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Background As opioid use disorder (OUD) incidence and its associated deaths continue to persist at elevated rates, the development of novel treatment modalities is warranted. Recent strides in this therapeutic area include novel anti-opioid vaccine approaches. This work compares logistical and ethical considerations surrounding currently available interventions for opioid use disorder with an anti-opioid vaccine approach. Methods The opinions of student pharmacists and practicing pharmacists assessing knowledge, perceptions, and attitudes toward current and future OUD management strategies were characterized using a staged, multi-modal research approach incorporating a focus group, pilot survey development and refinement, and final survey deployment. Survey responses were assessed using one- and two-way parametric and non-parametric analyses where appropriate, and multi-dimensional matrix profiles were compared using z-tests following an exhaustive combinatorial sum of differences calculation between items within each compared matrix. Results Focus group content analysis revealed a high level of agreeableness among participants regarding anti-opioid vaccine technology and a sense of shared ownership regarding solutions to the opioid epidemic at large. Pilot survey results demonstrated subject ability to consider both pragmatic and ethical considerations related to current therapeutics and novel interventions in a single instrument, with high endurance amongst engaged subjects. Access inequality was the most concerning ethical consideration identified for anti-opioid vaccines. Support for anti-opioid vaccine implementation across various clinical scenarios was strongest for voluntary use amongst individuals in recovery, and lowest for mandatory use in at-risk individuals. Conclusions Ethical and logistical concerns surrounding anti-opioid vaccines were largely similar to those for current OUD therapeutics overall. Anti-opioid vaccines were endorsed as helpful potential additions to current OUD therapeutic approaches, particularly for voluntary use in the later stages of clinical progression.

Within mycobacteria, polysaccharide chain length determines periplasm size and modulates antibiotic susceptibility., Bacteria control the length of their polysaccharides, which can control cell viability, physiology, virulence, and immune evasion. Polysaccharide chain length affects immunomodulation, but its impact on bacterial physiology and antibiotic susceptibility was unclear. We probed the consequences of truncating the mycobacterial galactan, an essential linear polysaccharide of about 30 residues. Galactan covalently bridges cell envelope layers, with the outermost cell wall linkage point occurring at residue 12. Reducing galactan chain length by approximately half compromises fitness, alters cell morphology, and increases the potency of hydrophobic antibiotics. Systematic variation of the galactan chain length revealed that it determines periplasm size. Thus, glycan chain length can directly affect cellular physiology and antibiotic activity, and mycobacterial glycans, not proteins, regulate periplasm size.

Many large provider networks are investing heavily in preventing disease within the communities that they serve. We explore the potential benefits and challenges associated with tackling depression at the community level using a unique dataset designed for one such provider network. The economic costs of having depression (increased medical care use, lower quality of life, and decreased workplace productivity) are among the highest of any disease. Depression often goes undiagnosed, yet many believe that depression can be treated or prevented altogether. We explore the prevalence, distribution, economic burden, and the psychosocial and economic factors associated with undiagnosed depression in a lower-income neighborhood in northern Manhattan. Even using state-of-the art data to “diagnose” the risk factors within a community, it can be challenging for provider networks to act against such risk factors., Highlights • Risk factors for undiagnosed depression include psychological stress, drug use, and co-morbid medical conditions. • Based on QALYs lost, the per-resident burden of having undiagnosed depression is $9950 of lost QALYs per resident. • Less advantaged residents bear an even greater economic burden of having undiagnosed depression. • There are both benefits and challenges associated with tackling depression at the community level.

Although frequent attendance at religious services is associated with healthier behaviors and improved health outcomes, this relationship is confounded to the extent that attending religious services requires and displays a certain degree of health. This study surveyed patients over multiple hospitalizations at a large urban academic medical center to test the hypothesis that changes in health status would be accompanied by parallel changes in religious attendance but not with self-rated religiosity and spirituality. Study data confirmed the hypothesis, suggesting that cross-sectional associations between religious attendance and good health outcomes reflect, to some degree, the way changes in health status impact one’s ability to attend religious services.

Decisions to withhold or withdraw life-sustaining treatment (LST) precede the majority of ICU deaths. Although professional guidelines generally treat the two as ethically equivalent, evidence suggests withdrawing LST is often more psychologically difficult than withholding it. The aim of the experiment was to investigate whether physicians are more supportive of withholding LST than withdrawing it and to assess how physicians' opinions are shaped by their religious characteristics, specialty, and experience caring for dying patients. In 2010, a survey was mailed to 2016 practicing US physicians. Physicians were asked whether physicians should always comply with a competent patient's request to withdraw LST, whether withdrawing LST is more psychologically difficult than withholding it, and whether withdrawing LST is typically more ethically problematic than withholding it. Of 1880 eligible physicians, 1156 responded to the survey (62%); 93% agreed that physicians should always comply with a competent patient's request to withdraw LST. More than half of the physicians reported that they find withdrawing LST more psychologically difficult than withholding it (61%), and that withdrawing LST is typically more ethically problematic (59%). Physician religiosity was associated with finding withdrawal more ethically problematic, but not with finding it more psychologically difficult. Physicians working in an end-of-life specialty and physicians with more experience caring for dying patients were less likely to endorse either a psychological or an ethical distinction between withdrawing and withholding LST. Most US physicians find withdrawing LST not only more psychologically difficult, but also more ethically problematic than withholding such treatment. Physicians' opinions are to some extent shaped by their religious characteristics, specialty, and levels of experience caring for dying patients.