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Extrapolation of clinical trial results comparing warfarin and direct-acting oral anticoagulant (DOAC) users experiencing major hemorrhage to clinical care is challenging due to differences seen among non-randomized oral anticoagulant users, bleed location, and etiology. We hypothesized that inpatient all-cause-mortality among patients presenting with major hemorrhage differed based on the home-administered anticoagulant medication class, DOAC versus warfarin. More than 1.5 million hospitalizations were screened and 3731 patients with major hemorrhage were identified in the REDS-III Recipient Database. Propensity score matching and stratification were used to account for potentially confounding factors. Inpatient all-cause-mortality was lower for DOAC (HR = 0.60, 95%CI 0.45–0.80, p = 0.0005) before accounting for confounding and competing events. Inpatient all-cause-mortality for 1266 propensity-score-matched patients compared using proportional hazards regression did not differ (HR = 0.84, 95%CI 0.58–1.22, p = 0.36). Inpatient all-cause-mortality in stratified analyses (warfarin as reference) produced: HR = 0.69 (95%CI 0.31–1.55) for traumatic head injuries; HR = 1.10 (95%CI 0.62–1.95) for non-traumatic head injuries; HR = 0.62 (95%CI 0.20–1.94) for traumatic, non-head injuries; and HR = 0.69 (95%CI 0.29–1.63) for non-traumatic, non-head injuries. Mean time to discharge was shorter for DOAC (HR = 1.17, 95%CI 1.05–1.30, p = 0.0034) in the propensity score matched analysis. Plasma transfusion occurred in 42% of warfarin hospitalizations and 11% of DOAC hospitalizations. Vitamin K was administered in 63% of warfarin hospitalizations. After accounting for differences in patient characteristics, location of bleed, and traumatic injury, inpatient survival was no different in patients presenting with major hemorrhage while on DOAC or warfarin. • Studies of DOAC outcomes following major hemorrhage have bias, confounding, and competing events. • We compared DOAC and warfarin users with major hemorrhage accounting for these factors. • All-cause inpatient mortality was no different; hospital length of stay was shorter for DOAC. • Use of plasma and vitamin K was greater among warfarin users. [ABSTRACT FROM AUTHOR]

The challenges associated with the identification of new NPS have become more apparent with the increasing number of new drugs in the market and the need to identify the specific isomer due to legislation concomitant with the lack of reference standards for comparison. A recent new tandem technique, solid deposition gas chromatography-infra red detection spectroscopy (GC-IRD), which incorporates the GC for the separation of the different components in the sample matrix and infrared red (IR) spectroscopy which provides unique IR spectra of each component, has provided the necessary discrimination for the identification of isomers. This paper presents the identification and the application of an algorithm-based criteria (ABC) for the evaluation of the quality match factor (QMF) as an objective critical criteria in determining the correctness of an identification of close analogues in four classes of compounds; namely the JWH-018 and its structural isomers, AM-2201 and its fluoro positional isomers in the pentyl group, methylmethcathinone (MMC) and its methyl positional isomers in the phenyl ring, and dibutylone and its close analogues. [ABSTRACT FROM AUTHOR]

Objective: To determine whether premature infants with invasive Candida infection caused by strains with increased virulence properties have worse clinical outcomes than those infected with less virulent strains.Study Design: Clinical isolates were studied from 2 populations of premature infants, those colonized with Candida spp (commensal; n = 27) and those with invasive candidiasis (n = 81). Individual isolates of C albicans and C parapsilosis were tested for virulence in 3 assays: phenotypic switching, adhesion, and cytotoxicity. Invasive isolates were considered to have enhanced virulence if detected at a level >1 SD above the mean for the commensal isolates in at least one assay. Outcomes of patients with invasive isolates with enhanced virulence were compared with those with invasive isolates lacking enhanced virulence characteristics.Results: Enhanced virulence was detected in 61% of invasive isolates of C albicans and 42% of invasive isolates of C parapsilosis. All C albicans cerebrospinal fluid isolates (n = 6) and 90% of urine isolates (n = 10) had enhanced virulence, compared with 48% of blood isolates (n = 40). Infants with more virulent isolates were younger at the time of positive culture and had higher serum creatinine levels.Conclusion: Individual isolates of Candida species vary in their virulence properties. Strains with higher virulence are associated with certain clinical outcomes. [ABSTRACT FROM AUTHOR]

The Helping End Addictions Long Term (HEALing) Communities Study (HCS) seeks to significantly reduce overdose deaths in 67 highly impacted communities in Kentucky (KY), Massachusetts (MA), New York (NY), and Ohio (OH) by implementing evidence-based practices (EBPs) to reduce overdose deaths. The Opioid-overdose Reduction Continuum of Care Approach (ORCCA) organizes EBP strategies under three menus: Overdose Education and Naloxone Distribution (OEND), Medication Treatment for Opioid Use Disorder (MOUD), and Safer Prescribing and Dispensing Practices (SPDP). The ORCCA sets requirements for strategy selection but allows flexibility to address community needs. This paper describes and compiles strategy selection and examines two hypotheses: 1) OEND selections will differ significantly between communities with higher versus lower opioid-involved overdose deaths; 2) MOUD selections will differ significantly between urban versus rural settings. Wave 1 communities (n = 33) provided data on EBP strategy selections. Selections were recorded as a combination of EBP menu, sector (behavioral health, criminal justice, and healthcare), and venue (e.g., jail, drug court, etc.); target medication(s) were recorded for MOUD strategies. Strategy counts and proportions were calculated overall and by site (KY, MA, NY, OH), setting (rural/urban), and opioid-involved overdose deaths (high/low). Strategy selection exceeded ORCCA requirements across all 33 communities, with OEND strategies accounting for more (40.8%) than MOUD (35.1%), or SPDP (24.1%) strategies. Site-adjusted differences were not significant for either hypothesis related to OEND or MOUD strategy selection. HCS communities selected strategies from the ORCCA menu well beyond minimum requirements using a flexible approach to address unique needs. • The HEALing Communities Study (HCS) seeks to reduce overdose deaths in 67 highly impacted communities in Kentucky, Massachustees, New York, and Ohio. • Overdose deaths are reduced by the implementation of evidence-based practices. • The Opioid-overdose Reduction Continuum of Care Approach organizes EBP strategies under three menus: Overdose Education and Naloxone Distribution, Medication Treatment for Opioid Use Disorder, and Safer Prescribing and Dispensing Practices. • This paper describes strategies selected by communities and whether selection of overdose education and naloxone distribution differes by opioid overdose deaths and whether medicaiton for opioid use disorder differs between urban and rural settings. [ABSTRACT FROM AUTHOR]

Abstract: Estimates of the proportions of the population who are at high risk of influenza complications because of prior health status or who are likely to have decreased vaccination response because of immunocompromising conditions would enhance public health planning and model-based projections. We estimate these proportions and how they vary by population subgroups using national data systems for 2006–2008. The proportion of individuals at increased risk of influenza complications because of health conditions varied 10-fold by age (4.2% of children <2 years to 47% of individuals >64 years). Age-specific prevalence differed substantially by gender, by racial/ethnic groups (with African Americans highest in all age groups) and by income. Individuals living in families with less than 200% of federal poverty level (FPL) were significantly more likely to have at least one of these health conditions, compared to individuals with 400% FPL or more (3-fold greater among <2 and 30% greater among >64 years). Among children, there were significantly elevated proportions in all regions compared to the West. The estimated prevalence of immunocompromising conditions ranged from 0.02% in young children to 6.14% older adults. However, national data on race/ethnicity and income are not available for most immunocompromising conditions, nor is it possible to fully identify the degree of overlap between persons with high-risk health conditions and with immunocompromising conditions. Modifications to current national data collection systems would enhance the value of these data for public health programs and influenza modeling. [Copyright &y& Elsevier]

Objective: To estimate the age- and gender-specific prevalence of early age-related macular degeneration (AMD; drusen and retinal pigmentary abnormalities) and advanced AMD (exudative AMD and geographic atrophy) in Latinos.Design: Population-based, cross-sectional study.Participants: Six thousand three hundred fifty-seven Latinos 40 years and older from 6 census tracts in Los Angeles, California.Methods: The study cohort consisted of self-identified Latinos 40 years and over. Participants underwent a complete ophthalmologic examination, including stereoscopic macular photographs. Photographs were graded using a modified Wisconsin Age-Related Maculopathy Grading System.Main outcome measures: Prevalence of early AMD, drusen, geographic atrophy, and exudative AMD.Results: Of the 7789 eligible subjects, 6357 participants (82%) completed an interview and clinical examination, and 5875 (75%) had gradable photographs. Prevalence of advanced AMD increased from 0% in those 40–49 years of age to 8.5% in those 80 or older; that of early AMD from 6.2% to 29.7%, that of retinal pigment abnormalities from 4.1% to 19.3%, that of large drusen (≥125 μm in diameter) from 8.5% to 45.3%, that of soft drusen from 15.4% to 58.1%, and that of soft indistinct drusen from 3.6% to 30.8%. The prevalence of early AMD and advanced AMD lesions increased with age (P<0.0001). Early AMD was significantly more common in males than in females. Of all participants with early or late AMD, only 57% reported ever visiting an eye care practitioner, and only 21% in the last year.Conclusion: Detailed population-based estimates of AMD in Latinos are provided. Despite relatively high rates of early AMD, corresponding rates of advanced AMD are not high. Data on progression of the high rates of early AMD in Latinos require further study. [Copyright &y& Elsevier]

Quinolin-8-yl 1-(5-fluoropentyl)-1H-indole-3-carboxylate (5-Fluoro-PB-22 or 5F-PB-22; QUPIC N-(5-fluoropentyl) analog), is a synthetic cannabinoid which mimics the effects of cannabis. Several countries have reported numerous detections of this compound and its abuse has led to adverse effects including death. The aim of this study was to separate and identify the fluoropentyl positional isomers of fluoro-PB-22 using gas chromatography-mass spectrometry, solid deposition gas chromatography-infrared detection spectroscopy and 1H and 13C nuclear magnetic resonance spectroscopy. Data acquired from these multiple techniques can assist forensic laboratories lacking the reference drug standard(s) to identify the specific isomer of fluoro-PB-22 in seized material. [ABSTRACT FROM AUTHOR]

Abstract: Background: We previously reported an association between prenatal cocaine exposure (PCE) and childhood behavior problems as observed by the parent or caretaker. However, these behavior problems may not manifest in a structured environment, such as a school setting. Objective: We determined whether there is an association between PCE and school behavior problems and whether ratings of behavior problems from the teacher differ from those noted by the parent or caretaker. Methods: The Maternal Lifestyle Study, a multicenter study, enrolled 1388 children with and without PCE at one month of age for longitudinal assessment. Teachers masked to prenatal drug exposure status completed the Teacher Report Form (TRF/6–18) when children were 7, 9, and 11years old. We also administered the Child Behavior Checklist-parent report (CBCL) to the parent/caretaker at same ages and then at 13years. We performed latent growth curve modeling to determine whether high PCE will predict externalizing, internalizing, total behavior, and attention problems at 7years of age and whether changes in problems'' scores over time differ between those exposed and non-exposed from both teacher and parent report. Besides levels of PCE as predictors, we controlled for the following covariates, namely: site, child characteristics (gender and other prenatal drug exposures), family level influences (maternal age, depression and psychological symptomatology, continuing drug use, exposure to domestic violence, home environment, and socioeconomic status), and community level factors (neighborhood and community violence). Results: The mean behavior problem T scores from the teacher report were significantly higher than ratings by the parent or caretaker. Latent growth curve modeling revealed a significant relationship between intercepts of problem T scores from teacher and parent ratings; i.e., children that were rated poorly by teachers were also rated poorly by their parent/caretaker or vice versa. After controlling for covariates, we found high PCE to be a significant predictor of higher externalizing behavior problem T scores from both parent and teacher report at 7years (p=0.034 and p=0.021, respectively) in comparison to non-PCE children. These differences in scores from either teacher or caregiver were stable through subsequent years or did not change significantly over time. Boys had higher T scores than girls on internalizing and total problems by caretaker report; they also had significantly higher T scores for internalizing, total, and attention problems by teacher ratings; the difference was marginally significant for externalizing behavior (p=0.070). Caretaker postnatal use of tobacco, depression, and community violence were significant predictors of all behavior problems rated by parent/caretaker, while lower scores on the home environment predicted all behavior outcomes by the teacher report. Conclusions: Children with high PCE are likely to manifest externalizing behavior problems; their behavior problem scores at 7years from either report of teacher or parent remained higher than scores of non-exposed children on subsequent years. Screening and identification of behavior problems at earlier ages could make possible initiation of intervention, while considering the likely effects of other confounders. [Copyright &y& Elsevier]