Salinity causes widespread restriction of methane emissions from small inland waters

Inland waters are one of the largest natural sources of methane (CH4), a potent greenhouse gas, but emissions models and estimates were developed for solute-poor ecosystems and may not apply to salt-rich inland waters. Here we combine field surveys and eddy covariance measurements to show that salinity constrains microbial CH4 cycling through complex mechanisms, restricting aquatic emissions from one of the largest global hardwater regions (the Canadian Prairies). Existing models overestimated CH4 emissions from ponds and wetlands by up to several orders of magnitude, with discrepancies linked to salinity. While not significant for rivers and larger lakes, salinity interacted with organic matter availability to shape CH4 patterns in small lentic habitats. We estimate that excluding salinity leads to overestimation of emissions from small Canadian Prairie waterbodies by at least 81% ( ~ 1 Tg yr-1 CO2 equivalent), a quantity comparable to other major national emissions sources. Our findings are consistent with patterns in other hardwater landscapes, likely leading to an overestimation of global lentic CH4 emissions. Widespread salinization of inland waters may impact CH4 cycling and should be considered in future projections of aquatic emissions.

Cocaine Use May Moderate the Associations of HIV and Female Sex with Neurocognitive Impairment in a Predominantly African American Population Disproportionately Impacted by HIV and Substance Use

HIV-associated neurocognitive disorders (HAND) remain a major challenge for people with HIV in the antiretroviral therapy era. Cocaine use may trigger/exacerbate HAND among African American (AA) adults, especially women. Between 2018 and 2019, 922 adults, predominantly AAs, with/without HIV and with/without cocaine use in Baltimore, Maryland, were enrolled in a study investigating the association of HIV and cocaine use with neurocognitive impairment (NCI). Neurocognitive performance was assessed with the NIH Toolbox Cognition Battery (NIHTB-CB). NCI was considered to be present if the fully adjusted standard score for at least two cognitive domains was 1.0 standard deviation below the mean. Although the overall analysis showed HIV and female sex were associated with NCI, the associations were dependent on cocaine use. Neither HIV [adj prevalence ratio (PR): 1.12, confidence interval (95% CI): 0.77-1.64] nor female sex (adj PR: 1.07, 95% CI: 0.71-1.61) was associated with NCI among cocaine nonusers, while both HIV (adj PR: 1.39, 95% CI: 1.06-1.81) and female sex (adj PR: 1.53, 95% CI: 1.18-1.98) were associated with NCI in cocaine users. HIV was associated with two NIHTB-CB measures overall. In addition, HIV was associated with a lower dimensional change card sort score (an executive function measure) in cocaine users and not in nonusers. Cognitive performance was poorer in female than in male cocaine users. The adverse effect of HIV on cognitive performance predominantly affected cocaine users. However, cocaine use may moderate the impact of HIV and female sex on cognitive performance, highlighting the importance of reducing cocaine use in NCI prevention among the AA population.

Remote delivery of a therapeutic intervention to court-mandated youths of Haitian descent during COVID-19

The threat generated by the COVID-19 pandemic has triggered sudden institutional changes in an effort to reduce viral spread. Restrictions on group gatherings and in-person engagement have increased the demand for remote service delivery. These restrictions have also affected the delivery of court-mandated interventions. However, much of the literature has focused on populations that voluntarily seek out face-to-face medical care or mental health services, whereas insufficient attention has been paid to telehealth engagement of court-mandated populations. This article draws on data gathered on an NIH/NIDA-funded study intervention implemented with juvenile justice-involved youths of Haitian heritage in Miami-Dade County, Florida, during the COVID-19 public health crisis. We explore the process of obtaining consent, technological access issues, managing privacy, and other challenges associated with remote delivery of family-based therapy to juvenile justice-involved youth. Our aim is to provide some insights for consideration by therapists, healthcare workers, advocates, researchers, and policymakers tasked with finding alternative and safer ways to engage nontraditional populations in health services. The clinical trial registration number is NCT03876171.

497 Targeting Improvements in The Elective Aneurysm Pathway in The Dorset and Wiltshire Vascular Network (DWVN)

Introduction

Two consecutive NVR reports identified the DWVN as the 7th slowest network to treat patients with AAAs. We aimed to detect if there were any significant delays in our pathway.

Method

We performed a retrospective audit of patients having elective open and endovascular repair. 144 patients who had AAA repair between 30/06/2016-01/08/2018 were included. Data were collected on the following stages: the date the AAA reached ≥55mm, referral date, date clinician reviewed, CT scan date, CPET testing date, MDT date and operation date. The time in days between each stage was recorded and any delays documented.

Results

At RBH the longest delay was between MDT and surgery (median 73 days, IQR 32 days-130 days). At DCH the major delay was between CPET and MDT (median 28.5 days, IQR 10 days-31 days). At SDH the longest stage was between MDT and operation (median of 88 days, IQR 37 days-154 days).

Examples of reasons for delays across the three hospitals included awaiting specialist opinions, patient being unwell and no ITU beds available.

Conclusions

The pathway for elective AAA treatment in the DWVN is slow across all three hospitals. The greatest delay is often between MDT and surgery. Targeting this stage could significantly shorten the pathway.

Assessment of the status and trends in abundance of a coastal pinniped, the Australian sea lion Neophoca cinerea

Australian sea lions Neophoca cinerea are endemic to Australia, with their contemporary distribution restricted to South Australia (SA) and Western Australia (WA). Monitoring of the species has proved challenging due to prolonged breeding events that occur non-annually and asynchronously across their range. The most recent available data from 80 extant breeding sites (48 in SA, 32 in WA) enabled us to estimate the species-wide pup abundance to be 2739, with 82% (2246) in SA and 18% (493) in WA, mostly based on surveys conducted between 2014 and 2019. We evaluated 1776 individual site-surveys undertaken between 1970 and 2019 and identified admissible time-series data from 30 breeding sites, which revealed that pup abundance declined on average by 2.0% yr-1 (range 9.9% decline to 1.7% growth yr-1). The overall reduction in pup abundance over 3 generations (42.3 yr) was estimated to be 64%, with over 98% of Monte Carlo simulations producing a decline >50% over a 3-generation period, providing strong evidence that the species meets IUCN ‘Endangered’ criteria (decline ≥50% and ≤80%). The population is much smaller than previously estimated and is declining. There is a strong cline in regional abundances (increasing from west to east), with marked within-region heterogeneity in breeding site pup abundances and trends. Results from this study should improve consistency in the assessment of the species and create greater certainty among stakeholders about its conservation status. To facilitate species management and recovery, we prioritise key data gaps and identify factors to improve population monitoring.

Features, State and Context of Narcissism in Drug Misuse

Both clinical and street-based encounters with people who misuse drugs have led the authors to examine the relationship between misuse of drugs and narcissism. Widely accepted criteria for diagnosing Substance Use Disorder (SUD) suggest parallels between narcissistic traits (e.g. invulnerability to consequences and lack of empathy for others) and the characteristics of drug abusers. Because narcissism as a concept has a long and somewhat confusing history, we first reviewed its origins in the psychoanalytic tradition of psychiatry and its exegesis into current clinical concepts in order to arrive at a set of attributes that may be useful when applied to problems of drug abuse. This process required extensive review of the literature on narcissism and its interactions with the literature on drug abuse. This process led to an understanding that positive self-concept may exemplify a variety of socially beneficial narcissism, but that at the other end of narcissism's continuum of traits may be found exploitative and non-empathetic traits. Furthermore, the negative traits of narcissism, as they may arise in adolescence along with drug use, can support an individual's ongoing dependence on drugs, especially if narcissism and drug use persist into adulthood. Our investigation of narcissism and drug use revealed, through in-depth interviewing, that some drug users employ drugs and alcohol to feed their self-concepts of superiority over other people. Our findings suggest that treatment for drug abuse cannot proceed assuming that drug users have low self-concepts. Rather, their continued use of drugs may emanate from a narcissistic sense of superiority.

Heterogeneous mass distribution of the rubble-pile asteroid (101955) Bennu

The gravity field of a small body provides insight into its internal mass distribution. We used two approaches to measure the gravity field of the rubble-pile asteroid (101955) Bennu: (i) tracking and modeling the spacecraft in orbit about the asteroid and (ii) tracking and modeling pebble-sized particles naturally ejected from Bennu's surface into sustained orbits. These approaches yield statistically consistent results up to degree and order 3, with the particle-based field being statistically significant up to degree and order 9. Comparisons with a constant-density shape model show that Bennu has a heterogeneous mass distribution. These deviations can be modeled with lower densities at Bennu's equatorial bulge and center. The lower-density equator is consistent with recent migration and redistribution of material. The lower-density center is consistent with a past period of rapid rotation, either from a previous Yarkovsky-O'Keefe-Radzievskii-Paddack cycle or arising during Bennu's accretion following the disruption of its parent body.

Two-Loop Four-Graviton Scattering Amplitudes

We present the analytic form of the two-loop four-graviton scattering amplitudes in Einstein gravity. To remove ultraviolet divergences we include counterterms quadratic and cubic in the Riemann curvature tensor. The two-loop numerical unitarity approach is used to deal with the challenging momentum dependence of the interactions. We exploit the algebraic properties of the integrand of the amplitude in order to reduce it to a minimal basis of Feynman integrals. Analytic expressions are obtained from numerical evaluations of the amplitude. Finally, we show that four-graviton scattering observables depend on fewer couplings than naïvely expected.

The dynamic geophysical environment of (101955) Bennu based on OSIRIS-REx measurements

The top-shape morphology of asteroid (101955) Bennu is commonly found among fast-spinning asteroids and binary asteroid primaries, and might have contributed significantly to binary asteroid formation. Yet a detailed geophysical analysis of this morphology for a fast-spinning asteroid has not been possible prior to the Origins, Spectral Interpretation, Resource Identification, and Security-Regolith Explorer (OSIRIS-REx) mission. Combining the measured Bennu mass and shape obtained during the Preliminary Survey phase of OSIRIS-REx, we find a significant transition in Bennu's surface slopes within its rotational Roche lobe, defined as the region where material is energetically trapped to the surface. As the intersection of the rotational Roche lobe with Bennu's surface has been most recently migrating towards its equator (given Bennu's increasing spin rate), we infer that Bennu's surface slopes have been changing across its surface within the last million years. We also find evidence for substantial density heterogeneity within this body, suggesting that its interior has a distribution of voids and boulders. The presence of such heterogeneity and Bennu's top-shape is consistent with spin-induced failure at some point in its past, although the manner of its failure cannot be determined yet. Future measurements by the OSIRIS-REx spacecraft will give additional insights and may resolve questions regarding the formation and evolution of Bennu's top-shape morphology and its link to the formation of binary asteroids.

Analytic Form of Planar Two-Loop Five-Gluon Scattering Amplitudes in QCD

We present the analytic form of the planar two-loop five-gluon scattering amplitudes in QCD for a complete set of independent helicity configurations of external gluons. These include the first analytic results for five-point two-loop amplitudes relevant for the computation of next-to-next-to-leading-order QCD corrections at hadron colliders. The results were obtained by reconstructing analytic expressions from numerical evaluations. The complexity of the computation is reduced by exploiting physical and analytical properties of the amplitudes, employing a minimal basis of so-called pentagon functions that have recently been classified.

Phosphorus Retention in Intact and Drained Prairie Wetland Basins: Implications for Nutrient Export

Draining of geographically isolated (no defined inlet or outlet) freshwater mineral soil wetlands has likely converted areas that acted historically as important P sinks to sources of P. To explore the role of wetland drainage on nonpoint-source P pollution, differences in the chemical characteristics and P sorption parameters of drained and intact wetlands were investigated in a small watershed situated in the Prairie Pothole Region of southwestern Manitoba, Canada. Chemical characteristics and P sorption parameters varied across landscape positions, particularly for landscape positions that were submerged. Intact wetlands had slightly higher concentrations of organic and total P relative to drained wetlands, which is indicative of their P trapping capacity. More importantly, the maximum P sorption capacity and P buffering capacity of intact wetlands were 3.6 (1752 vs. 492 mg kg) and 17 (1394 vs. 84 L kg) times greater than those in drained wetlands. Conversely, equilibrium P concentrations and bioavailable P concentrations in drained wetlands were an order of magnitude greater than those in intact prairie wetlands. Our study suggests that intact prairie wetlands may be effective sinks for P. As a result, prairie wetlands may play an important role in mitigating nonpoint-source pollution. Conversely, our findings suggest that drained prairie wetlands are potentially a high risk for P export and should be treated as important critical source areas within prairie watersheds.

Ibogaine Detoxification Transitions Opioid and Cocaine Abusers Between Dependence and Abstinence: Clinical Observations and Treatment Outcomes

Ibogaine may be effective for transitioning opioid and cocaine dependent individuals to sobriety. American and European self-help groups provided public testimonials that ibogaine alleviated drug craving and opioid withdrawal symptoms after only a single dose administration. Preclinical studies in animal models of addiction have provided proof-of-concept evidence in support of these claims. However, the purported therapeutic benefits of ibogaine are based on anecdotal reports from a small series of case reports that used retrospective recruitment procedures. We reviewed clinical results from an open label case series (N = 191) of human volunteers seeking to detoxify from opioids or cocaine with medical monitoring during inpatient treatment. Whole blood was assayed to obtain pharmacokinetic measures to determine the metabolism and clearance of ibogaine. Clinical safety data and adverse events (AEs) were studied in male and female subjects. There were no significant adverse events following administration of ibogaine in a dose range that was shown to be effective for blocking opioid withdrawal symptoms in this study. We used multi-dimensional craving questionnaires during inpatient detoxification to test if ibogaine was effective in diminishing heroin and cocaine cravings. Participants also completed standardized questionnaires about their health and mood before and after ibogaine treatment, and at program discharge. One-month follow-up data were reviewed where available to determine if ibogaine's effects on drug craving would persist outside of an inpatient setting. We report here that ibogaine therapy administered in a safe dose range diminishes opioid withdrawal symptoms and reduces drug cravings. Pharmacological treatments for opioid dependence include detoxification, narcotic antagonists and long-term opioid maintenance therapy. Our results support product development of single oral dose administration of ibogaine for the treatment of opioid withdrawal during medically supervised detoxification to transition drug dependent individuals to abstinence.

Alternative Inventory and Distribution Policies for a Regional Blood Banking System

This paper deals with the application of mathematical methods to the inventory of blood units in a regional supply system.

A complex simulation model was designed and implemented in the discrete simulation language SIMSCRIPT to investigate alternative inventory and distribution policies for blood units by means of defined objective criteria. These procedures include a method for inventory forecasting and blood donor call-up and a heuristic allocation model for blood units.

Empirical data was collected from the Berlin Blood Donor Service for model construction and validation.

The simulation results suggest that the inventory procedures presented may lead to a considerable cost reduction in a regional blood banking system.

A specific statistical testing procedure was employed to justify the simulation results statistically. In the final section it is suggested that the inventory methods described in this paper can be implemented within a computer information system providing the blood bank management with decision aids.

A Review of Computer Systems in Blood Banks and Discussion of the Applicability of Mathematical Decision Methods

The fast progress of transfusion medicine is leading to higher requirements in blood donor and transfusion services which can only be met by EDP in the long run.

This article gives an overview on the state of EDP system development in blood banks. The emphasis is on EDP systems in blood donor services. However, some transfusion medical EDP applications are also mentioned. The functional application areas of EDP are shown. The cost-benefit ratio of computer systems in this field is discussed and systems in operation or under development are compared in tabulated, form. Of particular interest in this comparison is the aspect of the applicability of mathematical decision methods for providing decision aids in blood banks by the computer.

The cost-efficiency of systems providing improved medical services at the same time leads to the conclusion that a fast growth of EDP applications in blood donor and transfusion services can be expected.

Evidence of an abnormal epithelial barrier in active, untreated and corticosteroid-treated eosinophilic esophagitis

BACKGROUND

Eosinophilic esophagitis (EoE) is a chronic, immune/antigen-mediated disease characterized by symptoms related to esophageal dysfunction and an eosinophil-predominant inflammation. This study has aimed to investigate whether the recently observed sensitization to Candida albicans in patients with EoE is owing to pre-existing disease and its underlying abnormal epithelial barrier or, alternatively, is linked to corticosteroid (CS) therapy.

METHODS

Medical histories, as well as serum and tissue samples of 60 patients with EoE (15 CS naive, 45 with current or previous CS therapy) and 20 controls, stored in the Swiss Eosinophilic Esophagitis Database (SEED) and Biobank, were analyzed. We applied ImmunoCAP to measure IgE levels and immunofluorescence techniques to examine epithelial barrier components.

RESULTS

Patients with EoE had higher total IgE levels and were more frequently sensitized to C. albicans than controls. In EoE tissue specimens, increased numbers of eosinophils and mast cells, a higher expression levels of thymic stromal lymphopoietin (TSLP), cathelicidin, proteases, that is, the kallikreins (KLK)-5 and KLK-7, were observed as compared with controls, while reduced expression of lympho-epithelial Kazal-type-related inhibitor (LEKTI), filaggrin, E-cadherin, claudin, occludin, desmoglein-1 was found, independent of CS therapy. In CS-treated EoE, significantly lower numbers of CD1a+ cells and cathelicidin expression were noted as compared to CS-naive EoE.

CONCLUSION

This study provides further evidence that EoE is associated with an abnormal epithelial barrier and postulates that CS therapy, by reducing innate immune mechanisms, may promote C. albicans colonization and likely subsequent sensitization.

Two-Loop Four-Gluon Amplitudes from Numerical Unitarity

We present the first numerical computation of two-loop amplitudes based on the unitarity method. As a proof of principle, we compute the four-gluon process in the leading-color approximation. We discuss the new method, analyze its numerical properties, and apply it to reconstruct the analytic form of the amplitudes. The numerical method is universal, and can be automated to provide multiscale two-loop computations for phenomenologically relevant signatures at hadron colliders.

First measurement of neutrino and antineutrino coherent charged pion production on argon

We report on the first cross section measurements for charged current coherent pion production by neutrinos and antineutrinos on argon. These measurements are performed using the ArgoNeuT detector exposed to the NuMI beam at Fermilab. The cross sections are measured to be 2.6(-1.0)(+1.2)(stat)(-0.4)(+0.3)(syst)×10(-38)  cm(2)/Ar for neutrinos at a mean energy of 9.6 GeV and 5.5(-2.1)(+2.6)(stat)(-0.7)(+0.6)(syst)×10(-39)  cm(2)/Ar for antineutrinos at a mean energy of 3.6 GeV.

Can a tibial tunnel in ACL surgery be placed anatomically without impinging on the femoral notch? A risk factor analysis

PURPOSE

To analyze anatomical risk factors and surgical technique dependent variables, which determine the risk for femoral notch impingement in anatomically correct placed tibial tunnels for anterior cruciate ligament (ACL) surgery.

METHODS

Twenty fresh frozen adult human knee specimens under the age of 65 years were used. Digital templates mimicking a tibial tunnel aperture at the tibia plateau were designed for different tibial tunnel diameters and different drill-guide angles. The centres of these templates were placed over the geometric centre of the native tibial ACL footprint. The distances between the anterior borders of the templates and the anterior borders of the footprints (graft free zone) were measured and compared. Furthermore, anatomic risk factors for femoral notch impingement were determined.

RESULTS

The graft free zone was statistically significantly longer for larger drill-guide angles compared to smaller drill-guide angles (p < 0.00001). Furthermore, 8 mm diameter tibial tunnels had a statistically significant larger graft free zone compared to 10-mm-diameter tibial tunnels (p < 0.00001). For the 10 mm diameter tibial tunnels with drill-guide angle of 45°, 9 out of 20 knees (45 %) were "at risk" for notching and 4 out of 20 knees (20 %) had "definite" notching. For 10-mm tunnels with drill-guide angle of 45°, a risk for notching was associated with smaller tibial ACL footprint (p < 0.05).

CONCLUSION

If a perfect centrally positioned tibial tunnel is drilled, a real risk for femoral notch impingement exists depending on the size of the tibial ACL footprint and surgery-related factors. Therefore, in anatomical tibial tunnel placement in single bundle ACL reconstruction surgery, particular attention should be paid to size of the tunnel and drill-guide angle to minimize the risk of femoral notch impingement.

Target feeding for improved smallholder beef production in the Mekong region: lessons from Cambodia and Lao PDR

Increased demand for red meat throughout the Greater Mekong Subregion (GMS) presents smallholder cattle and buffalo farmers with an opportunity to supply better quality animals to expanding regional markets. Cattle were target-fed in Cambodia with introduced forages to achieve gains of 0.19 kg/day over a 104-day period and this practice was compared with traditional cut-and-carry feeding practices where animals lost on average 0.04 kg/day. Target-fed animals were predicted to gain, on average, 25.9 kg more weight than animals fed in a traditional manner (P = 0.057), and to improve their estimated value by more than US$60. These outcomes were similar to outcomes in Lao PDR, where cattle and buffalo in fattening stalls gained 0.32 and 0.22 kg/day, respectively, over a 4-month period, and 0.04 and 0.09 kg/day when free-grazing. Greater weight gains are possible if farmers feed forages at the recommended 15% of bodyweight on a fresh-weight basis per day. Lack of knowledge of animal weights by farmers and traders was addressed by the creation of an accurate weight tape to provide a cheap and easy tool to monitor animal production and health, and to assist in negotiating a fair sale value. However, increased knowledge of appropriate forage plot size and feeding requirements of animals to be target-fed is required for farmers to change from being livestock keepers to livestock producers. To increase supply for the growing demand for red meat, an ongoing, multi-disciplinary extension program should be a priority for livestock improvement programs in the GMS.

First measurements of inclusive muon neutrino charged current differential cross sections on argon

The ArgoNeuT Collaboration presents the first measurements of inclusive muon neutrino charged current differential cross sections on argon. Obtained in the NuMI neutrino beam line at Fermilab, the flux-integrated results are reported in terms of outgoing muon angle and momentum. The data are consistent with the Monte Carlo expectation across the full range of kinematics sampled, 0°<θ(μ)<36° and 0<P(μ)<25 GeV/c. Along with confirming the viability of liquid argon time projection chamber technology for neutrino detection, the measurements allow tests of low-energy neutrino scattering models important for interpreting results from long baseline neutrino oscillation experiments designed to investigate CP violation and the orientation of the neutrino mass hierarchy.

Self expanding wall stents in malignant colorectal cancer: is complete obstruction a contraindication to stent placement?

OBJECTIVE

Technical failures have previously been associated with complete clinical obstruction and complete block to the retrograde flow of gastrograffin is considered by some to be a contraindication to the procedure. We report on the technical and clinical success rates of self-expanding metallic stents (SEMS) in both complete and incomplete obstruction in a prospective series of malignant colorectal obstructions.

METHOD

A prospective study of all patients undergoing attempted palliative and bridge to surgery SEMS placement for malignant colorectal obstruction over a 7-year period (April 1999-October 2006) was undertaken.

RESULTS

Seventy-two patients (49 males) with a mean age of 71 years (range 49-98) were included. Technical success was achieved in 27 of 32 patients (84%) with complete obstruction and 33 of 36 patients (92%) with incomplete obstruction, P < 0.46, Fishers exact test. Clinical success was achieved in 17 of 26 patients (65%) with complete obstruction and 24 of 33 patients (73%) with incomplete obstruction, P < 0.58, Fishers exact test. Although placed correctly in 89% cases, relief of symptoms occurred in only 71%, P = 0.002, matched pairs test. There were two colonic perforations in the series with one procedure related death.

CONCLUSION

Placement of SEMS for obstructing colorectal cancer is technically successful in a high proportion of cases. Complete radiological obstruction is not a contraindication to stent placement. The relief of obstructive symptoms following successful placement of a wall stent is less predictable.

Reversal of refractory septic shock with drotrecogin alpha (activated)

OBJECTIVE

We previously reported that early continuous veno-venous hemodiafiltration (CVVHDF) enables rapid identification of a subgroup of patients with "refractory" septic shock and a 100% risk of death. The objective of this study was to investigate whether early administration of drotrecogin alpha (activated) (DrotAA) to this selected subgroup of septic patients at extremely high risk of death would significantly improve prognosis.

METHOD

Prospective observational study in a medical intensive-care unit of a University Hospital. Twenty-three patients with refractory septic shock were included. "Refractory" shock was defined as persistent circulatory failure despite adequate circulatory support, associated with persisting lactic acidosis despite early CVVHDF. Response to CVVDHF was assessed after 6 h of this continuous procedure. Patients selected by this strategy received DrotAA infusion for four days.

RESULTS

The 28-day mortality rate of the 23 patients was 39%. No difference was observed at inclusion between survivors and nonsurvivors. In patients who finally survived, 12 h of DrotAA infusion was associated with a significant decrease in lactic acidosis and in norepinephrine dose.

CONCLUSION

DrotAA therapy was associated with unexpectedly high 28-day survival in patients with "refractory" septic shock.

Reflections on 40 Years of Drug Abuse Research: Changes in the Epidemiology of Drug Abuse

The discipline of epidemiology utilizes the constructs of agent, host, vector, and environment to study the incidence and prevalence (i.e., the nature, extent, distribution, correlates) and the contexts, and consequences of drug abuse in the United States. This paper provides a selected review of the results of 40 years of epidemiological study of drug abuse using surveillance systems, general population surveys, ethnography and qualitative research approaches. It then addresses the challenges in conducting research on drug abuse epidemiology. The paper concludes with some missed opportunities and lessons learned in four decades of a large portfolio of research studies conducted by an impressive array of distinguished scientists.

Effect of seasonal changes in upwelling activity on the foraging locations of a wide-ranging central-place forager, the New Zealand fur seal

Lactating New Zealand fur seals ( Arctocephalus forsteri (Lesson, 1828)) that breed at Cape Gantheaume, South Australia, experience broad-scale seasonal changes in ocean productivity. To assess how seasonal changes in ocean productivity influenced foraging behaviour, 18 lactating New Zealand fur seals were fitted with satellite transmitters and time–depth recorders (TDRs). Using temperature and depth data from TDRs, we used the presence of thermoclines as a surrogate measure of upwelling activity in continental-shelf waters. During the austral autumn 80% of lactating fur seals foraged on the continental shelf (114 ± 44 km from the colony), in a region associated with the Bonney upwelling. In contrast, during winter months seals predominantly foraged in oceanic waters (62%), in a region associated with the Subtropical Front (460 ± 138 km from the colony). Our results indicate that lactating New Zealand fur seals shift their foraging location from continental-shelf to oceanic waters in response to a seasonal decline in productivity over the continental shelf, attributed to the cessation of the Bonney upwelling. This study identified two regions used by lactating New Zealand fur seals: (1) a nearby and seasonally productive upwelling system and (2) a distant and permanent oceanic front.

[Evaluation of amoxicillin-clavulanic acid prescriptions in a teaching hospital of Parisian suburb]

OBJECTIVE

Prospective study of amoxicillin-clavulanic acid (amox-clav) prescriptions in the medical departments of a teaching hospital that prescribes this antibiotic very often.

DESIGN

From April to May 2004, each patient treated by amox-clav was included. Data were collected (age, sex, past diseases, associated-diseases, reason for hospitalization, prior antibiotic therapy, date of amox-clav prescription, indication for amox-clav prescription, other associated antibiotics, nosocomial or community-acquired infection, site of infection, bacteriologic samples and bacterial identification, treatment duration and status of the physician). Data were analysed by a muldisciplinary group and compared with a referential used for antibiotic prescriptions in our hospital.

RESULTS

One hundred and two medical files were analysed. Seventy-one percent of amox-clav prescriptions were in adequation with the referential. Combination of three criteria (indication of antibiotic therapy, choice of amox-clav and of an antibiotic combination) showed that 58 (57%) was acceptable, 29 (28%) was debatable and 15 (15%) was unacceptable. Unacceptable prescriptions were often made by a junior. The majority of inadequate antibiotic prescriptions referred to acute pulmonary infections. Antibiotic combinations were often inadequate and treatment duration was too long. The quality of the prescription was more accurate when made by a senior.

CONCLUSION

An effort should be made in our teaching hospital to optimize antibiotic prescriptions.

Cellular immunology in HIV-1 positive African American women using alcohol and cocaine

Co-use of illicit drugs, in particular cocaine and alcohol, is common among HIV-1(+) men and women of different ethnic groups. We compared cohorts of alcohol and cocaine co-users HIV-1(+) African American women and in cohorts of drug-free, or methamphetamine users HIV-1(+) men. We monitored clinical cellular immune parameters at repeated regular intervals. We found that significant inverse correlations between (CD8+)CD38+ cells and subpopulations of CD4+ cells distinguished by the expression of CD45RA in HIV-1(+) alcohol and cocaine co- users but not in drug-free HIV-1(+) patients. Following stratification for CD4+ cell number, we found the (CD4+)CD45RA+ subpopulation to be significantly higher (p < 0.05) in the drug user compared to drug-free HIV-1(+). Drug abuse may alter the change from the (CD4+)CD45RA+ to the (CD4+)CD45RA- phenotype selectively, which recovers in HIV-1+ methamphetamine abusers during treatment from baseline to 4-weeks, as manifested by improved IL-2 production in vitro. of TH1 and TH2 cytokines during progression to AIDS.

Prospective study on the presentation and outcome of patients with an acute hernia

Recent advances in hernia surgery should help to make operation more acceptable to patients and their doctors. The aim of this study was to prospectively assess the presentation and management of patients with an acute hernia in light of these changes. Data on all patients admitted with an acute hernia between March 2001 and February 2004 was entered on a prospective database. During the 3 year study period, of the 91 patients admitted with an acute hernia, 41 were ventral, 24 femoral, 24 inguinal and 2 parastomal. Forty-six had a previous medical assessment, 18 of these had been declared unfit for operation at that assessment; ten were ASA4 (ASA, American Society of Anaesthesiology), five ASA3 and three ASA2. Eleven patients were on the waiting list for operation, three of whom had a previous acute hospital admission. For 30 patients this hospital admission was the first indication that they had a hernia while the remaining were aware that they had a hernia but did not seek medical advice. Of the five patients who died, two while being assessed for operation and three postoperatively, three were ASA4 and had a ventral hernia while two were ASA3 with a femoral hernia. Despite advances in hernia surgery there is still room for improvement in preoperative assessment of patients presenting with an acute hernia.

The ontogeny of diving behaviour in New Zealand fur seal pups (Arctocephalus forsteri)

This study investigated the development of diving in 21 New Zealand fur seal pups, Arctocephalus forsteri (Lesson, 1828), prior to weaning at Cape Gantheaume, Kangaroo Island. Diving behaviour was examined using time–depth recorders, which were deployed during two time periods, 5 months prior to weaning (n = 6) and 2 months prior to weaning (n = 15). Scats were also examined to assess whether fur seal pups foraged prior to weaning. The maximum dive depth attained was 44 m, while the maximum dive duration was 3.3 min. Immediately prior to weaning, fur seal pups spent a greater proportion of their time diving at night, and concomitantly several measures of diving performance also increased. In general, pups dived successively deeper (6–44 m between June and September), and the average number of dives per day, dive frequency, and vertical distance travelled increased. Prey remains were present in approximately 30% of scats and indicated that some pups were foraging as early as June (5–6 months of age, approximately 4–5 months prior to weaning). Of the scats that contained prey remains, fish (South American pilchard, Sardinops sagax (Jenyns, 1842); Australian anchovy, Engraulis australis (White, 1790); and redbait, Emmelichthys nitidus Richardson, 1845) accounted for 43% of the prey items found, crustaceans accounted for 36%, and cephalopods (Gould's squid, Nototodarus gouldi (McCoy, 1888)) accounted for 20%.