Suboptimal Handling of Piccolo Samples or Reagent Discs for Consideration in Ebola Response.

Operating clinical analyzers within recommended parameters can be challenging during outbreak response. Using the Piccolo Xpress point-of-care blood chemistry analyzer on guinea pig blood, we found that values of many analytes are still readily comparable when samples and reagent discs are handled at various conditions outside of manufacturer recommendations.

Willingness to utilize a mobile treatment unit in five counties at the epicenter of the US rural opioid epidemic.

INTRODUCTION: US federal policies are evolving to expand the provision of mobile treatment units (MTUs) offering medications for opioid use disorder (MOUD). Mobile MOUD services are critical for rural areas with poor geographic access to fixed-site treatment providers. This study explored willingness to utilize an MTU among a sample of people who use opioids in rural Eastern Kentucky counties at the epicenter of the US opioid epidemic. METHODS: The study analyzed Cross-sectional survey data from the Kentucky Communities and Researchers Engaging to Halt the Opioid Epidemic (CARE2HOPE) study covering five rural counties in the state. Logistic regression models investigated the association between willingness to utilize an MTU providing buprenorphine and naltrexone and potential correlates of willingness, identified using the Behavioral Model for Vulnerable Populations. RESULTS: The analytic sample comprised 174 people who used opioids within the past six months. Willingness to utilize an MTU was high; 76.5 % of participants endorsed being willing. Those who had recently received MOUD treatment, compared to those who had not received any form of treatment or recovery support services, had six-fold higher odds of willingness to use an MTU. However, odds of being willing to utilize an MTU were 73 % lower among those who were under community supervision (e.g., parole, probation) and 81 % lower among participants who experienced an overdose within the past six months. CONCLUSIONS: There was high acceptability of MTUs offering buprenorphine and naltrexone within this sample, highlighting the potential for MTUs to alleviate opioid-related harms in underserved rural areas. However, the finding that people who were recently under community supervision or had overdosed were significantly less willing to seek mobile MOUD treatment suggest barriers (e.g., stigma) to mobile MOUD at individual and systemic levels, which may prevent improving opioid-related outcomes in these rural communities given their high rates of criminal-legal involvement and overdose.

The Mobile Overdose Response Program: A mobile, low-threshold opioid use disorder treatment model in Philadelphia.

INTRODUCTION: Low-threshold substance use treatment programs may help overcome barriers for marginalized individuals. The aims of this study were to 1) describe participant characteristics and treatment outcomes for a multi-site, Philadelphia-based mobile program providing street-based buprenorphine initiation, stabilization, and referral to ongoing care and 2) examine associations between patient characteristics and successful linkage. METHODS: We conducted a retrospective cohort study of patients receiving buprenorphine through Prevention Point Philadelphia's mobile overdose response program from 9/2020-12/2021. We abstracted electronic medical record data, including patient characteristics, mobile program treatment, and care linkage. We used descriptive statistics to characterize the sample and assessed the association between patient characteristics and successful care linkage using multi-variable logistic regression. RESULTS: Two hundred thirty-seven patients initiated buprenorphine in the program across six sites. Mean age was 46. Participants were majority men (67 %); 59 % identified as Black, 33 % identified as White, and 15 % reported Hispanic ethnicity. Most were publicly insured (74 %) and 30 % were unstably housed. Basedline engagement in primary care (32 %), psychiatric treatment (5 %), and counseling (2 %) were low. Most participants reported heroin or fentanyl use at intake (87 %), with high rates of IV drug use (37 %)., and co-occurring substance use and prior buprenorphine treatment experience were common.. 86 % completed ≥1 mobile follow-up visit, and 69 % completed ≥4 mobile program visits. 51 % of patients attended at least one visit at an outside site, and 30 % had ≥2 visits for buprenorphine prescriptions at an outside site. 35 % of the referrals were internal, meaning they went to University-based practices staffed by the mobile unit physicians. In a multivariable logistic regression model, internal referral was associated with significantly increased odds of effective care linkage (aOR 2.47, 95 % CI 1.20-5.09). CONCLUSIONS: Targeted community outreach with low-threshold substance use care facilitated treatment access among marginalized individuals. Participants showed high levels of engagement with the mobile program, but rates of outside care linkage, while comparable to retention in other low-threshold models, were lower. The only predictor of effective care linkage was referral to brick-and-mortar clinics staffed by mobile unit physicians. These findings support the importance of outreach beyond traditional health care settings to engage high-risk patients with OUD.

Mobile service delivery in response to the opioid epidemic in Philadelphia.

BACKGROUND: The harms of opioid use disorder (OUD) and HIV infection disproportionately impact marginalized populations, especially people experiencing homelessness and people who inject drugs (PWID). Mobile OUD service delivery models are emerging to increase access and reduce barriers to OUD care. While there is growing interest in these models, there is limited research about the services they provide, how they operate, and what barriers they face. We characterize the capacity, barriers, and sustainment of mobile OUD care services in a large city with a high incidence of OUD and HIV. METHODS: From May to August 2022, we conducted semi-structured interviews with leadership from all seven mobile OUD care units (MOCU) providing a medication for OUD or other substance use disorder services in Philadelphia. We surveyed leaders about their unit's services, staffing, operating location, funding sources, and linkages to care. Leaders were asked to describe their clinical approach, treatment process, and the barriers and facilitators to their operations. Interview recordings were coded using rapid qualitative analysis. RESULTS: MOCUs are run by small, multidisciplinary teams, typically composed of a clinician, one or two case managers, and a peer recovery specialist or outreach worker. MOCUs provide a range of services, including medications for OUD, wound care, medical services, case management, and screening for infectious diseases. No units provide methadone, but all units provide naloxone, six write prescriptions for buprenorphine, and one unit dispenses buprenorphine. The most frequently reported barriers include practical challenges of working on a MOCU (e.g. lack of space, safety), lack of community support, and patients with substantial medical and psychosocial needs. Interviewees reported concerns about funding and specifically as it relates to providing their staff with adequate pay. The most frequently reported facilitators include positive relationships with the community, collaboration with other entities (e.g. local nonprofits, the police department, universities), and having non-clinical staff (e.g. outreach workers, peer recovery specialists) on the unit. CONCLUSIONS: MOCUs provide life-saving services and engage marginalized individuals with OUD. These findings highlight the challenges and complexities of caring for PWID and demonstrate a need to strengthen collaborations between MOCU providers and the treatment system. Policymakers should consider programmatic funding for permanent mobile OUD care services.

Effects of a cannabis use disorder text message-delivered treatment on young adult alcohol misuse: Differential effects by gender.

Alcohol misuse is more prevalent, frequent, and severe among young adults who use cannabis. Treatment of dual alcohol and cannabis users may have mixed results, with some studies reporting that alcohol misuse increases when cannabis use decreases (substance substitution), while others report that alcohol misuse decreases along with decreasing cannabis use (treatment spillover), and others report no association. Additionally, little research tests whether gender differences are found in treatment of dual alcohol and cannabis users, which may be expected given previous alcohol-focused treatments showing larger effects for females. In the current study, we present a secondary analysis of a randomized clinical trial testing a text message-delivered cannabis use disorder (CUD) treatment (peer network counseling text or "PNC-txt"). The trial included 101 young adults ages 18-25 who met criteria for CUD. We tested whether alcohol use and binge drinking frequency (4+/5+ drinks for women/men) decreased in response to the PNC-txt treatment, which has previously shown effectiveness in reducing cannabis use days. Latent growth models tested PNC-txt effects on the monthly rate of change in alcohol use and binge drinking across three months. In the full sample, we found no evidence of significant treatment effects on alcohol use (d = -0.07) or binge drinking (d = -0.10). Moderation analyses, however, indicated the PNC-txt effect on both alcohol use and binge drinking differed significantly by gender. PNC-txt led to significantly larger decreases in alcohol use (d = -0.53) and binge drinking days (d = -0.43) across the three months for females, whereas the study saw opposite (but nonsignificant) effects for males (d = 0.30 and 0.16 for alcohol use and binge drinking, respectively). We found no evidence that reductions in alcohol use and binge drinking were associated with cannabis use decreases, arguing against direct substitution or spillover effects. These results provide evidence that treatments focused on cannabis use may have secondary beneficial effects for young-adult alcohol misuse, although such effects may be limited to women.

Mobile Peer-Support for Opioid Use Disorders: Refinement of an Innovative Machine Learning Tool.

BACKGROUND: The majority of individuals with Opioid Use Disorder (OUD) do not receive any formal substance use treatment. Due to limited engagement and access to traditional treatment, there is increasing evidence that patients with OUDs turn to online social platforms to access peer support and obtain health-related information about addiction and recovery. Interacting with peers before and during recovery is a key component of many evidence-based addiction recovery programs, and may improve self-efficacy and treatment engagement as well as reduce relapse. Commonly-used online social platforms are limited in utility and scalability as an adjunct to addiction treatment; lack effective content moderation (e.g., misinformed advice, maliciousness or "trolling"); and lack common security and ethical safeguards inherent to clinical care. METHODS: This present study will develop a novel, artificial-intelligence (AI) enabled, mobile treatment delivery method that fulfills the need for a robust, secure, technology-based peer support platform to support patients with OUD. Forty adults receiving outpatient buprenorphine treatment for OUD will be asked to pilot a smartphone-based mobile peer support application, the "Marigold App", for a duration of six weeks. The program will use (1) a prospective cohort study to obtain text message content and feasibility metrics, and (2) qualitative interviews to evaluate usability and acceptability of the mobile platform. ANTICIPATED FINDINGS AND FUTURE DIRECTIONS: The Marigold mobile platform will allow patients to access a tailored chat support group 24/7 as a complement to different forms of clinical OUD treatment. Marigold can keep groups safe and constructive by augmenting chats with AI tools capable of understanding the emotional sentiment in messages, automatically "flagging" critical or clinically relevant content. This project will demonstrate the robustness of these AI tools by adapting them to catch OUD-specific "flags" in peer messages while also examining the adoptability of the platform itself within OUD patients.

Development of an integrated digital health intervention to promote engagement in and adherence to medication for opioid use disorder.

BACKGROUND: Buprenorphine-naloxone is an evidence-based treatment for Opioid Use Disorder. However, despite its efficacy, nearly half of participants are unsuccessful in achieving stabilization (i.e., period of time following medication induction in which medication dose is adjusted to be effective in reducing cravings/withdrawal, minimize potential side effects, and eliminate illicit substance use). This paper presents the study design and protocol for a digital health intervention designed to promote engagement in and adherence to buprenorphine treatment, offered through an outpatient addiction treatment center, through motivational enhancement and distress tolerance skills training. Personalized feedback interventions represent a promising method to effectively motivate engagement in and adherence to buprenorphine treatment. These interventions are generally brief, individually tailored, and have the potential to be delivered via mobile platforms. Distress tolerance, a transdiagnostic vulnerability factor, has been implicated in the development and maintenance of substance use. Targeting distress tolerance may improve substance use treatment outcomes by promoting the ability to persist in goal-directed activity even when experiencing physical or emotional distress. METHODS: The study aims are to: (1) develop and refine an interactive computer- and text message-delivered personalized feedback intervention that incorporates distress tolerance skills training for persons who have elected to initiate outpatient buprenorphine treatment (iCOPE); (2) examine the feasibility, acceptability, and preliminary efficacy of iCOPE for increasing abstinence, adherence, and retention in treatment compared to a treatment as usual comparison condition; and, (3) examine potential mechanisms that may underlie the efficacy of iCOPE in improving outcomes, including motivation, distress tolerance, self-regulation, and negative affect. DISCUSSION: Results of this study will be used to determine whether to proceed with further testing through a large-scale trial. This work has the potential to improve treatment outcomes by reducing illicit opioid use, increasing adherence/retention, and preventing future overdose and other complications of illicit opioid use. Trial Registration NCT03842384.

Mobile App-Based Intervention for Adolescents With First-Episode Psychosis: Study Protocol for a Pilot Randomized Controlled Trial.

Introduction: Previous studies have shown an improvement in the access to treatment for patients with first-episode psychosis (FEP), specifically young patients, through mobile app-based interventions. The aim of this study is to test the effectiveness of a mobile app-based intervention to improve community functioning in adolescents with FEP. Mobile app-based interventions could increase quality of life and disease awareness, which improve adherence to treatment and reduce the frequency of relapses and rehospitalizations in adolescents with FEP. Methods: This article describes a mobile app treatment and the pilot trial protocol for patients with FEP. We will perform a single-blind randomized clinical trial (RCT) including patients with FEP aged 14-19 years recruited from Gregorio Marañón Hospital, Madrid, Spain. Patients will be randomly assigned to an intervention group, which will receive treatment as usual plus five modules of a psychological intervention through the mobile app (psychoeducation, recognition of symptoms and prevention of relapses, problem solving, mindfulness, and contact wall), or to a control group (standard care). The effectiveness of the intervention will be assessed by means of an extensive battery of clinical tests at baseline and at 3 months of follow-up. The primary outcome is reduction in psychotic and depressive symptoms; secondary outcomes comprise adherence, awareness, use of drugs, and quality of life. Data will be analyzed on an intention-to-treat (ITT) basis. Mixed model repeated-measures analysis will be used to explore the following effect: group × time interaction between the control group and the intervention group for clinical and functional variables during the follow-up period. Discussion: This is an innovative study for the assessment of a psychological intervention through a mobile app for patients with FEP during the critical period. This pilot RCT is intended to be a precursor to larger studies, which in turn could facilitate dissemination of mobile app therapy for patients with FEP. Ethics and Dissemination: The local ethics committee approved the study protocol. All participants must sign the informed consent, to participate. After finalizing the study, the results will be published. Trial registration: NCT03161249. NCT clinicaltrials.gov. Date of registration in primary registry 02 May 2017. clinicaltrials.gov.

What might get in the way: Barriers to the use of apps for depression.

OBJECTIVE: Smartphones are being used with increasing frequency to deliver behavioral interventions for depression via apps. However, barriers specific to using an app for depression are poorly defined. The purpose of the current study is to identify barriers to the use of a mobile app to deliver treatment for depression. Secondarily, design implications will be provided based upon identified barriers. METHOD: A card sorting task that ranked and grouped barriers to the use of apps for depression was completed. Participants first completed a card sorting task identifying barriers to face-to-face treatment, as a primer to identification of treatment barriers. The sample consisted of those above (n = 9) and below (n = 11) the threshold for a referral to psychotherapy, to capture anticipated barriers for likely end users. Cluster analyses were conducted to analyze the card sorting data. Multiple analyses were conducted to identify: 1) the most important barriers, and 2) how consistently barriers were ranked as important. RESULT: The card sorting task identified a number of primary barriers to the use of apps for depression treatment, including concerns over intervention efficacy, app functioning, privacy, cost, and lack of guidance and tailored feedback. The top face-to-face treatment barrier was cost, overlapping with mobile barriers. CONCLUSION: This study identified perceived barriers to the use of mobile treatment apps. Identification of barriers implicates design recommendations for apps for depression.

Extended-release naltrexone for pre-release prisoners: A randomized trial of medical mobile treatment.

BACKGROUND: Extended-release naltrexone (XR-NTX), is an effective treatment for opioid use disorder but is rarely initiated in US prisons or with criminal justice populations. Mobile treatment for chronic diseases has been implemented in a variety of settings. Mobile treatment may provide an opportunity to expand outreach to parolees to surmount barriers to traditional clinic treatment. METHODS: Male and female prisoners (240) with pre-incarceration histories of opioid use disorder who are within one month of release from prison will be enrolled in this randomized clinical trial. Participants are randomized to one of two study arms: 1) [XR-NTX-OTx] One injection of long-acting naltrexone in prison, followed by 6 monthly injections post-release at a community opioid treatment program; or 2) [XR-NTX+ MMTx] One injection of long-acting naltrexone in prison followed by 6 monthly injections post-release at the patient's place of residence utilizing mobile medical treatment. The primary outcomes are: treatment adherence; opioid use; criminal activity; re-arrest; reincarceration; and HIV risk-behaviors. RESULTS: We describe the background and rationale for the study, its aims, hypotheses, and study design. CONCLUSIONS: The use of long-acting injectable naltrexone may be a promising form of treatment for pre-release prisoners. Finally, as many individuals in the criminal justice system drop out of treatment, this study will assess whether treatment at their place of residence will improve adherence and positively affect treatment outcomes. ClinicalTrials.gov: NCT02867124.

Factors enabling women with pelvic organ prolapse to seek surgery at mobile surgical camps in two remote districts in Nepal: a qualitative study

Background: Pelvic organ prolapse (POP) is a major reproductive health problemin Nepal, though many women delay seeking treatment. To address this, theNepalese government has been providing free vaginal hysterectomies with pelvicfloor repair to women in mobile surgical camps. Studies exploring factors thatenable women to attend these camp settings are limited. This study aimed toidentify factors that affected women seeking surgical treatment for POP at mobilesurgical camps.Methods: The study used a qualitative approach. Twenty-one women with POPwere recruited in two week-long mobile surgical camps held in two remote districtsin Nepal during April and May 2013. Data were collected from individual face-toface interviews and were analysed thematically.Results: Three themes and six subthemes emerged from the analysis. The firsttheme, “health-system factors”, suggests that accessibility and affordability ofthe treatment, and the supportive role of female community health volunteersfacilitate women to seek treatment in the camp. The second theme, “factorsrelated to sociocultural norms”, reveals that reaching the end of reproductiveyears and approval by relevant influential family members empowers women totake up surgical treatment in the mobile surgical camp. Similarly, the third theme,“individual-level factors”, includes women’s experience of POP, such as worseningsymptoms and fear of development of cancer, as factors enabling women to seektreatment.Conclusion: Enablers to seeking treatment at mobile surgical camps forwomen are related to the Nepalese health system, sociocultural norms andindividual experiences of women. Each of these factors should be consideredwhen conducting mobile surgical camps, if women’s uptake of treatment is to beenhanced

The application of ExacTrac X-ray image guide system for the therapy of head tumor and quality control / 中华放射肿瘤学杂志

Objective To study the ExacTrac X-ray image guide system for patients with head and neck cancer.Methods Ten patients were chosen foe this study.It was immoblized using the head mask and frame fixtures.The two KV X-ray units were matched with the digitally reconstructed radiographs after positioning with the infrared markers.Then the setup errors on x (horizontal axis),y (vertical axis) and z (up-down) directions and rotation errors were obtained.Paired t-test between any two direction difference errors.Results The setup errors with ExacTrac X-ray image guide system for the patients in x,y,z directions and rotation errors were (0.57 ± 0.24) mm,(0.68 ± 0.19) mm,(1.54 ± 0.29) mm,(0.54 ±0.13) °,(0.60 ± 0.23) °,(0.51 ± 0.15) °.The z-axis direction have slightly larger error (P =0.02,0.01).The others have not statistical significance (P =0.06,0.10-0.41).Conclusions To use ExacTrac X-ray image guide system cooperating with the six degree of freedom treatment couch in image guided radiotherapy for is feasible,the motion errors ＜ 2 mm,the rotation errors ＜ 2°.Reduced of the setup errors with replace the sphere or to reduce pollution of the sphere,improve the accuracy,it could provide a better quality assurance in radiation therapy.