How to Improve a Medication-Assisted Treatment Program for Opioid Use Disorder: First, Look at the Evidence

The prevalence of Opioid Use Disorder (OUD) in the United States has been described as an epidemic, and rural areas have been affected in particular. A treatment paradigm called Medication-Assisted Treatment (MAT) has been demonstrated to be effective at treating OUD, and more and more rural, primary care clinics are establishing MAT programs. One such clinic is Hudson Headwaters Health Network, a FQHC in Upstate New York. I wrote a literature review and distributed it to staff involved in MAT program design, and I also wrote a practical evidence guide for MAT providers. Providers completed a survey assessing the evidence guide.https://scholarworks.uvm.edu/fmclerk/1513/thumbnail.jp

Role of the Dental Community in HPV Vaccination Promotion

Introduction. With increasing awareness that human papillomavirus (HPV) can cause oropharyngeal cancer (OPC), dental providers may play an important role in promoting HPV vaccination and preventing cancer. Our goal was to assess knowledge and current HPV vaccine counseling practices among Vermont dentists and dental hygienists to identify potential targets for state-level interventions to increase vaccine coverage. Methods. We developed a survey to assess knowledge, beliefs, practices and barriers regarding HPV vaccination, and distributed it via email to practicing Vermont dentists and dental hygienists. Free responses were analyzed using a coding framework generated from three key informant interviews. Results. 90% of providers believe it is important for them to play an “active role” in their patients’ general medical care, yet only 50% believe it is their responsibility to recommend HPV vaccine. Only 50% feel knowledgeable enough to recommend the vaccine. 78.6% of providers rarely discuss HPV vaccination with their age-appropriate patients, and 82% rarely recommend the vaccine. When asked to name the biggest barrier against recommending vaccination, providers named the following factors most frequently: “not responsibility of dental provider” (27%); lack of confidence in knowledge (19%); time constraints (14%); and parent philosophical/religious opposition (11%). Discussion. Because dentists and dental hygienists care for a broad pediatric population across the state, dental communities may be poised to play an expanded role in Vermont’s efforts to improve its HPV vaccination coverage. Our study identifies several potential areas for provider-focused interventions, which include educating providers about the HPV vaccine and reducing significant barriers against recommending.https://scholarworks.uvm.edu/comphp_gallery/1266/thumbnail.jp

Long-Term Profile Variability in Active Galactic Nuclei with Double-Peaked Balmer Emission Lines

An increasing number of Active Galactic Nuclei (AGNs) exhibit broad, double-peaked Balmer emission lines,which represent some of the best evidence for the existence of relatively large-scale accretion disks in AGNs. A set of 20 double-peaked emitters have been monitored for nearly a decade in order to observe long-term variations in the profiles of the double-peaked Balmer lines. Variations generally occur on timescales of years, and are attributed to physical changes in the accretion disk. Here we characterize the variability of a subset of seven double-peaked emitters in a model independent way. We find that variability is caused primarily by the presence of one or more discrete "lumps" of excess emission; over a timescale of a year (and sometimes less) these lumps change in amplitude and shape, but the projected velocity of these lumps changes over much longer timescales (several years). We also find that all of the objects exhibit red peaks that are stronger than the blue peak at some epochs and/or blueshifts in the overall profile, contrary to the expectations for a simple, circular accretion disk model, thus emphasizing the need for asymmetries in the accretion disk. Comparisons with two simple models, an elliptical accretion disk and a circular disk with a spiral arm, are unable to reproduce all aspects of the observed variability, although both account for some of the observed behaviors. Three of the seven objects have robust estimates of the black hole masses. For these objects the observed variability timescale is consistent with the expected precession timescale for a spiral arm, but incompatible with that of an elliptical accretion disk. We suggest that with the simple modification of allowing the spiral arm to be fragmented, many of the observed variability patterns could be reproduced.Comment: 74 pages, 4 tables, 35 figure

The Physical Conditions of the Intrinsic N V Narrow Absorption Line Systems of Three Quasars

We employ detailed photoionization models to infer the physical conditions of intrinsic narrow absorption line systems found in high resolution spectra of three quasars at z=2.6-3.0. We focus on a family of intrinsic absorbers characterized by N V lines that are strong relative to the Ly-alpha lines. The inferred physical conditions are similar for the three intrinsic N V absorbers, with metallicities greater than 10 times the solar value (assuming a solar abundance pattern), and with high ionization parameters (log U ~ 0). Thus, we conclude that the unusual strength of the N V lines results from a combination of partial coverage, a high ionization state, and high metallicity. We consider whether dilution of the absorption lines by flux from the broad-emission line region can lead us to overestimate the metallicities and we find that this is an unlikely possibility. The high abundances that we infer are not surprising in the context of scenarios in which metal enrichment takes place very early on in massive galaxies. We estimate that the mass outflow rate in the absorbing gas (which is likely to have a filamentary structure) is less than a few solar masses per year under the most optimistic assumptions, although it may be embedded in a much hotter, more massive outflow.Comment: To appear in the Astrophysical Journa

Broad-line Balmer Decrements in Blue Active Galactic Nuclei

We have investigated the broad-line Balmer decrements (Halpha/Hbeta) for a large, homogeneous sample of Seyfert 1 galaxies and QSOs using spectroscopic data obtained in the Sloan Digital Sky Survey. The sample, drawn from the Fourth Data Release, comprises 446 low redshift (z < 0.35) active galactic nuclei (AGN) that have blue optical continua as indicated by the spectral slopes in order to minimize the effect of dust extinction. We find that (i) the distribution of the intrinsic broad-line Halpha/Hbeta ratio can be well described by log-Gaussian, with a peak at Halpha/Hbeta=3.06 and a standard deviation of about 0.03 dex only; (ii) the Balmer decrement does not correlate with AGN properties such as luminosity, accretion rate, and continuum slope, etc.; (iii) on average, the Balmer decrements are found to be only slightly larger in radio-loud sources (3.37) and sources having double-peaked emission-line profiles (3.27) compared to the rest of the sample. We therefore suggest that the broad-line Halpha/Hbeta ratio can be used as a good indicator for dust extinction in the AGN broad-line region; this is especially true for radio-quiet AGN with regular emission-line profiles, which constitute the vast majority of the AGN population.Comment: To appear in MNRAS. The data and the fitted parameters for the decomposed spectral components (continuum, FeII and other emission lines) of the 446 blue AGNs are available at http://staff.ustc.edu.cn/~xbdong/Data_Release/blueAGN_DR4

The mass-metallicity relation of SDSS quasars

Active galactic nuclei (AGNs) are characterized by a clear correlation between luminosity and metallicity (L_AGN-Z_AGN relation). The origin of this correlation is not clear. It may result from a relation between the black hole mass (M_BH) and metallicity, or from a relation between the accretion rate (L/L_Edd) and metallicity. To investigate the origin of the L_AGN-Z_AGN relation, we use optical spectra of 2383 quasars at 2.3 < z < 3.0 from the Sloan Digital Sky Survey. By using this data set, we have constructed composite spectra of 33 subsamples in intervals of both M_BH and L/L_Edd. From these composite spectra we measure emission-line flux ratios that are sensitive to the metallicity of the broad line region (BLR); specifically, NV/CIV, NV/HeII, (SiIV+OIV])/CIV, and AlIII/CIV. We find that there is a significant correlation between M_BH and Z_BLR as inferred from all four metallicity-sensitive emission-line flux ratios. This result strongly suggests that the observed L_AGN-Z_AGN relation is mostly a consequence of the M_BH-Z_AGN relation. The relation between M_BH and Z_BLR is likely a consequence of both the M_BH-M_bul relation and of the mass-metallicity relation in the host galaxy. We also find that L/L_Edd correlates with the emission line flux ratios involving NV (more specifically, NV/CIV and NV/HeII), while it does not correlate with the other two metallicity sensitive emission line flux ratios, i.e., (SiIV+OIV])/CIV and AlIII/CIV. These correlations indicate that the emission-line flux ratios involving NV depend on both metallicity and relative abundance of nitrogen. We suggest that the relation between L/L_Edd and those line ratios involving nitrogen, is caused by a delay of the black hole accretion rate relative to the onset of nuclear star formation of about 10^8 years, which is the timescale required for the nitrogen enrichment.Comment: Accepted for publication in A&A, 16 pages, 6 figure

CIV Emission and the Ultraviolet through X-ray Spectral Energy Distribution of Radio-Quiet Quasars

In the restframe UV, two of the parameters that best characterize the range of emission-line properties in quasar broad emission-line regions are the equivalent width and the blueshift of the CIV line relative to the quasar rest frame. We explore the connection between these emission-line properties and the UV through X-ray spectral energy distribution (SED) for radio-quiet (RQ) quasars. Our sample consists of a heterogeneous compilation of 406 quasars from the Sloan Digital Sky Survey and Palomar-Green survey that have well-measured CIV emission-line and X-ray properties (including 164 objects with measured Gamma). We find that RQ quasars with both strong CIV emission and small CIV blueshifts can be classified as "hard-spectrum" sources that are (relatively) strong in the X-ray as compared to the UV. On the other hand, RQ quasars with both weak CIV emission and large CIV blueshifts are instead "soft-spectrum" sources that are (relatively) weak in the X-ray as compared to the UV. This work helps to further bridge optical/soft X-ray "Eigenvector 1" relationships to the UV and hard X-ray. Based on these findings, we argue that future work should consider systematic errors in bolometric corrections (and thus accretion rates) that are derived from a single mean SED. Detailed analysis of the CIV emission line may allow for SED-dependent corrections to these quantities.Comment: AJ, in press; 39 pages, 11 figures, 3 table

What controls the Fe II strength in active galactic nuclei?

We used a large, homogeneous sample of 4178 z <= 0.8 Seyfert 1 galaxies and QSOs selected from the Sloan Digital Sky Survey to investigate the strength of Fe II emission and its correlation with other emission lines and physical parameters of active galactic nuclei. We find that the strongest correlations of almost all the emission-line intensity ratios and equivalent widths (EWs) are with the Eddington ratio (L/L_{Edd}), rather than with the continuum luminosity at 5100\AA\ (L_{5100}) or black hole mass (M_{BH}); the only exception is the EW of ultraviolet Fe II emission, which does not correlate at all with broad-line width, L_{5100}, M_{BH}, or L/L_{Edd}. By contrast, the intensity ratios of both the ultraviolet and optical Fe II emission to Mg II \lambda 2800 correlate quite strongly with L/L_{Edd}. Interestingly, among all the emission lines in the near-UV and optical, the EW of narrow optical Fe II emission has the strongest correlation with L/L_{Edd}. We suggest that the variation of the emission-line strength in active galaxies is regulated by L/L_{Edd} because it governs the global distribution of the column density of the clouds gravitationally bound in the line-emitting region, as well as its overall gas supply. The systematic dependence on L/L_{Edd} must be corrected when using the FeII/MgII intensity ratio as a measure of the Fe/Mg abundance ratio to study the history of chemical evolution in QSO environments.Comment: V3: to match the ApJ version scheduled to publish in June 2011. Electronic tables are also available at http://staff.ustc.edu.cn/~xbdong/Data_Release/ell_effect

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research