Rapidly Dissolving Polymeric Microneedle Skin Patch of Naloxone for Opioid Overdose Treatment Tijani Akeemat1, Maria J. Peláez2, Prashant Dogra2,3, Ashana Puri1 1 Department of Pharmaceutical Sciences, Bill Gatton College of Pharmacy, East Tennessee State University, Johnson City, TN 37614. 2 Mathematics in Medicine Program, Houston Methodist Research Institute, Houston, TX 77030, USA 3 Department of Physiology and Biophysics, Weill Cornell Medical College, New York, NY 10065, USA Worldwide opioid abuse affects over 16 million people. A major cause of death in abusers is overdosing. Naloxone (NAL) is an opioid inhibitor that reverses its respiratory depressing effect. The use of this drug is limited mostly to invasive delivery: intravenous (IV), intramuscular (IM) and subcutaneous (SC) due to its significant hepatic clearance and poor oral bioavailability (2%). These routes are painful and worse still is the need for frequent injections for patient stabilization due to the short half-life of NAL. Non-invasive intranasal forms exist but this is fraught with a couple of limitations such as nasal damage and epistaxis. The need for alternatives without these limitations is thus evident. The feasibility of the use of metal microneedles (MNs) for the transdermal delivery of NAL was demonstrated in-vitro and through in-vitro in-vivo correlation modeling in our lab. The goal of the current study was to design a rapidly dissolving polymeric MN patch with delivery and pharmacokinetic (PK) properties comparable to that seen with the commercially available NAL products, eliminating their highlighted limitations. NAL loaded rapidly dissolving polyvinyl pyrrolidone-based MN arrays (500 µm, 100 needles) were fabricated by the mold casting technique. The permeation profile of fabricated MNs over a predetermined time were assessed via an in-vitro permeation set up using porcine ear skin. Samples were analyzed via HPLC. To improve on drug flux and amount permeated, the effect of increasing MN length and density (no. of needles/unit area) were assessed by fabricating MNs 300 µm longer and those with density double that of the initial array. Factors such as drug load and polymer strength influenced the needle fabrication. Compared to passive permeation, a reduced lag time of about 15 min was observed with a significant drug flux of 15.09 ± 7.68 g/cm2/h seen in the first 1 h (pin-vitro in-vivocorrelation we were able to predict an optimized design of the patch that can reproduce the clinical PK of NAL obtained with commercial devices. Increasing needle density and/or patch area was found to be of greater significance. Overall, drug flux seen over 1 h depicts the applicability of fabricated needles in opioid overdose emergencies with delivery properties comparable to that with IM and IN delivery.

Exposure to Poaceae airborne pollen (PAP) has been shown to induce allergic reactions in individuals sensitive to PAP. Patient care for individuals sensitive to PAP can be aided by knowledge of PAP profiles. Air samples were collected using a Rotorod M40 rotation impact sampler from February 2005 to September 2017. Air samples were collected daily, excluding weekends and winter months, and are expressed in grains per cubic meter (g/m3). Light microscopy at 400x magnification was used to analyze samples. Pollen was classified according to the classifications provided by the American Academy of Allergy Asthma and Immunology and the National Allergy Bureau. Detection of PAP onset averaged on day 84 (March 25th); end day averaged on day 285 (October 12th); average duration was 202 days; average peak level onset was on day 146 (May 26th) and the average peak level was 135 g/m3. Average number of days during Poaceae season with 1 to 19 g/m^3 detected was 95; with 20 to 39 g/m^3 was 7; with 40 to 59 g/m^3 was 4; and with 60 g/m^3 or more was 2. Day of onset of PAP trended to be 1.6 days earlier in the year over the course of our data collection, with R2= 0.3476. Poaceae airborne pollen in Johnson City, Tennessee was noticeable for almost 7 months out of the year. We can assume the riskiest months of the year are from March to October with the highest risk period being the end of May.

Objective: Multiple sclerosis (MS) is one of the most common neurological diseases affecting adults of working age, and those of younger ages of onset have been increasingly recognized. Twenty-seven percent of people with MS (PwMS) are age 30 years old or younger. The burden of MS for young adults puts them at risk for poorer outcomes regarding their education, family planning, vocation, and social skills as they transition to adulthood. Fine motor (FM) skill impairment might impede performance within the daily occupations of young adults who are transitioning into adulthood. Few studies focus on the occupations and occupational performance of younger adults with MS. Method: Forty participants with MS between the ages of 18 to 30 were recruited to participate in a study. Two standardized measures were used to identify possible FM dexterity deficits and one standardized self-report was used to measure the perceived satisfaction and performance of occupations for this population. A semi-structured interview was conducted with a subgroup of 18 participants to understand the lived experiences of young adults with MS (YAwMS) and their FM performance during their occupations. Results: With quantitative and qualitative analysis, a relationship was suggested between FM scores and both perceived performance and satisfaction scores of an adapted performance measure. Conclusion: Young adults with MS perceive difficulties with occupations that are influenced by their FM status. It is recommended that occupational therapy professionals consider the motor skill needed to perform and complete occupations that specifically require FM skills.

The increased emergence of childhood chronic illnesses in the United States of America has created a need for educational support in this unique student population. Research trends have showcased how the child's emotional health and vacancies in legislation are some of the affecting factors when discussing the level of academic aid these children receive from the state. Some other factors that come into play when ensuring children with chronic illnesses are not excluded from receiving quality education are their learning environment, school reintegration process, and evaluating pre-existing hospital-school programs which are all themes covered in this narrative. Teacher preparation programs are the best way to tackle this issue early on. By providing aspiring educators training on how to help these students, they will ensure a successful school reintegration for the child once they return to the traditional schooling setting. Hence, why this research focuses on the PedsAcademy, a pioneer Florida hospital-school program, and the aspiring educators' perceptions of their academic and socio-emotional impact on the students. The research questions are synthesized into three main topics: social-emotional impact, influence on aspiring educators, and state regulations. Each of these themes encompass further descriptive terms based on the survey and interview results, which include: meaningful academic and socio-emotional student progress, flexible teaching, unique opportunity, life-changing experience, and knowledge of state regulations. Through the data collection of survey and interview responses, this thesis records the research findings and establishes concrete recommendations that contribute to the preexisting materials on the educational support available for children with chronic illnesses.

The purpose of the present cross-sectional study was to examine the effects of ambiguity of loss and type of caregiver-to-patient relationship on anticipatory grief, negative physical and psychological outcomes associated with grief, and boundary ambiguity in family caregivers of chronically ill patients. Questionnaires were completed by 23 parents of ill children and 30 spouses of ill mates. Using an original and a revised concept for level of ambiguity, partial support was found for the prediction that parents and spouses in high ambiguity of loss circumstances would report more anticipatory grief than those in low ambiguity ones. Contrary to prediction, a slight but nonsignificant trend occurred for parents and spouses in low ambiguity situations to report more negative physical and psychological effects associated with grief as well. Level of ambiguity was not found to impact boundary ambiguity as had been hypothesized. Spouses reported more boundary ambiguity than parents, regardless of level of ambiguity of the loss. Contrary to prediction that parents would report less anticipatory grief and more negative physical and psychological outcomes than spouses, generally, no significant differences were found between the two groups. However, using the original concept of ambiguity, parents did tend to recall more past grief than spouses. The study highlighted several methodological concerns which impact research on loss and grief, particularly the difficulty involved in recruiting participants with subsequent occurrence of sampling bias, rudimentary status of available measurement tools, and a host of potentially confounding personal and sociodemographic variables. The present study supports a view of the loss which occurs in families dealing with chronic illness as a complex process whose impact on grief, distress, and family upheaval is influenced by multiple factors. Such factors include both the ambiguity of the loss and the type of family relationship involved. Complex research of a longitudinal nature using psychosocial models of illness is needed to better delineate the impact of factors such as these.

The problem with which this study is concerned is that of ascertaining the effects of intensive Remotivation Techniques on institutionalized geriatric mental patients in terms of their ward behavior, self-concept, and visual-motor perceptions and to compare these with the effects of a similar group experience that does not emphasize patient-staff or patient-patient interactions, and a third group which acts a a control. The investigation is designed to answer or obtain information concerning the following questions: (1) Do institutionalized geriatric mental patients in a state mental hospital manifest measurable changes in terms of their (A) ward behavior as defined as raw scores on the Hospital tment Scale (including interpersonal communication and interpersonal relations; self care and social responsibility; level of participation in ward activities, recreation and work therapy; total score), (B) self-concept as defined as Goodenough raw scores on the Draw-a-Person Test, and (C) awareness of environment as defined as Pascal and Suttell raw scores on the Bender Visual-Motor Gestalt Test, as a result of experiencing the social and verbal interactions of intensive Remotivation Techniques? (2) Is the Remotivation Technique more effective in producing these changes than a similar group experience that does not emphasize social and verbal interactions?

M Family Medicine research report - Faculty of Health Sciences / Residents of old age homes are at increased risk for the complications of influenza. Studies in developed countries have consistently shown that influenza vaccination of old age home residents and staff can significantly decrease morbidity and mortality rates and that influenza vaccination is one of the most cost effective interventions possible in this population. No studies have been done on the cost benefit of using influenza vaccine in old age home residents in South Africa. The aim of this study was to evaluate the costs of treating influenza and influenza-like illnesses in old age home residents, and to compare the costs in people who had received the influenza vaccine to those who had not. The study population comprised 151 people residing in two old age homes in Johannesburg, namely Sandringham Gardens and Nazareth House. The study population was divided into two groups- those who received influenza vaccine and those who had not been vaccinated. The residents of Nazareth House who gave consent had all been vaccinated. The subjects at Sandringham Gardens were sub- divided into two groups, namely: “Residents” and “Frail care / wards” section. The general health of the “Frail care” people was poorer than that of the “residents”. Medical records were reviewed, and details of the number of doctor consultations, medication and physiotherapy prescribed, special investigations performed and hospital referrals related to influenza and influenza-like infections were recorded. The costs were then calculated using “medical aid rates”. There were no significant differences in the treatment costs, comparing those who had been vaccinated to those who had not been vaccinated. There are a number of possible explanations for this. These include, most importantly, a low to moderate epidemic activity of influenza in the season that the study was conducted. Other explanations are low patient numbers, the use of symptoms for diagnosis and the use of over the counter therapy. Despite the findings in the present study, the international literature supports the view that influenza vaccination is a cost-effective intervention in the older adult population, particularly those at higher risk. These findings have been implemented in the official guidelines of many countries, including the South African Adult Influenza Vaccination Guideline.

SILVA, Juliana Lemos. Organização do trabalho e saúde dos trabalhadores: estudo com bancários do município de Uberaba-MG, 2009, 170 p. Dissertação de Mestrado apresentada ao Programa de Pós-graduação em Ciências Médicas da Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo/FMRP/USP, Departamento de Medicina Social. O setor bancário brasileiro passou por intenso processo de transformação nas últimas décadas e ocupou posição de liderança na incorporação de novas tecnologias e inovações organizacionais. A reestruturação produtiva observada no setor objetivou ajustá-lo às novas formas de acumulação capitalista: a intensa informatização do trabalho bancário e outras mudanças estruturais do setor afetaram não apenas a natureza dos produtos, mas também o próprio comportamento dos mercados, o que resultou em mudanças significativas nas condições de trabalho e, consequentemente, na saúde dos trabalhadores. Este estudo teve por objetivo investigar as condições de trabalho dos bancários de uma instituição privada em Uberaba, MG, Brasil, na tentativa de identificar em que medida as mudanças na organização do trabalho interferiram em sua saúde. A coleta de dados se deu através de entrevistas gravadas com onze bancários pertencentes a diferentes níveis hierárquicos, de ambos os sexos, e os critérios de inclusão adotados foram: a. que o entrevistado tivesse vínculo empregatício com a instituição quando da realização da pesquisa e, b. que metade dos entrevistados tivesse, no mínimo, dez anos de carreira na instituição. Os contatos com os trabalhadores foram mediados pelo sindicato da categoria. A reconstituição do processo de trabalho, na perspectiva dos bancários, denuncia que além de adoecimentos de ordem física, como as doenças ocupacionais diretamente relacionadas à intensificação do ritmo de trabalho, ocorreram também o aumento da incidência do sofrimento mental e a perda da identidade e da valorização profissional, em decorrência das novas exigências da profissão. A maioria dos entrevistados, independente de seu tempo de contratação, afirmou que o trabalho bancário perdeu seu status. Predominaram nos depoimentos sentimentos de frustração e insegurança em relação à carreira. Os dados revelaram também preocupação com a pressão psicológica sofrida, principalmente no que se refere ao cumprimento de metas. Expressões como desgaste mental, estresse, depressão, pressão psicológica, medo, incerteza e insegurança estiveram presentes na maioria dos depoimentos. / SILVA, Juliana Lemos. Organization of the work and the workers\' health: study with bank employees of the municipal district of Uberaba-MG, 2009, 170 p. Dissertação de Mestrado apresentada ao Programa de Pós-graduação em Ciências Médicas da Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo/FMRP/USP, Departamento de Medicina Social. The Brazilian banking sector passed for intense process of transformation in the last few decades and occupied position of leadership in the incorporation of new technologies and organizations innovations. The observed productive reorganization in the sector objectified to adjust it the new forms to it of capitalist accumulation: the intense computerization of the banking work and other structural changes of the sector had not only affected the nature of the products but also the proper behavior of the markets, what it resulted in significant changes in the work conditions and, consequently, in the health of the workers. This study it had for objective to investigate the conditions of work of the bank clerks of a private institution in Uberaba, MG, Brazil, in the attempt to identify where measured the changes in the organization of the work they had intervened with its health. The collection of data if gave through recorded interviews with ten pertaining bank clerks the different hierarchic levels, of both the sexes, and the adopted criteria of inclusion had been: a. that the interviewed one had employment bond with the institution when of the accomplishment of the research and, b. that half of the interviewed ones had, in the minimum, ten years of career in the institution. The contacts with the workers had been mediated by the union of the category. The reconstitution of the work process, in the perspective of the bank clerks, denounces that beyond illnesses of physical order, as the occupational illnesses directly related to the intensification of the work rhythm, had also occurred the increase of the incidence of the mental suffering and the loss of the identity and the professional valuation, in result of the new requirements of the profession. The majority of the interviewed ones, independent of its time of act of contract, affirmed that the banking work lost its status. Feelings of frustration and unreliability in relation to the career had predominated in the depositions. The data had also disclosed concern with the suffered psychological pressure, mainly as for the fulfillment of goals. Expressions as mental consuming, stress, depression, psychological pressure, fear, uncertainty and unreliability had been gifts in the majority of the depositions.

O objetivo geral desta pesquisa foi identificar e analisar as percepções dos Secretários Municipais de Saúde da 5ª Regional de Saúde do Estado do Paraná acerca da realização de atividades físicas no Programa Saúde da Família (PSF). Como objetivos específicos elegemos caracterizar e analisar a prática da atividade física nos PSFs dos referidos municípios, bem como, verificar a inserção de profissionais de educação física nessas equipes do PSF. Tomamos como pressuposto teórico as discussões sobre promoção da saúde presentes nas Conferências Internacionais de Promoção da Saúde, buscando articulá-las à teoria e a prática da atividade física. Trata-se de um estudo descritivo exploratório (TRIVIÑOS, 1992), com abordagem qualitativa, sendo os sujeitos constituídos de onze secretários de saúde dos municípios da regional citada, e também nove profissionais da área da saúde que são responsáveis pelas atividades físicas realizadas no PSF destes municípios. Os dados empíricos foram coletados através de entrevistas semi-estruturadas realizadas com os secretários de saúde, e também dos questionários aplicados com os profissionais de saúde responsáveis pela realização das atividades físicas. A organização dos dados foi feita conforme ferramenta metodológica do Discurso do Sujeito Coletivo - DSC (LEFÈVRE, 2000). Após construirmos os DSCs, elegemos três unidades temáticas, a partir dos conteúdos: Processo de Educação em Saúde, Atividades Físicas no PSF, Prevenção e Promoção da Saúde. Como considerações finais, ressaltamos: o processo de educação em saúde demonstra ter um caráter mais modelador que emancipatório. O entendimento de promoção da saúde está mais ligado à uma visão limitada do processo saúde-doença, pautado no conceito de saúde como ausência de doenças, com alguns apontamentos para uma visão mais ampliada, abarcando aspectos sociais e psicológicos. Verificamos de forma incipiente a realização de atividades físicas em nove equipes de PSF nos municípios participantes da pesquisa, principalmente a caminhada, sob a iniciativa e responsabilidade de profissionais da saúde (quatro enfermeiras, três fisioterapeutas e dois profissionais de Educação Física). Sobre a prática da atividade física no PSF, os gestores a identificam como uma estratégia na prevenção de doenças crônicas, em especial, obesidade, diabetes e hipertensão. Na perspectiva de se aproximar à um conceito mais ampliado de promoção da saúde, os gestores ressaltaram que a atividade física inserida na estratégia do PSF pode trazer outros benefícios além dos biológicos, tais como: desenvolvimento da autonomia para realização dos afazeres do dia-a-dia, melhoria do convívio social, interferência em situações de risco social, educação em saúde e como opção de lazer, no entanto, ainda de forma incipiente. Para tanto, sugerimos que é preciso se (re) pensar a formação dos profissionais da saúde, em especial, a do profissional de Educação Física, buscando uma visão de promoção da saúde, que abarque todas as suas possibilidades, potencialidades, bem como, sua complexidade. Também é preciso vislumbrar outras estratégias que ampliem as possibilidades da atividade física ser incorporada de forma mais sistematizada e ampliada, na atenção à saúde, valorizando o conhecimento da área de Educação Física na construção do SUS. / The general objective of this research was to identify and to analyze the perceptions of the Municipal Secretaries of Health of 5th Regional of Health in Paraná concerning the accomplishment of physical activities in the Health Family Program (PSF). As objective specific we choose to characterize and to analyze the practical one of the physical activity in the PSFs of the related cities, as well as, to verify the insertion of professionals of physical education in these teams of the PSF. We take as estimated theoretician the quarrels on promotion of the health gifts in the International Conferences of Promotion of the Health, searching to articulate them with the theory and the practical of the physical activity. It’s about an exploratory descriptive study (TRIVIÑOS, 1992), with qualitative boarding, being the consisting citizens of eleven secretaries of health of the cities in the regional one cited, and also nine professionals of the area of the health who are responsible for the carried through physical activities in the PSF of these cities. The empirical data had been collected through interviews half-structuralized carried through with the secretaries of health, and also of the questionnaires applied with the responsible professionals of health for the accomplishment of the physical activities. The organization of the data was made in a methodological agreement tool of the Speech of Collective Citizen - DSC (LEFÈVRE, 2000). After to construct the DSCs we choose three thematic units from the contents: Process of Education in Health, Physical Activities in the PSF, Prevention and Promotion of the Health. As final considerations, we stand out: the process of education in health demonstrates to have a character more modeler than emancipation. The agreement of promotion of the health is on to the one limited vision of the process health-illness based in the health concept as absence of illnesses, with some notes for an extended vision more, accumulating of stocks social and psychological aspects. We verify of incipient form the accomplishment of physical activities in nine teams of PSF in the participant cities of the research, mainly the walked one, under the initiative and responsibility of professionals of the health (four nurses, three physiotherapists and two professionals of Physical Education). On the practical one of the physical activity in the PSF, the managers identify it as a strategy in the prevention of chronic illnesses, in special, obesity, diabetes and high blood pressure. In the perspective of if more approaching to the one extended concept of promotion of the health, the managers had stood out that the inserted physical activity in the strategy of the PSF can bring other benefits beyond the biological ones, such as: development of the autonomy for accomplishment of the tasks of day-by-day, improvement of the social conviviality, interference in situations of social risk, education in health and as leisure option, however, still of incipient form. For in such a way, we suggest that she is necessary if (re) to think the formation of the professionals of the health, in special, of the professional of Physical Education, searching a vision of promotion of the health, that accumulates of stocks all its possibilities, potentialities, as well as, its complexity. Also it’s necessary to glimpse other strategies that more extend the possibilities of the physical activity to be incorporated of systemize and extended form, in the attention to the health, valuing the knowledge of the area of Physical Education in the construction of the SUS.

SILVA, Juliana Lemos. Organização do trabalho e saúde dos trabalhadores: estudo com bancários do município de Uberaba-MG, 2009, 170 p. Dissertação de Mestrado apresentada ao Programa de Pós-graduação em Ciências Médicas da Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo/FMRP/USP, Departamento de Medicina Social. O setor bancário brasileiro passou por intenso processo de transformação nas últimas décadas e ocupou posição de liderança na incorporação de novas tecnologias e inovações organizacionais. A reestruturação produtiva observada no setor objetivou ajustá-lo às novas formas de acumulação capitalista: a intensa informatização do trabalho bancário e outras mudanças estruturais do setor afetaram não apenas a natureza dos produtos, mas também o próprio comportamento dos mercados, o que resultou em mudanças significativas nas condições de trabalho e, consequentemente, na saúde dos trabalhadores. Este estudo teve por objetivo investigar as condições de trabalho dos bancários de uma instituição privada em Uberaba, MG, Brasil, na tentativa de identificar em que medida as mudanças na organização do trabalho interferiram em sua saúde. A coleta de dados se deu através de entrevistas gravadas com onze bancários pertencentes a diferentes níveis hierárquicos, de ambos os sexos, e os critérios de inclusão adotados foram: a. que o entrevistado tivesse vínculo empregatício com a instituição quando da realização da pesquisa e, b. que metade dos entrevistados tivesse, no mínimo, dez anos de carreira na instituição. Os contatos com os trabalhadores foram mediados pelo sindicato da categoria. A reconstituição do processo de trabalho, na perspectiva dos bancários, denuncia que além de adoecimentos de ordem física, como as doenças ocupacionais diretamente relacionadas à intensificação do ritmo de trabalho, ocorreram também o aumento da incidência do sofrimento mental e a perda da identidade e da valorização profissional, em decorrência das novas exigências da profissão. A maioria dos entrevistados, independente de seu tempo de contratação, afirmou que o trabalho bancário perdeu seu status. Predominaram nos depoimentos sentimentos de frustração e insegurança em relação à carreira. Os dados revelaram também preocupação com a pressão psicológica sofrida, principalmente no que se refere ao cumprimento de metas. Expressões como desgaste mental, estresse, depressão, pressão psicológica, medo, incerteza e insegurança estiveram presentes na maioria dos depoimentos. / SILVA, Juliana Lemos. Organization of the work and the workers\' health: study with bank employees of the municipal district of Uberaba-MG, 2009, 170 p. Dissertação de Mestrado apresentada ao Programa de Pós-graduação em Ciências Médicas da Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo/FMRP/USP, Departamento de Medicina Social. The Brazilian banking sector passed for intense process of transformation in the last few decades and occupied position of leadership in the incorporation of new technologies and organizations innovations. The observed productive reorganization in the sector objectified to adjust it the new forms to it of capitalist accumulation: the intense computerization of the banking work and other structural changes of the sector had not only affected the nature of the products but also the proper behavior of the markets, what it resulted in significant changes in the work conditions and, consequently, in the health of the workers. This study it had for objective to investigate the conditions of work of the bank clerks of a private institution in Uberaba, MG, Brazil, in the attempt to identify where measured the changes in the organization of the work they had intervened with its health. The collection of data if gave through recorded interviews with ten pertaining bank clerks the different hierarchic levels, of both the sexes, and the adopted criteria of inclusion had been: a. that the interviewed one had employment bond with the institution when of the accomplishment of the research and, b. that half of the interviewed ones had, in the minimum, ten years of career in the institution. The contacts with the workers had been mediated by the union of the category. The reconstitution of the work process, in the perspective of the bank clerks, denounces that beyond illnesses of physical order, as the occupational illnesses directly related to the intensification of the work rhythm, had also occurred the increase of the incidence of the mental suffering and the loss of the identity and the professional valuation, in result of the new requirements of the profession. The majority of the interviewed ones, independent of its time of act of contract, affirmed that the banking work lost its status. Feelings of frustration and unreliability in relation to the career had predominated in the depositions. The data had also disclosed concern with the suffered psychological pressure, mainly as for the fulfillment of goals. Expressions as mental consuming, stress, depression, psychological pressure, fear, uncertainty and unreliability had been gifts in the majority of the depositions.