Use of a Telemedicine Bridge Clinic to Engage Patients in Opioid Use Disorder Treatment.

OBJECTIVES: We aimed to assess the feasibility of using a telemedicine bridge clinic model as a low-barrier mechanism to initiate patients on medication treatment for opioid use disorder (MOUD) while facilitating engagement in long-term treatment. METHODS: We established a telemedicine bridge clinic after the U.S. Drug Enforcement Administration temporarily suspended regulations limiting initial treatment of patients with buprenorphine via both audiovisual and audio-only technology during the COVID-19 public health emergency. The rate of engagement in medication treatment for opioid use disorder MOUD based upon review of the Prescription Drug Monitoring Program is described. Referral sources, technology utilization, and payer mix are also presented. RESULTS: The Bridge Clinic scheduled 208 new patient visits and physicians evaluated 200, a show rate of 96% from April 2020 to July 2021. Of the 200 patients who were treated, 192 (96%) were diagnosed with opioid use disorder. Most patients (159/200, 79%) scheduled audio-only visits. At least 1 prescription for buprenorphine was filled by 185/192 (96%) of opioid use disorder patients within 30 days of the telemedicine visit and 147/192 (77%) of patients filled 2 or more prescriptions. Most patients were covered by Medicaid (62%) or were uninsured (19%). There was no significant difference in outcomes for patients evaluated by audio-only vs. audiovisual techniques. CONCLUSION: A Bridge Clinic using audiovisual and audio-only telemedicine served a high-risk, vulnerable population and facilitated engagement in evidence-based MOUD.

A Message from our Sponsor

LISTERINE® Antiseptic Mouthwash was first marketed as an oral antiseptic to dental professionals in 1895, but it wasn't until 1914 that it was sold directly to consumers.2 LISTERINE® has been studied and published in hundreds of peer-reviewed publications spanning back more than a century, beginning with The Journal of Infectious Diseases in 1906.3 In this special issue of the Journal of Dental Hygiene, two long-term (12-week) clinical trials demonstrate the adjunctive benefits of various regimens to twice daily brushing, adding to the large body of evidence on the benefits of LISTERINE® mouthrinse products containing essential oils. Furthermore, brushing and flossing provided no additional plaque reduction compared to brushing only but did provide reductions in gingivitis and gingival bleeding compared to brushing only at 12 weeks.5 The second study included two additional components, dexterity and behavior.6,7 To clarify the role of dexterity on clinical measures of gingivitis, a licensed occupational therapist evaluated study participants' dexterity using a validated test. The research presented in this special issue directly addresses this goal and provides additional data-driven, clinically meaningful evidence to assist dental healthcare providers in recommending plaque and gingivitis control methods as part of their patients' daily oral care routines.

Integrated autolysis, DNA hydrolysis and precipitation enables an improved bioprocess for Q-Griffithsin, a broad-spectrum antiviral and clinical-stage anti-COVID-19 candidate.

Across the biomanufacturing industry, innovations are needed to improve efficiency and flexibility, especially in the face of challenges such as the COVID-19 pandemic. Here we report an improved bioprocess for Q-Griffithsin, a broad-spectrum antiviral currently in clinical trials for COVID-19. Q-Griffithsin is produced at high titer in E. coli and purified to anticipated clinical grade without conventional chromatography or the need for any fixed downstream equipment. The process is thus both low-cost and highly flexible, facilitating low sales prices and agile modifications of production capacity, two key features for pandemic response. The simplicity of this process is enabled by a novel unit operation that integrates cellular autolysis, autohydrolysis of nucleic acids, and contaminant precipitation, giving essentially complete removal of host cell DNA as well as reducing host cell proteins and endotoxin by 3.6 and 2.4 log10 units, respectively. This unit operation can be performed rapidly and in the fermentation vessel, such that Q-GRFT is obtained with 100% yield and > 99.9% purity immediately after fermentation and requires only a flow-through membrane chromatography step for further contaminant removal. Using this operation or variations of it may enable improved bioprocesses for a range of other high-value proteins in E. coli.

Working and learning from home during COVID-19: International experiences among social work educators and students.

This research seeks to explore the experiences of social work educators and students working and learning from home. The findings, from an international survey sample of 166 educators and students, showed that the respondents faced issues with private and personal boundaries, felt the impact of working and learning from home on both physical and emotional levels, and experienced challenges to what was expected of them. The respondents primarily used two types of coping mechanisms to manage these challenges. These findings contribute to a broader discussion of the impact of working and learning from home and are relevant for education administrators responsible for their employees' and students' well-being.

Addressing Self-Care for Students and Field Educators with Mindfulness: A Collaborative Approach to Field Placement

[...]social work organizations are often forced to restructure and demand their social workers carry higher caseloads, leaving less time and emphasis on providing voluntary field supervision (George et al., 2013). In response to these challenges, new models of field education should be proposed that require less time on the part of field educators and community agencies and an increase of tangible benefits to the agency through the provision of field education. The World Health Organization found that 35% of students reported having a mental health disorder, with Major Depressive Disorder and Generalized Anxiety Disorder as the top two mental health disorders (Auerbach et al., 2018). The University at Buffalo’s Health Promotion Office provides free four-session Koru introduction to mindfulness classes for undergraduate and graduate students.

Countries with delayed COVID-19 introduction - characteristics, drivers, gaps, and opportunities.

BACKGROUND: Three months after the first reported cases, COVID-19 had spread to nearly 90% of World Health Organization (WHO) member states and only 24 countries had not reported cases as of 30 March 2020. This analysis aimed to 1) assess characteristics, capability to detect and monitor COVID-19, and disease control measures in these 24 countries, 2) understand potential factors for the reported delayed COVID-19 introduction, and 3) identify gaps and opportunities for outbreak preparedness, particularly in low and middle-income countries (LMICs). We collected and analyzed publicly available information on country characteristics, COVID-19 testing, influenza surveillance, border measures, and preparedness activities in these countries. We also assessed the association between the temporal spread of COVID-19 in all countries with reported cases with globalization indicator and geographic location. RESULTS: Temporal spreading of COVID-19 was strongly associated with countries' globalization indicator and geographic location. Most of the 24 countries with delayed COVID-19 introduction were LMICs; 88% were small island or landlocked developing countries. As of 30 March 2020, only 38% of these countries reported in-country COVID-19 testing capability, and 71% reported conducting influenza surveillance during the past year. All had implemented two or more border measures, (e.g., travel restrictions and border closures) and multiple preparedness activities (e.g., national preparedness plans and school closing). CONCLUSIONS: Limited testing capacity suggests that most of the 24 delayed countries may have lacked the capability to detect and identify cases early through sentinel and case-based surveillance. Low global connectedness, geographic isolation, and border measures were common among these countries and may have contributed to the delayed introduction of COVID-19 into these countries. This paper contributes to identifying opportunities for pandemic preparedness, such as increasing disease detection, surveillance, and international collaborations. As the global situation continues to evolve, it is essential for countries to improve and prioritize their capacities to rapidly prevent, detect, and respond, not only for COVID-19, but also for future outbreaks.

Mitigation Policies and COVID-19-Associated Mortality - 37 European Countries, January 23-June 30, 2020.

As cases and deaths from coronavirus disease 2019 (COVID-19) in Europe rose sharply in late March, most European countries implemented strict mitigation policies, including closure of nonessential businesses and mandatory stay-at-home orders. These policies were largely successful at curbing transmission of SARS-CoV-2, the virus that causes COVID-19 (1), but they came with social and economic costs, including increases in unemployment, interrupted education, social isolation, and related psychosocial outcomes (2,3). A better understanding of when and how these policies were effective is needed. Using data from 37 European countries, the impact of the timing of these mitigation policies on mortality from COVID-19 was evaluated. Linear regression was used to assess the association between policy stringency at an early time point and cumulative mortality per 100,000 persons on June 30. Implementation of policies earlier in the course of the outbreak was associated with lower COVID-19-associated mortality during the subsequent months. An increase by one standard deviation in policy stringency at an early timepoint was associated with 12.5 cumulative fewer deaths per 100,000 on June 30. Countries that implemented stringent policies earlier might have saved several thousand lives relative to those countries that implemented similar policies, but later. Earlier implementation of mitigation policies, even by just a few weeks, might be an important strategy to reduce the number of deaths from COVID-19.

Demographic Characteristics of Persons Vaccinated During the First Month of the COVID-19 Vaccination Program - United States, December 14, 2020-January 14, 2021.

In December 2020, two COVID-19 vaccines (Pfizer-BioNTech and Moderna) were authorized for emergency use in the United States for the prevention of coronavirus disease 2019 (COVID-19).* Because of limited initial vaccine supply, the Advisory Committee on Immunization Practices (ACIP) prioritized vaccination of health care personnel† and residents and staff members of long-term care facilities (LTCF) during the first phase of the U.S. COVID-19 vaccination program (1). Both vaccines require 2 doses to complete the series. Data on vaccines administered during December 14, 2020-January 14, 2021, and reported to CDC by January 26, 2021, were analyzed to describe demographic characteristics, including sex, age, and race/ethnicity, of persons who received ≥1 dose of COVID-19 vaccine (i.e., initiated vaccination). During this period, 12,928,749 persons in the United States in 64 jurisdictions and five federal entities§ initiated COVID-19 vaccination. Data on sex were reported for 97.0%, age for 99.9%, and race/ethnicity for 51.9% of vaccine recipients. Among persons who received the first vaccine dose and had reported demographic data, 63.0% were women, 55.0% were aged ≥50 years, and 60.4% were non-Hispanic White (White). More complete reporting of race and ethnicity data at the provider and jurisdictional levels is critical to ensure rapid detection of and response to potential disparities in COVID-19 vaccination. As the U.S. COVID-19 vaccination program expands, public health officials should ensure that vaccine is administered efficiently and equitably within each successive vaccination priority category, especially among those at highest risk for infection and severe adverse health outcomes, many of whom are non-Hispanic Black (Black), non-Hispanic American Indian/Alaska Native (AI/AN), and Hispanic persons (2,3).

Imposed mutational meltdown as an antiviral strategy.

Following widespread infections of the most recent coronavirus known to infect humans, SARS-CoV-2, attention has turned to potential therapeutic options. With no drug or vaccine yet approved, one focal point of research is to evaluate the potential value of repurposing existing antiviral treatments, with the logical strategy being to identify at least a short-term intervention to prevent within-patient progression, while long-term vaccine strategies unfold. Here, we offer an evolutionary/population-genetic perspective on one approach that may overwhelm the capacity for pathogen defense (i.e., adaptation) - induced mutational meltdown - providing an overview of key concepts, review of previous theoretical and experimental work of relevance, and guidance for future research. Applied with appropriate care, including target specificity, induced mutational meltdown may provide a general, rapidly implemented approach for the within-patient eradication of a wide range of pathogens or other undesirable microorganisms.

Low-Cost, Large-Scale Production of the Anti-viral Lectin Griffithsin.

Griffithsin, a broad-spectrum antiviral lectin, has potential to prevent and treat numerous viruses including HIV, HCV, HSV, SARS-CoV, and SARS-CoV-2. For these indications, the annual demand for Griffithsin could reach billions of doses and affordability is paramount. We report the lab-scale validation of a bioprocess that supports production volumes of >20 tons per year at a cost of goods sold below $3,500/kg. Recombinant expression in engineered E. coli enables Griffithsin titers ∼2.5 g/L. A single rapid precipitation step provides > 90% yield with 2-, 3-, and 4-log reductions in host cell proteins, endotoxin, and nucleic acids, respectively. Two polishing chromatography steps remove residual contaminants leading to pure, active Griffithsin. Compared to a conventional one this process shows lower costs and improved economies of scale. These results support the potential of biologics in very large-scale, cost-sensitive applications such as antivirals, and highlight the importance of bioprocess innovations in enabling these applications.