Mobile, Community-Based Buprenorphine Treatment for Veterans Experiencing Homelessness With Opioid Use Disorder: A Pilot, Feasibility Study.

BACKGROUND AND OBJECTIVES: Adults experiencing homelessness with opioid use disorder (OUD) utilize buprenorphine (BUP), a first-line medication for OUD, at very low rates. Innovative and tailored approaches are needed to reduce barriers to treatment and increase utilization of BUP in this population. This study describes a pilot Mobile Community-based Access Team (M-CAT) that used mobile technology and FaceTime in addition to existing community-based case management programs to provide BUP treatment for veterans with OUD experiencing homelessness who had difficulties engaging in the regular BUP clinic. METHODS: We conducted a retrospective chart review of veterans enrolled in M-CAT or the usual BUP clinic between January 2015 and December 2017 (N = 36). We abstracted demographic, medical, substance use, prescription, health care utilization, and drug use data from medical records. RESULTS: Twelve veterans were enrolled in M-CAT and 24 were enrolled in BUP clinic. Mean retention in treatment was 19.2 months (standard deviation [SD] = 10.2) in M-CAT and 36 months (SD = 27.6) in BUP clinic. At the endpoint, 66.7% (n = 8) in M-CAT and 100% (n = 24) in BUP clinic remained on BUP. DISCUSSION AND CONCLUSION: M-CAT is an innovative and tailored pilot project that successfully integrated specific OUD medication treatment into existing case management programs for veterans experiencing homelessness using mobile technology and Facetime. M-CAT can potentially increase utilization of BUP for OUD among high-risk population of veterans experiencing homelessness who are otherwise not engaged in treatment. SCIENTIFIC SIGNIFICANCE: Integrating telemedicine, BUP treatment, and community-based case management to treat OUD among veterans experiencing homelessness is feasible with high treatment retention. (Am J Addict 2020;29:485-491).

Training peer specialists with mental illness in motivational interviewing: A pilot study.

OBJECTIVE: The objective of this study was to evaluate the effects of providing motivational interviewing (MI) training to peer specialists in the Veterans Affairs (VA) health-care system. METHODS: Fourteen peer specialists at a local VA medical center received a 2-day workshop on MI and 2 monthly booster sessions afterward. A total of 55 therapy sessions between peer specialists and their peer service recipients were audio-recorded and independently rated on MI fidelity before the workshop and each month after the workshop for 3 months. Sessions were rated on fidelity scales assessing Fundamental MI Adherence and Competence, Advanced MI Adherence and Competence, and MI Inconsistent Adherence scales. One item was created for this study that assessed Sharing Lived Experiences. Repeated measures analysis was conducted to examine change in MI fidelity over time. RESULTS: Peer specialists had a significant decline in MI Inconsistent Adherence scale scores over time. Specifically, they showed reductions in providing unsolicited advice and emphasizing absolute abstinence. Peer specialists also showed a significant decline in the Sharing Lived Experience Adherence item score. There were no significant changes on MI Fundamental and Advance scale scores. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Training peer specialists in MI is feasible and may lead to some change in practices, but comprehensive training and ongoing supervision is needed to incur and sustain changes. Guidance and assessment of how peer specialists share their lived experiences with fellow veterans may be needed to capitalize on their unique experiences and skill sets. (PsycINFO Database Record

Nitroxide-Mediated Polymerization at Elevated Temperatures.

A new alkoxyamine based on a highly thermally stable nitroxide is used for the controlled polymerization of styrene and butyl acrylate at temperatures up to 200 °C. High monomer conversions are reached in a few minutes with a linear increase in polymer chain-length with conversion, a final dispersity (D) of ∼1.2, and successful chain-extension of the resulting material. The alkoxyamine concentration was altered to target various chain lengths, with autopolymerization dictating the polymerization rate of styrene regardless of alkoxyamine concentration. Controlled polymerization of methacrylate monomers and acrylic acid was successful with the addition of styrene. The new material opens the possibility to increase the range of specialty products made for applications in coatings, inks, overprint varnishes, and adhesives.

Inhibition of the sodium-calcium exchanger via SEA0400 altered manganese-induced T1 changes in isolated perfused rat hearts.

Manganese (Mn(2+) )-enhanced MRI (MEMRI) provides the potential for the in vivo evaluation of calcium (Ca(2+) ) uptake in the heart. Recent studies have also suggested the role of the sodium-calcium (Na(+) -Ca(2+) ) exchanger (NCX) in Mn(2+) retention, which may have an impact on MEMRI signals. In this study, we investigated whether MEMRI with fast T(1) mapping allowed the sensitive detection of changes in NCX activity. We quantified the dynamics of the Mn(2+) -induced T(1) changes in isolated perfused rat hearts in response to SEA0400, an NCX inhibitor. The experimental protocol comprised 30 min of Mn(2+) perfusion (wash-in), followed by a 30-min wash-out period. There were three experimental groups: 1, NCX inhibition by 1 µ m SEA0400 during Mn(2+) wash-in only (SEAin, n=6); 2, NCX inhibition by 1 µ m SEA0400 during Mn(2+) wash-out only (SEAout, n=6); 3, no NCX inhibition during both wash-in and wash-out to serve as the control group (CNTL, n=5). Rapid T(1) mapping at a temporal resolution of 3 min was performed throughout the perfusion protocol using a triggered saturation-recovery Look-Locker sequence. Our results showed that NCX inhibition during Mn(2+) wash-in caused a significant increase in relaxation rate (R(1) ) at the end of Mn(2+) perfusion. During the wash-out period, NCX inhibition led to less reduction in R(1) . Further analysis of Mn(2+) content in myocardium with flame atomic absorption spectroscopy was consistent with the MRI findings. These results suggest that Mn(2+) accumulation and retention in rat hearts are, in part, dependent on NCX activity. Hence, MEMRI may provide an imaging method that is also sensitive to changes in NCX activity.

Free radical copolymerization kinetics of γ-methyl-α-methylene-γ-butyrolactone (MeMBL).

The propagation kinetics and copolymerization behavior of the biorenewable monomer γ-methyl-α-methylene-γ-butyrolactone (MeMBL) are studied using the pulsed laser polymerization (PLP)/size exclusion chromatography (SEC) technique. The propagation rate coefficient for MeMBL is 15% higher than that of its structural analogue, methyl methacrylate (MMA), with a similar activation energy of 21.8 kJ·mol(-1). When compared to MMA, MeMBL is preferentially incorporated into copolymers when reacted with styrene (ST), MMA, and n-butyl acrylate (BA); the monomer reactivity ratios fit from bulk MeMBL/ST, MeMBL/MMA, and MeMBL/BA copolymerizations are r(MeMBL) = 0.80 ± 0.04 and r(ST) = 0.34 ± 0.04, r(MeMBL) = 3.0 ± 0.3 and r(MMA) = 0.33 ± 0.01, and r(MeMBL) = 7.0 ± 2.0 and r(BA) = 0.16 ± 0.03, respectively. In all cases, no significant variation with temperature was found between 50 and 90 °C. The implicit penultimate unit effect (IPUE) model was found to adequately fit the composition-averaged copolymerization propagation rate coefficient, k(p,cop), for the three systems.

Mycobacterium tuberculosis infection in a closed colony of rhesus macaques (Macaca mulatta).

Mycobacterium infections in nonhuman primates can devastate the colonies and place human handlers at risk. Despite conservative measures to prevent exposure, infections occur even in closed colonies. Here we describe a recent case of M. tuberculosis within a closed colony of rhesus macaques at our Thailand facility and the procedures instituted to prevent subsequent infections. Investigation of the outbreak did not confirm the source of the infection, but even with intensive occupational safety measures in place, human contact remains the most likely possibility.

Seasonal and environmental determinants of leptospirosis and scrub typhus in small mammals captured at a U.S. military training site (Dagmar North), Republic of Korea, 2001-2004.

OBJECTIVE: This study sought to identify seasonal and environmental determinants of scrub typhus, murine typhus, and leptospirosis in small mammals trapped at Dagmar North training area, Gyeonggi Province, South Korea. METHODS: Small mammals received titer assays to the aforementioned diseases. Logistic regression analyses were conducted to determine whether associations existed between risk of small-mammal infection and independent variables such as season of capture, habitat, small-mammal species, and sex. RESULTS: Murine typhus was not detected among the animals assayed. Risk of scrub typhus infection was associated with season, habitat, and small-mammal species. Risk of leptospirosis infection was associated with season and habitat. CONCLUSIONS: These findings indicate determinants of infection exist for scrub typhus and leptospirosis at this training site. This information can be used for developing appropriate preventive medicine plans and coordinating troop activity during periods of reduced exposure decreasing the likelihood of disease transmission to humans.