dynamic interplay shapes and guides actions leading to the normalisation or the rejection of the patient safety programme. Conclusions: Heightened awareness of the influence of context on the local implementation of patient safety programmes is required to inform the design of such interventions and to ensure their effective implementation and operationalisation in the day-to-day practice of health-care teams. Future work is required to elaborate our conceptual model and findings in similar settings where different interventions are introduced, and in different settings where similar innovations are implemented. Funding: The National Institute for Health Research Health Services and Delivery Research programme