Interprofessional Naloxone Student Training to Manage Suspected Opioid Overdose.

PURPOSE: The study purpose was to examine the effect of interprofessional naloxone training on students' knowledge, confidence, and interprofessional collaboration competency. The overarching goal was to decrease mortality related to opioid overdoses. DESIGN/METHODS: A training session for interprofessional students consisted of a lecture presentation, demonstration, and hands-on practice regarding appropriate administration of naloxone for suspected opioid overdose. A questionnaire elicited baseline and change in knowledge, confidence, and interprofessional collaboration competency scores at pretraining and posttraining. In addition, changes in knowledge and confidence were also measured 3 weeks after the training. Thematic analysis explored training components that students perceived as valuable or needing improvement. RESULTS: Participants (N = 100) were nursing (n = 33), physician assistant (n = 37), and pharmacy (n = 30) students. Pretraining and posttraining comparison demonstrated increased knowledge (P < .001), confidence (P < .001), and collaboration scores (P < .001). At 3 weeks, knowledge and confidence remained higher than pretraining (P < .001). Knowledge was trending downward compared with posttraining (P = .09). Thematic analysis identified 4 themes: (a) indications for administration of different naloxone types, (b) learning modalities, (c) knowledge application, and (d) improvements. CONCLUSIONS: An interprofessional naloxone administration training resulted in increased knowledge, confidence, and interprofessional teamwork. Educators can adapt this training for a variety of future or current healthcare professionals to improve immediate intervention and outcomes in suspected opioid overdoses.

Response to 'The implications of three major new trials for the effect of water, sanitation and hygiene on childhood diarrhea and stunting: a consensus statement' by Cumming et al.

Please see related article: https://doi.org/10.1186/s12916-019-1410-x.

Attachment insecurity and obsessive-compulsive personality disorder among inpatients with serious mental illness.

BACKGROUND: Obsessive-compulsive personality disorder (OCPD) is characterized by traits such as extreme rigidity, perfectionism, and controlling behavior, all of which have a negative impact on interpersonal functioning. Attachment theory provides a useful framework to elucidate the interpersonal dysfunction characteristic of OCPD; yet, there is a dearth of attachment research on OCPD in the context of severe mental illness. METHODS: Attachment security and personality disorders were assessed in adult inpatients with severe mental illness. Propensity Score Matching (PSM) was used to match OCPD and control subjects on age, gender, number of psychiatric disorders, and number of criteria endorsed for borderline personality disorder. RESULTS: Consistent with hypotheses, the OCPD group (n=61) showed greater attachment avoidance than controls (n=61), and the avoidance was manifested in a predominance of the most insecure attachment style, fearful attachment. Correlations between attachment anxiety/avoidance with specific OCPD diagnostic criteria revealed that attachment avoidance was correlated with four of eight OCPD criteria across the full sample. Within the subset of OCPD patients, attachment avoidance was significantly correlated with OCPD criterion 3 (is excessively devoted to work and productivity to the exclusion of leisure activities and friendships). LIMITATIONS: The use of self-report measure of attachment and the high burden of illness in the SMI population may not generalize to interview based assessment or outpatients, respectively. CONCLUSIONS: Findings attest to the severity of impairment in interpersonal functioning and attachment avoidance, in particular, is characteristic of OCPD patients. These results suggest that viable treatment targets include interpersonal functioning along with more classical features of OCPD such as perfectionism and obsessiveness in task performance.

Synthesis and SAR of novel isoquinoline CXCR4 antagonists with potent anti-HIV activity.

Using AMD070 as a starting point for structural modification, a novel series of isoquinoline CXCR4 antagonists was developed. A structure-activity scan of alternate lower heterocycles led to the 3-isoquinolinyl moiety as an attractive replacement for benzimidazole. Side chain optimization in the isoquinoline series led to a number of compounds with low nanomolar anti-HIV activities and promising rat PK properties.

Amine substituted N-(1H-benzimidazol-2ylmethyl)-5,6,7,8-tetrahydro-8-quinolinamines as CXCR4 antagonists with potent activity against HIV-1.

Several novel amine substituted N-(1H-benzimidazol-2ylmethyl)-5,6,7,8-tetrahydro-8-quinolinamines were synthesized which had potent activity against HIV-1. The synthetic approaches adopted allowed for variation of the substitution pattern and resulting changes in antiviral activity are highlighted. This led to the identification of compounds with low and sub-nanomolar anti-HIV-1 activity.

Tetrahydrocarbazole amides with potent activity against human papillomaviruses.

Synthesis of a series of tetrahydrocarbazole amides with potent activity against human papillomaviruses is described. Synthetic approaches allowing for variation of the substitution pattern of the tetrahydrocarbazole and the amide are outlined and resulting changes in antiviral activity and certain developability parameters are highlighted. Several compounds with in vitro antiviral activity (W12 antiviral assay) in the single digit nanomolar range were identified and N-[(1R)-6-chloro-2,3,4,9-tetrahydro-1H-carbazol-1-yl]-2-pyridinecarboxamide was selected for further evaluation.

Substituted tetrahydrocarbazoles with potent activity against human papillomaviruses.

The synthesis and SAR of a series of substituted 1-aminotetrahydrocarbazoles with potent activity against human papillomaviruses are described. Synthetic approaches allowing for variation of the substitution pattern of the tetrahydrocarbazole are outlined and resulting changes in antiviral activity are highlighted. Several compounds with in vitro antiviral activity (W12 antiviral assay) in the low nanomolar range were identified and (1R)-6-bromo-N-[(1R)-1-phenylethyl]-2,3,4,9-tetrahydro-1H-carbazole-1-amine was selected for further evaluation.

Biochemical findings in common inborn errors of metabolism.

The application of tandem mass spectrometry (MS/MS) to newborn screening has led to the detection of patients with a wider spectrum of inborn errors of metabolism. A definitive diagnosis can often be established early enough to start treatment before symptoms appear. Here, we review common biochemical findings in disorders caused by deficiency of 3-methylcrotonyl-CoA carboxylase, isobutyryl-CoA dehydrogenase, 2-methyl-3-hydroxybutyryl-CoA dehydrogenase, 3-ketothiolase, 2-methylbutyryl-CoA dehydrogenase, and medium chain acyl CoA dehydrogenase. The diagnosis of these disorders requires biochemical confirmation by measurement of plasma acylcarnitine profile, urine organic acids, and urine acylglycine profiles followed by measurement of enzyme activity or detection of causative mutations. Early treatment can improve the outcome of these disorders.

Deuterium enriched irrigation indicates different forms of rain use in shrub/grass species of the Colorado Plateau.

We contrasted the seasonal use of simulated large rain events (24 mm) by three native species of the arid Colorado Plateau: the perennial grass Hilaria jamesii and two shrubs Artemesia filifolia and Coleogyne ramosissima. Deuterium-enriched water was used to distinguish shallow "pulse" water from water in deeper soil layers that were unaffected by the water input. We also measured the leaf gas exchange rates of watered and unwatered control plants for 5 days after the rain event. H. jamesii had twice the pulse water proportion in its xylem than the two shrubs in spring (approx. 70% vs 35%). In summer, the pulse water proportions of all species were around 70%. The increase in the relative pulse water uptake of the two shrubs was caused primarily by a reduction in the rate of water uptake from deeper sources, consistent with the decrease in the availability of stored winter water. Rain increased the rates of gas exchange in C. ramosissima in both seasons, in H. jamesii only in summer and had no significant effect on A. filifolia. In H. jamesii, summer rain also increased water use efficiency. This suggests three principle mechanisms for rainwater use: (1) immediate increase in gas exchange via stomatal opening (C. ramisissima), (2) immediate increase in water use efficiency through restoration of the photosynthetic apparatus (H. jamesii) and (3) conservation of deeper soil water, potentially extending photosynthetic activity into later drought periods (A. filifolia). On a ground-area basis, A. filifolia was by far the largest consumer of spring and summer rain, due to its greater ground cover, while rain use by H. jamesii was negligible. We hypothesize that a population's fraction of the total community Leaf Area Index, more than species identity, determines which species takes up most of the spring and summer precipitation and we discuss this idea in the context of Walter and Stadelmann's (1974, In: Brown JW Jr (ed) Desert biology. Academic Press, New York, pp 213-310) water partitioning hypothesis.