Opioid misuse and overdose deaths remain a public health concern in the United States. Pennsylvania has one of the highest rates of opioid overdose deaths in the country, with Philadelphia County's being 3 times higher than the national average. Despite several multimodal interventions, including use of SBIRT (screening, brief intervention, and referral to treatment) methods and naloxone distribution, the rate of overdose deaths remains high. To gain insights on strategies for improving access to naloxone and naloxone distribution by pharmacists in Philadelphia County, a study was conducted in 11 community pharmacies (chain and independent) in Philadelphia. Twenty-four pharmacists were recruited and completed SBIRT and naloxone trainings. Each pharmacy elected to have at least 1 pharmacy champion who received additional training on and helped develop pharmacy site-specific naloxone dispensing protocols. Pre-post survey results showed a reduction in stigmatizing attitudes regarding naloxone dispensing aning practices, leading to an overall increase in naloxone dispensing by community pharmacists. The study addressed overall gaps in pharmacists' knowledge, reduced stigma, and prepared pharmacists to address opioid use and overdose prevention with their patients. The described pharmacist-led patient counseling and intervention service for overdose prevention may be explored as a model for other community pharmacies to adopt to improve naloxone dispensing and similar interventions to reduce overdose deaths.Distinguishing disseminated Mycobacterium marinum from multifocal cutaneous disease in HIV/AIDS patients can present a diagnostic challenge, especially in the context of immune reconstitution inflammatory syndrome (IRIS). In this work, we demonstrate the utility of flow cytometry and whole genome sequencing (WGS) to diagnose disseminated M. marinum unmasked by IRIS following initiation of antiretroviral therapy. Flow cytometry demonstrated robust cytokine production by CD4 T-cells in response to stimulation with M. marinum lysate. WGS of isolates from distinct lesions was consistent with clonal dissemination, supporting that preexisting disseminated M. marinum disease was uncovered by inflammatory manifestations, consistent with unmasking mycobacterial IRIS.Outbreaks of the gypsy moth (Lymantria dispar japonica Motschulsky) cause serious defoliation in birch. A single year of defoliation has no significant impact on the trees, whereas continuous defoliation events could be fatal. How birch species avoid serious damage caused by gypsy moth outbreak is yet to be revealed. Trichomes on leaf surfaces of birch trees are an effective antiherbivore defense strategy. We examined a 1-yr delayed induction of glandular (GT) and nonglandular trichomes (NGT) on leaf surfaces caused by stress in white birch (Betula platyphylla Sukaczev var. japonica [Miq.] Hara) and monarch birch (Betula maximowicziana Regel). Saplings were subjected to four treatments in June 2009 herbivory (50% of the leaf area was grazed by gypsy moths), mechanical cutting (50% of the leaf area was cut using scissors), shading (50% light shading with a black sheet), and control (covered with a net to prevent herbivory). Then, the density of GT and NGT on early leaves was determined in April 2010. In both birch species, the density of GT was higher in herbivory than in other treatments. The density of GT due to mechanical cutting was higher than that in the control, but only for white birch. However, the density of NGT was lower after mechanical cutting than in other treatments for white birch. There were no differences in the density of NGT among treatments for monarch birch. These results show that 1-yr delayed induction of GT by herbivory was stronger in white birch than in monarch birch.Multisystem Inflammatory Syndrome in Children (MIS-C) is a newly recognized disease process that can complicate SARS-CoV-2 infection. We present what we believe to be the earliest case of MIS-C, occurring in February 2020. Our patient's SARS-CoV-2 infection was caused by an emerging lineage with the D614G variant in the Spike protein. This lineage would subsequently become the predominant cause of SARS-CoV-2 outbreaks in Europe and the United States where MIS-C was first described. State prescription drug monitoring programs (PDMPs) identify controlled medications dispensed across providers and systems. Department of Veterans Affairs (VA) policy requires electronic health record documentation of PDMP queries at least annually for VA patients receiving controlled medications; however, queries are not uniformly conducted. We examined factors associated with PDMP queries for veterans receiving long-term opioid therapy. Veterans with a VA provider who received long-term opioid therapy between August 2015 and August 2016 within a four-state region were identified; 9,879 were due for a PDMP query between August 2016 and February 2017. Likelihood of veterans' PDMP queries during this follow-up period was modeled as a function of patient, provider, and facility characteristics of interest in mixed-effects modified Poisson models estimating relative risk and 95% confidence intervals. selleck Multivariable models controlled for potential confounders identified through the use of directed acyclic graphs. PDMP queries were documented for 62.1% of veterans that were due for a PDMP query. Veterans were more likely to be queried if they were Hispanic or if they received methadone, had average daily milligram morphine equivalents >20, or received urine drug screening during the studied period. Veterans were less likely to be queried if they had a rural address, mail order medication, or cancer diagnosis. Likelihood of PDMP queries was also lower for veterans whose opioid-prescribing provider was an oncologist or working in a low-complexity facility. Adherence to PDMP query policy within the VA varied by patient, clinician, and facility factors. Mechanisms to standardize the conduct of PDMP queries may be needed.Adherence to PDMP query policy within the VA varied by patient, clinician, and facility factors. Mechanisms to standardize the conduct of PDMP queries may be needed.