Reducing Alcohol and Opioid Use Among Youth in Rural Counties: An Innovative Training Protocol for Primary Health Care Providers and School Personnel.

BACKGROUND: Given that youth alcohol use is more common in rural communities, such communities can play a key role in preventing alcohol use among adolescents. Guidelines recommend primary care providers incorporate screening, brief intervention, and referral to treatment (SBIRT) into routine care. OBJECTIVE: The aim is to train primary care providers and school nurses within a rural 10-county catchment area in Pennsylvania to use SBIRT and facilitate collaboration with community organizations to better coordinate substance use prevention efforts. METHODS: To build capacity to address underage drinking and opioid use among youth aged 9-20 years, this project uses telehealth, specifically Project ECHO (Extension for Community Healthcare Outcomes), to train primary care providers and school nurses to address substance use with SBIRT. Our project will provide 120 primary care providers and allied health professionals as well as 20 school nurses with SBIRT training. Community-based providers will participate in weekly virtual ECHO sessions with a multidisciplinary team from Penn State College of Medicine that will provide SBIRT training and facilitate case discussions among participants. RESULTS: To date, we have launched one SBIRT ECHO project with school personnel, enrolling 34 participants. ECHO participants are from both rural (n=17) and urban (n=17) counties and include school nurses (n=15), school counselors (n=8), teachers (n=5), administrators (n=3), and social workers (n=3). Before the study began, only 2/13 (15.5%) of schools were screening for alcohol use. CONCLUSIONS: This project teaches primary care clinics and schools to use SBIRT to prevent the onset and reduce the progression of substance use disorders, reduce problems associated with substance use disorders, and strengthen communities' prevention capacity. Ours is an innovative model to improve rural adolescent health by reducing alcohol and opioid use. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/21015.

Multi-model implementation of evidence-based care in the treatment of opioid use disorder in Pennsylvania.

Pennsylvania has the third highest rate of death due to drug overdose (44.3 per 100,000) in the country, which is significantly higher than the national rate. This continues to have drastic societal impact. Medication assisted treatment (MAT), which includes opioid agonist medications, is the gold standard in treatment for OUD; however, a significant gap remains between the number of individuals in need of treatment and the number of MAT providers. Penn State Health established a system to address the opioid epidemic through the Pennsylvania Coordinated Medication Assisted Treatment program utilizing lessons learned from existing validated models. Connecting primary care sites and hospital systems through a combination of Hub and Spoke, bridge clinic services provided at the Hub, peer recovery services, Project Extension for Community Health Outcomes (ECHO), and layered emergency department (ED) initiation of buprenorphine, this model is an innovative approach that addresses many known barriers to MAT treatment initiation. Early results within the first six months indicate significantly shortened wait time for patients seeking treatment, provision of waiver training to 70 local physicians to prescribe buprenorphine, and improved knowledge and ability to provide patient care for providers participating in our first Project ECHO cohort.

Intracranial salivary gland choristoma within optic nerve dural sheath: case report and review of the literature.

OBJECTIVE: Salivary gland choristomas or their neoplastic derivatives may appear throughout the intracranial space, most frequently in the middle ear or sella. Here, we present the case of a salivary gland choristoma embedded within the optic nerve dural sheath and review the literature of intracranial salivary gland masses. CASE PRESENTATION: A 28-year-old female patient presented with headache and visual complaints. Magnetic resonance imaging revealed a prechiasmatic suprasellar cystic lesion. Operatively, the mass appeared as a cyst filled with mucinous fluid associated with abnormal tissue embedded within the optic nerve. RESULTS: We deflated and biopsied the cyst, which revealed normal-appearing salivary tissue. The patient remains asymptomatic without radiographic evidence of cyst recurrence 2 years postoperatively. CONCLUSION: Intracranial salivary tissue has been previously described but never before in the suprasellar space. Although rare, knowledge of their natural history and pathologic features may inform surgical management if they are encountered in the operating room.

Cyclin D1 overexpression increases susceptibility to 4-nitroquinoline-1-oxide-induced dysplasia and neoplasia in murine squamous oral epithelium.

The cyclin D1 oncogene is frequently amplified/overexpressed in oral squamous cell carcinomas. Mice with overexpression of cyclin D1 targeted to the stratified squamous epithelia of the tongue, esophagus, and forestomach develop a phenotype of epithelial dysplasia at these sites. In this study, we examined the effect of cyclin D1 overexpression on susceptibility of mice to carcinogen-induced tumorigenesis, using 4-nitroquinoline-1-oxide (4NQO), an established potent oral carcinogen in mice. Cyclin D1 overexpressing mice and nontransgenic littermates were administered 4NQO (20 or 50 parts per million (ppm) in the drinking water) for 8 wk and monitored for an additional 16 wk. Histopathological analyses of the tongue revealed significantly higher severity of dysplasia in the cyclin D1 overexpression mice, compared with nontransgenic controls and with untreated controls. Moreover, only the cyclin D1 overexpression mice developed neoplastic lesions in the oro-esophageal epithelia. Examination of the dysplastic and neoplastic lesions revealed abnormal proliferation. Our findings suggest that cyclin D1 overexpression enhances susceptibility to carcinogen-induced oral tumorigenesis. These results underscore the importance of cyclin D1 in the process of oral neoplastic development. Further, they emphasize the value of this transgenic model to study the pathogenesis of oral precancer and cancer and establish it as a model system to test candidate agents for chemoprevention of upper aero-digestive cancer.

Effects of anesthetic agents on serum parathyroid hormone and calcium concentrations in mice.

OBJECTIVE: To determine the effects of three anesthetic regimens on serum calcium and parathyroid hormone (PTH) in mice. STUDY DESIGN: Prospective experimental study. ANIMALS: Twenty-seven, 12-week-old, FVB mice. METHODS: Mice were anesthetized with either isoflurane, a combination of ketamine plus xylazine (100 and 10 mg kg(-1), respectively) or ketamine alone (100 mg kg(-1)). Blood was collected before and after the induction of anesthesia. Serum calcium and PTH concentrations were measured and compared. RESULTS: Isoflurane or ketamine did not significantly alter either serum calcium or serum PTH concentrations. A combination of ketamine plus xylazine significantly increased serum PTH, but not serum calcium concentrations. CONCLUSIONS: A combination of ketamine and xylazine should be avoided prior to collection of blood for measurement of serum PTH concentrations. Isoflurane is suitable for this purpose.