An Integrated Hospital Protocol for Persons With Injection-Related Infections May Increase Medications for Opioid Use Disorder Use but Challenges Remain.

BACKGROUND: Hospital-based strategies that link persons with infectious complications of opioid use disorder (OUD) to medications for OUD (MOUD) are of great interest. The objective of this study is to determine whether a hospital-based protocol would increase the use of MOUD and to identify barriers to MOUD during admission and at the time of discharge. METHODS: This study included participants with a documented or suspected history of injection drug usage receiving care for an infection at the University of Alabama at Birmingham Hospital from 2015 to 2018. The protocol, the intravenous antibiotic and addiction team (IVAT), included Addiction Medicine and Infectious Diseases consultation and a 9-item risk assessment. We quantified MOUD use before and after IVAT and used logistic regression to determine factors associated with MOUD. We explored barriers to MOUD uptake using chart review. RESULTS: A total of 37 and 98 patients met criteria in the pre- and post-IVAT periods, respectively. With IVAT, the percentage with OUD receiving MOUD significantly increased (29% pre-IVAT and 37% post-IVAT; P = .026) and MOUD use was higher in "high risk" participants (62%). Clinical and sociodemographic factors were not associated with MOUD receipt. CONCLUSIONS: A hospital-based protocol may increase the use of MOUD; however, the uptake of MOUD remains suboptimal (<50%).

Colloidal-electrochemical fabrication strategies for functional composites of linear polyethylenimine.

Colloidal-electrochemical fabrication strategies have been developed for the deposition of linear polyethylenimine (LPEI) composite materials. Electrophoretic deposition (EPD) allowed for the fabrication of composite films containing Mn3O4 and ZnO nanoparticles, as well as advanced flame retardant materials, such as halloysite nanotubes and memory-type Al-Mg-Zr complex hydroxide (AMZ) in the matrix of the water-insoluble LPEI. A liquid-liquid extraction method has been designed for the agglomerate-free processing of AMZ particles. Efficient extraction was achieved using decylphosphonic acid as an extractor. A conceptually new polymer complex (PC)-EPD method has been developed, which is based on the use of LPEI-metal ion complexes. Proof-of-concept studies involved the fabrication of LPEI-Ni(OH)2 and LPEI-MnOx nanocomposites. The composites showed valuable flame retardant and charge-storage properties. The analysis of basic EPD and PC-EPD mechanisms as well as complexing properties of LPEI has driven the development of new strategies for the fabrication of organic composites. Hemoglobin was used as a model protein for the fabrication of composite films. Another important finding was the fabrication of composites, containing cyclodextrin, which is a unique carrier of various functional organic molecules. EPD and PC-EPD are versatile methods, which allow for the deposition of novel LPEI based composites containing various functional materials.

Room-temperature, atmospheric-pressure microsputtering of dense, electrically conductive, sub-100 nm gold films.

In this study, we investigate the effects of deposition parameters (i.e. gas flow rates, bias voltages, and nozzle-to-substrate separation) on the microstructure of <100 nm thick gold deposits made with a room-temperature, atmospheric-pressure, ion-drag microsputterer. Without resorting to the use of vacuum or substrate heating, optimization of the printing process yields dense, continuous deposits (96.5% coverage) with low electrical resistivity (45 µΩ cm). Using statistical analysis, we developed a simple model that provides insight into the dynamics of such a printing method; based on this model, we identify electrostatic effects as the most important factor that influences the deposition process.

Synthesis and liquid-liquid extraction of non-agglomerated Al(OH)3 particles for deposition of cellulose matrix composite films.

A cathodic electrophoretic deposition (EPD) method has been developed for the deposition of quaternized hydroxyethyl cellulose ethoxylate (QHECE) films. A quartz crystal microbalance was used for in-situ investigation of the deposition yield in dilute QHECE solutions. The deposition rate increased with increasing QHECE concentration in the range of 1-10gL-1. Aluminium hydroxide (AH) was prepared by a chemical precipitation method and used as a flame retardant additive for QHECE. AH particle agglomeration was avoided by a new strategy, based on combined synthesis and liquid-liquid extraction method. In the biomimetic surface modification approach, 3,4-dihydroxybenzaldehyde (R'-CHO) and 2,3,4-trihydroxybenzaldehyde (R''-CHO) were used for particle modification during synthesis. The Schiff base reaction at the water-n-butanol interface between R'-CHO or R''-CHO adsorbed on the particle surface in water, and hexadecylamine in the n-butanol phase, allowed for efficient particle modification and phase transfer from water to the n-butanol phase. The extraction mechanism was confirmed by FTIR investigation. The modified particles showed good suspension stability and were utilized for the EPD of smooth and uniform QHECE-AH films. The formation a composite material, which contained flame retardant AH in the QHECE matrix was confirmed by the thermogravimetric and differential thermal analyses. Further development of the particle synthesis and liquid-liquid extraction method can be used for the fabrication of advanced QHECE composites, containing various functional materials.

Utility of tissue expansion in pediatric phallic reconstruction: a 10-year experience.

OBJECTIVE: Boys with complex penile anomalies often undergo multiple operations, leaving a paucity of unscarred skin for further reconstructive procedures. Our objective was to evaluate the ability of tissue expansion to provide local skin for successful phallic reconstruction. MATERIALS AND METHODS: Eighty boys (mean age of 11.9 years) with hypospadias (n = 42) or epispadias (n = 38) formed the study cohort. All patients had undergone at least one failed reconstructive operation. Indications for tissue expansion included scarcity of penile skin with urethral stenosis, urethrocutaneous fistula, chordee, and/or residual defect. One or two expanders were placed under the skin of the penile shaft and removed at the time of reconstruction. RESULTS: Average time between expander placement and reconstruction was 10.9 weeks. Mean follow-up time was 25.3 months. Complications during expansion occurred in 33 patients (41.3%). Twenty-two patients (27.5%) had at least one expander removed prematurely and 46.9% were replaced. Expansion yielded adequate tissue for reconstruction in 76 patients (95.0%). Successful outcomes were achieved in 39 patients after initial reconstruction and 25 patients after further intervention, yielding an overall success rate of 80.0%. CONCLUSION: Tissue expansion is a useful tool with an acceptable rate of complications for phallic reconstruction in patients who have failed prior surgical reconstruction.

Differential effects of infliximab on absolute circulating blood leucocyte counts of innate immune cells in early and late rheumatoid arthritis patients.

Anti-tumour necrosis factor (TNF) biologics have revolutionized therapy of rheumatoid arthritis (RA). We compared the effects of infliximab on numbers of circulating leucocyte subsets in early RA (disease/symptom duration of ≤1 year) and late RA patients (>1 year). A control group consisted of early RA patients treated with a combination of methotrexate (MTX) and methylprednisolone. Blood samples were obtained at baseline (pre-therapy) from all RA patients, divided into three groups: (i) late RA receiving infliximab/MTX, (ii) early RA-infliximab/MTX, (iii) early RA-steroid/MTX, and also from follow-up patients at 2 and 14 weeks. Significant differences in absolute counts of monocytes and granulocytes were observed between healthy controls and RA patients. At baseline CD14(bright) monocytes and CD16(+) granulocytes were increased in both early RA and late RA patients. CD4(+) T cells, CD8(+) T cells and B cells were all increased at baseline in early RA, but not in late RA. At 2 weeks following infliximab treatment decreased granulocytes were observed in both early and late RA and decreased natural killer (NK) cells in late RA. CD16(+) granulocytes and NK cells were also decreased at 14 weeks post-infliximab in early RA. Biotinylated infliximab was used to detect membrane-associated TNF (mTNF)-expressing leucocytes in RA patients. CD16(+) granulocytes, NK cells and CD14(dim) monocytes all expressed higher levels of mTNF in RA patients. In summary infliximab is associated with decreased CD16(+) granulocyte and NK cell counts, possibly through binding of mTNF. Differential effects of infliximab between early and late RA suggest that pathogenic mechanisms change as disease progresses.

The role of acculturation in health status and utilization of health services among the iranian elderly in metropolitan Sydney.

The present study explores the impact of acculturation on health status and use of health and community aged care services among elderly Iranian-born immigrants to Australia. Three hundred two Iranian immigrants aged 65 years and over who had lived in the Sydney Metropolitan area for at least six months participated. Data were collected using a written survey instrument, face-to-face interviews, and telephone interviews. Iranian immigrants had higher levels of psychological distress, more limited physical function, greater need for help or assistance with activities of daily living, lower feelings of wellbeing, and were much less likely to use aged care services than the general population of older Australians. Participants who did not speak English at home were more likely to experience psychological distress and had greater limitations in their physical functioning. Elderly Iranians with better English proficiency had lower levels of anxiety and depressive symptoms and reported less need for help and supervision in activities of daily living; they were also more likely to access health care services. Elderly Iranian immigrants experience higher levels of psychological distress and lower levels of physical function than the general population of older Australians; those with limited proficiency in English are at greatest risk. These findings contribute to the enrichment of multicultural policy, social fairness, access, and equity for ethnic aged people.

Using video simulated presence to reduce resistance to care and increase participation of adults with dementia.

BACKGROUND: Cognitive and functional decline in dementia generally impairs performance of basic care activities. Staff assistance during these activities frequently results in confusion, anxiety, and distress, expressed through resistance to care (RTC). METHODS: A single-system ABA withdrawal design (n = 1) evaluated the effect of video-simulated presence (VSP) for decreasing RTC and increasing participation. A family member pre-recorded videos for use during episodes of RTC, in which the family member spoke directly to the participant to encourage participation. RESULTS: Introduction of the VSP significantly reduced RTC during the basic care tasks of feeding and talking medication. This effect was reversed when the intervention was withdrawn. Participation increased following VSP, demonstrating clear trends toward clinical significance. CONCLUSIONS: This person-centered intervention, based on VSP of a family member, provides encouraging results for reducing RTC and increasing participation of adults with dementia in basic care tasks.

Pre- and postoccupancy evaluation of new dementia care cottages.

Concerns about negative outcomes associated with relocating residents are common. Fifty-five residents of a traditional high-care nursing home moved to new, purpose-built, dementia-specific cottages; 35 additional residents moved into the cottages within the first 8 months of operation. Direct-care staff participated in workshops on engaging residents in life-skill activities. Resident behavior was observed using a time sampling and a de-identified behavior mapping procedure. Results showed increases in resident engagement following the move and further increases after staff training. Staff engagement in resident interactive tasks similarly increased both after the move and again after staff training. The newly built cottages scored higher across all domains of 3 different types of environmental assessment, and family satisfaction ratings also improved. These results suggest that relocation need not negatively affect residents with dementia and that this environment provides an attractive model of care for dementia facilities.

Rates and types of hospitalisations for children who have subsequent contact with the child protection system: a population based case-control study.

OBJECTIVES: To determine whether children who have child maltreatment allegation or substantiation have a higher rate of general hospital admissions and injury related admissions when compared to other children and to investigate other types of admissions, such as mental health, infections and admissions due to external causes. STUDY DESIGN: A prospective matched case-control study of children born in Western Australia between 1990 and 2005 using de-identified record linked Child Protection and Hospital Morbidity data. Rates of prior hospital admissions for cases versus controls were calculated, and conditional logistic regression was used to estimate the effect of hospital admission rate on the risk of child maltreatment allegation and substantiated allegation. RESULTS: Children with child maltreatment allegations and substantiations had higher mean prior admission rates compared to controls. Higher rates of general admissions and admissions for injuries, infections, mental and behavioural disorders, and external causes of morbidity, were associated with a markedly increased risk of child maltreatment allegations and substantiation. CONCLUSIONS: The hospital system plays not only an important role both in the surveillance of maltreatment-related injuries and conditions but also in the role of prevention in the referral of families who may need support and assistance in ensuring the health and safety of their children. This research highlights the importance of moving to electronic patient records in identifying children who have high rates of admissions and the types of conditions they have previously presented with, particularly for injuries, mental and behavioural disorders and external causes of admissions.

Participation of older adults in cyberspace: how Australian older adults use the Internet.

AIM: The present study explores how Australian older adults use the Internet. METHOD: Older adults were recruited online to complete an online survey. RESULTS: Participants primarily used the Internet for interpersonal communication, followed by information seeking, commerce and entertainment. CONCLUSION: The Internet is an important technology in helping older adults lead independent and social lives.

Internet use as a predictor of sense of community in older people.

The Internet opens new options for communication and may change the extent to which older people use other modes of communication. The importance of older adults' participation in cyberspace has increased as Internet use for commerce and communication has increased. The present study explores how older adults' Internet use affects their sense of community. An online survey was conducted at the University of Sydney to determine the associations between Internet use and seniors' sense of community and well-being. Participants were recruited online. There was a positive association between a sense of belonging to an online community, sense of community, and well-being. Seniors' use of the Internet for communication and information, and the frequency and history of their Internet use, were consistently related to a greater sense of community.

Internet use and loneliness in older adults.

Use of the Internet by seniors as a communication technology may lead to changes in older adult social relationships. This study used an online questionnaire to survey 222 Australians over 55 years of age on Internet use. Respondents primarily used the Internet for communication, seeking information, and commercial purposes. The results showed negative correlations between loneliness and well-being. Multiple regression analyses revealed that greater use of the Internet as a communication tool was associated with a lower level of social loneliness. In contrast, greater use of the Internet to find new people was associated with a higher level of emotional loneliness.

A novel TNFRSF1A splice mutation associated with increased nuclear factor kappaB (NF-kappaB) transcription factor activation in patients with tumour necrosis factor receptor associated periodic syndrome (TRAPS).

OBJECTIVE: To characterise and investigate the functional consequences of a novel TNFRSF1A splice site mutation causing tumour necrosis factor receptor associated periodic syndrome (TRAPS) in a 16-year-old male patient and his mother. METHODS: Mutational DNA screening was performed in the patient and his mother. Western blotting was used to analyse protein expression levels of TNFR1. A multiplex bead immunoassay was used to quantify serum levels of range of cytokines, and an ELISA-based transcription factor assay to measure nuclear factor (NF)-kappaB transactivation. Serum levels of soluble TNFR1 (sTNFR1) were measured by ELISA and fluorescence-activated cell sorting (FACS) analysis used to measure monocyte TNFR1 cell surface expression. RESULTS: A novel mutation, c.472+1G>A (C158delinsYERSSPEAKPSPHPRG), involving a splice site in intron 4 of TNFRSF1A, was found in the proband and affected mother leading to a 45 nucleotide insertion of intronic DNA into the mRNA, resulting in an in-frame insertion of 15 amino acids in the mature TNFR1 protein and a deletion of a cysteine residue C129 (158) in cysteine rich domain (CRD)3. The patients had reduced serum sTNFR1 and surface expression levels of TNFR1, with marked increases in pro- and anti-inflammatory cytokine. Their peripheral blood mononuclear cells (PBMC) had increased basal NF-kappaB activation compared with healthy controls and also had increased p50 nuclear expression following tumour necrosis factor (TNF) stimulation compared with PBMC from healthy controls, as well as T50M (T79M) and C88R (C117R) patients with TRAPS and patients with rheumatoid arthritis (RA). CONCLUSION: A novel, TRAPS causing, TNFRSF1A splice site mutation is associated with decreased sTNFR1 levels, cell surface and whole cell extract expression and increased NF-kappaB transcription factor activation.

Laser energy source in surgical atrial fibrillation ablation: preclinical experience.

PURPOSE: The purpose of this study was to evaluate diffusing tip laser energy in surgical atrial fibrillation ablation using a canine model. This is the first report to describe the pathological and histological findings using a laser energy source. DESCRIPTION: The surgical atrial fibrillation ablation procedure was performed through a left atriotomy; the pulmonary veins were encircled in 16 dogs using a diode laser (980 nm) with a diffusing tip that permits linear ablation perpendicular to the fiber direction. Lesion durations were 45 seconds with a power density of 3.8 or 4.5 W/cm. Six animals were allowed to survive 4 hours after the procedure, with the remainder sacrificed at 1 week (n = 1), 4 weeks (n = 3), and 6 weeks (n = 6). Electrophysiologic effectiveness was judged using unipolar or bipolar pacing from the pulmonary veins after attempting isolation. Hearts were harvested for histologic examination using standard trichrome staining. EVALUATION: All animals tolerated the procedure. The animals required an average of 5.6 +/- 0.82 lesions to complete the procedure. All animals had confirmed isolation of the pulmonary veins as judged by unipolar or bipolar pacing, and this isolation persisted in those animals that were allowed to survive. Pathology revealed all lesions to be transmural with an average tissue thickness of 3.62 +/- 1.50 mm (range, 0.95 mm to 7.06 mm). CONCLUSIONS: Diffusing tip laser technology reproducibly makes rapid, transmural, and electrophysiologically effective atrial lesions.

Staff-administered functional analysis and treatment of aggression by an elder with dementia.

In the current study, nursing home staff were taught to administer functional analyses to determine the variables maintaining aggression by an elder with dementia. The results indicated that aggression was evoked during bathroom routines and that escape maintained aggression. Staff then reduced aggression to near-zero levels with noncontingent escape. Implications for the assessment and treatment of problem behaviors in nursing home settings are discussed.

The use of combined bladder and epispadias repair in boys with classic bladder exstrophy: outcomes, complications and consequences.

PURPOSE: Despite widespread use of modern staged reconstruction for classic bladder exstrophy, there remains a role for combined bladder closure and epispadias repair when primary closure is delayed or initial reconstruction has failed. The principle of combining bladder and urethral closure in 1 operation was first proposed more than 40 years ago, and represents a demanding technical procedure. We recount our experience to date with this approach. MATERIALS AND METHODS: A total of 38 boys underwent combined bladder and epispadias repair using pelvic osteotomies. Five cases were delayed primary closures owing to a bladder template unsuitable for newborn closure. A total of 30 cases were previous failed bladder closures, with concurrent epispadias repair in 6. The 3 remaining cases were staged closures where the epispadias repair failed, leading to bladder prolapse via the posterior urethra. Overall, there was a major bladder prolapse in 25 cases, and separation of the pubic symphysis with dehiscence of anterior abdominal wall structures and bladder in 8. RESULTS: Mean age at surgery was 26.5 months for the 33 reclosures. A total of 10 boys had development of a urethrocutaneous fistula and 4 had development of strictures. A total of 19 patients required additional procedures of the bladder neck (endoscopic), urethra or penis. A later bladder neck reconstruction was undertaken in 19 boys, of whom 12 are continent. Seven boys underwent continent diversion and 5 are considering the procedure. A total of 14 boys are awaiting adequate capacity for bladder neck reconstruction. Ureteral reimplantation was performed in 22 patients, and no patient was rendered hypospadiac. CONCLUSIONS: When combined closure is applied to failed previous exstrophy repair one can expect at best a 50% continence rate without continent diversion. Furthermore, based on the experience at this institution the majority of patients require ureteral reimplantation, and many require additional surgery to the penis or urethra. However, with the application of modern reconstructive techniques continence and a cosmetically pleasing phallus can be expected in most cases, although at the expense of multiple surgical procedures.

Assessment of active music participation as an indication of subsequent music making engagement for persons with midstage dementia.

Persons with midstage dementia and in special care (N = 45) were assessed in groups by a music therapy practitioner to determine the level of engagement in a 15-minute protocol that included a five-minute segment for each of three music activity types--rhythm playing, exercising with music, and singing. Activity staff with little to no formal music training who were employed by the facility were taught to use the protocol to conduct eight subsequent activity sessions for small groups from which activity engagement data were collected for each subject. Results indicated the protocol was accessible and successful for indigenous activity staff, initial assessments were strong predictors of subsequent engagement, and participation levels were stable over time and across each of the three activities.

Applications of the modified Cantwell-Ransley epispadias repair in the exstrophy-epispadias complex.

OBJECTIVE: The Cantwell-Ransley technique is the most popular and widely used approach to epispadias repair. This is an evaluation and update of the long-term results of using the modified Cantwell-Ransley technique for epispadias repair. PATIENTS AND METHODS: The modified Cantwell-Ransley epispadias repair technique was performed on 129 boys of which 97 had classic bladder exstrophy and 32 complete epispadias. For 106 boys this was primary urethral repair (82 with classic exstrophy, 24 with epispadias) and for the other 23 boys it was a repeat repair (15 with exstrophy, eight with epispadias). RESULTS: At a mean follow-up of 88 months, 120 had a penis that was inclined downward or horizontally while standing. In patients with exstrophy, fistulae were noted in 16% and 33% after primary and repeat urethral repair, respectively. In patients with epispadias, fistulae were noted in 13% and 25% after primary and secondary repair, respectively. In total, five boys with a fistula appearing in the immediate postoperative period following primary urethral repair demonstrated spontaneous healing by 3 months' follow-up. Urethral stricture requiring treatment developed in nine patients. Minor wound infection and skin separation occurred in nine with exstrophy and three with epispadias. Endoscopic examination or catheterization in 120 cases revealed an easily manipulated neourethra. Of 15 sexually active patients, all reported orgasms and ejaculation with a straight penis on erection, although one has complained that his penis is shorter since surgery. CONCLUSIONS: The modified Cantwell-Ransley technique for epispadias repair produces durable functional and cosmetic results, and fewer major complications than seen with other repairs. Fistulae occurring after primary urethral repair may close spontaneously, but all those occurring after repeat closure will require further surgery.