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Reports on the death rate from poisoning in the U.S. from 1990 to 2001. Percentage increase in death rate from poisoning during the period; Percentage of poisonings that involved drugs and other biologic substances; Categories that were used to examine the trends in poisoning deaths.

The article deals with the results of an analysis conducted by human and health services agencies in Washington on overdose deaths involving prescription opioids during the 2004-2007 period. It reveals that 1668 persons died from prescription overdose during the period. The highest percentage of death was found among the people in the 45-54 years old age group. The Washington State Department of Health developed a definition of overdose death involving prescription opioids based on the analysis. Also noted is the limitations of the analysis, such as underestimation of the number of overdoses involving prescription opioids. INSET: What is already known on this topic?.

Introduction: Burns are painful injuries associated with a long recovery. Patients may not be receiving sufficient pain management education to optimize their experience and recovery after burn injury. Therefore, we aimed to obtain patients' perspectives about the effectiveness of current burn pain education to inform future efforts., Methods: We used a mixed-methods research design that included both inpatients and outpatients cared for at a single, American Burn Association-verified burn center. Participants were at least 14 years of age with an acute burn who received a minimum of two wound interventions. The interview was designed by clinician stakeholders using a modified Delphi technique and focused on patient respondent's pain experience, understanding and desire to gain knowledge concerning burn pain and its management. Descriptive quantitative analysis was performed on categorical data. Recorded interview segments were transcribed for content analysis., Results: Twenty-one adult burn patients were interviewed. Participants reported experiencing variable levels of pain and pain management effectiveness. Inpatients reported more severe pain than outpatients. Only 11% of inpatients reported having received enough pain information, compared to 50% of outpatients. Content analysis yielded 3 themes: patient's pain experience, range of expectations, and clinical information/services desired. Mental and physical effects were key factors in respondents' pain experiences, with many participants reporting mental anguish in addition to pain. Of participants who had pain expectations, most were matched by their experience (56%), although many individuals (44%) described higher pain levels than they anticipated. Positive experiences with the burn care team primarily revolved around receiving pain education from a provider, whereas negative experiences focused on wound care events. Participants desired more information on sleep and pain medications, alternative treatments, weaning and addiction risk, realistic expectations of recovery timelines, and available mental health services. Written (pamphlet) education ranked as the most desirable delivery method, followed by in-person and video education., Conclusions: Burn patients reported variable pain experiences and a strong desire to receive additional pain education. This project informs key strategies to educate burn patients on pain: leverage the high-level of interest in pain to foster education, describe pharmacologic and alternative therapies, offer weaning plans and explanation of addiction risks., Applicability to Practice: Burn patients' perspectives help inform strategies and content creation for pain-related education materials that burn centers can provide to improve patients' experiences., External Funding: Project was supported in part by the NIH grant for Insight Student Research Program at the Harborview Injury Prevention and Research Center (R25 HD094336)., (Copyright © 2021 Elsevier Ltd and ISBI. All rights reserved.)

Background and Aims: In the United States, overdose deaths resulting from methamphetamine and other amphetamine-type stimulants (METH/AMPH) have been increasing. We describe rates and characterize patients hospitalized after a METH/AMPH-involved overdose in Washington State, to guide prevention and control measures., Design Setting Participants: We conducted a trend analysis of hospitalized Washington State residents aged ≥15 years who received a METH/AMPH-involved overdose diagnosis in Washington's civilian hospitals and reported in the Comprehensive Hospital Abstract Reporting System., Measurements: We used Joinpoint regression analysis to study trends in rates of hospitalized patients who received a METH/AMPH-involved overdose diagnosis during 2010-2017. We used 2016-2017 data to describe characteristics of patients with nonfatal and fatal outcomes and used chi-square test (for categorical variables) and Wilcoxon rank-sum test (for continuous variables) to compare characteristics of patients by outcome., Findings: During 2010-2017, 3587 patients were hospitalized and received a METH/AMPH-involved overdose diagnosis. The age-adjusted rate for METH/AMPH-involved overdose hospitalization increased from 6.3/100,000 persons in 2010 to 8.5/100,000 persons in 2017. Patients aged ≥55 years had the greatest increase in rate of overdose hospitalizations. Among these patients, 86% also had a substance use disorder diagnosis involving substances other than METH/AMPH, and 35% experienced a polysubstance overdose., Conclusions: We observed increasing rates of METH/AMPH-involved overdose hospitalizations in Washington State, particularly among persons aged ≥55 years. Approximately a third of patients also experienced a polysubstance overdose, which can be considered when designing interventions to address increasing rates of overdose hospitalizations in Washington State., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2021 Published by Elsevier Ltd.)

During January 1, 2020-May 18, 2020, approximately 1.3 million cases of coronavirus disease 2019 (COVID-19) and 83,000 COVID-19-associated deaths were reported in the United States (1). Understanding the demographic and clinical characteristics of decedents could inform medical and public health interventions focused on preventing COVID-19-associated mortality. This report describes decedents with laboratory-confirmed infection with SARS-CoV-2, the virus that causes COVID-19, using data from 1) the standardized CDC case-report form (case-based surveillance) (https://www.cdc.gov/coronavirus/2019-ncov/php/reporting-pui.html) and 2) supplementary data (supplemental surveillance), such as underlying medical conditions and location of death, obtained through collaboration between CDC and 16 public health jurisdictions (15 states and New York City).

Context: To address risks associated with prescription opioid medications, guidelines recommend lower dose, shorter duration of use, and avoidance of concurrent sedatives. Monitoring opioid-prescribing practices is critical for assessing guideline impact, comparing populations, and targeting interventions to reduce risks., Objective: To describe development of Washington (WA) State opioid-prescribing metrics, provide purpose and definitions, and apply metrics to prescription data for WA health care organizations., Design: We describe the development and testing of opioid-prescribing metrics by the WA State Bree Collaborative opioid work group., Setting: Washington State., Participants: Kaiser Permanente of Washington (KPW) Integrated Group Practice, KPW-contracted care providers, and WA Medicaid., Main Outcome Measures: Set of 6 strategic metrics tested across 3 different health systems adopted by WA State in 2017 for uniform tracking of opioid-prescribing guidelines and state policies. These metrics include (1) overall prevalence of any opioid use, (2) chronic use, (3) high-dose chronic use, (4) concurrent chronic sedative use, (5) days' supply of new prescriptions, and (6) transition from acute to chronic use., Results: In the first quarter of 2010, 10% to 12% of KPW and 14% of Medicaid patients received at least 1 opioid prescription. Among opioid users, 22% to 24% of KPW and 36% of Medicaid patients received chronic opioids. Among patients receiving chronic opioids, 16% to 22% of KPW and 32% of Medicaid patients received high doses (≥90 morphine-equivalent dose per day) and 20% to 23% of KPW and 33% of Medicaid patients received concurrent chronic sedatives. Five percent of Medicaid and 2% to 3% of KPW patients receiving new opioid prescriptions transitioned to chronic opioid use., Conclusions: The metrics are relatively easy to calculate from electronic health care data and yield meaningful comparisons between populations or health plans. These metrics can be used to display trends over time and to evaluate the impact of opioid-prescribing policy interventions.

Background: Many university students are becoming involved in mentoring programs, yet few studies describe the impact of mentoring on the mentor. Additionally, many studies report that students graduating from college are not prepared to enter the workforce in terms of key career skills and/or content knowledge. Herein, we examine the impact of our program, NE STEM 4U (Nebraska Science, Technology, Engineering and Math for You), in which undergraduate (UG) mentors engage K-8 youth in after-school STEM experiments. The UGs reflected upon their experiences using post-mentoring evaluations, 12- and 24-week interviews, and exit surveys. Many of the questions asked of the mentors related directly to their own professional development, such as self-evaluation of communication, organization, and problem-solving skills, while other questions related to content knowledge and reflection., Results: Post-mentoring, UGs reflected on the delivery/teaching significantly more ( p  ≤ 0.001 for each) than other variables (i.e., their own content knowledge gains, the students' content knowledge gains, scaffolding the lessons, or overall professional growth). By analyzing the evaluations and interviews together, some significant, self-reported gains emerged. For example, 94.15% of the UG reported that the experience was beneficial to their education. Additionally, UG mentors self-reported significant gains ( p  ≤ 0.01 for each) moving from 12- to 24-weeks in the program in the categories of organization, STEM content knowledge, preparedness to teach, and engagement in the program. However, UG did not report significant gains in dependability. Importantly, when mentors ranked themselves at 24-weeks, they were blinded to (unaware of) the ranking they gave themselves at 12-weeks., Conclusions: This study helps to fill a gap in the literature by providing insight into the gains UG mentors report attaining after mentoring to K-8 students. These data suggest that participation by UGs in this program promoted self-reflection as well as self-reported gains related to career preparedness and STEM content knowledge.

An epidemic of morbidity and mortality has swept across the United States related to the use of prescription opioids for chronic noncancer pain. More than 100,000 people have died from unintentional overdose, making this one of the worst manmade epidemics in history. Much of health care delivery in the United States is regulated at the state level; therefore, both the cause and much of the cure for the opioid epidemic will come from state action. We detail the strong collaborations across executive health care agencies, and between those public agencies and practicing leaders in the pain field that have led to a substantial reversal of the epidemic in Washington State.

Purpose: To evaluate the neuroprotective potential of glial cell line-derived neurotrophic factor (GDNF) in the retinal degeneration (rd/rd) mouse model of human retinitis pigmentosa., Methods: Subretinal injections of GDNF were made into rd/rd mice at 13 and 17 days of age and electroretinograms (ERGs) recorded at 22 days. Control mice received saline vehicle injections or underwent no procedure. At 23 days of age, retinas from treated and control mice were fixed and processed for wholemount immunohistochemistry using an anti-rod opsin antibody, and rod numbers were estimated using an unbiased stereological systematic random approach. Subsequent to counting, immunolabeled retinas were re-embedded and sectioned in a transverse plane and the numbers of rods recalculated., Results: Although ERGs could not be recorded from sham-operation or nonsurgical rd/rd mice at 22 days of age, detectable responses (both a- and b-waves) were observed in 4 of 10 GDNF-treated mice. Stereological assessment of immunolabeled rods at 23 days showed that control rd/rd retinas contained 41,880+/-3,890 (mean +/- SEM; n = 6), phosphate-buffered saline (PBS)-injected retinas contained 61,165+/-4,932 (n = 10; P < 0.001 versus control retinas) and GDNF-injected retinas contained 89,232+/-8,033 (n = 10; P < 0.001 versus control retinas, P < 0.002 versus PBS). This increase in rod numbers after GDNF treatment was confirmed by cell counts obtained from frozen sections., Conclusions: GDNF exerts both histologic and functional neuroprotective effects on rod photoreceptors in the rd/rd mouse. Thus rescue was demonstrated in an animal model of inherited retinal degeneration in which the gene defect was located within the rods themselves, similar to most forms of human retinitis pigmentosa. GDNF represents a candidate neurotrophic factor for palliating some forms of hereditary human blindness.

Analyses of 45 samples of sour dough and various kinds of bread have shown that no appreciable amounts of propionic acid are formed during sour dough fermentation. Bread has no natural propionic acid content.

The usefulness of ultrasonography in the preliminary evaluation of obstructive jaundice is described in 35 consecutive patients with icterus. Diagnosis was substantiated by laparotomy, autopsy, or liver biopsy. In 23 patients with dilated bile ducts at ultrasonography, obstruction by tumor, stone, or stricture was proven operatively. Obstructive jaundice was differentiated from hepatocellular jaundice in 86% of cases; the site of obstruction was noted to be correct in 85%. The accuracy in the diagnosis of obstructive jaundice was 100% in patients with moderate or severe icterus.