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Sample records for manage withdrawal related

  1. Methadone Management of Withdrawal Associated With Loperamide-related Opioid Use Disorder.

    Science.gov (United States)

    Leo, Raphael J; Ghazi, Muhammad A; Jaziri, Kelly S

    : Loperamide hydrochloride is an over-the-counter anti-diarrheal agent, acting via mu-opioid receptor agonist effects in the intestinal myenteric plexus. Although preclinical investigations suggested that abuse liability associated with loperamide use is low, there are increasing numbers of cases reported to the US Food and Drug Administration, of abuse, dependence, and withdrawal associated with loperamide use. A case of a patient with opioid use disorder, that is, in the form of protracted loperamide excess use, requiring management of withdrawal with methadone is presented. Management of withdrawal from abrupt loperamide discontinuation has not been discussed in the literature. Long-term treatment issues are also described.

  2. Buprenorphine for managing opioid withdrawal.

    Science.gov (United States)

    Gowing, Linda; Ali, Robert; White, Jason M; Mbewe, Dalitso

    2017-02-21

    outcome. Buprenorphine is more effective than clonidine or lofexidine for managing opioid withdrawal in terms of severity of withdrawal, duration of withdrawal treatment, and the likelihood of treatment completion.Buprenorphine and methadone appear to be equally effective, but data are limited. It remains possible that the pattern of withdrawal experienced may differ and that withdrawal symptoms may resolve more quickly with buprenorphine.It is not possible to draw any conclusions from the available evidence on the relative effectiveness of different rates of tapering the buprenorphine dose. The divergent findings of studies included in this review suggest that there may be multiple factors affecting the response to the rate of dose taper. One such factor could be whether or not the initial treatment plan includes a transition to subsequent relapse prevention treatment with naltrexone. Indeed, the use of buprenorphine to support transition to naltrexone treatment is an aspect worthy of further research.Most participants in the studies included in this review were male. None of the studies reported outcomes on the basis of sex, preventing any exploration of differences related to this variable. Consideration of sex as a factor influencing response to withdrawal treatment would be relevant research for selecting the most appropriate type of intervention for each individual.

  3. Aggression and withdrawal related behavior within conflict management progression in preschool boys with language impairment.

    Science.gov (United States)

    Horowitz, Laura; Westlund, Karolina; Ljungberg, Tomas

    2007-10-01

    This study examined conflict behavior in naturalistic preschool settings to better understand the role of non-affiliative behavior and language in conflict management. Free-play at preschool was filmed among 20 boys with typically developing language (TL) and among 11 boys with Language Impairment (LI); the boys 4-7 years old. Conflict behavior was coded and analyzed with a validated system. Post-conflict non-affiliative behavior (aggression and withdrawal) displays, and the links between the displays and reconciliation (i.e., former opponents exchange friendly behavioral shortly after conflict termination) was examined. Group comparisons revealed boys with LI displayed aggression in a smaller share of conflicts, but exhibited [Symbol: see text]active' withdrawal (left the room), in a larger conflict share. Boys with TL overcame aggression (more common TL behavior) and after reconciled, to a greater extent than the boys with LI after active withdrawal (more common LI behavior). Also, after reciprocal or only verbal aggression, boys with LI reconciled to a lesser extent than boys with TL. The boys with LI demonstrated difficulties confronting conflict management, as well as concluding emotionally heightened and aggressive behavioral turns.

  4. Aggression and Withdrawal Related Behavior within Conflict Management Progression in Preschool Boys with Language Impairment

    Science.gov (United States)

    Horowitz, Laura; Westlund, Karolina; Ljungberg, Tomas

    2007-01-01

    Objective: This study examined conflict behavior in naturalistic preschool settings to better understand the role of non-affiliative behavior and language in conflict management. Method: Free-play at preschool was filmed among 20 boys with typically developing language (TL) and among 11 boys with Language Impairment (LI); the boys 4-7 years old.…

  5. The benzodiazepine withdrawal syndrome and its management.

    OpenAIRE

    Onyett, S R

    1989-01-01

    The literature on benzodiazepine dependence and withdrawal is reviewed with an emphasis on social and psychological considerations. The problems of when to prescribe, identifying withdrawal symptoms, effective communication with the patient, the structure of withdrawal programmes, and the use of drugs, psychological approaches and other services are discussed.

  6. Clinical management of alcohol withdrawal: A systematic review

    Directory of Open Access Journals (Sweden)

    Shivanand Kattimani

    2013-01-01

    Full Text Available Alcohol withdrawal is commonly encountered in general hospital settings. It forms a major part of referrals received by a consultation-liaison psychiatrist. This article aims to review the evidence base for appropriate clinical management of the alcohol withdrawal syndrome. We searched Pubmed for articles published in English on pharmacological management of alcohol withdrawal in humans with no limit on the date of publication. Articles not relevant to clinical management were excluded based on the titles and abstract available. Full-text articles were obtained from this list and the cross-references. There were four meta-analyses, 9 systematic reviews, 26 review articles and other type of publications like textbooks. Alcohol withdrawal syndrome is a clinical diagnosis. It may vary in severity. Complicated alcohol withdrawal presents with hallucinations, seizures or delirium tremens. Benzodiazepines have the best evidence base in the treatment of alcohol withdrawal, followed by anticonvulsants. Clinical institutes withdrawal assessment-alcohol revised is useful with pitfalls in patients with medical comorbidities. Evidence favors an approach of symptom-monitored loading for severe withdrawals where an initial dose is guided by risk factors for complicated withdrawals and further dosing may be guided by withdrawal severity. Supportive care and use of vitamins is also discussed.

  7. Smartphone Restriction and its Effect on Subjective Withdrawal Related Scores

    OpenAIRE

    Aarestad, Sarah Helene; Eide, Tine Almenning

    2017-01-01

    Smartphone overuse is associated with a number of negative consequences for the individual and the environment. In the right end of the distribution of smartphone usage, concepts such as smartphone addiction seem warranted. An area that so far lacks research concerns the effect of smartphone restriction generally and specifically on subjective withdrawal related scores across different degrees of smartphone usage. The present study examined withdrawal related scores on the Smartphone Withdraw...

  8. 76 FR 39857 - Alaska Coastal Management Program Withdrawal From the National Coastal Management Program Under...

    Science.gov (United States)

    2011-07-07

    ... DEPARTMENT OF COMMERCE National Oceanic Atmospheric Administration Alaska Coastal Management Program Withdrawal From the National Coastal Management Program Under the Coastal Zone Management Act (CZMA) AGENCY: Office of Ocean and Coastal Resource Management (OCRM), National Ocean Service (NOS...

  9. A 'symptom-triggered' approach to alcohol withdrawal management.

    Science.gov (United States)

    Murdoch, Jay; Marsden, Janet

    In acute hospital settings, alcohol withdrawal often causes significant management problems and complicates a wide variety of concurrent conditions, placing a huge burden on the NHS. A significant number of critical incidents around patients who were undergoing detoxification in a general hospital setting led to the need for a project to implement and evaluate an evidence-based approach to the management of alcohol detoxification-a project that included a pre-intervention case note audit, the implementation of an evidence-based symptom-triggered detoxification protocol, and a post-intervention case note audit. This change in practice resulted in an average reduction of almost 60% in length of hospital stay and a 66% reduction in the amount of chlordiazepoxide used in detoxification, as well as highlighting that 10% of the sample group did not display any signs of withdrawal and did not require any medication. Even with these reductions, no patient post-intervention developed any severe signs of withdrawal phenomena, such as seizures or delirium tremens. The savings to the trust (The Pennine Acute Hospital Trust) are obvious,but the development of a consistent, quality service will lead to fewer long-term negative effects for patients that can be caused by detoxification. This work is a project evaluation of a locally implemented strategy, which, it was hypothesised,would improve care by providing an individualised treatment plan for the management of alcohol withdrawal symptoms.

  10. 76 FR 14592 - Safety Management System; Withdrawal

    Science.gov (United States)

    2011-03-17

    ...), Federal Aviation Administration, 800 Independence Avenue, SW., Washington, DC 20591; telephone (202) 494...). The FAA also chartered the Safety Management System Aviation Rulemaking Committee (ARC) (Order No..., including the ANPRM. On March 31, 2010, the ARC submitted its report to the FAA. As a result of the...

  11. Experience of the use of Ketamine to manage opioid withdrawal in an addicted woman: a case report.

    Science.gov (United States)

    Lalanne, Laurence; Nicot, Chloe; Lang, Jean-Philippe; Bertschy, Gilles; Salvat, Eric

    2016-11-10

    Opioids are good painkillers, but many patients treated with opioids as painkillers developed a secondary addiction. These patients need to stop misusing opioids, but the mild-to-severe clinical symptoms associated with opioid withdrawal risk increasing their existing pain. In such cases, ketamine, which is used by anaesthetists and pain physicians to reduce opioid medication, may be an effective agent for managing opioid withdrawal. We describe the case of a woman who developed a severe secondary addiction to opioids in the context of lombo-sciatic pain. She presented a severe opioid addiction, and her physicians refused to prescribe such high doses of opioid treatment (oxycontin® extended-release 120 mg daily, oxycodone 60 mg daily, and acetaminophen/codeine 300 mg/25 mg 6 times per day). To assist her with her opioid withdrawal which risked increasing her existing pain, she received 1 mg/kg ketamine oral solution, and two days after ketamine initiation her opioid treatment was gradually reduced. The patient dramatically reduced the dosage of opioid painkillers and ketamine was withdrawn without any withdrawal symptoms. Ketamine displays many interesting qualities for dealing with all symptoms relating to opioid withdrawal. Accordingly, it could be used instead of many psychotropic treatments, which interact with each other, to help with opioid withdrawal. However, the literature describes addiction to ketamine. All in all, although potentially addictive, ketamine could be a good candidate for the pharmacological management of opioid withdrawal.

  12. Phenibut (β-Phenyl-γ-aminobutyric Acid) Dependence and Management of Withdrawal: Emerging Nootropics of Abuse.

    Science.gov (United States)

    Ahuja, Tania; Mgbako, Ofole; Katzman, Caroline; Grossman, Allison

    2018-01-01

    This case report describes the development of withdrawal from phenibut, a gamma-aminobutyric acid-receptor type B agonist. Although phenibut is not an FDA-approved medication, it is available through online retailers as a nootropic supplement. There are reports of dependence in patients that misuse phenibut. We report a case in which a patient experienced withdrawal symptoms from phenibut and was successfully treated with a baclofen taper. This case report highlights the development of phenibut use disorder with coingestion of alcohol and potential management for phenibut withdrawal. We believe clinicians must be aware of how phenibut dependence may present and how to manage the withdrawal syndrome.

  13. Phenibut (β-Phenyl-γ-aminobutyric Acid Dependence and Management of Withdrawal: Emerging Nootropics of Abuse

    Directory of Open Access Journals (Sweden)

    Tania Ahuja

    2018-01-01

    Full Text Available This case report describes the development of withdrawal from phenibut, a gamma-aminobutyric acid-receptor type B agonist. Although phenibut is not an FDA-approved medication, it is available through online retailers as a nootropic supplement. There are reports of dependence in patients that misuse phenibut. We report a case in which a patient experienced withdrawal symptoms from phenibut and was successfully treated with a baclofen taper. This case report highlights the development of phenibut use disorder with coingestion of alcohol and potential management for phenibut withdrawal. We believe clinicians must be aware of how phenibut dependence may present and how to manage the withdrawal syndrome.

  14. Withdrawal-Related Changes in Delay Discounting Predict Short-Term Smoking Abstinence.

    Science.gov (United States)

    Miglin, Rickie; Kable, Joseph W; Bowers, Maureen E; Ashare, Rebecca L

    2017-06-01

    Impulsive decision making is associated with smoking behavior and reflects preferences for smaller, immediate rewards and intolerance of temporal delays. Nicotine withdrawal may alter impulsive decision making and time perception. However, little is known about whether withdrawal-related changes in decision making and time perception predict smoking relapse. Forty-five smokers (14 female) completed two laboratory sessions, one following 24-hour abstinence and one smoking-as-usual (order counterbalanced; biochemically verified abstinence). During each visit, participants completed measures of time perception, decision making (ie, discount rates), craving, and withdrawal. Following the second laboratory session, subjects underwent a well-validated model of short-term abstinence (quit week) with small monetary incentives for each day of biochemically confirmed abstinence. Smokers significantly overestimated time during abstinence, compared to smoking-as-usual (p = .021), but there were no abstinence effects on discount rates (p = .6). During the quit week, subjects were abstinent for 3.5 days (SD = 2.15) and smoked a total of 12.9 cigarettes (SD = 15.8). Importantly, higher discount rates (ie, preferences for immediate rewards) during abstinence (abstinence minus smoking difference score) predicted greater number of days abstinent (p = .01) and fewer cigarettes smoked during the quit week (p = .02). Withdrawal-related change in time reproduction did not predict relapse (p = .2). These data suggest that individuals who have a greater preference for immediate rewards during abstinence (vs. smoking-as-usual) may be more successful at maintaining short-term abstinence when provided with frequent (eg, daily) versus less frequent incentive schedules (eg, 1 month). Abstinence-induced changes in decision making may be important for identifying smokers who may benefit from interventions that incentivize abstinence such as contingency management (CM). The present results

  15. Iatrogenic Opioid Withdrawal in Critically Ill Patients: A Review of Assessment Tools and Management.

    Science.gov (United States)

    Chiu, Ada W; Contreras, Sofia; Mehta, Sangeeta; Korman, Jennifer; Perreault, Marc M; Williamson, David R; Burry, Lisa D

    2017-12-01

    To (1) provide an overview of the epidemiology, clinical presentation, and risk factors of iatrogenic opioid withdrawal in critically ill patients and (2) conduct a literature review of assessment and management of iatrogenic opioid withdrawal in critically ill patients. We searched MEDLINE (1946-June 2017), EMBASE (1974-June 2017), and CINAHL (1982-June 2017) with the terms opioid withdrawal, opioid, opiate, critical care, critically ill, assessment tool, scale, taper, weaning, and management. Reference list of identified literature was searched for additional references as well as www.clinicaltrials.gov . We restricted articles to those in English and dealing with humans. We identified 2 validated pediatric critically ill opioid withdrawal assessment tools: (1) Withdrawal Assessment Tool-Version 1 (WAT-1) and (2) Sophia Observation Withdrawal Symptoms Scale (SOS). Neither tool differentiated between opioid and benzodiazepine withdrawal. WAT-1 was evaluated in critically ill adults but not found to be valid. No other adult tool was identified. For management, we identified 5 randomized controlled trials, 2 prospective studies, and 2 systematic reviews. Most studies were small and only 2 studies utilized a validated assessment tool. Enteral methadone, α-2 agonists, and protocolized weaning were studied. We identified 2 validated assessment tools for pediatric intensive care unit patients; no valid tool for adults. Management strategies tested in small trials included methadone, α-2 agonists, and protocolized sedation/weaning. We challenge researchers to create validated tools assessing specifically for opioid withdrawal in critically ill children and adults to direct management.

  16. 75 FR 71559 - Hazardous Waste Management System; Identification and Listing of Hazardous Waste; Withdrawal of...

    Science.gov (United States)

    2010-11-24

    ... ENVIRONMENTAL PROTECTION AGENCY 40 CFR Part 261 [EPA-R06-RCRA-2010-0066; SW FRL-9231-4] Hazardous Waste Management System; Identification and Listing of Hazardous Waste; Withdrawal of Direct Final Exclusion AGENCY: Environmental Protection Agency (EPA). ACTION: Withdrawal of direct final exclusion...

  17. Object relations, reality testing, and social withdrawal in schizophrenia and bipolar disorder.

    Science.gov (United States)

    Hansen, Charlotte Fredslund; Torgalsbøen, Anne-Kari; Røssberg, Jan Ivar; Romm, Kristin Lie; Andreassen, Ole Andreas; Bell, Morris D; Melle, Ingrid

    2013-03-01

    In this study, we investigated the relationships between observed social withdrawal (Positive and Negative Syndrome Scale [PANSS] Passive Social Withdrawal and PANSS Active Social Avoidance), subjectively experienced social withdrawal (Social Functioning Scale [SFS] Withdrawal and SFS Interpersonal Behavior), and their associations to the underlying psychological patterns of Object Relations and Reality Testing. Patients with schizophrenia (n = 55) and bipolar disorder (n = 51) from the ongoing Thematically Organized Psychosis project, Oslo University Hospital, Norway, were evaluated using the Bell Object Relations and Reality Testing Inventory, the PANSS, and the SFS. Object relations and reality testing subscales related differentially to PANSS Passive Social Withdrawal and PANSS Active Social Avoidance. These two measures, together with the level of alienation, explained a significant amount of variance in self-experienced social dysfunction. Findings reveal the multidimensional nature of social dysfunction in severe mental disorders.

  18. Recognition and management of iatrogenically induced opioid dependence and withdrawal in children.

    Science.gov (United States)

    Galinkin, Jeffrey; Koh, Jeffrey Lee

    2014-01-01

    Opioids are often prescribed to children for pain relief related to procedures, acute injuries, and chronic conditions. Round-the-clock dosing of opioids can produce opioid dependence within 5 days. According to a 2001 Consensus Paper from the American Academy of Pain Medicine, American Pain Society, and American Society of Addiction Medicine, dependence is defined as "a state of adaptation that is manifested by a drug class specific withdrawal syndrome that can be produced by abrupt cessation, rapid dose reduction, decreasing blood level of the drug, and/or administration of an antagonist." Although the experience of many children undergoing iatrogenically induced withdrawal may be mild or goes unreported, there is currently no guidance for recognition or management of withdrawal for this population. Guidance on this subject is available only for adults and primarily for adults with substance use disorders. The guideline will summarize existing literature and provide readers with information currently not available in any single source specific for this vulnerable pediatric population.

  19. Neuroticism and Conscientiousness as Moderators of the Relation Between Social Withdrawal and Internalizing Problems in Adolescence.

    Science.gov (United States)

    Smith, Kelly A; Barstead, Matthew G; Rubin, Kenneth H

    2017-04-01

    Social withdrawal, or refraining from social interaction in the presence of peers, places adolescents at risk of developing emotional problems like anxiety and depression. The personality traits of neuroticism and conscientiousness also relate to emotional difficulties. For example, high conscientiousness predicts lower incidence of anxiety disorders and depression, while high neuroticism relates to greater likelihood of these problems. Based on these associations, socially withdrawn adolescents high in conscientiousness or low in neuroticism were expected to have lower levels of anxiety and depressive symptoms. Participants included 103 adolescents (59 % female) who reported on their personality traits in 8th grade and their anxiety and depressive symptoms in 9th grade. Peer ratings of social withdrawal were collected within schools in 8th grade. A structural equation model revealed that 8th grade withdrawal positively predicted 9th grade anxiety and depressive symptoms controlling for 8th grade anxiety and depressive symptoms, but neuroticism did not. Conscientiousness moderated the relation of withdrawal with depressive symptoms but not anxiety, such that high levels of conscientiousness attenuated the association between withdrawal and depressive symptoms. This buffering effect may stem from the conceptual relation between conscientiousness and self-regulation. Conscientiousness did not, however, moderate the association between withdrawal and anxiety, which may be partly due to the role anxiety plays in driving withdrawal. Thus, a conscientious, well-regulated personality partially protects withdrawn adolescents from the increased risk of emotional difficulties.

  20. The Combination Very Low-Dose Naltrexone–Clonidine in the Management of Opioid Withdrawal

    Science.gov (United States)

    Mannelli, Paolo; Peindl, Kathleen; Wu, Li-Tzy; Patkar, Ashwin A.; Gorelick, David A.

    2013-01-01

    Background The management of withdrawal absorbs substantial clinical efforts in opioid dependence (OD). The real challenge lies in improving current pharmacotherapies. Although widely used, clonidine causes problematic adverse effects and does not alleviate important symptoms of opioid withdrawal, alone or in combination with the opioid antagonist naltrexone. Very low-dose naltrexone (VLNTX) has been shown to attenuate withdrawal intensity and noradrenaline release following opioid agonist taper, suggesting a combination with clonidine may result in improved safety and efficacy. Objectives We investigated the effects of a VLNTX–clonidine combination in a secondary analysis of data from a double-blind, randomized opioid detoxification trial. Methods Withdrawal symptoms and treatment completion were compared following VLNTX (.125 or .25 mg/day) and clonidine (.1–.2 mg q6h) in 127 individuals with OD undergoing 6-day methadone inpatient taper at a community program. Results VLNTX was more effective than placebo or clonidine in reducing symptoms and signs of withdrawal. The use of VLNTX in combination with clonidine was associated with attenuated subjective withdrawal compared with each medication alone, favoring detoxification completion in comparison with clonidine or naltrexone placebo. VLNTX/clonidine was effective in reducing symptoms that are both undertreated and well controlled with clonidine treatment and was not associated with significant adverse events compared with other treatments. Conclusions and Scientific Significance Preliminary results elucidate neurobiological mechanisms of OD and support the utility of controlled studies on a novel VLNTX + low-dose clonidine combination for the management of opioid withdrawal. PMID:22233189

  1. Effect of Nimodipine on Morphine-related Withdrawal Syndrome in Rat Model: An Observational Study

    Science.gov (United States)

    Mishra, Pravash Ranjan; Barik, Mayadhar; Ray, Subrata Basu

    2017-01-01

    Objective: To observe the effect of L-type calcium channel blocker like nimodipine on morphine's withdrawal when it was administered continuously along with morphine versus a single bolus dose of nimodipine, which was administered at the end of the experiment before the precipitation of withdrawal reaction in morphine-dependent rats. Materials and Methods: Four groups of adult male Wistar rats were rendered morphine dependent by subcutaneous injections of morphine at a dose of 10 mg/kg for 10 days. Nimodipine 10 mg/kg intraperitoneally (ip) administered to one group once daily before morphine administration in the entire experimental period, and another group received nimodipine only once at the end of the experiment as a single bolus dose 2 mg/kg before the administration of naloxone. Naloxone 3 mg/kg was administered ip to all the groups to precipitate withdrawal reactions. The withdrawal reactions were evaluated and scored as per the Gellert and Holtzman global withdrawal rating scale. Results: Nimodipine when administered as a single bolus dose before naloxone administration in morphine-dependant rats reduced the features of withdrawal reactions more effectively than continuous administration of nimodipine along with morphine throughout the experimental period. Conclusion: We discovered that nimodipine helps in attenuating the severity of morphine withdrawal having potential role encountered during pharmacotherapy with morphine management of opioid dependence, well memory, impairement, cell signaling and phosphorylation of neuron. PMID:28553371

  2. Adjunct Ketamine Use in the Management of Severe Ethanol Withdrawal.

    Science.gov (United States)

    Pizon, Anthony F; Lynch, Michael J; Benedict, Neal J; Yanta, Joseph H; Frisch, Adam; Menke, Nathan B; Swartzentruber, Greg S; King, Andrew M; Abesamis, Michael G; Kane-Gill, Sandra L

    2018-05-08

    Ketamine offers a plausible mechanism with favorable kinetics in treatment of severe ethanol withdrawal. The purpose of this study is to determine if a treatment guideline using an adjunctive ketamine infusion improves outcomes in patients suffering from severe ethanol withdrawal. Retrospective observational cohort study. Academic tertiary care hospital. Patients admitted to the ICU and diagnosed with delirium tremens by Diagnostic and Statistical Manual of Mental Disorders V criteria. Pre and post guideline, all patients were treated in a symptom-triggered fashion with benzodiazepines and/or phenobarbital. Postguideline, standard symptom-triggered dosing continued as preguideline, plus, the patient was initiated on an IV ketamine infusion at 0.15-0.3 mg/kg/hr continuously until delirium resolved. Based upon withdrawal severity and degree of agitation, a ketamine bolus (0.3 mg/kg) was provided prior to continuous infusion in some patients. A total of 63 patients were included (29 preguideline; 34 postguideline). Patients treated with ketamine were less likely to be intubated (odds ratio, 0.14; p trend toward a shorter hospitalization.

  3. The Relative Potency of Inverse Opioid Agonists and a Neutral Opioid Antagonist in Precipitated Withdrawal and Antagonism of Analgesia and Toxicity

    OpenAIRE

    Sirohi, Sunil; Dighe, Shveta V.; Madia, Priyanka A.; Yoburn, Byron C.

    2009-01-01

    Opioid antagonists can be classified as inverse agonists and neutral antagonists. In the opioid-dependent state, neutral antagonists are significantly less potent in precipitating withdrawal than inverse agonists. Consequently, neutral opioid antagonists may offer advantages over inverse agonists in the management of opioid overdose. In this study, the relative potency of three opioid antagonists to block opioid analgesia and toxicity and precipitate withdrawal was exa...

  4. 76 FR 54384 - California State Implementation Plan, South Coast Air Quality Management District; Withdrawal of...

    Science.gov (United States)

    2011-09-01

    ... ENVIRONMENTAL PROTECTION AGENCY 40 CFR Part 52 [EPA-R09-OAR-2011-0537; FRL-9457-6] California State Implementation Plan, South Coast Air Quality Management District; Withdrawal of Direct Final Rule... Implementation Plan (SIP). This revision concerned South Coast Air Quality Management District (SCAQMD) Rule 1143...

  5. Treatment for amphetamine withdrawal.

    Science.gov (United States)

    Shoptaw, Steven J; Kao, Uyen; Heinzerling, Keith; Ling, Walter

    2009-04-15

    Few studies examined treatments for amphetamine withdrawal, although it is a common problem among amphetamine users. Its symptoms, in particular intense craving, may be a critical factor leading to relapse to amphetamine use. In clinical practice, medications for cocaine withdrawal are commonly used to manage amphetamine withdrawal although the pharmacodynamic and pharmacokinetic properties of these two illicit substances are different. To assess the effectiveness of pharmacological alone or in combination with psychosocial treatment for amphetamine withdrawals on discontinuation rates, global state, withdrawal symptoms, craving, and other outcomes. MEDLINE (1966 - 2008), CINAHL (1982 - 2008), PsycINFO (1806 - 2008), CENTRAL (Cochrane Library 2008 issue 2), references of obtained articles. All randomised controlled and clinical trials evaluating pharmacological and or psychosocial treatments (alone or combined) for people with amphetamine withdrawal symptoms. Two authors evaluated and extracted data independently. The data were extracted from intention-to-treat analyses. The Relative Risk (RR) with the 95% confidence interval (95% CI) was used to assess dichotomous outcomes. The Weighted Mean Difference (WMD) with 95% CI was used to assess continuous outcomes. Four randomised controlled trials (involving 125 participants) met the inclusion criteria for the review. Two studies found that amineptine significantly reduced discontinuation rates and improved overall clinical presentation, but did not reduce withdrawal symptoms or craving compared to placebo. The benefits of mirtazapine over placebo for reducing amphetamine withdrawal symptoms were not as clear. One study suggested that mirtazapine may reduce hyperarousal and anxiety symptoms associated with amphetamine withdrawal. A more recent study failed to find any benefit of mirtazapine over placebo on retention or on amphetamine withdrawal symptoms. No medication is effective for treatment of amphetamine

  6. Tramadol versus methadone for the management of acute opioid withdrawal: an add-on study

    Directory of Open Access Journals (Sweden)

    M Salehi

    2006-07-01

    Full Text Available BACKGROUND: Opioid agonists such as methadone have been used widely in controlling opioid withdrawal symptoms. Tramadol, a partial opioid agonist, also has been prescribed to manage acute and chronic pain. We sought to compare the efficacy of tramadol and methadone in reducing the severity of opioid withdrawal symptoms. METHODS: In a double blind clinical trial 70 opioid dependent patients who used daily opium equal to 15 mg methadone randomly were assigned in two groups. In one group, methadone was started at 15 mg/day while in the other group 450 mg/day tramadol was prescribed. Both drugs were tapered in a week and placebo was prescribed in the 2nd week. The severity of withdrawal symptoms were assessed five times by short opioid withdrawal scale (SOWS. Data were analyzed by Repeated Measures Analysis of Variance, Mann-Whitney U, and Wilcoxon tests. RESULTS: There were statistically significant differences between two groups in the severity of anxiety (P = 0.015, irritability (P = 0.044, palpitation (P = 0.018, agitation (P = 0.037, and dysphoria (P = 0.044 that all were more common in methadone group. Comparison of side effects revealed statistically significant differences in sweating (P = 0.003 and drowsiness (P = 0.019 between two groups that were more frequent in methadone group. DISCUSSION: Tramadol was more efficacious in controlling opioid withdrawal symptoms with lower side effects. KEYWORDS: Methadone, tramadol, opioid withdrawal.

  7. Acute exercise effects on smoking withdrawal symptoms and desire to smoke are not related to expectation.

    Science.gov (United States)

    Daniel, James Z; Cropley, Mark; Fife-Schaw, Chris

    2007-11-01

    Recent research has shown that 10 min of moderate intensity exercise reduce smoking withdrawal symptoms and desire to smoke in acutely abstinent smokers. The aim of the current study was to determine whether the reductions are related to participant expectation of these effects. Forty-five sedentary participants who had smoked ten or more cigarettes per day for at least 3 years reported their expectation of the effects of exercise on smoking withdrawal symptoms. Approximately 1 month later, participants were randomly assigned to one of three groups after 11-15 h of overnight smoking abstinence. Each group read either a positive, negative or neutral statement concerning exercise effects on smoking withdrawal symptoms. They rated their expectation again and then completed 10 min of moderate intensity exercise on a stationary bicycle ergometer. Using standardised scales, participants rated smoking withdrawal symptoms and desire to smoke at 10, 5 and 0 min before exercise, then at 5 and 10 min during exercise and 15 and 20 min post-exercise. Expectation of exercise effects on withdrawal were manipulated in the predicted directions. No significant group main effects were found for any symptom. Significant reductions in symptoms and desire to smoke occurred during and after exercise regardless of participant expectation. Ten minutes of moderate intensity exercise can lead to reductions in desire to smoke and smoking withdrawal symptoms, which are not due to the participant's expectation of exercise effects. These findings support the use of short periods of exercise as an aid to smoking cessation.

  8. Managing acute alcohol withdrawal with Homoeopathy: A prospective, observational, multicentre exploratory study

    Directory of Open Access Journals (Sweden)

    Debadatta Nayak

    2014-01-01

    Full Text Available Background: Alcohol dependence is a common social problem which may be associated with other risk factors and co-morbidities. Abrupt cessation of alcohol intake may provoke an acute alcohol withdrawal phase with varying degrees of signs and symptoms. In conventional medical system, specific pharmacological interventions are used for management of Acute Alcohol Withdrawal (AAW. There exists a need to explore safe and holistic treatment of AAW. The present work reports the results of a prospective, observational, exploratory, multicentre trial (2008-2011 to assess the role of Homoeopathy in AAW. Materials and Methods: Individualised Homoeopathy was given to 112 patients reporting with AAW. The clinical assessment was done for 05 days using Clinical Institute Withdrawal Assessment Scale of Alcohol-Revised (CIWA-Ar. Post-withdrawal phase, quality of life of patients was assessed at end of 01 st , 03 rd and 06 th month using World Health Organisation quality of life (WHOQOL- BREF. Results and Analysis: There was a significant decrease in CIWA-Ar mean scores and increase in quality of life score (P < 0.001. The most common remedies used were Arsenicum album, Lycopodium clavatum, Belladonna, Nux vomica and Pulsatilla. Conclusion: The results of current observational pilot study suggest the promising use of Homoeopathy in the management of acute alcohol withdrawal. Further studies with large sample size and rigorous design are warranted.

  9. 76 FR 59960 - Hazardous Waste Management System; Identification and Listing of Hazardous Waste; Withdrawal of...

    Science.gov (United States)

    2011-09-28

    ... Waste Management System; Identification and Listing of Hazardous Waste; Withdrawal of proposed rule... Permitting Division, Corrective Action and Waste Minimization Section (6PD-C), 1445 Ross Avenue, Dallas, TX... petition. A new petition will be required for this waste stream. List of Subjects in 40 CFR Part 261...

  10. Kratom, an Emerging Drug of Abuse: A Case Report of Overdose and Management of Withdrawal.

    Science.gov (United States)

    Diep, Jack; Chin, David Tian; Gupta, Somdatta; Syed, Faraz; Xiong, Ming; Cheng, Jianguo

    2018-04-15

    Kratom is an herb indigenous to Southeast Asia with psychoactive opioid compounds, often used as a treatment for chronic pain or opiate withdrawal symptoms. It is legally and readily available via Internet sales and has been identified as an emerging drug of abuse in the United States. Kratom use has been associated with psychosis, seizures, and even death. At lower doses, kratom acts as a stimulant, while at higher doses, it produces analgesia and euphoria. Here, we describe the successful management of kratom overdose and withdrawal in a young man with negative toxicology screens.

  11. Delirium and High Creatine Kinase and Myoglobin Levels Related to Synthetic Cannabinoid Withdrawal

    Directory of Open Access Journals (Sweden)

    Ahmet Bulent Yazici

    2017-01-01

    Full Text Available Synthetic cannabinoids (SCs are included in a group of drugs called new psychoactive substances. Effects of SCs on the central nervous system are similar to other cannabinoids, but 2–100 times more potent than marijuana. Thus, addiction and withdrawal symptoms are more severe than natural cannabinoids. Withdrawal symptoms of SCs were reported in the literature previously. But there is no report about SC withdrawal delirium and its treatment. Several studies reported that agonists of CB1 receptors play a role in GABA and glutamatergic neurotransmission, which is similar to the effects of alcohol on GABA and glutamatergic receptors. Previous studies on alcohol delirium cases suggested that elevated creatine kinase (CK can be a marker of progress. This study reports delirium and high serum CK levels related to SC withdrawal and offers a treatment with benzodiazepine for them. We described two cases treated in our inpatient clinic about SC withdrawal with increase of serum CK level and other laboratory parameters. One of them demonstrated delirium symptoms and the other did not with early rapid treatment.

  12. 76 FR 18384 - Withdrawal of Regulations Related to Validity and Priority of Federal Tax Lien

    Science.gov (United States)

    2011-04-04

    ... furnishing of goods) made under a written agreement which was entered into before tax lien filing and which... DEPARTMENT OF THE TREASURY Internal Revenue Service 26 CFR Part 301 [TD 9520] RIN 1545-BG13 Withdrawal of Regulations Related to Validity and Priority of Federal Tax Lien AGENCY: Internal Revenue...

  13. Management of the geriatric trauma patient at risk of death: therapy withdrawal decision making.

    Science.gov (United States)

    Trunkey, D D; Cahn, R M; Lenfesty, B; Mullins, R

    2000-01-01

    The management of geriatric injured patients admitted to a trauma center includes the selective decision to provide comfort care only, including withdrawal of therapy, and a choice to not use full application of standard therapies. The decision makers in this process include multiple individuals in addition to the patient. Retrospective review of documentation by 2 blinded reviewers of the cohort of patients over a recent 5-year period (1993-1997). Trauma service of a level I trauma center. A convenience sample of patients aged 65 years and older who died, and whose medical record was available for review. Patients were categorized as having withdrawal of therapy, and documentation in the medical record of who made the assessment decisions and recommendations, and to what extent the processes of care were documented. Among 87 geriatric trauma patients who died, 47 had documentation interpreted as indicating a decision was made to withdraw therapy. In only a few circumstances was the patient capable of actively participating in these decisions. The other individuals involved in recommendations for withdrawal of therapy were, in order of prevalence, the treating trauma surgeon, family members (as proxy reporting the patient's preferences), or a second physician. Documentation regarding the end-of-life decisions was often fragmentary, and in some cases ambiguous. Copies of legal advance directives were rarely available in the medical record, and ethics committee participation was used only once. Withdrawal of therapy is a common event in the terminal care of geriatric injured patients. The process for reaching a decision regarding withdrawal of therapy is complex because in most circumstances patients' injuries preclude their full participation. Standards for documentation of essential information, including patients' preferences and decision-making ability, should be developed to improve the process and assist with recording these complicated decisions that often

  14. The relative potency of inverse opioid agonists and a neutral opioid antagonist in precipitated withdrawal and antagonism of analgesia and toxicity.

    Science.gov (United States)

    Sirohi, Sunil; Dighe, Shveta V; Madia, Priyanka A; Yoburn, Byron C

    2009-08-01

    Opioid antagonists can be classified as inverse agonists and neutral antagonists. In the opioid-dependent state, neutral antagonists are significantly less potent in precipitating withdrawal than inverse agonists. Consequently, neutral opioid antagonists may offer advantages over inverse agonists in the management of opioid overdose. In this study, the relative potency of three opioid antagonists to block opioid analgesia and toxicity and precipitate withdrawal was examined. First, the potency of two opioid inverse agonists (naltrexone and naloxone) and a neutral antagonist (6beta-naltrexol) to antagonize fentanyl-induced analgesia and lethality was determined. The order of potency to block analgesia was naltrexone > naloxone > 6beta-naltrexol (17, 4, 1), which was similar to that to block lethality (13, 2, 1). Next, the antagonists were compared using withdrawal jumping in fentanyl-dependent mice. The order of potency to precipitate withdrawal jumping was naltrexone > naloxone 6beta-naltrexol (1107, 415, 1). The relative potencies to precipitate withdrawal for the inverse agonists compared with the neutral antagonist were dramatically different from that for antagonism of analgesia and lethality. Finally, the effect of 6beta-naltrexol pretreatment on naloxone-precipitated jumping was determined in morphine and fentanyl-dependent mice. 6beta-Naltrexol pretreatment decreased naloxone precipitated withdrawal, indicating that 6beta-naltrexol is a neutral antagonist. These data demonstrate that inverse agonists and neutral antagonists have generally comparable potencies to block opioid analgesia and lethality, whereas the neutral opioid antagonist is substantially less potent in precipitating opioid withdrawal. These results support suggestions that neutral antagonists may have advantages over inverse agonists in the management of opioid overdose.

  15. Love withdrawal is related to heightened processing of faces with emotional expressions and incongruent emotional feedback : Evidence from ERPs

    NARCIS (Netherlands)

    Huffmeijer, Renske; Tops, Mattie; Alink, Lenneke R. A.; Bakermans-Kranenburg, Marian J.; van Ijzendoorn, Marinus H.

    Parental use of love withdrawal is thought to affect children's later psychological functioning because it creates a link between children's performance and relational consequences. To investigate whether love withdrawal is also associated with the underlying level of basic information processing in

  16. Opium tincture versus methadone syrup in management of acute raw opium withdrawal: A randomized, double-blind, controlled trial.

    Science.gov (United States)

    Tabassomi, Farzaneh; Zarghami, Mehran; Shiran, Mohammad-Reza; Farnia, Samaneh; Davoodi, Mohsen

    2016-01-01

    The aim of this study was to evaluate the effectiveness of opium tincture versus methadone syrup in the management of acute withdrawal syndrome in opium dependent patients during the detoxification period. In this double-blind randomized controlled study, a total of 74 adult male raw opium dependent patients were treated with opium tincture or methadone syrup 2 times daily for 5 consecutive days. Detoxification was initiated by tapered dose reductions to reach abstinence. At the end of the 10th day, the medications were discontinued. The Objective Opioid Withdrawal Scale was used to assess withdrawal symptoms every day. Significant decreases on the Objective Opioid Withdrawal Scale were found for both treatment methods during the study period (p Opium tincture can be considered as a potential substitute for methadone syrup for suppression of raw opium withdrawal symptoms, with minimal adverse effects.

  17. Experience of the use of Ketamine to manage opioid withdrawal in an addicted woman: a case report

    OpenAIRE

    Lalanne, Laurence; Nicot, Chloe; Lang, Jean-Philippe; Bertschy, Gilles; Salvat, Eric

    2016-01-01

    Background Opioids are good painkillers, but many patients treated with opioids as painkillers developed a secondary addiction. These patients need to stop misusing opioids, but the mild-to-severe clinical symptoms associated with opioid withdrawal risk increasing their existing pain. In such cases, ketamine, which is used by anaesthetists and pain physicians to reduce opioid medication, may be an effective agent for managing opioid withdrawal. Case presentation We describe the case of a woma...

  18. The relation between Bulimic symptoms and the social withdrawal syndrome during early adolescence.

    Science.gov (United States)

    Rotenberg, Ken J; Sangha, Rajvir

    2015-12-01

    The short-term longitudinal study tested the hypothesis that there was a prospective relation between the social withdrawal syndrome and Bulimic symptoms during early adolescence. Ninety-six adolescents (47 males, mean age=13 years - 10 months) completed standardized scales assessing Bulimic symptoms, trust beliefs in others and loneliness at Time 1/T1 and again 5 months later at Time 2/T2. Analyses showed that: (1) Bulimic symptoms were negatively correlated with trust beliefs, (2) Bulimic symptoms were positively correlated with loneliness, and (3) trust beliefs were negatively correlated with loneliness. The SEM and mediation analyses showed that trust beliefs at T1 were negatively and concurrently associated with Bulimic symptoms at T1 and longitudinally (and negatively) predicted changes in Bulimic symptoms. It was found that loneliness at T1 statistically mediated those concurrent and longitudinal relations. The findings yielded support for the conclusion that the social withdrawal syndrome, as assessed by low trust beliefs and resulting experiences of loneliness, contributes to Bulimia nervosa during early adolescence. Copyright © 2015 Elsevier Ltd. All rights reserved.

  19. Outpatient alcohol withdrawal management for Aboriginal and Torres Strait Islander peoples.

    Science.gov (United States)

    Brett, Jonathan; Lawrence, Leanne; Ivers, Rowena; Conigrave, Kate

    2014-08-01

    There is concern from within Aboriginal and Torres Strait Islander communities about the lack of access to alcohol withdrawal management ('detox') services. Outpatient detox is described within national Australian guidelines as a safe option for selected drinkers. However, uncertainly exists as to how suited Aboriginal and Torres Strait Islander peoples are to this approach. 
 Consultations were conducted with stakeholders of four health services providing outpatient detox for Aboriginal and Torres Strait Islander peoples in NSW. Thematic analysis was performed to determine elements perceived as important for success. Key themes that emerged were individual engagement, flexibility, assessment of suitability, Aboriginal staff and community engagement, practical support, counselling, staff education and support, coping with relapse and contingency planning. 
 There is a need to improve access to alcohol detox services for Aboriginal and Torres Strait Islander peoples. The outpatient setting seems to be a feasible and safe environment to provide this kind of service for selected drinkers.

  20. BLM National Surface Management Agency: Area Polygons, Withdrawal Area Polygons, and Special Public Purpose Withdrawal Area Polygons

    Data.gov (United States)

    Federal Geographic Data Committee — The SMA implementation is comprised of one feature dataset, with several polygon feature classes, rather than a single feature class. SurfaceManagementAgency: The...

  1. Management of precipitated opiate withdrawal syndrome induced by nalmefene mistakenly prescribed in opiate-dependent patients: a review for clinicians.

    Science.gov (United States)

    Franchitto, Nicolas; Jullian, Benedicte; Salles, Juliette; Pelissier, Fanny; Rolland, Benjamin

    2017-06-01

    Nalmefene, a long-acting µ-opioid antagonist approved to treat alcohol use disorder, is occasionally mistakenly prescribed to opiate-dependent or opioid-treated patients. We review recent literature on drug-drug interactions between nalmefene and opioids that lead to precipitated opioid withdrawal, and focus on its management and planning for care at discharge. Areas covered: This article provides a brief and comprehensive review of management of precipitated opioid withdrawal syndrome when nalmefene is associated with an opioid, whether misused or legally prescribed. Expert opinion: When treating an opiate-dependent patient with co-occurring alcohol use disorder, both conditions need to be a focus of clinical attention. New drugs for alcohol use disorder have been approved, but must be given cautiously and with a full understanding of their potential drug-drug interactions with opioid medications. Opiate-dependent patients should be intensively monitored for risk factors of alcohol use disorder and should be continuously motivated for treatment maintenance. When nalmefene is administered to opiate-dependent patients, acute opioid withdrawal syndrome may occur. Management of precipitated acute opioid withdrawal may include short or long-acting µ-opioid agonists during hospitalization, in addition to supportive treatment. The best management of polydrug abusers is based on a multidisciplinary approach, which should be pursued and improved through continuing medical education.

  2. Prospective Relations among Fearful Temperament, Protective Parenting, and Social Withdrawal: The Role of Maternal Accuracy in a Moderated Mediation Framework

    Science.gov (United States)

    Kiel, Elizabeth J.; Buss, Kristin A.

    2011-01-01

    Early social withdrawal and protective parenting predict a host of negative outcomes, warranting examination of their development. Mothers' accurate anticipation of their toddlers' fearfulness may facilitate transactional relations between toddler fearful temperament and protective parenting, leading to these outcomes. Currently, we followed 93…

  3. Comment on: withdrawal of growth-promoting antibiotics in Europe and its effects in relation to human health

    DEFF Research Database (Denmark)

    Hammerum, Anette Marie; Heuer, Ole Eske; Lester, Camilla H.

    2007-01-01

    In response to a review titled 'Withdrawal of growth-promoting antibiotics in Europe and its effects in relation to human health', published in this Journal by Ian Phillips, we hereby comment on the review. Phillips makes use of data from the Danish Integrated Antimicrobial Resistance Monitoring...

  4. 75 FR 24394 - Animal Drugs, Feeds, and Related Products; Withdrawal of Approval of a New Animal Drug...

    Science.gov (United States)

    2010-05-05

    ... [Docket No. FDA-2010-N-0002] Animal Drugs, Feeds, and Related Products; Withdrawal of Approval of a New Animal Drug Application; Buquinolate; Coumaphos AGENCY: Food and Drug Administration, HHS. ACTION: Final rule. SUMMARY: The Food and Drug Administration (FDA) is amending the animal drug regulations by...

  5. 75 FR 65565 - Animal Drugs, Feeds, and Related Products; Withdrawal of Approval of New Animal Drug Applications...

    Science.gov (United States)

    2010-10-26

    ... 558 [Docket No. FDA-2010-N-0002] Animal Drugs, Feeds, and Related Products; Withdrawal of Approval of New Animal Drug Applications; Aklomide; Levamisole Hydrochloride; Nitromide and Sulfanitran AGENCY...) is amending the animal drug regulations by removing those portions that reflect approval of eight new...

  6. Development of Ethanol Withdrawal-Related Sensitization and Relapse Drinking in Mice Selected for High or Low Ethanol Preference

    Science.gov (United States)

    Lopez, Marcelo F.; Grahame, Nicholas J.; Becker, Howard C.

    2010-01-01

    did not change from baseline levels of intake. In contrast, HAP-2 females and LAP-2 mice of both sexes did not show changes in ethanol intake as a consequence of intermittent ethanol exposure. Conclusions Overall, these results indicate that the magnitude of ethanol withdrawal-related seizures is inversely related to inherited ethanol intake preference. Additionally, intermittent ethanol vapor exposure appears more likely to affect high-drinking mice (C57BL/6J and HAP-2) than low drinkers, even though these animals are less affected by ethanol withdrawal. PMID:21314693

  7. Managing or Relating?

    DEFF Research Database (Denmark)

    Sproedt, Henrik; Buur, Jacob

    2010-01-01

    This paper describes a case of user-driven innovation. We draw on social capital theory and the concept of complex responsive processes to examine the role of relations for the exchange and generation of knowledge across different knowledge traditions. We argue that innovation as a social phenome...... phenomenon with a high degree of uncertainty and complexity requires more relating and less managing to use conflict as a resource by turning the friction between different knowledge traditions into creative friction....

  8. Amantadine as Augmentation in Managing Opioid Withdrawal with Clonidine: a randomized controlled trial.

    Directory of Open Access Journals (Sweden)

    Shahrokh Amiri

    2014-09-01

    Full Text Available Withdrawal symptoms are a main reason of continuous use of opioid. This study compares the efficacy of augmentation of amantadine with clonidine in decreasing opioid withdrawal symptoms.This double-blind randomized clinical trial was carried out in the detoxification and rehabilitation inpatient ward at Razi Hospital, Tabriz, Iran during 2012. The patients were randomly assigned to receive clonidine or clonidine plus amantadine; and withdrawal symptoms were evaluated in the admission day and 24, 48, and 72 hours later. Data were analyzed using SPSS by the 2*2 repeated analyses of variances (ANOVA.From the total of 69 participants, 30 patients completed the trial in each group. The severity of symptoms, however, had an increasing trend in both groups. Analysis of variance of the symptom severity score (by The Clinical Opiate Withdrawal Scale revealed a significant group-time interaction, and the patients who were receiving amantadine experienced milder symptoms.Treatment of opioid withdrawal symptoms with amantadine and clonidine would result in a better outcome compared with clonidine alone.

  9. Differential Changes in Expression of Stress- and Metabolic-Related Neuropeptides in the Rat Hypothalamus during Morphine Dependence and Withdrawal.

    Directory of Open Access Journals (Sweden)

    Bernadett Pintér-Kübler

    Full Text Available Chronic morphine treatment and naloxone precipitated morphine withdrawal activates stress-related brain circuit and results in significant changes in food intake, body weight gain and energy metabolism. The present study aimed to reveal hypothalamic mechanisms underlying these effects. Adult male rats were made dependent on morphine by subcutaneous implantation of constant release drug pellets. Pair feeding revealed significantly smaller weight loss of morphine treated rats compared to placebo implanted animals whose food consumption was limited to that eaten by morphine implanted pairs. These results suggest reduced energy expenditure of morphine-treated animals. Chronic morphine exposure or pair feeding did not significantly affect hypothalamic expression of selected stress- and metabolic related neuropeptides - corticotropin-releasing hormone (CRH, urocortin 2 (UCN2 and proopiomelanocortin (POMC compared to placebo implanted and pair fed animals. Naloxone precipitated morphine withdrawal resulted in a dramatic weight loss starting as early as 15-30 min after naloxone injection and increased adrenocorticotrophic hormone, prolactin and corticosterone plasma levels in morphine dependent rats. Using real-time quantitative PCR to monitor the time course of relative expression of neuropeptide mRNAs in the hypothalamus we found elevated CRH and UCN2 mRNA and dramatically reduced POMC expression. Neuropeptide Y (NPY and arginine vasopressin (AVP mRNA levels were transiently increased during opiate withdrawal. These data highlight that morphine withdrawal differentially affects expression of stress- and metabolic-related neuropeptides in the rat hypothalamus, while relative mRNA levels of these neuropeptides remain unchanged either in rats chronically treated with morphine or in their pair-fed controls.

  10. Relations between Chinese Mothers' Parenting Practices and Social Withdrawal in Early Childhood

    Science.gov (United States)

    Nelson, Larry J.; Hart, Craig H.; Wu, Bo; Yang, Chongming; Roper, Susanne Olsen; Jin, Shenghua

    2006-01-01

    Researchers have identified specific parenting practices used by parents of preschoolers in mainland China (e.g., physical coercion, overprotection, shaming, directiveness, encouragement of modesty). Some of the intrusive practices have been linked to social withdrawal in western societies (e.g., United States, Canada). It seemed important to…

  11. Wnt16 Is Associated with Age-Related Bone Loss and Estrogen Withdrawal in Murine Bone.

    Directory of Open Access Journals (Sweden)

    Henry Todd

    Full Text Available Genome Wide Association Studies suggest that Wnt16 is an important contributor to the mechanisms controlling bone mineral density, cortical thickness, bone strength and ultimately fracture risk. Wnt16 acts on osteoblasts and osteoclasts and, in cortical bone, is predominantly derived from osteoblasts. This led us to hypothesize that low bone mass would be associated with low levels of Wnt16 expression and that Wnt16 expression would be increased by anabolic factors, including mechanical loading. We therefore investigated Wnt16 expression in the context of ageing, mechanical loading and unloading, estrogen deficiency and replacement, and estrogen receptor α (ERα depletion. Quantitative real time PCR showed that Wnt16 mRNA expression was lower in cortical bone and marrow of aged compared to young female mice. Neither increased nor decreased (by disuse mechanical loading altered Wnt16 expression in young female mice, although Wnt16 expression was decreased following ovariectomy. Both 17β-estradiol and the Selective Estrogen Receptor Modulator Tamoxifen increased Wnt16 expression relative to ovariectomy. Wnt16 and ERβ expression were increased in female ERα-/- mice when compared to Wild Type. We also addressed potential effects of gender on Wnt16 expression and while the expression was lower in the cortical bone of aged males as in females, it was higher in male bone marrow of aged mice compared to young. In the kidney, which we used as a non-bone reference tissue, Wnt16 expression was unaffected by age in either males or females. In summary, age, and its associated bone loss, is associated with low levels of Wnt16 expression whereas bone loss associated with disuse has no effect on Wnt16 expression. In the artificially loaded mouse tibia we observed no loading-related up-regulation of Wnt16 expression but provide evidence that its expression is influenced by estrogen receptor signaling. These findings suggest that while Wnt16 is not an

  12. The alcohol withdrawal syndrome.

    LENUS (Irish Health Repository)

    McKeon, A

    2008-08-01

    The alcohol withdrawal syndrome (AWS) is a common management problem in hospital practice for neurologists, psychiatrists and general physicians alike. Although some patients have mild symptoms and may even be managed in the outpatient setting, others have more severe symptoms or a history of adverse outcomes that requires close inpatient supervision and benzodiazepine therapy. Many patients with AWS have multiple management issues (withdrawal symptoms, delirium tremens, the Wernicke-Korsakoff syndrome, seizures, depression, polysubstance abuse, electrolyte disturbances and liver disease), which requires a coordinated, multidisciplinary approach. Although AWS may be complex, careful evaluation and available treatments should ensure safe detoxification for most patients.

  13. Current and future groundwater withdrawals: Effects, management and energy policy options for a semi-arid Indian watershed

    Science.gov (United States)

    Sishodia, Rajendra P.; Shukla, Sanjay; Graham, Wendy D.; Wani, Suhas P.; Jones, James W.; Heaney, James

    2017-12-01

    Effects of future expansion/intensification of irrigated agriculture on groundwater and surface water levels and availability in a semi-arid watershed were evaluated using an integrated hydrologic model (MIKE SHE/MIKE 11) in conjunction with biophysical measurements. Improved water use efficiency, water storage, and energy policy options were evaluated for their ability to sustain the future (2035) increased groundwater withdrawals. Three future withdrawal scenarios (low = 20, medium = 30, high = 50 wells/100 km2/year) based on the historical rate of growth of irrigation wells were formulated. While well drying from falling groundwater levels was limited to drought and consecutive below average rainfall years, under the current (2015) withdrawals, significant increases in frequency and duration (17-97 days/year) of well drying along with 13-26% (19-37 mm) reductions in surface flows were predicted under the future withdrawals. Higher (27-108%) energy demands of existing irrigation pumps due to declining groundwater levels and reduced hydroelectric generation due to decreased surface flows would create a vicious water-food-energy nexus in the future. Crop failure, one of the main causes of farmers' emotional distress and death in the region, is predicted to exacerbate under the future withdrawal scenarios. Shift to negative net recharge (-63 mm) and early and prolonged drying of wells under the high scenario will reduce the groundwater availability and negatively affect crop production in more than 60% and 90% of cropped areas in the Rabi (November-February) and summer (March-May) seasons, respectively during a drought year. Individual and combined demand (drip irrigation and reduced farm electricity subsidy) and supply (water storage) management options improved groundwater levels and reduced well drying by 55-97 days/year compared to business-as-usual management under the high scenario. The combined management (50% drip conversion, 50% reduction in subsidy, and

  14. Supersensitive Kappa Opioid Receptors Promotes Ethanol Withdrawal-Related Behaviors and Reduce Dopamine Signaling in the Nucleus Accumbens.

    Science.gov (United States)

    Rose, Jamie H; Karkhanis, Anushree N; Chen, Rong; Gioia, Dominic; Lopez, Marcelo F; Becker, Howard C; McCool, Brian A; Jones, Sara R

    2016-05-01

    Chronic ethanol exposure reduces dopamine transmission in the nucleus accumbens, which may contribute to the negative affective symptoms associated with ethanol withdrawal. Kappa opioid receptors have been implicated in withdrawal-induced excessive drinking and anxiety-like behaviors and are known to inhibit dopamine release in the nucleus accumbens. The effects of chronic ethanol exposure on kappa opioid receptor-mediated changes in dopamine transmission at the level of the dopamine terminal and withdrawal-related behaviors were examined. Five weeks of chronic intermittent ethanol exposure in male C57BL/6 mice were used to examine the role of kappa opioid receptors in chronic ethanol-induced increases in ethanol intake and marble burying, a measure of anxiety/compulsive-like behavior. Drinking and marble burying were evaluated before and after chronic intermittent ethanol exposure, with and without kappa opioid receptor blockade by nor-binaltorphimine (10mg/kg i.p.). Functional alterations in kappa opioid receptors were assessed using fast scan cyclic voltammetry in brain slices containing the nucleus accumbens. Chronic intermittent ethanol-exposed mice showed increased ethanol drinking and marble burying compared with controls, which was attenuated with kappa opioid receptor blockade. Chronic intermittent ethanol-induced increases in behavior were replicated with kappa opioid receptor activation in naïve mice. Fast scan cyclic voltammetry revealed that chronic intermittent ethanol reduced accumbal dopamine release and increased uptake rates, promoting a hypodopaminergic state of this region. Kappa opioid receptor activation with U50,488H concentration-dependently decreased dopamine release in both groups; however, this effect was greater in chronic intermittent ethanol-treated mice, indicating kappa opioid receptor supersensitivity in this group. These data suggest that the chronic intermittent ethanol-induced increase in ethanol intake and anxiety

  15. Psychosis following Tramadol Withdrawal

    OpenAIRE

    Rajabizadeh, Ghodratolah; Kheradmand, Ali; Nasirian, Mansoureh

    2009-01-01

    Background: Tramadol is a centrally acting opioid analgesic used to treat moderate to sever pain. It has more advantage and less opioid adverse effects than conventional opioid analgesia. Case Report: This article reports a patient with tramadol dependency that had psychosis after tramadol withdrawal. Conclusion: By the increase of tramadol usage for relief of chronic pain, tramadol abuse and dependency is increased. Some of tramadol withdrawal symptoms are not related to opioid, for example ...

  16. Complete Remission of Methotrexate-Related Epstein-Barr-Virus-Associated Hodgkin-Like Lymphoma following Withdrawal of MTX Coupled with Clarithromycin Administration

    Directory of Open Access Journals (Sweden)

    Nobuo Takemori

    2012-01-01

    Full Text Available Patients with rheumatoid arthritis (RA are known to develop lymphoproliferative disorders (LPDs during the course of illness, particularly in cases treated with methotrexate (MTX for long periods. We describe a case of MTX-related Epstein-Barr-virus-(EBV- associated LPD resembling Hodgkin’s lymphoma (HL, in which a dramatic complete remission was achieved after withdrawal of MTX coupled with clarithromycin (CAM administration. Withdrawal of MTX coupled with CAM administration seemed to be effective for treating MTX-related EBV-associated LPDs. In particular, an immunomodulative effect of CAM might have been involved in achieving complete remission.

  17. Relations between precipitation, groundwater withdrawals, and changes in hydrologic conditions at selected monitoring sites in Volusia County, Florida, 1995--2010

    Science.gov (United States)

    Murray, Louis C.

    2012-01-01

    A study to examine the influences of climatic and anthropogenic stressors on groundwater levels, lake stages, and surface-water discharge at selected sites in northern Volusia County, Florida, was conducted in 2009 by the U.S. Geological Survey. Water-level data collected at 20 monitoring sites (17 groundwater and 3 lake sites) in the vicinity of a wetland area were analyzed with multiple linear regression to examine the relative influences of precipitation and groundwater withdrawals on changes in groundwater levels and lake stage. Analyses were conducted across varying periods of record between 1995 and 2010 and included the effects of groundwater withdrawals aggregated from municipal water-supply wells located within 12 miles of the project sites. Surface-water discharge data at the U.S. Geological Survey Tiger Bay canal site were analyzed for changes in flow between 1978 and 2001. As expected, water-level changes in monitoring wells located closer to areas of concentrated groundwater withdrawals were more highly correlated with withdrawals than were water-level changes measured in wells further removed from municipal well fields. Similarly, water-level changes in wells tapping the Upper Floridan aquifer, the source of municipal supply, were more highly correlated with groundwater withdrawals than were water-level changes in wells tapping the shallower surficial aquifer system. Water-level changes predicted by the regression models over precipitation-averaged periods of record were underestimated for observations having large positive monthly changes (generally greater than 1.0 foot). Such observations are associated with high precipitation and were identified as points in the regression analyses that produced large standardized residuals and/or observations of high influence. Thus, regression models produced by multiple linear regression analyses may have better predictive capability in wetland environments when applied to periods of average or below average

  18. The Role of Maternal Behavior in the Relation between Shyness and Social Reticence in Early Childhood and Social Withdrawal in Middle Childhood

    Science.gov (United States)

    Hane, Amie Ashley; Cheah, Charissa; Rubin, Kenneth H.; Fox, Nathan A.

    2008-01-01

    The moderating effect of maternal behavior in the relations between social reticence and shyness in preschool and subsequent social withdrawal was investigated. Eighty children (47 females) were judged for degree of social reticence during play with unfamiliar peers at the age of four and mothers completed the Colorado child temperament inventory…

  19. Stress Sensitive Healthy Females Show Less Left Amygdala Activation in Response to Withdrawal-Related Visual Stimuli under Passive Viewing Conditions

    Science.gov (United States)

    Baeken, Chris; Van Schuerbeek, Peter; De Raedt, Rudi; Vanderhasselt, Marie-Anne; De Mey, Johan; Bossuyt, Axel; Luypaert, Robert

    2012-01-01

    The amygdalae are key players in the processing of a variety of emotional stimuli. Especially aversive visual stimuli have been reported to attract attention and activate the amygdalae. However, as it has been argued that passively viewing withdrawal-related images could attenuate instead of activate amygdalae neuronal responses, its role under…

  20. Differentiating Delirium From Sedative/Hypnotic-Related Iatrogenic Withdrawal Syndrome: Lack of Specificity in Pediatric Critical Care Assessment Tools.

    Science.gov (United States)

    Madden, Kate; Burns, Michele M; Tasker, Robert C

    2017-06-01

    To identify available assessment tools for sedative/hypnotic iatrogenic withdrawal syndrome and delirium in PICU patients, the evidence supporting their use, and describe areas of overlap between the components of these tools and the symptoms of anticholinergic burden in children. Studies were identified using PubMed and EMBASE from the earliest available date until July 3, 2016, using a combination of MeSH terms "delirium," "substance withdrawal syndrome," and key words "opioids," "benzodiazepines," "critical illness," "ICU," and "intensive care." Review article references were also searched. Human studies reporting assessment of delirium or iatrogenic withdrawal syndrome in children 0-18 years undergoing critical care. Non-English language, exclusively adult, and neonatal intensive care studies were excluded. References cataloged by study type, population, and screening process. Iatrogenic withdrawal syndrome and delirium are both prevalent in the PICU population. Commonly used scales for delirium and iatrogenic withdrawal syndrome assess signs and symptoms in the motor, behavior, and state domains, and exhibit considerable overlap. In addition, signs and symptoms of an anticholinergic toxidrome (a risk associated with some common PICU medications) overlap with components of these scales, specifically in motor, cardiovascular, and psychiatric domains. Although important studies have demonstrated apparent high prevalence of iatrogenic withdrawal syndrome and delirium in the PICU population, the overlap in these scoring systems presents potential difficulty in distinguishing syndromes, both clinically and for research purposes.

  1. Predicting Persistence and Withdrawal: An Analysis of Factors Relating to Students' Choice of Course.

    Science.gov (United States)

    de Rome, E. A.; Wieneke, C. E.

    Information relating to course choice and commitment, and use of pre-enrollment information and advisory resources, were collected at the time of enrollment in 1980 from 1,375 first-year students at the University of New South Wales. The students were enrolled in the faculties of arts, architecture, and engineering. Multivariate analyses were used…

  2. Platelet rebound effect of alcohol withdrawal and wine drinking in rats. Relation to tannins and lipid peroxidation.

    Science.gov (United States)

    Ruf, J C; Berger, J L; Renaud, S

    1995-01-01

    We investigated in rats fed a purified diet for 2 and 4 months whether wine drinking was associated with the rebound effect on thrombin-induced platelet aggregation observed after alcohol withdrawal. With 6% ethanol drinking or its equivalent in red or white wine, platelet aggregation was reduced similarly by 70% when the animals drank the alcoholic beverages up to the venipuncture. Depriving the rats of alcoholic beverages for 18 hours was associated with an increase in the platelet response of 124% in those receiving 6% ethanol, of 46% with white wine but a decrease of 59% in those with red wine. The protective effect of red wine on platelets could be reproduced by tannins (procyanidins) extracted from grape seeds or red wine and added to 6% ethanol, but not by glycerol or wine without alcohol. That was related to inhibition of the alcohol-induced lipid peroxidation as shown by the lowering of conjugated dienes, lipid peroxides, and the increase in vitamin E in plasma. Owing to tannins, the platelets of rats drinking red wine did not exhibit the rebound effect observed hours after alcohol drinking, eventually associated with sudden death and stroke in humans.

  3. Hydrogen sulfide inhibits opioid withdrawal-induced pain sensitization in rats by down-regulation of spinal calcitonin gene-related peptide expression in the spine.

    Science.gov (United States)

    Yang, Hai-Yu; Wu, Zhi-Yuan; Bian, Jin-Song

    2014-09-01

    Hyperalgesia often occurs in opioid-induced withdrawal syndrome. In the present study, we found that three hourly injections of DAMGO (a μ-opioid receptor agonist) followed by naloxone administration at the fourth hour significantly decreased rat paw nociceptive threshold, indicating the induction of withdrawal hyperalgesia. Application of NaHS (a hydrogen sulfide donor) together with each injection of DAMGO attenuated naloxone-precipitated withdrawal hyperalgesia. RT-PCR and Western blot analysis showed that NaHS significantly reversed the gene and protein expression of up-regulated spinal calcitonin gene-related peptide (CGRP) in naloxone-treated animals. NaHS also inhibited naloxone-induced cAMP rebound and cAMP response element-binding protein (CREB) phosphorylation in rat spinal cord. In SH-SY5Y neuronal cells, NaHS inhibited forskolin-stimulated cAMP production and adenylate cyclase (AC) activity. Moreover, NaHS pre-treatment suppressed naloxone-stimulated activation of protein kinase C (PKC) α, Raf-1, and extracellular signal-regulated kinase (ERK) 1/2 in rat spinal cord. Our data suggest that H2S prevents the development of opioid withdrawal-induced hyperalgesia via suppression of synthesis of CGRP in spine through inhibition of AC/cAMP and PKC/Raf-1/ERK pathways.

  4. Factors associated with pretreatment and treatment dropouts: comparisons between Aboriginal and non-Aboriginal clients admitted to medical withdrawal management

    Science.gov (United States)

    2013-01-01

    Background Addiction treatment faces high pretreatment and treatment dropout rates, especially among Aboriginals. In this study we examined characteristic differences between Aboriginal and non-Aboriginal clients accessing an inpatient medical withdrawal management program, and identified risk factors associated with the probabilities of pretreatment and treatment dropouts, respectively. Methods 2231 unique clients (Aboriginal = 451; 20%) referred to Vancouver Detox over a two-year period were assessed. For both Aboriginal and non-Aboriginal groups, multivariate logistic regression analyses were conducted with pretreatment dropout and treatment dropout as dependent variables, respectively. Results Aboriginal clients had higher pretreatment and treatment dropout rates compared to non-Aboriginal clients (41.0% vs. 32.7% and 25.9% vs. 20.0%, respectively). For Aboriginal people, no fixed address (NFA) was the only predictor of pretreatment dropout. For treatment dropout, significant predictors were: being female, having HCV infection, and being discharged on welfare check issue days or weekends. For non-Aboriginal clients, being male, NFA, alcohol as a preferred substance, and being on methadone maintenance treatment (MMT) at referral were associated with pretreatment dropout. Significant risk factors for treatment dropout were: being younger, having a preferred substance other than alcohol, having opiates as a preferred substance, and being discharged on weekends. Conclusions Our results highlight the importance of social factors for the Aboriginal population compared to substance-specific factors for the non-Aboriginal population. These findings should help clinicians and decision-makers to recognize the importance of social supports especially housing and initiate appropriate services to improve treatment intake and subsequent retention, physical and mental health outcomes and the cost-effectiveness of treatment. PMID:24325629

  5. Opiate and opioid withdrawal

    Science.gov (United States)

    ... opiate withdrawal; Oxycontin - opiate withdrawal; Hydrocodone - opiate withdrawal; Detox - opiates; Detoxification - opiates ... facilities set up to help people with detoxification (detox). In a regular hospital, if symptoms are severe. ...

  6. Attention Biases Towards and Away from Threat Mark the Relation between Early Dysregulated Fear and the Later Emergence of Social Withdrawal.

    Science.gov (United States)

    Morales, Santiago; Pérez-Edgar, Koraly E; Buss, Kristin A

    2015-08-01

    Fearful temperament, mostly studied as behavioral inhibition (BI), has been extensively associated with social withdrawal in childhood and the later emergence of anxiety disorders, especially social anxiety disorder (SAD). Recent studies have characterized a distinct type of fearful temperament marked by high levels of fear in low threat situations - labeled dysregulated fear. Dysregulated fear has been related to SAD over and above risks associated with BI. However, the mechanism by which dysregulated fear is related to SAD has not been studied. Cognitive mechanisms, such as attentional bias towards threat, may be a possible conduit. We examined differences in attentional bias towards threat in six-year-olds who displayed a pattern of dysregulated fear at age two (N = 23) compared with children who did not display dysregulated fear (N = 33). Moreover, we examined the concurrent relation between attentional bias and social withdrawal. Results indicated that children characterized by dysregulated fear showed a significant bias away from threat, and that this bias was significantly different from the children without dysregulated fear, who showed no significant bias. Moreover, attentional bias towards threat was positively related to social withdrawal only for the dysregulated fear group. These results are discussed in consideration of the existing knowledge of attentional bias to threat in the developmental and pediatric anxiety literatures, as well as recent studies that find important heterogeneity in attentional bias.

  7. Anticonvulsants for alcohol withdrawal.

    Science.gov (United States)

    Minozzi, Silvia; Amato, Laura; Vecchi, Simona; Davoli, Marina

    2010-03-17

    Alcohol abuse and dependence represents a most serious health problem worldwide with major social, interpersonal and legal interpolations. Besides benzodiazepines, anticonvulsants are often used for the treatment of alcohol withdrawal symptoms. Anticonvulsants drugs are indicated for the treatment of alcohol withdrawal syndrome, alone or in combination with benzodiazepine treatments. In spite of the wide use, the exact role of the anticonvulsants for the treatment of alcohol withdrawal has not yet bee adequately assessed. To evaluate the effectiveness and safety of anticonvulsants in the treatment of alcohol withdrawal. We searched Cochrane Drugs and Alcohol Group' Register of Trials (December 2009), PubMed, EMBASE, CINAHL (1966 to December 2009), EconLIT (1969 to December 2009). Parallel searches on web sites of health technology assessment and related agencies, and their databases. Randomized controlled trials (RCTs) examining the effectiveness, safety and overall risk-benefit of anticonvulsants in comparison with a placebo or other pharmacological treatment. All patients were included regardless of age, gender, nationality, and outpatient or inpatient therapy. Two authors independently screened and extracted data from studies. Fifty-six studies, with a total of 4076 participants, met the inclusion criteria. Comparing anticonvulsants with placebo, no statistically significant differences for the six outcomes considered.Comparing anticonvulsant versus other drug, 19 outcomes considered, results favour anticonvulsants only in the comparison carbamazepine versus benzodiazepine (oxazepam and lorazepam) for alcohol withdrawal symptoms (CIWA-Ar score): 3 studies, 262 participants, MD -1.04 (-1.89 to -0.20), none of the other comparisons reached statistical significance.Comparing different anticonvulsants no statistically significant differences in the two outcomes considered.Comparing anticonvulsants plus other drugs versus other drugs (3 outcomes considered), results

  8. Public relations in crisis management

    Directory of Open Access Journals (Sweden)

    Anna Dziadkiewicz

    2012-12-01

    Full Text Available The company crisis decreases its value. Undoubtedly, it ruins the company’s image, the stakeholders’ opinion and puts the company at a disadvantage on the market. It strikes very unexpectedly and destroys the company financially. Moreover, the company loses its credibility and limits its relations with the environment. It does effect the emotional sphere of the top management and employees, which is crucial for the company. This report presents the heart of crisis management. It defines such terms as issue and crisis management, as well as shows the most effective way to create the communications channel in case of crisis and its reduction. Apart from the academic aspect, there are also practical references concerning insurance agreement as a means of risk elimination.

  9. The impact of oxytocin administration and maternal love withdrawal on event-related potential (ERP) responses to emotional faces with performance feedback.

    Science.gov (United States)

    Huffmeijer, Renske; Alink, Lenneke R A; Tops, Mattie; Grewen, Karen M; Light, Kathleen C; Bakermans-Kranenburg, Marian J; van Ijzendoorn, Marinus H

    2013-03-01

    This is the first experimental study on the effect of oxytocin administration on the neural processing of facial stimuli conducted with female participants that uses event-related potentials (ERPs). Using a double-blind, placebo-controlled within-subjects design, we studied the effects of 16 IU of intranasal oxytocin on ERPs to pictures combining performance feedback with emotional facial expressions in 48 female undergraduate students. Participants also reported on the amount of love withdrawal they experienced from their mothers. Vertex positive potential (VPP) and late positive potential (LPP) amplitudes were more positive after oxytocin compared to placebo administration. This suggests that oxytocin increased attention to the feedback stimuli (LPP) and enhanced the processing of emotional faces (VPP). Oxytocin heightened processing of the happy and disgusted faces primarily for those reporting less love withdrawal. Significant associations with LPP amplitude suggest that more maternal love withdrawal relates to the allocation of attention toward the motivationally relevant combination of negative feedback with a disgusted face. Copyright © 2012 Elsevier Inc. All rights reserved.

  10. Age-related differences in anxiety-like behavior and amygdalar CCL2 responsiveness to stress following alcohol withdrawal in male Wistar rats.

    Science.gov (United States)

    Harper, Kathryn M; Knapp, Darin J; Park, Meredith A; Breese, George R

    2017-01-01

    Behavioral and neuroimmune vulnerability to withdrawal from chronic alcohol varies with age. The relation of anxiety-like behavior to amygdalar CCL2 responses following stress after withdrawal from chronic intermittent alcohol (CIA) was investigated in adolescent and adult rats. Adolescent and adult Wistar rats were exposed to CIA (three 5-day blocks of dietary alcohol separated by 2 days of withdrawal) at concentrations that created similar blood alcohol levels across age. Twenty-four hours into the final withdrawal, half of the rats were exposed to 1 h of restraint stress. Four hours post-stress, rats were used for behavior or tissue assays. Anxiety-like behavior was increased versus controls by CIA in adolescents and by CIA + stress in adults. CCL2 mRNA was increased versus controls by CIA in adolescents and by CIA and CIA + stress in adults. CCL2 co-localization with neuronal marker NeuN was decreased versus controls by CIA in adolescents and by CIA + stress in adults. CCL2 co-localization with astrocytic marker GFAP was decreased versus controls by CIA and CIA + stress in adolescents, but experimental groups did not differ from controls in adults. CCL2 co-localization with microglial marker Iba1 was decreased versus controls by stress alone in adolescents and by CIA + stress in adults. Changes in CCL2 protein might control behavior at either age but are particularly associated with CIA alone in adolescents and with CIA + stress in adults. That the number of CeA neurons expressing CCL2 was altered after CIA and stress is consistent with CCL2 involvement in neural function.

  11. Withdrawal: Expanding a Key Addiction Construct.

    Science.gov (United States)

    Piper, Megan E

    2015-12-01

    Withdrawal is an essential component of classical addiction theory; it is a vital manifestation of dependence and motivates relapse. However, the traditional conceptualization of withdrawal as a cohesive collection of symptoms that emerge during drug deprivation and decline with either the passage of time or reinstatement of drug use, may be inadequate to explain scientific findings or fit with modern theories of addiction. This article expands the current understanding of tobacco withdrawal by examining: (1) withdrawal variability; (2) underlying causes of withdrawal variability, including biological and person factors, environmental influences, and the influence of highly routinized behavioral patterns; (3) new withdrawal symptoms that allow for enhanced characterization of the withdrawal experience; and (4) withdrawal-related cognitive processes. These topics provide guidance regarding the optimal assessment of withdrawal and illustrate the potential impact modern withdrawal conceptualization and assessment could have on identifying treatment targets. © The Author 2015. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  12. 5 CFR 362.207 - Withdrawal and readmission.

    Science.gov (United States)

    2010-01-01

    ... 5 Administrative Personnel 1 2010-01-01 2010-01-01 false Withdrawal and readmission. 362.207... PRESIDENTIAL MANAGEMENT FELLOWS PROGRAM Program Administration § 362.207 Withdrawal and readmission. (a...) An agency must notify OPM when a Fellow or Senior Fellow withdraws from the Program. (b) Readmission...

  13. Ethical Analysis of Withdrawing Total Artificial Heart Support.

    Science.gov (United States)

    DeMartino, Erin S; Wordingham, Sara E; Stulak, John M; Boilson, Barry A; Fuechtmann, Kayla R; Singh, Nausheen; Sulmasy, Daniel P; Pajaro, Octavio E; Mueller, Paul S

    2017-05-01

    To describe the characteristics of patients who undergo withdrawal of total artificial heart support and to explore the ethical aspects of withdrawing this life-sustaining treatment. We retrospectively reviewed the medical records of all adult recipients of a total artificial heart at Mayo Clinic from the program's inception in 2007 through June 30, 2015. Management of other life-sustaining therapies, approach to end-of-life decision making, engagement of ethics and palliative care consultation, and causes of death were analyzed. Of 47 total artificial heart recipients, 14 patients or their surrogates (30%) requested withdrawal of total artificial heart support. No request was denied by treatment teams. All 14 patients were supported with at least 1 other life-sustaining therapy. Only 1 patient was able to participate in decision making. It is widely held to be ethically permissible to withdraw a life-sustaining treatment when the treatment no longer meets the patient's health care-related goals (ie, the burdens outweigh the benefits). These data suggest that some patients, surrogates, physicians, and other care providers believe that this principle extends to the withdrawal of total artificial heart support. Copyright © 2017 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.

  14. Opioid withdrawal syndrome: emerging concepts and novel therapeutic targets.

    Science.gov (United States)

    Rehni, Ashish K; Jaggi, Amteshwar S; Singh, Nirmal

    2013-02-01

    Opioid withdrawal syndrome is a debilitating manifestation of opioid dependence and responds poorly to the available clinical therapies. Studies from various in vivo and in vitro animal models of opioid withdrawal syndrome have led to understanding of its pathobiology which includes complex interrelated pathways leading to adenylyl cyclase superactivation based central excitation. Advancements in the elucidation of opioid withdrawal syndrome mechanisms have revealed a number of key targets that have been hypothesized to modulate clinical status. The present review discusses the neurobiology of opioid withdrawal syndrome and its therapeutic target recptors like calcitonin gene related peptide receptors (CGRP), N-methyl-D-aspartate (NMDA) receptors, gamma aminobutyric acid receptors (GABA), G-proteingated inwardly rectifying potassium (GIRK) channels and calcium channels. The present review further details the potential role of second messengers like calcium (Ca2+) / calmodulin-dependent protein kinase (CaMKII), nitric oxide synthase, cytokines, arachidonic acid metabolites, corticotropin releasing factor, fos and src kinases in causing opioid withdrawal syndrome. The exploitation of these targets may provide effective therapeutic agents for the management of opioid dependence-induced abstinence syndrome.

  15. Crisis - Strategic Management in Public Relation

    OpenAIRE

    Saari Ahmad

    2012-01-01

    This is a concept paper to explore the strategic management approaches in public relations during crisis. The main objective of this article is to identify the most effective action plan for Public relation. The review of the strategic management in public relations literature reveals that the relationship between strategic management and public relations is still vague. Four stages were identified in the process of establishing the action plan for public relations and eleven strategic action...

  16. Cocaine withdrawal causes delayed dysregulation of stress genes in the hippocampus.

    Directory of Open Access Journals (Sweden)

    M Julia García-Fuster

    Full Text Available Relapse, even following an extended period of withdrawal, is a major challenge in substance abuse management. Delayed neurobiological effects of the drug during prolonged withdrawal likely contribute to sustained vulnerability to relapse. Stress is a major trigger of relapse, and the hippocampus regulates the magnitude and duration of stress responses. Recent work has implicated hippocampal plasticity in various aspects of substance abuse. We asked whether changes in stress regulatory mechanisms in the hippocampus may participate in the neuroadaptations that occur during prolonged withdrawal. We therefore examined changes in the rat stress system during the course of withdrawal from extended daily access (5-hours of cocaine self-administration, an animal model of addiction. Tissue was collected at 1, 14 and 28 days of withdrawal. Plasma corticosterone levels were determined and corticosteroid receptors (GR, MR, MR/GR mRNA ratios and expression of other stress-related molecules (HSP90AA1 and HSP90AB1 mRNA were measured in hippocampal subfields using in situ hybridization. Results showed a delayed emergence of dysregulation of stress genes in the posterior hippocampus following 28 days of cocaine withdrawal. This included increased GR mRNA in DG and CA3, increased MR and HSP90AA1 mRNA in DG, and decreased MR/GR mRNA ratio in DG and CA1. Corticosterone levels progressively decreased during the course of withdrawal, were normalized following 28 days of withdrawal, and were correlated negatively with GR and positively with MR/GR mRNA ratio in DG. These results suggest a role for the posterior hippocampus in the neuroadaptations that occur during prolonged withdrawal, and point to a signaling partner of GR, HSP90AA1, as a novel dysregulated target during cocaine withdrawal. These delayed neurobiological effects of extended cocaine exposure likely contribute to sustained vulnerability to relapse.

  17. Alcohol Withdrawal Mimicking Organophosphate Poisoning

    Directory of Open Access Journals (Sweden)

    Nezihat Rana Disel

    2014-02-01

    Full Text Available Organophosphates, which can cause occupational poisoning due to inappropriate personal protective measures, are widely used insecticides in agricultural regions of southern Turkey. Therefore, the classical clinical findings of this cholinergic poisoning are myosis, excessive secretions, bradicardia and fasciculations are easy to be recognized by local medical stuff. Diseases and conditions related to alcoholism such as mental and social impairments, coma, toxicity, withdrawal, and delirium are frequent causes of emergency visits of chronic alcoholic patients. Here we present a case diagnosed and treated as organophosphate poisoning although it was an alcohol withdrawal in the beginning and became delirium tremens, due to similar symptoms.

  18. 78 FR 25353 - Proposed Guidance on Deposit Advance Products; Withdrawal of Proposed Guidance on Deposit-Related...

    Science.gov (United States)

    2013-04-30

    ... existing customer relationships. \\5\\ See OCC Bulletin, 2001-47, ``Third-Party Relationships: Risk Management Principles for Third-Party Relationships'' (November 1 2001). Compliance and Consumer Protection... protection statutes, management's oversight, and relationships with third parties will also be assessed...

  19. Stakeholder relations in the oil sands : managing uncertainty

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2009-05-15

    Alberta's oil sands are now at the crossroads of a series of significant and complex global issues that will require careful negotiation by all stakeholders involved in the oil sands industry. This paper discussed methods of managing uncertainty and risk related to the oil sands industry's agenda for the future. Oil sands developers must continue to secure permission from communities and other key stakeholders in order to develop oil sand projects. Stakeholder relations between oil sands operators, First Nations, and Metis Nation communities must ensure that respect is maintained while environmental impacts are minimized and long-term economic benefits are secured for all parties. Environmental non-governmental organizations (ENGOs) must ensure that oil sands resources are developed responsibly, and that environmental standards are maintained. Seven key shifts in stakeholder relations resulting from the recent economic crisis were identified. These included (1) withdrawal from the multi-stakeholder process, (2) increased focus on government to demonstrate policy leadership, (3) a stronger push from ENGOs to express environmental concerns, (4) global lobby and public relations efforts from ENGOs, (5) companies retreating to local community stakeholders, (6) more active demands from First Nations and Metis Nations groups, and (7) companies challenging ENGO campaigns. The study concluded by suggesting that government leadership is needed to clear policy and regulatory frameworks for Canada's oil sands.

  20. Tolerance and withdrawal from prolonged opioid use in critically ill children.

    Science.gov (United States)

    Anand, Kanwaljeet J S; Willson, Douglas F; Berger, John; Harrison, Rick; Meert, Kathleen L; Zimmerman, Jerry; Carcillo, Joseph; Newth, Christopher J L; Prodhan, Parthak; Dean, J Michael; Nicholson, Carol

    2010-05-01

    After prolonged opioid exposure, children develop opioid-induced hyperalgesia, tolerance, and withdrawal. Strategies for prevention and management should be based on the mechanisms of opioid tolerance and withdrawal. Relevant manuscripts published in the English language were searched in Medline by using search terms "opioid," "opiate," "sedation," "analgesia," "child," "infant-newborn," "tolerance," "dependency," "withdrawal," "analgesic," "receptor," and "individual opioid drugs." Clinical and preclinical studies were reviewed for data synthesis. Mechanisms of opioid-induced hyperalgesia and tolerance suggest important drug- and patient-related risk factors that lead to tolerance and withdrawal. Opioid tolerance occurs earlier in the younger age groups, develops commonly during critical illness, and results more frequently from prolonged intravenous infusions of short-acting opioids. Treatment options include slowly tapering opioid doses, switching to longer-acting opioids, or specifically treating the symptoms of opioid withdrawal. Novel therapies may also include blocking the mechanisms of opioid tolerance, which would enhance the safety and effectiveness of opioid analgesia. Opioid tolerance and withdrawal occur frequently in critically ill children. Novel insights into opioid receptor physiology and cellular biochemical changes will inform scientific approaches for the use of opioid analgesia and the prevention of opioid tolerance and withdrawal.

  1. Neonatal opioid withdrawal syndrome.

    Science.gov (United States)

    Sutter, Mary Beth; Leeman, Lawrence; Hsi, Andrew

    2014-06-01

    Neonatal opioid withdrawal syndrome is common due to the current opioid addiction epidemic. Infants born to women covertly abusing prescription opioids may not be identified as at risk until withdrawal signs present. Buprenorphine is a newer treatment for maternal opioid addiction and appears to result in a milder withdrawal syndrome than methadone. Initial treatment is with nonpharmacological measures including decreasing stimuli, however pharmacological treatment is commonly required. Opioid monotherapy is preferred, with phenobarbital or clonidine uncommonly needed as adjunctive therapy. Rooming-in and breastfeeding may decease the severity of withdrawal. Limited evidence is available regarding long-term effects of perinatal opioid exposure. Copyright © 2014 Elsevier Inc. All rights reserved.

  2. Non-analgesic effects of opioids: management of opioid-induced constipation by peripheral opioid receptor antagonists: prevention or withdrawal?

    Science.gov (United States)

    Holzer, Peter

    2012-01-01

    The therapeutic action of opioid analgesics is compromised by peripheral adverse effects among which opioid-induced constipation (OIC) is the most disabling, with a prevalence reported to vary between 15 and 90 %. Although OIC is usually treated with laxatives, there is insufficient clinical evidence that laxatives are efficacious in this indication. In contrast, there is ample evidence from double- blind, randomized and placebo-controlled trials that peripheral opioid receptor antagonists (PORAs) counteract OIC. This specific treatment modality is currently based on subcutaneous methylnaltrexone for the interruption of OIC in patients with advanced illness, and a fixed combination of oral prolonged-release naloxone with prolonged-release oxycodone for the prevention of OIC in the treatment of non-cancer and cancer pain. Both drugs counteract OIC while the analgesic effect of opioids remains unabated. The clinical studies show that more than 50 % of the patients with constipation under opioid therapy may benefit from the use of PORAs, while PORA-resistant patients are likely to suffer from non-opioid-induced constipation, the prevalence of which increases with age. While the addition of naloxone to oxycodone seems to act by preventing OIC, the intermittent dosing of methylnaltrexone every other day seems to stimulate defaecation by provoking an intestinal withdrawal response. The availability of PORAs provides a novel opportunity to specifically control OIC and other peripheral adverse effects of opioid analgesics (e.g., urinary retention and pruritus). The continuous dosing of a PORA has the advantage of few adverse effects, while intermittent dosing of a PORA can be associated with abdominal cramp-like pain.

  3. Acute oral administration of the novel, competitive and selective glucocorticoid receptor antagonist ORG 34517 reduces the severity of ethanol withdrawal and related hypothalamic-pituitary-adrenal axis activation.

    Science.gov (United States)

    Reynolds, Anna R; Saunders, Meredith A; Brewton, Honoree' W; Winchester, Sydney R; Elgumati, Ibrahim S; Prendergast, Mark A

    2015-09-01

    The development of ethanol dependence is associated with alterations in hypothalamic-pituitary-adrenal (HPA) axis and activation of type II glucocorticoid receptors (GR). These effects may contribute to withdrawal-associated anxiety, craving and relapse to drinking. The present studies examined acute and oral administration of the novel, selective and competitive GR antagonist ORG 34517 on the severity of ethanol withdrawal. Adult, male Sprague-Dawley rats were administered ethanol (4g/kg/i.g.) twice daily for 5 days followed by 2 days of withdrawal for 1, 2 or 3 consecutive cycles. Blood ethanol levels (BELs) were determined at 0930 on Day 4 of each week, while blood corticosterone levels (BCLs) were obtained at 11:00hours on the first day of each ethanol withdrawal. During early withdrawal, subjects received oral administration of ORG 345617 (60mg/kg/i.g.) or a placebo and withdrawal was monitored. Peak BELs of 225.52mg/dl were observed during the third week. Withdrawal from three cycles of the regimen produced marked behavioral abnormalities (e.g., aggression, rigidity, and hypoactivity) and significant increases in BCLs of ethanol-dependent subjects. Acute, oral administration of ORG 34517 during early withdrawal significantly reduced both the severity of ethanol withdrawal, as reflected in reduced rigidity, aggression, and hypoactivity, and elevations in BCL without producing any sedative-like effects. The present findings demonstrate that repeated ethanol exposure and withdrawal is associated with significant behavioral abnormalities and dysregulation of HPA axis activation. Further these data suggest that selective GR antagonists should be further considered as putative pharmacotherapies for treatment of ethanol dependence. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  4. Effects of acute caffeine on anxiety-related behavior in rats chronically exposed to the drug, with some evidence of possible withdrawal-reversal.

    Science.gov (United States)

    Hughes, Robert N; Hancock, Nicola J

    2017-03-15

    For 20days male and female PVG/c hooded rats were provided with caffeinated (approximately 50mg/kg/day) or unadulterated drinking water, and then their anxiety-related behavior was observed in an open field and elevated plus maze. Their choices of a brightness change were also observed in a Y maze to assess any caffeine effects on spatial memory. 24h later, all rats were tested again following an intraperitoneal injection of 50mg/kg acute caffeine, or vehicle. Earlier chronic caffeine decreased ambulation, walking, rearing, center occupancy and increased immobility in the open field thereby suggesting increased anxiety. However, occupancy of the plus-maze open arms and the Y-maze novel arm were increased by caffeine for male rats, but decreased for females probably because of sex differences in control levels of the response rather than to drug effects on anxiety and memory respectively. Following caffeine withdrawal, acute caffeine had the opposite effect to chronic treatment namely, increased open-field ambulation, walking, center occupancy and decreased immobility and defecation for caffeine-naïve rats that were suggestive of decreased anxiety. Similar but more consistent effects (plus decreased emergence latencies from a darkened start box into the open field) also typified the caffeine-experienced rats which in this case may have been accentuated by caffeine withdrawal-reversal. There was no evidence of either chronic or acute caffeine affecting spatial memory measured in the Y maze. There were also examples of lower overall activity and higher anxiety in male rats, than in females, and some sex-dependent caffeine effects. Copyright © 2016 Elsevier B.V. All rights reserved.

  5. 15 CFR 10.13 - Withdrawal of a published standard.

    Science.gov (United States)

    2010-01-01

    ...) Before withdrawing a standard published under these procedures, the Director will review the relative... 15 Commerce and Foreign Trade 1 2010-01-01 2010-01-01 false Withdrawal of a published standard. 10... DEVELOPMENT OF VOLUNTARY PRODUCT STANDARDS § 10.13 Withdrawal of a published standard. (a) Standards published...

  6. Health-related quality of life and functional outcomes from a randomized-withdrawal study of long-term lisdexamfetamine dimesylate treatment in children and adolescents with attention-deficit/hyperactivity disorder.

    Science.gov (United States)

    Banaschewski, Tobias; Johnson, Mats; Lecendreux, Michel; Zuddas, Alessandro; Adeyi, Ben; Hodgkins, Paul; Squires, Liza A; Coghill, David R

    2014-12-01

    The stimulant prodrug lisdexamfetamine dimesylate (LDX) is an effective and generally well tolerated treatment for the symptoms of attention-deficit/hyperactivity disorder (ADHD). Positive impacts of LDX on health-related quality of life and functional impairment have previously been demonstrated in a 7-week, randomized, double-blind, placebo-controlled, phase III study in children and adolescents in Europe. Maintenance of these broad benefits, as well as symptomatic control, is a key goal of long-term management of ADHD. Secondary objectives of this multinational study in children and adolescents with ADHD were to assess the long-term maintenance of effectiveness of LDX in improving health-related quality of life and reducing functional impairment, as gauged using the Child Health and Illness Profile-Child Edition: Parent Report Form (CHIP-CE: PRF) and the Weiss Functional Impairment Rating Scale-Parent Report (WFIRS-P), respectively. Patients aged 6-17 years with diagnosed ADHD and a baseline ADHD Rating Scale IV total score of at least 28 were enrolled from the previous European study and from US sites. Patients who completed an open-label LDX treatment period of at least 26 weeks were randomized (1:1) to continue on their optimized dose of LDX or to switch to placebo for a 6-week, double-blind, withdrawal period. Parents completed CHIP-CE: PRF and WFIRS-P questionnaires at weeks 0, 8 and 26 of the open-label period and at weeks 0 and 6 of the randomized-withdrawal period, or at early termination. The endpoint of each period was defined as the last visit with valid data. Effect sizes were the difference (LDX minus placebo) in least-squares (LS)-mean change from baseline to endpoint divided by root-mean-square error. P values were nominal and not adjusted for multiple comparisons. The open-label and randomized full analysis sets comprised 262 and 153 (LDX n = 76; placebo n = 77) patients, respectively. Mean pretreatment CHIP-CE: PRF T-scores were more than one

  7. Perinatal risk factors and social withdrawal behaviour.

    Science.gov (United States)

    Guedeney, Antoine; Marchand-Martin, Laetitia; Cote, Sylvana J; Larroque, Béatrice

    2012-04-01

    The objectives of the study were (1) to assess prevalence of social withdrawal behaviour in infants aged 12 months included in the French Perinatal Risk Factor Study Eden; (2) To study the correlation between relational withdrawal and several perinatal and parental factors assessed in the EDEN study. A longitudinal study using the ADBB scale was conducted within the Eden Cohort in the year 2008. 1,586 infants were included in the study. Fourteen percent of the children who had an ADBB assessment had a score at 5 and over on the ADBB, a scale designed to assess social withdrawal behaviour at age 0-24 months. Social withdrawal at 12 months was associated with low birth weight, low gestational age and with intra uterine growth retardation. Social withdrawal was independently associated with several maternal and paternal risk factors. The level of social withdrawal behaviour increased with a score of maternal difficulties. This study on a large longitudinally followed volunteer sample demonstrate a clear association of social withdrawal behaviour at age one with low birth weight and preterm birth, possibly mediated by parental vulnerabilities. Social withdrawal behaviour seems to be an important alarm signal to detect early on particularly in premature and small for date babies. © Springer-Verlag 2012

  8. Stigma Management in International Relations

    DEFF Research Database (Denmark)

    Adler-Nissen, Rebecca

    2014-01-01

    This article develops a theoretical approach to stigma in international relations and resituates conventional approaches to the study of norms and international order. Correcting the general understanding that common values and norms are the building blocks of social order, this article claims...

  9. Manager, Employee and Labour Relations | IDRC - International ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    Develop high-level presentations to senior management on strategic labour ... Plan, IDRC Annual Report, Corporate Dashboard and other reporting obligations by ... complex employee relations cases by supporting the HR Business Solutions ...

  10. Roadway related tort liability and risk management.

    Science.gov (United States)

    2010-06-01

    This workbook provide government employees background information related to tort liability and risk management. Past experience with lawsuits against government entities are summarized. The reasons for the lawsuits and results are analyzed. The obje...

  11. Quantifying the Clinical Significance of Cannabis Withdrawal

    Science.gov (United States)

    Allsop, David J.; Copeland, Jan; Norberg, Melissa M.; Fu, Shanlin; Molnar, Anna; Lewis, John; Budney, Alan J.

    2012-01-01

    Background and Aims Questions over the clinical significance of cannabis withdrawal have hindered its inclusion as a discrete cannabis induced psychiatric condition in the Diagnostic and Statistical Manual of Mental Disorders (DSM IV). This study aims to quantify functional impairment to normal daily activities from cannabis withdrawal, and looks at the factors predicting functional impairment. In addition the study tests the influence of functional impairment from cannabis withdrawal on cannabis use during and after an abstinence attempt. Methods and Results A volunteer sample of 49 non-treatment seeking cannabis users who met DSM-IV criteria for dependence provided daily withdrawal-related functional impairment scores during a one-week baseline phase and two weeks of monitored abstinence from cannabis with a one month follow up. Functional impairment from withdrawal symptoms was strongly associated with symptom severity (p = 0.0001). Participants with more severe cannabis dependence before the abstinence attempt reported greater functional impairment from cannabis withdrawal (p = 0.03). Relapse to cannabis use during the abstinence period was associated with greater functional impairment from a subset of withdrawal symptoms in high dependence users. Higher levels of functional impairment during the abstinence attempt predicted higher levels of cannabis use at one month follow up (p = 0.001). Conclusions Cannabis withdrawal is clinically significant because it is associated with functional impairment to normal daily activities, as well as relapse to cannabis use. Sample size in the relapse group was small and the use of a non-treatment seeking population requires findings to be replicated in clinical samples. Tailoring treatments to target withdrawal symptoms contributing to functional impairment during a quit attempt may improve treatment outcomes. PMID:23049760

  12. Quantifying the clinical significance of cannabis withdrawal.

    Directory of Open Access Journals (Sweden)

    David J Allsop

    Full Text Available Questions over the clinical significance of cannabis withdrawal have hindered its inclusion as a discrete cannabis induced psychiatric condition in the Diagnostic and Statistical Manual of Mental Disorders (DSM IV. This study aims to quantify functional impairment to normal daily activities from cannabis withdrawal, and looks at the factors predicting functional impairment. In addition the study tests the influence of functional impairment from cannabis withdrawal on cannabis use during and after an abstinence attempt.A volunteer sample of 49 non-treatment seeking cannabis users who met DSM-IV criteria for dependence provided daily withdrawal-related functional impairment scores during a one-week baseline phase and two weeks of monitored abstinence from cannabis with a one month follow up. Functional impairment from withdrawal symptoms was strongly associated with symptom severity (p=0.0001. Participants with more severe cannabis dependence before the abstinence attempt reported greater functional impairment from cannabis withdrawal (p=0.03. Relapse to cannabis use during the abstinence period was associated with greater functional impairment from a subset of withdrawal symptoms in high dependence users. Higher levels of functional impairment during the abstinence attempt predicted higher levels of cannabis use at one month follow up (p=0.001.Cannabis withdrawal is clinically significant because it is associated with functional impairment to normal daily activities, as well as relapse to cannabis use. Sample size in the relapse group was small and the use of a non-treatment seeking population requires findings to be replicated in clinical samples. Tailoring treatments to target withdrawal symptoms contributing to functional impairment during a quit attempt may improve treatment outcomes.

  13. Fluctuations in groundwater levels related to regional and local withdrawals in the fractured-bedrock groundwater system in northern Wake County, North Carolina, March 2008-February 2009

    Science.gov (United States)

    Chapman, Melinda J.; Almanaseer, Naser; McClenney, Bryce; Hinton, Natalie

    2011-01-01

    A study of dewatering of the fractured-bedrock aquifer in a localized area of east-central North Carolina was conducted from March 2008 through February 2009 to gain an understanding of why some privately owned wells and monitoring wells were intermittently dry. Although the study itself was localized in nature, the resulting water-resources data and information produced from the study will help enable resource managers to make sound water-supply and water-use decisions in similar crystalline-rock aquifer setting in parts of the Piedmont and Blue Ridge Physiographic Provinces. In June 2005, homeowners in a subdivision of approximately 11 homes on lots approximately 1 to 2 acres in size in an unincorporated area of Wake County, North Carolina, reported extremely low water pressure and temporarily dry wells during a brief period. This area of the State, which is in the Piedmont Physiographic Province, is undergoing rapid growth and development. Similar well conditions were reported again in July 2007. In an effort to evaluate aquifer conditions in the area of intermittent water loss, a study was begun in March 2008 to measure and monitor water levels and groundwater use. During the study period from March 2008 through February 2009, regular dewatering of the fractured-bedrock aquifer was documented with water levels in many wells ranging between 100 and 200 feet below land surface. Prior to this period, water levels from the 1980s through the late 1990s were reported to range from 15 to 50 feet below land surface. The study area includes three community wells and more than 30 private wells within a 2,000-foot radius of the dewatered private wells. Although groundwater levels were low, recovery was observed during periods of heavy rainfall, most likely a result of decreased withdrawals owing to less demand for irrigation purposes. Similar areal patterns of low groundwater levels were delineated during nine water-level measurement periods from March 2008 through

  14. Management of JJ stent-related symptoms.

    Science.gov (United States)

    Papatsoris, Athanasios; Dellis, Athanasios; Daglas, George; Sanguedolce, Francesco

    2014-01-01

    Ureteric JJ stents are inserted in numerous pa- tients as a routine procedure. Nevertheless, the ideal JJ stent that does not cause any lower urinary tract symptoms has not been developed yet. Even special validated ques- tionnaires have been used for the assessment of JJ stent-related symtoms. For the management of such symtoms usually alpha-blockers are admin- istered. Also, studies have examined the efficacy and safety of anticholinergics and calcium channel blo- ckers. In this article we review the literature upon the management of JJ stent-related symptoms.

  15. Disengagement as Withdrawal From Public Space: Rethinking the Relation Between Place Attachment, Place Appropriation, and Identity-Building Among Older Adults.

    Science.gov (United States)

    Wanka, Anna

    2018-01-18

    Empirical research indicates that engagement with public space decreases with age. Why do some older adults withdraw from the public, and which role does the (urban) environment play in spatial (dis-)engagement? Environmental gerontology's model of person-environment (PE) fit suggests an interrelation between agency and belonging and their causal effects on identity and wellbeing in later life. However, there is little research on how these dimensions are actually related. This study sets out to investigate this relationship and how PE can be better adapted for deprived neighborhoods. The study follows a qualitative case studies approach, focusing on a deprived neighborhood in Vienna, Austria. Nonparticipant observations were conducted at this site and complemented by 13 episodic interviews with older residents. The results challenge PE's model of interrelation between agency and belonging and their causal effects on identity, wellbeing, and autonomy in later life. Spatial agency in the deprived neighborhood was intense but so was spatial alienation and distancing oneself from one's neighborhood. Drawing on notions of territorial stigma, this might be a coping strategy to prevent one's self-identity from being "stained". Which strategy is being adopted by whom depends on the position and the trajectory in social and physical space. PE can be complemented with intersubjective measures of environmental conditions (e.g., stigma) and spatial engagement. Gerontology should proceed to consider not only the poor, disadvantaged, disengaged elderly, but also the rebellious, resisting, provocative new generation of older adults. © The Author 2017. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  16. The efficacy of fall-risk-increasing drug (FRID) withdrawal for the prevention of falls and fall-related complications: protocol for a systematic review and meta-analysis.

    Science.gov (United States)

    Lee, Justin Yusen; Holbrook, Anne

    2017-02-20

    Despite limited evidence of effectiveness, withdrawal (discontinuation or dose reduction) of high risk medications known as "fall-risk increasing drugs" (FRIDs) is typically conducted as a fall prevention strategy based on presumptive benefit. Our objective is to determine the efficacy of fall-risk increasing drugs (FRIDs) withdrawal on the prevention of falls and fall-related complications. We will search for all published and unpublished randomized controlled trials evaluating the effect of FRID withdrawal compared to usual care on the rate of falls, incidence of falls, fall-related injuries, fall-related fractures, fall-related hospitalizations, or adverse effects related to the intervention in adults aged 65 years or older. Electronic database searches will be conducted in MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), and CINAHL. A grey literature search will be conducted including clinical trial registries and conference proceedings and abstracts. Two reviewers will independently perform in duplicate citation screening, full-text review, data abstraction, and risk of bias assessment. Conflicts will be resolved through team discussion or by a third reviewer if no consensus can be reached. The Grades of Recommendation, Assessment, Development and Evaluation (GRADE) criteria will be used to independently rate overall confidence in effect estimates for each outcome. Results will be synthesized descriptively, and a random effects meta-analysis will be conducted for each outcome if studies are deemed similar methodologically, clinically, and statistically. We will attempt to determine whether a FRID withdrawal strategy alone is effective at preventing falls in older adults. Our results will be used to optimize and focus fall prevention strategies and initiatives internationally with a goal of improving the health of older adults. PROSPERO CRD42016040203.

  17. The efficacy of fall-risk-increasing drug (FRID withdrawal for the prevention of falls and fall-related complications: protocol for a systematic review and meta-analysis

    Directory of Open Access Journals (Sweden)

    Justin Yusen Lee

    2017-02-01

    Full Text Available Abstract Background Despite limited evidence of effectiveness, withdrawal (discontinuation or dose reduction of high risk medications known as “fall-risk increasing drugs” (FRIDs is typically conducted as a fall prevention strategy based on presumptive benefit. Our objective is to determine the efficacy of fall-risk increasing drugs (FRIDs withdrawal on the prevention of falls and fall-related complications. Methods/design We will search for all published and unpublished randomized controlled trials evaluating the effect of FRID withdrawal compared to usual care on the rate of falls, incidence of falls, fall-related injuries, fall-related fractures, fall-related hospitalizations, or adverse effects related to the intervention in adults aged 65 years or older. Electronic database searches will be conducted in MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL, and CINAHL. A grey literature search will be conducted including clinical trial registries and conference proceedings and abstracts. Two reviewers will independently perform in duplicate citation screening, full-text review, data abstraction, and risk of bias assessment. Conflicts will be resolved through team discussion or by a third reviewer if no consensus can be reached. The Grades of Recommendation, Assessment, Development and Evaluation (GRADE criteria will be used to independently rate overall confidence in effect estimates for each outcome. Results will be synthesized descriptively, and a random effects meta-analysis will be conducted for each outcome if studies are deemed similar methodologically, clinically, and statistically. Discussion We will attempt to determine whether a FRID withdrawal strategy alone is effective at preventing falls in older adults. Our results will be used to optimize and focus fall prevention strategies and initiatives internationally with a goal of improving the health of older adults. Systematic review registration PROSPERO CRD

  18. Are smartphone dependence symptoms related to FoMO, craving and withdrawal symptoms during smartphone abstinence? : Findings from a natural experiment

    NARCIS (Netherlands)

    van den Eijnden, R.J.J.M.; Doornwaard, S.M.; ter Bogt, T.F.M.

    Background and aims: Adding to the ongoing discussion about the concept of behavioral addictions (Rosenburg & Feder, 2014), the present study tested whether or not individuals high on symptoms of smartphone addiction experience more craving and more withdrawal symptoms during a period of smartphone

  19. 76 FR 28034 - Labor-Management Relations Information Collection Requests

    Science.gov (United States)

    2011-05-13

    ... FEDERAL MEDIATION AND CONCILIATION SERVICE Labor-Management Relations Information Collection... of Subjects Labor-management relations, employee management relations, and Information collection... opportunity to comment on the following information collection requests. The information collection requests...

  20. Sodium Valproate Withdrawal Correlates with Reduced Aggression

    Science.gov (United States)

    Pritchard, Duncan; Hoerger, Marguerite; Dyer, Tim; Graham, Nicola; Penney, Heather; Mace, F. Charles

    2014-01-01

    People with learning disabilities are sometimes prescribed psychotropic medication to help manage their challenging behaviour. This case study describes how a multicomponent behavioural intervention in conjunction with the systematic withdrawal of sodium valproate was strongly correlated with reduced aggression. No symptoms of bipolar disorder or…

  1. Recent advances in alcohol withdrawal states.

    Science.gov (United States)

    Fialkov, M J

    1977-11-26

    Recent advances in alcohol withdrawal states are described. New concepts of classification, the development of the syndrome and its management are outlined. In the light of recent research, more optimistic results for this much maligned but common condition may be achieved.

  2. Conducting a Withdrawal Survey.

    Science.gov (United States)

    Aldridge, Sue; Rowley, Jennifer

    2001-01-01

    A survey at Edge Hill College of Higher Education in Canada, designed to be part of the mechanism for monitoring and evaluating the quality of the student experience, revealed that key factors influencing withdrawal were: course not as expected, traveling difficulties, institution not as expected, domestic difficulties, and financial difficulties.…

  3. β-Arrestin-2 knockout prevents development of cellular μ-opioid receptor tolerance but does not affect opioid-withdrawal-related adaptations in single PAG neurons.

    Science.gov (United States)

    Connor, M; Bagley, E E; Chieng, B C; Christie, M J

    2015-01-01

    Tolerance to the behavioural effects of morphine is blunted in β-arrestin-2 knockout mice, but opioid withdrawal is largely unaffected. The cellular mechanisms of tolerance have been studied in some neurons from β-arrestin-2 knockouts, but tolerance and withdrawal mechanisms have not been examined at the cellular level in periaqueductal grey (PAG) neurons, which are crucial for central tolerance and withdrawal phenomena. μ-Opioid receptor (MOPr) inhibition of voltage-gated calcium channel currents (ICa ) was examined by patch-clamp recordings from acutely dissociated PAG neurons from wild-type and β-arrestin-2 knockout mice treated chronically with morphine (CMT) or vehicle. Opioid withdrawal-induced activation of GABA transporter type 1 (GAT-1) currents was determined using perforated patch recordings from PAG neurons in brain slices. MOPr inhibition of ICa in PAG neurons was unaffected by β-arrestin-2 deletion. CMT impaired coupling of MOPrs to ICa in PAG neurons from wild-type mice, but this cellular tolerance was not observed in neurons from CMT β-arrestin-2 knockouts. However, β-arrestin-2 knockouts displayed similar opioid-withdrawal-induced activation of GAT-1 currents as wild-type PAG neurons. In β-arrestin-2 knockout mice, the central neurons involved in the anti-nociceptive actions of opioids also fail to develop cellular tolerance to opioids following chronic morphine. The results also provide the first cellular physiological evidence that opioid withdrawal is not disrupted by β-arrestin-2 deletion. However, the unaffected basal sensitivity to opioids in PAG neurons provides further evidence that changes in basal MOPr sensitivity cannot account for the enhanced acute nociceptive response to morphine reported in β-arrestin-2 knockouts. This article is part of a themed section on Opioids: New Pathways to Functional Selectivity. To view the other articles in this section visit http://dx.doi.org/10.1111/bph.2015.172.issue-2. © 2014 The British

  4. Impacts of impervious cover, water withdrawals, and climate change on river flows in the conterminous US

    Directory of Open Access Journals (Sweden)

    P. V. Caldwell

    2012-08-01

    Full Text Available Rivers are essential to aquatic ecosystem and societal sustainability, but are increasingly impacted by water withdrawals, land-use change, and climate change. The relative and cumulative effects of these stressors on continental river flows are relatively unknown. In this study, we used an integrated water balance and flow routing model to evaluate the impacts of impervious cover and water withdrawal on river flow across the conterminous US at the 8-digit Hydrologic Unit Code (HUC watershed scale. We then estimated the impacts of projected change in withdrawals, impervious cover, and climate under the B1 "Low" and A2 "High" emission scenarios on river flows by 2060. Our results suggest that compared to no impervious cover, 2010 levels of impervious cover increased river flows by 9.9% on average with larger impacts in and downstream of major metropolitan areas. In contrast, compared to no water withdrawals, 2005 withdrawals decreased river flows by 1.4% on average with larger impacts in heavily irrigated arid regions of Western US. By 2060, impacts of climate change were predicted to overwhelm the potential gain in river flow due to future changes in impervious cover and add to the potential reduction in river flows from withdrawals, decreasing mean annual river flows from 2010 levels by 16% on average. However, increases in impervious cover by 2060 may offset the impact of climate change during the growing season in some watersheds. Large water withdrawals will aggravate the predicted impact of climate change on river flows, particularly in the Western US. Predicted ecohydrological impacts of land cover, water withdrawal, and climate change will likely include alteration of the terrestrial water balance, stream channel habitat, riparian and aquatic community structure in snow-dominated basins, and fish and mussel extirpations in heavily impacted watersheds. These changes may also require new infrastructure to support increasing anthropogenic

  5. Relating Performative and Ostensive Management Accounting Research

    DEFF Research Database (Denmark)

    Hansen, Allan

    2011-01-01

    . Findings – The paper illustrates how the process is a balancing act. On the one hand, it requires performative researchers to relate more closely to aspects decisive for ostensive researchers; yet, on the other, they need to preserve the distinctiveness of the performative approach. Originality....../value – This paper exemplifies these issues with reference to management accounting research and contributes by clarifying the methodological implications of moving performative research closer to ostensive research....

  6. Neurobiology of opioid withdrawal: Role of the endothelin system.

    Science.gov (United States)

    Bhalla, Shaifali; Andurkar, Shridhar V; Gulati, Anil

    2016-08-15

    Morphine and oxycodone are potent opioid analgesics most commonly used for the management of moderate to severe acute and chronic pain. Their clinical utility is limited by undesired side effects like analgesic tolerance, dependence, and withdrawal. We have previously demonstrated that endothelin-A (ETA) receptor antagonists potentiate opioid analgesia and eliminate analgesic tolerance. Mechanistically, G proteins and regulatory proteins such as β-arrestins have shown to play an important role in mediating opioid tolerance, dependence, and withdrawal. Recently, the involvement of central ET mechanisms in opioid withdrawal was investigated. ETA receptor antagonist was shown to block majority of the signs and symptoms associated with opioid withdrawal. This review focuses on ET as one of the potential novel strategies to manage the challenge of opioid withdrawal. An overview of additional players in this process (G proteins and β-arrestin2), and the possible therapeutic implications of these findings are presented. Copyright © 2016 Elsevier Inc. All rights reserved.

  7. Is this ?complicated? opioid withdrawal?

    OpenAIRE

    Parkar, S.R.; Seethalakshmi, R; Adarkar, S; Kharawala, S

    2006-01-01

    Seven patients with opioid dependence admitted in the de-addiction centre for detoxification developed convulsions and delirium during the withdrawal phase. After ruling out all other possible causes of these complications, opioid withdrawal seemed to emerge as the most likely explanation. The unpredictability of the course of opioid dependence and withdrawal needs to be considered when treating patients with opioid dependence.

  8. Ketogenic Diet Suppresses Alcohol Withdrawal Syndrome in Rats.

    Science.gov (United States)

    Dencker, Ditte; Molander, Anna; Thomsen, Morgane; Schlumberger, Chantal; Wortwein, Gitta; Weikop, Pia; Benveniste, Helene; Volkow, Nora D; Fink-Jensen, Anders

    2018-02-01

    Alcohol use disorder is underdiagnosed and undertreated, and up to 50% of alcohol-abstinent patients diagnosed with alcohol dependence relapse within the first year of treatment. Current treatments for the maintenance of alcohol abstinence in patients with alcohol use disorder have limited efficacy, and there is an urgent need for novel treatment strategies. Decreased cerebral glucose metabolism and increased brain uptake of acetate were recently reported in heavy drinkers, relative to controls. Given the switch of metabolic fuel from glucose to acetate in the alcohol-dependent brain, we investigated the potential therapeutic benefit of a ketogenic diet in managing alcohol withdrawal symptoms during detoxification. Male Sprague Dawley rats fed either ketogenic or regular diet were administered ethanol or water orally, twice daily for 6 days while the diet conditions were maintained. Abstinence symptoms were rated 6, 24, 48, and 72 hours after the last alcohol administration. Maintenance on a ketogenic diet caused a significant decrease in the alcohol withdrawal symptoms' "rigidity" and "irritability." Our preclinical pilot study suggests that a ketogenic diet may be a novel approach for treating alcohol withdrawal symptoms in humans. Copyright © 2017 by the Research Society on Alcoholism.

  9. Predictors of withdrawal: possible precursors of avoidant personality disorder.

    Science.gov (United States)

    Eggum, Natalie D; Eisenberg, Nancy; Spinrad, Tracy L; Valiente, Carlos; Edwards, Alison; Kupfer, Anne S; Reiser, Mark

    2009-01-01

    Relations of avoidant personality disorder (AvPD) with shyness and inhibition suggest that a precursor of AvPD is withdrawal. Using a sample of 4.5- to 7-year-olds studied four times, 2 years apart, four and three classes of children differing in trajectories of mother- and teacher-reported withdrawal, respectively, were identified. Mothers and teachers generally did not agree on children's trajectories but the pattern of findings in the two contexts did not differ markedly. The mother-identified high and declining withdrawal class, in comparison with less withdrawn classes, and the teacher-identified high and declining class compared with low withdrawal classes, were associated with relatively high levels of anger and low levels of attentional control and resiliency. The mother-identified moderate and increasing withdrawal class was distinguished from less problematic withdrawal classes by higher anger, lower resiliency, and sometimes, lower attentional control. The teacher-identified low and increasing withdrawal class was distinguished from less problematic withdrawal classes by lower resiliency and lower attentional control. Findings are discussed in terms of the developmental precursors to social withdrawal and avoidant behavior.

  10. CONSUMER'S RIGHT TO WITHDRAW

    Directory of Open Access Journals (Sweden)

    ANCA NICOLETA GHEORGHE

    2013-05-01

    Full Text Available The right of withdrawal (of a contract belongs to the consumer, and is an essential means for the improvement of regulations that protect the consumer.. Right of withdrawal is not a recent creation and is not even specific to the consumer field. He was previously recognized in civil and commercial law (without special regulation. The right to withdraw may even have as ground the parties will. Thus, based on the contractual freedom, the parties may agree that one of them has the right to terminate the contract unilaterally The possibility of unilateral denunciation of the contract, gives the consumer, added protection by being able to reflect the decision and to check how the trader fulfil its obligations. In this context, through its effects, the right of denunciation, forces the professional parties to conduct themselves as fair as possible to the consumer and to execute the contract properly. In the study of the consumer protection, the time of conclusion is essential because in this stage is manifested, the inequality between the consumer and professional. Thus, the lack of information, the major of products and activities, commercial practices, influence the formation of consumer will, preventing the expression of a freely and knowingly consent.

  11. Considerations related to Cernavoda NPP lifetime management

    International Nuclear Information System (INIS)

    Cojan, Mihail

    2007-01-01

    Cernavoda NPP, the first CANDU in Europe, is one of the original CANDU 6 plants and the first CANDU 6 producing over 706 MWe. While the first series of CANDU 6 plants (which entered service in the early 1980 s) have now reached the 2/3 of their 30 years design life, the Cernavoda NPP was put into service on the 2nd December 1996. After 10 years of operation the Plant Life Management (PLiM) Program for Cernavoda should be an increasingly important program to Utility ('CNE - Prod') in order to protect the investment and the continued success of plant operation. The goal of the paper is to present some considerations related to Cernavoda NPP lifetime management. The Plant Life Management Program, known as PLiM Program is concerned with the analysis of technical limits of the safe operation - from the point of view of nuclear safety - in NPP units, aiming at attaining the planned 30 years life duration and its extension to 40 or even 50 years of safe and economical operation. For the CANDU reactors the so-called PLiM and PLEX Programs are just applied. These are applied research programs that approach with priority the current practices for assessing the capability of safe operation within the limits of nuclear safety (fitness-for-service assessment). These programs also approach inspection, monitoring are prevention of degrading due to the ageing of critical systems, structures and components (CSSCs). As each nuclear plant is somewhat different in its components and systems, materials composition, procurement, construction, and operational history, directed research and development programs into materials behavior, monitoring techniques, and methods to mitigate ageing are required to support the lifetime management. Over the past 6 years, INR Pitesti (Institute for Nuclear Research - Romania) has been working on R and D Programs to support a comprehensive and integrated Cernavoda NPP Life Management Program (PLiM) that will see the Cernavoda NPP successfully and

  12. Social Withdrawal, Friendship, and Depressed Mood in Adolescents

    NARCIS (Netherlands)

    Aleva, A.E.|info:eu-repo/dai/nl/141299789; van Beek, Y.|info:eu-repo/dai/nl/107292300

    2017-01-01

    Social withdrawal in children may develop into a depressed mood in early adolescence , through experiences of problematic peer relationships, while friendship may function as a buffer (Rubin, Coplan, & Bowker, 2009). Our study examines the predictive relation between social withdrawal and depressive

  13. FRAMIS, Relational Data Base Management System

    International Nuclear Information System (INIS)

    Taylor, S.; Johnson, K.W.

    1985-01-01

    Description of program or function: FRAMIS is a relational database management tool that may be used to store, retrieve, and manipulate data stored in a FRAMIS database. A FRAMIS database is a set of tables or relations. These tables normally contain information about a set of real-world entities (e.g., persons, buildings, or computers). Each table consists of one or more named columns and zero or more rows. It is sometimes convenient to think of the rows of a table as similar to records in a file and to think of the columns as fields. The columns represent attributes of the entity (e.g., for persons - name, address, and sex; or for buildings - number of rooms, year built, and location). The rows represent specific instances of the real-world entity (e.g., John Doe's name, address, and sex or the characteristics of the house at 222 Maple Street). FRAMIS is intended to be particularly useful as an interactive management and analysis tool for scientific and engineering data

  14. Effect of Potassium Channel Modulators on Morphine Withdrawal in Mice

    Directory of Open Access Journals (Sweden)

    Vikas Seth

    2010-01-01

    Full Text Available The present study was conducted to investigate the effect of potassium channel openers and blockers on morphine withdrawal syndrome. Mice were rendered dependent on morphine by subcutaneous injection of morphine; four hours later, withdrawal was induced by using an opioid antagonist, naloxone. Mice were observed for 30 minutes for the withdrawal signs ie, the characteristic jumping, hyperactivity, urination and diarrhea. ATP-dependent potassium (K + ATP channel modulators were injected intraperitoneally (i.p. 30 minutes before the naloxone. It was found that a K + ATP channel opener, minoxidil (12.5–50 mg/kg i.p., suppressed the morphine withdrawal significantly. On the other hand, the K + ATP channel blocker glibenclamide (12.5–50 mg/kg i.p. caused a significant facilitation of the withdrawal. Glibenclamide was also found to abolish the minoxidil's inhibitory effect on morphine withdrawal. The study concludes that K + ATP channels play an important role in the genesis of morphine withdrawal and K + ATP channel openers could be useful in the management of opioid withdrawal. As morphine opens K + ATP channels in neurons, the channel openers possibly act by mimicking the effects of morphine on neuronal K + currents.

  15. Cystic Fibrosis-Related Diabetes (CFRD): Daily Management

    Science.gov (United States)

    Cystic Fibrosis-Related Diabetes (CFRD): Daily Management September 20, 2011 This Web cast is supported by an unrestricted ... Moran, MD Professor, Pediatric Endocrinology University of Minnesota Cystic Fibrosis-Related Diabetes (CFRD): Daily Management September 20, 2011 ...

  16. Ketogenic Diet suppresses Alcohol Withdrawal Syndrome in Rats

    DEFF Research Database (Denmark)

    Dencker, Ditte; Molander, Anna; Thomsen, Morgane

    2018-01-01

    , we investigated the potential therapeutic benefit of a ketogenic diet in managing alcohol withdrawal symptoms during detoxification. METHODS: Male Sprague Dawley rats fed either ketogenic or regular diets were administered ethanol or water orally, twice daily for 6 days while the diet conditions were...... maintained. Abstinence symptoms were rated 6, 24, 48, and 72 hours after the last alcohol administration. RESULTS: Maintenance on a ketogenic diet caused a significant decrease in the alcohol withdrawal symptoms 'rigidity' and 'irritability'. CONCLUSION: Our preclinical pilot study suggests that a ketogenic...... diet may be a novel approach for treating alcohol withdrawal symptoms in humans. This article is protected by copyright. All rights reserved....

  17. Sedative-hypnotic drug withdrawal syndrome: recognition and treatment [digest].

    Science.gov (United States)

    Santos, Cynthia; Olmedo, Ruben E; Kim, Jeremy

    2017-03-22

    Sedative-hypnotic drugs include gamma-Aminobutyric acid (GABA)ergic agents such as benzodiazepines, barbiturates, gamma-Hydroxybutyric acid [GHB], gamma-Butyrolactone [GBL], baclofen, and ethanol. Chronic use of these substances can cause tolerance, and abrupt cessation or a reduction in the quantity of the drug can precipitate a life-threatening withdrawal syndrome. Benzodiazepines, phenobarbital, propofol, and other GABA agonists or analogues can effectively control symptoms of withdrawal from GABAergic agents. Managing withdrawal symptoms requires a patient-specific approach that takes into account the physiologic pathways of the particular drugs used as well as the patient's age and comorbidities. Adjunctive therapies include alpha agonists, beta blockers, anticonvulsants, and antipsychotics. Newer pharmacological therapies offer promise in managing withdrawal symptoms. [Points & Pearls is a digest of Emergency Medicine Practice].

  18. THE CHANGING DIMENSIONS OF PUBLIC RELATIONS: THE RELATIONSHIP BETWEEN BRAND MANAGEMENT AND PUBLIC RELATIONS

    OpenAIRE

    KÖKER, E. PELİN BAYTEKİN MİNE YENİÇERİ ALEMDAR

    2008-01-01

    The changes in the dimensions of public relations, due to the globalization effect on the business enterprises, are remarkable. In this manner, the relationship of public relations with re-engineering, total quality management, six sigma approach, event management, crisis management, reputation management, knowledge management and customer relationship management is evaluated in this study. Moreover, after establishing these interactions, the relationship between public relations and brand ma...

  19. Method for Estimating Water Withdrawals for Livestock in the United States, 2005

    Science.gov (United States)

    Lovelace, John K.

    2009-01-01

    Livestock water use includes ground water and surface water associated with livestock watering, feedlots, dairy operations, and other on-farm needs. The water may be used for drinking, cooling, sanitation, waste disposal, and other needs related to the animals. Estimates of water withdrawals for livestock are needed for water planning and management. This report documents a method used to estimate withdrawals of fresh ground water and surface water for livestock in 2005 for each county and county equivalent in the United States, Puerto Rico, and the U.S. Virgin Islands. Categories of livestock included dairy cattle, beef and other cattle, hogs and pigs, laying hens, broilers and other chickens, turkeys, sheep and lambs, all goats, and horses (including ponies, mules, burros, and donkeys). Use of the method described in this report could result in more consistent water-withdrawal estimates for livestock that can be used by water managers and planners to determine water needs and trends across the United States. Water withdrawals for livestock in 2005 were estimated by using water-use coefficients, in gallons per head per day for each animal type, and livestock-population data. Coefficients for various livestock for most States were obtained from U.S. Geological Survey water-use program personnel or U.S. Geological Survey water-use publications. When no coefficient was available for an animal type in a State, the median value of reported coefficients for that animal was used. Livestock-population data were provided by the National Agricultural Statistics Service. County estimates were further divided into ground-water and surface-water withdrawals for each county and county equivalent. County totals from 2005 were compared to county totals from 1995 and 2000. Large deviations from 1995 or 2000 livestock withdrawal estimates were investigated and generally were due to comparison with reported withdrawals, differences in estimation techniques, differences in livestock

  20. Mitragynine attenuates withdrawal syndrome in morphine-withdrawn zebrafish.

    Directory of Open Access Journals (Sweden)

    Beng-Siang Khor

    Full Text Available A major obstacle in treating drug addiction is the severity of opiate withdrawal syndrome, which can lead to unwanted relapse. Mitragynine is the major alkaloid compound found in leaves of Mitragyna speciosa, a plant widely used by opiate addicts to mitigate the harshness of drug withdrawal. A series of experiments was conducted to investigate the effect of mitragynine on anxiety behavior, cortisol level and expression of stress pathway related genes in zebrafish undergoing morphine withdrawal phase. Adult zebrafish were subjected to two weeks chronic morphine exposure at 1.5 mg/L, followed by withdrawal for 24 hours prior to tests. Using the novel tank diving tests, we first showed that morphine-withdrawn zebrafish display anxiety-related swimming behaviors such as decreased exploratory behavior and increased erratic movement. Morphine withdrawal also elevated whole-body cortisol levels, which confirms the phenotypic stress-like behaviors. Exposing morphine-withdrawn fish to mitragynine however attenuates majority of the stress-related swimming behaviors and concomitantly lower whole-body cortisol level. Using real-time PCR gene expression analysis, we also showed that mitragynine reduces the mRNA expression of corticotropin releasing factor receptors and prodynorphin in zebrafish brain during morphine withdrawal phase, revealing for the first time a possible link between mitragynine's ability to attenuate anxiety during opiate withdrawal with the stress-related corticotropin pathway.

  1. Afghanistan after NATO Withdrawal

    Directory of Open Access Journals (Sweden)

    Bojor Laviniu

    2015-06-01

    Full Text Available The conclusion of a conflict, called by some American analysts as “America’s Longest War”, after the withdrawal of the majority of NATO military forces, requires a careful analysis of the conditions and security environment that ISAF mission, International Security Afghan Forces, leaves as legacy to the Afghan military forces. The transfer of authority towards a strong government, recognized by most Afghan provinces, and benefiting from the support of national military forces able to cope with terrorist and insurgent threats on its own, are the minimum and necessary conditions leading the country towards a stable and secure environment and towards a sustainable development. Given these realities, any approach on the consequences of the transition towards self-sustainable governance becomes interesting and timely for any military political study. These are the prospects that we propose in our paper.

  2. Management of Dysgeusia related to Cancer

    Directory of Open Access Journals (Sweden)

    DURGESHWORI MUNANKARMI

    2017-05-01

    Full Text Available Introduction: Taste change due to cancer is a notorious side effect, adversely affecting appetite and weight. Even though taste change or dysgeusia is one of the major causes of poor nutritional status in cancer survivors, it is not addressed as a significant problem and is often left untreated. The main purpose of this review is to explore current knowledge of pharmacological and behavioral interventions for the treatment of cancer related taste change. Methods: This systematic review was conducted in accordance with PRISMA guidelines to identify original articles on taste change. Multiple databases including; Scopus, Medline, EMBASE, CINAHL, and all databases via Pro quest were searched for original articles or studies related to taste change caused by cancer or its treatment. Relevant articles were subjected to a full text evaluation and assessed by Critical appraisal skills program (CASP guidelines and the Effective public health practice project (EPHPP instrument. Results: The search revealed 12 eligible studies, six of which were randomized controlled trials. Most of the studies used a standardized validated tool to measure taste change. Dysgeusia is common in cancer, 14 to 100% cancer patient report it. Pharmacological management with zinc remains inconclusive as one study reports it as beneficial and two other studies reported null effect. Few studies suggested dietary modifications such as use of sugary, salty foods that are helpful to reduce the effect of dysgeusia. Conclusion: Dietary counseling and informing the patient well about self-care strategies before treatment has consistently shown positive results on taste change, with strong statistical power. Other potential treatments for dysgeusia such as zinc, amifostine, and megestrol acetate gave inconsistent results.

  3. Considerations in change management related to technology.

    Science.gov (United States)

    Luo, John S; Hilty, Donald M; Worley, Linda L; Yager, Joel

    2006-01-01

    The authors describe the complexity of social processes for implementing technological change. Once a new technology is available, information about its availability and benefits must be made available to the community of users, with opportunities to try the innovations and find them worthwhile, despite organizational resistances. The authors reviewed the literature from psychiatry, psychology, sociology, business, and technology to distill common denominators for success and failure related to implementing technology. Beneficial technological innovations that are simple to use and obviously save everyone time and effort are easy to inaugurate. However, innovations that primarily serve management rather than subordinates or front-line utilizers may fail, despite considerable institutional effort. This article reviews and outlines several of the more prominent theoretical models governing successful institutional change. Successful implementation of difficult technological changes requires visionary leadership that has carefully considered the benefits, consulted with influence leaders at all organizational levels to spot unintended consequences and sources of resistance, and developed a detailed plan and continuous quality assurance process to foster implementation over time.

  4. Time-course of the DSM-5 cannabis withdrawal symptoms in poly-substance abusers

    DEFF Research Database (Denmark)

    Hesse, Morten; Thylstrup, Birgitte

    2013-01-01

    Background Evidence is accumulating that a cannabis withdrawal syndrome is common, of clinical significance, and has a clear time course. Up till now, very limited data exist on the cannabis withdrawal symptoms in patients with co-morbid substance use disorders, other than cannabis use and tobacco...... the DSM-5 Withdrawal Symptom Check List with withdrawal symptoms from all classes of substances, with no indication that the described symptoms should be attributed to withdrawal. Self-reported time since last use of cannabis was used as a predictor of cannabis withdrawal severity. Results...... With the exception of loss of appetite, time since last use of cannabis was associated with all types of withdrawal symptoms listed in the DSM-5. Only four of 19 symptoms intended to measure withdrawal from other substances were related to time since last use of cannabis, including vivid, unpleasant dreams...

  5. Application of project management methodology in design management of nuclear safety related structure

    International Nuclear Information System (INIS)

    Chen Mao

    2004-01-01

    This paper focuses on the application of project management methodology in the design management of Nuclear Safety Related Structure (NSRS), considering the design management features of its civil construction. Based on the experiences from the management of several projects, the project management triangle is proposed to be used in the management, to well treat the position of design interface in the project management. Some other management methods are also proposed

  6. Sleep-related headache and its management.

    Science.gov (United States)

    Singh, Niranjan N; Sahota, Pradeep

    2013-12-01

    apnea, which includes cluster headache, hypnic headache, and headache related to obstructive sleep apnea; and (2) headaches with high prevalence of insomnia, medication overuse, and psychiatric comorbidity including chronic migraine and chronic tension-type headache. The initial step in the management of sleep related headache is proper diagnosis with exclusion of secondary headaches. Screening for sleep disorders with the use of proper tests including polysomnography and referral to sleep clinic, when appropriate is very helpful. Control of individual episode in less than 2 hours should be the initial goal using measures to abort and prevent a relapse. Cluster headache responds very well to injectable Imitrex and oxygen. Verapamil, steroids and lithium are used for preventive treatment of cluster headache. Intractable cluster headache patients have responded to hypothalamic deep brain stimulation. Hypnic headache patients respond to nightly caffeine, indomethacin, and lithium. Paroxysmal hemicrania responds very well to indomethacin. Early morning headaches associated with obstructive sleep apnea respond to CPAP or BiPAP with complete resolution of headache within a month. Patient education and lifestyle modification play a significant role in overall success of the treatment. Chronic tension-type headache and chronic migraine have high prevalence of insomnia and comorbid psychiatric disorders, which require behavioral insomnia treatment and medication if needed along with psychiatric evaluation. Apart from the abortive treatment tailored to the headache types, - such as triptans and DHE 45 for migraine and nonsteroidal anti-inflammatory medication for chronic tension-type headache, preventive treatment with different class of medications including antiepileptics (Topamax and Depakote), calcium channel blockers (verapamil), beta blockers (propranolol), antidepressants (amitriptyline), and Botox may be used depending upon the comorbid conditions.

  7. Control rod withdrawal monitoring device

    International Nuclear Information System (INIS)

    Ebisuya, Mitsuo.

    1984-01-01

    Purpose: To prevent the power ramp even if a plurality of control rods are subjected to withdrawal operation at a time, by reducing the reactivity applied to the reactor. Constitution: The control rod withdrawal monitoring device is adapted to monitor and control the withdrawal of the control rods depending on the reactor power and the monitoring region thereof is divided into a control rod group monitoring region a transition region and a control group monitoring not interfere region. In a case if the distance between a plurality of control rods for which the withdrawal positions are selected is less than a limiting value, the coordinate for the control rods, distance between the control rods and that the control rod distance is shorter are displayed on a display panel, and the withdrawal for the control rods are blocked. Accordingly, even if a plurality of control rods are subjected successively to the withdrawal operation contrary to the control rod withdrawal sequence upon high power operation of the reactor, the power ramp can be prevented. (Kawakami, Y.)

  8. Mitigating risks related to facilities management.

    Science.gov (United States)

    O'Neill, Daniel P; Scarborough, Sydney

    2013-07-01

    By looking at metrics focusing on the functionality, age, capital investment, transparency, and sustainability (FACTS) of their organizations' facilities, facilities management teams can build potential business cases to justify upgrading the facilities. A FACTS analysis can ensure that capital spent on facilities will produce a higher or more certain ROI than alternatives. A consistent process for managing spending helps to avoid unexpected spikes that cost the enterprise more in the long run.

  9. Alcohol consumption increases locomotion in an open field and induces Fos-immunoreactivity in reward and approach/withdrawal-related neurocircuitries.

    Science.gov (United States)

    Wscieklica, Tatiana; de Barros Viana, Milena; Le Sueur Maluf, Luciana; Pouza, Kathlein Cristiny Peres; Spadari, Regina Célia; Céspedes, Isabel Cristina

    2016-02-01

    Drug addiction is a chronically relapsing disorder characterized by compulsion to seek and take the drug, loss of control in limiting intake and, eventually, the emergence of a negative emotional state when access to the drug is prevented. Both dopamine and corticotropin-releasing factor (CRF)-mediated systems seem to play important roles in the modulation of alcohol abuse and dependence. The present study investigated the effects of alcohol consumption on anxiety and locomotor parameters and on the activation of dopamine and CRF-innervated brain regions. Male Wistar rats were given a choice of two bottles for 31 days, one containing water and the other a solution of saccharin + alcohol. Control animals only received water and a solution of 0.2% saccharin. On the 31st day, animals were tested in the elevated plus-maze and open field, and euthanized immediately after the behavioral tests. An independent group of animals was treated with ethanol and used to measure blood ethanol concentration. Results showed that alcohol intake did not alter behavioral measurements in the plus-maze, but increased the number of crossings in the open field, an index of locomotor activity. Additionally, alcohol intake increased Fos-immunoreactivity (Fos-ir) in the prefrontal cortex, in the shell region of the nucleus accumbens, in the medial and central amygdala, in the bed nucleus of the stria terminalis, in the septal region, and in the paraventricular and dorsomedial hypothalamus, structures that have been linked to reward and to approach/withdrawal behavior. These observations might be relevant to a better understanding of the behavioral and physiological alterations that follow alcohol consumption. Copyright © 2016 Elsevier Inc. All rights reserved.

  10. Collective management of copyright and related rights

    CERN Document Server

    2010-01-01

    In the course of the last decade, collective management organizations (CMOs) have become the nerve centres of copyright licensing in virtually every country. Their expertise and knowledge of copyright law and management have proven essential to make copyright work in the digital age. This book, an extensively revised and updated edition of the only major work on the legal status of CMOs, offers an indepth analysis of the various operating CMO models, their rights and obligations vis-a-vis both users and members, acquisition of legal authority to license, and (most important) the rights to license digital uses of protected material and build (or improve current) information systems to deal with ever more complex rights management and licensing tasks. All the chapters have been updated since the 2005 edition, and a new chapter on multiterritorial licensing has been added. Factors considered include the following: * role of 'families' such as the International Confederation of Societies of Authors and Composers ...

  11. 76 FR 12992 - Notice of Public Meeting for Proposed Withdrawal

    Science.gov (United States)

    2011-03-09

    ... DEPARTMENT OF THE INTERIOR Bureau of Land Management [LLCAC09000 L14300000.ET0000; CACA 51408] Notice of Public Meeting for Proposed Withdrawal AGENCY: Bureau of Land Management, Interior. ACTION: Notice of public meeting. SUMMARY: A Notice was published in the Federal Register on August 3, 2010...

  12. Relational Information Management Data-Base System

    Science.gov (United States)

    Storaasli, O. O.; Erickson, W. J.; Gray, F. P.; Comfort, D. L.; Wahlstrom, S. O.; Von Limbach, G.

    1985-01-01

    DBMS with several features particularly useful to scientists and engineers. RIM5 interfaced with any application program written in language capable of Calling FORTRAN routines. Applications include data management for Space Shuttle Columbia tiles, aircraft flight tests, high-pressure piping, atmospheric chemistry, census, university registration, CAD/CAM Geometry, and civil-engineering dam construction.

  13. Relational XES: Data management for process mining

    NARCIS (Netherlands)

    Dongen, van B.F.; Shabani, S.; Grabis, J.; Sandkuhl, K.

    2015-01-01

    Information systems log data during the execution of business processes in so called "event logs". Process mining aims to improve business processes by extracting knowledge from event logs. Currently, the de-facto standard for storing and managing event data, XES, is tailored towards sequential

  14. Relational XES : data management for process mining

    NARCIS (Netherlands)

    Dongen, van B.F.; Shabani, S.

    2015-01-01

    Information systems log data during the execution of business processes in so called "event logs". Process mining aims to improve business processes by extracting knowledge from event logs. Currently, the de-facto standard for storing and managing event data, XES, is tailored towards sequential

  15. Is medical treatment of Alcohol Withdrawal Syndrome a Stag Hunt? Challenges and opportunities in managing risk and uncertainty in addiction cessation

    Directory of Open Access Journals (Sweden)

    Mendoza RL

    2017-12-01

    Full Text Available Roger Lee Mendoza School of Business, Wilmington University, New Castle, DE, USA Purpose: While the individual and social costs of alcoholism or alcohol use disorder are well established, few are aware that medical problems can arise during detoxification, some of which can be life-threatening. This study determines if sustained treatment for Alcohol Withdrawal Syndrome (AWS might be based on the strategic choices and expectations of patients and health care providers alike, as well as the risk mitigation options available to them.Design/approach: AWS was modeled as a Stag Hunt to explain both risk and decision-making in medical treatments for detoxification, since it can deduce a set of equilibrium strategies available to both patient and provider. Modeling was based on a review of juried literature gathered from search engines with the use medical subject heading terms.Main findings: While there is little evidence that decision-making is shared between patient and physician in AWS treatments, the outcomes of their interactions depend on utility-maximizing choices each makes in anticipation of the other. Payoff-dominant and risk-dominant treatment outcomes are equally likely and equally cost-efficient, as conditioned by the presence (or absence of mutual trust and assurance in reciprocal transactions.Conclusion/value: Simulation games, such as the Stag Hunt, offer a viable framework to understand patient and provider incentives and health-affecting behaviors during treatments for addiction cessation. If both anticipate indefinitely interacting in the absence of any predetermined or foreseeable final visit, they can maximize future payoffs from mutual cooperation and accountability, which fosters health promotion. However, this study suggests that the effect of cooperation is distinct from the effect of time in AWS and other addiction-cessation programs. Keywords: health-affecting behaviors, healthcare provider, patient compliance, payoff

  16. Accounting data in business management in relation to quality management.

    OpenAIRE

    ŠKRDLETOVÁ, Kateřina

    2013-01-01

    The aim of this bachelor thesis is to describe the influence that the quality accounting data have on the quality of management and the evaluation of psychological and ethical aspects. The theoretical part describes financial statements, ethics, the fraud triangle and Coso model of internal controls. The practical part contains the analysis of the internal control of the company. This model consists of five parts: control environment, risk assessment, control activities, information and commu...

  17. Managing IT-related operational risks

    Directory of Open Access Journals (Sweden)

    Savić Ana

    2008-01-01

    Full Text Available Not so long ago, information technology (IT risk occupied a small corner of operational risk - the opportunity loss from a missed IT development deadline. Today, the success of an entire financial institution may lay on managing a broad landscape of IT risks. IT risk is a potential damage to an organization's value, resulting from inadequate managing of processes and technologies. IT risk includes the failure to respond to security and privacy requirements, as well as many other issues such as: human error, internal fraud through software manipulation, external fraud by intruders, obsolesce in applications and machines, reliability issues or mismanagement. The World Economic Forum provides best information about this problem. They rank a breakdown of critical information infrastructure among the most likely core global risks, with 10-20 % likelihood over the next 10 years and potential worldwide impact of $250 billion. Sustained investment in IT - almost $1.2 trillion or 29% of 2006 private-sector capital investment in the U.S. alone fuels growing exposure to IT risk. Greg Hughes, chief strategy officer in Symantec Corp. recently claimed "IT risk management is more than using technology to solve security problems. With proper planning and broad support, it can give an organization the confidence to innovate, using IT to outdistance competitors".

  18. Prospective evaluation of ursodeoxycholic acid withdrawal in patients with primary sclerosing cholangitis.

    Science.gov (United States)

    Wunsch, Ewa; Trottier, Jocelyn; Milkiewicz, Malgorzata; Raszeja-Wyszomirska, Joanna; Hirschfield, Gideon M; Barbier, Olivier; Milkiewicz, Piotr

    2014-09-01

    Ursodeoxycholic acid (UDCA) is no longer recommended for management of adult patients with primary sclerosing cholangitis (PSC). We undertook a prospective evaluation of UDCA withdrawal in a group of consecutive patients with PSC. Twenty six patients, all treated with UDCA (dose range: 10-15 mg/kg/day) were included. Paired blood samples for liver biochemistry, bile acids, and fibroblast growth factor 19 (FGF19) were collected before UDCA withdrawal and 3 months later. Liquid chromatography/tandem mass spectrometry was used for quantification of 29 plasma bile acid metabolites. Pruritus and health-related quality of life (HRQoL) were assessed with a 10-point numeric rating scale, the Medical Outcomes Study Short Form-36 (SF-36), and PBC-40 questionnaires. UDCA withdrawal resulted in a significant deterioration in liver biochemistry (increase of alkaline phosphatase of 75.6%; Pacid analysis revealed a significant decrease in lithocholic acid and its derivatives after UDCA withdrawal, but no effect on concentrations of primary bile acids aside from an increased accumulation of their taurine conjugates. After UDCA removal cholestatic parameters, taurine species of cholic acid and chenodeoxycholic acid correlated with serum FGF19 levels. No significant effect on HRQoL after UDCA withdrawal was observed; however, 42% of patients reported a deterioration in their pruritus. At 3 months, discontinuation of UDCA in patients with PSC causes significant deterioration in liver biochemistry and influences concentrations of bile acid metabolites. A proportion of patients report increased pruritus, but other short-term markers of quality of life are unaffected. © 2014 by the American Association for the Study of Liver Diseases.

  19. Caffeine withdrawal symptoms and self-administration following caffeine deprivation.

    Science.gov (United States)

    Mitchell, S H; de Wit, H; Zacny, J P

    1995-08-01

    This study examined the effects of complete or partial caffeine deprivation on withdrawal symptomatology and self-administration of coffee in caffeine-dependent coffee drinkers. Nine habitual coffee drinkers abstained from dietary sources of caffeine for 33.5 h. Caffeine deprivation was manipulated by administering capsules containing 0%, 50%, or 100% of each subject's daily caffeine intake (complete, partial, and no deprivation conditions). Caffeine withdrawal symptomatology was measured using self-report questionnaires. Caffeine self-administration was measured using: i) the amount of coffee subjects earned on a series of concurrent random-ratio schedules that yielded coffee and money reinforcers; ii) the amount of earned coffee they consumed. Saliva samples revealed that subjects complied with the caffeine abstinence instructions. Caffeine withdrawal symptoms occurred reliably following complete caffeine deprivation, though not in the partial deprivation condition. Caffeine self-administration was not related to deprivation condition. We conclude that caffeine withdrawal symptomatology is not necessarily associated with increased caffeine consumption.

  20. Caffeine Withdrawal and Dependence: A Convenience Survey Among Addiction Professionals.

    Science.gov (United States)

    Budney, Alan J; Brown, Pamela C; Griffiths, Roland R; Hughes, John R; Juliano, Laura M

    2013-06-01

    Caffeine withdrawal was included in the research appendix of the DSM-IV to encourage additional research to assist with determining its status for the next version of the manual. Caffeine dependence was not included because of a lack of empirical research at the time of publication. This study assessed the beliefs of addiction professionals about the clinical importance of caffeine withdrawal and dependence. A 6-item survey was developed and delivered electronically to the members of six professional organizations that focus on addiction. Open-ended comments were also solicited. Five hundred members responded. The majority (95%) thought that cessation of caffeine could produce a withdrawal syndrome, and that caffeine withdrawal can have clinical importance (73%); however, only half (48%) thought that caffeine withdrawal should be included in the Diagnostic and Statistical Manual of Mental Disorders (DSM). A majority (58%) believed that some people develop caffeine dependence; however, only 44% indicated that it should be in the DSM. Comments suggested that trepidation about inclusion of caffeine diagnoses was due to the concerns about the field of psychiatry being criticized for including common disorders with a relatively low clinical severity. Others, however, expressed an urgent need to take caffeine-related problems more seriously. The majority of addiction professionals believe that caffeine withdrawal and dependence disorders exist and are clinically important; however, these professionals are divided in whether caffeine withdrawal and dependence should be included in DSM. Wider dissemination of the extant literature on caffeine withdrawal and additional research on caffeine dependence will be needed to provide additional guidance to policymakers and healthcare workers.

  1. Infants in Drug Withdrawal: A National Description of Nurse Workload, Infant Acuity, and Parental Needs.

    Science.gov (United States)

    Smith, Jessica G; Rogowski, Jeannette A; Schoenauer, Kathryn M; Lake, Eileen T

    Infants in drug withdrawal have complex physiological and behavioral states, requiring intensive nursing care. The study objectives were to describe acuity, parental needs, and nurse workload of infants in drug withdrawal compared with other infants. The design was cross-sectional and involved secondary nurse survey data from 6045 staff nurses from a national sample of 104 neonatal intensive care units. Nurses reported the care of 15 233 infants, 361 (2.4%) of whom were in drug withdrawal. Three-fourths of hospitals had at least 1 infant in drug withdrawal. In these hospitals, the mean number of infants in drug withdrawal was 4.7. Infant acuity was significantly higher among infants in drug withdrawal. Parents of infants in drug withdrawal required significantly more care to address complex social situations (51% vs 12%). The number of infants assigned to nurses with at least 1 infant in withdrawal (mean = 2.69) was significantly higher than typical (mean = 2.51). Given infant acuity and parental needs, policies legislating patient-to-nurse ratios should permit professional discretion on the number of patients to assign nurses caring for infants in drug withdrawal. Managers and charge nurses should consider the demands of caring for infants in drug withdrawal in assignment decisions and provide support and education.

  2. Sports Related Injuries: Incidence, Management and Prevention

    OpenAIRE

    Stanger, Michael A.

    1982-01-01

    The incidence of injury related to various sports is reviewed according to sport, area of injury, number of participants and hours per week spent at the sport. Organized sports accounted for fewer injuries than unsupervised recreational activities like tree climbing, skateboarding and running. The knee is the most commonly injured site. Sensitivity to patients' commitment to their sport is necessary: sometimes instead of rest, they can substitute a less hazardous form of exercise. Principles ...

  3. Managing Objects in a Relational Framework

    Science.gov (United States)

    1989-01-01

    Database Week, San Jose CA, May.1983, pp.107-113. [Stonebraker 85] Stonebraker,M. and Rowe,L.: "The Design of POSTGRES " Tech.Report UC Berkeley, Nov...latter is equivalent to the definition of an attribute in a POSTGRES relation using the generic Quel facility. Recently, recursive query languages have...utilize rewrite rules. OSQL [Lynl 88] provides a language for associative access. 2. The POSTGRES model [Sto 86] allows Quel and C-procedures as the

  4. Healthcare managers' construction of the manager role in relation to the medical profession.

    Science.gov (United States)

    von Knorring, Mia; Alexanderson, Kristina; Eliasson, Miriam A

    2016-05-16

    Purpose - The purpose of this paper is to explore how healthcare managers construct the manager role in relation to the medical profession in their organisations. Design/methodology/approach - In total, 18 of Sweden's 20 healthcare chief executive officers (CEOs) and 20 clinical department managers (CDMs) were interviewed about their views on management of physicians. Interviews were performed in the context of one aspect of healthcare management; i.e., management of physicians' sickness certification practice. A discourse analysis approach was used for data analysis. Findings - Few managers used a management-based discourse to construct the manager role. Instead, a profession-based discourse dominated and managers frequently used the attributes "physician" or "non-physician" to categorise themselves or other managers in their managerial roles. Some managers, both CEOs and CDMs, shifted between the management- and profession-based discourses, resulting in a kind of "yes, but […]" approach to management in the organisations. The dominating profession-based discourse served to reproduce the power and status of physicians within the organisation, thereby rendering the manager role weaker than the medical profession for both physician and non-physician managers. Research limitations/implications - Further studies are needed to explore the impact of gender, managerial level, and basic profession on how managers construct the manager role in relation to physicians. Practical implications - The results suggest that there is a need to address the organisational conditions for managers' role taking in healthcare organisations. Originality/value - Despite the general strengthening of the manager position in healthcare through political reforms during the last decades, this study shows that a profession-based discourse clearly dominated in how the managers constructed the manager role in relation to the medical profession on the workplace level in their organisations.

  5. 25 CFR 1200.34 - Can a tribe withdraw redeposited funds?

    Science.gov (United States)

    2010-04-01

    ... 25 Indians 2 2010-04-01 2010-04-01 false Can a tribe withdraw redeposited funds? 1200.34 Section 1200.34 Indians OFFICE OF THE SPECIAL TRUSTEE FOR AMERICAN INDIANS, DEPARTMENT OF THE INTERIOR AMERICAN INDIAN TRUST FUND MANAGEMENT REFORM ACT Returning Tribal Funds to Trust § 1200.34 Can a tribe withdraw...

  6. 77 FR 15378 - Agency Information Collection Activities: Application for Withdrawal of Bonded Stores for Fishing...

    Science.gov (United States)

    2012-03-15

    ... Activities: Application for Withdrawal of Bonded Stores for Fishing Vessels and Certificate of Use AGENCY: U... information collection request to the Office of Management and Budget (OMB) for review and approval in accordance with the Paperwork Reduction Act: Application for Withdrawal of Bonded Stores for Fishing Vessels...

  7. A case of rhabdomyolysis associated with severe opioid withdrawal.

    Science.gov (United States)

    Gangahar, Deepali

    2015-08-01

    While the risk of opioid overdose is widely accepted, the dangers of opioid withdrawal are far less clearly defined. The purpose of this publication is to provide evidence against the erroneous clinical dictum that opioid withdrawal is never life-threatening. This case report (N = 1) illustrates an unfortunate, common scenario of a man abusing prescription opioids and heroin. His attempt at self-detoxification with buprenorphine-naloxone resulted in life-threatening opioid withdrawal. A detailed account of each day of his withdrawal period was documented by patient and family report and review of all medical records. The patient was contacted three months after hospitalization to verify information and determine progress in treatment and abstinence from drugs and alcohol. A review of the literature was completed on severe cases of precipitated and spontaneous opioid withdrawal followed by a discussion of the significance as it relates to this case. Given the widespread use of prescription opioids and opioid maintenance treatment, physicians should be aware of the complications of acute opioid withdrawal and should be equipped to treat these complications. © American Academy of Addiction Psychiatry.

  8. Managing work-related stress in the district nursing workplace.

    Science.gov (United States)

    Burke, Michelle

    2013-11-01

    This article aims to highlight the issue of work-related stress within the district nursing workplace. It will acknowledge how the management of work-related stress has previously been discussed within nursing literature and will consider the emerging relationship between staff working conditions, staff wellbeing and quality of patient care. It will reintroduce the Health and Safety Executive's (HSE's) Management Standards approach to tackling work-related stress, which provides management support to reduce environmental work stressors and encourage enabling work environments and a positive workplace culture.

  9. Paying Attention to and Not Neglecting Social Withdrawal and Social Isolation

    Science.gov (United States)

    Rubin, Kenneth H.; Coplan, Robert J.

    2004-01-01

    This commentary outlines the origins, history, and current status of research related to children's social withdrawal and social isolation. Early research related to children's peer relationships is first explored, followed by a discussion of the relative "neglect" of social withdrawal prior to the 1980s. Increased research attention since that…

  10. ICIT activities related to tritium management

    International Nuclear Information System (INIS)

    Zamfirache, Marius; Bornea, Anisia; Stefanescu, Ioan; Ana, George; Stefan, Liviu

    2016-01-01

    Highlights: • We present the main directions of ICIT research in the field of hydrogen isotopes. • Tritium Removal Facility became a nuclear installation. • ICIT had begun the transfer of detritiation technology. - Abstract: National Research and Development Institute for Cryogenics and Isotopic Technologies (ICIT) was established in 1970 as a research focused Industrial Pilot Plant. This new Institute was created with the purpose to develop the heavy water production technology. This technology has been successfully transferred to the heavy water production plant in 1988 (with a capacity of 360 t/year). Currently, research within ICIT is focused on the following main objectives: support for the National Nuclear Program, hydrogen and fuel cells, cryogenics, environment. Within ICIT it has been built an Experimental Pilot Plant having as the main objective the development of a technology for heavy water detritiation. The purpose of this Pilot Plant is to obtain technological data and functional characteristics of specific equipment in order to design a Detritiation Facility used for Nuclear Power Plants with CANDU reactors. This work is focused on the presentation of ICIT research activities, perspectives and its capability related to water detritiation technologies and also to on issues in the field of nuclear fusion.

  11. The manager role in relation to the medical profession

    OpenAIRE

    Knorring, Mia von

    2012-01-01

    Background: Managers and physicians have two important roles in healthcare organisations. However, several studies have identified problems in the manager–physician relationship and more knowledge is needed to improve the situation. Using theories on organisation, professions, and role taking to inform thinking, this thesis addresses one aspect of the manager-physician relationship, namely how managers handle their role in relation to the medical profession. This was studied in the context of...

  12. Public Relations Manager Involvement in Strategic Issue Diagnosis.

    Science.gov (United States)

    Lauzen, Martha M.

    1995-01-01

    Reports on an exploratory study that seeks to build theoretical understanding of how public relations practitioner involvement in one type of strategic organizational decision making--strategic issue diagnosis--is related to shared values with top management, diagnosis accuracy, strategy pursued, and the power of the public relations function. (TB)

  13. Crisis Communication and Management: Surviving a Public Relations Crisis

    Science.gov (United States)

    Eramo, Eric M.

    2009-01-01

    Crisis management, or crisis communication, is never a good thing for a business to experience. It is, however, a public relations' professional moment to shine and put their honed skills to good use. A good crisis management plan is not only action during the crisis but preparation and reflection. Hiring a PR firm that deals with crisis…

  14. Managing domino effect-related security of industrial areas

    NARCIS (Netherlands)

    Reniers, Genserik L L; Dullaert, W.; Audenaert, Amaryllis; Ale, B. J.M.; Soudan, K.

    In chemical enterprises, security managers are interested in easy-to-handle and user-friendly decision-support tools, providing them with straightforward information ready for implementation. Therefore, a theoretical conceptualization on how to manage-in a relatively simple way-the prevention and

  15. 76 FR 43331 - Labor-Management Relations Information Collection Requests

    Science.gov (United States)

    2011-07-20

    ... FEDERAL MEDIATION AND CONCILIATION SERVICE Labor-Management Relations Information Collection... the following public information collection requests (ICR) to the Office of Management and Budget (OMB... information collection requests are FMCS forms: Arbitrator's Report and Fee Statement (Agency Form R-19...

  16. 77 FR 56842 - Labor-Management Relations Information Collection Requests

    Science.gov (United States)

    2012-09-14

    ... FEDERAL MEDIATION AND CONCILIATION SERVICE Labor-Management Relations Information Collection... the following public information collection request (ICR) to the Office of Management and Budget (OMB... information collection request is the Notice to Mediation Agencies (Agency Form F-7), OMB control number 3076...

  17. Reputation Management: The New Face of Corporate Public Relations?

    Science.gov (United States)

    Hutton, James G.; Goodman, Michael B.; Alexander, Jill B.; Genest, Christina M.

    2001-01-01

    Presents an empirical study of the Fortune 500 companies suggesting that "reputation management" is gaining ground as a driving philosophy behind corporate public relations. Finds some interesting correlations between reputation and specific categories of spending. Concludes that if reputation management is the new face of corporate…

  18. Management by Objectives: Authentic Assessment in a Public Relations Practicum.

    Science.gov (United States)

    Fall, Lisa T.

    Incorporation of management principles in the classroom can motivate students to successfully complete project work. The Communication Arts Department at Georgia Southern University developed a Public Relations Event Management course in which the students were responsible for planning a campus-wide special event to raise funds for two clients.…

  19. Withdrawal cognition among workers in distressed banks: Roles of ...

    African Journals Online (AJOL)

    Results indicated that employees who perceived low organisational support and high inequality had high level of withdrawal cognition. Based on these findings, the researchers recommended that bank managers should provide adequate social supports for their employees and treat them equally or make sure that rewards ...

  20. Exploring differences of soil quality as related to management in ...

    African Journals Online (AJOL)

    soil, vegetation and biodiversity) and productivity. Vegetation condition in contrasting land-use management systems is well documented in semiarid rangelands, but relatively little information is available on soil quality. This study explores soil ...

  1. Turbulent times : Consequences for crisis management and related future research

    NARCIS (Netherlands)

    van der Molen, I.; Vos, Marita F.; Vos, Marita

    In this chapter, we will address the idea that organisational resilience calls for management across organisational and discipline borders. We will also discuss the need for related applied research and technological development. Finally, we will look into future research design.

  2. Water withdrawals in Florida, 2012

    Science.gov (United States)

    Marella, Richard L.

    2015-09-01

    In 2012, the total amount of water withdrawn in Florida was estimated to be 14,237 million gallons per day (Mgal/d). Saline water accounted for 7,855 Mgal/d (55 percent), and freshwater accounted for 6,383 Mgal/d (45 percent). Groundwater accounted for 4,167 Mgal/d (65 percent) of freshwater withdrawals, and surface water accounted for the remaining 2,216 Mgal/d (35 percent). Surface water accounted for nearly all (99.9 percent) saline-water withdrawals. Freshwater withdrawals were greatest in Palm Beach County (682 Mgal/d), and saline-water withdrawals were greatest in Pasco County (1,822 Mgal/d). Fresh groundwater provided drinking water (through either public supply or private domestic wells) for 17.699 million residents (93 percent of Florida’s population), and fresh surface water provided drinking water for 1.375 million residents (7 percent). The statewide public-supply gross per capita water use for 2012 was estimated at 136 gallons per day.

  3. Political Public Relations − Media and Information Management

    OpenAIRE

    Tomić, Zoran; Grbavac, Ivana

    2016-01-01

    Political public relations, as one of the PR programmes, has slowly created strategies and tactics for communication with the public and the media. Media management and information management are the most important activities of the political public relations. These activities are frequently connected with non-ethical communication, whose aim is media manipulation and manipulation of the public. Media manipulation is well known as communication spin. These activities are created by governm...

  4. The Relationship between Trail Running Withdrawals and Race Topography

    Directory of Open Access Journals (Sweden)

    Antonini Philippe Roberta

    2017-12-01

    Full Text Available Context: A growing amount of recent research in sport psychology has focused on trying to understand withdrawals from ultra-races. However, according to the Four E approach, the studies underestimated the embedded components of these experiences and particularly how they were linked to the specific environmental conditions in which the experiences occurred. Objective: This study aimed to characterize trail running withdrawals in relationship to race topography. Design: Qualitative design, involving self-confrontation interviews and use of a race map. Setting: Use of the race map for description of the race activity and self-confrontation interviews took place 1–3 days after the races. Participants: Ten runners who withdrew during an ultra-trail race. Data Collection and Analysis: Data on past activity traces and experiences were elicited from self-confrontation interviews. Data were coded and compared to identify common sequences and then each type of sequence was counted with regard to race topography. Results: Results showed that each sequence was related to runners’ particular possibilities for acting, feeling, and thinking, which were in turn embedded in the race topography. These sequences allowed the unfolding of the activity and increased its overall effectiveness in relation to the constraints of this specific sport. Conclusion: This study allowed us to highlight important information on how ultra-trail runners manage their races in relationship to the race environment and more specifically to its topography. The result will also help us to recommend potential adjustments to ultra-trail runners’ performance-oriented training and preparation.

  5. Caseload management, work-related stress and case manager self-efficacy among Victorian mental health case managers.

    Science.gov (United States)

    King, Robert

    2009-05-01

    In Australia and comparable countries, case management has become the dominant process by which public mental health services provide outpatient clinical services to people with severe mental illness. There is recognition that caseload size impacts on service provision and that management of caseloads is an important dimension of overall service management. There has been little empirical investigation, however, of caseload and its management. The present study was undertaken in the context of an industrial agreement in Victoria, Australia that required services to introduce standardized approaches to caseload management. The aims of the present study were therefore to (i) investigate caseload size and approaches to caseload management in Victoria's mental health services; and (ii) determine whether caseload size and/or approach to caseload management is associated with work-related stress or case manager self-efficacy among community mental health professionals employed in Victoria's mental health services. A total of 188 case managers responded to an online cross-sectional survey with both purpose-developed items investigating methods of case allocation and caseload monitoring, and standard measures of work-related stress and case manager personal efficacy. The mean caseload size was 20 per full-time case manager. Both work-related stress scores and case manager personal efficacy scores were broadly comparable with those reported in previous studies. Higher caseloads were associated with higher levels of work-related stress and lower levels of case manager personal efficacy. Active monitoring of caseload was associated with lower scores for work-related stress and higher scores for case manager personal efficacy, regardless of size of caseload. Although caseloads were most frequently monitored by the case manager, there was evidence that monitoring by a supervisor was more beneficial than self-monitoring. Routine monitoring of caseload, especially by a workplace

  6. Management of work-related stress by Finnish occupational physicians.

    Science.gov (United States)

    Kinnunen-Amoroso, M; Liira, J

    2013-07-01

    Occupational stress is a serious threat to the well-being of employees and organizations and may cause ill-health and loss of productivity. Determining the methods that occupational health (OH) services and employers use to manage work-related stress can help to detect both barriers and facilitating factors for effective stress management. To examine stress management methods used by OH physicians in Finland. Anonymous, self-administered e-mail questionnaire to Finnish OH physicians. A total of 222 OH physicians responded. Neither OH services nor their client organizations used standardized tools to assess or manage work-related stress. Work-related stress was assessed using patient interviews. Physicians reported that the main method used to manage occupational stress was supporting the individual employee. Half of the physicians attempted to involve workplaces in stress management by asking their patients to contact their supervisors regarding stress issues. In order to tackle work-related stress consistently and effectively employers and OH services should have agreed standardized protocols for managing stress in the workplace.

  7. Impacts of crop insurance on water withdrawals for irrigation

    Science.gov (United States)

    Deryugina, Tatyana; Konar, Megan

    2017-12-01

    Agricultural production remains particularly vulnerable to weather fluctuations and extreme events, such as droughts, floods, and heat waves. Crop insurance is a risk management tool developed to mitigate some of this weather risk and protect farmer income in times of poor production. However, crop insurance may have unintended consequences for water resources sustainability, as the vast majority of freshwater withdrawals go to agriculture. The causal impact of crop insurance on water use in agriculture remains poorly understood. Here, we determine the empirical relationship between crop insurance and irrigation water withdrawals in the United States. Importantly, we use an instrumental variables approach to establish causality. Our methodology exploits a major policy change in the crop insurance system - the 1994 Federal Crop Insurance Reform Act - which imposed crop insurance requirements on farmers. We find that a 1% increase in insured crop acreage leads to a 0.223% increase in irrigation withdrawals, with most coming from groundwater aquifers. We identify farmers growing more groundwater-fed cotton as an important mechanism contributing to increased withdrawals. A 1% increase in insured crop acreage leads to a 0.624% increase in cotton acreage, or 95,602 acres. These results demonstrate that crop insurance causally leads to more irrigation withdrawals. More broadly, this work underscores the importance of determining causality in the water-food nexus as we endeavor to achieve global food security and water resources sustainability.

  8. A Content Analysis on Management and Terms related with Management in the Quran

    Directory of Open Access Journals (Sweden)

    Kürşat ÖZDAŞLI

    2014-05-01

    Full Text Available Guidelines and principles feeding the system of belief have the power of diverting behaviors of an individual included in that system as well as being able to affect the management style of managers. Therefore, use of the term of management by basic sources of Islamic belief and which other sources it refers to along with the term of management will be helpful in understanding the holistic message given in terms of management in Islamic style, and approaching from a different aspect to the management literature. This study aims to reveal characteristics of management and related terms in basic Islamic sources, and with which words and in what aspects they are associated and used, and to see the perception of the religion of Islam on management. The content analysis conducted in this context included examination of the verses containing the terms of management, administration, leader, directing and steering

  9. Prediction of withdrawal symptoms during opioid detoxification

    NARCIS (Netherlands)

    Dijkstra, Boukje A G; Krabbe, Paul F M; De Jong, Cor A J; van der Staak, Cees P F

    2008-01-01

    OBJECTIVE: The severity of self-reported withdrawal symptoms varies during detoxification of opioid-dependent patients. The aim of this study is to identify subgroups of withdrawal symptoms within the detoxification trajectory and to predict the severity of withdrawal symptoms on the basis of

  10. Prediction of withdrawal symptoms during opioid detoxification

    NARCIS (Netherlands)

    Dijkstra, B.A.G.; Krabbe, P.F.M.; Jong, C.A.J. de; Staak, C.P.F. van der

    2008-01-01

    Objective: The severity of self-reported withdrawal symptoms varies during detoxification of opioid-dependent patients. The aim of this study is to identify subgroups of withdrawal symptoms within the detoxification trajectory and to predict the severity of withdrawal symptoms on the basis of

  11. PUBLIC RELATIONS PROFESSIONALS’ PERCEPTION OF CONFLICT MANAGEMENT AS A MANAGEMENT FUNCTION

    Directory of Open Access Journals (Sweden)

    Tugce Ertem Eray

    2016-12-01

    Full Text Available Conflicts are a part of daily life that people encounter at home, work, and in organizations. It is evident that organizational conflicts are becoming more complex. In this respect, it is important for senior executives not to disregard these conflicts and involve public relations professionals in the conflict management processes. Hence, it is expected that public relations professionals become participants in the strategic planning process and that senior management relies on their experience and talents during the strategic planning process of organizations and resolution of issues. Another definition of public relations has emerged over the past years, even though the recent definitions of public relations focus on developing mutually beneficial relationships between organizations and their publics. Glen T. Cameron from University of Missouri defines public relations as management of conflict and competition strategically for the benefit of one’s own organization and, if possible, mutual benefit of organizations and individuals. It is impossible to disregard the influence of public relations professionals on managing the conflicts between an organization and its peers, and hence it is important to conduct further research on their approach to conflict management. With this motive, research questions have been generated based on the data presented by Professor Kenneth Plowman as a result of his analysis of strategic management of public relations in conflict management. Using the semi-structured interview technique, public relations professionals in Turkey were asked to describe their approach to conflict management.

  12. Managing Power Relations in Doctoral Education through Research ...

    African Journals Online (AJOL)

    Drawing mainly on the power theory of Foucault, this paper examines the power relations existing in research supervision. It explores the importance of mentoring as a key to managing such power relations. Mentoring is an empowering process of nurturing students with sufficient tools for research. The conditions for ...

  13. Selecting a Relational Database Management System for Library Automation Systems.

    Science.gov (United States)

    Shekhel, Alex; O'Brien, Mike

    1989-01-01

    Describes the evaluation of four relational database management systems (RDBMSs) (Informix Turbo, Oracle 6.0 TPS, Unify 2000 and Relational Technology's Ingres 5.0) to determine which is best suited for library automation. The evaluation criteria used to develop a benchmark specifically designed to test RDBMSs for libraries are discussed. (CLB)

  14. Establishing management information system to solve the information management problem of nuclear safety related personnel's qualification management

    International Nuclear Information System (INIS)

    Sun Haipeng; Liu Zhijun; Li Tianshu

    2013-01-01

    With the rapid progress of nuclear energy and nuclear technology utilization, nuclear safety related personnel play an increasingly important role in ensuring nuclear safety. NNSA personnel qualification management information system conducts a multi-faceted, effective, real-time monitoring and information collection for nuclear safety staff practice unit management, knowledge management, license application, appraisal management or supervision, training management or supervision and certified staff management, and also is a milestone for NNSA to build the state department with 'five-feature' (learning-oriented, service-oriented, economical, innovative, clean-type). (authors)

  15. Reconstruction of global gridded monthly sectoral water withdrawals for 1971-2010 and analysis of their spatiotemporal patterns

    Science.gov (United States)

    Huang, Zhongwei; Hejazi, Mohamad; Li, Xinya; Tang, Qiuhong; Vernon, Chris; Leng, Guoyong; Liu, Yaling; Döll, Petra; Eisner, Stephanie; Gerten, Dieter; Hanasaki, Naota; Wada, Yoshihide

    2018-04-01

    timescales. The reconstructed gridded water withdrawal dataset is open access, and can be used for examining issues related to water withdrawals at fine spatial, temporal, and sectoral scales.

  16. 75 FR 41237 - Public Land Order No. 7746; Withdrawal of Public Lands, South Fork of the American River; California

    Science.gov (United States)

    2010-07-15

    ... DEPARTMENT OF THE INTERIOR Bureau of Land Management [LLCAC08000-L1430000-ET0000; CACA 41334] Public Land Order No. 7746; Withdrawal of Public Lands, South Fork of the American River; California AGENCY: Bureau of Land Management, Interior. ACTION: Public Land Order. SUMMARY: This order withdraws 2...

  17. Optimizing withdrawal from drinking water reservoirs to reduce downstream temperature pollution and reservoir hypoxia.

    Science.gov (United States)

    Weber, M; Rinke, K; Hipsey, M R; Boehrer, B

    2017-07-15

    Sustainable management of drinking water reservoirs requires balancing the demands of water supply whilst minimizing environmental impact. This study numerically simulates the effect of an improved withdrawal scheme designed to alleviate the temperature pollution downstream of a reservoir. The aim was to identify an optimal withdrawal strategy such that water of a desirable discharge temperature can be supplied downstream without leading to unacceptably low oxygen concentrations within the reservoir. First, we calibrated a one-dimensional numerical model for hydrodynamics and oxygen dynamics (GLM-AED2), verifying that the model reproduced water temperatures and hypolimnetic dissolved oxygen concentrations accurately over a 5 year period. Second, the model was extended to include an adaptive withdrawal functionality, allowing for a prescribed withdrawal temperature to be found, with the potential constraint of hypolimnetic oxygen concentration. Scenario simulations on epi-/metalimnetic withdrawal demonstrate that the model is able to autonomously determine the best withdrawal height depending on the thermal structure and the hypolimnetic oxygen concentration thereby optimizing the ability to supply a desirable discharge temperature to the downstream river during summer. This new withdrawal strategy also increased the hypolimnetic raw water volume to be used for drinking water supply, but reduced the dissolved oxygen concentrations in the deep and cold water layers (hypolimnion). Implications of the results for reservoir management are discussed and the numerical model is provided for operators as a simple and efficient tool for optimizing the withdrawal strategy within different reservoir contexts. Copyright © 2017 Elsevier Ltd. All rights reserved.

  18. Water withdrawals, use, and trends in Florida, 2010

    Science.gov (United States)

    Marella, Richard L.

    2014-01-01

    -landscape irrigation and domestic self-supplied (5 percent each), and power generation (less than 1 percent). Agricultural self-supplied accounted for 51 percent of fresh surface-water withdrawals, followed by power generation (25 percent), public supply (11 percent), recreational-landscape irrigation (9 percent), and commercial-industrial-mining self-supplied (4 percent). Power generation accounted for nearly all (99.8 percent) saline-water withdrawals. Of the 18.80 million people who resided in Florida during 2010, 41 percent (7.68 million people) resided in the South Florida Water Management District (SFWMD), 25 percent each resided in the Southwest Florida Water Management District (SWFWMD) and the St. Johns River Water Management District (SJRWMD) (4.73 and 4.70 million people, respectively), 7 percent (1.36 million people) resided in the Northwest Florida Water Management District (NWFWMD), and 2 percent (0.33 million people) resided in the Suwannee River Water Management District (SRWMD). The largest percentage of freshwater withdrawals was from the SFWMD (47 percent), followed by the SJRWMD (21 percent), SWFWMD (18 percent), NWFWMD (9 percent), and SRWMD (5 percent). Between 1950 and 2010, the population of Florida increased by 16.03 million (580 percent), and the total water withdrawals (fresh and saline) increased by 12,334 Mgal/d (465 percent). More recently, total freshwater withdrawals decreased by more than 1,792 Mgal/d (22 percent) between 2000 and 2010, while the population increased by 2.82 million (18 percent), and total freshwater withdrawals decreased by more than 474 Mgal/d (7 percent) between 2005 and 2010, while the population increased by 0.88 million (8 percent). The recent trend of decreases in freshwater withdrawals is a result of increased rainfall during this period, the development and use of alternative water sources, water conservation efforts, more conservative regulations and mandates, changes in economic conditions, and losses of irrigated lands

  19. An Introduction to the DB Relational Database Management System

    OpenAIRE

    Ward, J.R.

    1982-01-01

    This paper is an introductory guide to using the Db programs to maintain and query a relational database on the UNIX operating system. In the past decade. increasing interest has been shown in the development of relational database management systems. Db is an attempt to incorporate a flexible and powerful relational database system within the user environment presented by the UNIX operating system. The family of Db programs is useful for maintaining a database of information that i...

  20. The Network Configuration of an Object Relational Database Management System

    Science.gov (United States)

    Diaz, Philip; Harris, W. C.

    2000-01-01

    The networking and implementation of the Oracle Database Management System (ODBMS) requires developers to have knowledge of the UNIX operating system as well as all the features of the Oracle Server. The server is an object relational database management system (DBMS). By using distributed processing, processes are split up between the database server and client application programs. The DBMS handles all the responsibilities of the server. The workstations running the database application concentrate on the interpretation and display of data.

  1. Acute pregabalin withdrawal: a case report and review of the literature

    Directory of Open Access Journals (Sweden)

    Barrett JA

    2015-05-01

    Full Text Available Objective: Pregabalin is a commonly prescribed GABA analog most commonly used for the treatment of neuralgia. Recently, case reports on pregabalin have been published describing episodes that may be associated with withdrawal-like symptoms after extended or aggressive therapy. This report describes a case in which long term exposure of high dose pregabalin may have resulted in acute withdrawal, and outlines the subsequent medical management of these symptoms. Case Summary: A 61-year-old male presenting with severe agitation presumed to be withdrawal from long term and high dose exposure to pregabalin. Medical management included the use of haloperidol, diphenhydramine, lorazepam and the addition of clonidine over the course of several days for the pharmacological management of withdrawal symptoms. Discussion: Although case reports are available to guide clinicians in the recognition of acute pregabalin withdrawal, definitive evidence on how best to treat these patients remains severely limited. With an increase in the prescribing practices of pregabalin, insight into the acute management by fellow clinicians is further needed. Conclusion: Caution must be practiced when prescribing and educating patients on the use of pregabalin to prevent associated withdrawal-like symptoms. In addition, documentation by the medical community on methods utilized to treat pregabalin withdrawal syndromes remains crucial for the advancement of patient care. Benzodiazepines and clonidine are the current therapies that have been documented as potentially effective treatment modalities at this time.

  2. Work-related stress management by Finnish enterprises.

    Science.gov (United States)

    Kinnunen-Amoroso, Maritta; Liira, Juha

    2014-01-01

    Work-related stress has become one of the major problems in working societies and it increases employees' risk of disease. Its importance has been emphasized also due to its' great socio-economic consequences. Different stress management and worksite interventions have been implemented, however, the actual practices in companies have been assessed little. The purpose of this study was to examine how enterprises in Finland manage work-related stress. An assessment of work-related stress methods was conducted in 40 enterprises acting in the metropolitan area of Finland in May 2010 by a questionnaire. The concept of work-related stress was well known by participants. Enterprises rarely had their own work-related stress management protocol even though all of the workplaces had experienced work-related stress at some point. The collaboration between the workplace and occupational health services varied. Companies easily placed the responsibility for work-related stress assessment and handling on occupational health services. Workplaces have to pay more attention to work-related stress and related issues. The easiest way to do this is to collaborate with occupational health services. Protocols for collaboration should be developed jointly using the available models which have been established as cost-effective.

  3. Managing Relational Legacies: Lessons from British Columbia, Canada

    Directory of Open Access Journals (Sweden)

    Sofiane Baba

    2014-01-01

    Full Text Available Issues related to company-community relations and the social license to operate have emerged as strategic business issues. This paper aims to contribute to the growing body of research on long-term company-community relations. An analysis of the relationship between Alcan (Aluminum of Canada, Montréal, Canada part of Rio Tinto since 2007 with the Cheslatta Carrier First Nation in the Kemano-Kitimat area of northern British Columbia, Canada, provides three contributions. The first is related to the notion of relational legacy, which refers to the sedimentation of unresolved issues that have the potential to impede the realization of corporate activities and the reproduction of low levels of social license to operate. The second concerns stakeholder management. While the literature suggests that stakeholders should be managed by companies according to the degree of salience, this analysis suggests that researchers and managers should consider the evolution of the environmental context in their analyses. Third, the analysis suggests that small or marginalized groups, depicted by the stakeholder management literature as dormant stakeholders, should not be underestimated.

  4. Water Withdrawals, Use, and Trends in Florida, 2005

    Science.gov (United States)

    Marella, Richard L.

    2009-01-01

    generation (20.5 percent), public supply (13 percent), recreational irrigation (6 percent), and commercial-industrial self-supplied (4.5 percent). Power generation accounted for nearly all (99.9 percent) saline-water withdrawals. Of the 17.92 million people who resided in Florida during 2005, 41 percent (7.36 million people) resided in the South Florida Water Management District (SFWMD), followed by the St. Johns River Water Management District (SJRWMD) and the Southwest Florida Water Management District (SWFWMD) with 25 percent each (4.46 and 4.44 million people, respectively), the Northwest Florida Water Management District (NWFWMD) with 7.5 percent (1.34 million people), and the Suwannee River Water Management District (SRWMD) with 1.5 percent (0.32 million people). The largest amount of freshwater withdrawals was from the SFWMD, which was one-half (50 percent) of the State's total freshwater withdrawals, followed by the SJRWMD (19 percent), SWFWMD (16 percent), NWFWMD (10 percent), and SRWMD (5 percent). Between 1950 and 2005, the population of Florida increased by 15.15 million (550 percent), and the total water withdrawals (fresh and saline) increased 15,700 Mgal/d (600 percent). More recently, total withdrawals decreased 1,790 Mgal/d (9 percent) between 2000 and 2005, but the total population increased by 1.94 million (12 percent). Between 1990 and 2005, saline-water withdrawals increased 1,120 Mgal/d (11 percent), whereas between 2000 and 2005, saline-water withdrawals decreased 470 Mgal/d (4 percent). Between 1990 and 2005, freshwater withdrawals decreased 710 Mgal/d (9 percent), whereas between 2000 and 2005, freshwater withdrawals decreased 1,320 Mgal/d (16 percent). The use of highly mineralized groundwater as a source of supply, primarily for public supply, also has increased in Florida. This water, referred as nonpotable water, increased from just less than 2 Mgal/d in 1970, to 142 Mgal/d in 2005. Nonpotable water is treated to meet drin

  5. Nature cures nature: Hypericum perforatum attenuates physical withdrawal signs in opium dependent rats.

    Science.gov (United States)

    Khan, Munasib; Subhan, Fazal; Khan, Arif-Ullah; Abbas, Muzaffar; Ali, Gowhar; Rauf, Khalid; Gilani, Anwarul Hassan

    2014-05-01

    Hypericum perforatum Linn. (Hypericaceae) (St. John's wort) attenuates opium withdrawal signs. To explore the therapeutic potential of Hypericum perforatum in the management of opium-induced withdrawal syndrome. The effect of the Hypericum perforatum hydro-ethanol extract was investigated for potential to reverse naloxone (0.25 mg/kg)-induced opium withdrawal physical signs. Rats received opium extract (80-650 mg/kg) twice daily for 8 days along with Hypericum perforatum (20 mg/kg, orally) twice daily in chronic treatment and the same single dose 1 h before induction of withdrawal syndrome in the acute treated group. Hypericum perforatum reduced stereotype jumps and wet dog shake number in the chronic treatment compared to the saline control group (F(2, 24) = 3.968, p opium withdrawal syndrome possibly through direct or indirect interaction with opioid receptors. Further study is needed to clarify its mechanism.

  6. Takotsubo Cardiomyopathy and Catatonia in the Setting of Benzodiazepine Withdrawal

    Directory of Open Access Journals (Sweden)

    Teng J. Peng

    2016-01-01

    Full Text Available We report two serious and unusual complications of benzodiazepine withdrawal in a single patient: takotsubo cardiomyopathy and catatonia. This 61-year-old female patient was brought to the emergency department with lethargy and within hours had declined into a state of catatonia. Although there was never a complaint of chest pain, ECG showed deep anterior T-wave inversions and cardiac enzymes were elevated. An echocardiogram was consistent with takotsubo cardiomyopathy. She later received 1 mg of midazolam and within minutes had resolution of catatonic symptoms. Careful history revealed that she had omitted her daily dose of lorazepam for 3 days prior to admission. To our knowledge, the case presented herein is the first report of simultaneous catatonia and takotsubo cardiomyopathy in the setting of benzodiazepine withdrawal. The pathogenesis of both conditions is poorly understood but may be indirectly related to the sudden decrease in γ-aminobutyric acid (GABA signaling during benzodiazepine withdrawal.

  7. Attention biases to threat and behavioral inhibition in early childhood shape adolescent social withdrawal.

    Science.gov (United States)

    Pérez-Edgar, Koraly; Bar-Haim, Yair; McDermott, Jennifer Martin; Chronis-Tuscano, Andrea; Pine, Daniel S; Fox, Nathan A

    2010-06-01

    Behavioral inhibition (BI) is a temperament characterized in young children by a heightened sensitivity to novelty, social withdrawal, and anxious behaviors. For many children, these social difficulties dissipate over time. For others, patterns of social withdrawal continue into adolescence. Over time, attention biases to threat may influence the stability of BI and its association with social withdrawal, ultimately modulating the risk for anxiety disorders in BI children. However, we know relatively little about the cognitive processes that accompany BI and shape later socio-emotional functioning. We examined the relations among BI in childhood, attention biases to threat in adolescence, and adolescent social withdrawal in a longitudinal study (N = 126, Mean age = 15 years). As has been reported in anxious adults, adolescents who were behaviorally inhibited as toddlers and young children showed heightened attention bias to threat. In addition, attention bias to threat moderated the relation between childhood BI and adolescent social withdrawal.

  8. Diagnosis-Related Groups (DRG and Hospital Business Performance Management

    Directory of Open Access Journals (Sweden)

    Szynkiewicz Piotr

    2014-12-01

    Full Text Available The goal of this article is to present the possibility of using Diagnosis- Related Groups (DRG in the hospital management process and to analyse the need for business performance management on the part of hospital management staff. The following research methods were used: literature analysis, case studies, and poll analysis. It is not possible to increase the effectiveness of operation of healthcare entities without increasing the importance of IT systems and using DRG more effectively in the management process. Training users in IT and the use of DRGs is important to achieving hospital effectiveness. The increased importance of analyses and planning in a hospital should be reflected in the organisational structure of service providers. Hospital controllers should have a similar role to those present in most companies in other industries.

  9. 41 CFR 101-39.307 - Grounds for withdrawal of vehicle.

    Science.gov (United States)

    2010-07-01

    ... VEHICLES 39-INTERAGENCY FLEET MANAGEMENT SYSTEMS 39.3-Use and Care of GSA Interagency Fleet Management... 41 Public Contracts and Property Management 2 2010-07-01 2010-07-01 true Grounds for withdrawal of vehicle. 101-39.307 Section 101-39.307 Public Contracts and Property Management Federal Property...

  10. The role of managed care in work-related injuries.

    Science.gov (United States)

    Shor, M J; Miller, J C

    1996-10-01

    Many opportunities exist today for orthopedic surgeons in the treatment and management of work-related injuries. Physicians wishing to enter or participate in this market must realize that the role of the physician in the treatment of the injured worker has expanded from one of being solely the care giver to being a patient manager, a problem solver, and a communicator. A number of years ago, many orthopedic surgeons missed out on managed care contracting for health maintenance organizations because they thought they could survive without it. They soon learned the challenges of sitting on the sidelines. Whether we like it or not, managed care for work-related injuries is here and its likelihood for going away is about zero. If your state has not yet adopted utilization management standards or managed care for workers' compensation-enabling legislation, when you wake up tomorrow they may have done so. Because of its relative embryonic development, there are exceptional opportunities for practitioners to take active roles in shaping the models that will serve employees and employers in the year 2000. Physicians who are interested in the treatment of injured workers have a unique opportunity right now to develop relationships in the managed workers' compensation arena. Payment and patient referrals for workers' compensation may turn out to be more attractive financially than many of the contracts currently in place with health maintenance organizations and other general health plans. Physicians willing to partner with employers and other players in the workers' compensation arena currently face some challenging, rewarding, and exciting opportunities. In the immortal words of Hippocrates, "Healing is a matter of time, but it is sometimes a matter of opportunity."3 It is unclear whether Hippocrates ever imagined our current level of science, practice, and organization, but it is clear the opportunities to be an active participant in the changes occurring in workers

  11. A relational database for personnel radiation exposure management

    International Nuclear Information System (INIS)

    David, W.; Miller, P.D.

    1993-01-01

    In-house utility personnel developed a relational data base for personnel radiation exposure management computer system during a 2 1/2 year period. The (PREM) Personnel Radiation Exposure Management System was designed to meet current Nuclear Regulatory Commission (NRC) requirements related to radiological access control, Radiation Work Permits (RWP) management, automated personnel dosimetry reporting, ALARA planning and repetitive job history dose archiving. The system has been operational for the past 18 months which includes a full refueling outage at Clinton Power Station. The Radiation Protection Department designed PREM to establish a software platform for implementing future revisions to 10CFR20 in 1993. Workers acceptance of the system has been excellent. Regulatory officials have given the system high marks as a radiological tool because of the system's ability to track the entire job from start to finish

  12. Managing risk in statistics - "Relative risk" | Durrheim | South African ...

    African Journals Online (AJOL)

    South African Family Practice. Journal Home · ABOUT THIS JOURNAL · Advanced Search · Current Issue · Archives · Journal Home > Vol 45, No 8 (2003) >. Log in or Register to get access to full text downloads. Username, Password, Remember me, or Register. Managing risk in statistics - "Relative risk". DN Durrheim ...

  13. HIV-related symptoms and management in HIV and antiretroviral ...

    African Journals Online (AJOL)

    Karl Peltzer

    2014-01-03

    Jan 3, 2014 ... To cite this article: Karl Peltzer (2013) HIV-related symptoms and management in HIV and antiretroviral therapy patients ...... Fear/worry. 14.2. 22. 2.5. 20 ..... Internalized Stigma, Discrimination, and Depression among Men and.

  14. A Balanced Scorecard Approach to Public Relations Management Assessment.

    Science.gov (United States)

    Fleisher, Craig S.; Mahaffy, Darren

    1997-01-01

    Describes a new managerial approach to assessing public relations/communications (PR/C) performance using a "balanced scorecard." Reviews the current state of PR/C management assessment; illustrates the balanced scorecard framework; highlights its strengths and weaknesses; describes the process of applying the scorecard to PR/C units;…

  15. Research in adaptive management: working relations and the research process.

    Science.gov (United States)

    Amanda C. Graham; Linda E. Kruger

    2002-01-01

    This report analyzes how a small group of Forest Service scientists participating in efforts to implement adaptive management approach working relations, and how they understand and apply the research process. Nine scientists completed a questionnaire to assess their preferred mode of thinking (the Herrmann Brain Dominance Instrument), engaged in a facilitated...

  16. Management of Gender Relations and Response To Change at the ...

    African Journals Online (AJOL)

    The establishment of the UDSM reflected the societal gender relations that influenced the perpetuation of gender inequalities in student's admission, academic and administrative recruitments, and management of staff through policies, directives and governance structures. Earlier initiatives directed by national politics and ...

  17. Benefits of a relational database for computerized management

    International Nuclear Information System (INIS)

    Shepherd, W.W.

    1991-01-01

    This paper reports on a computerized relational database which is the basis for a hazardous materials information management system which is comprehensive, effective, flexible and efficient. The system includes product information for Material Safety Data Sheets (MSDSs), labels, shipping, and the environment and is used in Dowell Schlumberger (DS) operations worldwide for a number of programs including planning, training, emergency response and regulatory compliance

  18. Beyond the contract: managing risk in supply chain relations

    NARCIS (Netherlands)

    Dekker, H.C.; Sakaguchi, J.; Kawai, T.

    2013-01-01

    As a consequence of the development of intensified relations with suppliers, for many firms the supply chain has become a significant source of risk exposure. In this paper we examine firms' use of control practices to manage risks associated with intensified collaboration with supply chain

  19. 29 CFR 1956.24 - Procedures for withdrawal of approval.

    Science.gov (United States)

    2010-07-01

    ... 29 Labor 9 2010-07-01 2010-07-01 false Procedures for withdrawal of approval. 1956.24 Section 1956.24 Labor Regulations Relating to Labor (Continued) OCCUPATIONAL SAFETY AND HEALTH ADMINISTRATION... do so, at least developmentally), no industrial or occupational issues may be considered a separable...

  20. The social side of shame : approach versus withdrawal

    NARCIS (Netherlands)

    de Hooge, Ilona E.; Breugelmans, Seger M.; Wagemans, Fieke M.A.; Zeelenberg, Marcel

    2018-01-01

    At present, the consequences and functions of experiences of shame are not yet well understood. Whereas psychology literature typically portrays shame as being bad for social relations, motivating social avoidance and withdrawal, there are recent indications that shame can be reinterpreted as having

  1. The social side of shame: approach versus withdrawal

    NARCIS (Netherlands)

    Hooge, De Ilona E.; Breugelmans, Seger M.; Wagemans, Fieke M.A.; Zeelenberg, Marcel

    2018-01-01

    At present, the consequences and functions of experiences of shame are not yet well understood. Whereas psychology literature typically portrays shame as being bad for social relations, motivating social avoidance and withdrawal, there are recent indications that shame can be reinterpreted as having

  2. Temporal Withdrawal Behaviors in an Educational Policy Context

    Science.gov (United States)

    Rosenblatt, Zehava; Shapira-Lishchinsky, Orly

    2017-01-01

    Purpose: The purpose of this paper is to investigate the differential relations between two teacher withdrawal behaviors: work absence and lateness, and two types of school ethics: organizational justice (distributive, procedural) and ethical climate (formal, caring), all in the context of school turbulent environment. Design/methodology/approach:…

  3. Bulimic symptoms and the social withdrawal syndrome.

    Science.gov (United States)

    Rotenberg, Ken J; Bharathi, Carla; Davies, Helen; Finch, Tom

    2013-08-01

    One hundred and thirty-seven undergraduates (81 females; mean age = 21 years-10 months) completed the Bulimic SEDS subscale and standardized measures of trust beliefs in close others (mother, father, and friend), disclosure to them, and loneliness. Structural Equation Modelling yielded: (1) a negative path between Bulimic Symptoms and trust beliefs, (2) a positive path between trust beliefs and disclosure, (3) a negative path between trust beliefs and loneliness, and (4) a negative path between disclosure and loneliness. As expected, trust beliefs statistically mediated the relations between Bulimic Symptoms and both disclosure and loneliness and disclosure statistically mediated the relation between trust beliefs and loneliness. The findings supported the conclusion that individuals with bulimia nervosa are prone to the social withdrawal syndrome comprising a coherent and integrated pattern of low trust beliefs in close others, low disclosure to close others, and high loneliness. Copyright © 2013 Elsevier Ltd. All rights reserved.

  4. Withdrawal: Plews and Laursen (2017).

    Science.gov (United States)

    2018-03-01

    We, the Editors and Publishers of the International Journal of Sports Physiology and Performance, have withdrawn the following article in whole: Plews, DJ, Laursen, PB. Training intensity distribution over a four-year cycle in Olympic champion rowers: different roads lead to Rio [version of record published online ahead of print September 27, 2017]. Int J Sports Physiol Perform. doi: 10.1123/ijspp.2017-0343 . The Editorial Office was contacted with the request to withdraw this article informing the Editor-in-Chief that the data in this article were not permissible to use due to undisclosed contractual obligations.

  5. Cancer related fatigue: implementing guidelines for optimal management.

    Science.gov (United States)

    Pearson, Elizabeth J M; Morris, Meg E; McKinstry, Carol E

    2017-07-18

    Cancer-related fatigue (CRF) is a key concern for people living with cancer and can impair physical functioning and activities of daily living. Evidence-based guidelines for CRF are available, yet inconsistently implemented globally. This study aimed to identify barriers and enablers to applying a cancer fatigue guideline and to derive implementation strategies. A mixed-method study explored the feasibility of implementing the CRF guideline developed by the Canadian Association for Psychosocial Oncology (CAPO). Health professionals, managers and consumers from different practice settings participated in a modified Delphi study with two survey rounds. A reference group informed the design of the study including the surveys. The first round focused on guideline characteristics, compatibility with current practice and experience, and behaviour change. The second survey built upon and triangulated the first round. Forty-five health practitioners and managers, and 68 cancer survivors completed the surveys. More than 75% of participants endorsed the CAPO cancer related fatigue guidelines. Some respondents perceived a lack of resources for accessible and expert fatigue management services. Further barriers to guideline implementation included complexity, limited practical details for some elements, and lack of clinical tools such as assessment tools or patient education materials. Recommendations to enhance guideline applicability centred around four main themes: (1) balancing the level of detail in the CAPO guideline with ease of use, (2) defining roles of different professional disciplines in CRF management, (3) how best to integrate CRF management into policy and practice, (4) how best to ensure a consumer-focused approach to CRF management. Translating current knowledge on optimal management of CRF into clinical practice can be enhanced by the adoption of valid guidelines. This study indicates that it is feasible to adopt the CAPO guidelines. Clinical application may

  6. Energy use and related risk management problems in CEE countries

    International Nuclear Information System (INIS)

    Ney, R.; Michna, J.; Ekmanis, J.; Zeltins, N.; Zebergs, V.

    2008-01-01

    Nowadays, the efficiency of energy use in the Central and East-European (CEE) countries is insufficient, being much lower than in the 'Old Europe'. The problem becomes increasingly pressing due to non-stop increasing prices of energy carriers (especially of crude oil). The authors trace the development of research activities in this sphere, classifying the revealed changes in parameters of energy consumption processes in particular time intervals into deterministic, probabilistic, and fuzzy. The paper presents a thorough analysis of decision-making in the energy management at its different levels normative, strategic, and operative. Particular attention is given to the management under uncertainty conditions - i.e. to the risk management. The most wanted research directions in this area proposed by the energy and environment policy (EEP) Center specially created for CEE countries concern management under risk connected with innovations, international activities, loss of reputation, etc.. The authors consider in detail the risk management with insufficient knowledge (non-knowledge) and under chaos. Much consideration is given to the scenario management and the game theory principles as related to the sphere of energy use. (Authors)

  7. Evaluation of occupational burnout and related factors in industry managers

    Directory of Open Access Journals (Sweden)

    M. Sadaf

    2008-10-01

    Full Text Available Background and aims   Occupational burnout is considered as side effects of occupational  stress. It includes some mental, functional, and personal characteristics in which a person has some symptoms of them. Occupational burnout can be caused in all jobs..it diminishes performance and utilization,   depression and disease. Due to the important role of managers, this study was carried to asses the  occupational burnout in industry managers in Kashan.   Methods   The industrial managers of Kashan at high managerial levels were enrolled in the  survey. Burnout data collected by standard questionnaire of Maslach Burnout Inventory (MBI was then analyzed using SPSS-13 software and statistical methods of chi-square, t-test, ANOVA,   and regression analysis.   Results   Between 100 different industrial managers that were involved in this study, 90 persons responded to questionnaire, Include: 16 persons (17.8% were employer,26 persons top manager(28.9%,36 persons (40% middle-manager,12 persons (13.3%high managers.97% were men and mean of age, work hours in week, work years duration respectly were 40.3(±8.26years, 53.4(±20.6 hours, 15.7(±8.7 years. It seems that most people under study had  mild occupational burnout. sever occupational burnout was observed in emotional exhaustion(   3%in severity and10.9% in frequencyand depersonalization( 6.8%in severity and7.8% in  frequency.according to this study age, region, kind of management, month earn didn't relation with burnout . work years duration and number of workers had reveres relation with burnout . direct relation with burnout and work hours was founded.   Conclusion   Despite the low rate of moderate or severe burnout among the managers, further effort is advised to reduce stress in this group and probe them in psycho mental disorders.

  8. Statistics and Corporate Environmental Management: Relations and Problems

    DEFF Research Database (Denmark)

    Madsen, Henning; Ulhøi, John Parm

    1997-01-01

    Statistical methods have long been used to analyse the macroeconomic consequences of environmentally damaging activities, political actions to control, prevent, or reduce these damages, and environmental problems in the natural environment. Up to now, however, they have had a limited and not very...... specific use in corporate environmental management systems. This paper will address some of the special problems related to the use of statistical techniques in corporate environmental management systems. One important aspect of this is the interaction of internal decisions and activities with conditions...

  9. Oxidative stress and anxiety-like symptoms related to withdrawal of passive cigarette smoke in mice: beneficial effects of pecan nut shells extract, a by-product of the nut industry.

    Science.gov (United States)

    Reckziegel, P; Boufleur, N; Barcelos, R C S; Benvegnú, D M; Pase, C S; Muller, L G; Teixeira, A M; Zanella, R; Prado, A C P; Fett, R; Block, J M; Burger, M E

    2011-09-01

    The present study evaluated the role of pecan nut (Carya illinoensis) shells aqueous extract (AE) against oxidative damage induced by cigarette smoke exposure (CSE) and behavioral parameters of smoking withdrawal. Mice were passively exposed to cigarette smoke for 3 weeks (6, 10, and 14 cigarettes/day) and orally treated with AE (25 g/L). CSE induced lipid peroxidation in brain and red blood cells (RBC), increased catalase (CAT) activity in RBC, and decreased plasma ascorbic acid levels. AE prevented oxidative damage and increased antioxidant defenses of mice exposed to cigarette smoke. In addition, AE reduced the locomotor activity and anxiety symptoms induced by smoking withdrawal, and these behavioral parameters showed a positive correlation with RBC lipid peroxidation. Our results showed the beneficial effects of this by-product of the pecan industry, indicating its usefulness in smoking cessation. Copyright © 2011 Elsevier Inc. All rights reserved.

  10. Management of Myositis-Related Interstitial Lung Disease.

    Science.gov (United States)

    Morisset, Julie; Johnson, Cheilonda; Rich, Eric; Collard, Harold R; Lee, Joyce S

    2016-11-01

    Interstitial lung disease (ILD) is a frequent pulmonary manifestation and an important cause of morbidity and mortality in patients with idiopathic inflammatory myopathy. Myositis-related ILD presents a therapeutic challenge for clinicians, as there are no available guidelines to help with management decisions. This review covers the existing evidence on the pharmacologic and nonpharmacologic management of myositis-related ILD, highlighting the lack of randomized controlled data to guide treatment. Given the absence of existing guidelines to inform treatment decisions, we provide a comprehensive summary, including dosing, side effects, and suggested monitoring of the commonly used immunosuppressive agents and a proposed treatment algorithm based on the existing literature. Copyright © 2016 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

  11. In-office management of sport-related concussion.

    Science.gov (United States)

    Reynolds, Erin; Collins, Michael W

    2014-01-01

    The field of sport-related concussion has grown exponentially over the past decade, with more concussion-specific clinics being identified in major hospital systems as well as independent practitioner's offices. To date, there is no standardized in-office protocol for managing ongoing symptoms. The University of Pittsburgh Medical Center (UPMC) Sports Concussion Program, established in 2000, is one of the largest programs in the USA, pioneering the way in clinical management, research, and education of sport-related concussion. This report will outline the essential components of a successful concussion clinic, using the UPMC Sports Concussion Program as a case example of best practice. We will share several case studies illustrating the individualized and complex nature of this injury, as well as review important rehabilitation components. © 2014 S. Karger AG, Basel.

  12. Effect of intensive epilimnetic withdrawal on phytoplankton community in a (subtropical deep reservoir

    Directory of Open Access Journals (Sweden)

    Man Zhang

    2013-10-01

    more attention to grazing from large crustaceans. It is recommended that, in the management of reservoirs, intensive epilimnetic withdrawal during autumn should be avoided in order to control excessive phytoplankton in the tropics and subtropics. 

  13. Withdrawal of cerivastatin from the world market

    Directory of Open Access Journals (Sweden)

    Pitt Bertram

    2001-09-01

    Full Text Available Abstract Cerivastatin was recently withdrawn from the market because of 52 deaths attributed to drug-related rhabdomyolysis that lead to kidney failure. The risk was found to be higher among patients who received the full dose (0.8 mg/day and those who received gemfibrozil concomitantly. Rhabdomyolysis was 10 times more common with cerivastatin than the other five approved statins. We address three important questions raised by this withdrawal. Should we continue to approve drugs on surrogate efficacy? Are all statins interchangeable? Do the benefits outweigh the risks of statins? We conclude that decisions regarding the use of drugs should be based on direct evidence from long-term clinical outcome trials.

  14. It's self defense: how perceived discrimination promotes employee withdrawal.

    Science.gov (United States)

    Volpone, Sabrina D; Avery, Derek R

    2013-10-01

    Integrating theory on stress, stigma, and coping, the present study sheds light on how employees react to perceived discrimination (PD) in the workplace. Using three national samples, we found that PD based on race, sex, age, family obligation, and sexual orientation related to physical withdrawal (i.e., lateness, absenteeism,and intent to quit) indirectly through psychological withdrawal (i.e., burnout and engagement) such that PD corresponded in less engagement and more burnout, which related to increased lateness, absenteeism, and intent to quit [corrected].Further, these indirect relationships were moderated by employees' coping mechanisms with those who were more apt to change the situation or to avoid the stressor exhibiting weaker relationships between PD and psychological withdrawal. Though each of these studies is cross-sectional in nature and therefore cannot provide strong evidence of causal ordering of the variables in our model, the replication and extension of results over three databases and multiple forms of discrimination, coping, psychological, and physical withdrawal demonstrates that understanding the relationships explored in these studies can aid researchers and practitioners in enhancing employee quality of life and productivity.

  15. Socially anxious smokers experience greater negative affect and withdrawal during self-quit attempts.

    Science.gov (United States)

    Buckner, Julia D; Langdon, Kirsten J; Jeffries, Emily R; Zvolensky, Michael J

    2016-04-01

    Despite evidence of a strong and consistent relation between smoking and elevated social anxiety, strikingly little empirical work has identified mechanisms underlying the smoking-social anxiety link. Persons with elevated social anxiety may rely on smoking to cope with more severe nicotine withdrawal and post-quit negative mood states; yet, no known studies have investigated the relation of social anxiety to withdrawal severity. The current study examined the relation of social anxiety to post-quit nicotine withdrawal severity among 51 (33.3% female, Mage = 34.6) community-recruited smokers during the first two weeks following an unaided (i.e., no treatment) cessation attempt. Ecological momentary assessment was used to collect multiple daily ratings of withdrawal and negative mood states. Baseline social anxiety was related to increases in negative affect during the monitoring period and remained significantly related to post-quit withdrawal after controlling for negative affect, gender, lapses, and substance use. Persons with elevated social anxiety experience more severe post-quit withdrawal symptoms and increases in negative affect during a cessation attempt and may therefore benefit from intervention and treatment strategies geared toward helping them learn to cope with withdrawal and negative affect to improve cessation rates among these vulnerable smokers.

  16. Factors relating to the perceived management of emergency situations

    DEFF Research Database (Denmark)

    Birkvad Rasmussen, Maria; Tolsgaard, Martin G; Dieckmann, Peter

    2014-01-01

    -workers familiarity with ALS principles', 'own confidence as ALS-provider' and 'own social/inter-personal skills'. CONCLUSION: The results of this survey emphasise that ALS providers' perceived ability to apply ALS skills were substantially affected by teamwork skills and co-workers' skills. Team related factors...... associated with successful outcome were related to clear role distribution, clear inter-personal communication and attentive listening, as well as respectful behaviour and positive team atmosphere. Although intensity of setting was attributed to ability to apply ALS principles, this did not affect management...

  17. 41 CFR 101-39.105-2 - Agency requests to withdraw participation.

    Science.gov (United States)

    2010-07-01

    ..., AND MOTOR VEHICLES 39-INTERAGENCY FLEET MANAGEMENT SYSTEMS 39.1-Establishment, Modification, and Discontinuance of Interagency Fleet Management Systems § 101-39.105-2 Agency requests to withdraw participation. (a) Executive agencies receiving motor vehicle services from fleet management systems may request...

  18. 76 FR 67473 - Notice of Proposed Withdrawal, Transfer of Jurisdiction, and Notice of Public Meeting; California

    Science.gov (United States)

    2011-11-01

    ... DEPARTMENT OF THE INTERIOR Bureau of Land Management [CACA 43949, LLCA930000, L14300000.ET0000] Notice of Proposed Withdrawal, Transfer of Jurisdiction, and Notice of Public Meeting; California AGENCY: Bureau of Land Management, Interior. ACTION: Notice; Correction. SUMMARY: The Bureau of Land Management...

  19. 75 FR 70288 - Notice of Proposed Withdrawal, Transfer of Jurisdiction, and Notice of Public Meeting; California

    Science.gov (United States)

    2010-11-17

    ... DEPARTMENT OF THE INTERIOR Bureau of Land Management [LLCAD06000-L14300000-ET0000; CACA 43949] Notice of Proposed Withdrawal, Transfer of Jurisdiction, and Notice of Public Meeting; California AGENCY: Bureau of Land Management, Interior. ACTION: Correction. SUMMARY: The Bureau of Land Management published...

  20. 42 CFR 457.170 - Withdrawal process.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 4 2010-10-01 2010-10-01 false Withdrawal process. 457.170 Section 457.170 Public... Plans for Child Health Insurance Programs and Outreach Strategies § 457.170 Withdrawal process. (a... amendment, or any portion of a proposed State plan or plan amendment, at any time during the review process...

  1. 75 FR 7526 - Withdrawal of Regulatory Guide

    Science.gov (United States)

    2010-02-19

    ...'s Electronic Reading Room at http://www.nrc.gov/reading-rm/doc-collections . Regulatory guides are... NUCLEAR REGULATORY COMMISSION [NRC-2010-0052] Withdrawal of Regulatory Guide AGENCY: Nuclear Regulatory Commission. ACTION: Withdrawal of Regulatory Guide 1.56, ``Maintenance of Water Purity in Boiling...

  2. Opioid antagonists with minimal sedation for opioid withdrawal.

    Science.gov (United States)

    Gowing, Linda; Ali, Robert; White, Jason M

    2017-05-29

    Managed withdrawal is a necessary step prior to drug-free treatment or as the endpoint of long-term substitution treatment. To assess the effects of opioid antagonists plus minimal sedation for opioid withdrawal. Comparators were placebo as well as more established approaches to detoxification, such as tapered doses of methadone, adrenergic agonists, buprenorphine and symptomatic medications. We updated our searches of the following databases to December 2016: CENTRAL, MEDLINE, Embase, PsycINFO and Web of Science. We also searched two trials registers and checked the reference lists of included studies for further references to relevant studies. We included randomised and quasi-randomised controlled clinical trials along with prospective controlled cohort studies comparing opioid antagonists plus minimal sedation versus other approaches or different opioid antagonist regimens for withdrawal in opioid-dependent participants. We used standard methodological procedures expected by Cochrane. Ten studies (6 randomised controlled trials and 4 prospective cohort studies, involving 955 participants) met the inclusion criteria for the review. We considered 7 of the 10 studies to be at high risk of bias in at least one of the domains we assessed.Nine studies compared an opioid antagonist-adrenergic agonist combination versus a treatment regimen based primarily on an alpha 2 -adrenergic agonist (clonidine or lofexidine). Other comparisons (placebo, tapered doses of methadone, buprenorphine) made by included studies were too diverse for any meaningful analysis. This review therefore focuses on the nine studies comparing an opioid antagonist (naltrexone or naloxone) plus clonidine or lofexidine versus treatment primarily based on clonidine or lofexidine.Five studies took place in an inpatient setting, two studies were in outpatients with day care, two used day care only for the first day of opioid antagonist administration, and one study described the setting as outpatient

  3. Withdrawal of food and fluid.

    Science.gov (United States)

    Daly, B J

    1990-05-01

    John S. is a 72-year-old patriarch of a large, extended family. He underwent a mitral and aortic valve replacement, followed by a complicated postoperative course. His recovery was complicated by hemodynamic instability, several cardiac arrests, acute renal failure, and sepsis. He has been in the ICU for 14 weeks and has been unable to wean from mechanical ventilation. After many conferences between the patient's family and the ICU staff, a decision was made to remove ventilator support. This was done 3 days ago. John's condition seems stable now, but it is clear that he will not regain his former state of health. He is very debilitated, may require chronic dialysis, and has suffered some anoxic brain damage during his arrests. The nursing and medical staff are now faced with the question of further withdrawal of treatment and are considering whether or not to discontinue his parenteral nutrition and all IV fluids.

  4. Socially Anxious Smokers Experience Greater Negative Affect and Withdrawal during Self-Quit Attempts

    OpenAIRE

    Buckner, Julia D.; Langdon, Kirsten J.; Jeffries, Emily R.; Zvolensky, Michael J.

    2016-01-01

    Despite evidence of a strong and consistent relation between smoking and elevated social anxiety, strikingly little empirical work has identified mechanisms underlying the smoking-social anxiety link. Persons with elevated social anxiety may rely on smoking to cope with more severe nicotine withdrawal and post-quit negative mood states; yet, no known studies have investigated the relation of social anxiety to withdrawal severity. The current study examined the relation of social anxiety to po...

  5. [An examination of the determinants of social withdrawal and affinity for social withdrawal].

    Science.gov (United States)

    Watanabe, Asami; Matsui, Yutaka; Takatsuka, Yusuke

    2010-12-01

    This study examined the determinants of social withdrawal using data from a survey by the Tokyo Metropolitan Government Office for Youth Affairs and Public Safety (2008). In addition, this study identified young people who showed an affinity for social withdrawal although they were not in a state of withdrawal, and examined the determinants of an affinity for social withdrawal. The results of stepwise discriminant analysis showed that factors such as social phobia, depression, violence, and emotional bonds with family differentiated between the general youth group and the social withdrawal group and the "affinity group". Social phobia, violence, and refusal to be interfered in self-decision making differentiated between the social withdrawal group and the "affinity group". This study shows that an "affinity group" should be cared as well as an actual withdrawal group.

  6. The pathogenesis of propranolol-withdrawal syndrome in essential hypertension.

    Science.gov (United States)

    Kristensen, B O; Steiness, E; Weeke, J

    1979-12-01

    1. In hypertension, the beta-adrenoreceptor-blocker-withdrawal syndrome comprises tachycardia, sweating, tremor and general malaise, symptoms resembling thyrotoxicosis. 2. The effect of abrupt cessation of propranolol on serum concentrations of thyroxine (T4) and triiodothyronine (T3) was therefore investigated in five patients with uncomplicated essential hypertension, treated with propranolol in doses from 160 to 480 mg/day. 3. Four of the five patients developed one or more of the above-mentioned symptoms within 2-6 days after withdrawal of propranolol. 4. A mean relative increase in serum free T3 of 51% (range 22-74%) was found in these four patients on the day of onset of symptoms. 5. The increase in free T3 in the five patients correlated positively with total serum propranolol on the last day the drug was given (r = 0.91, 2P = 0.03). 6. As an increase in T3 was found only in patients suffering the withdrawal syndrome, and was maximal the day the symptoms appeared, despite a variation in time of onset from 2 to 6 days, it is suggested that the beta-adrenoreceptor-blocker-withdrawal syndrome, at least partially, is caused by rebound increased production of T3, induced by the well-known inhibition of the monodeiodination of T4 to T3 during beta-adrenoreceptor blockade. 7. This assumption may explain the clinical symptoms and the reported transient increased beta-adrenoreceptor sensitivity with unchanged serum concentrations of catecholamines.

  7. Diagnosis and Management of AIDS-related Diarrhea

    Directory of Open Access Journals (Sweden)

    John F Johanson

    1996-01-01

    Full Text Available The spectrum of illness associated with the acquired immunodeficiency syndrome (AIDS has been increasing since the initial description in 1981. While virtually all organ systems may be affected, the gastrointestinal tract appears to be a major target. Diarrhea is the most common symptom, affecting up to half of all AIDS patients during the course of their disease. Although diarrhea occurs frequently, its optimal management remains controversial. An extensive evaluation including stool studies and endoscopic biopsies of both the colon and small intestine has been widely recommended to identify all potential pathogenic organisms. An alternative approach is a more limited evaluation consisting of stool and blood cultures followed by symptomatic treatment with antidiarrheal agents if no specific organisms are identified. The clinical presentation of the most common opportunistic pathogens are reviewed, including several recently discovered organisms. Recommendations for treatment are followed by a brief discussion of management strategies used to care for patients with AIDS-related diarrhea.

  8. Organisation of facilities management in relation to core business

    DEFF Research Database (Denmark)

    Jensen, Per Anker

    2011-01-01

    as mainly a specific customer orientation. It is concluded that a market relationship – internally or externally – is appropriate for non-strategic functions, while it is important to create a kind of coalition between strategic FM functions and the core business management. Originality/value: The paper......Purpose: The purpose of this article is to clarify the organisational relationships between Facilities Management (FM) and core business and how these relationships vary for strategic and operational support functions. Approach: The research takes a starting point in Michael Porter’s theory...... of value chains but also draws on theory of strategic FM, governance and forms of coordination. The value chains for core businesses and support functions are analysed and related to empirical data from a case study on a broadcasting corporation during a major relocation. Findings: A particular support...

  9. Issues related to EM management of DOE spent nuclear fuel

    International Nuclear Information System (INIS)

    Abbott, D.G.; Abashian, M.S.; Chakraborti, S.; Roberson, K.; Meloin, J.M.

    1993-07-01

    This document is a summary of the important issues involved in managing spent nuclear fuel (SNF) owned by the Department of Energy (DOE). Issues related to civilian SNF activities are not discussed. DOE-owned SNF is stored primarily at the Hanford Site, Idaho National Engineering Laboratory (INEL), Savannah River Site (SRS), Oak Ridge National Laboratory (ORNL), and West Valley Demonstration Project. Smaller quantities of SNF are stored at Brookhaven National Laboratory, Sandia National Laboratories, and Los Alamos National Laboratory (LANL). There is a wide variety of fuel types, including both low and high enrichment fuels from weapons production, DOE reactors, research and development programs, naval programs, and universities. Most fuel is stored in pools associated with reactor or reprocessing facilities. Smaller quantities are in dry storage. Physical conditions of the fuel range from excellent to poor or severely damaged. An issue is defined as an important question that must be answered or decision that must be made on a topic or subject relevant to achieving the complimentary objectives of (a) storing SNF in compliance with applicable regulations and orders until it can be disposed, and (b) safely disposing of DOE's SNF. The purpose of this document is to define the issues; no recommendations are made on resolutions. As DOE's national SNF management program is implemented, a system of issues identification, documentation, tracking, and resolution will be implemented. This document is an initial effort at issues identification. The first section of this document is an overview of issues that are common to several or all DOE facilities that manage SNF. The common issues are organized according to specific aspects of spent fuel management. This is followed by discussions of management issues that apply specifically to individual DOE facilities. The last section provides literature references

  10. Cannabinoid and opioid interactions: implications for opiate dependence and withdrawal.

    Science.gov (United States)

    Scavone, J L; Sterling, R C; Van Bockstaele, E J

    2013-09-17

    Withdrawal from opiates, such as heroin or oral narcotics, is characterized by a host of aversive physical and emotional symptoms. High rates of relapse and limited treatment success rates for opiate addiction have prompted a search for new approaches. For many opiate addicts, achieving abstinence may be further complicated by poly-drug use and co-morbid mental disorders. Research over the past decade has shed light on the influence of endocannabinoids (ECs) on the opioid system. Evidence from both animal and clinical studies point toward an interaction between these two systems, and suggest that targeting the EC system may provide novel interventions for managing opiate dependence and withdrawal. This review will summarize the literature surrounding the molecular effects of cannabinoids and opioids on the locus coeruleus-norepinephrine system, a key circuit implicated in the negative sequelae of opiate addiction. A consideration of the trends and effects of marijuana use in those seeking treatment to abstain from opiates in the clinical setting will also be presented. In summary, the present review details how cannabinoid-opioid interactions may inform novel interventions in the management of opiate dependence and withdrawal. Copyright © 2013 IBRO. Published by Elsevier Ltd. All rights reserved.

  11. Estimated water withdrawals and use in Pennsylvania, 1995

    Science.gov (United States)

    Ludlow, Russell A.; Gast, William A.

    2000-01-01

    In practical terms, water use is divided into two basic types: instream use and offstream use. Instream use is water used in its natural channel, basin, or behind a dam and includes activities such as fishing, boating, and other recreational activities. Instream use also includes hydroelectric power generation. Off-stream use is water pumped or diverted from its natural channel, basin, or aquifer. Off-stream uses are divided into the following categories: public supply, domestic, commercial, industrial, thermoelectric power, mining, livestock, and irrigation. This fact sheet provides an overview of offstream and hydroelectric power water use in Pennsylvania. It describes water withdrawals by source, water withdrawals and deliveries by category, changes in water use over time, and water-management responsibilities in the State.

  12. Codes of practice and related issues in biomedical waste management

    Energy Technology Data Exchange (ETDEWEB)

    Moy, D.; Watt, C. [Griffith Univ. (Australia)

    1996-12-31

    This paper outlines the development of a National Code of Practice for biomedical waste management in Australia. The 10 key areas addressed by the code are industry mission statement; uniform terms and definitions; community relations - public perceptions and right to know; generation, source separation, and handling; storage requirements; transportation; treatment and disposal; disposal of solid and liquid residues and air emissions; occupational health and safety; staff awareness and education. A comparison with other industry codes in Australia is made. A list of outstanding issues is also provided; these include the development of standard containers, treatment effectiveness, and reusable sharps containers.

  13. Ecohydrology and Its Relation to Integrated Groundwater Management

    Science.gov (United States)

    Hunt, Randall J.; Hayashi, Masaki; Batelaan, Okke

    2016-01-01

    In the twentieth century, groundwater characterization focused primarily on easily measured hydraulic metrics of water storage and flows. Twenty-first century concepts of groundwater availability, however, encompass other factors having societal value, such as ecological well-being. Effective ecohydrological science is a nexus of fundamental understanding derived from two scientific disciplines: (1) ecology, where scale, thresholds, feedbacks and tipping points for societal questions form the basis for the ecologic characterization, and (2) hydrology, where the characteristics, magnitude, and timing of water flows are characterized for a defined system of interest. In addition to ecohydrology itself, integrated groundwater management requires input from resource managers to understand which areas of the vast world of ecohydrology are important for decision making. Expectations of acceptable uncertainty, or even what ecohydrological outputs have utility, are often not well articulated within societal decision making frameworks, or within the science community itself. Similarly, “acceptable levels of impact” are difficult to define. Three examples are given to demonstrate the use of ecohydrological considerations for long-term sustainability of groundwater resources and their related ecosystem function. Such examples illustrate the importance of accommodating ecohydrogeological aspects into integrated groundwater management of the twenty-first century, regardless of society, climate, or setting.

  14. Statistics and Corporate Environmental Management: Relations and Problems

    DEFF Research Database (Denmark)

    Madsen, Henning; Ulhøi, John Parm

    1997-01-01

    Statistical methods have long been used to analyse the macroeconomic consequences of environmentally damaging activities, political actions to control, prevent, or reduce these damages, and environmental problems in the natural environment. Up to now, however, they have had a limited and not very...... in the external environment. The nature and extent of the practical use of quantitative techniques in corporate environmental management systems is discussed on the basis of a number of company surveys in four European countries.......Statistical methods have long been used to analyse the macroeconomic consequences of environmentally damaging activities, political actions to control, prevent, or reduce these damages, and environmental problems in the natural environment. Up to now, however, they have had a limited and not very...... specific use in corporate environmental management systems. This paper will address some of the special problems related to the use of statistical techniques in corporate environmental management systems. One important aspect of this is the interaction of internal decisions and activities with conditions...

  15. Flumazenil in treatment benzodiazepine withdrawal syndrome: Case report

    Directory of Open Access Journals (Sweden)

    Ramah Aleksandar J.

    2015-01-01

    withdrawal syndrome. Given the existence of certain concerns and relatively little experience in this procedure, it is necessary to define further all aspects of the procedure.

  16. Dexmedetomidine infusion to facilitate opioid detoxification and withdrawal in a patient with chronic opioid abuse

    Directory of Open Access Journals (Sweden)

    Surjya Prasad Upadhyay

    2011-01-01

    Full Text Available Many patients are admitted to the intensive care unit (ICU for acute intoxication, serious complication of overdose, or withdrawal symptoms of illicit drugs. An acute withdrawal of drugs with addiction potential is associated with a sympathetic overactivity leading to marked psychomimetic disturbances. Acute intoxication or withdrawal of such drugs is often associated with life-threatening complications which require ICU admission and necessitate prolonged sedative analgesic medications, weaning from which is often complicated by withdrawal and other psychomimetic symptoms. Dexmedetomidine, an alpha-2 (α2 agonist, has been used successfully to facilitate withdrawal and detoxification of various drugs and also to control delirium in ICU patients. Herein, we report a case of a chronic opioid abuse (heroin patient admitted with acute overdose complications leading to a prolonged ICU course requiring sedative-analgesic medication; the drug withdrawal-related symptoms further complicated the weaning process. Dexmedetomidine infusion was successfully used as a sedative-analgesic to control the withdrawal-related psychomimetic symptoms and to facilitate smooth detoxification and weaning from opioid and other sedatives.

  17. Status Report on Hydrogen Management and Related Computer Codes

    International Nuclear Information System (INIS)

    Liang, Z.; Chan, C.K.; Sonnenkalb, M.; Bentaib, A.; Malet, J.; Sangiorgi, M.; Gryffroy, D.; Gyepi-Garbrah, S.; Duspiva, J.; Sevon, T.; Kelm, S.; Reinecke, E.A.; Xu, Z.J.; Cervone, A.; Utsuno, H.; Hotta, A.; Hong, S.W.; Kim, J.T.; Visser, D.C.; Stempniewicz, M.M.; Kuriene, L.; Prusinski, P.; Martin-Valdepenas, J.M.; Frid, W.; Isaksson, P.; Dreier, J.; Paladino, D.; Algama, D.; Notafrancesco, A.; Amri, A.; Kissane, M.; )

    2014-01-01

    In follow-up to the Fukushima Daiichi NPP accident, the Committee on the Safety of Nuclear Installations (CSNI) decided to launch several high priority activities. At the 14. plenary meeting of the Working Group on Analysis and Management of Accidents (WGAMA), a proposal for a status paper on hydrogen generation, transport and mitigation under severe accident conditions was approved. The proposed activity is in line with the WGAMA mandate and it was considered to be needed to revisit the hydrogen issue. The report is broken down into five Chapters and two appendixes. Chapter 1 provides background information for this activity and expected topics defined by the WGAMA members. A general understanding of hydrogen behavior and control in severe accidents is discussed. A brief literature review is included in this chapter to summarize the progress obtained from the early US NRC sponsored research on hydrogen and recent international OECD or EC sponsored projects on hydrogen related topics (generation, distribution, combustion and mitigation). Chapter 2 provides a general overview of the various reactor designs of Western PWRs, BWRs, Eastern European VVERs and PHWRs (CANDUs). The purpose is to understand the containment design features in relation to hydrogen management measures. Chapter 3 provides a detailed description of national requirements on hydrogen management and hydrogen mitigation measures inside the containment and other places (e.g., annulus space, secondary buildings, spent fuel pool, etc.). Discussions are followed on hydrogen analysis approaches, application of safety systems (e.g., spray, containment ventilation, local air cooler, suppression pool, and latch systems), hydrogen measurement strategies as well as lessons learnt from the Fukushima Daiichi nuclear power accident. Chapter 4 provides an overview of various codes that are being used for hydrogen risk assessment, and the codes capabilities and validation status in terms of hydrogen related

  18. DART - for design basis justification and safety related information management

    International Nuclear Information System (INIS)

    Billington, A.; Blondiaux, P.; Boucau, J.; Cantineau, B.; Doumont, C.; Mared, A.

    2000-01-01

    DART is the acronym for Design Analysis Re-engineering Tool. It embodies a systematic and integrated approach to NPP safety re-assessment and configuration management, that makes use of Reverse Failure Mode and Effect Analysis in conjunction with a state-of-the-art relational database and a standardized data format, to permit long-term management of plant safety related information. The plant design is reviewed in a step-by-step logical fashion by constructing fault trees that identify the link between undesired consequences and their causes. Each failure cause identified in a fault tree is addressed by defining functional requirements, which are in turn addressed by documenting the specific manner in which the plant complies with the requirement. The database can be used to generate up-to-date plant safety related documents, including: SAR, Systems Descriptions, Technical Specifications and plant procedures. The approach is open-minded by nature and therefore is not regulatory driven, however the plant licensing basis will also be reviewed and documented within the same database such that a Regulatory Conformance Program may be integrated with the other safety documentation. This methodology can thus reconstitute the plant design bases in a comprehensive and systematic way, while allowing to uncover weaknesses in design. The original feature of the DART methodology is that it links all the safety related documents together, facilitating the evaluation of the safety impact resulting from any plant modification. Due to its capability to retrieve the basic justifications of the plant design, it is also a useful tool for training the young generation of plant personnel. The DART methodology has been developed for application to units 2, 3 and 4 at Vattenfall's Ringhals site in Sweden. It may be applied to any nuclear power plant or industrial facility where public safety is a concern. (author)

  19. DART - for design basis justification and safety related information management

    International Nuclear Information System (INIS)

    Billington, A.; Blondiaux, B.; Boucau, J.; Cantineau, B.; Mared, A.

    2001-01-01

    DART is the acronym for Design Analysis Re-Engineering Tool. It embodies a systematic and integrated approach to NPP safety re-assessment and configuration management, that makes use of Reverse Failure Mode and Effect Analysis in conjunction with a state-of-the-art relational database and a standardized data format, to permit long-term management of plant safety related information. The plant design is reviewed in a step-by-step logical fashion by constructing fault trees that identify the link between undesired consequences and their causes. Each failure cause identified in a fault tree is addressed by defining functional requirements, which are in turn addressed by documenting the specific manner in which the plant complies with the requirement. The database can then be used to generate up-to-date plant safety related documents, including: SAR, Systems Descriptions, Technical Specifications and plant procedures. The approach is open-minded by nature and therefore is not regulatory driven, however the plant licensing basis will also be reviewed and documented within the same database such that a Regulatory Conformance Program may be integrated with the other safety documentation. This methodology can thus reconstitute the plant design bases in a comprehensive and systematic way, while allowing to uncover weaknesses in design. The original feature of the DART methodology is that it links all the safety related documents together, facilitating the evaluation of the safety impact resulting from any plant modification. Due to its capability to retrieve the basic justifications of the plant design, it is also a useful tool for training the young generation of plant personnel. The DART methodology has been developed for application to units 2, 3 and 4 at Vattenfall's Ringhals site in Sweden. It may be applied to any nuclear power plant or industrial facility where public safety is a concern. (author)

  20. Management of acid-related disorders in patients with dysphagia.

    Science.gov (United States)

    Howden, Colin W

    2004-09-06

    Dysphagia affects a large and growing number of individuals in the United States, particularly the elderly and those who are neurologically impaired. Swallowing difficulties may be due to age-related changes in oropharyngeal and esophageal functioning as well as central nervous system diseases such as stroke, Parkinson disease, and dementia. Among institutionalized individuals, dysphagia is associated with increased morbidity and mortality. An appreciation of the physiology of swallowing and the pathophysiology of dysphagia is necessary for proper patient management. Careful history, physical examination, and evaluation of radiologic and endoscopic studies should differentiate oropharyngeal and esophageal etiologies of dysphagia and distinguish mechanical (anatomic) disorders from functional (motor) disorders. A significant percentage of patients with dysphagia have concomitant acid-related disorders that are managed best with proton pump inhibitor (PPI) therapy. Three of the currently available PPIs are manufactured as capsules containing enteric-coated granules that may be mixed with soft foods or fruit juices before oral administration to those with swallowing difficulties. In addition, omeprazole and lansoprazole may be administered via gastrostomy or nasogastric feeding tubes as suspensions in sodium bicarbonate. Novel dosage formulations of lansoprazole that may be appropriate for patients with dysphagia include the commercially manufactured lansoprazole strawberry-flavored enteric-coated granules for suspension and lansoprazole orally disintegrating tablets.

  1. Management of sport-related concussion in young athletes.

    Science.gov (United States)

    Patel, Dilip R; Shivdasani, Vandana; Baker, Robert J

    2005-01-01

    Sport-related head injuries are a common clinical problem. Most head injuries in young athletes are mild traumatic brain injuries or concussions. The highest number of sport-related concussions has been reported in American football. In addition to the well described physical and psychosocial growth, there is ongoing neurocognitive development of the brain during childhood and through adolescence. This developmental process has direct implications in the assessment and management of head injuries in young athletes. Research on the management and long-term outcome following brain injuries in young athletes is limited. Traditionally, the assessment of concussion has been based on clinical history and physical and neurological examination. Increasingly, neuropsychological testing, especially computerised testing, is providing objective measures for the initial assessment and follow-up of young athletes following brain injuries. Numerous guidelines have been published for grading and return to play criteria following concussion; however, none of these have been prospectively validated by research and none are specifically applicable to children and adolescents.

  2. Pseudopheochromocytoma induced by anxiolytic withdrawal.

    Science.gov (United States)

    Páll, Alida; Becs, Gergely; Erdei, Annamária; Sira, Lívia; Czifra, Arpád; Barna, Sándor; Kovács, Péter; Páll, Dénes; Pfliegler, György; Paragh, György; Szabó, Zoltán

    2014-10-08

    Symptomatic paroxysmal hypertension without significantly elevated catecholamine concentrations and with no evidence of an underlying adrenal tumor is known as pseudopheochromocytoma. We describe the case of a female patient with paroxysmal hypertensive crises accompanied by headache, vertigo, tachycardia, nausea and altered mental status. Previously, she was treated for a longer period with alprazolam due to panic disorder. Causes of secondary hypertension were excluded. Neurological triggers (intracranial tumor, cerebral vascular lesions, hemorrhage, and epilepsy) could not be detected. Setting of the diagnosis of pseudopheochromocytoma treatment was initiated with alpha- and beta-blockers resulting in reduced frequency of symptoms. Alprazolam was restarted at a daily dose of 1 mg. The patient's clinical condition improved rapidly and the dosage of alpha- and beta-blockers could be decreased. We conclude that the withdrawal of an anxiolytic therapeutic regimen may generate sympathetic overdrive resulting in life-threatening paroxysmal malignant hypertension and secondary encephalopathy. We emphasize that pseudopheochromocytoma can be diagnosed only after exclusion of the secondary causes of hypertension. We highlight the importance of a psychopharmacological approach to this clinical entity.

  3. International Companies Withdrawal from Lithuania: Problematics and Alternative Solutions

    Directory of Open Access Journals (Sweden)

    Viktorija Tauraitė

    2017-06-01

    Full Text Available The main attention in this article is focused on the problematic of international companies’ withdrawal from Lithuania and presentation of alternative solutions of this problem. The macro(Sweden, Austria, Latvia, Lithuania, Estonia, Poland level analysis and micro (“Coca-Cola”, “Nordea” and DNB, “Orkla” level analysis showed that competitiveness, business conditions, employment relations, institutional environment and innovation should be improved and the corruption should be reduced in Lithuania. It is advisable that current Lithuanian Labour Code should be revised in order to increase the efficiency of labour relations. It is found out that the significance of “Coca-Cola”company is the highest in the context of the withdrawing companies from Lithuania. It is assumed that the most rational solution for each company is to move from Lithuania to another country.

  4. The social side of shame: approach versus withdrawal

    OpenAIRE

    Hooge, De, Ilona E.; Breugelmans, Seger M.; Wagemans, Fieke M.A.; Zeelenberg, Marcel

    2018-01-01

    At present, the consequences and functions of experiences of shame are not yet well understood. Whereas psychology literature typically portrays shame as being bad for social relations, motivating social avoidance and withdrawal, there are recent indications that shame can be reinterpreted as having clear social tendencies in the form of motivating approach and social affiliation. Yet, until now, no research has ever put these alternative interpretations of shame-motivated behaviours directly...

  5. 21 CFR 314.530 - Withdrawal procedures.

    Science.gov (United States)

    2010-04-01

    ... Serious or Life-Threatening Illnesses § 314.530 Withdrawal procedures. (a) For new drugs approved under... benefit; (2) The applicant fails to perform the required postmarketing study with due diligence; (3) Use...

  6. MITS Feed and Withdrawal Subsystem: operating procedures

    International Nuclear Information System (INIS)

    Brown, W.S.

    1980-01-01

    This procedure details the steps required to provide continuous feed flow and withdrawal of process product and waste flows in support of thruput operation in the cascade or its elements. It particularly requires operator attention to safety considerations

  7. Timing of nicotine lozenge administration to minimize trigger induced craving and withdrawal symptoms.

    Science.gov (United States)

    Kotlyar, Michael; Lindgren, Bruce R; Vuchetich, John P; Le, Chap; Mills, Anne M; Amiot, Elizabeth; Hatsukami, Dorothy K

    2017-08-01

    Smokers are often advised to use nicotine lozenge when craving or withdrawal symptoms occur. This may be too late to prevent lapses. This study assessed if nicotine lozenge use prior to a common smoking trigger can minimize trigger induced increases in craving and withdrawal symptoms. Eighty-four smokers completed two laboratory sessions in random order. At one session, nicotine lozenge was given immediately after a stressor (to approximate current recommended use - i.e., after craving and withdrawal symptoms occur); at the other session subjects were randomized to receive nicotine lozenge at time points ranging from immediately to 30min prior to the stressor. Withdrawal symptoms and urge to smoke were measured using the Minnesota Nicotine Withdrawal Scale and the Questionnaire of Smoking Urges (QSU). Relative to receiving lozenge after the stressor, a smaller increase in pre-stressor to post-stressor withdrawal symptom scores occurred when lozenge was used immediately (p=0.03) and 10min prior (p=0.044) to the stressor. Results were similar for factors 1 and 2 of the QSU when lozenge was used immediately prior to the stressor (pnicotine lozenge prior to a smoking trigger can decrease trigger induced craving and withdrawal symptoms. Future studies are needed to determine if such use would increase cessation rates. Clinicaltrials.gov # NCT01522963. Copyright © 2017 Elsevier Ltd. All rights reserved.

  8. 78 FR 51741 - Notice of Application for Withdrawal and Opportunity for Public Meeting; California

    Science.gov (United States)

    2013-08-21

    ... DEPARTMENT OF THE INTERIOR Bureau of Land Management [LLCAN06000-L14300000-ET0000/CACA 54303] Notice of Application for Withdrawal and Opportunity for Public Meeting; California AGENCY: Bureau of Land Management, Interior. ACTION: Notice. SUMMARY: The United States Forest Service (USFS) filed an...

  9. Mothers' early depressive symptoms and children's first-grade adjustment: a transactional analysis of child withdrawal as a mediator.

    Science.gov (United States)

    Yan, Ni; Dix, Theodore

    2014-05-01

    The depression-inhibition hypothesis suggests that mothers' depressive symptoms undermine development because they lead children to withdraw from social contact. To test this, this study examined whether poor first-grade adjustment among children of mothers with depressive symptoms is mediated by the emergence of child withdrawal in early development. Based on 1,364 dyads, four waves of data spanning from 24 months to first grade (7 years) were used to examine paths by which children's withdrawal mediates relations between mothers' early depressive symptoms and three first-grade outcomes: social competence, academic performance, and externalizing behavior problems. Structural equation modeling revealed three principal paths. First, direct relations were observed: Mothers' depressive symptoms predicted early child withdrawal and increases in child withdrawal over time, which predicted poor first-grade adjustment. Second, reciprocal relations were observed: Mothers' depressive symptoms predicted child withdrawal, which predicted increases in depressive symptoms. Third, relations via mother-child mutual responsiveness were observed: Depression-related increases in child withdrawal predicted declines in mutual responsiveness, which predicted poor first-grade adjustment. The findings suggest that, due to its interdependence with maternal depression and low mother-child mutual responsiveness over time, child withdrawal may play an important role in the poor first-grade adjustment of children whose mothers are high in depressive symptoms. © 2013 The Authors. Journal of Child Psychology and Psychiatry. © 2013 Association for Child and Adolescent Mental Health.

  10. Practical management of adverse events related to apomorphine therapy

    DEFF Research Database (Denmark)

    Bhidayasiri, Roongroj; Garcia Ruiz, Pedro J; Henriksen, Tove

    2016-01-01

    The potential for adverse events is often cited as a barrier to the use of subcutaneous apomorphine therapy (intermittent injections and continuous infusion) in the management of Parkinson's disease. However, with proactive management most adverse effects are manageable if reported and tackled...... titration, initiation and long-term treatment, and discuss practical management strategies....

  11. Leadership Behaviors and Its Relation with Principals’ Management Experience

    Directory of Open Access Journals (Sweden)

    Vali Mehdinezhad

    2016-01-01

    Full Text Available This paper aims at studying the leadership behaviors reported by principals and observed by teachers and its relationship with management experience of principals. A quantitative method was used in this study. The target population included all principals and teachers of guidance schools and high schools in the Dashtiari District, Iran. A sample consisting of 46 principals and 129 teachers was selected by stratified sampling and simple random sampling methods. A leadership Behavior Description Questionnaire (LBDQ developed by Kozes and Posner (2001 was used for data collection. The obtained data were analyzed using one sample and independent t-test, correlation coefficient and crosstabs pearson Chi-square test. The results showed that teachers describe leadership behaviors of their principals relatively well. However, principals themselves evaluated their leadership behaviors as very well. Comparing between leadership behaviors self-reported by principals and those observed by teachers, a significant difference was found between the views and evaluations of teachers and principals on all components of leadership behaviors of principals, except that regarding empowerment. In fact, principals described their leadership behaviors better and at a more appropriate level than teachers. From the perspective of both teachers and principals, there was no significant relationship between any of the components of leadership behaviors and management experience of principals.

  12. Obesity and the Social Withdrawal Syndrome.

    Science.gov (United States)

    Rotenberg, Ken J; Bharathi, Carla; Davies, Helen; Finch, Tom

    2017-08-01

    The relation between obesity and Social Withdrawal Syndrome (SWS) was examined using the data gathered by Rotenberg, Bharathi, Davies, and Finch (2013). One hundred and 35 undergraduates (80 females; Mage=21years-10months) completed standardized scales that assessed the SWS (low emotional trust beliefs in close others, low disclosure to close others, and high loneliness). BMI was calculated from self-reported weight and height. As hypothesized, quadratic relations were found in which participants with BMI>30 (i.e., obese) demonstrated the SWS pattern of low emotional trust beliefs in close others, low disclosure to close others, and high loneliness. As further evidence, lower emotional trust in close others, lower disclosure to close others, and greater loneliness were found for obese participants (>30 BMI, n=27) than both normal weight (<25 BMI, n=67) and overweight participants (25 to 30 BMI, n=41). The findings confirmed the hypothesis that obesity was associated with the SWS. The findings suggested that the lack of trust in others by obese individuals contributes to their unwillingness to seek out help for health and psychosocial problems. Copyright © 2017 Elsevier Ltd. All rights reserved.

  13. Splenic trauma management in relation to mode and grade

    International Nuclear Information System (INIS)

    Gangat, S.A.; Khaskhali, A.A.; Memon, I.A.

    2008-01-01

    To study the prevalence and management of splenic trauma in relation to its mode and grade. All cases admitted in emergency with abdominal trauma and splenic injury. The data of all the patients who had splenic trauma was entered on a proforma and analyzed. A total of 44 patients with ages between 20-40 years presented with splenic injury; 32(72.7%) were male. The commonest mode of splenic trauma was blunt abdominal injury (50%), and most (47%) patients had Grade- III injury. Splenectomy was carried out in 84% patients, while 9% underwent splenic salvage. Seven (15.9%) patients with splenectomy died in the series. Splenic injury was mostly caused by blunt abdominal trauma. Proper assessment of the grade of injury at the time of laparotomy resulted in more splenic salvage procedures with decreased risk of complications. (author)

  14. Tobacco withdrawal among opioid-dependent smokers.

    Science.gov (United States)

    Streck, Joanna M; Heil, Sarah H; Higgins, Stephen T; Bunn, Janice Y; Sigmon, Stacey C

    2018-04-01

    Prevalence of cigarette smoking among opioid-dependent individuals is 6-fold that of the general U.S. adult population and their quit rates are notoriously poor. One possible reason for the modest cessation outcomes in opioid-dependent smokers may be that they experience more severe tobacco withdrawal upon quitting. In this secondary analysis, we evaluated tobacco withdrawal in opioid-dependent (OD) smokers versus smokers without co-occurring substance use disorders (SUDs). Participants were 47 methadone- or buprenorphine-maintained smokers and 25 non-SUD smokers who completed 1 of several 2-week studies involving daily visits for biochemical monitoring, delivery of financial incentives contingent on smoking abstinence, and assessment of withdrawal via the Minnesota Nicotine Withdrawal Scale (MNWS). Prior to quitting smoking, OD smokers presented with higher baseline withdrawal scores than non-SUD smokers (1.7 ± 0.2 vs. 0.7 ± 0.2, respectively; F [1, 63] = 7.31, p non-SUD smokers, suggesting that elevated withdrawal severity following quitting may not be a major factor contributing to the poor cessation outcomes consistently observed among OD smokers. Further scientific efforts are needed to improve our understanding of the high smoking rates and modest cessation outcomes in this challenging population. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

  15. Managing the relational character of public-private partnership contracts

    Directory of Open Access Journals (Sweden)

    Cvetković Predrag

    2015-01-01

    Full Text Available A public-private partnership contract has the character of a relational contract. Relational contracts are incomplete agreements governing transactions where the contracting parties have mutually agreed that it is impossible or economically inefficient to contractually define ex ante possible difficulties and contingencies in the contract implementation, nor the difficulties and contingencies underlying the ex post control of contract performance by a third entity (court or arbitration. Considering the methodology of managing relational contracts, it is essential that the theory of relational contracts does not advocate for the establishment of relational contracts as a separate category of contracts, with specifically designated contractual instruments. This theory defines the relational contract as a category which legitimizes 'the relational mode' of a particular contract. The methodology of relational contracts is important for contracts on public-private partnership as it ensures that the contractual relationship is aligned with the changes in the immediate environment where the PPP contract operates. The aforementioned alignment has two aspects. The first one is the ex ante aspect of the alignment which is primarily aimed at preventing the detrimental effect of such alignment to the public partner's interests. Therefore, the intent to prevent such an effect shall be taken into account when defining the criteria for the selection of the most favorable private partner and the best offer. At the same time, it is essential to establish verifiable standards for measuring the private partner performance in the phase of contract implementation. For this goal to be achieved, it is crucial to specify the subject matter of the private partner's obligations, to establish the priority rank of PPP project objectives, to elaborate on the specific requirements governing the eligibility of private partners to participate in the bidding process, to specify

  16. Factors Relating to Managerial Stereotypes: The Role of Gender of the Employee and the Manager and Management Gender Ratio

    OpenAIRE

    Stoker, Janka I.; Van der Velde, Mandy; Lammers, Joris

    2011-01-01

    Purpose Several studies have shown that the traditional stereotype of a ?good? manager being masculine and male still exists. The recent changes in the proportion of women and female managers in organizations could affect these two managerial stereotypes, leading to a stronger preference for feminine characteristics and female leaders. This study examines if the gender of an employee, the gender of the manager, and the management gender ratio in an organization are related to employees? manag...

  17. 20 CFR 408.355 - Can you withdraw your application?

    Science.gov (United States)

    2010-04-01

    ... Section 408.355 Employees' Benefits SOCIAL SECURITY ADMINISTRATION SPECIAL BENEFITS FOR CERTAIN WORLD WAR II VETERANS Filing Applications Withdrawal of Application § 408.355 Can you withdraw your application? (a) Request for withdrawal filed before a determination is made. You may withdraw your application...

  18. 19 CFR 144.38 - Withdrawal for consumption.

    Science.gov (United States)

    2010-04-01

    ... 19 Customs Duties 2 2010-04-01 2010-04-01 false Withdrawal for consumption. 144.38 Section 144.38... Withdrawal for consumption. (a) Form. Withdrawals for consumption of merchandise in bonded warehouses shall... considered a withdrawal for consumption pursuant to § 181.53 of this chapter. (c) Information to be shown on...

  19. 21 CFR 514.7 - Withdrawal of applications without prejudice.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 6 2010-04-01 2010-04-01 false Withdrawal of applications without prejudice. 514... Withdrawal of applications without prejudice. The sponsor may withdraw his pending application from.... Such withdrawal may be made without prejudice to a future filing. Upon resubmission, the time...

  20. Determination of Screw and Nail Withdrawal Resistance of Some Important Wood Species

    Directory of Open Access Journals (Sweden)

    Alper Aytekin

    2008-04-01

    Full Text Available In this study, screw and nail withdrawal resistance of fir (Abies nordmanniana, oak (Quercus robur L. black pine (Pinus nigra Arnold and Stone pine (Pinus pinea L. wood were determined and compared. The data represent the testing of withdrawal resistance of three types of screws as smart, serrated and conventional and common nails. The specimens were prepared according to TS 6094 standards. The dimensions of the specimens were 5x5x15cm and for all of the directions. Moreover, the specimens were conditioned at ambient room temperature and 65±2% relative humidity. The screws and nails were installed according to ASTM-D 1761 standards. Nail dimensions were 2.5mm diameter and 50 mm length, conventional screws were 4x50mm, serrated screws were 4x45mm and smart screws were 4x50mm. Results show that the maximum screw withdrawal resistance value was found in Stone pine for the serrated screw. There were no significant differences between Stone pine and oak regarding screw withdrawal resistance values. Conventional screw yielded the maximum screw withdrawal resistance value in oak, followed by Stone pine, black pine and fir. Oak wood showed the maximum screw withdrawal resistance value for the smart screw, followed by Stone pine, black pine, and fir. Oak wood showed higher nail withdrawal resistances than softwood species. It was also determined that oak shows the maximum nail withdrawal resistance in all types. The nail withdrawal resistances at the longitudinal direction are lower with respect to radial and tangential directions.

  1. Time-dependent negative reinforcement of ethanol intake by alleviation of acute withdrawal.

    Science.gov (United States)

    Cunningham, Christopher L; Fidler, Tara L; Murphy, Kevin V; Mulgrew, Jennifer A; Smitasin, Phoebe J

    2013-02-01

    Drinking to alleviate the symptoms of acute withdrawal is included in diagnostic criteria for alcoholism, but the contribution of acute withdrawal relief to high alcohol intake has been difficult to model in animals. Ethanol dependence was induced by passive intragastric ethanol infusions in C57BL/6J (B6) and DBA/2J (D2) mice; nondependent control animals received water infusions. Mice were then allowed to self-administer ethanol or water intragastrically. The time course of acute withdrawal was similar to that produced by chronic ethanol vapor exposure in mice, reaching a peak at 7 to 9 hours and returning to baseline within 24 hours; withdrawal severity was greater in D2 than in B6 mice (experiment 1). Postwithdrawal delays in initial ethanol access (1, 3, or 5 days) reduced the enhancement in later ethanol intake normally seen in D2 (but not B6) mice allowed to self-infuse ethanol during acute withdrawal (experiment 2). The postwithdrawal enhancement of ethanol intake persisted over a 5-day abstinence period in D2 mice (experiment 3). D2 mice allowed to drink ethanol during acute withdrawal drank more ethanol and self-infused more ethanol than nondependent mice (experiment 4). Alcohol access during acute withdrawal increased later alcohol intake in a time-dependent manner, an effect that may be related to a genetic difference in sensitivity to acute withdrawal. This promising model of negative reinforcement encourages additional research on the mechanisms underlying acute withdrawal relief and its role in determining risk for alcoholism. Copyright © 2013 Society of Biological Psychiatry. Published by Elsevier Inc. All rights reserved.

  2. 20 CFR 422.515 - Forms used for withdrawal, reconsideration and other appeals, and appointment of representative.

    Science.gov (United States)

    2010-04-01

    ... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false Forms used for withdrawal, reconsideration... SOCIAL SECURITY ADMINISTRATION ORGANIZATION AND PROCEDURES Applications and Related Forms § 422.515 Forms used for withdrawal, reconsideration and other appeals, and appointment of representative. The...

  3. The cannabis withdrawal syndrome: current insights

    Science.gov (United States)

    Bonnet, Udo; Preuss, Ulrich W

    2017-01-01

    The cannabis withdrawal syndrome (CWS) is a criterion of cannabis use disorders (CUDs) (Diagnostic and Statistical Manual of Mental Disorders – Fifth Edition) and cannabis dependence (International Classification of Diseases [ICD]-10). Several lines of evidence from animal and human studies indicate that cessation from long-term and regular cannabis use precipitates a specific withdrawal syndrome with mainly mood and behavioral symptoms of light to moderate intensity, which can usually be treated in an outpatient setting. Regular cannabis intake is related to a desensitization and downregulation of human brain cannabinoid 1 (CB1) receptors. This starts to reverse within the first 2 days of abstinence and the receptors return to normal functioning within 4 weeks of abstinence, which could constitute a neurobiological time frame for the duration of CWS, not taking into account cellular and synaptic long-term neuroplasticity elicited by long-term cannabis use before cessation, for example, being possibly responsible for cannabis craving. The CWS severity is dependent on the amount of cannabis used pre-cessation, gender, and heritable and several environmental factors. Therefore, naturalistic severity of CWS highly varies. Women reported a stronger CWS than men including physical symptoms, such as nausea and stomach pain. Comorbidity with mental or somatic disorders, severe CUD, and low social functioning may require an inpatient treatment (preferably qualified detox) and post-acute rehabilitation. There are promising results with gabapentin and delta-9-tetrahydrocannabinol analogs in the treatment of CWS. Mirtazapine can be beneficial to treat CWS insomnia. According to small studies, venlafaxine can worsen the CWS, whereas other antidepressants, atomoxetine, lithium, buspirone, and divalproex had no relevant effect. Certainly, further research is required with respect to the impact of the CWS treatment setting on long-term CUD prognosis and with respect to

  4. The cannabis withdrawal syndrome: current insights

    Directory of Open Access Journals (Sweden)

    Bonnet U

    2017-04-01

    Full Text Available Udo Bonnet,1,2 Ulrich W Preuss3,4 1Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, Evangelisches Krankenhaus Castrop-Rauxel, Academic Teaching Hospital of the University of Duisburg-Essen, Castrop-Rauxel, 2Department of Psychiatry and Psychotherapy, Faculty of Medicine, LVR-Hospital Essen, University of Duisburg-Essen, Essen, 3Vitos-Klinik Psychiatrie und Psychotherapie Herborn, Herborn, 4Martin Luther University Halle-Wittenberg, Halle (Saale, Germany Abstract: The cannabis withdrawal syndrome (CWS is a criterion of cannabis use disorders (CUDs (Diagnostic and Statistical Manual of Mental Disorders – Fifth Edition and cannabis dependence (International Classification of Diseases [ICD]-10. Several lines of evidence from animal and human studies indicate that cessation from long-term and regular cannabis use precipitates a specific withdrawal syndrome with mainly mood and behavioral symptoms of light to moderate intensity, which can usually be treated in an outpatient setting. Regular cannabis intake is related to a desensitization and downregulation of human brain cannabinoid 1 (CB1 receptors. This starts to reverse within the first 2 days of abstinence and the receptors return to normal functioning within 4 weeks of abstinence, which could constitute a neurobiological time frame for the duration of CWS, not taking into account cellular and synaptic long-term neuroplasticity elicited by long-term cannabis use before cessation, for example, being possibly responsible for cannabis craving. The CWS severity is dependent on the amount of cannabis used pre-cessation, gender, and heritable and several environmental factors. Therefore, naturalistic severity of CWS highly varies. Women reported a stronger CWS than men including physical symptoms, such as nausea and stomach pain. Comorbidity with mental or somatic disorders, severe CUD, and low social functioning may require an inpatient treatment (preferably qualified detox and

  5. The social side of shame: approach versus withdrawal.

    Science.gov (United States)

    de Hooge, Ilona E; Breugelmans, Seger M; Wagemans, Fieke M A; Zeelenberg, Marcel

    2018-01-05

    At present, the consequences and functions of experiences of shame are not yet well understood. Whereas psychology literature typically portrays shame as being bad for social relations, motivating social avoidance and withdrawal, there are recent indications that shame can be reinterpreted as having clear social tendencies in the form of motivating approach and social affiliation. Yet, until now, no research has ever put these alternative interpretations of shame-motivated behaviours directly to the test. The present paper presents such a test by studying the extent to which shame motivates a preference for social withdrawal versus a preference for social approach. Two studies (N = 148 and N = 133) using different shame inductions both showed people experiencing shame to prefer to be together with others (social approach) over being alone (social withdrawal). In addition, the preference for a social situation was found to be unique for shame; it was not found for the closely related emotion of guilt. Taken together, these findings provide direct empirical support for the idea that shame can have positive interpersonal consequences.

  6. Team management in the 21 st century: A human relations theory ...

    African Journals Online (AJOL)

    Team management in the 21 st century: A human relations theory angle. ... a team is about understanding human relation, that is, the manager understanding the ... The problem ranges from membership isolation to lack of communication and ...

  7. Strategy of public relations in the system of management of organization

    OpenAIRE

    Tereschenko, D.

    2010-01-01

    The question of links of the strategic planning of public relations and a system approach to management of organization activity have been researched. The maintenance of stages of strategic plan of public relations in the organization's management system is opened.

  8. Reconstruction of global gridded monthly sectoral water withdrawals for 1971–2010 and analysis of their spatiotemporal patterns

    Directory of Open Access Journals (Sweden)

    Z. Huang

    2018-04-01

    the seasonal and annual timescales. The reconstructed gridded water withdrawal dataset is open access, and can be used for examining issues related to water withdrawals at fine spatial, temporal, and sectoral scales.

  9. An exploratory study of cannabis withdrawal among Indigenous Australian prison inmates: study protocol.

    Science.gov (United States)

    Rogerson, Bernadette; Copeland, Jan; Buttner, Petra; Bohanna, India; Cadet-James, Yvonne; Sarnyai, Zoltan; Clough, Alan R

    2013-05-28

    Cannabis use and dependence is a serious health and criminal justice issue among incarcerated populations internationally. Upon abrupt, enforced cessation of cannabis, prisoners may suffer irritability and anger that can lead to threatening behaviour, intimidation, violence, sleep disturbances and self-harm. Cannabis withdrawal syndrome, proposed for inclusion in the Diagnostic and Statistical Manual of Mental Disorders in 2013, has not been examined in Indigenous populations. Owing to the exceptionally high rates of cannabis use in the community, high proportions of Australian Indigenous prisoners may suffer from withdrawal upon entry to custody. 60 male and 60 female Indigenous prisoners (18-40 years) at a high risk of cannabis dependence will be recruited upon entry to custody. A pictorial representation of the standard Cannabis Withdrawal Scale will be tested for reliability and validity. Cortisol markers will be measured in saliva, as the indicators of onset and severity of cannabis withdrawal and psychological distress. The characteristics will be described as percentages and mean or median values with 95% CI. Receiver operator curve analysis will determine an ideal cut-off of the Cannabis Withdrawal Scale and generalised estimating equations modelling will test changes over time. The acceptability and efficacy of proposed resources will be assessed qualitatively using thematic analysis. A valid and reliable measure of cannabis withdrawal for use with Indigenous populations, the onset and time course of withdrawal symptoms in this population and the development of culturally acceptable resources and interventions to identify and manage cannabis withdrawal. The project has been approved by the James Cook University Human Research Ethics Committee (approval number H4651).The results will be reported via peer reviewed publications, conference, seminar presentations and on-line media for national and international dissemination.

  10. The logic of relations and the logic of management.

    Science.gov (United States)

    Buntinx, W

    2008-07-01

    Increasing emphasis on financial and administrative control processes is affecting service culture in support organisations for persons with intellectual disability. This phenomenon is currently obvious in Dutch service organisations that find themselves in transition towards more community care and at the same time under pressure from new administrative and funding managerial bureaucracy. As a result, the logic of management is becoming more dominant in direct support settings and risk to overshadow the logic of relationships between staff and clients. The article presents a reflection on this phenomenon, starting from a description of service team characteristics as found in the literature. Next, findings about direct support staff (DSS) continuity are summarised from four Dutch studies. Following up these findings, the concept of 'microsystems' is explored as a possible answer to the organisational challenges demonstrated in the studies. Team characteristics, especially team size and membership continuity for DSS, appear relevant factors for assuring supportive relationships and service quality in direct support teams. The structure of the primary support team shows to be of special interest. The organisational concept of 'microsystems' is explored with respect to transcending the present conflict between bureaucratic managerial pressure and the need for supportive relationships. Service organisations need to create structural conditions for the efficacy of direct support teams in terms of client relationships and relevant client outcomes. At the same time, the need for administrative and control processes can not be denied. The concept of 'microsystems', application of a Quality of Life framework and the use of new instruments, such as the Supports Intensity Scale, can contribute to an organisational solution for the present conflicting logic of relations and management.

  11. Customer Relations Management sebagai Salah Satu Upaya Public Relations Perusahaan Jasa Perbankan Menciptakan Good Image

    Directory of Open Access Journals (Sweden)

    Prima Ayu Rizqi Mahanani

    2017-01-01

    Full Text Available This article deals with marketing trends in the 21st century is shifting from a transactional approach to the relational approach with focus on the fulfillment of needs, satisfaction, and pleasure affect business banking customers are very dependent on the customer. Map business services banking services fickle demands creativity public relations in providing the best service to its customers get a good image. Service concept using the service paradigm leading to cultivate the power of the customer based on the customer satisfaction-oriented, widely used by business banking services at this time. Paradigms that focus on how to provide services to the customer so that the customer was satisfied, beyond what can be given to something that is important and not to be underestimated. Skills to understand and fulfill customer expectations should be every company’s business philosophy of banking services and customer relationship management is a strategy

  12. 36 CFR 1237.10 - How must agencies manage their audiovisual, cartographic, and related records?

    Science.gov (United States)

    2010-07-01

    ... their audiovisual, cartographic, and related records? 1237.10 Section 1237.10 Parks, Forests, and Public Property NATIONAL ARCHIVES AND RECORDS ADMINISTRATION RECORDS MANAGEMENT AUDIOVISUAL, CARTOGRAPHIC, AND RELATED RECORDS MANAGEMENT § 1237.10 How must agencies manage their audiovisual, cartographic, and related...

  13. USA Withdrawal from Paris Agreement – What Next?

    Directory of Open Access Journals (Sweden)

    Sergey Chestnoy

    2017-12-01

    Full Text Available In June 2017, President Trump announced the USA’s withdrawal from the Paris Climate Accord, which had been ratified for less than a year, thanks in large part to the USA. That drastic shift followed the change in residency at the White House. Withdrawing from the Paris Accord presents an interesting topic for analysis. There’s the practical side of the withdrawal procedure as set out in Article 28 of the agreement, not to mention the consequences of US non-participation in addressing international climate issues. There are other international forums (Such as G8 and G20, which also have an interest in climate related topics. The Article analyses the U.S. position in negotiations and its commitments assumed the moment the United Nations Framework Convention on Climate Change (UNFCCC came into effect until now: the reduction of greenhouse gas emissions, financial aid and reporting. It also provides general analysis of national legal obligations under the Paris Accord, ratification of that agreement in general and in particularly another that took place in the USA, it focuses on the specifics of withdrawal. The specified three-year period from the Agreement becoming active, after which any party may withdraw from it (2019, is a noteworthy detail. It is well-known that the Paris Agreement provides a framework that does not impose individual national commitments or a commitment to a compliance system. In essence, and from a legal point of view, it is nonbinding. This was what allowed the USA to accept the terms of the accord relatively quickly and to use the simplified procedure, which by-passed Congress. In the opinion of the authors, President Trump’s resolution to withdraw should, possibly, be considered as a simple continuation of his election discourse and the fulfilment of a campaign promise. Additionally, President Trump’s declared intent to review the Paris Accord has legal grounds on which to launch further international negotiations

  14. Control rod excess withdrawal prevention device

    International Nuclear Information System (INIS)

    Takayama, Yoshihito.

    1992-01-01

    Excess withdrawal of a control rod of a BWR type reactor is prevented. That is, the device comprises (1) a speed detector for detecting the driving speed of a control rod, (2) a judging circuit for outputting an abnormal signal if the driving speed is greater than a predetermined level and (3) a direction control valve compulsory closing circuit for controlling the driving direction of inserting and withdrawing a control rod based on an abnormal signal. With such a constitution, when the with drawing speed of a control rod is greater than a predetermined level, it is detected by the speed detector and the judging circuit. Then, all of the direction control valve are closed by way of the direction control valve compulsory closing circuit. As a result, the operation of the control rod is stopped compulsorily and the withdrawing speed of the control rod can be lowered to a speed corresponding to that upon gravitational withdrawal. Accordingly, excess withdrawal can be prevented. (I.S)

  15. Fearfulness moderates the link between childhood social withdrawal and adolescent reward response.

    Science.gov (United States)

    Morgan, Judith K; Shaw, Daniel S; Forbes, Erika E

    2015-06-01

    Withdrawal from peers during childhood may reflect disruptions in reward functioning that heighten vulnerability to affective disorders during adolescence. The association between socially withdrawn behavior and reward functioning may depend on traits that influence this withdrawal, such as fearfulness or unsociability. In a study of 129 boys, we evaluated how boys' fearfulness and sociability at age 5 and social withdrawal at school at ages 6 to 10 and during a summer camp at age 9/10 were associated with their neural response to reward at age 20. Greater social withdrawal during childhood was associated with heightened striatal and mPFC activation when anticipating rewards at age 20. Fearfulness moderated this effect to indicate that social withdrawal was associated with heightened reward-related response in the striatum for boys high on fearfulness. Altered striatal response associated with social withdrawal and fearfulness predicted greater likelihood to have a lifetime history of depression and social phobia at age 20. These findings add greater specificity to previous findings that children high in traits related to fear of novelty show altered reward responses, by identifying fearfulness (but not low levels of sociability) as a potential underlying mechanism that contributes to reward alterations in withdrawn children. © The Author (2014). Published by Oxford University Press. For Permissions, please email: journals.permissions@oup.com.

  16. Monitoring asthma in childhood: management-related issues

    Directory of Open Access Journals (Sweden)

    Bart L. Rottier

    2015-06-01

    Full Text Available Management-related issues are an important aspect of monitoring asthma in children in clinical practice. This review summarises the literature on practical aspects of monitoring including adherence to treatment, inhalation technique, ongoing exposure to allergens and irritants, comorbid conditions and side-effects of treatment, as agreed by the European Respiratory Society Task Force on Monitoring Asthma in Childhood. The evidence indicates that it is important to discuss adherence to treatment in a non-confrontational way at every clinic visit, and take into account a patient's illness and medication beliefs. All task force members teach inhalation techniques at least twice when introducing a new inhalation device and then at least annually. Exposure to second-hand tobacco smoke, combustion-derived air pollutants, house dust mites, fungal spores, pollens and pet dander deserve regular attention during follow-up according to most task force members. In addition, allergic rhinitis should be considered as a cause for poor asthma control. Task force members do not screen for gastro-oesophageal reflux and food allergy. Height and weight are generally measured at least annually to identify individuals who are susceptible to adrenal suppression and to calculate body mass index, even though causality between obesity and asthma has not been established. In cases of poor asthma control, before stepping up treatment the above aspects of monitoring deserve closer attention.

  17. Sports-related concussions: diagnosis, complications, and current management strategies.

    Science.gov (United States)

    Hobbs, Jonathan G; Young, Jacob S; Bailes, Julian E

    2016-04-01

    Sports-related concussions (SRCs) are traumatic events that affect up to 3.8 million athletes per year. The initial diagnosis and management is often instituted on the field of play by coaches, athletic trainers, and team physicians. SRCs are usually transient episodes of neurological dysfunction following a traumatic impact, with most symptoms resolving in 7-10 days; however, a small percentage of patients will suffer protracted symptoms for years after the event and may develop chronic neurodegenerative disease. Rarely, SRCs are associated with complications, such as skull fractures, epidural or subdural hematomas, and edema requiring neurosurgical evaluation. Current standards of care are based on a paradigm of rest and gradual return to play, with decisions driven by subjective and objective information gleaned from a detailed history and physical examination. Advanced imaging techniques such as functional MRI, and detailed understanding of the complex pathophysiological process underlying SRCs and how they affect the athletes acutely and long-term, may change the way physicians treat athletes who suffer a concussion. It is hoped that these advances will allow a more accurate assessment of when an athlete is truly safe to return to play, decreasing the risk of secondary impact injuries, and provide avenues for therapeutic strategies targeting the complex biochemical cascade that results from a traumatic injury to the brain.

  18. Neural effects of positive and negative incentives during marijuana withdrawal.

    Directory of Open Access Journals (Sweden)

    Francesca M Filbey

    Full Text Available In spite of evidence suggesting two possible mechanisms related to drug-seeking behavior, namely reward-seeking and harm avoidance, much of the addiction literature has focused largely on positive incentivization mechanisms associated with addiction. In this study, we examined the contributing neural mechanisms of avoidance of an aversive state to drug-seeking behavior during marijuana withdrawal. To that end, marijuana users were scanned while performing the monetary incentive delay task in order to assess positive and negative incentive processes. The results showed a group x incentive interaction, such that marijuana users had greater response in areas that underlie reward processes during positive incentives while controls showed greater response in the same areas, but to negative incentives. Furthermore, a negative correlation between withdrawal symptoms and response in the amygdala during negative incentives was found in the marijuana users. These findings suggest that although marijuana users have greater reward sensitivity and less harm avoidance than controls, that attenuated amygdala response, an area that underlies fear and avoidance, was present in marijuana users with greater marijuana withdrawal symptoms. This is concordant with models of drug addiction that involve multiple sources of reinforcement in substance use disorders, and suggests the importance of strategies that focus on respective mechanisms.

  19. Intractable nausea caused by zolpidem withdrawal: a case report.

    Science.gov (United States)

    Baruch, Edward; Vernon, Leonard F; Hasbun, Rafael J

    2007-03-01

    First launched in France in 1988, zolpidem (Ambien®) is a short-acting hypnotic agent. Early studies reported that that the development of physical dependence and tolerance to sedative-hypnotic drugs, such as the depressant and anticonvulsant effects evidenced with benzodiazepines, is not found with zolpidem. Direct to consumer advertising by the manufacturer continues to state that the risk for dependency is low; however, recent publications seem to contradict this. Additionally, adverse drug reactions affecting the central nervous system, gastrointestinal tract, and respiratory system have been reported. Other studies have examined the interactions of selective serotonin reuptake inhibitors and zolpidem as a possible cause of hallucinations. With continued physician marketing efforts touting the safety and efficacy of zolpidem, there is a high likelihood to overlook the risk of dependency and the symptoms related to zolpidem withdrawal. We report a case of a 41-year-old female who developed a dependency to zolpidem, who on her own decided to decrease her dosage, resulting in intractable nausea requiring hospitalization. Reported cases of zolpidem withdrawal have occurred with doses in excess of 160 mg per day, none of these have reported with intractable nausea as the sole symptom. In our reported case, although exceeding recommended dosage withdrawal phenomenon seemed to be severe after withdrawal from a comparatively low dose of zolpidem. Before zolpidem is prescribed, patient education should include warnings about the potential problems associated with dependency and abrupt discontinuation. Education about this common and likely underrecognized clinical phenomenon will help prevent future episodes and minimize the risk of misdiagnosis.

  20. Tobacco Withdrawal Amongst African American, Hispanic, and White Smokers.

    Science.gov (United States)

    Bello, Mariel S; Pang, Raina D; Cropsey, Karen L; Zvolensky, Michael J; Reitzel, Lorraine R; Huh, Jimi; Leventhal, Adam M

    2016-06-01

    Persistent tobacco use among racial and ethnic minority populations in the United States is a critical public health concern. Yet, potential sources of racial/ethnic disparities in tobacco use remain unclear. The present study examined racial/ethnic differences in tobacco withdrawal-a clinically-relevant underpinning of tobacco use that has received sparse attention in the disparities literature-utilizing a controlled laboratory design. Daily smokers (non-Hispanic African American [n = 178], non-Hispanic white [n = 118], and Hispanic [n = 28]) attended two counterbalanced sessions (non-abstinent vs. 16-hour abstinent). At both sessions, self-report measures of urge, nicotine withdrawal, and affect were administered and performance on an objective behavioral task that assessed motivation to reinstate smoking was recorded. Abstinence-induced changes (abstinent scores vs. non-abstinent scores) were analyzed as a function of race/ethnicity. Non-Hispanic African American smokers reported greater abstinence-induced declines in several positive affect states in comparison to other racial/ethnic groups. Relative to Hispanic smokers, non-Hispanic African American and non-Hispanic white smokers displayed larger abstinence-provoked increases in urges to smoke. No racial/ethnic differences were detected for a composite measure of nicotine withdrawal symptomatology, negative affect states, and motivation to reinstate smoking behavior. These results suggest qualitative differences in the expression of some components of tobacco withdrawal across three racial/ethnic groups. This research helps shed light on bio-behavioral sources of tobacco-related health disparities, informs the application of smoking cessation interventions across racial/ethnic groups, and may ultimately aid the overall effort towards reducing the public health burden of tobacco addiction in minority populations. The current study provides some initial evidence that there may be qualitative differences in the

  1. Evaluation of Time Management Behaviors and Its Related Factors in the Senior Nurse Managers, Kermanshah-Iran

    OpenAIRE

    Ziapour, Arash; Khatony, Alireza; Jafari, Faranak; Kianipour, Neda

    2015-01-01

    Background and Objective: Time management is an extensive concept that is associated with promoting the performance of managers. The present study was carried out to investigate the time management behaviors along with its related factors among senior nurse mangers. Materials and Methods: In this descriptive-analytical study, 180 senior nurse managers were selected using census method. The instrument for data collection was a standard time behavior questionnaire. Data were analyzed by descrip...

  2. Risk Management in Supply Chain using Consistent Fuzzy Preference Relations

    OpenAIRE

    Ahmad Jafarnejad; Mehran Ebrahimi; Mohammad Ali Abbaszadeh; Seyed Mehdi Abtahi

    2014-01-01

    Nowadays, supply chains are exposed to numerous risks. Thus, to success in risky business environment, it is imperative for firms to systematically manage supply chain risks. Risk management is the identification, assessment, and prioritization of supply chain risks. The purpose of this paper is to propose a comprehensive approach to risk management in supply chains. Thus, by an appropriate review of the literature, supply chain risk sources are identified in six areas. Then, a CFPR method is...

  3. Using Relative Humidity Forecasts to Manage Meningitis in the Sahel

    Science.gov (United States)

    Pandya, R. E.; Adams-Forgor, A.; Akweogno, P.; Awine, T.; Dalaba, M.; Dukic, V.; Dumont, A.; Hayden, M.; Hodgson, A.; Hopson, T. M.; Hugonnet, S.; Yoksas, T. C.

    2012-12-01

    the number cases of meningitis in the Sahel. Using currently available forecast models contributed through the WMO Thorpex-Tigge project, and applying quantile regression to enhance their accuracy, we can forecast the average weekly relative humidity to two weeks in advance which allows us to anticipate the end of an epidemic in a region of the Sahel up to four weeks in advance. This would allow public health officials to deploy vaccines to areas in which the epidemics are likely to persist due to continued dryness and avoid vaccinating in areas where the epidemics will end with higher humidity. Our presentation will conclude by introducing the relative humidity decision-information tool developed for use by public-health officials. We will also summarize the results of a weekly meningitis forecast exercise held during the 2011-2012 dry season with public health decision makers from several African countries and the World Health Organization. Finally, we highlight some results of concurrent socio-economic research that suggests other interventions for managing meningitis and helps quantify the economic impact of the disease in Ghana. Overall, while our research has demonstrated an actionable relationship between weather and disease, this relationship is only one factor in a complex and coupled human-natural system which merits continued investigation.

  4. The Director General withdraws its proposal to Council

    CERN Multimedia

    Staff Association

    2015-01-01

    Dear Colleagues, The Staff Association and the CERN-ESO Pensioners’ Association want to let you know that they are deeply worried. Decisions taken by CERN Council at its latest closed sessions attracted our attention.  Since these sessions took place behind closed doors, without the presence of the Association, we had to investigate, crossing several sources of information. Result: The attitude of some delegations shocked us and fills us with indignation. Let us recall the facts: the Management's action plan to compensate for the soaring Swiss franc against the euro, did not reach a consensus among the Member States, forcing Management to withdraw it. Strange, when one considers that CERN was the only international organization based in Switzerland to come forward with such an initiative. On the contrary, Council is once again using the Pension Fund as a “scape goat”. It should be recalled here, that past decisions by CERN Council on the Fund's manag...

  5. Withdrawal-oriented therapy for smokers.

    Science.gov (United States)

    Hajek, P

    1989-06-01

    The treatment approach of the Maudsley Hospital Smokers Clinic is described. It stems from the notion that smokers seeking help are dependent on nicotine, and that withdrawal discomfort is a major block to their success in quitting. Accordingly, therapy focuses on helping clients overcome nicotine deprivation. It uses nicotine replacement and a special format of group treatment. Details are given of preparation of clients, use of nicotine chewing gum, use of group-oriented groupwork, use of information about withdrawal, and training in withdrawal-oriented therapy. Data are presented concerning characteristics of the clientele, treatment adherence, and treatment results. A number of controversial issues are addressed, such as the optimal duration of treatment, timing of the quit date, the value of educational input, and the value of individualization of treatment goals.

  6. Management of Work–Related Injuries Leading to Amputation and Its Relation with Treatment Outcome

    Directory of Open Access Journals (Sweden)

    Iravan Masoudi-Asl

    2011-04-01

    Full Text Available Normal 0 false false false EN-US X-NONE AR-SA /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal" mso-tstyle-rowband-size:0 mso-tstyle-colband-size:0 mso-style-noshow:yes mso-style-priority:99 mso-style-parent:"" mso-padding-alt:0mm 5.4pt 0mm 5.4pt mso-para-margin-top:0mm mso-para-margin-right:0mm mso-para-margin-bottom:10.0pt mso-para-margin-left:0mm line-height:115% mso-pagination:widow-orphan font-size:11.0pt font-family:"Calibri","sans-serif" mso-ascii-font-family:Calibri mso-ascii-theme-font:minor-latin mso-hansi-font-family:Calibri mso-hansi-theme-font:minor-latin mso-bidi-font-family:Arial mso-bidi-theme-font:minor-bidi}   Objective: Work related accidents are considered as a significant health problem of working population. The goal of this study was to determine relation of treatment management with treatment outcome of Work-Related injuries leading to amputation.   Materials & Methods: current study was based on correlation method which was evidence based and was based on actual data of medical records of occupational accidents leading to amputations. Study population included all injuries that suffered limb amputation due to work and were referred to Laleh hospital during 2005 to 2009 (N=135. The data were collected by check list and analyzed by descriptive and inferential Statistics.   Results: Taking care method had a considerable effect on success of replant operation of that limb (P<0.001 so that in 95.23% of injuries whom principles of primary care had been done for them during transportation of amputated limb to hospital, had a successful operation. Treatment results of injuries in large limbs have had a strong relation to interval of incident occurrence to start of operation (P=0.038 How to refer injuries to hospital has not had a meaningful impact on treatment outcome (P=0.469 although referring injuries from health centers of workplace directly to hospital had more successful result comparing to

  7. Development of a Relational Database for Learning Management Systems

    Science.gov (United States)

    Deperlioglu, Omer; Sarpkaya, Yilmaz; Ergun, Ertugrul

    2011-01-01

    In today's world, Web-Based Distance Education Systems have a great importance. Web-based Distance Education Systems are usually known as Learning Management Systems (LMS). In this article, a database design, which was developed to create an educational institution as a Learning Management System, is described. In this sense, developed Learning…

  8. CHANGE MANAGEMENT STRATEGIES RELATED TO THE GLOBAL ENVIRONMENT COMPLEXITY

    Directory of Open Access Journals (Sweden)

    Elena DOVAL

    2016-12-01

    Full Text Available The changes in organizations appear as a reaction to the organizational environment changes. In order to manage these changes successfully, the managers need to anticipate and design alternative strategies by preparing different options.  Nevertheless, the complexity of the global environment forces the managers to adopt strategies for their organizations that are facilitating the creation of new strategic competences and competitive advantages to face the environmental rapid changes. In this context, this paper is aiming to illustrate the main directions the change management may consider to change the organization strategies in order to harmonize them to the external environment, such as: integration versus externalization, flexible specialization and flexible organization, standardization versus adaptation, market segmentation, relationship building and maintaining and communication integration.  However, the new strategies are based on a changed attitude of the managers towards the competitive advantage that is dynamic and focused on creation rather then to operations.

  9. [Treatment of gamma-hydroxybutyrate withdrawal].

    Science.gov (United States)

    Strand, Niels August Willer; Petersen, Tonny Studsgaard; Nielsen, Lars Martin; Boegevig, Soren

    2017-12-11

    Gamma-hydroxybutyrate (GHB) is a drug of abuse, for which physical addiction develops quickly. GHB withdrawal can develop into a life-threatening condition and has previously been treated mainly with benzodiazepines. These have not always proven effective, leading to long hospitalizations in intensive care units. Based on successful Dutch treatment results for using GHB to treat GHB withdrawal symptoms, we propose to implement a similar method in Denmark. The method requires an interdisciplinary effort for which The Danish Poison Information Centre should be consulted for expertise.

  10. Children's judgements of social withdrawal behaviours.

    Science.gov (United States)

    Watling, Dawn

    2015-06-01

    Ding et al. (Brit. J. Dev. Psychol., 2015; 33, 159-173) demonstrated that Chinese children discriminate between the three subtypes of social withdrawal: Shyness, unsociability, and social avoidance. This commentary on the Ding et al.'s paper highlights the need to further explore the following: (1) children's understanding of the implications of being shy, unsociable, or socially avoidant, including assessing these which we know are associated with outcomes for socially withdrawn children; (2) what additional subtypes might exist naturally within the Chinese culture; and (3) consider the implications of social withdrawal on children's developing social skills. © 2015 The British Psychological Society.

  11. Multidisciplinary Management of Pediatric Sports-Related Concussion.

    Science.gov (United States)

    Ellis, Michael J; Ritchie, Lesley J; McDonald, Patrick J; Cordingley, Dean; Reimer, Karen; Nijjar, Satnam; Koltek, Mark; Hosain, Shahid; Johnston, Janine; Mansouri, Behzad; Sawyer, Scott; Silver, Norm; Girardin, Richard; Larkins, Shannon; Vis, Sara; Selci, Erin; Davidson, Michael; Gregoire, Scott; Sam, Angela; Black, Brian; Bunge, Martin; Essig, Marco; MacDonald, Peter; Leiter, Jeff; Russell, Kelly

    2017-01-01

    To summarize the clinical characteristics and outcomes of pediatric sports-related concussion (SRC) patients who were evaluated and managed at a multidisciplinary pediatric concussion program and examine the healthcare resources and personnel required to meet the needs of this patient population. We conducted a retrospective review of all pediatric SRC patients referred to the Pan Am Concussion Program from September 1st, 2013 to May 25th, 2015. Initial assessments and diagnoses were carried out by a single neurosurgeon. Return-to-Play decision-making was carried out by the multidisciplinary team. 604 patients, including 423 pediatric SRC patients were evaluated at the Pan Am Concussion Program during the study period. The mean age of study patients was 14.30 years (SD: 2.32, range 7-19 years); 252 (59.57%) were males. Hockey (182; 43.03%) and soccer (60; 14.18%) were the most commonly played sports at the time of injury. Overall, 294 (69.50%) of SRC patients met the clinical criteria for concussion recovery, while 75 (17.73%) were lost to follow-up, and 53 (12.53%) remained in active treatment at the end of the study period. The median duration of symptoms among the 261 acute SRC patients with complete follow-up was 23 days (IQR: 15, 36). Overall, 25.30% of pediatric SRC patients underwent at least one diagnostic imaging test and 32.62% received referral to another member of our multidisciplinary clinical team. Comprehensive care of pediatric SRC patients requires access to appropriate diagnostic resources and the multidisciplinary collaboration of experts with national and provincially-recognized training in TBI.

  12. Opioid withdrawal suppression efficacy of oral dronabinol in opioid dependent humans.

    Science.gov (United States)

    Lofwall, Michelle R; Babalonis, Shanna; Nuzzo, Paul A; Elayi, Samy Claude; Walsh, Sharon L

    2016-07-01

    The cannabinoid (CB) system is a rational novel target for treating opioid dependence, a significant public health problem around the world. This proof-of-concept study examined the potential efficacy of a CB1 receptor partial agonist, dronabinol, in relieving signs and symptoms of opioid withdrawal. Twelve opioid dependent adults participated in this 5-week, inpatient, double-blind, randomized, placebo-controlled study. Volunteers were maintained on double-blind oxycodone (30mg oral, four times/day) and participated in a training session followed by 7 experimental sessions, each testing a single oral test dose (placebo, oxycodone 30 and 60mg, dronabinol 5, 10, 20, and 30mg [decreased from 40mg]). Placebo was substituted for oxycodone maintenance doses for 21h before each session in order to produce measurable opioid withdrawal. Outcomes included observer- and participant-ratings of opioid agonist, opioid withdrawal and psychomotor/cognitive performance. Oxycodone produced prototypic opioid agonist effects (i.e. suppressing withdrawal and increasing subjective effects indicative of abuse liability). Dronabinol 5 and 10mg produced effects most similar to placebo, while the 20 and 30mg doses produced modest signals of withdrawal suppression that were accompanied by dose-related increases in high, sedation, bad effects, feelings of heart racing, and tachycardia. Dronabinol was not liked more than placebo, showed some impairment in cognitive performance, and was identified as marijuana with increasing dose. CB1 receptor activation is a reasonable strategy to pursue for the treatment of opioid withdrawal; however, dronabinol is not a likely candidate given its modest withdrawal suppression effects of limited duration and previously reported tachycardia during opioid withdrawal. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  13. Decree nr 2014-764 of the 3 July 2014 related to electricity load managements

    International Nuclear Information System (INIS)

    Valls, Manuel; Royal, Segolene; Montebourg, Arnaud

    2014-01-01

    This decree issued by the Ministry of ecology, sustainable development and energy aims at defining the methodology used to establish rules of valorisation of electricity load managements. It concerns energy suppliers and load management operators. A first chapter defines what electricity load management is and who a load management operator is. The next chapter addresses the methodology, the definition of the electricity load management volume, data used for the certification of load management volumes. The third chapter describes how to calculate the premium awarded to load management operators. The last chapters indicate how the ministries define the premium amount, and some aspects related to the communication of data to load management operators

  14. Use of a public film event to promote understanding and help seeking for social withdrawal.

    Science.gov (United States)

    Teo, Alan Robert; Stufflebam, Kyle Whitaker; Lu, Francis; Fetters, Michael Derwin

    2015-06-01

    This study aimed to implement a public film event about mental health aspects of social withdrawal. Secondary aims were to assess participants' knowledge, attitudes, and intended behaviors related to social withdrawal. The event, held at three U.S. sites, consisted of a film screening, question-and-answer session, and lecture. Participants completed a post-event survey. Of the 163 participants, 115 (70.6%) completed surveys. Most of the sample deemed social withdrawal a significant mental health issue. Regarding post-event intended behaviors, 90.2% reported intent to get more information, 48.0% to being vigilant for social withdrawal in others, and 19.6% to talking with a health care professional about concerns for social withdrawal in themselves or someone they knew. Asian participants were significantly more likely than non-Asians to intend to encourage help-seeking for social withdrawal (p = .001). A public film event may be a creative way to improve mental health awareness and treatment-seeking. © 2014 Wiley Publishing Asia Pty Ltd.

  15. Marijuana withdrawal and aggression among a representative sample of U.S. marijuana users

    Science.gov (United States)

    Smith, Philip H.; Homish, Gregory G.; Leonard, Kenneth E.; Collins, R. Lorraine

    2013-01-01

    Background Previous laboratory-based research suggests that withdrawal from marijuana may cause increased aggression. It is unclear whether this finding extends beyond the laboratory setting to the general population of marijuana users. The purpose of this study was to test a cross-sectional association between marijuana withdrawal symptoms and aggression among a representative sample of U.S. adult marijuana users, and to test whether this association was moderated by previous history of aggression. Methods Data were analyzed from the National Epidemiologic Survey on Alcohol and Related Conditions. Wave Two data (2004–2005) were used for all variables except for history of aggression, which was assessed during the Wave One interview (2001–2002). Two outcomes were examined: self-report general aggression and relationship aggression. Odds ratios for aggression based on withdrawal symptoms and the interaction between withdrawal symptoms and history of aggression were calculated using logistic regression, adjusting for covariates and accounting for the complex survey design. Results Among marijuana users with a history of aggression, marijuana withdrawal was associated with approximately 60% higher odds of past year relationship aggression (p aggression among those without a history of aggression, and no association with general aggression regardless of history of aggression. Conclusions The findings from this study support the notion that laboratory-based increases in aggression due to marijuana withdrawal extend to the general population of marijuana users who have a previous history of aggression. PMID:23380439

  16. Cerebral blood flow and oxygen consumption during ethanol withdrawal in the rat.

    Science.gov (United States)

    Hemmingsen, R; Barry, D I; Hertz, M M; Klinken, L

    1979-09-14

    The ethanol withdrawal syndrome in man and animals is characterized by signs of CNS hyperactivity although a direct measurement of a physiological variable reflecting this CNS hyperactivity has never been performed in untreated man or in animals. We induced ethanol dependence in the rat by means of intragastric intubation with a 20% w/v ethanol solution, thus keeping the animals in a state of continuous severe intoxication for 3--4 days; during the subsequent state of withdrawal characterized by tremor, rigidity, stereotyped movements and general seizures a 25% increase in cerebral oxygen consumption (CMRO2) could be measured; this increase was not due to catecholamines originating from adrenal medulla as adrenomedullectomized animals showed a similar increase in CMRO2 (28%); the withdrawing animals showed a corresponding cerebral blood flow (CBF) increase. The elevated CMRO2 and CBF could be reduced to normal by administration of a beta-adrenergic receptor blocker (propranolol 2 mg/kg i.v.), and hence the increased CMRO2 during ethanol withdrawal could be related to catecholaminergic systems in the brain, e.g. the noradrenergic locus coeruleus system which is anatomically well suited as a general activating system. This interpretation is supported by the earlier neurochemical finding of an increased cerebral noradrenaline turnover during ethanol withdrawal. The exact mechanism underlying the increased cerebral oxygen consumption during ethanol withdrawal and the effect of propranolol on cerebral function during this condition remains to be clarified.

  17. 48 CFR 52.251-2 - Interagency Fleet Management System Vehicles and Related Services.

    Science.gov (United States)

    2010-10-01

    ... CLAUSES Text of Provisions and Clauses 52.251-2 Interagency Fleet Management System Vehicles and Related Services. As prescribed in 51.205, insert the following clause: Interagency Fleet Management System... to obtain interagency fleet management system vehicles and related services for use in the...

  18. 29 CFR 541.201 - Directly related to management or general business operations.

    Science.gov (United States)

    2010-07-01

    ... management or general business operations. (a) To qualify for the administrative exemption, an employee's... operations of the employer or the employer's customers. The phrase “directly related to the management or... 29 Labor 3 2010-07-01 2010-07-01 false Directly related to management or general business...

  19. High School Students' Time Management Skills in Relation to Research Anxiety

    Science.gov (United States)

    Akcoltekin, Alpturk

    2015-01-01

    This study aimed to determine the opinions of high school students relating to time management and present a correlation of their time management skills with demographic variables, as well as examining the relation between their level of research anxiety and time management skills. The study group composed 270 12th-grade students (127 males and…

  20. 78 FR 16715 - National Council on Federal Labor-Management Relations Meeting

    Science.gov (United States)

    2013-03-18

    ... functions listed in Section 1(b) of the Executive Order. The meetings are open to the public. Please contact... OFFICE OF PERSONNEL MANAGEMENT National Council on Federal Labor-Management Relations Meeting... Federal Labor-Management Relations plans to meet on the following date-- Wednesday, May 15, 2013. The...

  1. Community Relations: DOD’s Approach for Using Resources Reflects Sound Management Principles

    Science.gov (United States)

    2016-09-01

    COMMUNITY RELATIONS DOD’s Approach for Using Resources Reflects Sound Management Principles Report to...Sound Management Principles What GAO Found The Department of Defense’s (DOD) approach for determining which community relations activities to...undertake reflects sound management principles —both for activities requested by non-DOD entities and for activities initiated by the department. DOD and

  2. Simulation of groundwater flow to assess future withdrawals associated with Base Realignment and Closure (BRAC) at Fort George G. Meade, Maryland

    Science.gov (United States)

    Raffensperger, Jeff P.; Fleming, Brandon J.; Banks, William S.L.; Horn, Marilee A.; Nardi, Mark R.; Andreasen, David C.

    2010-01-01

    recharge represented in the earlier model. The calibrated model provides a tool for future forecasts of changes in the system under different management scenarios, and for simulating potential effects of withdrawals at Fort Meade and the surrounding area on water levels in the near-outcrop area and base flow in the outcrop area. Model error was assessed by comparing observed and simulated water levels from 62 wells (55 in the parent model and 7 in the child model). The root-mean-square error values for the parent and child model were 8.72 and 11.91 feet, respectively. Root-mean-square error values for the 55 parent model observation wells range from 0.95 to 30.31 feet; the range for the 7 child model observation wells is 5.00 to 24.17 feet. Many of the wells with higher root-mean-square error values occur at the perimeter of the child model and near large pumping centers, as well as updip in the confined aquifers. Root-mean-square error values decrease downdip and away from the large pumping centers. Both the parent and child models are sensitive to increasing withdrawal rates. The parent model is more sensitive than the child model to decreasing transmissivity of layers 3, 4, 5, and 6. The parent model is relatively insensitive to riverbed vertical conductance, however, the child model does exhibit some sensitivity to decreasing riverbed conductance. The overall water budget for the model included sources and sinks of water including recharge, surface-water bodies and rivers and streams, general-head boundaries, and withdrawals from permitted wells. Withdrawal from wells in 2005 was estimated to be equivalent to 8.5 percent of the total recharge rate.

  3. A Relative Comparison of Leading Supply Chain Management Software Packages

    OpenAIRE

    Zhongxian Wang; Ruiliang Yan; Kimberly Hollister; Ruben Xing

    2009-01-01

    Supply Chain Management (SCM) has proven to be an effective tool that aids companies in the development of competitive advantages. SCM Systems are relied on to manage warehouses, transportation, trade logistics and various other issues concerning the coordinated movement of products and services from suppliers to customers. Although in today’s fast paced business environment, numerous supply chain solution tools are readily available to companies, choosing the right SCM software is not an e...

  4. Oshkosh Logistic Management and Public Relations Responsibilities at NASA Langley

    Science.gov (United States)

    Beck, Danielle

    1995-01-01

    The central focus of my study for the summer of 1995 was to provide logistical support to Margaret Hunt, the logistics manager of the OSHKOSH airshow. In this capacity responsibilities included making arrangements for participants from NASA centers and SBIR companies for their stay in Wisconsin, while visiting the airshow, and managing staff for exhibits and the aerospace theater. A secondary purpose was to serve in other public service capacities by writing news releases, fact sheets, announcements, and articles for the Researcher News.

  5. Evaluation of time management behaviors and its related factors in the senior nurse managers, Kermanshah-Iran.

    Science.gov (United States)

    Ziapour, Arash; Khatony, Alireza; Jafari, Faranak; Kianipour, Neda

    2015-01-21

    Time management is an extensive concept that is associated with promoting the performance of managers. The present study was carried out to investigate the time management behaviors along with its related factors among senior nurse mangers. In this descriptive-analytical study, 180 senior nurse managers were selected using census method. The instrument for data collection was a standard time behavior questionnaire. Data were analyzed by descriptive and analytical statistics. The findings showed that among the dimensions of time management behaviors, setting objectives and prioritization, and mechanics of time management dimensions obtained the highest and lowest frequency, respectively. Comparison of the mean scores of time management behaviors indicated a significant difference in the gender (p<0.05), age (p<0.001), education (p=0.015), job experience (p<0.001), managerial experience (p<0.001) and management rank management (p<0.029). On the whole, senior nurse managers enjoyed a favorable time management skill. Given the importance of time management behaviors, it seems that teaching these behaviors more seriously through regular educational programs can effectively promote the performance of senior nurse managers.

  6. Teachers' Withdrawal Behaviors: Integrating Theory and Findings

    Science.gov (United States)

    Shapira-Lishchinsky, Orly

    2012-01-01

    Purpose: The article aims to investigate the relationships between different dimensions of organizational ethics and different withdrawal symptoms--lateness, absence, and intent to leave work. Design/methodology/approach: Participants were 1,016 school teachers from 35 high schools in Israel. A joint model of Glimmix procedure of SAS was used for…

  7. Withholding and withdrawing treatment: practical applications of ...

    African Journals Online (AJOL)

    Withholding and withdrawing treatment: practical applications of ethical principles in end-of-life care. L Gwyther. Abstract. No Abstract South African Journal of Bioethics and Law Vol. 1 (1) 2008: pp. 24-26. Full Text: EMAIL FREE FULL TEXT EMAIL FREE FULL TEXT · DOWNLOAD FULL TEXT DOWNLOAD FULL TEXT.

  8. 75 FR 22868 - Withdrawal of Regulatory Guide

    Science.gov (United States)

    2010-04-30

    ...'s public Web site under ``Regulatory Guides'' in the NRC's Electronic Reading Room at http://www.nrc.gov/reading-rm/doc-collections . Regulatory guides are also available for inspection at the NRC's... NUCLEAR REGULATORY COMMISSION [NRC-2010-0167] Withdrawal of Regulatory Guide AGENCY: Nuclear...

  9. MITS Feed and Withdrawal Subsystem: operating procedures

    International Nuclear Information System (INIS)

    Brown, W.S.

    1980-01-01

    This document details procedures for the operation of the MITS (Machine Interface Test System) Feed and Withdrawal Subsystem (F and W). Included are fill with UF 6 , establishment of recycle and thruput flows, shutdown, UF 6 makeup, dump to supply container, Cascade dump to F and W, and lights cold trap dump, all normal procedures, plus an alternate procedure for trapping light gases

  10. MITS Feed and Withdrawal Subsystem: operating procedures

    International Nuclear Information System (INIS)

    Brown, W.S.

    1980-01-01

    This procedure details the steps involved in filling two of the four MITS (Machine Interface Test System) Feed and Withdrawal subsystem main traps and the Sample/Inventory Make-up Pipette with uranium hexafluoride from the ''AS RECEIVED'' UF 6 supply

  11. Agency relations and managed performance in public universities in Uganda

    Directory of Open Access Journals (Sweden)

    James R.K. Kagaari

    2013-01-01

    Research purpose: The purpose of this article was to review the need for appropriate employer-employee relationships that will ensure quality services and service delivery in public universities in Uganda. Motivation for the study: The researchers set out to examine why managers of public universities in Uganda were continuously paying less attention to the needs of the employees. Research design, approach and method: A descriptive research design was employed and 12 respondents, purposively selected from 4 public universities, were interviewed. Data were recorded, transcribed and analysed using Nvivo software. This article is based on the perspective of agency theory, and discussed the contractual relationship between management and employees. The agency theory was deemed necessary because of its contribution to organisational literature. Main findings: There is a need to create and nurture a collegial working climate that promotes quality interactions through information sharing. This results in creating and retaining motivated and committed employees, and also helps to overcome the paradox of balancing the high demand for university education whilst offering quality services. Practical/managerial implications: Managers have to continuously monitor and accommodate employee needs and demands. Contribution/value-add: The potential value of the paper is its function as a guide for public universities to have visionary managers that will introduce new approaches to managing public universities in a competitive global environment.

  12. Agency relations and managed performance in public universities in Uganda

    Directory of Open Access Journals (Sweden)

    James R.K. Kagaari

    2013-01-01

    Full Text Available Orientation: This article focused on the need for improved employer-employee relationships in order for public universities in Uganda to achieve their intended objectives.Research purpose: The purpose of this article was to review the need for appropriate employer-employee relationships that will ensure quality services and service delivery in public universities in Uganda.Motivation for the study: The researchers set out to examine why managers of public universities in Uganda were continuously paying less attention to the needs of the employees.Research design, approach and method: A descriptive research design was employed and 12 respondents, purposively selected from 4 public universities, were interviewed. Data were recorded, transcribed and analysed using Nvivo software. This article is based on the perspective of agency theory, and discussed the contractual relationship between management and employees. The agency theory was deemed necessary because of its contribution to organisational literature.Main findings: There is a need to create and nurture a collegial working climate that promotes quality interactions through information sharing. This results in creating and retaining motivated and committed employees, and also helps to overcome the paradox of balancing the high demand for university education whilst offering quality services.Practical/managerial implications: Managers have to continuously monitor and accommodate employee needs and demands.Contribution/value-add: The potential value of the paper is its function as a guide for public universities to have visionary managers that will introduce new approaches to managing public universities in a competitive global environment.

  13. Factors relating to professional self-concept among nurse managers.

    Science.gov (United States)

    Kantek, Filiz; Şimşek, Belkıs

    2017-12-01

    To investigate the self-concept in nurse managers in Turkey and the effects of certain variables on professional self-concept. Professional self-concept plays a significant role in improving certain professional behaviours. Nursing managers have the potential to influence other members of the profession with their attitudes and behaviours. The study was designed as a cross-sectional descriptive study. This study was conducted with 159 nurse managers in nine different hospitals. The study data were collected with a Personal Information Form and Professional Self-concept Nursing Inventory, and the data analysis was accomplished with descriptive statistics, Cronbach's alpha coefficients and Chi-squared Automatic Interaction Detector analyses. The professional self-concept score of nurse managers was 3·33 (SD = 0·308). Professional competence subdimension had the highest scores, while professional satisfaction subdimension had the lowest. The types of hospital were found to be influential on professional self-concept. The types of hospital were reported to influence the professional self-concept of nurses. Nursing managers are visionaries who can potentially influence nursing practices and decisions. Nursing leaders must monitor and administer strategies to improve their professional self-concept. © 2017 John Wiley & Sons Ltd.

  14. Evaluation of Ashwagandha in alcohol withdrawal syndrome

    Directory of Open Access Journals (Sweden)

    Ruby B

    2012-10-01

    Full Text Available Objective: To evaluate the effect of Ashwagandha (ASW in attenuation of alcohol withdrawal in ethanol withdrawal mice model. Methods: Alcohol dependence was induced in mice by the oral, once-daily administration of 10% v/v ethanol (2 g/kg for one week. Once the animals were withdrawn from alcohol, the efficacy of ASW (200mg/kg and 500mg/kg in comparison with diazepam (1 mg/kg in the attenuation of withdrawal was studied using, pentylenetetrazole (PTZ kindling test for seizure threshold, forced swim test (FST for depression and locomotor activity (LCA in open field test (OFT. 6 hours after the last ethanol administration, seizure threshold was measured in all the groups by administering the convulsant drug, PTZ with a subconvulsive dose of 30 mg/kg i.p. In FST, mice were forced to swim and the total duration of immobility (seconds was measured during the last 4 min of a single 6-min test session. In OFT, number of crossings of the lines marked on the floor was recorded for a period of 5 min. Results: Compared to ethanol group, ASW (500 mg/Kg has suppressed the PTZ kindling seizures in ethanol withdrawal animals [0% convulsion], FST has shown decreased immobility time and OFT has exhibited increase in the number of line crossing activity by mice which may be the consequence of anxiolytic activity of ASW similar to that of diazepam. Conclusions: The present study provides satisfactory evidence to use ASW as a safe and reliable alternative to diazepam in alcohol withdrawal conditions.

  15. Brand Management in Business-to-Business Context : Relational Perspective

    OpenAIRE

    Siponen, Jere

    2012-01-01

    It is a common belief among managers that branding is only useful in Business-to-Consumer markets and not in Business-to-Business. These managers think that the Busi-ness-to-Business rational and unemotional buying decision-making process cannot be affected by brand because it is only concerned with features, price, quality and so on. This is incorrect information. The possibility to choose between competitors has grown during time and this has expanded the traditional view of branding. A tru...

  16. Management of complications relating to finger amputation and replantation.

    Science.gov (United States)

    Woo, Sang-Hyun; Kim, Young-Woo; Cheon, Ho-Jun; Nam, Hyun-Je; Kang, Dong-Ho; Kim, Jong-Min; Ahn, Hee-Chan

    2015-05-01

    There are many options in the management of fingertip or finger amputations. Injudicious revision amputation may cause complications. These complications can be prevented by tension-free closure of the amputation stump or primary coverage with appropriate flap. Replantation is the best way to keep the original length and maintain digital function. Patent vein repair or venous drainage with bleeding until neovascularization to the replanted part is the key to successful replantation. Prevention and management of complications in replantation and revision amputation increase patients' satisfaction and decrease costs. Research is needed to define new indications of replantation for digital amputation. Copyright © 2015 Elsevier Inc. All rights reserved.

  17. A psychometric validation of the Short Alcohol Withdrawal Scale (SAWS)

    DEFF Research Database (Denmark)

    Elholm, Bjarne; Larsen, Klaus; Hornnes, Nete

    2010-01-01

    The study aimed to evaluate psychometrically a Danish translation of the Short Alcohol Withdrawal Scale (SAWS) in an outpatient setting in patients with Alcohol Dependence (AD) and Alcohol Withdrawal Symptoms/Syndrome (AWS).......The study aimed to evaluate psychometrically a Danish translation of the Short Alcohol Withdrawal Scale (SAWS) in an outpatient setting in patients with Alcohol Dependence (AD) and Alcohol Withdrawal Symptoms/Syndrome (AWS)....

  18. An overview of research on social withdrawal in childhood

    OpenAIRE

    野村, あすか; NOMURA, Asuka

    2013-01-01

    In recent years, “HIKIKOMORI” in adolescence or adulthood has grown into a serious problem in Japan and the need for early intervention and support has been emphasized. Among the risk factors of “HIKIKOMORI” is social withdrawal in childhood. With this in mind, I reviewed previous studies on the social withdrawal in children living abroad. The review commences with an examination of definitions of social withdrawal, which showed that in some foreign countries, social withdrawal refers to the ...

  19. Portfolio Management Decision Support Tools Analysis Relating to Management Value Metrics

    National Research Council Canada - National Science Library

    Goodson, Christopher J; Knutson, Richard D

    2007-01-01

    .... The results of this research will assist MDA managers, and operational leaders, in making portfolio management decisions for allocating resources to create the correct support tools for MDA processes...

  20. Why do care workers withdraw from elderly care?

    DEFF Research Database (Denmark)

    Liveng, Anne

    2012-01-01

    . The article illustrates how working consciously with the researcher's subjectivity makes it possible to understand apparently irrational patterns. The insights thus gained may be used to prevent withdrawals in care work as an argument for care workers' need for emotional supervision....... relations, independently of whether we are in the role of care providers or care receivers. Through collusion theory, the interpretation accepts both the anxiety which the helpless elderly people arouse in the care workers and their motivation for care work as two sides of a subjectively important theme...

  1. A Water-Withdrawal Input-Output Model of the Indian Economy.

    Science.gov (United States)

    Bogra, Shelly; Bakshi, Bhavik R; Mathur, Ritu

    2016-02-02

    Managing freshwater allocation for a highly populated and growing economy like India can benefit from knowledge about the effect of economic activities. This study transforms the 2003-2004 economic input-output (IO) table of India into a water withdrawal input-output model to quantify direct and indirect flows. This unique model is based on a comprehensive database compiled from diverse public sources, and estimates direct and indirect water withdrawal of all economic sectors. It distinguishes between green (rainfall), blue (surface and ground), and scarce groundwater. Results indicate that the total direct water withdrawal is nearly 3052 billion cubic meter (BCM) and 96% of this is used in agriculture sectors with the contribution of direct green water being about 1145 BCM, excluding forestry. Apart from 727 BCM direct blue water withdrawal for agricultural, other significant users include "Electricity" with 64 BCM, "Water supply" with 44 BCM and other industrial sectors with nearly 14 BCM. "Construction", "miscellaneous food products"; "Hotels and restaurants"; "Paper, paper products, and newsprint" are other significant indirect withdrawers. The net virtual water import is found to be insignificant compared to direct water used in agriculture nationally, while scarce ground water associated with crops is largely contributed by northern states.

  2. Consequences of dextropropoxyphene market withdrawal in elderly patients with chronic pain.

    Science.gov (United States)

    Becquemont, Laurent; Delespierre, Tiba; Bauduceau, Bernard; Benattar-Zibi, Linda; Berrut, Gilles; Corruble, Emmanuelle; Danchin, Nicolas; Derumeaux, Geneviève; Doucet, Jean; Falissard, Bruno; Forette, Francoise; Hanon, Olivier; Pasquier, Florence; Pinget, Michel; Ourabah, Rissane; Bucher, Sophie; Lazkani, Aida; Piedvache, Celine; Bertin, Philippe

    2014-10-01

    Describe the consequences of dextropropoxyphene (DXP) market withdrawal on analgesic prescriptions and on the quality of therapeutic management of chronic pain. From a cohort of non-institutionalised elderly patients with chronic pain recruited by general practitioners, we selected patients who were treated with DXP daily for at least 6 months just prior to DXP market withdrawal and who had an evaluation of pain and its impact on daily activities before and after DXP withdrawal. One hundred three patients took DXP daily for chronic pain. Immediately after DXP market withdrawal, 42 (40.8%), 55 (53.4%) and 3 (2.9%) patients were treated with step 1, 2 and 3 analgesics, respectively, and 3 patients (2.9%) were no longer receiving any analgesic medication. Among the 55 patients who continued on step 2 analgesics, 37 were treated with tramadol, 14 with codeine and 9 with opium. Pain intensity and the impact of pain on daily activities remained stable. DXP market withdrawal had no consequences on the intensity or impact of chronic pain in elderly patients.

  3. Phenobarbital for acute alcohol withdrawal: a prospective randomized double-blind placebo-controlled study.

    Science.gov (United States)

    Rosenson, Jonathan; Clements, Carter; Simon, Barry; Vieaux, Jules; Graffman, Sarah; Vahidnia, Farnaz; Cisse, Bitou; Lam, Joseph; Alter, Harrison

    2013-03-01

    Acute alcohol withdrawal syndrome (AAWS) is encountered in patients presenting acutely to the Emergency Department (ED) and often requires pharmacologic management. We investigated whether a single dose of intravenous (i.v.) phenobarbital combined with a standardized lorazepam-based alcohol withdrawal protocol decreases intensive care unit (ICU) admission in ED patients with acute alcohol withdrawal. This was a prospective, randomized, double-blind, placebo-controlled study. Patients were randomized to receive either a single dose of i.v. phenobarbital (10 mg/kg in 100 mL normal saline) or placebo (100 mL normal saline). All patients were placed on the institutional symptom-guided lorazepam-based alcohol withdrawal protocol. The primary outcome was initial level of hospital admission (ICU vs. telemetry vs. floor ward). There were 198 patients enrolled in the study, and 102 met inclusion criteria for analysis. Fifty-one patients received phenobarbital and 51 received placebo. Baseline characteristics and severity were similar in both groups. Patients that received phenobarbital had fewer ICU admissions (8% vs. 25%, 95% confidence interval 4-32). There were no differences in adverse events. A single dose of i.v. phenobarbital combined with a symptom-guided lorazepam-based alcohol withdrawal protocol resulted in decreased ICU admission and did not cause increased adverse outcomes. Copyright © 2013 Elsevier Inc. All rights reserved.

  4. Sleep-disordered breathing decreases after opioid withdrawal: results of a prospective controlled trial.

    Science.gov (United States)

    Schwarzer, Andreas; Aichinger-Hinterhofer, Marie; Maier, Christoph; Vollert, Jan; Walther, Jörg Werner

    2015-11-01

    An increased cardiovascular event rate in elderly patients under opioid medications was recently reported. One reason for this increase could be the occurrence of nocturnal apnea and hypoxia, as a consequence of sleep-disordered breathing (SDB). Using a controlled study, we prospectively analyzed SDB using polysomnography in a total of 18 patients before and after opioid withdrawal (opioid withdrawal group [OG]) and 14 patients before and after comprehensive pain management (without any strong-acting opioids) who served as the control group (CG). To analyze the differences, unpaired/paired t tests and Mann-Whitney U tests/Wilcoxon rank tests were used. At baseline, the OG presented more nocturnal apneas/hypopneas than the CG with an apnea-hypopnea index (AHI) of 41.4 ± 27.8 vs 21.8 ± 15.9 (P = 0.018). After treatment, the AHI decreased significantly only in the withdrawal group (OG: 16.7 ± 8.9; CG: 20.1 ± 12.9) (P opioid withdrawal and in none of the patients after withdrawal (P opioid intake; these findings may explain the opioid-associated cardiovascular morbidity. Thus, SDB may be a risk at lower opioid doses than hitherto described, and particular caution should be exercised in patients with comorbidities that might make them vulnerable to the consequences of SDB.

  5. Withdrawal from long-term hemodialysis in patients with end-stage renal disease in Taiwan.

    Science.gov (United States)

    Lai, Chun-Fu; Tsai, Hung-Bin; Hsu, Su-Hsuan; Chiang, Chih-Kang; Huang, Jenq-Wen; Huang, Sheng-Jean

    2013-10-01

    Withdrawal from dialysis is ethically appropriate for some patients with multiple comorbidities and a shortened life expectancy. Taiwan has the highest prevalence of dialysis patients in the world, and the National Health Insurance (NHI) program offers renal replacement therapy free of charge. In this review, we discuss its current status and many background issues related to withdrawing dialysis from patients with advanced renal failure in Taiwan. Compared with dialysis therapy, the medical resources for hospice care are relatively sparse. Since the announcement of the Statute for Palliative Care in 2000, there has been a gradual improvement in the laws and health polices supporting dialysis withdrawal. Culture and social customs also have a significant impact on the practice of hospice care. Based on current evidence and in accordance with the local environment, we propose recommendations for the clinical practice of dialysis withdrawal and hospice care. There remains a need to expand upon the community-based hospice care and home care systems to better serve patients. In conclusion, there are cross-cultural differences relating to dialysis withdrawal between Taiwan and Western countries. Our experience and clinical recommendations may be helpful for the countries with NHI systems or for the Eastern countries. Copyright © 2013. Published by Elsevier B.V.

  6. The Role of Public Relations as A Management Function in Higher Education

    OpenAIRE

    Anggreni Putri

    2018-01-01

    Nowadays, public relations in higher education institution become an integral part of the management team. It must contribute to achieve organizational goals and demonstrate an organizational accountability identified by measurable result. Placement public relations at certain positions in management has consequences in the process of implementation of the public relations function. It happened because the management, workflow and hierarchy greatly affects work patterns as well as patterns of...

  7. The Law of Federal Labor-Management Relations

    Science.gov (United States)

    1993-11-01

    is not only proper, but may be construed as an obligation of agency management. Agencies should be concerned with the maximum exercise of the franchise ...543 (1964). Operating Engineers, Local 150 v. Flair Builders, Inc., 406 U.S. 487 (1972). Nolde Brothers, Inc. v. Bakery Workers, Local 358, 430 U.S

  8. Trust and cooperation relations in environmental management of Lebanon

    NARCIS (Netherlands)

    Abbas, Nivine; van der Molen, I.; Nader, M.R.; Lovett, Jonathan Cranidge

    2014-01-01

    This paper investigates trust and cooperation in the context of environmental management in Lebanon. Literature already indicated increasing environmental problems in this area that suffered from repeated episodes of armed conflict. The Lebanese government has been faced by many difficulties to

  9. Detection and Management of Adverse Drug Reactions Related to ...

    African Journals Online (AJOL)

    The objective of this study was to establish the detection, prevalence and management of various adverse drug reactions associated with antiretroviral drugs occurring in patients attending Comprehensive Care Centre (CCC) of Kiambu District Hospital. The study was a cross sectional survey where the patients included ...

  10. Relative Importance of Professional Practice and Engineering Management Competencies

    Science.gov (United States)

    Pons, Dirk

    2016-01-01

    Problem: The professional practice of engineering always involves engineering management, but it is difficult to know what specifically to include in the undergraduate curriculum. Approach: The population of New Zealand practising engineers was surveyed to determine the importance they placed on specific professional practice and engineering…

  11. Pint-Sized Public Relations: The Development of Reputation Management.

    Science.gov (United States)

    Silver, Ike M; Shaw, Alex

    2018-04-01

    Until recently, many psychologists were skeptical that young children cared about reputation. New evidence suggests that by age five, children begin to understand the broad importance of reputation and to engage in surprisingly sophisticated impression management. These findings prompt exciting new questions about the development of a fundamental social competency. Copyright © 2018 Elsevier Ltd. All rights reserved.

  12. Research in the Management of Learning, Change and Relations

    NARCIS (Netherlands)

    B. Nooteboom (Bart)

    2001-01-01

    textabstractThis note sketches opportunities for interdisciplinary research in management, and the distinctive contribution that might be made from a European perspective. It highlights a few major domains of research, conceptual issues, disciplines, and specific opportunities and needs in Europe.

  13. Leadership Behaviors and Its Relation with Principals' Management Experience

    Science.gov (United States)

    Mehdinezhad, Vali; Sardarzahi, Zaid

    2016-01-01

    This paper aims at studying the leadership behaviors reported by principals and observed by teachers and its relationship with management experience of principals. A quantitative method was used in this study. The target population included all principals and teachers of guidance schools and high schools in the Dashtiari District, Iran. A sample…

  14. 19 CFR 144.36 - Withdrawal for transportation.

    Science.gov (United States)

    2010-04-01

    ... 19 Customs Duties 2 2010-04-01 2010-04-01 false Withdrawal for transportation. 144.36 Section 144... § 144.36 Withdrawal for transportation. (a) Time limit. Merchandise may be withdrawn from warehouse for transportation to another port of entry if withdrawal for consumption or exportation can be accomplished at the...

  15. 19 CFR 144.37 - Withdrawal for exportation.

    Science.gov (United States)

    2010-04-01

    ...) Class 9 warehouse withdrawals for exportation—(1) Applicability of sales ticket procedure. Merchandise... be eligible for withdrawal under the sales ticket procedure specified in this paragraph. (2) Sales ticket content and handling. Sales ticket withdrawals must be made only under a blanket permit to...

  16. 47 CFR 1.8 - Withdrawal of papers.

    Science.gov (United States)

    2010-10-01

    ... 47 Telecommunication 1 2010-10-01 2010-10-01 false Withdrawal of papers. 1.8 Section 1.8 Telecommunication FEDERAL COMMUNICATIONS COMMISSION GENERAL PRACTICE AND PROCEDURE General Rules of Practice and Procedure General § 1.8 Withdrawal of papers. The granting of a request to dismiss or withdraw an...

  17. 45 CFR 400.301 - Withdrawal from the refugee program.

    Science.gov (United States)

    2010-10-01

    ... 45 Public Welfare 2 2010-10-01 2010-10-01 false Withdrawal from the refugee program. 400.301... Waivers and Withdrawals § 400.301 Withdrawal from the refugee program. (a) In the event that a State... assistance, social services, preventive health, and an unaccompanied minors program if appropriate. A State...

  18. 20 CFR 404.640 - Withdrawal of an application.

    Science.gov (United States)

    2010-04-01

    ... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false Withdrawal of an application. 404.640 Section 404.640 Employees' Benefits SOCIAL SECURITY ADMINISTRATION FEDERAL OLD-AGE, SURVIVORS AND DISABILITY INSURANCE (1950- ) Filing of Applications and Other Forms Withdrawal of Application § 404.640 Withdrawal of...

  19. 20 CFR 416.355 - Withdrawal of an application.

    Science.gov (United States)

    2010-04-01

    ... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false Withdrawal of an application. 416.355 Section 416.355 Employees' Benefits SOCIAL SECURITY ADMINISTRATION SUPPLEMENTAL SECURITY INCOME FOR THE AGED, BLIND, AND DISABLED Filing of Applications Withdrawal of Application § 416.355 Withdrawal of an...

  20. 29 CFR 102.104 - Withdrawal of petition.

    Science.gov (United States)

    2010-07-01

    ... 29 Labor 2 2010-07-01 2010-07-01 false Withdrawal of petition. 102.104 Section 102.104 Labor... Orders and Advisory Opinions Regarding Board Jurisdiction § 102.104 Withdrawal of petition. The petitioner may withdraw his petition at any time prior to issuance of the Board's advisory opinion. ...

  1. 21 CFR 171.7 - Withdrawal of petition without prejudice.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 3 2010-04-01 2009-04-01 true Withdrawal of petition without prejudice. 171.7... Withdrawal of petition without prejudice. (a) In some cases the Commissioner will notify the petitioner that... clarification or the obtaining of additional data. This withdrawal will be without prejudice to a future filing...

  2. 21 CFR 571.7 - Withdrawal of petition without prejudice.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 6 2010-04-01 2010-04-01 false Withdrawal of petition without prejudice. 571.7... Withdrawal of petition without prejudice. (a) In some cases the Commissioner will notify the petitioner that... clarification or the obtaining of additional data. This withdrawal will be without prejudice to a future filing...

  3. [The Utilization of Health-Related Applications in Chronic Disease Self-Management].

    Science.gov (United States)

    Kao, Chi-Wen; Chuang, Hui-Wan; Chen, Ting-Yu

    2017-08-01

    The dramatic increase in smartphone usage has spurred the development of many health-related mobile applications (apps). On the other hand, population aging and the associated rise in the incidence of chronic disease is increasing the demand for long-term care. Effective chronic disease self-management has been shown to help patients improve their health condition. Numerous smartphone applications currently support patient self-management of chronic disease, facilitating health management and health promotion. The purpose of the present article was to introduce the definition, contents, and types of health-related apps; to discuss the effectiveness of self-management health-related apps in promoting chronic disease management; and to assess and evaluate these apps. We hope that the present article helps give to healthcare professionals and patients who are willing to manage their diseases a general understanding of health-related apps and their potential to facilitate the self-management of chronic diseases.

  4. The influence of propoxyphene withdrawal on opioid use in veterans.

    Science.gov (United States)

    Hayes, Corey J; Hudson, Teresa J; Phillips, Martha M; Bursac, Zoran; Williams, James S; Austin, Mark A; Edlund, Mark J; Martin, Bradley C

    2015-11-01

    Our aim is to determine if propoxyphene withdrawal from the US market was associated with opioid continuation, continued chronic opioid use, and secondary propoxyphene-related adverse events (emergency department visits, opioid-related events, and acetaminophen toxicity). Medical service use and pharmacy data from 19/11/08 to 19/11/11 were collected from the national Veterans Healthcare Administration healthcare databases. A quasi-experimental pre-post retrospective cohort design utilizing a historical comparison group provided the study framework. Logistic regression controlling for baseline covariates was used to estimate the effect of propoxyphene withdrawal. There were 24,328 subjects (policy affected n = 10,747; comparison n = 13,581) meeting inclusion criteria. In the policy-affected cohort, 10.6% of users ceased using opioids, and 26.6% stopped chronic opioid use compared with 3.8% and 13.5% in the historical comparison cohort, respectively. Those in the policy-affected cohort were 2.7 (95%CI: 2.5-2.8) and 3.2 (95%CI: 2.9-3.6) times more likely than those in the historical comparison cohort to discontinue chronic opioid and any opioid use, respectively. Changes in adverse events and Emergency Department (ED) visits were not different between policy-affected and historical comparison cohorts (p > 0.05). The withdrawal of propoxyphene-containing products resulted in rapid and virtually complete elimination in propoxyphene prescribing in the veterans population; however, nearly 90% of regular users of propoxyphene switched to an alternate opioid, and three quarters continued to use opioids chronically. Copyright © 2015 John Wiley & Sons, Ltd.

  5. Simulation of groundwater flow and hydrologic effects of groundwater withdrawals from the Kirkwood-Cohansey aquifer system in the Pinelands of southern New Jersey

    Science.gov (United States)

    Charles, Emmanuel; Nicholson, Robert S.

    2012-01-01

    The Kirkwood-Cohansey aquifer system is an important source of present and future water supply in southern New Jersey. Because this unconfined aquifer system also supports sensitive wetland and aquatic habitats within the New Jersey Pinelands (Pinelands), water managers and policy makers need up-to-date information, data, and projections that show the effects of potential increases in groundwater withdrawals on these habitats. Finite-difference groundwater flow models (MODFLOW) were constructed for three drainage basins (McDonalds Branch Basin, 14.3 square kilometers (km2); Morses Mill Stream Basin, 21.63 km2; and Albertson Brook Basin, 52.27 km2) to estimate the effects of potential increases in groundwater withdrawals on water levels and the base-flow portion of streamflow, in wetland and aquatic habitats. Three models were constructed for each drainage basin: a transient model consisting of twenty-four 1-month stress periods (October 2004 through September 2006); a transient model to simulate the 5- to 10-day aquifer tests that were performed as part of the study; and a high-resolution, steady-state model used to assess long-term effects of increased groundwater withdrawals on water levels in wetlands and on base flow. All models were constructed with the same eight-layer structure. The smallest horizontal cell dimensions among the three model areas were 150 meters (m) for the 24-month transient models, 10 m for the steady-state models, and 3 m for the transient aquifer-test models. Boundary flows of particular interest to this study and represented separately are those for wetlands, streams, and evapotranspiration. The final variables calibrated from both transient models were then used in steady-state models to assess the long-term effects of increased groundwater withdrawals on water levels in wetlands and on base flow. Results of aquifer tests conducted in the three study areas illustrate the effects of withdrawals on water levels in wetlands and on base

  6. Factors Relating to Managerial Stereotypes: The Role of Gender of the Employee and the Manager and Management Gender Ratio.

    Science.gov (United States)

    Stoker, Janka I; Van der Velde, Mandy; Lammers, Joris

    2012-03-01

    PURPOSE: Several studies have shown that the traditional stereotype of a "good" manager being masculine and male still exists. The recent changes in the proportion of women and female managers in organizations could affect these two managerial stereotypes, leading to a stronger preference for feminine characteristics and female leaders. This study examines if the gender of an employee, the gender of the manager, and the management gender ratio in an organization are related to employees' managerial stereotypes. DESIGN/METHODOLOGY/APPROACH: 3229 respondents working in various organizations completed an electronic questionnaire. FINDINGS: The results confirm our hypotheses that, although the general stereotype of a manager is masculine and although most prefer a man as a manager, female employees, employees with a female manager, and employees working in an organization with a high percentage of female managers, have a stronger preference for feminine characteristics of managers and for female managers. Moreover, we find that proximal variables are much stronger predictors of these preferences than more distal variables. IMPLICATIONS: Our study suggests that managerial stereotypes could change as a result of personal experiences and changes in the organizational context. The results imply that increasing the proportion of female managers is an effective way to overcome managerial stereotyping. ORIGINALITY/VALUE: This study examines the influence on managerial stereotypes of various proximal and distal factors derived from theory among a large group of employees (in contrast to students).

  7. Update on Management of Cancer-Related Cachexia.

    Science.gov (United States)

    Anderson, Lindsey J; Albrecht, Eliette D; Garcia, Jose M

    2017-01-01

    Cachexia is a metabolic syndrome driven by inflammation and characterized by loss of muscle with or without loss of fat mass. In cancer cachexia, the tumor burden and host response induce increased inflammation, decreased anabolic tone, and suppressed appetite leading to the clinical presentation of reduced body weight and quality of life (QOL). There is no approved treatment for cancer cachexia, and commonly used nutritional and anti-inflammatory strategies alone have proven ineffective for management of symptoms. Several other pharmacological agents are currently in development and have shown promise as a clinical strategy in early-phase trials. Recently, it has been proposed that multimodal strategies, with an anabolic focus, initiated early in the disease/treatment progression may provide the most therapeutic potential for symptom management. Here we review the data from recent clinical trials in cancer cachexia including pharmacological, exercise, and nutritional interventions.

  8. Balance assessment in the management of sport-related concussion.

    Science.gov (United States)

    Guskiewicz, Kevin M

    2011-01-01

    Although neuropsychological testing has proven to be a valuable tool in concussion management, it is most useful when administered as part of a comprehensive assessment battery that includes grading of symptoms and clinical balance tests. A thorough sideline and clinical examination by the certified athletic trainer and team physician is considered an important first step in the management of concussion. The evaluation should be conducted in a systematic manner, whether on the field or in the clinical setting. The evaluation should include obtaining a history for specific details about the injury (eg, mechanism, symptomatology, concussion history), followed by assessing neurocognitive function and balance, which is the focus of this article. The objective measures from balance testing can provide clinicians with an additional piece of the concussion puzzle, remove some of the guesswork in uncovering less obvious symptoms, and assist in determining readiness to return safely to participation. Copyright © 2011 Elsevier Inc. All rights reserved.

  9. Management of age-related degradation for nuclear power plants

    International Nuclear Information System (INIS)

    Gregor, Frank E.

    2004-01-01

    Life extension for nuclear power plants has been studied in the USA for the last six years, largely supported by EPRI, DOE and the USNRC. Though there are diverse opinions for the strategies and priorities of life extension and aging management, one common conclusion has been formulated regarding the need of current maintenance programs having to focus on aging and degradation management. Such program, called 'Maintenance Effectiveness Evaluation and Enhancement' or M3E for short, has been developed to assist plant operators to upgrade and enhance existing programs by integrating aging/degradation management activities for important or critical equipment and components. The key elements of the M3E program consist of the definition and selection of the critical components or commodities to be included in the scope, the survey/inventory of the current programs and their respective action steps, frequencies, corrective measures and extent of coverage, the component/commodity degradation mechanism, sites and severity, safety functions and service environments and lastly, the correlation of degradation/aging with the individual maintenance activities. The degree of correlation provides a measure of effectiveness and the opportunity to identify/specify needed enhancements, abandonment or generation of new maintenance activities. Implementation of the activities can then be prioritized at the option of the plant staff. (author)

  10. Relative importance of professional practice and engineering management competencies

    Science.gov (United States)

    Pons, Dirk

    2016-09-01

    Problem: The professional practice of engineering always involves engineering management, but it is difficult to know what specifically to include in the undergraduate curriculum. Approach: The population of New Zealand practising engineers was surveyed to determine the importance they placed on specific professional practice and engineering management competencies. Findings: Results show that communication and project planning were the two most important topics, followed by others as identified. The context in which practitioners use communication skills was found to be primarily with project management, with secondary contexts identified. The necessity for engineers to develop the ability to use multiple soft skills in an integrative manner is strongly supported by the data. Originality: This paper is one of only a few large-scale surveys of practising engineers to have explored the soft skill attributes. It makes a didactic contribution of providing a ranked list of topics which can be used for designing the curriculum and prioritising teaching effort, which has not previously been achieved. It yields the new insight that combinations of topics are sometimes more important than individual topics.

  11. 48 CFR 51.204 - Use of interagency fleet management system (IFMS) vehicles and related services.

    Science.gov (United States)

    2010-10-01

    ... Contractor Use of Interagency Fleet Management System (IFMS) 51.204 Use of interagency fleet management system (IFMS) vehicles and related services. Contractors authorized to use interagency fleet management... 48 Federal Acquisition Regulations System 1 2010-10-01 2010-10-01 false Use of interagency fleet...

  12. Withdrawal of repeated morphine enhances histamine-induced scratching responses in mice.

    Science.gov (United States)

    Abe, Kenji; Kobayashi, Kanayo; Yoshino, Saori; Taguchi, Kyoji; Nojima, Hiroshi

    2015-04-01

    An itch is experientially well known that the scratching response of conditions such as atopic dermatitis is enhanced under psychological stress. Morphine is typical narcotic drug that induces a scratching response upon local application as an adverse drug reaction. Although long-term treatment with morphine will cause tolerance and dependence, morphine withdrawal can cause psychologically and physiologically stressful changes in humans. In this study, we evaluated the effects of morphine withdrawal on histamine-induced scratching behavior in mice. Administration of morphine with progressively increasing doses (10-50 mg/kg, i.p.) was performed for 5 consecutive days. At 3, 24, 48, and 72 hr after spontaneous withdrawal from the final morphine dose, histamine was intradermally injected into the rostral part of the back and then the number of bouts of scratching in 60 min was recorded and summed. We found that at 24 hr after morphine withdrawal there was a significant increase in histamine-induced scratching behavior. The spinal c-Fos positive cells were also significantly increased. The relative adrenal weight increased and the relative thymus weight decreased, both significantly. Moreover, the plasma corticosterone levels changed in parallel with the number of scratching bouts. These results suggest that morphine withdrawal induces a stressed state and enhances in histamine-induced scratching behavior. Increased reaction against histamine in the cervical vertebrae will participate in this stress-induced itch enhancement.

  13. SI-SHY: Dysregulated Fear in Toddlerhood Predicts Kindergarten Social Withdrawal through Protective Parenting.

    Science.gov (United States)

    Kiel, Elizabeth J; Buss, Kristin A

    2014-05-01

    Two recent advances in the study of fearful temperament (behavioral inhibition) include the validation of dysregulated fear as a temperamental construct that more specifically predicts later social withdrawal and anxiety, and the use of conceptual and statistical models that place parenting as a mechanism of development from temperament to these outcomes. The current study further advances these areas by examining whether protective parenting mediated the relation between dysregulated fear in toddlerhood and social withdrawal in kindergarten. Participants included 93 toddlers and their mothers, who engaged in laboratory tasks assessing traditional fearful temperament, dysregulated fear, and protective parenting. When children reached kindergarten, they returned to the laboratory for a multimethod assessment of social withdrawal. Results confirmed the hypothesis that dysregulated fear predicted social withdrawal through protective parenting, and this occurred above and beyond the effect of traditional fearful temperament. These findings bolster support for the use of dysregulated fear as a temperamental construct related to, but perhaps more discerning of risk than traditionally measured fearful temperament/behavioral inhibition and highlight the importance of transactional influences between the individual and the caregiving environment in the development of social withdrawal.

  14. SI-SHY: Dysregulated Fear in Toddlerhood Predicts Kindergarten Social Withdrawal through Protective Parenting

    Science.gov (United States)

    Kiel, Elizabeth J.; Buss, Kristin A.

    2014-01-01

    Two recent advances in the study of fearful temperament (behavioral inhibition) include the validation of dysregulated fear as a temperamental construct that more specifically predicts later social withdrawal and anxiety, and the use of conceptual and statistical models that place parenting as a mechanism of development from temperament to these outcomes. The current study further advances these areas by examining whether protective parenting mediated the relation between dysregulated fear in toddlerhood and social withdrawal in kindergarten. Participants included 93 toddlers and their mothers, who engaged in laboratory tasks assessing traditional fearful temperament, dysregulated fear, and protective parenting. When children reached kindergarten, they returned to the laboratory for a multimethod assessment of social withdrawal. Results confirmed the hypothesis that dysregulated fear predicted social withdrawal through protective parenting, and this occurred above and beyond the effect of traditional fearful temperament. These findings bolster support for the use of dysregulated fear as a temperamental construct related to, but perhaps more discerning of risk than traditionally measured fearful temperament/behavioral inhibition and highlight the importance of transactional influences between the individual and the caregiving environment in the development of social withdrawal. PMID:25242893

  15. “Real-life” inhaled corticosteroid withdrawal in COPD: a subgroup analysis of DACCORD

    Directory of Open Access Journals (Sweden)

    Vogelmeier C

    2017-02-01

    that ICS withdrawal is possible with no increased risk of exacerbations in patients with COPD managed in the primary and secondary care. Keywords: COPD exacerbations, chronic obstructive pulmonary disease exacerbations, health-related quality of life, inhaled steroids

  16. Gender Moderates the Progression from Fearful Temperament to Social Withdrawal through Protective Parenting.

    Science.gov (United States)

    Kiel, Elizabeth J; Premo, Julie E; Buss, Kristin A

    2016-05-01

    Child gender may exert its influence on development, not as a main effect, but as a moderator among predictors and outcomes. We examined this notion in relations among toddler fearful temperament, maternal protective parenting, maternal accuracy in predicting toddler distress to novelty, and child social withdrawal. In two multi-method, longitudinal studies of toddlers (24 months at Time 1; n s = 93 and 117, respectively) and their mothers, few main effect gender differences occurred. Moderation existed in both studies: only for highly accurate mothers of boys, fearful temperament related to protective parenting, which then predicted later social withdrawal. Thus, studying only main-effect gender differences may obscure important differences in how boys and girls develop from fearful temperament to later social withdrawal.

  17. Gender Moderates the Progression from Fearful Temperament to Social Withdrawal through Protective Parenting

    Science.gov (United States)

    Kiel, Elizabeth J.; Premo, Julie E.; Buss, Kristin A.

    2015-01-01

    Child gender may exert its influence on development, not as a main effect, but as a moderator among predictors and outcomes. We examined this notion in relations among toddler fearful temperament, maternal protective parenting, maternal accuracy in predicting toddler distress to novelty, and child social withdrawal. In two multi-method, longitudinal studies of toddlers (24 months at Time 1; ns = 93 and 117, respectively) and their mothers, few main effect gender differences occurred. Moderation existed in both studies: only for highly accurate mothers of boys, fearful temperament related to protective parenting, which then predicted later social withdrawal. Thus, studying only main-effect gender differences may obscure important differences in how boys and girls develop from fearful temperament to later social withdrawal. PMID:27231411

  18. Radionuclide withdrawal from animal and human body

    International Nuclear Information System (INIS)

    Arkhipov, A.S.; Sidorova, T.F.

    1995-01-01

    The authors review the history of the problem of radionuclide withdrawal from animal and human body and discuss methodological approaches to it. Results of studies of radionuclide elimination by means of chemical and bioactive substances are analyzed. Special attention is paid to decorporation of radioactive elements which are the most hazardous as regards intoxication in connection with the Chernobyl accident: 131 I, 89 St and 90 Sr, 137 Cs, 238 Pu, and 241 Am. The authors analyze the results of studies of radionuclide withdrawal based on the dissolution effect, ionic antagonism, and by means of complexons, carried out in humans and animals. Efficacies of alimentary fibers and other adsorbents, foodstuffs and drinks are demonstrated. 48 refs

  19. Adolescents' and mothers' conflict management constellations: Links with individual and relational functioning

    NARCIS (Netherlands)

    Missotten, L.; Luyckx, Koen; Vanhalst, J.; Nelemans, S.A.; Branje, S.J.T.

    2017-01-01

    In the present multi-informant study, we examined dyadic combinations of adolescent and maternal conflict management styles through stepwise latent class analysis. We investigated how these dyadic conflict classes related to adolescents' and mothers' perceptions of individual and relational

  20. Socioeconomic factors relating to diabetes and its management in India.

    Science.gov (United States)

    Shrivastava, Usha; Misra, Anoop; Gupta, Rajeev; Viswanathan, Vijay

    2016-01-01

    Diabetes is an escalating problem in India and has major socioeconomic dimensions. Rapid dietary changes coupled with decreased levels of physical activity have resulted in increases in obesity and diabetes in rural and semi-urban areas, as well as in urban-based people living in resettlement colonies. Increasing risk has also been recorded in those who suffered from poor childhood nutrition and in rural-to-urban migrants. Social inequity manifests in disparities in socioeconomic status (SES), place of residence, education, gender, and level of awareness and affects prevention, care, and management. All these population subsets have major socioeconomic challenges: low levels of awareness regarding diabetes and prevention, inadequate resources, insufficient allotment of healthcare budgets, and lack of medical reimbursement. Unawareness and delays in seeking medical help lead to complications, resulting in many-fold increased costs in diabetes care. These costs plunge individuals and households into a vicious cycle of further economic hardship, inadequate management, and premature mortality, resulting in more economic losses. At the societal level, these are massive losses to national productivity and the exchequer. Overall, there is an immediate need to strengthen the healthcare delivery system to generate awareness and for the prevention, early detection, cost-effective management, and rehabilitation of patients with diabetes, with a focus on people belonging to the lower SES and women (with a particular focus on nutrition before and during pregnancy). Because of an enhanced awareness campaign spearheaded through the National Program on Prevention of Cardiovascular Disease, Cancer, Diabetes and Stroke (NCPCDS) initiated by Government of India, it is likely that the level of awareness and early detection of diabetes may increase. © 2015 Ruijin Hospital, Shanghai Jiaotong University School of Medicine and Wiley Publishing Asia Pty Ltd.

  1. Nuclear Security Management for Research Reactors and Related Facilities

    International Nuclear Information System (INIS)

    2016-03-01

    This publication provides a single source guidance to assist those responsible for the implementation of nuclear security measures at research reactors and associated facilities in developing and maintaining an effective and comprehensive programme covering all aspects of nuclear security on the site. It is based on national experience and practices as well as on publications in the field of nuclear management and security. The scope includes security operations, security processes, and security forces and their relationship with the State’s nuclear security regime. The guidance is provided for consideration by States, competent authorities and operators

  2. Object-Relational Management of Multiply Represented Geographic Entities

    DEFF Research Database (Denmark)

    Friis-Christensen, Anders; Jensen, Christian Søndergaard

    2003-01-01

    Multiple representation occurs when information about the same geographic entity is represented electronically more than once. This occurs frequently in practice, and it invariably results in the occurrence of inconsistencies among the different representations. We propose to resolve this situation...... by introducing a multiple representation management system (MRMS), the schema of which includes rules that specify how to identify representations of the same entity, rules that specify consistency requirements, and rules used to restore consistency when necessary. In this paper, we demonstrate by means...

  3. SSRI and SNRI withdrawal symptoms reported on an internet forum.

    Science.gov (United States)

    Stockmann, Tom; Odegbaro, Dolapo; Timimi, Sami; Moncrieff, Joanna

    2018-05-09

    Antidepressant withdrawal symptoms are well-recognised, but their potential duration remains uncertain. We aimed to describe the characteristics of withdrawal associated with two popular classes of antidepressants, including duration. We analysed the content of a sample of posts on an antidepressant withdrawal website. We compared the characteristics of withdrawal associated with SSRIs and SNRIs, including time of onset, duration and nature of symptoms. 110 posts about SSRI withdrawal, and 63 concerning SNRI withdrawal, were analysed. The mean duration of withdrawal symptoms was significantly longer with SSRIs than SNRIs: 90.5 weeks (standard deviation, SD, 150.0) and 50.8 weeks (SD 76.0) respectively; p = 0.043). Neurological symptoms, such as 'brain zaps,' were more common among SNRI users (p = 0.023). Psychosexual/genitourinary symptoms may be more common among SSRI users (p = 0.054). The website aims to help people with antidepressant withdrawal, and is therefore likely to attract people who have difficulties. Length of prior use of antidepressants was long, with a mean of 252.2 weeks (SD 250.8). People accessing antidepressant withdrawal websites report experiencing protracted withdrawal symptoms. There are some differences in the characteristics of withdrawal associated with different classes of antidepressants.

  4. Moves to withdraw nuclear weapons from NATO?

    International Nuclear Information System (INIS)

    Dumoulin, A.

    2008-01-01

    The American nuclear landscape in Europe could change in the coming months. The signs are already there, and a new strategic posture will have major implications for the Europeans as well as for the visibility of France deterrent force. Nonetheless, the Georgian crisis, tensions with Iran, Russian muscle flexing and NATO's line cast doubt on the idea that a partial or even complete withdrawal of American B-61 bombs could be on the agenda at the Alliance's 60. anniversary in April 2009. (author)

  5. Vagal withdrawal during endoscopic retrograde cholangiopancreatography

    DEFF Research Database (Denmark)

    Christensen, M; Rasmussen, Verner; Schulze, S

    2000-01-01

    BACKGROUND: Patients undergoing endoscopic retrograde cholangiopancreatography (ERCP) are at risk of developing cardiorespiratory complications, but the mechanism is still unknown. Treatment with metoprolol 2 h before the endoscopy has been shown to decrease the incidence of myocardial ischaemia......: The existence of a defence-like reaction ('vagal withdrawal') during ERCP has been shown. Metoprolol given 2 h before the procedure did not affect the occurrence of this phenomenon. The interaction of other periendoscopic factors is still unclear and should be studied further....

  6. Blurring 'the Other': Transforming relations in the management of the ...

    African Journals Online (AJOL)

    dependent on the transformation of relations between hitherto belligerent parties through ... events leading to the Zangon Kataf 1992 post-conflict scenario. .... the emergence of exclusive colonial politics to the corrupt and oppressive political ...

  7. Managing the relational character of public-private partnership contracts

    OpenAIRE

    Cvetković, Predrag

    2015-01-01

    A public-private partnership contract has the character of a relational contract. Relational contracts are incomplete agreements governing transactions where the contracting parties have mutually agreed that it is impossible or economically inefficient to contractually define ex ante possible difficulties and contingencies in the contract implementation, nor the difficulties and contingencies underlying the ex post control of contract performance by a third entity (court or arbitration). Cons...

  8. Programmable Relations for Managing Change During Software Development

    Science.gov (United States)

    1988-09-15

    POSTGRES [37], in which attributes of relations can include abstract data types, although not other relations. POSTGRES [39] also includes other...that programmability of this type is missing from both POSTGRES and ALGRES. Nevertheless, programmable implementations are not mutually incompatible...December 1975. [37] L. A. Rowe and Michael R. Stonebraker. "The POSTGRES Data Model". In Proc. of the 13th VLDB Conference, pages 83-96, 1987. [38

  9. Client-Oriented Approach: Forming the System of Management of the Bank Relations with Clients

    OpenAIRE

    Zavadska Diana V.

    2015-01-01

    The aim of the article is to develop the theoretical principles of forming the bank relations with clients as part of the client-oriented strategy implementation. As a result of the conducted research there has been presented the definition of client-orientation, mechanism and system of management. The system of management of the bank relations with clients, the purpose and objectives of its formation have been substantiated. The hierarchy of subjects of forming and managing the process...

  10. Network position and related power : how they affect and are affected by network management and outcomes

    NARCIS (Netherlands)

    Oukes, Tamara

    2018-01-01

    In network position and related power you learn more about how network position and related power affect and are affected by network management and outcomes. First, I expand our present understanding of how startups with a fragile network position manage business relationships by taking an

  11. Love withdrawal predicts electrocortical responses to emotional faces with performance feedback: a follow-up and extension.

    Science.gov (United States)

    Huffmeijer, Renske; Bakermans-Kranenburg, Marian J; Alink, Lenneke R A; van IJzendoorn, Marinus H

    2014-06-02

    Parental use of love withdrawal is thought to affect children's later psychological functioning because it creates a link between children's performance and relational consequences. In addition, recent studies have begun to show that experiences of love withdrawal also relate to the neural processing of socio-emotional information relevant to a performance-relational consequence link, and can moderate effects of oxytocin on social information processing and behavior. The current study follows-up on our previous results by attempting to confirm and extend previous findings indicating that experiences of maternal love withdrawal are related to electrocortical responses to emotional faces presented with performance feedback. More maternal love withdrawal was related to enhanced early processing of facial feedback stimuli (reflected in more positive VPP amplitudes, and confirming previous findings). However, attentional engagement with and processing of the stimuli at a later stage were diminished in those reporting higher maternal love withdrawal (reflected in less positive LPP amplitudes, and diverging from previous findings). Maternal love withdrawal affects the processing of emotional faces presented with performance feedback differently in different stages of neural processing.

  12. Acute effects of glucose tablets on craving, withdrawal symptoms, and sustained attention in 12-h abstinent tobacco smokers.

    Science.gov (United States)

    Harakas, P; Foulds, J

    2002-05-01

    Glucose administration may decrease desire to smoke in abstinent smokers. Moreover, glucose administration has been associated with improved performance on measures of attention in healthy humans but evidence remains modest. The present study aimed to determine whether reported craving and nicotine withdrawal symptoms can be relieved, and sustained attention on the Rapid Visual Information Processing (RVIP) task improved, with the administration of 12 g oral glucose in nicotine-deprived smokers. Forty-one smokers, abstinent for 12 h, participated in a double-blind, placebo-controlled, randomized study to examine the effect of glucose on desire to smoke, withdrawal symptoms, and attention. Participants completed the RVIP task once and then rated craving and nicotine withdrawal symptoms before chewing four 3 g glucose tablets (experimental group) or four matched placebo tablets (control group). Following tablet consumption participants rated craving and withdrawal symptoms at 5-min intervals for 20 min. Subsequently a second RVIP task was performed, followed by a final rating of craving and withdrawal symptoms. Any effect of glucose across time was not statistically significant on craving, withdrawal symptoms, or performance on the RVIP task. There were no differences between the groups in measures of 'satisfaction' or 'sickness'. The present study failed to find a significant effect of 12 g oral glucose on tobacco craving, withdrawal symptoms, or sustained attention in relatively young tobacco smokers after 12 h of tobacco abstinence.

  13. 77 FR 47089 - Public Land Order No. 7795; Withdrawal of Public Lands, Clear Creek Serpentine Area of Critical...

    Science.gov (United States)

    2012-08-07

    ... DEPARTMENT OF THE INTERIOR Bureau of Land Management [LLCAC09000, 16100000.DQ; CACA 051408] Public Land Order No. 7795; Withdrawal of Public Lands, Clear Creek Serpentine Area of Critical Environmental Concern; California AGENCY: Bureau of Land Management, Interior. ACTION: Public Land Order. SUMMARY: This...

  14. Issues related to public perception of radioactive waste management options

    International Nuclear Information System (INIS)

    Taylor, D.M.

    2007-01-01

    Public perceptions about radioactive waste are generally rather or even strongly negative. They are also very poorly informed. This is rather unfortunate as it is these perceptions that appear to greatly influence the Public views on nuclear energy in general. This, in turn, has had an influence on political decisions. On the other hand, in a very clear majority of the Member States of the European Union, the Public have already indicated that they would be ready to accept the important role of nuclear in their future energy mix as long as all the radioactive wastes can be safely managed. However perceptions about nuclear energy and radioactive waste should be seen in the context of the Public wider perceptions on energy and, in particular, the role in the future of different sources. It may be wrong for political decisions on nuclear energy in the future to rely to heavily on the Public perceptions. (author)

  15. Status of technologies related to radioactive waste management and disposal

    International Nuclear Information System (INIS)

    1979-09-01

    The document discusses the status of technologies relevant to radioactive waste management and disposal, as defined by the INFCE Working Group 7 study. All fuel cycle wastes, with the exception of mill tailings, are placed in mined geologic repositories. In addition to the availability of technologies, the document discusses the: a) importance of the systems viewpoint, b) importance of modeling, c) need for site-specific investigations, d) consideration of future sub-surface human activities and e) prospects for successful isolation. In the sections on waste isolation and repository safety assessments, principal considerations are discussed. The document concludes that successful isolation of radioactive wastes from the biosphere appears technically feasible for periods of thousands of years provided that the systems view is used in repository siting and design

  16. Issues Raised in Relation to Radioactive Waste Management

    International Nuclear Information System (INIS)

    Atherton, Elizabeth

    2003-01-01

    Nirex has undertaken various consultations with different stakeholders to identify their issues and concerns about radioactive waste management in general and specific aspects of Nirex's work. This paper will outline what dialogue techniques Nirex has undertaken and the issues and concerns that people have raised during the events. It will outline some of the work that Nirex is undertaking to address stakeholders' issues and concerns. Nirex has used a variety of dialogue techniques co-ordinated under the Nirex Involvement Programme to engage with stakeholders about the work we undertake. We are now trying to address the issues, concerns, scenarios and questions raised in our work programme. Key lessons that we have learned in undertaking the dialogues include: The importance of appropriate facilitation and organisation of meetings; The need for a clear purpose for meetings; Being flexible to the needs of the attendees and the issues they raise; Providing feedback to those who participate and following up issues. Through engaging with the public Nirex has learned that: Radioactive waste is not an everyday concern for people; The public can, will and want to engage with the issue of radioactive waste management. This includes engaging with the ethical debate. To facilitate this Nirex and others need to: Provide information in a neutral form outlining the pros and cons and including various people's opinions; Use proactive techniques to allow access and space for people to discuss the issues; Demonstrate how people's opinions have been taken into account. People understand the issues very differently to the way institutions understand them. There is a need for institutions to learn to understand public concerns and the ways in which the public understand issues, as well as for the public to understand the institutional positions better. We are using these insights to develop our future work in this area

  17. Enhanced DIII-D Data Management Through a Relational Database

    Science.gov (United States)

    Burruss, J. R.; Peng, Q.; Schachter, J.; Schissel, D. P.; Terpstra, T. B.

    2000-10-01

    A relational database is being used to serve data about DIII-D experiments. The database is optimized for queries across multiple shots, allowing for rapid data mining by SQL-literate researchers. The relational database relates different experiments and datasets, thus providing a big picture of DIII-D operations. Users are encouraged to add their own tables to the database. Summary physics quantities about DIII-D discharges are collected and stored in the database automatically. Meta-data about code runs, MDSplus usage, and visualization tool usage are collected, stored in the database, and later analyzed to improve computing. Documentation on the database may be accessed through programming languages such as C, Java, and IDL, or through ODBC compliant applications such as Excel and Access. A database-driven web page also provides a convenient means for viewing database quantities through the World Wide Web. Demonstrations will be given at the poster.

  18. Sedatives for opiate withdrawal in newborn infants.

    Science.gov (United States)

    Osborn, David A; Jeffery, Heather E; Cole, Michael J

    2010-10-06

    Neonatal abstinence syndrome (NAS) due to opiate withdrawal may result in disruption of the mother-infant relationship, sleep-wake abnormalities, feeding difficulties, weight loss and seizures. Treatments used to ameliorate symptoms and reduce morbidity include opiates, sedatives and non-pharmacological treatments. To assess the effectiveness and safety of using a sedative compared to a non-opiate control for NAS due to withdrawal from opiates, and to determine which type of sedative is most effective and safe. This update included searches of the Cochrane Central Register of Controlled Trials (Issue 1, 2010), MEDLINE 1966 to April 2010 and abstracts of conference proceedings. Trials enrolling infants with NAS born to mothers with an opiate dependence with > 80% follow-up and using random or quasi-random allocation to sedative or control. Control could include another sedative or non-pharmacological treatment. Each author assessed study quality and extracted data independently. Seven studies enrolling 385 patients were included. There were substantial methodological concerns for most studies including the use of quasi-random allocation methods and sizeable, largely unexplained differences in reported numbers allocated to each group.One study reported phenobarbitone compared to supportive care alone did not reduce treatment failure or time to regain birthweight, but resulted in a significant reduction in duration of supportive care (MD -162.1 min/day, 95% CI -249.2, -75.1). Comparing phenobarbitone to diazepam, meta-analysis of two studies found phenobarbitone resulted in a significant reduction in treatment failure (typical RR 0.39, 95% CI 0.24, 0.62). Comparing phenobarbitone with chlorpromazine, one study reported no significant difference in treatment failure.In infants treated with an opiate, one study reported addition of clonidine resulted in no significant difference in treatment failure, seizures or mortality. In infants treated with an opiate, one study

  19. Preparing Nursing and Social Work Students to Care for Patients in Acute Alcohol Withdrawal.

    Science.gov (United States)

    Gates, Sharon A; Brown, James R

    Alcohol and other drug abuse has become a national crisis with approximately 26% of general medical patients having alcohol-related problems. New nurses and social workers are often not prepared to care for patients with severe alcohol withdrawal symptoms because they lack experience in actual crisis situations. The purpose of this study was to prepare nursing and social work students to care for a patient undergoing an acute alcohol withdrawal process. Nine groups of 8-10 students participated in a 2.5-hour simulation event that included an alcohol withdrawal seizure, team meeting, and discharge of the patient. Students recognized the importance of all the professional roles and how each professional benefits patient care. Before the simulation, students thought they were prepared to care for patients experiencing alcohol withdrawal; however, the crisis of an alcohol seizure decreased the student's ability to perform skills and communicate effectively. These findings suggest that new nurses and social workers may not be prepared to care for the acute alcohol withdrawal patient.

  20. The association between social anhedonia, withdrawal and psychotic experiences in general and high-risk populations.

    Science.gov (United States)

    Velthorst, Eva; Meijer, Carin

    2012-07-01

    Social anhedonia (SA) and withdrawal are clinically relevant phenomena in schizophrenia. To examine the nature of the overlap between SA, withdrawal and positive symptoms, we investigated whether the co-occurrence of these phenotypes is more prominent in siblings of patients with a psychotic disorder compared to healthy controls, and if this association is independent of the amount of distress caused by psychotic experiences (PEs). Data were derived from 646 unaffected siblings and 326 healthy controls who were included in the Dutch Genetic Risk and Outcome in Psychosis (GROUP) study. PEs were assessed with the Community Assessment of Psychic Experiences and the Structured Interview for Schizotypy-Revised was used to examine social anhedonia and withdrawal. Our results show relatively small but significant cross-sectional associations between SA, withdrawal and PEs in unaffected siblings and none in the control group, irrespective of the level of distress caused by PEs. The findings of the present study suggest that the overlap between SA, withdrawal and psychotic symptoms often reported in schizophrenia patients, may at least partly reflect a shared genetic vulnerability, instead of merely being either a state marker of - or reaction to - acute psychotic symptoms. Copyright © 2012. Published by Elsevier B.V.

  1. Cost effectiveness of withdrawal of fall-risk-increasing drugs in geriatric outpatients.

    Science.gov (United States)

    van der Velde, Nathalie; Meerding, Willen Jan; Looman, Caspar W; Pols, Huibert A P; van der Cammen, Tischa J M

    2008-01-01

    Withdrawal of fall-risk-increasing drugs has been proven to be effective in older persons. However, given the enormous rise in healthcare costs in recent decades, the effect of such withdrawals on healthcare costs also needs to be considered. Within a common geriatric outpatient population, patients with a history of falls were assessed for falls risk (n = 139). Fall-risk-increasing drugs were withdrawn when appropriate (n = 75). All participants had a 2-month follow-up for fall incidents. The number of prevented falls was calculated using a loglinear regression model. The savings on health expenditures as a result of prevented injuries (estimated from a literature review) and reduced consumption of pharmaceuticals were compared with the intervention costs. After adjustment for confounders, drug withdrawal resulted in a falls risk reduction of 0.89 (95% CI 0.33, 0.98) per patient compared with the non-withdrawal group. Net cost savings were euro1691 (95% CI 662, 2181) per patient in the cohort. This resulted in a cost saving of euro491 (95% CI 465, 497) per prevented fall. Withdrawal of fall-risk-increasing drugs generates significant cost savings. Extrapolation of these findings to a national scale results in an estimated reduction of euro60 million in healthcare expenditures, that is, 15% of fall-related health costs.

  2. Career involvement and family involvement as moderators of relationships between work-family conflict and withdrawal from a profession.

    Science.gov (United States)

    Greenhaus, J H; Parasuraman, S; Collins, K M

    2001-04-01

    This study extended prior analyses by J. H. Greenhaus, K. M. Collins, R. Singh, and S. Parasuraman (1997) by examining relationships between 2 directions of work-family conflict (work-to-family conflict and family-to-work conflict) and withdrawal from public accounting. The sample consisted of 199 members of the American Institute of Certified Public Accountants (135 men and 64 women) who were married or in a long-term relationship and who had 1 or more children. It was found that work-to-family conflict (but not family-to-work conflict) was positively related to withdrawal intentions. In addition, relationships of work-to-family conflict with withdrawal intentions and withdrawal behavior were stronger for individuals who were relatively uninvolved in their careers than for those who were highly involved in their careers. The implications of the findings for future research are discussed.

  3. Manager relations, psychological need satisfaction and intention to leave in the agricultural sector

    Directory of Open Access Journals (Sweden)

    Sebastiaan Rothmann

    2013-08-01

    Research purpose: The aim of this study was to investigate the relationship between manager relations, the satisfaction of the psychological needs of employees and their intentions to leave. Motivation for the study: The effective retention of skilled employees is necessary in organisations in South Africa. However, studies on the psychological processes (and specifically the satisfaction of psychological needs, through which manager relations could promote the retention of staff, are necessary. Research design, approach and method: The authors used a cross-sectional survey design. They drew convenience samples of managers in agricultural organisations (N = 507 in South Africa. They administered the Manager Relations Scale, the Work-related Basic Need Satisfaction Scale and the Turnover Intention Scale. Main findings: The results confirmed a model in which manager relations affected the satisfaction of psychological needs and intentions to leave. Autonomy satisfaction mediated the relationship between manager relations and the intentions of employees to leave. Practical/managerial implications: Managers should participate in training on applying self determination theory to support the autonomy and the relatedness satisfaction of employees. Contribution/value add: This study contributes to the literature by exploring the processes through which manager relations influence the intentions of employees to leave.

  4. The management of breast cancer-related lymphoedema

    African Journals Online (AJOL)

    Definition. Breast cancer-related lymphoedema (BCRL) is a secondary form of lymphoedema and a major complication of post-breast cancer surgery and radiotherapy. It occurs when the network of lymphatic vessels and lymph nodes is damaged by disease, surgery or radiotherapy. The lymph, a protein-rich fluid, then ...

  5. European Insecurity: Managing Changing Relations at Home and Abroad

    Directory of Open Access Journals (Sweden)

    Julie Fraser interviews Dr. M Drent and Dr. B van Ginkel of the Clingendael Institute

    2012-02-01

    Full Text Available Interviews with Dr. Margriet Drent and Dr. Bibi van Ginkel of the Security and Conflict Programme of the Netherlands Institute of International Relations 'Clingendael' Dr. Margriet Drent is a Senior Research Fellow at the Security and Conflict Programme of the Netherlands Institute of International Relations 'Clingendael' and Assistant Professor at the International Relations and International Organisation Department of the University of Groningen. Dr. Drent's PhD on the 'Europeanisation of security' focused on what is now known as the Common Security and Defence Policy. She is also a member of the Peace and Security Committee of the Advisory Council on International Affairs. Dr. Bibi van Ginkel, LL.M. is a Senior Research Fellow at Security and Conflict Programme of the Netherlands Institute of International Relations 'Clingendael'. She is also a fellow at the International Centre on Counter-Terrorism. Her research concentrates on legal aspects of security issues. She received her doctorate at Utrecht University with a dissertation on the practice of the United Nations on combating terrorism. She is also a member of the Peace and Security Committee of the Advisory Council of International Affairs.   

  6. Nebraska withdraws its intent to deny site license

    International Nuclear Information System (INIS)

    Anon.

    1993-01-01

    The state of Nebraska has withdrawn its notice of intent to deny the US Ecology (USE) license application for the proposed low-level radioactive waste disposal site in Boyd County, near Butte, Neb. On October 4, after review of USE's August 27 submittal of a revision to the boundaries of the proposed site, a letter from the state's Department of Health (DOH) and Department of Environmental Quality (DEQ) to John. H. DeOld, the USE project manager for the Central Interstate Compact's proposed LLW site, noted that open-quotes...we are hereby withdrawing the Notice of Intent to Deny License as a moot, and will conduct a substantive review of the reconfigured site for compliance with the applicable regulations.close quotes

  7. Renouncement of renal replacement therapy: withdrawal and refusal

    Directory of Open Access Journals (Sweden)

    José Andrade Moura Neto

    Full Text Available Abstract Renouncement of renal replacement therapy (RRT is a medical dilemma. This review covers the concept, the magnitude, the prognosis, and discusses strategies and management approaches about this subject in patients with CKD and AKI. Evidence suggests that refusal is more frequent and carries a more guarded prognosis than withdrawal of RRT. When RRT is not expected to be beneficial in terms of survival or quality of life, conservative treatment and palliative care are alternatives. We review the historical evolution of guidelines about renouncement of RRT and palliative care, and highlight the absence of specific recommendations in Brazil. However renouncement of RRT may be ethically and legally accepted in Brazil, as the right to a dignified death. Longer life expectancy, economic pressures, and greater awareness will require a more detailed discussion about indications and sustainable use of RRT, and possibly the elaboration of national guidelines.

  8. Some Operational Aspects Relating to Quality Management and Total Quality Management

    OpenAIRE

    Sorin GRESOI; Aurelian DIACONU

    2013-01-01

    The work pass in review a few basic concepts found in quality management focusing on operational aspects of quality assurance in production activity and continue with issues regarding total quality strategy, the vector of competitiveness on the market.

  9. Considerations related to plant life management for Cernavoda-1

    International Nuclear Information System (INIS)

    Cojan, Mihail

    2002-01-01

    Cernavoda-1 NPP, the first CANDU 6 Unit in Eastern Europe, is one of the original five CANDU 6 plants and the first CANDU 6 producing over 700 MWe. CANDU Pressurized Heavy Water Reactors (PHWR) continues to play a significant role in electricity supply both in Canada and some offshore countries (Korea, Argentina, Romania). The commercial versions of CANDU reactors were put into service more than 30 years ago. While the first series of CANDU 6 plants (which entered service in the early 1980's) have now reached the middle portion of their 30 years design life, the Cernavoda-1 was put into service on 2 December 1996. However, the Cernavoda-1 Plant Life Management should be an increasingly important program to Utility ('CNE-Prod') in order to protect the investment and the continued success of plant operation. Over the past three years, INR (Institute for Nuclear Research - Romania) has been working with AECL-Canada on R and D Programs to support a comprehensive and integrated Cernavoda-1 Plant Life Management (PLiM) program that will see the Cernavoda-1 NPP successfully and reliably through to design life and beyond. The PLiM program has a focus on critical systems, structures, and components (CSSCs) and will be applied in three phases: Phase 1 - Planning (assessment and recommendations); Phase 2 - Life attainment implementation, and; Phase 3 - Plant Life Extension (PLEx), also known as plant extended operation. The key activities during each phase are shown. The schedule of each Phase are shown using the in service date of 1983 as the basis. This schedule applies to three original CANDU 6 plants with an in-service date of 1983: Point Lepreau, Gentilly-2, Wolsong-1 and shortly thereafter (1984) the 4th original CANDU 6 Embalse NPP was declared in service. Cernavoda-1 is the 5th original CANDU 6 plant and was put into service on 2 December 1996 (on site activities were started in 1980). The paper will describe the elements of an integrated program, the multiphase

  10. The relation between project management education and newer streams in project management research

    DEFF Research Database (Denmark)

    Leimbach, Timo; Goodall, Julie Bladt

    2017-01-01

    In the last decades, research in project management (PM) has experienced significant new inputs from a range of new PM methodologies and critical research streams. As a consequence, members of the more critical streams have called for the education of project managers to advance from that of trai......In the last decades, research in project management (PM) has experienced significant new inputs from a range of new PM methodologies and critical research streams. As a consequence, members of the more critical streams have called for the education of project managers to advance from...... that of training technicians, to fostering reflective practitioners that are better equipped to handle the increasing complexity of the profession. This paper is based on a recently commenced re-search project titled "Rethinking Project Management Education – the Role of Universities" that is aimed at analysing...... how the development of PM research is reflected in the education of project managers. On the basis of a short overview of the state of the art of PM education research and practices, the possible challenges for the development of PM education are discussed, and, finding that there is a lack...

  11. network: A Package for Managing Relational Data in R

    Directory of Open Access Journals (Sweden)

    Carter T. Butts

    2007-12-01

    Full Text Available Effective memory structures for relational data within R must be capable of representing a wide range of data while keeping overhead to a minimum. The network package provides an class which may be used for encoding complex relational structures composed a vertex set together with any combination of undirected/directed, valued/unvalued, dyadic/hyper, and single/multiple edges; storage requirements are on the order of the number of edges involved. Some simple constructor, interface, and visualization functions are provided, as well as a set of operators to facilitate employment by end users. The package also supports a C-language API, which allows developers to work directly with network objects within backend code.

  12. Controversies relating to the management of acromioclavicular joint dislocations.

    Science.gov (United States)

    Modi, C S; Beazley, J; Zywiel, M G; Lawrence, T M; Veillette, C J H

    2013-12-01

    The aim of this review is to address controversies in the management of dislocations of the acromioclavicular joint. Current evidence suggests that operative rather than non-operative treatment of Rockwood grade III dislocations results in better cosmetic and radiological results, similar functional outcomes and longer time off work. Early surgery results in better functional and radiological outcomes with a reduced risk of infection and loss of reduction compared with delayed surgery. Surgical options include acromioclavicular fixation, coracoclavicular fixation and coracoclavicular ligament reconstruction. Although non-controlled studies report promising results for arthroscopic coracoclavicular fixation, there are no comparative studies with open techniques to draw conclusions about the best surgical approach. Non-rigid coracoclavicular fixation with tendon graft or synthetic materials, or rigid acromioclavicular fixation with a hook plate, is preferable to fixation with coracoclavicular screws owing to significant risks of loosening and breakage. The evidence, although limited, also suggests that anatomical ligament reconstruction with autograft or certain synthetic grafts may have better outcomes than non-anatomical transfer of the coracoacromial ligament. It has been suggested that this is due to better restoration horizontal and vertical stability of the joint. Despite the large number of recently published studies, there remains a lack of high-quality evidence, making it difficult to draw firm conclusions regarding these controversial issues.

  13. Blood eosinophil count and exacerbations in severe chronic obstructive pulmonary disease after withdrawal of inhaled corticosteroids

    DEFF Research Database (Denmark)

    Watz, Henrik; Tetzlaff, Kay; Wouters, Emiel F M

    2016-01-01

    were seen with eosinophil cutoffs of 300 cells per μL and 400 cells per μL, and mutually exclusive subgroups. INTERPRETATION: Blood eosinophil counts at screening were related to the exacerbation rate after complete ICS withdrawal in patients with severe to very severe COPD and a history...... of exacerbations. Our data suggest that counts of 4% or greater or 300 cells per μL or more might identify a deleterious effect of ICS withdrawal, an effect not seen in most patients with eosinophil counts below these thresholds. FUNDING: Boehringer Ingelheim....

  14. Factors influencing exacerbation-related self-management in patients with COPD: a qualitative study.

    Science.gov (United States)

    Korpershoek, Yjg; Vervoort, Scjm; Nijssen, Lit; Trappenburg, Jca; Schuurmans, M J

    2016-01-01

    In patients with COPD, self-management skills are important to reduce the impact of exacerbations. However, both detection and adequate response to exacerbations appear to be difficult for some patients. Little is known about the underlying process of exacerbation-related self-management. Therefore, the objective of this study was to identify and explain the underlying process of exacerbation-related self-management behavior. A qualitative study using semi-structured in-depth interviews was performed according to the grounded theory approach, following a cyclic process in which data collection and data analysis alternated. Fifteen patients (male n=8; age range 59-88 years) with mild to very severe COPD were recruited from primary and secondary care settings in the Netherlands, in 2015. Several patterns in exacerbation-related self-management behavior were identified, and a conceptual model describing factors influencing exacerbation-related self-management was developed. Acceptance, knowledge, experiences with exacerbations, perceived severity of symptoms and social support were important factors influencing exacerbation-related self-management. Specific factors influencing recognition of exacerbations were heterogeneity of exacerbations and habituation to symptoms. Feelings of fear, perceived influence on exacerbation course, patient beliefs, ambivalence toward treatment, trust in health care providers and self-empowerment were identified as specific factors influencing self-management actions. This study provided insight into factors influencing exacerbation-related self-management behavior in COPD patients. The conceptual model can be used as a framework for health care professionals providing self-management support. In the development of future self-management interventions, factors influencing the process of exacerbation-related self-management should be taken into account.

  15. Managers' perceptions of the manager role in relation to physicians: a qualitative interview study of the top managers in Swedish healthcare

    Directory of Open Access Journals (Sweden)

    de Rijk Angelique

    2010-09-01

    Full Text Available Abstract Background This study focused on the manager role in the manager-physician relationship, considered from the manager perspective. The aim was to understand how top executives in Swedish healthcare regard management of physicians in their organisations, and what this implies for the manager role in relation to the medical profession. Abbott's theory of professional jurisdiction was used to inform thinking about managerial control and legitimacy in relation to physicians. Methods Data from semi-structured individual interviews with 18 of the 20 county council chief executive officers (CEOs in Sweden were subjected to qualitative analysis. Results The results show that, when asked about their views on management of physicians, the CEOs talked about "how physicians are" rather than describing their own or their subordinate managers' managerial behaviour or strategies. Three types of descriptions of physicians were identified: 1 they have high status and expertise; 2 they lack knowledge of the system; 3 they do what they want in the organisation. The CEOs seldom reported that general management strategies were used to manage physicians. Instead, they described four types of physician-specific management strategies that were used in their organisations: organisational separation of physicians; "nagging and arguing"; compensations; relying on the physician role. These strategies seemed to reflect pragmatic behaviour on behalf of the managers that helped them to maintain control over physicians in daily work. However, in a longer perspective, they seemed to decrease the legitimacy of the manager role and also contribute to weakening of that role in the organisation. Conclusions Many CEOs seemed to regard the manager role in their organisations as weak and described difficulties in both taking and defining that role (for themselves or others in relation to the physician role. Further research is needed to elucidate how managers in healthcare

  16. Managers' perceptions of the manager role in relation to physicians: a qualitative interview study of the top managers in Swedish healthcare.

    Science.gov (United States)

    von Knorring, Mia; de Rijk, Angelique; Alexanderson, Kristina

    2010-09-17

    This study focused on the manager role in the manager-physician relationship, considered from the manager perspective. The aim was to understand how top executives in Swedish healthcare regard management of physicians in their organisations, and what this implies for the manager role in relation to the medical profession. Abbott's theory of professional jurisdiction was used to inform thinking about managerial control and legitimacy in relation to physicians. Data from semi-structured individual interviews with 18 of the 20 county council chief executive officers (CEOs) in Sweden were subjected to qualitative analysis. The results show that, when asked about their views on management of physicians, the CEOs talked about "how physicians are" rather than describing their own or their subordinate managers' managerial behaviour or strategies. Three types of descriptions of physicians were identified: 1) they have high status and expertise; 2) they lack knowledge of the system; 3) they do what they want in the organisation. The CEOs seldom reported that general management strategies were used to manage physicians. Instead, they described four types of physician-specific management strategies that were used in their organisations: organisational separation of physicians; "nagging and arguing"; compensations; relying on the physician role. These strategies seemed to reflect pragmatic behaviour on behalf of the managers that helped them to maintain control over physicians in daily work. However, in a longer perspective, they seemed to decrease the legitimacy of the manager role and also contribute to weakening of that role in the organisation. Many CEOs seemed to regard the manager role in their organisations as weak and described difficulties in both taking and defining that role (for themselves or others) in relation to the physician role. Further research is needed to elucidate how managers in healthcare organisations assume the manager role in relation to the medical

  17. The Role of Public Relations as A Management Function in Higher Education

    Directory of Open Access Journals (Sweden)

    Anggreni Putri

    2018-01-01

    Full Text Available Nowadays, public relations in higher education institution become an integral part of the management team. It must contribute to achieve organizational goals and demonstrate an organizational accountability identified by measurable result. Placement public relations at certain positions in management has consequences in the process of implementation of the public relations function. It happened because the management, workflow and hierarchy greatly affects work patterns as well as patterns of decision making in carrying out communication tasks performed by public relations.The goal of research to find out the role and position in public relations in management education institution (university in achieving its objectives. After identification of roles and positions performance public relations firm, the study aims to evaluate the performance of public relations as part of management.This study used a qualitative descriptive research method with the study subjects were Mahendradatta University Public Relations and internal stakeholders. Data drawn from interviews with the help of the interview guide and then processed into information that can answer the research objectives.The result of the research shows that not all public relations officers in Mahendradatta University, do their role as real public relations officers. They also do not have the same understanding about the role of a public relations officer will just place public relations in same position as marketing.

  18. Human resource management and labour relations in the Indian industrial sector

    OpenAIRE

    Rai, Soumi

    2012-01-01

    This paper addresses gaps in research related to study and understanding of Human Resource Management in the context of Indian Automobile sector. The review is based on the available and published literature in peer reviewed journals of reputation and academic standing. A total of 138 papers were reviewed related to the general context of Human Resource Management practices. Of these, about 65 papers were found relevant and relating to understanding of HRM practices in India specifically in t...

  19. Regional Competitiveness: Labor-Management Relations, Workplace Practices, and Workforce Quality

    OpenAIRE

    Jack Kleinhenz; Russ Smith

    2011-01-01

    This paper examines regional competitiveness as it relates to regional labor-management relations. A survey of recent literature provides perspective and secondary evidence regarding labor-management relations, workplace practices, and workforce quality. It does not answer the question, “Are unions good or bad?” Rather, it investigates the themes of productivity, wage premium, job security, innovation, communication, and economic development—the larger picture to consider when evaluating the ...

  20. Age-Related Macular Degeneration: Advances in Management and Diagnosis

    Directory of Open Access Journals (Sweden)

    Yoshihiro Yonekawa

    2015-02-01

    Full Text Available Age-related macular degeneration (AMD is the most common cause of irreversible visual impairment in older populations in industrialized nations. AMD is a late-onset deterioration of photoreceptors and retinal pigment epithelium in the central retina caused by various environmental and genetic factors. Great strides in our understanding of AMD pathogenesis have been made in the past several decades, which have translated into revolutionary therapeutic agents in recent years. In this review, we describe the clinical and pathologic features of AMD and present an overview of current diagnosis and treatment strategies.

  1. Lymphoedema management in breast cancer-related lymphoedema.

    Science.gov (United States)

    Jones, Joanne

    2013-04-01

    Due to developments in diagnosis and treatment of breast cancer, survival rates are rising. This leads to a population of mainly women, who also experience breast cancer-related lymphoedema (BCRL). Long after the cancer has been treated, lymphoedema persists at a time when individuals have returned to work. Large limb volumes can present a problem to these individuals and innovative treatments are needed, in order to retain as much normality as possible and reduce excessive limb volumes that patients can experience with lymphoedema long after treatment. It is also important that these treatments do not disrupt daily living and, for some, work-life balance. With the introduction of wrap around compression systems and collaborative working with the patient, it is possible to achieve an acceptable outcome to those patients with these issues. This approach leads to patient satisfaction and stabilisation of limb volume to within acceptable limits for these patients, in conjunction with the therapist.

  2. Conscientious Withdrawal from Religious Education in Scotland: Anachronism or Necessary Right?

    Science.gov (United States)

    Nixon, Graeme

    2018-01-01

    This paper considers the right of parental withdrawal from the statutory subject Religious Education (RE) in Scottish primary and secondary schools. The background, history and current legislative situation relating to this right are considered, as well as current discussions and debates about this issue. The intentions are to establish how often…

  3. Influence of caffeine and caffeine withdrawal on headache and cerebral blood flow velocities

    NARCIS (Netherlands)

    Couturier, EGM; Laman, DM; vanDuijn, MAJ; vanDuijn, H

    Caffeine consumption may cause headache, particularly migraine. Its withdrawal also produces headaches and may be related to weekend migraine attacks. Transcranial Doppler sonography (TCD) has shown changes in cerebral blood flow velocities (BFV) during and between attacks of migraine. In order to

  4. Observed Gossip Moderates the Link between Anxious Withdrawal and Friendship Quality in Early Adolescence

    Science.gov (United States)

    Menzer, Melissa M.; McDonald, Kristina L.; Rubin, Kenneth H.; Rose-Krasnor, Linda; Booth-LaForce, Cathryn; Schulz, Annie

    2012-01-01

    We evaluated whether gossip between best friends moderated the relation between anxious withdrawal and friendship quality in early adolescence, using an Actor-Partner Interdependence Model ("APIM," Kenny, Kashy, & Cook, 2006) approach. Participants (n = 256) were 5th and 6th grade young adolescents (actors) and their best friends…

  5. Negative Affect in Victimized Children: The Roles of Social Withdrawal, Peer Rejection, and Attitudes toward Bullying

    Science.gov (United States)

    Dill, Edward J.; Vernberg, Eric M.; Fonagy, Peter; Twemlow, Stuart W.; Gamm, Bridget K.

    2004-01-01

    This study evaluated the validity of mediating pathways in predicting self-assessed negative affect from shyness/social withdrawal, peer rejection, victimization by peers (overt and relational), and the attitude that aggression is legitimate and warranted. Participants were 296 3rd through 5th graders (156 girls, 140 boys) from 10 elementary…

  6. 78 FR 20160 - Self-Regulatory Organizations; Chicago Mercantile Exchange Inc.; Notice of Withdrawal of Proposed...

    Science.gov (United States)

    2013-04-03

    ... Organizations; Chicago Mercantile Exchange Inc.; Notice of Withdrawal of Proposed Rule Change Related to the Liquidity Factor of CME's CDS Margin Methodology March 28, 2013. On December 10, 2012, Chicago Mercantile... Section 19(b)(1) of the Securities Exchange Act of 1934 \\1\\ and Rule 19b-4 thereunder,\\2\\ a proposed rule...

  7. The role of eltrombopag in the management of hepatitis C virus-related thrombocytopenia

    Directory of Open Access Journals (Sweden)

    Danish FA

    2013-03-01

    Full Text Available Fazal-i-Akbar Danish,1 Saeeda Yasmin21James Paget University Hospital, Great Yarmouth, Norfolk, United Kingdom; 2Shifa International Hospital, Islamabad, PakistanAbstract: Eltrombopag is a 2nd generation thrombopoietin-receptor agonist. It binds with the thrombopoietin-receptors found on the surfaces of the megakaryocytes & increases platelet production. Many recent studies have suggested a potential role for this novel agent in the treatment of thrombocytopenia associated with hepatitis-C infection. Studies have shown that adjunct treatment with Eltrombopag can help avoid dose reductions/withdrawals of pegylated interferon secondary to thrombocytopenia. It may also have a role in priming up platelet levels to help initiate antiviral therapy. Similarly, chronic liver disease patients with thrombocytopenia who need to undergo an invasive procedure may be potential candidates for short two-week courses of eltrombopag in the periprocedural period to help reduce the risk of bleeding. Besides the price (deemed very expensive and probably not cost-effective, there are some legitimate concerns about the safety profile of this novel agent (most importantly, portal vein thrombosis, bone marrow fibrosis and hepatotoxicity. In this article, the potential role of eltrombopag in the context of hepatitis C virus (HCV-related thrombocytopenia is reviewed. To write this article, a MEDLINE search was conducted (1990 to November 2012 using the search terms “eltrombopag,” “HCV,” and “thrombocytopenia.”Keywords: liver disease, chronic immune thrombocytopenic purpura, thrombopoietin-receptor agonist, romiplostim

  8. New Drugs of Abuse and Withdrawal Syndromes.

    Science.gov (United States)

    Andrabi, Sara; Greene, Spencer; Moukaddam, Nidal; Moukkadam, Nidal; Li, Benjamin

    2015-11-01

    New drugs of abuse continue to emerge, including synthetic cannabinoids, synthetic cathinones, and hallucinogens. It is important to recognize their individual psychopharmacologic properties, symptoms of intoxication, and symptoms of withdrawal. Providers must be vigilant of acute medical or psychiatric complications that may arise from use of these substances. Treatment of the patient also includes recognition of any substance use disorders as well as comorbid psychiatric disorders. Although pharmacologic treatments for substance use disorder (of the drugs included in this article) are limited, there are a variety of psychotherapeutic modalities that may be of some benefit. Published by Elsevier Inc.

  9. Spontaneous reduction of prolactinoma post cabergoline withdrawal

    Directory of Open Access Journals (Sweden)

    Sampath Kumar Venkatesh

    2012-01-01

    Full Text Available Prolactinomas are common pituitary tumors usually highly responsive to dopamine agonists. Around 70-90% of the prolactinomas exhibit decrease in tumor size, though variably with these agents. Uncommonly, there may be little or no shrinkage in pituitary tumor. In the absence of medical therapy, pituitary apoplexy may also result in tumor shrinkage, albeit rarely. We report here a case showing only modest reduction in prolactinoma with cabergoline given for a period of one and a half years. Surprisingly, this tumor showed a 40% reduction in the tumor size 3 months after cabergoline withdrawal in the absence of clinical or radiological evidence of apoplexy.

  10. Relative Physical Position as an Impression-Management Strategy: Sex Differences in Its Use and Implications.

    Science.gov (United States)

    Makhanova, Anastasia; McNulty, James K; Maner, Jon K

    2017-05-01

    People's physical position relative to others may shape how those others perceive them. The research described here suggests that people use relative physical position to manage impressions by strategically positioning themselves either higher or lower relative to ostensible observers. Five studies supported the prediction that women take and display photographs portraying themselves in a low relative physical position to highlight their youthful features and appear attractive, whereas men take and display photographs portraying themselves in a high relative physical position to highlight their size and appear dominant. The effectiveness of these strategies was confirmed in two studies that measured social perceptions of male and female targets who varied in their relative position. In sum, as do members of other social species, people use relative physical position to manage social impressions, and although these impression-management strategies may have deep ancestral roots, they appear to manifest themselves through a contemporary human modality-photographs.

  11. Neural mechanisms underlying morphine withdrawal in addicted patients: a review

    Directory of Open Access Journals (Sweden)

    Nima Babhadiashar

    2015-06-01

    Full Text Available Morphine is one of the most potent alkaloid in opium, which has substantial medical uses and needs and it is the first active principle purified from herbal source. Morphine has commonly been used for relief of moderate to severe pain as it acts directly on the central nervous system; nonetheless, its chronic abuse increases tolerance and physical dependence, which is commonly known as opiate addiction. Morphine withdrawal syndrome is physiological and behavioral symptoms that stem from prolonged exposure to morphine. A majority of brain regions are hypofunctional over prolonged abstinence and acute morphine withdrawal. Furthermore, several neural mechanisms are likely to contribute to morphine withdrawal. The present review summarizes the literature pertaining to neural mechanisms underlying morphine withdrawal. Despite the fact that morphine withdrawal is a complex process, it is suggested that neural mechanisms play key roles in morphine withdrawal.

  12. The ethics of withdrawal: the case of follow-up from first-in-human clinical trials.

    Science.gov (United States)

    Hug, Kristina; Johansson, Mats

    2017-01-01

    This paper aims to analyze whether patients should be allowed to veto research-related use of medical data collected during routine follow-ups after their withdrawal from first-in-human clinical trials. Forms of withdrawal are identified and it is argued that the right to withdraw might be limited to some of these. The paper concludes that if veto right is denied, then: the research participant should be informed about the potential use of his/her follow-up data in case of his/her withdrawal and consent to it; follow-up should not be initiated for research purposes; compulsory use of follow-up data should imply the use of data anyway collected, requiring no additional effort from the patient; and before deciding about the veto right, investigation of concerned patients' value preferences is needed.

  13. USER principle as relating the human environmental management

    International Nuclear Information System (INIS)

    Kernakis

    2005-01-01

    The environmental variable can be understood as the resulting biosphere space that has suffered the occurrence of pre-biotic, biotic and anthropic processes. This necessary expansion of the environmental frontier allows understand clearly the magnitude the great complexity of the process immersed in the current environmental problematic. This, taking into account the analysis of the reference systems used by the different species to face their interaction with the nature. Hence, it is necessary to evaluate the human referential process of reality, as a responsible specie of the derange shown by the Environmental Mother Eve. The latest hominid development of an Artificial Reference System (ARS) (linguistic symbols), points to the constitution of the casual factor that triggers such an environmental problematic. The expansive dynamics accomplished by the ARS has not always made reference to the natural ambience that created them. The formulation of the Unprivilegeness of Symbolic Endogenous Referents (USER) Principle (Kernakis 1986, 1997), as a necessary epistemological consequence of the Special Relativity from Einstein, entails to the reversion of the local privileges created by the ARS, stating a referential crisis as alternative to a potential environmental collapse. AII these could lead to the most intra-specific understanding with the nature, antonomastical fragmented by the privileges of the ARS. Such integration species-nature would allow to make possible an spontaneous natural-cultural arranging of the environmental balance

  14. PREVALENCE, MECHANISMS, AND MANAGEMENT OF CANCER-RELATED COGNITIVE IMPAIRMENT

    Science.gov (United States)

    Janelsins, Michelle C.; Kesler, Shelli R.; Ahles, Tim A.; Morrow, Gary R.

    2014-01-01

    This review summarizes the current literature on cancer-related cognitive impairment (CRCI) with a focus on prevalence, mechanisms, and possible interventions for CRCI in those who receive adjuvant chemotherapy for non-central nervous system tumors and is primarily focused on breast cancer. CRCI is characterized as deficits in areas of cognition including memory, attention, concentration, and executive function. Development of CRCI can impair quality of life and impact treatment decisions. CRCI is highly prevalent; these problems can be detected in up to 30% of patients prior to chemotherapy; up to 75% of patients report some form of CRCI during treatment, and CRCI is still present in up to 35% of patients many years following completion of treatment. While the trajectory of CRCI is becoming better understood, the mechanisms underlying the development of CRCI are still obscure; however, host characteristics, immune dysfunction, neural toxicity, and genetics may play key roles in the development and trajectory of CRCI. Intervention research is limited, though strategies to maintain function are being studied with promising preliminary findings. This review highlights key research being conducted in these areas, both in patient populations and in animals, which will ultimately result in better understanding and effective treatments for CRCI. PMID:24716504

  15. Management of severely damaged nuclear fuel and related waste

    International Nuclear Information System (INIS)

    1991-01-01

    This report is concerned primarily with severe fuel damage accidents in large electric power producing reactors such as those in the TMI and Chernobyl plants. It does include, as appropriate, knowledge gained from accidents in other power, research and military reactors. It is believed that the conclusions and recommendations apply to a large extent to severe fuel damage accidents in all types of reactors. The period considered in this publication begins after the initial crisis of an accident has been brought under control. (This initial crisis could be from one day to several weeks after the event, depending on the specific conditions). Accordingly, it is assumed that the plant is shut down, the reactor is under control and decay heat removal is in progress in a stable manner so that attention must be given to cleanup. This report addresses the principles involved in planning, engineering, construction, operation and other activities to characterize, clean up and dispose of the fuel and related waste. The end of the period under consideration is when the fuel and abnormal wastes are packaged either for interim storage or final disposal and activities are started either to restore the plant to service or to establish a safe state from which decommissioning planning can start. 36 refs, 3 figs, 4 tabs.

  16. Prevention and management of work-related cardiovascular disorders

    Directory of Open Access Journals (Sweden)

    Akizumi Tsutsumi

    2015-02-01

    Full Text Available Cardiovascular disorders (CVDs constitute a major burden for health of working populations throughout the world with as much as 50% of all causes of death and at least 25% of work disability. There are some changes in CVD risk factors among occupational classes. This is mainly due to the new types of work-related causes of morbidity associated with the recent developments in global work life, particularly in the industrialized countries. Meanwhile, in the developing countries or those in transition (e.g., in Eastern Europe, CVD mortality is increasing due to major socioeconomic changes, the demographic transition and rapid industrialisation and urbanisation, all leading to growing challenges to cardiovascular health. Better control of known risk factors (i.e., smoking, obesity, physical inactivity, high cholesterol, high blood pressure, and high blood glucose is effective to prevent CVD incidence. But the expected improvement has not been achieved. The obstacles of achieving such impact are due to lack of awareness, lack of policies and their implementation into practice and shortage of infrastructures and human resources. These are needed for wide-scale and long-term programme implementation. Considering the WHO Global Strategy on Occupational Health for All, the WHO Global Action Plan on Workers’ Health, the WHO Programme on Prevention of Non-communicable Diseases and the ILO Decent Work agenda, the 6th ICOH International Conference on Work Environment and Cardiovascular Diseases adopted the Tokyo Declaration.

  17. Management Strategies and Outcomes for VHL-related Craniospinal Hemangioblastomas

    Directory of Open Access Journals (Sweden)

    Christ Ordookhanian

    2017-08-01

    Full Text Available Hemangioblastomas are rare and benign tumors accounting for less than 2% of all central nervous system (CNS tumors. The vast majority of hemangioblastomas occur sporadically, whereas a small number of cases, especially in younger patients, are associated with Von Hippel–Lindau (VHL syndrome. It is thought that loss of tumor suppressor function of the VHL gene results in stabilization of hypoxia-inducible factor alpha with downstream activation of cellular proliferative and angiogenic genes that promote tumorigenesis. VHL-related hemangioblastomas predominantly occur in the cerebellum and spine. Lesions are often diagnosed on contrast-enhanced craniospinal MRIs, and the diagnosis of VHL occurs through assessment for germline VHL mutations. Surgical resection remains the primary treatment modality for symptomatic or worrisome lesions, with excellent local control rates and neurological outcomes. Stereotactic radiotherapy can be employed in patients who are deemed high risk for surgery, have multiple lesions, or have non-resectable lesions. Given the tendency for development of either new or multiple lesions, close radiographic surveillance is often recommended for asymptomatic lesions.

  18. On the relationship between Indian monsoon withdrawal and Iran's fall precipitation onset

    Science.gov (United States)

    Babaeian, Iman; Rezazadeh, Parviz

    2017-09-01

    Indian monsoon is the most prominent of the world's monsoon systems which primarily affects synoptic patterns of India and adjacent countries such as Iran in interaction with large-scale weather systems. In this article, the relationship between the withdrawal date of the Indian monsoon and the onset of fall precipitation in Iran has been studied. Data included annual time series of withdrawal dates of the Indian monsoon prepared by the Indian Institute for Tropical Meteorology, and time series of the first date of 25 mm accumulated precipitation over Iran's synoptic weather stations in a 10-day period which is the basis for the cultivation date. Both time series were considered in Julian calendar with the starting date on August 1. The studied period is 1960-2014 which covers 55 years of data from 36 meteorological stations in Iran. By classifying the withdrawal dates of the Indian monsoon in three stages of late, normal, and early withdrawals, its relation with the onset of fall precipitation in western, southwestern, southern, eastern, central, and northern regions of Iran was studied. Results demonstrated that in four out of the six mentioned regions, the late withdrawal of the Indian monsoon postpones the onset of fall precipitation over Iran. No significant relation was found between the onset of fall precipitation in central region of Iran and the monsoon's withdrawal date. In the western, southwestern, southern, and eastern regions of Iran, the late monsoon delays the onset of fall's precipitation; while in the south Caspian Sea coastal area, it causes the early onset of autumnal precipitation. The lag in onset of fall precipitation in Iran which is coordinated with the late withdrawal of monsoon is accompanied with prolonged subtropical high settling over Iran's plateau that prevents the southward movement of polar jet frontal systems. Such conditions enhance northerly wind currents over the Caspian Sea which, in turn, increase the precipitation in Caspian

  19. Norms and international standards related to reduce risk management: A literature review

    Directory of Open Access Journals (Sweden)

    César Fuentes

    2011-09-01

    Full Text Available The current work aims to develop a revision of the literature within the main concepts in the international rules and standards related to risk management in companies. By this way, there will be an analysis of issues such as the COSO - ERM model, an introduction to the ISO 27000 and 31000 standards; and the Project Management according to PMI targeted at risk management

  20. Relation Analysis of Knowledge Management, Research, and Innovation in University Research Groups

    Directory of Open Access Journals (Sweden)

    Heyder Paez-Logreira

    2016-12-01

    Full Text Available Knowledge is a competitive advantage for companies. Knowledge Management helps to keep this competitiveness. Universities face with challenges in research, innovation and international competitiveness. The purpose of this paper includes studying Knowledge Management Models, and Innovation Models apply to Research Groups of Universities, through an analysis of relation in inter-organizational level. Some researchers and leaders of research groups participated in a survey about knowledge management and innovation. Here we show the relationship between knowledge management, innovation and research, including processes and operations performed by universities around these. We organize the results in three dimensions: Knowledge Management perception, the relationship between Knowledge Management and Innovation, and Strategic Knowledge organization. Too, we identify a generality of good practices, challenges, and limitations on Research Groups for Knowledge Management.

  1. Prevention and management of work-related cardiovascular disorders.

    Science.gov (United States)

    Tsutsumi, Akizumi

    2015-01-01

    Cardiovascular disorders (CVDs) constitute a major burden for health of working populations throughout the world with as much as 50% of all causes of death and at least 25% of work disability. There are some changes in CVD risk factors among occupational classes. This is mainly due to the new types of work-related causes of morbidity associated with the recent developments in global work life, particularly in the industrialized countries. Meanwhile, in the developing countries or those in transition (e.g., in Eastern Europe), CVD mortality is increasing due to major socioeconomic changes, the demographic transition and rapid industrialisation and urbanisation, all leading to growing challenges to cardiovascular health. Better control of known risk factors (i.e., smoking, obesity, physical inactivity, high cholesterol, high blood pressure, and high blood glucose) is effective to prevent CVD incidence. But the expected improvement has not been achieved. The obstacles of achieving such impact are due to lack of awareness, lack of policies and their implementation into practice and shortage of infrastructures and human resources. These are needed for wide-scale and long-term programme implementation. Considering the WHO Global Strategy on Occupational Health for All, the WHO Global Action Plan on Workers' Health, the WHO Programme on Prevention of Non-communicable Diseases and the ILO Decent Work agenda, the 6th ICOH International Conference on Work Environment and Cardiovascular Diseases adopted the Tokyo Declaration. This work is available in Open Access model and licensed under a CC BY-NC 3.0 PL license.

  2. Analysis of Medical Equipment Management in Relation to the Mandatory Medical Equipment Safety Manager (MESM in Japan

    Directory of Open Access Journals (Sweden)

    Kai Ishida

    2014-01-01

    Full Text Available Half a decade has passed since the fifth revision of the medical law and mandatory appointment of a medical equipment safety manager (MESM in hospitals in Japan. During this period, circumstances have changed regarding maintenance of medical equipment (ME. We conducted a survey to examine these changes and the current situation in ME management. Maintenance of ME and related work were found to have increased in many hospitals, but the number of clinical engineering technologists (CETs has only slightly increased. The appointed MESM was a CET or physician in most hospitals. In hospitals where physicians were appointed as the MESM, 81% had operation managers. Many respondents commented that it was difficult for one person to cover all the tasks required by the MESM, due to a lack of knowledge, too much work, or other reasons. This suggests the importance of an operation manager for ME to work under the MESM.

  3. Demand-Withdraw Patterns in Marital Conflict in the Home

    OpenAIRE

    Papp, Lauren M.; Kouros, Chrystyna D.; Cummings, E. Mark

    2009-01-01

    The present study extended laboratory-based findings of demand-withdraw communication into marital conflict in the home and further explored its linkages with spousal depression. U.S. couples (N = 116) provided diary reports of marital conflict and rated depressive symptoms. Hierarchical linear modeling results indicated that husband demand-wife withdraw and wife demand-husband withdraw occurred in the home at equal frequency, and both were more likely to occur when discussing topics that con...

  4. The management of work-related asthma guidelines: a broader perspective

    NARCIS (Netherlands)

    Baur, X.; Aasen, T.B.; Burge, P.S.; Heederik, D.

    2012-01-01

    The aim of the European Respiratory Society work-related asthma guidelines is to present the management and prevention options of work-related asthma and their effectiveness. Work-related asthma accounts for 5-25% of all adult asthma cases and is responsible for a significant socioeconomic burden.

  5. Assessment of Groups Influence on Management Style as Related to University Governance

    Science.gov (United States)

    Irtwange, S. V.; Orsaah, S.

    2010-01-01

    The study was undertaken with the objective of assessing groups influence on management style as related to University governance with University of Agriculture, Makurdi as a case study from academic staff perspective. The management style of the Vice Chancellor of the University of Agriculture, Makurdi between the period September 3, 1996 to…

  6. A psychology literature study on modality related issues for multimodal presentation in crisis management

    NARCIS (Netherlands)

    Cao, Y.

    2008-01-01

    The motivation of this psychology literature study is to obtain modality related guidelines for real-time information presentation in crisis management environment. The crisis management task is usually companied by time urgency, risk, uncertainty, and high information density. Decision makers

  7. Keeping Track of Our Treasures: Managing Historical Data with Relational Database Software.

    Science.gov (United States)

    Gutmann, Myron P.; And Others

    1989-01-01

    Describes the way a relational database management system manages a large historical data collection project. Shows that such databases are practical to construct. States that the programing tasks involved are not for beginners, but the rewards of having data organized are worthwhile. (GG)

  8. 75 FR 66125 - Federal Land Managers' Air Quality Related Values Work Group (FLAG)

    Science.gov (United States)

    2010-10-27

    ... pollutants that could affect the health and status of resources in areas managed by the three agencies... Work Group (FLAG) AGENCY: National Park Service, Interior. ACTION: Notice of availability of final... Public Comments document. The Federal Land Managers' Air Quality Related Values Work Group (FLAG) was...

  9. FEATURES OF INNOVATIVE MANAGEMENT OF REFORMATORY CHANGES IN SYSTEM OF THE LAND RELATIONS

    Directory of Open Access Journals (Sweden)

    Tatyana ZAVOLICHNA

    2017-06-01

    Full Text Available In the article the authors investigated the state of land reform in Ukraine evaluated the prospects of its development following on from the experience of Bulgaria, Romania and Hungary. An innovative algorithm of change management in the system of administration of land relations was suggested, which role is to provide opportunities to expeditiously manage land conversion, effectively overcome resistance to change.

  10. Reduction of opioid withdrawal and potentiation of acute opioid analgesia by systemic AV411 (ibudilast).

    Science.gov (United States)

    Hutchinson, Mark R; Lewis, Susannah S; Coats, Benjamen D; Skyba, David A; Crysdale, Nicole Y; Berkelhammer, Debra L; Brzeski, Anita; Northcutt, Alexis; Vietz, Christine M; Judd, Charles M; Maier, Steven F; Watkins, Linda R; Johnson, Kirk W

    2009-02-01

    Morphine-induced glial proinflammatory responses have been documented to contribute to tolerance to opioid analgesia. Here, we examined whether drugs previously shown to suppress glial proinflammatory responses can alter other clinically relevant opioid effects; namely, withdrawal or acute analgesia. AV411 (ibudilast) and minocycline, drugs with distinct mechanisms of action that result in attenuation of glial proinflammatory responses, each reduced naloxone-precipitated withdrawal. Analysis of brain nuclei associated with opioid withdrawal revealed that morphine altered expression of glial activation markers, cytokines, chemokines, and a neurotrophic factor. AV411 attenuated many of these morphine-induced effects. AV411 also protected against spontaneous withdrawal-induced hyperactivity and weight loss recorded across a 12-day timecourse. Notably, in the spontaneous withdrawal study, AV411 treatment was delayed relative to the start of the morphine regimen so to also test whether AV411 could still be effective in the face of established morphine dependence, which it was. AV411 did not simply attenuate all opioid effects, as co-administering AV411 with morphine or oxycodone caused three-to-five-fold increases in acute analgesic potency, as revealed by leftward shifts in the analgesic dose response curves. Timecourse analyses revealed that plasma morphine levels were not altered by AV411, suggestive that potentiated analgesia was not simply due to prolongation of morphine exposure or increased plasma concentrations. These data support and extend similar potentiation of acute opioid analgesia by minocycline, again providing converging lines of evidence of glial involvement. Hence, suppression of glial proinflammatory responses can significantly reduce opioid withdrawal, while improving analgesia.

  11. Maintenance treatment with azathioprine in ulcerative colitis: outcome and predictive factors after drug withdrawal.

    Science.gov (United States)

    Cassinotti, Andrea; Actis, Giovanni C; Duca, Piergiorgio; Massari, Alessandro; Colombo, Elisabetta; Gai, Elisa; Annese, Vito; D'Albasio, Giuseppe; Manes, Gianpiero; Travis, Simon; Porro, Gabriele Bianchi; Ardizzone, Sandro

    2009-11-01

    Whether the duration of maintenance treatment with azathioprine (AZA) affects the outcome of ulcerative colitis (UC) is unclear. We investigated clinical outcomes and any predictive factors after withdrawal of AZA in UC. In this multicenter observational retrospective study, 127 Italian UC patients, who were in steroid-free remission at the time of withdrawal of AZA, were followed-up for a median of 55 months or until relapse. The frequency of clinical relapse or colectomy after AZA withdrawal was analyzed according to demographic, clinical, and endoscopic variables. After drug withdrawal, a third of the patients relapsed within 12 months, half within 2 years and two-thirds within 5 years. After multivariable analysis, predictors of relapse after drug withdrawal were lack of sustained remission during AZA maintenance (hazard ratio, HR 2.350, confidence interval, CI 95% 1.434-3.852; P=0.001), extensive colitis (HR 1.793, CI 95% 1.064-3.023, P=0.028 vs. left-sided colitis; HR 2.024, CI 95% 1.103-3.717, P=0.023 vs. distal colitis), and treatment duration, with short treatments (3-6 months) more disadvantaged than >48-month treatments (HR 2.783, CI 95% 1.267-6.114, P=0.008). Concomitant aminosalicylates were the only predictors of sustained remission during AZA therapy (P=0.009). The overall colectomy rate was 10%. Predictors of colectomy were drug-related toxicity as the cause of AZA withdrawal (P=0.041), no post-AZA drug therapy (P=0.031), and treatment duration (P<0.0005). Discontinuation of AZA while UC is in remission is associated with a high relapse rate. Disease extent, lack of sustained remission during AZA, and discontinuation due to toxicity could stratify relapse risk. Concomitant aminosalicylates were advantageous. Prospective randomized controlled trials are needed to confirm whether treatment duration is inversely associated with outcome.

  12. Withdrawal symptoms in internet gaming disorder: A systematic review.

    Science.gov (United States)

    Kaptsis, Dean; King, Daniel L; Delfabbro, Paul H; Gradisar, Michael

    2016-02-01

    Internet gaming disorder (IGD) is currently positioned in the appendix of the DSM-5 as a condition requiring further study. The aim of this review was to examine the state of current knowledge of gaming withdrawal symptomatology, given the importance of withdrawal in positioning the disorder as a behavioral addiction. A total of 34 studies, including 10 qualitative studies, 17 research reports on psychometric instruments, and 7 treatment studies, were evaluated. The results indicated that the available evidence on Internet gaming withdrawal is very underdeveloped. Internet gaming withdrawal is most consistently referred to as 'irritability' and 'restlessness' following cessation of the activity. There exists a concerning paucity of qualitative studies that provide detailed clinical descriptions of symptoms arising from cessation of internet gaming. This has arguably compromised efforts to quantify withdrawal symptoms in empirical studies of gaming populations. Treatment studies have not reported on the natural course of withdrawal and/or withdrawal symptom trajectory following intervention. It is concluded that many more qualitative clinical studies are needed, and should be prioritised, to develop our understanding of gaming withdrawal. This should improve clinical descriptions of problematic internet gaming and in turn improve the quantification of IGD withdrawal and thus treatments for harmful internet gaming. Copyright © 2015 Elsevier Ltd. All rights reserved.

  13. [Alcohol withdrawal syndrome dynamics during treatment with nooclerin (deanoli aceglumas)].

    Science.gov (United States)

    Agibalova, T V; Buzik, O Zh; Rychkova, O V; Smyshlyaev, A V; Rumbesht, V V

    2018-01-01

    To study the efficacy of nooclerin (deanoli aceglumas) in alcohol withdrawal syndrome assessed by clinical and biochemical characteristics. A multicenter, open, randomized, comparative study of nooclerin in the complex treatment of alcohol withdrawal syndrome included 90 patients. The patients were randomized into nooclerin group (n=55) and control group (n=35). Nooclerin reduced alcohol withdrawal symptoms more significantly throughout the whole study period. There were significant between-group differences on the Clinical Institute Withdrawal Assessment of Alcohol Scale (CIWA-Ar) and the Multidimensional Fatigue Inventory (МFI-20). However, patients exhibited no excessive activity. No adverse side-effects were observed.

  14. The Non-Proliferation Treaty and the Withdrawal Clause

    International Nuclear Information System (INIS)

    Boutherin, Gregory

    2008-01-01

    Like any international agreement, the NPT includes a withdrawal clause. The North Korean withdrawal, which was announced in 1993 and became effective in 2003, shows how difficult it is to preserve this possibility, while guaranteeing compliance with signed agreements. To achieve this target, two conditions are required: first, enhancing the means by which the reasons for withdrawals can be made clear and second, to allow the Security Council to draw all the consequences of withdrawals that could imply that a treaty has been violated

  15. Official Time as a Form of Union Security in Federal Sector Labor-Management Relations

    National Research Council Canada - National Science Library

    Bullock, Kenneth

    2006-01-01

    Can a nationwide labor-management relations system based on the principle of exclusive representation operate effectively, even if the law deprives the unions of the ability to obtain adequate financial support...

  16. Work-related stress management between workplace and occupational health care.

    Science.gov (United States)

    Kinnunen-Amoroso, Maritta; Liira, Juha

    2016-06-13

    Work-related stress has been evaluated as one of the most important health risks in Europe. Prevention of work related stress and interventions to reduce risk factors for stress in the workplace are conducted together by the enterprise and occupational health services. The aim of the study was to examine the experiences of Finnish occupational physicians on the stress management with enterprises. From the Finnish Association of Occupational Health Physicians membership list 207 physicians responded to self-administered anonymous questionnaire. The data were analysed using SPSS 17.0. The client enterprises contacted occupational health services frequently about work-related stress. Collaboration between occupational health and enterprises was strongest in companies' own occupational health services and generally with most experienced physicians. Occupational health services and enterprises shared responsibility for managing work-related stress. Professional experience and close contact with organisation management favours successful stress management between occupational health and enterprises.

  17. Health-related quality of life and satisfaction with case management in cancer survivors.

    Science.gov (United States)

    Hsu, Ya-Hui; Chai, Hsiu-Ying; Lin, Yu-Fen; Wang, Chao-Hui; Chen, Shu-Ching

    2017-12-01

    To (i) investigate the characteristics of health-related quality of life and satisfaction with case management and (ii) to identify factors associated with health-related quality of life in cancer survivors. The level of health-related quality of life can reflect treatment efficacy and satisfaction with cancer care. A cross-sectional study design was adopted. Subjects from the outpatient setting of a cancer centre in northern Taiwan were recruited by consecutive sampling. A set of questionnaires were employed, including a background information form, case management service satisfaction survey (CMSS) and The European Quality of Life Scale (EQ-5D). Descriptive statistics were used to examine levels of health-related quality of life and satisfaction with case management. Pearson's correlation was used to identify relationships between treatment characteristics, satisfaction with case management and health-related quality of life. Multiple stepwise regression was used to identify factors associated with health-related quality of life. A total of 252 cancer patients were recruited. The three lowest scores for items of health-related quality of life were mobility, self-care and usual activities. Cancer survivors with higher mobility, less pain and discomfort, and lower anxiety and depression were more likely to have better health-related quality of life. Mobility, pain and discomfort, and anxiety and depression are important predictive factors of high health-related quality of life in cancer survivors. In clinical care, patients' physical mobility, pain and discomfort, and anxiety and depression are important indicators of health-related quality of life. Case managers should include self-care and symptom management into survivorship care plans to improve health-related quality of life during survival after treatment concludes. © 2017 John Wiley & Sons Ltd.

  18. Nicotine Withdrawal Disrupts Contextual Learning but Not Recall of Prior Contextual Associations: Implications for Nicotine Addiction

    OpenAIRE

    Portugal, George S.; Gould, Thomas J.

    2008-01-01

    Interactions between nicotine and learning could contribute to nicotine addiction. Although previous research indicates that nicotine withdrawal disrupts contextual learning, the effects of nicotine withdrawal on contextual memories acquired before withdrawal are unknown. The present study investigated whether nicotine withdrawal disrupted recall of prior contextual memories by examining the effects of nicotine withdrawal on recall of nicotine conditioned place preference (CPP) and contextual...

  19. Case management services for work related upper extremity disorders. Integrating workplace accommodation and problem solving.

    Science.gov (United States)

    Shaw, W S; Feuerstein, M; Lincoln, A E; Miller, V I; Wood, P M

    2001-08-01

    A case manager's ability to obtain worksite accommodations and engage workers in active problem solving may improve health and return to work outcomes for clients with work related upper extremity disorders (WRUEDs). This study examines the feasibility of a 2 day training seminar to help nurse case managers identify ergonomic risk factors, provide accommodation, and conduct problem solving skills training with workers' compensation claimants recovering from WRUEDs. Eight procedural steps to this case management approach were identified, translated into a training workshop format, and conveyed to 65 randomly selected case managers. Results indicate moderate to high self ratings of confidence to perform ergonomic assessments (mean = 7.5 of 10) and to provide problem solving skills training (mean = 7.2 of 10) after the seminar. This training format was suitable to experienced case managers and generated a moderate to high level of confidence to use this case management approach.

  20. Sleep Disturbance During Smoking Cessation: Withdrawal or Side Effect of Treatment?

    Science.gov (United States)

    Ashare, Rebecca L; Lerman, Caryn; Tyndale, Rachel F; Hawk, Larry W; George, Tony P; Cinciripini, Paul; Schnoll, Robert A

    2017-06-01

    The nicotine-metabolite ratio (NMR) predicts treatment response and is related to treatment side effect severity. Sleep disturbance may be one important side effect, but understanding sleep disturbance effects on smoking cessation is complicated by the fact that nicotine withdrawal also produces sleep disturbance. To evaluate the effects of withdrawal and treatment side effects on sleep disturbance. This is a secondary analysis of data from a clinical trial (Lerman et al., 2015) of 1,136 smokers randomised to placebo ( n = 363), transdermal nicotine (TN; n = 381), or varenicline ( n = 392) and stratified based on NMR (559 slow metabolisers; 577 normal metabolisers). Sleep disturbance was assessed at baseline and at 1-week following the target quit date (TQD). We also examined whether sleep disturbance predicted 7-day point-prevalence abstinence at end-of-treatment (EOT). The varenicline and TN groups exhibited greater increases in sleep disturbance (vs. placebo; treatment × time interaction; p = 0.005), particularly among those who quit smoking at 1-week post-TQD. There was a main effect of NMR ( p = 0.04), but no interactions with treatment. TN and varenicline attenuated withdrawal symptoms unrelated to sleep (vs. placebo). Greater baseline sleep disturbance predicted relapse at EOT ( p = 0.004). Existing treatments may not mitigate withdrawal-related sleep disturbance and adjunctive treatments that target sleep disturbance may improve abstinence rates.

  1. Efficacy of Tramadol Extended-Release for Opioid Withdrawal: A Randomized Clinical Trial.

    Science.gov (United States)

    Dunn, Kelly E; Tompkins, D Andrew; Bigelow, George E; Strain, Eric C

    2017-09-01

    Opioid use disorder (OUD) is a significant public health problem. Supervised withdrawal (ie, detoxification) from opioids using clonidine or buprenorphine hydrochloride is a widely used treatment. To evaluate whether tramadol hydrochloride extended-release (ER), an approved analgesic with opioid and nonopioid mechanisms of action and low abuse potential, is effective for use in supervised withdrawal settings. A randomized clinical trial was conducted in a residential research setting with 103 participants with OUD. Participants' treatment was stabilized with morphine, 30 mg, administered subcutaneously 4 times daily. A 7-day taper using clonidine (n = 36), tramadol ER (n = 36), or buprenorphine (n = 31) was then instituted, and patients were crossed-over to double-blind placebo during a post-taper period. The study was conducted from October 25, 2010, to June 23, 2015. Retention, withdrawal symptom management, concomitant medication utilization, and naltrexone induction. Results were analyzed over time and using area under the curve for the intention-to-treat and completer groups. Of the 103 participants, 88 (85.4%) were men and 43 (41.7%) were white; mean (SD) age was 28.9 (10.4) years. Buprenorphine participants (28 [90.3%]) were significantly more likely to be retained at the end of the taper compared with clonidine participants (22 [61.1%]); tramadol ER retention was intermediate and did not differ significantly from that of the other groups (26 [72.2%]; χ2 = 8.5, P = .01). Time-course analyses of withdrawal revealed significant effects of phase (taper, post taper) for the Clinical Opiate Withdrawal Scale (COWS) score (taper mean, 5.19 [SE, .26]; post-taper mean, 3.97 [SE, .23]; F2,170 = 3.6, P = .03) and Subjective Opiate Withdrawal Scale (SOWS) score (taper mean,8.81 [SE, .40]; post-taper mean, 4.14 [SE, .30]; F2,170 = 15.7, P withdrawal severity between the taper and post-taper periods for clonidine (taper mean, 13.1; post

  2. Dynamic tables: an architecture for managing evolving, heterogeneous biomedical data in relational database management systems.

    Science.gov (United States)

    Corwin, John; Silberschatz, Avi; Miller, Perry L; Marenco, Luis

    2007-01-01

    Data sparsity and schema evolution issues affecting clinical informatics and bioinformatics communities have led to the adoption of vertical or object-attribute-value-based database schemas to overcome limitations posed when using conventional relational database technology. This paper explores these issues and discusses why biomedical data are difficult to model using conventional relational techniques. The authors propose a solution to these obstacles based on a relational database engine using a sparse, column-store architecture. The authors provide benchmarks comparing the performance of queries and schema-modification operations using three different strategies: (1) the standard conventional relational design; (2) past approaches used by biomedical informatics researchers; and (3) their sparse, column-store architecture. The performance results show that their architecture is a promising technique for storing and processing many types of data that are not handled well by the other two semantic data models.

  3. Hypocretin/orexin signaling in the hypothalamic paraventricular nucleus is essential for the expression of nicotine withdrawal.

    Science.gov (United States)

    Plaza-Zabala, Ainhoa; Flores, África; Maldonado, Rafael; Berrendero, Fernando

    2012-02-01

    Hypocretin (orexin) signaling is involved in drug addiction. In this study, we investigated the role of these hypothalamic neuropeptides in nicotine withdrawal by using behavioral and neuroanatomical approaches. Nicotine withdrawal syndrome was precipitated by mecamylamine (2 mg/kg, subcutaneous) in C57BL/6J nicotine-dependent mice (25 mg/kg/day for 14 days) pretreated with the hypocretin receptor 1 (Hcrtr-1) antagonist SB334867 (5 and 10 mg/kg, intraperitoneal), the hypocretin receptor 2 antagonist TCSOX229 (5 and 10 mg/kg, intraperitoneal), and in preprohypocretin knockout mice. c-Fos expression was analyzed in several brain areas related to nicotine dependence by immunofluorescence techniques. Retrograde tracing with rhodamine-labeled fluorescent latex microspheres was used to determine whether the hypocretin neurons project directly to the paraventricular nucleus of the hypothalamus (PVN), and SB334867 was locally administered intra-PVN (10 nmol/side) to test the specific involvement of Hcrtr-1 in this brain area during nicotine withdrawal. Somatic signs of nicotine withdrawal were attenuated in mice pretreated with SB334867 and in preprohypocretin knockout mice. No changes were found in TCSOX229 pretreated animals. Nicotine withdrawal increased the percentage of hypocretin cells expressing c-Fos in the perifornical, dorsomedial, and lateral hypothalamus. In addition, the increased c-Fos expression in the PVN during withdrawal was dependent on hypocretin transmission through Hcrtr-1 activation. Hypocretin neurons directly innervate the PVN and the local infusion of SB334867 into the PVN decreased the expression of nicotine withdrawal. These data demonstrate that hypocretin signaling acting on Hcrtr-1 in the PVN plays a crucial role in the expression of nicotine withdrawal. Copyright © 2012 Society of Biological Psychiatry. Published by Elsevier Inc. All rights reserved.

  4. Risk factors associated with iatrogenic opioid and benzodiazepine withdrawal in critically ill pediatric patients: a systematic review and conceptual model.

    Science.gov (United States)

    Best, Kaitlin M; Boullata, Joseph I; Curley, Martha A Q

    2015-02-01

    Analgesia and sedation are common therapies in pediatric critical care, and rapid titration of these medications is associated with iatrogenic withdrawal syndrome. We performed a systematic review of the literature to identify all common and salient risk factors associated with iatrogenic withdrawal syndrome and build a conceptual model of iatrogenic withdrawal syndrome risk in critically ill pediatric patients. Multiple databases, including PubMed/Medline, EMBASE, CINAHL, and the Cochrane Central Registry of Clinical Trials, were searched using relevant terms from January 1, 1980, to August 1, 2014. Articles were included if they were published in English and discussed iatrogenic withdrawal syndrome following either opioid or benzodiazepine therapy in children in acute or intensive care settings. Articles were excluded if subjects were neonates born to opioid- or benzodiazepine-dependent mothers, children diagnosed as substance abusers, or subjects with cancer-related pain; if data about opioid or benzodiazepine treatment were not specified; or if primary data were not reported. In total, 1,395 articles were evaluated, 33 of which met the inclusion criteria. To facilitate analysis, all opioid and/or benzodiazepine doses were converted to morphine or midazolam equivalents, respectively. A table of evidence was developed for qualitative analysis of common themes, providing a framework for the construction of a conceptual model. The strongest risk factors associated with iatrogenic withdrawal syndrome include duration of therapy and cumulative dose. Additionally, evidence exists linking patient, process, and system factors in the development of iatrogenic withdrawal syndrome. Most articles were prospective observational or interventional studies. Given the state of existing evidence, well-designed prospective studies are required to better characterize iatrogenic withdrawal syndrome in critically ill pediatric patients. This review provides data to support the

  5. Role of Social Relations of Outside Directors with CEO in Earnings Management

    Directory of Open Access Journals (Sweden)

    Muhammad Shaique

    2017-12-01

    Full Text Available The purpose of this study is to examine the impact of social relations among the board members on earnings management in Pakistani listed companies. Specifically, we have analyzed the social networks between CEO and outside board members. The modified Jones model has been used in this study to measure earnings management and we have captured social relations through SOCIAL (Social networking index. Our results suggest that firms with more connected boards show a positive relationship between board independence and earnings management. Further, we have shown that firms with CEO duality exhibit a higher association between social connections of the board and earnings management than firms with non-duality. Social relations among the board members undermine monitoring ability of outside directors and the impact becomes more severe in the presence of CEO duality.

  6. Gender Differences in Child and Adolescent Social Withdrawal: A Commentary.

    Science.gov (United States)

    Rubin, Kenneth H; Barstead, Matthew G

    2014-04-01

    In a manuscript entitled, "Bashful boys and coy girls: A review of gender differences in childhood shyness" Doey et al. (2013) suggest that shyness and its related constructs pose a greater developmental risk for boys compared to girls. They support this claim by citing empirical evidence suggesting that shy and anxiously withdrawn boys are responded to more negatively by important others (i.e., parents, peers, and teachers) and that the relationship between internalizing problems and anxious withdrawal is stronger for boys compared to girls. The principal aim of our commentary is to provide a critical examination of Doey et al.'s conclusions vis-à-vis gender differences in child and adolescent shyness. In this response, we begin by providing important theoretical background regarding shyness and its related constructs. Next, we critically examine the two main arguments the authors use in support of their conclusion through a review of existing empirical and theoretical work as well as the presentation of data from The Friendship Project . These data were analyzed with the specific purpose of providing an empirical test of the hypotheses implicit in Doey et al.'s primary arguments: 1) shy and anxiously withdrawn boys are responded to more negatively than girls and 2) the association between anxious withdrawal and internalizing problems is stronger for boys compared to girls. Our results indicate mixed support for these two claims. Finally, we conclude by suggesting new directions for future researchers interested in clarifying the relationship between gender and both the correlates and outcomes of childhood shyness.

  7. Simulating the effects of ground-water withdrawals on streamflow in a precipitation-runoff model

    Science.gov (United States)

    Zarriello, Philip J.; Barlow, P.M.; Duda, P.B.

    2004-01-01

    Precipitation-runoff models are used to assess the effects of water use and management alternatives on streamflow. Often, ground-water withdrawals are a major water-use component that affect streamflow, but the ability of surface-water models to simulate ground-water withdrawals is limited. As part of a Hydrologic Simulation Program-FORTRAN (HSPF) precipitation-runoff model developed to analyze the effect of ground-water and surface-water withdrawals on streamflow in the Ipswich River in northeastern Massachusetts, an analytical technique (STRMDEPL) was developed for calculating the effects of pumped wells on streamflow. STRMDEPL is a FORTRAN program based on two analytical solutions that solve equations for ground-water flow to a well completed in a semi-infinite, homogeneous, and isotropic aquifer in direct hydraulic connection to a fully penetrating stream. One analytical method calculates unimpeded flow at the stream-aquifer boundary and the other method calculates the resistance to flow caused by semipervious streambed and streambank material. The principle of superposition is used with these analytical equations to calculate time-varying streamflow depletions due to daily pumping. The HSPF model can readily incorporate streamflow depletions caused by a well or surface-water withdrawal, or by multiple wells or surface-water withdrawals, or both, as a combined time-varying outflow demand from affected channel reaches. These demands are stored as a time series in the Watershed Data Management (WDM) file. This time-series data is read into the model as an external source used to specify flow from the first outflow gate in the reach where these withdrawals are located. Although the STRMDEPL program can be run independently of the HSPF model, an extension was developed to run this program within GenScn, a scenario generator and graphical user interface developed for use with the HSPF model. This extension requires that actual pumping rates for each well be stored

  8. Comparison of vitality states of finishers and withdrawers in trail running: An enactive and phenomenological perspective.

    Directory of Open Access Journals (Sweden)

    Nadège Rochat

    Full Text Available Studies on ultra-endurance suggest that during the races, athletes typically experience three vitality states (i.e., preservation, loss, and revival at the phenomenological level. Nevertheless, how these states contribute to the management and outcome of performance remains unclear. The aim of this study was to determine whether and how the vitality states experienced by runners and their evolution during a trail race can be used to distinguish finishers from withdrawers. From an enactive and phenomenological framework, we processed enactive interviews and blog posts of race narratives. We distinguished units of meaning, which were grouped into sequences of experience; each sequence was then categorized as one of the three vitality states: state of vitality preservation (SVP, state of vitality loss (SVL or state of vitality revival (SVR. We analyzed the distribution of these vitality states and their temporal organization at the beginning, in the second and third quarters, and at the end of the races, and we qualitatively characterized runners' adaptations to SVL. Results showed that finishers completed the race in SVP, with overall significantly more sequences in SVP and significantly fewer sequences in SVL than withdrawers. SVR did not discriminate finishers from withdrawers. The temporal organization of the vitality states showed a significant difference in the emergence of SVP from the second quarter of the race, as well as a significant difference in the emergence of SVL from the third quarter of the race. The analysis of adaptations to SVL confirmed that finishers were more capable of exiting SVL by enacting a preservation world when they felt physical or psychological alerts, whereas withdrawers remained in SVL. Our results showed that finishers and withdrawers did not enact the same phenomenological worlds in the race situation, especially in the organization of vitality adaptations and their relationships to difficulties; the cumulative

  9. Management of radiological related equipments. Creating the equipment management database and analysis of the repair and maintenance records

    International Nuclear Information System (INIS)

    Eguchi, Megumu; Taguchi, Keiichi; Oota, Takashi; Kajiwara, Hiroki; Ono, Kiyotune; Hagio, Kiyofumi; Uesugi, Ekizo; Kajishima, Tetuo; Ueda, Kenji

    2002-01-01

    In 1997, we established the committee of equipments maintenance and management in our department. We designed the database in order to classify and register all the radiological related equipments using Microsoft Access. The management of conditions and cost of each equipment has become easier, by keeping and recording the database in the equipments management ledger and by filing the history of repairs or maintenances occurred to modalities. We then accounted numbers, cost of repairs and downtimes from the data of the repair and maintenance records for four years, and we reexamined the causal analysis of failures and the contents of the regular maintenance for CT and MRI equipments that had shown the higher numbers of repairs. Consequently, we have found the improvement of registration method of the data and the more economical way to use of the cost of repair. (author)

  10. 12 CFR 563g.11 - Withdrawal or abandonment.

    Science.gov (United States)

    2010-01-01

    ... 12 Banks and Banking 5 2010-01-01 2010-01-01 false Withdrawal or abandonment. 563g.11 Section 563g.11 Banks and Banking OFFICE OF THRIFT SUPERVISION, DEPARTMENT OF THE TREASURY SECURITIES OFFERINGS § 563g.11 Withdrawal or abandonment. (a) Any offering circular, amendment, or exhibit may be withdrawn...

  11. 5 CFR 831.1207 - Withdrawal of disability retirement applications.

    Science.gov (United States)

    2010-01-01

    ... type. (d) OPM also considers a disability retirement application to be withdrawn when the agency... 5 Administrative Personnel 2 2010-01-01 2010-01-01 false Withdrawal of disability retirement...) CIVIL SERVICE REGULATIONS (CONTINUED) RETIREMENT Disability Retirement § 831.1207 Withdrawal of...

  12. 49 CFR 450.16 - Withdrawal of delegation.

    Science.gov (United States)

    2010-10-01

    ... 49 Transportation 6 2010-10-01 2010-10-01 false Withdrawal of delegation. 450.16 Section 450.16... SECURITY SAFETY APPROVAL OF CARGO CONTAINERS GENERAL Procedure for Delegation to Approval Authorities § 450.16 Withdrawal of delegation. (a) The Chief, Office of Operating and Environmental Standards (CG-522...

  13. 20 CFR 410.232 - Withdrawal of a claim.

    Science.gov (United States)

    2010-04-01

    ... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false Withdrawal of a claim. 410.232 Section 410.232 Employees' Benefits SOCIAL SECURITY ADMINISTRATION FEDERAL COAL MINE HEALTH AND SAFETY ACT OF 1969... Claims and Evidence § 410.232 Withdrawal of a claim. (a) Before adjudication of claim. A claimant (or an...

  14. 20 CFR 410.690 - Withdrawal of charges.

    Science.gov (United States)

    2010-04-01

    ... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false Withdrawal of charges. 410.690 Section 410.690 Employees' Benefits SOCIAL SECURITY ADMINISTRATION FEDERAL COAL MINE HEALTH AND SAFETY ACT OF 1969... Review, Finality of Decisions, and Representation of Parties § 410.690 Withdrawal of charges. If an...

  15. Trajectories of Social Withdrawal from Middle Childhood to Early Adolescence

    Science.gov (United States)

    Oh, Wonjung; Rubin, Kenneth H.; Bowker, Julie C.; Booth-LaForce, Cathryn; Rose-Krasnor, Linda; Laursen, Brett

    2008-01-01

    Heterogeneity and individual differences in the developmental course of social withdrawal were examined longitudinally in a community sample (N = 392). General Growth Mixture Modeling (GGMM) was used to identify distinct pathways of social withdrawal, differentiate valid subgroup trajectories, and examine factors that predicted change in…

  16. 27 CFR 19.997 - Withdrawal of fuel alcohol.

    Science.gov (United States)

    2010-04-01

    ... 27 Alcohol, Tobacco Products and Firearms 1 2010-04-01 2010-04-01 false Withdrawal of fuel alcohol. 19.997 Section 19.997 Alcohol, Tobacco Products and Firearms ALCOHOL AND TOBACCO TAX AND TRADE BUREAU... and Transfers § 19.997 Withdrawal of fuel alcohol. For each shipment or other removal of fuel alcohol...

  17. 75 FR 12804 - Withdrawal of Regulatory Guide 8.6

    Science.gov (United States)

    2010-03-17

    ... ``Regulatory Guides'' in the NRC's Electronic Reading Room at http://www.nrc.gov/reading-rm/doc-collections... NUCLEAR REGULATORY COMMISSION [NRC-2010-0103] Withdrawal of Regulatory Guide 8.6 AGENCY: Nuclear Regulatory Commission. ACTION: Withdrawal of Regulatory Guide 8.6, ``Standard Test Procedure for Geiger-M...

  18. 40 CFR 180.8 - Withdrawal of petitions without prejudice.

    Science.gov (United States)

    2010-07-01

    ... prejudice. 180.8 Section 180.8 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED... § 180.8 Withdrawal of petitions without prejudice. In some cases the Administrator will notify the... clarification or the obtaining of additional data. This withdrawal may be without prejudice to a future filing...

  19. Employee perceptions of management relations as influences on job satisfaction and quit intentions

    NARCIS (Netherlands)

    Frenkel, S.; Sanders, Karin; Bednall, T.

    2013-01-01

    In this paper we use a relational approach to investigate how employee perceptions of their relationships with three types of managers—senior, line, and human resource managers—are related to employees’ job satisfaction and intention to quit. Based on an employee survey (n = 1,533), and manager

  20. High-Performance Classrooms for Women? Applying a Relational Frame to Management/Organizational Behavior Courses.

    Science.gov (United States)

    Buttner, E. Holly

    2002-01-01

    Attributes of relational theory, based on women's development, include preventive connecting, mutual empowering, achieving, and team building. These attributes are compatible with the practices of high performance work organizations. Relational practices should be integrated into management and organizational behavior courses. (Contains 53…

  1. Monitoring device for withdrawing control rods

    International Nuclear Information System (INIS)

    Higashigawa, Yuichi.

    1985-01-01

    Purpose: To improve the sensitivity and the responsivity to an equivalent extent to those in the case where local power range monitors are densely arranged near each of the control rods, with no actual but pseudo increase of the number of local power range monitors. Constitution: The monitor arrangement is patterned by utilizing the symmetricity of the reactor core and stored in a monitor designating device. The symmetricity of control rods to be selected and withdrawn by an operator is judged by a control rod symmetry monitoring device, while the symmetricity of the withdrawn control rods is judged by a control rod withdrawal state monitoring device. Then, only when both of the devices judge the symmetricity, the control rods are subjected to gang driving by the control rod drive mechanisms. In this way, monitoring at a high sensitivity and responsivity is enabled with no increase for the number of monitors. (Yoshino, Y.)

  2. Clinical Manifestations of the Opiate Withdrawal Syndrome

    Directory of Open Access Journals (Sweden)

    Faniya Shigakova

    2015-09-01

    Full Text Available Currently, substance abuse is one of the most serious problems facing our society. The aim of this study was to investigate the clinical manifestations of the opiate withdrawal syndrome (OWS. The study included 112 patients (57 women and 55 men aged from 18 to 64 years with opium addiction according to the DSM-IV. To study the clinical manifestation of OWS, the special 25-score scale with four sections to assess severity of sleep disorders, pain syndrome, autonomic disorders, and affective symptoms was used. Given the diversity of the OWS symptoms, attention was focused on three clinical variants, affective, algic and mixed. The OWS affective variant was registered more frequently in women, while the mixed type of OWS was more typical of men.

  3. The Public Relations Specialist and his Role in the Management of a Private Company in Galati

    Directory of Open Access Journals (Sweden)

    Daniela Tănase Popa

    2016-12-01

    Full Text Available This paper shows the way in which the specialist in public relations conducts its activity within the private companies of Galati, identifying its role in organizational management. From the theoretical point of view, the paper focuses on definitions of public relations and analyses the role and functions of public relations in an institution and the management of a company. The case study is based on a qualitative analysis. The data collection was conducted through in-depth interview method applied based on a structured guide.

  4. Management of mining-related damages in abandoned underground coal mine areas using GIS

    International Nuclear Information System (INIS)

    Lee, U.J.; Kim, J.A.; Kim, S.S.; Kim, W.K.; Yoon, S.H.; Choi, J.K.

    2005-01-01

    The mining-related damages such as ground subsidence, acid mine drainage (AMD), and deforestation in the abandoned underground coal mine areas become an object of public concern. Therefore, the system to manage the mining-related damages is needed for the effective drive of rehabilitation activities. The management system for Abandoned Underground Coal Mine using GIS includes the database about mining record and information associated with the mining-related damages and application programs to support mine damage prevention business. Also, this system would support decision-making policy for rehabilitation and provide basic geological data for regional construction works in abandoned underground coal mine areas. (authors)

  5. Anticonvulsants for the treatment of alcohol withdrawal syndrome and alcohol use disorders.

    Science.gov (United States)

    Hammond, Christopher J; Niciu, Mark J; Drew, Shannon; Arias, Albert J

    2015-04-01

    Alcoholic patients suffer from harmful allostatic neuroplastic changes in the brain causing an acute withdrawal syndrome upon cessation of drinking followed by a protracted abstinence syndrome and an increased risk of relapse to heavy drinking. Benzodiazepines have long been the treatment of choice for detoxifying patients and managing alcohol withdrawal syndrome (AWS). Non-benzodiazepine anticonvulsants (NBACs) are increasingly being used both for alcohol withdrawal management and for ongoing outpatient treatment of alcohol dependence, with the goal of either abstinence or harm reduction. This expert narrative review summarizes the scientific basis and clinical evidence supporting the use of NBACs in treating AWS and for reducing harmful drinking patterns. There is less evidence in support of NBAC therapy for AWS, with few placebo-controlled trials. Carbamazepine and gabapentin appear to be the most promising adjunctive treatments for AWS, and they may be useful as monotherapy in select cases, especially in outpatient settings and for the treatment of mild-to-moderate low-risk patients with the AWS. The body of evidence supporting the use of the NBACs for reducing harmful drinking in the outpatient setting is stronger. Topiramate appears to have a robust effect on reducing harmful drinking in alcoholics. Gabapentin is a potentially efficacious treatment for reducing the risk of relapse to harmful drinking patterns in outpatient management of alcoholism. Gabapentin's ease of use, rapid titration, good tolerability, and efficacy in both the withdrawal and chronic phases of treatment make it particularly appealing. In summary, several NBACs appear to be beneficial in treating AWS and alcohol use disorders.

  6. A Critical Perspective on Relations between Staff Nurses and their Nurse Manager: Advancing Nurse Empowerment Theory.

    Science.gov (United States)

    Udod, Sonia; Racine, Louise

    2014-12-01

    This study considers empowerment in nurse-manager relations by examining how conflict is handled on both sides and how the critical social perspective has influenced these relations. The authors use inductive analysis of empirical data to explain how (1) nursing work is organized, structured, and circumscribed by centrally determined policies and practices that downplay nurses' professional judgement about patient care; (2) power is held over nurses in their relationship with their manager; and (3) nurses' response to power is to engage in strategies of resistance. The authors illustrate how power influences relations between staff nurses and managers and provide a critical analysis of the strategies of resistance that result in personal, relational, and critical empowerment among staff nurses. Through resistance, staff nurses engage in alternative discourses to counteract the prevailing neoliberal organizational and managerial discourses of efficiency and cost-effectiveness. Copyright© by Ingram School of Nursing, McGill University.

  7. [Effects of gout web based self-management program on knowledge related to disease, medication adherence, and self-management].

    Science.gov (United States)

    Oh, Hyun Soo; Park, Won; Kwon, Seong Ryul; Lim, Mie Jin; Suh, Yeon Ok; Seo, Wha Sook; Park, Jong Suk

    2013-08-01

    This study was conducted to examine the changing patterns of knowledge related to disease, medication adherence, and self-management and to determine if outcomes were more favorable in the experimental group than in the comparison group through 6 months after providing a web-based self-management intervention. A non-equivalent control group quasi-experimental design was used and 65 patients with gout, 34 in experimental group and 31 in comparison group, were selected from the rheumatic clinics of two university hospitals. Data were collected four times, at baseline, at 1 month, 3 months, and 6 months after the intervention. According to the study results, the changing patterns of knowledge and self-management were more positive in the experimental group than in the control group, whereas difference in the changing pattern of medication adherence between two groups was not significant. The results indicate that the web-based self-management program has significant effect on improving knowledge and self-management for middle aged male patients with gout. However, in order to enhance medication adherence, the web-based intervention might not be sufficient and other strategies need to be added.

  8. Why withdrawal from the European Union is undemocratic

    DEFF Research Database (Denmark)

    Olsen, Tore Vincents; Rostbøll, Christian F.

    2017-01-01

    The Lisbon Treaty from 2009 introduced the possibility for individual member states to withdraw from the European Union (EU) on the basis of a unilateral decision. In June 2016 the UK decided to leave the EU invoking article 50 of the treaty. But is withdrawal democratically legitimate? In fact......, the all affected principle suggests that it is undemocratic for subunits to leave larger political units when it adversely affects other citizens without including them in the decision. However, it is unclear what the currency of this affectedness is and, hence, why withdrawal would be undemocratic. We...... argue that it is the effect of withdrawal on the status of citizens as free and equal that is decisive and that explains why unilateral withdrawal of subunits from larger units is democratically illegitimate. Moreover, on the ‘all affected status principle’ that we develop, even multilaterally agreed...

  9. Demand-Withdraw Patterns in Marital Conflict in the Home.

    Science.gov (United States)

    Papp, Lauren M; Kouros, Chrystyna D; Cummings, E Mark

    2009-06-01

    The present study extended laboratory-based findings of demand-withdraw communication into marital conflict in the home and further explored its linkages with spousal depression. U.S. couples (N = 116) provided diary reports of marital conflict and rated depressive symptoms. Hierarchical linear modeling results indicated that husband demand-wife withdraw and wife demand-husband withdraw occurred in the home at equal frequency, and both were more likely to occur when discussing topics that concerned the marital relationship. For both patterns, conflict initiator was positively linked to the demander role. Accounting for marital satisfaction, both demand-withdraw patterns predicted negative emotions and tactics during marital interactions and lower levels of conflict resolution. Spousal depression was linked to increased likelihood of husband demand-wife withdraw.

  10. Opiate Withdrawal Complicated by Tetany and Cardiac Arrest

    Directory of Open Access Journals (Sweden)

    Irfanali R. Kugasia

    2014-01-01

    Full Text Available Patients with symptoms of opiate withdrawal, after the administration of opiate antagonist by paramedics, are a common presentation in the emergency department of hospitals. Though most of opiate withdrawal symptoms are benign, rarely they can become life threatening. This case highlights how a benign opiate withdrawal symptom of hyperventilation led to severe respiratory alkalosis that degenerated into tetany and cardiac arrest. Though this patient was successfully resuscitated, it is imperative that severe withdrawal symptoms are timely identified and immediate steps are taken to prevent catastrophes. An easier way to reverse the severe opiate withdrawal symptom would be with either low dose methadone or partial opiate agonists like buprenorphine. However, if severe acid-base disorder is identified, it would be safer to electively intubate these patients for better control of their respiratory and acid-base status.

  11. Acute coronary ischemia during alcohol withdrawal: a case report

    Directory of Open Access Journals (Sweden)

    Sriram Ganeshalingam

    2011-08-01

    Full Text Available Abstract Introduction The potential of alcohol withdrawal to cause acute coronary events is an area that needs the urgent attention of clinicians and researchers. Case presentation We report the case of a 52-year-old heavy-alcohol-using Sri Lankan man who developed electocardiogram changes suggestive of an acute coronary event during alcohol withdrawal. Despite the patient being asymptomatic, subsequent echocardiogram showed evidence of ischemic myocardial dysfunction. We review the literature on precipitation of myocardial ischemia during alcohol withdrawal and propose possible mechanisms. Conclusions Alcohol withdrawal is a commonly observed phenomenon in hospitals. However, the number of cases reported in the literature of acute coronary events occurring during withdrawal is few. Many cases of acute ischemia or sudden cardiac deaths may be attributed to other well known complications of delirium tremens. This is an area needing the urgent attention of clinicians and epidemiologists.

  12. Nicotine Withdrawal Induces Neural Deficits in Reward Processing.

    Science.gov (United States)

    Oliver, Jason A; Evans, David E; Addicott, Merideth A; Potts, Geoffrey F; Brandon, Thomas H; Drobes, David J

    2017-06-01

    Nicotine withdrawal reduces neurobiological responses to nonsmoking rewards. Insight into these reward deficits could inform the development of targeted interventions. This study examined the effect of withdrawal on neural and behavioral responses during a reward prediction task. Smokers (N = 48) attended two laboratory sessions following overnight abstinence. Withdrawal was manipulated by having participants smoke three regular nicotine (0.6 mg yield; satiation) or very low nicotine (0.05 mg yield; withdrawal) cigarettes. Electrophysiological recordings of neural activity were obtained while participants completed a reward prediction task that involved viewing four combinations of predictive and reward-determining stimuli: (1) Unexpected Reward; (2) Predicted Reward; (3) Predicted Punishment; (4) Unexpected Punishment. The task evokes a medial frontal negativity that mimics the phasic pattern of dopaminergic firing in ventral tegmental regions associated with reward prediction errors. Nicotine withdrawal decreased the amplitude of the medial frontal negativity equally across all trial types (p nicotine dependence (p Nicotine withdrawal had equivocal impact across trial types, suggesting reward processing deficits are unlikely to stem from changes in phasic dopaminergic activity during prediction errors. Effects on tonic activity may be more pronounced. Pharmacological interventions directly targeting the dopamine system and behavioral interventions designed to increase reward motivation and responsiveness (eg, behavioral activation) may aid in mitigating withdrawal symptoms and potentially improving smoking cessation outcomes. Findings from this study indicate nicotine withdrawal impacts reward processing signals that are observable in smokers' neural activity. This may play a role in the subjective aversive experience of nicotine withdrawal and potentially contribute to smoking relapse. Interventions that address abnormal responding to both pleasant and

  13. Withdrawing and withholding medical treatment: a comparative study between the Malaysian, English and Islamic law.

    Science.gov (United States)

    Kassim, Puteri Nemie Jahn; Adeniyi, Omipidan Bashiru

    2010-09-01

    The permissibility and lawfulness of withdrawing and withholding medical treatment has attracted considerable debates and criticisms, as the legal issues are drawn into entering the slippery slope of euthanasia. Proponents of "sanctity of life" views that withdrawing and withholding medical treatment with knowledge that death would result is still within the sphere of euthanasia, whereas proponents of "quality of life" argue that it is not, as death is not intended. Their arguments maintain that for patients who are totally dependant on machines to ensure the work of some bodily functions, living may amount to little more than survival as dying is prolonged. Furthermore, the prolonging of life of the dying patient has profound implications on patients themselves, their relatives, dependants and medical providers. Thus, withdrawing and withholding medical treatment would not only respect a patient's right to self-determination, by allowing them to die in their underlying condition, but will ensure that medical providers are able to concentrate on more worthwhile treatments. This paper discusses the intractable difficulties with the moral distinction between withholding and withdrawing treatment and euthanasia, as well as makes a comparative study between the present state of law in Malaysia and England on this issue. The paper further highlights the differences between civil law and Islamic law in this controversial area.

  14. Phenolic Compounds Protect Cultured Hippocampal Neurons against Ethanol-Withdrawal Induced Oxidative Stress

    Directory of Open Access Journals (Sweden)

    Marianna E. Jung

    2009-04-01

    Full Text Available Ethanol withdrawal is linked to elevated oxidative damage to neurons. Here we report our findings on the contribution of phenolic antioxidants (17β-estradiol, p-octyl-phenol and 2,6-di-tert-butyl-4-methylphenol to counterbalance sudden ethanol withdrawal-initiated oxidative events in hippocampus-derived cultured HT-22 cells. We showed that ethanol withdrawal for 4 h after 24-h ethanol treatment provoked greater levels of oxidative damage than the preceding ethanol exposure. Phenolic antioxidant treatment either during ethanol exposure or ethanol withdrawal only, however, dose-dependently reversed cellular oxidative damage, as demonstrated by the significantly enhanced cell viability, reduced malondialdehyde production and protein carbonylation, compared to untreated cells. Interestingly, the antioxidant treatment schedule had no significant impact on the observed neuroprotection. In addition, the efficacy of the three phenolic compounds was practically equipotent in protecting HT-22 cells in spite of predictions based on an in silico study and a cell free assay of lipid peroxidation. This finding implies that free-radical scavenging may not be the sole factor responsible for the observed neuroprotection and warrants further studies to establish, whether the HT-22 line is indeed a suitable model for in vitro screening of antioxidants against EW-related neuronal damage.

  15. Assessment of the MDNBR enhancement methodologies for the SMART control rods banks withdrawal event

    International Nuclear Information System (INIS)

    Yang, Soo Hyung; Chung, Young-Jong; Kim, Hee Cheol

    2005-01-01

    For an electricity generation and seawater desalination, a 330 MW System-integrated Modular Advanced ReacTor (SMART) was developed by KAERI. The safety level of the SMART is enhanced when compared to that of the typical commercial reactors, with the aid of an elimination of a large break loss of coolant accident by placing the major components of the primary system in a reactor vessel and the adoption of a new technology and a passive design concept into the safety system. However, the events related to reactivity and power distribution anomalies have been evaluated as vulnerable points when compared to the other initiating events in the SMART, since the reactivity worth of the control rods (CR) banks is quite large due to the boron free core concept. Especially, safety margins, i.e., minimum departure from nucleate boiling ratio (MDNBR), are significantly threatened during the CR banks withdrawal event. Therefore, MDNBR enhancement methodology for the CR banks withdrawal event should be considered to further enhance the safety level of the SMART design. Two methodologies have been suggested to enhance the MDNBR during the CR banks withdrawal event: the application of a DNBR trip function into a core protection system and a turbine trip delay methodology. Sensitivity studies are performed to evaluate the two MDNBR enhancement methodologies and show that the suggested methodologies could enhance the MDNBR during the CR banks withdrawal event of the SMART

  16. A Review Study on the Effect of Iranian Herbal Medicines on Opioid Withdrawal Syndrome.

    Science.gov (United States)

    Ebrahimie, Marzieh; Bahmani, Mahmoud; Shirzad, Hedayatollah; Rafieian-Kopaei, Mahmoud; Saki, Kourosh

    2015-10-01

    Addiction is a chronic and recurring disease that recurrence phenomenon is the most important challenge in treatment of this disease. Recent experiences have shown that synthetic drugs have undesirable side effects. Recent studies on medicinal plants have shown that they might be effective in treatment of different stages of addiction with lower side effects and costs. The aim of this study was to review the effects of medicinal plants in the treatment of morphine addiction in experimental animals. In this review article, by using keywords of morphine, withdrawal, and plants or herbal medicine in databases of indexing cites, desired articles were obtained since 1994. Inclusion criteria for selecting articles were the articles related to application of medicinal plants in decreasing symptoms resulting from morphine withdrawal were selected. Results of this study on experimental studies have shown that medicinal plants such as Trachyspermum copticum L and Melissa officinalis decrease the symptoms of withdrawal syndrome in a dose-dependent. Also, medicinal plants like Avena sativa, Hypericum perforatu, Passiflora incarnate, Valeriana officinalis, Satureja hortensis L, and Mentha piperita can have effects on behavior, emotions, and other problems of addicts, decreasing withdrawal symptoms. Results of this study showed that medicinal plants can be effective in controlling deprivation, decreasing dependency creation, and possibly DETOXIFICATION: of opioid addicts. © The Author(s) 2015.

  17. Experiences addressing health-related financial challenges with disease management among African American women with asthma.

    Science.gov (United States)

    Patel, Minal R; Caldwell, Cleopatra H; Id-Deen, Effat; Clark, Noreen M

    2014-06-01

    Despite economic hardship, compliance with self-management regimens is still evident among individuals and families managing chronic disease. The purpose of this study was to describe how women with asthma address cost-related challenges to management of their condition. In 2012 and 2013, four focus groups were conducted in Southeast Michigan with 26 African American women with asthma, recruited based on maximum variation sampling procedures. A semi-structured interview protocol was employed by trained facilitators. Coded transcripts were analyzed for themes regarding means to reduce the impact of the cost of asthma management. Major themes identified were acceptance of the status quo; stockpiling and sharing medicines; utilizing community assistance programs; reaching out to healthcare providers and social networks for help; foregoing self-management; and utilizing urgent care. Awareness of strategies that are helpful to patients in reducing out-of-pocket costs may better equip service providers and others to develop interventions to make useful strategies more widely available.

  18. The discourse of health managers on aspects related to the delay in tuberculosis diagnosis

    Directory of Open Access Journals (Sweden)

    Lenilde Duarte de Sa

    2013-10-01

    Full Text Available The aim of this study was to analyze the discourse of health managers on aspects related to delay in tuberculosis diagnosis. This was a qualitative research study, conducted with 16 Family Health Unit managers. The empirical data were obtained through semi-structured interviews. The analysis was based on the theoretical framework of the French school of discourse analysis. According to the managers’ statements, the delay in tuberculosis diagnosis is related to patient and health service aspects. As for patient aspects, managers report fear, prejudice and lack of information as factors that may promote a delayed diagnosis. Regarding health service aspects, structural problems and lack of professional skills were reported. The discourse of managers should be considered to qualify tuberculosis control actions and to prevent delays in diagnosis.

  19. Withdrawing to a Virtual World: Associations between Subtypes of Withdrawal, Media Use, and Maladjustment in Emerging Adults

    Science.gov (United States)

    Nelson, Larry J.; Coyne, Sarah M.; Howard, Emily; Clifford, Brandon N.

    2016-01-01

    An approach-avoidance model of social withdrawal (Asendorpf, 1990) identifies 3 types of social withdrawal including shyness, unsociability, and avoidance. Each appears to be uniquely associated with varying indicators of maladjustment in emerging adulthood (Nelson, 2013) but little, if any, work has been done to see how they might be linked to…

  20. Methods for Estimating Water Withdrawals for Mining in the United States, 2005

    Science.gov (United States)

    Lovelace, John K.

    2009-01-01

    The mining water-use category includes groundwater and surface water that is withdrawn and used for nonfuels and fuels mining. Nonfuels mining includes the extraction of ores, stone, sand, and gravel. Fuels mining includes the extraction of coal, petroleum, and natural gas. Water is used for mineral extraction, quarrying, milling, and other operations directly associated with mining activities. For petroleum and natural gas extraction, water often is injected for secondary oil or gas recovery. Estimates of water withdrawals for mining are needed for water planning and management. This report documents methods used to estimate withdrawals of fresh and saline groundwater and surface water for mining during 2005 for each county and county equivalent in the United States, Puerto Rico, and the U.S. Virgin Islands. Fresh and saline groundwater and surface-water withdrawals during 2005 for nonfuels- and coal-mining operations in each county or county equivalent in the United States, Puerto Rico, and the U.S. Virgin Islands were estimated. Fresh and saline groundwater withdrawals for oil and gas operations in counties of six states also were estimated. Water withdrawals for nonfuels and coal mining were estimated by using mine-production data and water-use coefficients. Production data for nonfuels mining included the mine location and weight (in metric tons) of crude ore, rock, or mineral produced at each mine in the United States, Puerto Rico, and the U.S. Virgin Islands during 2004. Production data for coal mining included the weight, in metric tons, of coal produced in each county or county equivalent during 2004. Water-use coefficients for mined commodities were compiled from various sources including published reports and written communications from U.S. Geological Survey National Water-use Information Program (NWUIP) personnel in several states. Water withdrawals for oil and gas extraction were estimated for six States including California, Colorado, Louisiana, New

  1. Baseline geophysical data for hazard management in coastal areas in relation to earthquakes and tsunamis

    Digital Repository Service at National Institute of Oceanography (India)

    Murthy, K.S.R.

    is another factor for some of the intraplate earthquakes in the South Indian Shield, which includes the Eastern and Western Continental Margins of India. Baseline geophysical data for hazard management in coastal areas in relation to earthquakes... surge. Keywords Hazard management, marine geophysical data, geomorphology and tsunami surge, coastal seismicity Date received: 7 August 2015; accepted: 15 October 2015 CSIR – National Institute of Oceanography, Visakhapatnam, India Corresponding author...

  2. Quality Management, Job-related Contentment and Performance: an empirical analysis of British workplaces

    OpenAIRE

    de Menezes, L. M.; Wood, S.

    2015-01-01

    Purpose - This article investigates whether a quality management philosophy underlies the joint use of operations and human resource management practices, and the relationships with job-related contentment and performance.\\ud \\ud Design/ methodology/approach - Data from an economy-wide survey is used to test hypotheses via latent variable analyses (latent trait and latent class models) and structural equation models. The sensitivity of each path is then assessed using regression models.\\ud \\u...

  3. First Approximations of Prescribed Fire Risks Relative to Other Management Techniques Used on Private Lands.

    Directory of Open Access Journals (Sweden)

    Dirac Twidwell

    Full Text Available Fire is widely recognized as a critical ecological and evolutionary driver that needs to be at the forefront of land management actions if conservation targets are to be met. However, the prevailing view is that prescribed fire is riskier than other land management techniques. Perceived risks associated with the application of fire limits its use and reduces agency support for prescribed burning in the private sector. As a result, considerably less cost-share support is given for prescribed fire compared to mechanical techniques. This study tests the general perception that fire is a riskier technique relative to other land management options. Due to the lack of data available to directly test this notion, we use a combination of approaches including 1 a comparison of fatalities resulting from different occupations that are proxies for techniques employed in land management, 2 a comparison of fatalities resulting from wildland fire versus prescribed fire, and 3 an exploration of causal factors responsible for wildland fire-related fatalities. This approach establishes a first approximation of the relative risk of fatality to private citizens using prescribed fire compared to other management techniques that are readily used in ecosystem management. Our data do not support using risks of landowner fatalities as justification for the use of alternative land management techniques, such as mechanical (machine-related equipment, over prescribed fire. Vehicles and heavy machinery are consistently leading reasons for fatalities within occupations selected as proxies for management techniques employed by ranchers and agricultural producers, and also constitute a large proportion of fatalities among firefighters. Our study provides the foundation for agencies to establish data-driven decisions regarding the degree of support they provide for prescribed burning on private lands.

  4. Attitudes to the administrative management of service patients with epilepsy and related disorders among army physicians.

    Science.gov (United States)

    Whiteoak, R; Findley, L J

    1986-02-01

    The case histories of ten patients suffering from epilepsy or related disorders were sent to all serving Consultant Physicians and Senior Specialists in Medicine in the Army. They were asked their opinions on the PULHEEMS Grading and restriction of duty in each case. In many cases there was a wide range of opinion on the management. Clearer guidelines concerning the diagnosis and administrative management of patients need to be drawn up to allow Service physicians to be consistent and fair to their patients.

  5. Organizational needs for managing and preserving geospatial data and related electronic records

    Directory of Open Access Journals (Sweden)

    R R Downs

    2006-01-01

    Full Text Available Government agencies and other organizations are required to manage and preserve records that they create and use to facilitate future access and reuse. The increasing use of geospatial data and related electronic records presents new challenges for these organizations, which have relied on traditional practices for managing and preserving records in printed form. This article reports on an investigation of current and future needs for managing and preserving geospatial electronic records on the part of localand state-level organizations in the New York City metropolitan region. It introduces the study and describes organizational needs observed, including needs for organizational coordination and interorganizational cooperation throughout the entire data lifecycle.

  6. 10 CFR Appendix F to Part 50 - Policy Relating to the Siting of Fuel Reprocessing Plants and Related Waste Management Facilities

    Science.gov (United States)

    2010-01-01

    ... and Related Waste Management Facilities F Appendix F to Part 50 Energy NUCLEAR REGULATORY COMMISSION... Relating to the Siting of Fuel Reprocessing Plants and Related Waste Management Facilities 1. Public health... facilities for the temporary storage of highlevel radioactive wastes, may be located on privately owned...

  7. [Opioid therapy for chronic noncancer pain: retrospective analysis of patients hospitalized for withdrawal].

    Science.gov (United States)

    Faure, Delinger; Giniès, Patrick; Eiden, Céline; Portet, Laure; Peyrière, Hélène

    2013-01-01

    The prescription of opioids for the treatment of chronic non-cancer pain (CNCP) is not recommended for all of them, and can expose the patients to a benefit/risk ratio unfavorable. The objective of this study was to evaluate the management of patients hospitalized at the centre for evaluation and treatment of pain for opioid withdrawal, their outcome during hospitalization. This is a retrospective descriptive study. The medical record of each patient was consulted to identify relevant data (demographics, treatments at the entrance and discharge of hospitalization, comorbidities, rating scale of pain). During the study period (3 years), 53 patients (64% of women), with a median age of 52 years, were included. Pain was mainly back pain and neck pain (52%). Morphine (43%) and fentanyl (42%) were the most frequently used opioids. At admission, 62% of patients had a depressive state. At hospital discharge, withdrawal was total in 18 patients (34%) and a total improvement of pain was observed for 19% of them. In this study, 57% of patients received, at admission to hospital, an opioid other than morphine in the treatment of CNCP. The management of pain offered by the pain clinic led to a total or partial opioid withdrawal in 94% of patients. © 2013 Société Française de Pharmacologie et de Thérapeutique.

  8. The Successful Treatment of Opioid Withdrawal-Induced Refractory Muscle Spasms with 5-HTP in a Patient Intolerant to Clonidine.

    Science.gov (United States)

    Dais, Jennifer; Khosia, Ankur; Doulatram, Gulshan

    2015-01-01

    Instituting drug holidays for chronic opioid using patients is becoming commonplace for pain practitioners initiating procedures such as intrathecal pump or spinal cord stimulator trials. As such, pain practitioners need to be adept in their management of acute opioid withdrawal. Successfully weaning an opioid dependent patient off of chronic opioids requires a thorough knowledge of the available adjuvants to assist in this process. However, that selection can become exhausted by adjuvant side effects or by ineffective attenuation of opioid withdrawal symptoms. In that case, novel drugs, or novel application of currently available medications must be sought after to assist in the drug holiday. We present a case in which refractory muscle spasms secondary to opioid withdrawal were successfully treated with an over-the-counter supplement that is not typically used for the attenuation of opioid withdrawal symptoms. In a patient intolerant to the side effects of clonidine, we were able to successfully wean chronic opiates by treating refractory muscle spasms with the serotonin precursor, 5-hydroxytryptophan (5-HTP). We hypothesize that our success with this medication gives further credence to the role of serotonin in opioid withdrawal somatic symptomatology, and supports the need for future research to clarify the role of serotonin precursors or serotonin modulating drugs as potential alternatives in those unable to follow standard treatment protocols.

  9. Implementation of public management of social relations in the face of social changes

    Directory of Open Access Journals (Sweden)

    Andrii Leonidovych Prokopenko

    2013-11-01

    Full Text Available The article considers the problems of regulation of social relations in Ukraine, particularly in the economic, political and humanitarian sphere. Based on the analysis of works of Western social theorists, as well as international experience, defines the basic directions of modernization of public management of social relations in the conditions of social changes. Deals with the historical background of review governance model and consider it as a system that creates and develops the potential of self-government of private and public, individual and collective social actors. Highlights the role of the implementation of public management approaches that stimulate engagement of public institutions, individual and organized public services users to develop policy initiatives for better public management of social relations.

  10. Factors influencing emergency medicine physicians' management of sports-related concussions: a community-wide study.

    Science.gov (United States)

    Giebel, Stephen; Kothari, Rashmi; Koestner, Amy; Mohney, Gretchen; Baker, Robert

    2011-12-01

    Numerous guidelines to grade and manage sports-related concussions have been published. However, little is known about how frequently they are implemented in the emergency department. This study evaluates the current practices of emergency physicians (EPs) in managing sports-related concussions. To evaluate the current practice of EP evaluation and management of sports-related concussions. All EPs and emergency medicine residents in Kalamazoo County were surveyed regarding their management of sports-related concussions. The surveys obtained demographic data, participants' use of guidelines, and the importance of clinical and non-clinical factors in deciding when to allow a player to return to play. Of the 73 EP respondents, only 23% used a nationally recognized guideline, with no significant difference between attending and resident EPs. The symptomatic complaints of loss of consciousness, amnesia of the event, and difficulty concentrating were ranked most important by EPs in assessing patients with sports-related concussions. Among non-clinical factors, residents were significantly more likely than attendings to report that medical-legal, parental, and players' concerns were more likely to influence their decision in allowing a patient to return to play. EPs take into consideration important clinical factors in assessing patients with sports-related concussion. However, almost 75% do not use any nationally recognized guideline in their evaluation. Residents are more likely than attendings to be influenced by non-clinical factors. Copyright © 2011 Elsevier Inc. All rights reserved.

  11. Symposium on diseases related to ultraviolet radiation: A risk-management approach

    International Nuclear Information System (INIS)

    Gibbons, L.

    1992-01-01

    A symposium on diseases related to ultraviolet radiation (UVR), sponsored by the Laboratory Centre for Disease Control was attended by 50 national and international experts in the fields of dermatology, ophthalmology and epidemiology, as well as representatives from various national and provincial public health organizations. The objectives of the symposium were as follows: to review the evidence relating UVR to the incidence of melanoma of the skin and eye, non melanotic cancer of the skin and lip, nonmalignant skin conditions and cataract; to review the effectiveness of primary prevention and early detection of UVR-related diseases; and to recommend strategies for risk management through regulation, public education and screening programs, as well as research priorities. Fourteen experts presented papers on issues related to UVR exposure. After the presentations the participants met in working groups to discuss questions pertaining to the identification, assessment and management of health risks relating to UVR. (author)

  12. A CONSOLIDATED MODEL OF ANALYSIS OF THE RELATIONS BETWEEN POLITICS AND MANAGEMENT WITHIN PUBLIC ORGANIZATIONS

    Directory of Open Access Journals (Sweden)

    Catalina Maria GEORGESCU

    2011-01-01

    Full Text Available An interdisciplinary approach which combines the theoretical, empirical andconceptual dimensions, the present study tries to offer a new workperspective on the assessment and modeling of the relation between themanagement of public organizations and the political environment. Thetheoretical research was centered on reviewing the literature on the relationbetween the management of public organizations and the politicalenvironment. The empirical research was materialized by modeling with theregression technique of several aspects integrated to the relations betweenthe management of human resources within public organizations in theeducation field and the external political environment.

  13. Psychosocial withdrawal characteristics of nicotine compared with alcohol and caffeine.

    Science.gov (United States)

    Miyata, Hisatsugu; Hironaka, Naoyuki; Takada, Kohji; Miyasato, Katsumasa; Nakamura, Koichi; Yanagita, Tomoji

    2008-10-01

    The purpose of the present study was to observe the psychosocial characteristics of withdrawal from cigarette smoking in comparison with those from caffeine (CAF) and alcoholic (ALC) beverage withdrawal. Twenty-seven healthy volunteers at a medial level of dependence on both cigarettes (nicotine, NCT) and either CAF or ALC, as judged by the DSM-IV-TR criteria for substance dependence, participated in this study. The participants were required to abstain from smoking and either CAF or ALC for 7 days, each one after another, with a 7-day interval. The order of abstinence was counterbalanced among the participants. Psychosocial parameters, including a desire for substances, social activity function, well-being, withdrawal symptoms, and vital signs, were assessed during the withdrawal periods. The study protocol was approved by the Jikei University Review Board. The results indicated that there were no differences in the maximum level of desire for a substance and the influence on social activity function between NCT and other substances during the withdrawal periods. As for withdrawal symptoms, NCT caused a more intensive degree of irritability than CAF or ALC, and a more intensive degree of difficulty concentrating and restlessness than did withdrawal from ALC. However, the subjective well-being questionnaire indicated no differences in these symptoms between NCT and other substances. The present results suggest that there are no significant differences in psychosocial manifestations regarding the difficulty in abstaining from NCT, CAF, and ALC.

  14. Cannabis Withdrawal in Adults With Attention-Deficit/Hyperactivity Disorder.

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    Chauchard, Emeline; Hartwell, Karen J; McRae-Clark, Aimee L; Sherman, Brian J; Gorelick, David A

    2018-02-22

    Cannabis withdrawal has not been studied in adults with attention-deficit/hyperactivity disorder (ADHD) who have high rates of cannabis use. We aimed to describe cannabis withdrawal, motivations to quit, and strategies to quit cannabis use in cannabis-dependent adults with ADHD. Twenty-three adults with ADHD enrolled in a controlled clinical trial of pharmacotherapy (atomoxetine) for cannabis dependence (DSM-IV criteria) completed the Marijuana Quit Questionnaire (MJQQ) to provide information on their "most serious" quit attempt made without formal treatment. The study was conducted between November 2005 and June 2008. Participants were predominantly male (82.6%, n = 19), with a mean (SD) age of 27.4 (8.5) years (range, 18-53) at the start of their index quit attempt. The most common motive for quitting cannabis was "to save money" (87%, n = 20); the most common strategy to maintain abstinence was "stopped associating with people who smoke marijuana" (43%, n = 10). Almost all (96%, n = 22) subjects reported ≥ 1 cannabis withdrawal symptom; 7 (30%) met DSM-5 diagnostic criteria for cannabis withdrawal syndrome. Participants with comorbid ADHD and cannabis dependence reported withdrawal symptoms similar to other samples of non-treatment-seeking cannabis-dependent adults with no psychiatric comorbidity. These findings suggest that ADHD does not influence cannabis withdrawal in the way that it does tobacco (nicotine) withdrawal. Data used in this secondary analysis came from ClinicalTrials.gov identifier: NCT00360269. © Copyright 2018 Physicians Postgraduate Press, Inc.

  15. Effect of Morphine Withdrawal Syndrome on Cerebral Ischemia

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    Mohammad Allahtavakoli

    2011-01-01

    Full Text Available Objective(sOpioid abuse is still remained a major mental health problem, a criminal legal issue and may cause ischemic brain changes including stroke and brain edema. In the present study, we investigated whether spontaneously withdrawal syndrome might affect stroke outcomes.Materials and MethodsAddiction was induced by progressive incremental doses of morphine over 7 days. Behavioral signs of withdrawal were observed 24, 48 and 72 hr after morphine deprivation and total withdrawal score was determined. Cerebral ischemia was induced 18-22 hr after the last morphine injection by placing a natural clot into the middle cerebral artery (MCA. Neurological deficits were evaluated at 2, 24 and 48 hr after ischemia induction, and infarct size and brain edema were determined at 48 hr after stroke.ResultsMorphine withdrawal animals showed a significant increase in total withdrawal score and decrease of weight gain during the 72 hr after the last morphine injection. Compared to the addicted and control animals, infarct volume and brain edema were significantly increased in the morphine deprived animals (P< 0.05 at 48 hr after cerebral ischemia. Also, neurological deficits were higher in the morphine-withdrawn rats at 48 hr after stroke (P< 0.05. ConclusionOur data indicates that spontaneous withdrawal syndrome may worsen stroke outcomes. Further investigations are necessary to elucidate mechanisms of opiate withdrawal syndrome on stroke.

  16. [The effect of palonosetron on rocuronium-induced withdrawal movement].

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    Park, Ki-Bum; Jeon, Younghoon; Yi, Junggu; Kim, Ji-Hyun; Chung, Seung-Yeon; Kwak, Kyung-Hwa

    Rocuronium causes pain and withdrawal movement during induction of anesthesia. In this study, palonosetron was investigated to have analgesic effect on the reduction of rocuronium-induced withdrawal movement. 120 patients were randomly assigned to one of three groups to receive either saline, lidocaine 20mg, or palonosetron 0.075mg with a tourniquet applied two minutes before thiopental sodium (5mg.kg -1 ) was given intravenously. After loss of consciousness, rocuronium (0.6mg.kg -1 ) was injected and the withdrawal movement was estimated by 4-point scale in a double-blind manner. The overall incidence of rocuronium withdrawal movement was 50% with lidocaine (p=0.038), 38% with palonosetron (p=0.006) compared with 75% for saline. The incidence of no pain to mild pain was significantly lower in the lidocaine and palonosetron groups (85% and 92% respectively) than in the saline group (58%). However, there was no significant difference in withdrawal movement between the lidocaine and palonosetron groups. There was no severe movement with palonosetron. Pretreatment of palonosetron with venous occlusion may attenuate rocuronium-induced withdrawal movement as effective as the use of lidocaine. It suggested that peripheral action of palonosetron was effective to reduce rocuronium-induced withdrawal movement. Copyright © 2016. Publicado por Elsevier Editora Ltda.

  17. Opioid withdrawal signs and symptoms in children: frequency and determinants.

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    Fisher, Deborah; Grap, Mary Jo; Younger, Janet B; Ameringer, Suzanne; Elswick, R K

    2013-01-01

    The purpose of this study was to, in a pediatric population, describe the frequency of opioid withdrawal signs and symptoms and to identify factors associated with these opioid withdrawal signs and symptoms. Opioids are used routinely in the pediatric intensive care population for analgesia, sedation, blunting of physiologic responses to stress, and safety. In children, physical dependence may occur in as little as 2-3 days of continuous opioid therapy. Once the child no longer needs the opioid, the medications are reduced over time. A prospective, descriptive study was conducted. The sample of 26 was drawn from all patients, ages 2 weeks to 21 years admitted to the Children's Hospital of Richmond pediatric intensive care unit (PICU) and who have received continuous infusion or scheduled opioids for at least 5 days. Data collected included: opioid withdrawal score (WAT-1), opioid taper rate (total dose of opioid per day in morphine equivalents per kilogram [MEK]), pretaper peak MEK, pretaper cumulative MEK, number of days of opioid exposure prior to taper, and age. Out of 26 enrolled participants, only 9 (45%) had opioid withdrawal on any given day. In addition, there was limited variability in WAT-1 scores. The most common symptoms notes were diarrhea, vomit, sweat, and fever. For optimal opioid withdrawal assessments, clinicians should use a validated instrument such as the WAT-1 to measure for signs and symptoms of opioid withdrawal. Further research is indicated to examine risk factors for opioid withdrawal in children. Copyright © 2013 Elsevier Inc. All rights reserved.

  18. Negative Affect and Excessive Alcohol Intake Incubate during Protracted Withdrawal from Binge-Drinking in Adolescent, But Not Adult, Mice

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    Kaziya M. Lee

    2017-07-01

    Full Text Available Binge-drinking is common in underage alcohol users, yet we know little regarding the biopsychological impact of binge-drinking during early periods of development. Prior work indicated that adolescent male C57BL6/J mice with a 2-week history of binge-drinking (PND28-41 are resilient to the anxiogenic effects of early alcohol withdrawal. Herein, we employed a comparable Drinking-in-the-Dark model to determine how a prior history of binge-drinking during adolescence (EtOHadolescents influences emotionality (assayed with the light-dark box, marble burying test, and the forced swim test and the propensity to consume alcohol in later life, compared to animals without prior drinking experience. For additional comparison, adult mice (EtOHadults with comparable drinking history (PND56-69 were subdivided into groups tested for anxiety/drinking either on PND70 (24 h withdrawal or PND98 (28 days withdrawal. Tissue from the nucleus accumbens shell (AcbSh and central nucleus of the amygdala (CeA was examined by immunoblotting for changes in the expression of glutamate-related proteins. EtOHadults exhibited some signs of hyperanxiety during early withdrawal (PND70, but not during protracted withdrawal (PND98. In contrast, EtOHadolescents exhibited robust signs of anxiety-l and depressive-like behaviors when tested as adults on PND70. While all alcohol-experienced animals subsequently consumed more alcohol than mice drinking for the first time, alcohol intake was greatest in EtOHadolescents. Independent of drinking age, the manifestation of withdrawal-induced hyperanxiety was accompanied by reduced Homer2b expression within the CeA and increased Group1 mGlu receptor expression within the AcbSh. The present data provide novel evidence that binge-drinking during adolescence produces a state characterized by profound negative affect and excessive alcohol consumption that incubates with the passage of time in withdrawal. These data extend our prior studies on the

  19. Profitability recent open stock funds in Brazil: analysis of the performance of a management Funds Group active in relation to management fees charged for resource managers

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    Sergio Ricardo Mendes Vasconcelos

    2016-10-01

    Full Text Available This paper aimed to evaluate the performance of a specific group of active management equity investments funds relating it to the management fees charged by managers in order to answer the following research problem: open equity funds with active management, that charge higher management fees, are those that provide the best returns for the investor? The objective was to test the hypothesis under which it is evident that the funds that charged the highest rates are those with the best performances evaluated according to the average yield of the last five years. To achieve this objective, a study of descriptive nature was carried out with a quantitative approach having as object of study the profitability of Brazilian Equity Fund ranked by the Brazilian Association of Financial and Capital Markets (Anbima as IBX Active Equity Funds in the period 2010 to 2014. The analyzed returns were calculated from the Information ratio index, which measures the risk-adjusted return of the asset class. The study found no correlation between the performance of the funds and charged management fees.

  20. Tobacco withdrawal symptoms mediate motivation to reinstate smoking during abstinence.

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    Aguirre, Claudia G; Madrid, Jillian; Leventhal, Adam M

    2015-08-01

    Withdrawal-based theories of addiction hypothesize that motivation to reinstate drug use following acute abstinence is mediated by withdrawal symptoms. Experimental tests of this hypothesis in the tobacco literature are scant and may be subject to methodological limitations. This study utilized a robust within-subject laboratory experimental design to investigate the extent to which composite tobacco withdrawal symptomatology level and 3 unique withdrawal components (i.e., low positive affect, negative affect, and urge to smoke) mediated the effect of smoking abstinence on motivation to reinstate smoking. Smokers (≥10 cigarettes per day; N = 286) attended 2 counterbalanced sessions at which abstinence duration was differentially manipulated (1 hr vs. 17 hr). At both sessions, participants reported current withdrawal symptoms and subsequently completed a task in which they were monetarily rewarded proportional to the length of time they delayed initiating smoking, with shorter latency reflecting stronger motivation to reinstate smoking. Abstinence reduced latency to smoking initiation and positive affect and increased composite withdrawal symptom level, urge, and negative affect. Abstinence-induced reductions in latency to initiating smoking were mediated by each withdrawal component, with stronger effects operating through urge. Combined analyses suggested that urge, negative affect, and low positive affect operate through empirically unique mediational pathways. Secondary analyses suggested similar effects on smoking quantity, few differences among specific urge and affect subtypes, and that dependence amplifies some abstinence effects. This study provides the first experimental evidence that within-person variation in abstinence impacts motivation to reinstate drug use through withdrawal. Urge, negative affect, and low positive affect may reflect unique withdrawal-mediated mechanisms underlying tobacco addiction. (c) 2015 APA, all rights reserved).