Enhancing risk perception may be insufficient to curtail prescription opioid use and misuse among youth after surgery: A randomized controlled trial.

OBJECTIVE: This randomized controlled trial examined whether an interactive, risk-focused educational program was associated with higher risk perceptions and decreased prescription opioid use/misuse among emerging adults. METHODS: 503 participants aged 15-24 years scheduled for ambulatory surgery were randomized to routine prescription education with or without our Scenario-Tailored Opioid Messaging Program (STOMP) provided prior to receipt of a prescribed opioid. Surveys were completed preoperatively, and at days 7&14, months 1&3 postoperatively. Outcomes included analgesic risk perceptions, opioid use, and misuse intentions/behavior. RESULTS: Compared to Controls, STOMP was associated with stable but higher risk perceptions on day 14 (ß = 1.76 [95% CI 0.53, 2.99], p = .005) and month 3 (ß = 2.13 [95% CI 0.86, 3.40], p = .001). There was no effect of STOMP or analgesic misuse risk perceptions on days of opioid use or subsequent misuse intentions/behavior. The degree to which participants valued pain relief over analgesic risk (trade-off preference) was, however, associated with prolonged postoperative opioid use and later misuse. CONCLUSION: Education emphasizing the risks of opioids was insufficient in reducing opioid use and misuse in youth who were prescribed these analgesics for acute pain relief. PRACTICE IMPLICATIONS: Education may need to better address analgesic expectations to shorten opioid use and mitigate misuse.

Zero-Valent Iron Filtration Reduces Microbial Contaminants in Irrigation Water and Transfer to Raw Agricultural Commodities.

Groundwater depletion is a critical agricultural irrigation issue, which can be mitigated by supplementation with water of higher microbiological risk, including surface and reclaimed waters, to support irrigation needs in the United States. Zero-valent iron (ZVI) filtration may be an affordable and effective treatment for reducing pathogen contamination during crop irrigation. This study was performed to determine the effects of ZVI filtration on the removal and persistence of Escherichia coli, and pepper mild mottle virus (PMMoV) in irrigation water. Water was inoculated with E. coli TVS 353, filtered through a ZVI filtration unit, and used to irrigate cucurbit and cruciferous crops. Water (n = 168), leaf (n = 40), and soil (n = 24) samples were collected, the E. coli were enumerated, and die-off intervals were calculated for bacteria in irrigation water. Variable reduction of PMMoV was observed, however E. coli levels were consistently and significantly (p < 0.05) reduced in the filtered (9.59 lnMPN/mL), compared to unfiltered (13.13 lnMPN/mL) water. The die-off intervals of the remaining bacteria were significantly shorter in the filtered (-1.50 lnMPN/day), as compared to the unfiltered (-0.48 lnMPN/day) water. E. coli transfer to crop leaves and soils was significantly reduced (p < 0.05), as expected. The reduction of E. coli in irrigation water and its transfer to crops, by ZVI filtration is indicative of its potential to reduce pathogens in produce pre-harvest environments.

Energy Restriction Suppresses Muscle Protein Synthesis, and High Protein Diets Extend Protein Half-Lives Across the Muscle Proteome in Obese Female Zucker Rats.

BACKGROUND: Effects of high protein (HP) diets and prolonged energy restriction (ER) on integrated muscle protein kinetics have not been determined. OBJECTIVE: The objective of this study was to measure protein kinetics in response to prolonged ER and HP on muscle protein synthesis (MPS; absolute rates of synthesis) and muscle protein breakdown (MPB; half-lives) for proteins across the muscle proteome. METHODS: Female 6-wk-old obese Zucker rats (Leprfa+/fa+, n = 48) were randomly assigned to one of four diets for 10 wk: ad libitum-standard protein (AL-SP; 15% kcal from protein), AL-HP (35% kcal from protein), ER-SP, and ER-HP (both fed 60% feed consumed by AL-SP). During week 10, heavy/deuterated water (2H2O) was administered by intraperitoneal injection, and isotopic steady-state was maintained via 2H2O in drinking water. Rats were euthanized after 1 wk, and mixed-MPS as well as fractional replacement rate (FRR), relative concentrations, and half-lives of individual muscle proteins were quantified in the gastrocnemius. Data were analyzed using 2-factor (energy × protein) ANOVAs and 2-tailed t-tests or binomial tests as appropriate. RESULTS: Absolute MPS was lower in ER than AL for mixed-MPS (-29.6%; P < 0.001) and MPS of most proteins measured [23/26 myofibrillar, 48/60 cytoplasmic, and 46/60 mitochondrial (P < 0.05)], corresponding with lower gastrocnemius mass in ER compared with AL (-29.4%; P < 0.001). Although mixed-muscle protein half-life was not different between groups, prolonged half-lives were observed for most individual proteins in HP compared with SP in ER and AL (P < 0.001), corresponding with greater gastrocnemius mass in HP than SP (+5.3%; P = 0.043). CONCLUSIONS: ER decreased absolute bulk MPS and most individual MPS rates compared with AL, and HP prolonged half-lives of most proteins across the proteome. These data suggest that HP, independent of energy intake, may reduce MPB, and reductions in MPS may contribute to lower gastrocnemius mass during ER by reducing protein deposition in obese female Zucker rats.

Enteric Viruses and Pepper Mild Mottle Virus Show Significant Correlation in Select Mid-Atlantic Agricultural Waters.

Enteric viruses (EVs) are the largest contributors to foodborne illnesses and outbreaks globally. Their ability to persist in the environment, coupled with the challenges experienced in environmental monitoring, creates a critical aperture through which agricultural crops may become contaminated. This study involved a 17-month investigation of select human EVs and viral indicators in nontraditional irrigation water sources (surface and reclaimed waters) in the Mid-Atlantic region of the United States. Real-time quantitative PCR was used for detection of Aichi virus, hepatitis A virus, and norovirus genotypes I and II (GI and GII, respectively). Pepper mild mottle virus (PMMoV), a common viral indicator of human fecal contamination, was also evaluated, along with atmospheric (air and water temperature, cloud cover, and precipitation 24 h, 7 days, and 14 days prior to sample collection) and physicochemical (dissolved oxygen, pH, salinity, and turbidity) data, to determine whether there were any associations between EVs and measured parameters. EVs were detected more frequently in reclaimed waters (32% [n = 22]) than in surface waters (4% [n = 49]), similar to PMMoV detection frequency in surface (33% [n = 42]) and reclaimed (67% [n = 21]) waters. Our data show a significant correlation between EV and PMMoV (R2 = 0.628, P < 0.05) detection levels in reclaimed water samples but not in surface water samples (R2 = 0.476, P = 0.78). Water salinity significantly affected the detection of both EVs and PMMoV (P < 0.05), as demonstrated by logistic regression analyses. These results provide relevant insights into the extent and degree of association between human (pathogenic) EVs and water quality data in Mid-Atlantic surface and reclaimed waters, as potential sources for agricultural irrigation. IMPORTANCE Microbiological analysis of agricultural waters is fundamental to ensure microbial food safety. The highly variable nature of nontraditional sources of irrigation water makes them particularly difficult to test for the presence of viruses. Multiple characteristics influence viral persistence in a water source, as well as affecting the recovery and detection methods that are employed. Testing for a suite of viruses in water samples is often too costly and labor-intensive, making identification of suitable indicators for viral pathogen contamination necessary. The results from this study address two critical data gaps, namely, EV prevalence in surface and reclaimed waters of the Mid-Atlantic region of the United States and subsequent evaluation of physicochemical and atmospheric parameters used to inform the potential for the use of indicators of viral contamination.

Temporal and Agricultural Factors Influence Escherichia coli Survival in Soil and Transfer to Cucumbers.

Biological soil amendments of animal origin (BSAAO) increase nutrient levels in soils to support the production of fruits and vegetables. BSAAOs may introduce or extend the survival of bacterial pathogens which can be transferred to fruits and vegetables to cause foodborne illness. Escherichia coli survival over 120 days in soil plots (3 m2) covered with (mulched) or without plastic mulch (not mulched), amended with either poultry litter, composted poultry litter, heat-treated poultry pellets, or chemical fertilizer, and transfer to cucumbers in 2 years (2018 and 2019) were evaluated. Plots were inoculated with E. coli (8.5 log CFU/m2) and planted with cucumber seedlings (Supremo). The number of days needed to reduce E. coli levels by 4 log CFU (dpi4log) was determined using a sigmoidal decline model. Random forest regression and one-way analysis of variance (ANOVA; P < 0.05) identified predictors (soil properties, nutrients, and weather factors) of dpi4log of E. coli and transfer to cucumbers. The combination of year, amendment, and mulch (25.0% increase in the mean square error [IncMSE]) and year (9.75% IncMSE) were the most prominent predictors of dpi4log and transfer to cucumbers, respectively. Nitrate levels at 30 days and soil moisture at 40 days were also impactful predictors of dpi4log. Differing rainfall amounts in 2018 (24.9 in.) and 2019 (12.6 in.) affected E. coli survival in soils and transfer to cucumbers. Salmonella spp. were recovered sporadically from various plots but were not recovered from cucumbers in either year. Greater transfer of E. coli to cucumbers was also shown to be partially dependent on dpi4log of E. coli in plots containing BSAAO.IMPORTANCE Poultry litter and other biological soil amendments are commonly used fertilizers in fruit and vegetable production and can introduce enteric pathogens such as Escherichia coli O157:H7 or Salmonella previously associated with outbreaks of illness linked to contaminated produce. E. coli survival duration in soils covered with plastic mulch or uncovered and containing poultry litter or heat-treated poultry litter pellets were evaluated. Nitrate levels on day 30 and moisture content in soils on day 40 on specific days were good predictors of E. coli survival in soils; however, the combination of year, amendment, and mulch type was a better predictor. Different cumulative rainfall totals from year to year most likely affected the transfer of E. coli from soils to cucumbers and survival durations in soil. E. coli survival in soils can be extended by the addition of several poultry litter-based soil amendments commonly used in organic production of fruits and vegetables and is highly dependent on temporal variation in rainfall.

Participant Perspectives on the Contributions of Physical, Psychological, and Sociological Fidelity to Learning in Interprofessional Mental Health Simulation.

INTRODUCTION: Simulation has been identified as a key training modality to enhance interprofessional care for patients with co-occurring physical and mental illnesses. Fidelity is an important instructional design consideration for interprofessional simulation; however, research examining the contribution of physical, psychological, and sociological fidelity in achieving learning outcomes remains limited. This qualitative study explored the relationship between fidelity and learning from the perspective of interprofessional simulation course participants. METHODS: Semistructured interviews were conducted with participants from the Interprofessional Simulations of Patient Experiences Across the Care Continuum - Child and Youth course. Consistent with grounded theory, data collection and analysis proceeded in an iterative fashion and emergent themes were identified by the research team through a process of constant comparative analysis. RESULTS: Data saturation was reached after 10 interviews. High psychological fidelity allowed participants to engage in the simulation scenarios in ways that were congruent with their professional roles, which supported individual practice change. Tasks that were too closely aligned with their clinical experiences sometimes, however, limited new learning opportunities. Selective manipulations of sociological fidelity seemed to support learning outcomes related to understanding and appreciating the roles and responsibilities of other health professionals. Physical fidelity was less essential. CONCLUSIONS: Psychological and sociological fidelity were perceived by participants as being most critical to learning in interprofessional mental health simulation. Improving our understanding of how simulation works in this context is important to effectively direct the efforts of learners, instructors, and designers toward maximizing the benefit of simulation-based learning in a cost-efficient manner.

Can the financial burden of being a community health volunteer in western Kenya exacerbate poverty?

Community health volunteers (CHVs) act as vital links between communities and health facilities, bridging the health service delivery gap common in low- and middle-income countries. In 2013, changes in funding in western Kenya left most CHVs without their individual monthly stipend. In this article, we explore how the implementation of a pooled incentive model had an impact on the lives of CHVs from two counties in western Kenya. Participation in this form of table banking was meant to allow CHVs to pool their resources together and invest in income-generating activities to offset the costs of unpaid health work. A pre-post qualitative study, consisting of focus group discussions and in-depth interviews explored CHV compensation, motivations and challenges experienced in 2013 and 2015, prior to and after the implementation of this pooled incentive model. Following withdrawal of the monthly stipend, we found that CHVs continued to take on roles and responsibilities of paid health workers, motivated by shared social identities and connections to their communities. However, replacing the stipend with a pooled-group incentive model seemingly exacerbated the financial burden already experienced by this vulnerable population. This study brings into question the sustainability and viability of a volunteer community health worker programme and highlights the need to address the financial burden associated with the CHV role in western Kenya.

Improving Access to Lactation Consultation and Early Breast Milk Use in an Outborn NICU.

INTRODUCTION: Increasing the use of breast milk in critically ill neonates is an important priority to improve neonatal care. Lactation consultants (LCs) educate mothers about evidence-based benefits of breast milk and provide technical support. LC support can lead to increased breastfeeding initiation. The project aim was to improve access to lactation services for mothers of patients admitted at <48 hours after birth to an exclusively outborn level III/IV neonatal intensive care unit (NICU). METHODS: The interventions included (1) implementation of an automatic electronic admission order for a lactation consult, (2) initiation of a daily lactation team notification, (3) assignment of a consistent NICU LC, and (4) targeted education. The percent of mothers who received lactation consults, the time to the first consultation, and the percent of patients receiving breast milk at 7 days of age were measured over 32 months and analyzed using statistical process control charts. RESULTS: The lactation consultation rate increased significantly from 74% to 88% with a shift in the mean by statistical process control chart analysis that was sustained over time. Concurrently, the time to first lactation consultation significantly decreased from hospital days 5 to 3.3, and variation decreased. Rates of breast milk use at 7 days of age also significantly increased from 75.6% to 89.6%. CONCLUSIONS: Targeted quality improvement interventions led to an increased rate of lactation consultations, decreased time to first lactation consult, and increased rate of breast milk use at 7 days of age. These interventions could feasibly be implemented in similar referral NICU settings.

Lessons Learned: Implementing UK-Developed Interprofessional Simulation Training Courses in a Canadian Setting.

OBJECTIVE: In response to the need for practitioners to improve their skills in integrating mental and physical healthcare, the Centre for Addiction and Mental Health (CAMH) (Canada) invited education specialists from Maudsley Simulation (UK) to pilot two of their existing interprofessional simulation courses on the mental-physical interface in Toronto. Participants' experiences as well as the courses' educational impact were evaluated. METHODS: Participants completed pre-and post-course questionnaires, a 2-week follow-up questionnaire, and individual interviews 6 months after course completion. RESULTS: Participants (n = 23) found the courses to be relevant and applicable to their practice. Over half of the participants interviewed (8/15) reported changing their practice as a result of the course. However, concerns regarding the sociological fidelity of these courses within the Canadian context were noted. CONCLUSION: The findings support the transferability of interprofessional simulation courses developed in other countries. It is important, however, to contextualize course material to fit local healthcare systems and to ensure sociological fidelity where professional roles may vary.

Anxiety in Williams Syndrome: The Role of Social Behaviour, Executive Functions and Change Over Time.

Anxiety is a prevalent mental health issue for individuals with Williams syndrome (WS). Relatively little is known about the developmental course of anxiety, or how it links with core features of WS, namely social and executive functioning (EF). In this study, parent-reports of anxiety were compared across a 4-year period (N = 17), and links between anxiety, social and EF were explored from concurrent parent-reports (N = 26). Results indicated that high anxiety persisted over time, and anxiety was related to impairments in both social and executive functioning. Importantly, results indicated that impairments in EFs may drive the links between anxiety and social functioning. This timely investigation provides new insights into anxiety in WS and highlights potential areas for intervention.