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OBJECTIVE The ANCHOR program offered buprenorphine treatment to people who inject drugs engaged in hepatitis C (HCV) treatment at a Washington, DC harm reduction organization. This analysis describes the program model and outcomes of the opioid care continuum at 1 year. METHODS Primary outcomes were initiation of buprenorphine and retention in care, defined by an active buprenorphine prescription at given time points. Secondary outcomes included treatment interruptions, reasons for treatment noninitiation and termination, buprenorphine and opiate use, and HIV risk behaviors. Buprenorphine and opiate use were measured by urine toxicology screens and HIV risk behavior was quantified using a validated survey. RESULTS Of 67 patients receiving HCV treatment not on opioid agonist therapy at baseline, 96% (n = 64) were interested and 73% (n = 49) initiated buprenorphine. Retention was 82% (n = 40), 65% (n = 32), and 59% (n = 29) at months 1, 6, and 12, respectively. Retention at 12 months was associated with self-reported engagement in routine medical care (P

Background The COVID-19 pandemic has had especially devastating effects on people who use drugs. Due to pandemic protocols in the USA, medication-assisted treatment (MAT) regulations became more flexible, permitting our community-based nonprofit organization to transition its low-threshold MAT clinic to an audio-only telehealth model of care in 2020. Lessons learned have the potential to improve MAT delivery to people with OUD. Case presentation This case study describes our transition from a low-threshold community-based in-person MAT clinic to an audio-only telehealth model. We extracted data from electronic health records to describe patient characteristics and to calculate treatment retention rates. Patients were predominantly male (74.4%) and black (90.6%). The mean age was 53 years old with more than half of the clients aged 55 or older. Less than half (42.3%) of the patients lived in stable housing. Patients commonly had self-reported comorbid conditions such as hypertension (35.4%), hepatitis C (23.5%), diabetes (11.9%), human immunodeficiency virus (HIV) (7.2%). A majority of patients (68.6%) reported engagement with behavioral health care. We measure the success of our intervention relative to published retention rates, both overall as well as for in-person and telehealth care. In-person retention rates at 90- and 180-days were substantially higher than telehealth retention rates (93.9% vs 68.4% and 91.5% vs 51.9%, respectively). Conclusions Low-threshold medication-assisted treatment in the care of people with opioid use disorder is essential to increasing treatment access and continuity. We found that an audio-only telehealth model was viable. Although we had decreased retention rates following the transition to an audio-only telehealth model, our rates remained excellent compared to published values for in-person MAT care. We call for advocacy and regulations to support continued use of telehealth services throughout and beyond the COVID-19 pandemic.

Background People who inject drugs have a high prevalence of hepatitis C virus (HCV) and significant disease associated with drug use; however, HCV treatment often occurs in absence of interventions to address opioid use disorder and drug use–related harms. The impact of concurrent initiation of opioid agonist therapy (OAT) on HCV treatment and drug use outcomes is unknown. Methods In this prospective, open-label, observational trial at a harm reduction organization’s drop-in center in Washington, DC, 100 patients with chronic HCV infection, opioid use disorder, and ongoing injection drug use were treated with sofosbuvir-velpatasvir for 12-weeks and offered buprenorphine initiation. The primary end point was sustained virologic response (SVR), and secondary end points included uptake of and retention in OAT, change in risk behavior, and determinants of SVR. Results Eighty-two patients (82%) achieved SVR, which was not associated with baseline OAT status (P = .33), on-treatment drug use (P >.99), or imperfect daily adherence (P = .35) but was significantly associated with completing 2 or more 28-pill bottles of sofosbuvir-velpatasvir (P Conclusions The Novel Model of Hepatitis C Treatment as an Anchor to Prevent HIV, Initiate Opioid Agonist Therapy, and Reduce Risky Behavior study demonstrates high uptake of buprenorphine collocated with HCV treatment, and it shows that concurrent initiation of OAT with HCV treatment can result in high rates of SVR while reducing risks associated with drug use. Clinical Trials Registration NCT03221309.

Receptor tyrosine-protein kinase ERBB3 (HER3) is expressed in most

Water resource developments alter riverine environments by disrupting longitudinal connectivity, transforming lotic habitats, and modifying in-stream hydraulic conditions. Effective management of anthropogenic disturbances therefore requires an understanding of the range of potential ecosystem effects and the inherent traits symptomatic of elevated vulnerability to disturbance. Using 42 riverine fish native to South Eastern Australia as a case study, we quantified six morphological, behavioral, and life-history traits to classify species into groups reflecting potential differences in their response to ecosystem changes as a result of water resource development. Classification analysis identified five strategies based on fish life-history dispersal requirements, climbing potential, and habitat preference. These strategies in turn highlight the potential species at risk from the separate impacts of water resource development and inform management decisions to mitigate those risks. Swimming ability did not contribute to distinguishing species into functional groups, likely due to methodological inconsistencies in quantifying swimming performance that may ultimately hinder the ability of fish passage facilities to function within the physical capabilities of species at risk of habitat fragmentation. This study improves our ability to predict the performance of groups of species at risk from the multiple environmental changes imposed by humans and goes beyond broad-scale dispersal requirements as a predictor of individual species response.

We describe here the neurovirulence properties of a herpes simplex virus type 1 γ34.5 second-site suppressor mutant. γ34.5 mutants are nonneurovirulent in animals and fail to grow in a variety of cultured cells due to a block at the level of protein synthesis. Extragenic suppressors with restored capacity to replicate in cells that normally do not support the growth of the parental γ34.5 deletion mutant have been isolated. Although the suppressor virus reacquires the ability to grow in nonpermissive cultured cells, it remains severely attenuated in mice and is indistinguishable from the mutant γ34.5 parent virus at the doses investigated. Repairing the γ34.5 mutation in the suppressor mutant restores neurovirulence to wild-type levels. These studies illustrate that (i) the protein synthesis and neurovirulence defects observed in γ34.5 mutant viruses can be genetically separated by an extragenic mutation at another site in the viral chromosome; (ii) the extragenic suppressor mutation does not affect neurovirulence; and (iii) the attenuated γ34.5 mutant, which replicates poorly in many cell types, can be modified by genetic selection to generate a nonpathogenic variant that regains the ability to grow robustly in a nonpermissive glioblastoma cell line. As this γ34.5 second-site suppressor variant is attenuated and replicates vigorously in neoplastic cells, it may have potential as a replication-competent, viral antitumor agent.

Summary 1. A case of acute meningococcemia with meningitis complicated by the Shwartzman phenomenon in a 7-monthold white male infant is reported. 2. The Shwartzman phenomenon isbriefly described and the etiological and pathological aspects of the cutaneous complications of acute meningococcemia are reviewed. 3. The role of the Shwartzman phenomenon in causing cutaneous lesions in acute meningococcemia is emphasized.

To test the clinical observation that Performance I.Q. was a predictor of hospital treatment outcome, 75 consecutive patients were given the Wechsler Adult Intelligence Test. At discharge, they were rated as improved or unimproved. Low Performance I.Q. was found to significantly differentiate patients who improved from those who did not. However, knowledge of Performance I.Q. alone was not sufficient to predict outcome. Reasons for and practical implications of these findings are discussed.

Summary 1. Interstitial plasma cell pneumonia is a type of infantile pneumonia, occurring chiefly in Europe, which is clinically and pathologically distinctly different from the usual respiratory diseases seen in the United States. 2. It shows a predilection for premature and dystrophic mature infants. 3. It becomes clinically recognizable only in the age group from 6 weeks to 4 months. 4. Prior to onset of dramatic symptoms, the only noticeable clinical signs are related to feeding, decrease in intake, vomiting, and lassitude being the most common. 5. Following a slow onset, a rapid progression of symptoms takes place, consisting of: (a) increased respiratory rate, (b) retraction of the chest walls with flaring of the flanks, (c) cyanosis about the mouth and a gencralized grayish cyanotic tinge. Physical examination of the chest is essentially negative, and the temperature is usually normal. 6. If the infant does not survive, this picture becomes progressive until the child dies of asphyxia. 7. If the child survives, after a severe critical period of from one to four weeks, one may begin to hear showers of râles in the chest and the signs and symptoms of respiratory illness slowly disappear. 8. The child may remain completely asymptomatic throughout the course and yet may show a very diffuse roent-genographic involvement. The roent-genographic picture is of prime diagnostic aid, since the infiltration is practically identical in all the cases of this disease, both in its quality and distribution. 9. The etiology is unknown, but the disease acts like an infection in its epidemiology. No present-day therapeutic measures seem to be of any definite value. It is our impression that supportive therapy with oxygen mist contributes to the general improvement.

Summary Hospitalized psychiatric patients responding on the Bender-Gestalt Test with the ‘penetration’ of Design 6 into Design 5, did display significantly more suicidal ideation in the predicted direction than did a matched control group (P < .005). The results were taken to suggest the utility of combining this variable with other predictive criteria derived from Rorschach research to help the clinician make recommendations about suicidally ideated psychiatric patients.

Summary 1. The diagnosis of high gastrointestinal obstruction in the newborn infant by plain roentgenograms of the abdomen is discussed. 2. The earlier and more frequent use of this technique in infants with persistent vomiting is suggested. 3. It is suggested that plain films of the abdomen be taken in both the erect and prone positions before and after gastric suction for maximum information.

Summary B. mucosus capsulatus is reported as the causative agent of diarrhea occurring in two premature twins. One twin, in addition, had a membranous stomatitis due to the same organism. Sulfadiazine therapy improved the clinical condition, but aureomycin was necessary to eradicate the organism.