Barriers to Buprenorphine Prescribing Among Attending Physicians in an Academic Residency Program - Implications for Increased Buprenorphine Usage.

The need for outpatient management of opioid use disorder with medication-assisted treatment has continued to rise yet physician comfort with prescribing buprenorphine remains low. A survey assessing comfort prescribing was disseminated to attending physicians in the Division of General Internal Medicine at an academic medical center followed by semi-structured qualitative interviews. The majority of respondents (71%) reported that they had not prescribed buprenorphine in an outpatient setting despite being trained and 67% stated that they felt "uncomfortable" or "very uncomfortable" doing so. However, almost all survey respondents (89%) reported comfort precepting residents prescribing buprenorphine. Attending physicians attribute this differential comfort to structural forces including a lack of team-based care, time, and psychosocial support services in their own practice as compared to the academic residency clinic. These findings highlight the barriers to prescribing buprenorphine and challenge the existing notion that academic centers are not suitable places for substance use treatment.

A New Kind of Academic MLP: Addressing Clients' Criminal Legal Needs to Promote Health Justice and Reduce Mass Incarceration.

This article describes a new type of medical-legal partnership (MLP) that targets the health and justice concerns of people enmeshed in the U.S criminal justice system: a partnership between clinicians who care for people with criminal system involvement and public defenders. This partnership offers an opportunity to not only improve patient health outcomes but also to facilitate less punitive court dispositions, such as jointly advocating for community-based rehabilitation and treatment rather than incarceration.

Initiation and early growth of the skull vault in zebrafish.

The zebrafish offers powerful advantages as a model system for examining the growth of the skull vault and the formation of cranial sutures. The zebrafish is well suited for large-scale genetic screens, available in large numbers, and continual advances in genetic engineering facilitate precise modeling of human genetic disorders. Most importantly, zebrafish are continuously accessible for imaging during critical periods of skull formation when both mouse and chick are physically inaccessible. To establish a foundation of information on the dynamics of skull formation, we performed a longitudinal study based on confocal microscopy of individual live transgenic zebrafish. Discrete events occur at stereotyped stages in overall growth, with little variation in timing among individuals. The frontal and parietal bones initiate as small clusters of cells closely associated with cartilage around the perimeter of the skull, prior to metamorphosis and the transition to juvenile fish. Over a period of ~30 days, the frontal and parietal bones grow towards the apex of the skull and meet to begin suture formation. To aid in visualization, we have generated interactive three-dimensional models based on the imaging data, with annotated cartilage and bone elements. We propose a framework to conceptualize development of bones of the skull vault in three phases: initiation in close association with cartilage; rapid planar growth towards the apex of the skull; and finally overlapping to form sutures. Our data provide an important framework for comparing the stages and timing of skull development across model organisms, and also a baseline for the examination of zebrafish mutants affecting skull development. To facilitate these comparative analyses, the raw imaging data and the models are available as an online atlas through the FaceBase consortium (facebase.org).