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Study protocol for the Respond to Prevent Study: a multi-state randomized controlled trial to improve provision of naloxone, buprenorphine and nonprescription syringes in community pharmacies
No full textAccess to the opioid antidote naloxone is a critical component of addressing the opioid crisis. Naloxone is a population-level prevention intervention associated with substantial reductions in overdose mortality and reduction of nonfatal overdose. Pharmacies\u27 pivotal role in dispensing medications like buprenorphine for the treatment of opioid use disorder and selling nonprescription syringes places them at the crossroads of opioid access and risk mitigation methods like naloxone provision. Testing ways to optimize pharmacy-based naloxone provision will be key as the country expands the implementation of naloxone through the medical system. In the Respond to Prevent Study, we conducted a large, practical study of a pharmacy-focused intervention in a sample of Washington, Oregon, Massachusetts and New Hampshire community chain pharmacies to increase naloxone dispensing and improve opioid safety. The intervention integrated two evidence-based educational toolkits and streamlined materials to enhance the focus on naloxone policy, stigma reduction, and patient communications around naloxone, nonprescription syringes and buprenorphine access. The real-world study implemented a stepped wedge, clustered randomized trial design across 175 community chain pharmacies to evaluate the effectiveness of the Respond to Prevent intervention in increasing: (a) pharmacy based naloxone distribution rates, naloxone-related patient engagement, and pharmacist and technicians\u27 attitudes, knowledge, perceived behavioral control and self-efficacy toward naloxone; and (b) pharmacy nonprescription syringe sales, and pharmacist and technicians\u27 attitudes, knowledge, perceived behavioral control and self-efficacy toward dispensing buprenorphine for opioid use disorder (secondary outcomes). This commentary provides a brief narrative about the study and presents insights on the design and adaptations to our study protocol, including those adopted during the unprecedented COVID-19 pandemic further compounded by Western wildfires in 2020
Corrigendum to: Generalizing evidence from randomized trials using inverse probability of sampling weights (Journal of the Royal Statistical Society: Series A (Statistics in Society), (2018), 181, 4, (1193-1209), 10.1111/rssa.12357)
No full textRegarding the paper Buchanan, A. L., Hudgens, M. G., Cole, S. R., Mollan, K. R., Sax, P. E., Daar, E. S., … & Mugavero, M. J. (2018). Generalizing evidence from randomized trials using inverse probability of sampling weights. Journal of the Royal Statistical Society. Series A, (Statistics in Society), 181(4), 1193-1209. The expression on page 1196 for the weight for each individual in the cohort should be (Formula presented.). Corrections to online appendix B appear below. Following those corrections, the paragraph on page 1198 should be revised as follows: A comparison of equations (3) and (5) shows that the variance is typically smaller in this setting when the sampling scores are estimated (see the online appendix B). Therefore, even if the correct sampling scores are known, estimation of the sampling scores is often preferable because of improved efficiency. This is analogous to a well-known result for inverse-treatment-weighted estimators (Hirano et al., 2003; Robins et al., 1992; Wooldridge, 2007). These changes do not affect the simulation results in Section 4 or the data analysis in Section 5. We thank Michael Jetsupphasuk, Fan Li, and George Papandonatos for their comments. REVISED APPENDIX B First consider the case when β is known. The asymptotic variance of (Formula presented.) can be expressed as (Formula presented.) where τ = (1,−1) and (Formula presented.). Next consider the case when β is estimated. Let (Formula presented.) and define (Formula presented.) and let (Formula presented.). Then, using block matrix notation note (Formula presented.) where in general (Formula presented.) is a r×c matrix of zeros. It follows that (Formula presented.) where * denotes quantities not expressed explicitly and (Formula presented.) Therefore, (Formula presented.) where (Formula presented.). If (Formula presented.) is semi-positive definite, then (Formula presented.). Below we derive sufficient conditions for this to be the case. Assume as m, n, N→∞ that n/N → Pr[S=1], (m+n)/N → f ∈ (0,1), and m/(N−n) → g ∈ (0,1). Then it is straightforward to show (Formula presented.) and (Formula presented.) Because (Formula presented.) it follows that (Formula presented.) Suppose w = w(Z) \u3c m/N for all Z. That is, the conditional probability for any individual of participating in a trial is less than the probability of participating in a cohort study. Often cohort studies are larger than trials, so this assumption may be reasonable in many settings. It follows that (Formula presented.), implying that (Formula presented.
Untangling media literacy, information literacy, and digital literacy: A systematic meta-review of core concepts in media education
Get PDFThis article presents a systematic meta-review of the scientific literature discussing the concepts of information literacy, media literacy, and digital literacy. While carrying out a cross analysis of the way in which literature reviews specifically address these three concepts, this article identifies, and articulates a critical analysis of, the main findings from the reviewed texts regarding the conceptual landscape that they cover. This work highlights confusion between the constitutive dimensions of literacies, recurrent difficulties in establishing theoretical articulations between contributions, and operationalization problems in observing and assessing these literacies. These issues are the subject of a discussion grounded in the specific field of media education
Evaluating Providers’ Prescription Opioid Instructions to Pediatric Patients
Get PDFReceiving an opioid prescription during childhood increases the risk of hazardous prescription opioid (PO) use during emerging adulthood. Instruction on how to safely use POs plays an essential role in pediatric patients’ capacity to utilize as well as to discontinue POs appropriately. This study aimed to evaluate pediatric PO label instructions provided to a large sample of pediatric outpatients. Data were extracted from the electronic healthcare records system identifying pediatric patients who received a PO between 2016 and 2019 from pediatric outpatient medical clinics were affiliated with a northwestern United States medical center and children’s hospital. Pediatric patients (n = 12,613) between 0–17 years old who received a PO during outpatient care were included. Patients with chronic health conditions (e.g., cancer) or who received their PO from an inpatient medical setting were excluded. Patient demographics, medication instructions, associated diagnoses, and other prescription information (e.g., name of medication, dose, and quantity dispensed) were examined using automated text classification. Many label instructions did not include any indication/reason for use (20.8%). Virtually none of the POs (\u3e99%) included instructions for how to reduce/wean off POs, contact information for questions about the POs, and/or instructions around how to dispose of the POs. Efforts are needed to ensure that pediatric PO instructions contain essential elements to improve comprehension of when and how to use POs for pediatric patients
Anti-inflammatory Activities of Cranberry Fruit Extracts in Human THP-1 Monocytes are Influenced by Their Phytochemical Composition
No full textThe secondary metabolite content of cranberry fruits can vary with cultivar and environmental factors, which may in turn impact their potential biological activities. To evaluate the influence of composition on anti-inflammatory activity, cranberry fruits were collected from two major U.S. growing regions. Eight extracts from these fruits were prepared, analyzed for phytochemical composition, and evaluated for their anti-inflammatory effects in human monocytes (THP-1 cells). The extracts varied widely in polyphenol and triterpenoid content. All were able to reduce lipopolysaccharide (LPS)-induced production of pro-inflammatory cytokine interleukin 6 (IL-6) at 100 μg/mL, with inhibition ranging between 18.8 and 48.8%. Of these, three extracts high in anthocyanins, triterpenoids, or total polyphenols decreased levels of IL-6 and tumor necrosis factor alpha (TNF-α) at concentrations of 0.1-10 μg/mL compared to LPS-exposed control. Several individual cranberry phytochemicals were also capable of reducing production of IL-6, IL-1β, and TNF-α. The data suggest that phytochemicals present in varying quantities in cranberry fruits including anthocyanins, hyperoside, ursolic acid, and corosolic acid play a role in the anti-inflammatory effects of cranberry extracts on human monocytes
Magnetoelectric Polymer Membrane-Based Electrical Microenvironment with Magnetically Controlled Antibacterial Activity
No full textThe hard to clean parts of food processing devices (e.g., the corners of pipes) are difficult to disinfect. This challenge might be overcome through the application of a positive electrical environment. However, the chemical modification of a material surface is complex and difficult. In this work, we developed a smart electroactive TbxDy1-xFe alloy/poly(vinylidene fluoride-trifluoroethylene) (TD/P(VDF-TrFE)) magnetoelectric coating to endow stainless steel with the function of a smart adjustable electrical environment, which was realized by the introduction of a magnetic field of various intensities (0-1800 Oe). An antibacterial assay showed that the polarized coating@stainless steel (P-CS) exhibited antibacterial effects, with the highest antibacterial effect observed at 1800 Oe. Furthermore, in this study, we have, for the first time, explored the antibacterial mechanism of TD/P(VDF-TrFE)-assisted electrical stimulation based on the bacterial intracellular reactive oxygen species (ROS) level, cell respiratory chain, and membrane potential. The results showed that a microelectric field was formed on the P-CS sample in an aqueous solution, which not only generated ROS on the cathode surface but also caused H+ consumption in the electrochemical gradient of the bacterial membrane, leading to OH- production and inhibition of adenosine triphosphate (ATP) synthesis. In addition, the electric field also induced hyperpolarization of the membrane potential in Escherichia coli cells via a K+ efflux, thus inducing rearrangement of the outer membrane. In conclusion, an adjustable surface potential was established through the introduction of magnetoelectric polymer coatings, which endowed stainless steel with magnetically controlled antibacterial effects
Temporal and Spatial Comparison of Pseudo-nitzschia Species Composition and Domoic Acid in Narragansett Bay, Rhode Island and the Northeast U.S. Shelf
Get PDFDiatoms are unicellular algae that make up a significant portion of phytoplankton biomass at the base of marine food webs. Narragansett Bay (NB), RI is home to several species of the diatom genus Pseudo-nitzschia (P-n), some of which are known to cause harmful algal blooms through the production of the potent neurotoxin domoic acid (DA). This toxin can lead to Amnesic Shellfish Poisoning in humans through the consumption of affected shellfish. Although the presence of P-n has been well established in NB for over 50 years, DA levels have only recently become a problem, with shellfish harvest closures in 2016 and 2017. Although there have not been closures in the years since, DA continues to be detected in NB with seasonal peaks observed in the fall and summer (Sterling 2021). One of the hypothesized contributors to this seasonal upregulation in toxin production is fluctuations in species composition due to water input from the Atlantic Ocean, specifically, the New England Shelf (NES), which potentially carries P-n into NB.
The NES LTER cruises occur during the winter and summer each year, sampling a north-south transect from New England to just beyond the NES break. Sampling performed during the 2018-2021 cruises has shown the presence of known toxin producing P-n species and DA presence at some of the stations closest to NB. In order to gain a more comprehensive understanding of the ecological changes leading to P-n blooms and toxin production within NB, species composition at each station was genetically identified, toxin levels were measured, and environmental conditions including temperature and nutrients were analyzed. This data was then compared with samples collected in NB during the same month as LTER cruises to identify temporal and spatial patterns that may influence P-n species composition and DA production