West Texas VA Health Care System

The quantity of soil material transported by wind will decrease with height above the surface. Airborne samples were obtained at five levels above four soils. Mass distribution with height differs for materials in saltation or in suspension. A technique was developed to mathematically describe the two modes of transport so the total quantity being transported could be determined by integrating the two equations. Transition height, where the transport mode changes from saltation to suspension, is termed TSS. TSS decreases as surface soil texture changes from a fine sandy loam to a loam, indicating a higher percentage of the eroded material is moving at a greater distance above the soil surface. TSS increases as roughness of the soil surface increases, indicating a decrease in the suspension component and that the majority of eroded material is moving close to the soil surface.

Pharmacists are often the primary source of emergency contraception (EC) access and patient information. This study aims to identify differences in pharmacist-reported EC access and counseling between states which do or do not permit pharmacist-prescribed EC. This prospective, mystery caller study was completed in California (CA), which permits pharmacist-prescribed EC after completion of continuing education, and Georgia (GA), which does not. All community pharmacies that were open to the public in San Diego and San Francisco, CA, and Atlanta, GA were called by researchers who posed as adult females inquiring about EC via a structured script. Primary endpoints were EC availability and counseling. Statistical analyses completed with SPSS. Researchers called 395 pharmacies, 98.2% were reached and included. Regarding levonorgestrel (LNG), CA pharmacists more frequently discussed (CA 90.4% vs. GA 81.2%, p = 0.02), stocked (CA 89.5% vs. GA 67.8%, p < 0.01), and correctly indicated it “will work” or “will work but may be less effective” 4 days after intercourse (CA 67.5% vs. GA 17.5%, p < 0.01). Ulipristal was infrequently discussed (CA 22.6% vs. GA 3.4%, p < 0.01) and rarely stocked (CA 9.6% vs. GA 0.7%, p < 0.01). Pharmacists practicing in states which permit pharmacist-prescribed EC with completion of required continuing education may be associated with improved patient access to oral EC and more accurate patient counseling.

ABSTRACT: A case of the uncommon association of scleredema and diabetes mellitus is presented. Such patients usually are obese, and the scleredema quite extensive and longlasting. The difference between this entity and scleredema adultorum is discussed. Attempts at treatment during a two‐week period were unsuccessful.

Back to table of contents Previous article Next article Letters to the EditorFull AccessCOVID-19, Medication-Assisted Treatment, and Increased Risk for Further Respiratory DepressionJenny Boyer, M.D., Ph.D.Jenny BoyerSearch for more papers by this author, M.D., Ph.D.Published Online:1 Jul 2020https://doi.org/10.1176/appi.ajp.2020.20030348AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail To the Editor: The COVID-19 infection is characterized by respiratory distress, which has sparked Herculean efforts to increase the supply of ventilators in the United States. Even as the medical establishment races to cope with this pandemic, clinical authorities continue to emphasize the need for opioid agonist treatment, more commonly known as medication-assisted treatment, which includes methadone and buprenorphine. In fact, longstanding rules are now being relaxed to allow people receiving medication-assisted treatment to receive a full 28-day supply of their medication to decrease the spread of the novel coronavirus at treatment centers. Medication-assisted treatment has been demonstrated to significantly decrease mortality associated with substance use. In their recent epidemiological study, Pearce et al. demonstrated that the relative risk of mortality off of medication-assisted treatment was 2.1 (1).In considering the overall health of Americans, including those with known respiratory compromise secondary to long-term tobacco use, asthma, and bronchitis, as well as chronic obstructive pulmonary disease in the elderly and the possibility of respiratory compromise related to vaping among the young, it is important to remember that many of these same patients are also taking prescribed opiates and/or may be misusing opiates. Further, it is essential that those prescribing medication-assisted treatment are acutely aware that these opiate agonists and agonist/antagonists are also capable of causing significant respiratory distress (2). Finally, it is important to remember that benzodiazepines (especially when combined with opiates) are associated with respiratory depression in patients with other respiratory challenges (3).Patients prescribed opiates and benzodiazepines should be advised of these risks and collaborate with their care team to establish the lowest effective dosage of their medications during this pandemic. If nothing else, it is always prudent to periodically review dosages of controlled substances to ensure safety and satisfaction. In cases in which the patient becomes symptomatic and/or has tested positive for COVID-19, clinicians are advised to discuss at least temporarily decreasing the dosage and quantity of prescribed opiates or medication-assisted treatment. In addition, clinicians need to be aware of the availability and value of naltrexone inhalers, which, if prescribed, could prove lifesaving in a patient with respiratory compromise that has been exacerbated by an opiate or opioid agonist treatment.West Texas Health Care System, Big Spring.Send correspondence to Dr. Boyer ([email protected]).The contents of the letter reflect the opinion of the author and do not in any way represent the views or policies of the U.S. Department of Veterans Affairs or the U.S. government.The author reports no financial relationships with commercial interests.References1 Pearce LA, Min JE, Piske M, et al.: Opioid agonist treatment and risk of mortality during opioid overdose public health emergency: population based retrospective cohort study. BMJ 2020; 368:m772Crossref, Medline, Google Scholar2 Substance Abuse and Mental Health Services Administration: Promoting Safety from Opioid Overdose. June 20, 2018. https://blog.samhsa.gov/2018/06/20/promoting-safety-from-opioid-overdoseGoogle Scholar3 American Society of Addiction Medicine: The ASAM National Practice Guideline for the Treatment of Opioid Use Disorder: 2020 Focused Update. https://www.asam.org/docs/default-source/quality-science/npg-jam-supplement.pdf?sfvrsn=a00a52c2_2Google Scholar FiguresReferencesCited byDetailsCited byCOVID-19, Substance Use, Anorexia Nervosa, 22q11.2 Deletion Syndrome, and StressNed H. Kalin, M.D.1 July 2020 | American Journal of Psychiatry, Vol. 177, No. 7 Volume 177Issue 7 July 01, 2020Pages 636-636 Metrics KeywordsOpioidsOpioid Use DisorderRespiratory CompromiseMedication-Assisted TreatmentPandemicCOVID-19CoronavirusPDF download History Accepted 29 April 2020 Published online 1 July 2020 Published in print 1 July 2020

Letters20 June 2017Brain-Type Natriuretic Peptide and Amino-Terminal Pro–Brain-Type Natriuretic Peptide Discharge Thresholds for Acute Decompensated Heart FailureNeil J. Nusbaum, JD, MDNeil J. Nusbaum, JD, MDFrom West Texas VA Health Care System, Big Spring, Texas.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/L17-0193 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:McQuade and colleagues (1) suggest that achieving predischarge natriuretic peptide (NP) thresholds is associated with reduced heart failure mortality and readmissions. Although this proposed association has biological plausibility, it should be evaluated with caution. One suspects that clinicians would hesitate to discharge patients who seem clinically unstable even if their NP level had decreased. As a result, patients would tend to remain hospitalized longer if their discharge was contingent on achieving both the clinical appearance of stability and a decreasing NP level rather than solely the former. A longer hospital stay in turn would mean that an ...Reference1. McQuade CN, Mizus M, Wald JW, Goldberg L, Jessup M, Umscheid CA. Brain-type natriuretic peptide and amino-terminal pro–brain-type natriuretic peptide discharge thresholds for acute decompensated heart failure: a systematic review. Ann Intern Med. 2017;166:180-90. [PMID: 27894126]. doi:10.7326/M16-1468 LinkGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From West Texas VA Health Care System, Big Spring, Texas.Disclaimer: The views expressed here are those of the author and are not necessarily those of the Department of Veterans Affairs.Disclosures: Authors have disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=L17-0193. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoBrain-Type Natriuretic Peptide and Amino-Terminal Pro–Brain-Type Natriuretic Peptide Discharge Thresholds for Acute Decompensated Heart Failure Casey N. McQuade , Marisa Mizus , Joyce W. Wald , Lee Goldberg , Mariell Jessup , and Craig A. Umscheid Brain-Type Natriuretic Peptide and Amino-Terminal Pro–Brain-Type Natriuretic Peptide Discharge Thresholds for Acute Decompensated Heart Failure Casey N. McQuade and Craig A. Umscheid Metrics 20 June 2017Volume 166, Issue 12Page: 915KeywordsConflicts of interestDisclosureHeart failureHospitalizationsLength of stayMortalityNatriuretic peptidesOutpatient clinicsOutpatients ePublished: 20 June 2017 Issue Published: 20 June 2017 Copyright & PermissionsCopyright © 2017 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...

Tick and tick-borne disease (TBD) research is an important aspect of public health, yet, little is known about their distribution in North Central West Virginia. Since 2018, our team has collected 2,866 tick samples, with the goal of analyzing species diversity and TBD pathogen prevalence. Using real-time PCR, we have tested DNA from these samples for the presence of Borrelia burgdorferi, the causative agent of Lyme borreliosis, and Anaplasma phagocytophilum, the causative agent of Anaplasmosis. In these past eight years, we have analyzed the DNA from 726 Ixodes scapularis and 126 Dermacentor variabilis ticks. Of the I. scapularis samples, 698 have been tested for B. burgdorferi with 14 (~2%) having shown a positive result. As expected, no D. variabilis samples indicated a positive result for B. burgdorferi, essentially acting as a negative control. In the case of A. phagocytophilum, 160 of the 538 I. scapularis samples tested were shown to obtain the pathogen (~30%) as well as 12 of the 30 tested D. variabilis samples (40%). Interestingly, the detection rate of B. burgdorferi has remained low, despite the significant burden that Lyme borreliosis has had on West Virginia in this time, while the detection of A. phagocytophilum has shown drastically larger rates despite Anaplasmosis’s low case numbers. In West Virginia, Lyme borreliosis receives by far the most attention in regards to tick-borne infections, however, our work indicates that Anaplasmosis may be an additional concern.

This article studies hand gestures and specifies four different possible uses: (1) one-handed gestures; (2) symmetrical two-handed gestures; (3) symmetrical two-handed gestures in which the hands alternately perform the same movement; (4) asymmetrical two-handed gestures. The paper shows how a speaker employs various hand gestures to explain her teaching experiences and views the concurrence of gestures with speech, body posture, shrugs, gaze, and facial expressions as reciprocal actions to an interlocutor's responses. The final section of the paper discusses the flexibility of hand gestures and the different ways in which it is revealed.