Nurse Care Management for Opioid Use Disorder Treatment: The PROUD Cluster Randomized Clinical Trial.

Importance: Few primary care (PC) practices treat patients with medications for opioid use disorder (OUD) despite availability of effective treatments. Objective: To assess whether implementation of the Massachusetts model of nurse care management for OUD in PC increases OUD treatment with buprenorphine or extended-release injectable naltrexone and secondarily decreases acute care utilization. Design, Setting, and Participants: The Primary Care Opioid Use Disorders Treatment (PROUD) trial was a mixed-methods, implementation-effectiveness cluster randomized clinical trial conducted in 6 diverse health systems across 5 US states (New York, Florida, Michigan, Texas, and Washington). Two PC clinics in each system were randomized to intervention or usual care (UC) stratified by system (5 systems were notified on February 28, 2018, and 1 system with delayed data use agreement on August 31, 2018). Data were obtained from electronic health records and insurance claims. An implementation monitoring team collected qualitative data. Primary care patients were included if they were 16 to 90 years old and visited a participating clinic from up to 3 years before a system's randomization date through 2 years after. Intervention: The PROUD intervention included 3 components: (1) salary for a full-time OUD nurse care manager; (2) training and technical assistance for nurse care managers; and (3) 3 or more PC clinicians agreeing to prescribe buprenorphine. Main Outcomes and Measures: The primary outcome was a clinic-level measure of patient-years of OUD treatment (buprenorphine or extended-release injectable naltrexone) per 10 000 PC patients during the 2 years postrandomization (follow-up). The secondary outcome, among patients with OUD prerandomization, was a patient-level measure of the number of days of acute care utilization during follow-up. Results: During the baseline period, a total of 130 623 patients were seen in intervention clinics (mean [SD] age, 48.6 [17.7] years; 59.7% female), and 159 459 patients were seen in UC clinics (mean [SD] age, 47.2 [17.5] years; 63.0% female). Intervention clinics provided 8.2 (95% CI, 5.4-∞) more patient-years of OUD treatment per 10 000 PC patients compared with UC clinics (P = .002). Most of the benefit accrued in 2 health systems and in patients new to clinics (5.8 [95% CI, 1.3-∞] more patient-years) or newly treated for OUD postrandomization (8.3 [95% CI, 4.3-∞] more patient-years). Qualitative data indicated that keys to successful implementation included broad commitment to treat OUD in PC from system leaders and PC teams, full financial coverage for OUD treatment, and straightforward pathways for patients to access nurse care managers. Acute care utilization did not differ between intervention and UC clinics (relative rate, 1.16; 95% CI, 0.47-2.92; P = .70). Conclusions and Relevance: The PROUD cluster randomized clinical trial intervention meaningfully increased PC OUD treatment, albeit unevenly across health systems; however, it did not decrease acute care utilization among patients with OUD. Trial Registration: ClinicalTrials.gov Identifier: NCT03407638.

Development of two devices for high-throughput screening of ethanol-producing microorganisms by real-time CO2 production monitoring.

Bioethanol's importance as a renewable energy carrier led to the development of new devices for the high-throughput screening (HTS) of ethanol-producing microorganisms, monitoring ethanol production, and process optimization. This study developed two devices based on measuring CO2 evolution (an equimolar byproduct of microbial ethanol fermentation) to allow for a fast and robust HTS of ethanol-producing microorganisms for industrial purposes. First, a pH-based system for identifying ethanol producers (Ethanol-HTS) was established in a 96-well plate format where CO2 emission is captured by a 3D-printed silicone lid and transferred from the fermentation well to a reagent containing bromothymol blue as a pH indicator. Second, a self-made CO2 flow meter (CFM) was developed as a lab-scale tool for real-time quantification of ethanol production. This CFM contains four chambers to simultaneously apply different fermentation treatments while LCD and serial ports allow fast and easy data transfer. Applying ethanol-HTS with various yeast concentrations and yeast strains displayed different colors, from dark blue to dark and light green, based on the amount of carbonic acid formed. The results of the CFM device revealed a fermentation profile. The curve of CO2 production flow among six replications showed the same pattern in all batches. The comparison of final ethanol concentrations calculated based on CO2 flow by the CFM device with the GC analysis showed 3% difference which is not significant. Data validation of both devices demonstrated their applicability for screening novel bioethanol-producer strains, determining carbohydrate fermentation profiles, and monitoring ethanol production in real time.

Prioritizing potential use of urban treated wastewater using expert-oriented and multi-criteria decision-making approaches: a case study in Iran.

Allocating effluent of wastewater treatment plants to users of economic sectors and satisfying their requirements has created a challenging debate and a need for prioritization. This study assesses the importance of sectors that utilize treated wastewater (TWW) using risk and social acceptability indexes based on expert-oriented approaches. Considered sectors are agriculture, industry, urban green space and natural resources and the study area is located in Iran, around the Isfahan North Wastewater Treatment Plant. The risk index is calculated using Frank and Morgan model and consequently TWW use in the industrial sector is less dangerous than other sectors. Moreover, the social acceptability index, which was determined using Mamdani fuzzy inference set, indicates higher acceptability of TWW use in natural resources sector compared with other sectors. By constructing the conceptual model, generating the decision matrix and using the results of gray relational analysis decision-making model for the four sectors, the allocation priorities of TWW became industry, natural resource, green space, and agriculture respectively. It is suggested that Water and Wastewater Company grant permission for TWW use to water-consuming industries and man-made forests development, which result in increasing employment, reduction of harmful effects of dust, and water consumption decrease.

Genome-wide identification and co-expression network analysis of nuclear factor-Y in barley revealed potential functions in salt stress.

Nuclear factor-Ys (NF-Ys) were previously shown to have important regulatory impacts in different developmental and physiological process. However, in barley the function of the NF-Y genes at system levels is not well known. To identify barley NF-Ys, Arabidopsis and wheat NF-Y protein sequences were retrieved and the BLAST program along with the hidden Markov model were used. Multiple sequence alignments of identified NF-Ys were constructed using ClustalW. Expression patterns of the NF-Ys at different physiological and developmental conditions were also surveyed based on microarray datasets in public databases and subsequently co-expression network were constructed. Validation of in silico expression analysis was performed by real-time qPCR under salt stress condition. In total, 23 barley NF-Ys (8 NF-YA, 11 NF-YB and 4 NF-YC) were identified. Based on the sequence homology, the subunits of the NF-Y complex were divided into three to five groups. Structural analysis highlighted the conserved domains of HvNF-YA, HvNF-YB and HvNF-YC. Co-expression network analysis indicated the potential functions of HvNF-Ys in photosynthesis, starch biosynthesis and osmotic stress tolerance. The results of qRT-PCR also confirmed the HvNF-Ys roles in adaptation responses of barley to salt stress. We identified some potential candidate genes which could be used for improvements of cereals tolerance to salinity stress.

Review of Static Approaches to Surgical Correction of Presbyopia.

Presbyopia is the primary cause of reduction in the quality of life of people in their 40s, due to dependence on spectacles. Therefore, presbyopia correction has become an evolving and rapidly progressive field in refractive surgery. There are two primary options for presbyopia correction: the dynamic approach uses the residual accommodative capacity of the eye, and the static approach attempts to enhance the depth of focus of the optical system. The dynamic approach attempts to reverse suspected pathophysiologic changes. Dynamic approaches such as accommodative intraocular lenses (IOLs), scleral expansion techniques, refilling, and photodisruption of the crystalline lens have attracted less clinical interest due to inconsistent results and the complexity of the techniques. We have reviewed the most popular static techniques in presbyopia surgery, including multifocal IOLs, PresbyLASIK, and corneal inlays, but we should emphasize that these techniques are very different from the physiologic status of an untouched eye. A systematic PubMed search for the keywords "presbylasik", "multifocal IOL", and "presbyopic corneal inlay" revealed 634 articles; 124 were controlled clinical trials, 95 were published in the previous 10 years, and 78 were English with available full text. We reviewed the abstracts and rejected the unrelated articles; other references were included as needed. This narrative review compares different treatments according to available information on the optical basis of each treatment modality, including the clinical outcomes such as near, intermediate, and far visual acuity, spectacles independence, quality of vision, and dysphotopic phenomena.

How to use composite indicator and linear programming model for determine sustainable tourism.

BACKGROUND: The tourism industry which is one of the most dynamic economic activities in today's world plays a significant role in the sustainable development. Therefore, in addition to paying attention to tourism, sustainable tourism must be taken into huge account; otherwise, the environment and its health will be damaged irreparably. METHODS: To determine the level of sustainability in this study, indicators of sustainable tourism were first presented in three environmental health, economic and social aspects. Then, the levels of sustainable tourism and environmental sustainability were practically measured in different cities of Kerman Province using a composite indicator, a linear programming model, Delphi method and the questionnaire technique. Finally, the study cities (tourist attractions) were ranked. RESULTS: Result of this study showed that unfortunately the tourism opportunities were not used appropriately in these cities and tourist destinations, and that environmental aspect (health and environmental sustainability) had very bad situations compared to social and economic aspects. In other words, environmental health had the lowest levels of sustainability. CONCLUSIONS: The environment is a place for all human activities like tourism, social and economic issues; therefore, its stability and health is of great importance. Thus, it is necessary to pay more attention to sustainability of activities, management and environmental health in planning sustainable development in regional and national policy.