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The Prescription Opioid Misuse and Abuse Questionnaire (POMAQ) was developed to identify prescription opioid misuse and abuse among patients with chronic pain. A clinical scoring algorithm was developed and refined to align with the patient experience. This study utilized data from the POMAQ validation study (3033-4, NCT02660606) conducted on a sample of patients with chronic pain living in the United States. The study was carried out in two phases. Two purposefully enriched patient samples, one for each phase, were created based on patient responses to select POMAQ items and the availability of urine and hair samples. Two clinical experts (SHS, SFB) reviewed patient data to classify prescription opioid use behavior. Classification differences were adjudicated by a third clinical expert (JTF). Comparisons were made between the final clinical classification determined by the experts and the proposed classification based on the POMAQ algorithm. Sixty patients were included in Phase I (only POMAQ data) and 52 in Phase II (including POMAQ and ancillary sources [e.g. electronic medical records, urine toxicity screen]). Refinements were made to the POMAQ scoring algorithm following discussions with clinical experts to ensure it was clinically relevant. For both phases, classifications were reviewed and discussed to achieve maximal concordance of classifications across experts. The proposed scoring algorithm was then modified to maximize agreement with the expert interpretation of clinically relevant patient experiences. The clinical scoring algorithm for the POMAQ was developed and refined to reflect clinically relevant patient behaviors identified by expert review. Future testing is needed to determine the sensitivity and specificity of this measure.

To identify patient risk factors associated with prescription opioid misuse and abuse as well as groupings of misuse and abuse behaviors as measured by the Prescription Opioid Misuse and Abuse Questionnaire (POMAQ). Adults with chronic pain requiring long-term treatment with opioids completed the POMAQ and other study questionnaires. Latent class analysis (LCA) was used to examine underlying subgroups exhibiting particular risk profiles. Patient demographic and clinical characteristics were examined as covariates and the concordance between the identified latent classes at-risk classifications and the POMAQ clinical scoring algorithm was assessed. Analysis of data from 809 patients revealed four classes: “chronic pain, low risk” (n = 473, low to no prevalence of POMAQ behaviors), “chronic pain, comorbid condition” (n = 152, high prevalence of anti-anxiety, sleeping pill, and antihistamine use), “at risk” (n = 154, taking more opioids than prescribed and drinking alcohol with opioids more frequently than other groups), and “high risk” (n = 30, highest prevalence of each behavior). The “high risk” group was associated with being younger, less educated, and unemployed compared to other groups. When examining the LCA classes by groups defined by the original POMAQ clinical scoring algorithm, the “high risk” class had the highest proportion of participants identified with abuse behaviors (46.7%), compared to just 4.7% in the “chronic pain, low risk” group. Findings suggest there are four distinct subgroups of patients defined by chronic opioid misuse and abuse behaviors and support the use of the POMAQ to identify risk factors associated with prescription opioid misuse and abuse.

A chronic pain patient sample living in the United States who participated in a cross-sectional study to evaluate the validity and reproducibility of the Prescription Opioid Misuse and Abuse Questionnaire is characterized.Patients with chronic pain identified through electronic medical records as refilling at least one opioid prescription within the prior 3 months were recruited from five United States Department of Defense Military Health System clinics. Patients completed the Prescription Opioid Misuse and Abuse Questionnaire, Brief Pain Inventory-Short Form, Medical Outcomes Study: 36-item Short Form, and sociodemographic questions online. Clinical characteristics and electronic medical records for 1 year prior to consent were collected.809 (86.2%) participants completed the Prescription Opioid Misuse and Abuse Questionnaire. Mean (± standard deviation) age was 55.4 ± 12.7 years; the majority female (55.5%) and white (74.8%). Mean duration of chronic pain was 14.7 ± 10.5 years; the most common pain conditions were lower back pain (76.6%), neck or shoulder pain (60.3%), and osteoarthritis (38.7%). The most commonly prescribed opioids were oxycodone (35.7%), tramadol (34.5%), and hydrocodone (26.9%); 54.8% took one opioid, 44.9% took 2 or more opioids.Participants' health status was poor; pain severity and interference were moderate. Electronic medical record data revealed high healthcare resource utilization. This chronic pain population was severely impacted by their pain condition(s).

The Prescription Opioid Misuse and Abuse Questionnaire was developed to identify prescription opioid abuse and misuse among patients with chronic pain, however evidence of construct validity and reproducibility is needed. Chronic pain patients were recruited from five Department of Defense Military Health System clinics across the United States. Construct validity was examined using subjective clinician-reported and patient-reported measures as well as objective information (e.g., hair/urine drug screens and electronic medical records). Test-retest reliability was assessed across 2-time points among a subgroup of patients with stable chronic pain. Of 3,263 screened patients, 938 (28.7%) met eligibility and were enrolled; 809 (86.2%) completed the Prescription Opioid Misuse and Abuse Questionnaire. Construct validity was supported by comparison to other validated questionnaires and hair and urine screens which yielded high agreements with patient reports on the Prescription Opioid Misuse and Abuse Questionnaire. Electronic medical record data supported patients’ Prescription Opioid Misuse and Abuse Questionnaire responses regarding physician and emergency room visits and opioid refills. The Prescription Opioid Misuse and Abuse Questionnaire had excellent test-retest reliability; the percentage agreement between the two Prescription Opioid Misuse and Abuse Questionnaire administrations was high (>90%) for most questions. Results suggest that the Prescription Opioid Misuse and Abuse Questionnaire is a valid and reproducible tool that can be used to assess the presence of prescription opioid misuse and abuse among patients with chronic pain.

Content validation is essential in the development of patient-reported instruments to ensure relevancy and understandability. The aim was to evaluate patient understanding of the Prescription Opioid Misuse and Abuse Questionnaire (POMAQ) using cognitive interviewing among adults with chronic moderate to severe pain.This qualitative study involved a one-time in-clinic visit to conduct one-on-one cognitive interviews among participants with chronic moderate to severe pain from four groups: (1) Known Opioid Abuse; (2) Known Abuse of Other Substances (e.g. alcohol, benzodiazepines); (3) Opioid Non-abuse; and (4) No Chronic Opioid Use. Patients were recruited from 6 US clinical centers. Concept elicitation questions regarding misuse and abuse were asked at interview start; the POMAQ was completed56 patients were enrolled. Mean age was 48.7 ± 12.3 years; 57% female; 80% Caucasian; mean duration of chronic pain was 11.2 ± 8.2 years with lower back pain predominating at 75%. Overall, the POMAQ was well-understood and received positive feedback. A few (The POMAQ demonstrated content validity among patients with moderate to severe chronic pain and is undergoing psychometric evaluation among a larger cohort of patients.

ObjectivesInforming research participants of the results of studies in which they took part is viewed as an ethical imperative. However, there is little guidance in the literature about how to do this. The Fluoxetine Or Control Under Supervision trial randomised 3127 patients with a recent acute stroke to 6 months of fluoxetine or placebo and was published in the Lancet on 5 December 2018. The trial team decided to inform the participants of the results at exactly the same time as the Lancet publication, and also whether they had been allocated fluoxetine or placebo. In this report, we describe how we informed participants of the results.DesignIn the 6-month and 12-month follow-up questionnaires, we invited participants to provide an email address if they wished to be informed of the results of the trial. We re-opened our trial telephone helpline between 5 December 2018 and 31 March 2019.SettingUK stroke services.Participants3127 participants were randomised. 2847 returned 6-month follow-up forms and 2703 returned 12-month follow-up forms; the remaining participants had died (380), withdrawn consent or did not respond.ResultsOf those returning follow-up questionnaires, a total of 1845 email addresses were provided and a further 50 people requested results to be sent by post. Results were sent to all email and postal addresses provided; 309 emails were returned unrecognised. Seventeen people replied, of whom three called the helpline and the rest responded by email.ConclusionIt is feasible to disseminate results of large trials to research participants, though only around 60% of those randomised wanted to receive the results. The system we developed was efficient and required very little resource, and could be replicated by trialists in the future.Trial registration numberISRCTN83290762; Post-results.

Objective Some crush-resistant tablet formulations (CRTs) reduce prescription opioid abuse by nonoral routes of administration (ROAs), especially insufflation and injection, while oral abuse increases. Oral abuse involving product manipulation vs swallowing whole for CRTs and comparators was examined. Methods Abuse by oral modes of administration (e.g., swallowing whole, chewing, dissolving in the mouth), was examined using the ASI-MV, a computerized, clinical interview for adults in substance abuse treatment from January 2009 to March 2015. CRTs (reformulated oxycodone extended-release [ER], reformulated oxymorphone ER, and tapentadol ER) were compared with non-CRT versions, morphine ER, and oxycodone immediate-release single entity. Analyses employed descriptive statistics and logistic regression. Results Among 364,329 unique assessments, 18,135 patients reported oral abuse of the CRTs and comparators examined. CRTs had a higher prevalence of oral abuse involving product manipulation than comparators (P

The aim was to examine prevalence of past 30-day prescription stimulant nonmedical use (NMU) by adults assessed for substance use problems and to better understand patterns of route of administration (ROA) and drug problem severity. Data were collected from a computer administered assessment of substance use problems completed by adults (age ≥ 18) using the Addiction Severity Index-Multimedia Version (ASI-MV

Wason’s selection task requires that one imagine which of four cards, each of which has a letter on one side and a number on the other, one would have to turn over to determine whether a statement about the cards is true or false. For example, one might see four cards showing T, H, 6, and 4 and be asked to say which card or cards one would have to turn over to determine whether a statement in the form of If a card has T on one side, it has 4 on the other is true. In the great majority of experiments with this task no cards are actually turned. This limits the conclusions that can be drawn from experimental results. In two experiments participants actually turned (had a computer turn) virtual cards so as to show what they contained on their originally hidden sides. Participants were given a monetary incentive to do well on the task, and they performed it, with trial-by-trial feedback, many times. Performance was much better than is typically obtained with the more common way of performing the task. Results also demonstrate the importance of the precise wording of the statement to be evaluated and how a misinterpretation could help account for a tendency for people to turn only a single card even when the turning of two is required. Results prompt several questions of a theoretical nature and are discussed as they relate to recent theoretical treatments of the selection task.

Objective. A comprehensive electronic self-report assessment, called PainCAS® (Clinical Assessment System), was developed and implemented in three clinics. PainCAS captures demographic information, pain assessment, quality-of-life variables, and contains validated, electronic versions of screeners for risk of aberrant opioid-related behaviors (the SOAPP and COMM). This investigation sought to determine the impact of PainCAS on documentation of pain and opioid risk evaluations. Exploratory hypotheses examined changes in the content of the patient- provider interaction and any impact on outcome. Methods. In study 1, chart reviews were conducted between pain patients who completed the electronic program (N = 89) and controls who represented standard of care (N = 120). In study 2, two groups of chronic pain patients (treatment-as-usual Control condition = 75, PainCAS Experimental condition = 72) were interviewed after completing their index clinic visit and completed mailed questionnaires 3 months later. Results. Results revealed significantly more key, pain-relevant chart elements documented in charts of patients who completed the PainCAS than those using a traditional paper questionnaire (Study 1

Background: The Screener and Opioid Assessment for Patients with Pain-Revised (SOAPP-R) is a 24-item self-report instrument that was developed to aid providers in predicting aberrant medication-related behaviors among chronic pain patients. Although the SOAPP-R has garnered widespread use, certain patients may be dissuaded from taking it because of its length. Administrative barriers associated with lengthy questionnaires further limit its utility.Objective: To investigate the extent to which two techniques for computer-based administration (curtailment and stochastic curtailment) reduce the average test length of the SOAPP-R without unduly affecting sensitivity and specificity.Design: Retrospective study.Setting: Pain management centers.Subjects: Four hundred and twenty-eight chronic non-cancer pain patients.Methods: Subjects had taken the full-length SOAPP-R and been classified by the Aberrant Drug Behavior Index (ADBI) as having engaged or not engaged in aberrant medication-related behavior. Curtailment and stochastic curtailment were applied to the data in post-hoc simulation. Sensitivity and specificity with respect to the ADBI, as well as average test length, were computed for the full-length test, curtailment, and stochastic curtailment.Results: The full-length SOAPP-R exhibited a sensitivity of 0.745 and a specificity of 0.671 for predicting the ADBI. Curtailment reduced the average test length by 26% while exhibiting the same sensitivity and specificity as the full-length test. Stochastic curtailment reduced the average test length by as much as 65% while always exhibiting sensitivity and specificity for the ADBI within 0.035 of those of the full-length test.Conclusions: Curtailment and stochastic curtailment have potential to improve the SOAPP-R's efficiency in computer-based administrations.

Different water quality sampling practices such as location selection or frequency can inform future watershed management strategies. The objective of this work was to compare water quality sampling strategies based on different weighted criteria to determine the optimal sampling frequency and sampling location for an urbanized, eutrophic, freshwater system. Weekly water sampling was conducted over a 2-year period at five locations for six water quality parameters. This high frequency (HF) dataset was then deconstructed into a lower frequency (LF) dataset to simulate a monthly sampling strategy. Statistical analyses conducted showed that for all sampling locations the LF datasets were not significantly different from the HF datasets, suggesting monthly sampling is sufficient to capture the overall water quality conditions in this system. A multi-criteria decision analysis was constructed for statistical and operational criteria to determine the optimal sampling locations given different criteria weights. Results showed that the optimal sampling location changed depending on the criteria weighting, suggesting that statistical analyses alone would not be sufficient to determine optimal sampling locations in this system. This analysis was then used if optimal sampling location depended on specific water quality monitoring goals. Results showed that the optimal location depends on the particular water quality monitoring goals and that this effect should also be considered in the design of future sampling programs.

Objective: To examine abuse prevalence for OxyContin and comparator opioids over a 6-year period prior to and following market entry of reformulated OxyContin and assess consistency in abuse across treatment settings and geographic regions. Design: An observational study examining longitudinal changes using cross-sectional data from treatment centers for substance use disorder. Setting: A total of 874 facilities in 39 states in the United States within the National Addictions Vigilance Intervention and Prevention Program (NAVIPPRO ® ) surveillance system. Participants: Adults (72,060) assessed for drug problems using the Addiction Severity Index-Multimedia Version (ASI-MV ®) from January 2009 through December 2015 who abused prescription opioids. Main outcome measure(s): Percent change in past 30-day abuse. Results: OxyContin had significantly lower abuse 5 years after reformulation compared to levels for original OxyContin. Consistency of magnitude in OxyContin abuse reductions across geographic regions, ranging from 41 to 52 percent with differences in abuse reductions in treatment setting categories occurred. Changes in geographic region and treatment settings across study years did not bias the estimate of lower OxyContin abuse through confounding. Conclusion: In the postmarket setting, limitations and methodologic challenges in abuse measurement exist and it is difficult to isolate singular impacts of any one intervention given the complexity of prescription opioid abuse. Expectations for a reasonable threshold of abuse for any one ADF product or ADF opioids as a class are still uncertain and undefined. A significant decline in abuse prevalence of reformulated OxyContin was observed 5 years after its reformulation among this treatment sample of individuals assessed for substance use disorder that was lower historically for the original formulation of this product.

Objective The Current Opioid Misuse Measure (COMM) is a commonly used self-report instrument to identify and monitor aberrant opioid-related behavior in chronic pain patients on opioid therapy. However, the length of the COMM may limit its clinical utility. Additionally, this paper-and-pencil screener requires hand scoring, which increases paperwork and staff burden. Therefore, the current study presents development of the "COMM-9," a brief electronically administered form of the COMM. Methods Patients (N = 517) with chronic noncancer pain on opioid therapy completed the COMM. Patients were classified as either being positive or negative for aberrant drug-related behavior based on self-report data from a structured interview, physician-report data, and urine toxicology screen (the Aberrant Drug Behavior Index [ADBI]). COMM items with the strongest classification accuracy were identified using the LASSO method as the selection criterion in conjunction with the leave-one-out cross-validation method as the stop criterion. A sub-set of patients (n=55) completed a second administration of the COMM one week later to evaluate test-retest reliability. Results Nine items were identified before the selection criterion stopped, and logistic regression was utilized to predict probabilities of positive ADBI from the 9 COMM items using all data and the cross-validation procedure. Receiver operating characteristic curves revealed high levels of classification accuracy that were essentially equivalent to the full COMM. Cut-points were identified to classify patients as having no/low risk, moderate risk, and high risk for aberrant opioid-related behavior. Test-retest reliability of the COMM-9 was comparable to the full 17-item COMM. Conclusions This study presents the successful development of a brief electronic screener to identify current aberrant opioid-related behavior in chronic pain patients on long-term opioid therapy.

Aim This study investigated whether multiple health-care robots could have any benefits or cause any problems in an aged care facility. Method Fifty-three residents and 53 staff participated in a non-randomised controlled trial over 12 weeks. Six robots provided entertainment, communication and health-monitoring functions in staff rooms and activity lounges. These settings were compared to control settings without robots. Results There were no significant differences between groups in resident or staff outcomes, except a significant increase in job satisfaction in the control group only. The intervention group perceived the robots had more agency and experience than the control group did. Perceived agency of the robots decreased over time in both groups. Overall, we received very mixed responses with positive, neutral and negative comments. Conclusions The robots had no major benefits or problems. Future research could give robots stronger operational roles, use more specific outcome measures, and perform cost–benefit analyses.

Objective Research on substance abusers in treatment suggests that tapentadol, a prescription analgesic, may have relatively low abuse potential. Messages posted by recreational drug abusers on online forums were examined for amount of discussion and endorsement for abuse of tapentadol and comparator drugs. Methods Internet messages posted between January 1, 2011 and September 30, 2012 on seven drug-abuse web forums were evaluated. Proportions of posts and unique authors discussing tapentadol were compared with eight comparator compounds. Postcontent was coded to compare endorsement for abuse of tapentadol with two comparators, one drug with high desirability for abuse and one with low desirability for abuse. Results A total of 1,940,121 messages posted during the study period were copied from selected web forums. The proportion of all posts discussing tapentadol (proportion = 0.0003) was significantly lower than any of the comparator compounds (range of odds ratios from 16.6 to 104.3; P

Introduction: Tablet computer-based screening may have the potential for detecting patients at risk for opioid abuse in the emergency department (ED). Study objectives were a) to determine if the revised Screener and Opioid Assessment for Patients with Pain (SOAPP®-R), a 24-question previously paper-based screening tool for opioid abuse potential, could be administered on a tablet computer to an ED patient population; b) to demonstrate that >90% of patients can complete the electronic screener without assistance in 35 years. One hundred percent of subjects completed the screener. Median time to completion was 148 (interquartile range 117.5-184.3) seconds, and 95% (n=78) completed in

Objective Although the Screener and Opioid Assessment for Patients with Pain-Revised (SOAPP-R) has become a widely used screener for aberrant opioid-related behavior in adults, the length of the instrument may limit its utility. The purpose of the current study was to develop a short form of the SOAPP-R by retaining as few items as possible while maximizing predictive accuracy. Methods Participants (N = 555), recruited from pain clinics, completed the 24-item SOAPP-R and participated in a five-month follow-up visit to evaluate aberrant drug-related behaviors. Opioid aberrant-related behavior was determined through self-report, physician report, and urine toxicology screen. The optimal subset of SOAPP-R items to predict aberrant opioid-related behavior was identified empirically by employing the LASSO selection method and the leave-one-out cross-validation (LOOCV) method offered in the GLMSELECT procedure in SAS 9.4 in conjunction with content expertise. Results Eight items were identified before the selection method stopped. The receiver operating characteristic curve generated from the predicted probabilities from the model produced an area under the curve (AUC) value greater than the AUC value produced by the 24-item SOAPP-R total score and yielded a sensitivity of 0.74 and a specificity of 0.66. Conclusions These results provide strong preliminary support for the SOAPP-8 as a brief screening tool of aberrant opioid-related behavior in chronic pain patients.

Purpose: To develop and validate an Optically Stimulated Luminescent (OSL) dosimeter for exposure control verification of x‐ray projection mammographyimaging systems. Methods: The active detection element of the dosimeter is a strip of OSL material 3.0 mm wide, 0.13 mm thick and 30.0 mm long with an overlying aluminum step wedge with thicknesses of 0, 0.2, 0.4 and 0.6 mm Al, encapsulated in a light‐tight plastic enclosure with outer dimensions of 10.0 mm wide, 5.4 mm thick, and 54.0 mm long. The dosimeter is used in conjunction with a breast phantom for the purpose of estimating the half‐value layer (HVL), entrance surface exposure (ESE), and average glandular dose (AGD) in conventional projection mammography. ESE and HVL were computed based on analysis of exposure profiles obtained from exposed strip dosimeters. The AGD was estimated by multiplying the ESE by the appropriate exposure to dose conversion factor for the thickness and % glandular tissue fraction represented by the phantom and target‐filter combination employed. The accuracy and reproducibility of the ESE, HVL and AGD estimates obtained using the dosimeter positioned on the surface of the ACR phantom at the chest wall edge, was evaluated using mammography systems utilizing different imaging receptor technology, i.e. screen‐film (SF), computed radiography(CR) and direct radiography (DR) and compared against results obtained using a calibrated ion chamber fitted with a mammography probe. Results: ESE, AGD and HVL results obtained using the OSLmammography QA dosimeter agreed with results obtained using an ion chamber to within 5–10%, depending on the target‐filter combination used. Repeat readings were highly consistent with a coefficient of variation = 5%. Conclusions: The OSLmammography QA dosimeter has been shown to effectively estimate ESE, HVL and AGD, demonstrating its usefulness for secondary monitoring of output exposure of mammographyimaging systems.

Chrysomya megacephala (F.) and Chrysomya rufifacies (Macquart) were colonized so that larval growth rates could be compared. Colonies were also established to provide insight into the protein needs of adult C. rufifacies and developmental rates of the ensuing larvae. The C. megacephala and C. rufifacies laboratory colonies were reared for five and six generations, respectively, at 28°C. C. megacephala developmental mean rate from egg to adult was 20.4 ± 0.38 d. First-instar larvae emerge in 1.4 ± 0.24 d, second-instar larvae develop in 2.6 ± 0.38 d and third instars occur at 6.3 ± 0.72 d. Development from egg to pupation occurred in 12 ± 1.10 d. C. rufifacies developed at a mean rate of 16.2 ± 0.78 d from egg to adult emergence. Each stage occurred in succession from first-instar larvae 1.1 ± 0.25 d, second-instar larvae developed 2.3 ± 0.25 d later, and the third-instar larvae developed 5.7 ± 0.41 d later. The larvae pupated 10.0 ± 0.57 d after oviposition. Both of these flies can be collected in the wild and easily colonized using conditioned chicken as an oviposition and larval medium. C. megacephala apparently prefers a lower development and maintenance temperature than C. rufifacies, as evidenced by the high pupal mortality. Laboratory-reared C. rufifacies benefited from bloodmeal as a protein supplement to enhance egg production. C. rufifacies larvae were not observed preying on each other and additional larval species were not provided to serve as prey.

Introduction. Given the increase in misuse and abuse of prescription opioids, clinicians clearly benefit from a standardized tool to screen patients being considered for chronic opioid therapy. The Screener and Opioid Assessment for Patients with Pain-Revised (SOAPP-R) is a widely used opioid risk assessment tool in clinical practice. As one third of the US population experiences chronic noncancer pain at any given time, and the Hispanic population now accounts for about 16% of the nation's population, the availability of a Spanish-language SOAPP-R fills an important clinical need. Objective. To derive a linguistically validated Spanish-language version of the SOAPP®-R. Method. Each step of Spanish translation and linguistic validation of the SOAPP-R was based on the US Food and Drug Administration and the International Society for Pharmacoeconomics and Outcomes Research translation process. Result. A linguistically validated Spanish-language version of the SOAPP-R. Conclusion. The Spanish SOAPP-R may be useful as a risk assessment tool, considered along with other clinical information, by clinicians who prescribe opioid therapy for patients whose preferred language is Spanish.

Objective: To determine what, if any, public health and societal impacts are associated specifically with injection of prescription opioids. Design: Cross-sectional observational study. Setting: Five hundred forty treatment facilities in 35 states across the United States performing Addiction Severity Index-Multimedia Version (ASI-MV) assessments. Participants: Adult patients (29,459) who reported past 30-day abuse of any prescription opioid on the ASI-MV assessment between January 2007 and January 2011. Main outcome measures: The public health indicators selected for this study were liver disease, HIV/AIDS status, recent visit to an emergency room, treatment for pain, treatment for overdosing, homelessness, residence with alcohol/substance abuser, and unemployment. Results: Prescription opioid injection was significantly associated with health problems, psychosocial problems, and utilization of medical services. Conclusions: This study demonstrates an approach to measure the potential impact of injecting prescription opioids on public health indicators. Findings indicate a positive association between injection of prescription opioids and public health indicators suggesting a need for prescription opioid formulations that may inhibit injection of these medications. Keywords: prescription drug injection, public health, correlates DOI:10.5055/jom.2013.0142

The Radiation Protection in Medicine conference, reviewed in this journal supplement, outlined nine strategies to promote radiation protection for patients. The Alliance for Radiation Safety in Pediatric Imaging has focused its work on three of those areas: creating awareness of the need and opportunities for radiation protection for children; developing open-source educational materials for medical professionals and parents on this critical topic for improved patient safety and communication; and lastly, advocating on behalf of children with industry, government and regulatory bodies to improve equipment design and safety features, standardisation of nomenclature and displays of dose reports across vendor platforms that reflect the special considerations of children.

BACKGROUND: Vector-borne diseases continue to present significant threats to human, animal and plant health. Mosquitoes, houseflies, sand flies and stable flies are well-known vectors of several human and animal pathogens. The toxicity of selected semiochemicals with molecular structures indicative of insecticidal activity was determined against these insect species with the aim of developing novel insecticides toxic to multiple insect species. RESULTS: Three semiochemicals, namely beta-damascone, cyclemone A and melafleur, showed remarkable toxicity to three mosquitoes, Aedes aegypti L., Ae. albopictus (Skuse) and Anopheles quadrimaculatus Say, the housefly, Musca domestica L., the stable fly, Stomoxys calcitrans L., and the sand fly, Lutzomyia shannoni (Dyar). The chemicals were equally toxic to several field-collected permethrin-tolerant housefly strains. When formulated as 500 mL L−1 emulsifiable concentrates, the chemicals demonstrated stability and toxicity on filter paper and camouflage military fabrics, with persistence up to 8 days under laboratory conditions. The chemicals were equally effective under field conditions when evaluated on unpainted plywood panels, although a higher dosage was required under field conditions to achieve similar efficacy. CONCLUSION: Laboratory quantification of LC50 values and field efficacy of three semiochemicals as formulated compounds on mosquitoes, houseflies, stable flies and sand flies showed that these semiochemicals could serve as potent insecticides for multiple insect species. Copyright © 2010 Society of Chemical Industry

BACKGROUND: Mosquitoes are the most important vectors of human pathogens. Wide-scale use of pesticides has led to the development of resistance to most common insecticide groups. The need to develop novel products that have a low impact on human health and the environment is well established. The toxicity of selected semiochemicals with molecular structures indicative of insecticidal activity was determined against adult Aedes aegypti (L.) and Anopheles quadrimaculatus (Say). The two most active insecticides against Ae. aegypti were also evaluated against Ae. albopictus (Skuse). RESULTS: Fifteen semiochemicals classified as terpenoid alcohols, ketones or carboxylic esters showed toxicity to both mosquito species. Geranyl acetone (LC50 = 38.51 µg cm−2) followed by citronellol (LC50 = 48.55 µg cm−2) were the most toxic compounds to Ae. aegypti, while geraniol and lavonax, with LC50 values of 31.88 and 43.40 µg cm−2, showed the highest toxicity to An. quadrimaculatus. Both geranyl acetone and citronellol were highly toxic to Ae. albopioctus. No semiochemical showed fumigation activity against either species. All semiochemicals persisted for less than 24 h when tested on filter paper. CONCLUSION: Quantification of LC50 values of several semiochemicals against Ae. Aegypti, An. quadrimaculatus and Ae. albopioctus showed that semiochemicals not only modify insect behaviors but also hold potential as potent insecticides for mosquito control programs. Copyright © 2010 Society of Chemical Industry

The International Atomic Energy Agency (IAEA) has a mandate to assist member states in areas of human health and particularly in the use of radiation for diagnosis and treatment. Clinical audit is seen as an essential tool to assist in assuring the quality of radiation medicine, particularly in the instance of multidisciplinary audit of diagnostic radiology. Consequently, an external clinical audit programme has been developed by the IAEA to examine the structure and processes existent at a clinical site, with the basic objectives of: (1) improvement in the quality of patient care; (2) promotion of the effective use of resources; (3) enhancement of the provision and organisation of clinical services; (4) further professional education and training. These objectives apply in four general areas of service delivery, namely quality management and infrastructure, patient procedures, technical procedures and education, training and research. In the IAEA approach, the audit process is initiated by a request from the centre seeking the audit. A three-member team, comprising a radiologist, medical physicist and radiographer, subsequently undertakes a 5-d audit visit to the clinical site to perform the audit and write the formal audit report. Preparation for the audit visit is crucial and involves the local clinical centre completing a form, which provides the audit team with information on the clinical centre. While all main aspects of clinical structure and process are examined, particular attention is paid to radiation-related activities as described in the relevant documents such as the IAEA Basic Safety Standards, the Code of Practice for Dosimetry in Diagnostic Radiology and related equipment and quality assurance documentation. It should be stressed, however, that the clinical audit does not have any regulatory function. The main purpose of the IAEA approach to clinical audit is one of promoting quality improvement and learning. This paper describes the background to the clinical audit programme and the IAEA clinical audit protocol.

Objective. The present study builds on research to model abusers' perceptions of particular analgesics' attractiveness for abuse and extends these methods to derive an estimate of attractiveness for abuse of a not-yet-marketed abuse-deterrent formulation (ADF) of a prescription opioid (Remoxy®, Pain Therapeutics, Inc., San Mateo, CA, and King Pharmaceuticals, Inc., Bristol, TN). In a previous study, the Opioid Attractiveness Technology Scaling (OATS) method identified, from a drug abuser's point of view, the particular features of a prescription opioid relevant to its attractiveness for recreational use. A second online sample rated the extent to which these features applied to particular products they had actually used/abused. These data were used to model the abusers' overall preference for prescription opioids they had used/abused. Design. In the present study, this method was applied to a not-yet-marketed ADF using substance abuse counselors as proxies for prescription opioid abusers. Thirty-eight counselors were given materials describing the new ADF along with four known products. Results. Thirty-two counselors demonstrated sufficient agreement with abusers' ratings of the overall attractiveness of these drugs. The overall model yielded a significant pseudo R2 of 0.15 ( P < 0.001), with increasing model fit based on preferred route of administration, from swallowing whole (pseudo R2 = 0.06; P < 0.001) and best for those who preferred to inject (pseudo R2 = 0.40; P < 0.001). Data from a cross-validation group of 16 counselors/proxies were used to calculate the OATS scores for the five rated drugs and revealed significant differences between the ADF and OxyContin® (Purdue Pharma LP, Stamford, CT), Percocet® (Endo Pharmaceuticals, Chadds Ford, PA), and Vicodin® (Abbott Laboratories, Abbott Park, IL), but not Talwin® NX (Sanofi-aventis, Bridgewater, NJ), which was identified in the prior study as a highly unattractive drug for recreational purposes. Conclusions. The OATS method shows promise for providing pre-marketing estimates of attractiveness for abuse of not-yet-marketed ADFs.

Imiquimod 5% cream (Aldara) was approved by the Food and Drug Administration for the treatment of non-facial superficial basal cell carcinomas (sBCC) in 2004 and has become one of the most commonly used topical treatments for this variant of basal cell carcinoma. Application of the cream once a day, 5 days per week for 6 weeks has demonstrated a clinical and histological cure rate approximating 80% for non-facial sBCCs. Erythema, erosions, and crusting are common local adverse events; but systemic side effects are much less common. The clinical use of imiqimod for nodular or facial basal cell carcinomas, particularly on the nose, has not been as successful. Cure rates range from 42%–76%, depending on the frequency and duration of use. Several reports have described the usefulness of imiquimod cream as an adjunctive therapy of basal cell carcinomas when combined with a surgical modality. However, most of these “adjunctive” studies were neither blinded nor controlled. We review the safety and efficacy of imiquimod 5% cream in the treatment of sBCC, report on its effectiveness in the treatment of nodular and facial basal cell carcinomas, and comment on its role as an adjunctive therapy.

Objective. Prescription opioids are the second most misused/abused drug in the United States behind only marijuana. Recreational prescription opioid users appear to prefer some products over others; however, the extent to which attributes of any particular formulation account for such preferences has yet to be determined. The Opioid Attractiveness Technology Scaling was developed to identify the particular features of a prescription opioid that are relevant to its attractiveness for recreational use, and to use these features to model attractiveness for recreational use of particular prescription opioid formulations. Design. Four hundred and ninety-one self-reported recreational prescription opioid users identified 43 product features as being relevant to determining whether a product is “attractive” or “unattractive” for recreational use. Average ratings were used to determine appropriate weights to be applied to the features. A factor analysis yielded 10, highly differentiated factors. Five hundred and sixty-four prescription opioid abusers were then asked to rate the extent to which the 43 features identified in Study 1 were relevant to specific prescription opioid products they had used. Results. Respondents provided an overall preference rating of these products and a model was created. A random intercept model yielded a significant pseudo R2 of 0.14 (chi-square = 310.02, degrees of freedom [df] = 10, P < 0.001). The model fit least well, albeit significantly, for abusers who preferred to swallow the drug (pseudo R2 = 0.06; chi-square = 55.52, df = 10, P < 0.001) and best for those who preferred to inject (pseudo R2 = 0.37; chi-square = 199.34, df = 10, P < 0.001). Conclusions. The relevance of the model is discussed along with possible modifications that might allow prediction of “attractiveness” of “abuse deterrent” formulations that have not yet been marketed.

OBJECTIVE. Medical physicists currently use two standardized phantoms to estimate CT patient radiation dose. This “one-size-fits-all” adult model results in underestimates of displayed pediatric CT radiation dose on the console of current CT scanners. The purpose of this article is to discuss the Alliance for Radiation Safety in Pediatric Imaging Vendor Summit.CONCLUSION. Stakeholders were invited to discuss the development of better estimates of pediatric patient radiation dose. These stakeholders agreed to partner to improve CT radiation dose estimates for children.

The first goal of this study was to compare the degree of personal protection against biting insects provided by geraniol, linalool, and citronella candle (5%) vapors outdoors, where such products are commonly used. At a distance of 1.0 m, citronella candles reduced the number of female mosquitoes caught in Centers for Disease Control and Prevention traps by 35.4% and sand flies by 15.4%, linalool candles reduced female mosquitoes by 64.9% and sand flies by 48.5%, while geraniol candles reduced female mosquitoes by 81.5% and sand flies by 69.8%. By increasing the distance to 2 m and 3 m, the repellency dropped significantly. The second goal was to compare the degree of personal protection provided by the best performing candle, geraniol, under conditions of high and low biting pressure. The introduction of geraniol candles to protect volunteers in a high biting pressure environment reduced the mosquito pressure by an average of 56% and the sand fly pressure by 62% over a distance of 1.0 m. In the low biting pressure environment, geraniol reduced the mosquito pressure by an average of 62%. No sand flies were present at this site.

The historical abundance of salmon along the west coast of North America has been significantly reduced during the last two centuries of industrial harvest. Commercial fisheries from California to Alaska and points in between have faced clearly documented restrictions on fishing effort and collapse of specific salmon runs.' Even while salmon runs on some large river systems remain (i.e., the Fraser and Skeena rivers), many smaller runs have all but disappeared. The life histories of many twentieth-century fisheries have been depressingly similar: initial coexistence with indigenous fisheries; emergence of large-scale industrial expansion followed by resource collapse; introduction of limited restrictions on fishing effort, which become increasingly severe, making it hard for fishing communities to survive and to reproduce themselves. Yet for nearly two millennia prior to the industrial extraction of salmon, indigenous peoples maintained active harvests of salmon, which are estimated to have been at or near median industrial harvests during the twentieth century.' Part of the explanation for salmon stock collapses in the twentieth century resides in the different methodologies used by the indigenous and industrial fisheries. As Joseph E. Taylor comments, "aboriginal and industrial harvests appear statistically similar, but the fishery had changed radically. Indians had harvested various runs and species from March to November, but Euro-American consumers preferred the deep orange meat of chinook [spring] and sockeye. Canners quickly learned to concentrate on the runs of favored species between April and July."' While our research substantiates Taylor's contention that "what distinguished the two fisheries was their raison d'etre,'' our results directly contradict

Lichen planus is an inflammatory process that can affect the skin, mucosa, and hair follicles. An increased risk of squamous cell carcinoma has been noted in lichen planus of the mucosa. Rarely, in chronic, hypertrophic lichen planus of the skin, squamous cell neoplasms have been reported. We report a case of new onset lichen planopilaris with multiple squamous cell neoplasms.

John Milton alludes to the classical myth of Pandora several times in his writings. His earliest reference is in his third prolusion, "On the Harmony of the Spheres," which he wrote while a student at Christ's College, Cambridge, between 1625 and 1632. "The fact that we are unable to hear this harmony," says Milton, "seems certainly to be due to the presumption of that thief Prometheus, which brought so many evils upon men" (CPW 1:238-39). Though Milton does not mention Pandora by name, her eventual role in the Fall is implicit in his remarks (CPW 1:239n15). His first explicit allusion to Pandora is in his fourth prolusion, "In the Destruction of any Substance there can be no Resolution into First Matter," which he begins by saying: "This is not the place in which to enquire too nicely whether Error escaped from Pandora's box, or from the depths of the Styx, or lastly whether he is to be accounted one of the sons of Earth who conspired against the gods" (CPW 1:249). Milton makes his final reference to Pandora in Paradise Lost (1667 and 1674), where he compares the unfallen Eve to the character from classical myth. Eve is [...] more adorn'd, More lovely than Pandora, whom the Gods Endow'd with all thir gifts, and O too like In sad event. (4.713-16) Between his Cambridge years and Paradise Lost, Milton mentions Pandora in the 1644 second edition of The Doctrine and Discipline of Divorce. In that greatly expanded version of the 1643 first edition, he alludes to Pandora to illuminate the Fall and to absolve God of responsibility for creating sin: Yet considering the perfection wherin man was created, and might have stood, no decree necessitating his free will, but subsequent though not in time yet in order to causes which were in his owne power, they [the Jesuits and Arminians] might, methinks be perswaded to absolve both God and us. Whenas the doctrine of Plato and Chrysippus with their followers the Academics and the Stoics, who knew not what a consummat and most adorned Pandora was bestow'd upon Adam to be the nurse and guide of his arbitrary happinesse and perseverance, I mean his native innocence and perfection, which might have kept him from being our true Epimetheus, and though they taught of vertue and vice to be both the gift of divine destiny, they could yet find reasons not invalid, to justifie the counsels of God and Fate from the insulsity of mortall tongues: That mans own freewill self corrupted is the adequat and sufficient cause of his disobedience besides [i.e., other than] Fate; as Homer also wanted not [i.e., did not fail] to expresse both in his Iliad and Odyssei. (CPW 2:293-94) The above passage has yielded conflicting interpretations. Milton alludes to "a consummat and most adorned Pandora" given to Adam, and some critics have read his words as a reference to Eve. Such a reading, in turn, makes Milton seem more charitable toward women in his divorce tract. Others, however, have challenged the interpretation that Eve was given to Adam "to be the nurse and guide of his arbitrary happinesse and perseverance," and also that she "might have kept him from being our true Epimetheus." So, too, Eve had been condemned in patristic writings, thus making her an unlikely moral guardian. While Milton's allusion to Pandora in The Doctrine and Discipline of Divorce has generated debate, the meaning of the passage becomes clearer in light of the writings of the Church Father Tertullian, with whose works Milton was well acquainted. Tertullian denounces Eve and associates her with Pandora, but he also treats Pandora as a rhetorical figure denoting the perfect combination of all good gifts. The myth of Pandora originated with Hesiod, who says in the Theogony (c. 720 B.C.) that at Zeus' command Hephaestus made her to avenge Prometheus' theft of fire. Athena adorned her, and Hephaestus crowned her. …

Dear Editor, We thank Drs. Villarreal and Markman for their thoughtful comments [1] on the clinical limitations of our recently published work describing a linguistically validated Spanish version of the Screener and Opioid Assessment for Patients with Pain-Revised (SOAPP-R) screening tool for aberrant medication-related behaviors [2]. The letter provides valuable clinical insight into the limitations of the linguistic validation process used in …

Objective The reformulation of oxycodone hydrochloride controlled-release (CR) tablets in August 2010 created a natural experiment at a national scale, providing an opportunity to evaluate patterns of abuse of prescription opioids and other drugs before and after introduction of this abuse-deterrent formulation (ADF). Design Observational, cross-sectional study Setting Sentinel sample of adults assessed for substance abuse treatment within the NAVIPPRO® surveillance system Subjects Two hundred thirty-two thousand and eight hundred seventy-four adults at 437 facilities during January 1, 2008 through December 31, 2011. Methods Time-series analysis using logistic regression to estimate quarterly prevalence of past 30-day abuse (adjusted for covariates and prescription volume) and changes in abuse pre-and post-ADF introduction. Results Increases in abuse prevalence occurred for all prescription opioids as a class and for extended-release (ER) opioids. Significantly greater abuse of ER oxymorphone and buprenorphine occurred in the post-ADF period (relative risk [RR] = 2.91, 95% confidence interval [CI] = 2.59–3.27 and RR = 1.85, 95% CI = 1.74–1.96). Increases in abuse for these two compounds were significant among groups who reported abuse via preferential routes of administration (oral only, snorting only, injection only) post-ADF introduction. Conclusions Replacement of a widely prescribed opioid formulation known for its abuse potential alone may have had little impact on overall rates of prescription opioids as a class. However, changes in abuse levels of certain opioids coinciding with ADF introduction suggest possible switching of abuse among this study sample to specific long-acting opioid analgesics. Additional follow-up studies will be important to monitor changing abuse patterns and their public health impact as new opioid formulations are developed and introduced to market.

Change in self-understanding of maladaptive interpersonal patterns has been an important mechanism of symptom change in theories of dynamic psychotherapy and has been specified as an important treatment outcome by psychotherapy clients. The current investigation evaluated the reliability and validity of a new self-report measure of Self-Understanding of Interpersonal Patterns (SUIP). The measure was administered to 3 clinical samples and a student sample. The measure demonstrated good internal consistency, test-retest reliability, and discriminant validity. The SUIP further demonstrated convergent validity with measures of analytical and self-improving personality traits in a clinical sample. Finally, there was significantly greater change in self-understanding in a dynamic psychotherapy as compared with a medication treatment condition, despite comparable symptom change across both treatment conditions.

Research has raised the possibility that the length of time one engages in nonmedical use of prescription opioids may be associated with abuse of other drugs, more risky drug-related behavior, and more severe functional problems. This study drew on data from the Addiction Severity Index-Multimedia Version® Connect system. A total of 55,341 client assessments at substance abuse treatment centers were analyzed to help understand the impact of length of time one has abused opioids on the patterns of abuse and functional problems. From this larger sample, 5,686 individuals who had abused a prescription opioid within the past 30 days were studied. Multiple logistic regression analyses were run to examine the impact of length of time abusing any opioid, after adjusting for several demographic variables, on route of administration (injection or injection/snorting), other drugs abused, and functioning in the areas of medical status, employment, drug and alcohol use, legal status, family and social problems, and psychiatric status. Overall findings supported the hypothesis that length of opioid abuse is associated with higher risk of drug use patterns as well as functional problems.

BACKGROUND: The housefly, Musca domestica L., and stable fly, Stomoxys calcitrans (L.) are cosmopolitan pests of both farm and home environments. Houseflies have been shown to be resistant to a variety of insecticides, and new chemistries are slow toemergeonthemarket.Toxicitiesofselectedsemiochemicalswithmolecularstructuresindicativeofinsecticidalactivitywere determinedagainstadultsfromaninsecticide-susceptiblelaboratorystrainofhouseflies.Thethreemostactivesemiochemicals were also evaluated against recently colonized housefly and stable fly strains. RESULTS: Nineteen semiochemicals classified as aliphatic alcohols, terpenoids, ketones and carboxylic esters showed toxicity to houseflies and stable flies. Rosalva (LC50 = 25.98 µ gc m −2 ) followed by geranyl acetone and citronellol (LC50 = 49.97 and 50.02 µ gc m −2 ) were identified as the most toxic compounds to houseflies. Permethrin was up to 144-fold more toxic than rosalvaonthesusceptiblestrain.However,itwasonly35-foldmoretoxictotheinsecticide-tolerantfieldstrain.Thecompounds generated high toxicity to stable flies, with LC50 values ranging from 16.30 to 40.41 µ gc m −2 . CONCLUSION: Quantification of LC50 values of rosalva, citronellol and geranyl acetone against susceptible housefly and field-collected housefly and stable fly strains showed that semiochemicals could serve as potent insecticides for fly control programs. c � 2010 Society of Chemical Industry

LY264826 (A82846B) is a naturally-occurring glycopeptide antibiotic, differing from vancomycin in the stereochemistry of the amino-sugar of the disaccharide function, and the presence of a third sugar attached at the benzylic position of amino acid residue 6. Despite these seemingly subtle differences, LY264826 is approximately 10 times more active than vancomycin against the enterococci. In the pursuit of new antibiotics active against multiresistant Gram-positive organisms, an extensive side chain SAR was developed focusing on the reductive alkylation of LY264826 at the amino function of the disaccharide moiety. A new series of derivatives having varying degrees of structural diversity in the side chain (e.g. varying lengths and degrees of rigidity) was found to have potent activity against vancomycin-resistant enterococci (MIC's < 1.0 μg/ml) as well as activity against staphylococci and streptococci as good or better than vancomycin.

AJR:194, April 2010 This article suggests 10 steps that radiologists and radiologic technologists, with the assistance of their medical physicist, can take to obtain good quality CT images while properly managing radiation dose for children undergoing CT. The first six steps ideally should be completed before performing any CT on a pediatric patient. The final four steps address the unique consideration that should be given for each scanned patient.

Unfed adults of the African ticks, Amblyomma hebraeum Koch and A. variegatum (Fabricius), important vectors of human and animal diseases, were exposed to volatile compounds in an olfactometer in efforts to identify both tick-produced or synthetic chemicals capable of eliciting an attraction response. A formula, relative efficacy of attraction, was devised for comparison of responses between species and sexes to a particular test stimulus, or within a homogeneous population to different stimuli. Adults of both species responded strongly to known tick-pheromone constituents, nonanoic acid, methyl salicylate, 2.6-dichlorophenol and benzyl alcohol, as well as to a commercially produced antiseptic, TCP (Pfizer), and its major components, chlorinated and iodinated phenols. Benzaldehyde, a proposed tick-pheromone component, and heptadecane, not known from ticks, were markedly attractive to adults of A. hebraeum but not to those of A. variegatum. Males of the former species, but neither conspecific females not either sex of the latter species, responded significantly to salicylaldehyde (known from males of four species of ticks, including A. variegatum). o-nitrophenol, a major component of the aggregation-attachment pheromone of males of both A. variegatum and A hebraeum and a proven long-range attractant for them in the field, was only partially attractive to either species in the olfactometer. Neither species was attracted to 2-methylpropanoic acid, previously identified in volatile effluents form feeding male A. hebraeum. It is concluded that these important disease vectors respond positively to a variety of volatile chemicals, which may conceivably be used to attract them to traps, animals or acaricides in efforts to control ticks or the diseases they transmit.