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Lucas Kosobuski,1 Carolyn O’Donnell,1 Cynthia P Koh-Knox Sharp,2 Nathaniel Chen,1 Laura Palombi1 1Pharmacy Practice and Pharmaceutical Sciences, University of Minnesota - College of Pharmacy, Duluth, MN, USA; 2Purdue University College of Pharmacy, West Lafayette, IN, USACorrespondence: Laura Palombi, Pharmacy Practice and Pharmaceutical Sciences, University of Minnesota – College of Pharmacy, 1110 Kirby Drive, 232 Life Science, Duluth, MN, 55812, USA, Tel +1 218-726-6000, Fax +1 218-726-6500, Email lpalombi@d.umn.eduIntroduction: The opioid overdose crisis has claimed hundreds of thousands of lives in the United States in the last decade, with overdose numbers continuing to climb. At the same time, the role of the pharmacist in combating the opioid crisis continues to evolve.Methods: A literature search was conducted in Ovid MEDLINE that incorporated both MeSH terms and keywords to describe two concepts: the opioid epidemic and pharmacists/pharmacies. The search was limited to articles published after 2010 through the end of 2021 and returned 196 articles that were analyzed thematically.Results: Thematic analysis revealed the following themes: prevention, interventions, public health role of the pharmacist, pharmacists in multiple roles, barriers, pharmacist and healthcare provider attitudes, educational initiatives for pharmacists and student pharmacists, and future research.Discussion: While a great deal of progress has been made in the role of the pharmacist in supporting individuals with opioid use disorder (OUD) in the last two decades, pharmacists must seek to invest time and resources into practices with a strong evidence base to better mitigate the growing, devastating impact of the opioid crisis. Pharmacists must be willing to embrace new and non-traditional roles in patient care, service and research, and seek to advance evidence-based knowledge and practice.Conclusion: Pharmacy practice has expanded greatly in the past decade with pharmacists taking on new and creative approaches to addressing the opioid crisis. Collaborative and interdisciplinary approaches to addressing the root causes of opioid misuse and opioid overdose are still desperately needed. These include attention to the critical roles of social determinants of health, stigma elimination, legislative advocacy for patients with OUD, and focused education for providers, pharmacists, and the community. Recognition and support of the value of collaboration to both improve public health and individual patient care, continued investments in pharmacy practice advancement in OUD treatment and harm reduction, and the creation of workflows and prescribing algorithms to assist in dosing medications to prevent withdrawal symptoms and achieve improved pain control are desperately needed.Keywords: pharmacist, pharmacy, opioid, overdose, pharmacy practice

Breast cancer is the most common cancer among women worldwide. Molecular and clinical evidence indicated that Fragile X Messenger Ribonucleoprotein 1 (FMRP) plays a role in different types of cancer, including breast cancer. FMRP is an RNA binding protein that regulates the metabolism of a large group of mRNAs coding for proteins involved in both neural processes and in epithelial-mesenchymal transition, a pivotal mechanism that in cancer is associated to tumor progression, aggressiveness and chemoresistance. Here, we carried out a retrospective case-control study of 127 patients, to study the expression of FMRP and its correlation with metastasis formation in breast cancer. Consistent with previous findings, we found that FMRP levels are high in tumor tissue. Two categories have been analyzed, tumor with no metastases (referred as control tumors, 84 patients) and tumor with distant metastatic repetition, (referred as cases, 43 patients), with a follow-up of 7 years (mean). We found that FMRP levels were lower in both the nuclei and the cytoplasm in the cases compared to control tumors. Next, within the category cases (tumor with metastases) we evaluated FMRP expression in the specific sites of metastasis revealing a nuclear staining of FMRP. In addition, FMRP expression in both the nuclear and cytoplasmic compartment was significantly lower in patients who developed brain and bone metastases and higher in hepatic and pulmonary sites. While further studies are required to explore the underlying molecular mechanisms of FMRP expression and direct or inverse correlation with the secondary metastatic site, our findings suggest that FMRP levels might be considered a prognostic factor for site-specific metastasis. [ABSTRACT FROM AUTHOR]

Copyright of Annali di Igiene, Medicina Preventiva e di Comunità is the property of Societa Editrice Universo s.r.l. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Annali di Igiene, Medicina Preventiva e di Comunità is the property of Societa Editrice Universo s.r.l. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background. The United Nations Children's Fund (UNICEF) reported that ~1 770 000 adolescents were living with HIV infection in 2017, of whom >80% were in sub-Saharan Africa. In Malawi, ~25 000 boys and 46 000 girls are infected with HIV. Objective. The present study aimed to evaluate a specific adolescent-friendly service implemented in a Diseases Relief through Excellence and Advanced Means (DREAM) health centre in Malawi. Methods. All HIV-positive patients aged 10 - 19 years in the care of the DREAM centre in Blantyre on 17 December 2016 were included in the study and followed-up until 1 January 2018. The service was organised for one adult-free day, with some side activities managed by a co-ordinator and youth leaders. Assessments were performed at the end of the period (EOP). Results. On 17 December 2016, 425 patients were enrolled in the study. Follow-up status at EOP was 403 (94.8%) patients in care, 7 (1.6%) lost to follow-up (LTFU), 2 (0.5%) died and 13 (3.1%) were transferred to other facilities. Death and LTFU rates were 0.72/100 and 2.9/100 person-years, respectively. Moreover, 50.6% (n=198/391) of patients had an improvement in body mass index (BMI)-for-age z-scores, and 70.2% (n=33/47) of patients who were malnourished at baseline improved (higher improvement in older patients). Mean (standard deviation (SD)) haemoglobin levels increased from 12.5 (1.5) mg/dL to 13.1 (1.9) mg/dL (significance level p=0.000). At the EOP, 79.0% (n=309/391) of patients had viral suppression. Conclusion. Care of adolescent HIV+ patients remains a challenge, but the implementation of specific projects involving adolescents and youth leaders can increase adherence and improve viral suppression. [ABSTRACT FROM AUTHOR]

Background: Tuberculosis (TB) represents the ninth leading cause of death worldwide. In 2016 are estimated 1.3 million TB deaths among HIV negative people and an additional 374,000 deaths among HIV positive people. In 2016 are estimated 1.4 million new cases of TB in people living with HIV (PLHIV), 74% of whom were living in Africa. In light of these data, the reduction of mortality caused by TB in PLHIV is strongly required specially in low-income countries as Mozambique. According to international guidelines, the initial TB screening in HIV+ patients should be done with the four symptoms screening (4SS: fever, current cough, night sweats and weight loss). The diagnostic test more used in resource-limited countries is smear microscopy (SMEAR). World Health Organization (WHO) recommended Lateral Flow urine LipoArabinoMannan assay (LF-LAM) in immunocompromised patients; in 2010 WHO endorsed the use of Xpert Mycobacterium Tuberculosis/Rifampicin (MTB/RIF) test for rapid TB diagnosis but the assay is not used as screening test in all HIV+ patients irrespectively of symptoms due to cost and logistical barriers. The paper aims to evaluate the cost-effectiveness of three screening protocols: standard (4SS and SMEAR in positive patients to 4SS); MTB/RIF; LF-LAM / MTB/RIF. Methods: We developed a model to assess the cost-effectiveness of the MTB/RIF protocol versus the common standard and LF-LAM / MTB/RIF protocol. The model considered a sample of 1,000 HIV+ antiretroviral treatment naïve patients in Mozambique. We evaluated disability-adjusted life year (DALY) averted for each protocol, cost per DALY, and incremental cost-effectiveness ratio (ICER), over 1-year, assuming a national healthcare system perspective. The model considered the delayed diagnosis as the time elapsed between a false negative test and the diagnosis and treatment of TB. Additional health system organization delay is defined as the time interval between positive test and treatment initiation caused by a delay in the delivery of results due organization of services. We conducted a sensitivity analysis on more relevant variables. Results: The MTB/RIF protocol was cost-effective as compared to the standard protocol with an ICER of $56.54 per DALY saved. In a cohort of 1,000 patients MTB/RIF and LF-LAM / MTB/RIF protocol generated 1,281 and 1,254 DALY’s saved respectively, with a difference of 174 and 147 DALY respect to the standard protocol. The total cost of MTB/RIF protocol was lower ($92,263) than the standard ($147,226) and the LF-LAM / MTB/RIF ($113,196). Therefore, the cost per DALY saved including new infections due to delayed diagnosis with the standard protocol was $79.06, about 5 fold higher than MTB/RIF and LF-LAM / MTB/RIF protocols. The cost of additional TB infections due to delays in diagnosis plus health system delay seemed the more relevant costs. The low sensibility and sensitivity of the standard protocol led to a high number of false negatives, thus delayed TB diagnoses and treatment lead to the development of newly transmitted TB infections. Conclusions: Our study shows that the MTB/RIF adoption could lead to an increasing of TB case-finding and a reduction in costs compared with standard and LF-LAM / MTB/RIF protocols. [ABSTRACT FROM AUTHOR]

A new class of multi-heteroatomic cyclic compounds containing N, S and O has been achieved in an enantioselective fashion via desymmetrization of 2-cyano-N-tosylbenzylidenimine with thiols and subsequent catalytic dynamic kinetic resolution (DKR). Both organo- and phase transfer catalysis based on cinchona alkaloids having two H-bonding coordination sites proved to be effective to furnish very good level of enantioselectivity (up to 95:5 er) in the heterocyclization of racemic N-Tosyl-protected N,S-acetals deriving from 2-formyl benzonitriles. [ABSTRACT FROM AUTHOR]

CFD (Computational Fluid Dynamics) simulations are widely used nowadays to predict the behaviour of fluids in pure research and in industrial applications. This approach makes it possible to get quantitatively meaningful results, often in good agreement with the experimental ones. The aim of this paper is to show how CFD calculations can help to understand the time evolution of two possible CBRNe (Chemical-Biological-Radiological-Nuclear-explosive) events: (1) hazardous dust mobilization due to the interaction between a jet of air and a metallic powder in case of a LOVA (Loss Of Vacuum Accidents) that is one of the possible accidents that can occur in experimental nuclear fusion plants; (2) toxic gas release in atmosphere. The scenario analysed in the paper has consequences similar to those expected in case of a release of dangerous substances (chemical or radioactive) in enclosed or open environment during nonconventional events (like accidents or man-made or natural disasters). [ABSTRACT FROM AUTHOR]

The use of weapons of mass destruction for military purposes is a problem that has its origins in the early history of humanity. Many substances were used as weapon but the chemical ones were the first to be used in history. The first use of chemical agents dates back to 7th century B.C. during the siege of Cirrha, a Greek city. In the literature of that time there are many examples of the use of chemicals, for example in Thucydides' papers, in which the Greek author describes how the Spartans had burned trees previously soaked with sulphur to produce toxic gases that would have reduced the Plataea city's protections. Unfortunately, their plan failed when the wind direction suddenly changed, poisoning their troops instead. Even the Middle Ages offer many testimonies of the use of chemicals as weapons. A real large-scale use of these substances took place in many other events, for example: during the American Civil war (1861-1865) when General Gilmore used explosive shells against the Confederates. In 1865, when Napoleon used hydrogen for military purposes and in 1900, during the Crimean war, when sulphuric gas was used against the Russian troops near Sevastopol. However, the highest levels of use of chemical agents were achieved during World Wars I and II (WWI and WWII). During these years of wars, the international community deemed necessary to regulate the use of this kind of substances and for this aim a couple of conferences were organized in 1899 and 1907 in The Hague to discuss the regulation of chemical agents' use during war. The most important conference took place in Geneva in 1925 where the Chemical Weapons Convention was born. This work is a review of the historical events involving dangerous chemical agents. [ABSTRACT FROM AUTHOR]

Three different studies are reported concerning the environmental pollution caused by viruses in Albania. The first study describes an outbreak of gastroenteritis in the capital city, involving 2,722 children attending the Paediatric Unit of Tirana Hospital. The age group with the highest morbidity was 0-5 years, with 89.5%; no fatalities were recorded during the outbreak. Rotavirus was detected in 26/28 faecal samples by RT-PCR, although astrovirus, adenovirus and calicivirus were also present. The second study describes an outbreak of hepatitis A virus involving the city of Lac. Two hundred cases were recorded, with the highest incidence in the age-group 5-9 years. Phylogenetic analysis of the VP1/2A region showed the presence of a unique sequence: genotype IA. Rotavirus was identified in drinking-water samples collected during the outbreak. The third study describes the prevalence of HAV and HEV in 202 sera randomly collected from 12 different cities in Albania. HAV showed a high incidence (66.2%), whereas none was positive for HEV. The genomic analysis of the VP1/2A junction revealed the presence of only one genotype (IA) with few point mutations and just two amino acid substitutions at codons 22 and 34. Additionally, two potential antigenic variants were detected, the first at position 46 of VP3 and the second at position 23 of VP1. [ABSTRACT FROM AUTHOR]

Presents a study to evaluate the development of a realistic model of the different socio-economic and hygienic areas of Tirane, Albania. How interviewers from the city's Public Health Directorate, contacted randomly, door-to-door, the residents, submitting a questionnaire and collecting water samples at the same time; Findings of relevant differences regarding distribution and quality of drinking water between the centre and peripheral areas.

Examines the requirements for non-hospital services for patients with AIDS and AIDS-related complex (ARC) in Rome, Italy. Relation of demand of services to the state of health and socio-economic situation; Pattern of severe socio-economic difficulties; Main problems; Most frequently required social services.

Introduction: One in six adolescents aged suffers from mental health problems. Despite the presence of general information on Italian adolescents' mental health, provided by periodic epidemiological studies, researches conducted with standardized assessment tools are scarce in the scientific literature. Objectives: To evaluate the prevalence of self-reported behavioral and emotional problems in a group of Italian adolescents and to examine their relation to important socio-demographical variables, in order to provide relevant information about of adolescence mental health in our country. Methods: A population-based survey was conducted on high school students from urban areas of Rome and Latina. Sociodemographic variables, including age, gender, type of school, socio-economic status, urbanicity, as well as Youth Self-Report (YSR) evaluating 3 broadband scales (Internalizing Disorders; Externalizing Disorders; Total Problem scale) were collected. Univariable and Multivariable Logistic regression were used to assess the association between socio-demographic variables and YSR. Results: Our final sample consisted of 1400 adolescents (38.61% male, mean age 16 yrs, SD 1.42). Prevalence of Internalizing Problems, Externalizing Problems and Total Problems was 29.55%, 18.34% and 24.13%. Internalizing Symptoms were not explained by sociodemographic variables, while Externalizing Symptoms were explained by Male Gender (OR=1.53, [1.14,2.06]), older age (OR=2.06, [1.52,2.79]) and attending a Professional Institute (OR=2.15, [1.53,3.02] Adjusted R²=4.32%). Total Problems were explained by School Type (Professional Institutes and Art and Humanities vs. Grammar and Science School; OR 1.93 [1.40,2.67] and 1.64 [1.08,2.47], adjusted R²=1.94). Conclusions: The study estimates the prevalence of self-reported behavioral and emotional problems in a large sample of Italian adolescents, highlighting the role of socio-demographic risk factors for externalizing behaviors. [ABSTRACT FROM AUTHOR]

Abstract Background The DREAM Project operates within the framework of the national health systems of several sub-Saharan African countries and aims to introduce the essential components of an integrated strategy for the prevention and treatment of HIV/AIDS. The project is intended to serve as a model for a wide-ranging scale-up in the response to the epidemic. This paper aims to show DREAM's challenges and the solutions adopted. One of the solutions is the efficient management of the clinical data regarding the treatment of the patients and epidemiological analyses. Methods Specific software for the management of the patients' EMR has been created within the DREAM programme in order to deal with the challenges deriving from the context in which DREAM operates. Setting up a computer infrastructure in health centres, providing a power supply, as well as managing the data and the project resources efficiently and reliably, are some of the questions that have been analysed in this study. Results Over the years this software has proved that it is able to respond to the need for efficient management of the clinical data and organization of the health centres. Today it is used in 10 countries in sub-Saharan Africa by thousands of professionals and by now it has reached its fourth version. The medical files of over 73,000 assisted patients are managed by this software and the data collected with it have become essential for the epidemiological research that is carried out to improve the effectiveness of the therapy. Conclusion Sub-Saharan Africa is the region hardest hit by HIV and AIDS in the world. However, the resources and responses adopted so far, to confront the epidemic, have at times been rather minimalist. The DREAM project has faced the battle against the epidemic by equipping itself with qualitative standards comparable to Western ones. The experience of DREAM has revealed that it is indeed possible to guarantee levels of excellence in developing countries, also in the sphere of ICT (Information and Communication Technology), thus making the intervention even more effective and contributing to bridging the digital divide.

The Thomson scattering diagnostics are fundamental for a reliable determination of electron density and temperature profiles in Tokamak experiments. In JT-60SA, two systems are currently under development: one is dedicated to the core plasma region, the other to the edge region. They aim to measure the T e and n e profiles with a precision better than 10% and 5%, respectively, at an electron density of 1019 m−3 and with an electron temperature ranging from 10 eV up to 10 keV for the edge system and from 100 eV to 30 keV for the core one. The polychromators design, based on interference filters and APD detectors, is critical to achieve such performance. Each polychromator comprises 6 spectral channels measuring from 1064 nm down to 500 nm for the core system and to 660 nm for the edge one. The design aims at maximizing the efficiency and minimizing the noise under different plasma conditions. About 100 polychromators are manufactured by G.N.R.srl under an F4E contract. In this work, we present the polychromators design and performance. The key features of the optical design and of the mechanical structure are discussed. State of the art interference filters and APD detectors with custom electronics are described. Overall optical transmission measurements of the assembled polychromators and spectral channels calibration are then presented. More specific studies of the APD electrical noise and temperature dependence are discussed. The transmission functions are finally used to predict the error expected in the determination of the electron temperature and density under different levels of plasma light intensity. • New modular polychromator design for Thomson scattering application. • JT-60SA edge Thomson scattering performance assessment. • Polychromator design optimized through optical ray tracing • Custom electronics for APD bias and amplification • Quality control of polychromator key characteristics [ABSTRACT FROM AUTHOR]

Abstract: Fluorescence lidar is a non-invasive, remote sensing technique that makes it possible to extend the application of the laser-induced fluorescence technique to the outdoor environment, where uncontrolled external conditions must be met. Although initially developed for the investigation of marine environment and vegetation, in the past decade this technique has been successfully applied to the field of the cultural heritage. Among other applications, the detection and characterisation of photoautotrophic biodeteriogens has become very promising: the method is based on the detection of chlorophyll a fluorescence, while fluorescent accessory pigments can be exploited for a rough classification of the biodeteriogens present on the surface. Early experiments on monuments date back to the mid 1990s, when fluorescence lidar point measurements were conducted on the Cathedral and Baptistery of Parma, Italy. Subsequently, the technique has taken further advantage of the introduction of imaging capabilities in lidar instrumentation and this has led to the acquisition of hyperspectral fluorescence maps over extended areas of several monuments from distances as great as 80 m. Here, we present the main achievements obtained in the outdoor cultural heritage so far and the latest developments in the technique. [Copyright &y& Elsevier]

Abstract: The detection of frail elderly people is a crucial point in planning health care services. The aim of this study is to assess the effectiveness of a multidimensional evaluation instrument in order to identify frail elderly people, in a primary care setting. In 1994, a 15–20-min multidimensional questionnaire, called Geriatric Functional Evaluation (GFE), was administered to 3060 over 65-year-old citizens of Ragusa (Italy), who live in their own home. The sample was subdivided in three groups (independent, moderately impaired, and severely impaired) on the basis of the Final Synthetic Score (FSS) originated by the answers to the questionnaire. A follow up was carried out in 1999 with survival and institutionalization as the end-point. The lost to follow-up rate was 1.2%. After 5 years, the Kaplan–Meyer survival analysis showed that the survival rate of the three groups was 42%, 68%, and 88%, respectively. The Cox Proportional Survival analysis showed that the risk of death was doubled in the moderately impaired group and tripled in the severely impaired group compared with higher FSS group. The multivariate analysis showed that the use of services was increased by 40% and therefore indirectly their need, shifting from the lowest to the highest score. The FGE questionnaire had a strong predictivity of both mortality and need of services. The use of FGE in a primary care setting could make it possible to detect the frail population in order to address the community based services. [Copyright &y& Elsevier]