Systematic content analysis of patient evaluations of START NOW psychotherapy reveals practical strategies for improving the treatment of opioid use disorder

Background Clinical trials provide consistent evidence for buprenorphine’s efficacy in treating opioid use disorder (OUD). While the Drug Addiction Treatment Act of 2000 requires physicians to combine medication-assisted treatment (MAT) with behavioral intervention, there is no clear evidence for what form or elements of psychotherapy are most effective when coupled with MAT to treat OUD. This investigation involves focus groups designed to collect patient opinions about a specific psychotherapy, called START NOW, as well as general beliefs about various elements of psychotherapy for treating OUD. Our analysis reveals trends about patient preferences and strategies for improving OUD treatment. Methods Subjects included patients enrolled in buprenorphine/naloxone MAT at our institution’s office-based opioid treatment program. All subjects participated in a single START NOW group session, which was led by a provider (physician or nurse practitioner trained and standardized in delivering START NOW). Consented subjects participated in satisfaction surveys and audio-recorded focus groups assessing individual beliefs about various elements of psychotherapy for treating OUD. Results Overall, 38 different focus groups, 92 participation events, and 44 unique subjects participated in 1-to-6 different START NOW session/audio-recorded focus group sessions led by a certified moderator. Demographic data from 36/44 subjects was collected. Seventy-five percent (33/44) completed the START NOW Assessment Protocol, which revealed self-reported behavioral trends. Analysis of all 92 START NOW Satisfaction Questionnaire results suggests that subjects’ opinions about START NOW improved with increased participation. Our analysis of audio-recorded focus groups is divided into three subsections: content strategies for new psychotherapies, implementation strategies, and other observations. For example, participants request psychotherapies to target impulsivity and to teach future planning and build positive relationships. Conclusions The results of this study may guide implementation of psychotherapy and improve the treatment of OUD, especially as it relates to improving the modified START NOW program for treating OUD. Our study also reveals a favorable outlook of START NOW with increased participation, suggesting that any initial reticence to this program can be overcome to allow for effective implementation.

A conformal array of microfabricated optically-pumped first-order gradiometers for magnetoencephalography

An array of 21 first-order gradiometers based on zero-field optically-pumped magnetometers is demonstrated for use in magnetoencephalography. Sensors are oriented radially with respect to the head and housed in a helmet with moveable holders which conform to the shape of a scalp. Our axial gradiometers have a baseline of 2 cm and reject laser and vibrational noise as well as common-mode environmental magnetic noise. The median sensitivity of the array is 15.4 fT/Hz1/2, measured in a human-sized magnetic shield. All magnetometers are operated independently with negative feedback to maintain atoms at zero magnetic field. This yields higher signal linearity and operating range than open-loop operation and a measurement system that is less sensitive to systematic and ambient magnetic fields. All of the system electronics and lasers are compacted into one equipment rack which offers a favorable outlook for use in clinical settings.

Ethical Cultures in Perinatal Care: Do They Exist? Correlation of Provider Attitudes with Periviability Practices at Six Centers

Objective This study aimed to compare attitudes of providers regarding perinatal management and outcomes for periviable newborns of caregivers at centers with higher resuscitation (HR) and lower resuscitation (LR) rates in the delivery room. Study Design All obstetric and neonatal clinical providers at six U.S. sites were invited to complete an anonymous online survey. Survey responses were compared with clinical data collected from a previous retrospective study comparing centers' rates of planned resuscitation. Responses were analyzed by multivariable logistic and linear regression to assess how HR versus LR center respondents differed in management preferences and outcome predictions. Results Paradoxically, HR versus LR respondents, when adjusting for other variables, were less likely to respond that interventions such as antenatal steroids (odds ratio: 0.61, 95% confidence interval [CI]: 0.42–0.88, p < 0.009) and resuscitation (OR: 0.59, 95% CI: 0.44–0.78, p < 0.001) should be given at 22 weeks. HR versus LR respondents also reported lower likelihood of survival and acceptable quality of life (OR: 0.7, 95% CI: 0.53–0.93, p = 0.012) at 23 weeks. Conclusion Despite higher rates of planned resuscitation at 22 and 23 weeks, steroid usage and survival rates did not differ between HR and LR sites. In this subsequent survey, respondents from HR centers had a less favorable outlook on interventions for these newborns than those at LR centers, suggesting that instead of driving practices, attitudes may be more closely associated with experiences of clinical outcomes.

Raynaud’s phenomenon in the endocrinologist’s practice

Raynauds phenomenon or syndrome (RS) is an episodic attacks of transient digital ischemia resulting from vasospasm of the digital artery, precapillary arterioles, and skin arteriovenous shunts in response to exposure to cold temperature or emotional stress. Prevalence averages 35%. The high prevalence of RS in the population, as well as the frequent association with other, often life-threatening, diseases and conditions, determines its clinical significance. In 8090% of cases, RS is idiopathic. It is assumed that the spasmodic reactivity of the vessels is caused by a violation of the central and local dysregulation of vascular tone. The most important role is played by vascular endothelial, intravascular and neuronal disorders. In at least 10% of cases, this is a secondary phenomenon. Most often, RS is associated with systemic rheumatic diseases. Along with this, endocrine diseases can develop, including those affected by the pituitary, thyroid and parathyroid glands, adrenal glands, and diabetes mellitus. In some cases, RS may be the only symptom of endocrine pathology. In general, SR is a condition with a favorable outlook and a stable course. The most informative instrumental method for the differential diagnosis of primary and secondary syndrome is the capillaroscopy of the nail bed.

An Optimistic Outlook Creates a Rosy Past: The Impact of Episodic Simulation on Subsequent Memory

People frequently engage in future thinking in everyday life, but it is unknown how simulating an event in advance changes how that event is remembered once it takes place. To initiate study of this important topic, we conducted two experiments in which participants simulated emotional events before learning the hypothetical outcome of each event via narratives. Memory was assessed for emotional details contained in those narratives. Positive simulation resulted in a liberal response bias for positive information and a conservative bias for negative information. Events preceded by positive simulation were considered more favorably in retrospect. In contrast, negative simulation had no impact on subsequent memory. Results were similar across an immediate and delayed memory test and for past and future simulation. These results provide novel insights into the cognitive consequences of episodic future simulation and build on the optimism-bias literature by showing that adopting a favorable outlook results in a rosy memory.

HISTORICAL DEVELOPMENT OF THE HTAsiaLINK NETWORK AND ITS KEY DETERMINANTS OF SUCCESS

Objectives:The aim of this study was to describe the historical development of the HTAsiaLink network, draw lessons for other similar initiatives globally, and to analyze key determinants of its success and challenges for its future development.Methods:This study is based on the collective and direct experiences of the founding members of the HTAsiaLink Network. Data were collected from presentations they made at various international forums and additional information was reviewed. Data analysis was done using the framework developed by San Martin-Rodriguez et al.Results and Conclusions:HTAsiaLink is a network of health technology assessment (HTA) agencies in Asia established in 2011 with the aim of strengthening individual and institutional HTA capacity, reducing duplication and optimizing resources, transfer and sharing of HTA-related lessons among members, and beyond. During its 6 years, the network has expanded, initiating several capacity building activities and joint-research projects, raising awareness of the importance of HTA within the region and beyond, and gaining global recognition while establishing relationships with other global networks. The study identifies the determinants of success of the collaboration. The systemic factors include the favorable outlook toward HTA as an approach for healthcare priority setting in countries with UHC mandates. On organizational factors, the number of newly established HTA agencies in the region with similar needs for capacity building and peer-to-peer support was catalytic for the network development. The interactional aspects include ownership, trust, and team spirit among network members. The network, however, faces challenges notably, financial sustainability and management of the expanded network.

The Use of Constant Market Share (CMS) Model to Assess Brazil Nut Market Competitiveness

This paper aims to evaluate the variation of market share explained by structural and competitive forces using the Constant Market Share (CMS) model. Assuming that a country should maintain its market share to keep competitive, the equation used in the model analyzes the export basket composition, exports destination, growth or shrinkage of the world market and the competitiveness effect. The overall loss of the Brazilian market share in a time series from 1998-2012 is given due to the barriers of potential European markets and reduction of the market growth of the product with shell. In a different way, the increase in exports of shelled nuts to markets with higher growth rates contributed to a favorable outlook for Bolivian and Peruvian markets, which had a market share gain on the period.

Race, Ethnicity, and the American Criminal Justice System: The Perceptions and Experiences of West Indian Men

Using in-depth interview data from 30 young Black men of West Indian background, we examine their experiences with and perceptions of the American criminal justice system. Their experiences lead these men to contend that the system, especially police authorities, do not differentiate between Blacks based on ethnicity and subsequently treat West Indians and African Americans in a similar manner, that is, race trumps ethnicity. These men discuss their concerns about stereotypes of minorities, especially as they are reflected in the media, as the primary reasons for their treatment. However, these men also provide nuanced accounts in which not all system actors engage in discriminatory behavior. These accounts rest on an immigrant lens regarding criminal justice, which may indicate a more favorable outlook compared to their native-born Black counterparts. Overall, though, the interview data suggest that a Black–White divide regarding such perceptions will persist in an era of substantial sociodemographic change.

Public attitudes toward biofuels: Effects of knowledge, political partisanship, and media use

Despite large-scale investments and government mandates to expand biofuels development and infrastructure in the United States, little is known about how the public conceives of this alternative fuel technology. This study examines public opinion of biofuels by focusing on citizen knowledge and the motivated processing of media information. Specifically, we explore the direct effects of biofuels knowledge and the moderating effect of partisanship on the relationship between media use and benefit vs. risk perceptions in the following four domains: environmental impacts, economic consequences, ethical/social implications, and political ramifications. Our results suggest that more knowledgeable respondents see fewer benefits of biofuels relative to risks, and that Democrats and Republicans are affected differently by media use when forming opinions about biofuels. Among Democrats, greater attention to political media content leads to a more favorable outlook toward the technology across several domains of interest, while among Republicans, an increase in attention to political content has the opposite effect. Possible reasons for these results, as well as implications of the findings at the intersection of politics and the life sciences, are discussed.