Psychiatrists can save lives with naloxone.

OBJECTIVES: Naloxone is an effective medication used to reverse opioid overdoses. Distributing naloxone directly to those at risk, therefore, reduces the risk of opioid-related deaths. New legislation in Australia means a prescription is no longer required to access naloxone. Whilst acknowledging the benefits of increased access, we aim to evaluate the impact psychiatrists can have on naloxone provision due to their unique position as doctors often working with those who may be at risk. METHODS: Data was recorded on those accessing naloxone from a co-located addiction and mental health service. Descriptive statistics were generated to establish the cohort characteristics, prior knowledge of naloxone and outcome of previously supplied naloxone. RESULTS: Naloxone was dispensed 488 times from 2021 to 2023. 267 people had previously been prescribed naloxone from these sites where 137 (51.3%) were reportedly used in an opioid reversal. CONCLUSIONS: Our findings highlight the importance of community access to naloxone in reducing opioid-related harm. Whilst removing the need for a prescription makes naloxone more accessible, it remains vital that doctors remain involved in this process to broaden the reach of supply to those at risk.

The Current Epidemiology of Injecting Drug Use-Associated Infective Endocarditis in Victoria, Australia in the Midst of Increasing Crystal Methamphetamine Use.

BACKGROUND: Infective endocarditis (IE) is associated with significant mortality and morbidity despite recent advances in management. Injecting drug use (IDU) remains an important risk factor. Our aim was to evaluate the rates and patient demographics of IE and injecting drug use-associated infective endocarditis (IDU-IE) in Victoria from 2009 to 2014. METHODS: The Victorian Admitted Episode Dataset (VAED) was used to identify a population-based cohort with a diagnosis of IE and IDU-IE between 2009 and 2014 in Victoria. Incidence rates were calculated per 100,000 people/year. Rate ratios were calculated using Poisson distributions, and chi squared (χ2) test for trend were calculated to identify significant linear trends. RESULTS: The incidence rate of IE overall has risen significantly from 11.09 to 13.56 per 100,000 people/year from 2009 to 2014 (rate ratio 1.22, 95% confidence interval (CI) 1.10, 1.36, p<0.001). The incidence of IDU-IE has also risen significantly from 0.92 to 1.76 per 100,000 people/year from 2009 to 2014 (rate ratio 1.93, 95% CI 1.28, 2.90, p=0.002). The chi squared (χ2) test for trend of both IE and IDU-IE also suggests a statistically significant linear trend (p=0.0015 and 0.005 respectively). Descriptive epidemiology revealed men are twice as likely to be affected by IE overall. The elderly were found to be the most affected by IE overall (ages 75 to 79 years) with IDU-IE affecting a much younger age group (ages 30 to 34 years). Validation of hospital coding for IDU-IE was shown to have sensitivity of 77.2% (95% CI 64.8, 86.2). CONCLUSIONS: This study identified that from 2009 to 2014 there has been a significant increase in incidence of both IE overall and IDU-IE in Victoria. These findings highlight the need for the planning of targeted interventions to mitigate the incidence of disease.

"It can save your life, that's all I know," barriers and facilitators for engagement in take-home naloxone for people receiving opioid substitution treatment in regional Australia: An explorative study.

Engagement in take-home naloxone (THN) programs by people receiving opioid substitution treatment (OST) in Australia is low despite methadone being a significant contributor to opioid overdose deaths. Our aim was to explore barriers and facilitators for OST patients to engage in THN. We used a descriptive qualitative design with thematic analysis to gain insight into naloxone uptake by people engaged in an OST program in regional Australia. Eleven participants were interviewed; eight had previously engaged with THN. Barriers to THN included limited knowledge and understanding, lack of information, and not personally experiencing an overdose. Facilitators included having a traumatic experience of overdose, knowledge and understanding of THN and overdose, empowerment in carrying naloxone, and expanding THN programs. Support for the expansion of THN programs is desired among participants, and widespread peer distribution is understood to be the key to success. This study found that prior traumatic experience of overdose facilitates acceptance of THN, and being offered THN was the most important factor in engagement. Less clear is how to engage people who lack a traumatic overdose experience.

Usability Evaluation of a Blood Glucose Monitoring System With a Spill-Resistant Vial, Easier Strip Handling, and Connectivity to a Mobile App: Improvement of Patient Convenience and Satisfaction.

BACKGROUND: Proper management of diabetes mellitus requires regular self-monitoring of blood glucose (SMBG). This research evaluated the usability of the Accu-Chek® Guide Meter that includes a spill-resistant vial, easier strip handling, and wireless connectivity to a mobile app. METHODS: A total of 197 participants were allowed to experience typical blood glucose testing tasks on the Accu-Chek Guide Meter, review data such as last result, patterns, and target percentage on the meter and on the mobile app, and then evaluate their experience through a human factors usability survey. Participants used a 6-point agree/disagree scale to rate 34 market statement questions. RESULTS: The results of a Pearson chi-square proportions test for each of the 34 market statement questions showed a significant difference (P < .0001) between the disagree responses (1-3) and agree responses (4-6). An overwhelming majority of participants found all aspects of the system, including the test strips, strip vial, and data analysis on the meter and the mobile app, to be a good fit for their lifestyle and to provide a better testing experience. CONCLUSIONS: This study found superior usability of the new meter system over the participants' current meters in both the United States and France.

Discrepancy in Vancomycin AUC/MIC Ratio Targeted Attainment Based upon the Susceptibility Testing in Staphylococcus aureus.

This study demonstrated a statistically significant difference in vancomycin minimum inhibitory concentration (MIC) for Staphylococcus aureus between a common automated system (Vitek 2) and the E-test method in patients with S. aureus bloodstream infections. At an area under the serum concentration time curve (AUC) threshold of 400 mg∙h/L, we would have reached the current Infectious Diseases Society of America (IDSA)/American Society of Health System Pharmacists (ASHP)/Society of Infectious Diseases Pharmacists (SIDP) guideline suggested AUC/MIC target in almost 100% of patients while using the Vitek 2 MIC data; however, we could only generate 40% target attainment while using E-test MIC data (p < 0.0001). An AUC of 450 mg∙h/L or greater was required to achieve 100% target attainment using either Vitek 2 or E-test MIC results.

Methoxychlor and its metabolite HPTE inhibit cAMP production and expression of estrogen receptors α and ß in the rat granulosa cell in vitro.

The major metabolite of the estrogenic pesticide methoxychlor (MXC) HPTE is a stronger ESR1 agonist than MXC and acts also as an ESR2 antagonist. In granulosa cells (GCs), FSH stimulates estradiol via the second messenger cAMP. HPTE inhibits estradiol biosynthesis, and this effect is greater in FSH-treated GCs than in cAMP-treated GCs. Therefore; we examined the effect of MXC/HPTE on FSH-stimulated cAMP production in cultured GCs. To test involvement of ESR-signaling, we used the ESR1 and ESR2 antagonist ICI 182,780, ESR2 selective antagonist PHTPP, and ESR2 selective agonist DPN. ESR1 and ESR2 mRNA and protein levels were quantified. Both HPTE and MXC inhibited the FSH-induced cAMP production. ICI 182,780 and PHTPP mimicked the inhibitory action of HPTE. MXC/HPTE reduced FSH-stimulated Esr2 mRNA and protein to basal levels. MXC/HPTE also inhibited FSH-stimulated Esr1. The greater inhibition on FSH-stimulated GCs is likely due to reduced cAMP level that involves ESR-signaling, through ESR2.

Evolving epidemiology of injecting drug use-associated infective endocarditis: A regional centre experience.

INTRODUCTION AND AIMS: Injecting drug use (IDU) is a major risk factor for infective endocarditis (IE). An understanding of the epidemiology of IE and IDU is vital for delivery of health care for this disease. Our aim was to examine the rates of IDU-associated IE (IDU-IE) in a single centre over the last 12 years. DESIGN AND METHODS: Retrospective analysis of two cohorts of consecutive patients (n = 226) admitted with IE from 2002 to 2013. Numbers of cases and rates of IE were compared between two cohorts (2002-2006 and 2009-2013). Rate ratios were calculated using Poisson distributions. Poisson regression was used to examine relationship over time. RESULTS: One hundred thirty cases of endocarditis were seen in the first observation period (6 IDU-IE) and 96 in the second observation period (15 IDU-IE). The estimated incidence rate of IE had fallen from 10.1 to 6.45 per 100, 000 person-years [rate ratio 0.64, 95% confidence interval (CI) 0.48, 0.85]. In contrast, the estimated incidence rate of IDU-E has risen from 0.48 to 0.79 per 100, 000 person-years (rate ratio 1.65, 95% CI 0.59, 4.57). Incidence rate regression suggests that the number of IDU-IE cases is expected to increase by a factor of 1.25 (95%CI 1.09-1.44) for each increase of 1 year. DISCUSSION AND CONCLUSIONS: Over the last decade, there has been a decrease in incidence rate and total number of cases of IE but a rise in rate and number of cases of IDU-IE. This may indicate increasing IDU or increased rates of endocarditis in intravenous drug users in this region. This finding may inform health-care planning in the area.

Rapid temporal recalibration occurs crossmodally without stimulus specificity but is absent unimodally.

Crossmodal integration of sensory signals can improve perception and behavior but requires the signals to occur close in time. Differences in propagation and processing speeds make this difficult. Temporal recalibration is a useful 're-alignment' process by which the point of subjective synchrony is temporally realigned towards an adapted asynchrony. A recent study by Van der Burg et al. (2013). J. Neurosci. 33, 14633-14637 showed temporal recalibration can occur rapidly following a single exposure to a brief audiovisual asynchrony. Using a similar procedure, this study confirms their rapid recalibration effect and shows that it occurs even when the single exposure differs in its auditory and visual features from the test stimulus. Using the same procedure in a unimodal context showed that rapid recalibration does not occur in audition following exposure to asynchronous tones of different frequencies, nor in vision following asynchronous lines differing in colour and orientation. This pattern of results suggests that rapid recalibration is in essence an inter-sensory temporal process. It serves to realign asynchronies between modalities with no selectivity for feature identity and does not operate within modalities.

The Economic Impact of Starting, Stopping, and Restarting an Antibiotic Stewardship Program: A 14-Year Experience.

Regions Hospital started a multidisciplinary antibiotic stewardship program (ASP) in 1998. The program effectively shut down from 2002-2004 as key personnel departed and was then restarted but without the dedicated pharmacist and infectious diseases physician. Purchasing data (in dollars or dollars/patient/day) unadjusted for inflation served as a surrogate marker of antibiotic consumption. These data were reviewed monthly, quarterly, and yearly along with antibiotic susceptibility patterns on a semi-annual basis. Segmented regression analysis was use to compare restricted antibiotic purchases for performance periods of 1998-2001 (construction), 2002-2004 (de-construction), and 2005-2011 (reconstruction). After 4 years (1998-2001) of operation, a number of key participants of the ASP departed. For the following three years (2002-2004) the intensity and focus of the program floundered. This trend was averted when the program was revitalized in early 2005. The construction, deconstruction, and reconstruction of our ASP provided a unique opportunity to statistically examine the financial impact of our ASP or lack thereof in the same institution. We demonstrate a significant economic impact during ASP deconstruction and reconstruction.

Neck disorders among construction workers: understanding the physical loads on the cervical spine during static lifting tasks.

In this study a common yet very strenuous construction work activity, was evaluated biomechanically by studying electromyography (EMG) of the major neck muscles. The muscles studied were the sternocleidomastoid and the upper trapezius. Fifteen healthy participants (10 males and 5 females) with no history of musculoskeletal abnormalities participated in this study. The participants lifted 25%, 50%, and 75% of their maximum shoulder height static strength at neutral, maximally flexed, and maximally extended neck postures. The weight lifted as well as the neck posture significantly affected the activities of the neck muscles. Increase in the weight increased the activation of the neck muscles. The sternocleidomastoid muscle was most active at the extended neck posture, while the upper trapezius muscle was most active at the flexed neck posture. The results of this study indicate that the neck muscles play an active role during lifting and holding tasks at shoulder height. Thus, such tasks could be probable risk factors associated with neck disorders prevalent among construction workers.

Effect of the methoxychlor metabolite HPTE on the rat ovarian granulosa cell transcriptome in vitro.

Ovarian granulosa cells play a central role in steroidogenesis, which is critical for female reproduction. Follicle-stimulating hormone (FSH) promotes cyclic adenosine monophosphate (cAMP)-mediated signaling to regulate granulosa cell steroidogenesis. We have shown previously that 2,2-bis-(p-hydroxyphenyl)-1,1,1-trichloroethane (HPTE) inhibits FSH- and dibutyryl cAMP-stimulated steroidogenesis and affects the messenger RNA levels of steroidogenic pathway enzymes in rat granulosa cells. However, HPTE showed a differential effect in FSH- and cAMP-stimulated cells in that HPTE more completely blocked FSH- when compared to cAMP-driven steroidogenesis. The objective of this study was to analyze the effects of HPTE on global gene expression profiles in untreated granulosa cells and those challenged with FSH or cAMP. Granulosa cells from immature rats were cultured with 0, 1, 5, or 10 microM HPTE in the presence or absence of either 3 ng FSH/ml or 1mM cAMP for 48 h. Total RNA was isolated for real-time quantitative PCR and microarray analysis using the GeneChip Rat Genome 230 2.0 and ArrayAssist Microarray Suite. An investigation of changes in gene expression across all HPTE treatments showed that HPTE altered more genes in FSH- (approximately 670 genes) than in cAMP-stimulated cells (approximately 366 genes). Analysis confirmed that HPTE more effectively inhibited FSH- than cAMP-induced steroid pathway gene expression and steroidogenesis. Furthermore, expression patterns of novel genes regulating signal transduction, transport, cell cycle, adhesion, differentiation, motility and growth, apoptosis, development, and metabolism were all altered by HPTE. This study further established that HPTE exerts differential effects within the granulosa cell steroidogenic pathway and revealed that these effects include broader changes in gene expression.

Comparison of current U.S. and Canadian cigarette pack warnings.

Cigarette smoking is the single most preventable cause of death in the United States. From 1985 to date, one of four mandatory cigarette warnings proposed by the Comprehensive Smoking Education Act of 1984 has been displayed on cigarette packages. In addition to cigarette warnings, states like California, Massachusetts, Arizona, Oregon and Maine have implemented "Tobacco Control Programs" (TCP) to reduce the overall number of smokers. However, the decline in the rate of smoking is not occurring fast enough to meet the national health objective by 2010. The present U.S. cigarette warnings are verbal in form and provide information, which is inadequate but appropriate to make it legally adequate. On the other hand, warnings in other countries such as Canada and Brazil are more descriptive and specific and are accompanied by vivid and sometimes gruesome pictures. In the present study, six pictorial Canadian labels and four U.S. verbal labels were analyzed for potential effectiveness among eighty subjects using a survey questionnaire. The survey findings are compared with recent Canadian smoking data. It is concluded that placing pictorial labels on cigarette packages in the U.S. will allow the product to carry warnings that potentially provide better results than current verbal messages and less TCP funds will need to be used.

The development of a theoretical framework and design tool for process usability assessment.

The purpose of usability engineering is to facilitate the deployment of new products by decreasing development costs and improving the quality of systems. This paper will discuss the development and delivery of a unique, theoretically based software tool that provides engineers and designers with easy access to the most recent advances in human-machine interface design. This research combines several theoretical views of the interaction process into a hybrid model. Based on this model, a software tool was produced that allows engineers to model the human interaction process within their design. The system then provides feedback on the interaction process through items such as: the amount of mental effort required by a user, the degree to which the system conforms to human capabilities, the expected time to complete the interaction, where potential human error may occur, as well as potential misunderstandings or points of confusion to the users. The designer may then use this information to improve the design of the system. Validation of this technique indicates that the hybrid model produces accurate predictions of usability attributes and that the technique transfers from the laboratory to the real world.