Addressing a Lack of Education Surrounding Fentanyl Use and Recovery

Nursing Leadership Executive Summary: Addressing a Lack of Education Surrounding Fentanyl Use and Recovery Our project focused on assisting a nonprofit organization who exists to serve the most vulnerable of families in the Seattle area. They offer a number of programs including a mobile outreach team that seeks to bring resources to families, a program for families which provides the opportunity for new mothers to bond with their newborn, and another program which assists families with medically fragile children to find healthcare resources, and more. Our team was made up of six students from the Lydia Green Nursing Program at Seattle Pacific University who were enrolled in the Nursing Leadership in Community Engagement class. The aim of this course was to practically apply our leadership skills in the context of public health by providing resources to a local health agency to complement their current programs. This was done by collecting data on the target population and communicating with the agency to identify an issue that could be addressed through an evidence-based project. Upon our first meeting with the staff at the community agency, we identified the issue of deficient knowledge among the staff related to fentanyl use and recovery, as evidenced by relapse occurrence, unsafe handling of the drug, and self-report from the staff. Our team in collaboration with the agency decided to create an evidence-based resource for the staff that would detail overdose and Narcan use, education on fentanyl, and safe disposal of the needles, all displayed in a concise binder that the staff can continue to use for years to come. Background A King County Point-in-Time Count revealed that there were over 11,500 people experiencing homelessness, which was a five percent increase from the year prior (Constantine, 2020). Another qualitative study looking at addiction recovery of women in opioid use disorder described postpartum pain and anxiety as the primary reason for mothers to turn back to opioid substances (Rankin, 2022). These statistics informed us of the need for resources to address the issue of substance relapse in mothers. This agency was only a few years old at the time of this project and was in need of procedures and protocols to address health issues for their population, in addition to resources outside the agency. The staff of the community center were enthusiastic about the idea of educational resources for their employees. By educating the staff, our group empowered them to provide quality care to their clients. Activities with Rationale One of the primary resources that the community agency provides to their clients is their mobile outreach team, which strives to meet people at their place of residence to provide medical, financial, and educational support. At the time of this project, the agency was in dire need of educational resources for their outreach staff. The goal of our project was to provide access to evidence-based research through educational binders and badges for the staff. The first item we created was an educational pocket/badge card. The literature demonstrates pocket cards are effective tools for process improvement when a rapid response is needed. In one study, the use of a pocket card increased the use of narcan four-fold (Russel, et al., 2015). Because pocket cards are such an effective tool, our team created a pocket card for staff and clients around proper Narcan administration. The second item we created was an educational binder. Each section of the binder was focused on a different topic of interest that the staff had asked for more education on. The first tab in the educational binder focused on education surrounding fentanyl use. Our goal was to educate the staff on the public health crisis surrounding fentanyl use in Seattle by discussing common drugs that can be laced with fentanyl, addressing misconceptions of how someone overdoses from fentanyl, and what an overdose looks like (Centers for Disease Control and Prevention, 2022). A lot of our efforts also focused on naloxone (Narcan) education due to the services that the agency provides to their clients. The community center is frequently working with a population that utilizes substances, resulting in the need for their staff to be thoroughly educated and comfortable with the use of Narcan. The information in our binder covered what an overdose looks like by using the acronym “S.U.S.P.E.C.T.”, which stands for slack muscles, unresponsive, scratching, pupils constricted, emesis, and choking sounds (Illinois Department of Public Health, n.d.). Our education then shifted to proper use of naloxone, which outlined how to administer it in a safe way. Another resource that the agency had indicated a need for was detailed information regarding needle and sharps disposal. Upon our first meeting with the community center, the executive director mentioned the lack of information their clients have on proper disposal of sharps. The population that they serve often does not have access to a proper sharps bin, which creates the need for alternative options. Our education focused on creative ways to dispose of needles through the use of everyday objects, such as an old laundry detergent bottle (What to Do With Used Sharps in Washington, 2020). We also touched on the laws in Washington State that govern disposal of needles, and where the clients can dispose of their collected needles. The final resource we put together for the staff was information surrounding methadone and the role it has in preventing further opioid dependence. Our goal was to educate the staff on what methadone is, and the risks that come with using it. It is widely known in the literature that access to educational resources can improve work-flow, decision making, and outcomes. Outcomes The staff at the community center demonstrated the need for education surrounding the health issues that their clients face. Based on the needs assessment, we identified the nursing diagnosis to be knowledge deficit among the staff related to fentanyl use and recovery, as evidenced by relapse occurrence, unsafe handling of the drug, and self-report from the staff. Our goal was to equip their mobile outreach team and staff based out of the agency with information that would guide the interventions used for their clients, based on the evidence in the literature. Our binder of educational information was received very well by the staff. The badge resource we created was also very appreciated by the staff, and the director said it would be very useful for their mobile outreach team. The team verbalized understanding of the educational content. Pre and post outcomes were outside the scope of this project. Each week during the development of our project, our team liaison would communicate with the agency regarding the progress of our research and project. The outreach coordinator was enthusiastic about the resources we were providing them, and frequently thanked our team for the interventions we were providing the agency. By equipping the employees, we were able to provide tangible health and nursing knowledge for their clientele. Conclusion In conclusion, our interventions on behalf of the community agency were able to address their goals of educating their staff on problems relevant to the population they serve. Our team also met our goal of providing a resource to the agency based on the nursing process, which includes assessment, diagnosis, planning and outcomes, implementation, and evaluation. Based on the needs assessment, our nursing diagnosis was a knowledge deficit surrounding fentanyl use and recovery. We met this need by providing an evidence based pocket card and educational binder. Our project ultimately has the potential to make an impact on the community that the agency serves, and should continue to make a difference as the educational binder is used for years to come. In the future we recommend further education surrounding fentanyl use and recovery, along with education in other areas where the agency shows a knowledge deficit. References Center for Disease Control and Prevention. (2022). Fentanyl facts. Department of Health and Human Services. https://www.cdc.gov/stopoverdose/fentanyl/index.html Constantine, D. (2020). News. Executive News. https://kingcounty.gov/elected/executive/constantine/news/release/2020/July/01-homeless-count.aspx Illinois Department of Public Health. How to use naloxone and prevent overdose. (n.d.) State of Illinois. https://dph.illinois.gov/content/dam/soi/en/web/idph/files/images/naloxone-brochure-09052017.pdf Rankin, L., Mendoza, N. S., & Grisham, L. (2022). Unpacking perinatal experiences with opioid use disorder: Relapse risk implications. Clinical Social Work Journal. https://doi.org/10.1007/s10615-022-00847-x Russell, C. D., Young, I., Leung, V., & Morris, K. (2015). Healthcare Workers\u27 decision-making about transmission-based infection control precautions is improved by a guidance summary card. Journal of Hospital Infection, 90(3), 235–239. https://doi.org/10.1016/j.jhin.2014.12.025 What to Do with Used Sharps in Washington. Safe Needle Disposal. (2020, April 7). https://safeneedledisposal.org/states/washington

Effects of auditory sleep modulation approaches on brain oscillatory and cardiovascular dynamics

Slow waves, the hallmark feature of deep nonrapid eye movement sleep, do potentially drive restorative effects of sleep on brain and body functions. Sleep modulation techniques to elucidate the functional role of slow waves thus have gained large interest. Auditory slow wave stimulation is a promising tool; however, directly comparing auditory stimulation approaches within a night and analyzing induced dynamic brain and cardiovascular effects are yet missing. Here, we tested various auditory stimulation approaches in a windowed, 10 s ON (stimulations) followed by 10 s OFF (no stimulations), within-night stimulation design and compared them to a SHAM control condition. We report the results of three studies and a total of 51 included nights and found a large and global increase in slow-wave activity (SWA) in the stimulation window compared to SHAM. Furthermore, slow-wave dynamics were most pronouncedly increased at the start of the stimulation and declined across the stimulation window. Beyond the changes in brain oscillations, we observed, for some conditions, a significant increase in the mean interval between two heartbeats within a stimulation window, indicating a slowing of the heart rate, and increased heart rate variability derived parasympathetic activity. Those cardiovascular changes were positively correlated with the change in SWA, and thus, our findings provide insight into the potential of auditory slow wave enhancement to modulate cardiovascular restorative conditions during sleep. However, future studies need to investigate whether the potentially increased restorative capacity through slow-wave enhancements translates into a more rested cardiovascular system on a subsequent day

A dynamic clamping approach using in silico IK1 current for discrimination of chamber-specific hiPSC-derived cardiomyocytes

: Human induced pluripotent stem cell (hiPSC)-derived cardiomyocytes (CM) constitute a mixed population of ventricular-, atrial-, nodal-like cells, limiting the reliability for studying chamber-specific disease mechanisms. Previous studies characterised CM phenotype based on action potential (AP) morphology, but the classification criteria were still undefined. Our aim was to use in silico models to develop an automated approach for discriminating the electrophysiological differences between hiPSC-CM. We propose the dynamic clamp (DC) technique with the injection of a specific IK1 current as a tool for deriving nine electrical biomarkers and blindly classifying differentiated CM. An unsupervised learning algorithm was applied to discriminate CM phenotypes and principal component analysis was used to visualise cell clustering. Pharmacological validation was performed by specific ion channel blocker and receptor agonist. The proposed approach improves the translational relevance of the hiPSC-CM model for studying mechanisms underlying inherited or acquired atrial arrhythmias in human CM, and for screening anti-arrhythmic agents

Mercury Production and Use in Colonial Andean Silver Production: Emissions and Health Implications

Background: Colonial cinnabar mining and refining began in Huancavelica, Peru, in 1564. With a local source of mercury, the amalgamation process was adopted to refine silver in Potosí, Bolivia, in the early 1570s. As a result, large quantities of mercury were released into the environment

MARCH1 protects the lipid raft and tetraspanin web from MHCII proteotoxicity in dendritic cells

Dendritic cells (DCs) produce major histocompatibility complex II (MHCII) in large amounts to function as professional antigen presenting cells. Paradoxically, DCs also ubiquitinate and degrade MHCII in a constitutive manner. Mice deficient in the MHCII-ubiquitinating enzyme membrane-anchored RING-CH1, or the ubiquitin-acceptor lysine of MHCII, exhibit a substantial reduction in the number of regulatory T (Treg) cells, but the underlying mechanism was unclear. Here we report that ubiquitin-dependent MHCII turnover is critical to maintain homeostasis of lipid rafts and the tetraspanin web in DCs. Lack of MHCII ubiquitination results in the accumulation of excessive quantities of MHCII in the plasma membrane, and the resulting disruption to lipid rafts and the tetraspanin web leads to significant impairment in the ability of DCs to engage and activate thymocytes for Treg cell differentiation. Thus, ubiquitin-dependent MHCII turnover represents a novel quality-control mechanism by which DCs maintain homeostasis of membrane domains that support DC's Treg cell-selecting function

QT interval prolongation after sertraline overdose: a case report

BACKGROUND: Selective serotonin reuptake inhibitors (SSRIs) are the most common antidepressants used in first-world countries and are generally well tolerated. Specifically, less cardiovascular toxicity has been reported in comparison with tricyclic antidepressants. Here we report QT interval prolongation after an overdose of the SSRI sertraline. CASE PRESENTATION: A previously healthy female patient presented with an attempted suicide with overdoses sertraline (2250 mg), diazepam (200 mg), and temazepam (400 mg). Routine laboratory studies were normal and her ECG upon admission showed a normal QT interval. The next day, her ECG showed prolongation of the QT(c )interval up to 525 ms. After discontinuation of sertraline the QT interval normalized. Echocardiography and exercise electrocardiography were normal. After hospitalization, the patient resumed sertraline in the normally recommended dose and QT interval remained within normal ranges. CONCLUSION: It seems that the SSRI sertraline in overdose may cause QT interval prolongation

Storage of carbon reserves in spruce trees is prioritized over growth in the face of carbon limitation

Climate change is expected to pose a global threat to forest health by intensifying extreme events like drought and insect attacks. Carbon allocation is a fundamental process that determines the adaptive responses of long-lived late-maturing organisms like trees to such stresses. However, our mechanistic understanding of how trees coordinate and set allocation priorities among different sinks (e.g., growth and storage) under severe source limitation remains limited. Using flux measurements, isotopic tracing, targeted metabolomics, and transcriptomics, we investigated how limitation of source supply influences sink activity, particularly growth and carbon storage, and their relative regulation in Norway spruce (Picea abies) clones. During photosynthetic deprivation, absolute rates of respiration, growth, and allocation to storage all decline. When trees approach neutral carbon balance, i.e., daytime net carbon gain equals nighttime carbon loss, genes encoding major enzymes of metabolic pathways remain relatively unaffected. However, under negative carbon balance, photosynthesis and growth are down-regulated while sucrose and starch biosynthesis pathways are up-regulated, indicating that trees prioritize carbon allocation to storage over growth. Moreover, trees under negative carbon balance actively increase the turnover rate of starch, lipids, and amino acids, most likely to support respiration and mitigate stress. Our study provides molecular evidence that trees faced with severe photosynthetic limitation strategically regulate storage allocation and consumption at the expense of growth. Understanding such allocation strategies is crucial for predicting how trees may respond to extreme events involving steep declines in photosynthesis, like severe drought, or defoliation by heat waves, late frost, or insect attack.DATA AVAILABITY : All study data are included in the article and/or supporting information. Transcriptome data have been deposited in the NCBI database under BioProject accession no. PRJNA751264.Max Planck Society.https://www.pnas.orghj2022BiochemistryForestry and Agricultural Biotechnology Institute (FABI)GeneticsMicrobiology and Plant Patholog

Eyes on the future – evidence for trade‐offs between growth, storage and defense in Norway spruce

Carbon (C) allocation plays a central role in tree responses to environmental changes. Yet, fundamental questions remain about how trees allocate C to different sinks, for example, growth vs storage and defense. In order to elucidate allocation priorities, we manipulated the whole‐tree C balance by modifying atmospheric CO2 concentrations [CO2] to create two distinct gradients of declining C availability, and compared how C was allocated among fluxes (respiration and volatile monoterpenes) and biomass C pools (total biomass, nonstructural carbohydrates (NSC) and secondary metabolites (SM)) in well‐watered Norway spruce (Picea abies) saplings. Continuous isotope labelling was used to trace the fate of newly‐assimilated C. Reducing [CO2] to 120 ppm caused an aboveground C compensation point (i.e. net C balance was zero) and resulted in decreases in growth and respiration. By contrast, soluble sugars and SM remained relatively constant in aboveground young organs and were partially maintained with a constant allocation of newly‐assimilated C, even at expense of root death from C exhaustion. We conclude that spruce trees have a conservative allocation strategy under source limitation: growth and respiration can be downregulated to maintain ‘operational’ concentrations of NSC while investing newly‐assimilated C into future survival by producing SM.Supplementary material: Fig. S1 Concentrations of soluble sugars, starch and NSC (soluble sugars + starch) expressed as percentage of control (400 ppm [CO2]) at the whole‐tree level. Fig. S2 Concentrations of soluble sugars, starch and NSC (soluble sugars + starch) at the whole‐tree level. Fig. S3 Concentrations of phenolic compounds, monoterpenes and total secondary metabolites expressed as percentage of control (400 ppm [CO2]) at the whole‐tree level. Fig. S4 Concentrations of phenolic compounds, monoterpenes and total secondary metabolites (phenolic compounds + monoterpenes) at the whole‐tree level. Fig. S5 δ13C (‰) of bulk tissue, water soluble C and phenolic compounds at the whole‐tree level. Methods S1 TD‐GC‐MS conditions for BVOC analysis. Table S1 Internal standards, weight‐based response factors and methods used for the measurements of secondary metabolites. Table S2 A rough estimation of allocation of newly‐assimilated carbon.JH was funded by the Chinese Scholarship Council and Max Planck Institute for Biogeochemistry, and acknowledges support from the International Max Planck Research School for Global Biogeochemical Cycles.http://www.newphytologist.com2020-04-01hj2019Forestry and Agricultural Biotechnology Institute (FABI)Zoology and Entomolog