Assessment of the impact of an opioid-specific education series on rates of medication-assisted treatment for opioid use disorder in veterans

PURPOSE

The impact of a focused inpatient educational intervention on rates of medication-assisted therapy (MAT) for veterans with opioid use disorder (OUD) was evaluated.

METHODS

A retrospective cohort analysis compared rates of MAT, along with rates of OUD-related emergency department (ED) visits and/or hospital admission within 1 year, between veterans with a diagnosis of OUD who completed inpatient rehabilitation prior to implementation of a series of group sessions designed to engage intrinsic motivation to change behavior surrounding opioid abuse and provide education about MAT (the control group) and those who completed rehabilitation after implementation of the education program (the intervention group). A post hoc, multivariate analysis was performed to evaluate possible predictors of MAT use and ED and/or hospital readmission, including completion of the opioid series, gender, age (>45 years), race, and specific prior substance(s) of abuse.

RESULTS

One hundred fifty-eight patients were included: 95 in the control group and 63 in the intervention group. Rates of MAT were 25% (24 of 95 veterans) and 75% (47 of 63 veterans) in control and intervention groups, respectively (P < 0.01). Gender, completion of the opioid series, prior heroin use, and marijuana use met prespecified significance criteria for inclusion in multivariate regression modeling of association with MAT utilization, with participation in the opioid series (odds ratio [OR], 9.56; 95% confidence interval [CI], 4.36-20.96) and prior heroin use (OR, 3.26; 95% CI, 1.18-9.01) found to be significant predictors of MAT utilization on multivariate analysis. Opioid series participation and MAT use were independently associated with decreased rates of OUD-related ED visits and/or hospital admission (hazard ratios of 0.16 [95% CI, 0.06-0.44] and 0.32 [95% CI, 0.14-0.77], respectively) within 1 year after rehabilitation completion.

CONCLUSION

Focused OUD-related education in a substance abuse program for veterans with OUD increased rates of MAT and was associated with a decrease in OUD-related ED visits and/or hospital admission within 1 year.

Development and validation of a typology of criminal defendants admitted for inpatient competency restoration: A latent class analysis

OBJECTIVE

To develop a typology of criminal defendants found incompetent to stand trial using data-driven classification techniques and validate it against forensically relevant outcomes.

HYPOTHESES

We hypothesized that discrete groups of defendants determined to be incompetent exist that can be identified in the structure of observed clinical, demographic, and criminological data. We also expected that class membership would be differentially associated with competency restoration.

METHOD

We coded hospital records for 492 consecutive male criminal defendants committed to a secure hospital for competency restoration between 2013 and 2017 (mean [M] age = 38.7 years, standard deviation [SD] = 14.2; 61.0% White, 34.2% Black, 2.6% Hispanic, 2.2% "Other"). Clinical, demographic, and criminological data were analyzed using latent class analysis. Validation analyses modeled competency restoration outcomes as a function of class membership.

RESULTS

An 8-class solution best fit the data and included 3 discrete classes of patients with psychotic disorders (Class 2, n = 74; Class 3, n = 78; Class 6, n = 68), as well as classes characterized by intellectual limitations without comorbid psychosis (Class 4, n = 54), comorbid psychosis and intellectual limitations (Class 1, n = 41), mood disorders (Class 5, n = 80), older adults with neurocognitive disorders (Class 8, n = 59), and chronic instability (Class 7, n = 38). The restoration rate in the overall sample was 87.8%, and Classes 1-7 showed restoration rates similar to the overall sample, ranging from 82.9% to 100%. The restoration rate of Class 8 was 66.1%, and this was the only class to show significantly lower odds (odds ratio [OR] = 0.181, 95% confidence interval [CI: 0.093, 0.353], p < .001) and hazards (hazard ratio [HR] = 0.511, 95% CI [0.361, 0.724], p < .001) of restoration.

CONCLUSION

Older adults with neurocognitive disorders admitted for competency restoration are at increased risk of failed restoration. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Noninvasive In-Situ Measurement of Blood Lactate Using Microwave Sensors

GOAL

This paper reports a novel electromagnetic sensor technique for real-time noninvasive monitoring of blood lactate in human subjects.

METHODS

The technique was demonstrated on 34 participants who undertook a cycling regime, with rest period before and after, to produce a rising and falling lactate response curve. Sensors attached to the arm and legs of participants gathered spectral data, blood samples were measured using a Lactate Pro V2; temperature and heart rate data was also collected.

RESULTS

Pointwise mutual information and neural networks are used to produce a predictive model. The model shows a good correlation between the standard invasive and novel noninvasive electromagnetic wave based blood lactate measurements, with an error of 13.4% in the range of 0-12 mmol/L.

CONCLUSION

The work demonstrates that electromagnetic wave sensors are capable of determining blood lactate level without the need for invasive blood sampling.

SIGNIFICANCE

Measurement of blood metabolites, such as blood lactate, in real-time and noninvasively in hospital environments will reduce the risk of infection, increase the frequency of measurement and ensure timely intervention only when necessary. In sports, such tools will enhance training of athletes, and enable more effecting training regimes to be prescribed.

A retrospective chart review of a symptom-triggered alcohol withdrawal protocol versus previous standard of care at a veterans hospital

Alcohol is a commonly abused substance, and it is important that healthcare facilities properly manage alcohol withdrawal. Studies have found that the most efficient way to manage alcohol withdrawal is to use a symptom-triggered approach and only administer medications if symptoms surpass a specific threshold determined by a clinician administered rating scale. Alternatively, a standard fixed-dose medication regimen can be utilized. This study assessed if a new symptom-triggered protocol, utilizing the Clinical Institute Withdrawal for Alcohol, Revised (CIWA-Ar) scale for the assessment of symptoms, resulted in the anticipated patient outcomes of decreased length of hospital stay, less benzodiazepine administered per patient, and a shorter administration time from first dose of benzodiazepine given to last dose, when compared to the previous standard of care. A retrospective chart review was performed for 70 patients who had been treated for alcohol withdrawal. Patients who were treated with the symptom-triggered protocol had a decreased length of hospital stay when compared to the previous standard of care (−2.62 days, p = 0.0054). Both secondary efficacy outcomes were also statistically significant in favor of the symptom-triggered group. This retrospective chart review adds to the body of evidence supporting the use of symptom-triggered protocols as opposed to fixed-dose protocols in the management of alcohol withdrawal.

A review of atypical antipsychotics and their utility in post-traumatic stress disorder

Post traumatic stress disorder (PTSD) is a chronic and debilitating mental illness. Atypical antipsychotics are often utilized for treatment of PTSD despite the limited data. The purpose of this article is to review published clinical trials of atypical antipsychotics used in the treatment of PTSD. Certain patients may benefit from therapy with an atypical antipsychotic, particularly for those with hyper-arousal or re-experiencing symptom clusters. At this time, guidelines suggest against the use of risperidone as augmentation therapy in patients with PTSD. Data are only available for olanzapine, quetiapine, and aripiprazole; however, data were conflicting, not very robust, and studies had limited sample sizes and narrow demographics. It is important to provide proper patient education and weigh the risks versus benefits of therapy with an atypical antipsychotic as metabolic side effects are well documented.

Psychosocial characteristics of physically abused children and adolescents

OBJECTIVE

To examine the association between physical abuse and selected psychosocial measures in a community-based probability sample of children and adolescents.

METHOD

A sample of 9- through 17-year-olds (N = 665) and their caretakers in New York State and Puerto Rico were interviewed in the Methods for the Epidemiology of Child and Adolescent Mental Disorders (MECA) Study. Assessments included the Columbia Impairment Scale, the Instrumental and Social Competence Scale, the Diagnostic Interview Schedule for Children, the Peabody Picture Vocabulary Test, and questions regarding physical abuse. Regression analyses were conducted controlling for family income, family psychiatric history, perinatal problems, physical health, and sexual abuse.

RESULTS

A history of physical abuse was reported in 172 (25.9%) of the sample. It was significantly associated with global impairment, poor social competence, major depression, conduct disorder, oppositional defiant disorder, agoraphobia, overanxious disorder, and generalized anxiety disorder but not with suicidality, school grades, or receptive language ability.

CONCLUSION

A community probability sample of children and adolescents demonstrated significant associations between physical abuse and psychopathology, after controlling for potential confounders. This supports comprehensive screening for psychopathology among physically abused children and for physical abuse among those with psychopathology. Interventions aimed at improving social competence may be indicated.

Effects of ovine corticotropin-releasing factor and vasopressin on plasma beta-endorphin, cortisol and behavior after minor surgery in sheep

The evidence for an analgesic effect arising from increased peripheral concentrations of beta-endorphin (beta-EP) in various animal species is controversial, and has not been fully evaluated in the sheep. To stimulate beta-EP release, ovine corticotropin-releasing factor (oCRF) and arginine vasopressin (AVP) were injected intravenously (iv) into a group of 12 out of 24 sheep, 15 min prior to minor surgery on all sheep. This brought about significant increases (P less than 0.01) in plasma beta-endorphin (beta-EP) and cortisol concentrations, relative to the non-injected control sheep, 15-30 min after injection. Ultrafiltration indicated that less than 30% of the released beta-EP immunoreactivity was present as higher molecular weight forms (mol. wt greater than 10,000) and that the majority (about 75%) of the beta-EP was probably bound to plasma proteins. By 75 min after injection there was no significant difference in plasma beta-EP or cortisol concentrations between the two groups of sheep. Consistent with previous observations the sheep showed a characteristic aversive behavior to the human handler following surgery, lasting several days. This behavior appeared to be unaffected by a pre-operative increase in peripheral plasma beta-EP, and may indicate that this increase in beta-EP was not sufficiently analgesic to block the cognitive response to the operation, or long-lasting enough to prevent the perception of post-operative soreness.

Effect of myiasis and acute restraint stress on plasma levels of immunoreactive beta-endorphin, adrenocorticotrophin (ACTH) and cortisol in the sheep

Cutaneous myiasis in sheep arising from the activity of Lucilia cuprina larvae can result in significant physiological changes in susceptible animals. The stress imposed on the pituitary-adrenal axis of the sheep in response to myiasis and acute restraint is the subject of this investigation. Merino wethers were exposed to handling restraint, and blood sampling, during examination for blowfly strike; where necessary, they were treated for cutaneous myiasis. Significant changes in the plasma concentrations of immunoreactive beta-endorphin (beta-EP), ACTH and cortisol were found in sheep with extensive myiasis, as compared with unstruck sheep or those with only localized myiasis. In five susceptible sheep with extensive cutaneous myiasis, mean plasma levels of beta-EP, ACTH and cortisol were 307 +/- 71 pg ml-1, 953 +/- 58 pg ml-1 and 232 +/- 46 nmol l-1 respectively, compared with 818 +/- 89 pg ml-1, 641 +/- 41 pg ml-1 and 107 +/- 17 nmol l-1 in six unstruck sheep handled similarly. Whereas significant increases in plasma ACTH and cortisol can result from pituitary-adrenal responses to acute emotional or surgical stress, and are usually accompanied by a concomitant release of beta-EP from the pituitary, the present findings indicate a marked reduction in beta-EP levels and a significant increase in ACTH and cortisol in sheep following blowfly strike and acute handling restraint. This result suggests that cutaneous myiasis in susceptible sheep can alter the pituitary-adrenal response to acute restraint stress, and this could occur either by an alteration of precursor processing in the pituitary or by the selective release of ACTH.

Stress responses in lambs docked and castrated surgically or by the application of rubber rings

A comparative study has been made in lambs 3 to 6 weeks of age of the behavioural responses and changes in plasma immunoreactive beta-endorphin (ir beta-endorphin) and cortisol after docking or docking plus castration by the application of rubber rings or by surgery. The use of rubber rings on lambs at this age was characterised by very agitated behaviour indicative of considerable distress for a period of up to 1 h. In contrast, surgery was accompanied by some post-operative shock exhibited by reduced exploratory and social behaviour, at least in the lambs exposed to docking plus castration. In the latter group there were highly significant increases in both plasma ir beta-endorphin and cortisol concentrations that may be consistent with the induction of stress-induced analgesia. We conclude that surgery caused less distress than the rubber rings, and is therefore preferable for docking and castration of lambs 3 to 6 weeks of age.

Stress-induced Changes in Plasma Concentrations of Immunoreactive ß-Endorphin and Cortisol in Response to Routine Surgical Procedures in Lambs

Following four different surgical procedures in lambs 3-5 weeks old, plasma immunoreactive {3- endorphin ({3-EP) and cortisol were assayed at 15 min and 24 h as determinants of post-operative stress. A threefold increase in mean plasma {3-EP levels occurred 15 min after tail docking, and a maximal eight- to tenfold increase occurred in response to castration and/or mulesing with tail docking. Significant increments in mean plasma cortisol levels followed these surgical procedures with the maximal response 15 min after mulesing plus castration with tail docking. The physiologically active 'free' cortisol in plasma represents about 25% of the cortisol, as measured, and the two are highly correlated. At 24 h, {3-EP levels in all. treated groups were similar to controls, although a small elevation in cortisol levels was still present in the lambs subjected to mulesing. Ultrafiltration of plasma extracts showed that peak {3-EP levels contained about 40% immunoreactivity from low molecular weight species (mol. wt the most potent analgesic endorphin, 10% {3-EP l- 27 , and 15% a-N-acetyl-{3-EP. Increased {3-EPI-31 levels may modulate post-operative pain in lambs.

Western Equine Encephalitis in Saskatchewan Reptiles and Amphibians, 1961-1963

Western equine encephalitis (WEE) antibodies were found in blood samples from garter snakes and leopard frogs collected in Saskatchewan but WEE virus was not recovered from any of the specimens. Evidence of natural WEE infection in snakes was found in 8 different localities while in frogs in two only. Experimentally, garter snakes were readily infected and developed a high, relatively sustained viremia without signs of disease. After experimental exposure, viremia persisted regularly for 10 to 12 days, while the longest observed duration of viremia was 30 days. Anamnestic responses were elicited in snakes as a result of second inoculations of virus after the antibody levels from first exposures had fallen. Newborn snakes were observed to be more sensitive to infection than adults. The possibility of virus and antibody transmission from infected pregnant garter snakes to their offspring was investigated. Snakes and frogs were both susceptible to infection by the oral route. Two bull snakes collected at Steveville, Alberta, were found to have antibody for St. Louis Encephalitis virus.

Isolation of Western Equine Encephalomyelitis (Wee) Virus From Mosquitoes In Saskatchewan, 1962

Saskatchewan, in the summer of 1962, was the scene of an extensive outbreak of western equine encephalomyelitis (WEE) in horses. The results of mosquito survey work showed Culiseta inornata and Culex tarsalis respectively to be the two most abundant mosquito species during midsummer. These species are those reported to be most commonly associated with outbreaks of WEE. Five hundred and sixty-four pools of mosquitoes were examined for the presence of WEE virus. Six pools, three of C. tarsalis and one each of C. inornata, Aedes flavescens and Aedes dorsalis, yielded WEE virus. Positive mosquitoes were from St. Walburg (C. inornata), Saskatoon (C. tarsalis - two, A. dorsalis - one), Outlook (C. tarsalis) and Kisbey (A. flavescens).

THE EFFECT OF MOLDY WHEAT ON GROWTH, LIVABILITY AND THE INCIDENCE OF MYCOTIC INFECTION IN TURKEY POULTS

Four experiments are reported in which six moldy wheats were incorporated into the rations of turkey poults for a 6-week period.In only one of these did moldy wheat, used as the sole source of cereal grain in the starter, significantly (P < 0.05) lower body weights below those of the control rations.Assays of 40 samples of moldy wheats showed that only two (5 per cent) carried Aspergillus fumigatus, whereas Candida albicans was not found on any of them.Mortality was low in all experiments and could not be attributed to the dietary treatments.Pathological examination of 5 birds from each replicate (600 birds in all) showed that 58 carried minor lesions which were suspected of being mycotic. Isolates from these, which were incubated at 39 to 41 °C., produced some mold growth, but only one bird produced growth of A. fumigatus. None produced growth of C. albicans.

Immunization and Parenteral Chemotherapy for the Control of Cattle Grubs Hypoderma Lineatum

Immunization with two types of warble larvae antigens A and B, the latter treated with tannic acid, and injections of dimethoate, an organic phosphate, were tried for the control of prehypodermic larvae of Hypoderma lineatum De Vill., and H. bovis L., in range calves. In test groups of 20 calves, given intramuscularly, antigen A had no effect, but combined treatment with antigens A and B reduced the number of H. bovis L., larvae by 81 per cent (P<.001), and proved as effective as dimethoate subcutaneously or intramuscularly. H. lineatum De Vill., did not respond to any treatment. Antigen B and dimethoate were free from harmful effects on the host, but antigen A caused anaphylaxis and irritation at the site of injection.

EFFECT OF ESTRADIOL AND TESTOSTERONE INJECTIONS AND THYROIDECTOMY ON WOOL GROWTH IN SHEARLING SHEEP

An experiment was conducted to determine the effect of relatively high doses of estradiol and testosterone, with and without thyroidectomy, on clean wool production and certain endocrine glands of shearling sheep. The administration of 5 milligrams of estradiol intramuscularly at biweekly intervals to sheep with thyroids caused a reduction in the average weight of clean wool (p <.05) and fibre length (p <.01). This treatment produced increases (p <.01) in thyroid, pituitary, and adrenal weights. The administration of estradiol to thyroidectomized ewes reduced the weight of clean wool (p < 05) when compared with the thyroidectomized controls but no such response was observed in wethers. Testosterone administered at levels of 175 milligrams bi-weekly produced no effect on weights of clean wool, in ewes or wethers, but when it was administered to thyroidectomized animals average fibre lengths were decreased (p <.05).

Silica Urolithiasis In Beef Cattle : 3. Chemical and Physical Composition of the Uroliths

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Silica Urolithiasis In Beef Cattle: I. Observation On Its Occurrence

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POLYMORPHUS PARADOXUS SP. NOV. (ACANTHOCEPHALA) PARASITIZING BEAVERS AND MUSKRATS IN ALBERTA, CANADA

A new species of Acanthocephala, Polymorphus paradoxus, is described from beavers (Castor canadensis) and muskrats (Ondatra zibethica) from a lake in Elk Island National Park, Alberta. A species of amphipod in the lake was heavily infected with larval Acanthocephala, although the possible relationship of this infection to that in the beaver and muskrat has not yet been determined. While all other species of Polymorphus have been described from birds, a possible avian host of P. paradoxus has not yet been found.

Incoordination (Cerebellar Ataxia) Among Lambs From Ewes Fed Peavine Silage

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Contagious Ecthyma in Rocky Mountain Sheep

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Studies of Swine Erysipelas. I. Literature Review and Survey of Erysipelothrix Rhusiopathiae Infection in Canada

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Veterinary Service District in Saskatchewan

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