Geographic access to buprenorphine prescribers for patients who use public transit.

OBJECTIVE: Urban Medicaid enrollees with opioid use disorder often rely on public transit to reach buprenorphine prescribers. Research has not shown whether public transit provides this population with adequate geographic access to buprenorphine prescribers. We examined travel times to buprenorphine prescribers by car and public transit in urban areas, and determined whether car-based Medicaid regulatory standards produce their intended geographic coverage. METHODS: We obtained data for this study from the Substance Abuse and Mental Health Services Administration's Buprenorphine Practitioner Locator, Microsoft Bing Maps, and the American Community Survey. We examined four urban counties at the centers of the metropolitan statistical areas with the highest 2017 accidental drug poisoning death rates: Kanawha, WV; Montgomery, OH; Philadelphia, PA; and St. Louis City, MO. These counties comprised 696 census tracts representing 1,038,564 households. We calculated travel times from each census tract center to the nearest buprenorphine prescribers by car and public transit, and compared that to 30-min regulatory standards and by whether census tracts had below median levels of car access. We calculated Global Moran's I statistics to determine whether spatial clustering was present among census tracts with limited access to buprenorphine prescribers. RESULTS: Households in all but two census tracts could access a buprenorphine prescriber within 30 min by car. However, households in 12.1% (84) of census tracts could not do so by public transit. The correlation between car- and public transit-based travel times to the nearest buprenorphine prescriber was 0.11 (95% CI = 0.07-0.22). More than 15% (47,918) of households in the two less densely populated counties could not travel to the nearest prescriber in 30 min and resided in census tracts where access to cars was relatively low. There was no evidence of spatial clustering among census tracts with public transit travel times exceeding 30 min, or among census tracts with public transit travel times exceeding 30 min and below median values of access to cars. CONCLUSIONS: Geographic access to buprenorphine prescribers is overestimated by regulatory standards that apply car-based travel time estimates, which are a weak proxy for public transit-based travel times. Since geographic areas with limited access to buprenorphine prescribers do not tend to cluster near one another, individually targeted interventions may be necessary to improve buprenorphine access and utilization.

Quantum-Limited Time-Frequency Estimation through Mode-Selective Photon Measurement.

By projecting onto complex optical mode profiles, it is possible to estimate arbitrarily small separations between objects with quantum-limited precision, free of uncertainty arising from overlapping intensity profiles. Here we extend these techniques to the time-frequency domain using mode-selective sum-frequency generation with shaped ultrafast pulses. We experimentally resolve temporal and spectral separations between incoherent mixtures of single-photon level signals ten times smaller than their optical bandwidths with a tenfold improvement in precision over the intensity-only Cramér-Rao bound.

Heralded generation of high-purity ultrashort single photons in programmable temporal shapes.

We experimentally demonstrate a source of nearly pure single photons in arbitrary temporal shapes heralded from a parametric down-conversion (PDC) source at telecom wavelengths. The technology is enabled by the tailored dispersion of in-house fabricated waveguides with shaped pump pulses to directly generate the PDC photons in on-demand temporal shapes. We generate PDC photons in Hermite-Gauss and frequency-binned modes and confirm a minimum purity of 0.81, even for complex temporal shapes.

Potential drug-drug and drug-disease interactions in well-functioning community-dwelling older adults.

WHAT IS KNOWN AND OBJECTIVE: There are few studies examining both drug-drug and drug-disease interactions in older adults. Therefore, the objective of this study was to describe the prevalence of potential drug-drug and drug-disease interactions and associated factors in community-dwelling older adults. METHODS: This cross-sectional study included 3055 adults aged 70-79 without mobility limitations at their baseline visit in the Health Aging and Body Composition Study conducted in the communities of Pittsburgh PA and Memphis TN, USA. The outcome factors were potential drug-drug and drug-disease interactions as per the application of explicit criteria drawn from a number of sources to self-reported prescription and non-prescription medication use. RESULTS: Over one-third of participants had at least one type of interaction. Approximately one quarter (25·1%) had evidence of had one or more drug-drug interactions. Nearly 10·7% of the participants had a drug-drug interaction that involved a non-prescription medication. % The most common drug-drug interaction was non-steroidal anti-inflammatory drugs (NSAIDs) affecting antihypertensives. Additionally, 16·0% had a potential drug-disease interaction with 3·7% participants having one involving non-prescription medications. The most common drug-disease interaction was aspirin/NSAID use in those with history of peptic ulcer disease without gastroprotection. Over one-third (34·0%) had at least one type of drug interaction. Each prescription medication increased the odds of having at least one type of drug interaction by 35-40% [drug-drug interaction adjusted odds ratio (AOR) = 1·35, 95% confidence interval (CI) = 1·27-1·42; drug-disease interaction AOR = 1·30; CI = 1·21-1·40; and both AOR = 1·45; CI = 1·34-1·57]. A prior hospitalization increased the odds of having at least one type of drug interaction by 49-84% compared with those not hospitalized (drug-drug interaction AOR = 1·49, 95% CI = 1·11-2·01; drug-disease interaction AOR = 1·69, CI = 1·15-2·49; and both AOR = 1·84, CI = 1·20-2·84). WHAT IS NEW AND CONCLUSION: Drug interactions are common among community-dwelling older adults and are associated with the number of medications and hospitalization in the previous year. Longitudinal studies are needed to evaluate the impact of drug interactions on health-related outcomes.

Spectrally Engineering Photonic Entanglement with a Time Lens.

A time lens, which can be used to reshape the spectral and temporal properties of light, requires the ultrafast manipulation of optical signals and presents a significant challenge for single-photon application. In this work, we construct a time lens based on dispersion and sum-frequency generation to spectrally engineer single photons from an entangled pair. The strong frequency anticorrelations between photons produced from spontaneous parametric down-conversion are converted to positive correlations after the time lens, consistent with a negative-magnification system. The temporal imaging of single photons enables new techniques for time-frequency quantum state engineering.

Disruption of cellulose synthesis by isoxaben causes tip swelling and disorganizes cortical microtubules in elongating conifer pollen tubes.

In elongating pollen tubes of the conifer Picea abies (Norway spruce), microtubules form a radial array beneath the plasma membrane only at the elongating tip and an array parallel with elongation throughout the tube. Tips specifically swell following microtubule disruption. Here we test whether these radial microtubules coordinate cell wall deposition and maintain tip integrity as tubes elongate. Control pollen tubes contain cellulose throughout the walls, including the tip. Pollen tubes grown in the presence of isoxaben, which disrupts cellulose synthesis, are significantly shorter with a decrease in cellulose throughout the walls. Isoxaben also significantly increases the frequency of tip swelling, with no effect on tube width outside of the swollen tip. The decrease in cellulose is more pronounced in pollen tubes with swollen tips. The effects of isoxaben are reversible. Following isoxaben treatment, the radial array of microtubules persists beneath the plasma membrane of nonswollen tips, while this array is specifically disrupted in swollen tips. Microtubules instead form a random network throughout the tip. Growth in these pollen tubes is turgor driven, but the morphological changes due to isoxaben are not just the result of weakened cell walls since pollen tubes grown in hypoosmotic media are not significantly shorter but do have swollen tips and tubes are wider along their entire length. We conclude that the radial microtubules in the tip do maintain tip integrity and that the specific inhibition of cellulose microfibril deposition leads to the disorganization of these microtubules. This supports the emerging model that there is bidirectional communication across the plasma membrane between cortical microtubules and cellulose microfibrils.

Medicaid behavioral health carve-outs: a new generation of privatization decisions.

This article addresses issues related to the privatization of various functions within the mental health system. It acknowledges the contributions of Robert Dorwart, who explored trends with regard to the privatization of inpatient psychiatric services. The authors then highlight changes in the division of labor between the public and private sectors regarding the financing and delivery of mental health services and the management of the system. Responsibility for funding the mental health system has remained largely a public responsibility while responsibility for production or delivery of services in the mental health system is typically held by private, for-profit, and not-for-profit organizations. The roles of managing the mental health system and setting policy are now shared between the private and public sectors in a number of states that have implemented Medicaid behavioral health carve-out programs. This article explores the impact of such privatization on cost, access, and quality of services by examining the experiences of three states with carve-outs. The authors suggest that while organizational form is an important issue, concerns about privatization should be tempered by attention to the contracting decisions made by purchasers, the level of resources devoted to services, and the adequacy of administration of the system.

ATSDR evaluation of health effects of chemicals. VI. Di(2-ethylhexyl)phthalate. Agency for Toxic Substances and Disease Registry.

Di(2-ethylhexyl)phthalate (also known as DEHP, bis(2-ethylhexyl)phthalate, or BEHP; CAS Registry Number 117-81-7) is a widely-used plasticizer. It is found in numerous plastic articles, such as paints, inks, floor tiles, upholstery, shower curtains, footwear, plastic bags, food-packaging materials, toys, and medical tubing. Not surprisingly, DEHP appears at many waste sites. As part of its mandate, the Agency for Toxic Substances and Disease Registry (ATSDR) prepares toxicological profiles on hazardous chemicals that are of greatest public health concern at Comprehensive Environmental Response, Compensation, and Liability Act (CERCLA) National Priority List (NPL) sites. These profiles comprehensively summarize toxicological and environmental information. This article constitutes the release of the bulk of ATSDR's profile for DEHP (ATSDR, 1993) into the mainstream scientific literature. An extensive listing of human and animal health effects, organized by route, duration, and endpoint, is presented. Toxicological information on toxicokinetics, biomarkers, interactions, sensitive subpopulations, reducing toxicity after exposure, and relevance to public health is also included. Environmental information encompasses physical properties, production and use, environmental fate, levels seen in the environment, analytical methods, and a listing of regulations. ATSDR, at the behest of Congress and therefore the citizenry, prepares these profiles to inform the public about site contaminants.

Platelet function in adolescent idiopathic scoliosis.

Recent studies have reported abnormal platelet morphology and function in patients with adolescent idiopathic scoliosis. These abnormalities include increased platelet size and dense body numbers, abnormal aggregation, thromboxane A2 synthesis, serotonin release to adenosine diphosphate and epinephrine stimulus, and decreased myosin-adenosine-triphosphatase-specific activity. It was postulated that a membrane-specific defect in calcium transport may be partially responsible for the abnormalities found. In response to a suggestion in the literature that platelet screening could be clinically useful in scoliosis evaluation as well as in basic research of its pathophysiology, a study was performed to evaluate platelet morphology, biochemistry, and function in patients with adolescent idiopathic scoliosis. Platelets from nine volunteers with adolescent idiopathic scoliosis were compared with cells from a control group of nine patients. No significant differences in measured platelet parameters were noted between adolescent idiopathic scoliosis patients and control groups. Platelets from both groups demonstrated normal aggregation and release patterns with all agents except for a mild decreased aggregation and secretion response to epinephrine. No significant differences were noted in serotonin or adenine nucleotide levels. No significant ultrastructural differences were noted. Earlier findings of an abnormal aggregation and secretion response to adenosine diphosphate, increased numbers of dense bodies, or increased intracellular calcium could not be confirmed. On the contrary, we found normal, if not slightly decreased, numbers of dense bodies per platelet and calcium levels that were not different from controls.

Mycotic aneurysm in angiitis associated with herpes zoster ophthalmicus.

Varicella zoster (VZ) is an unusual cause of CNS angiitis, usually occurring in older patients and immunocompromised hosts. The infection most commonly presents as herpes zoster ophthalmicus with contralateral hemiplegia. Mycotic aneurysm formation associated with VZ angiitis is rare. We report two cases of VZ angiitis with mycotic aneurysm formation (both aneurysms eventually ruptured) and one case of probable VZ angiitis with distal carotid occlusion and cerebral infarction. The CT and angiographic appearances, clinical course, and histopathology are presented.

The effects of indirect blunt trauma on adult canine articular cartilage.

UNLABELLED: In order to determine the effect of subfracture loads on articular cartilage, we impacted twelve adult canine patellofemoral joints utilizing a drop-tower with two different force-levels. The joints were examined with light and electron microscopy at two, four, and six weeks after impaction. In ten additional animals a single knee was impacted and they were analyzed biochemically at similar time-periods, using the contralateral joint as a control. In all impacted specimens changes were observed in the zone of calcified cartilage, represented by an increase in cellular clones, vascular invasion, and proteoglycan content of the matrix. Ultrastructural evaluation of the superficial and deep radial zones of the articular cartilage revealed loss of the cellular processes and territorial matrices of chondrocytes in both layers. Ruthenium-red staining of impacted samples revealed a 40 per cent decrease in proteoglycan associated with collagen fibers in the extraterritorial matrix. An increase in collagen-fiber width was observed in the four and six-week groups. The earliest changes in articular cartilage included activation of the zone of calcified cartilage as well as ultrastructural alterations in the superficial and radial zones. Biochemical analysis revealed an increase in water content and hexuronic acid at two weeks. These changes occurred at a subfracture level in the absence of surface disruption. CLINICAL RELEVANCE: These animal experiments indicate that adult articular cartilage may show significant alterations in its histological, biochemical, and ultrastructural characteristics without disruption of the articular surface. This model of articular cartilage "contusion" may represent a corollary to the joint damage that is observed following direct blunt trauma transmitted across articular surfaces without radiographic evidence of fracture. The possibility that this form of injury may be the precursor of chondromalacic changes in patellar or femoral cartilage merits further study.

Changes in the surface fine structure of rat third ventricular ependyma following chronic acetazolamide treatment.

Participation of non-choroidal elements, particularly of ventricular ependyma, in CSF production is well recognized. The present investigation is an attempt to elucidate possible surface changes in the ventricular lining following chronic acetazolamide administration in the rat. A progressive time-dependent change was observed in the ependyma of the third ventricle. In the dorsal ciliated zone the appearance of dilatations and surface evaginations on cilial shafts were the predominent features. The ventral non-cilated area was characterized by eruption of blebs and microvilli with apical swellings. The significance of these surface fine structural changes are discussed in the light of available studies. It appears that the ependyma is stimulated into increased activity. However, the precise nature of such a response--whether secretory or absorptive--must remain conjectural until correlative scanning and transmission electron microscopic data become available.

Changes in the surface of fine structure of choroid plexus epithelium following chronic acetazolamide treatment.

Surface changes in the epithelium of the choroid plexuses of the lateral and third ventricles of rats induced by chronic administration of acetazolamide have been studied by scanning electron microscopy. After 3 weeks atrophic changes were evident, the microvilli and blebs normally seen on the ventricular surface of the cells appeared attenuated, and in extreme cases they disappeared, leaving the cell surface completely denuded. Localized areas of hypertrophy, indicated by secondary spherical budding, were occasionally observed. The atrophic changes accord with the known inhibitory effects of acetazolamide on CSF formation: perhaps the small number of cells undergoing hypertrophy compensate to some extent for the atrophic ones and maintain some CSF secretion.