Emergency Department Clinicians’ Attitudes Toward Opioid Use Disorder and Emergency Department-initiated Buprenorphine Treatment: A Mixed-Methods Study

Introduction: Emergency department (ED) visits related to opioid use disorder (OUD) have increased nearly twofold over the last decade. Treatment with buprenorphine has been demonstrated to decrease opioid-related overdose deaths. In this study, we aimed to better understand ED clinicians’ attitudes toward the initiation of buprenorphine treatment in the ED.Methods: We performed a mixed-methods study consisting of a survey of 174 ED clinicians (attending physicians, residents, and physician assistants) and semi-structured interviews with 17 attending emergency physicians at a tertiary-care academic hospital.Results: A total of 93 ED clinicians (53% of those contacted) completed the survey. While 80% of respondents agreed that buprenorphine should be administered in the ED for patients requesting treatment, only 44% felt that they were prepared to discuss medication for addiction treatment. Compared to clinicians with fewer than five years of practice, those with greater experience were less likely to approve of ED-initiated buprenorphine. In our qualitative analysis, physicians had differing perspectives on the role that the ED should play in treating OUD. Most physicians felt that a buprenorphine-based intervention in the ED would be feasible with institutional support, including training opportunities, protocol support within the electronic health record, counseling and support staff, and a robust referral system for outpatient follow-up.Conclusion: ED clinicians’ perception of buprenorphine varied by years of practice and training level. Most ED clinicians did not feel prepared to initiate buprenorphine in the ED. Qualitative interviews identified several addressable barriers to ED-initiated buprenorphine

Quantitative high-resolution 7T MRI to assess longitudinal changes in articular cartilage after anterior cruciate ligament injury in a rabbit model of post-traumatic osteoarthritis

Objective To demonstrate an ultra-high field (UHF) 7 T delayed gadolinium-enhanced MRI of cartilage (dGEMRIC) protocol for quantitative post-traumatic osteoarthritis (PTOA) detection and monitoring in a rabbit anterior cruciate ligament transection (ACLT) model. Design ACL transections were performed unilaterally in 5 rabbits (33-weeks-old, 3.5 ± 0.5 kg) to induce PTOA. MRI exams were performed at 7 T prior to and 2, 4, 7 and 10-weeks after ACLT using a modified dGEMRIC protocol. Voxel-based T1 and T2 maps were created over manually drawn femoral cartilage ROIs from the center of the tibial plateau to the posterior meniscus. Femoral, tibial, and patellar epiphyses were harvested 10-weeks post-surgery and processed for μCT imaging and histology. Results Quantitative analysis revealed a 35% and 39% decrease in dGEMRIC index in the medial ACLT knee compartment 7- and 10-weeks post-surgery, respectively (p = 0.009 and p = 0.006) when compared to baseline. There was no significant change in the lateral ACLT compartment or in either compartment of the control knees. Visual inspection of histology confirmed PTOA in the ACLT knees. Osteophytes were found only in ACLT knees (osteophyte volume in femur: 94.53 ± 44.08 mm3, tibia: 29.35 ± 13.79 mm3, and patella: 3.84 ± 0.92 mm3) and were significantly larger in the medial compartments of the femur than lateral (p = 0.0312). Conclusion The dGEMRIC technique quantitatively applied at 7 T UHF-MRI demonstrates site-specific cartilage degeneration in a large animal PTOA model. This should encourage further investigation, with potential applications in drug and therapeutic animal trials as well as human studies

Ferroelectric photovoltaic properties in doubly substituted (Bi0.9La0.1)(Fe0.97Ta0.03)O3 thin films

This work was supported by the DOE-EPSCoR Grant No. DE-FG02-08ER46526. Acknowledgment is also due to NSF Grant No. #1002410 for providing fellowships to R.K.K., D.B., and J.S.Y.Doubly substituted [Bi0.9La0.1][Fe0.97Ta0.03]O3 (BLFTO) films were fabricated on Pt/TiO2/SiO2/Si substrates by pulsed laser deposition. The ferroelectric photovoltaic properties of ZnO:Al/BLFTO/Pt thin film capacitor structures were evaluated under white light illumination. The open circuit voltage and short circuit current density were observed to be ∼0.20 V and ∼1.35 mA/cm2, respectively. The band gap of the films was determined to be ∼2.66 eV, slightly less than that of pure BiFeO3 (2.67 eV). The PVproperties of BLFTO thin films were also studied for various pairs of planar electrodes in different directions in polycrystalline thin films.Publisher PDFPeer reviewe

IMPACT: The Journal of the Center for Interdisciplinary Teaching and Learning. Volume 12, Issue 1, Summer 2023

The essays in this issue explore how to enhance teaching and student learning in the classroom. Our first contributor argues that providing students the opportunity to write questions about course material is a fruitful way to address students’ reticence about asking questions during class and also may result in students performing better on testable material. Moreover, instructors benefit from having students’ questions because the written questions can also be used by the instructor to know better what students are and are not understanding about course material and alerts instructors to where they can further explain or clarify course material. Finally, our first contributor also suggests that students in interdisciplinary classrooms might especially benefit from writing their questions, while instructors of interdisciplinary courses may find the flexibility with using technology to address the written questions in “real time” via the use of technology especially beneficial. In our second contribution, the author argues that pre-service teachers’ educational curriculum should address the academic literature that links poor musical-rhythmic tendencies with reading struggles for reading learners. The author also argues that the rhythm-reading connection is applicable to interdisciplinary educators because it asks those educators to reflect on possible connections between the body and the acquisition of skills that are usually considered purely intellectual. Our Impact book reviewers cover a varied set of interesting and important topics in this issue. One reviewer informs readers about a handbook on community psychology that prioritizes applied and interdisciplinary work; another reviewer details an author’s synthesis of what contemporary archaeology has now come to understand about Maya civilization’s resilient and complex society through time and within their varied mosaic of managed environments; a different reviewer delves into an author’s exploration of how digital media platforms generate novel opportunities for sufferers of trauma to make sense of their experience, and our final reviewer details an author’s accounting of the history, origins, and evolution of the Camp Fire Girls, one of America’s longest-serving girls’ youth movements, its impact on girls’ lives, and how the organization adapted to and resisted dominant ideologies about girls, culture, and race across time

P-rex1 cooperates with PDGFRβ to drive cellular migration in 3D microenvironments

Expression of the Rac-guanine nucleotide exchange factor (RacGEF), P-Rex1 is a key determinant of progression to metastasis in a number of human cancers. In accordance with this proposed role in cancer cell invasion and metastasis, we find that ectopic expression of P-Rex1 in an immortalised human fibroblast cell line is sufficient to drive multiple migratory and invasive phenotypes. The invasive phenotype is greatly enhanced by the presence of a gradient of serum or platelet-derived growth factor, and is dependent upon the expression of functional PDGF receptor β. Consistently, the invasiveness of WM852 melanoma cells, which endogenously express P-Rex1 and PDGFRβ, is opposed by siRNA of either of these proteins. Furthermore, the current model of P-Rex1 activation is advanced through demonstration of P-Rex1 and PDGFRβ as components of the same macromolecular complex. These data suggest that P-Rex1 has an influence on physiological migratory processes, such as invasion of cancer cells, both through effects upon classical Rac1-driven motility and a novel association with RTK signalling complexes

Factors Associated with Opioid Overdose after an Initial Opioid Prescription

Importance: The opioid epidemic continues to be a public health crisis in the US. Objective: To assess the patient factors and early time-varying prescription-related factors associated with opioid-related fatal or nonfatal overdose. Design, Setting, and Participants: This cohort study evaluated opioid-naive adult patients in Oregon using data from the Oregon Comprehensive Opioid Risk Registry, which links all payer claims data to other health data sets in the state of Oregon. The observational, population-based sample filled a first (index) opioid prescription in 2015 and was followed up until December 31, 2018. Data analyses were performed from March 1, 2020, to June 15, 2021. Exposures: Overdose after the index opioid prescription. Main Outcomes and Measures: The outcome was an overdose event. The sample was followed up to identify fatal or nonfatal opioid overdoses. Patient and prescription characteristics were identified. Prescription characteristics in the first 6 months after the index prescription were modeled as cumulative, time-dependent measures that were updated monthly through the sixth month of follow-up. A time-dependent Cox proportional hazards regression model was used to assess patient and prescription characteristics that were associated with an increased risk for overdose events. Results: The cohort comprised 236921 patients (133 839 women [56.5%]), of whom 667 (0.3%) experienced opioid overdose. Risk of overdose was highest among individuals 75 years or older (adjusted hazard ratio [aHR], 3.22; 95% CI, 1.94-5.36) compared with those aged 35 to 44 years; men (aHR, 1.29; 95% CI, 1.10-1.51); those who were dually eligible for Medicaid and Medicare Advantage (aHR, 4.37; 95% CI, 3.09-6.18), had Medicaid (aHR, 3.77; 95% CI, 2.97-4.80), or had Medicare Advantage (aHR, 2.18; 95% CI, 1.44-3.31) compared with those with commercial insurance; those with comorbid substance use disorder (aHR, 2.74; 95% CI, 2.15-3.50), with depression (aHR, 1.26; 95% CI, 1.03-1.55), or with 1 to 2 comorbidities (aHR, 1.32; 95% CI, 1.08-1.62) or 3 or more comorbidities (aHR, 1.90; 95% CI, 1.42-2.53) compared with none. Patients were at an increased overdose risk if they filled oxycodone (aHR, 1.70; 95% CI, 1.04-2.77) or tramadol (aHR, 2.80; 95% CI, 1.34-5.84) compared with codeine; used benzodiazepines (aHR, 1.06; 95% CI, 1.01-1.11); used concurrent opioids and benzodiazepines (aHR, 2.11; 95% CI, 1.70-2.62); or filled opioids from 3 or more pharmacies over 6 months (aHR, 1.38; 95% CI, 1.09-1.75). Conclusions and Relevance: This cohort study used a comprehensive data set to identify patient and prescription-related risk factors that were associated with opioid overdose. These findings may guide opioid counseling and monitoring, the development of clinical decision-making tools, and opioid prevention and treatment resources for individuals who are at greatest risk for opioid overdose

Dark soliton states of Bose-Einstein condensates in anisotropic traps

Dark soliton states of Bose-Einstein condensates in harmonic traps are studied both analytically and computationally by the direct solution of the Gross-Pitaevskii equation in three dimensions. The ground and self-consistent excited states are found numerically by relaxation in imaginary time. The energy of a stationary soliton in a harmonic trap is shown to be independent of density and geometry for large numbers of atoms. Large amplitude field modulation at a frequency resonant with the energy of a dark soliton is found to give rise to a state with multiple vortices. The Bogoliubov excitation spectrum of the soliton state contains complex frequencies, which disappear for sufficiently small numbers of atoms or large transverse confinement. The relationship between these complex modes and the snake instability is investigated numerically by propagation in real time.Comment: 11 pages, 8 embedded figures (two in color

B-Type Natriuretic Peptide and Cardiac Troponin I Are Associated With Adverse Outcomes in Stable Kidney Transplant Recipients

Approximately 200,000 kidney transplant recipients are living in the US; they are at increased risk for cardiovascular and other adverse outcomes. Biomarkers predicting these outcomes are needed. Using specimens collected during the FAVORIT (Folic Acid for Vascular Outcome Reduction In Transplantation) trial, we determined whether plasma levels of B-type natriuretic peptide (BNP) and cardiac troponin I are associated with adverse outcomes in stable kidney transplant recipients