Seattle Pacific University

We examined fentanyl use and outcomes among people who inject drugs (PWID) in the urban Pacific Northwest (PNW). We conducted secondary analysis of data from the 2022 National HIV Behavioral Surveillance PWID cycle from Seattle, WA and Portland, OR. We calculated proportions of any fentanyl, injection fentanyl, non-injection fentanyl, and street pill use. Next, we compared characteristics, behaviors, and outcomes by any fentanyl use. Finally, we estimated adjusted relative risk (aRR) of overdose outcomes associated with fentanyl use and injecting less associated with type of street pill use. Among 830 PWID, 76% reported any fentanyl use, 47% specifically reported injection fentanyl use, 68% specifically reported non-injection fentanyl use, and 66% reported street pill use. Of those who used pills, 94% smoked them. Fentanyl use was crudely associated with age; race; housing; detainment; usual drug injected; injection frequency; syringe service programs, substance treatment, non-fatal overdose, and naloxone (p < 0.05). With adjustment, any fentanyl use (aRR = 3.20, 95% CI 1.58-6.47), injection fentanyl use (aRR = 3.51, 95% CI 1.63-7.58), and non-injection fentanyl use (aRR = 2.29, 95% CI 1.23-4.28) were associated with higher risk of overdose. Participants who smoked street pills were more likely to report injecting less because of pill use (aRR = 1.82, 95% CI 1.24-2.66). Fentanyl use was highly prevalent among PWID in the urban PNW. Non-injection fentanyl use was most common and street pills were frequently administered by smoking which was associated with injecting less. All fentanyl use was associated with increased risk for overdose. There is ongoing need for access to naloxone for PWID who use fentanyl.

Sleep disturbances during breast cancer (BC) treatment may represent a modifiable contributor to left ventricular ejection fraction (LVEF) decline during BC treatment. We investigated the association of sleep disturbance and LVEF decline in a prospective cohort of 247 women with non-metastatic BC scheduled for chemotherapy as part of the UPBEAT study conducted through the Wake Forest NCI Community Oncology Research Program Research Base (WF NCORP RB; WF-97415, UG1CA189824). Participants completed cardiac magnetic resonance imaging to measure LVEF, six-minute walk distance, and validated surveys assessing sleep disturbance, physical health, and mental health at baseline and 3 months. Sleep disturbance was measured using the Patient Reported Outcomes Measurement Information System Sleep Disturbance survey. At 3-month follow-up, 30.3% of participants experienced a clinically meaningful increase in sleep disturbance, with a mean LVEF decline of -4.13%-points compared to -1.93%-points in those without increased disturbance (p = 0.10). In multivariable models adjusting for baseline risk factors and concurrent changes in health, a 10-point increase in sleep disturbance was associated with a 1.31%-point reduction in LVEF (β= -0.131; 95% CI: -0.24,-0.02; p = 0.02). Associations were robust across sensitivity analyses. This study provides evidence linking sleep disturbance during BC treatment to early LVEF decline, suggesting sleep disturbance may contribute to subclinical cardiac dysfunction independent of general health decline. Longitudinal studies incorporating objective sleep measures are warranted to clarify mechanisms and evaluate whether behavioral interventions targeting sleep could mitigate cardiovascular risk in BC survivors.

The Mental Help Seeking Attitudes Scale (MHSAS) is commonly used in psychological research. This nine-item unidimensional scale was designed to measure how favorable or unfavorable respondents' attitudes are toward seeking help from a mental health professional and was originally validated using a primarily White sample. To address the potential limitations of using this scale cross-culturally, we recruited participants who identified as Asian American (n = 161), Black American (n = 259), and Latine American (n = 259) to take the MHSAS, and then we ran confirmatory factor analyses. Our samples also all consisted of individuals with chronic pain. The original measure validation demonstrated excellent overall model fit; however, all three of our non-White samples had only adequate overall model fit and factor loading values. An exploratory bifactor analysis still confirmed the unidimensional structure of the scale. These findings suggest that the MHSAS should be used cautiously in cross-cultural contexts with racially minoritized groups experiencing chronic pain.

The development of smart, implantable devices localized at the site of inflammation to conditionally and proactively combat active inflammation for inflammatory bowel disease (IBD), has the potential to transform the patient's quality of life compared to conventional treatment modalities. Engineered probiotic organisms can enable dynamic production of therapeutic compounds in response to inflammatory biomarkers. However, delivery and localization of these engineered organisms to the site of inflammation requires their integration into a material or device that sustains their viability and metabolic activity. To this end, a 3D printed engineered living material (ELM) is developed using an engineered probiotic organism (E. coli Nissle 1917) with genetic circuits to sense biomarkers for inflammation and respond with the production of anti-inflammatory compounds. These organisms are incorporated into poly(ethylene glycol) diacrylate (PEGDA) resins for the light-based 3D printing of 3D constructs. The organisms are physically encapsulated within the PEGDA and are fully viable and metabolically active. The 3D printed ELM devices are able to detect clinically relevant amounts of nitric oxide as an inflammatory biomarker and respond with the production of tryptamine or 1-acetyl-3-carboxyl-β-carboline as representative anti-inflammatory agents. Additionally, the ELM devices are efficacious in treating in vitro models of inflammation, including murine macrophages and intestinal epithelial cells. Looking forward, these ELM devices could serve as theranostic modalities for the long-term treatment of inflammatory disorders such as IBD.

Abstract This chapter considers the role of rehabilitation psychology in low- and middle-income countries (LMICs). It begins with an overview of the experience and environmental conditions affecting the well-being of people with disabilities in LMICs and the potential contribution of rehabilitation psychology to this context. It then considers common themes, challenges, and opportunities encountered when contextualizing rehabilitation psychology expertise in LMIC settings, with a particular focus on capacity building. Several examples of human resource, education, and research capacity building will be presented, along with case studies that illuminate the individual perspectives of disabled persons living in LMIC environments. Finally, the chapter considers the rehabilitation challenges in LMICs that have been highlighted and exacerbated by the COVID-19 pandemic and how rehabilitation psychology is uniquely situated to respond to these challenges.