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Excessive Use (excessive + use)
Selected AbstractsRecreational ecstasy use and the neurotoxic potential of MDMA: current status of the controversy and methodological issuesDRUG AND ALCOHOL REVIEW, Issue 3 2006MICHAEL LYVERS Abstract The controversy over possible MDMA-induced serotonergic neurotoxicity in human recreational ecstasy users is examined critically in light of recent research findings. Although the designs of such studies have improved considerably since the 1990s, the evidence to date remains equivocal for a number of reasons, including (1) inconsistent findings on the existence and reversibility of persistent ecstasy-related serotonergic and cognitive deficits; (2) lack of clear association between changes in brain imaging measures and functional deficits attributed to MDMA-induced neurotoxicity; (3) the contribution of concomitant cannabis or other drug use to both brain imaging abnormalities and cognitive deficits; (4) methodological shortcomings such as failure to adequately match samples of ecstasy users and controls; (5) the questionable relevance of animal models of MDMA-induced neurotoxicity to typical human patterns of ecstasy use; and (6) the potential role of inherent pre-drug deficits in serotonergic systems, impulse control and executive cognitive function that may predispose to excessive use of drugs including ecstasy. Given the retrospective nature of nearly all studies of ecstasy users to date, the controversy over whether MDMA has ever caused neurotoxicity or cognitive deficit in human ecstasy users is likely to continue for some time without resolution. [source] Proposed diagnostic criteria for internet addictionADDICTION, Issue 3 2010Ran Tao ABSTRACT Objective The objective of this study was to develop diagnostic criteria for internet addiction disorder (IAD) and to evaluate the validity of our proposed diagnostic criteria for discriminating non-dependent from dependent internet use in the general population. Methods This study was conducted in three stages: the developmental stage (110 subjects in the survey group; 408 subjects in the training group), where items of the proposed diagnostic criteria were developed and tested; the validation stage (n = 405), where the proposed criteria were evaluated for criterion-related validity; and the clinical stage (n = 150), where the criteria and the global clinical impression of IAD were evaluated by more than one psychiatrist to determine inter-rater reliability. Results The proposed internet addiction diagnostic criteria consisted of symptom criterion (seven clinical symptoms of IAD), clinically significant impairment criterion (functional and psychosocial impairments), course criterion (duration of addiction lasting at least 3 months, with at least 6 hours of non-essential internet usage per day) and exclusion criterion (exclusion of dependency attributed to psychotic disorders). A diagnostic score of 2 + 1, where the first two symptoms (preoccupation and withdrawal symptoms) and at least one of the five other symptoms (tolerance, lack of control, continued excessive use despite knowledge of negative effects/affects, loss of interests excluding internet, and use of the internet to escape or relieve a dysphoric mood) was established. Inter-rater reliability was 98%. Conclusion Our findings suggest that the proposed diagnostic criteria may be useful for the standardization of diagnostic criteria for IAD. [source] Application of Regression-Discontinuity Analysis in Pharmaceutical Health Services ResearchHEALTH SERVICES RESEARCH, Issue 2 2006Ilene H. Zuckerman Objective. To demonstrate how a relatively underused design, regression-discontinuity (RD), can provide robust estimates of intervention effects when stronger designs are impossible to implement. Data Sources/Study Setting. Administrative claims from a Mid-Atlantic state Medicaid program were used to evaluate the effectiveness of an educational drug utilization review intervention. Study Design. Quasi-experimental design. Data Collection/Extraction Methods. A drug utilization review study was conducted to evaluate a letter intervention to physicians treating Medicaid children with potentially excessive use of short-acting ,2 -agonist inhalers (SAB). The outcome measure is change in seasonally-adjusted SAB use 5 months pre- and postintervention. To determine if the intervention reduced monthly SAB utilization, results from an RD analysis are compared to findings from a pretest,posttest design using repeated-measure ANOVA. Principal Findings. Both analyses indicated that the intervention significantly reduced SAB use among the high users. Average monthly SAB use declined by 0.9 canisters per month (p<.001) according to the repeated-measure ANOVA and by 0.2 canisters per month (p<.001) from RD analysis. Conclusions. Regression-discontinuity design is a useful quasi-experimental methodology that has significant advantages in internal validity compared to other pre,post designs when assessing interventions in which subjects' assignment is based on cutoff scores for a critical variable. [source] Analysis of the current methods used to size a wind/hydrogen/fuel cell-integrated system: A new perspectiveINTERNATIONAL JOURNAL OF ENERGY RESEARCH, Issue 12 2010H. G. Geovanni Abstract As an alternative to the production and storage of intermittent renewable energy sources, it has been suggested that one can combine several renewable energy technologies in one system, known as integrated or hybrid system, that integrate wind technology with hydrogen production unit and fuel cells. This work assesses the various methods used in sizing such systems. Most of the published papers relate the use of simulation tools such as HOMER, HYBRID2 and TRNSYS, to simulate the operation of different configurations for a given application in order to select the best economic option. But, with these methods one may not accurately determine certain characteristics of the energy resources available on a particular site, the profiles of estimated consumption and the demand for hydrogen, among other factors, which will be the optimal parameters of each subsystem. For example, velocity design, power required for the wind turbine, power required for the fuel cell and electrolyzer and the storage capacity needed for the system. Moreover, usually one makes excessive use of bi-parametric Weibull distribution function to approximate the histogram of the observed wind to the theoretical, which is not appropriate when there are bimodal frequency distributions of wind, as is the case in several places in the world. A new perspective is addressed in this paper, based on general system theory, modeling and simulation with a systematic approach and the use of exergoeconomic analysis. There are some general ideas on the advantages offered in this method, which is meant for the implementation of wind/hydrogen/fuel cell-integrated systems and in-situ clean hydrogen production. Copyright © 2009 John Wiley & Sons, Ltd. [source] First palaeopathological example of Kienböck's disease from early modern Sakhalin AinuINTERNATIONAL JOURNAL OF OSTEOARCHAEOLOGY, Issue 2 2002M. Nakai Abstract A disorder of the carpal lunate has been diagnosed as Kienböck's disease in a skeleton of a middle-aged Ainu male that was excavated from Sakhalin Island, northeast Asia. The bone lesion is primarily and unilaterally associated with the right wrist, where the right carpal lunate is collapsed and the radiocarpal joint shows degenerative arthritis. Interestingly, the left arm is more robust than the right and the left elbow shows considerable osteoarthritis. The most plausible explanation for these pathologies is that after developing Kienböck's disease in the right wrist, excessive use of the left arm made his left arm robust and finally gave rise to osteoarthritis in the left elbow. In archaeology, where only a few osteochondroses have been reported up until now, the present example is the first diagnosis of Kienböck's disease in skeletal remains. Copyright © 2002 John Wiley & Sons, Ltd. [source] The demography of nurses and patients on acute psychiatric wards in EnglandJOURNAL OF CLINICAL NURSING, Issue 6 2009Len Bowers Aims and objectives., To describe the ethnic and demographic composition of staff and patients on acute psychiatric wards in England. Background., A significant proportion of the UK population (7·6%) belong to an ethnic minority and there are concerns that ethnic minority patients are not well served by psychiatry, in particular that they are subject to excessive force and coercion. Design., Survey of a random sample of psychiatric wards in three regions. Methods., A survey was conducted of staff (n = 1536) and patients (n = 11 128) on 136 acute admission psychiatric wards. Results., Ethnic minority patients were more likely to be admitted with a diagnosis of schizophrenia, younger, more likely to be admitted for a risk of harm to others and more likely to be legally detained. The association between ethnic minority status and detention remains, even when risk, age, gender and diagnosis are taken into account. Ethnic minority patients come from areas of greater social deprivation and fragmentation. Ethnic concordance between staff and patients varies, but the greatest difference is found in London where the proportion of minority staff is greater than the proportion of minority patients. Conclusions., There continues to be evidence that ethnic minority patients are subject to an excessive amount of legal coercion in English mental health services. However, the proportion of staff belonging to an ethnic minority is greater than the proportion of patients. Relevance to clinical practice., Solutions to the problem of excessive use of legal coercion with ethnic minority patients need to be found. Changes of recruitment strategies are required if concordance is to be achieved. [source] Use of preventive measures for air travel-related venous thrombosis in professionals who attend medical conferencesJOURNAL OF THROMBOSIS AND HAEMOSTASIS, Issue 11 2006S. KUIPERS Summary.,Background:,Lack of guidelines for prevention of air travel-related venous thrombosis may lead to excessive use of potentially dangerous precautions. Objectives:,To assess the use of preventive measures for air travel-related thrombosis in professionals employed in the field of thrombosis and hemostasis and in other fields. Methods:,A survey amongst delegates of the XXth ISTH Congress, the 15th ISDB Congress and the 13th Cochrane Colloquium, which all took place in Australia 2005. Results:,Two thousand and eighty-nine questionnaires were completed (response 53%). Overall, 80% of the respondents had used preventive measures. Low-molecular-weight heparin and vitamin K antagonists were mostly used by ISTH delegates (10% vs. 1% at the other conferences). Medical doctors used more pharmacological prophylaxis (31%) than research fellows (11%) and non-clinical scientists (22%). Dutch (64%) and Asian respondents (67%) least used any prevention, whereas Israeli used most (94%). Subjects with risk factors for thrombosis more often used prophylaxis (90%) than those without (77%). In a multivariate analysis, conference, nationality, age, presence of risk factors and profession were determinants of prophylaxis use. Conclusion:,Major differences in the use of prophylactic measures for air travel-related thrombosis stress the need for studies of interventions and clear guidelines on prevention of air travel-related venous thrombosis. [source] Characterization of urinary metabolites of testosterone, methyltestosterone, mibolerone and boldenone in greyhound dogsJOURNAL OF VETERINARY PHARMACOLOGY & THERAPEUTICS, Issue 3 2000T. M. Williams Androgenic steroids are used in female greyhound dogs to prevent the onset of estrus; moreover, these steroids also have potent anabolic activity. As anabolic steroids increase muscle mass and aggression in animals, the excessive use of these agents in racing greyhounds gives an unfair performance advantage to treated dogs. The biotransformation of most anabolic steroids has not been determined in greyhound dogs. The objective of the present study was to identify the urinary metabolites of testosterone, methyltestosterone, mibolerone, and boldenone in greyhound dogs. These steroids were administered orally (1 mg/kg) to either male or female greyhound dogs and urine samples were collected pre-administration and at 2, 4, 8, 12, 24, 72, and 96 h post-administration. Urine extracts were analyzed by high-performance liquid chromatography/mass spectrometry (HPLC/MS) to identify major metabolites and to determine their urinary excretion profiles. Major urinary metabolites, primarily glucuronide, conjugated and free, were detected for the selected steroids. Sulfate conjugation did not appear to be a major pathway for steroid metabolism and excretion in the greyhound dog. Phase I biotransformation was also evaluated using greyhound dog liver microsomes from untreated dogs. The identification of several in vivo steroid metabolites generated in this study will be useful in detecting these steroids in urine samples submitted for drug screening. [source] Late hepatic allograft dysfunctionLIVER TRANSPLANTATION, Issue 11B 2001Professor of Medicine Russell H. Wiesner MD Key Points 1Lifelong monitoring of graft function, immunosuppressive levels, and screening for drug toxicity is required in all liver recipients. 2Late hepatic allograft dysfunction is common and is caused by a variety of etiologies including rejection, infection, biliary/vascular abnormalities, recurrence of disease, and drug hepatotoxicity. 3In all patients with late hepatic allograft dysfunction, liver biopsy should be performed to assess for the presence of rejection, and to thus avoid excessive use of bolus corticosteroid therapy and guide appropriate immunosuppressive management. 4Recurrence of disease is the most common cause of late hepatic allograft dysfunction. 5Hepatitis C universally reinfects the hepatic allograft, and is associated with decreased patient and graft survival and leads to the recurrence of cirrhosis in 28% of patients within 5 years of transplantation. 6Major advances have been made in preventing recurrence of hepatitis B by the use of hepatitis B immune globulin in combination with lamivudine therapy. 7Autoimmune liver diseases such as primary biliary cirrhosis, primary sclerosing cholangitis, and autoimmune hepatitis have a recurrence rate of approximately 20% to 30%. 8In patients developing recurrence of autoimmune hepatitis, steroid withdrawal is the most common cause. 9Recurrent hepatocellular cancer can be markedly reduced if strict guidelines are adhered to in selecting patients. 10Drug hepatotoxicity must always be considered in the differential diagnosis of late hepatic allograft dysfunction. [source] Metabolomic analysis of host plant resistance to thrips in wild and cultivated tomatoes,PHYTOCHEMICAL ANALYSIS, Issue 1 2010Mohammad Mirnezhad Abstract Introduction , Western flower thrips (Frankliniella occidentalis) are among the most serious crop pests worldwide. Control of thrips mainly depends on pesticides, excessive use of which leads to human health risks and environmental contamination. As an alternative, we study host plant resistance to thrips. Objective , To apply nuclear magnetic resonance spectroscopy (NMR) metabolomics to study host plant resistance to thrips in wild and cultivated tomatoes. Methodology , Ten wild species and 10 cultivated tomato lines were compared. Five replicates of each species and lines were used for a thrips bioassay while another five replicates were used for the metabolomic analysis. The three most resistant and susceptible wild species, and cultivated lines, as identified by the thrips bioassay, were used for the metabolomics, performed by 1H NMR spectroscopy followed by principal component analysis. Results , Wild and cultivated tomatoes differed significantly in thrips resistance. Only wild tomatoes were thrips-resistant, among which Lycopersicon pennellii and L. hirsutum exhibited the lowest thrips damage. Their 1H NMR-based metabolomic profiles were significantly different from those of thrips-susceptible tomatoes. Thrips-resistant tomatoes contained acylsugars, which are known for their negative effect on herbivores. Conclusion , The identification of acylsugars as a resistance factor for thrips in tomato proves that NMR-based metabolomics an important tool to study plant defences, providing fundamental information for the development and realisation of herbivore resistance breeding programmes in agricultural crops. Copyright © 2009 John Wiley & Sons, Ltd. [source] The low-level katabatic jet height versus Monin,Obukhov heightTHE QUARTERLY JOURNAL OF THE ROYAL METEOROLOGICAL SOCIETY, Issue 629 2007B. Grisogono Abstract In this short note we discuss a long-standing problem in modelling the atmospheric boundary layer (ABL) over complex terrain: namely, an excessive use of the Monin,Obukhov length scale LMO. This issue becomes increasingly relevant with the ever-increasing resolution of numerical weather-prediction and climate models, which typically use LMO in one way or another for parametrizing the surface layer, or at least for formulating the lower boundary conditions. Hence, inevitably, the models under-represent a significant part of the mesoscale flow variability. We focus here on the stable ABL over land: in particular, sloped cooled flows. However, a qualitatively similar reasoning applies to the corresponding unstable ABL. We show that for sufficiently stratified flows over moderately sloped surfaces, Monin,Obukhov scaling is inadequate for describing the basic ABL dynamics, which is often governed by katabatic and drainage flows. Copyright © 2007 Royal Meteorological Society [source] Breast pathology guideline implementation in low- and middle-income countries,CANCER, Issue S8 2008Shahla Masood MD Abstract The quality of breast healthcare delivery and the ultimate clinical outcome for patients with breast cancer are directly related to the quality of breast pathology practices within the healthcare system. The Breast Health Global Initiative (BHGI) held its third Global Summit in Budapest, Hungary from October 1 to 4, 2007, bringing together internationally recognized experts to address the implementation of breast healthcare guidelines for the early detection, diagnosis, and treatment in low-income and middle-income countries (LMCs). From this group, a subgroup of experts met to address the specific needs and concerns related to breast pathology program implementation in LMCs. Specific recommendations were made by the group and process indicators identified in the areas of personnel and training, cytology and histopathology interpretation, accuracy of pathology interpretation, pathology reporting, tumor staging, causes of diagnostic errors, use of immunohistochemical markers, and special requirements to facilitate breast conservation therapy. The group agreed that the financial burden of establishing and maintaining breast pathology services is counterbalanced by the cost savings from decreased adverse effects and excessive use of treatment resources that result from incorrect or incomplete pathologic diagnosis. Proper training in breast pathology for pathologists and laboratory technicians is critical and provides the underpinnings of programmatic success for any country at any level of economic wealth. Cancer 2008;113(8 suppl):2297,304. © 2008 American Cancer Society. [source] Acidosis and Catecholamine Evaluation Following Simulated Law Enforcement "Use of Force" EncountersACADEMIC EMERGENCY MEDICINE, Issue 7 2010Jeffrey D. Ho MD ACADEMIC EMERGENCY MEDICINE 2010; 17:E60,E68 © 2010 by the Society for Academic Emergency Medicine Abstract Objectives:, Law enforcement authorities are often charged with controlling resisting suspects. These encounters sometimes result in the sudden and unexpected death of the suspect. Drug intoxication, excited delirium syndrome, or excessive uses of force are factors that are often blamed, but sometimes the mechanism of these deaths is not fully understood. It is possible that worsening acidosis or excessive catecholamine release play a part. The objective of this study was to determine the effect on markers of acidosis and catecholamines of various tasks intended to simulate common arrest-related situations. Methods:, Subjects were assigned to one of five task groups: 1) a 150-meter sprint and wall hurdle (simulated flight from arrest); 2) 45 seconds of striking a heavy bag (simulated physical resistance); 3) a 10-second TASER X26 electronic control device exposure; 4) a fleeing and resistance exercise involving a law enforcement dog (K-9); or 5) an oleoresin capsicum (OC) exposure to the face and neck. Baseline serum pH, lactate, potassium, troponin I, catecholamines, and creatine kinase (CK) were evaluated. Serum catecholamines, pH, lactate, and potassium were sampled immediately after the task and every 2 minutes for 10 minutes posttask. Vital signs were repeated immediately after the task. Serum CK and troponin I were evaluated again at 24 hours posttask. Results:, Sixty-six subjects were enrolled; four did not complete their assigned task. One subject lost the intravenous (IV) access after completing the task and did not have data collected, and one subject only received a 5-second TASER device exposure and was excluded from the study, leaving 12 subjects in each task group. The greatest changes in acidosis markers occurred in the sprint and heavy bag groups. Catecholamines increased the most in the heavy bag group and the sprint group and increased to a lesser degree in the TASER, OC, and K-9 groups. Only the sprint group showed an increase in CK at 24 hours. There were no elevations in troponin I in any group, nor any clinically important changes in potassium. Conclusions:, The simulations of physical resistance and fleeing on foot led to the greatest changes in markers of acidosis and catecholamines. These changes may be contributing or causal mechanisms in sudden custodial arrest-related deaths (ARDs). This initial work may have implications in guiding applications of force for law enforcement authorities (LEAs) when apprehending resisting subjects. [source] | |||||||||||||