Preliminary Effectiveness of a Remotely Monitored Blood Alcohol Concentration Device as Treatment Modality: Protocol for a Randomized Controlled Trial

Background

Alcohol use disorder is a chronic disorder with a high likelihood of relapse. The consistent monitoring of blood alcohol concentration through breathalyzers is critical to identifying relapse or misuse. Smartphone apps as a replacement of or in conjunction with breathalyzers have shown limited effectiveness. Yet, there has been little research that has effectively utilized wireless or Wi-Fi–enabled breathalyzers that can accurately, securely, and reliably measure blood alcohol concentration.

Objective

The purpose of this study is to evaluate the impact of a wireless blood alcohol concentration device in collaboration with long-term treatment on dropout rates, psychological distress, treatment motivation, quality of life, and need for higher levels of follow-up care for patients with alcohol use disorder.

Methods

The randomized clinical trial will include two arms, access to the wireless breathalyzer versus no access to the breathalyzer, while both groups have access to treatment. Evaluation will last 3 months with a 6-week follow-up, during which each participant will be interviewed at admission, 1 month in, 2 months in, 3 months in, and follow-up. Individuals will be recruited online through a secure telehealth meeting invitation. Outcomes will focus on the impact of the wireless breathalyzer within the alcohol use disorder population, and the combined effect on psychological distress, treatment motivation, and quality of life. In addition, we intend to investigate the impact of the breathalyzer on dropout rates and participants’ need for higher levels of follow-up care and treatment.

Results

The recruitment of this study started in July 2020 and will run until 2022.

Conclusions

This information will be important to develop cost-effective treatments for alcohol dependence. Ongoing monitoring allows treatment providers to take an individualized disease management approach and facilitates timely intervention by the treatment provider.

Trial Registration

ClinicalTrials.gov NCT04380116; http://clinicaltrials.gov/ct2/show/NCT04380116

International Registered Report Identifier (IRRID)

DERR1-10.2196/30186

Human immunodeficiency virus infection is associated with a differential increase in cytokine response and increased risk of perforation in acute appendicitis

HIV infection causes increased perforation rate in acute appendicitis and alters cytokine profile resulting in increased pro-inflammatory cytokines in serum but decreased in peritoneal fluid. It is also accompanied by increased anti-inflammatory cytokines.

10 kHz accuracy of an optical frequency reference based on (12)C2H2-filled large-core kagome photonic crystal fibers

Saturated absorption spectroscopy reveals the narrowest features so far in molecular gas-filled hollow-core photonic crystal fiber. The 48-68 mum core diameter of the kagome-structured fiber used here allows for 8 MHz full-width half-maximum sub-Doppler features, and its wavelength-insensitive transmission is suitable for high-accuracy frequency measurements. A fiber laser is locked to the (12)C2H2 nu(1); + nu(3) P(13) transition inside kagome fiber, and compared with frequency combs based on both a carbon nanotube fiber laser and a Cr:forsterite laser, each of which are referenced to a GPS-disciplined Rb oscillator. The absolute frequency of the measured line center agrees with those measured in power build-up cavities to within 9.3 kHz (1 sigma error), and the fractional frequency instability is less than 1.2 x 10(-11) at 1 s averaging time.

Length-tension properties of extraocular muscles in patients with esotropia and intermittent exotropia

The purpose of this study was to determine the passive length-tension characteristics of horizontal recti muscles in patients with non-restrictive horizontal strabismus. A system to measure intraoperative continuous-registration passive length-tension curves of detached extraocular muscles was designed. The size of the preoperative deviation and the change in the deviation as a result of surgery was correlated with the passive tension of the medial rectus muscle in patients with acquired esotropia. Patients with infantile esotropia or intermittent exotropia showed no relationship between passive tension and either preoperative deviation or response to surgery. Surgical recession of both the medial and lateral recti muscles produced large changes in the passive tension characteristics of both of these muscles. Medial rectus muscle recession produced larger changes in the passive tension than equal amounts of recession of lateral recti muscles.

The prevalence of ocular disorders among Hispanic and Caucasian children screened by the UCLA Mobile Eye Clinic

A cross-sectional study was performed to describe the prevalence of ocular abnormalities among six and seven year old children of Hispanic and Caucasian ancestry in Los Angeles County. Data were obtained from vision screenings of lower to middle income Hispanic and Caucasian children completed by the UCLA Mobile Eye Clinic at public neighborhood elementary schools and community centers between January and August of 1989, and January and March of 1990. Out of a total sample of 854 children, 64% were Hispanic; 36% were Caucasian; 51% were female and 49% were male. Ocular abnormalities observed were similar for both ethnic groups. Caucasians, however, showed non-significant, but consistently higher prevalences of most ocular abnormalities. Stronger associations between ethnicity and visual abnormalities were observed within the female subgroup. For example, hyperopia was found more commonly among female Caucasian children than among female Hispanic children (p < 0.01). This information can be used in planning for the eye care needs of communities with Caucasian and Hispanic components.

Clinical reactivation of herpes simplex virus type 2 infection in seropositive pregnant women with no history of genital herpes

OBJECTIVE

To determine the risk for genital herpes and asymptomatic herpes simplex virus (HSV) shedding in late pregnancy and delivery in a population of HSV type 2 (HSV-2)-seropositive but previously asymptomatic pregnant women.

DESIGN

A prospective inception cohort study.

PARTICIPANTS

A total of 1355 pregnant women with no history of genital herpes referred from three private obstetrics practices between November 1985 and June 1988.

MAIN OUTCOME MEASURES

Confidential questionnaires evaluated sexual risk factors in relation to HSV-2 serologic status as determined by Western blot analysis. Herpes simplex virus shedding was determined by viral culture of the cervix and vulva and of any suspicious lesions.

RESULTS

Antibody to HSV-2 was detected in 439 of 1355 pregnant women (32%) with no history of genital herpes. Asymptomatic HSV shedding was detected in 5 of 1160 cultures (0.43%) obtained in late pregnancy and during delivery. A first episode of clinical genital herpes was recognized by 43 of 264 HSV-2-seropositive women (16%) during their pregnancy.

CONCLUSIONS

Serologic evidence of unknown HSV-2 infection was common in pregnant women without a history of genital herpes. Asymptomatic viral shedding in these women occurred at a rate similar to that seen in women with symptomatic genital HSV-2 infection. To improve recognition of genital herpes near term, obstetricians should counsel pregnant women about the high prevalence and mild and diverse symptoms of genital HSV-2 infection.

A clinical and demographic profile of a sample of adults with attention deficit hyperactivity disorder, residual state

It is becoming increasingly recognized that one third to one half of children diagnosed as having attention deficit/hyperactivity disorder (ADHD) continue to exhibit symptoms of the disorder into adulthood. The nature of the clinical picture is not well understood by a substantial number of clinicians. The purpose of this study is to report on the demographic and clinical profile of 56 adults, age 19 to 65 years (48 men, eight women) who present with adult ADHD and meet DSM-III-R criteria for the disorder. Patients underwent a diagnostic work-up consisting of medical and psychiatric evaluation, a structured interview Schedule for Affective Disorders and Schizophrenia-Lifetime Version [SADS-L]), the Symptoms Checklist Revised (SCL-9OR), Conners Attention Deficit Disorder With Hyperactivity (ADDH) scale, structured interview of ADDH, the Global Assessment of Functioning Scale (GAF), and, when available, information from parents was obtained. Ninety-one percent of our sample met the Utah Criteria for adult ADHD. The majority of the sample had additional DSM-III-R diagnoses and only seven had ADHD diagnosis alone. Fifty-three percent of the sample met the criteria for generalized anxiety disorder, 34% alcohol abuse or dependence, 30% drug abuse, 25% dysthymic disorder, and 25% cyclothymic disorder. These findings were similar to those reported in the literature.

Myocardial sarcolemma in ischemia: a quantitative freeze-fracture study

Freeze-fracture electron microscopy permits the visualization of the intramembrane particles (IMP). These IMPs are presumably proteins responsible for the main functions of the membrane. Quantitative techniques (Clark-Evan statistics) were applied to determine in a critical manner whether IMP pattern shifts (random, clustered, or ordered) occur under the ischemic conditions (5-45 min with and without reperfusion) and whether this change is related to the experimental condition. In each case three hearts, eight replicas/heart, one area of 0.25 micron 2 of membrane fracture face/replica was measured to give a total of 6 micron 2 of membrane counted for each condition (control vs. ischemic). A mixed effects nested model analysis of variance was performed in each variable. We found that IMP aggregation can be present in some control membranes, but the degree of aggregation was greater and more consistent in membranes made ischemic and followed by reperfusion. Most striking was the significant clustering of IMPs in membranes from hearts ischemic for only 5 min. Reperfusion after only 5 min of ischemia reversed IMP clustering. Functionally at this time there is an increase in K+ concentration in the interstitial space that reaches approximately 15 mM within 10 min and reverses on reperfusion. The structural alteration in IMPs appears to parallel the function in ischemic hearts.

Open-eye corneal swelling secondary to hydrogel contact lens wear

Three hydrogel contact lenses of measured oxygen transmissibility (Dk/L = 20, 12, and 6 x 10(-9) cm ml O2/s ml mm Hg, respectively) were used to induce central corneal swelling as measured by optical pachometry in five human subjects under open-eye conditions (8 h wear). Both contact lenses with higher Dk/L values induced mean central corneal swelling of about 1.5%. The lower Dk/L lens induced a mean central corneal swelling of 2.2%. However, statistical analysis of the differences in central corneal swelling between the lens-wearing and the control eyes indicates that swelling induced by the higher Dk/L lenses is not identical, and indicates that even a Dk/L of 20 x 10(-9) is insufficient to reduce corneal swelling to zero. This suggests that the "critical oxygen tension" (COT) could be in excess of 20 to 40 mm Hg, but not necessarily as high as 70 mm Hg.

Prediction of cervical neoplasia diagnosis groups. Discriminant analysis on digitized cell images

The purpose of this study was to develop discriminant analysis models for predicting cervical dysplasia/neoplasia case diagnoses using cytometric features derived from the digital image analysis of cell monolayers. The data base consisted of 925 cells from 27 cases diagnosed either as moderate dysplasia (n = 10), severe dysplasia (n = 5), carcinoma in situ (n = 8) or invasive carcinoma (n = 4) on both tissue biopsy and monolayer preparations. Cell features examined were cell diameter, nuclear diameter, nuclear mean optical density (OD), nuclear integrated OD (IOD), nuclear OD standard deviation, normalized IOD, nuclear texture and nuclear-cytoplasmic ratio. Features derived from cells visually classified as moderate dysplasia correctly predicted the case diagnosis of moderate dysplasia versus more severe disease for 85% of the cells. Prediction models using summary measures (mean and variance) derived from all visually classified abnormal cells within each case correctly separated all cases into their respective diagnostic categories. These findings suggest that dysplastic cells in a cytologic sample have features that collectively reflect the tissue diagnosis, regardless of the visual differences among the cells. Such information has potential use for diagnosis and possibly for prognosis.

Nonsurgical ovum transfer as a treatment for intractable infertility: what effectiveness can we realistically expect?

Using previously reported human, primate, and cattle reproductive performance data, we developed a mathematical model to predict the cumulative probability of pregnancy per woman per month theoretically obtainable by ovum transfer. We then conducted a preliminary ovum transfer clinical trial and compared the results of that trial to the results predicted by the model. Based on the nine spontaneously ovulating fertile donors and seven spontaneously ovulating infertile recipients available for the trial, the model predicted occurrence of between 0.63 and 8.65 pregnancies during the 6-month period of the study. We actually obtained two pregnancies. The model further predicted, with sufficient numbers of donors to produce one match per ovulation for each prospective patient, that the probability of that patient becoming pregnant from ovum transfer ranges from 0.05 to 0.35 per cycle.

Discriminant analysis of congenital esotropia surgery. Predictor variables for short- and long-term outcomes

In a retrospective study, a computer-based stepwise discriminant analysis was used to create a biostatistical model of the results of surgery in congenital esotropia. One hundred fifty-seven patients who had bilateral medial rectus muscle recession as an initial operative procedure with at least 6 months postoperative follow-up were studied. The outcome groups for the discriminant analysis were based on the ocular deviation 6 weeks after the first surgery and at the patient's last visit, or the presence or absence of stereopsis at the last visit. With respect to the two predominant ocular deviation groups (Esotropia or Success) 6 weeks after surgery, 11 independent variables were analyzed; those determined to be prognostic of the outcome grouping were preoperative deviation, millimeters of medial rectus muscle recession, and interval between the onset of strabismus and surgery. With respect to ocular deviation at last visit, 105 patients were followed for over 2 years and were last examined when over 5 years of age; of the 12 independent variables analyzed, only postoperative deviation at 6 weeks was predictive. With respect to stereopsis, 94 patients had similar follow-up; of the 12 independent variables analyzed, preoperative deviation and age at surgery were prognostic. The results indicate that a smaller preoperative deviation and earlier surgical intervention increase the probability of achieving some degree of stereopsis in patients with congenital esotropia.

Discriminant analysis of acquired esotropia surgery. Predictor variables for short- and long-term outcomes

In a retrospective study, a computer-based stepwise discriminant analysis was used to create a biostatistical model of the results of surgery in acquired esotropia. One hundred seventy-two patients who had bilateral medial rectus muscle recession as an initial operative procedure with at least 6 months postoperative follow-up were studied. The outcome groups for the discriminant analysis were based on the ocular deviation 6 weeks after the first surgery and at the patient's last visit, or the presence or absence of stereopsis at the last visit. With respect to the two predominant ocular deviation groups (Esotropia or Success) 6 weeks after surgery, 11 independent variables were analyzed; those determined to be prognostic of the outcome grouping were refractive error of the left eye and preoperative deviation, in that order. With respect to ocular deviation at last visit, 146 patients were followed for over 2 years and were last examined when over 5 years of age; of the 12 independent variables analyzed, postoperative deviation at 6 weeks, refractive error of the right eye, and age of onset were predictive. With respect to stereopsis, 126 patients had similar follow-up; of the 11 independent variables analyzed, only postoperative deviation at 6 weeks was prognostic. The results indicate that in patients with acquired esotropia the postoperative deviation is the most important prognostic factor for both the maintenance of ocular alignment and the status of stereopsis; refractive error and the age of onset of the esotropia influence the ocular alignment at the last visit.

Diabetes mellitus and intraocular lens implantation

Prospective evaluation of extracapsular cataract extraction with posterior chamber intraocular lens (ECCE-posterior chamber IOL) in 234 eyes of 20 diabetics, with and without nonproliferative retinopathy, and 209 nondiabetics demonstrated no statistically significant difference in operative or postoperative complications. A postoperative final visual acuity of 20/40 or better was achieved in 65% of diabetic surgical eyes and in 90% of nondiabetic surgical eyes, a difference that was statistically significant (P = 0.0049). When eyes with diabetic retinopathy or other pre-existing ophthalmic disease responsible for decreased vision were excluded, postoperative visual acuity of 20/40 or better was obtained in 93% of diabetic eyes and 96% of nondiabetic eyes, a difference that was not statistically significant (P = 0.5045). Therefore, the relatively less favorable outcome of ECCE-posterior chamber IOL surgery in diabetics, with or without nonproliferative retinopathy, is due to greater frequency of retinopathy or other ophthalmic disease responsible for decreased vision. Based on this study and all available information, guidelines regarding diabetes mellitus and intraocular lens implantation are presented.

A new type of penicillin resistance of Staphylococcus aureus

Penicillin--"tolerant" Staphylococcus aureus strains are resistant to the lethal action of penicillins, but are inhibited by normal (low) concentrations. They are deficient in autolytic enzyme activity which appears to be necessary for bacteriolysis and the lethal action of penicillins. This "deficiency" is caused by a large excess of an inhibitor of autolysin. Seven such tolerant strains have been isolated from blood, bone, or sputum of patients who responded poorly to penicillin treatment of endocarditis, osteomyelitis, or staphylococcal pneumonia. These isolates were of different phage-types, and most showed cross-tolerance to the killing action of cephalosporins or vancomycin, antibiotics to which they were sensitive (inhibited). They were killed at normal rates by gentamicin, cycloserine, and rifampicin. Population analysis indicated that the proportion of tolerant organisms within a resistant strain is 7% or less; their ability to inhibit autolytic activity within their own and neighbouring cells appears to account for the net decreased autolytic activity of the entire strain; 44% of the bacteraemic strains studied showed penicillin tolerance. Tolerance is thus a common, clinically important form of penicillin resistance, that differs from previously described forms of pencillin resistance, that due to beta-lactamase, and that due to "intrinsic" (e.g., methicillin resistance) mechanisms.