ASAP: A pharmacy-level intervention to increase nonprescription syringe sales to reduce bloodborne illnesses.

BACKGROUND: Pharmacy syringe sales are effective structural interventions to reduce bloodborne illnesses in populations, and are legal in all but two states. Yet evidence indicates reduced syringe sales in recent years. This study was designed as a feasibility test of an intervention to promote syringe sales by pharmacies in Arizona. METHODS: A four-month pilot among three Arizona pharmacies measured feasibility and acceptability through monthly surveys to 18 enrolled pharmacy staff members. RESULTS: Pharmacy staff reported increased ease of dispensing syringes across the study. Rankings of syringe dispensing as 'easiest' among 6 measured pharmacy practices increased from 38.9 % at baseline to 50.1 % post intervention module training, and to 83.3 % at pilot conclusion. The majority (72.2 %) of pharmacy staff agreed that intervention materials were easy to use. Over 70 % indicated that the intervention was influential in their "being more open to selling syringes without a prescription to someone who might use them for illicit drug use," and 61.1 % reported that in the future, they were highly likely to dispense syringes to customers who would use them to inject drugs. A vast majority (92 %) reported being likely to dispense subsidized naloxone if available to their pharmacy at no cost. CONCLUSIONS: An education-based intervention was found to be feasible and acceptable to pharmacy staff and had an observed impact on perceptions of ease and likelihood of dispensing syringes without a prescription to people who may use them to inject drugs.

Capacity building to address antimicrobial resistance in remote Australia: The inaugural HOT NORTH Antimicrobial Academy.

BACKGROUND: Rates of antimicrobial resistance (AMR) for some pathogens in Australia are considerably higher in rural and remote compared to urban regions. The inaugural Hot North Antimicrobial Academy was a 9-month educational programme aimed to build workforce knowledge and capacity in antimicrobial use, audit, stewardship, surveillance and drug resistance in remote primary health care. METHODS: The Academy was advertised to Aboriginal and Torres Strait Islander, regional and remote healthcare workers. Participants were Aboriginal health practitioners, nurses, pharmacists and doctors from Queensland, Northern Territory, South Australia and Western Australia working in remote primary health care with a focus on Indigenous health. Due to COVID-19 restrictions, the Academy ran virtually from February-November 2021 using Microsoft Teams. The Academy was evaluated using surveys and yarning circles to assess impact and knowledge gain. RESULTS: Participants and faculty from across Australia attended 19 lectures and mentorship sessions. Eleven participants commenced and eight (73%) completed the Academy. The Academy raised participants awareness of AMR guidelines, governance and generating change; built confidence in advocacy; grew knowledge about drug resistant infections; and created a community of AMR champions in Indigenous health. CONCLUSION: The evaluation confirmed the Academy met the needs of participants, provided opportunities to move stewardship from tertiary hospitals into Indigenous and remote clinics and developed skills in research, audit, stewardship and advocacy for all involved. All sessions were recorded for future use, with facilitation by the National Aboriginal Community Controlled Health Organisation (NACCHO) in future years.

Feasibility and acceptability of a proposed pharmacy-based harm reduction intervention to reduce opioid overdose, HIV and hepatitis C.

BACKGROUND: Evidence-based harm reduction intervention components which might benefit pharmacy patients have not been integrated and studied. OBJECTIVE: To investigate the feasibility and acceptability of a proposed pharmacy-based harm reduction intervention to reduce opioid overdose, HIV and hepatitis C called PharmNet. METHODS: Indiana managing pharmacists were surveyed in 2018 to assess the feasibility and acceptability of an intervention for opioid misuse screening, brief intervention, syringe and naloxone dispensing, and referrals provision. The Consolidated Framework for Implementation Research informed the survey development and analysis. RESULTS: The sample included 303 (30.8%) pharmacists; 215 (70.9%) provided detailed written comments. Intervention Characteristics: 83.3% believed PharmNet would benefit patients, and that staff could deliver the intervention with adequate training (70.0%). Inner Setting: While 77.2% believed their pharmacy culture supported practice change, 57.5% of chain pharmacists believed their pharmacies would not have time for PharmNet. Outer Setting: 73.3% believed additional addiction and overdose screening is needed in their community, and pharmacies should offer new services to help reduce opioid overdose and addiction among their patients (79.5%). A vast majority (97.7%) were asked by patients in the past 2 years about syringe related issues; 67.7% were asked about syringes for non-prescription injection drug use. Individuals Involved: While 62.4% believed PharmNet was within pharmacy scope of practice and 90.1% were comfortable consulting about syringe use, pharmacists reported that they had limited control over the implementation environment. PROCESS: 38.0% of pharmacists indicated interest in advising the development of PharmNet. CONCLUSIONS: An implementation trial of a modified version of PharmNet is likely feasible; yet will be challenged by structural pressures particularly in chain pharmacies. Successful implementation will involve the development of resources and policy components to manage outer and inner setting characteristics and align the intervention to the implementation environment.

Remembering episodes: a selective role for the hippocampus during retrieval.

Some memories are linked to a specific time and place, allowing one to re-experience the original event, whereas others are accompanied only by a feeling of familiarity. To uncover the distinct neural bases for these two types of memory, we measured brain activity during memory retrieval using event-related functional magnetic resonance imaging. We show that activity in the hippocampus increased only when retrieval was accompanied by conscious recollection of the learning episode. Hippocampal activity did not increase for items recognized based on familiarity or for unrecognized items. These results indicate that the hippocampus selectively supports the retrieval of episodic memories.

Material-specific lateralization of prefrontal activation during episodic encoding and retrieval.

Although numerous neuroimaging studies have examined the functional neuroanatomy supporting episodic memory for verbal material, there have been few investigations of non-verbal episodic encoding and retrieval. We used fMRI to directly compare prefrontal activation elicited by verbal and non-verbal material during encoding and during retrieval. Regardless of the mnemonic operation (encoding/retrieval), inferior prefrontal activation lateralized based on material type. Verbal encoding and retrieval resulted in greater left inferior prefrontal activation, whereas non-verbal encoding and retrieval resulted in greater right inferior prefrontal activation. The similarity between inferior prefrontal activity during encoding and during retrieval indicates that these mnemonic operations depend on shared processes mediated by inferior prefrontal regions.

Neural influence on slow muscle properties: inactivity with and without cross-reinnervation.

The effects of altering (cross-reinnervation, CR) and/or eliminating (spinal isolation, SI) the activation-dependent neural input to the cat soleus for 8 months on its mechanical and biochemical properties were determined. The percent fast fibers was 0, 27, 38, and 54% for normal control (NC), NC-CR, SI, and SI-CR cats. Calcium-activated whole muscle myofibrillar adenosine triphosphatase activity was higher in SI-CR and NC cats. Isometric twitch speed properties and frequency of stimulation:tension response were faster in all experimental groups compared to NC. Maximum twitch and tetanic (Po) force, physiological cross-sectional area (PCSA), and specific tension (Po/PCSA) were unaffected in NC-CR cats, but reduced in SI and SI-CR cats. The soleus was more fatigable in SI-CR compared to NC cats. Alpha-glycerophosphate dehydrogenase activity was higher in all experimental groups compared to NC. All eight parameters reflecting the type of muscle were shifted toward those observed in a "faster" muscle in SI-CR vs. SI cats. These data suggest that electrically silent motoneurons can influence type-related skeletal muscle properties.

Assessing consumption of high-fat foods: the effect of grouping foods into single questions.

Questionnaires on the frequency of consumption of foods are commonly used to measure dietary intake in epidemiologic research. To reduce the burden on respondents, questionnaires are often shortened by combining inquiries on similar foods into a single question. The effect of this practice on the reporting of dietary intake has never been investigated, however. To address this issue, we used two food frequency questionnaires in a telephone survey designed to rank adult residents of Alabama by their intake of dietary fat. One questionnaire included 29 questions about separate high-fat foods, whereas the other grouped these same foods into 14 questions. Compared with the 443 respondents interviewed using the 29-item separated-foods questionnaire, the 465 respondents responding to the 14-item grouped-foods questionnaire reported lower average intakes of the foods. In addition, a substantially higher percentage of respondents to the grouped-foods questionnaire reported never consuming the foods.

Efficacy of vaginal spaying and anabolic implants on growth and carcass characteristics in beef heifers.

Ninety crossbred beef heifers averaging 260 kg were blocked by weight and allotted randomly to 15 pens of six heifers each, with three replicates per treatment. The treatments were spayed heifers (S); intact heifers (I); S + Synovex-H7 (SH); I + Synovex-H (IH); and S + Synovex-S7 (SS). The heifers were spayed vaginally with a Willis instrument; intact heifers were rectally palpated for reproductive soundness. Heifers were fed a growing diet (55 d), re-implanted and subsequently fed a finishing ration (73 or 101 d). All heifers were observed for estrus daily at approximately 0600 and 2000 until d 69. A jugular vein blood sample was obtained from each heifer on d 48, 55, 62 and 69 for blood progesterone analysis. Results of blood progesterone analysis and reproductive tract examination indicated that two spayed heifers were incompletely spayed, a 96% success rate. The SH and SS heifers continued to exhibit estrous behavior despite being successfully spayed. Heifers implanted with Synovex-H had greater (P less than .01) ADG and were more efficient (P less than .03) than nonimplanted heifers. The SS heifers had greater ADG (P less than .05) during the finishing phase than SH heifers, but no advantage of SS over SH was apparent during the growing phase. The overall ADG response to implantation was fourfold greater (P less than .07) in the spayed heifers than in the intact heifers (32 vs 8%). Heifers implanted with Synovex-H had greater adjusted hot carcass weight (P less than .02) and ribeye area (P less than .002) than nonimplanted heifers. For adjusted live weight and ribeye area, the response to implantation was approximately threefold greater in the spayed heifer than the intact heifer. These results demonstrate that spaying and implanting heifers can increase rates and efficiency of gain even though behavioral estrus is not eliminated.

Lumbosacral spinal isolation in cat: surgical preparation and health maintenance.

This paper describes a preparation in which the skeletal neuromuscular system of the hind limb of the adult cat is rendered permanently quiet with respect to electrical and contractile activity. The surgical method, regime for maintaining the health of the cats, and the condition of the cats are reported in detail. The characteristics of the isolated neuromuscular system are briefly summarized. The lumbosacral spinal cord carrying the innervation to the lower hind limb was surgically isolated from excitatory inputs from both dorsal root afferent fibers and upper motoneurons. This was accomplished by a bilateral dorsal rhizectomy between two transections of the cord, just rostral to the L5 segment and approximately at the S3 segment. The laminectomy was restricted to retain laminar structures sufficient to protect the cord from mechanical stimulation. During the rostral transection, the ventral artery was spared, preserving the blood supply to the ventral region of isolated cord. Daily maintenance and surveillance procedures were extremely important, but simple and brief. With strict adherence to procedures for both surgery and care, the cats remained healthy except for bladder infections, and their hind legs were in chronic flaccid paralysis.

Neural influences on the distribution of troponin I isotypes in the cat.

An immunohistochemical technique was used to study changes in the distribution of fast and slow forms of troponin I (TN-I) in response to alterations in the nerve supply. Hind limb muscles from normal, spinal-isolated, and cordotomized cats, one leg of which had undergone cross innervation between slow (soleus) and fast (flexor hallucis longus, FHL) muscles, were examined. At 8 months after cross innervation of normal soleus by the FHL nerve, the number of fast TN-I-positive cells had increased from 0.26 to 22.1%. At 8 months after cross innervation of normal FHL muscle with the soleus nerve, the number of fast TN-I-positive cells had decreased from 86.5 to 30.5%. The number of intermediate cells staining for both fast and slow TN-I, increased considerably after cross innervation of both soleus and FHL muscles. Spinal isolation by itself had a dramatic effect on the distribution of fast and slow TN-I, converting almost all the originally slow fibers in the FHL and 60.0% of the soleus fibers to fast TN-I-positive cells in 8 months. Cordotomy, in contrast, produced an increase of only 15.6% in the soleus, and did not change the FHL. There was no quantitative difference in the crossed-and uncrossed muscles of spinal isolated cats. In cordotomized cats, cross innervation of the soleus by the FHL nerve resulted in 32.3% fast TN-I-positive cells, with some fiber type grouping. Thus, distribution of fast and slow forms of TN-I changed after each neural manipulation which altered amounts and patterns of muscle contraction and stretch.

Spinal innervation of flexor hallucis longus in the cat.

The segmental levels of the innervation of the flexor hallucis longus (FHL) in the cat have been unclear. To clarify the location of the spinal innervation of the FHL, physiologic techniques were used both to identify the ventral roots supplying the FHL and to relate the distribution of its segmental innervation to that of another calf muscle, the soleus, in the same cat. The soleus was used as a reference because its innervation has been consistently located by several investigators using a variety of techniques. The contributions of the various lumbosacral ventral roots were assessed by measuring the muscle contractions produced by electrically stimulating individual roots. The FHL was found to be supplied only by roots L6 and L7 and the soleus, as reported by previous investigators, only by L7 and S1. In every cat, at least some part of the innervation to the FHL was rostral to that of the soleus. Comparison of these results with those of Sherrington, Romanes, and Jefferson strongly suggests that the FHL in the present study corresponds to the adjacent synergistic muscle labeled flexor digitorum longus by Sherrington and Romanes.

Vertebral location of cord segments innervating cat hind limb musculature.

To facilitate future studies requiring efficient surgical access to spinal cord segments innervating cat hind limb muscles, lumbosacral cord segments L3 through S2 were located with reference to the dorsolateral tips of the rostral articular processes of the surrounding vertebrae. A map showing means and ranges of vertebral loci of these segments from 20 cats was constructed. Correlation analysis was then used to find a practical way of narrowing the predicted range of loci of segments supplying the lower hind limb muscles in a particular cat. Several of the midlumbar junctions were determined to be good predictors of the position of the S2-S3 junction, the caudal limit of hind limb innervation. However, L4-L5 was found to be the most feasible to use experimentally, because of the ease of exposing and identifying it. Because all of the lumbosacral segments L3 through S2 in a given cat show a similar tendency with regard to relative length, the positions of the segments L6 through S1 can be interpolated from the prediction of the S2-S3 junction.

Alterations in cat skeletal neuromuscular junctions following prolonged inactivity.

1. The distributions of acetylcholine (ACh) receptors, cholinesterase (ChE) activity and nerve terminals were studied on cat muscle fibres which had been inactive for 2-3 years. 2. Neuromuscular junctions increased in size as a result of sprouting of terminal branches. In addition some fibres were multiply innervated at separate sites. 3. In muscles from two cats, some areas at the junction showed ChE activity but had only a relatively low density of ACh receptors. 4. The extrajunctional receptor density was higher than in normal muscles but lower than in muscles denervated for up to 10 months.

Almond harvesting, processing, and microbial flora.

This survey was set up on a statistical sampling plan to determine the microbial quality of almonds as they are received at the processing plant. The total aerobic bacterial count and yeast and mold count distribution were skewed by a few high counts compared with the majority of relatively low counts. Hard shell varieties of almonds had lower counts than did soft shell, and almonds with complete shells had lower counts than shelled almonds. Almonds harvested onto canvas had lower counts than those harvested by knocking onto the ground. Nuts with the least amounts of foreign material mixed into the sample had the lowest counts, as did nuts with the least amount of insect damage. Coliforms, Escherichia coli, and Streptococcus were isolated from the nuts, and their presence was correlated with soil contamination. When almonds are stored, the total plate count, the Streptococcus count, and the E. coli count after an initial drop remain nearly constant for more than 3 months. In addition to the indicator organisms, several genera of bacteria were isolated including Bacillus, Xanthomonas, Achromobacter, Pseudomonas, Micrococcus or Staphylococcus, and Brevibacterium.