Dispensing Naloxone Without a Prescription: Survey Evaluation of Ohio Pharmacists.

BACKGROUND: The Centers for Disease Control and Prevention (CDC) reports a 200% escalation in the rate of opioid overdose deaths in the United States. Unfortunately, Ohio has been deemed the epicenter of the nation's opioid epidemic. In 2015, Ohio passed a bill that permits a pharmacist to distribute naloxone without a prescription. OBJECTIVES: This survey was aimed to discover pharmacists' knowledge of naloxone and Ohio law, perceived barriers that may prohibit naloxone dispensing, and Ohio pharmacists' general confidence, comfort, perception, and experience dispensing naloxone per physician protocol. METHODS: Pharmacists' knowledge of naloxone and Ohio law pertaining to dispensing naloxone; perceived barriers to naloxone distribution; and overall experience, willingness, comfort, and perceptions of personally supplying naloxone were assessed using multiple-choice and Likert-type scale questions through an e-mail survey. RESULTS: Overall, Ohio pharmacists were knowledgeable about naloxone and displayed confidence in their training and ability to provide patient education on naloxone. Pharmacists were less certain about Ohio law pertaining to naloxone distribution, especially those who have been in practice longer. Pharmacists indicated several barriers to dispensing naloxone and the need for more training. Younger pharmacists were more likely to report a concern with clientele who would frequent their pharmacy and moral and ethical concerns as barriers to dispensing naloxone. CONCLUSION: Additional educational programs should be delivered to Ohio pharmacists to inform them of the state law and policies. Continuing education programs that review substance abuse and attempt to reduce social stigma may assist with increasing naloxone distribution to those in need, especially, if directed toward younger pharmacists in Ohio.

Mass discharge assessment at a brominated DNAPL site: Effects of known DNAPL source mass removal.

Management and closure of contaminated sites is increasingly being proposed on the basis of mass flux of dissolved contaminants in groundwater. Better understanding of the links between source mass removal and contaminant mass fluxes in groundwater would allow greater acceptance of this metric in dealing with contaminated sites. Our objectives here were to show how measurements of the distribution of contaminant mass flux and the overall mass discharge emanating from the source under undisturbed groundwater conditions could be related to the processes and extent of source mass depletion. In addition, these estimates of mass discharge were sought in the application of agreed remediation targets set in terms of pumped groundwater quality from offsite wells. Results are reported from field studies conducted over a 5-year period at a brominated DNAPL (tetrabromoethane, TBA; and tribromoethene, TriBE) site located in suburban Perth, Western Australia. Groundwater fluxes (qw; L(3)/L(2)/T) and mass fluxes (Jc; M/L(2)/T) of dissolved brominated compounds were simultaneously estimated by deploying Passive Flux Meters (PFMs) in wells in a heterogeneous layered aquifer. PFMs were deployed in control plane (CP) wells immediately down-gradient of the source zone, before (2006) and after (2011) 69-85% of the source mass was removed, mainly by groundwater pumping from the source zone. The high-resolution (26-cm depth interval) measures of qw and Jc along the source CP allowed investigation of the DNAPL source-zone architecture and impacts of source mass removal. Comparable estimates of total mass discharge (MD; M/T) across the source zone CP reduced from 104gday(-1) to 24-31gday(-1) (70-77% reductions). Importantly, this mass discharge reduction was consistent with the estimated proportion of source mass remaining at the site (15-31%). That is, a linear relationship between mass discharge and source mass is suggested. The spatial detail of groundwater and mass flux distributions also provided further evidence of the source zone architecture and DNAPL mass depletion processes. This was especially apparent in different mass-depletion rates from distinct parts of the CP. High mass fluxes and groundwater fluxes located near the base of the aquifer dominated in terms of the dissolved mass flux in the profile, although not in terms of concentrations. Reductions observed in Jc and MD were used to better target future remedial efforts. Integration of the observations from the PFM deployments and the source mass depletion provided a basis for establishing flux-based management criteria for the site.

Sustainability of integrated leprosy services in rural India: perceptions of community leaders in Uttar Pradesh.

As part of a community-based action research to reduce leprosy stigma, village committees were formed in 3 hyper endemic states of India. From a total of 10 village committees with nearly 200 members from Uttar Pradesh, a systematic random sample of 69 men and 23 women were interviewed in-depth regarding their views on sustainability of integrated leprosy services, as currently adopted. Their recommendations were also sought for further enhancement. Percentages were computed and compared for statistical significance using the z-normal test. The findings show that less than 50% of the respondents were confident that the present trend in voluntary early reporting for MDT and management of complications was adequate to sustain the integrated leprosy services. There were no differences by men or women members and they felt that lack of proper facilities, training and orientation of staff are most influencing factors. Many suggestions were given for improving the sustainability.

Public awareness on integration of leprosy services at primary health centres in Uttar Pradesh, India.

Leprosy services were integrated into the general health a decade ago but it seems that a majority of public are still ignorant of this development. Hence, a study was done in Uttar Pradesh, India to determine the awareness about integration and its relationships to various socio-demographic factors. A multistage representative random sample of 3000 persons was chosen in Faizabad district, selecting a sample of 3 villages each situated within 1 km, 1-3 km and beyond 3 km of a PHC. A systematic random sample of 10% of households was chosen from selected villages and an adult male and an adult female from each household interviewed by a qualified investigator. Data were computerized and cross- tabulated against distance from the PHC, sex, age, education and occupational status. Only 45.7% in Uttar Pradesh are aware of the availability of leprosy treatment facilities at PHC but most knew that MDT was free. A smaller proportion was also aware of other facilities such as ulcer dressing and treatment of complications. Family members and health workers and PHC were the main source of information. It is concluded that massive efforts are urgently needed to educate the rural public on integration.

Prioritizing genomic drug targets in pathogens: application to Mycobacterium tuberculosis.

We have developed a software program that weights and integrates specific properties on the genes in a pathogen so that they may be ranked as drug targets. We applied this software to produce three prioritized drug target lists for Mycobacterium tuberculosis, the causative agent of tuberculosis, a disease for which a new drug is desperately needed. Each list is based on an individual criterion. The first list prioritizes metabolic drug targets by the uniqueness of their roles in the M. tuberculosis metabolome ("metabolic chokepoints") and their similarity to known "druggable" protein classes (i.e., classes whose activity has previously been shown to be modulated by binding a small molecule). The second list prioritizes targets that would specifically impair M. tuberculosis, by weighting heavily those that are closely conserved within the Actinobacteria class but lack close homology to the host and gut flora. M. tuberculosis can survive asymptomatically in its host for many years by adapting to a dormant state referred to as "persistence." The final list aims to prioritize potential targets involved in maintaining persistence in M. tuberculosis. The rankings of current, candidate, and proposed drug targets are highlighted with respect to these lists. Some features were found to be more accurate than others in prioritizing studied targets. It can also be shown that targets can be prioritized by using evolutionary programming to optimize the weights of each desired property. We demonstrate this approach in prioritizing persistence targets.

Flux-based assessment at a manufacturing site contaminated with trichloroethylene.

Groundwater and contaminant fluxes were measured, using the passive flux meter (PFM) technique, in wells along a longitudinal transect passing approximately through the centerline of a trichloroethylene (TCE) plume at a former manufacturing plant located in the Midwestern US. Two distinct zones of hydraulic conductivity were identified from the measured groundwater fluxes; a 6-m-thick upper zone ( approximately 7 m to 13 m below the ground surface or bgs) with a geometric mean Darcy flux (q(0)) of 2 cm/day, and a lower zone ( approximately 13 m to 16.5m bgs) with a q(0) approximately 15 cm/day; this important hydrogeologic feature significantly impacts any remediation technology used at the site. The flux-averaged TCE concentrations estimated from the PFM results compared well with existing groundwater monitoring data. It was estimated that at least 800 kg of TCE was present in the source zone. The TCE mass discharge across the source control plane (85 m x 38 m) was used to estimate the "source strength" ( approximately 365 g/day), while mass discharges across multiple down-gradient control planes were used to estimate the plume-averaged, TCE degradation rate constant (0.52 year(-1)). This is close to the rate estimated using the conventional centerline approach (0.78 year(-1)). The mass discharge approach provides a more robust and representative estimate than the centerline approach since the latter uses only data from wells along the plume centerline while the former uses all wells in the plume.

Evaluation of remediation performance and cost for field-scale single-phase microemulsion (SPME) flushing.

Pump-and-treat strategies employed to contain contaminant plumes have been demonstrated to be inefficient, and often ineffective, for remediation of aquifers contaminated by nonaqueous phase liquids (NAPLs). This has prompted the development of alternative technologies to provide enhanced remediation of NAPL source zones. The results reported here are from a solubilization study wherein the objective was to achieve high NAPL remediation efficiencies using a low concentration of chemical additives in the flushing solution. A surfactant/alcohol mixture was used to generate a Winsor Type I system, where the NAPL was solubilized and transported as a single-phase microemulsion (SPME). For the SPME process, only 5.5 wt% of the flushing solution comprised chemical additives. The costs associated with this project are discussed and approaches aimed at reducing costs are suggested.

Morphometric assessment of the innominate vein in the prediction of persistent left superior vena cava.

This study sought to develop a simple echocardiographic predictor of persistent left (L) superior vena cava (SVC) in subjects with bilateral SVC. Two groups of children were studied: one with known LSVC (n = 19) and the other, a control group, without LSVC (n = 15). Both groups were of similar age (3.5 +/- 3.0, mean +/- SD vs 3.8 +/- 3.1 years; p = 0.8) and weight (14.6 +/- 7.1 vs 15 +/- 8 kg; p = 0.9). The left innominate vein was either absent (n = 11) or hypoplastic (n = 8) in the LSVC group. The ratio of the innominate vein to the innominate artery was found to be independent of age or body surface area but was significantly smaller in the LSVC group than in the control group (0.33 +/- 0.1 vs 0.97 +/- 0.1; p < 0.001). A cutoff value of 0.47 or less discriminated the LSVC group from the control subjects. Interobserver and intraobserver variations, although important, did not influence the discriminating value of the ratio in the diagnosis of LSVC. Validation of the proposed ratio in 30 consecutive prospectively studied patients with LSVC proved to be 100% sensitive in predicting LSVC. No false-positive diagnosis of LSVC was made when this principle was applied. Absent or hypoplastic left innominate vein measuring 0.47 or less of the innominate artery is an easily recognizable and reliable echocardiographic predictor of LSVC.

Early marriage among rural and urban females of south India.

Data on 2972 marriages in rural areas and 1180 marriages in urban areas of North Arcot Ambedkar district of South India, during 1982-88, were analysed. The mean age at marriage of females was 18.6 in the rural and 19.6 in the urban area. The proportion of females married before attaining the legal age of 18 years was higher among the rural community (36.8%) than in the urban community (28.9%). Univariate analysis revealed an association between early age at marriage and the socioeconomic variables religion, caste, consanguinity, marital distance, spousal age difference, education and occupation of both bride and bridegroom, and socioeconomic status of the family. Multivariate analysis showed an independent relationship of marital distance and bridegroom's occupation with early age at marriage of females in the rural area alone and the bridegroom's education in the urban area alone. Consanguinity, spousal age difference and bride's education were found to be independently related with early age at marriage of females in both rural and urban areas.

PIP: The research was carried out in the representative segments of KV Kuppam block, a rural area, and Vellore town, an urban area of North Arcot Ambedkar district of Tamil Nadu, India, during 1982-88. 2972 marriages were studied in the rural area and 1180 marriages in the urban area. In the rural community the mean age at marriage was 18.56 +or- 2.86 years compared to 19.55 +or- 3.44 years for the urban community (p 0.001). In the rural community 36.8% of women married before the legal age of 18 years compared to 28.9% in the urban area (p 0.001). Univariate analysis revealed that socioeconomic variables had a significant association with early age at marriage (p 0.001). 42.4% of those who married early in the rural area were among Muslims, 36.9% among Hindus, and only 9.1% among Christians. Similarly, in the urban area these respective figures were 39.9%, 24.2%, and 12%. Early marriage was also related to caste: 36.7% of scheduled caste and tribal women, 37% of backward caste women, and 32% of forward caste women in the rural areas married early. The respective urban figures were 37.8%, 23.6%, and 20.9%. In rural areas 44.1% of early marriages were consanguineous vs. 40.6% in urban areas. The spousal age difference of 10 years or more was also a significant factor: it was 58.7% in rural areas and 42.4% in the urban areas. The marital distance of less than 10 km was 40.5% in rural areas vs. 31.8% in urban areas. When the distance was over 51 km, 32.3% of rural women and 23.2% of urban women married early. Early age at marriage was negatively related to the educational status of both bride and bridegroom. In both areas secondary education and above (10 or more years) significantly reduced early marriage. In rural areas 23.6% and in urban areas 12.8% of women married early. When the bridegroom's occupational status was low, then early marriage was higher, 39.5% in rural areas and 35.6% in urban areas vs. 33.4% and 24.5%, respectively, for high status occupation. In general, low socioeconomic status favored early marriage.

Quantitative assessment of the visibility of unmyelinated corneal nerves in leprosy.

Unmyelinated corneal nerves were counted in 383 leprosy patients whose eyes looked normal on clinical examination and in an equal number of healthy controls. Visibility of these nerves was decreased significantly (p < 0.01) in the nasal half of the cornea in both patients and controls. There was a significant (p < 0.01) inverse correlation between age and the visibility of these nerves in patients and controls. There was a significant (p < 0.05) reduction in the visibility of these nerves as the spectrum of the disease moved from the tuberculoid to the lepromatous pole. There was no significant correlation between visibility of these nerves and the smear positivity of the patient. Neither did duration of the disease nor the duration of antileprosy treatment alter the visibility of these nerves significantly. Overall, there was a reduction in the visibility of these nerves in patients who had had leprosy reactions.

Correlates of menstrual cycle length in south Indian women: a prospective study.

There has been a lack of agreement on the variation in and the correlates of menstrual cycle length in the literature. A total of 2566 women from rural and urban areas in one district of Tamil Nadu in southern India were studied prospectively to identify correlates of menstrual cycle length. Rural women had higher odds for short and for long cycle lengths. Younger women, those with higher age at marriage, and those with lower educational status had significantly longer cycle lengths.

Consanguinity and its trend in a Mendelian population of Andhra Pradesh, India.

Consanguineous marriages have decreased significantly (p < 0.01) among the Kamma of Andhra Pradesh over the past forty years. The decline in uncle-niece marriages has contributed heavily to the decline in consanguinity, which may be due to shifting from agriculture to other occupations like government service and the rapid growth of industrialization. More recently, the tendency toward a lower consanguinity rate has been strengthened by reduction in number of children per marriage which reduces the number of eligible cousins. Marriages beyond first cousin have remained more or less constant.

PIP: Consanguineous marriages change gene frequencies. The highest values for this type of marriage in India have been reported from the southern regions, especially from the state of Andhra Pradesh. The authors examine the frequency of consanguineous marriages and their changes through time in a Mendelian population, the Kamma of Andhra Pradesh. The Kamma is a forward caste whose traditional occupation is agriculture. It is one of the dominant groups in Andhra Pradesh in all socioeconomic factors and belongs to Dravidian stock. The Kamma are strictly endogamous and widow marriage is not allowed among them. Study findings are based upon data collected from 400 couples in seven villages spread over three taluks or revenue mandals of the Chittoor District. A family pedigree was drawn for each marriage to determine the type of consanguinity involved, with the year of marriage noted to determine the trend of consanguinity. Armitage's test determined the linear trend of consanguinity. Consanguineous marriages were found to have decreased significantly among the Kamma over the past forty years. The decline in uncle-niece marriages has helped fuel this trend and may be due to the shift from agriculture to other occupations such as government service and the rapid growth of industrialization. The tendency toward a lower consanguinity rate more recently has been strengthened by a reduction in the number of children per marriage which reduces the number of eligible cousins. Marriages beyond first cousin have remained more or less constant.

Socio-economic differentials in mothers at risk based on pre-pregnancy weights & heights.

Data on heights and weights of women measured as part of a longitudinal study on maternal and child health in Tamil Nadu state, south India are presented and discussed in relation to various socioeconomic and demographic factors. The mean (+/- SD) heights in rural and urban women were 151.2 +/- 5.4 cm and 150.8 +/- 6.6 cm respectively. The mean weights were 42.6 +/- 5.4 kg; and 44.0 +/- 7.9 kg respectively. The mean BMI were 18.6 +/- 2.2 and 19.4 +/- 3.5 respectively. The differences were statistically significant. Forty two per cent of rural and 48 per cent of urban women were less than either 145 cm in height or 40 kg in weight. The need to identify and care for such women as part of the "Risk Approach" in maternal and child health programmes is emphasized.

Specificity of oxygen radical scavengers and assessment of free radical scavenger efficiency using luminol enhanced chemiluminescence.

The selective scavenging capacities of 19 important oxygen radical scavengers were determined by adding them individually to each of the four oxy radical standards, (superoxide, hydroxy, alkoxy and hydroperoxy, and singlet O2), calculating the percent chemiluminescence inhibited, and extrapolating O2 equivalents neutralized from baseline. The sensitivity (0.01 nm/ml) and selectivity of this method not only allows identification of individual oxygen free radical species but also quantitates the efficiency of free radical scavengers.

Should air-oxygen replace nitrous oxide-oxygen in general anaesthesia?

The use of compressed air-oxygen mixtures to replace nitrous oxide-oxygen in general anaesthesia was investigated in 378 patients. There were neither prolongations of recovery time nor instances of awareness under anaesthesia. The cost of general anaesthesia using compressed air-oxygen was about half that for nitrous oxide-oxygen mixtures.

Rural-urban differentials in fertility of south Indian women.

PIP: Differential fertility in the North Arcot district of Tamil Nadu, India, is analyzed. The data, collected during 1970-1973, concern 9,360 rural and 7,960 urban women. Reasons for the higher fertility of rural women at all ages are considered, including social customs and contraceptive knowledge and practice.^ieng

Socioeconomic and demographic correlates of medical care and health practices.

PIP: using a 2-stage stratified sampling procedure, a random sample of 1021 rural families in North Arcot District of Tamil Nadu State in South India was studied to determine the interrelationships of utilization of medical care and health behavior with social, demographic and economic factors. Distance from a town, education, and accessibility of medical facilities seem to play a prominent role in the various decision making processes. 81.5% of respondents preferred only home treatment for common ailments at the initial stages of the disease. Of the remainder 1/2 preferred to go to a hospital and the other 1/2 chose a qualified physician. If the ailment persisted, 53% preferred to go to a hospital and 43% to a physician. The 1st choice for outside medical care for 44.8% of the respondents was a private medical practitioner, for 42.9% it was the government hospital and for the remaining 11.4% it was a nearly clinic or private hospital. In 88% of the cases, the head of the household met all the expenses. In only 4% of the cases were the expenses met by the employer or through another arrangement. Nearly 2/3 of the respondents agreed and 2i% disagreed that treatment would be better if provided free of cost and most thought it would be improved if health facilities were situated within the village itself. At the initial stages of common ailments some 90% of those residing within 5 km from a town said that they would treat themselves at home. If the ailment persisted, 52.4% preferred to go to the hospital and 43.7% to approach a physician. Only 63.7% of those living beyond 10 km from town preferred home treatment during early stages, and when the ailment persisted, 45% preferred the hospital while 55% preferred to approach a physician. 90% of respondents with lower incomes preferred home treatment for common ailments in the initial stages, compared to 56% of those with higher incomes. The proportion choosing a private medical practitioner as the 1st choice is much lower in the lowest income groups than in the highest income group. Those in the upper income groups preferred the source of medical care where they could get quick relief; lower income groups preferred the source of free services. The proportion who said they would approach a physician even during the initial stages of ailments increased significantly with education. The proportion whose 1st choice was a government hospital declined as education increased.^ieng