Effect of a Co-Located Bridging Recovery Initiative on Hospital Length of Stay Among Patients With Opioid Use Disorder: The BRIDGE Randomized Clinical Trial.

Importance: Co-located bridge clinics aim to facilitate a timely transition to outpatient care for inpatients with opioid use disorder (OUD); however, their effect on hospital length of stay (LOS) and postdischarge outcomes remains unclear. Objective: To evaluate the effect of a co-located bridge clinic on hospital LOS among inpatients with OUD. Design, Setting, and Participants: This parallel-group randomized clinical trial recruited 335 adult inpatients with OUD seen by an addiction consultation service and without an existing outpatient clinician to provide medication for OUD (MOUD) between November 25, 2019, and September 28, 2021, at a tertiary care hospital affiliated with a large academic medical center and its bridge clinic. Intervention: The bridge clinic included enhanced case management before and after hospital discharge, MOUD prescription, and referral to a co-located bridge clinic. Usual care included MOUD prescription and referrals to community health care professionals who provided MOUD. Main Outcomes and Measures: The primary outcome was the index admission LOS. Secondary outcomes, assessed at 16 weeks, were linkage to health care professionals who provided MOUD, MOUD refills, same-center emergency department (ED) and hospital use, recurrent opioid use, quality of life (measured by the Schwartz Outcome Scale-10), overdose, mortality, and cost. Analysis was performed on an intent-to-treat basis. Results: Of 335 participants recruited (167 randomized to the bridge clinic and 168 to usual care), the median age was 38.0 years (IQR, 31.9-45.7 years), and 194 (57.9%) were male. The median LOS did not differ between arms (adjusted odds ratio [AOR], 0.94 [95% CI, 0.65-1.37]; P = .74). At the 16-week follow-up, participants referred to the bridge clinic had fewer hospital-free days (AOR, 0.54 [95% CI, 0.32-0.92]), more readmissions (AOR, 2.17 [95% CI, 1.25-3.76]), and higher care costs (AOR, 2.25 [95% CI, 1.51-3.35]), with no differences in ED visits (AOR, 1.15 [95% CI, 0.68-1.94]) or deaths (AOR, 0.48 [95% CI, 0.08-2.72]) compared with those receiving usual care. Follow-up calls were completed for 88 participants (26.3%). Participants referred to the bridge clinic were more likely to receive linkage to health care professionals who provided MOUD (AOR, 2.37 [95% CI, 1.32-4.26]) and have more MOUD refills (AOR, 6.17 [95% CI, 3.69-10.30]) and less likely to experience an overdose (AOR, 0.11 [95% CI, 0.03-0.41]). Conclusions and Relevance: This randomized clinical trial found that among inpatients with OUD, bridge clinic referrals did not improve hospital LOS. Referrals may improve outpatient metrics but with higher resource use and expenditure. Bending the cost curve may require broader community and regional partnerships. Trial Registration: ClinicalTrials.gov Identifier: NCT04084392.

When Saying Sorry May Not Help: The Impact of Apologies on Social Rejections.

If you have to socially reject someone, will it help to apologize? Social rejection is a painful emotional experience for targets, yet research has been silent on recommendations for rejectors. Across three sets of studies, apologies increased hurt feelings and the need to express forgiveness but did not increase feelings of forgiveness. The investigation of hurt feelings arising from a social rejection is challenging because previous research has shown that participants are reluctant to admit they felt hurt by the rejection. The present research addressed the self-report issue in two ways. First, participants rated how much social rejections would hurt someone's feelings as a function of whether an apology was included across various social rejection scenarios (Studies 1a-e). Second, aggressive behavior was measured in response to face-to-face social rejections that were manipulated to include or exclude apologies (Studies 2a-c). More specifically, Studies 1a-e (N = 1096) found that although individuals sometimes use apologies in social rejections, social rejections with apologies are associated with higher levels of explicit hurt feelings. Studies 2a-c (N = 355) manipulated the presence of an apology in face-to-face social rejections and found that social rejections with apologies cause more aggressive behavior. As in previous research, participants are reluctant to admit to feeling hurt. Finally, Study 3 (N = 426) found that in response to social rejections with apologies, individuals feel more compelled to express forgiveness despite not actually feeling more forgiveness. Implications for the role of language in social rejections are discussed.

Daily online testing in large classes: boosting college performance while reducing achievement gaps.

An in-class computer-based system, that included daily online testing, was introduced to two large university classes. We examined subsequent improvements in academic performance and reductions in the achievement gaps between lower- and upper-middle class students in academic performance. Students (N = 901) brought laptop computers to classes and took daily quizzes that provided immediate and personalized feedback. Student performance was compared with the same data for traditional classes taught previously by the same instructors (N = 935). Exam performance was approximately half a letter grade above previous semesters, based on comparisons of identical questions asked from earlier years. Students in the experimental classes performed better in other classes, both in the semester they took the course and in subsequent semester classes. The new system resulted in a 50% reduction in the achievement gap as measured by grades among students of different social classes. These findings suggest that frequent consequential quizzing should be used routinely in large lecture courses to improve performance in class and in other concurrent and subsequent courses.

Aminopyralid soil residues affect rotational vegetable crops in Florida.

BACKGROUND: Bahiagrass (Paspalum notatum Flueggé) is a poor host of several soilborne pests of vegetable crops; therefore vegetable crops are commonly grown in a rotation with bahiagrass pastures in Florida. The herbicide aminopyralid provides foliar and soil residual weed control and increases forage production in bahiagrass pastures; however, the soil residual activity of aminopyralid makes carryover injury likely in subsequent sensitive vegetable crops. Field research was conducted to determine the sensitivity of five vegetable crops to soil residues of aminopyralid. RESULTS: At an aminopyralid soil concentration of 0.2 µg kg(-1) (the limit of quantitation for aminopyralid in this research), crop injury ratings were 48% (bell pepper), 67% (eggplant), 71% (tomato), 3% (muskmelon) and 3% (watermelon), and fruit yield losses (relative to the untreated control) at that concentration were 61, 64, 95, 8 and 14% in those respective crops. CONCLUSIONS: The crops included in this research were negatively affected by aminopyralid at soil concentrations less than the limit of quantitation (0.2 µg kg(-1) ). Therefore, it was concluded that a field bioassay must be used to determine whether carryover injury will occur when these crops are planted on a site where aminopyralid has been previously applied.

Sorption and desorption of flumioxazin to soil, clay minerals and ion-exchange resin.

Flumioxazin adsorption kinetics were described using a Greenville sandy clay loam soil. Adsorption kinetics experiments showed that 72% of total herbicide was absorbed after 1 h of continuous shaking and continued to increase to 78% after 72 h. Flumioxazin adsorption was then tested on seven agriculturally important soils throughout the southern USA. Adsorption isotherms for all soils had K(f) (Freundlich distribution coefficient) values that ranged from 8.8 to 0.4, with many near 1.5. Soil organic matter content was the parameter most highly correlated with flumioxazin adsorption (r(2) = 0.95, P < 0.001). Sorption to clay minerals had K(f) values ranging from 50 for bentonite to 4.7 for kaolinite. However, normalizing K(f) for sorbent surface area revealed that aluminum hydroxide (gibbsite) possessed the greatest flumioxazin sorption per unit area. Sorption to anionic exchange resin (K(f) 676) was greater than cationic exchange resin (K(f) 42). Molecular model calculations were performed to elucidate why sorption was greater to anionic exchangers. These calculations indicated that a region of dense electronegativity exists on the 3-dione moiety of the molecule. This would lead to greater flumioxazin sorption by positively charged surface sites. Desorption isotherms from soil exhibited no effect of hysteresis. Desorption from clay minerals was very rapid and flumioxazin in solution was undetectable after three desorption steps. From these data it was concluded that flumioxazin can become readily available in soil solution with increase in soil water content.

Gas chromatographic/mass spectrometric determination of flumioxazin extracted from soil and water.

A method was developed for determining flumioxazin in soil and water. Recovery efficiencies for solid-phase extraction (SPE) of flumioxazin from deionized, well, and surface water were between 72 and 77%. SPE was superior to liquid-liquid extraction, using water-hexane and water-chloroform emulsions, which resulted in retrieval efficiencies of 25 and 22%, respectively. However, liquid-liquid extraction with ethyl acetate improved recovery of total flumioxazin to >64%. Extraction from soil samples by direct solvent/soil extraction methods recovered between 18 and 76% of applied flumioxazin, depending on the solvent combination used. However, the use of accelerated solvent extraction techniques resulted in a 106 +/- 8% recovery of flumioxazin from soil. In analysis by capillary gas chromatography with mass selective detection, flumioxazin had a calculated limit of detection of 9 ng/mL with a retention time of 16.66 min.

Flumioxazin soil persistence and mineralization in laboratory experiments.

Flumioxazin is an herbicide registered for use in soybean and peanut. However, few published papers concerning the soil persistence of flumioxazin are available. Therefore, laboratory studies were initiated to determine the half-life (t(1/2)) of flumioxazin in Greenville sandy clay loam and Tifton loamy sand soils when incubated at 15 and 25 degrees C. Results indicated that temperature had little effect on flumioxazin persistence. The t(1/2) for the Greenville soil was 17.9 and 16.0 days while the Tifton soil was 13.6 and 12.9 days, at 15 and 25 degrees C, respectively. These data correspond to the greater clay content of the Greenville soil (32%) as compared to the Tifton soil (2%). Therefore, the Greenville soil had greater soil adsorption and less flumioxazin was generally available to be degraded by soil microorganisms. In soils that were heat treated to reduce microbe populations, 99% of initial flumioxazin was accounted for after 16 days. Mineralization of flumioxazin, measured as 14CO2 evolution, was also greater in the Tifton soil (2.2% after 64 days) than in the Greenville soil (2.0% after 64 days). From these data, it was concluded that microbes were the most influential factor concerning the degradation of flumioxazin.