In 2018, the Surgeon General released a public health advisory emphasizing the importance of naloxone in preventing opioid overdose deaths. Legislation is rapidly changing to simplify the process of obtaining naloxone by expanding who can receive and distribute the life-saving drug. Even with legislation in place expanding access to naloxone, the drug is underutilized and health care providers are responsible for ensuring these efforts are put to use within their practice. Legislative changes will be summarized and the role of the health care provider will be discussed.
This paper describes a generalised linear mixed model (GLMM) approach for understanding spatial patterns of participation in population health screening, in the presence of multiple screening facilities. The models presented have dual focus, namely the prediction of expected patient flows from regions to services and relative rates of participation by region- service combination, with both outputs having meaningful implications for the monitoring of current service uptake and provision. The novelty of this paper lies with the former focus, and an approach for distributing expected participation by region based on proximity to services is proposed. The modelling of relative rates of participation is achieved through the combination of different random effects, as a means of assigning excess participation to different sources. The methodology is applied to participation data collected from a government-funded mammography program in Brisbane, Australia.
Nature conservation and agricultural production may be considered as conflicting objectives, but for a wheat and sheep property in Western Australia they have been pivotal management objectives for the last 48 years. Koobabbie, a 7,173 ha property, has retained 41.5% of the original native vegetation, and is a designated Important Bird Area by BirdLife Australia, while still being an economically profitable agricultural enterprise. Since 1987 the owners of Koobabbie have kept detailed records of the avifauna of the property, and encouraged staff from government, non-government and academic organisations to conduct research and monitoring of the endangered Carnaby's Cockatoo Calyptorhynchus latirostris breeding on their property. In addition, they have instituted control programs for two over-abundant cockatoo species which compete with Carnaby's Cockatoo for nest sites, and for Feral Cats that are predators of nesting female Carnaby's Cockatoo and their offspring. This paper presents the results of research and monitoring from 2003-2013, during which seven artificial nesting hollows were erected, and former active nest hollows that had become derelict were repaired. By 2008, the number of breeding pairs on the property was at least 27, but two mass deaths of breeding females in 2009 and 2012 reduced the number of breeding pairs by 80%. This study illustrates the importance of monitoring conservation on private property, and raises a number of issues in relation to management of endangered species dependent on large hollow-bearing trees on private property.
AbstractIntroductionHIV reservoirs and infected cells may persist in tissues with low concentrations of antiretrovirals (ARVs). Traditional pharmacology methods cannot assess variability in ARV concentrations within morphologically complex tissues, such as lymph nodes (LNs). We evaluated the distribution of six ARVs into LNs and the proximity of these ARVs to CD4+ T cells and cell‐associated RT‐SHIV viral RNA.MethodsBetween December 2014 and April 2017, RT‐SHIV infected (SHIV+; N = 6) and healthy (SHIV–; N = 6) male rhesus macaques received two selected four‐drug combinations of six ARVs over 10 days to attain steady‐state conditions. Serial cryosections of axillary LN were analysed by a multimodal imaging approach that combined mass spectrometry imaging (MSI) for ARV disposition, RNAscope in situ hybridization for viral RNA (vRNA) and immunohistochemistry for CD4+ T cell and collagen expression. Spatial relationships across these four imaging domains were investigated by nearest neighbour search on co‐registered images using MATLAB.ResultsThrough MSI, ARV‐dependent, heterogeneous concentrations were observed in different morphological LN regions, such as the follicles and medullary sinuses. After 5–6 weeks of infection, more limited ARV penetration into LN tissue relative to the blood marker heme was found in SHIV+ animals (SHIV+: 0.7 [0.2–1.4] mm; SHIV–: 1.3 [0.5–1.7] mm), suggesting alterations in the microcirculation. However, we found no detectable increase in collagen deposition. Regimen‐wide maps of composite ARV distribution indicated that up to 27% of SHIV+ LN tissue area was not exposed to detectable ARVs. Regions associated with B cell follicles had median 1.15 [0.94–2.69] ‐fold reduction in areas with measurable drug, though differences were only statistically significant for tenofovir (p = 0.03). Median co‐localization of drug with CD4+ target cells and vRNA varied widely by ARV (5.1–100%), but nearest neighbour analysis indicated that up to 10% of target cells and cell‐associated vRNA were not directly contiguous to at least one drug at concentrations greater than the IC50 value.ConclusionsOur investigation of the spatial distributions of drug, virus and target cells underscores the influence of location and microenvironment within LN, where a small population of T cells may remain vulnerable to infection and low‐level viral replication during suppressive ART.
