Feasibility of paying people who use drugs cash to distribute naloxone within their networks

INTRODUCTION

Immediate access to naloxone is needed to prevent fatal opioid-related overdoses in the presence of fentanyl analogs saturating the opioid supply. Peer models engage impacted populations who are not accessing naloxone through standard venues, yet compensating peers who utilize syringe service programs with cash stipends to distribute naloxone within networks of people who use drugs is not well described.

METHODS

As part of the HEALing Communities Study, syringe service program-based interventions were developed in Holyoke and Gloucester, MA, which paid people who use drugs ("peers") cash to distribute naloxone. Early program outcomes were evaluated for the time each program was funded within the HCS study period.

RESULTS

During 22 study-months of observation, peers in two communities distributed 1104 naloxone kits. The total cost of peer compensation for program delivery was $10,510. The rate of peer-distributed naloxone per 100 K population reached 109 kits/mo and 222 kits/mo in the two communities. Participating peers addressed gaps in harm reduction outreach and distributed naloxone and other harm reduction equipment to individuals who were not syringe service program participants, expanding organizational reach. Being compensated with unrestricted cash stipends supported dignity and acknowledged peers' work in overdose prevention.

CONCLUSION

The underutilization of compensated peer models is often attributed to funding and organizational barriers. These programs demonstrate that providing cash stipends to peers is feasible and expanded naloxone distribution at two existing syringe service programs. Providing cash stipends for peers who engage in secondary naloxone distribution offers promise in delivering naloxone to people not accessing syringe services.

[Laparoscopic approach for treatement of gastroesophageal reflux in newborns and infants with severe respiratory disorders. When to indicate it?]

Gastroesophageal reflux (GER) is a common finding in the newborn period, which is in general well tolerated, and tends to resolve spontaneously at about 18 months of age. However, a small number of children will present important respiratory manifestations (aspiration and apneic episodes), or increase in the manifestations of pre existing conditions (tracheomalacia, laryngomalacia), which can produce life threatning events. Ph monitoring does not completely discard the possibility of GER and the use of prokinetic drugs, in association with other drugs to protect the esophagus do not prevent serious consecuences produced by reflux to the airway. In this report six children with severe airway disease and marked GER, with no response to initial medical treatment required laparoscopic fundoplication. They have all resolved their airway disease, and are currently well. The laparocopic technique for fundoplication of small children seems to be a secure, well tolerated and definitive treatment in the hands of trained surgeons.

Effect of posterior cut angle on tibial component loading

Although clinical studies have shown that posterior cut angle affects tibial component stability, biomechanical studies are lacking. Fifteen Sawbones tibiae were divided into 5 groups and prepared with 0 degrees , 3 degrees, 6 degrees, 9 degrees, and -5 degrees tibial surface cuts, and a tibial component was implanted with cement. Using a standard and then a highly congruent polyethylene insert, the knee was loaded at 0 degrees and 30 degrees of flexion. There were statistically significant increases in anterior micromotion of the standard polyethylene component for each increase in posterior slope cut angle, which increased for the highly congruent polyethylene component. The anterior slope cut (-5 degrees) led to significant posterior micromotion of the tibial polyethylene component. Increased posterior slope cut angle significantly decreased tibial anterior compressive strains and significantly increased tibial posterior compressive strains. The highly congruent insert significantly increased this posterior strain. The results indicate that cutting the articular surface of the tibia at a 0 degrees or 3 degrees posterior slope provides the greatest tibial component stability.

Esophageal fibrovascular polyp protruding from the mouth

A case of a 66-year-old woman with a giant fibrovascular polyp protruding from the mouth is presented. The polyp was successfully removed by a cervical esophagotomy.

Studies of the cyclic adenosine monophosphate chemoreceptor of Paramecium

A doublet of proteins (approximately 48,000 Mr) from the Paramecium cell body membrane fits several criteria for the external cAMP chemoreceptor. These criteria include: (i) selective elution from a cAMP affinity column, matching a specificity that could be predicted from the behavioral response and whole-cell binding; (ii) binding to wheat germ agglutinin indicating the presence of carbohydrate moieties indicating surface exposure; and (iii) selective inhibition of the intact cells' chemoresponse to cAMP by antibodies against the doublet. Additional evidence for the existence of a receptor, in general, comes from selective elimination of the cAMP chemoresponse by photoaffinity labeling of while cells with 8-N3-cAMP. The doublet proteins are not identical to the regulatory subunit of a cAMP-dependent protein kinase from Paramecium, the Dictyostelium cAMP chemoreceptor, or the 42-45 kDa range proteins related to the large surface glycoprotein in Paramecium. The doublet proteins are not readily separable and, as in Dictyostelium, may represent two different covalent modification states of the same protein. Amino acid analysis indicates that the proteins are similar, but does not distinguish between the possibilities of proteolysis and covalent modification. Once cloned, this doublet may prove to be only the fifth external, eukaryotic chemoreceptor to be identified.