Motivation and context of concurrent stimulant and opioid use among persons who use drugs in the rural United States: a multi-site qualitative inquiry.

BACKGROUND: In recent years, stimulant use has increased among persons who use opioids in the rural U.S., leading to high rates of overdose and death. We sought to understand motivations and contexts for stimulant use among persons who use opioids in a large, geographically diverse sample of persons who use drugs (PWUD) in the rural settings. METHODS: We conducted semi-structured individual interviews with PWUD at 8 U.S. sites spanning 10 states and 65 counties. Content areas included general substance use, injection drug use, changes in drug use, and harm reduction practices. We used an iterative open-coding process to comprehensively itemize and categorize content shared by participants related to concurrent use. RESULTS: We interviewed 349 PWUD (64% male, mean age 36). Of those discussing current use of stimulants in the context of opioid use (n = 137, 39%), the stimulant most used was methamphetamine (78%) followed by cocaine/crack (26%). Motivations for co-use included: 1) change in drug markets and cost considerations; 2) recreational goals, e.g., seeking stronger effects after heightened opioid tolerance; 3) practical goals, such as a desire to balance or alleviate the effects of the other drug, including the use of stimulants to avoid/reverse opioid overdose, and/or control symptoms of opioid withdrawal; and 4) functional goals, such as being simultaneously energized and pain-free in order to remain productive for employment. CONCLUSION: In a rural U.S. cohort of PWUD, use of both stimulants and opioids was highly prevalent. Reasons for dual use found in the rural context compared to urban studies included changes in drug availability, functional/productivity goals, and the use of methamphetamine to offset opioid overdose. Education efforts and harm reduction services and treatment, such as access to naloxone, fentanyl test strips, and accessible drug treatment for combined opioid and stimulant use, are urgently needed in the rural U.S. to reduce overdose and other adverse outcomes.

Aqueous extract OF Moringa oleifera Lam leaves added to freezing extenders damages goat sperm membranes.

BACKGROUND: Semen cryopreservation is a biotechnology used frequently in animal production; however, there are some obstacles, such as those caused by high levels of reactive oxygen species (ROS). Moringa oleifera (MO) is known as a potent source of antioxidants and might be an important adjuvant. OBJECTIVE: The objective of this study was to determine the effect of different concentrations of MO extract supplementation on goat semen cryopreservation efficiency. MATERIALS AND METHODS: Ejaculates (n=6) from four goat breeders were pooled and diluted in skimmed milk (SM) or Tris-egg yolk (TEY)-based extenders and supplemented with different concentrations of MO extract (0, 1, 2 and 5 mg/mL). After the freeze-thaw cycle, sperm kinetics and viability were assessed. RESULTS: With the SM extender, straightness, wobble and plasma membrane integrity were lower than in the control group (P < 0.05). With the TEY extender, wobble was lower in with 5 mg/mL MO extract than in the control group (P < 0.05). As regards sperm ultrastructure, evaluated by SEM, the MO extract, regardless of the diluent used, damaged the membrane of sperm cells in a dose-dependent manner. CONCLUSION: The addition of aqueous extract of MO leaves in both diluents at all concentrations tested affects the parameters of sperm progressivity and damages the plasma membrane in a dose-dependent manner. DOI: 10.54680/fr23310110712.

Individual and poly-substance use and condomless sex among HIV-uninfected adults reporting heterosexual sex in a multi-site cohort.

BACKGROUND: We analyzed the association between substance use (SU) and condomless sex (CS) among HIV-negative adults reporting heterosexual sex in the Seek, Test, Treat, and Retain (STTR) consortium. We describe the impact of SU as well as person/partner and context-related factors on CS, identifying combinations of factors that indicate the highest likelihood of CS. METHODS: We analyzed data from four US-based STTR studies to examine the effect of SU on CS using two SU exposures: 1) recent SU (within 3 months) and 2) SU before/during sex. Behavioral data were collected via 1:1 or self-administered computerized interviews. Adjusted individual-study, multivariable relative risk regression was used to examine the relationship between CS and SU. We also examined interactions with type of sex and partner HIV status. Pooled effect estimates were calculated using traditional fixed-effects meta-analysis. We analyzed data for recent SU (n = 6781; 82% men, median age = 33 years) and SU before/during sex (n = 2915; 69% men, median age = 40 years). RESULTS: For both exposure classifications, any SU other than cannabis increased the likelihood of CS relative to non-SU (8-16%, p-values< 0.001). In the recent SU group, however, polysubstance use did not increase the likelihood of CS compared to single-substance use. Cannabis use did not increase the likelihood of CS, regardless of frequency of use. Type of sex was associated with CS; those reporting vaginal and anal sex had a higher likelihood of CS compared to vaginal sex only for both exposure classifications (18-21%, p < 0.001). Recent SU increased likelihood of CS among those reporting vaginal sex only (9-10%, p < 0.001); results were similar for those reporting vaginal and anal sex (5-8%, p < 0.01). SU before/during sex increased the likelihood of CS among those reporting vaginal sex only (20%; p < 0.001) and among those reporting vaginal and anal sex (7%; p = 0.002). Single- and poly-SU before/during sex increased the likelihood of CS for those with exclusively HIV-negative partners (7-8%, p ≤ 0.02), and for those reporting HIV-negative and HIV-status unknown partners (9-13%, p ≤ 0.03). CONCLUSION: Except for cannabis, any SU increased the likelihood of CS. CS was associated with having perceived HIV-negative partners and with having had both anal/vaginal sex.

Barriers to retention in inpatient and residential drug treatment among persons who use opioids and/or injection drugs living in the rural U.S.

AIM: Barriers to retention in inpatient and residential care for persons who use drugs are understudied in the rural context. We sought to better understand barriers to retention in inpatient and residential drug treatment in a large, multi-site, geographically diverse sample of persons who use opioids and/or injection drugs in the rural U.S. METHODS: We conducted semi-structured individual interviews with persons currently using opioids and/or injection drugs in 9 U.S. states, including Illinois, Kentucky, Massachusetts, North Carolina, New Hampshire, Ohio, Oregon, Vermont, and Wisconsin. Content areas included substance use history and experiences with all modalities of drug treatment. We performed initial structural coding followed by an iterative "open-coding" process of itemizing and categorizing content within each code, and a multi-coder memoing process to summarize themes. We identified themes using three levels of the Social-Ecological Model (SEM): individual, interpersonal, and facility-level (organizational) barriers. RESULTS: Among 304 interviewed, over half (n = 166, 54 %) reported having experienced inpatient and residential treatment. Lack of treatment retention was driven by interrelated factors at all levels of the SEM. Person-level factors inhibiting retention included lack of readiness to stop using, which was particularly true for court-ordered treatment, and dislike of "freedom limitations". The sole interpersonal-level factor was the influence of other patients on re-initiation of drug use. Facility-level barriers included unaddressed withdrawal symptoms and lack of access to MOUD, staff relatability, inadequate staff training, and, particularly in residential treatment, lack of structure and supervision. Lack of preparation for coping with real-world triggers was seen as a barrier to engagement in ongoing treatment. CONCLUSION: Barriers to retention in inpatient and residential substance use treatment were present at three levels of the SEM. Interviews suggest much room for improvement in inpatient and residential drug treatment programs with respect to improving access to MOUD, tailoring content to better address social challenges in the rural context, and improving quality control measures with respect to staff and resident supervision.

Assessing abundance and distribution of an invasive thrips Frankliniella schultzei (Thysanoptera: Thripidae) in south Florida.

Within-plant and within-field distribution of larvae and adults of an invasive thrips species, Frankliniella schultzei (Trybom) on cucumber, Cucumis sativus L. was studied in 2008 and 2009 in Homestead, Florida. The majority of thrips were found inhabiting flowers of cucumber plants and little or none was found on the other parts of the plant. Thrips were aggregated in the field, as indicated by the two regression models, Taylor's power and Iwao's patchiness regression. Iwao's patchiness regression provided a better fit than Taylor's power law. The distribution was clumped during the initial stages of infestation at the edges of the field and became random thereafter. However, with increase in population density, thrips again formed aggregates in the field. Based on the average pest density per flower in a ∼0.25-ha field, minimum sample size (number of flowers) required at the recommended precision level (0.25) was 51. The number of samples required at two levels of predetermined pest density was also calculated, which would help growers in collecting optimum number of samples required to determine the correct threshold level of pest in fields. Results from seasonal abundance indicated that density of thrips peaked during the fifth week of sampling with an average of 25 and 34 adults per ten flowers during autumn 2008 and 2009, respectively. Results from these studies will help growers and extension personnel in understanding the abundance and distribution of F. schultzei in the field, which are important components required in developing a sound management program.

Prevalence of Acanthamoeba and other naked amoebae in South Florida domestic water.

The purpose was to identify the prevalence of naked amoebae in tap water in south Florida to ascertain the risk of amoebal infections of the cornea in contact lens wearers. Over the course of a 2-year period, water samples were collected from sites throughout Broward, Palm Beach, and Dade counties, Florida. The presence of amoebae in samples was based on an enrichment cultivation method appropriate for Acanthamoeba. Amoebae were identified using diagnostic features discernable by light microscopy. A total of 283 water samples were processed and amoebae were noted in 80 of these. Acanthamoeba were found on 8 occasions (2.8%). The genera Hartmannella and Vahlkampfia, rarely involved in keratitis cases, were found in 3.5% and 2.8% of samples, respectively. A total of 19 different naked amoebae were recorded and amoebae (regardless of genus) were present in 19.4% of all samples. Previous surveys in England and Korea have shown that acanthamoebae are found in 15 to 30% of tap water samples in the home and have been associated with corneal infection in contact lens wearers. The incidence of acanthamoebae infection in the USA (2.8%) has been found to be lower than that in the UK and it has been postulated that this is related to the lack of a storage water tank in the roof loft space. However, the level of treatment of municipal water is clearly not effective at killing amoebal cysts (or trophozoites) as evidenced by the high occurrence of amoebae (19.4%) in this study.

A longitudinal, qualitative analysis of the context of substance use and sexual behavior among 18- to 29-year-old men after their release from prison.

Substance use, sexual behavior, and reincarceration among 89 men from 5 state prisons across the USA, aged 18-29 years, were examined in relation to individual patterns of coping with community reintegration after their release from prison. Analyses of a series of qualitative interviews conducted over a 6-month period post-release revealed three global reintegration coping patterns: moving toward successful reintegration, resuming behavioral patterns that preceded incarceration, and reintegrating through withdrawal or isolation. Four key contextual factors that differentiated these three coping patterns were the consistency and extensiveness of social relationships, the nature of social support, and the degree of structural stability (e.g., stable employment and housing). Participants were assigned a Likert scale score (1 for poor rating to 3 for better rating) for their pattern of global reintegration and for their rating on each of the four contextual factors across the longitudinal qualitative interviews. Collectively, these five factors differentiated the prevalence and frequency of substance use, patterns of sexual behavior, and incidence of reincarceration as assessed by a quantitative survey administered 6 months post-release. Poorer ratings on all five contextual indices were related to the use of substances other than marijuana and alcohol. Men with less consistent social relationships reported more sexual partners. However, vaginal or anal sex without a condom was associated with greater social consistency and greater structural stability, possibly due to the presence of a steady main partner. Reincarceration was significantly associated with poorer global reintegration ratings, more negative social support, and less structural stability. These findings highlight the need to consider the role of social and structural support systems in HIV and sexually transmitted infection risk reduction interventions for men after their release from prison.

Attraction, Oviposition Preferences, and Olfactory Responses of Corn-Infesting Ulidiidae (Diptera) to Various Host-Based Substrates.

Fresh market sweet corn (Zea mays L., convar. saccharata var. rugosa, Poales: Poaceae) ears produced in Florida are damaged by the larvae of Euxesta stigmatias Loew, Euxesta eluta Loew, and Chaetopsis massyla Walker (Diptera: Ulidiidae) that renders ears unmarketable. No standard lure exists for monitoring these pests. Oviposition substrate and attractant bioassays were designed to identify attractive substrates for further semiochemical investigation. Frass from the fall armyworm, Spodoptera frugiperda J.E. Smith (Lepidoptera: Noctuidae), was more attractive than other ovipositional substrates tested for E. eluta and C. massyla, and resulted in greater ovipositional output. Tassel-derived armyworm frass was more attractive than leaf-derived frass for oviposition. Frass also resulted in greater oviposition output by two species. In attraction bioassays, frass was generally preferred over the corresponding corn tissue, and only C. massyla demonstrated a preference for silk-frass over tassel-frass. The most promising substrates were then evaluated by electroantennography (EAG) to quantify olfactory responses. Frass volatiles also elicited greater antennal responses than corn volatiles. With tassel-frass, greater amplitude EAG responses were recorded from immature E. eluta female antennae, while mature female E. stigmatias exhibited greater responses. Equivalent antennal response to silk-frass was observed from E. eluta. Overall, silk-frass elicited the greatest EAG responses among all three fly species. Our results indicate that armyworm frass is an important resource in the chemical ecology of corn-infesting silk flies, and this substrate warrants further investigation for potential attractants that may facilitate development of novel management tools for these pests.

Variable Pyrethroid Susceptibility Among the Sweet Corn-Infesting Ulidiidae (Diptera) in Florida and New Baseline Susceptibilities.

Florida sweet corn is intensively treated to prevent infestation from the corn-infesting picture-winged fly complex (hereafter referred to as silk flies, Diptera: Ulidiidae). Previous bioassays performed on Euxesta stigmatias Loew demonstrated some pyrethroids performed weakly, while others were more efficacious and with longer-lasting residual activity. Since the last published bioassays, new active ingredients have been made available, other species in the complex discovered, and label restrictions increased for some products. For these reasons, topical bioassays were performed on the three most common species to assess insecticide efficacy of current commercial products labeled for either silk fly or fall armyworm ( Spodoptera frugiperda (J.E. Smith), Lepidoptera: Noctuidae) control. Bioassays were conducted using formulated product mixed in water and applied using a Generation III Research Spray Booth. The median lethal concentration ratio (LC 50 ) of beta-cyfluthrin with and without the pyrethroid synergist piperonyl butoxide was investigated. Acetamiprid, chlorantraniliprole, carbaryl, and flubendiamide did not result in high mortality to any species tested. Euxesta eluta Loew was susceptible to all other insecticides tested, and exhibited the lowest LC 50 to beta-cyfluthrin. Both Chaetopsis massyla Walker and E. stigmatias recovered from several pyrethroid treatments. Euxesta stigmatias also had the highest beta-cyfluthrin LC 50 , and piperonyl butoxide restored beta-cyfluthrin efficacy and lowered the LC 50 s of all three species.

Host Selection, Growth, and Survival of Melonworm (Lepidoptera: Crambidae) on Four Cucurbit Crops Under Laboratory Conditions.

The melonworm, Diaphania hyalinata L. (Lepidoptera: Crambidae), is one of the most serious insect problems affecting cucurbit production. We evaluated the relative preference and suitability of yellow squash, zucchini, cucumber, and watermelon to melonworm by measuring its oviposition, larval feeding preference, survivorship, and developmental responses in the laboratory. Whole plants were used for oviposition study, whereas host leaf discs were used for all the other studies. Watermelon feeding resulted in the longest larval development period (14.3 d), greatest prepupal weights and survivals rates (92%; first instar to adult) among the four crops. However, for watermelon, adult oviposition preference (199.5 eggs/♀), egg survival (70%), and larval feeding (4.1% defoliation) were numerically or statistically lowest, and larval head capsule widths and whole-body lengths were smallest. When differences occurred among these variables, yellow squash, zucchini, and cucumber were each typically higher (or quicker to develop) than watermelon. So why do melonworm adults not prefer watermelon, or at least select it as frequently as squash and cucumber when ovipositing? The answer likely is that there might be some variation in the important chemical components among these cucurbits. We suggest that comparison of kairomones and allomones from watermelon and related cucurbits would be very useful for determining the combination resulting in the lowest risk of damage to the more susceptible cucurbits (assuming the levels can be modified without seriously affecting the crops).

Screening for sexually transmitted diseases and hepatitis in 18-29-year-old men recently released from prison: feasibility and acceptability.

Men entering prisons have high rates of sexually transmitted disease (STD), hepatitis, and HIV. This study sought to determine the acceptability and feasibility of screening for STD and hepatitis in young men released from prison. Participants were interviewed six months after release and offered free screening. Of 42 (56%) eligible men who participated in the qualitative interview, 33 (79%) provided at least a blood or urine specimen. Eight of 33 (24%) men tested had chlamydia, trichomoniasis, hepatitis B or C virus (HBV or HCV). Three of 32 (9%) had chlamydia, three of 32 (9%) had trichomoniasis, two of 28 (7%) had prior syphilis, and two of 28 (7%) had HCV. Of 28 tested for HBV, six (21%) were immune, two (7%) had chronic infection, and 20 (71%) were susceptible. Barriers to screening included lack of forewarning, inconvenience, and insufficient incentive. In conclusion, screening for STD and hepatitis among former inmates can be acceptable and feasible. Forewarning, reducing the time burden, and providing monetary incentives may increase screening rates.

Acanthamoeba griffini. Molecular characterization of a new corneal pathogen.

PURPOSE: Acanthamoeba was isolated from the cornea of a soft contact lens wearer who had keratitis. The protozoan was also isolated from the contact lens storage case and the domestic water supply used to clean the case. Using morphologic features, all three isolates were identified tentatively as A. griffini, a species not previously associated with keratitis. Complete small subunit ribosomal RNA gene (18S rDNA) sequence analysis was used to characterize further the three isolates. METHODS: 18S rDNA was polymerase chain reaction-amplified from whole cell DNA derived from amoebal lysates. The genes were cloned and sequenced. Complete sequences of approximately 2800 base pairs were obtained from each culture and compared wih those stored in a data base for homologous Acantamoeba sequences. RESULTS: The isolates were unequivocally identified as A. griffini both by comparison of the gene sequence available for the type strain of the species and the presence of a unique group I intron located within the small subunit rDNA. Sequences obtained for the three isolates were identical, indicating that they were the same strain. CONCLUSIONS: The first direct connection between human disease and A. griffini is reported from a case of Acanthamoeba keratitis. The type strain of this species was isolated from a marine environment, but the disease-causing strain ws isolated from a domestic water supply. The DNA sequences obtained confirmed unequivocally the epidemiologic association between a keratitis-causing strain of Acanthamoeba, the contact lens storage case, and the domestic water supply.

Streptococcal necrotising fasciitis: comparison between histological and clinical features.

Nineteen acute and 17 subacute cases of necrotising fasciitis due to beta haemolytic streptococci are described. Excised tissue from seven and four cases, respectively, was available for histological examination. The two clinical types showed remarkable similarities, with inflammation and necrosis from epidermis to subcutaneous fat. Haemorrhage was present in variable amounts in both types. Gram positive cocci were not always identified in tissue, nor cultured, when serological tests were required to confirm the diagnosis. The only apparent difference between the acute and subacute type was the higher incidence of thrombi in some blood vessels of acute cases, whereas patent vessels or recanalized thrombus were usually found in subacute cases. This quantitative difference in the degree of thrombosis may alone be responsible for the varying clinical features and response to antibiotics.

Characterisation of an epidemic strain of Klebsiella and its variants by computer analysis.

An outbreak of hospital-acquired klebsiella infection was investigated by means of six different typing schemes. Interpretation of the information generated by these schemes proved difficult and allowed only tentative conclusions to be reached concerning the origin of some strains. Consequently, the results were subjected to computer analysis by means of a numerical taxonomic programme adapted for the purpose. A dendrogram was constructed giving the percentage similarity between strains. It established the source of four atypical strains and showed that three of them were derived from the original clone. This form of numerical epidemiological analysis could have useful applications in the investigation of hospital-acquired infection.

Epidemiology of diarrhoea caused by enterotoxigenic Clostridium perfringens.

Enterotoxigenic strains of Clostridium perfringens have recently been implicated in some cases of antibiotic-associated diarrhoea. We present here the results of an epidemiological study of this disease. Five cases of diarrhoea caused by C. perfringens serotype 41 occurred during a 9-week period, and then during a 6-week period there were three cases due to serotype 27 and two due to serotype 24; in all but one case two geriatric wards were involved. In total there were 16 cases in 22 months. All cases were identified by the detection of C. perfringens enterotoxin in the faeces. The mean number of C. perfringens in these cases was 10(8.8) cfu/g of faeces. Of 37 patients who had negative test results for C. perfringens enterotoxin, 18 had positive cultures for C. perfringens, with mean faecal counts of 10(5.3) cfu/g, and nine of these patients had diarrhoea. Thirteen different serotypes were isolated from these 18 patients, including type 41 from seven patients and type 27 from one. Hand carriage of the offending serotype was demonstrated in three of four infected patients, none of four controls and two of 14 ward staff. C. perfringens of serotypes causing disease was isolated from 59% of environmental areas where there was active disease, 27% of areas where there had been disease which had since resolved and 9% of areas where there was no history of disease. The findings imply that cross infection may occur.

Role of cell-mediated immunity to staphylococci in blepharitis.

We studied cell-mediated immunity to staphylococcal antigens in 116 patients with chronic blepharitis and eight normal subjects. Antibodies in tears and blood were measured. Enhanced cell-mediated immunity to Staphylococcus aureus was demonstrated in 46 of 116 patients (40%) in the absence of antibodies to teichoic acid but not among normal subjects. Symptoms of grittiness and morning stickiness were more frequent among patients without enhanced responses. Folliculitis occurred more commonly among patients with enhanced immunity. Marginal keratitis occurred equally among patients with and without enhanced systemic immunity, but patients with enhanced response more commonly required topical corticosteroid therapy. Desensitization to staphylococcal antigens could be investigated as a potential therapeutic approach in selected patients.

Contact lens wear by hospital health care staff: is there cause for concern?

Microbial keratitis can occur in association with contact lens wear. The absolute risk of infection is low but may be enhanced as a consequence of increased exposure to potentially pathogenic microbes in a hospital setting. There is variation in risk depending on type of lens worn and its modality of use. Extended-wear lenses carry the greatest risk. Pseudomonas aeruginosa and Acanthamoeba are causes of potentially devastating ocular infections in contact lens wearers. The risk of these infections could be reduced by fastidious hygiene practice. Hydrogen peroxide disinfection is recommended when a storage case is included in the care regimen. This should be cleaned thoroughly and dried prior to disinfection and never exposed to tap water. Daily wear of one-day 'disposable' soft contact lenses or use of rigid gas permeable lenses is recommended for hospital staff. Contact lenses should be removed immediately and discarded or disinfected if the eye becomes contaminated and/or use of an eyewash is required.

Comparison of flow rates into vented and non-vented urinary drainage bags: possible relevance to infection.

Tests on vented and non-vented urinary drainage bags were carried out to establish if differences existed in the flow of fluid into them and whether air bubbles and air trapping were affected by venting. At flow rates of 3-12 ml sec-1 there was consistent flow into the vented bag until it was full. There was no air trapping in the bag, and no retrograde flow of air bubbles or fluid up the tube. Flow rates into non-vented bags were strongly affected by air in the drainage tube but, if this cleared, the flow rate was high until the bags were nearly full, at which time air was pushed into the tube. If air remained in the tube the flow rate was reduced. The non-vented bags required a higher pressure in the drainage tube to fill them than the vented bags, and allowed air bubbles to ascend from the bag up the drainage tube.

The use of cefotaxime for treating suspected neonatal sepsis: 2 years' experience.

In 1982, the antibiotic treatment policy for suspected sepsis in neonates admitted to the Southampton special care baby unit was changed from intravenous gentamicin plus penicillin to intravenous cefotaxime with or without penicillin. Analysis of blood culture results during the first 2 years following the change indicates that a higher proportion of blood culture isolates showed sensitivity to cefotaxime compared with gentamicin. Only one baby died with proven bacterial sepsis and this was not thought to be due to treatment failure. Our data suggest that, on our unit, cefotaxime is a suitable alternative to the aminoglycosides for the management of suspected sepsis in the newborn.