Outcomes of a NYC Public Hospital System Low-Threshold Tele-Buprenorphine Bridge Clinic at 1 Year.

Background: This study evaluated clinical outcomes of a low barrier tele-buprenorphine bridge program for NYC residents with opioid use disorder (OUD) at 1 year during the coronavirus disease 2019 (COVID-19) pandemic. Methods and materials: This retrospective analysis of the NYC Health + Hospitals (NYC H + H) Virtual Buprenorphine Clinic registry assessed baseline demographic and clinical characteristics, rates of referrals to community treatment, and induction-related adverse events among city residents with OUD, from March 2020 to the end of March 2021. Results: The program enrolled 199 patients, of whom 62.3% were provided same-day visits (n = 124). Patients were enrolled in the program for a median of 14 days (range 0-130 days). Referrals sources included hospital and clinic staff (n = 83, 47.7%), word of mouth (n = 30, 17.2%), and correctional health or reentry services (n = 30, 17.2%). Induction-related adverse events were mostly limited to precipitated withdrawal symptoms (n = 21, 5%). Roughly half of patients were referred to community treatment (n = 109, 54.8%) and of those 51.4% (n = 56/109) completed at least one visit in community treatment. Discussion: Our experience indicates that a low threshold tele-buprenorphine bridge program in place of a safe and feasible approach to facilitating entry in community treatment for underserved people who use opioids in a large metropolitan area.

A Telemedicine Buprenorphine Clinic to Serve New York City: Initial Evaluation of the NYC Public Hospital System's Initiative to Expand Treatment Access During the COVID-19 Pandemic.

OBJECTIVES: The purpose of this study was to assess the feasibility and clinical impact of telemedicine-based opioid treatment with buprenorphine-naloxone following the Coronavirus disease 2019 pandemic. METHODS: Participants included in this retrospective analysis consisted of adult New York City residents with opioid use disorder eligible for enrollment in the NYC Health+Hospitals Virtual Buprenorphine Clinic between March and May 2020 (n = 78). Follow-up data were comprised of rates of retention in treatment at 2 months, referrals to community treatment, and induction-related events. RESULTS: During the initial 9 weeks of clinic operations, the clinic inducted 78 patients on to buprenorphine-naloxone and completed 252 visits. Patient referrals included non-NYC Health + Hospitals (n = 22, 28.2%) and NYC Health + Hospitals healthcare providers (n = 17, 21.8%), homeless shelter staff (n = 13, 16.7%), and the NYC Health + Hospitals jail reentry program in Rikers Island (n = 11, 14.1%). At 8 weeks, 42 patients remained in care (53.8%), 21 were referred to a community treatment program (26.9%), and 15 were lost to follow-up (19.2%). No patients were terminated from care due to disruptive behavior or suspicions of diversion or misuse of Buprenorphine. Adverse clinical outcomes were uncommon and included persistent withdrawal symptoms (n = 8, 4.3%) and one nonfatal opioid overdose (0.5%). CONCLUSIONS: Telemedicine-based opioid treatment and unobserved home induction on buprenorphine-naloxone offers a safe and feasible approach to expand the reach of opioid use disorder treatment, primary care, and behavioral health for a highly vulnerable urban population during an unprecedented natural disaster.

Offline Next Generation Metagenomics Sequence Analysis Using MinION Detection Software (MINDS).

Field laboratories interested in using the MinION often need the internet to perform sample analysis. Thus, the lack of internet connectivity in resource-limited or remote locations renders downstream analysis problematic, resulting in a lack of sample identification in the field. Due to this dependency, field samples are generally transported back to the lab for analysis where internet availability for downstream analysis is available. These logistics problems and the time lost in sample characterization and identification, pose a significant problem for field scientists. To address this limitation, we have developed a stand-alone data analysis packet using open source tools developed by the Nanopore community that does not depend on internet availability. Like Oxford Nanopore Technologies' (ONT) cloud-based What's In My Pot (WIMP) software, we developed the offline MinION Detection Software (MINDS) based on the Centrifuge classification engine for rapid species identification. Several online bioinformatics applications have been developed surrounding ONT's framework for analysis of long reads. We have developed and evaluated an offline real time classification application pipeline using open source tools developed by the Nanopore community that does not depend on internet availability. Our application has been tested on ATCC's 20 strain even mix whole cell (ATCC MSA-2002) sample. Using the Rapid Sequencing Kit (SQK-RAD004), we were able to identify all 20 organisms at species level. The analysis was performed in 15 min using a Dell Precision 7720 laptop. Our offline downstream bioinformatics application provides a cost-effective option as well as quick turn-around time when analyzing samples in the field, thus enabling researchers to fully utilize ONT's MinION portability, ease-of-use, and identification capability in remote locations.

Efficacy and Safety of a Percutaneous Tenotomy System for Debridement of Tendinopathic Tissues.

During acute inflammatory phases of tendinopathy, a combination of physical therapy and corticosteroid injections is considered to be moderately effective for acute inflammation. However, surgical debridement of tendinopathic tissues is often required for chronic cases. The TenJet system created by HydroCision, Inc. is a percutaneous device that uses high-pressure saline to debride pathologic tissues during tenotomy. Here, we use a collagenase-induced tendinopathy model on explants from bovine ankle extensor tendons. We use the volume of defect debrided as a metric to determine the efficacy of using high-velocity fluid flow as a debridement tool as well as the effect of velocity magnitude on efficacy. Furthermore, we highlight the negligible disruption of healthy tissue surrounding pathologic tissue.

Frankliniella fusca resistance to neonicotinoid insecticides: an emerging challenge for cotton pest management in the eastern United States.

BACKGROUND: Over the past two decades, neonicotinoid seed treatments have become the primary method to manage tobacco thrips, Frankliniella fusca Hinds, on seedling cotton. Because this insect is highly polyphagous and the window of insecticide exposure is short, neonicotinoid resistance was expected to pose a minimal risk. However, reports of higher than expected F. fusca seedling damage in seed-treated cotton fields throughout the Mid-South and Southeast US production regions suggested neonicotinoid resistance had developed. To document this change, F. fusca populations from 86 different locations in the eastern United States were assayed in 2014 and 2015 for imidacloprid and thiamethoxam resistance to determine the extent of the issue in the region. RESULTS: Approximately 57 and 65% of the F. fusca populations surveyed had reduced imidacloprid and thiamethoxam sensitivity respectively. Survivorship in diagnostic bioassays was significantly different at both the state and regional scales. Multiple-dose bioassays conducted on 37 of the populations documented up to 55- and 39-fold resistance ratios for imidacloprid and thiamethoxam respectively. CONCLUSION: Estimates of neonicotinoid resistance indicate an emerging issue for management of F. fusca in the eastern United States. Significant variation in survivorship within states and regions indicated that finer-scale surveys were needed to determine factors (genetic, insecticide use) driving resistance evolution. © 2016 Society of Chemical Industry.

From pro forma to proactive. As hospitals buy physician practices, board compensation oversight must shift into high gear.

It's time for the board to dig into physician compensation.

Replacing amino acids in translation: expanding chemical diversity with non-natural variants.

Here, we describe a strategy for synthesis of peptides with multiple unnatural amino acids (UAAs) using in vitro translation. Our method involves removing a natural amino acid and replacing it with an UAA variant in a reconstituted translation system. Whereas other systems require engineered components or chemical synthesis to charge UAAs onto tRNAs prior to translation, our strategy utilizes the wild-type machinery and charging occurs concomitant with translation. The design of the system allows for easy quantification of the UAA's incorporation efficiency and fidelity.

Crystal structure of histamine dehydrogenase from Nocardioides simplex.

Histamine dehydrogenase (HADH) isolated from Nocardioides simplex catalyzes the oxidative deamination of histamine to imidazole acetaldehyde. HADH is highly specific for histamine, and we are interested in understanding the recognition mode of histamine in its active site. We describe the first crystal structure of a recombinant form of HADH (HADH) to 2.7-A resolution. HADH is a homodimer, where each 76-kDa subunit contains an iron-sulfur cluster ([4Fe-4S](2+)) and a 6-S-cysteinyl flavin mononucleotide (6-S-Cys-FMN) as redox cofactors. The overall structure of HADH is very similar to that of trimethylamine dehydrogenase (TMADH) from Methylotrophus methylophilus (bacterium W3A1). However, some distinct differences between the structure of HADH and TMADH have been found. Tyr(60), Trp(264), and Trp(355) provide the framework for the "aromatic bowl" that serves as a trimethylamine-binding site in TMADH is comprised of Gln(65), Trp(267), and Asp(358), respectively, in HADH. The surface Tyr(442) that is essential in transferring electrons to electron-transfer flavoprotein (ETF) in TMADH is not conserved in HADH. We use this structure to propose the binding mode for histamine in the active site of HADH through molecular modeling and to compare the interactions to those observed for other histamine-binding proteins whose structures are known.

Expression, purification, crystallization and preliminary X-ray studies of histamine dehydrogenase from Nocardioides simplex.

Histamine dehydrogenase (HADH) from Nocardioides simplex catalyzes the oxidative deamination of histamine to produce imidazole acetaldehyde and an ammonium ion. HADH is functionally related to trimethylamine dehydrogenase (TMADH), but HADH has strict substrate specificity towards histamine. HADH is a homodimer, with each 76 kDa subunit containing two redox cofactors: a [4Fe-4S] cluster and an unusual covalently bound flavin mononucleotide, 6-S-cysteinyl-FMN. In order to understand the substrate specificity of HADH, it was sought to determine its structure by X-ray crystallography. This enzyme has been expressed recombinantly in Escherichia coli and successfully crystallized in two forms. Diffraction data were collected to 2.7 A resolution at the SSRL synchrotron with 99.7% completeness. The crystals belonged to the orthorhombic space group P2(1)2(1)2(1), with unit-cell parameters a = 101.14, b = 107.03, c = 153.35 A.

Breeding birds on small islands: island biogeography or optimal foraging?

1. We test MacArthur and Wilson's theory about the biogeography of communities on isolated habitat patches using bird breeding records from 16 small islands off the coasts of Britain and Ireland. 2. A traditional examination of patterns of species richness on these islands suggests that area and habitat diversity are important predictors, but that isolation and latitude have a negligible impact in this system. 3. Unlike traditional studies, we directly examine the fundamental processes of colonization and local extinction (cessation of breeding), rather than higher-order phenomena such as species richness. 4. We find that many of MacArthur and Wilson's predictions hold: colonization probability is lower on more isolated islands, and extinction probability is lower on larger islands and those with a greater diversity of habitats. 5. We also find an unexpected pattern: extinction probability is much lower on more isolated islands. This is the strongest relationship in these data, and isolation is the best single predictor of colonization and extinction. 6. Our results show that examination of species richness alone is misleading. Isolation has a strong effect on both of the dynamic processes that underlie richness, and in this system, the reductions in both colonization and extinction probability seen on more distant islands have opposing influences on species richness, and largely cancel each other out. 7. We suggest that an appropriate model for this system might be optimal foraging theory, which predicts that organisms will stay longer in a resource patch if the distance to a neighbouring patch is large. If nest sites and food are the resources in this system, then optimal foraging theory predicts the pattern we observe. 8. We advance the hypothesis that there is a class of spatial systems, defined by their scale and by the taxon under consideration, at which decision-making processes are a key driver of the spatiotemporal dynamics. The appropriate theory for such systems will be a hybrid of concepts from biogeography/metapopulation theory and behavioural ecology.

Effect of strip length on the contractile dysfunction of bladder smooth muscle after partial outlet obstruction.

OBJECTIVES: Partial outlet obstruction mediates decreased contractile responses and increased collagen synthesis; however, it is not known to what extent the increased collagen contributes to contractile dysfunction. METHODS: Sixteen WNZ rabbits were divided into three groups: control, 2-week obstructed, and 2-week sham. Each rabbit was anesthetized, and the bladder was excised and cut into equal width strips of 0.5, 1.0, and 2.0-cm lengths. The contractile responses to field stimulation, carbachol, potassium chloride, and adenosine triphosphate were determined. At the end of the experiment, each strip was fixed in formalin and immunostained for collagen. RESULTS: The contractile responses for the control and sham strips were similar for all strip lengths. In obstructed tissue, the shorter strip lengths generated significantly more tension per cross-sectional area than did the longer strips. The collagen density and distribution were similar for the control and sham bladders. The obstructed bladders had significantly increased collagen deposits between and within the smooth muscle bundles and cells. CONCLUSIONS: Because the relationship between strip size and contraction were similar for field stimulation, carbachol, and potassium chloride, it is the increased density of connective tissue within and between the muscle bundles and fibers that interferes with contraction (ie, the greater the strip length, the greater the interference and the greater the contractile dysfunction). Therefore, both functional and structural alterations in the obstructed bladder participate in contractile dysfunction.