From Microtiter Plates to Droplets-There and Back Again.

Droplet-based microfluidic screening techniques can benefit from interfacing established microtiter plate-based screening and sample management workflows. Interfacing tools are required both for loading preconfigured microtiter-plate (MTP)-based sample collections into droplets and for dispensing the used droplets samples back into MTPs for subsequent storage or further processing. Here, we present a collection of Digital Microfluidic Pipetting Tips (DMPTs) with integrated facilities for droplet generation and manipulation together with a robotic system for its operation. This combination serves as a bidirectional sampling interface for sample transfer from wells into droplets (w2d) and vice versa droplets into wells (d2w). The DMPT were designed to fit into 96-deep-well MTPs and prepared from glass by means of microsystems technology. The aspirated samples are converted into the channel-confined droplets' sequences separated by an immiscible carrier medium. To comply with the demands of dose-response assays, up to three additional assay compound solutions can be added to the sample droplets. To enable different procedural assay protocols, four different DMPT variants were made. In this way, droplet series with gradually changing composition can be generated for, e.g., 2D screening purposes. The developed DMPT and their common fluidic connector are described here. To handle the opposite transfer d2w, a robotic transfer system was set up and is described briefly.

Transition from methadone to subcutaneous buprenorphine depot in patients with opioid use disorder in custodial setting - a case series.

BACKGROUND: Methadone, a full opioid agonist, and buprenorphine, a partial agonist at the opioid receptor, are established first-line medications for opioid maintenance therapy. Transition from methadone to sublingual buprenorphine may precipitate withdrawal and is usually performed only in patients on low dose of methadone (<30-40 mg). Transition from methadone to a novel subcutaneous buprenorphine depot (Buvidal) has not been previously described. OBJECTIVES: To test the hypothesis that a rapid transition from methadone to buprenorphine depot after a single dose of buprenorphine 4 mg sublingual is safe and well tolerated. METHODS: Retrospective chart analysis of a case series of seven opioid users under custodial setting (prison) who were switched from methadone to buprenorphine depot (initial dose 16 mg weekly subcutaneously) after an initial test dose of buprenorphine 4 mg sublingual within 48 hours. RESULTS: Clinical data indicate that a rapid transition from methadone to depot buprenorphine is feasible (six patients within 48 hours, one within 4 days). All patients were successfully switched to buprenorphine depot and the transfer period was completed without dropouts or major medical problems. Further dose adjustments were performed in 4 of 7 patients. CONCLUSIONS: Transition of opioid users from methadone to buprenorphine depot is feasible and safe via 4 mg buprenorphine sublingual. This procedure may facilitate induction of buprenorphine depot formulations in patients treated with methadone.

Inpatient risk management with mentally ill offenders: results of a survey on clinical decision-making about easing restrictions.

BACKGROUND: Procedures for easing restrictions in forensic hospitals are an important part of treatment and serve to prepare inpatients for community conditions. In spite of this, there are still very few empirical data on the assessment of the risks involved. Clinical experience, expert knowledge and theoretical considerations indicate that the risk factors for recidivism after discharge from hospital are not identical with those that predict incidents during hospitalization or during the easing of restrictions. AIMS: To determine both possible risk factors for incidents during hospitalization and criteria allowing easing of regulations and confinement. METHODS: A survey was conducted of clinicians in forensic hospitals concerning their perception of risk and protective factors. RESULTS: The survey revealed that stable dynamic factors were more relevant for clinicians than static risk factors. Furthermore, clinicians rated protective factors as being as important as risk factors. Depending on the rehabilitation process, aspects of the social network outside the institutions were also rated as being important. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: These findings offer some clarification of the concept of clinical judgment as applied to assessment of readiness for discharge of offender patients from specialist forensic psychiatric hospitals. Research into risk assessment and management might be improved by taking account of explicit clinical concerns.