No abstract

Of the reported cases of H1N1 in health care workers, 49% occurred in a population that constitutes less than 20% of the total population studied. Physicians and medical personnel had a higher infection rate than other employee positions, whereas ED personnel had the highest infection rate.

Opioid use disorder (OUD) is increasing in prevalence throughout the world, with approximately three million individuals in the United States affected. Buprenorphine is a medication designed, researched, and effectively used to assist in OUD recovery. Objective: This narrative review discusses an approach to initiating buprenorphine in the emergency department (ED) for opioid-abuse recovery. Discussion: Buprenorphine is a partial mu-opioid receptor agonist with high affinity and low intrinsic activity. Buprenorphine's long half-life, high potency, and 'ceiling effect' for both euphoric sensation and adverse effects make it an optimal treatment alternative for patients presenting to the ED with opioid withdrawal. While most commonly provided as a sublingual film or tablet, buprenorphine can also be delivered via transbuccal, transdermal, subdermal (implant), subcutaneous, and parenteral routes. Prior to ED administration, caution is recommended to avoid precipitation of buprenorphine-induced opioid withdrawal. Following the evaluation of common opioid withdrawal symptoms, a step-by-step approach to buprenorphine can by utilized to reach a sustained withdrawal relief. A multimodal medication-assisted treatment (MAT) plan involving pharmacologic treatment, as well as counseling and behavioral therapy, is essential to maintaining opioid remission. Patients may be safely discharged with safe-use counseling, close outpatient follow-up, and return precautions for continued management of their OUD. Establishing a buprenorphine program in the ED involves a multifactorial approach to establish a pro-buprenorphine culture. Conclusions: Buprenorphine is an evidence-based, safe, effective treatment option for OUD in an ED-setting. Though successfully utilized by many ED-based treatment programs, the stigma of 'replacing one opioid with another' remains a barrier. Evidence-based discussions on the safety and benefits of buprenorphine are essential to promoting a culture of acceptance and optimizing ED OUD treatment.

No abstract

Background: The Global Terrorism Database (GTD) is an open-source database that includes information on terrorist incidents that have occurred around the world since 1970. It is maintained by the Center for Terrorism and Intelligence Studies and the University of Maryland National Consortium for the Study of Terrorism and Responses to Terrorism (START), a Department of Homeland Security Center of Excellence. Objective: To characterize chemical terrorism incidents reported to the GTD and understand more about the kinds of chemical agents used, the associated morbidity and mortality, the geography of incidents, and the intended targets. Methods: We searched the GTD database to identify all terrorism incidents categorized as “chemical” or with “chemical weapon” in the incident description; we excluded duplicate entries and those not involving a chemical agent. We reviewed each incident and assigned it to one of eight chemical agent categories. We analyzed the total number of chemical terrorism incidents between 1970 and 2015 by chemical agent category, injury and fatality volume, geographic region, and target. We determined injury and fatality counts and mean number of injuries and fatalities by chemical agent category. Results: During the study period, 156,772 terrorism incidents were reported to the GTD, of which 321 (0.2%) were reported as “chemical” or “chemical weapons” incidents. Of these, 292 (90.1%) met our inclusion criteria for analysis (duplicate reports and incidents that did not involve a chemical terrorism agent were excluded). The reported chemical agent categories were: unknown chemical (30.5%); corrosives (23.3%); tear gas/mace (12.3%); unspecified gas (11.6%); cyanide (8.2%); pesticides (5.5%); metals (6.5%); and nerve gas (2.1%). On average, chemical terrorism incidents in this dataset resulted in 51 injuries (mean range across agents: 2.5–1622) and 7 deaths (mean range across agents: 0.0–224.3) per incident. Nerve gas incidents (2.1%) had the highest reported mean number of fatalities (n=224) and injuries (n=1622) per incident. The highest number of reported chemical terrorism incidents occurred in South Asia (29.5%), Western Europe (16.8%), Middle East/North Africa (13%), and South America (9.3%). The most common targets were private citizens (19.5%). Conclusions: This is the first publication to characterize chemical terrorism incidents collected by the GTD. Data suggest that morbidity and mortality vary by chemical category and by region. Results may be helpful in developing and optimizing regional chemical terrorism preparedness activities.