Applications of Liquid Chromatography-Tandem Mass Spectrometry in Natural Products Research: Tropane Alkaloids as a Case Study.

Although many drugs utilized today are synthetic in origin, natural products still provide a rich source of novel chemical diversity and bioactivity, and can yield promising leads for resistant or emerging diseases. The challenge, however, is twofold: not only must researchers find natural products and elucidate their structures, but they must also identify what is worth isolating and assaying (and what is already known - a process known as dereplication). With the advent of modern analytical instrumentation, the pace of natural product discovery and dereplication has accelerated. Liquid chromatography-tandem mass spectrometry (LC-MS/MS) has become an especially valuable technique for identifying and classifying chemical structures. Tropane alkaloids (TAs) are plant-derived compounds of great medicinal and toxicological significance. In this study, we developed an LC-MS/MS-based screening workflow utilizing the multiple MS/MS configurations available on a triple-quadrupole (QQQ) mass spectrometer to annotate and classify TA structures based on their distinct fragmentation patterns. By using a combination of data-dependent (DD) product ion scans, precursor ion scans (PrIS), and neutral loss scans (NLS), we applied this method to TA-rich extracts of the nightshades Datura stramonium and Datura metel. This method is rapid, sensitive, and was successfully employed for both preliminary dereplication of complex TA-containing samples and for the discovery of a novel candidate for isolation, purification (and eventual bioassay).

Validation of a High Flow Rate Puff Topography System Designed for Measurement of Sub-Ohm, Third Generation Electronic Nicotine Delivery Systems.

There are few known puff topography devices designed solely for gathering electronic cigarette puff topography information, and none made for high-powered sub-ohm devices. Ten replicate Bernoulli flow cells were designed and 3D printed. The relationship between square root of pressure difference and flow rate was determined across 0−70 L/min. One representative flow cell was used to estimate puff volume and flow rate under six simulated puffing regimes (0.710 L, 2.000 L and 3.000 L, at low and high flow rates) to determine the system's accuracy and utility of using dual pressure sensors for flow measurement. The relationship between flow rate and square root of pressure differential for the ten replicate cells was best fit with a quadratic model (R2 = 0.9991, p < 0.0001). The higher-pressure sensor was accurate at both low and high flow rates for 0.71 L (102% and 111% respectively), 2.00 L (96% and 103% respectively), and 3.00 L (100.1% and 107% respectively) but the lower-pressure sensor provided no utility, underpredicting volume and flow. This puff topography system generates very little resistance to flow, easily fits between user's atomizer and mouthpiece, and is calibrated to measure flows up to 70 L/min.

Osteopathic Physician Mortality in the Influenza Pandemic of 1918-1920.

The influenza outbreak that occurred during 1918-1920 was a defining moment in the history of the world and osteopathic medicine. Despite the tremendous loss of human life, osteopathic physicians also observed greater success in the treatment of patients with the disease, in contrast with their allopathic counterparts. Osteopathic physicians also succumbed to the deadly influenza effects while treating patients. A list of osteopathic physicians who died of influenza or related complications during the pandemic, obtained from osteopathic journals from that time, is provided, along with the historical context of the pandemic.

Medication adherence in patients with mental illness and recent homelessness: contributing factors and perceptions on mobile technology use.

OBJECTIVES: The primary objective was to determine medication-taking behaviours and factors influencing adherence in patients with mental illness and recent homelessness. Secondary objectives were to explore patients' perceptions on mobile technology use to support adherence. METHODS: A constructivist approach and qualitative description method was used. The sample population consisted of patients with recent homelessness and mental illness affiliated with a community-based outreach programme in Canada. Participants were purposefully selected; semi-structured interviews were conducted to elicit information on medication-taking strategies and mobile technology to support adherence. A standardized questionnaire collected demographic and medical information; the Medication Adherence Rating Scale (MARS) was used to evaluate self-reported adherence. Questionnaire data were analysed using summary descriptive statistics. Interview data were subject to qualitative content analysis. KEY FINDINGS: Fifteen participants with a mean age of 44 years were included. The mean MARS score ± standard deviation was 7.3 ± 1.5. Themes arising from the data included patient factors (i.e. insight, attitudes towards medications, coping strategies) and external factors (i.e. therapeutic alliance, family support that impacted adherence) and technology use and health. Eight participants (53%) had access to a mobile phone. There was a moderate interest in the use of mobile technology to support adherence, with cost and technology literacy identified as barriers. CONCLUSION: External supports and individual medication management strategies were important in supporting medication adherence in this patient group. Perceived need for mobile technology, in addition to existing supports for adherence, was not high. Challenges accessing and maintaining consistent mobile technology and individual preferences should be considered when developing mobile technology-based interventions.

Challenges, Opportunities, and Motivators for Developing and Applying Food Literacy in a University Setting: A Qualitative Study.

BACKGROUND: Evolving norms and complex food environments may require new skill sets and mind-sets to maintain a healthy diet. Food literacy acknowledges the influence of external factors in shaping a person's development and application of the knowledge, skills, and behaviors required for healthy eating. Food literacy among college students is not well understood; however, higher education presents a unique opportunity for promoting food literacy. OBJECTIVE: This study aimed to identify a range of challenges, opportunities, and motivators for students to develop and apply food literacy in a university setting. DESIGN: Eleven focus groups were conducted with four student subpopulations: three with residential undergraduates, three with off-campus undergraduates, three with graduate students, and two with students using food security resources. PARTICIPANTS/SETTING: Eighty-two students enrolled at a large, diverse, public university in an urban setting in California. ANALYSIS: Guided by an ecological perspective, transcripts were analyzed using an integrated approach. This involved an inductive development of themes and deductive organization of themes according to research aims. RESULTS: We developed a novel model as a starting point for understanding and addressing the dynamic challenges, opportunities, and motivators for students to develop and apply food literacy. Challenges include the physical food environment, confusing information, capacity and resource constraints, and social tensions. Opportunities include media and the Internet, academic courses, peer learning, campus resources, and dining halls. Motivators include health, social responsibility, personal development, and enjoyment and bonding. CONCLUSIONS: Students view college as an appropriate time to develop food literacy and the university as a trusted partner. However, efforts to promote food literacy should acknowledge perceived challenges and varying motivations for engaging with food.

Text messaging interventions for individuals with mental health disorders including substance use: A systematic review.

We completed a systematic review of the literature to characterize the impact of text messaging interventions on medication adherence or mental health related outcomes in people with mental health disorders including substance use. Four electronic databases were searched from January 1999 to October 2015. Seven studies met our inclusion criteria: three studies evaluated text messaging in patients with schizophrenia or schizoaffective disorder diagnosis, two studies evaluated text messaging in patients with chronic alcohol dependence, and two studies reviewed text messaging in patients with mood disorders. Six studies were randomized controlled trials and one was a prospective pilot study with pre-post intervention design. Text messaging frequency ranged from once weekly to twelve per day. The effect of text messaging on medication adherence was measured in five studies; one study reporting significant improvements in the text messaging intervention group. The effect of text messaging on mental health related outcomes was measured in all seven studies, with five studies showing significant improvements in a variety of psychiatric and social functioning assessments. Collectively, these studies suggest text messaging is a promising tool to support management of patients with mental illness. Further research examining theory-based text messaging interventions in larger samples of patients is required.

An International Survey to Understand Infection Control Practices for Spinal Cord Stimulation.

OBJECTIVES: Surgical site infections (SSIs) are associated with significant healthcare costs and morbidity. Limited research exists specific to the prevention of spinal cord stimulation (SCS) SSIs. The objectives of this international survey were to examine current infection control practices for SCS trials and implants and to compare reported responses with evidence-based recommendations. MATERIALS AND METHODS: A 33-question survey was developed based on an extensive literature review for infection control policies. The survey was hosted on the Internet. Dispersion of the survey occurred through professional associations and device manufacturers. Responses to 15 questions directly related to defined CDC, NICE, and SCIP evidence-based infection control practice recommendations were classified as either compliant or noncompliant. The survey was open for 20 days. Responses also were grouped and analyzed based on geographic location, practice location, and procedural volumes. RESULTS: Five hundred six physicians responded to the survey. Compliance rates for CDC, NICE, SCIP infection control practice recommendations were low with only four of the 15 questions having compliance rates ≥80%. Areas associated with high levels of noncompliance included weight-based antibiotic dosing, hair removal strategies, double gloving, surgical dressing, skin antiseptic agent selection, and postoperative continuation of antibiotics. Geographic and practice type variations existed for particular infection control practices. Procedural volume influenced operative implant times with low physician procedural volumes associated with extended operative times. CONCLUSIONS: The survey provided significant insight into current practices and will assist in the development of specific SCS infection control policies. Based on the survey, further education is warranted on infection control strategies for physicians performing spinal cord stimulator trials and implants.

The interaction between the composition of preinjected fluids and duration of radiofrequency on lesion size.

BACKGROUND: Clinical recommendations for the duration of radiofrequency (RF) delivery have been based on no-fluid design, which may not be representative of clinical practice where fluid preinjection occurs. The purpose of this study was to examine the interaction between the preinjection of fluids of differing compositions and duration of RF on lesion size. The variability of lesion development under different preinjection conditions was also examined across the RF lesion duration. METHODS: Monopolar RF was performed with ex vivo chicken samples for 180 seconds without fluid preinjection or with fluid preinjected. Nonionic and ionic fluids were investigated. Lesion size parameters and and power levels were measured every 10 seconds. The surface area and efficiency index were calculated. RESULTS: The preinjection of specific fluid increased the maximum mean surface area. Lesion growth continued throughout the entire lesion cycle. When all groups were considered together, the largest mean surface area occurred at 180 seconds. The preinjection of specific fluids altered the rate of lesion growth and the time required to achieve maximum lesion size in a fluid-specific manner. Significant variability was documented in the rate and amount of lesion growth under each condition. Extending lesioning time resulted in reduced lesion variability. CONCLUSIONS: Fluid preinjection alters both final lesion size and the time required to achieve maximum lesion size. Extending the duration of RF lesion cycle beyond 90 seconds when fluid is preinjected allows for lesion size to be maximized while limiting lesion size variability, both of which assist in successfully lesioning a targeted nerve.

Stemming the tide of drug-resistant Neisseria gonorrhoeae: the need for an individualized approach to treatment.

Drug-resistant Neisseria gonorrhoeae poses a significant public health challenge. In recent years, gonococci resistant to first- and second-line antibiotics have spread worldwide and new strains have developed that are increasingly resistant to third-generation cephalosporins, which are currently our last line of available treatments. Given the timeline required to develop new drugs or an effective vaccine for N. gonorrhoeae, a top priority is to use the drugs that are available as effectively as possible. Currently, clinical management of gonorrhoea is based upon treatment guidelines informed by international gonococcal antimicrobial susceptibility surveillance programmes. This approach, although currently the most practical, is subject to a number of limitations since surveillance data inherently provide population-level information. As a result, basing treatment guidelines on these data can result in the prescription of more aggressive or broader treatment than is needed by individual patients and hence inadvertently contribute to the development and spread of resistance to important drugs. Clearly, methods are needed that provide patient-specific drug susceptibility information in a time frame that would allow clinicians to prescribe individualized treatment regimens for gonorrhoea. Fortunately, in recent years, there have been a number of advances in the development of rapid methods for characterizing both the genotype and the drug resistance phenotype of N. gonorrhoeae strains. Here, we review these advances and propose additional studies that would help facilitate a transition towards an individualized treatment approach for gonorrhoea.

Pharmacists and harm reduction: A review of current practices and attitudes.

BACKGROUND: Injection drug use and other high-risk behaviours are the cause of significant morbidity and mortality and thus have been the focus of many health promotion strategies. Community pharmacists are considered underutilized health providers and are often thought to be more accessible than other health professionals. The purpose of this review is to provide an overview of community pharmacists' practices as well as pharmacists' attitudes and identified barriers toward providing harm reduction services. We will highlight the major harm reduction services being offered through community pharmacies, as well as identify barriers to implementing these services. METHODS: A review of the literature from 1995 to 2011 was conducted using the electronic databases MEDLINE, PubMed and Scopus, encompassing pharmacists' involvement in harm reduction services. Keywords included pharmacist, harm reduction, disease prevention, health promotion, attitudes, competence and barriers. References of included articles were examined to identify further relevant literature. RESULTS: Pharmacists are primarily involved in providing clean needles to injection drug users, as well as opioid substitution. Pharmacists generally have a positive attitude toward providing health promotion and harm reduction programs and express some interest in increasing their role in this area. Common barriers to expanding harm reduction strategies in community pharmacists' practice include lack of time and training, insufficient remuneration, fear of attracting unruly clientele and inadequate communication between health providers. CONCLUSION: As one of the most accessible health care providers, community pharmacists are in an ideal position to provide meaningful services to injection drug users. However, in order to do so, pharmacists require additional support in the form of better health team and system integration, as well as remuneration models.

Effect of localizing fruit and vegetable consumption on greenhouse gas emissions and nutrition, Santa Barbara County.

The US agrifood system is very productive, but highly centralized and resource intensive with very weak links between production and consumption. This contributes to high levels of malnutrition and greenhouse gas emissions (GHGE). A popular approach to improvement is localization-reducing direct transport (farm to retail distance, or "food miles"). We examined Santa Barbara County (SBC) California, which mirrors the high production, nutritional and environmental problems, and growing localization movement of California. SBC ranks in the top 1% of US counties in value of agricultural products, and >80% of this value is produce (fruits and vegetables). We calculated the amount of produce grown in and consumed in SBC and estimated that >99% of produce grown in SBC is exported from the county, and >95% of produce consumed in SBC is imported. If all produce consumed in SBC was grown in the county (100% localization), it would reduce GHGE from the agrifood system <1%, and not necessarily affect nutrition. While food miles capture only a portion of the environmental impact of agrifood systems, localization could be done in ways that promote synergies between improving nutrition and reducing GHGE, and many such efforts exist in SBC.