2019 James R. Browning Distinguished Lecture in Law, Holding the Delicate Balance Steady and True : The History of FISA\u27s Grand Bargain

The Honorable Richard C. Tallman and his career law clerk Tania M. Culbertson explain what led to the passage of the Foreign Intelligence Surveillance Act ( FISA ) and its creation of the FISA courts, and describe the grand bargain that was struck between our three branches of government when creating FISA\u27s judicial review procedures over domestic espionage and counter-terrorism investigations. Their hope is to leave you with a keener understanding of how we have arrived at where we are today, and how the judiciary understands its oversight role within FISA\u27s statutory framework under our Constitution

Impact of academic detailing on clinical pharmacy specialist involvement in medication assisted

Title: Impact of academic detailing on clinical pharmacy specialist involvement in medication assisted treatment for opioid use disorder in a primary care setting Lindsey Bartos, PharmD; Kristin Tallman, PharmD, BCPS, BCACP; Dara Johnson, PharmD, BCPP, BCACP Introduction: Opioid prescribing and opioid overdose deaths have increased steadily since the 1990s, reaching a 6-fold increase between 1999 and 2017. The opioid crisis, as it became known, was declared a public health emergency in 2017. In 2018 alone, an estimated two million people had a diagnosed opioid use disorder (OUD). The use of medication-assisted treatment (MAT) for OUD reduces the use and cravings of opiates, and risk of all-cause and opioid-related mortality. The inclusion of clinical pharmacy specialists (CPSs) on multidisciplinary healthcare teams has been shown to improve health outcomes, increase cost-effectiveness, and improve the quality of healthcare. Nevertheless, CPS involvement in MAT for OUD in a primary care setting remains limited. This study will provide information regarding barriers to CPS involvement in MAT, and the effectiveness of academic detailing provided to CPSs in increasing CPS involvement. Objectives: The objectives of this project are to identify and describe the most common barriers to CPS involvement in MAT for OUD, then assess the impact of academic detailing on CPS comfort level with being involved in the care of patients undergoing MAT for OUD in the primary care setting. Additionally, this project will assess the hypothesis that academic detailing will increase the number of patients with a CPS involved in the treatment of OUD. Methods: Study participants are CPSs recruited from a large medical group in Oregon and SW Washington who completed a survey before and after participating in academic detailing. The pre-survey was used to assess demographics, current involvement with MAT, perceived barriers to involvement in MAT, and asked participants to anonymously assess their comfort level, knowledge, and beliefs regarding MAT for OUD using a 0-5 point scale. Academic detailing was developed based on reported barriers, and consisted of handouts, two 45 minute interactive presentations, and small group work with case-based application. Participants then filled out a post-survey to re-assess their comfort level, knowledge, and beliefs regarding MAT for OUD following academic detailing. Survey results were compared and summarized by using either % of respondents in each category or mean (standard deviation) for each question across all respondents, then compared using a Wilcoxon-rank-sum test. CPS involvement in MAT will be reassessed using a survey or electronic intervention tracking in June. Results: 19 CPSs responded to the pre-survey and 20 CPSs responded to the post-survey. 4 respondents (21.05%) were currently active in MAT, and of these respondents, 3 indicated they are involved with MAT for 1-5 patients annually, and 1 indicated they are involved with MAT for 20+ patients annually. The most common barriers to involvement in MAT were lack of time (23.08%), lack of X-waivered providers (23.08%), and lack of knowledge regarding MAT (21.15%). There was no change in the number of CPSs involved in MAT between the pre-survey and the post-survey. Median responses to 6 of the 8 survey questions differed significantly between the pre and post surveys (p Conclusions: Most CPSs within PMG are not involved in the use of buprenorphine in MAT for OUD, likely due to a combination of time constraints, a lack of providers with the ability to prescribe buprenorphine, and unfamiliarity with buprenorphine in MAT. Following academic detailing to address these barriers, CPS comfort with buprenorphine in MAT had significantly improved in most areas. CPS involvement in MAT for OUT will be reassessed in June, 3 months following the academic detailing intervention.https://digitalcommons.psjhealth.org/pharmacy_PGY2/1001/thumbnail.jp

Water Insecurity, Self-reported Physical Health, and Objective Measures of Biological Health in the Peruvian Amazon

ObjectivesThis study examines the associations between water insecurity, self-reported physical health, and objective measures of biological health among 225 Awajún adults (107 women; 118 men) living in the Peruvian Amazon, a “water-abundant” region.MethodsA survey, which included multiple measures of self-reported physical health, and objective measures of biological health such as blood pressure and nutritional and immune biomarkers.ResultsGreater water insecurity was associated with multiple measures of self-reported physical health, including higher incidence of reported diarrhea, nausea, back pain, headaches, chest pain, fatigue, dizziness, overall poor perceived health, and “being sick.” These symptoms align with the physical strain associated with water acquisition and with drinking contaminated water. A significant association between higher water insecurity and lower systolic blood pressure emerged, which may be linked to dehydration. None of the other biomarkers, including those for nutrition, infection, and stress were significantly associated with water insecurity scores.ConclusionsThese analyses add to the growing body of research examining the associations between water insecurity and health. Biocultural anthropologists are well-positioned to continue probing these connections. Future research will investigate relationships between measures of water insecurity and biomarkers for gastrointestinal infection and inflammation in water-scarce and water-abundant contexts

Cardiovascular disease in the Peruvian Andes: local perceptions, barriers, and paths to preventing chronic diseases in the Cajamarca region

Objectives: Public health interventions can be improved by understanding peoples' explanatory models of disease. We explore awareness and perceptions of cardiovascular diseases (CVD) and options for preventative actions in young adults living in rural Andean communities. Methods: We used convenience sampling to select 46 men and women from communities in Cajamarca (Peru). Subjects participated in eight focus groups where they discussed their understanding and perceived causes of CVD as well as barriers and pathways to healthy lifestyles. Results: Fresh foods, physical activity, unpleasant emotions, and healthcare access were cited as important determinants of healthy lifestyles. Barriers to healthy diets included lacking nutritional knowledge, fluctuating food prices, and limited access to foodstuffs. Women felt particularly vulnerable to CVD and identified gendered barriers to manage stress and engage in sports. Low health literacy, poor doctor-patient relationships, and long distances prevented participants from fully accessing healthcare. Conclusion: CVD prevention interventions should consider local knowledge of these diseases and of healthy lifestyles, and harness ongoing programmes that have successfully promoted good nutrition in children and pregnant women. In concert with public-private parterships, governments should include disease prevention interventions for the entire family

Tapinarof in the treatment of psoriasis: A review of the unique mechanism of action of a novel therapeutic AhR modulating agent (TAMA)

Tapinarof, a novel, first-in-class small-molecule topical therapeutic aryl hydrocarbon receptor (AhR) modulating agent (TAMA), is in clinical development for the treatment of psoriasis and atopic dermatitis. The efficacy of tapinarof in psoriasis is attributed to its specific binding and activation of AhR, a ligand-dependent transcription factor, leading to the downregulation of pro-inflammatory cytokines, including interleukin-17, and regulation of skin barrier protein expression to promote skin barrier normalization. AhR signaling regulates gene expression in immune cells and skin cells, and has critical roles in the regulation of skin homeostasis. Tapinarof-mediated AhR signaling underlies the mechanistic basis for the significant efficacy and acceptable tolerability observed in early phase clinical trials of tapinarof cream in the treatment of psoriasis

Understanding the Burden of Atopic Dermatitis in Africa and the Middle East

Atopic dermatitis (AD) is a common inflammatory skin disease characterized by intensely pruritic lesions. The prevalence of atopic dermatitis is increasing in developing regions, including Africa and the Middle East. However, these regions are underrepresented in the dermatology literature, and a better understanding of the growing burden of atopic dermatitis in Africa and the Middle East is necessary. Herein, we summarize current knowledge on atopic dermatitis epidemiology, disease burden, and treatment options in Africa and the Middle East, highlighting the unmet needs of patients in these regions. With these needs in mind, we provide clinical recommendations for appropriate management of atopic dermatitis in Africa and the Middle East. Funding: Pfizer Inc. Plain Language Summary: Plain language summary available for this article.Editorial/medical writing support under the guidance of the authors was provided by Madeline L. Pfau, PhD, and Corey Mandel, PhD, at ApotheCom, New York, NY, and San Francisco, CA, USA, and was funded by Pfizer Inc., New York, NY, USA, in accordance with Good Publication Practice (GPP3) guidelines ( Ann Intern Med. 2015;163:461-464).Scopu

The femur of \u3ci\u3eOrrorin tugenensis\u3c/i\u3e exhibits morphometric affinities with both Miocene apes and later hominins

Orrorin tugenensis (Kenya, ca. 6 Ma) is one of the earliest putative hominins. Its proximal femur, BAR 1002′00, was originally described as being very human-like, although later multivariate analyses showed an australopith pattern. However, some of its traits (for example, laterally protruding greater trochanter, medially oriented lesser trochanter and presence of third trochanter) are also present in earlier Miocene apes. Here, we use geometric morphometrics to reassess the morphological affinities of BAR 1002′00 within a large sample of anthropoids (including fossil apes and hominins) and reconstruct hominoid proximal femur evolution using squared-change parsimony. Our results indicate that both hominin and modern great ape femora evolved in different directions from a primitive morphology represented by some fossil apes. Orrorin appears intermediate between Miocene apes and australopiths in shape space. This evidence is consistent with femoral shape similarities in extant great apes being derived and homoplastic and has profound implications for understanding the origins of human bipedalism

Early anthropoid femora reveal divergent adaptive trajectories in catarrhine hind-limb evolution

The divergence of crown catarrhines—i.e., the split of cercopithecoids (Old World monkeys) from hominoids (apes and humans)—is a poorly understood phase in our shared evolutionary history with other primates. The two groups differ in the anatomy of the hip joint, a pattern that has been linked to their locomotor strategies: relatively restricted motion in cercopithecoids vs. more eclectic movements in hominoids. Here we take advantage of the first well-preserved proximal femur of the early Oligocene stem catarrhine Aegyptopithecus to investigate the evolution of this anatomical region using 3D morphometric and phylogenetically-informed evolutionary analyses. Our analyses reveal that cercopithecoids and hominoids have undergone divergent evolutionary transformations of the proximal femur from a similar ancestral morphology that is not seen in any living anthropoid, but is preserved in Aegyptopithecus, stem platyrrhines, and stem cercopithecoids. These results highlight the relevance of fossil evidence for illuminating key adaptive shifts in primate evolution