Enhancing knowledge, attitudes, and practices related to dental caries in mothers and caregivers of children through a neuroeducational strategy.

BACKGROUND: Knowledge, attitudes, and practices related to oral health among parents play a crucial role in shaping oral hygiene and preventing early childhood caries. This study was intended to determine the effect of a neuroeducational strategy in improving knowledge, attitudes, and practices related to early childhood caries among mothers or caregivers of children. METHODS: A quasi-experimental study was conducted, implementing an educational strategy involving 33 mothers or female caregivers of children who met specific selection criteria. The strategy consisted of three key elements derived from neuroeducation: (1) experiment, (2) surprise and play, and (3) learn. Based on the participants' attendance at the sessions, they were categorized into two groups: those who underwent in-person intervention (G1) and those who received a combined in-person and virtual intervention (G2). The impact of the strategy was evaluated by comparing the participants' knowledge and attitudes, as well as their children's plaque index, before and after the intervention (immediate and 6-month impact). RESULTS: The participants exhibited a favorable and statistically significant effect on the median number of correct answers related to knowledge (G1 immediate effect (IE): p = 0.03, 6-month effect (ME): p = 0.002; G2 IE p = 0.002, ME: p = 0.001), and in the children's plaque index (G1 IE: p = 0.003, ME: p = 0.003; G2 IE: p = 0.033, ME: p = 0.003). Furthermore, there was an increase in the number of participants with a high level of knowledge (G1 IE: 41.5%; ME: 75%; G2 IE: 45.5%, ME: 42.9%), and of children with a good level of oral hygiene (G1 IE: 50%; ME: 73.0%; G2 IE: 27.3%, ME: 84.6%). Finally, qualitative interviews revealed a lasting clarity in concepts and sustained knowledge and attitudes at the six-month mark. However, a slightly diminished understanding of the relationship between bacteria, sugar, and caries was observed in G2 group, and some loss of association in the G1 group, at six months. CONCLUSION: The implementation of this strategy resulted in significant and lasting impacts on knowledge, attitudes, and practices, especially in the G1 group. Nevertheless, there is a need for further reinforcement of the association between bacteria, sugar, and caries.

Statins and oral biofilm: Simvastatin as a promising drug to control periodontal dysbiosis.

OBJECTIVES: This study evaluated antimicrobial activity of atorvastatin, pravastatin, rosuvastatin, and simvastatin against oral bacteria, and the interaction of simvastatin with standard antimicrobials (amoxicillin and metronidazole). METHODS: Minimal inhibitory concentration assays were performed with Porphyromonas gingivalis, Prevotella intermedia, Fusobacterium nucleatum, Actinomyces odontolyticus, Streptococcus oralis, Streptococcus mitis, Streptococcus salivarius, Streptococcus sanguinis, and Streptococcus gordonii; checkerboard microdilution assays between simvastatin and standard antimicrobials; monospecies and multispecies biofilms. RESULTS: Simvastatin showed the best antimicrobial activity against most species (MIC range from 3.12 to 25 µg/ml), highlighting the sensitivity of P. gingivalis. In the checkerboard assay, synergistic interaction was found between simvastatin and amoxicillin against S. oralis and S. sanguinis. P. gingivalis biofilm was inhibited by simvastatin at 10 and 50× Minimal inhibitory concentration, with similar effects to metronidazole. For multispecies biofilm, SMV reduced the biofilm metabolic activity (79%) and total counts (87%), comparable to amoxicillin. Simvastatin also reduced bacterial counts of Veilonnella parvula, P. gingivalis, Streptococcus mutans, Actinomyces naeslundii, P. intermedia, and Capnocytophaga ochracea in the multispecies biofilm. CONCLUSIONS: Simvastatin showed antimicrobial and antibiofilm activity against oral bacteria and may contribute to the control of dysbiosis, and may be considered in clinical studies as an adjuvant in the treatment of periodontitis.

Developing and validating an opioid overdose prevention and response curriculum for undergraduate medical education.

Introduction: As rates of overdose and substance use disorders (SUDs) increase, medical schools are starting to incorporate more content on SUDs and harm reduction in undergraduate medical education (UME). Initial data suggest these additions may improve medical student knowledge and attitudes toward patients with SUDs; however, there is no standard curriculum. Methods: This project uses a six-step approach to UME curricular development to identify needs and goals regarding SUDs and opioid overdose at a large single-campus medical school in the United States. We first developed and delivered a pilot curriculum to a small group of medical students. Pilot results and a larger survey led to implementing a one-hour Opioid Overdose Prevention and Response (OOPR) Training for first-year students. Effects of training were tracked using baseline and post-training surveys examining knowledge and attitudes toward opioid overdose and patients with SUDs. Results: Needs assessment indicated desire and need for training. The pilot study (N = 66) resulted in significantly improved knowledge regarding opioid overdose; 100% of students enjoyed training and believed others should receive it. The larger replication study surveyed all incoming students (N = 266) to gauge initial knowledge and experiences with these topics. Results prompted enhancement of the OOPR Training curriculum, which was delivered to half of the first-year class. Post-training survey results replicated the pilot study findings. The majority (95.2%) of students enjoyed training and 98.4% believed all students should receive it. Conclusion: Delivering a thorough curriculum on SUDs and harm reduction in UME is critical. Although many schools are implementing training, there is no standard curriculum. We outline a low-resource training intervention for OOPR. Our findings identified key features to include in these UME curricula. This approach provides a replicable template for schools seeking to develop brief educational interventions and identify essential content for curricula in SUDs and harm reduction.

A disulfide-stabilised helical hairpin fold in acrorhagin I: An emerging structural motif in peptide toxins.

Acrorhagin I (U-AITX-Aeq5a) is a disulfide-rich peptide identified in the aggressive organs (acrorhagi) of the sea anemone Actinia equina. Previous studies (Toxicon 2005, 46:768-74) found that the peptide is toxic in crabs, although the structural and functional properties of acrorhagin I have not been reported. In this work, an Escherichia coli (BL21 strain) expression system was established for the preparation of 13C,15N-labelled acrorhagin I, and the solution structure was determined using NMR spectroscopy. Structurally, acrorhagin I is similar to B-IV toxin from the marine worm Cerebratulus lacteus (PDB id 1VIB), with a well-defined helical hairpin structure stabilised by four intramolecular disulfide bonds. The recombinant peptide was tested in patch-clamp electrophysiology assays against voltage-gated potassium and sodium channels, and in bacterial and fungal growth inhibitory assays and haemolytic assays. Acrorhagin I was not active against any of the ion channels tested and showed no activity in functional assays, indicating that this peptide may possess a different biological function. Metal ion interaction studies using NMR spectroscopy showed that acrorhagin I bound zinc and nickel, suggesting that its function might be modulated by metal ions or that it may be involved in regulating metal ion levels and their transport. The similarity between the structure of acrorhagin I and that of B-IV toxin from a marine worm suggests that this fold may prove to be a recurring motif in disulfide-rich peptides from marine organisms.

Antimicrobial activity and structure of a consensus human ß-defensin and its comparison to a novel putative hBD10.

The spread of multidrug resistant bacteria owing to the intensive use of antibiotics is challenging current antibiotic therapies, and making the discovery and evaluation of new antimicrobial agents a high priority. The evaluation of novel peptide sequences of predicted antimicrobial peptides from different sources is valuable approach to identify alternative antibiotic leads. Two strategies were pursued in this study to evaluate novel antimicrobial peptides from the human ß-defensin family (hBD). In the first, a 32-residue peptide was designed based on the alignment of all available hBD primary structures, while in the second a putative 35-residue peptide, hBD10, was mined from the gene DEFB110. Both hBDconsensus and hBD10 were chemically synthesized, folded and purified. They showed antimicrobial activity against Escherichia coli, Staphylococcus aureus, and Mycobacterium tuberculosis, but were not hemolytic on human red blood cells. The NMR-based solution structure of hBDconsensus revealed that it adopts a classical ß-defensin fold and disulfide connectivities. Even though the mass spectrum of hBD10 confirmed the formation of three disulfide bonds, it showed limited dispersion in 1 H NMR spectra and structural studies were not pursued. The evaluation of different ß-defensin structures may identify new antimicrobial agents effective against multidrug-resistant bacterial strains.

Access to naloxone at community pharmacies under the Massachusetts statewide standing order.

OBJECTIVE: This study aimed to evaluate access to, and barriers to accessing, naloxone at community pharmacies throughout Massachusetts following implementation of new legislation that requires all community pharmacies to maintain a sufficient supply for dispensing under a statewide standing order. DESIGN: From September 2018 through January 2019, we conducted a cross-sectional telephone-based survey of Massachusetts pharmacies by having an interviewer pose as a customer seeking naloxone. SETTING AND PARTICIPANTS: Community pharmacies were identified from a list of all actively licensed pharmacies provided by the Massachusetts Department of Public Health and one-half were randomly selected for inclusion. Pharmacies that were permanently closed, duplicated on the list, or closed to the general public were excluded from analysis. OUTCOME MEASURES: Rates of stocked naloxone, perceived need for identification or prescription, and pricing. RESULTS: Of the 524 pharmacies surveyed, 97.7% (n = 512) reported routinely stocking naloxone. Of those, 90.4% (n = 463) had naloxone in stock on the day of contact. Most pharmacies with naloxone in stock did not require a prescription (96.1%; n = 445); at these pharmacies, personal identification was required by 38.9% (n = 180). The average out-of-pocket naloxone nasal spray price was $128.34 ± $40.75. CONCLUSION: Nearly all Massachusetts community pharmacies routinely stock naloxone as required by state law; however, barriers remain regarding perceived need for identification and high out-of-pocket costs.

Bacterial Alkyl-4-quinolones: Discovery, Structural Diversity and Biological Properties.

The alkyl-4-quinolones (AQs) are a class of metabolites produced primarily by members of the Pseudomonas and Burkholderia genera, consisting of a 4-quinolone core substituted by a range of pendant groups, most commonly at the C-2 position. The history of this class of compounds dates back to the 1940s, when a range of alkylquinolones with notable antibiotic properties were first isolated from Pseudomonas aeruginosa. More recently, it was discovered that an alkylquinolone derivative, the Pseudomonas Quinolone Signal (PQS) plays a key role in bacterial communication and quorum sensing in Pseudomonas aeruginosa. Many of the best-studied examples contain simple hydrocarbon side-chains, but more recent studies have revealed a wide range of structurally diverse examples from multiple bacterial genera, including those with aromatic, isoprenoid, or sulfur-containing side-chains. In addition to their well-known antimicrobial properties, alkylquinolones have been reported with antimalarial, antifungal, antialgal, and antioxidant properties. Here we review the structural diversity and biological activity of these intriguing metabolites.

Equisetum giganteum influences the ability of Candida albicans in forming biofilms over the denture acrylic resin surface.

CONTEXT: Equisetum giganteum L. (Equisetaceae) is an endemic plant of Central and South America used in traditional medicine. Natural drugs have been frequently used in the treatment of a myriad of diseases, proving to be an alternative to synthetic chemicals, and have been intensively studied in the prevention of sicknesses, including oral diseases. OBJECTIVE: This study evaluated the in vitro antiadherent activity of E. giganteum extract against Candida albicans biofilms. MATERIALS AND METHODS: Crystal violet and colony-forming units assays were used to quantify the total biofilm biomass and biofilm living cells on a denture base acrylic resin pretreated with hydroethanolic extract of E. giganteum in different concentrations (50, 25, 16, 8, and 4 mg/mL), after 24 h of biofilm development. RESULTS: Equisetum giganteum affected biofilms by reduction of biomass and living cells per area of acrylic specimens. The results revealed reduction of 15-44% of the biofilm mass and reduction of numbers of colony-forming units (CFUs) present in biofilms (79%) compared to the untreated control (CTRL/PBS). At all concentrations, it demonstrated important antiadherent activity on Candida albicans biofilms, the main microbe in denture stomatitis. DISCUSSION AND CONCLUSION: The present findings show that E. giganteum antimicrobial effects may qualify the extract as a promising natural alternative for topical treatment or prevention of denture stomatitis. The usage of drugs made of natural products shows advantages in relation to synthetic drugs on the market, such as lower cost, lower toxicity, and in relation to the occurrence of microbial resistance.

Atlantoaxial Rotatory Subluxation: A Review for the Pediatric Emergency Physician.

Pediatric emergency physicians must have a high clinical suspicion for atlantoaxial rotatory subluxation (AARS), particularly when a child presents with neck pain and an abnormal head posture without the ability to return to a neutral position. As shown in the neurosurgical literature, timely diagnosis and swift initiation of treatment have a greater chance of treatment success for the patient. However, timely treatment is complicated because torticollis can result from a variety of maladies, including: congenital abnormalities involving the C1-C2 joint or the surrounding supporting muscles and ligaments, central nervous system abnormalities, obstetric palsies from brachial plexus injuries, clavicle fractures, head and neck surgery, and infection. The treating pediatrician must discern the etiology of the underlying problem to determine both timing and treatment paradigms, which vary widely between these illnesses. We present a comprehensive review of AARS that is intended for pediatric emergency physicians. Management of AARS can vary widely bases on factors, such as duration of symptoms, as well as the patient's history. The goal of this review is to streamline the management paradigms and provide an inclusive review for pediatric emergency first responders.

Alvimopan, a peripherally acting µ-opioid receptor antagonist, is associated with reduced costs after radical cystectomy: economic analysis of a phase 4 randomized, controlled trial.

PURPOSE: We evaluated the effect of alvimopan treatment vs placebo on health care utilization and costs related to gastrointestinal recovery in patients treated with radical cystectomy in a randomized, phase 4 clinical trial. MATERIALS AND METHODS: Resource utilization data were prospectively collected and evaluated by cost consequence analysis. Hospital costs were estimated from 2012 Medicare reimbursement rates and medication wholesale acquisition costs. Differences in base case mean costs between the study cohorts for total postoperative ileus related costs (hospital days, study drug, nasogastric tubes, postoperative ileus related concomitant medication and postoperative ileus related readmissions) and total combined costs (postoperative ileus related, laboratory, electrocardiograms, nonpostoperative ileus related concomitant medication and nonpostoperative ileus related readmission) were evaluated by probabilistic sensitivity analysis using a bootstrap approach. RESULTS: Mean hospital stay was 2.63 days shorter for alvimopan than placebo (mean±SD 8.44±3.05 vs 11.07±8.23 days, p=0.005). Use of medications or interventions likely intended to diagnose or manage postoperative ileus was lower for alvimopan than for placebo, eg total parenteral nutrition 10% vs 25% (p=0.001). Postoperative ileus related health care costs were $2,340 lower for alvimopan and mean total combined costs were decreased by $2,640 per patient for alvimopan vs placebo. Analysis using a 10,000-iteration bootstrap approach showed that the mean difference in postoperative ileus related costs (p=0.04) but not total combined costs (p=0.068) was significantly lower for alvimopan than for placebo. CONCLUSIONS: In patients treated with radical cystectomy alvimopan decreased hospitalization cost by reducing the health care services associated with postoperative ileus and decreasing the hospital stay.

A scarab beetle (Coleoptera: Scarabaeidae) causes tree mortality, delayed growth, and yield reduction in cacao with genotype-specific susceptibility to herbivory.

BACKGROUND: This study explored the impact of Leucothyreus femoratus, a previously unreported folivorous pest in cacao cultivation, on cacao tree survival, development, and yield. The study was conducted in an experimental cacao plot in the Colombian plains, it featured 20 cacao genotypes in an agroforestry system, with plantain and Mexican sunflower providing temporary shade, and yopo offering permanent shade. RESULTS: We found an infestation rate of 2.9 ± 0.3 adult beetles per cacao tree. L. femoratus larvae were discovered in association with the roots of all plants within the agroforestry arrangement; however, yopo and plantain exhibited the highest incidence of root-feeding larvae among these associated plants. Interestingly, male and female L. femoratus displayed distinct leaf consumption patterns in the laboratory, with females consuming more foliage relative to their body weight. Moreover, field observations highlighted the detrimental impact of L. femoratus herbivory on cacao tree survival and growth, leading to leaf skeletonization, reduced plant height, and stem diameter. Trees with over 50% leaf consumption suffered more than 20% mortality. Additionally, herbivory negatively affected cacao yield, correlating higher leaf surface damage with a decrease in harvested pods. The study also identified varying antixenotic resistance in different cacao genotypes, with some consistently displaying resistance while others showed variable levels during tree establishment and production stages. CONCLUSION: This research underscores the significant role of L. femoratus as a cacao pest, emphasizing its adverse effects on cacao tree survival, development, and yield. Consequently, implementing effective control measures is vital for ensuring sustainable cacao cultivation. © 2023 Society of Chemical Industry.

Short Interpregnancy Intervals Among Women Experiencing Homelessness in Colorado.

Importance: Short interpregnancy intervals (SIPIs) are associated with increased risk of adverse maternal and neonatal outcomes. Disparities exist across socioeconomic status, but there is little information on SIPIs among women experiencing homelessness. Objective: To investigate (1) differences in rates and characteristics of SIPIs between women experiencing homelessness and domiciled women, (2) whether the association of homelessness with SIPIs differs across races and ethnicities, and (3) whether the association between SIPIs of less than 6 months (very short interpregnancy interval [VSIPIs]) and maternal and neonatal outcomes differs between participant groups. Design, Setting, and Participants: This cohort study used a Colorado statewide database linking the Colorado All Payer Claims Database, Homeless Management Information System, death records, and infant birth records. Participants included all women who gave birth between January 1, 2016, and December 31, 2021. Data were analyzed from September 1, 2022, to May 10, 2023. Exposures: Homelessness and race and ethnicity. Main Outcomes and Measures: The primary outcome consisted of SIPI, a binary variable indicating whether the interval between delivery and conception of the subsequent pregnancy was shorter than 18 months. The association of VSIPI with maternal and neonatal outcomes was also tested. Results: A total of 77 494 women (mean [SD] age, 30.7 [5.3] years) were included in the analyses, of whom 636 (0.8%) were women experiencing homelessness. The mean (SD) age was 29.5 (5.4) years for women experiencing homelessness and 30.7 (5.3) years for domiciled women. In terms of race and ethnicity, 39.3% were Hispanic, 7.3% were non-Hispanic Black, and 48.4% were non-Hispanic White. Associations between homelessness and higher odds of SIPI (adjusted odds ratio [AOR], 1.23 [95% CI, 1.04-1.46]) were found. Smaller associations between homelessness and SIPI were found among non-Hispanic Black (AOR, 0.59 [95% CI, 0.37-0.96]) and non-Hispanic White (AOR, 0.57 [95% CI, 0.39-0.84]) women compared with Hispanic women. A greater association of VSIPI with emergency department visits and low birth weight was found among women experiencing homelessness compared with domiciled women, although no significant differences were detected. Conclusions and Relevance: In this cohort study of women who gave birth from 2016 to 2021, an association between homelessness and higher odds of SIPIs was found. These findings highlight the importance of conception management among women experiencing homelessness. Racial and ethnic disparities should be considered when designing interventions.

The Timing, Factors, and Impact of USMLE Step 1 Becoming Pass/Fail on the Process of Choosing a Specialty.

Background  Choosing a medical specialty is an important decision. A combination of factors influenced this decision. Student characteristics and examination performances can influence this decision. With the transition of the United States Medical Licensing Examination (USMLE) Step 1 becoming pass/fail, it is important to analyze the specialty decision process. Objective The purpose of this multimethod study is to assess when in the curriculum students choose a specialty, what factors influence their decision, and the impact of USMLE Step 1 scores on a student's assessment of competitiveness. Methods In February 2022, a survey was prepared and approved by the University of Nevada, Las Vegas (UNLV) Institutional Review Board (IRB). The survey contained multiple-choice questions and a free-response section. The survey was sent to the Class of 2022 and 2023 students at Kirk Kerkorian School of Medicine who follow a Longitudinal Integrated Clerkship. Descriptive statistics and one-sample t-tests were calculated. Results A total of 89 students completed the survey: 42 out of 60 students (70%) from the Class of 2022 and 47 out of 61 students (77%) from the Class of 2023. This study found that 78.8% of longitudinal interleaved clerkship (LInC) students committed to their specialty during the second half of the clinical year. The effects of positive and negative experiences during clerkships were most significantly different (p < 0.001). Conclusion The majority of LInC students arrive at their decision by the latter half of the clinical year. A variety of factors help students arrive at their decision. Our findings suggest that the pass/fail grading system will make it more difficult for students to assess their personal competitiveness.

Antiracism and mental health recovery: Bridging the gap to improve health disparities among veteran populations.

Viewing the Substance Abuse and Mental Health Services Administration's recovery principles through an antiracist lens has guided the authors' vision of recovery-oriented systems for all. In this brief letter, they present some considerations arising from their application of recovery principles to areas affected by racial bias. They are also identifying best practices for incorporating micro and macro antiracism efforts into recovery-oriented health care. These are important steps in promoting recovery-oriented care, but there is much more to do. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

The Perception of Surgery Program Directors of Residency Applicants From Longitudinal Integrated Curriculum Medical Schools: A Survey of the Association of Program Directors in Surgery Members.

Research statement This study explores whether longitudinal integrated clerkship (LIC) students are competitive general surgery applicants and if they are perceived as adequately prepared for general surgery residency compared to traditional block rotation (BR) students. Background/relevance of the study There is increasing interest in LIC models of clinical education versus BR models. LIC students have been shown to perform similarly on examinations to BR students. However, while LICs seem well suited for students pursuing primary care specialties, little is known about how this approach impacts clinical education for surgery. Design and methods An electronic survey was prepared and approved by the Association of Program Directors in Surgery (APDS) and our university's institutional review board (IRB). Ten multiple-choice questions were administered along with an option for narrative comments. Surveys were sent over a one-month period to members of APDS Listserv. Returned emails were de-identified, and the results were tabulated. Results From 43 responses, the majority identified as program directors (PDs) (65%) and reported being somewhat familiar or very familiar with LICs (90%). When asked about the statement "LIC students are prepared for surgical residency," 22% "disagreed" or "strongly disagreed." When asked "How would you rank a LIC prospective applicant in comparison to a BR student?" 35% responded that they would rank the LIC student lower or not at all. Of the respondents, 47% reported that they have current residents who were LIC students. Most of these residents (65%) are graded as "average" for current performance. Conclusions The results suggest that medical students who are trained using LICs may be disadvantaged when applying to general surgery residencies. Interpretation is limited by the small number of respondents, and it only reflects the opinions of active APDS Listserv members. Further study is needed to confirm these findings and elucidate the basis of perceived deficiencies in LICs. Students from these schools should be advised to obtain additional surgery experience.

Exenatide as a novel weight loss modality in patients without diabetes.

OBJECTIVE: To evaluate the potential role of exenatide for weight loss in overweight or obese adults without diabetes. DATA SOURCES: PubMed (1946-August 2012) and EMBASE (1974-August 2012) were used to conduct a literature search utilizing the terms exenatide, weight loss, obesity, and overweight. Additional references were identified by bibliographic review of relevant articles. STUDY SELECTION AND DATA EXTRACTION: Studies assessing the use of exenatide in adult subjects without type 2 diabetes or polycystic ovary syndrome and reporting effects on body weight were included. DATA SYNTHESIS: Five studies were identified that reported use of exenatide in nondiabetic adults and included weight change as an outcomes measure. In all 5 of these studies, subjects taking exenatide experienced statistically significant weight loss, which ranged from 2.0 ± 2.8 to 5.1 ± 0.5 kg. Two of the trials were randomized, placebo-controlled studies; 1 trial was a randomized, open-label investigation; 1 study had a prospective, open-label cohort design; and the remaining study was a chart review. Adverse events experienced with exenatide were primarily gastrointestinal in nature, although each trial reported the drug to be well tolerated. CONCLUSIONS: Obesity continues to be a national epidemic, while choices for effective pharmacologic treatments are extremely limited. Exenatide appears to have promising effects on weight in overweight or obese adults without type 2 diabetes. Further investigations with large, placebo-controlled trials assessing long-term weight loss as a primary outcome are warranted.

Drug overdose resulting in quadriplegia.

PURPOSE: To describe a case of cervical flexion myelopathy resulting from a drug overdose. METHODS: A 56-year-old male presented to the emergency department unable to move his extremities following drug overdose. Neurological examination revealed him to be at C6 ASIA A spinal cord injury. The CT of his cervical spine revealed no fracture; however, an MRI revealed cord edema extending from C3 to C6 as well as posterior paraspinal signal abnormalities suggestive of ligamentous injury. RESULTS: The patient underwent a posterior cervical laminectomy and fusion from C3 to C7. Neurologically he regained 3/5 bilateral tricep function and 2/5 grip; otherwise, he remained at ASIA A spinal cord injury at 6 months. CONCLUSION: Our patient suffered a spinal cord injury likely due to existing cervical stenosis, and in addition to an overdose of sedating medications, he likely sat in flexed neck position for prolonged period of time with the inability to modify his position. This likely resulted in cervical spine vascular and/or neurological compromise producing an irreversible spinal cord injury. Spinal cord injury is a rare finding in patients presenting with drug overdose. The lack of physical exam findings suggestive of trauma may delay prompt diagnosis and treatment, and thus clinicians must have a high index of suspicion when evaluating patients in this setting.

Long-term effects of opioid overdose prevention and response training on medical student knowledge and attitudes toward opioid overdose: A pilot study.

BACKGROUND: Medical settings provide ideal opportunities to identify patients with substance use disorders and provide harm reduction and treatment resources. Medical students often volunteer in the community and can spend substantial time with patients, serving as touchpoints. Accordingly, medical schools have begun training in harm reduction. Initial studies show such training acutely improves knowledge, but sustained effects remain unclear. This pilot study explored longer-term impacts of Opioid Overdose Prevention and Response Training (OOPRT) on medical student knowledge about opioids, overdose, and naloxone. METHODS: Students completed a survey about knowledge of opioid use disorder, overdoses, and attitudes towards patients. This included Opioid Overdose Knowledge (OOKS) and Opioid Overdose Attitudes (OOAS) scales. A subset of students was invited to attend OOPRT and complete a post-training survey. All who completed the baseline survey were invited to complete a 6-month follow-up. We analyzed long-term training effects on OOKS and OOAS scores. RESULTS: 89 students completed baseline and 6-month follow-up surveys; of these, 22 received training. OOPRT yielded significant improvements in knowledge of signs of opioid overdose (F(2,38) = 18.04, P < .001), actions to take during overdose (F(2,38) = 8.32, P = .001), and naloxone use (F(2,38) = 35.46, P < .001), along with attitudes regarding overdose competencies (F(2,38) = 99.40, P < .001) and concerns (F(2,38) = 8.86, P < .001). When comparing over time, students who attended OOPRT retained significantly higher competency scores than those who did not attend F(1,87) = 40.82, P < .001). No other significant differences were observed. CONCLUSIONS: This study demonstrates immediate efficacy of OOPRT in improving opioid overdose knowledge and attitudes and sustained changes at 6 months, compared to standard undergraduate medical curricula alone. Future research with larger sample sizes is underway to validate these preliminary findings and examine the difference in attitudes and knowledge retention over time. Given that students report interest in receiving OOPRT and consider it worthwhile, systematic study is warranted.

Evaluation of Two Beta-Tricalcium Phosphates with Different Particle Dimensions in Human Maxillary Sinus Floor Elevation: A Prospective, Randomized Clinical Trial.

This study aimed to compare two beta-tricalcium phosphates with different particle sizes in human maxillary sinuses lifting. The immunolabeling of cells for RUNX2 and VEGF were performed to evaluate the osteoblast precursor cells and the vascular formation after 6 months of bone repair. Ten maxillary sinuses were grafted with autogenous bone graft (Group 1), 10 were grafted with ChronOs® (Group 2), and 10 were grafted with BETA-TCP® (Group 3). After 6 months of bone healing, biopsies were obtained to assess the new bone formed by histomorphometric and immunohistochemical evaluation for RUNX2 and VEGF. The mean bone formation for Group 1 was 51.4 ± 17.4%. Group 2 presented 45.5 ± 9.9%, and Group 3 conferred 35.4 ± 8.0% of new bone formation. The RUNX2 offered low for Groups 1 and 2 with high cellular activity for osteoblast in Group 3. The VEGF immunolabeling was moderate for Groups 1 and 2 and intense for Group 3. In conclusion, it was possible to show that the bone substitutes evaluated in the present study presented suitable outcomes for bone regeneration, being an alternative for the autogenous bone graft in maxillary sinus bone height reconstruction.

Training medical students in opioid overdose prevention and response: Comparison of In-Person versus online formats.

Medical education has increasingly shifted towards replacing large lectures with a combination of online and smaller in-person group sessions. This study compares the efficacy of a virtual Opioid Overdose Prevention and Response Training (OOPRT) for first-year medical students with an identical in-person training. During their first unit of medical school, students in the class of 2023 (cohort 1) received OOPRT in-person and students in the class of 2024 (cohort 2) received training via Zoom. Aside from the delivery format, trainings were identical. Both cohorts completed identical surveys at medical school entry and post-training to evaluate knowledge and experiences using the Opioid Overdose Knowledge Scale, Opioid Overdose Attitudes Scale, Medical Conditions Regard Scale, and Naloxone Related Risk Compensation Beliefs. Of 430 students, 84.2% (362: 124 in cohort 1; 238 in cohort 2) completed baseline and post-training surveys. Students reported significantly improved opioid overdose knowledge and attitudes in all 4 knowledge and 3 attitudes subscales after training. Only one outcome differed by training type: knowledge of opioid overdose signs. Cohorts did not differ in opinions of training; 97.2% enjoyed it and 99.4% believed future classes should receive it. Medical students' attitudes and knowledge significantly improved after OOPRT; only one of 13 outcomes showed a cohort difference. There were no differences in enjoyment, indicating that switching to virtual learning does not undermine the learning experience. Further studies are needed to confirm that these results can be extended to other medical school topics where small group interactive discussion is preferred.