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Hospitals are increasingly filled with people admitted for medical and surgical complications of substance use disorder (SUD). Hospitalization can be a reachable moment to engage and initiate SUD care. Yet most hospitals do not have systems in place to adequately address addiction, and most providers have little to no addiction training. There is widespread need for protocols and tools to implement hospital-based SUD care. We share best practices from our hospital-based Improving Addiction Care Team (IMPACT). We include a description of interprofessional roles (medical providers, social workers, peers with lived experience in recovery) and include detailed appendices of practical tools such as medication protocols (eg, buprenorphine induction), risk assessments (eg, outpatient parenteral antibiotic therapy) and treatment tools (eg, a patient safety care plan to manage patient and staff expectations surrounding risks for in hospital drug use). A case example illustrates how IMPACT works and how tools can be applied. We hope other hospitals can adapt and integrate these tools to support widespread implementation of hospital-based SUD care.

Invasive fungal infections cause 1.6 million deaths annually, primarily in immunocompromised individuals. Mortality rates are as high as 90% due to limited treatments. The azole class antifungal, fluconazole, is widely available and has multi-species activity but only inhibits growth instead of killing fungal cells, necessitating long treatments. To improve treatment, we used our novel high-throughput method, the overlap2 method (O2M) to identify drugs that interact with fluconazole, either increasing or decreasing efficacy. We identified 40 molecules that act synergistically (amplify activity) and 19 molecules that act antagonistically (decrease efficacy) when combined with fluconazole. We found that critical frontline beta-lactam antibiotics antagonize fluconazole activity. A promising fluconazole-synergizing anticholinergic drug, dicyclomine, increases fungal cell permeability and inhibits nutrient intake when combined with fluconazole. In vivo, this combination doubled the time-to-endpoint of mice with Cryptococcus neoformans meningitis. Thus, our ability to rapidly identify synergistic and antagonistic drug interactions can potentially alter the patient outcomes., eLife digest Individuals with weakened immune systems – such as recipients of organ transplants – can fall prey to illnesses caused by fungi that are harmless to most people. These infections are difficult to manage because few treatments exist to fight fungi, and many have severe side effects. Antifungal drugs usually slow the growth of fungi cells rather than kill them, which means that patients must remain under treatment for a long time, or even for life. One way to boost efficiency and combat resistant infections is to combine antifungal treatments with drugs that work in complementary ways: the drugs strengthen each other’s actions, and together they can potentially kill the fungus rather than slow its progression. However, not all drug combinations are helpful. In fact, certain drugs may interact in ways that make treatment less effective. This is particularly concerning because people with weakened immune systems often take many types of medications. Here, Wambaugh et al. harnessed a new high-throughput system to screen how 2,000 drugs (many of which already approved to treat other conditions) affected the efficiency of a common antifungal called fluconazole. This highlighted 19 drugs that made fluconazole less effective, some being antibiotics routinely used to treat patients with weakened immune systems. On the other hand, 40 drugs boosted the efficiency of fluconazole, including dicyclomine, a compound currently used to treat inflammatory bowel syndrome. In fact, pairing dicyclomine and fluconazole more than doubled the survival rate of mice with severe fungal infections. The combined treatment could target many species of harmful fungi, even those that had become resistant to fluconazole alone. The results by Wambaugh et al. point towards better treatments for individuals with serious fungal infections. Drugs already in circulation for other conditions could be used to boost the efficiency of fluconazole, while antibiotics that do not decrease the efficiency of this medication should be selected to treat at-risk patients.

SummaryInvasive fungal infections cause 1.6 million deaths annually, primarily in immunocompromised individuals. Mortality rates are as high as 90% due to limited number of efficacious drugs and poor drug availability. The azole class antifungal, fluconazole, is widely available and has multi-species activity but only inhibits fungal cell growth instead of killing fungal cells, necessitating long treatments. To improve fluconazole treatments, we used our novel high-throughput method, the overlap2method (O2M), to identify drugs that interact with fluconazole, either increasing or decreasing efficacy. Although serendipitous identification of these interactions is rare, O2M allows us to screen molecules five times faster than testing combinations individually and greatly enriches for interactors. We identified 40 molecules that act synergistically (amplify activity) and 19 molecules that act antagonistically (decrease efficacy) when combined with fluconazole. We found that critical frontline beta-lactam antibiotics antagonize fluconazole activity. A promising fluconazole-synergizing anticholinergic drug, dicyclomine, increases fungal cell permeability and inhibits nutrient intake when combined with fluconazole.In vivo, this combination doubled the time-to-endpoint of mice with disseminatedCryptococcus neoformansinfections. Thus, our ability to rapidly identify synergistic and antagonistic drug interactions can potentially alter the patient outcomes.

Although a surgical removal of tunneled central venous catheter is usually simple, it can become complicated when the catheter is found to be stuck because of its adherence within a central vein. If a catheter is pulled too hard, it may fracture within a central vein in two pieces. In this report, we describe the mechanics of central venous catheter breakage and provide a solution that minimizes the possibility of catheter from breaking as it is pulled out from its stuck position within a central vein.

A theoretical analysis on the polarization effects of a light beam propagating in a birefringent single-mode fiber is presented. We derive a system of differential equations representing the evolution of Stokes parameters and illustrate their application to polarization effects in a straight birefringent single mode optical fiber. The solutions to the set of equations are obtained using specifically the methods of the unified formalism for polarization optics which adopt the use of the Stokes–Mueller equation and the Lorentz group to model polarization phenomena in media such as optical fibers. The analytical results presented using this approach are identical to results obtained from other conventional methods. We observe the characteristic exponential decrease in the total intensity of the input light due to attenuation by the fiber.

Between 2005 and 2011, the WHO Regional Office for Europe assisted the member states of the WHO European Region to prepare and respond to outbreaks of avian influenza H5N1, the 2009 pandemic, and to enhance their capacities for the prevention and control of seasonal influenza. It did this through conducting a combination of regional and subregional meetings and trainings, establishing a regional network for influenza surveillance, providing operational guidance for implementing influenza surveillance and strengthening the capacities of National Influenza Centers, and through assistance at the country-level where needed. In all, close to 60 country-missions or country-level activities were conducted. These activities were conducted in close coordination with WHO headquarters, WHO European Region Country Offices, the European Commission, the European Centre for Disease Prevention and Control, and with other partner organizations, and were in line with the implementation of the International Health Regulations (2005). The results of activities as well as guidance documents were disseminated to a wide audience through publication on the WHO Regional Office for Europe Influenza website, on the EuroFlu website, and through peer-reviewed publications.

In this letter, a polarization model based on a Mueller matrix approach is used to determine the degree of linear polarization of light propagating in an optical fiber deployed in a nontrivial configuration, i.e., helically wound on a cylindrical shell experiencing uniform radial displacement. Simulations are performed to investigate the effect of externally induced birefringence and compared to results from a polarization model found in the literature. A comparison of the simulations using both models showed that birefringence due to the fiber deployment and geometry greatly effected the polarization properties of the light transmitted in the fiber. The polarization model based on a Mueller matrix approach includes the effects of fiber deployment and geometry, and accurately describes polarization phenomena for nontrivial fiber configurations.

Optical projections of a stained, intact guinea pig cochlea are reconstructed from 36 projection images, spaced every 5 degrees around a semicircle, a three-dimensional image is computed within a cube of dimensions 256*256*256 pixels. Acquisition of data about a single tilt axis allows the 3-D reconstruction problem to be simplified to the reconstruction of multiple 2-D slices from 1-D projections. The resolution of the reconstruction matrix is approximately 15 mu m/sup 3/ per volume element. Various anatomical features are recognizable, including the scalae, the basilar membrane, the round and oval windows, and the modiolus. >

B. Dresser’,‘, E. Pope’,*, N. Chin3, J. Liu*, N. Loskutoff4, E. Behnke3, C. Brown4, M. McRae’, C. Sinoway3, M. Campbell’, K. Cameron’, R. Evans’, 0. 0wens3, C. Johnson’, M. Cedars* ‘Cincinnati Zoo Center for Reproduction of Endangered Wildlife (CREW), 3400 Vine Street, Cincinnati, OH 45220 USA; *University of Cincinnati College of Medicine, Department of Obstetrics and Gynecology, Cincinnati, OH; 3The Christ Hospital, Cincinnati, OH; 40maha’s Henry Doorly Zoo, Omaha, NE; 5Bethesda Hospital, Cincinnati, OH.

An experimental study of the polarization properties of a rectangular polarization-maintaining (PM) fiber is reported. The extinction ratio is measured at 1320 nm for lengths of 20, 40, 100, 310, and 804 m. The length dependence of the extinction ratio is demonstrated to be in excellent agreement with the predictions of a model derived from random coupling theory. This agreement is due to the careful winding and packaging of the rectangular PM fiber, whereby minimal external perturbations are introduced. This is facilitated by the rectangular geometry of the fiber. The polarization-holding parameter is 2.08+or-0.09*10/sup -6/ m/sup -1/. >

A novel and practical polarization shuttle pulse (PSP) technique has been developed to measure the intrinsic birefringence in short lengths of nominally circular-core low-birefringence single-mode fibers. By adding a linear polarizer, a Soleil-Babinet compensator, and a linear analyzer to the conventional shuttle-pulse arrangement, the length dependence of the phase delay (and hence the birefringence) can be measured nondestructively. An order-of-magnitude improvement in measurement repeatability over the conventional cut-back method has been achieved.