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People who overdose on opioids when they are alone or unmonitored are at heightened risk of death as other people do not know they should provide an emergency response. Wearable technology provides an opportunity to continuously measure respiratory function and ultimately send an alert if respiratory depression occurs. This study evaluates the feasibility and acceptability of PneumoWave DC in UK homeless hostels or supported accommodation settings (equivalent to Housing First in the USA) for individuals at high risk of opioid overdose. The PneumoWave system consists of a wearable biosensor that is affixed to the chest and records chest motion and which, in future, could potentially provide early detection of respiratory depression and trigger overdose response. RESCU-2 is a non-randomised, observational trial conducted in supported accommodation facilities across the UK. 50 participants who currently use opioids and live in homeless hostels in England and Scotland will wear the PneumoWave biosensor for varying periods to collect data over 2,000 participant-days. The biosensor will be linked via Bluetooth to a hub for continuous respiratory data collection. Self-reported drug use during the trial will be measured using drug diaries. Quantitative acceptability data will be measured using structured satisfaction surveys, while qualitative acceptability data will be obtained from interviews and focus groups with both residents and staff. Statistical analysis will include descriptive evaluation of feasibility outcomes, while qualitative data will undergo thematic analysis. The primary objectives of the study are: 1) feasibility of the study protocol within the hostel setting; 2) acceptability and usability of the device among people who use opioids and live in hostels; 3) acceptability of the device among staff who work in hostels and respond to overdose events. Primary outcomes are recruitment, total hours of usable data collected and successful recording of key outcome measures, among others. Trial registration: ISRCTN12060022. Findings will inform the feasibility of future integration of chest biosensor technology into hostel settings, assessing participant adherence, usability, and acceptability among people who use substances and staff. Insights gained will support the design of future trials and further development of remote monitoring technologies for overdose prevention and response strategies.

Accidental opioid overdose and Sudden Unexpected Death in Epilepsy (SUDEP) represent major forms of preventable mortality, often involving sudden-onset catastrophic events that could be survivable with rapid detection and intervention. The current physiological monitoring technologies are potentially applicable, but face challenges, including complex setups, poor patient compliance, high costs, and uncertainty about community-based use. Paradoxically, simple clinical observation in supervised injection facilities has proven highly effective, suggesting observable changes in central body motion may be sufficient to detect life-threatening events. We describe a novel wearable biosensor for continuous central body motion monitoring, offering a potential early warning system for life-threatening events. The biosensor incorporates a low-power, triaxial MEMS accelerometer within a discreet, chest-worn device, enabling long-term monitoring with minimal user burden. Two system architectures are described: stored data for retrospective analysis/research, and an in-development system for real-time overdose detection and response. Early user research highlights the importance of accuracy, discretion, and trust for adoption among people who use opioids. The initial clinical data collection, including the OD-SEEN study, demonstrates feasibility for capturing motion data during real-world opioid use. This technology represents a promising advancement in non-invasive monitoring, with potential to improve the outcomes for at-risk populations with multiple health conditions.

Opioid overdose is a global health crisis, affecting over 27 million individuals worldwide, with more than 100,000 drug overdose deaths in the United States in 2022-2023. This protocol outlines the development of the PneumoWave chest biosensor, a wearable device being designed to detect respiratory depression in real time through chest motion measurement, intending to enhance early intervention and thereby reduce fatalities. The study aims to (1) differentiate opioid-induced respiratory depression (OIRD) from nonfatal opioid use patterns to develop and refine an overdose detection algorithm and (2) examine participants' acceptability of the chest biosensor. The study adopts an observational design over a 6-month period. The biosensor, a small device, will be worn by consenting participants during injecting events to capture chest motion data. Safe injecting facilities (SIF) in Melbourne, Victoria (site 1), and Sydney, New South Wales (site 2), which are legally sanctioned spaces where individuals can use preobtained illicit drugs under medical supervision. Each site is anticipated to recruit up to 100 participants who inject opioids and attend the SIF. Participants will wear the biosensor during supervised injecting events at both sites. The biosensor will attempt to capture data on an anticipated 40 adverse drug events. The biosensor's ability to detect OIRD will be compared to the staff-identified events that use standard protocols for managing overdoses. Measurements will include (1) chest wall movement measured by the biosensor, securely streamed to a cloud, and analyzed to refine an overdose detection algorithm and (2) acute events or potential overdose identified by site staff. Acceptability will be measured by a feedback questionnaire as many times as the participant is willing to throughout the study. As of April 2024, a total of 47 participants have been enrolled and data from 1145 injecting events have already been collected, including 10 overdose events. This consists of 17 females and 30 males with an average age of 45 years. Data analysis is ongoing. This protocol establishes a foundation for advancing wearable technology in opioid overdose prevention within SIFs. The study will provide chest wall movement data and associated overdose data that will be used to train an algorithm that allows the biosensor to detect an overdose. The study will contribute crucial insights into OIRD, emphasizing the biosensor's potential step forward in real-time intervention strategies. DERR1-10.2196/57367.

Opiate overdose is the primary cause of death among injection-drug users, representing a major public health concern worldwide. Opiate overdose can be reversed through timely administration of naloxone, and users have expressed willingness to carry the antidote for emergency use (take-home naloxone). In November 2014, new WHO guidelines identified that naloxone should be made available to anyone at risk of witnessing an overdose. We present the case of a 46-year-old man in opioid-maintenance treatment who used take-home naloxone to rescue an overdose victim. This is the first- ever account of a patient using dose titration of naloxone to restore respiratory function while minimising the risk of adverse effects. To improve the safety of take-home naloxone, the authors call for clinicians involved in the treatment of opiate users to: prescribe take-home naloxone to all patients; forewarn patients of potential side effects; and instruct patients in naloxone dose titration.

Background: Globally, more than 100,000 people die annually from opioid overdose, and this number continues to increase. In the UK, opioid-related deaths are at an all-time high. The depressant effects of opioids on breathing centres in the brain cause 'respiratory depression' with effects on regular breathing rhythm and neural respiratory drive (signals coming from brain to breathing muscles), which then impairs the adequately balanced levels of blood oxygen and carbon dioxide. Mechanisms of opioid overdose and the degree of opioid-induced respiratory depression among long-term users are not well understood. Aims: This thesis incorporates retrospective analyses as well as direct clinical investigations to examine risk factors for overdose, as captured through clinical samples and in a clinical research facility, exploring influence of dose, route of administration and pre-existing disease. Methods: Primary and secondary data were collected and analysed. Primary data collection involved two clinical studies utilising novel objective markers of respiratory depression. First, an observational study investigated the severity of respiratory depression in long-term heroin users on an opioid substitution treatment. The second clinical study, in a clinical research facility, examined effects of varying doses of pharmaceutical heroin (diamorphine) on physiological markers of respiratory depression and observed and subjective ratings of drug effect. Secondary data analysis involved physiological data from a previous clinical study, and data extraction from historical literature. Results: Major impairment of respiratory function was identified across a broad clinical sample of dependent opioid users, and particularly following intravenous heroin administration (studied in an experimental clinical laboratory context). Conclusions: Without a practical, 'gold standard' measure of respiratory depression, it is crucial that reliable and sensitive techniques are used to elucidate the complex physiological responses to opioid use. Important next steps are identified for research to inform better understanding and better public response to the opioid overdose crisis.

Background and Objectives. The aim of this study was to show whether the level of lactate in venous blood compared with the Glasgow-Blatchford Bleeding Score (GBS), in patients diagnosed with upper gastrointestinal system (UGI) bleeding in the emergency department, will help to predict the need for transfusion and prognosis. Materials and Methods. Patients with UGI bleeding who were admitted to the emergency department were included in the study. The parameters age, gender, referral complaints, comorbidities, lactate levels in venous blood, GBS, endoscopy findings, length of hospital stay, transfusion amount, and outcome of patients were recorded in the data collection form. Results. A total of 139 patients were included in the study. The most common complaints were melena (38.1%) and hematemesis (32.4%). The most frequent endoscopic diagnosis was duodenal ulcer (40.3%). The cutoff value of the venous blood lactate level for the prediction of the need for red blood cell transfusion was 1.58 mmol/L, and the cutoff value for GBS was 9.5. While 124 patients were discharged, 15 patients died. The mean value of venous lactate in survived patients was 2.37 mmol/L and 4.80 in dead patients. This difference was statistically significant (p=0.044). The cutoff value of lactate for the prediction of mortality was 2.32 mmol/L, and the cutoff value for GBS was 13.5. Conclusions. The venous blood lactate value of a patient who was admitted to the emergency department with UGI bleeding might be helpful in predicting the transfusion needs of the patient and predicting the mortality.

Wastewater from the textile industry contains high concentrations of pollutants, so the wastewater must be treated before it is discharged. In addition, the reuse of treated wastewater should be considered from an environmental point of view, as large volumes of wastewater are produced. Since textile wastewater mainly contains dyestuffs, it must be treated effectively using environmentally friendly technologies. Membrane processes are widely used in textile wastewater treatment as they have distinct advantages over conventional wastewater treatment methods. This study reports the pilot-scale manufacturing and characterization of three different NF membranes. Three different types of membranes were fabricated. The fabricated membranes were compared through characterization by surface properties, chemical structure and morphology. Membranes were tested for pure water flux. Then the synthetic wastewater (SWW) was tested for flux and rejection. Lastly, the textile wastewater was tested. The textile wastewater flux of pure piperazine (PIP), 60% S-DADPS and 0.04% halloysite nanotubes (HNTs) were 22.42, 79.58 and 40.06 L m−2 h−1. It has been proven that the 60% s-DADPS membrane provides up to four times improvement in wastewater flux and simultaneously. In addition, NF membranes produced using HNT and sDADPS on a pilot scale have brought innovation to the literature with the good results obtained.

Severe acute respiratory syndrome coronavirus 2 had devastating consequences for human health. Despite the introduction of several vaccines, COVID-19 continues to pose a serious health risk due to emerging variants of concern. DNA vaccines gained importance during the pandemic due to their advantages such as induction of both arms of immune response, rapid development, stability, and safety profiles. Here, we report the immunogenicity and protective efficacy of a DNA vaccine encoding spike protein with D614G mutation (named pcoSpikeD614G) and define a large-scale production process. According to the in vitro studies, pcoSpikeD614G expressed abundant spike protein in HEK293T cells. After the administration of pcoSpikeD614G to BALB/c mice through intramuscular (IM) route and intradermal route using an electroporation device (ID + EP), it induced high level of anti-S1 IgG and neutralizing antibodies ( P  < 0.0001), strong Th1-biased immune response as shown by IgG2a polarization ( P  < 0.01), increase in IFN-γ levels ( P  < 0.01), and increment in the ratio of IFN-γ secreting CD4 + (3.78–10.19%) and CD8 + (5.24–12.51%) T cells. Challenging K18-hACE2 transgenic mice showed that pcoSpikeD614G administered through IM and ID + EP routes conferred 90–100% protection and there was no sign of pneumonia. Subsequently, pcoSpikeD614G was evaluated as a promising DNA vaccine candidate and scale-up studies were performed. Accordingly, a large-scale production process was described, including a 36 h fermentation process of E. coli DH5α cells containing pcoSpikeD614G resulting in a wet cell weight of 242 g/L and a three-step chromatography for purification of the pcoSpikeD614G DNA vaccine.

Objective: The aim of this study is to investigate the relationship between anxiety due to traumatic brain injury (TBI) and prefrontal cortex serotonin (5-HT) and 5-[HT.sub.2A] receptor in immature rats. Methods: Seven days old rats were subjected to traumatic brain injury model. They were divided into five groups. 1-Sham; 2-TBI group; 3-TBI followed by 14 days of administration of essitalopram (selective serotonin reuptake inhibitors; SSRI) (10 mg/kg) group (TbI+SSRi); 4-TBI and cyproheptadine (nonspecific serotonin receptor antagonist; A) (5 mg/kg) given by gastric gavage one hour prior to behavioral tests (TBI+A); 5-TBI followed by 14 days of essitalopram (SSRI) and cypro heptadine (A) given 1 hour prior to behavioral tests (TBI+SSRI+A). Elevated T-maze test and open field test applied to all groups and then blood corticosterone, prefrontal cortex tissue 5-HT and 5-[HT.sub.2A] receptor quantities measured. Prefrontal cortex neuron density histologically evaluated. Results: In the TBI group, the time spent in the peripheral cells, the time spent in the elevated T-maze closed arms, and serum corticosterone levels found to increase as a result of anxiety. Neuronal density decreased in prefrontal cortex. SSRI treatment reduced the time spent on the closed arms in the elevated T-maze test. SSRI decreased serum corticosterone levels and increased neuronal density. Tissue serotonin levels decreased in all groups exposure to TBI compared to sham group. 5-[HT.sub.2A] receptor levels were higher in the TBI and A group. Conclusion: SsRIs showed anxiolytic effect for anxiety, secondary to TBI in immature rats. (Anatolian Journal of Psychiatry 2019; 20(4):368-376) Keywords: immature rats, traumatic brain injury, prefrontal cortex, serotonin, serotonin 2A receptor, SSRI Amac: Bu calismanin amaci immatur ratlarda, travmatik beyin hasarinda ortaya cikan anksiyetenin, prefrontal kortekste serotonin (5-HT) ve 5-[HT.sub.2A] reseptoru ile iliskisini arastirmaktir. Yontem: Yedi gunluk yavru ratlara travmatik beyin hasari modeli uygulandi ve bes gruba ayrildi: 1-Sham; 2-Travmatik beyin hasari (tBh) grubu; 3-Travma uygulanip ardindan 14 gun, 10 mg/kg essitalopram (secici serotonin gerialim inhibitoru; SSRI) verilen grup (TBH+SSRI grubu); 4-Travma uygulanip davranis deneylerinden 1 saat once gastrik gavaj ile siproheptadin (non-spesifik serotonin reseptor antagonisti, A) 5 mg/kg verilen grup (TBH+A grubu); 5-Travma uygulanip ardindan 14 gun essitalopram ve davranis deneylerinden 1 saat once gastrik gavaj ile siproheptadin verilen grup (TBH+SSRI+A grubu). Tum gruplara yukseltilmis +labirent testi ve acik alan testi uygulanmis, sonrasinda kan kortikosteron, prefrontal korteks doku serotonin ve 5-[HT.sub.2A] reseptor miktarlari olculmustur. Prefrontal korteks noron yogunlugu degerlendirilmistir. Bulgular: TBH uygulanan grupta, acik alan testinde cevre hucrelerde gecirilen zaman ve yukseltilmis +labirentin kapali kollarinda gecirilen zaman ve serum kortikosteron duzeyleri anksiyete ile dogru orantili olarak artmis bulundu. Prefrontal kortekste noron yogunlugunda ise azalma gozlendi. SSRI tedavisi yukseltilmis +labirent testinde kapali kollarda gecirilen sureyi azaltti. Serum kortikosteron duzeylerini dusurdu ve noron yogunlugunu artirdi. Doku serotonin duzeyleri, TBH uygulanan tum gruplarda, sham grubuna gore azalmis olarak saptandi. 5-[HT.sub.2A] reseptor duzeyleri, TBH ve siproheptadin kullanan grupta yuksek bulundu. Sonuc: Immatur ratlarda TBH'ye ikincil ortaya cikan anksiyetede SSRI'lar antianksiyete etki gostermistir. (Anadolu Psikiyatri Derg 2019; 20(4):368-376) Anahtar sozcukler: Immatur rat, travmatik beyin hasari, prefrontal korteks, serotonin, serotonin 2A reseptoru, SSRI