Leveraging the Full Continuum of Care to Prevent Opioid Use Disorder

Substance use disorder prevention programs are most effective when matched appropriately to the baseline risk of the population. Individuals who misuse opioids often have unique risk profiles different from those who use other substances such as alcohol or cannabis. However, most substance use prevention programs are geared toward universal audiences, neglecting key inflection points along the continuum of care. The HEAL Prevention Cooperative (HPC) is a unique cohort of research projects that represents a continuum of care, from community-level universal prevention to indicated prevention among older adolescents and young adults who are currently misusing opioids or other substances. This paper describes the theoretical basis for addressing opioid misuse and opioid use disorder across the prevention continuum, using examples from research projects in the HPC.

The "Women and Trauma" study and its national impact on advancing trauma specific approaches in community substance use treatment and research

INTRODUCTION

The "Women and Trauma" Study (WTS) conducted in the National Drug Abuse Treatment Clinical Trials Network (CTN-0015) resulted in research publications, presentations, and a train-the-trainer workshop to support dissemination efforts for skills-based trauma treatment in substance use community treatment. Twelve years after its completion, this paper aims to examine whether and how the WTS contributed to knowledge in the field of trauma and addictions and inspired community treatment programs (CTPs) to train staff to identify and provide trauma-related services.

METHOD

We present findings from two different analyses that explored longer term study impacts on treatment and dissemination: (1) a post-study site survey covering 4 domains from 4/7 programs that participated in delivering the WTS to evaluate their perceptions of study impact on their treatment community; and (2) an analysis of citations of its publications to determine impact on the scientific community.

RESULTS

Surveys from responding sites indicated that participation in the study significantly increased their agencies'' awareness of the need to take a focused approach to treating trauma issues in this population. Specifically, these sites increased their commitment to using skills-based trauma treatment with the study's target population of female patients with SUD and trauma histories, as well as expanding it to other groups affected by trauma. Citation analysis revealed that according to the Web of Science, as of August 2019, the number of citations of 24 CTN-0015 articles, ranged from 1 to 135 (Mean = 20, SD = 33; Median = 6). Four of the most influential are discussed.

CONCLUSIONS

This manuscript provides original information about the contributions of the WTS study, demonstrating how the study contributed to serving women with trauma in community substance use treatment.

Environmental refuges increase performance of juvenile mussels Mytilus chilensis: Implications for mussel seedling and farming strategies

Estuarine ecosystems are characterized by a wide physical-chemical variation that in the context of global change scenarios may be exacerbated in the future. The fitness of resident organisms is expected to be influenced by such variation and, hence, its study is a priority. Some of that variation relates to water vertical stratification, which may create "environmental refuges" or distinct layers of water with conditions favoring the fitness of some individuals and species. This study explored the performance of juvenile mussels (M. chilensis) settled in two distinctive water depths (1 m and 4 m) of the Reloncaví fjord (southern Chile) by conducting a reciprocal transplants experiment. Salinity, saturation state and the contents of CO₃ in seawater were among the factors that best explained the differences between the two layers. In such environmental conditions, the mussel traits that responded to such variation were growth and calcification rates, with significantly higher values at 4 m deep, whereas the opposite, increased metabolic stress, was higher in mussels raised and transplanted to the surface waters (1 m). Such differences support the notion of an environmental refuge, where species like mussels can find better growth conditions and achieve higher performance levels. These results are relevant considering the importance of M. chilensis as a shellfish resource for aquaculture and a habitat forming species. In addition, these results shed light on the variable responses exhibited by estuarine organisms to small-scale changes in the characteristics of the water column, which in turn will help to better understand the responses of the organisms to the projected scenarios of climate global change.

Metagenomics-based approach for studying and selecting bioprotective strains from the bacterial community of artisanal cheeses

A metagenome-based approach was used to assess the taxonomic affiliation and functional potential for bacteriocin production of the bacterial community in cow's milk artisanal cheeses from Northwestern Argentina. Three different samples were analyzed by high-throughput sequencing of the V4 region of the 16S rRNA gene and shotgun metagenomics. Taxonomic analysis showed that cheese A and C were quite similar whereas cheese B displayed a rather different bacterial composition. Overall, two families, Streptococceae and Enterococceae, dominated the artisanal cheese microbiota, being the former family prevalent in cheese B and the later family the most important in samples A and C. Besides the usual species associated to cheeses, a number of bacterial taxa that have not been previously found in Argentinean artisanal cheeses were reported in the present work such as Macrococcus caseolyticus and Streptococcus macedonicus Functional metagenomics analysis using the bacteriocin mining software BAGEL3, identified 2 ORFs encoding antimicrobial peptides in cheese B and 42 different peptides in sample C. The bacteriocin genes found showed good correlation with taxonomy. Based on the microbial diversity and functional features found through shotgun metagenomic sequencing, a culture-dependent approach was applied aiming to isolate bacteriocin-producing bacteria able to inhibit the growth of the foodborne pathogen Listeria monocytogenes. From 151 bacterial colonies derived from the cheese samples, 10 were associated to high anti-Listeria activity. Based on partial 16S rRNA gene sequencing and RAPD-PCR analysis, all bacteriocinogenic isolates were identified as Enterococcus faecium. Finally, we carried out a pilot experiment with L. monocytogenes-contaminated cheese using one of the enterococcal isolates as a bioprotective adjunct culture. The use of E. faecium CRL1879 during artisanal cheese manufacturing did not alter the main organoleptic properties of the cheese and ensured an efficient control of the foodborne pathogen up to 30 days. This finding supports the use of E. faecium CRL1879 as an adjunct culture in the cheese-making process with a combination of both safety and minimal processing.

New immunobiotics from highly proteolytic Lactobacillus delbrueckii strains: their impact on intestinal antiviral innate immune response

Proteolytic starter cultures with intrinsic immunomodulatory activities are desirably features for the development of functional foods, which would significantly reduce the cost of their production (one-strain starter) having an additional beneficial effect on the host. In this work, Lactobacillus delbrueckii strains were selected according to their ability to efficiently hydrolyse β-casein and to modulate the immune system. Among 36 strains evaluated, the highest proteolytic activities were found for L. delbrueckii subsp. lactis CRL581 and L. delbrueckii subsp. bulgaricus CRL656. The immunomodulatory effect of both strains and their β-casein hydrolysates (CRL581 and CRL656 hydrolysates, respectively) were studied in a murine model. Balb/c mice were fed lactobacilli or their hydrolysates for three days. One day after the last lactobacilli or hydrolysate treatments, mice were challenged with the Toll-like receptor 3 (TLR3) agonist poly(I:C) by intraperitoneal injection. Before and after poly(I:C) challenge the phagocytic and microbicidal activity of peritoneal macrophages, intestinal immunoglobulin A (IgA), cytokine profile, and histological analysis of the intestine were analysed. L. delbrueckii subsp. lactis CRL581 significantly increased the activation of peritoneal macrophages as well as the levels of intestinal IgA, interleukin (IL)-10 and interferon (IFN)-γ when compared to untreated controls. In addition, the CRL581 strain was able to significantly reduce the intestinal inflammatory damage triggered by TLR3 activation. L. delbrueckii CRL581 increased the levels of IL-10, IFN-γ and IFN-β, and reduced tumour necrosis factor alpha and IL-6 concentrations in the intestine of poly(I:C)-challenged mice. No immunomodulatory effects were observed for the CRL656 strain or for the CRL581 or CRL656 hydrolysates. The results of this work show that the technologically relevant and high proteolytic strain L. delbrueckii CRL581 is able to beneficially modulate the intestinal innate antiviral immune response. Although further studies with the CRL581 strain are required to corroborate and deepen its immunological effects, this bacterium is an interesting alternative for the development of new functional foods with antiviral capabilities.

Oral administration of Lactobacillus fermentum CRL1446 improves biomarkers of metabolic syndrome in mice fed a high-fat diet supplemented with wheat bran

This work evaluated the effect of oral administration of Lactobacillus fermentum CRL1446, feruloyl esterase producing, on metabolic biomarkers and intestinal microbiota of high fat diet-induced metabolic syndrome mice and supplemented with wheat bran.

Trajectories and predictors of response in youth anxiety CBT: Integrative data analysis

OBJECTIVE

Integrative data analysis was used to combine existing data from nine trials of cognitive-behavioral therapy (CBT) for anxious youth (N = 832) and identify trajectories of symptom change and predictors of trajectories.

METHOD

Youth- and parent-reported anxiety symptoms were combined using item-response theory models. Growth mixture modeling assessed for trajectories of treatment response across pre-, mid-, and posttreatment and 1-year follow-up. Pretreatment client demographic and clinical traits and treatment modality (individual- and family-based CBT) were examined as predictors of trajectory classes.

RESULTS

Growth mixture modeling supported three trajectory classes based on parent-reported symptoms: steady responders, rapid responders, and delayed improvement. A 4-class model was supported for youth-reported symptoms: steady responders, rapid responders, delayed improvement, and low-symptom responders. Delayed improvement classes were predicted by higher number of diagnoses (parent and youth report). Receiving family CBT predicted membership in the delayed improvement class compared to all other classes and membership in the steady responder class compared with rapid responders (youth report). Rapid responders were predicted by older age (parent report) and higher number of diagnoses (parent report). Low-symptom responders were more likely to be male (youth report).

CONCLUSIONS

Integrative data analysis identified distinct patterns of symptom change. Diagnostic complexity, age, gender, and treatment modality differentiated response classes. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Compatibility and safety of five lectin-binding putative probiotic strains for the development of a multi-strain protective culture for poultry

The ban on the use of antibiotics as feed additives for animal growth promotion in the European Union and United States and the expectation of this trend to further expand to other countries in the short term have prompted a surge in probiotic research. Multi-species probiotics including safe and compatible strains with the ability to bind different nutritional lectins with detrimental effects on poultry nutrition could replace antibiotics as feed additives. Lactobacillus salivarius LET201, Lactobacillus reuteri LET210, Enterococcus faecium LET301, Propionibacterium acidipropionici LET103 and Bifidobacterium infantis CRL1395 have proved to be compatible as evaluated through three different approaches: the production and excretion of antimicrobial compounds, growth inhibition by competition for essential nutrients and physical contact, and a combination of both. The safety of P. acidipropionici LET103 was confirmed, since no expression of virulence factors or antibiotic resistance was detected. The innocuity of E. faecium LET301 should be further evaluated, since the presence of genes coding for certain virulence factors (gelE, efaAfm and efaAfs) was observed, albeit no expression of gelE was previously detected for this strain and there are no reports of involvement of efaAfm in animal pathogenicity. Finally, a combination of the five strains effectively protected intestinal epithelial cells of broilers from the cytotoxicity of mixtures of soybean agglutinin, wheat germ agglutinin and concanavalin A. To our knowledge, this is the first time that a combination of strains is evaluated for their protection against lectins that might be simultaneously present in poultry feeds.

Maximizing Effectiveness Trials in PTSD and SUD Through Secondary Analysis: Benefits and Limitations Using the National Institute on Drug Abuse Clinical Trials Network "Women and Trauma" Study as a Case Example

Recent federal legislation and a renewed focus on integrative care models underscore the need for economical, effective, and science-based behavioral health care treatment. As such, maximizing the impact and reach of treatment research is of great concern. Behavioral health issues, including the frequent co-occurrence of substance use disorders (SUD) and posttraumatic stress disorder (PTSD), are often complex, with a myriad of factors contributing to the success of interventions. Although treatment guides for comorbid SUD/PTSD exist, most patients continue to suffer symptoms following the prescribed treatment course. Further, the study of efficacious treatments has been hampered by methodological challenges (e.g., overreliance on "superiority" designs (i.e., designs structured to test whether or not one treatment statistically surpasses another in terms of effect sizes) and short term interventions). Secondary analyses of randomized controlled clinical trials offer potential benefits to enhance understanding of findings and increase the personalization of treatment. This paper offers a description of the limits of randomized controlled trials as related to SUD/PTSD populations, highlights the benefits and potential pitfalls of secondary analytic techniques, and uses a case example of one of the largest effectiveness trials of behavioral treatment for co-occurring SUD/PTSD conducted within the National Drug Abuse Treatment Clinical Trials Network (NIDA CTN) and producing 19 publications. The paper concludes with implications of this secondary analytic approach to improve addiction researchers' ability to identify best practices for community-based treatment of these disorders. Innovative methods are needed to maximize the benefits of clinical studies and better support SUD/PTSD treatment options for both specialty and non-specialty healthcare settings. Moving forward, planning for and description of secondary analyses in randomized trials should be given equal consideration and care to the primary outcome analysis.

Combined effect of synthetic enterocin CRL35 with cell wall, membrane-acting antibiotics and muranolytic enzymes against Listeria cells

AIMS

To evaluate the inhibition effectiveness of enterocin CRL35 in combination with cell wall, membrane-acting antibiotics and muranolytic enzymes against the foodborne pathogen Listeria.

METHODS AND RESULTS

Synthetic enterocin CRL35 alone and in combination with monensin, bacitracin, gramicidin, mutanolysin and lysozyme were used in this study. Minimal inhibitory concentration (MIC) and fractional inhibitory concentration (FIC) index assays were performed using Listeria innocua 7 and Listeria monocytogenes FBUNT as sensitive strains. Antibiotics showed positive interactions with the bacteriocin in both strains tested. On the other hand, when mutanolysin and enterocin CRL35 were added to resting cells in a buffer system, the lytic effect of mutanolysin was enhanced. However, the addition of mutanolysin showed no effect on the growth of L. innocua 7 cells in a culture medium. Moreover, mutanolysin allowed the overgrowth of L. innocua 7 cells to an OD similar to control cells in the presence of inhibitory concentration of enterocin CRL35. In contrast, the combination of lysozyme and enterocin CRL35 resulted in a 50% inhibition of the L. innocua 7 growth.

CONCLUSIONS

Based on our results, we conclude that the combination of synthetic enterocin CRL35 with some antibiotics is effective against L. innocua 7 and L. monocytogenes FBUNT cells, and more importantly the amount of these agents to be used was considerably reduced. The effectiveness of the combination of synthetic enterocin CRL35 with muramidases seems to depend on complex environments, and more detailed studies need to be performed to elucidate this issue.

SIGNIFICANCE AND IMPACT OF THE STUDY

Enterocin CRL35 represents a promising agent that not only can ensure the quality and safety of food but it can also be combined with several antimicrobial agents important in the medical field.

Determination of clozapine in serum of patients with schizophrenia as a measurement of medication compliance

Abstract Although antipsychotic drugs have been effective in reducing symptoms of schizophrenia, issues with adherence to these agents continue to be a barrier to the implementation and delivery of a successful treatment plan. An estimated 25% of patients with schizophrenia are partially adherent or non-adherent within 7-10 days of beginning therapy. There are some ways to evaluate the pharmacotherapy adherence of the patients: evaluation of the disease symptoms and/or the side effects of the drugs, questionnaires to evaluate quality of life, patient attitude toward his (her) drugs and pill counts. Although these methods represent a good option, they are subjective; for example, if the patients lie this leads to false results. Drug monitoring of patients' biological fluids can be a useful tool to evaluate adherence by relating the serum or plasma levels of drugs with pharmacotherapy compliance. The aim of this study was to determine if serum clozapine levels are a suitable method for evaluating patient adherence to clozapine therapy. Clozapine concentration was determined in serum of 26 volunteer patients who were using this drug as pharmacotheraphy for 6 months to 5 years (steady state conditions at 7-10 days of treatment with the drug). The analysis was done for 6 months, with three samples taken for each patient during this time, relating clozapine serum concentration of lower than therapeutic range with pharmacotherapy non-adherence of patients. Moreover, we compared the evaluation of the pharmacotherapy adherence from serum levels of the drug, with the evaluation of the pharmacotherapy adherence from an indirect tool to evaluate symptoms of disease. Twelve patients were found non-adherent by clozapine serum concentration (46.15%), whereas eight patients were found non-adherent using clinician questionnaire (30.76%). After to evaluate some factors (cigarettes, co-medication, inter-individual variability) that could give different results of adherence from evaluation of serum concentrations and from indirect methods, we can conclude that the clozapine serum concentration is a more objective method of evaluating pharmacotherapy adherence of patients receiving this drug.

Development of a frit-free SPE-based in-column preconcentration system for capillary electrophoresis

An in-capillary sample preconcentration strategy based on solid phase extraction (SPE) technology coupled with capillary electrophoresis (CE) has been developed taking advantage of both techniques (SPE and CE). An in-line frit-free preconcentration device for capillary electrophoresis containing MCX beads, obtained from the corresponding Waters OASIS cartridges, was prepared. The retention of the particles was based on the relative diameters of the particles, carefully selected, and the capillaries. An experimental preconcentration factor of 100 was found for the system. Conditions were optimised for 3-nitrotyrosine measurement in rat urine being 4.4 microM spiked in the urine the lowest value detectable.

Chromatography-based on- and in-line pre-concentration methods in capillary electrophoresis

Capillary electrophoresis (CE) poses unique challenges in many different analytical applications, mainly to biological and complex samples and when only small amounts of sample are available, due to its low sample consumption. As a consequence, poor limits of detection are usually observed with this technique, especially with UV photodetectors. Minimal or no sample treatment is desirable in any analytical method to avoid external sources of contamination or errors and to provide a high throughput. On- and in-capillary sample pre-concentration strategies, based on solid-phase extraction (SPE) technology can take advantage of both techniques (SPE and CE), while avoiding sample contamination and tedious manipulations when the sample amount is an issue. Moreover, the combination can provide two-dimensional separations. This review collects the most recent strategies that merge SPE technology built on- and in-capillary pre-concentration for increasing sensitivity and/or selectivity.

Prevalence and risk factors for gallstone disease

Gallstone disease is a main public health problem. The overall prevalence data range from 3.9% in the pre-echographic era to 13.7% when ultrasonography was used as a diagnostic tool. This study is aimed to determine the prevalence of gallstone disease in a medium income level population in Lima, as well as the relationship with some risk factors: age, sex, familiar history and obesity. A total of 534 adult men and women from a medium economic level underwent ultrasonographic examination of abdomen for detection of gallstone disease (July 2003). The echographic evaluation was performed by 10 general surgeons trained in ultrasonography. Likewise, 4 risk factors--age, gender, familial history, and obesity--were analyzed. Pearson chi2 test (2-sided) was used with a probability of <0.05 for statistical significance and logistic regression analyses for assessment of confounding factors. The prevalence founded was 15%. Eighty-one of 534 participants had lithiasis. Compared to the age group under 30, the odds ratio for the 31 to 50 years and >50 years of age group was 0.9 and 1.1, respectively. The female-male ratio was 1.07 and the odds ratio 0.8. The prevalence of gallstone disease in people reporting a first-degree relative with lithiasis was 21%, whereas in participants without such a condition, it was 13%. On the other hand, a familial history was present in 38% of the lithiasis group and in 25% of the nonlithiasis group. The odds ratio for familial history was 1.8 (P = 0.01, 95% confidence interval 1.1-2.9). The prevalence of the disease for body mass index <24, 25 to 29, and higher than 30 was 17%, 14% and 13%, respectively. Compared to the reference group (body mass index <24), the other 2 groups (body mass index 25-29 and >30) both had a similar odds ratio, 0.8. Logistic regression analyses showed an odds ratio of 1.9 for familiar history (95% confidence interval 1.1-3.2), whereas the odds ratio of the overweight (body mass index 25-29) and obese group (body mass index >30) when compared to the normal group, BMI <24, was 0.7 and 0.9, respectively. The prevalence data for gallstone disease remain slightly higher than those previously reported. Although the familiar history was the only characteristic with a statistically significant positive relationship with lithiasis, additional studies are needed because few biases could not be completely avoided and some confounding factors were not controlled.

Urinary analysis of nephrolithiasis markers

Renal stone disease is an ancient and common affliction, common in industrialised nations. The causes and incidence of nephrolithiasis are presented. Afterwards, the promoters and inhibitors of renal stone formation analysis in urine are described including enzymatic methods, chromatography, capillary electrophoresis and other techniques. Aspects such as sample collection and storage are also included. The review article includes referenced tables that provide summaries of methodology for the analysis of nephrolithiasis related compounds.

Optimization of the separation lactic acid enantiomers in body fluids by capillary electrophoresis

The optimization of the separation conditions of the two optical isomers of lactic acid by a factorial design is reported. Initially, different chiral selectors were systematically investigated and then a experimental design with three quantitative factors (cyclodextrin concentration and background buffer pH and concentration) were evaluated. Optimal conditions for obtaining a resolution higher than 1.5 were: phosphate buffer 200 mM at pH=6.0 with 413 mM 2-hydroxypropyl-beta-cyclodextrin added (HP-beta-CD), 20 degrees C, -20 kV of applied potential and polyacrylamide-coated capillary. The method was validated for the measurement in plasma and it was applied to the identification of both isomers in body fluids such as urine, amniotic fluid and cerebrospinal fluid. Samples were centrifuged and diluted (1:4) prior to the analysis.

Capillary electrophoresis for evaluating orange juice authenticity: a study on Spanish oranges

Fruit juices have very distinct organic acid profiles that can be used as fingerprints for establishing possible adulteration. Recently, our group developed and validated a capillary electrophoresis method using UV detection for determining citric, isocitric, tartaric, and malic acids in natural and commercial orange juices. Sample treatment consisted of only dilution and centrifugation or filtration. This method has been applied to evaluate these acids and their ratios in 63 samples of Navelina, the most common variety of Spanish oranges, over a three month period. This evaluation has been conducted to establish ranges of acid concentrations and to compare them with those found in commercial juices. The more reliable parameter, because of the lower variability in fresh samples, was found to be the citrate/isocitrate ratio with a value of 113 (RSD = 10%). Only one of nine ramdonly selected commercial juices presented values within the range of those of the population of just-pressed Navelina orange juice. Moreover, three of them had measurable tartrate values, which is not a natural component of orange juice, showing mixtures with cheaper fruits.

Vaginal bacterial microflora modifications during the growth of healthy cows

The aim of this work was first, to determine the predominant groups capable of colonizing the vagina and maintaining high numbers with time. The normal microbial flora of the cow's vagina and its evolution from weaning to service was then studied using standard microbiological methods. The results show that the most dominant bacteria belong to the streptococci, followed by the staphylococci, with similar levels during the whole study period. Enterobacteriaceae and lactobacilli were present at very low levels, the latter increasing during the cow's growth, suggesting some kind of hormonal influence. The results will allow the selection of micro-organisms with probiotic characteristics, classified as GRAS (Generally Regarded as Safe), to be used in the prevention of infections in the vaginal tract of cows, such as metritis, which produces delayed periods between partum and conception, and consequent economic losses.

Development and validation of a capillary electrophoresis method for direct measurement of isocitric, citric, tartaric and malic acids as adulteration markers in orange juice

Fruit juices each have very distinct organic acids profiles that can be used as fingerprints for establishing authenticity. A method has been developed, optimised and validated for measuring by capillary electrophoresis citric, isocitric, malic and tartaric acids as authenticity markers in orange juices, without any sample treatment other than dilution and filtration. Final conditions were phosphate buffer 200 mM, pH 7.50, -14 kV as applied potential, and 57 cm length neutral capillary. Detection was direct UV at 200 nm. Different kinds and marks of orange juice, chosen from the great variety existent in the market, were analysed and clear differences could be found between them and just pressed orange juice.

Optimization and validation of a method for the determination of caffeine, 8-chlorotheophylline and diphenhydramine by isocratic high-performance liquid chromatography. Stress test for stability evaluation

The optimization of a HPLC method for caffeine, 8-chlorotheophylline and diphenhydramine separation with UV detection at 229 nm is described. The conditions studied included: stationary phase, compositions of mobile phases with pH modulators. Optimal conditions were: SymmetryShield RP8 column and acetonitrile-(0.01 M H3PO4-triethylamine, pH 2.8) (22:78, v/v). Validation was performed using standards and a pharmaceutical preparation containing the compounds described above. Results from both standards and samples show suitable validation parameters. The pharmaceutical grade substances were tested by factors that could influence the chemical stability. These reaction mixtures were analyzed to evaluate the capability of the method to separate degradation products. Degradation products did not interfere with the determination of the substances tested by the assay.