WorldWideScience

Sample records for range land withdrawal

  1. Land Use Withdrawal, McGregor Range, Fort Bliss, Texas

    Science.gov (United States)

    1977-08-01

    34Ferruginous owl." 5. Page A-34, table 5 (cont), under Order Passeriformes - Perching Birds : delete "Wied’s crested flycatcher" and "Olivaceous...2. Page A-23, paragraph d: delete the reference to "ferruginous owl o" 3. Page A-32, table 4 under I. Birds : delete "Red-shouldered hawk." Delete...that are common to the entire range (e.g., many birds and rodents). The biota of the five ecozones or communities is in constant interaction, and even

  2. 75 FR 27361 - Notice of Public Meeting, Whiskey Mountain Bighorn Sheep Range Locatable Mineral Withdrawal...

    Science.gov (United States)

    2010-05-14

    ... Bureau of Land Management Notice of Public Meeting, Whiskey Mountain Bighorn Sheep Range Locatable... Bighorn Sheep Range Locatable Mineral Withdrawal Extension to protect and preserve bighorn sheep winter... INFORMATION: The Notice of Proposed Withdrawal Extension for the Whiskey Mountain Bighorn Sheep Winter Range...

  3. 77 FR 60458 - Public Land Order No. 7803; Withdrawal of Public Lands for the Limestone Hills Training Area; MT

    Science.gov (United States)

    2012-10-03

    ... Bureau of Land Management Public Land Order No. 7803; Withdrawal of Public Lands for the Limestone Hills... laws, for a period of 5 years. This withdrawal will protect the Limestone Hills Training Area in... hours. SUPPLEMENTARY INFORMATION: The Limestone Hills Training Area withdrawal will maintain the current...

  4. 75 FR 26788 - Public Land Order No. 7742; Withdrawal of Public Land for the Manning Canyon Tailings Repository; UT

    Science.gov (United States)

    2010-05-12

    ...This order withdraws 109.43 acres of public land from location and entry under the United States mining laws for a period of 5 years to protect the integrity of the Manning Canyon Tailings Repository and surrounding drainage structures while the Bureau of Land Management completes land use planning for the area.

  5. An Aerial Radiological Survey of the Yucca Mountain Project Proposed Land Withdrawal and Adjacent Areas

    Energy Technology Data Exchange (ETDEWEB)

    Craig Lyons, Thane Hendricks

    2006-07-01

    An aerial radiological survey of the Yucca Mountain Project (YMP) proposed land withdrawal was conducted from January to April 2006, and encompassed a total area of approximately 284 square miles (73,556 hectares). The aerial radiological survey was conducted to provide a sound technical basis and rigorous statistical approach for determining the potential presence of radiological contaminants in the Yucca Mountain proposed Land withdrawal area. The survey site included land areas currently managed by the Bureau of Land Management, the U.S. Air Force as part of the Nevada Test and Training Range or the U.S. Department of Energy (DOE), National Nuclear Security Administration Nevada Site Office (NNSA/NSO) as part of the Nevada Test Site (NTS). The survey was flown at an approximate ground speed of 70 knots (36 meters per second), at a nominal altitude of 150 ft (46 m) above ground level, along a set of parallel flight lines spaced 250 ft (76 m) apart. The flight lines were oriented in a north-south trajectory. The survey was conducted by the DOE NNSA/NSO Remote Sensing Laboratory-Nellis, which is located in Las Vegas, Nevada. The aerial survey was conducted at the request of the DOE Office of Civilian Radioactive Waste Management. The primary contaminant of concern was identified by YMP personnel as cesium-137 ({sup 137}Cs). Due to the proposed land withdrawal area's proximity to the historical Nuclear Rocket Development Station (NRDS) facilities located on the NTS, the aerial survey system required sufficient sensitivity to discriminate between dispersed but elevated {sup 137}Cs levels from those normally encountered from worldwide fallout. As part of that process, the survey also measured and mapped the exposure-rate levels that currently existed within the survey area. The inferred aerial exposure rates of the natural terrestrial background radiation varied from less than 3 to 22 microroentgens per hour. This range of exposure rates was primarily due to the

  6. 77 FR 64126 - Notice of Proposed Withdrawal of Public Land for the Buffalo Bill Dam and Reservoir Modification...

    Science.gov (United States)

    2012-10-18

    ... Policy, Management and Budget to withdraw 32.56 acres of public land from settlement, sale, location, and.... SUPPLEMENTARY INFORMATION: The Assistant Secretary for Policy, Management and Budget proposes to withdraw, subject to valid existing rights, the following described public land from settlement, sale, location, and...

  7. 75 FR 59743 - Public Land Order No. 7751; Revocation of the Withdrawal Established by Executive Order Dated...

    Science.gov (United States)

    2010-09-28

    ... Executive Order Dated January 19, 1861; Michigan AGENCY: Bureau of Land Management, Interior. ACTION: Public land order. SUMMARY: This order revokes in its entirety the withdrawal established by an Executive... no longer needed. This order opens the land to the operation of the public land laws, subject to...

  8. Bureau of Land Management Range Allotments

    Data.gov (United States)

    Earth Data Analysis Center, University of New Mexico — This data has been collected by the U.S. Bureau of Land Management (BLM) in New Mexico at both the New Mexico State Office and the various field offices. Collection...

  9. Simulation of the Effects of Water Withdrawals, Wastewater Return Flows, and Land-Use Change on Streamflow in the Blackstone River Basin, Massachusetts and Rhode Island

    Science.gov (United States)

    Barbaro, Jeffrey R.

    2007-01-01

    Streamflow in many parts of the Blackstone River Basin in south-central Massachusetts and northern Rhode Island is altered by water-supply withdrawals, wastewater-return flows, and land-use change associated with a growing population. Simulations from a previously developed and calibrated Hydrological Simulation Program?FORTRAN (HSPF) precipitation-runoff model for the basin were used to evaluate the effects of water withdrawals, wastewater-return flows, and land-use change on streamflow. Most of the simulations were done for recent (1996?2001) conditions and potential buildout conditions in the future when all available land is developed to provide a long-range assessment of the effects of possible future human activities on water resources in the basin. The effects of land-use change were evaluated by comparing the results of long-term (1960?2004) simulations with (1) undeveloped land use, (2) 1995?1999 land use, and (3) potential buildout land use at selected sites across the basin. Flow-duration curves for these land-use scenarios were similar, indicating that land-use change, as represented in the HSPF model, had little effect on flow in the major tributary streams and rivers in the basin. However, land-use change?particularly increased effective impervious area?could potentially have greater effects on the hydrology, water quality, and aquatic habitat of the smaller streams in the basin. The effects of water withdrawals and wastewater-return flows were evaluated by comparing the results of long-term simulations with (1) no withdrawals and return flows, (2) actual (measured) 1996?2001 withdrawals and wastewater-return flows, and (3) potential withdrawals and wastewater-return flows at buildout. Overall, the results indicated that water use had a much larger effect on streamflow than did land use, and that the location and magnitude of wastewater-return flows were important for lessening the effects of withdrawals on streamflow in the Blackstone River Basin

  10. Modeling of earth fissures caused by land subsidence due to groundwater withdrawal

    Directory of Open Access Journals (Sweden)

    B. B. Panda

    2015-11-01

    Full Text Available Land subsidence and earth fissures are phenomena related to groundwater withdrawal in a sedimentary basin. If the rock basement or basin lithology is irregular, both vertical and horizontal displacements can be induced due to differential settlement and tensile stresses appearing in the soil mass. If the differential settlement is of sufficient magnitude, earth fissuring can occur within tensile zones. The magnitudes of compaction and fissure geometry are closely related to the thickness and skeletal compressibility of fine-grained sediments within the aquifer system. Land subsidence and earth fissuring were modeled by employing a two-dimensional (2-D coupled seepage and stress-strain finite element analysis. The basin bedrock geometry, lithological variation, measurements of surface displacements, and changes in hydraulic head were the critical input parameter for the subsidence modeling. Simulation results indicate that strain had exceeded the approximate threshold for fissure formation of 0.02 to 0.06 % in the area of the identified fissures. The numerical model was used to predict future subsidence and potential earth fissures for flood control structures within the metro Phoenix area.

  11. Withdrawal of corticosteroids in inflammatory bowel disease patients after dependency periods ranging from 2 to 45 years: a proposed method.

    LENUS (Irish Health Repository)

    Murphy, S J

    2012-02-01

    BACKGROUND: Even in the biologic era, corticosteroid dependency in IBD patients is common and causes a lot of morbidity, but methods of withdrawal are not well described. AIM: To assess the effectiveness of a corticosteroid withdrawal method. METHODS: Twelve patients (10 men, 2 women; 6 ulcerative colitis, 6 Crohn\\'s disease), median age 53.5 years (range 29-75) were included. IBD patients with quiescent disease refractory to conventional weaning were transitioned to oral dexamethasone, educated about symptoms of the corticosteroid withdrawal syndrome (CWS) and weaned under the supervision of an endocrinologist. When patients failed to wean despite a slow weaning pace and their IBD remaining quiescent, low dose synthetic ACTH stimulation testing was performed to assess for adrenal insufficiency. Multivariate analysis was performed to assess predictors of a slow wean. RESULTS: Median durations for disease and corticosteroid dependency were 21 (range 3-45) and 14 (range 2-45) years respectively. Ten patients (83%) were successfully weaned after a median follow-up from final wean of 38 months (range 5-73). Disease flares occurred in two patients, CWS in five and ACTH testing was performed in 10. Multivariate analysis showed that longer duration of corticosteroid use appeared to be associated with a slower wean (P = 0.056). CONCLUSIONS: Corticosteroid withdrawal using this protocol had a high success rate and durable effect and was effective in patients with long-standing (up to 45 years) dependency. As symptoms of CWS mimic symptoms of IBD disease flares, gastroenterologists may have difficulty distinguishing them, which may be a contributory factor to the frequency of corticosteroid dependency in IBD patients.

  12. 76 FR 1629 - Public Land Order No. 7757; Withdrawal of National Forest System Land for the Big Ice Cave; Montana

    Science.gov (United States)

    2011-01-11

    ... Big Ice Cave; Montana AGENCY: Bureau of Land Management, Interior. ACTION: Public Land Order. SUMMARY... Big Ice Cave, its subterranean water supply, and Federal improvements. The land has been and will...-5052. SUPPLEMENTARY INFORMATION: The Forest Service will manage the land to protect the Big Ice Cave...

  13. Alcohol withdrawal.

    Science.gov (United States)

    Manasco, Anton; Chang, Shannon; Larriviere, Joseph; Hamm, L Lee; Glass, Marcia

    2012-11-01

    Alcohol withdrawal is a common clinical condition that has a variety of complications and morbidities. The manifestations can range from mild agitation to withdrawal seizures and delirium tremens. The treatments for alcohol withdrawal include benzodiazepines, anticonvulsants, beta-blockers and antihypertensives. Although benzodiazepines are presently a first-line therapy, there is controversy regarding the efficacies of these medications compared with others. Treatment protocols often involve one of two contrasting approaches: symptom-triggered versus fixed-schedule dosing of benzodiazepines. We describe these protocols in our review and examine the data supporting symptom-triggered dosing as the preferred method for most patients in withdrawal.The Clinical Institute Withdrawal Assessment for Alcohol scoring system for alcohol withdrawal streamlines care, optimizes patient management, and is the best scale available for withdrawal assessment. Quality improvement implications for inpatient management of alcohol withdrawal include increasing training for signs of withdrawal and symptom recognition, adding new hospital protocols to employee curricula, and ensuring manageable patient-to-physician and patient-to-nurse ratios.

  14. Ankle-dorsiflexion range of motion and landing biomechanics.

    Science.gov (United States)

    Fong, Chun-Man; Blackburn, J Troy; Norcross, Marc F; McGrath, Melanie; Padua, Darin A

    2011-01-01

    A smaller amount of ankle-dorsiflexion displacement during landing is associated with less knee-flexion displacement and greater ground reaction forces, and greater ground reaction forces are associated with greater knee-valgus displacement. Additionally, restricted dorsiflexion range of motion (ROM) is associated with greater knee-valgus displacement during landing and squatting tasks. Because large ground reaction forces and valgus displacement and limited knee-flexion displacement during landing are anterior cruciate ligament (ACL) injury risk factors, dorsiflexion ROM restrictions may be associated with a greater risk of ACL injury. However, it is unclear whether clinical measures of dorsiflexion ROM are associated with landing biomechanics. To evaluate relationships between dorsiflexion ROM and landing biomechanics. Descriptive laboratory study. Research laboratory. Thirty-five healthy, physically active volunteers. Passive dorsiflexion ROM was assessed under extended-knee and flexed-knee conditions. Landing biomechanics were assessed via an optical motion-capture system interfaced with a force plate. Dorsiflexion ROM was measured in degrees using goniometry. Knee-flexion and knee-valgus displacements and vertical and posterior ground reaction forces were calculated during the landing task. Simple correlations were used to evaluate relationships between dorsiflexion ROM and each biomechanical variable. Significant correlations were noted between extended-knee dorsiflexion ROM and knee-flexion displacement (r  =  0.464, P  =  .029) and vertical (r  =  -0.411, P  =  .014) and posterior (r  =  -0.412, P  =  .014) ground reaction forces. All correlations for flexed-knee dorsiflexion ROM and knee-valgus displacement were nonsignificant. Greater dorsiflexion ROM was associated with greater knee-flexion displacement and smaller ground reaction forces during landing, thus inducing a landing posture consistent with reduced ACL injury risk and

  15. Applications of laser ranging to ocean, ice, and land topography

    Science.gov (United States)

    Degnan, John J.

    1991-01-01

    The current status and some future applications of satellite laser ranging (SLR) are briefly reviewed. The demonstrated subcentimeter precision of ground-based SLR systems is attracting new users, particularly, in the area of high-resolution ocean, ice, and land topography. Future airborne or spaceborne SLR system will not only provide topographic data with a horizontal and vertical resolution never achieved previously, but, in addition, ground-based SLR systems, via precise tracking of spaceborne microwave and laser altimeters, will permit the expression of the topographic surface in a common geocentric reference frame.

  16. 78 FR 58555 - Public Land Order No. 7821; Withdrawal of National Forest System Land for Steamboat Rock Picnic...

    Science.gov (United States)

    2013-09-24

    ... Steamboat Rock Picnic Grounds; South Dakota AGENCY: Bureau of Land Management, Interior. ACTION: Public Land... to protect the recreational uses and improvements at the Steamboat Rock Picnic Grounds within the... and improvements within the Steamboat Rock Picnic Grounds. Order By virtue of the authority vested in...

  17. Estimation of the effects of land use and groundwater withdrawals on streamflow for the Pomperaug River, Connecticut

    Science.gov (United States)

    Bjerklie, David M.; Starn, J. Jeffrey; Tamayo, Claudia

    2010-01-01

    A precipitation runoff model for the Pomperaug River watershed, Connecticut was developed to address issues of concern including the effect of development on streamflow and groundwater recharge, and the implications of water withdrawals on streamflow. The model was parameterized using a strategy that requires a minimum of calibration and optimization by establishing basic relations between the parameter value and physical characteristics of individual hydrologic response units (HRUs) that comprise the model. The strategy was devised so that the information needed can be obtained from Geographic Information System and other general databases for Connecticut. Simulation of groundwater recharge enabled evaluation of the temporal and spatial mapping of recharge variation across the watershed and the spatial effects of changes in land cover on base flow and surface runoff. The modeling indicated that over the course of a year, groundwater provides between 60 and 70 percent of flow in the Pomperaug River; the remainder is generated by more rapid flow through the shallow subsurface and runoff from impermeable surfaces and saturated ground. Groundwater is recharged primarily during periods of low evapotranspiration in the winter, spring, and fall. The largest amount of recharge occurs in the spring in response to snowmelt. During floods, the Weekeepeemee and Nonnewaug Rivers (tributaries that form the Pomperaug River) respond rapidly with little flood peak attenuation due to flood-plain storage. In the Pomperaug River, flood-plain storage is more important in attenuating floods; abandoned quarry ponds (O&G ponds) adjacent to the river provide substantial flood storage above specific river stages when flow from the river spills over the banks and fills the ponds. Discharge from the ponds also helps to sustain low flows in the Pomperaug River. Similarly, releases from the Bronson-Lockwood reservoir sustain flow in the Nonnewaug River and tend to offset the effect of

  18. 76 FR 24513 - Public Land Order No. 7765; Partial Revocation Jupiter Inlet Lighthouse Withdrawal; Florida

    Science.gov (United States)

    2011-05-02

    ... Bureau of Land Management Public Land Order No. 7765; Partial Revocation Jupiter Inlet Lighthouse... Management to continue to be managed as part of the Jupiter Inlet Lighthouse Outstanding Natural Area. DATES... Resource Act of 2008 (43 U.S.C. 1787), which created the Jupiter Inlet Lighthouse Outstanding Natural Area...

  19. A precipitation-runoff model for the analysis of the effects of water withdrawals and land-use change on streamflow in the Usquepaug-Queen River Basin, Rhode Island

    Science.gov (United States)

    Zarriello, Phillip J.; Bent, Gardner C.

    2004-01-01

    outlet, but withdrawals have little effect on flows that are exceeded less than about 90 percent of the time. Tests of alternative model structures to evaluate model uncertainty indicate that the lowest mean daily flows ranged between 3 and 5 cubic feet per second (ft3/s) without withdrawals and 2.2 to 4 ft3/s with withdrawals. Changes in the minimum daily streamflows are more pronounced, however; at the upstream streamflow-gaging station, a minimum daily flow of 0.2 ft3/s was sustained without withdrawals, but simulations with withdrawals indicate that the reach would stop flowing part of a day about 5 percent of the time. The effect on streamflow of potential ground-water withdrawals of 0.20, 0.90, and 1.78 million gallons per day (Mgal/d) at the former Ladd School near the central part of the basin were evaluated. The lowest daily mean flows in model reach 3, the main stem of the Queen River closest to the pumped wells, decreased by about 50 percent for withdrawals of 0.20 Mgal/d (from about 0.4 to 0.2 ft3/s) in comparison to current withdrawals. Reach 3 would occasionally stop flowing during part of the day at the 0.20-Mgal/d withdrawal rate because of diurnal fluctuation in streamflow. The higher withdrawal rates (0.90 and 1.78 Mgal/d) would cause reach 3 to stop flowing about 10 to 20 percent of the time, but the effects of pumping rapidly diminished downstream because of tributary inflows. Simulation results indicate little change in the annual 1-, 7-, and 30-day low flows at the 0.20 Mgal/d pumping rate, but at the 1.78 Mgal/d pumping rate, reach 3 stopped flowing for nearly a 7-day period every year and for a 30-day period about every other year. At the 0.90 Mgal/d pumping rate, reach 3 stopped flowing about every other year for a 7-day period and about once every 5 years for a 30-day period. Land-use change was simulated by converting model hydrologic-response units (HRUs) representing undeveloped areas to HRUs representing developed areas o

  20. Lunar Laser Ranging Experiment for Japanese SELENE-2 landing mission

    Science.gov (United States)

    Noda, H.; Kunimori, H.; Araki, H.; Fuse, T.; Hanada, H.; Katayama, M.; Otsubo, T.; Sasaki, S.; Tazawa, S.; Tsuruta, S.; Funazaki, K.; Taniguchi, H.; Murata, K.

    2012-04-01

    We present the development status of the Lunar Laser Ranging experiment proposed to Japanese SELENE-2 lunar landing mission. The Lunar Laser Ranging measures the distance between laser link stations on the Earth and retroreflectors on the Moon, by detecting the time of flight of photons of high-powered laser emitted from the ground station. Since the Earth-Moon distance contains information of lunar orbit, lunar solid tides, and lunar orientation and rotation, we can estimate the inner structure of the Moon through orientation, rotation and tide. Retroreflectors put by the Apollo and Luna missions in 1970's are arrays of many small Corner Cube Prisms (CCP). Because of the tilt of these arrays from the Earth direction due to the optical libration, the returned laser pulse is broaden, causing the main range error of more than 1.5 cm ([1]). Therefore retroreflectors with larger single aperture are necessary for more accurate ranging, and we propose a large single retroreflector of hollow-type with 15 cm aperture. Larger aperture up to 20 cm might be favorable if more mass is permitted for payloads. To cancel the velocity aberration, a large, single aperture retroreflector needs small amount of offset angle between the reflecting planes to spoil the return beam pattern. This angle offset, called Dihedral Angle Offset (DAO) must be optimized to be less than 1 second of arc with 0.1 seconds of arc accuracy to accumulate more photons [2, 3]. The realization of such small DAO is challenging with current technology, therefore the development of fabrication method is important. As for the mirror material, some ceramic products (ZPF: Zero-expansion Pore-free ceramics or SiC: silicon carbide) are under consideration in terms of weight, hardness and handling. The thermal quality of the material can be evaluated by both the thermal conductivity and the coefficient of thermal expansion. The method to fasten three planes each other with precise DAO must be developed.

  1. Groundwater withdrawals 1976, 1990, and 2000--10 and land-surface-elevation changes 2000--10 in Harris, Galveston, Fort Bend, Montgomery, and Brazoria Counties, Texas

    Science.gov (United States)

    Kasmarek, Mark C.; Johnson, Michaela R.

    2013-01-01

    The study area comprising Harris County and parts of Galveston, Fort Bend, Montgomery, and Brazoria Counties in southeastern Texas forms part of one of the largest areas of land-surface-elevation change in the United States. Land-surface-elevation change in the study area primarily is caused by the withdrawal of groundwater. Groundwater withdrawn from the Chicot and Evangeline aquifers has been the primary source of water for municipal supply, industrial and commercial use, and irrigation in the study area. Groundwater withdrawals cause compaction of clay and silt layers abundant in the aquifers, which has in turn resulted in the widespread, substantial land-surface-elevation changes in the region with increased flooding. To estimate land-surface-elevation changes, the U.S. Geological Survey (USGS), in cooperation with the Harris-Galveston Subsidence District (HGSD), documented land-surface-elevation changes in the study area that occurred during 2000–10 and 2005–10 based on elevation data measured by 11 USGS borehole-extensometer sites, a National Geodetic Survey Continuously Operating Reference Station, and Global Positioning System Port-A-Measure (PAM) sites operated by the HGSD and the Fort Bend Subsidence District. Groundwater withdrawals in the study area also were documented for 1976, 1990, and 2000–10.

  2. Public Land Survey (Township, Range, and Section) for northern Arizona, including Grand Canyon National Park.

    Data.gov (United States)

    National Park Service, Department of the Interior — This ALRIS (Arizona Land Resource Information System) coverage contains Public Land Survey gridding and labels for Townships, Ranges, and Sections for Northern Arizona

  3. Using Radar Interferometry (DinSAR) to Evaluate Land Subsidence Caused by Excessive Groundwater Withdrawal in Morocco

    Science.gov (United States)

    Durham, M. C.; Milewski, A.; El Kadiri, R.

    2013-12-01

    The combination of natural, anthropogenic, and climate change impacts on the water resources of the Middle East and North Africa (MENA) region has devastated its water resources well beyond its current and projected populations. The increased exploitation of groundwater resources in the past half-century coupled with successive droughts has resulted in the acceleration of subsidence rates in the Souss and Massa basins in Morocco. We have completed a preliminary investigation of these impacts on the Souss and Massa basins (~27,000 km2) in the southwestern part of Morocco. This area is characterized by a semi-arid climate (annual precipitation 70-250 mm/year) with agriculture, tourism, and commercial fishing as the primary economic activities, all of which require availability of adequate freshwater resources. Additionally the primary groundwater aquifer (Plio-Quaternary Plain Aquifer), an unconfined aquifer formed mostly of sand and gravel, is being harvested by >20,000 wells at a rate of 650 MCM/yr., exceeding the rate of recharge by 260 MCM/year. Intense development over the past 50 years has exposed the aquifer to a serious risk of groundwater table drawdown (0.5m-2.5m/yr.), land subsidence, loss of artesian pressure, salinization, salt water intrusions along the coast, and deterioration of water quality across the watershed. Differential Interferometry Synthetique Aperture Radar (DInSAR) was utilized to measure ground subsidence induced by groundwater withdrawal. Land subsidence caused by excessive groundwater extraction was determined using a threefold methodology: (1) extraction of subsidence and land deformation patterns using radar interferometry, (2) correlation of the high subsidence areas within the basins to possible natural and anthropogenic factors (e.g. sea level rise, unconsolidated lithological formations distribution, urbanization, excessive groundwater extraction), and (3) forecasting the future of the Souss and Massa basins over the next century

  4. Aquarius Whole Range Calibration: Celestial Sky, Ocean, and Land Targets

    Science.gov (United States)

    Dinnat, Emmanuel P.; Le Vine, David M.; Bindlish, Rajat; Piepmeier, Jeffrey R.; Brown, Shannon T.

    2014-01-01

    Aquarius is a spaceborne instrument that uses L-band radiometers to monitor sea surface salinity globally. Other applications of its data over land and the cryosphere are being developed. Combining its measurements with existing and upcoming L-band sensors will allow for long term studies. For that purpose, the radiometers calibration is critical. Aquarius measurements are currently calibrated over the oceans. They have been found too cold at the low end (celestial sky) of the brightness temperature scale, and too warm at the warm end (land and ice). We assess the impact of the antenna pattern model on the biases and propose a correction. We re-calibrate Aquarius measurements using the corrected antenna pattern and measurements over the Sky and oceans. The performances of the new calibration are evaluated using measurements over well instrument land sites.

  5. Achieving sustainable irrigation water withdrawals: global impacts on food security and land use

    Science.gov (United States)

    Liu, Jing; Hertel, Thomas W.; Lammers, Richard B.; Prusevich, Alexander; Baldos, Uris Lantz C.; Grogan, Danielle S.; Frolking, Steve

    2017-10-01

    Unsustainable water use challenges the capacity of water resources to ensure food security and continued growth of the economy. Adaptation policies targeting future water security can easily overlook its interaction with other sustainability metrics and unanticipated local responses to the larger-scale policy interventions. Using a global partial equilibrium grid-resolving model SIMPLE-G, and coupling it with the global Water Balance Model, we simulate the consequences of reducing unsustainable irrigation for food security, land use change, and terrestrial carbon. A variety of future (2050) scenarios are considered that interact irrigation productivity with two policy interventions— inter-basin water transfers and international commodity market integration. We find that pursuing sustainable irrigation may erode other development and environmental goals due to higher food prices and cropland expansion. This results in over 800 000 more undernourished people and 0.87 GtC additional emissions. Faster total factor productivity growth in irrigated sectors will encourage more aggressive irrigation water use in the basins where irrigation vulnerability is expected to be reduced by inter-basin water transfer. By allowing for a systematic comparison of these alternative adaptations to future irrigation vulnerability, the global gridded modeling approach offers unique insights into the multiscale nature of the water scarcity challenge.

  6. Environmental Impact Analysis Process. Deployment Area Selection and Land Withdrawal/Acquisition DEIS. Chapter V. Appendices.

    Science.gov (United States)

    1980-12-01

    A * . ., . References Latimer, D.A., R.W. Bergstrom, S.R. Hayes, M.K. Liu, J.H. Seinfeld, G.Z. Whitten, \\I.A. Wojcik, and M.J. Hillyer , September...McNamara, K.S. Berwick, and E. Hillyer , 1980. Elk on the Aspen Mountain Winter Range, Pitkin County, Colorado. Yale School of Forestry and Environmental

  7. Public Land Survey System (PLSS) Township Range Polygons, California, 2015, Bureau of Land Management

    Data.gov (United States)

    U.S. Environmental Protection Agency — PLSSTownship: This dataset represents the GIS Version of the Public Land Survey System including both rectangular and non-rectangular surveys. The primary source for...

  8. A randomized, double-blind, placebo-controlled dose range study of dexmedetomidine as adjunctive therapy for alcohol withdrawal.

    Science.gov (United States)

    Mueller, Scott W; Preslaski, Candice R; Kiser, Tyree H; Fish, Douglas N; Lavelle, James C; Malkoski, Stephen P; MacLaren, Robert

    2014-05-01

    To evaluate dexmedetomidine as adjunctive therapy to lorazepam for severe alcohol withdrawal. Prospective, randomized, double-blind, placebo-controlled trial. Single center; medical ICU. Twenty-four adult patients with a Clinical Institute Withdrawal Assessment score greater than or equal to 15 despite greater than or equal to 16 mg of lorazepam over a 4-hour period. Patients received a symptom-triggered Clinical Institute Withdrawal Assessment protocol with lorazepam and were randomized to dexmedetomidine 1.2 μg/kg/hr (high dose), 0.4 μg/kg/hr (low dose), or placebo as adjunctive therapy for up to 5 days or resolution of withdrawal symptoms. High-dose and low-dose groups were combined as a single dexmedetomidine group for primary analysis with secondary analysis exploring a dose-response relationship. The difference in 24-hour lorazepam requirements after versus before study drug was greater in the dexmedetomidine group compared with the placebo group (-56 mg vs -8 mg, p = 0.037). Median differences were similar for high dose and low dose. The 7-day cumulative lorazepam requirements were not statistically different between dexmedetomidine and placebo (159 mg vs 181 mg). Clinical Institute Withdrawal Assessment or Riker sedation-agitation scale scores representing severe agitation (13% vs 25%) or moderate agitation (27% vs 22%) within 24 hours of initiating study drug were similar for dexmedetomidine and placebo groups, respectively. Bradycardia occurred more frequently in the dexmedetomidine group versus placebo group (25% vs 0%, p = not significant), with the majority of bradycardia occurring in the high-dose group (37.5%). Study drug rate adjustments occurred more often in the dexmedetomidine group compared with the placebo group (50% vs 0%, p = 0.02). Neither endotracheal intubation nor seizure occurred in any group while on study drug. Adjunctive dexmedetomidine for severe alcohol withdrawal maintains symptom control and reduces lorazepam exposure in the

  9. Alcohol withdrawal syndrome.

    Science.gov (United States)

    Bayard, Max; McIntyre, Jonah; Hill, Keith R; Woodside, Jack

    2004-03-15

    The spectrum of alcohol withdrawal symptoms ranges from such minor symptoms as insomnia and tremulousness to severe complications such as withdrawal seizures and delirium tremens. Although the history and physical examination usually are sufficient to diagnose alcohol withdrawal syndrome, other conditions may present with similar symptoms. Most patients undergoing alcohol withdrawal can be treated safely and effectively as outpatients. Pharmacologic treatment involves the use of medications that are cross-tolerant with alcohol. Benzodiazepines, the agents of choice, may be administered on a fixed or symptom-triggered schedule. Carbamazepine is an appropriate alternative to a benzodiazepine in the outpatient treatment of patients with mild to moderate alcohol withdrawal symptoms. Medications such as haloperidol, beta blockers, clonidine, and phenytoin may be used as adjuncts to a benzodiazepine in the treatment of complications of withdrawal. Treatment of alcohol withdrawal should be followed by treatment for alcohol dependence.

  10. Comparison of impact forces, accelerations and ankle range of motion in surfing-related landing tasks.

    Science.gov (United States)

    Lundgren, Lina E; Tran, Tai T; Nimphius, Sophia; Raymond, Ellen; Secomb, Josh L; Farley, Oliver R L; Newton, Robert U; Sheppard, Jeremy M

    2016-01-01

    This study aimed to describe the impact forces, accelerations and ankle range of motion in five different landing tasks that are used in training and testing for competitive surfing athletes, to assist coaches in the prescription of landing task progression and monitoring training load. Eleven competitive surfing athletes aged 24 ± 7 years participated, and inertial motion sensors were fixed to the anterior aspect of the feet, mid-tibial shafts, sacrum and eighth thoracic vertebrae on these athletes. Three tasks were performed landing on force plates and two tasks in a modified gymnastics set-up used for land-based aerial training. Peak landing force, resultant peak acceleration and front and rear side ankle dorsiflexion ranges of motion during landing were determined. The peak acceleration was approximately 50% higher when performing aerial training using a mini-trampoline and landing on a soft-density foam board, compared to a similar landing off a 50 cm box. Furthermore, the ankle ranges of motion during the gymnastic type landings were significantly lower than the other landing types (P ≤ 0.05 and P ≤ 0.001), for front and rear sides, respectively. Conclusively, increased task complexity and specificity of the sport increased the tibial peak acceleration, indicating greater training load.

  11. For Sale--Scotland's Most Famous Mountain Range: Land "Ownership" in Scotland

    Science.gov (United States)

    Slattery, Deirdre

    2005-01-01

    The nature of land ownership is infrequently discussed by practitioners of outdoor education, though it is often central to the way they work. The recent controversy over the proposed sale of the Cuillin mountain range on the Isle of Skye in Scotland provoked heated discussion over rights to and benefits of this important place. The main point at…

  12. Frequency-Range Distribution of Boulders Around Cone Crater: Relevance to Landing Site Hazard Avoidance

    Science.gov (United States)

    Clegg-Watkins, R. N.; Jolliff, B. L.; Lawrence, S. J.

    2016-01-01

    Boulders represent a landing hazard that must be addressed in the planning of future landings on the Moon. A boulder under a landing leg can contribute to deck tilt and boulders can damage spacecraft during landing. Using orbital data to characterize boulder populations at locations where landers have safely touched down (Apollo, Luna, Surveyor, and Chang'e-3 sites) is important for determining landing hazard criteria for future missions. Additionally, assessing the distribution of boulders can address broader science issues, e.g., how far craters distribute boulders and how this distribution varies as a function of crater size and age. The availability of new Lunar Reconnaissance Orbiter Camera (LROC) Narrow Angle Camera (NAC) images [1] enables the use of boulder size- and range frequency distributions for a variety of purposes [2-6]. Boulders degrade over time and primarily occur around young or fresh craters that are large enough to excavate bedrock. Here we use NAC images to analyze boulder distributions around Cone crater (340 m diameter) at the Apollo 14 site. Cone crater (CC) was selected because it is the largest crater where astronaut surface photography is available for a radial traverse to the rim. Cone crater is young (approximately 29 Ma [7]) relative to the time required to break down boulders [3,8], giving us a data point for boulder range-frequency distributions (BRFDs) as a function of crater age.

  13. Impacts of land cover data selection and trait parameterisation on dynamic modelling of species' range expansion.

    Directory of Open Access Journals (Sweden)

    Risto K Heikkinen

    Full Text Available Dynamic models for range expansion provide a promising tool for assessing species' capacity to respond to climate change by shifting their ranges to new areas. However, these models include a number of uncertainties which may affect how successfully they can be applied to climate change oriented conservation planning. We used RangeShifter, a novel dynamic and individual-based modelling platform, to study two potential sources of such uncertainties: the selection of land cover data and the parameterization of key life-history traits. As an example, we modelled the range expansion dynamics of two butterfly species, one habitat specialist (Maniola jurtina and one generalist (Issoria lathonia. Our results show that projections of total population size, number of occupied grid cells and the mean maximal latitudinal range shift were all clearly dependent on the choice made between using CORINE land cover data vs. using more detailed grassland data from three alternative national databases. Range expansion was also sensitive to the parameterization of the four considered life-history traits (magnitude and probability of long-distance dispersal events, population growth rate and carrying capacity, with carrying capacity and magnitude of long-distance dispersal showing the strongest effect. Our results highlight the sensitivity of dynamic species population models to the selection of existing land cover data and to uncertainty in the model parameters and indicate that these need to be carefully evaluated before the models are applied to conservation planning.

  14. ENVIRONMENTAL ASSESSMENT FOR THE PROPOSED WITHDRAWAL OF PUBLIC LANDS WITHIN AND SURROUNDING THE CALIENTE RAIL CORRIDOR, NEVADA

    Energy Technology Data Exchange (ETDEWEB)

    DOE

    2005-12-01

    The purpose for agency action is to preclude surface entry and the location of new mining claims, subject to valid existing rights, within and surrounding the Caliente rail corridor as described in the Yucca Mountain FEIS (DOE 2002). This protective measure is needed to enhance the safe, efficient, and uninterrupted evaluation of land areas for potential rail alignments within the Caliente rail corridor. The evaluation will assist the DOE in determining, through the Rail Alignment environmental impact statement (EIS) process, whether to construct a branch rail line, and to provide support to the BLM in deciding whether or not to reserve a ROW for the rail line under the Federal Land Policy and Management Act (FLPMA). The BLM participated as a cooperating agency in preparing this EA because it is the responsible land manager and BLM staff could contribute resource specific expertise.

  15. Effects of land use/land cover on diurnal temperature range in the temperate grassland region of China.

    Science.gov (United States)

    Shen, Xiangjin; Liu, Binhui; Lu, Xianguo

    2017-01-01

    As a fragile ecological zone, the temperate grassland region of China has experienced dramatic land use/land cover (LULC) changes due to human disturbances. So far, the impacts of LULC change on climate especially the diurnal temperature range (DTR) in this region are still not well understood. Based on the OMR (observation minus reanalysis) method, this study investigated the effects of LULC on DTR in the temperate grassland region of China. Considering the possible uncertainty of the results due to spatial resolution of the reanalysis dataset, two reanalysis datasets with different spatial resolutions were utilized. Results showed that LULC generally contributed to the decline of DTR in the temperate grassland region of China during 1980 to 2005. Due to different warming effects on monthly maximum temperature (Tmax) and minimum temperature (Tmin), grassland and forest tend to slightly decrease monthly DTR (approximately -0.053 to -0.050°C/decade and approximately -0.059 to -0.055°C/decade, respectively), while bare land has a slightly positive effect on DTR (approximately 0.018-0.021°C/decade). By contrast, cropland and urban tend to slightly decrease Tmax, obviously increase Tmin and thus result in a rapid decline of DTR (approximately -0.556 to -0.503°C/decade and approximately -0.617 to -0.612°C/decade, respectively). In the temperate grassland region of China, grassland vegetation changes due to human disturbances can have some effects on DTR mainly by changing the Tmax. Conversion from grassland to cropland could decrease the DTR by slowing down the increase of Tmax. But the conversion from grassland to bare land, as well as the reduction of grassland vegetation cover will increase Tmax, and consequently the DTR. The results suggest that grassland degradation is likely to result in daylight warming and increased DTR in the temperate grassland region of China. Copyright © 2016 Elsevier B.V. All rights reserved.

  16. Weight-Bearing Dorsiflexion Range of Motion and Landing Biomechanics in Individuals With Chronic Ankle Instability.

    Science.gov (United States)

    Hoch, Matthew C; Farwell, Kelley E; Gaven, Stacey L; Weinhandl, Joshua T

    2015-08-01

    People with chronic ankle instability (CAI) exhibit less weight-bearing dorsiflexion range of motion (ROM) and less knee flexion during landing than people with stable ankles. Examining the relationship between dorsiflexion ROM and landing biomechanics may identify a modifiable factor associated with altered kinematics and kinetics during landing tasks. To examine the relationship between weight-bearing dorsiflexion ROM and single-legged landing biomechanics in persons with CAI. Cross-sectional study. Laboratory. Fifteen physically active persons with CAI (5 men, 10 women; age = 21.9 ± 2.1 years, height = 168.7 ± 9.0 cm, mass = 69.4 ± 13.3 kg) participated. Participants performed dorsiflexion ROM and single-legged landings from a 40-cm height. Sagittal-plane kinematics of the lower extremity and ground reaction forces (GRFs) were captured during landing. Static dorsiflexion was measured using the weight-bearing-lunge test. Kinematics of the ankle, knee, and hip were observed at initial contact, maximum angle, and sagittal displacement. Sagittal displacements of the ankle, knee, and hip were summed to examine overall sagittal displacement. Kinetic variables were maximum posterior and vertical GRFs normalized to body weight. We used Pearson product moment correlations to evaluate the relationships between dorsiflexion ROM and landing biomechanics. Correlations (r) were interpreted as weak (0.00-0.40), moderate (0.41-0.69), or strong (0.70-1.00). The coefficient of determination (r(2)) was used to determine the amount of explained variance among variables. Static dorsiflexion ROM was moderately correlated with maximum dorsiflexion (r = 0.49, r(2) = 0.24), ankle displacement (r = 0.47, r(2) = 0.22), and total displacement (r = 0.67, r(2) = 0.45) during landing. Dorsiflexion ROM measured statically and during landing demonstrated moderate to strong correlations with maximum knee (r = 0.69-0.74, r(2) = 0.47-0.55) and hip (r = 0.50-0.64, r(2) = 0.25-0.40) flexion, hip

  17. Range and Richness of Vascular Land Plants: The Role of Variable Light

    Science.gov (United States)

    Schultz, Colin

    2010-12-01

    The observation that the number of species decreases—while at the same time the average range of local species increases—with increasing latitude is known within ecological circles as Rapoport's rule. In the AGU monograph Range and Richness of Vascular Land Plants: The Role of Variable Light, former AGU president Peter S. Eagleson seeks a cause for Rapoport's rule. Using a tightly focused analysis, Eagleson delves into the complex interactions that govern ecosystems to propose the primary importance to range and richness of one key variable, the locally incident shortwave radiation. In this interview, Eos talks with Eagleson.

  18. Renewal of the Nellis Air Force Range Land Withdrawal, Legislative Environmental Impact Statement. Volume 1. Chapters 1-11

    Science.gov (United States)

    1999-03-01

    will move farther down the slopes during the winter. Wild burros ( Equus asinus ), which escaped or were released periodically over the last 200 years...Pronghorn antelope (Antilocapra americana) and wild horses ( Equus caballus), however, occur predominantly in desert scrub communities found in the North

  19. Facilitating climate-change-induced range shifts across continental land-use barriers.

    Science.gov (United States)

    Robillard, Cassandra M; Coristine, Laura E; Soares, Rosana N; Kerr, Jeremy T

    2015-12-01

    Climate changes impose requirements for many species to shift their ranges to remain within environmentally tolerable areas, but near-continuous regions of intense human land use stretching across continental extents diminish dispersal prospects for many species. We reviewed the impact of habitat loss and fragmentation on species' abilities to track changing climates and existing plans to facilitate species dispersal in response to climate change through regions of intensive land uses, drawing on examples from North America and elsewhere. We identified an emerging analytical framework that accounts for variation in species' dispersal capacities relative to both the pace of climate change and habitat availability. Habitat loss and fragmentation hinder climate change tracking, particularly for specialists, by impeding both propagule dispersal and population growth. This framework can be used to identify prospective modern-era climatic refugia, where the pace of climate change has been slower than surrounding areas, that are defined relative to individual species' needs. The framework also underscores the importance of identifying and managing dispersal pathways or corridors through semi-continental land use barriers that can benefit many species simultaneously. These emerging strategies to facilitate range shifts must account for uncertainties around population adaptation to local environmental conditions. Accounting for uncertainties in climate change and dispersal capabilities among species and expanding biological monitoring programs within an adaptive management paradigm are vital strategies that will improve species' capacities to track rapidly shifting climatic conditions across landscapes dominated by intensive human land use. © 2015 Society for Conservation Biology.

  20. On the Use of a Range Trigger for the Mars Science Laboratory Entry Descent and Landing

    Science.gov (United States)

    Way, David W.

    2011-01-01

    In 2012, during the Entry, Descent, and Landing (EDL) of the Mars Science Laboratory (MSL) entry vehicle, a 21.5 m Viking-heritage, Disk-Gap-Band, supersonic parachute will be deployed at approximately Mach 2. The baseline algorithm for commanding this parachute deployment is a navigated planet-relative velocity trigger. This paper compares the performance of an alternative range-to-go trigger (sometimes referred to as Smart Chute ), which can significantly reduce the landing footprint size. Numerical Monte Carlo results, predicted by the POST2 MSL POST End-to-End EDL simulation, are corroborated and explained by applying propagation of uncertainty methods to develop an analytic estimate for the standard deviation of Mach number. A negative correlation is shown to exist between the standard deviations of wind velocity and the planet-relative velocity at parachute deploy, which mitigates the Mach number rise in the case of the range trigger.

  1. Retrieval and Mapping of Soil Texture Based on Land Surface Diurnal Temperature Range Data from MODIS

    Science.gov (United States)

    Wang, De-Cai; Zhang, Gan-Lin; Zhao, Ming-Song; Pan, Xian-Zhang; Zhao, Yu-Guo; Li, De-Cheng; Macmillan, Bob

    2015-01-01

    Numerous studies have investigated the direct retrieval of soil properties, including soil texture, using remotely sensed images. However, few have considered how soil properties influence dynamic changes in remote images or how soil processes affect the characteristics of the spectrum. This study investigated a new method for mapping regional soil texture based on the hypothesis that the rate of change of land surface temperature is related to soil texture, given the assumption of similar starting soil moisture conditions. The study area was a typical flat area in the Yangtze-Huai River Plain, East China. We used the widely available land surface temperature product of MODIS as the main data source. We analyzed the relationships between the content of different particle soil size fractions at the soil surface and land surface day temperature, night temperature and diurnal temperature range (DTR) during three selected time periods. These periods occurred after rainfalls and between the previous harvest and the subsequent autumn sowing in 2004, 2007 and 2008. Then, linear regression models were developed between the land surface DTR and sand (> 0.05 mm), clay (soil texture. The spatial distribution of soil texture from the studied area was mapped based on the model with the minimum RMSE. A validation dataset produced error estimates for the predicted maps of sand, clay and physical clay, expressed as RMSE of 10.69%, 4.57%, and 12.99%, respectively. The absolute error of the predictions is largely influenced by variations in land cover. Additionally, the maps produced by the models illustrate the natural spatial continuity of soil texture. This study demonstrates the potential for digitally mapping regional soil texture variations in flat areas using readily available MODIS data. PMID:26090852

  2. Retrieval and Mapping of Soil Texture Based on Land Surface Diurnal Temperature Range Data from MODIS.

    Directory of Open Access Journals (Sweden)

    De-Cai Wang

    Full Text Available Numerous studies have investigated the direct retrieval of soil properties, including soil texture, using remotely sensed images. However, few have considered how soil properties influence dynamic changes in remote images or how soil processes affect the characteristics of the spectrum. This study investigated a new method for mapping regional soil texture based on the hypothesis that the rate of change of land surface temperature is related to soil texture, given the assumption of similar starting soil moisture conditions. The study area was a typical flat area in the Yangtze-Huai River Plain, East China. We used the widely available land surface temperature product of MODIS as the main data source. We analyzed the relationships between the content of different particle soil size fractions at the soil surface and land surface day temperature, night temperature and diurnal temperature range (DTR during three selected time periods. These periods occurred after rainfalls and between the previous harvest and the subsequent autumn sowing in 2004, 2007 and 2008. Then, linear regression models were developed between the land surface DTR and sand (> 0.05 mm, clay (< 0.001 mm and physical clay (< 0.01 mm contents. The models for each day were used to estimate soil texture. The spatial distribution of soil texture from the studied area was mapped based on the model with the minimum RMSE. A validation dataset produced error estimates for the predicted maps of sand, clay and physical clay, expressed as RMSE of 10.69%, 4.57%, and 12.99%, respectively. The absolute error of the predictions is largely influenced by variations in land cover. Additionally, the maps produced by the models illustrate the natural spatial continuity of soil texture. This study demonstrates the potential for digitally mapping regional soil texture variations in flat areas using readily available MODIS data.

  3. A high-resolution aeromagnetic survey over the Lanterman Range, northern Victoria Land, Antarctica

    Science.gov (United States)

    Ruppel, Antonia; Läufer, Andreas; Crispini, Laura; Capponi, Giovanni; Lisker, Frank

    2017-04-01

    During the GANOVEX XI (German North Victoria Land Expedition) in 2015-16, a high-resolution aeromagnetic survey was carried out over the Lanterman Range in northern Victoria Land (NVL). The helicopter-based survey aimed to resolve the fine structure over the so-called Lanterman Suture Zone, which represents one of the main key areas regarding geodynamic evolution of NVL during the Early Palaeozoic Ross Orogeny. This was achieved by reducing the flight line spacing to 1-2 km with 10 km tie lines and flying in a terrain-following mode. The survey was completed by ground truth magnetic susceptibility readings by using a Kappameter KM-7. The Ross-aged basement of NVL is subdivided into three tectonometamorphic so-called "terranes", comprising from W to E the Wilson-, the Bowers- and the Robertson Bay Terrane. They are generally interpreted to have formed by accretion processes at the Palaeo-Pacific active continental margin of East Gondwana in the Cambrian and Ordovician. The survey over the Lanterman Range covered parts of the two western terranes, namely the Wilson and Bowers terranes, which are separated by the Lanterman Fault Zone. This polyphase tectonic discontinuity is characterized by a belt of mafic and ultramafic rocks comprising metabasites with eclogite-facies relicts. Preliminary results show two distinct and nearly parallel magnetic lineaments in the survey area that will be further interpreted by combined magnetic susceptibility measurements and geological field data. One magnetic lineament correlates well with the known boundary between the Wilson and Bowers terranes, which comprises also a metaconglomerate belt with mafic to ultramafic clasts. The second, further easterly magnetic lineament is so far not supported by outcrops of associated highly magnetic rocks in the field. Similar parallel structures have been observed further to the southeast and seem to be offset by a major sinistral strike-slip fault zone of possibly post-Jurassic age. One

  4. Hedgehogs on the move: Testing the effects of land use change on home range size and movement patterns of free-ranging Ethiopian hedgehogs.

    Directory of Open Access Journals (Sweden)

    Mohammad A Abu Baker

    Full Text Available Degradation and alteration of natural environments because of agriculture and other land uses have major consequences on vertebrate populations, particularly on spatial organization and movement patterns. We used GPS tracking to study the effect of land use and sex on the home range size and movement of a typical model species, the Ethiopian hedgehogs. We used free-ranging hedgehogs from two areas with different land use practices: 24 from an area dominated by irrigated farms (12 ♂♂, 12 ♀♀ and 22 from a natural desert environment within a biosphere reserve (12 ♂♂, 10 ♀♀. Animals were significantly heavier in the resource-rich irrigated farms area (417.71 ±12.77SE g in comparison to the natural desert area (376.37±12.71SE g. Both habitat and sex significantly influenced the home range size of hedgehogs. Home ranges were larger in the reserve than in the farms area. Total home ranges averaged 103 ha (±17 SE for males and 42 ha (±11SE for females in the farms area, but were much larger in the reserve averaging 230 ha (±33 SE for males and 150 ha (±29 SE for females. The home ranges of individuals of both sexes overlapped. Although females were heavier than males, body weight had no effect on home range size. The results suggest that resources provided in the farms (e.g. food, water, and shelters influenced animal density and space use. Females aggregated around high-resource areas (either farms or rawdhats, whereas males roamed over greater distances, likely in search of mating opportunities to maximize reproductive success. Most individual home ranges overlapped with many other individuals of either sex, suggesting a non-territorial, promiscuous mating. Patterns of space use and habitat utilization are key factors in shaping aspects of reproductive biology and mating system. To minimize the impacts of agriculture on local wildlife, we recommend that biodiversity-friendly agro-environmental schemes be introduced in the Middle

  5. Hedgehogs on the move: Testing the effects of land use change on home range size and movement patterns of free-ranging Ethiopian hedgehogs.

    Science.gov (United States)

    Abu Baker, Mohammad A; Reeve, Nigel; Conkey, April A T; Macdonald, David W; Yamaguchi, Nobuyuki

    2017-01-01

    Degradation and alteration of natural environments because of agriculture and other land uses have major consequences on vertebrate populations, particularly on spatial organization and movement patterns. We used GPS tracking to study the effect of land use and sex on the home range size and movement of a typical model species, the Ethiopian hedgehogs. We used free-ranging hedgehogs from two areas with different land use practices: 24 from an area dominated by irrigated farms (12 ♂♂, 12 ♀♀) and 22 from a natural desert environment within a biosphere reserve (12 ♂♂, 10 ♀♀). Animals were significantly heavier in the resource-rich irrigated farms area (417.71 ±12.77SE g) in comparison to the natural desert area (376.37±12.71SE g). Both habitat and sex significantly influenced the home range size of hedgehogs. Home ranges were larger in the reserve than in the farms area. Total home ranges averaged 103 ha (±17 SE) for males and 42 ha (±11SE) for females in the farms area, but were much larger in the reserve averaging 230 ha (±33 SE) for males and 150 ha (±29 SE) for females. The home ranges of individuals of both sexes overlapped. Although females were heavier than males, body weight had no effect on home range size. The results suggest that resources provided in the farms (e.g. food, water, and shelters) influenced animal density and space use. Females aggregated around high-resource areas (either farms or rawdhats), whereas males roamed over greater distances, likely in search of mating opportunities to maximize reproductive success. Most individual home ranges overlapped with many other individuals of either sex, suggesting a non-territorial, promiscuous mating. Patterns of space use and habitat utilization are key factors in shaping aspects of reproductive biology and mating system. To minimize the impacts of agriculture on local wildlife, we recommend that biodiversity-friendly agro-environmental schemes be introduced in the Middle East where

  6. Timber RAM. . .a long-range planning method for commercial timber lands under multiple-use management

    Science.gov (United States)

    Daniel I. Navon

    1971-01-01

    Timber RAM (Resource Allocation Method) is a long-range planning method for commercial timber lands under multiple-use management. Timber RAM can produce cutting and reforestation schedules and related harvest and economic reports. Each schedule optimizes an index of performance, subject to periodic constraints on revenues, costs, and, harvest levels. Periodic...

  7. Integrated Land Data Assimilation System for Numerical Weather Prediction at the European Center for Medium-Range Weather Forecasts

    Science.gov (United States)

    de Rosnay, Patricia; Hólm, Elias; Bonavita, Massimo; English, Steve

    2017-04-01

    The European Centre for Medium-Range Weather Forecasts (ECMWF) system relies on an Earth System approach focusing on atmosphere, ocean, waves, land, and sea ice. Different data assimilation methods are used for the each component of the Earth System. A hybrid 4D-Var is used for the atmosphere, a simplified sea-surface temperature (SST) and sea ice analysis is used for medium-range forecasts and for the reanalyses (ERA-Interim and ERA5). The ECMWF land and atmosphere data assimilation systems are weakly coupled, using a coupled land-atmosphere background forecast and separate analyses for the atmosphere and for the surface (soil moisture and snow). Conventional and satellite observations that inform on the state of both subsystems are assimilated. They are located at the land-atmosphere interface and include two-metre temperature and relative humidity, snow depth, and soil moisture. In this presentation we present the land-atmosphere weakly coupled assimilation currently used at ECMWF for Numerical Weather Prediction (NWP) purpose. Perspectives of coupling enhancement using Ensemble Data Assimilaton (EDA) and EDA-based cross correlation estimates with coupling at the outer loop level of the atmospheric 4D-Var are discussed.

  8. Benzodiazepine withdrawal seizures and management.

    Science.gov (United States)

    Hu, Xiaohong

    2011-02-01

    Since the first report of benzodiazepine withdrawal seizure in 1961, many case reports have followed. Withdrawal seizures have occurred with short, medium, and long halflife benzodiazepine, if discontinued abruptly. Withdrawal seizures usually occur in patients who have been taking these medications for long periods of time and at high doses. Seizures have also been reported with less than 15 days of use and at therapeutic dosage. Almost all the withdrawal seizures reported were grand mal seizures. The severity of seizures range from a single episode to coma and death. Benzodiazepine dose tapering can be done faster in a hospital setting in high-dose abusers, but must be done more slowly in the outpatient setting in therapeutic dosage users.

  9. RANGE RAM: a long-term planning method for managing grazing lands

    Science.gov (United States)

    Henricus C. Jansen

    1976-01-01

    Range RAM (Resource Allocation Method) is a computerized planning method designed to assist range managers in developing and selecting alternatives in spatial and temporal allocation of resources. The technique is applicable at the frest or district management levels, or their equivalents. Range RAM can help formulate plans that maximize the production of range outputs...

  10. Weightbearing ankle dorsiflexion range of motion and sagittal plane kinematics during single leg drop jump landing in healthy male athletes.

    Science.gov (United States)

    Dowling, Brittany; McPherson, April L; Paci, James M

    2017-06-21

    Passive ankle dorsiflexion range of motion (DROM) measures have been identified as a risk factor for injury during landings. However, passive measurements might not be indicative of dynamic ankle movement, whereas a weightbearing ROM might be a better tool when evaluating movement. The purpose of this study was to investigate the relationship between weightbearing DROM and sagittal plane landing mechanics in a single leg drop jump task. 73 male athletes (22.1 ± 3.9 years old, height 186.2 ± 11 cm, and weight 100.2 ± 21.8 kg) performed bilateral modified-lunge tasks and bilateral single leg drop jump landings while 3D kinematic data were collected. Hip, knee, and ankle joint angles were calculated at initial contact (IC) maximum knee flexion (MKF), and total excursion (TE) during a single leg drop jump landing. No bilateral differences in DROM and single leg landing mechanics existed. Decreased ankle DROM was correlated to decreased ankle dorsiflexion at MKF (p=0.00) and TE (p=0.00) for both dominant and non-dominant limbs. Decreased ankle DROM was also correlated to decreased knee flexion at IC (p=0.00), MKF(p=0.00), and TE (p=0.1), for both dominant and non-dominant limbs. Ankle DROM correlated to hip flexion at MKF (r=0.25) and TE (r=0.30) in the dominant limb. Restrictions in DROM may contribute to a stiff landing with less flexion at the ankle and knee. These findings may be useful in designing training programs aimed at increasing DROM in order to improve an athlete's landing mechanics and decrease risk of injury.

  11. Akathisia induced by gabapentin withdrawal.

    Science.gov (United States)

    See, Sharon; Hendriks, Erin; Hsiung, Leslie

    2011-06-01

    To report a case of akathisia in a patient with type 2 diabetes after abrupt discontinuation of gabapentin. A 76-year-old female with type 2 diabetes was admitted for change in mental status, agitation, and restless limb movements. She had been taking gabapentin 3600 mg daily for approximately 1 month for diabetic neuropathy. Her other home medications were glyburide 10 mg twice daily, oxycodone/acetaminophen 5 mg/325 mg every 6 hours as needed for leg pain, and zolpidem 5 mg at bedtime. She had taken none of these drugs for 4 days prior to admission because she was unable to have the prescriptions refilled. Subsequently, the patient exhibited repeated arm and leg motions in response to an inner restlessness. Upon admission to the emergency department, she was agitated and restless; all vital signs and results of laboratory studies were within normal limits. Gabapentin was restarted at the original dosage and the symptoms resolved within 8 hours. Because the patient developed lethargy, the gabapentin dosage was reduced and titrated to the original level over 2 days. After 3 days, the patient was well oriented and experienced no further symptoms. She was discharged on the original dosage of gabapentin. To our knowledge, this is the first reported cases of akathisia induced by gabapentin withdrawal. Available case reports suggest that gabapentin withdrawal can occur at doses ranging from 400-8000 mg/day. Patients experienced symptoms similar to those that develop with benzodiazepine withdrawal and were taking gabapentin for as little as 3 weeks to as long as 5 years. This is the first case report to describe akathisia induced by gabapentin withdrawal. The Naranjo probability scale revealed a probable relationship between akathisia and gabapentin withdrawal. If gabapentin discontinuation is desired, it is prudent to gradually taper the dose to avoid withdrawal symptoms, which may occur after as little as 1 month of treatment. Should the patient experience withdrawal

  12. Mangrove expansion and contraction at a poleward range limit: Climate extremes and land-ocean temperature gradients

    Science.gov (United States)

    Osland, Michael J.; Day, Richard H.; Hall, Courtney T.; Brumfield, Marisa D; Dugas, Jason; Jones, William R.

    2017-01-01

    Within the context of climate change, there is a pressing need to better understand the ecological implications of changes in the frequency and intensity of climate extremes. Along subtropical coasts, less frequent and warmer freeze events are expected to permit freeze-sensitive mangrove forests to expand poleward and displace freeze-tolerant salt marshes. Here, our aim was to better understand the drivers of poleward mangrove migration by quantifying spatiotemporal patterns in mangrove range expansion and contraction across land-ocean temperature gradients. Our work was conducted in a freeze-sensitive mangrove-marsh transition zone that spans a land-ocean temperature gradient in one of the world's most wetland-rich regions (Mississippi River Deltaic Plain; Louisiana, USA). We used historical air temperature data (1893-2014), alternative future climate scenarios, and coastal wetland coverage data (1978-2011) to investigate spatiotemporal fluctuations and climate-wetland linkages. Our analyses indicate that changes in mangrove coverage have been controlled primarily by extreme freeze events (i.e., air temperatures below a threshold zone of -6.3 to -7.6 °C). We expect that in the past 121 years, mangrove range expansion and contraction has occurred across land-ocean temperature gradients. Mangrove resistance, resilience, and dominance were all highest in areas closer to the ocean where temperature extremes were buffered by large expanses of water and saturated soil. Under climate change, these areas will likely serve as local hotspots for mangrove dispersal, growth, range expansion, and displacement of salt marsh. Collectively, our results show that the frequency and intensity of freeze events across land-ocean temperature gradients greatly influences spatiotemporal patterns of range expansion and contraction of freeze-sensitive mangroves. We expect that, along subtropical coasts, similar processes govern the distribution and abundance of other freeze

  13. Range and Richness of Vascular Land-Plants: The role of variable light (Invited)

    Science.gov (United States)

    Eagleson, P. S.

    2009-12-01

    Since the time of Darwin it has been recognized that with increasing latitude, the average continuous range of latitudes occupied by all the plant species found locally increases, while the number of different species found there (i.e. the local richness of species) decreases. General agreement has developed that climate is somehow responsible, but as recently as 1992 E.O. Wilson found the richness gradient still to be "...one of the great theoretical problems of evolutionary biology", and the 2006 Millenium Ecosystem Assessment found that "We lack a robust theoretical basis for linking ecological diversity to ecosystem dynamics...". In a "zeroth-order" approximation of reality, we posit here that incident SW radiation is the principal driver of these phenomena. We show that the species-specific intersection of the asymptotes of the photosynthetic-capacity curves of the C3 plants overwhelmingly predominant in the extra-tropics offer, at these latitudes, a unique state defining the Darwinian-optimum species (horizontal leaf-area index) for each local climate (average incident SW radiation). This provides a basis for a locally-linear transformation of the probability density function of observed local SW flux into the resulting probability density function of stable species and thence into the range of latitudes separating the same species when appearing in the extremes of this distribution. Further assuming the maximum number of stable local species to be the one-for-one result of separate germination-cum-species-supporting SW flux events, we model their local arrival as a stochastic process and count their annual number as an estimate of the local maximum richness. Range and richness are found here to be inversely related theoretically as was noted observationally by Rapoport (1975), and agreement of both theories with observations is found to be excellent at extra-tropical latitudes. [Currently in the publication process, this work will appear shortly as a

  14. Modeling Climate-Change Effects on Snake Range Extents for Military Land Management

    Science.gov (United States)

    2013-09-01

    34Factors Influencing Home-Range Sizes of Eastern Indigo Snakes in Central Florida." Journal of Herpetology 45.4 (2011): 484-490. Breininger, David... Herpetology 17.3, 256-264. Dyck, S. 1983, Overview on the present status of the concepts of water balance models, in: Van der Beken, A. and Herrmann, A...versus Unharvested Forest Stands." Journal or Herpetology 39.4, 619-626. Speake, D. W., and J. Diemer. 1983. “The Distribution of the Eastern Indigo

  15. Sandia National Laboratories land use permit for operations at Oliktok Alaska Long Range Radar Station.

    Energy Technology Data Exchange (ETDEWEB)

    Catechis, Christopher Spyros

    2013-02-01

    The property subject to this Environmental Baseline Survey (EBS) is located at the Oliktok Long Range Radar Station (LRRS). The Oliktok LRRS is located at 70À 30 W latitude, 149À 53 W longitude. It is situated at Oliktok Point on the shore of the Beaufort Sea, east of the Colville River. The purpose of this EBS is to document the nature, magnitude, and extent of any environmental contamination of the property; identify potential environmental contamination liabilities associated with the property; develop sufficient information to assess the health and safety risks; and ensure adequate protection for human health and the environment related to a specific property.

  16. Deployment Area Selection and Land Withdrawal/Acquisition. M-X/MPS (M-X/Multiple Protective Shelter) Environmental Technical Report. Native Americans Nevada/Utah.

    Science.gov (United States)

    1981-10-02

    and the persistence of cultural values regarding reproduction and family structure have led to a numerical replenishment of the Indian population. The...this belt were favored by some Great Basin peoples as winter village sites. Artemisia Belt This floristic zone typifies the bulk of lands in Nevada and...manufacturing purposes. The Artemisia belt also supported important small game, such as the jackrabbit, and in limited regions was coursed by

  17. Deployment Area Selection and Land Withdrawal/Acquisition. M-X/MPS (M-X/Multiple Protective Shelter) Environmental Technical Report. Atmospheric Resources

    Science.gov (United States)

    1981-10-02

    AD-Ai49 983 DEPLOYMENT AREA SELECTION AND LAND 1/4 WIITHDRAWAL/ACQUISITION M-X/MPS (M-X/MU..(U) HENNINGSON DURHAM AND RICHARDSON SANTA BARBARA CA 92...Ballistic Missile Office i .tr.j, t .i/ Norton Air Force Base, California Ava. 1 , II [,odes B y .. . . . ..... .. . - Henningson, Durham & Richardson, Inc... pollen , ash, soot, metal particles, or chemical droplets. Collectively, this group is known as "total suspended particulates" (TSP). Particulate

  18. Land

    CSIR Research Space (South Africa)

    Audouin, M

    2007-01-01

    Full Text Available Unsustainable agricultural practices have had a role to play in the degradation of land on which agriculture depends. South Africa has an international obligation to develop a National Action Programme (NAP), the purpose of which is to identify...

  19. Impact of urbanization and land-use/land-cover change on diurnal temperature range: a case study of tropical urban airshed of India using remote sensing data.

    Science.gov (United States)

    Mohan, Manju; Kandya, Anurag

    2015-02-15

    Diurnal temperature range (DTR) is an important climate change index. Its knowledge is important to a range of issues and themes in earth sciences central to urban climatology and human-environment interactions. The present study investigates the effect of urbanization on the land surface temperature (LST) based DTR. This study presents spatial and temporal variations of satellite based estimates of annually averaged DTR over megacity Delhi, the capital of India, which are shown for a period of 11 years during 2001-2011 and analyzes this with regard to its land-use/land-cover (LU/LC) changes and population growth. Delhi which witnessed massive urbanization in terms of population growth (decadal growth rate of Delhi during 2001-2011 was 20.96%) and major transformations in the LU/LC (built-up area crossed more than 53%) are experiencing severity in its micro and macroclimate. There was a consistent increase in the areas experiencing DTR below 11°C which typically resembled the 'urban class' viz. from 26.4% in the year 2001 to 65.3% in the year 2011 and subsequently the DTR of entire Delhi which was 12.48°C in the year 2001 gradually reduced to 10.34°C in the year 2011, exhibiting a significant decreasing trend. Rapidly urbanizing areas like Rohini, Dwarka, Vasant Kunj, Kaushambi, Khanjhawala Village, IIT, Safdarjung Airport, etc. registered a significant decreasing trend in the DTR. In the background of the converging DTR, which was primarily due to the increase in the minimum temperatures, a grim situation in terms of potentially net increase in the heat-related mortality rate especially for the young children below 15years of age is envisaged for Delhi. Considering the earlier findings that the level of risk of death remained the highest and longest for Delhi, in comparison to megacities like Sao Paulo and London, the study calls for strong and urgent heat island mitigation measures. Copyright © 2014 Elsevier B.V. All rights reserved.

  20. Numerical modeling of land subsidence due to groundwater withdrawal in Aguascalientes Valley using regional coefficients of deformation determined by InSAR analysis.

    Science.gov (United States)

    Pacheco, J.; Cabral, E.; Wdowinski, S.; Hernandez-Marin, M.; Ortíz, J. Á.; Solano Rojas, D. E.; Oliver-Cabrera, T.

    2014-12-01

    Land subsidence due to groundwater over-exploitation is a deformation process affecting many cities around the world. This type of subsidence develops gradual vertical deformations reaching only a few centimeters per year, but can affect large areas. Consequently, inhabitants of subsiding areas are not aware of the process until others effects are observed, such as ground surface faulting, damage to building, or changes in the natural superficial drain. In order to mitigate and forecast subsidence consequences, it is useful to conduct numerical modeling of the subsidence process. Modeling the subsidence includes the following three basic tasks: a) Delimitation of the shape of the deforming body; b) Determination of the forces that are causing the deformations; and c) Determination of the mechanical properties of the deforming body according with an accepted rheological model. In the case of a land subsidence process, the deforming body is the aquifer system that is being drained. Usually, stratigraphic information from pumping wells, and other geophysical data are used to define the boundaries and shape of the aquifer system. The deformation governing forces, or stresses, can be calculated using the theory of "effective stress". Mechanical properties are usually determined with laboratory testing of samples from shallow strata, because the determination of these properties in samples from the deepest strata is economically or technically unviable. Consequently, the results of the numerical modeling do not necessarily match the observed subsidence evolution and ground faulting. We present in this work numerical simulation results of the land subsiding of the Valley of Aguascalientes, Mexico. Two analyses for the same subsiding area are presented. In the first of them, we used the mechanical properties of only the shallow strata, whereas in the second analysis we used "macroscopic" mechanical properties data determined for the whole aquifer system using In

  1. Clonidine and alcohol withdrawal.

    Science.gov (United States)

    Cushman, P

    1987-01-01

    Clonidine attenuates opiate withdrawal syndrome, via reduction in catecholamine activity in the brain, most probably at the locus ceruleus. Clonidine and locus ceruleus lesions, in animals with alcohol dependency as with the opiates, modify alcohol withdrawal. Both alcohol loading and withdrawal from steady alcohol use alter catecholamines in man and animals. Clonidine's potential to treat alcoholics in withdrawal is reviewed. Several double blind studies showed clonidine, or similar analogues, to be somewhat superior to placebo in acute alcohol withdrawal. Major improvements were in pulse, blood pressure and composite alcohol withdrawal scores. Side effects were minor and mainly included mild sedation, or postural hypotension. In the only available published study clonidine compared reasonably well to a standard sedative in alcohol withdrawal, and greatly influential in plasma catecholamine levels. Other components of alcohol withdrawal, as seizures and hallucinations-delirium tremens have not been documented to change with clonidine. The alpha-2-adrenergic agonists in alcohol treatment seemed modestly effective for treatment of some parts of alcohol withdrawal. They represent a promising, novel, but still investigational approach. Additional data, particularly comparing them to the benzodiazepines, are needed before their potential in therapeutics can be assessed.

  2. 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.

  3. Free-ranging domestic cats (Felis catus) on public lands: estimating density, activity, and diet in the Florida Keys

    Science.gov (United States)

    Cove, Michael V.; Gardner, Beth; Simons, Theodore R.; Kays, Roland; O'Connell, Allan F.

    2017-01-01

    Feral and free-ranging domestic cats (Felis catus) can have strong negative effects on small mammals and birds, particularly in island ecosystems. We deployed camera traps to study free-ranging cats in national wildlife refuges and state parks on Big Pine Key and Key Largo in the Florida Keys, USA, and used spatial capture–recapture models to estimate cat abundance, movement, and activities. We also used stable isotope analyses to examine the diet of cats captured on public lands. Top population models separated cats based on differences in movement and detection with three and two latent groups on Big Pine Key and Key Largo, respectively. We hypothesize that these latent groups represent feral, semi-feral, and indoor/outdoor house cats based on the estimated movement parameters of each group. Estimated cat densities and activity varied between the two islands, with relatively high densities (~4 cats/km2) exhibiting crepuscular diel patterns on Big Pine Key and lower densities (~1 cat/km2) exhibiting nocturnal diel patterns on Key Largo. These differences are most likely related to the higher proportion of house cats on Big Pine relative to Key Largo. Carbon and nitrogen isotope ratios from hair samples of free-ranging cats (n = 43) provided estimates of the proportion of wild and anthropogenic foods in cat diets. At the population level, cats on both islands consumed mostly anthropogenic foods (>80% of the diet), but eight individuals were effective predators of wildlife (>50% of the diet). We provide evidence that cat groups within a population move different distances, exhibit different activity patterns, and that individuals consume wildlife at different rates, which all have implications for managing this invasive predator.

  4. Visualization of groundwater withdrawals

    Science.gov (United States)

    Winston, Richard B.; Goode, Daniel J.

    2017-12-21

    Generating an informative display of groundwater withdrawals can sometimes be difficult because the symbols for closely spaced wells can overlap. An alternative method for displaying groundwater withdrawals is to generate a “footprint” of the withdrawals. WellFootprint version 1.0 implements the Footprint algorithm with two optional variations that can speed up the footprint calculation. ModelMuse has been modified in order to generate the input for WellFootprint and to read and graphically display the output from WellFootprint.

  5. Groundwater withdrawal rates from the Ozark Plateaus aquifer system, 1900 to 2010

    Science.gov (United States)

    Knierim, Katherine J.; Nottmeier, Anna M.; Worland, Scott C.; Westerman, Drew A.; Clark, Brian R.

    2016-01-01

    PREP. Briefly, groundwater use was modeled by 1) acquiring site-specific and county-level groundwater withdrawal rates and well locations (with and without pumping information) from state agencies and the U.S. Geological Survey, 2) linearly interpolating groundwater withdrawal rates to create a yearly time-step for the period of observations (generally 1962 to 2010), 3) extrapolating county-level groundwater withdrawal rates to 1900 for non-agriculture, agriculture, and livestock groundwater use by assuming a linear decrease from the oldest, recorded groundwater withdrawal rate (generally between 1962 and 1985) to 0 million liters per day (ML/d) in 1900, 4) extrapolating site-specific (public supply) and county-level (domestic) groundwater withdrawal rates to 1900 assuming use was linearly related to population change, then constraining groundwater withdrawal rate to 0 ML/d in 1900 using a multiplier that incrementally ranged from zero in 1900 to one in 2010, 5) attributing groundwater withdrawal rates to well locations using a hierarchical process where observed site-specific groundwater withdrawal rates were used first, followed by county-level groundwater withdrawal rates disaggregated to wells where pumping was known to occur at any time, and lastly county-level groundwater withdrawal rates disaggregated to well locations with a potential groundwater-use type based on land use, and 6) aggregation into model cells (row, column, layer) and counties by summing modeled site-specific groundwater withdrawal rates using well location and depth. The large dataset (148,836 well locations) and long period (110 years) necessitated modeling groundwater use programmatically using Python 2.7. 

  6. Withdrawal Method (Coitus Interruptus)

    Science.gov (United States)

    ... fluid and pregnancy Withdrawal method (coitus interruptus) About Advertisement Mayo Clinic does not endorse companies or products. ... a Job Site Map About This Site Twitter Facebook Google YouTube Pinterest Mayo Clinic is a not- ...

  7. Progesterone withdrawal I: pro-convulsant effects.

    Science.gov (United States)

    Moran, M H; Smith, S S

    1998-10-05

    Pro-convulsant withdrawal properties have been reported for a variety of GABA-modulatory drugs, such as the benzodiazepines (BDZs, [S.E. File, The history of BDZ dependence: a review of animal studies, Neurosci. Biobehav. Rev. 14 (1990) 135-146; P.R. Finley, P. E. Nolan, Precipitation of BDZ withdrawal following sudden discontinuation of midazolam, DICP 23 (1989) 151-152]), barbiturates and ethanol [N. Kokka, D.E. Sapp, U. Witte, R.W. Olsen, Sex differences in sensitivity to pentylenetetrazol but not in GABAA receptor binding, Pharm. Biochem. Behav. 43 (1992) 441-447]. In this report, we test the hypothesis that pro-convulsant effects are produced by withdrawal from the GABA-modulatory neurosteroid 3alpha-OH-5alpha-pregnan-20-one (3alpha,5alpha-THP) after sustained exposure to elevated circulating levels of its parent compound progesterone (P). Seizure activity was precipitated by picrotoxin or with the BDZ inverse agonist n-methyl-beta-carboline-3-carboxamide (beta-CC), and a seizure rating determined 24 h after abrupt discontinuation of P following a multiple withdrawal/chronic administration paradigm. In some cases, a pseudopregnant rat model was employed to produce increased ovarian production of P prior to withdrawal (ovariectomy). Rats undergoing P withdrawal exhibited greater seizure-like activity than vehicle-treated controls, and received seizure scores in the same range as rats undergoing BDZ withdrawal. Administration of a 5alpha-reductase blocker, MK-906, along with P, prevented this pro-convulsant effect of P withdrawal, suggesting that the GABA-modulatory 3alpha,5alpha-THP is the active compound responsible for this withdrawal effect. Combined administration of P and diazepam produced synergistic effects upon withdrawal and produced a seizure score higher than observed after withdrawal from either agent alone. These results suggest that P exhibits withdrawal properties via the neuroactive steroid 3alpha, 5alpha-THP, that include exacerbation of

  8. Management of alcohol withdrawal.

    Science.gov (United States)

    Erstad, B L; Cotugno, C L

    1995-04-01

    The diagnosis, evaluation and assessment, supportive care, and pharmacologic treatment of acute alcohol withdrawal are reviewed. Patients in alcohol withdrawal have decreased or stopped their heavy, prolonged ingestion of alcohol and have subsequently begun to have at least two of the following symptoms: autonomic hyperactivity, tremor, nausea or vomiting, hallucinations, psychomotor agitation, anxiety, and grand mal seizures. Evaluation of the patient at risk for alcohol withdrawal should include a complete history and physical examination; laboratory tests are often indicated. The patient's progress should be assessed before, during, and after therapy, preferably with a validated instrument. After the initial evaluation and assessment but before the administration of dextrose-containing solutions, a 100-mg dose of thiamine hydrochloride should be given by i.m. or i.v. injection. Routine supplementation with calcium, magnesium, and phosphate is questionable. The need for fluid and electrolyte administration varies depending on losses. Most patients in alcohol withdrawal can be managed with supportive care alone, but for more severe or complicated withdrawal, pharmacologic therapy may be necessary. Benzodiazepines, especially diazepam and chlordiazepoxide, are the drugs of choice. Barbiturates, beta-blockers, and antipsychotics are generally not recommended as first-line therapy. Several drugs in other classes, including carbamazepine and clonidine, have been shown to be about as effective as benzodiazepines in a few studies, but the studies were small, the patients were usually in mild withdrawal, and validated instruments for assessing withdrawal were often not used. Some agents, such as beta-blockers, may play a role as adjuncts to, not replacements for, benzodiazepine therapy. For patients in alcohol withdrawal who do not respond to supportive care, benzodiazepines are the treatment of choice.

  9. 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 ...

  10. 78 FR 15043 - Notice of Proposed Withdrawal and Opportunity for a Public Meeting; New Mexico

    Science.gov (United States)

    2013-03-08

    ... Interior for Policy, Management and Budget proposes to withdraw 5,670.71 acres of public lands to protect... Concern (ACEC). This notice segregates the lands for up to 2 years from settlement, sale, location, ] and... Policy, Management and Budget to withdraw, subject to valid existing rights, the following described...

  11. The Withdrawal Assessment Tool-1 (WAT-1): an assessment instrument for monitoring opioid and benzodiazepine withdrawal symptoms in pediatric patients.

    Science.gov (United States)

    Franck, Linda S; Harris, Sion Kim; Soetenga, Deborah J; Amling, June K; Curley, Martha A Q

    2008-11-01

    To develop and test the validity and reliability of the Withdrawal Assessment Tool-1 for monitoring opioid and benzodiazepine withdrawal symptoms in pediatric patients. Prospective psychometric evaluation. Pediatric critical care nurses assessed eligible at-risk pediatric patients for the presence of 19 withdrawal symptoms and rated the patient's overall withdrawal intensity using a Numeric Rating Scale where zero indicated no withdrawal and 10 indicated worst possible withdrawal. The 19 symptoms were derived from the Opioid and Benzodiazepine Withdrawal Score, the literature and expert opinion. Two pediatric intensive care units in university-affiliated academic children's hospitals. Eighty-three pediatric patients, median age 35 mos (interquartile range: 7 mos-10 yrs), recovering from acute respiratory failure who were being weaned from more than 5 days of continuous infusion or round-the-clock opioid and benzodiazepine administration. Repeated observations during analgesia and sedative weaning. A total of 1040 withdrawal symptom assessments were completed, with a median (interquartile range) of 11 (6-16) per patient over 6.6 (4.8-11) days. Generalized linear modeling was used to analyze each symptom in relation to withdrawal intensity ratings, adjusted for site, subject, and age group. Symptoms with high redundancy or low levels of association with withdrawal intensity ratings were dropped, resulting in an 11-item (12-point) scale. Concurrent validity was indicated by high sensitivity (0.872) and specificity (0.880) for Withdrawal Assessment Tool-1 > 3 predicting Numeric Rating Scale > 4. Construct validity was supported by significant differences in drug exposure, length of treatment and weaning from sedation, length of mechanical ventilation and intensive care unit stay for patients with Withdrawal Assessment Tool-1 scores > 3 compared with those with lower scores. The Withdrawal Assessment Tool-1 shows excellent preliminary psychometric performance when used

  12. 24 CFR 1710.505 - Withdrawal of State certification.

    Science.gov (United States)

    2010-04-01

    ... HOUSING AND URBAN DEVELOPMENT (INTERSTATE LAND SALES REGISTRATION PROGRAM) LAND REGISTRATION Certification... 24 Housing and Urban Development 5 2010-04-01 2010-04-01 false Withdrawal of State certification. 1710.505 Section 1710.505 Housing and Urban Development Regulations Relating to Housing and Urban...

  13. Alcohol Withdrawal Syndrome: Benzodiazepines and Beyond.

    Science.gov (United States)

    Sachdeva, Ankur; Choudhary, Mona; Chandra, Mina

    2015-09-01

    Alcohol dependence is an increasing and pervasive problem. Alcohol withdrawal symptoms are a part of alcohol dependence syndrome and are commonly encountered in general hospital settings, in most of the departments. Alcohol withdrawal syndrome ranges from mild to severe. The severe complicated alcohol withdrawal may present with hallucinations, seizures or delirium tremens. Benzodiazepines have the largest and the best evidence base in the treatment of alcohol withdrawal, and are considered the gold standard. Others, such as anticonvulsants, barbiturates, adrenergic drugs, and GABA agonists have been tried and have evidence. Supportive care and use of vitamins is essential in the management. Symptom triggered regime is favoured over fixed tapering dose regime, although monitoring through scales is cumbersome. 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 'Alcohol withdrawal syndrome' in humans during the last 10 years. A total of 1182 articles came up. Articles not relevant to clinical utility and management were excluded based on the titles and abstract available. Full text articles, meta-analyses, systematic reviews and randomized controlled trials were obtained from this list and were considered for review.

  14. [Benzodiazepine withdrawal with carbamazepine].

    Science.gov (United States)

    Kaendler, S H; Volk, S; Pflug, B

    1996-05-01

    Seventeen patients who had been dependent on benzodiazepines for more than 0.5 years were subjected to abrupt withdrawal with carbamazepine (CBZ, 400 mg twice a day). Most patients were had been taking benzodiazepines because of panic disorder or neurosis. In 2 cases the patients were regarded as having high dose dependency. In 2 others withdrawal was discontinued because of loss of motivation or medical problems (HIV infection). During the withdrawal the patients were rated daily for anxiety, mood alterations, perception disturbances, neurological symptoms, and vegetative signs. Perception disturbances were noted in 14 patients. Most patients showed sleep disturbances, mood alterations or anxiety. Epileptic seizures, a well known complication of benzodiazepine withdrawal, did not occur. The CBZ treatment was well tolerated by all patients and caused no severe problems. Compared with a gradual tapering off of benzodiazepines, abrupt withdrawal plus CBZ medication seems to be better tolerated; in particular, the period of hospitalization for these patients can be shorter. Because anxiety, the reason for the benzodiazepine treatment in many cases, often recurs, the patients must be offered continuous after-care to prevent a new dependence.

  15. Diversity and Abundance of Beetle (Coleoptera) Functional Groups in a Range of Land Use System in Jambi, Sumatra

    OpenAIRE

    SURYO HARDIWINOTO; INDRIYATI; FRANCISCUS XAVERIUS SUSILO

    2009-01-01

    Degradation of tropical rain forest might exert impacts on biodiversity loss and affect the function and stability of the related ecosystems. The objective of this study was to study the impact of land use systems (LUS) on the diversity and abundance of beetle functional groups in Jambi area, Sumatra. This research was carried out during the rainy season (May-June) of 2004. Inventory and collection of beetles have been conducted using winkler method across six land use systems, i.e. primary f...

  16. New narrow-range endemic land snails from the sky islands of northern South Africa (Gastropoda: Streptaxidae and Urocyclidae

    Directory of Open Access Journals (Sweden)

    David G. Herbert

    2016-10-01

    Full Text Available One new genus and five new species of land snails are described from high altitude, insular, Afrotemperate forest habitats in northern South Africa. The distribution of these species is discussed in relation to other narrowly endemic land snails occurring in this and neighbouring regions. The new genus is Ptilototheca gen. nov.; the five new species are: Gulella davisae sp. nov., G. hadroglossa sp. nov., Ptilototheca soutpansbergensis gen. et sp. nov., Sheldonia monsmaripi sp. nov. and S. wolkbergensis sp. nov.

  17. 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.

  18. Alcohol withdrawal seizures.

    Science.gov (United States)

    Hughes, John R

    2009-06-01

    The topic of alcohol withdrawal syndrome (AWS), including delirium tremens and especially seizures, is reviewed. From mice and rat studies, it is known that both N-methyl-d-aspartate (NMDA) and gamma-aminobutyric acid (GABA) receptors are involved in AWS. During alcohol intoxication chronic adaptations of NMDA and GABA receptors occur, and during alcohol withdrawal a hyperexcitable state develops. In studies on humans, during intoxication the NMDA receptors are activated and mediate tonic inhibition. In withdrawal, a rebound activation of these receptors occurs. Both GABA-A and GABA-B receptors, especially the alpha2 subunit of GABA-A receptors, are also likely involved. Homocysteine increases with active drinking, and in withdrawal, excitotoxicity likely is induced by a further increase in homocysteine, viewed as a risk factor for AWS and also as a screening tool. The dopamine transporter gene is also associated with AWS. Characteristics involves changes in the ECG, especially an increase in QT interval, and EEG changes, including abnormal quantified EEG, at times periodic lateralized epileptiform discharges, and especially seizures, usually occurring 6-48h after the cessation of drinking. Therapy has emphasized benzodiazepines, mainly diazepam and lorazepam, but more standard antiepileptic drugs, like carbamazepine and topiramate, are also effective and safe.

  19. Hypertension after clonidine withdrawal.

    Science.gov (United States)

    Husserl, F E; deCarvalho, J G; Batson, H M; Frohlich, E D

    1978-05-01

    Rebound hypertension occurred in two patients upon clonidine withdrawal. Treatment of the hypertensive crisis consists of both alpha- and beta-adrenergic receptor blockade, reserpine, or the reintroduction of clonidine. With effective control of pressure during the crisis, long-term antihypertensive therapy must be resumed.

  20. 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

  1. Alcohol withdrawal syndrome: preventive measures.

    Science.gov (United States)

    2015-12-01

    A withdrawal syndrome of variable intensity and severity may be triggered when an alcohol-dependent individual stops drinking altogether or significantly reduces alcohol consumption. Preventive measures can be implemented after identifying patients at risk of a severe alcohol withdrawal syndrome. Patients at risk of alcohol withdrawal syndrome should be closely monitored during the first 48 hours of abstinence, either on an outpatient or inpatient basis. When medication is needed to prevent alcohol withdrawal syndrome, a benzodiazepine is the drug of first choice.

  2. Exogenous Cushing's syndrome and glucocorticoid withdrawal.

    Science.gov (United States)

    Hopkins, Rachel L; Leinung, Matthew C

    2005-06-01

    Glucocorticoid therapy in various forms is extremely common for a wide range of inflammatory, autoimmune, and neoplastic disorders. It is therefore important for the physician to be aware of the possibility of both iatrogenic and factitious Cushing's syndrome. Although most common with oral therapy, it is also important to be alert to the fact that all forms of glucocorticoid delivery have the potential to cause Cushing's syndrome. Withdrawal from chronic glucocorticoid therapy presents significant challenges. These include the possibility of adrenal insufficiency after discontinuation of steroid therapy, recurrence of underlying disease as the glucocorticoid is being withdrawn, and the possibility of steroid withdrawal symptoms. Nonetheless, with patience and persistence, a reasonable approach to withdrawal of glucocorticoid therapy can be achieved.

  3. Proceedings of the International Symposium on Frozen Soil Impacts on Agricultural, Range, and Forest Lands Held at Spokane, Washington on March 21-22, 1990

    Science.gov (United States)

    1990-03-01

    Thoms-Hjirpe (1986) Simulated and measured soil water dynamics of unfertilized and fertilized barley. Acta Agricultura Scendinavica, Vol. 36, pp. 162...27, No. 2-3, pp. 89-109. Steen, E., P.-E. Jansson and J. Persson (1984) Experimental site of the ’Ecology of Arable Land’ project. Acta Agricultura ...the 38 degree North Latitude line but the high mountain ranges of New Mexico , Arizona, and California. Therefore, knowledge of the complex phenomena

  4. Acute withdrawal: diagnosis and treatment.

    Science.gov (United States)

    Brust, John C M

    2014-01-01

    Symptoms of alcohol withdrawal range in severity from mild "hangover" to fatal delirium tremens (DTs). Tremor, hallucinosis, and seizures usually occur within 48 hours of abstinence. Seizures tend to be generalized without focality, occurring singly or in a brief cluster, but status epilepticus is not unusual. DTs usually appears after 48 hours of abstinence and consists of marked inattentiveness, agitation, hallucinations, fluctuating level of alertness, marked tremulousness, and sympathetic overactivity. The mainstay of treatment for alcohol withdrawal is benzodiazepine pharmacotherapy, which can be used to control mild early symptoms, to prevent progression to DTs, or to treat DTs itself. Alternative less evidence-based pharmacotherapies include phenobarbital, anticonvulsants, baclofen, gamma-hydroxybutyric acid, beta-blockers, alpha-2-agonists, and N-methyl-d-aspartate receptor blockers. Treatment of DTs is a medical emergency requiring heavy sedation in an intensive care unit, with close attention to autonomic instability, fever, fluid loss, and electrolyte imbalance. Frequent comorbid disorders include hypoglycemia, liver failure, pancreatitis, sepsis, meningitis, intracranial hemorrhage, and Wernicke-Korsakoff syndrome. © 2014 Elsevier B.V. All rights reserved.

  5. 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.

  6. Alcohol and Sedative-Hypnotic Withdrawal Catatonia: Two Case Reports, Systematic Literature Review, and Suggestion of a Potential Relationship With Alcohol Withdrawal Delirium.

    Science.gov (United States)

    Oldham, Mark A; Desan, Paul H

    2016-01-01

    Withdrawal from alcohol and sedative-hypnotics can be complicated by seizures, hallucinations, or delirium. Withdrawal catatonia is another, less commonly discussed complication that clinicians should appreciate. We present a case of alcohol withdrawal catatonia and a case of benzodiazepine withdrawal catatonia and offer a systematic review of previous cases of alcohol or sedative-hypnotic withdrawal catatonia. We outline clinical features that suggest a potential link between withdrawal catatonia and withdrawal delirium. We identified 26 cases of withdrawal catatonia in the literature-all principally with catatonic stupor-with an average age of 56 years (range: 27-92) and balanced prevalence between sexes. Withdrawal catatonia tends to occur only after chronic use of alcohol or sedative-hypnotic agents with a typical onset of 3-7 days after discontinuation and duration of 3-10 days. Withdrawal catatonia is responsive to benzodiazepines or electroconvulsive therapy. Features that suggest a parallel between withdrawal catatonia and withdrawal delirium include time course, neurobiologic convergence, efficacy of benzodiazepines and electroconvulsive therapy, typical absence of abnormal electroencephalographic findings, and phenotypic classification suggested by a recent literature in sleep medicine. Alcohol and sedative-hypnotic withdrawal may present with catatonia or catatonic features. The clinical and neurobiologic convergence between withdrawal catatonia and withdrawal delirium deserves further attention. In view of these similarities, we propose that withdrawal delirium may represent excited catatonia: these new viewpoints may serve as a substrate for a better understanding of the delirium-catatonia spectrum. Copyright © 2016 The Academy of Psychosomatic Medicine. Published by Elsevier Inc. All rights reserved.

  7. 77 FR 74690 - Notice of Amended Proposed Withdrawal; Partial Termination of Segregative Effect; Arizona...

    Science.gov (United States)

    2012-12-17

    ... Budget has approved an amendment to a previously filed application to withdraw public lands in Arizona, California, Colorado, Nevada, New Mexico, and Utah from settlement, sale, location, and entry under the... the Interior for Policy, Management and Budget to withdraw, subject to valid existing rights...

  8. Withdrawing benzodiazepines in primary care.

    Science.gov (United States)

    Lader, Malcolm; Tylee, Andre; Donoghue, John

    2009-01-01

    assisting in the discontinuation of benzodiazepines but the available data are insufficient for recommendations to be made regarding its use. Antidepressants can help if the patient is depressed before withdrawal or develops a depressive syndrome during withdrawal. The clearest strategy was to taper the medication; abrupt cessation can only be justified if a very serious adverse effect supervenes during treatment. No clear evidence suggests the optimum rate of tapering, and schedules vary from 4 weeks to several years. Our recommendation is to aim for withdrawal in benzodiazepine can be helpful, at least logistically, as diazepam is available in a liquid formulation.Psychological interventions range from simple support through counselling to expert cognitive-behavioural therapy (CBT). Group therapy may be helpful as it at least provides support from other patients. The value of counselling is not established and it can be quite time consuming. CBT needs to be administered by fully trained and experienced personnel but seems effective, particularly in obviating relapse.The outcome of successful withdrawal is gratifying, both in terms of improved functioning and abstinence from the benzodiazepine usage. Economic benefits also ensue.Some of the principles of withdrawing benzodiazepines are listed. Antidepressants may be helpful, as may some symptomatic remedies. Care must be taken not to substitute one drug dependence problem for the original one.

  9. The decreasing range between dry- and wet- season precipitation over land and its effect on vegetation primary productivity

    Science.gov (United States)

    2017-01-01

    One consequence of climate change is the alteration of global water fluxes, both in amount and seasonality. As a result, the seasonal difference between dry- (p 100 mm/month) precipitation (p) has increased over land during recent decades (1980–2005). However, our analysis expanding to a 60-year period (1950–2009) showed the opposite trend. This is, dry-season precipitation increased steadily, while wet-season precipitation remained constant, leading to reduced seasonality at a global scale. The decrease in seasonality was not due to a change in dry-season length, but in precipitation rate; thus, the dry season is on average becoming wetter without changes in length. Regionally, wet- and dry-season precipitations are of opposite sign, causing a decrease in the seasonal variation of the precipitation over 62% of the terrestrial ecosystems. Furthermore, we found a high correlation (r = 0.62) between the change in dry-season precipitation and the trend in modelled net primary productivity (NPP), which is explained based on different ecological mechanisms. This trend is not found with wet-season precipitation (r = 0.04), These results build on the argument that seasonal water availability has changed over the course of the last six decades and that the dry-season precipitation is a key driver of vegetation productivity at the global scale. PMID:29284050

  10. Predicting potential ranges of primary malaria vectors and malaria in northern South America based on projected changes in climate, land cover and human population.

    Science.gov (United States)

    Alimi, Temitope O; Fuller, Douglas O; Qualls, Whitney A; Herrera, Socrates V; Arevalo-Herrera, Myriam; Quinones, Martha L; Lacerda, Marcus V G; Beier, John C

    2015-08-20

    Changes in land use and land cover (LULC) as well as climate are likely to affect the geographic distribution of malaria vectors and parasites in the coming decades. At present, malaria transmission is concentrated mainly in the Amazon basin where extensive agriculture, mining, and logging activities have resulted in changes to local and regional hydrology, massive loss of forest cover, and increased contact between malaria vectors and hosts. Employing presence-only records, bioclimatic, topographic, hydrologic, LULC and human population data, we modeled the distribution of malaria and two of its dominant vectors, Anopheles darlingi, and Anopheles nuneztovari s.l. in northern South America using the species distribution modeling platform Maxent. Results from our land change modeling indicate that about 70,000 km(2) of forest land would be lost by 2050 and 78,000 km(2) by 2070 compared to 2010. The Maxent model predicted zones of relatively high habitat suitability for malaria and the vectors mainly within the Amazon and along coastlines. While areas with malaria are expected to decrease in line with current downward trends, both vectors are predicted to experience range expansions in the future. Elevation, annual precipitation and temperature were influential in all models both current and future. Human population mostly affected An. darlingi distribution while LULC changes influenced An. nuneztovari s.l. distribution. As the region tackles the challenge of malaria elimination, investigations such as this could be useful for planning and management purposes and aid in predicting and addressing potential impediments to elimination.

  11. Linking land cover and species distribution models to project potential ranges of malaria vectors: an example using Anopheles arabiensis in Sudan and Upper Egypt

    Directory of Open Access Journals (Sweden)

    Fuller Douglas O

    2012-08-01

    Full Text Available Abstract Background Anopheles arabiensis is a particularly opportunistic feeder and efficient vector of Plasmodium falciparum in Africa and may invade areas outside its normal range, including areas separated by expanses of barren desert. The purpose of this paper is to demonstrate how spatial models can project future irrigated cropland and potential, new suitable habitat for vectors such as An. arabiensis. Methods Two different but complementary spatial models were linked to demonstrate their synergy for assessing re-invasion potential of An. arabiensis into Upper Egypt as a function of irrigated cropland expansion by 2050. The first model (The Land Change Modeler was used to simulate changes in irrigated cropland using a Markov Chain approach, while the second model (MaxEnt uses species occurrence points, land cover and other environmental layers to project probability of species presence. Two basic change scenarios were analysed, one involving a more conservative business-as-usual (BAU assumption and second with a high probability of desert-to-cropland transition (Green Nile to assess a broad range of potential outcomes by 2050. Results The results reveal a difference of 82,000 sq km in potential An. arabiensis range between the BAU and Green Nile scenarios. The BAU scenario revealed a highly fragmented set of small, potential habitat patches separated by relatively large distances (maximum distance = 64.02 km, mean = 12.72 km, SD = 9.92, while the Green Nile scenario produced a landscape characterized by large patches separated by relatively shorter gaps (maximum distance = 49.38, km, mean = 4.51 km, SD = 7.89 that may be bridged by the vector. Conclusions This study provides a first demonstration of how land change and species distribution models may be linked to project potential changes in vector habitat distribution and invasion potential. While gaps between potential habitat patches remained large in the

  12. When and where to move: Dynamic occupancy models explain the range dynamics of a food nomadic bird under climate and land cover change.

    Science.gov (United States)

    Kalle, Riddhika; Ramesh, Tharmalingam; Downs, Colleen T

    2018-01-01

    Globally, long-term research is critical to monitor the responses of tropical species to climate and land cover change at the range scale. Citizen science surveys can reveal the long-term persistence of poorly known nomadic tropical birds occupying fragmented forest patches. We applied dynamic occupancy models to 13 years (2002-2014) of citizen science-driven presence/absence data on Cape parrot (Poicephalus robustus), a food nomadic bird endemic to South Africa. We modeled its underlying range dynamics as a function of resource distribution, and change in climate and land cover through the estimation of colonization and extinction patterns. The range occupancy of Cape parrot changed little over time (ψ = 0.75-0.83) because extinction was balanced by recolonization. Yet, there was considerable regional variability in occupancy and detection probability increased over the years. Colonizations increased with warmer temperature and area of orchards, thus explaining their range shifts southeastwards in recent years. Although colonizations were higher in the presence of nests and yellowwood trees (Afrocarpus and Podocarpus spp.), the extinctions in small forest patches (≤227 ha) and during low precipitation (≤41 mm) are attributed to resource constraints and unsuitable climatic conditions. Loss of indigenous forest cover and artificial lake/water bodies increased extinction probabilities of Cape parrot. The land use matrix (fruit farms, gardens, and cultivations) surrounding forest patches provides alternative food sources, thereby facilitating spatiotemporal colonization and extinction in the human-modified matrix. Our models show that Cape parrots are vulnerable to extreme climatic conditions such as drought which is predicted to increase under climate change. Therefore, management of optimum sized high-quality forest patches is essential for long-term survival of Cape parrot populations. Our novel application of dynamic occupancy models to long-term citizen

  13. Demographic consequences of climate change and land cover help explain a history of extirpations and range contraction in a declining snake species.

    Science.gov (United States)

    Pomara, Lars Y; LeDee, Olivia E; Martin, Karl J; Zuckerberg, Benjamin

    2014-07-01

    Developing conservation strategies for threatened species increasingly requires understanding vulnerabilities to climate change, in terms of both demographic sensitivities to climatic and other environmental factors, and exposure to variability in those factors over time and space. We conducted a range-wide, spatially explicit climate change vulnerability assessment for Eastern Massasauga (Sistrurus catenatus), a declining endemic species in a region showing strong environmental change. Using active season and winter adult survival estimates derived from 17 data sets throughout the species' range, we identified demographic sensitivities to winter drought, maximum precipitation during the summer, and the proportion of the surrounding landscape dominated by agricultural and urban land cover. Each of these factors was negatively associated with active season adult survival rates in binomial generalized linear models. We then used these relationships to back-cast adult survival with dynamic climate variables from 1950 to 2008 using spatially explicit demographic models. Demographic models for 189 population locations predicted known extant and extirpated populations well (AUC = 0.75), and models based on climate and land cover variables were superior to models incorporating either of those effects independently. These results suggest that increasing frequencies and severities of extreme events, including drought and flooding, have been important drivers of the long-term spatiotemporal variation in a demographic rate. We provide evidence that this variation reflects nonadaptive sensitivity to climatic stressors, which are contributing to long-term demographic decline and range contraction for a species of high-conservation concern. Range-wide demographic modeling facilitated an understanding of spatial shifts in climatic suitability and exposure, allowing the identification of important climate refugia for a dispersal-limited species. Climate change vulnerability

  14. Benzodiazepines for alcohol withdrawal.

    Science.gov (United States)

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

    2010-03-17

    Alcohol abuse and dependence represents a serious health problem worldwide with social, interpersonal and legal interpolations. Benzodiazepines have been widely used for the treatment of alcohol withdrawal symptoms. Moreover it is unknown whether different benzodiazepines and different regimens of administration may have the same merits. To evaluate the effectiveness and safety of benzodiazepines in the treatment of alcohol withdrawal. Cochrane Drugs and Alcohol Group' Register of Trials (December 2009), PubMed, EMBASE, CINAHL (January 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 examining effectiveness, safety and risk-benefit of benzodiazepines in comparison with placebo or other pharmacological treatment and between themselves. All patients were included regardless of age, gender, nationality, and outpatient or inpatient therapy. Two authors independently screened and extracted data from studies. Sixty four studies, 4309 participants, met the inclusion criteria.- Comparing benzodiazepines versus placebo, benzodiazepines performed better for seizures, 3 studies, 324 participants, RR 0.16 (0.04 to 0.69), no statistically significant difference for the other outcomes considered.- Comparing benzodiazepines versus other drugs, there is a trend in favour of benzodiazepines for seizure and delirium control, severe life threatening side effect, dropouts, dropouts due to side effects and patient's global assessment score. A trend in favour of control group was observed for CIWA-Ar scores at 48 hours and at the end of treatment. The results reach statistical significance only in one study, with 61 participants, results on Hamilton anxiety rating scale favour control MD -1.60 (-2.59 to -0.61)- Comparing different benzodiazepines among themselves,results never reached statistical significance but chlordiazepoxide performed better

  15. Dexmedetomidine for acute baclofen withdrawal.

    Science.gov (United States)

    Morr, Simon; Heard, Christopher M; Li, Veetai; Reynolds, Renée M

    2015-04-01

    Intrathecal baclofen is widely accepted as a treatment option for severe spasticity through its γ-Aminobutyric acid-B (GABAB ) agonist properties. Abrupt cessation can lead to severe and life-threatening withdrawal characterized by altered mental status, autonomic dysreflexia, rigidity, and seizures. This symptomatic presentation is similar to alcohol withdrawal, which is mediated by modification of GABAA expression. Use of the α2-adrenergic agonist dexmedetomidine for the treatment of ethanol withdrawal has been widely reported, raising the question of its potential role in baclofen withdrawal. We present a case of the successful treatment of acute severe baclofen withdrawal with a dexmedetomidine infusion. A 15-year-old patient with spastic quadriparesis and cerebral palsy underwent unexpected removal of his baclofen pump due to an infection that was encountered during a planned pump revision. Following removal, he was placed on high dose enteral baclofen every 6 h. Despite further benzodiazepine supplementation, he had progressive hemodynamic instability, severe rebound spasticity, and intermittent spontaneous clonus consistent with baclofen withdrawal. A dexmedetomidine infusion was titrated to a peak dose of 16 mcg per hour with successful treatment of withdrawal symptoms. The patient became normotensive without tachycardia. Tone and agitation improved. Dexmedetomidine is to our knowledge a previously unreported option for treatment of acute severe baclofen withdrawal. We report a case of safe and efficacious use in a patient with spastic quadriparesis on chronic intrathecal baclofen. Scientifically rigorous comparison with other options remains to be performed.

  16. 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.

  17. Recalls, Market Withdrawals and Safety Alerts

    Science.gov (United States)

    ... Home Safety Recalls, Market Withdrawals, & Safety Alerts Recalls, Market Withdrawals, & Safety Alerts Share Tweet Linkedin Pin it ... Safety Alerts Archive. Sign up to receive Recalls, Market Withdrawals and Safety Alerts . * FDA Employees: Use Chrome ...

  18. Returns in the Western Range Cattle Industry: Reconstructing the Financial History of the Matador Land and Cattle Company, 1883-1920

    Directory of Open Access Journals (Sweden)

    Mary Jo Billiot

    2017-06-01

    Full Text Available Much has been written concerning the rate of return earned by investors in cattle ranching during the open range era of the American West. Individual and foreign investors supplied large amounts of capital to stock the ranges; fortunes were made and lost in a short 20-year span. Financial histories abound in the literature regarding the return on investments. Most, if not all, rely on published financial data to determine performance. Yet, accounting practices of the time render any financial performance calculated from published financials problematic. This article estimates the financial performance of the Matador Land and Cattle Company for the years 1882-1920 by adjusting the published financial data to conform to modern accounting practices. In doing so, a more accurate picture of the financial performance of a large Scottish cattle firm operating on the open range emerges. Additionally, the article estimates the return that a typical investor earned holding stock in the Matador. Taken together, these measures provide a reflection of the rate of return during the open range era of the American West.

  19. Benzodiazepine dependence and withdrawal: identification and medical management.

    Science.gov (United States)

    Landry, M J; Smith, D E; McDuff, D R; Baughman, O L

    1992-01-01

    Primary care physicians prescribe benzodiazepines for the treatment of anxiety. Although most patients use the benzodiazepines appropriately, some patients experience benzodiazepine abuse, addiction, or physical dependence, each one of which is a distinct syndrome. Benzodiazepine dependence, which relates to the development of tolerance and an abstinence syndrome, can be produced by three disparate benzodiazepine use patterns. These distinct benzodiazepine use patterns can in turn create distinct withdrawal syndromes. High-dose benzodiazepine use between 1 and 6 months can produce an acute sedative-hypnotic withdrawal syndrome. In contrast, low-dose therapeutic range benzodiazepine use longer than 6 months can produce a prolonged, subacute low-dose benzodiazepine withdrawal syndrome. Daily, high-dose benzodiazepine use for more than 6 months can cause a combination of an acute high-dose benzodiazepine withdrawal and a prolonged, subacute low-dose withdrawal syndrome. In addition, patients may experience syndrome reemergence. A literature search was conducted using the medical subject headings benzodiazepines, substance abuse, substance dependence, substance withdrawal syndrome, and benzodiazepines adverse effects. The years 1970 to the present were reviewed. Medical management for acute benzodiazepine withdrawal includes the graded reduction of the current benzodiazepine dosage, substitution of a long-acting benzodiazepine, and phenobarbital substitution. However, the medical management of benzodiazepine dependence does not constitute treatment of benzodiazepine addiction. Primary care physicians can accept complete, moderate, or limited medical responsibility regarding patients with substance use disorders. However, all physicians should provide diagnostic and referral services.

  20. Psychometric evaluation of the Sophia Observation withdrawal symptoms scale in critically ill children.

    Science.gov (United States)

    Ista, Erwin; de Hoog, Matthijs; Tibboel, Dick; Duivenvoorden, Hugo J; van Dijk, Monique

    2013-10-01

    The Sophia Observation withdrawal Symptoms scale is an instrument for screening benzodiazepine and opioid withdrawal syndrome in pediatric critical care patients. The objectives of this study were to establish cutoff scores and to test sensitivity to change. Second, risk factors for withdrawal syndrome were explored. Prospective observational study with repeated measures. Level IV ICU at a university children's hospital. A total of 154 children with median age 5 months (interquartile range, 0-42 mo) who received continuous infusion of benzodiazepines and/or opioids for 5 or more days. None. Nurses repeatedly applied the Sophia Observation withdrawal Symptoms scale and the Numeric Rating Scale withdrawal when children were weaned off benzodiazepines and opioids. The latter represents the nurse's expert opinion. We analyzed 3,754 paired assessments; the median number per child was 15 (interquartile range, 7-31) over a median of 5 days (interquartile range, 3-11 d). Sensitivity and specificity were 0.83 and 0.93, respectively, for the Sophia Observation withdrawal Symptoms scale cutoff score of 4 or higher against a Numeric Rating Scale-withdrawal score of 4 or higher. Sensitivity to change was determined by comparing 156 Sophia Observation withdrawal Symptoms scale assessments (n = 51 patients) before and after additional sedatives or opioids. Multilevel regression analysis showed a mean decline of 1.5 points (at score range 0-15) after intervention (p Sophia Observation withdrawal Symptoms scale is a valid tool with good psychometric properties to assess withdrawal symptoms in PICU patients.

  1. Intrathecal baclofen withdrawal mimicking sepsis.

    Science.gov (United States)

    Kao, Louise W; Amin, Yama; Kirk, Mark A; Turner, Michael S

    2003-05-01

    Baclofen (Lioresal) is a drug of choice to treat spasticity and is increasingly being administered intrathecally via an implantable pump in cases refractory to oral therapy. Emergency physicians will likely treat patients with baclofen withdrawal or overdose as this treatment becomes more widespread. The syndrome of baclofen withdrawal presents with altered mental status, fever, tachycardia, hypertension or hypotension, seizures, and rebound spasticity, and may be fatal if not treated appropriately. Baclofen withdrawal may mimic other diseases including sepsis, meningitis, autonomic dysreflexia, malignant hyperthermia, or neuroleptic malignant syndrome. Treatment consists of supportive care, reinstitution of baclofen, benzodiazepines, and diagnosis and eventual repair of intrathecal pump and catheter malfunction.

  2. Notice of Withdrawal.

    Science.gov (United States)

    2015-03-27

    Notice of Withdrawal: 'Odanacatib restores trabecular bone of skeletally mature female rabbits with osteopenia but induces brittleness of cortical bone: a comparative study of the investigational drug with PTH, Estrogen and Alendronate' by Mohd. Parvez Khan, Atul Kumar Singh, Abhishek Kumar Singh, Pragya Shrivastava, Mahesh Chandra Tiwari, Geet Kumar Nagar, Himangshu Kousik Bora, Venkitanarayanan Parameswaran, Sabyasachi Sanyal, Jayesh R. Bellare and Naibedya Chattopadhyay The above article from the Journal of Bone and Mineral Research, published online on 27 March 2015 in Wiley Online Library (wileyonlinelibrary.com), has been withdrawn by agreement between the journal's editor-in-chief, Juliet E. Compston, the American Society for Bone and Mineral Research, and Wiley Periodicals, Inc. This action has been agreed due to an error at the publishers which caused a duplicate of the article to be published on 22 September 2015. The correct version of the article is to be found at: 'Odanacatib restores trabecular bone of skeletally mature female rabbits with osteopenia but induces brittleness of cortical bone: a comparative study of the investigational drug with PTH, Estrogen and Alendronate' by Mohd. Parvez Khan, Atul Kumar Singh, Abhishek Kumar Singh, Pragya Shrivastava, Mahesh Chandra Tiwari, Geet Kumar Nagar, Himangshu Kousik Bora, Venkitanarayanan Parameswaran, Sabyasachi Sanyal, Jayesh R. Bellare and Naibedya Chattopadhyay (doi: 10.1002/jbmr.2719). © 2015 American Society for Bone and Mineral Research.

  3. Carbamazepine treatment for benzodiazepine withdrawal.

    Science.gov (United States)

    Ries, R K; Roy-Byrne, P P; Ward, N G; Neppe, V; Cullison, S

    1989-04-01

    Nine patients were given carbamazepine before rapid discontinuation of benzodiazepines. Most patients had had long-term benzodiazepine treatment and had abused benzodiazepines; five had taken high doses. All patients tolerated rapid discontinuation well and none developed significant withdrawal symptoms.

  4. Hydro-meteorological risk reduction through land restoration in Rangárvellir, Iceland - an overview of the HydroResilience project

    Science.gov (United States)

    Finger, David C.; Pétursdóttir, Þórunn; Halldórsson, Guðmundur

    2017-04-01

    Ecosystems that are in equilibrium provide vital resources to local inhabitants, including protection from naturally occurring disasters. Natural vegetation cover has been optimized over many years to retain a maximum of rainfall runoff by increasing the field capacity (FC) of the soil cover, securing water availability during droughts and reducing the flood risk during heavy precipitation events. In this presentation we will present the HydroResilience project, which will assess the effects of ecosystem restoration on the runoff dynamics of rainfall water in Rangárvellir, a restoration area in southern Iceland. The Rangárvellir area presents ideal conditions for such investigations. Dramatic deforestation during the last millennium and year round livestock grazing along with devastating ash depositions during volcanic eruptions and a harsh sub-polar oceanic climate have led to severe degradation in Rangárvellir. Since the beginning of the 20th century diverse restoration measures have been implemented making Rangárvellir an ideal case study to investigate the effects of restoration on hydro-meteorological risk reduction. In this project we will assess and quantify the evolution of water resources in Rangárvellir by assessing the runoff dynamics in the main rivers of Rangárvellir under four main scenarios: i) present conditions, ii) degraded conditions as was the case 100 years ago, iii) under hypothetical fully restored ecosystems and, finally, iv) under conditions of a scenario developed in collaboration with local stakeholder groups to optimize socio-ecological benefits. For this purpose the dynamics of the relevant hydrological processes in the area (incl. river runoff, ground water table, snow cover duration, and soil moisture dynamics) will be reconstructed using hydrological models to run the above mentioned scenarios. The scientific findings and conclusion of this project will generate valuable insights on the effects of land restoration on hydro

  5. 77 FR 30023 - Notice of Withdrawal Application and Opportunity for Public Meeting; Alaska

    Science.gov (United States)

    2012-05-21

    ... AGENCY: Bureau of Land Management, Interior. ACTION: Notice. SUMMARY: The United States Air Force has... Interior withdraw approximately 640 acres of public land from settlement, sale, location, and entry under..., to protect the United States Air Force King Salmon Station. This notice gives the public an...

  6. Estimated withdrawals from principal aquifers in the United States, 2000

    Science.gov (United States)

    Maupin, Molly A.; Barber, Nancy L.

    2005-01-01

    Fresh ground-water withdrawals from 66 principal aquifers in the United States were estimated for irrigation, public-supply, and self-supplied industrial water uses for the year 2000. Total ground-water withdrawals were 76,500 million gallons per day, or 85,800 thousand acre-feet per year for these three uses. Irrigation used the largest amount of ground water, 56,900 million gallons per day, followed by public supply with 16,000 million gallons per day, and self-supplied industrial with 3,570 million gallons per day. These three water uses represented 92 percent of the fresh groundwater withdrawals for all uses in the United States, the remaining 8 percent included self-supplied domestic, aquaculture, livestock, mining, and thermoelectric power uses. Aquifer withdrawals were categorized by five lithologic groups: unconsolidated and semiconsolidated sand and gravel aquifers, carbonate-rock aquifers, igneous and metamorphic-rock aquifers, sandstone aquifers, and sandstone and carbonate-rock aquifers. Withdrawals from aquifers that were not included in one of the 66 principal aquifers were reported in an “Other” aquifers group. The largest withdrawals in the United States were from unconsolidated and semiconsolidated sand and gravel aquifers, which accounted for 80 percent of total withdrawals from all aquifers. Carbonate-rock aquifers provided 8 percent of the withdrawals, and igneous and metamorphic-rock aquifers, 6 percent. Withdrawals from sandstone aquifers, from sandstone and carbonate-rock aquifers, and from the “Other” aquifers category each constituted about 2 percent of the total withdrawals reported.Fifty-five percent of the total withdrawals for irrigation, public-supply, and self-supplied industrial water uses were provided by the High Plains aquifer, California Central Valley aquifer system, the Mississippi River Valley alluvial aquifer, and the Basin and Range basin-fill aquifers. These aquifers provided most of the withdrawals for irrigation

  7. Placebo caffeine reduces withdrawal in abstinent coffee drinkers.

    Science.gov (United States)

    Mills, Llewellyn; Boakes, Robert A; Colagiuri, Ben

    2016-04-01

    Expectancies have been shown to play a role in the withdrawal syndrome of many drugs of addiction; however, no studies have examined the effects of expectancies across a broad range of caffeine withdrawal symptoms, including craving. The purpose of the current study was to use caffeine as a model to test the effect of expectancy on withdrawal symptoms, specifically whether the belief that one has ingested caffeine is sufficient to reduce caffeine withdrawal symptoms and cravings in abstinent coffee drinkers. We had 24-h abstinent regular coffee drinkers complete the Caffeine Withdrawal Symptom Questionnaire (CWSQ) before and after receiving decaffeinated coffee. One-half of the participants were led to believe the coffee was regular caffeinated coffee (the 'Told Caffeine' condition) and one-half were told that it was decaffeinated (the 'Told Decaf' condition). Participants in the Told Caffeine condition reported a significantly greater reduction in the factors of cravings, fatigue, lack of alertness and flu-like feelings of the CWSQ, than those in the Told Decaf condition. Our results indicated that the belief that one has consumed caffeine can affect caffeine withdrawal symptoms, especially cravings, even when no caffeine was consumed. © The Author(s) 2016.

  8. Estimated economic impacts on the timber range and recreation programs on NFS and BLM public lands from adopting the proposed interim PACFISH.

    Science.gov (United States)

    Natalie A. Bolon; Christopher S. Hansen-Murray; Richard W. Haynes

    1995-01-01

    Implications of the interim comprehensive strategy for improved Pacific salmon and steelhead habitat management (PACFISH) were estimated for those Bureau of Land Management (BLM) districts and National Forest System (NFS) lands west of the Rocky Mountains that have anadromous fish. The physical impacts and associated mitigation costs from implementing the PACFISH...

  9. Reward, Addiction, Withdrawal to Nicotine

    Science.gov (United States)

    De Biasi, Mariella; Dani, John A.

    2011-01-01

    Nicotine is the principle addictive component that drives continued tobacco use despite users’ knowledge of the harmful consequences. The initiation of addiction involves the mesocorticolimbic dopamine system, which contributes to the processing of rewarding sensory stimuli during the overall shaping of successful behaviors. Acting mainly through nicotinic receptors containing the α4 and β2 subunits, often in combination with the α6 subunit, nicotine increases the firing rate and the phasic bursts by midbrain dopamine neurons. Neuroadaptations arise during chronic exposure to nicotine, producing an altered brain condition that requires the continued presence of nicotine to be maintained. When nicotine is removed, a withdrawal syndrome develops. The expression of somatic withdrawal symptoms depends mainly on the α5, α2, and β4 nicotinic subunits involving the epithalamic habenular complex and its targets. Thus, nicotine taps into diverse neural systems and an array of nicotinic acetylcholine receptor (nAChR) subtypes to influence reward, addiction, and withdrawal. PMID:21438686

  10. Treatment of Severe Alcohol Withdrawal.

    Science.gov (United States)

    Schmidt, Kyle J; Doshi, Mitesh R; Holzhausen, Jenna M; Natavio, Allycia; Cadiz, Megan; Winegardner, Jim E

    2016-05-01

    Approximately 50% of patients with alcohol dependence experience alcohol withdrawal. Severe alcohol withdrawal is characterized by seizures and/or delirium tremens, often refractory to standard doses of benzodiazepines, and requires aggressive treatment. This review aims to summarize the literature pertaining to the pharmacotherapy of severe alcohol withdrawal. PubMed (January 1960 to October 2015) was searched using the search termsalcohol withdrawal, delirium tremens, intensive care, andrefractory Supplemental references were generated through review of identified literature citations. Available English language articles assessing pharmacotherapy options for adult patients with severe alcohol withdrawal were included. A PubMed search yielded 739 articles for evaluation, of which 27 were included. The number of randomized controlled trials was limited, so many of these are retrospective analyses and case reports. Benzodiazepines remain the treatment of choice, with diazepam having the most favorable pharmacokinetic profile. Protocolized escalation of benzodiazepines as an alternative to a symptom-triggered approach may decrease the need for mechanical ventilation and intensive care unit (ICU) length of stay. Propofol is appropriate for patients refractory to benzodiazepines; however, the roles of phenobarbital, dexmedetomidine, and ketamine remain unclear. Severe alcohol withdrawal is not clearly defined, and limited data regarding management are available. Protocolized administration of benzodiazepines, in combination with phenobarbital, may reduce the need for mechanical ventilation and lead to shorter ICU stays. Propofol is a viable alternative for patients refractory to benzodiazepines; however, the role of other agents remains unclear. Randomized, prospective studies are needed to clearly define effective treatment strategies. © The Author(s) 2016.

  11. 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.

  12. [Ambulant treatment of alcohol withdrawal].

    Science.gov (United States)

    Nüstedt, Volker

    2016-07-01

    Most of the patients addicted to alcohol are socially well integrated. The offer of a low threshold ambulant withdrawal therapy opens an opportunity to build a sustainable therapeutic relationship. The so started empathic addiction therapy will be well accepted and will lead to a satisfying outcome. Using Clomethiazole or Oxazepam in a daily reduced dose and with daily personal contacts, the ambulant withdrawal in patients without seizures or delir in medical history is a secure and successful therapeutic option. © Georg Thieme Verlag KG Stuttgart · New York.

  13. Withdrawal and consumption of water by thermoelectric power plants in the United States, 2010

    Science.gov (United States)

    Diehl, Timothy H.; Harris, Melissa A.

    2014-01-01

    Estimates of water use at thermoelectric plants were developed by the U.S. Geological Survey based on linked heat and water budgets, and complement reported thermoelectric water withdrawals and consumption. The heat- and water-budget models produced withdrawal and consumption estimates, including thermodynamically plausible ranges of minimum and maximum withdrawal and consumption, for 1,290 water-using plants in the United States for 2010. Total estimated withdrawal for 2010 was about 129 billion gallons per day (Bgal/d), and total estimated consumption was about 3.5 Bgal/d. In contrast, total withdrawal reported by the U.S. Department of Energy, Energy Information Administration (EIA), was about 24 percent higher than the modeled estimates, and total EIA-reported consumption was about 8 percent lower. Most thermoelectric generation in 2010 was not associated with thermodynamically plausible EIA-reported values of both withdrawal and consumption.

  14. Cyproheptadine for intrathecal baclofen withdrawal.

    Science.gov (United States)

    Meythaler, Jay M; Roper, James F; Brunner, Robert C

    2003-05-01

    To evaluate the efficacy of cyproheptadine in the management of acute intrathecal baclofen (ITB) withdrawal. Descriptive case series. University hospital with a comprehensive in- and outpatient rehabilitation center. Four patients (3 with spinal cord injury, 1 with cerebral palsy) with implanted ITB infusion pumps for treatment of severe spasticity, who had ITB withdrawal syndrome because of interruption of ITB infusion. Patients were treated with 4 to 8mg of cyproheptadine by mouth every 6 to 8 hours, 5 to 10mg of diazepam by mouth every 6 to 12 hours, 10 to 20mg of baclofen by mouth every 6 hours, and ITB boluses in some cases. Clinical signs and symptoms of ITB withdrawal of varying severity were assessed by vital signs (temperature, heart rate), physical examination (reflexes, tone, clonus), and patient report of symptoms (itching, nausea, headache, malaise). The patients in our series improved significantly when the serotonin antagonist cyproheptadine was added to their regimens. Fever dropped at least 1.5 degrees C, and heart rate dropped from rates of 120 to 140 to less than 100bpm. Reflexes, tone, and myoclonus also decreased. Patients reported dramatic reduction in itching after cyproheptadine. These changes were associated temporally with cyproheptadine dosing. Acute ITB withdrawal syndrome occurs frequently in cases of malfunctioning intrathecal infusion pumps or catheters. The syndrome commonly presents with pruritus and increased muscle tone. It can progress rapidly to high fever, altered mental status, seizures, profound muscle rigidity, rhabdomyolysis, brain injury, and death. Current therapy with oral baclofen and benzodiazepines is useful but has variable success, particularly in severe cases. We note that ITB withdrawal is similar to serotonergic syndromes, such as in overdoses of selective serotonin reuptake inhibitors or the popular drug of abuse 3,4-methylenedioxymethamphetamine (Ecstasy). We postulate that ITB withdrawal may be a form of

  15. Cannabis withdrawal in chronic cannabis users with schizophrenia.

    Science.gov (United States)

    Boggs, Douglas L; Kelly, Deanna L; Liu, Fang; Linthicum, Jared A; Turner, Hailey; Schroeder, Jennifer R; McMahon, Robert P; Gorelick, David A

    2013-02-01

    Chronic users of cannabis often report withdrawal symptoms after abstinence from use, but little is known about cannabis withdrawal in people with schizophrenia. Cannabis use patterns and withdrawal symptoms in adults with schizophrenia who had at least weekly cannabis use before attempting to quit without formal treatment were assessed with the Marijuana Quit Questionnaire (MJQQ), a 176-item, semi-structured questionnaire. 120 participants, predominantly African-American (62.5%) and male (76.7%), met inclusion criteria. 20.1% reported that their first regular cannabis use (median age 15 years [range 8-48]) preceded their age at first psychotic symptoms (20 [4-50] years). Twenty (16.7%) participants met lifetime criteria for cannabis abuse; 98 (81.7%) met surrogate criteria for lifetime cannabis dependence. Withdrawal symptoms were reported by 113 (94.2%) participants, with 74.2% reporting ≥4 symptoms. The most frequently reported withdrawal symptoms were craving for cannabis (59.2%), feeling anxious (52.57%), feeling bored (47.5%), feeling sad or depressed (45.8%), feeling irritable or jumpy (45.0%), feeling restless (43.3%), and trouble failing asleep (33.3%). One hundred-and-four (92.0%) participants took some action to relieve at least one of their withdrawal symptoms during their index-quit attempt, including 26 (23.0%) participants who reported resuming cannabis use. Cannabis withdrawal is a clinically significant feature of cannabis use among people with schizophrenia, may serve as a negative reinforcer for relapse, and deserves greater attention in treatment and research. Clinical Trials registration NCT00679016. Published by Elsevier Ltd.

  16. A Detection Model of College Withdrawal

    Science.gov (United States)

    Pleskac, Timothy J.; Keeney, Jessica; Merritt, Stephanie M.; Schmitt, Neal; Oswald, Frederick L.

    2011-01-01

    Many students during their college careers consider withdrawing from their respective college or university. Understanding why some students decide to withdraw yet others persist has implications for both the well being of students as well as for institutes of higher education. The present study develops a model of the decision to withdraw drawing…

  17. 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

  18. 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

  19. 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.

  20. Caffeine: behavioral effects of withdrawal and related issues.

    Science.gov (United States)

    Dews, P B; O'Brien, C P; Bergman, J

    2002-09-01

    Acquired tolerance to some behavioral effects of caffeine in humans is widely assumed to occur but is poorly documented and appears, at most, to be of low magnitude. Withdrawal from regular consumption of caffeine has been reported to result in a variety of symptoms, including: irritability, sleepiness, dysphoria, delerium, nausea, vomiting, rhinorrhea, nervousness, restlessness, anxiety, muscle tension, muscle pains and flushed face. Some of these same symptoms have been reported following excess intake of caffeine. The prevalence of symptoms reported on withdrawal in different studies also covers a wide range from 11% or less to 100%. It is suggested that the evidence leads to the conclusion that non pharmacological factors related to knowledge and expectation are the prime determinants of symptoms and their reported prevalence on withdrawal of caffeine after regular consumption.

  1. The role of breeding range, diet, mobility and body size in associations of raptor communities and land-use in a West African savannah

    NARCIS (Netherlands)

    Buij, R.; Croes, B.M.; Gort, G.; Komdeur, J.

    2013-01-01

    To provide insight into raptor declines in western Africa, we investigated associations between land-use and raptor distribution patterns in Cameroon. We examined the role of breeding distribution, species’ migratory mobility, diet, body size, and thus area requirements, on 5-km scale patterns of

  2. The role of breeding range, diet, mobility and body size in associations of raptor communities and land-use in a West African savanna

    NARCIS (Netherlands)

    Buij, Ralph; Croes, Barbara M.; Gort, Gerrit; Komdeur, Jan

    2013-01-01

    To provide insight into raptor declines in western Africa, we investigated associations between land-use and raptor distribution patterns in Cameroon. We examined the role of breeding distribution, species' migratory mobility, diet, body size, and thus area requirements, on 5-km scale patterns of

  3. Neocortical hyperexcitability after GABA withdrawal in vitro.

    Science.gov (United States)

    Calixto, E; López-Colomé, A M; Casasola, C; Montiel, T; Bargas, J; Brailowsky, S

    2000-03-01

    The sharp interruption of the intracortical instillation of exogenous gamma-aminobutyric acid (GABA), generates an epileptic focus in mammals. Seizures elicited by GABA withdrawal last several days or weeks. The present work reports that GABA withdrawal-induced hyperexcitability can be produced in vitro: a sudden withdrawal of GABA (5 mM; 120 min) or benzodiazepine (60 microM flunitrazepam) from the superfusion, induced a gradual increase in the amplitude of the evoked population spike (PS) recorded on neocortical slices. PS enhancement reached 150% above the control value 2.5 h after GABA withdrawal. GABA withdrawal-induced hyperexcitability was facilitated by progesterone. PS enhancement induced by GABA withdrawal was associated with an impairment of GABA transmission occurring before epileptiform discharges were fully established. Paired pulse inhibition and evoked [3H]-GABA release appear decreased; suggesting that cortical hyperexcitability as a result of GABA withdrawal involves pre-synaptic changes. Specific muscimol binding decreased during GABA superfusion but recovered after GABA withdrawal. However, the sensitivity of the post-synaptic response to 3alpha-OH-5alpha-pregnan-20-one or allopregnanolone (alloP) was enhanced after GABA withdrawal, suggesting a functional change in the GABA(A) receptors. The changes described may be the cellular correlates of the withdrawal syndromes appearing after interruption of the administration of GABA(A) receptor agonists.

  4. The use of carbamazepine to treat benzodiazepine withdrawal in a geriatric population.

    Science.gov (United States)

    Swantek, S S; Grossberg, G T; Neppe, V M; Doubek, W G; Martin, T; Bender, J E

    1991-01-01

    Rapid withdrawal of short to intermediate half-life benzodiazepines may be hazardous, particularly in the elderly. The use of carbamazepine to facilitate withdrawal has been reported in younger patients. We describe four elderly patients (average age, 72.5 years) who had each experienced at least one unsuccessful attempt at alprazolam withdrawal and who were subsequently successfully withdrawn via the use of carbamazepine over a period ranging from 2 to 6 days. These geriatric patients experienced no major withdrawal symptoms, but mild symptoms were common. There was no correlation between dose or duration of alprazolam use and extent of withdrawal symptoms. We recommend use of this treatment regimen in a hospital setting only, where close monitoring can occur.

  5. Withdrawal

    Indian Academy of Sciences (India)

    The paper “Anaerobic oxidation of methane in coastal sediment from Guishan Island. (Pearl River Estuary), South China Sea” by Zijun Wu, Huaiyang Zhou, Xiaotong Peng,. Nan Jia, Yuhong Wang and Linxi Yuan (Journal of Earth System Science, Volume 117,. No. 6, pages 935–944, December 2008) overlaps in scope and ...

  6. A comparison of three federal datasets for thermoelectric water withdrawals in the United States for 2010

    Science.gov (United States)

    Harris, Melissa A.; Diehl, Timothy H.

    2017-01-01

    Historically, thermoelectric water withdrawal has been estimated by the Energy Information Administration (EIA) and the U.S. Geological Survey's (USGS) water-use compilations. Recently, the USGS developed models for estimating withdrawal at thermoelectric plants to provide estimates independent from plant operator-reported withdrawal data. This article compares three federal datasets of thermoelectric withdrawals for the United States in 2010: one based on the USGS water-use compilation, another based on EIA data, and the third based on USGS model-estimated data. The withdrawal data varied widely. Many plants had three different withdrawal values, and for approximately 54% of the plants the largest withdrawal value was twice the smallest, or larger. The causes of discrepancies among withdrawal estimates included definitional differences, definitional noise, and various nondefinitional causes. The uncertainty in national totals can be characterized by the range among the three datasets, from 5,640 m3/s (129 billion gallons per day [bgd]) to 6,954 m3/s (158 bgd), or by the aggregate difference between the smallest and largest values at each plant, from 4,014 m3/s (92 bgd) to 8,590 m3/s (196 bgd). When used to assess the accuracy of reported values, the USGS model estimates identify plants that need to be reviewed.

  7. Withdrawal symptoms after gabapentin discontinuation.

    Science.gov (United States)

    Hellwig, Thaddaus R; Hammerquist, Rhonda; Termaat, Jill

    2010-06-01

    A case of apparent gabapentin withdrawal symptoms after discontinuation of gabapentin therapy is reported. A 53-year-old woman had coffee ground emesis, a two-day history of black tarry stools, and abdominal pain. The patient did have an elevated ethanol concentration (323 mg/dL), with the last reported ingestion of ethanol about 12 hours before admission. Her medical history included liver cirrhosis secondary to ethanol abuse, ascites, portal hypertension, esophageal varices (with previous band ligation three weeks prior), anemia, gastroesophageal reflux disease, neuropathic pain, and depression. Her home medications included spironolactone, nadolol, lactulose, ursodiol, ferrous sulfate, omeprazole, gabapentin, citalopram, and trazodone. She was admitted to the intensive care unit, and upper gastrointestinal endoscopy was performed, with 12 band ligations applied. After the procedure, she ingested nothing orally, including home medications, for the first two days. On day 3 of hospitalization, she developed restlessness, disorientation, confusion, agitation, and anxiety. She was presumed to be suffering from ethanol withdrawal and was treated with benzodiazepines but had no improvement in symptoms. During days 4 and 5, the patient became increasingly confused, agitated, and anxious, with complaints of headache, light sensitivity, and increasing nervousness. On day 5, gabapentin was reinitiated, and the patient's confusion and agitation improved that evening. The next morning, the patient was calm, alert, and cooperative. Her symptoms resolved, and she was discharged on hospital day 7. A patient developed apparent withdrawal symptoms beginning two days after gabapentin therapy was discontinued. The symptoms were unresponsive to treatment with benzodiazepines but completely resolved with the reinitiation of gabapentin therapy.

  8. Buprenorphine for managing opioid withdrawal.

    Science.gov (United States)

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

    2017-02-21

    Managed withdrawal is a necessary step prior to drug-free treatment or as the endpoint of substitution treatment. To assess the effects of buprenorphine versus tapered doses of methadone, alpha 2 -adrenergic agonists, symptomatic medications or placebo, or different buprenorphine regimens for managing opioid withdrawal, in terms of the intensity of the withdrawal syndrome experienced, duration and completion of treatment, and adverse effects. We searched the Cochrane Central Register of Controlled Trials (CENTRAL, Issue 11, 2016), MEDLINE (1946 to December week 1, 2016), Embase (to 22 December 2016), PsycINFO (1806 to December week 3, 2016), and the Web of Science (to 22 December 2016) and handsearched the reference lists of articles. Randomised controlled trials of interventions using buprenorphine to modify the signs and symptoms of withdrawal in participants who were primarily opioid dependent. Comparison interventions involved reducing doses of methadone, alpha 2 -adrenergic agonists (clonidine or lofexidine), symptomatic medications or placebo, and different buprenorphine-based regimens. We used standard methodological procedures expected by Cochrane. We included 27 studies involving 3048 participants. The main comparators were clonidine or lofexidine (14 studies). Six studies compared buprenorphine versus methadone, and seven compared different rates of buprenorphine dose reduction. We assessed 12 studies as being at high risk of bias in at least one of seven domains of methodological quality. Six of these studies compared buprenorphine with clonidine or lofexidine and two with methadone; the other four studies compared different rates of buprenorphine dose reduction.For the comparison of buprenorphine and methadone in tapered doses, meta-analysis was not possible for the outcomes of intensity of withdrawal or adverse effects. However, information reported by the individual studies was suggestive of buprenorphine and methadone having similar capacity to

  9. 77 FR 53906 - Notice of Proposed Withdrawal and Opportunity for Public Meeting; California

    Science.gov (United States)

    2012-09-04

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF THE INTERIOR Bureau of Land Management Notice of Proposed Withdrawal and Opportunity for Public Meeting; California.... 9 E., Sec. 1, that portion of unpatented Mineral Survey No. 2653 lying in the NE\\1/4\\; Sec. 2, lots...

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

    Science.gov (United States)

    P. V. Caldwell; G. Sun; S. G. McNulty; E. C. Cohen; J. A. Moore Myers

    2012-01-01

    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...

  11. 78 FR 64531 - Notice of Proposed Withdrawal Extension, Sacramento Pass Recreation Area; Nevada

    Science.gov (United States)

    2013-10-29

    ... Bureau of Land Management Notice of Proposed Withdrawal Extension, Sacramento Pass Recreation Area..., but not from leasing under the mineral leasing laws, to protect the Sacramento Pass Recreation Area... recreation opportunities such as hiking, horseback riding, and low-impact camping. The use of a right-of-way...

  12. 78 FR 57373 - Appalachian Power Company; Notice of Application To Increase Water Withdraw and Construct Water...

    Science.gov (United States)

    2013-09-18

    ... use of project waters. The Commission's December 3, 2010 order, authorizes the licensee to allow... non-project use of project lands and waters for the ACSA to construct permanent water withdraw... from the applicant. A copy of any protest or motion to intervene must be served upon each...

  13. Cigarette craving, smoking withdrawal, and clonidine.

    Science.gov (United States)

    Glassman, A H; Jackson, W K; Walsh, B T; Roose, S P; Rosenfeld, B

    1984-11-16

    Clonidine, an alpha-2-adrenergic agonist, significantly reduces opiate withdrawal. Fifteen heavy smokers abstained from cigarettes on three separate occasions and received instead clonidine, placebo, or the benzodiazepine alprazolam. Clonidine and alprazolam diminished withdrawal symptoms. The two drugs suppressed anxiety, tension, irritability, and restlessness equally but clonidine had a greater effect than alprazolam on cigarette craving. These observations suggest that noradrenergic activity is a common feature in the pathophysiology of withdrawal and that a special relationship exists between central noradrenergic activity and craving.

  14. Effects of fencamfamine withdrawal in rats.

    Science.gov (United States)

    Planeta, C S; DeLucia, R; Aizenstein, M L

    1994-09-01

    1. The effects produced by discontinuation of long-term treatment with fencamfamine (FCF) were evaluated recording behavioral and body weight changes. 2. 48 hr after withdrawal of FCF rats showed a significant decrease in exploratory behavior when compared to saline-treated ones. 3. Discontinuation of treatment with FCF resulted in a significant increase in body weight on days of drug withdrawal. 4. These results suggest that FCF caused signs of withdrawal similar to other psychostimulant drugs.

  15. Waste Isolation Pilot Plant, Land Management Plan

    Energy Technology Data Exchange (ETDEWEB)

    1993-12-01

    To reflect the requirement of section 4 of the Wastes Isolation Pilot Plant Land Withdrawal Act (the Act) (Public Law 102-579), this land management plan has been written for the withdrawal area consistent with the Federal Land Policy and Management Act of 1976. The objective of this document, per the Act, is to describe the plan for the use of the withdrawn land until the end of the decommissioning phase. The plan identifies resource values within the withdrawal area and promotes the concept of multiple-use management. The plan also provides opportunity for participation in the land use planning process by the public and local, State, and Federal agencies. Chapter 1, Introduction, provides the reader with the purpose of this land management plan as well as an overview of the Waste Isolation Pilot Plant. Chapter 2, Affected Environment, is a brief description of the existing resources within the withdrawal area. Chapter 3, Management Objectives and Planned Actions, describes the land management objectives and actions taken to accomplish these objectives.

  16. Alcohol withdrawal in the critical care unit.

    Science.gov (United States)

    Corfee, Flora A

    2011-05-01

    Managing acute alcohol withdrawal in critical care presents a unique challenge to the critical care nurse. The prominence of alcohol use within the Australian community means that many critical care admissions involve acute alcohol withdrawal, an alcohol induced illness, or indeed an unrelated admission with underlying heavy alcohol intake. Current statistics suggest 1 in 5 Australians drink to 'risky' levels each month. This suggests that most critical care nurses will encounter a patient who is experiencing active withdrawal from alcohol, often without clear physiological symptomatology. Acute alcohol withdrawal delirium can be difficult to distinguish from other forms of delirium and in the absence of a comprehensive history, alcohol withdrawal and its sequelae may go untreated. Contemporary management guidelines for alcohol withdrawal suggest a common framework of first line benzodiazepine usage, with emerging research focusing on adjunctive therapy aimed at reducing benzodiazepine doses, and therefore reducing length of stay in the critical care unit. The controversial therapy of ethanol infusion and common assessment and withdrawal scales are examined in relation to their usefulness in critical care. Alcohol withdrawal management in critical care necessitates careful nursing assessment, including alcohol usage history, delirium management, withdrawal assessment and symptomatic relief using an evidence-based protocol. Copyright © 2010 Australian College of Critical Care Nurses Ltd. Published by Elsevier Ltd. All rights reserved.

  17. Use of anticonvulsants in benzodiazepine withdrawal.

    Science.gov (United States)

    Pages, K P; Ries, R K

    1998-01-01

    The problem of dependence on benzodiazepines has been aggravated by iatrogenic physiologic dependence on these medications and by polysubstance abusing patients using them in addition to other agents. A safe, rapid, and effective way to detoxify patients from benzodiazepines is of prime importance to facilitate further treatment of their psychiatric or substance use disorder. Patients withdrawing from these agents may experience physiologic withdrawal, rebound, and recurrence. In this paper the authors review the typical syndrome associated with withdrawal from benzodiazepines and discuss treatment of benzodiazepine withdrawal using carbamazepine and valproate.

  18. Carbamazepine monotherapy in the treatment of alcohol withdrawal.

    Science.gov (United States)

    Stuppaeck, C H; Barnas, C; Hackenberg, K; Miller, C H; Fleischhacker, W W

    1990-10-01

    More than 135 different strategies for medical treatment have been described for the treatment of alcohol withdrawal syndromes. The substances used most frequently (benzodiazepines, barbiturates, or clomethiazol) themselves pose some risk for abuse or addiction. Anticonvulsants, especially carbamazepine (CBZ), have been discussed for the treatment of alcohol withdrawal since the early seventies. Various studies report favourable results with CBZ, usually combined with sedative agents. Nineteen out-patients and 19 in-patients took part in an open study of CBZ in alcohol withdrawal. The dose of CBZ was adjusted individually and ranged from a mean dose of 761 mg on day 1 to 616 mg on day 3 and to 388 mg on day 7 in the group of out-patients, and from 789 mg on day 1, 694 mg on day 3 to 562 mg on day 7 in the sample of in-patients. The "Objective Clinical Scale in Assessment and Measurement of Alcohol Withdrawal" (OCSAMAW) was used for treatment evaluation. Statistical analysis showed a significant improvement on the 5%-level in both groups; four in-patients needed concomitant treatment with oxazepam. Nausea and pruritus were the most common side-effects of CBZ treatment.

  19. Rimonabant-Induced Δ9-Tetrahydrocannabinol Withdrawal in Rhesus Monkeys: Discriminative Stimulus Effects and Other Withdrawal Signs

    OpenAIRE

    Stewart, Jennifer L.; McMahon, Lance R.

    2010-01-01

    Marijuana-dependent individuals report using marijuana to alleviate withdrawal, suggesting that pharmacotherapy of marijuana withdrawal could promote abstinence. To identify potential pharmacotherapies for marijuana withdrawal, this study first characterized rimonabant-induced Δ9-tetrahydrocannabinol (Δ9-THC) withdrawal in rhesus monkeys by using drug discrimination and directly observable signs. Second, drugs were examined for their capacity to modify cannabinoid withdrawal. Monkeys receivin...

  20. 31 CFR 103.84 - Withdrawing requests.

    Science.gov (United States)

    2010-07-01

    ... 31 Money and Finance: Treasury 1 2010-07-01 2010-07-01 false Withdrawing requests. 103.84 Section 103.84 Money and Finance: Treasury Regulations Relating to Money and Finance FINANCIAL RECORDKEEPING... requests. A person may withdraw a request for an administrative ruling at any time before the ruling has...

  1. 76 FR 14592 - Safety Management System; Withdrawal

    Science.gov (United States)

    2011-03-17

    ... in response to the ANPRM. The comment period closed on October 21, 2009. The Airline Safety and..., and 145 RIN 2120-AJ15 Safety Management System; Withdrawal AGENCY: Federal Aviation Administration... (``product/ service providers'') to develop a Safety Management System (SMS). The FAA is withdrawing the...

  2. 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...

  3. Treatment of benzodiazepine withdrawal symptoms with carbamazepine.

    Science.gov (United States)

    Garcia-Borreguero, D; Bronisch, T; Apelt, S; Yassouridis, A; Emrich, H M

    1991-01-01

    In 18 patients with a benzodiazepine (BZD) dependency the drug was withdrawn. The dose of BZD was gradually reduced in nine of the patients, while the others were additionally treated with carbamazepine (CBZ) for a further 15 days after BZD discontinuation. Withdrawal symptoms were assessed every third day during the study period. When comparing results in both groups, a clear trend towards less severe withdrawal symptoms could be observed in the group treated with CBZ. Some of the differences were statistically significant on days 9-12 after BZD withdrawal. Fundamental withdrawal symptoms (like hypersensitivity to sensory stimuli, abnormal perception of movement, depersonalisation or derealisation) were also less severe in the group treated with CBZ compared with the group not receiving that treatment. These findings support the results of previous reports indicating a therapeutical effect of CBZ in BZD withdrawal.

  4. [Carbamazepine in the treatment of alcohol withdrawal].

    Science.gov (United States)

    Wolańczyk, T; Wojnar, M; Cedro, A

    1997-01-01

    The authors present a review of literature on the initial rationale and efficacy in clinical trials of carbamazepine (CBZ) in the treatment of alcohol withdrawal, and the pharmacokinetics of carbamazepine in alcoholics as well. Neurophysiological and clinical studies support the kindling hypothesis in the pathophysiology of alcohol withdrawal. The exact physiological action mechanism of CBZ has not been entirely examined. However, the "antikindling effects" are of particular importance in epilepsy and other neurological and psychiatric conditions. Numerous controlled studies were able to demonstrate the effectiveness of carbamazepine in the treatment of alcohol withdrawal symptoms and have compared its properties to other drugs such as clomethiazole and benzodiazepines. Carbamazepine could be a useful alternative to conventional therapeutic approaches, especially in the treatment of mild and moderate alcohol withdrawal symptoms, and alcohol withdrawal with generalized tonic-clonic seizures.

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

    Science.gov (United States)

    Caldwell, P. V.; Sun, G.; McNulty, S. G.; Cohen, E. C.; Moore Myers, J. A.

    2012-08-01

    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 demand for water

  6. 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

  7. Managing alcohol withdrawal in the elderly.

    Science.gov (United States)

    Kraemer, K L; Conigliaro, J; Saitz, R

    1999-06-01

    The alcohol withdrawal syndrome is common in elderly individuals who are alcohol dependent and who decrease or stop their alcohol intake. While there have been few clinical studies to directly support or refute the hypothesis that withdrawal symptom severity, delirium and seizures increase with advancing age, several observational studies suggest that adverse functional and cognitive complications during alcohol withdrawal do occur more frequently in elderly patients. Most elderly patients with alcohol withdrawal symptoms should be considered for admission to an inpatient setting for supportive care and management. However, elderly patients with adequate social support and without significant withdrawal symptoms at presentation, comorbid illness or past history of complicated withdrawal may be suitable for outpatient management. Although over 100 drugs have been described for alcohol withdrawal treatment, there have been no studies assessing the efficacy of these drugs specifically in elderly patients. Studies in younger patients support benzodiazepines as the most efficacious therapy for reducing withdrawal symptoms and the incidence of delirium and seizure. While short-acting benzodiazepines, such as oxazepam and lorazepam, may be appropriate for elderly patients given the risk for excessive sedation from long-acting benzodiazepines, they may be less effective in preventing seizures and more prone to produce discontinuation symptoms if not tapered properly. To ensure appropriate benzodiazepine treatment, dose and frequency should be individualised with frequent monitoring, and based on validated alcohol withdrawal severity measures. Selected patients who have a history of severe or complicated withdrawal symptoms may benefit from a fixed schedule of benzodiazepine provided that medication is held for sedation. beta-Blockers, clonidine, carbamazepine and haloperidol may be used as adjunctive agents to treat symptoms not controlled by benzodiazepines. Lastly, the

  8. By land, sea and air (and space): Verifying UK methane emissions at a range of scales by integrating multiple measurement platforms

    Science.gov (United States)

    Rigby, M. L.; Lunt, M. F.; Ganesan, A.

    2015-12-01

    The Greenhouse gAs Uk and Global Emissions (GAUGE) programme and Department of Energy and Climate Change (DECC) network aim to quantify the magnitude and uncertainty of UK greenhouse gas (GHG) emissions at a resolution and accuracy higher than has previously been possible. The on going DECC tall tower network consists of three sites, and an eastern background site in Ireland. The GAUGE project includes instruments at two additional tall tower sites, a high-density measurement network over agricultural land in eastern England, a ferry that performs near-daily transects along the east coast of the UK, and a research aircraft that has been deployed on a campaign basis. Together with data collected by the GOSAT satellite, these data represent the GAUGE/DECC GHG measurement network that is being used to quantify UK GHG fluxes. As part of the wider GAUGE modelling efforts, we have derived methane flux estimates for the UK and northwest Europe using the UK Met Office NAME atmospheric transport model and a novel hierarchical Bayesian "trans-dimensional" inversion framework. We will show that our estimated fluxes for the UK as a whole are largely consistent between individual measurement platforms, albeit with very different uncertainties. Our novel inversion approach uses the data to objectively determine the extent to which we can further refine our national estimates to the level of large urban areas, major hotspots or larger sub-national regions. In this talk, we will outline some initial findings of the GAUGE project, tackling questions such as: At what spatial scale can we effectively derive greenhouse gas fluxes with a dense, multi-platform national network? Can we resolve individual metropolitan areas or major hotspots? What is relative impact of individual stations, platforms and network configurations on flux estimates for a country of the size of the UK? How can we effectively use multi-platform observations to cross-validate flux estimates and determine likely

  9. Hydrology and numerical simulation of groundwater flow and streamflow depletion by well withdrawals in the Malad-Lower Bear River Area, Box Elder County, Utah

    Science.gov (United States)

    Stolp, Bernard J.; Brooks, Lynette E.; Solder, John

    2017-03-28

    The Malad-Lower Bear River study area in Box Elder County, Utah, consists of a valley bounded by mountain ranges and is mostly agricultural or undeveloped. The Bear and Malad Rivers enter the study area with a combined average flow of about 1,100,000 acre-feet per year (acre-ft/yr), and this surface water dominates the hydrology. Groundwater occurs in consolidated rock and basin fill. Groundwater recharge occurs from precipitation in the mountains and moves through consolidated rock to the basin fill. Recharge occurs in the valley from irrigation. Groundwater discharge occurs to rivers, springs and diffuse seepage areas, evapotranspiration, field drains, and wells. Groundwater, including springs, is a source for municipal and domestic water supply. Although withdrawal from wells is a small component of the groundwater budget, there is concern that additional groundwater development will reduce the amount of flow in the Malad River. Historical records of surface-water diversions, land use, and groundwater levels indicate relatively stable hydrologic conditions from the 1960s to the 2010s, and that current groundwater development has had little effect on the groundwater system. Average annual recharge to and discharge from the groundwater flow system are estimated to be 164,000 and 228,000 acre-ft/yr, respectively. The imbalance between recharge and discharge represents uncertainties resulting from system complexities, and the possibility of groundwater inflow from surrounding basins.This study reassesses the hydrologic system, refines the groundwater budget, and creates a numerical groundwater flow model that is used to analyze the effects of groundwater withdrawals on surface water. The model uses the detailed catalog of locations and amounts of groundwater recharge and discharge defined during this study. Calibrating the model to adequately simulate recharge, discharge, and groundwater levels results in simulated aquifer properties that can be used to understand

  10. [Pharmacological basis for withdrawal of antiepileptic drugs].

    Science.gov (United States)

    Armijo, J A; Adín, J

    To review the pharmacological basis for withdrawal of antiepileptic drugs: the mechanisms by which seizures reappear, aspects of treatment which affect relapses and procedures for withdrawal of medication. Antiepileptic drugs are not curative, so when they are withdrawn the natural course of the condition becomes evident. Reappearance of seizures may be due to lack of protection and/or an abstinence syndrome. Seizures due to lack of protection occur following withdrawal of any antiepileptic drug when the epilepsy is not cured; they may not reappear for years (although over 80% occur within a year) and treatment then has to be restarted. They seem to be less frequent after withdrawal of carbamazepine or phenytoin than after withdrawing valproate, although the reason for this is not understood. Seizures due to an abstinence syndrome only occur after withdrawing benzodiazepines, phenobarbitone and primidone; they are seen in patients with both active and inactive epilepsy whilst the drug is being withdrawn and tend to be self-limiting. It is not necessary to reintroduce the drug when epilepsy is cured. Felbamate and vigabatrin cause seizures related to their withdrawal, but the mechanism of this is not clear. There is no scientifically established guideline for withdrawing antiepileptic drugs, but it is considered important to stop one at a time, starting with those which may cause abstinence syndromes, followed by the more toxic, less effective antiepileptic drugs, which cause more drug interactions and are more awkward to take. Further specific studies are necessary to establish the mechanisms of relapses and the scientific basis for withdrawal of antiepileptic drugs.

  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. Clonidine prophylaxis for narcotic and sedative withdrawal syndrome following laryngotracheal reconstruction.

    Science.gov (United States)

    Deutsch, E S; Nadkarni, V M

    1996-11-01

    To determine the efficacy of transdermal clonidine hydrochloride for prophylaxis of withdrawal syndromes that are common following more than 7 days of deep sedation after single-stage laryngotracheal reconstruction (LTR) surgery. Consecutive case series. Pediatric intensive care unit at tertiary care referral center, university-affiliated children's hospital. Ten consecutive patients who had undergone single-stage LTR and received sedation with a combination of narcotics and benzodiazepines. A sustained release transdermal clonidine hydrochloride patch (50-100 micrograms/d; mean, 5.8 micrograms/kg per day; range, 4.2-8.5 micrograms/kg per day) was applied to 8 consecutive patients before discontinuation of sedative infusions and elective extubation. Physicians continued to treat patients for withdrawal symptoms, if seen, at their discretion. Seventeen characteristic narcotic and sedative withdrawal symptoms recorded at baseline and serially for at least 48 hours following discontinuation of deep sedation. No severe symptoms of narcotic or sedative withdrawal (seizure, choreoathetosis, tremors, or dehydration) were seen in any patient during treatment with clonidine. Not more than 2 minor withdrawal symptoms (lethargy and respiratory rate > 40 breaths/min) occurred simultaneously during treatment with clonidine in any patient. Two of 8 patients had clonidine patches removed prematurely. Both patients experienced withdrawal symptoms within hours, and these symptoms subsided in the 1 patient whose clonidine patch was reinstituted. No significant sustained side effects, bradycardia, or dysrhythmia necessitated discontinuation of clonidine therapy, and no rebound withdrawal was seen with routine discontinuation of clonidine after 7 days of therapy. Transdermal clonidine prophylaxis may be a safe and efficacious adjunct to prevent withdrawal symptoms in pediatric patients who have undergone single-stage LTR. Use of a validated withdrawal symptom scoring tool is indicated

  13. Estimated Ground-Water Withdrawals from the Death Valley Regional Flow System, Nevada and California, 1913-98

    Science.gov (United States)

    Moreo, Michael T.; Halford, Keith J.; La Camera, Richard J.; Laczniak, Randell J.

    2003-01-01

    Ground-water withdrawals from 1913 through 1998 from the Death Valley regional flow system have been compiled to support a regional, three-dimensional, transient ground-water flow model. Withdrawal locations and depths of production intervals were estimated and associated errors were reported for 9,300 wells. Withdrawals were grouped into three categories: mining, public-supply, and commercial water use; domestic water use; and irrigation water use. In this report, groupings were based on the method used to estimate pumpage. Cumulative ground-water withdrawals from 1913 through 1998 totaled 3 million acre-feet, most of which was used to irrigate alfalfa. Annual withdrawal for irrigation ranged from 80 to almost 100 percent of the total pumpage. About 75,000 acre-feet was withdrawn for irrigation in 1998. Annual irrigation withdrawals generally were estimated as the product of irrigated acreage and application rate. About 320 fields totaling 11,000 acres were identified in six hydrographic areas. Annual application rates for high water-use crops ranged from 5 feet in Penoyer Valley to 9 feet in Pahrump Valley. The uncertainty in the estimates of ground-water withdrawals was attributed primarily to the uncertainty of application rate estimates. Annual ground-water withdrawal was estimated at about 90,000 acre-feet in 1998 with an assigned uncertainty bounded by 60,000 to 130,000 acre-feet.

  14. IDENTIFICATION AND MANAGEMENT OF ALCOHOL WITHDRAWAL SYNDROME

    Science.gov (United States)

    Mirijello, Antonio; D’Angelo, Cristina; Ferrulli, Anna; Vassallo, Gabriele; Antonelli, Mariangela; Caputo, Fabio; Leggio, Lorenzo; Gasbarrini, Antonio; Addolorato, Giovanni

    2016-01-01

    Symptoms of alcohol withdrawal syndrome may develop within 6–24 hours after the abrupt discontinuation or decrease of alcohol consumption. Symptoms can vary from autonomic hyperactivity and agitation to delirium tremens. The gold-standard treatment for alcohol withdrawal syndrome is represented by benzodiazepines. Among them, different agents (i.e., long-acting or short-acting) and different regimens (front-loading, fixed dose or symptom-triggered) may be chosen on the basis of patient characteristics. Severe withdrawal could require ICU admission and the use of barbiturates or propofol. Other drugs, such as alpha2-agonists (clonidine and dexmetedomidine) and beta-blockers can be used as adjunctive treatments to control neuroautonomic hyperactivity. Furthermore, neuroleptics can help control hallucinations. Finally, other medications for the treatment for alcohol withdrawal syndrome have been investigated with promising results. These include carbamazepine, valproate, sodium oxybate, baclofen, gabapentin, and topiramate. The usefulness of these agents will be discussed in the text. PMID:25666543

  15. Antiepileptic drug withdrawal in dogs with epilepsy

    Directory of Open Access Journals (Sweden)

    Felix Kaspar Gesell

    2015-08-01

    Full Text Available Epilepsy is one of the most common neurological disorders in dogs and is treated by chronic administration of antiepileptic drugs (AEDs. In humans with epilepsy, it is common clinical practice to consider drug withdrawal after a patient has been in remission (seizure free for three or more years, but withdrawal is associated with the risk of relapse. In the present study, the consequences of AED withdrawal were studied in dogs with epilepsy. Therefore, 200 owners of dogs with idiopathic or presumed idiopathic epilepsy were contacted by telephone interview, 138 cases could be enrolled. In 11 cases the therapy had been stopped after the dogs had become seizure free for a median time of 1 year. Reasons for AED withdrawal were appearance or fear of adverse side effects, financial aspects and the idea that the medication could be unnecessary. Following AED withdrawal, 4 of these dogs remained seizure free, 7 dogs suffered from seizure recurrence, of which only 3 dogs could regain seizure freedom after resuming AED therapy. Due to the restricted case number, an exact percentage of dogs with seizure recurrence after AED withdrawal cannot be given. However, the present study gives a hint that similar numbers as in human patients are found, and the data can help owners of epileptic dogs and the responsible clinician to decide when and why to stop antiepileptic medication.

  16. Antiepileptic Drug Withdrawal in Dogs with Epilepsy.

    Science.gov (United States)

    Gesell, Felix Kaspar; Hoppe, Sonja; Löscher, Wolfgang; Tipold, Andrea

    2015-01-01

    Epilepsy is one of the most common neurological disorders in dogs and is treated by chronic administration of antiepileptic drugs (AEDs). In human beings with epilepsy, it is common clinical practice to consider drug withdrawal after a patient has been in remission (seizure free) for three or more years, but withdrawal is associated with the risk of relapse. In the present study, the consequences of AED withdrawal were studied in dogs with epilepsy. Therefore, 200 owners of dogs with idiopathic or presumed idiopathic epilepsy were contacted by telephone interview, 138 cases could be enrolled. In 11 cases, the therapy had been stopped after the dogs had become seizure free for a median time of 1 year. Reasons for AED withdrawal were appearance or fear of adverse side effects, financial aspects, and the idea that the medication could be unnecessary. Following AED withdrawal, four of these dogs remained seizure free, seven dogs suffered from seizure recurrence, of which only three dogs could regain seizure freedom after resuming AED therapy. Due to the restricted case number, an exact percentage of dogs with seizure recurrence after AED withdrawal cannot be given. However, the present study gives a hint that similar numbers as in human patients are found, and the data can help owners of epileptic dogs and the responsible clinician to decide when and why to stop antiepileptic medication.

  17. Barbiturate withdrawal following Internet purchase of Fioricet.

    Science.gov (United States)

    Romero, Charles E; Baron, Joshua D; Knox, Anthony P; Hinchey, Judy A; Ropper, Allan H

    2004-07-01

    The Internet enables businesses to advertise their pharmaceutical products and services without medical supervision. The Internet also allows for the unsupervised purchase of medications that may have neurologic consequences. To describe acute withdrawal delirium following the abrupt discontinuation of Fioricet. The patient was a 37-year-old woman with a history of depression and migraine headaches but not drug abuse. She developed a florid withdrawal delirium following the discontinuation of a drug she purchased online. The medication, which contained butalbital, was self-administered in escalating doses for the treatment of chronic headaches. Daily doses of up to 750 mg to 1000 mg were reported. The patient was admitted to the hospital for the treatment of unexplained seizures that were followed by several days of an intense withdrawal syndrome. Little improvement was noted after the administration of benzodiazepines and phenothiazine. After parenteral phenobarbital administration, her symptoms resolved. The withdrawal state from barbiturates is similar to that from ethanol. Tolerance can develop with prolonged abuse, leading to escalating drug doses to achieve the desired effect. The suggested management of both types of withdrawal syndromes is similar, but the relative resistance of the behavioral and autonomic features in patients was remarkable. Physicians should be aware of the ease with which medications can be purchased without supervision from Internet pharmacies. The magnitude of the number of drugs that are made available through this means creates a proclivity to withdrawal states.

  18. Withdrawing Benzodiazepines in Patients With Anxiety Disorders.

    Science.gov (United States)

    Lader, Malcolm; Kyriacou, Andri

    2016-01-01

    The large class of CNS-depressant medications-the benzodiazepines-have been extensively used for over 50 years, anxiety disorders being one of the main indications. A substantial proportion (perhaps up to 20-30 %) of long-term users becomes physically dependent on them. Problems with their use became manifest, and dependence, withdrawal difficulties and abuse were documented by the 1980s. Many such users experience physical and psychological withdrawal symptoms on attempted cessation and may develop clinically troublesome syndromes even during slow tapering. Few studies have been conducted to establish the optimal withdrawal schedules. The usual management comprises slow withdrawal over weeks or months together with psychotherapy of various modalities. Pharmacological aids include antidepressants such as the SSRIs especially if depressive symptoms supervene. Other pharmacological agents such as the benzodiazepine antagonist, flumazenil, and the hormonal agent, melatonin, remain largely experimental. The purpose of this review is to analyse the evidence for the efficacy of the usual withdrawal regimes and the newer agents. It is concluded that little evidence exists outside the usual principles of drug withdrawal but there are some promising leads.

  19. Simulated effects of groundwater withdrawals from aquifers in Ocean County and vicinity, New Jersey

    Science.gov (United States)

    Cauller, Stephen J.; Voronin, Lois M.; Chepiga, Mary M.

    2016-10-21

    periods of low recharge and high withdrawals, and high recharge and low withdrawals, were examined to determine seasonal effects on the confined flow systems. The simulated potentiometric surface of the Rio Grande water-bearing zone and the Atlantic City 800-foot sand during selected stress periods indicates substantial declines from no-withdrawal conditions to 2000–03 conditions as a result of groundwater withdrawals. Cones of depression in Toms River Township, Seaside Heights and Seaside Park Boroughs, and Barnegat Light Borough developed in the potentiometric surface of the Piney Point aquifer in response to withdrawals.Maximum-allocation withdrawals decreased flow out of the Kirkwood-Cohansey aquifer system to constant head cells, increased flow out of the aquifer system to adjacent and lower layers, and reduced groundwater discharge to streams when compared with 2000–03 withdrawal conditions. Increases in withdrawals from the Rio Grande water-bearing zone, the Atlantic City 800-foot sand, and the Piney Point aquifer result in an increase in simulated net groundwater flow into these aquifers. Base-flow reduction from 2000–03 conditions to maximum-allocation conditions of 25 to 29 cubic feet per second in all streams draining to the Barnegat Bay-Little Egg Harbor also is indicated. Potentiometric surfaces of the Rio Grande water-bearing zone, Atlantic City 800-foot sand, and the Piney Point aquifer during two stress periods of simulated maximum-allocation withdrawal conditions indicated the expansion of several cones of depression developed during 2000–03 withdrawals.Simulation of average 2000–03 withdrawal conditions indicated the extent to which the groundwater-flow system is susceptible to potential saltwater intrusion into near-shore wells. Travel time from recharge to discharge location ranged from 11 to approximately 50,700 years in near-shore Kirkwood-Cohansey aquifer system wells. Those in Seaside Heights Borough, in Island Beach State Park (Berkeley

  20. Land Cover Characterization Program

    Science.gov (United States)

    ,

    1997-01-01

    The U.S. Geological Survey (USGS) has a long heritage of leadership and innovation in land use and land cover mapping. The USGS Anderson system defined the principles for land use and land cover mapping that have been the model both nationally and internationally for more than 20 years. The Land Cover Characterization Program (LCCP) is founded on the premise that the Nation's needs for land cover and land use data are diverse and increasingly sophisticated. The range of projects, programs, and organizations that use land cover data to meet their planning, management, development, and assessment objectives has expanded significantly. The reasons for this are numerous, and include the improved capabilities provided by geographic information systems, better and more data-intensive analytic models, and increasing requirements for improved information for decision making. The overall goals of the LCCP are to:

  1. Caffeine withdrawal and high-intensity endurance cycling performance.

    Science.gov (United States)

    Irwin, Christopher; Desbrow, Ben; Ellis, Aleisha; O'Keeffe, Brooke; Grant, Gary; Leveritt, Michael

    2011-03-01

    In this study, we investigated the impact of a controlled 4-day caffeine withdrawal period on the effect of an acute caffeine dose on endurance exercise performance. Twelve well-trained and familiarized male cyclists, who were caffeine consumers (from coffee and a range of other sources), were recruited for the study. A double-blind placebo-controlled cross-over design was employed, involving four experimental trials. Participants abstained from dietary caffeine sources for 4 days before the trials and ingested capsules (one in the morning and one in the afternoon) containing either placebo or caffeine (1.5 mg · kg(-1) body weight · day(-1)). On day 5, capsules containing placebo or caffeine (3 mg · kg(-1) body weight) were ingested 90 min before completing a time trial, equivalent to one hour of cycling at 75% peak sustainable power output. Hence the study was designed to incorporate placebo-placebo, placebo-caffeine, caffeine-placebo, and caffeine-caffeine conditions. Performance time was significantly improved after acute caffeine ingestion by 1:49 ± 1:41 min (3.0%, P = 0.021) following a withdrawal period (placebo-placebo vs. placebo-caffeine), and by 2:07 ± 1:28 min (3.6%, P = 0.002) following the non-withdrawal period (caffeine-placebo vs. caffeine-caffeine). No significant difference was detected between the two acute caffeine trials (placebo-caffeine vs. caffeine-caffeine). Average heart rate throughout exercise was significantly higher following acute caffeine administration compared with placebo. No differences were observed in ratings of perceived exertion between trials. A 3 mg · kg(-1) dose of caffeine significantly improves exercise performance irrespective of whether a 4-day withdrawal period is imposed on habitual caffeine users.

  2. Sinkholes Due to Groundwater Withdrawal in Tazerbo Wellfield, SE Libya.

    Science.gov (United States)

    Alfarrah, Nawal; Berhane, Gebremedhin; Hweesh, Abdelrahim; Walraevens, Kristine

    2017-07-01

    The desert of eastern Libya forms one of the most arid regions of the Sahara. The Great Man-Made River Project (GMRP) was established. It transports millions of cubic meters of water a day from desert wellfields to the coastal cities, where over 80% of the population lives. The Tazerbo Wellfield is one of the wellfields designed within the GMRP, delivering water to the eastern coast of Libya through an underground pipe network. Tazerbo Wellfield consists of 108 production wells; each well was designed to pump 100 L/s. The planned total groundwater withdrawal from all wells is 1 million m 3 /d. The deep sandstone aquifer (Nubian sandstone) is covered by a thick mudstone-siltstone aquitard and is being heavily pumped. The aquifer and fine-grained sediments of the aquitard may be compacted resulting in land subsidence as a result of high exploitation. Local sinkholes have developed in the area of Tazerbo since the start of the pumping from the wellfield in 2004. These sinkholes have been caused mainly by lowering of the piezometric heads due to the withdrawal of groundwater. In this study, a hydrogeological investigation is presented about the effect of large groundwater pumping from the Nubian sandstone aquifer in Tazerbo Wellfield, SE Libya, based on physical parameters for 108 production wells and 23 observation wells. © 2017, National Ground Water Association.

  3. Construction of the Sophia Observation withdrawal Symptoms-scale (SOS) for critically ill children.

    Science.gov (United States)

    Ista, Erwin; van Dijk, Monique; de Hoog, Matthijs; Tibboel, Dick; Duivenvoorden, Hugo J

    2009-06-01

    To construct a reliable and clinically practical instrument for monitoring opioids and benzodiazepine withdrawal symptoms in pediatric ICU patients. Instrument development. Intensive care unit in an academic children's hospital. 79 patients up to age 16 years on intravenous midazolam and/or opioids for > or =5 days. An expert panel of 85 physicians and nurses rated clinical relevance of withdrawal symptoms. During drug weaning repeated observations were performed with a checklist of 24 withdrawal symptoms described in the literature. For 76 children, 932 observations were obtained within 24 h after decrease and/or discontinuation of midazolam or opioids. Most frequent symptoms were tachypnea, agitation, motor disturbance, diarrhea, fever, anxiety, sleep disturbance and hypertension (14.6-29.6%). Multidimensional scaling (MDS) was performed to detect the underlying empirical structure of co-occurrences of symptoms. An expert panel judged clinical relevance of each withdrawal symptom on a four-point scale ranging from 'definitively so' to 'definitively not'. Agitation, anxiety, inconsolable crying, increased muscle tension, tremors, tachycardia and sweating were considered relevant by 85-95% of the experts. On the basis of the MDS results and the experts' opinions, 15 symptoms were included in the final instrument. We are the first to develop an assessment tool for withdrawal symptoms in pediatric ICU patients on the basis of the underlying empirical structure of co-occurrences of withdrawal symptoms that experts considered relevant. Future studies need to define cut-off points and clarify psychometric issues.

  4. An alcohol withdrawal test battery measuring multiple behavioral symptoms in mice.

    Science.gov (United States)

    Metten, Pamela; Schlumbohm, Jason P; Huang, Lawrence C; Greenberg, Gian D; Hack, Wyatt R; Spence, Stephanie E; Crabbe, John C

    2017-09-06

    Despite acceptance that risk for alcohol-use disorder (AUD) has a large genetic component, the identification of genes underlying various components of risk for AUD has been hampered in humans, in part by the heterogeneity of expression of the phenotype. One aspect of AUD is physical dependence. Alcohol withdrawal is a serious consequence of alcohol dependence with multiple symptoms, many of which are seen in multiple species, and can be experienced over a wide-ranging time course. In the present three studies, we developed a battery of withdrawal tests in mice, examining behavioral symptoms from multiple domains that could be measured over time. To permit eventual use of the battery in different strains of mice, we used male and female mice of a genetically heterogeneous stock developed from intercrossing eight inbred strains. Withdrawal symptoms were assessed using commonly used tests after administration of ethanol in vapor for 72 continuous hours. We found significant effects of ethanol withdrawal versus air-breathing controls on nearly all symptoms, spanning 4 days following ethanol vapor inhalation. Withdrawal produced hypothermia, greater neurohyperexcitability (seizures and tremor), anxiety-like behaviors using an apparatus (such as reduced transitions between light and dark compartments), anhedonia (reduced sucrose preference), Straub tail, backward walking, and reductions in activity; however, there were no changes in thermal pain sensitivity, hyper-reactivity to handling, or anxiety-like emergence behaviors in other apparatus. Using these data, we constructed a refined battery of withdrawal tests. Individual differences in severity of withdrawal among different tests were weakly correlated at best. This battery should be useful for identifying genetic influences on particular withdrawal behaviors, which should reflect the influences of different constellations of genes. Published by Elsevier Inc.

  5. Subsidence due to fluid withdrawal: a survey of analytical capabilities. [1225 citations

    Energy Technology Data Exchange (ETDEWEB)

    Engi, D.

    1985-08-01

    An extensive review of the literature was conducted in the area of land subsidence due to the withdrawal of fluids. A method of categorizing the citations was developed to facilitate identification of references relating to specific fields of interest. A brief review of the materials represented by the bibliography indicates the state-of-the-art within this area. The bibliography (containing 1225 citations) is presented in its categorized form. 5 figs., 3 tabs.

  6. 75 FR 65648 - Notice of Proposed Withdrawal Extension and Opportunity for Public Meeting for the Peony, Pole...

    Science.gov (United States)

    2010-10-26

    ... System land from location and entry under the United States mining laws in order to protect the integrity... proposed withdrawal extension is to continue the protection of the integrity and functionality of the seed... confidentiality. Before including your address, phone number, e-mail address, or other personal identifying...

  7. Inpatient management of acute alcohol withdrawal syndrome.

    Science.gov (United States)

    Perry, Elizabeth C

    2014-05-01

    Alcohol withdrawal is a common condition encountered in the hospital setting after abrupt discontinuation of alcohol in an alcohol-dependent individual. Patients may present with mild symptoms of tremulousness and agitation or more severe symptoms including withdrawal seizures and delirium tremens. Management revolves around early identification of at-risk individuals and symptom assessment using a validated tool such as the revised Clinical Institute Withdrawal Assessment for Alcohol score. Benzodiazepines remain the mainstay of treatment and can be administered using a front-loading, fixed-dose, or symptom-triggered approach. Long-acting benzodiazepines such as chlordiazepoxide or diazepam are commonly used and may provide a smoother withdrawal than shorter-acting benzodiazepines, but there are no data to support superiority of one benzodiazepine over another. Elderly patients or those with significant liver disease may have increased accumulation and decreased clearance of the long-acting benzodiazepines, and lorazepam or oxazepam may be preferred in these patients. Patients with symptoms refractory to high doses of benzodiazepines may require addition of a rescue medication such as phenobarbital, propofol or dexmedetomidine. Anticonvulsants (carbamazepine, valproate, gabapentin) may have a role in the management of mild to moderate withdrawal. Other medications such as β-antagonists or neuroleptics may offer additional benefit in select patients but should not be used a monotherapy.

  8. 78 FR 28894 - Public Land Order No. 7814; Partial Revocation of Bureau of Reclamation Order Dated July 11, 1955...

    Science.gov (United States)

    2013-05-16

    ... Bureau of Land Management Public Land Order No. 7814; Partial Revocation of Bureau of Reclamation Order... withdrawal created by a Bureau of Reclamation Order. The revocation affects 185.88 acres of public lands... Project. The Bureau of Reclamation has determined that it no longer needs the lands for reclamation...

  9. [Pathobiochemistry and pharmacotherapy of alcohol withdrawal delirium].

    Science.gov (United States)

    Rommelspacher, H; Schmidt, L G; Helmchen, H

    1991-11-01

    The spectrum and time course of different symptoms during alcohol withdrawal may be caused by the involvement of various neurotransmitter systems that are differentially vulnerable to the effects of ethanol. Withdrawal symptomatology results from increased activity of excitatory mechanisms (NMDA-receptor, catecholamines among others) and from reduced functioning of inhibitory receptors (GABAA-, alpha 2-adreno-receptor among others). The neuronal mechanisms are subject to different dynamics of restitution following intoxication. Some of these probably contribute to long-lasting changes in CNS functions by "kindling" processes. Therapeutic guidelines are deduced from results of basic research and clinical trials. It is concluded that clomethiazole and benzodiazepines are superior in treating delirium tremens and certain risk-patients, whereas carbamazepine and clonidine may be helpful in moderate withdrawal syndromes or as adjunctive agents. However, the need for improved methodological standards of method in clinical research is evident.

  10. Baclofen and gamma-hydroxybutyrate withdrawal.

    Science.gov (United States)

    LeTourneau, Jennifer L; Hagg, Daniel S; Smith, Stephen M

    2008-01-01

    Benzodiazepine treatment of life-threatening gamma-hydroxybutyrate (GHB) withdrawal is frequently unsatisfactory. Animal studies suggest strongly that treatment with GABA(B) agonists, such as baclofen, will be a more effective strategy. A case report from the medical intensive care unit (ICU) of the university tertiary care hospital. A 61-year-old woman was admitted to the medical ICU for severe withdrawal symptoms from chronic GHB use. This manifested as delirium, tremor, and seizures despite only small decreases in GHB dose and treatment with benzodiazepines. The addition of baclofen allowed the rapid sequential decreases in the GHB dose without seizure or delirium and resulted in long-term improvement of her tremor. Baclofen, a GABA(B) agonist, may be a useful agent in the treatment of severe GHB withdrawal.

  11. Gabapentin for the treatment of ethanol withdrawal.

    Science.gov (United States)

    Voris, John; Smith, Nancy L; Rao, Subba M; Thorne, Diana L; Flowers, Queen J

    2003-06-01

    Benzodiazepines (BZDs) are the drug of choice for the suppression of alcohol withdrawal symptoms. Gabapentin, a drug approved for use as adjunctive therapy in the treatment of partial seizures, has none of the BZD-type difficulties (drug interactions, abuse potential). We retrospectively report on the use of gabapentin for ethanol withdrawal in 49 patients. Thirty-one patients were treated in the outpatient program and 18 in the general inpatient psychiatric unit. Positive outcomes as evidenced by completion of gabapentin therapy were achieved in 25 out of 31 outpatients and 17 out of 18 inpatients. Statistical significance was reached regarding the positive relationship between prior ethanol use and inpatient "as needed" benzodiazepine use. Both sets of data suggest that gabapentin works well for the mild to moderate alcohol withdrawal patient.

  12. Benzodiazepine dependence: focus on withdrawal syndrome.

    Science.gov (United States)

    Authier, N; Balayssac, D; Sautereau, M; Zangarelli, A; Courty, P; Somogyi, A A; Vennat, B; Llorca, P-M; Eschalier, A

    2009-11-01

    Benzodiazepines are potentially addictive drugs: psychological and physical dependence can develop within a few weeks or years of regular or repeated use. The socioeconomic costs of the present high level of long-term benzodiazepine use are considerable. These consequences could be minimised if prescriptions for long-term benzodiazepines were decreased. However, many physicians continue to prescribe benzodiazepines and patients wishing to withdraw receive little advice or support. Particular care should be taken in prescribing benzodiazepines for vulnerable patients such as elderly persons, pregnant women, children, alcohol- or drug-dependent patients and patients with comorbid psychiatric disorders. The following update gives recent research results on the withdrawal pathophysiology and practical information in order to treat or prevent benzodiazepine withdrawal syndrome.

  13. Tolerance and withdrawal issues with sedation.

    Science.gov (United States)

    Zapantis, Antonia; Leung, Simon

    2005-09-01

    The stay in an ICU is a complex mixture of providing optimal care while keeping the patient safe. Means of reducing the anxiety associated with the ICU stay include frequent reorientation and maintenance of patient comfort with sedation supplemented by analgesia as needed. The most common agents used to provide sedation include benzodiazepines, propofol, and the newer dexmedetomidine. Others include barbiturate agents, neuroleptics, clonidine, etomidate, ketamine, and supplemental opioid analgesics for pain control. A common complication of sedation is tolerance, which can lead to withdrawal if the sedation is discontinued hastily. This article evaluates the occurrence of tolerance and withdrawal in the most commonly used sedatives in critically ill patients.

  14. Failure of clonidine treatment in benzodiazepine withdrawal.

    Science.gov (United States)

    Joyce, E M; Moodley, P; Keshavan, M S; Lader, M H

    1990-01-01

    Six subjects, dependent on benzodiazepines for at least 2 years, were gradually withdrawn, using placebo substitution, while taking clonidine. After withdrawal was complete, subjects were switched to clonidine-placebo. Despite administration of clonidine at doses sufficient to produce a fall in blood pressure, an abstinence syndrome was seen in five of the subjects. In none of these cases was the withdrawal syndrome exacerbated by changing from clonidine to clonidine-placebo. Scores of depression, subjective anxiety, observed anxiety and somatic symptoms did not change throughout the study.

  15. Withdrawal-related adverse events from clinical trials of clobazam in Lennox-Gastaut syndrome.

    Science.gov (United States)

    Tolbert, Dwain; Harris, Stuart I; Bekersky, Ihor; Lee, Deborah; Isojarvi, Jouko

    2014-08-01

    To assess withdrawal-related adverse event (AE) rates following abrupt clobazam discontinuation in Phase I trials and gradual clobazam tapering (2-3 weeks) following discontinuation from III trials met the criteria for potential/III trials, we evaluated AE data from four multiple-dosage Phase I trials (duration: 8-34 days). Therapeutic (20 and 40 mg/day) and supratherapeutic clobazam dosages (120 and 160 mg/day) were administered. Adverse events (AEs) were also assessed for patients with Lennox-Gastaut syndrome enrolled in Phase II (OV-1002) and Phase III (OV-1012) studies (duration ≤15 weeks) and in the open-label extension (OLE) trial OV-1004 (≤5 years). Potential withdrawal-related AEs were identified by preferred terms, provided that the AEs occurred ≥1 day following and ≤30 days after the last clobazam doses, or were deemed withdrawal symptoms by investigators. Clinical Institute Withdrawal Assessment for Benzodiazepines (CIWA-B) scale was used to evaluate withdrawal intensity in three of the four Phase I trials. A total of 207 participants in Phase I trials received steady-state clobazam dosages of 20-160 mg/day, 182 received clobazam dosages of ≥40 mg/day, and 94 received clobazam dosages of ≥120 mg/day. Abrupt clobazam discontinuation led to 193 withdrawal-related AEs for 68 Phase I participants. Nearly 50% of AEs occurred after discontinuation of clobazam dosages of ≥120 mg/day. Adverse events were mild or moderate and included headache (14% of Phase I participants), insomnia (12.6%), tremor (10.1%), and anxiety (8.7%). The CIWA-B scores varied (range: 0-59). Most scores were benzodiazepine withdrawal. III trials met the criteria for potential/III patients received clobazam dosages of ≤40 mg/day, and those in the OLE trial received clobazam dosages of ≤80 mg/day. Eighty-seven patients discontinued clobazam and were gradually tapered. No withdrawal-related AEs or incidences of status epilepticus were reported. Withdrawal-related AEs

  16. 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…

  17. 46 CFR 390.9 - Qualified withdrawals.

    Science.gov (United States)

    2010-10-01

    ... 46 Shipping 8 2010-10-01 2010-10-01 false Qualified withdrawals. 390.9 Section 390.9 Shipping MARITIME ADMINISTRATION, DEPARTMENT OF TRANSPORTATION REGULATIONS UNDER PUBLIC LAW 91-469 CAPITAL... example, if the party mortgages an office building in order to finance the construction of a vessel...

  18. withdrawal of South African essential medicines EDITORIALS

    African Journals Online (AJOL)

    2006-04-21

    Apr 21, 2006 ... Acetylcysteine (Parvolex), used in the management of acetaminophen overdose, also became unavailable and the supply was re-established only after direct communication with the pharmaceutical company. Withdrawal of an essential medicine may be acceptable if equivalent agents are available.

  19. Catatonia in mixed alcohol and benzodiazepine withdrawal

    OpenAIRE

    Aniruddha Basu; Amit Jagtiani; Rajiv Gupta

    2014-01-01

    Catatonia is mostly caused by different neuropsychiatric conditions. We report a case of a 30 year old man suffering from both alcohol and benzodiazepine dependence who exhibited catatonic features soon after stopping the intake of substances. This case will help clinicians to recognize catatonic features within the varied symptomatology of substance withdrawal and thereby helping in its early diagnosis and management.

  20. Alcohol withdrawal delirium - diagnosis, course and treatment.

    Science.gov (United States)

    Mainerova, Barbora; Prasko, Jan; Latalova, Klara; Axmann, Karel; Cerna, Monika; Horacek, Rostislav; Bradacova, Romana

    2015-03-01

    Delirium tremens represents the most severe complication of alcohol withdrawal syndrome and, in its complications, significantly increases the morbidity and mortality of patients. Alcohol withdrawal delirium is characterized by features of alcohol withdrawal itself (tremor, sweating, hypertension, tachycardia etc.) together with general delirious symptoms such as clouded consciousness, disorientation, disturbed circadian rhythms, thought processe and sensory disturbances, all of them fluctuating in time. The treatment combines a supportive and symptomatic approach. Benzodiazepines in supramaximal doses are usually used as drugs of choice but in some countries such as the Czech Republic or Germany, clomethiazole is frequently used as well. A computer search of the all the literature published between 1966 and December 2012 was accomplished on MEDLINE and Web of Science with the key words "delirium tremens", "alcohol withdrawal", "treatment" and "pharmacotherapy". There were no language or time limits applied. When not early recognized and treated adequately, delirium tremens may result in death due to malignant arrhythmia, respiratory arrest, sepsis, severe electrolyte disturbance or prolonged seizures and subsequent trauma. Owing to these possible fatalities and other severe unexpected complications, delirium tremens should be managed at an ICU or wards ensuring vital signs monitoring. In symptomatic treatment, high doses of benzodiazepines, especially lorazepam, diazepam and oxazepam are considered the gold standard drugs. Supportive therapy is also of great importance.

  1. Catatonia in mixed alcohol and benzodiazepine withdrawal.

    Science.gov (United States)

    Basu, Aniruddha; Jagtiani, Amit; Gupta, Rajiv

    2014-10-01

    Catatonia is mostly caused by different neuropsychiatric conditions. We report a case of a 30 year old man suffering from both alcohol and benzodiazepine dependence who exhibited catatonic features soon after stopping the intake of substances. This case will help clinicians to recognize catatonic features within the varied symptomatology of substance withdrawal and thereby helping in its early diagnosis and management.

  2. Update on anticonvulsants for the treatment of alcohol withdrawal.

    Science.gov (United States)

    Malcolm, R; Myrick, H; Brady, K T; Ballenger, J C

    2001-01-01

    Some anticonvulsants have been shown to be as effective as some benzodiazepines for the treatment of alcohol withdrawal. Anticonvulsants may offer advantages over benzodiazepines in the outpatient treatment of alcohol withdrawal: they lack abuse potential, have minimal interactions with alcohol, and may be more effective in ameliorating psychiatric symptoms of alcohol withdrawal. Carbamazepine appears to be as effective as lorazepam and oxazepam in ameliorating the symptoms of alcohol withdrawal. In addition, a recent study indicates that carbamazepine may suppress post-withdrawal alcohol use. Divalproex may also reduce symptoms of alcohol withdrawal, based on several open-label studies. However, both carbamazepine and divalproex have limited usefulness in alcoholics with severe hepatic or hematologic complications. Newer anticonvulsants, such as gabapentin and vigabatrin, also appear to reduce alcohol withdrawal symptoms in preclinical and open-label clinical trials while lacking the toxicities of carbamazepine and divalproex. Controlled trials are underway exploring the efficacy and safety of newer anticonvulsants for the treatment of alcohol withdrawal.

  3. 29 CFR 1626.13 - Withdrawal of charge.

    Science.gov (United States)

    2010-07-01

    ... DISCRIMINATION IN EMPLOYMENT ACT § 1626.13 Withdrawal of charge. Charging parties may request withdrawal of a... investigation and may secure relief for all affected persons notwithstanding a request by a charging party to...

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

    DEFF Research Database (Denmark)

    Elholm, Bjarne; Larsen, Klaus; Hornnes, Nete

    2011-01-01

    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)....

  5. How to expand irrigated land in a sustainable way ?

    Science.gov (United States)

    Pastor, Amandine V.; Ludwig, Fulco; Palazzo, Amanda; Havlik, Petr; Kabat, Pavel

    2015-04-01

    Allocation of agriculture commodities and water resources is subject to changes due to climate change, population increase and changes in dietary patterns. This study focused on including global water availability including environmental flow requirements with water withdrawal from irrigation and other sectors (industry, household and hydropower) at a monthly time-step in the GLOBIOM model. This model allows re-adjustment of land-use allocation, crop management, consumption and international trade. The GLOBIOM model induces an endogenous change in water price depending on water supply and demand. In this study, the focus was on how the inclusion of water resources affects land-use and, in particular, how global change will influence repartition of irrigated and rainfed lands at global scale. We used the climate change scenario including a radiative forcing of 2.6 W/m2 (RCP2.6), the socio-economic scenario (SSP2: middle-of-road), and the environmental flow method based on monthly flow allocation (the Variable Monthly Flow method) with high and low restrictions. Irrigation withdrawals were adjusted to a monthly time-step to account for biophysical water limitations at finer time resolution. Our results show that irrigated land might decrease up to 37% on average depending on the choice of EFR restrictions. Several areas were identified as future hot-spots of water stress such as the Mediterranean and Middle-East regions and parts of South-East Asia where the Water Stress Indicator (WSI) ranges from 0.4 to 1 by 2050. Other countries were identified to be in safe position in terms of water stress such as North-European countries. Some countries such as India expect a significant increase in water demand which might be compensated by an increase in water supply with climate change scenario. Re-allocation of rainfed and irrigated land might be useful information for land-use planners and water managers at an international level to decide on appropriate legislations on

  6. Effects of cerivastatin withdrawal on statin persistence.

    Science.gov (United States)

    Reaume, Kristen T; Erickson, Steven R; Dorsch, Michael P; Dunham, Niquole L M; Hiniker, Susan M; Prabhakar, Nitya; Kline-Rogers, Eva M; Eagle, Kim A

    2008-07-01

    Medication-taking behavior is influenced by many factors, as described by the Health Belief Model. Information on withdrawals of drugs from the market may be an example of negative external stimuli that might influence patients' decisions to persist with long-term drug therapy. To evaluate the association between the withdrawal of cerivastatin from the market and persistence in taking all other statins in patients who recently experienced acute coronary syndrome (ACS). Patients from a large ACS registry who responded to questions about medication use during a postdischarge telephone survey between November 2000 and February 2002 were categorized into 3 groups: pre- (November 1, 2000-April 30, 2001), peri- (May 1, 2001-August 31, 2001), and post- (September 1, 2001-February 28, 2002) cerivastatin withdrawal periods. Patients were considered persistent if, at the time of the survey, they continued to take study medication that had been prescribed at discharge. Persistence with angiotensin-converting enzyme inhibitors, aspirin, and beta-blockers was also assessed to determine whether changes in statin persistence were unique to the class or related to other medication issues that affected all classes. The Kruskal-Wallis test, with post hoc Mann-Whitney U test, was used to analyze the differences in persistence between the groups. All comparisons were considered statistically significant at p less than 0.05. There were no significant differences in patient characteristics between study groups. Persistence with statins decreased during the periwithdrawal period (88.4% pre vs 76.7% peri) and rebounded in the postwithdrawal period (90.8%; p = 0.007). There were no significant differences in persistence with the other drug classes. The temporary decline in statin persistence appeared to be associated with the withdrawal of cerivastatin, while persistence with the other study medications remained constant. Clinicians need to understand the potential effect of factors such

  7. 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.

  8. Precipitated and conditioned withdrawal in morphine-treated rats.

    Science.gov (United States)

    Becker, Ginger L; Gerak, Lisa R; Li, Jun-Xu; Koek, Wouter; France, Charles P

    2010-03-01

    Stimuli that are paired with opioid withdrawal can themselves produce effects similar to withdrawal that might promote relapse. This study compared precipitated and conditioned withdrawal and tested whether withdrawal is modified by clonidine or morphine. Morphine-treated rats (10 mg/kg/12 h) received naloxone (3.2 mg/kg) in a novel environment (conditioned stimuli [CS]). Other rats received naloxone in the absence of the CS. Body weight and observable signs were used to measure withdrawal. Naloxone produced weight loss and withdrawal signs in morphine-treated rats. Following pairings of the CS and naloxone, the CS alone had effects similar to naloxone; conditioned withdrawal was greater after three naloxone/CS pairings, as compared to one, and with longer morphine treatment. Antagonist-precipitated withdrawal was greater in rats that previously were physically dependent on morphine, as compared to withdrawal in rats that were never dependent; however, conditioned withdrawal did not differ between groups. When administered concurrently with naloxone, clonidine (0.1 mg/kg) attenuated some precipitated withdrawal signs, although conditioned withdrawal was largely unchanged. Administration of 10 mg/kg of morphine before the CS alone attenuated all conditioned withdrawal signs, whereas 0.1 mg/kg of clonidine before the CS alone reduced some directly observable signs and not weight loss. Conditioned withdrawal occurs rapidly and is greater with longer periods of morphine treatment or more pairings of naloxone and the CS; however, a history of physical dependence does not increase conditioned withdrawal. Modification of conditioned withdrawal by drugs might be a useful approach for treating relapse.

  9. 29 CFR 528.5 - Proceedings for withdrawal or annulment.

    Science.gov (United States)

    2010-07-01

    ... 29 Labor 3 2010-07-01 2010-07-01 false Proceedings for withdrawal or annulment. 528.5 Section 528... REGULATIONS ANNULMENT OR WITHDRAWAL OF CERTIFICATES FOR THE EMPLOYMENT OF STUDENT-LEARNERS, APPRENTICES... annulment. The representative authorized to withdraw or annul a certificate under § 528.3 shall institute...

  10. 29 CFR 528.3 - Withdrawal and annulment of certificates.

    Science.gov (United States)

    2010-07-01

    ... 29 Labor 3 2010-07-01 2010-07-01 false Withdrawal and annulment of certificates. 528.3 Section 528... REGULATIONS ANNULMENT OR WITHDRAWAL OF CERTIFICATES FOR THE EMPLOYMENT OF STUDENT-LEARNERS, APPRENTICES... RETAIL OR SERVICE ESTABLISHMENTS AT SPECIAL MINIMUM WAGE RATES § 528.3 Withdrawal and annulment of...

  11. 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...

  12. 12 CFR 341.5 - Withdrawal from registration.

    Science.gov (United States)

    2010-01-01

    ... 12 Banks and Banking 4 2010-01-01 2010-01-01 false Withdrawal from registration. 341.5 Section 341... POLICY REGISTRATION OF SECURITIES TRANSFER AGENTS § 341.5 Withdrawal from registration. (a) Notice of withdrawal from registration. Any transfer agent registered under this part that ceases to engage in the...

  13. Teachers' Withdrawal Behaviors and Their Relationship with Work Ethic

    Science.gov (United States)

    Erdemli, Özge

    2015-01-01

    Problem Situation: People experience ups and downs in their job satisfaction and motivation levels at different points of their work lives for various reasons. One of the outputs of low job satisfaction and motivation is defined as "withdrawal behaviors" in the literature. Withdrawal behaviors are any employee behavior of withdrawal from…

  14. Trajectories of Social Withdrawal from Middle Childhood to Early Adolescence

    OpenAIRE

    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 trajectories within subgroups. Assessments of individual (social withdrawal), interactive (prosocial behavior), relationship (friendship involvement, stability...

  15. 5 CFR 1650.2 - Eligibility for a TSP withdrawal.

    Science.gov (United States)

    2010-01-01

    ... 5 Administrative Personnel 3 2010-01-01 2010-01-01 false Eligibility for a TSP withdrawal. 1650.2... FUNDS FROM THE THRIFT SAVINGS PLAN General § 1650.2 Eligibility for a TSP withdrawal. (a) A participant... described in subpart B of this part. (b) A post-employment withdrawal will not be paid unless TSP records...

  16. Effects of lorazepam treatment for multiple ethanol withdrawals in mice.

    Science.gov (United States)

    Becker, Howard C; Veatch, Lynn M

    2002-03-01

    Although many alcohol-dependent patients present with a history of prior detoxifications, the efficacy and safety of pharmacotherapy in the context of multiple ethanol withdrawal experiences have not been extensively studied. The purpose of this study was to evaluate the ability of lorazepam treatment for multiple withdrawals to prevent or blunt the development/expression of sensitized central nervous system hyperexcitability during a subsequent untreated withdrawal episode. A mouse model of withdrawal sensitization involving repeated ethanol withdrawals was used. Adult male C3H/He mice were exposed to different patterns of chronic ethanol vapor in inhalation chambers. One group received four cycles of 16 hr of ethanol exposure separated by 8-hr withdrawal periods, another group was tested after a single 16-hr exposure period, and a final group served as ethanol-naïve controls. These groups were further divided into lorazepam dosage (0.25-1.0 mg/kg) conditions. Lorazepam was administered 1 hr into each of the first three withdrawal cycles (or equivalent times); no drug injections were given during the final (fourth) withdrawal cycle. The ability of lorazepam treatment to alter development and expression of sensitized handling-induced convulsions (HIC), as well as changes in pentylenetetrazol seizure threshold dosage during an untreated withdrawal episode, was examined. Separate animals were used to assess the effects of lorazepam treatment on blood ethanol clearance and plasma levels of the benzodiazepine during the test withdrawal cycle. Lorazepam dose-dependently reduced HIC activity during successive withdrawal cycles, and this resulted in attenuated expression of the sensitized HIC response during the acute phase of a subsequent untreated withdrawal episode. However, HIC activity was exacerbated at later time points during this final test withdrawal in mice that had received lorazepam treatment for earlier withdrawals. A similar pattern of results was obtained

  17. The effect of beta blocker withdrawal on adenosine myocardial perfusion imaging.

    Science.gov (United States)

    Hoffmeister, C; Preuss, R; Weise, R; Burchert, W; Lindner, O

    2014-12-01

    The effect of beta blockers on myocardial blood flow (MBF) under vasodilators has been studied in several SPECT and PET myocardial perfusion imaging (MPI) studies with divergent results. The present study evaluated the effect of a beta blocker withdrawal on quantitative adenosine MBF and on MPI results. Twenty patients with beta blockers and CAD history were studied with quantitative adenosine N-13 ammonia PET. The first study was performed under complete medication and the second after beta blocker withdrawal. The PET studies were independently read with respect to MPI result and clinical decision making. Global MBF showed an increase from 180.2 ± 59.9 to 193.6 ± 60.8 mL·minute(-1)/100 g (P = .02) after beta blocker withdrawal. The segmental perfusion values were closely correlated (R(2) = 0.82) over the entire range of perfusion values. An essentially different interpretation after beta blocker discontinuation was found in two cases (10%). A beta blocker withdrawal induces an increase in adenosine MBF. In the majority of cases, MPI interpretation and decision making are independent of beta blocker intake. If a temporary beta blocker withdrawal before MPI is not possible or was not realized by the patient, it is appropriate to perform adenosine stress testing without loss of the essential MPI result.

  18. Postponement of withdrawal bleeding with a monophasic oral contraceptive containing desogestrel and ethinylestradiol.

    Science.gov (United States)

    de Voogd, W S

    1991-08-01

    This study investigated the ability of a monophasic sub-50 oral contraceptive, containing desogestrel and ethinylestradiol, to postpone withdrawal bleeding in normal healthy women. In the analyzed group of 105 regular users of Marvelon, about 75% did not experience any vaginal bleeding during the 21 days of postponement. A 95% confidence interval was calculated which suggests that the percentage of women able to postpone their withdrawal bleeding successfully for 19 days ranges between 67.0% and 83.5%. Women with no vaginal blood loss in the postponement period were more willing to try this method of postponement again, compared to women who experienced vaginal blood loss in the postponement period. This difference was statistically significant. Nevertheless, the majority of women with vaginal blood loss were also willing to try this method again if necessary. The study results suggest that Marvelon offers an effective and acceptable method of postponing withdrawal bleeding for three weeks for most regular users of this contraceptive.

  19. Successful implementation of an alcohol-withdrawal pathway in a general hospital.

    Science.gov (United States)

    Repper-DeLisi, Jennifer; Stern, Theodore A; Mitchell, Monique; Lussier-Cushing, Mary; Lakatos, Barbara; Fricchione, Gregory L; Quinlan, Joan; Kane, Martha; Berube, Rhodes; Blais, Mark; Capasso, Virginia; Pathan, Firdosh; Karson, Andrew; Bierer, Michael

    2008-01-01

    Although alcohol use and abuse are common among general-hospital inpatients, many patients are inadequately assessed and treated for alcohol withdrawal. The purpose of this study was to determine whether the implementation of a clinical pathway for the treatment of alcohol withdrawal in medical inpatients would result in improvements in clinical practice and patient outcomes. Authors retrospectively reviewed 80 patient records (including 40 of those treated before the implementation of a pathway and 40 of those treated after pathway implementation). Assessment procedures and ordering patterns of physicians (medical house staff and staff physicians) shifted in a fashion consistent with the new treatment guidelines. Patient outcomes (e.g., length of stay and the incidence of delirium) improved for those patients who received benzodiazepines within the range of the pathway guidelines. Timely assessment and staff education can shift prescription patterns, increase patient monitoring, and reduce costs associated with alcohol withdrawal.

  20. Impact of natural climate change and historical land use on vegetation cover and geomorphological process dynamics in the Serra dos Órgãos mountain range in Rio de Janeiro State, Brazil

    Science.gov (United States)

    Nehren, U.; Sattler, D.; Heinrich, J.

    2010-03-01

    The Serra dos Órgãos mountain range in the hinterland of Rio de Janeiro contains extensive remnants of the Atlantic Forest (Mata Atlântica) biome, which once covered about 1.5 million km² from Northeast to South Brazil and further inland to Paraguay and Argentina. As a result of historical deforestation and recent land use intensification processes today only 5 to 8% of the original Atlantic Forest remains. Despite the dramatic habitat loss and a high degree of forest fragmentation, the remnants are among the Earth’s most diverse habitats in terms of species richness. Furthermore, they are characterized by a high level of endemism. Therefore, the biome is considered a "hotspot of biodiversity". In the last years many efforts have been taken to investigate the Mata Atlântica biome in different spatial and time scales and from different scientific perspectives. We are working in the Atlantic Forest of Rio de Janeiro since 2004 and focus in our research particularly on Quaternary landscape evolution and landscape history. By means of landscape and soil archives we reconstruct changes in the landscape system, which are mainly the result of Quaternary climate variability, young tectonic uplift and human impact. The findings throw light on paleoecological conditions in the Late Quaternary and the impact of pre-colonial and colonial land use practices on these landscapes. In this context, a main focus is set on climate and human-driven changes of the vegetation cover and its consequences for the geomorphological process dynamics, in particular erosion and sedimentation processes. Research methods include geomorphological field studies, interpretation of satellite images, physical and chemical sediment and soil analyses as well as relative and absolute dating (Feo/Fed ratio and 14C dating). For the Late Quaternary landscape evolution, the findings are compared with results from paleoclimatic and paloecological investigations in Southeast and South Brazil using other

  1. Alcohol, nicotine, and iatrogenic withdrawals in the ICU.

    Science.gov (United States)

    Awissi, Don-Kelena; Lebrun, Genevieve; Fagnan, Mylene; Skrobik, Yoanna

    2013-09-01

    The neurophysiology, risk factors, and screening tools associated with alcohol withdrawal syndrome in the ICU are reviewed. Alcohol withdrawal syndrome assessment and its treatment options are discussed. Description of nicotine withdrawal and related publications specific to the critically ill are also reviewed. A brief comment as to sedative and opiate withdrawal follows. The role of currently published alcohol withdrawal syndrome pharmacologic strategies (benzodiazepines, ethanol, clomethiazole, antipsychotics, barbiturates, propofol, and dexmedetomidine) is detailed. Studies on nicotine withdrawal management in the ICU focus mainly on the safety (mortality) of nicotine replacement therapy. Study characteristics and methodological limitations are presented. We recommend a pharmacologic regimen titrated to withdrawal symptoms in ICU patients with alcohol withdrawal syndrome. Benzodiazepines are a reasonable option; phenobarbital appears to confer some advantages in combination with benzodiazepines. Propofol and dexmedetomidine have not been rigorously tested in comparative studies of drug withdrawal treatment; their use as additional or alternative strategies for managing withdrawal syndromes in ICU patients should therefore be individualized to each patient. Insufficient data preclude recommendations as to nicotine replacement therapy and management of iatrogenic drug withdrawal in ICU patients.

  2. The window of opportunity for treatment withdrawal.

    Science.gov (United States)

    Wilkinson, Dominic

    2011-03-01

    Physicians sometimes refer to a "window of opportunity" for withdrawing life-sustaining treatment in patients with acute severe brain injury. There is a period of critical illness and physiological instability when treatment withdrawal is likely to be followed by death but prognosis is uncertain. If decisions are delayed, greater prognostic certainty can be achieved, but with the risk that the patient is no longer dependent on life support and survives with very severe disability. In this article I draw on the example of birth asphyxia and highlight the role that the window of opportunity sometimes plays in decisions about life-sustaining treatment in intensive care. I outline the potential arguments in favor of and against taking the window into account. I argue that it is, at least sometimes, ethical and appropriate for physicians and parents to be influenced by the window of opportunity in their decisions about life-sustaining treatment.

  3. Benzodiazepine withdrawal: behavioural pharmacology and neurochemical changes.

    Science.gov (United States)

    File, S E; Andrews, N

    1993-01-01

    This paper describes pharmacological treatments that can reverse the anxiogenic response detected in animal tests when rats are withdrawn from chronic treatment with diazepam. Concurrent treatment with the calcium channel antagonist verapamil prevented this withdrawal response and the benzodiazepine-receptor antagonist flumazenil reversed the anxiogenic response and restored the system to a drug-naive state. Other treatments that reversed the anxiogenic response were the GABAB agonist baclofen, the 5-HT1A receptor agonist buspirone, and the 5-HT3 receptor antagonist (R,S)-zacopride (GABA = gamma-aminobutyric acid; 5-HT = 5-hydroxytryptamine). Both the enantiomers of zacopride contributed to this reversal. These behavioural reversals are interpreted in the light of biochemical studies showing increased 45Ca2+ flux and [3H]5-HT release from the hippocampus, during benzodiazepine withdrawal (Fig. 1).

  4. The marijuana withdrawal syndrome: diagnosis and treatment.

    Science.gov (United States)

    Haney, Margaret

    2005-10-01

    A subset of marijuana smokers develop a cannabis use disorder and seek treatment for their marijuana use on their own initiative. A less well-known consequence of daily, repeated marijuana use is a withdrawal syndrome, characterized by a time-dependent constellation of symptoms: irritability, anxiety, marijuana craving, decreased quality and quantity of sleep, and decreased food intake. Treatment studies show that rates of continuous abstinence are low (comparable to relapse rates for other abused drugs), and more treatment options are needed. The objective of this review is to update clinicians on the current state of marijuana research and to describe features of marijuana withdrawal to facilitate the diagnosis and treatment of cannabis use disorders.

  5. Identification and management of alcohol withdrawal syndrome.

    Science.gov (United States)

    Mirijello, Antonio; D'Angelo, Cristina; Ferrulli, Anna; Vassallo, Gabriele; Antonelli, Mariangela; Caputo, Fabio; Leggio, Lorenzo; Gasbarrini, Antonio; Addolorato, Giovanni

    2015-03-01

    Symptoms of alcohol withdrawal syndrome (AWS) may develop within 6-24 h after the abrupt discontinuation or decrease of alcohol consumption. Symptoms can vary from autonomic hyperactivity and agitation to delirium tremens. The gold-standard treatment for AWS is with benzodiazepines (BZDs). Among the BZDs, different agents (i.e., long-acting or short-acting) and different regimens (front-loading, fixed-dose or symptom-triggered) may be chosen on the basis of patient characteristics. Severe withdrawal could require ICU admission and the use of barbiturates or propofol. Other drugs, such as α2-agonists (clonidine and dexmetedomidine) and β-blockers can be used as adjunctive treatments to control neuroautonomic hyperactivity. Furthermore, neuroleptic agents can help control hallucinations. Finally, other medications for the treatment for AWS have been investigated with promising results. These include carbamazepine, valproate, sodium oxybate, baclofen, gabapentin and topiramate. The usefulness of these agents are discussed.

  6. Perceived stress related to methadone withdrawal.

    Science.gov (United States)

    Carreras Alabau, Amparo; Carrobles Isabel, José A; Almendros Rodríguez, Carmen

    2016-08-01

    Stress is a known risk factor in addiction relapse, and prior studies show that relapse induced by stress may be more likely than drug-cue induced relapse. The main goal of our research was to establish the influence of perceived stress in methadone withdrawal outcome and the psychological factors involved. A sample of 81 methadone maintenance treatment outpatients was evaluated and then observed during methadone dose reduction. a multivariate analysis first showed that successful detoxification was predicted by perceived stress, patient-clinic staff agreement, pharmacotherapy support and social care; and second, perceived stress was predicted by anxiety, depression, self-control, social care and benzodiazepine use. These findings suggest that high levels of stress could increase the risk of failure in methadone detoxification, so a clinical intervention on the psychological factors related to stress would be indicated to improve effectiveness of methadone withdrawal treatment.

  7. [Alcohol withdrawal syndrome and delirium tremens. Diagnosis and therapy].

    Science.gov (United States)

    Zilker, T

    1999-08-19

    The alcohol withdrawal syndrome can be classified into three degrees of severity on the basis of the symptomatology, autonomic withdrawal, predelirium and delirium tremens. In American literature the severity of withdrawal is recorded using the CIWA-A scale (Clinical Institute Withdrawal Assessment--Alcohol). The pathophysiological causes lie in an imbalance between the inhibitory and excitatory neurotransmitters after giving up alcohol. This results in predomination by the excitatory system. Therapeutic intervention is possible here. Clomethiazole has effective sedative actions, stabilises the autonomic nervous system, and is an anticonvulsant. It is the drug of choice for autonomic withdrawal and predelirium. The benzodlazepines have a similar effect, but cannot be controlled so accurately. Carbamazepine can prevent withdrawal convulsions and progression of delirium. Clonidine acts on autonomic withdrawal and, together with neuroleptics and benzodiazepines, is easy to use parenterally for delirium tremens, while parenteral clomethiazole harbours dangers.

  8. Land acquisition

    Data.gov (United States)

    US Fish and Wildlife Service, Department of the Interior — This is a summary of lands acquired by Neal Smith National Wildlife Refuge between 1991 and 2009. Lists of acres and locations of land acquired are provided for each...

  9. Land Cover

    Data.gov (United States)

    Kansas Data Access and Support Center — The Land Cover database depicts 10 general land cover classes for the State of Kansas. The database was compiled from a digital classification of Landsat Thematic...

  10. Outpatient management of alcohol withdrawal syndrome.

    Science.gov (United States)

    Muncie, Herbert L; Yasinian, Yasmin; Oge', Linda

    2013-11-01

    Approximately 2% to 9% of patients seen in a family physician's office have alcohol dependence. These patients are at risk of developing alcohol withdrawal syndrome if they abruptly abstain from alcohol use. Alcohol withdrawal syndrome begins six to 24 hours after the last intake of alcohol, and the signs and symptoms include tremors, agitation, nausea, sweating, vomiting, hallucinations, insomnia, tachycardia, hypertension, delirium, and seizures. Treatment aims to minimize symptoms, prevent complications, and facilitate continued abstinence from alcohol. Patients with mild or moderate alcohol withdrawal syndrome can be treated as outpatients, which minimizes expense and allows for less interruption of work and family life. Patients with severe symptoms or who are at high risk of complications should receive inpatient treatment. In addition to supportive therapy, benzodiazepines, either in a fixed-dose or symptom-triggered schedule, are recommended. Medication should be given at the onset of symptoms and continued until symptoms subside. Other medications, including carbamazepine, oxcarbazepine, valproic acid, and gabapentin, have less abuse potential but do not prevent seizures. Typically, physicians should see these patients daily until symptoms subside. Although effective treatment is an initial step in recovery, long-term success depends on facilitating the patient's entry into ongoing treatment.

  11. Gambia Land Use Land Cover

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — This series of three-period land use land cover (LULC) datasets (1975, 2000, and 2013) aids in monitoring change in West Africa’s land resources (exception is...

  12. 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.

  13. The emergency medicine management of severe alcohol withdrawal.

    Science.gov (United States)

    Long, Drew; Long, Brit; Koyfman, Alex

    2017-07-01

    Alcohol use is widespread, and withdrawal symptoms are common after decreased alcohol intake. Severe alcohol withdrawal may manifest with delirium tremens, and new therapies may assist in management of this life-threatening condition. To provide an evidence-based review of the emergency medicine management of alcohol withdrawal and delirium tremens. The underlying pathophysiology of alcohol withdrawal syndrome (AWS) is central nervous system hyperexcitation. Stages of withdrawal include initial withdrawal symptoms, hallucinations, seizures, and delirium tremens. Management focuses on early diagnosis, resuscitation, and providing medications with gamma-aminobutyric acid (GABA) receptor activity. Benzodiazepines with symptom-triggered therapy have been the predominant medication class utilized and should remain the first treatment option with rapid escalation of dosing. Treatment resistant withdrawal warrants the use of phenobarbital or propofol, both demonstrating efficacy in management. Propofol can be used as an induction agent to decrease the effects of withdrawal. Dexmedetomidine does not address the underlying pathophysiology but may reduce the need for intubation. Ketamine requires further study. Overall, benzodiazepines remain the cornerstone of treatment. Outpatient management of patients with minimal symptoms is possible. Alcohol withdrawal syndrome can result in significant morbidity and mortality. Physicians must rapidly diagnose these conditions while evaluating for other diseases. Benzodiazepines are the predominant medication class utilized, with adjunctive treatments including propofol or phenobarbital in patients with withdrawal resistant to benzodiazepines. Dexmedetomidine and ketamine require further study. Published by Elsevier Inc.

  14. Clinical management of alcohol withdrawal: A systematic review.

    Science.gov (United States)

    Kattimani, Shivanand; Bharadwaj, Balaji

    2013-07-01

    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.

  15. Recurrence of Hyperprolactinemia after Withdrawal of Long-Term Cabergoline Therapy

    Science.gov (United States)

    Kharlip, J.; Salvatori, R.; Yenokyan, G.; Wand, G. S.

    2009-01-01

    Context: Recurrence of hyperprolactinemia after cabergoline withdrawal ranges widely from 36 to 80%. The Pituitary Society recommends withdrawal of cabergoline in selected patients. Objective: Our aim was to evaluate recurrence of hyperprolactinemia in patients meeting The Pituitary Society guidelines. Design: Patients were followed from the date of discontinuation to either relapse of hyperprolactinemia or the day of last prolactin test. Setting: We conducted the study at an academic medical center. Patients: Forty-six patients meeting Pituitary Society criteria (normoprolactinemic and with tumor volume reduction after 2 or more years of treatment) participated in the study. Interventions: After withdrawal, if prolactin returned above reference range, another measurement was obtained within 1 month, symptoms were assessed by questionnaire, and magnetic resonance imaging was performed. Main Outcome Measures: We measured risk of and time to recurrence estimates as well as clinical predictors of recurrence. Results: Mean age of patients was 50 ± 13 yr, and 70% were women. Thirty-one patients had microprolactinomas, 11 had macroprolactinomas, and four had nontumoral hyperprolactinemia. The overall recurrence was 54%, and the estimated risk of recurrence by 18 months was 63%. The median time to recurrence was 3 months (range, 1–18 months), with 91% of recurrences occurring within 1 yr after discontinuation. Size of tumor remnant prior to withdrawal predicted recurrence [18% increase in risk for each millimeter (95% confidence interval, 3–35; P = 0.017)]. None of the tumors enlarged in the patients experiencing recurrence, and 28% had symptoms of hypogonadism. Conclusions: Cabergoline withdrawal is practical and safe in a subset of patients as defined by The Pituitary Society guidelines; however, the average risk of long-term recurrence in our study was over 60%. Close follow-up remains important, especially within the first year. PMID:19336508

  16. Land Rights at Last!

    Directory of Open Access Journals (Sweden)

    Heidi Norman

    2009-10-01

    Full Text Available In 1978 the Wran Government announced an Inquiry to investigate a range of issues including Aboriginal land rights recognition, the causes of Aboriginal social and economic disadvantage, heritage protection and commonwealth and state relations. The Select Committee, chaired by state member Maurie Keane, in its ‘First Report’ that focused on land rights, not only fundamentally changed the way Government’s liaise and consult with Aboriginal people, the Committee unanimously endorsed far-reaching recommendations including the ability to recover land, compensation for cultural loss and three-tier community driven administrative structure. All of this was set in the context of Aboriginal rights to self-determination and fundamental attachment to land as a cultural relationship and historical reality. The movement for land rights was the culmination of many years of land justice activism, shifting policy at the Commonwealth level and wider international movements contesting colonial rule and racism. More specifically the land rights movement in NSW was galvanised in response to the previous Government’s renewed efforts to assimilate Aboriginal people and revoke reserve lands and the limited land rights recognition made possible through the Aboriginal Lands Trust (herein ‘the Trust’. This paper argues a more focused and pronounced campaign emerged in the mid 1970s whereby land rights ‘time had come’ as a result of Aboriginal political activism and the alliances formed with and among left social movements. This movement created the political climate for the Wran Government’s announcement of the Select Committee Inquiry in 1978.

  17. On the relationship between Indian monsoon withdrawal and Iran's fall precipitation onset

    Science.gov (United States)

    Babaeian, Iman; Rezazadeh, Parviz

    2017-09-01

    coastal provinces, which has a different behavior from the overall response of Iran's climate to the late withdrawal of monsoon. In the phase of early monsoon withdrawal, the subtropical jet is located at the 200 hPa level in 32.5° north latitude; compared with the late withdrawal date, it shows a 2° southward movement. Additionally, the 500 hPa trough is also located in the Eastern Mediterranean, and the MSL pressure anomaly is between - 4 to - 7 hPa. The Mediterranean trough in the late withdrawal phase is located in its central zones. It seems that the lack of significant correlation between late withdrawal date of Indian monsoon and late fall's precipitation onset in the central region of Iran depends on three reasons: 1. Lack of adequate weather stations in central region of Iran. 2. Precipitation standard deviations over arid and warm regions are high. 3. Central flat region of Iran without any source of humidity is located to the lee side of Zagros mountain range. So intensification or development of frontal systems is almost prohibited over there.

  18. Withdrawal of life-support in paediatric intensive care - a study of time intervals between discussion, decision and death

    Directory of Open Access Journals (Sweden)

    Tibballs James

    2011-05-01

    Full Text Available Abstract Background Scant information exists about the time-course of events during withdrawal of life-sustaining treatment. We investigated the time required for end-of-life decisions, subsequent withdrawal of life-sustaining treatment and the time to death. Methods Prospective, observational study in the ICU of a tertiary paediatric hospital. Results Data on 38 cases of withdrawal of life-sustaining treatment were recorded over a 12-month period (75% of PICU deaths. The time from the first discussion between medical staff and parents of the subject of withdrawal of life-sustaining treatment to parents and medical staff making the decision varied widely from immediate to 457 hours (19 days with a median time of 67.8 hours (2.8 days. Large variations were subsequently also observed from the time of decision to actual commencement of the process ranging from 30 minutes to 47.3 hrs (2 days with a median requirement of 4.7 hours. Death was apparent to staff at a median time of 10 minutes following withdrawal of life support varying from immediate to a maximum of 6.4 hours. Twenty-one per cent of children died more than 1 hour after withdrawal of treatment. Medical confirmation of death occurred at 0 to 35 minutes thereafter with the physician having left the bedside during withdrawal in 18 cases (48% to attend other patients or to allow privacy for the family. Conclusions Wide case-by-case variation in timeframes occurs at every step of the process of withdrawal of life-sustaining treatment until death. This knowledge may facilitate medical management, clinical leadership, guidance of parents and inform organ procurement after cardiac death.

  19. [Alcohol withdrawal--biological background, diagnosis and treatment].

    Science.gov (United States)

    Johnsen, J; Mørland, J

    1990-05-10

    Alcohol withdrawal reveals a condition of central nervous system (CNS) hyperexcitability opposite to that of the primary effect of the drug. Adaption to the decreased activity of the CNS during chronic ethanol ingestion may at least partly explain several of the symptoms of alcohol withdrawal. Benzodiazepines are therefore useful in the withdrawal state. The benzodiazepine loading dose technique, giving diazepam 20 mg every hour until the patient shows signs of clinical improvement and mild sedation, is the choice of treatment in cases of moderate to severe alcohol withdrawal. In general, neuroleptics should be avoided, because of increased risk of convulsions, but haloperidol can be used to control hallucinations and severe agitation. This treatment should then be combined with benzodiazepines. Most patients with mild withdrawal symptoms respond to non-pharmacological supportive care, except for those with a history of withdrawal seizures. These patients may need treatment with carbamazepine or diazepam.

  20. Why withdrawal from the European Union is undemocratic

    DEFF Research Database (Denmark)

    Rostbøll, Christian F.; Olsen, Tore Vincents

    2017-01-01

    The Lisbon Treaty from 2009 introduced the possibility for individual member states to withdraw from the European Union on the basis of a unilateral decision. But would withdrawal be democratically legitimate? In fact, the all-affected principle suggests that it is undemocratic for subunits...... to leave larger political units because 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 undesirable. Moreover, on the ‘all-affected status principle’ that we develop, even multilaterally agreed withdrawal is undemocratic because the latter diminishes the future...

  1. 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.

  2. 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.

  3. [Treatment of benzodiazepine-resistant alcohol withdrawal symptoms].

    Science.gov (United States)

    Madsen, Line Malmer; Lauritsen, Anne Øberg; Lorentzen, Kristian

    2015-08-17

    Alcohol withdrawal symptoms can lead to severe morbidity and potentially be fatal if untreated. A subgroup of patients treated for alcohol withdrawal symptoms will exhibit symptoms resistant to first-line treatment with benzodiazepines. The understanding of benziodiazepine-resistant alcohol withdrawal symptoms has increased with new knowledge of implicated neuroreceptors and possible treatment methods. This article aims to elucidate the patient population and the existing methods of treatment.

  4. The interpersonal process model of demand/withdraw behavior.

    Science.gov (United States)

    Baucom, Brian R; Dickenson, Janna A; Atkins, David C; Baucom, Donald H; Fischer, Melanie S; Weusthoff, Sarah; Hahlweg, Kurt; Zimmermann, Tanja

    2015-02-01

    The demand/withdraw interaction pattern is a destructive cycle of relationship communication behavior that is associated with negative individual and relationship outcomes. Demand/withdraw behavior is thought to be strongly linked to partners' emotional reactions, but current theories are inconsistent with empirical findings. The current study proposes the interpersonal process model of demand/withdraw behavior, which includes linkages between each partners' emotional reactions and the interpersonal behavior of demanding and withdrawing. Data come from problem solving discussions of 55 German couples with observationally coded demand/withdraw behavior and fundamental frequency (f₀) to measure vocally encoded emotional arousal. Actor-partner interdependence models (Kenny, Kashy, & Cook, 2006) were used to examine associations among demand/withdraw behavior and f₀ in the overall discussion and 5-min segments. Significant cross-partner associations emerged for demanding and withdrawing behavior across the whole conversation as well as within 5-min segments, and these associations are partially accounted for by each individual's f₀. When behaviorally coded demanders expressed more vocal arousal, they demanded more and withdrew less while their partners withdrew more. In contrast, when behaviorally coded withdrawers expressed more vocal arousal, their partners demanded less and withdrew more. Findings demonstrate that demand/withdraw behavior varies between couples (i.e., some couples engage in a stronger demand/withdraw cycle than others) and between segments (i.e., when 1 partner increases demanding, the other increases withdrawing). Findings support key elements of the interpersonal process model, showing intra- and interpersonal pathways linking demand/withdraw behavior and emotion and demonstrate the importance of partners' behavioral roles in these linkages. PsycINFO Database Record (c) 2015 APA, all rights reserved.

  5. [Clinical and therapeutic aspects of alcohol withdrawal syndrome].

    Science.gov (United States)

    Miniati, M; Bani, A; Mauri, M

    1993-09-01

    In this review the authors describe the symptomatology, and the etiopathogenetic hypothesis of alcohol withdrawal syndrome. Many drugs are used in the treatment of alcohol withdrawal syndrome: carbamazepine, clonidine, chlormethiazole, phenytoin and other compounds; actually benzodiazepines are the most important drugs for symptomatic relief to prevent major withdrawal syndrome. Particularly attention is recommended to the period of suspension with the aim of reducing alcohol consumption and correcting alcohol-related psychosocial problems.

  6. 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...

  7. Alcohol, barbiturate and benzodiazepine withdrawal syndromes: clinical management.

    OpenAIRE

    Sellers, E M

    1988-01-01

    The symptoms and clinical management of alcohol, barbiturate and benzodiazepine withdrawal syndromes are discussed in this article. People who suffer alcohol withdrawal should be admitted to hospital if they have medical or surgical complications or severe symptoms; supportive care and pharmacotherapy, especially diazepam loading, are the essential components of treatment. Barbiturate withdrawal requires pharmacotherapy and admission to hospital for patients who have taken more than 0.4 g/d o...

  8. Successful management of prolonged gamma-hydroxybutyrate and alcohol withdrawal.

    Science.gov (United States)

    Bowles, T M; Sommi, R W; Amiri, M

    2001-02-01

    A 27-year-old man was admitted with tremulousness, diaphoresis, tachypnea (28 breaths/min), full-body rigidity, irritability, paranoia, and auditory and visual hallucinations 2 days after stopping long-term gamma-hydroxybutyrate (GHB) and 8 hours after stopping alcohol intake. He received intravenous fluids and tapering dosages of lorazepam to control agitation and rigidity, and recovered with no significant sequelae after 8 days. Abrupt cessation of GHB after high-dosage abuse can precipitate a clinically significant withdrawal syndrome. Lorazepam should be considered for treatment of GHB withdrawal. Concomitant alcohol abuse may mask early GHB withdrawal symptoms and exacerbate withdrawal.

  9. Flumazenil in treatment benzodiazepine withdrawal syndrome: Case report

    National Research Council Canada - National Science Library

    Ramah, Aleksandar; Todorovic, Mirjana; Crnic, Katarina

    2015-01-01

    .... A particular problem is the process of detoxification and treatment of benzodiazepine withdrawal syndrome due to a recurrence of symptoms of anxiety disorder, availability of benzodiazepines, falling motivation...

  10. 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.

  11. Serotonergic anti-depressants and ethanol withdrawal syndrome: A review

    National Research Council Canada - National Science Library

    Uzbay, I. Tayfun

    ...: Some beneficial effects of fluoxetine, tianeptine, HPE, escitalopram and venlafaxine on ethanol withdrawal signs were observed, ranked as follows: fluoxetine = tianeptine > HPE > escitalopram > venlafaxine. Conclusions...

  12. [The withdrawal syndrome in benzodiazepine dependence and its management].

    Science.gov (United States)

    Străulea, A O; Chiriţă, V

    2009-01-01

    The authors present the result of an observational study about the withdrawal syndrome in benzodiazepine dependence, and the aspect of identifying withdrawal symptoms, effective communication with the patient and the structure of withdrawal programmes. The study included a number of 22 pacients hospitalised in the Drug-Dependence Clinic of Iaşi between January 2006 - December 2008. The present article consists of data covering current issues in the area of withdrawal syndrome in benzodiazepine dependence. The most prescribed benzodiazepines were diazepam (10 cases), followed by alprazolam (5 cases) and nitrazepam (4 cases). The clinical manifestations such as anxiety, insomnia, concentration problems, fatigability were present at all patients.

  13. Opioid and benzodiazepine withdrawal symptoms in paediatric intensive care patients.

    Science.gov (United States)

    Franck, Linda S; Naughton, Ita; Winter, Ira

    2004-12-01

    The purposes of this prospective repeated measures study were to: (a) describe the occurrence of withdrawal symptoms with the use of a standardised protocol to slowly taper opioids and benzodiazepines; and (b) to test the predictive validity of an opioid and benzodiazepine withdrawal assessment scoring tool in critically ill infants and young children after prolonged opioid and benzodiazepine therapy. Fifteen children (6 weeks-28 months of age) with complex congenital heart disease and/or respiratory failure who received opioids and benzodiazepines for 4 days or greater were evaluated for withdrawal symptoms using a standardized assessment tool. Thirteen children showed moderate to severe withdrawal symptoms a median 3 days after commencement of tapering. Symptom intensity was not related to prior opioid or benzodiazepine exposure, extracorporeal membrane oxygenation (ECMO) therapy or length of tapering. Children who received fentanyl in addition to morphine more often exhibited signs of withdrawal. This study demonstrated that significant withdrawal symptoms occur in critically ill children even with the use of a standardised assessment tool and tapering management protocol. The predictive validity and utility of the Opioid and Benzodiazepine Withdrawal Score (OBWS) was adequate for clinical use, but areas for further improvement of the tool were identified. Problems with the clinical withdrawal prevention and management guidelines were also identified. More research is needed to establish the optimal methods for prevention and management of iatrogenic opioid and benzodiazepine withdrawal in paediatric critical care.

  14. Levetiracetam as adjunctive therapy for acute alcohol withdrawal syndrome in hospitalized patients.

    Science.gov (United States)

    Youland, Kelly M; Miller, Ryan F; Mahoney, Lisa J; Borgert, Andrew J; Gundrum, Jacob D

    2014-12-01

    Benzodiazepines are often considered the standard of care for managing symptoms of acute alcohol withdrawal syndrome. Because of potential adverse effects, other agents have been evaluated in this patient population. Previous studies have produced mixed results on the efficacy of levetiracetam in alcohol withdrawal. The objective of this study was to determine whether adjunctive levetiracetam reduces the amount of symptom-triggered benzodiazepines required by patients experiencing symptoms of alcohol withdrawal. We conducted a retrospective chart review of patients who experienced symptoms of alcohol withdrawal while hospitalized. The outcomes of patients who received adjunctive levetiracetam were compared with those of patients who received only the standard of care (control group). Two hundred fifty patients (125 in each cohort) were included. No significant differences were found in the benzodiazepine requirements of the 2 cohorts. The control group required a median average daily dose of 2.0 mg of lorazepam (range, 0.1-17 mg/d) compared with the levetiracetam group, which required a median average daily dose of 1.3 mg of lorazepam (range, 0.0-53.5 mg/d) (P = 0.09). The patients in the control group required a median total of 6 mg of lorazepam during their hospitalization compared with a median total of 5.5 mg in the levetiracetam group. Both cohorts had a median length of stay of 3 days, although those in the levetiracetam group had a shorter length of intensive care unit stay and spent less time mechanically ventilated. The adjunctive use of levetiracetam does not significantly reduce the benzodiazepine requirements of patients experiencing symptoms of alcohol withdrawal in the inpatient setting.

  15. Transitioning to Zero Freshwater Withdrawal for Thermoelectric Generation

    Science.gov (United States)

    Macknick, J.; Tidwell, V. C.; Zemlick, K. M.; Sanchez, J.; Woldeyesus, T.

    2013-12-01

    The electricity sector is the largest withdrawer of freshwater in the United States. The primary demand for water from the electricity sector is for cooling thermoelectric power plants. Droughts and potential changes in water resources resulting from climate change pose important risks to thermoelectric power production in the United States. Power plants can minimize risk in a variety of ways. One method of reducing risk is to move away from dependency on freshwater resources. Here a scoping level analysis is performed to identify the technical tradeoffs and initial cost estimates for retrofitting all existing steam-powered generation to achieve zero freshwater withdrawal. Specifically, the conversion of existing freshwater-cooled plants to dry cooling or a wet cooling system utilizing non-potable water is considered. The least cost alternative is determined for each of the 1,178 freshwater using power plants in the United States. The use of non-potable water resources, such as municipal wastewater and shallow brackish groundwater, is considered based on the availability and proximity of those resources to the power plant, as well as the costs to transport and treat those resources to an acceptable level. The projected increase in levelized cost of electricity due to power plant retrofits ranges roughly from 0.20 to 20/MWh with a median value of 3.53/MWh. With a wholesale price of electricity running about 35/MWh, many retrofits could be accomplished at levels that would add less than 10% to current power plant generation expenses. Such retrofits could alleviate power plant vulnerabilities to thermal discharge limits in times of drought (particularly in the East) and would save 3.2 Mm3/d of freshwater consumption in watersheds with limited water availability (principally in the West). The estimated impact of retrofits on wastewater and brackish water supply is minimal requiring only a fraction of the available resource. Total parasitic energy requirements to

  16. Operant conditioning of gill withdrawal in Aplysia.

    Science.gov (United States)

    Hawkins, Robert D; Clark, Gregory A; Kandel, Eric R

    2006-03-01

    A basic question in neuroscience is how different forms of learning are related. To further address that question, we examined whether gill withdrawal in Aplysia, which has already been studied extensively for neuronal mechanisms contributing to habituation, sensitization, and classical conditioning, also undergoes operant conditioning. Animals were run in pairs. During the initial training period, the contingent (experimental) animal received a siphon shock each time its gill relaxed below a criterion level, and the yoked control animal received a shock whenever the experimental animal did, regardless of its own gill position. This was followed by an extinction period when there was no shock, a retraining period when both animals were contingent, and another extinction period. The experimental animals spent more time with their gills contracted above the criterion level than did the control animals during each period, demonstrating operant conditioning. The type of gill behavior modified by learning shifted over time: the experimental animals had a larger increase in the frequency and duration of spontaneous contractions than did the control animals during the first but not the last extinction period and a larger increase in the level of tonic contraction during the last but not the first extinction period. Because many of the neurons controlling spontaneous and tonic gill withdrawal have already been identified, it should now be possible to examine the cellular locus and mechanism of operant conditioning and compare them with those for other forms of learning of the same behavior.

  17. Observing and monitoring land use and land cover change

    Science.gov (United States)

    Loveland, Thomas R.; DeFries, Ruth S.

    Understanding the consequences of land use change requires robust documentation on the characteristics of change. Land use change observation and monitoring programs now rely on remotely sensed data coupled with field observations and corroborating information describing the social, economic, and physical dimensions of land use and land cover. Remote sensing approaches for observing and monitoring change vary depending on the geographic scope, ecological complexity, and the information required to understand ecosystem interactions. Strategies based on identifying spectral variability are useful for targeting areas of rapid change. Measuring changes in land cover biophysical properties requires a more complex approach, where different dates of remotely sensed data are transformed to such variables as surface imperviousness, canopy structure, and phenology, and then compared. Mapping the conversion of land use and land cover from one category to another (e.g., forest to urban) requires maps of the land use and land cover for two or more periods. These approaches have been used successfully at local, regional, and global scales using a range of remote sensing data (e.g., aerial photography, Landsat Thematic Mapper, Terra MODIS, Space Imaging's IKONOS), field measurements, and other supplemental sources. Challenges remain, however, and scientific advances in change detection methods, accuracy assessment procedures, and improved strategies for using land cover to more specifically infer land use are needed so that continued improvements in the types and quality of change measures used to study land use and ecosystem interactions can be realized.

  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. Land Use.

    Science.gov (United States)

    Land use in the Narragansett Bay Watershed (NBW) is subject to conversion, and these changes influence the Watershed’s hydrologic functions. Changes of natural habitat such as wetlands and forests to urban lands have impacted how water is delivered to rivers and lakes, to g...

  20. SOME ASPECTS OF SUSTAINABLE LAND MANAGEMENT AGRICULTURAL LAND USE AREAS WITHIN THE TERRITORIAL COMMUNITIES

    Directory of Open Access Journals (Sweden)

    Kapinos N.

    2016-05-01

    Full Text Available Land Fund in Ukraine is experiencing excessive human impact, which is reflected in its performance exceeding the allowable agricultural development and land structure imbalance. The environmental condition of land resources close to critical. Among the largest land area occupied by agricultural land (71% of which - 76% is arable land. Violation environmentally acceptable ratio of arable land, natural grasslands and forests negatively affected the sustainability of agricultural landscapes. Throughout the widespread land degradation processes, among which the most ambitious is the erosion (about 57.5% of the territory, pollution (20% of the territory, flooding (about 12% of the territory. Sustainable (balanced land is one of the key factors of sustainable nature of territorial entities and may be formed of a priority, taking into account environmental factors. In ecological optimization based on value criteria ekolohostabilizuyuchyh and anthropogenic pressures lands should necessarily provide for withdrawal of intensive land use, which in its modal properties can not ensure sustainability of land use. However, today in Ukraine within the territories of communities no project development to optimize land use on the basis of sustainable development. Accordingly, the purpose of the article was the study of certain aspects of Land Management sustainable development of agricultural land within the territories of local communities. The current structure of the land fund of Ukraine was actually formed in the Soviet period, under the influence of policies of extensive agricultural development. Violation environmentally acceptable ratio of arable land, natural grasslands and forests negatively affected the stability and condition of land, which is confirmed by relevant research. In such circumstances, balancing the land proposed to carry out in two stages - the ecological and economic. In ecological optimization criteria based on land value necessarily

  1. The Withdrawal Assessment Tool - Version 1 (WAT-1)

    Science.gov (United States)

    Franck, Linda S.; Harris, Sion Kim; Soetenga, Deborah J.; Amling, June K.; Curley, Martha A.Q.

    2008-01-01

    Objective To develop and test the validity and reliability of the Withdrawal Assessment Tool - Version 1 (WAT-1) for monitoring opioid and benzodiazepine withdrawal symptoms in pediatric patients. Design Prospective psychometric evaluation. Pediatric critical care nurses assessed eligible at-risk pediatric patients for the presence of 19 withdrawal symptoms and rated the patient’s overall withdrawal intensity using a numeric rating scale (NRS) where 0 indicated no withdrawal and 10 indicated worst possible withdrawal. The 19 symptoms were derived from the Opioid and Benzodiazepine Withdrawal Score (OBWS), the literature and expert opinion. Setting: Two Pediatric Intensive Care Units (PICU) in university-affiliated academic children’s hospitals. Patients 83 pediatric patients, median age 35 months (IQR: 7months -10 years), recovering from acute respiratory failure who were weaning from more than 5 days of continuous infusion or round-the-clock opioid and benzodiazepine administration. Interventions Repeated observations during analgesia and sedative weaning. A total of 1040 withdrawal symptom assessments were completed, with a median (IQR) of 11 (6-16) per patient over 6.6 (4.8-11) days. Measurements and Main Results Generalized linear modeling was used to analyze each symptom in relation to withdrawal intensity ratings, adjusted for site, subject and age group. Symptoms with high redundancy or low levels of association with withdrawal intensity ratings were dropped, resulting in an 11-item (12-point) scale. Concurrent validity was indicated by high sensitivity (.872) and specificity (.880) (WAT-1 ≥3 predicting NRS ≥4). Construct validity was supported by significant differences in drug exposure, length of treatment and weaning from sedation, length of mechanical ventilation and intensive care unit stay for patients with WAT-1 scores ≥3 compared to those with lower scores. Conclusions The WAT-1 shows excellent preliminary psychometric performance when used

  2. Emergency management of acute alcohol problems. Part 1: Uncomplicated withdrawal.

    OpenAIRE

    Etherington, J. M.

    1996-01-01

    Alcohol-related problems are common among patients in emergency departments. Primary care physicians must recognize and treat a variety of alcohol-related and alcohol-induced problems: alcohol withdrawal, alcohol-related seizures, delirium tremens, malnutrition, concomitant illness, poisoning, trauma, and lack of social support. This paper focuses an recognizing and managing acute alcohol withdrawal.

  3. Course Withdrawals: A Probit Model and Policy Recommendations.

    Science.gov (United States)

    Adams, John L.; Becker, William E.

    1990-01-01

    An analysis of student decisions to withdraw from specific courses before assignment of grades but after the "add-drop" period at the University of Minnesota is presented. In a probit model, withdrawals appear to occur randomly, with notable exceptions. Student, class, and teacher characteristics are considered as variables related to…

  4. Deadly pressure pneumothorax after withdrawal of misplaced feeding tube

    DEFF Research Database (Denmark)

    Andresen, Erik Nygaard; Frydland, Martin; Usinger, Lotte

    2016-01-01

    , but our patient died less than an hour after withdrawal. The autopsy report stated that cause of death was tension pneumothorax, which developed following withdrawal of the misplaced feeding tube. CONCLUSIONS: The indications for insertion of nasogastric feeding tubes are many and the procedure...

  5. The Relationship of Personality Variables to Organizational Withdrawal

    Science.gov (United States)

    Bernardin, H. John

    1977-01-01

    Investigates the relationship of personality characteristics to organizational withdrawal and tests the Porter and Steers "polar" hypothesis, i.e., employees with high levels of emotional instability, anxiety, achievement orientation, aggression, independence, self-confidence and sociability were more apt to withdraw from organizations…

  6. 40 CFR 304.24 - Intervention and withdrawal.

    Science.gov (United States)

    2010-07-01

    ... 40 Protection of Environment 27 2010-07-01 2010-07-01 false Intervention and withdrawal. 304.24 Section 304.24 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SUPERFUND, EMERGENCY... Intervention and withdrawal. (a)(1) No later than thirty days prior to the pre-hearing conference (see § 304.31...

  7. 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...

  8. 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.

  9. 17 CFR 41.47 - Withdrawal of margin.

    Science.gov (United States)

    2010-04-01

    ... 17 Commodity and Securities Exchanges 1 2010-04-01 2010-04-01 false Withdrawal of margin. 41.47... PRODUCTS Customer Accounts and Margin Requirements § 41.47 Withdrawal of margin. (a) By the customer... deposited as margin for positions in an account may be withdrawn, provided that the equity in the account...

  10. 17 CFR 242.405 - Withdrawal of margin.

    Science.gov (United States)

    2010-04-01

    ... 17 Commodity and Securities Exchanges 3 2010-04-01 2010-04-01 false Withdrawal of margin. 242.405...) REGULATIONS M, SHO, ATS, AC, AND NMS AND CUSTOMER MARGIN REQUIREMENTS FOR SECURITY FUTURES Customer Margin Requirements for Security Futures § 242.405 Withdrawal of margin. (a) By the customer. Except as otherwise...

  11. 19 CFR 144.38 - Withdrawal for consumption.

    Science.gov (United States)

    2010-04-01

    ... provided in § 141.61(e) of this chapter. (b) Withdrawal for exportation to Canada or Mexico. A withdrawal for exportation to Canada or Mexico or for entry into a duty-deferral program in Canada or Mexico is...) Textiles and textile products. Textiles and textile products subject to quota, visa or export license...

  12. 38 CFR 59.122 - Withdrawal of application.

    Science.gov (United States)

    2010-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 2 2010-07-01 2010-07-01 false Withdrawal of application. 59.122 Section 59.122 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS (CONTINUED) GRANTS TO STATES FOR CONSTRUCTION OR ACQUISITION OF STATE HOMES § 59.122 Withdrawal of...

  13. Alcohol withdrawal syndrome: current management strategies for the surgery patient.

    Science.gov (United States)

    Morris, P R; Mosby, E L; Ferguson, B L

    1997-12-01

    As advances in the therapeutic management of alcohol withdrawal syndrome occur, oral and maxillofacial surgeons should be aware of the current treatment philosophies and modalities. This article provides a comprehensive review of alcohol withdrawal syndrome and presents some of the current management strategies that can be used for these patients, whether it be in the office or in the hospital.

  14. Opiate withdrawal syndrome in buprenorphine abusers admitted to ...

    African Journals Online (AJOL)

    An ANOVA was conducted to examine the effect of different factors on the withdrawal scores. Results: 32 subjects were included. Among ... The sex v time interaction and the mode of consumption of buprenorphine had significant effects on the withdrawal scores ..... Naloxone reversal of buprenor- phine-induced respiratory ...

  15. 21 CFR 870.1800 - Withdrawal-infusion pump.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Withdrawal-infusion pump. 870.1800 Section 870.1800 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED... pump. (a) Identification. A withdrawal-infusion pump is a device designed to inject accurately drugs...

  16. 48 CFR 14.303 - Modification or withdrawal of bids.

    Science.gov (United States)

    2010-10-01

    ... for the bid. (c) Upon withdrawal of an electronically transmitted bid, the data received shall not be... of bids. 14.303 Section 14.303 Federal Acquisition Regulations System FEDERAL ACQUISITION REGULATION CONTRACTING METHODS AND CONTRACT TYPES SEALED BIDDING Submission of Bids 14.303 Modification or withdrawal of...

  17. Withdrawal-associated injury site pain (WISP): a descriptive case series of an opioid cessation phenomenon.

    Science.gov (United States)

    Rieb, Launette Marie; Norman, Wendy V; Martin, Ruth Elwood; Berkowitz, Jonathan; Wood, Evan; McNeil, Ryan; Milloy, M-J

    2016-12-01

    Withdrawal pain can be a barrier to opioid cessation. Yet, little is known about old injury site pain in this context. We conducted an exploratory mixed-methods descriptive case series using a web-based survey and in-person interviews with adults recruited from pain and addiction treatment and research settings. We included individuals who self-reported a past significant injury that was healed and pain-free before the initiation of opioids, which then became temporarily painful upon opioid cessation-a phenomenon we have named withdrawal-associated injury site pain (WISP). Screening identified WISP in 47 people, of whom 34 (72%) completed the descriptive survey, including 21 who completed qualitative interviews. Recalled pain severity scores for WISP were typically high (median: 8/10; interquartile range [IQR]: 2), emotionally and physically aversive, and took approximately 2 weeks to resolve (median: 14; IQR: 24 days). Withdrawal-associated injury site pain intensity was typically slightly less than participants' original injury pain (median: 10/10; IQR: 3), and more painful than other generalized withdrawal symptoms which also lasted approximately 2 weeks (median: 13; IQR: 25 days). Fifteen surveyed participants (44%) reported returning to opioid use because of WISP in the past. Participants developed theories about the etiology of WISP, including that the pain is the brain's way of communicating a desire for opioids. This research represents the first known documentation that previously healed, and pain-free injury sites can temporarily become painful again during opioid withdrawal, an experience which may be a barrier to opioid cessation, and a contributor to opioid reinitiation.

  18. THE RIGHT OF WITHDRAWAL FOR CONSUMPTION CONTRACTS

    Directory of Open Access Journals (Sweden)

    MOISE BOJINCA

    2011-04-01

    Full Text Available The romanian legislature in its attempt to align the national legislation with European law requirements stated by a series of acts the right of termination in some consumer contracts.The rule is not a general application one of this category of contracts but concerns only the conventions more dangerous or more disadvantageous to the consumer through the procedure for their termination or by the effects of engaging them. These consumerism rules relating to prior mandatory period of reflection and denial free and legal right applicable to training of certain consumer contracts aimed at trying to protect the consumer before the transaction contract.By the regulation, there is either delaying the final formation of the contract or subsequent withdrawal, in a certain period of time stipulated by the law of consent expressed, leading to derogate from the traditional way of reaching at the volitional agreement .

  19. Acute intrathecal baclofen withdrawal: a brief review of treatment options.

    Science.gov (United States)

    Ross, James C; Cook, Aaron M; Stewart, Gary L; Fahy, Brenda G

    2011-02-01

    Acute baclofen toxicity and withdrawal can present with a constellation of symptoms making differentiation between these two entities and other potential diagnoses challenging. Baclofen withdrawal is associated with numerous complications which may require neurocritical care expertise such as respiratory failure, refractory seizures, delirium, and blood pressure lability. Case report and literature review. This case report discusses a case of intrathecal baclofen (ITB) withdrawal, focusing on the differential diagnosis for acute baclofen withdrawal and reviews the various options that exist to treat the symptoms of acute baclofen withdrawal such as benzodiazepines, propofol, skeletal muscle relaxants, and tizanidine. Critical care practitioners should be prepared to treat this potentially devastating and often refractory complication of ITB therapy.

  20. 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.

  1. 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.

  2. Alcohol, barbiturate and benzodiazepine withdrawal syndromes: clinical management.

    Science.gov (United States)

    Sellers, E M

    1988-07-15

    The symptoms and clinical management of alcohol, barbiturate and benzodiazepine withdrawal syndromes are discussed in this article. People who suffer alcohol withdrawal should be admitted to hospital if they have medical or surgical complications or severe symptoms; supportive care and pharmacotherapy, especially diazepam loading, are the essential components of treatment. Barbiturate withdrawal requires pharmacotherapy and admission to hospital for patients who have taken more than 0.4 g/d of secobarbital or an equivalent amount of another barbiturate for 90 days or longer, or 0.6 g/d or an equivalent dose for 30 days or longer, or who have had withdrawal seizures or delirium; phenobarbital loading is recommended. Regular benzodiazepine therapy that has lasted at least 3 months should be gradually stopped. Short-acting agents should be replaced with long-acting ones, such as diazepam, to avoid withdrawal symptoms. Most of these patients can be managed on an outpatient basis.

  3. Biogeochemical Cycles in Degraded Lands

    Science.gov (United States)

    Davidson, Eric A.; Vieira, Ima Celia G.; ReisdeCarvalho, Claudio Jose; DeanedeAbreuSa, Tatiana; deSouzaMoutinho, Paulo R.; Figueiredo, Ricardo O.; Stone, Thomas A.

    2004-01-01

    The objectives of this project were to define and describe the types of landscapes that fall under the broad category of "degraded lands" and to study biogeochemical cycles across this range of degradation found in secondary forests. We define degraded land as that which has lost part of its capacity of renovation of a productive ecosystem, either in the context of agroecosystems or as native communities of vegetation. This definition of degradation permits evaluation of biogeochemical constraints to future land uses.

  4. Gene expression in the neuropeptide Y system during ethanol withdrawal kindling in rats

    DEFF Research Database (Denmark)

    Olling, Janne D; Ulrichsen, Jakob; Correll, Mette

    2010-01-01

    BACKGROUND: Multiple episodes of ethanol intoxication and withdrawal result in progressive, irreversible intensification of the withdrawal reaction, a process termed "ethanol withdrawal kindling." Previous studies show that a single episode of chronic ethanol intoxication and withdrawal causes...... of chronic ethanol intoxication by intragastric intubations followed by 5 days withdrawal. The study included 6 groups: 4 multiple withdrawal episode (MW) groups [peak withdrawal plus (MW+)/minus (MW-) seizures, 3-day (MW3d), and 1-month (MW1mth) withdrawal], a single withdrawal episode group (SW...... prominent changes in neuropeptide Y (NPY) and its receptors that have been implicated in regulating withdrawal hyperexcitability. This study for the first time examined the NPY system during ethanol withdrawal kindling. METHODS: Ethanol withdrawal kindling was studied in rats receiving 16 episodes of 2 days...

  5. 76 FR 31295 - Nectarines and Peaches Grown in California; Notice of Withdrawal

    Science.gov (United States)

    2011-05-31

    ...; ] DEPARTMENT OF AGRICULTURE Agricultural Marketing Service Nectarines and Peaches Grown in California; Notice of Withdrawal AGENCY: Agricultural Marketing Service, USDA. ACTION: Notice; withdrawal. SUMMARY: The Agricultural Marketing Service (AMS) is withdrawing the notice soliciting comments on its request for approval...

  6. Prolonged cannabis withdrawal in young adults with lifetime psychiatric illness.

    Science.gov (United States)

    Schuster, Randi Melissa; Fontaine, Madeleine; Nip, Emily; Zhang, Haiyue; Hanly, Ailish; Eden Evins, A

    2017-02-27

    Young adults with psychiatric illnesses are more likely to use cannabis and experience problems from use. It is not known whether those with a lifetime psychiatric illness experience a prolonged cannabis withdrawal syndrome with abstinence. Participants were fifty young adults, aged 18-25, recruited from the Boston-area in 2015-2016, who used cannabis at least weekly, completed the Structured Clinical Interview for DSM-IV to identify Axis I psychiatric diagnoses (PD+ vs PD-), and attained cannabis abstinence with a four-week contingency management protocol. Withdrawal symptom severity was assessed at baseline and at four weekly abstinent visits using the Cannabis Withdrawal Scale. Cannabis dependence, age of initiation, and rate of abstinence were similar in PD+ and PD- groups. There was a diagnostic group by abstinent week interaction, suggesting a difference in time course for resolution of withdrawal symptoms by group, F(4,46)=3.8, p=0.009, controlling for sex, baseline depressive and anxiety symptoms, and frequency of cannabis use in the prior 90days. In post hoc analyses, there was a difference in time-course of cannabis withdrawal. PD- had significantly reduced withdrawal symptom severity in abstinent week one [t(46)=-2.2, p=0.03], while PD+ did not report improved withdrawal symptoms until the second abstinent week [t(46)=-4.1, p=0.0002]. Cannabis withdrawal symptoms improved over four weeks in young people with and without a lifetime psychiatric diagnosis. However, those with a psychiatric illness reported one week delayed improvement in withdrawal symptom severity. Longer duration of cannabis withdrawal may be a risk factor for cannabis dependence and difficulty quitting. Copyright © 2017 Elsevier Inc. All rights reserved.

  7. 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…

  8. Nicotinic Mechanisms Modulate Ethanol Withdrawal and Modify Time Course and Symptoms Severity of Simultaneous Withdrawal from Alcohol and Nicotine.

    Science.gov (United States)

    Perez, Erika; Quijano-Cardé, Natalia; De Biasi, Mariella

    2015-09-01

    Alcohol and nicotine are among the top causes of preventable death in the United States. Unfortunately, people who are dependent on alcohol are more likely to smoke than individuals in the general population. Similarly, smokers are more likely to abuse alcohol. Alcohol and nicotine codependence affects health in many ways and leads to poorer treatment outcomes in subjects who want to quit. This study examined the interaction of alcohol and nicotine during withdrawal and compared abstinence symptoms during withdrawal from one of the two drugs only vs both. Our results indicate that simultaneous withdrawal from alcohol and nicotine produces physical symptoms that are more severe and last longer than those experienced during withdrawal from one of the two drugs alone. In animals experiencing withdrawal after chronic ethanol treatment, acute nicotine exposure was sufficient to prevent abstinence symptoms. Similarly, symptoms were prevented when alcohol was injected acutely in mice undergoing nicotine withdrawal. These experiments provide evidence for the involvement of the nicotinic cholinergic system in alcohol withdrawal. Furthermore, the outcomes of intracranial microinfusions of mecamylamine, a nonselective nicotinic receptor antagonist, highlight a major role for the nicotinic receptors expressed in medial habenula and interpeduncular nucleus during withdrawal. Overall, the data support the notion that modulating the nicotinic cholinergic system might help to maintain long-term abstinence from alcohol.

  9. Private lands

    Data.gov (United States)

    US Fish and Wildlife Service, Department of the Interior — This report summarizes private land activities on Neal Smith National Wildlife Refuge (formerly Walnut Creek National Wildlife Refuge) from 1994 to 2009.

  10. Land Research

    Science.gov (United States)

    EPA is working to develop methods and guidance to manage and clean up contaminated land, groundwater and nutrient pollution as well as develop innovative approaches to managing materials and waste including energy recovery.

  11. The influence of livestock management on land use competition between domestic and wild ungulates: sheep and chamois Rupicapra pyrenaica parva Cabrera in the Cantabrian range

    Directory of Open Access Journals (Sweden)

    Rebollo, S.

    1993-12-01

    Full Text Available The spatial distribution and competition for the use of resources between sheep —transhumant merino— and chamois Rupicapra pyrenaica parva. Cabrera, 1910 has been analyzed during the summer grazing period in the Cantabrian range. The studied area, —a 750 ha. wide high pass— was divided into sectors depending on geophysical variables (substratum, aspect and elevation and vegetation types. Sheep land use was analyzed by direct observation of the flock and by means of enquiries to the shepherd. Chamois were studied before and during the time sheep were present in the pastureland, with the help of fixed itineraries that enabled us to visually cover the whole area. The assessment of land use was carried out by corrected frequency and preference index for each of the studied environmental variables. Sheep grazed in the whole area excepting for beech woods (Fagus sylvatica, rocky and steep zones and dense scrub patches.
    The location of the sheepfolds —shelters, enclosures and associated pastures— is a key factor in the management of the pastoral system. They are usually placed in a central position from where the flock make their every day course, normally directed to higher zones, in the studied area, chamois distribution is limited by the scarcity of zones over 1.800 m., and by the strong sheep grazing pressure at all elevations. Chamois leave the areas grazed by the sheep flock, creating an almost total segregation. They occupy steep rocky slopes and the beech woods edges close to them, both situated furthest away from the sheepfolds.

    [es] Durante el periodo estival de utilización de los pastos de puerto en la Cordillera Cantábrica, se analiza la distribución espacial de las ovejas —merinas trashumantes— y rebecos —Rupicapra pyrenaica parva. Cabrera 1910— y su posible competencia en el uso de los recursos. Como referencia se llevó a cabo una sectorización del territorio —750 ha.— seg

  12. Waste Isolation Pilot Plant land management plan

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1996-05-01

    On October 30, 1992, the WIPP Land Withdrawal Act became law. This Act transferred the responsibility for the management of the WIPP Land Withdrawal Area (WILWA) from the Secretary of the Interior to the Secretary of Energy. In accordance with sections 3(a)(1) and (3) of the Act, these lands {open_quotes}{hor_ellipsis}are withdrawn from all forms of entry, appropriation, and disposal under the public land laws{hor_ellipsis}{close_quotes}and are reserved for the use of the Secretary of Energy {open_quotes}{hor_ellipsis}for the construction, experimentation, operation, repair and maintenance, disposal, shutdown, monitoring, decommissioning, and other activities, associated with the purposes of WIPP as set forth in the Department of Energy National Security and Military Applications of Nuclear Energy Act of 1980 and this Act.{close_quotes}. As a complement to this LMP, a MOU has been executed between the DOE and the BLM, as required by section 4(d) of the Act. The state of New Mexico was consulted in the development of the MOU and the associated Statement of Work (SOW).

  13. Public Lands, Other - Volusia County Public Land Survey

    Data.gov (United States)

    NSGIC Local Govt | GIS Inventory — Coded arcs for Public Land Surveys in Volusia County including Township, Range, and Section lines and County Boundary. This layer matches the Property Appraiser's...

  14. Alcohol withdrawal: a nationwide survey of inpatient treatment practices.

    Science.gov (United States)

    Saitz, R; Friedman, L S; Mayo-Smith, M F

    1995-09-01

    To describe current practices employed in the inpatient treatment for alcohol withdrawal. Survey. Inpatient alcoholism treatment programs in the United States. Medical directors of 176 (69%) of 257 eligible programs randomly selected from a national listing. The medical directors estimated that of all inpatients treated for alcohol withdrawal at the programs, 68% received one of the following medications. Benzodiazepines, including the long-acting chlordiazepoxide (33%) and diazepam (16%), and less frequently the short-acting oxazepam (7%) and lorazepam (4%), were the most commonly used agents. Barbiturates (11%), phenytoin (10%), clonidine (7%), beta-blockers (3%), carbamazepine (1%), and antipsychotics (1%) were less frequently given. Drug was most often given on a fixed dosing schedule with additional medication "as needed" (52% of the programs). Only 31% of the programs routinely used a standardized withdrawal severity scale to monitor patients. Mean duration of sedative treatment was three days; inpatient treatment, four days. Use of fixed-schedule regimens was associated with longer sedative treatment (mean four vs three days, p withdrawal included three days of long-acting benzodiazepines on a fixed schedule with additional medication "as needed." Standardized monitoring of the severity of withdrawal was not common practice. The directors reported using a variety of other regimens, some not known to prevent the major complications of withdrawal. Although geographic location and director specialty were significantly associated with treatment duration, much of the variation in treatment for alcohol withdrawal remains unexplained.

  15. Prolonged, severe intrathecal baclofen withdrawal syndrome: a case report.

    Science.gov (United States)

    Hansen, Colby R; Gooch, Judith L; Such-Neibar, Teresa

    2007-11-01

    Intrathecal baclofen (ITB) withdrawal is a well-recognized complication when drug delivery is disrupted for any reason. ITB withdrawal varies widely in its severity and poses the very real possibility of death if not promptly managed. Cases of withdrawal lasting greater than 1 or 2 weeks, however, are sparse. We report the case of an 11-year-old girl with spastic quadriplegic cerebral palsy who developed an infected pump and subsequent meningitis, prompting the removal of her pump and catheter. She subsequently developed a severe, prolonged baclofen withdrawal syndrome marked by increased spasticity, agitation, hypertension, and tachycardia that lasted nearly 2 months, requiring intensive care and continuous intravenous sedation with benzodiazepines and opiates. Her pump was eventually replaced on hospital day 56 and within 24 hours her symptoms dramatically improved. She was eventually weaned off sedating medications and returned to baseline functional status. Typical management of baclofen withdrawal is reviewed. To date, the literature has not discussed the potential role for opiates in managing baclofen withdrawal, yet a growing body of literature is examining the interplay between opiates and gamma-aminobutyric acid B pathways. A potential role for opiates in managing severe baclofen withdrawal is proposed.

  16. Effect of Morphine Withdrawal Syndrome on Cerebral Ischemia

    Directory of Open Access Journals (Sweden)

    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.

  17. Estimated Withdrawals from Stream-Valley Aquifers and Refined Estimated Withdrawals from Selected Aquifers in the United States, 2000

    Science.gov (United States)

    Sargent, B. Pierre; Maupin, Molly A.; Hinkle, Stephen R.

    2008-01-01

    The U.S. Geological Survey National Water Use Information Program compiles estimates of fresh ground-water withdrawals in the United States on a 5-year interval. In the year-2000 compilation, withdrawals were reported from principal aquifers and aquifer systems including two general aquifers - Alluvial and Other aquifers. Withdrawals from a widespread aquifer group - stream-valley aquifers - were not specifically identified in the year-2000 compilation, but they are important sources of ground water. Stream-valley aquifers are alluvial aquifers located in the valley of major streams and rivers. Stream-valley aquifers are long but narrow aquifers that are in direct hydraulic connection with associated streams and limited in extent compared to most principal aquifers. Based in large part on information published in U.S. Geological Survey reports, preliminary analysis of withdrawal data and hydrogeologic and surface-water information indicated areas in the United States where possible stream-valley aquifers were located. Further assessment focused on 24 states and the Commonwealth of Puerto Rico. Withdrawals reported from Alluvial aquifers in 16 states and withdrawals reported from Other aquifers in 6 states and the Commonwealth of Puerto Rico were investigated. Two additional States - Arkansas and New Jersey - were investigated because withdrawals reported from other principal aquifers in these two States may be from stream-valley aquifers. Withdrawals from stream-valley aquifers were identified in 20 States and were about 1,560 Mgal/d (million gallons per day), a rate comparable to withdrawals from the 10 most productive principal aquifers in the United States. Of the 1,560 Mgal/d of withdrawals attributed to stream-valley aquifers, 1,240 Mgal/d were disaggregated from Alluvial aquifers, 150 Mgal/d from glacial sand and gravel aquifers, 116 Mgal/d from Other aquifers, 28.1 Mgal/d from Pennsylvanian aquifers, and 24.9 Mgal/d from the Mississippi River Valley alluvial

  18. Acute Ethanol Withdrawal Impairs Contextual Learning and Enhances Cued Learning

    Science.gov (United States)

    Tipps, Megan E.; Raybuck, Jonathan D.; Buck, Kari J.; Lattal, K. Matthew

    2014-01-01

    Background Alcohol affects many of the brain regions and neural processes that support learning and memory, and these effects are thought to underlie, at least in part, the development of addiction. Although much work has been done regarding the effects of alcohol intoxication on learning and memory, little is known about the effects of acute withdrawal from a single alcohol exposure. Methods We assess the effects of acute ethanol withdrawal (6 h post-injection with 4 g/kg ethanol) on two forms of fear conditioning (delay and trace fear conditioning) in C57BL/6J and DBA/2J mice. The influence of a number of experimental parameters (pre- and post-training withdrawal exposure; foreground/background processing; training strength; non-associative effects) is also investigated. Results Acute ethanol withdrawal during training had a bidirectional effect on fear conditioned responses, decreasing contextual responses and increasing cued responses. These effects were apparent for both trace and delay conditioning in DBA/2J mice and for trace conditioning in C57BL/6J mice; however, C57BL/6J mice were selectively resistant to the effects of acute withdrawal on delay cued responses. Conclusions Our results show that acute withdrawal from a single, initial ethanol exposure is sufficient to alter long-term learning in mice. In addition, the differences between the strains and conditioning paradigms used suggest that specific learning processes can be differentially affected by acute withdrawal in a manner that is distinct from the reported effects of both alcohol intoxication and withdrawal following chronic alcohol exposure. Thus, our results suggest a unique effect of acute alcohol withdrawal on learning and memory processes. PMID:25684050

  19. Acute ethanol withdrawal impairs contextual learning and enhances cued learning.

    Science.gov (United States)

    Tipps, Megan E; Raybuck, Jonathan D; Buck, Kari J; Lattal, K Matthew

    2015-02-01

    Alcohol affects many of the brain regions and neural processes that support learning and memory, and these effects are thought to underlie, at least in part, the development of addiction. Although much work has been done regarding the effects of alcohol intoxication on learning and memory, little is known about the effects of acute withdrawal from a single alcohol exposure. We assess the effects of acute ethanol withdrawal (6 hours postinjection with 4 g/kg ethanol) on 2 forms of fear conditioning (delay and trace fear conditioning) in C57BL/6J and DBA/2J mice. The influence of a number of experimental parameters (pre- and post training withdrawal exposure; foreground/background processing; training strength; and nonassociative effects) is also investigated. Acute ethanol withdrawal during training had a bidirectional effect on fear-conditioned responses, decreasing contextual responses and increasing cued responses. These effects were apparent for both trace and delay conditioning in DBA/2J mice and for trace conditioning in C57BL/6J mice; however, C57BL/6J mice were selectively resistant to the effects of acute withdrawal on delay cued responses. Our results show that acute withdrawal from a single, initial ethanol exposure is sufficient to alter long-term learning in mice. In addition, the differences between the strains and conditioning paradigms used suggest that specific learning processes can be differentially affected by acute withdrawal in a manner that is distinct from the reported effects of both alcohol intoxication and withdrawal following chronic alcohol exposure. Thus, our results suggest a unique effect of acute alcohol withdrawal on learning and memory processes. Copyright © 2015 by the Research Society on Alcoholism.

  20. Tobacco withdrawal symptoms mediate motivation to reinstate smoking during abstinence.

    Science.gov (United States)

    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).

  1. 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

  2. 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

  3. Remission of acromegaly after treatment withdrawal in patients controlled by cabergoline alone or in combination with octreotide: results from a multicenter study.

    Science.gov (United States)

    Casagrande, A; Bronstein, M D; Jallad, R S; Mota, J I; Tabet, A; Abucham, J

    2017-05-01

    Remission of acromegaly has been reported after somatostatin analogs withdrawal, but not after withdrawal of combination therapy with cabergoline, and only in case reports of patients controlled by cabergoline alone. To establish the remission rates (normal IGF-1 for age/sex: IGF-1 ≤ 1.00 xULN) after withdrawal of combined treatment with octreotide LAR and cabergoline and of cabergoline alone, we prospectively studied 16 patients with acromegaly controlled by those treatments in the preceding 2 years as part of a larger study on remission of acromegaly after withdrawal of different medical treatments. Among 97 patients with controlled acromegaly included in the entire study, only 16 patients had been on combination therapy (n = 12) or cabergoline alone (n = 4). At 8 weeks after treatment withdrawal, three patients (19%) were in remission (short-term remission). At 60 weeks (long-term remission), IGF-1 levels were still in the normal range in two patients (12.5%) and remained normal up to 108 weeks after treatment withdrawal (last visit). One patient had been treated with cabergoline alone and another one with combination of octreotide and cabergoline before treatment withdrawal. Remission of acromegaly after treatment withdrawal seems to be uncommon in patients controlled by cabergoline, either as monotherapy or in combination with octreotide. In the future, larger studies and/or meta-analysis will be necessary to accurately establish the remission rates of acromegaly after withdrawal of cabergoline with or without somatostatin analogs.

  4. The Treatment of Clozapine-Withdrawal Delirium with Electroconvulsive Therapy

    Directory of Open Access Journals (Sweden)

    Anish Modak

    2017-01-01

    Full Text Available Clozapine, a commonly used atypical antipsychotic, can precipitate a severe withdrawal syndrome. In this report, we describe a case of delirium with catatonic features emerging after the immediate cessation of clozapine subsequent to concerns of developing neuroleptic malignant syndrome. After multiple treatments were found to be inefficacious, electroconvulsive therapy (ECT was initiated, resulting in significant improvement. A literature search revealed six previous cases of clozapine-withdrawal syndromes of varied symptomatology treated with ECT. To our knowledge, the present case represents the first reported clozapine-withdrawal delirium treated successfully with ECT.

  5. Intrathecal baclofen withdrawal: A rare cause of reversible cardiomyopathy.

    Science.gov (United States)

    Awuor, Stephen O; Kitei, Paul M; Nawaz, Yassir; Ahnert, Amy M

    2016-03-01

    Baclofen is commonly used to treat spasticity of central etiology. Unfortunately, a potentially lethal withdrawal syndrome can complicate its use. This is especially true when the drug is administered intrathecally. There are very few cases of baclofen withdrawal leading to reversible cardiomyopathy described in the literature. The authors present a patient with a history of chronic intrathecal baclofen use who, in the setting of acute baclofen withdrawal, develops laboratory, electrocardiogram, and echocardiogram abnormalities consistent with cardiomyopathy. Upon reinstitution of intrathecal baclofen, the cardiomyopathy and associated abnormalities quickly resolve. Although rare, it is crucial to be aware of this reversible cardiomyopathy to ensure its prompt diagnosis and treatment.

  6. Anodic oxidation of stilbenes bearing electron-withdrawing ring substituents

    Energy Technology Data Exchange (ETDEWEB)

    Halas, Summer M.; Okyne, Kwame; Fry, Albert J

    2003-06-15

    A number of disubstituted stilbenes bearing either two strong electron-withdrawing groups or one electron-withdrawing and one electron-donating group were synthesized and anodically oxidized in a divided cell in methanol at a carbon anode. A variety of types of products were obtained, most of which have never been observed upon oxidation of alkenes not bearing electron-withdrawing groups. A mechanistic scheme involving 2-methoxy-1,2-diarylethyl cations as key intermediates can account for all of the observed products. The nature of the products from each alkene is strongly correlated with the sum of the Hammett {sigma}{sup +} values of the ring substituents.

  7. Ketogenic Diet suppresses Alcohol Withdrawal Syndrome in Rats

    DEFF Research Database (Denmark)

    Dencker, Ditte; Molander, Anna; Thomsen, Morgane

    2017-01-01

    , 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....

  8. Long-term results of cabergoline therapy for macroprolactinomas and analyses of factors associated with remission after withdrawal.

    Science.gov (United States)

    Watanabe, Shinya; Akutsu, Hiroyoshi; Takano, Shingo; Yamamoto, Tetsuya; Ishikawa, Eiichi; Suzuki, Hiroaki; Matsumura, Akira

    2017-02-01

    Withdrawal of cabergoline is generally challenging, especially in patients with large or invasive macroprolactinomas. Therefore, we aimed to assess long-term results of cabergoline therapy for macroprolactinomas and remission achievement results after withdrawal in patients with macroprolactinomas. We also investigated clinical characteristics and factors related to remission after withdrawal. This was an institutional review board-approved retrospective analysis. We studied 46 macroprolactinoma patients who had taken cabergoline during the period from 2003 through 2013. Administration of cabergoline was maintained for 5 years before withdrawal. Median follow-up after the initiation of cabergoline therapy was 54·3 (range 5·3 to 137·2) months. Recurrences of hyperprolactinaemia were observed in 3 of 11 (27%) postwithdrawal patients at a median time of 3·0 (range; 2·9-11·2) months, indicating that a high percentage (73%) maintained remission for at least 12 months after cabergoline cessation. Factors significantly associated with remission were analysed in 21 patients receiving long-term cabergoline administration. On multivariate analysis, the absence of cavernous sinus invasion on pretreatment MRI (≥3/4 tumour encasement of the intracavernous internal carotid artery) (HR; 21·94, 95% CI; 2·06-1071·0, P = 0·006), initial PRL cabergoline therapy (HR; 5·14, 95% CI; 1·10-39·02, P = 0·04) showed statistically significant correlations with remission after withdrawal. Cabergoline therapy can achieve a high percentage (73% in this series) of remission maintenance for at least 12 months after cessation of a 5-year course of therapy, even in patients with macroprolactinomas. The absence of cavernous sinus invasion, serum PRL level lower than 132·7 ng/ml before cabergoline therapy or nadir serum PRL below 1·9 ng/ml were related to more frequent remission after withdrawal of cabergoline in patients receiving this medication for 5 years. © 2016 John Wiley

  9. Intramammary antibiotics in dairy goats : withdrawal periods of three intramammary antibiotics compared to recommended withdrawal periods for cows

    Directory of Open Access Journals (Sweden)

    J. Karzis

    2007-09-01

    Full Text Available Intramammary antibiotics are registered and tested for use in dairy cattle. This study investigated withdrawal periods of three intramammary antibiotics (Curaclox LC [Norbrook Pharmacia AH], Spectrazol Milking Cow (Schering-Plough Animal Health and Rilexine 200 LC (Logos Agvet [Virbac] in dairy goats and compared them to withdrawal periods recommended for use in cattle. Three trials were carried out in two different herds. The withdrawal periods for Curaclox LC in eight relatively low producing Saanen goats were 74.3 h (+ 19.21 measured by Thermo-Resistant Inhibitory Substances (TRIS, 90.0 h (+ 16.97 measured by colour dye, 99.4 h (+ 9.07 for cloxacillin measured by Parallux Beta Lactam Assay test (IDEXX distributors, and 92.6 h (+ 11.41 for ampicillin measured by Parallux. The withdrawal period for Curaclox LC recommended for use in cattle (72 h was significantly shorter than the withdrawal periods as measured by colour dye (P < 0.001, Parallux testing for cloxacillin (P < 0.001 and ampicillin (P = 0.003. There was a significant difference in withdrawal periods as measured by TRIS (P = 0.009 and colour dye (P = 0.036. The mean withdrawal periods measured on 12 relatively high producing Saanen and Saanen-Toggenburg crossbreed dairy goats measured by TRIS, colour dye and Parallux for ampicillin and cloxacillin were, however, shorter at 42.0 h (+ 7.077, 64.5 h (+ 60.26, 77.3 h (+ 13.56 and 70.7 h (+ 12.65, respectively. These withdrawal periods for Curaclox LC were significantly longer than the withdrawal periods recommended for cattle as measured by TRIS (P < 0.001 and colour dye (P < 0.001. The combined withdrawal periods for Curaclox LC in the two trials as measured by TRIS, colour dye, Parallux testing for Cloxacillin and Ampicillin were 58.64h (+ 24.31, 75.8 h (+ 17.70, 87.0 h (+ 16.10 and 80.3 h (+ 16.23, respectively. The withdrawal period, when data of the two trials were combined, measured by TRIS (P < 0.001 was significantly longer than

  10. The Role of Interdisciplinary Earth Science in the Assessment of Regional Land Subsidence Hazards: Toward Sustainable Management of Global Land and Subsurface-Fluid Resources

    Science.gov (United States)

    Galloway, D. L.

    2012-12-01

    Land-level lowering or land subsidence is a consequence of many local- and regional-scale physical, chemical or biologic processes affecting soils and geologic materials. The principal processes can be natural or anthropogenic, and include consolidation or compaction, karst or pseudokarst, hydrocompaction of collapsible soils, mining, oxidation of organic soils, erosive piping, tectonism, and volcanism. In terms of affected area, there are two principal regional-scale anthropogenic processes—compaction of compressible subsurface materials owing to the extraction of subsurface fluids (principally groundwater, oil and gas) and oxidation and compaction accompanying drainage of organic soils—which cause significant hazards related to flooding and infrastructure damage that are amenable to resource management measures. The importance of even small magnitude (System (GPS), Light Detection and Ranging (LiDAR) and Interferometric Synthetic Aperture Radar (InSAR), which have advanced our capabilities to detect, measure and monitor land-surface motion at multiple scales. Improved means for simulating aquifer-system and hydrocarbon-reservoir deformation, and the oxidation and compaction of organic soils are leading to refined predictive capabilities. The role of interdisciplinary earth science in improving the characterization of land subsidence attributed to subsurface fluid withdrawals and the oxidation and compaction of organic soils is examined. How these improved capabilities are translating into improved sustainable management of regional land and water resources in a few select areas worldwide are presented. The importance of incorporating these improved capabilities in coherent resource management strategies to control the depletion of resources and attendant hazards also are discussed.

  11. Freshmen Program Withdrawal: Types and Recommendations

    Directory of Open Access Journals (Sweden)

    Ana Bernardo

    2017-09-01

    Full Text Available University program dropout is a problem that has important consequences not only for the student that leaves but also for the institution in which the withdrawal occurs. Therefore, higher education institutions must study the problem in greater depth to establish appropriate prevention measures in the future. However, most research papers currently focus primarily on the characteristics of students who leave university, rather than on those who choose to pursue alternative courses of study and therefore fail to take into account the different kinds of abandonment. The aim of this paper is to identify the different types of dropout to define their characteristics and propose some recommendations. Thus, an ex post facto study was carried out on a sample of 1,311 freshmen from a university in the north of Spain using data gathered using an ad-hoc designed questionnaire, applied by telephone or an online survey, and completed with data available in the university data warehouse. A descriptive analysis was performed to characterize the sample and identify five different groups, including 1. Students persisting in their initiated degree 2. Students who change of program (within the same university 3. Students transferring to a different university 4. Students enrolling in non-higher-education studies 5. Students that quit studying. Also, data mining techniques (decision trees were applied to classify the cases and generate predictive models to aid in the design of differentiated intervention strategies for each of the corresponding groups.

  12. Cyclosporine arteriolopathy: effects of drug withdrawal.

    Science.gov (United States)

    Franceschini, N; Alpers, C E; Bennett, W M; Andoh, T F

    1998-08-01

    Renal arteriolopathy in chronic cyclosporine-induced nephrotoxicity is characterized by an eosinophilic granular transformation of vascular smooth muscle cells of afferent glomerular arterioles that is thought to eventually progress to necrosis of individual muscle cells and hyalinization of the vessel wall. Although the lesion is highly specific for cyclosporine-induced injury in humans, it has been difficult to reproduce in normotensive animals. To study the natural history of the cyclosporine arteriolopathy, we conducted sequential studies in salt-depleted Sprague-Dawley rats using cyclosporin A (15 mg/kg subcutaneously) treatment for 35 days, 49 days, 35 days plus 14 or 56 days of drug washout, or placebo (olive oil). Cyclosporin A produced a progressive decrease in renal function that significantly improved after discontinuation of the drug. The arteriolopathy, scored semiquantitatively, was present by day 35 and did not improve with cyclosporine withdrawal within 2 weeks but did dramatically regress after 56 days. However, tubulointerstitial changes did not regress with drug discontinuation and were present despite improvement in renal function. We conclude that cyclosporine-induced arteriolopathy may be reversible and associated with improving renal function. Thus, the morphological evidence of arteriolopathy is dissociable from the progressive tubulointerstitial scarring.

  13. Dopamine transporter availability and depressive symptoms during alcohol withdrawal.

    Science.gov (United States)

    Laine, T P; Ahonen, A; Räsänen, P; Tiihonen, J

    1999-06-30

    Alcohol-related temporary depressive symptoms are hypothesized to be related to dopaminergic dysfunction. The aim of this study was to investigate whether or not depressive symptoms correlate with reduced dopamine transporter (DAT) availability. We studied the DAT availability in 28 alcoholic subjects with beta-CIT ([123-iodium]-2-betacarbomethoxy-3-beta-(4-iodophenyl)-tropa ne) single photon emission tomography (SPET) and found a reduction in DAT availability during withdrawal that subsequently showed a significant increase during sobriety. The relationship between DAT availability and Montgomery-Asberg Depression Rating scale scores, both during withdrawal and after sobriety, was assessed. The main finding was a statistically significant correlation between DAT variances and depressive symptom scores during both states. The findings indicate a possible dopaminergic etiology for depressive symptoms in alcohol withdrawal, which suggests that dopaminergic antidepressants might be beneficial in the treatment of alcohol withdrawal.

  14. State National Pollutant Discharge Elimination System (NPDES) Program Withdrawal Petitions

    Data.gov (United States)

    U.S. Environmental Protection Agency — Search for pending and resolved NPDES withdrawal petitions by state, region, date, or keyword. "Pending" means EPA has received the petition and is working with the...

  15. [The comparison of tianeptine and carbamazepine in benzodiazepines withdrawal symptoms].

    Science.gov (United States)

    Kornowski, Jarosław

    2002-01-01

    Dealing with benzodiazepine dependent creates as serious clinical problem that requires knowledge and experience. Abrupt discontinuation of benzodiazepines, particularly those with short half-life is not advised to avoid severe withdrawal syndrome. Reports from literature suggest use of carbamazepine and recently tianeptine as substances useful in treatment of benzodiazepine dependence. This paper presents a double-blind trial in which both, carbamazepine and tianeptine were used in treatment of benzodiazepiene withdrawal syndrome. Patient mental state was evaluated by using questionnaire SCL-90, Beck Depression Inventory and specifically designed questionnaire assessing severity of symptoms following benzodiazepine withdrawal. It appears from this study that both drugs (carbamazepine and tianeptine) are comparable, safe and efficient in treating benzodiazepine withdrawal symptoms.

  16. Neurosteroid Withdrawal Model of Perimenstrual Catamenial Epilepsy

    National Research Council Canada - National Science Library

    Reddy, Doodipala S; Kim, Hee‐Yong; Rogawski, Michael A

    2001-01-01

    Purpose: Perimenstrual catamenial epilepsy, the increase in seizure frequency that some women with epilepsy experience near the time of menstruation, may in part be related to withdrawal of the progesterone...

  17. Alcohol withdrawal pharmacotherapy for inpatients with medical comorbidity.

    Science.gov (United States)

    Weaver, Michael F; Hoffman, Heather J; Johnson, Robert E; Mauck, Kimberly

    2006-01-01

    Studies show that symptom-triggered dosing is best for treatment of alcohol withdrawal in patients on chemical dependence wards without other illness. On general medical hospital wards, withdrawal may be affected by comorbid medical illness. A clinical trial was undertaken to determine whether there is a difference between symptom-triggered (ST) and fixed-schedule (FS) dosing of lorazepam in patients hospitalized on general medical wards at a university medical center. One hundred eighty-three subjects were assessed by their nurses with the Revised Clinical Institute Withdrawal Assessment for Alcohol (CIWA-Ar) scale. Subjects in the ST arm received lorazepam doses based on CIWA-Ar score. Subjects in the FS arm received scheduled lorazepam with tapering over 4 days. Symptom-triggered dosing for alcohol withdrawal for general medicine inpatients results in less lorazepam given with similar reduction in CIWA-Ar scores for the first 2 days, but a higher proportion of protocol errors.

  18. A Case Report of Kratom Addiction and Withdrawal.

    Science.gov (United States)

    Galbis-Reig, David

    2016-02-01

    Kratom, a relatively unknown herb among physicians in the western world, is advertised on the Internet as an alternative to opioid analgesics, as a potential treatment for oploid withdrawal and as a "legal high" with minimal addiction potential. This report describes a case of kratom addiction in a 37-year-old woman with a severe oploid-like withdrawal syndrome that was managed successfully with symptom-triggered clonidine therapy and scheduled hydroxyzine. A review of other case reports of kratom toxicity, the herb's addiction potential, and the kratom withdrawal syndrome is discussed. Physicians in the United States should be aware of the growing availability and abuse of kratom and the herb's potential adverse health effects, with particular attention to kratom's toxicity, addictive potential, and associated withdrawal syndrome.

  19. Editorial Leaving the party - withdrawal of South African essential ...

    African Journals Online (AJOL)

    Editorial Leaving the party - withdrawal of South African essential medicines. Jo M Wilmshurst, Marc Blockman, Andrew Argent, Eugenie Gordon-Graham, Jenny Thomas, Andrew Whitelaw, Mignon McCulloch, Malitha Ramiah, H Dyeshana, Joe Ireland ...

  20. Sedative-Hypnotic Drug Withdrawal Syndrome: Recognition And Treatment.

    Science.gov (United States)

    Santos, Cynthia; Olmedo, Ruben E

    2017-03-01

    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.

  1. Sedative/hypnotic dependence: patient stabilization, tolerance testing, and withdrawal.

    Science.gov (United States)

    Perry, P J; Alexander, B

    1986-01-01

    Physical dependence to sedative/hypnotic drugs is not an uncommon clinical problem. The withdrawal syndrome is analogous to alcohol withdrawal, except the duration of the syndrome occurs over a longer period of time with the symptoms being less intense than generally encountered with alcohol. The potential for withdrawal reactions is probably greater for the shorter-acting agents than the longer-acting drugs. Potentially dependent sedative/hypnotic users require stabilization of their symptoms initially, followed by tolerance testing. If tolerant, the patients should be withdrawn using either a long-acting sedative/hypnotic (e.g., diazepam) or phenobarbital. Compared to other benzodiazepines and barbiturates, diazepam appears to be the drug of choice for treating dependent patients. Diazepam is rapidly absorbed and distributed to the brain and therefore useful for stabilization and tolerance testing. It is metabolized on chronic administration to a long-acting metabolite, desmethyldiazepam, which makes the drug ideal for a tapered withdrawal schedule.

  2. 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].

  3. Steroid withdrawal in renal transplant patients: the Irish experience.

    LENUS (Irish Health Repository)

    Phelan, P J

    2012-02-01

    BACKGROUND: Steroid therapy is associated with significant morbidity in renal transplant recipients. However, there is concern that steroid withdrawal will adversely affect outcome. METHODS: We report on 241 renal transplant recipients on different doses of corticosteroids at 3 months (zero, <\\/= 5 mg\\/day, > 5 mg\\/day). Parameters analysed included blood pressure, lipid profile, weight change, new onset diabetes after transplantation (NODAT), allograft survival and acute rejection. RESULTS: Elimination of corticosteroids had no impact on allograft survival at 1 year. There were no cases of NODAT in the steroid withdrawal group compared with over 7% in each of the steroid groups. There were no significant improvements in weight gain, blood pressure control or total cholesterol with withdrawal of steroids before 3 months. CONCLUSIONS: In renal transplant patients treated with tacrolimus and mycophenolate, early withdrawal of steroids does not appear to adversely affect allograft outcome at 1 year. It may result in less NODAT.

  4. Prolonged social withdrawal disorder: a hikikomori case in Spain.

    Science.gov (United States)

    Ovejero, Santiago; Caro-Cañizares, Irene; de León-Martínez, Victoria; Baca-Garcia, Enrique

    2014-09-01

    The Japanese term hikikomori means literally 'to be confined'. Social withdrawal can be present in severe psychiatric disorders; however, in Japan, hikikomori is a defined nosologic entity. There have been only a few reported cases in occidental culture. We present a case report of a Spanish man with prolonged social withdrawal lasting for 4 years. This is a case of prolonged social withdrawal not bound to culture, as well as the second case of hikikomori reported in Spain. We propose prolonged social withdrawal disorder as a disorder not linked to culture, in contrast to hikikomori. Further documentation of this disorder is still needed to encompass all cases reported in Japan and around the world. © The Author(s) 2013.

  5. Post-transplant withdrawal of lamivudine results in fatal hepatitis ...

    African Journals Online (AJOL)

    Post-transplant withdrawal of lamivudine results in fatal hepatitis flares in kidney transplant recipients, under immune suppression, with inactive hepatitis B infection. Bin Miao, Xiang-Ming Lao, Guo-Li Lin ...

  6. OCS Oil and Gas Leasing Withdraw & Moratoria Areas - Atlantic Region

    Data.gov (United States)

    Bureau of Ocean Energy Management, Department of the Interior — Areas within the BOEM Atllantic Region currently under congressional moratoria or executive (presidential) withdraw from leasing for oil, gas, or minerals within the...

  7. The mechanism of pollination drop withdrawal in Ginkgo biloba L.

    Directory of Open Access Journals (Sweden)

    Jin Biao

    2012-05-01

    Full Text Available Abstract Background The pollination drop (PD is a characteristic feature of many wind-pollinated gymnosperms. Although accumulating evidence shows that the PD plays a critical role in the pollination process, the mechanism of PD withdrawal is still unclear. Here, we carefully observed the PD withdrawal process and investigated the underlying mechanism of PD withdrawal, which will aid the understanding of wind-pollination efficiency in gymnosperms. Results In Ginkgo biloba, PDs were secreted on the micropyle during the pollination period and persisted for about 240 h when not pollinated under laboratory conditions. The withdrawal of an isolated PD required only 1 h for evaporation, much less than a PD on the living ovule, which required 100 h. When pollinated with viable pollen, PDs withdrew rapidly within 4 h. In contrast, nonviable pollen and acetone-treated pollen did not cause PD withdrawal. Although 100% relative humidity significantly inhibited PD withdrawal, pollinated PDs still could withdraw completely within 48 h. Pollen grains of Cycas revoluta, which are similar to those of G. biloba, could induce PD withdrawal more rapidly than those of two distantly related gymnosperms (Pinus thunbergii and Abies firma or two angiosperms (Paeonia suffruticosa and Orychophragmus violaceus. Furthermore, pollen of G. biloba and C. revoluta submerged immediately when encountering the PD, then sank to the bottom and entered the micropyle. The saccate pollen of P. thunbergii and A. firma submerged into the PD, but remained floating at the top and finally accumulated on the micropyle after PD withdrawal. In contrast, pollen of the angiosperms P. suffruticosa, Salix babylonica, and O. violaceus did not submerge, instead remaining clustered at the edge without entering the PD. Conclusions We conclude that PD withdrawal is primarily determined by the dynamic balance between evaporation and ovule secretion, of which pollen is a critical stimulator

  8. The mechanism of pollination drop withdrawal in Ginkgo biloba L.

    Science.gov (United States)

    Jin, Biao; Zhang, Lei; Lu, Yan; Wang, Di; Jiang, Xiao X; Zhang, Min; Wang, Li

    2012-05-01

    The pollination drop (PD) is a characteristic feature of many wind-pollinated gymnosperms. Although accumulating evidence shows that the PD plays a critical role in the pollination process, the mechanism of PD withdrawal is still unclear. Here, we carefully observed the PD withdrawal process and investigated the underlying mechanism of PD withdrawal, which will aid the understanding of wind-pollination efficiency in gymnosperms. In Ginkgo biloba, PDs were secreted on the micropyle during the pollination period and persisted for about 240 h when not pollinated under laboratory conditions. The withdrawal of an isolated PD required only 1 h for evaporation, much less than a PD on the living ovule, which required 100 h. When pollinated with viable pollen, PDs withdrew rapidly within 4 h. In contrast, nonviable pollen and acetone-treated pollen did not cause PD withdrawal. Although 100% relative humidity significantly inhibited PD withdrawal, pollinated PDs still could withdraw completely within 48 h. Pollen grains of Cycas revoluta, which are similar to those of G. biloba, could induce PD withdrawal more rapidly than those of two distantly related gymnosperms (Pinus thunbergii and Abies firma) or two angiosperms (Paeonia suffruticosa and Orychophragmus violaceus). Furthermore, pollen of G. biloba and C. revoluta submerged immediately when encountering the PD, then sank to the bottom and entered the micropyle. The saccate pollen of P. thunbergii and A. firma submerged into the PD, but remained floating at the top and finally accumulated on the micropyle after PD withdrawal. In contrast, pollen of the angiosperms P. suffruticosa, Salix babylonica, and O. violaceus did not submerge, instead remaining clustered at the edge without entering the PD. We conclude that PD withdrawal is primarily determined by the dynamic balance between evaporation and ovule secretion, of which pollen is a critical stimulator. When conspecific pollen grains were submerged in the PD, ovule

  9. Built-up Land Expansion in Urban China

    Science.gov (United States)

    Chen, Yi; Chen, Zhigang; Huang, Xianjin

    2017-04-01

    Since the implementation of the reform and opening-up, rapid expansion of built-up land has caused a rapid reduction of arable land. The Ministry of Land and Resources of the People' s Republic of China has strengthened the management of built-up land through the basic arable land protection and the quota allocation of built-up land to control the urban sprawl. In addition, the general land use planning and the annual land use plan have been used to further ensure the effectiveness of land use management and control. However, the trend of built-up land expansion has not been effectively restrained. The built-up land expansion increased from 31.92 × 106 hm2 in 2005 to 38.89 × 106 hm2 in 2012. The rapid expansion of built-up land has been the major feature of land use changes in China and has led to built-up land vacancy and inefficient land use. This paper used a Data Envelopment Analysis (DEA) model to analyze the changes in built-up land efficiency in 336 cities in China from 2005 to 2012 during the implementation of National General Land Use Plan (2006-2020) (NGLUP). The results showed that the built-up land input-output efficiency of most cities declined, and more than half of the cities had excessive inputs of built-up land. Even in the most developed region of China, the built-up land efficiency was relatively low. The paper argues that the NGLUP failed to control the expansion of built-up land and to promote intensive land use. The allocation of built-up land designated by the Plan was not reasonable, and economic development has greatly relied on land inputs, which need to be improved. The paper finally suggests that the built-up land indices should be appropriately directed toward economically underdeveloped regions in central and western China, and the establishment of a withdrawal mechanism for inefficient land would better promote the efficient allocation of built-up land.

  10. Dexmedetomidine for opioid and benzodiazepine withdrawal in pediatric patients.

    Science.gov (United States)

    Oschman, Alexandra; McCabe, Tara; Kuhn, Robert J

    2011-07-01

    The published literature on the use of dexmedetomidine as an adjunct to sedation and analgesia in the management of pediatric narcotic withdrawal was reviewed. Pediatric narcotic withdrawal syndromes are reported to be increasingly frequent in pediatric intensive care units. A number of tools specifically designed for assessment of withdrawal in newborns and infants are in current use, including the widely used Finnegan Scoring System. A limited number of studies and case reports suggest that dexmedetomidine, an α(2)-receptor agonist with a mechanism of action similar to that of clonidine but with greater α(2)-receptor specificity, might have a role in the treatment of pediatric withdrawal (by blunting withdrawal symptoms without causing respiratory depression and by permitting shorter narcotic tapering schedules) and also in the prevention of pediatric narcotic withdrawal (by reducing narcotic requirements). Potential adverse effects associated with dexmedetomidine use in pediatric patients are generally associated with use of bolus doses and mainly involve central nervous system effects (e.g., hypotension, bradycardia), with no hemodynamic manifestations. When bolus doses are used, strategies described in published reports entail a loading dose of 0.5-1.0 μg/kg administered over 5-10 minutes, followed by a continuous infusion at 0.1-1.4 μg/kg/hr for a period of 1-16 days. More research is needed to define the optimal use of dexmedetomidine in the management of pediatric narcotic withdrawal. A limited body of published evidence from retrospective studies and case reports suggests a potential role for dexmedetomidine as an adjunct therapy to provide sedation and analgesia to reduce narcotic withdrawal symptoms in pediatric patients.

  11. Withdrawal in adolescent light smokers following 24-hour abstinence

    Science.gov (United States)

    Benowitz, Neal L.; Auerback, Glenna M.; Moscicki, Anna-Barbara

    2009-01-01

    Introduction: Withdrawal is one of the most important symptoms of nicotine addiction. We examined the extent to which adolescent light smokers experienced withdrawal symptoms when deprived of nicotine for a 24-hr period. Methods: A total of 20 adolescents aged 13–17 years who smoked 1–5 cigarettes/day (CPD) refrained from smoking for a 24-hr period. Withdrawal scales were administered, and heart rate was measured at baseline, 12, and 24 hr. Neuropsychological testing was performed at baseline and 24 hr. Participants were divided into two groups: very light smokers (1–3 CPD) and light smokers (4–5 CPD). Results: At 12 hr, very light smokers experienced a decrease in withdrawal symptoms versus light smokers, who reported an increase in symptoms (−2.9 vs. 2.8, p = .02). Similarly, at 24 hr, very light smokers experienced a mean decrease in withdrawal score compared with a mean increase for the light smoker group (–2.2 vs. 5.8, p = .04). We did not find a significant change in heart rate or any differences in participants’ scores on the memory or concentration tasks. Discussion: Based on our findings in this controlled laboratory experiment, adolescent very light smokers did not appear to have significant withdrawal symptoms following abstinence from nicotine. Adolescent light smokers who smoke 4–5 CPD experienced subjective withdrawal symptoms but did not have objective signs of nicotine withdrawal. The stage of smoking in which adolescents are smoking 5 CPD or fewer appears to be a crucial time for studying development of nicotine addiction in teens as they may be transitioning from social smoking to early addiction. PMID:19246428

  12. Withholding or withdrawing therapy in intensive care units

    DEFF Research Database (Denmark)

    Jensen, Hanne Irene; Ammentorp, Jette; Erlandsen, Mogens

    2011-01-01

    The purpose of the study was to determine the views of intensive care nurses, intensivists, and primary physicians regarding collaboration and other aspects of withholding and withdrawing therapy in the intensive care unit (ICU).......The purpose of the study was to determine the views of intensive care nurses, intensivists, and primary physicians regarding collaboration and other aspects of withholding and withdrawing therapy in the intensive care unit (ICU)....

  13. Desmopressin Withdrawal Strategy for Pediatric Enuresis: A Meta-analysis.

    Science.gov (United States)

    Chua, Michael E; Silangcruz, Jan Michael; Chang, Shang-Jen; Williams, Katharine; Saunders, Megan; Lopes, Roberto Iglesias; Farhat, Walid A; Yang, Stephen S

    2016-07-01

    A high relapse rate after discontinuation of desmopressin treatment of pediatric enuresis is consistently reported. Structured withdrawal strategies have been used to prevent relapse. To assess the efficacy of a structured withdrawal strategy of desmopressin on the relapse-free rate for desmopressin responder pediatric enuresis. Systematic literature search up to November 2015 on Medline, Embase, Ovid, Science Direct, Google Scholar, Wiley Online Library databases, and related references without language restriction. Related clinical trials were summarized for systematic review. Randomized controlled trials on the efficacy of structured versus abrupt withdrawal of desmopressin in sustaining relapse-free status in pediatric enuresis were included for meta-analysis. Eligible studies were evaluated according to Cochrane Collaboration recommendations. Relapse-free rate was extracted for relative risk (RR) and 95% confidence interval (CI). Effect estimates were pooled via the Mantel-Haenszel method with random effect model. Six hundred one abstracts were reviewed. Four randomized controlled trials (total 500 subjects) of adequate methodological quality were included for meta-analysis. Pooled effect estimates compared with the abrupt withdrawal, structured withdrawal results to a significantly better relapse-free rate (pooled RR: 1.38; 95% CI, 1.17-1.63; P = .0001). Subgroup analysis for a dose-dependent structured withdrawal regimen showed a significantly better relapse-free rate (pooled RR: 1.48; 95% CI, 1.21-1.80; P = .0001). The small number of studies included in meta-analysis represents a major limitation. Structured withdrawal of desmopressin results in better relapse-free rates. Specifically, the dose-dependent structured withdrawal regimen showed significantly better outcomes. Copyright © 2016 by the American Academy of Pediatrics.

  14. Intranasal oxytocin blocks alcohol withdrawal in human subjects.

    Science.gov (United States)

    Pedersen, Cort A; Smedley, Kelly L; Leserman, Jane; Jarskog, Lars Fredrik; Rau, Shane W; Kampov-Polevoi, Alexei; Casey, Robin L; Fender, Trace; Garbutt, James C

    2013-03-01

    The neuropeptide, oxytocin (OT), has been reported to block tolerance formation to alcohol and decrease withdrawal symptoms in alcohol-dependent rodents. Numerous recent studies in human subjects indicate that OT administered by the intranasal route penetrates into and exerts effects within the brain. In a randomized, double-blind clinical trial, intranasal OT (24 IU/dose, N = 7) or placebo (N = 4) was given twice daily for 3 days in alcohol-dependent subjects admitted to a research unit for medical detoxification using Clinical Institute Withdrawal Assessment for Alcohol (CIWA) score-driven PRN administration of lorazepam. Subjects rated themselves on the Alcohol Withdrawal Symptom Checklist (AWSC) each time CIWA scores were obtained. Subjects also completed the Penn Alcohol Craving Scale, an Alcohol Craving Visual Analog Scale (ACVAS) and the Profile of Mood States (POMS) on inpatient days 2 and 3. All subjects had drunk heavily each day for at least 2 weeks prior to study and had previously experienced withdrawal upon stopping/decreasing alcohol consumption. OT was superior to placebo in reducing alcohol withdrawal as evidenced by: less total lorazepam required to complete detoxification (3.4 mg [4.7, SD] vs. 16.5 [4.4], p = 0.0015), lower mean CIWA scores on admission day 1 (4.3 [2.3] vs. 11.8 [0.4], p block alcohol withdrawal in human subjects. Our results are consistent with previous findings in rodents that OT inhibits neuroadaptation to and withdrawal from alcohol. OT could have advantages over benzodiazepines in managing alcohol withdrawal because it may reverse rather than maintain sedative-hypnotic tolerance. It will be important to test whether OT treatment is effective in reducing drinking in alcohol-dependent outpatients. Copyright © 2012 by the Research Society on Alcoholism.

  15. Managing benzodiazepine withdrawal during pregnancy: case-based guidelines.

    Science.gov (United States)

    Gopalan, Priya; Glance, Jody B; Azzam, Pierre N

    2014-04-01

    Substance use disorders during pregnancy pose serious risks for both the mother and the fetus, demanding careful monitoring by the patient's medical providers. Sedative-hypnotic use, in particular, is common but remains poorly studied. Management of withdrawal from chronic benzodiazepine use during pregnancy presents unique challenges to the treating physician. We present two pregnant patients with dependence on sedative-hypnotic agents, outline principles of benzodiazepine withdrawal, and suggest guidelines for detoxification during pregnancy.

  16. Land reclamation program description

    Energy Technology Data Exchange (ETDEWEB)

    None

    1977-05-01

    The Land Reclamation Program will address the need for coordinated applied and basic research into the physical and ecological problems of land reclamation, and advance the development of cost-effective techniques for reclaiming and rehabilitating mined coal land to productive end uses. The purpose of this new program is to conduct integrated research and development projects focused on near- and long-term reclamation problems in all major U.S. coal resource regions including Alaska and to coordinate, evaluate, and disseminate the results of related studies conducted at other research institutions. The activities of the Land Reclamation Laboratory program will involve close cooperation with industry and focus on establishing a comprehensive field and laboratory effort. Research demonstration sites will be established throughout the United States to address regional and site-specific problems. Close cooperation with related efforts at academic institutions and other agencies, to transfer pertinent information and avoid duplication of effort, will be a primary goal of the program. The major effort will focus on the complete coal extraction/reclamation cycle where necessary to develop solutions to ameliorating the environmental impacts of coal development. A long-range comprehensive national reclamation program will be established that can schedule and prioritize research activities in all of the major coal regions. A fully integrated data management system will be developed to store and manage relevant environmental and land use data. Nine research demonstration sites have been identified.

  17. On the relationship between Indian summer monsoon withdrawal and Indo-Pacific SST anomalies before and after 1976/1977 climate shift

    Energy Technology Data Exchange (ETDEWEB)

    Sabeerali, C.T.; Rao, Suryachandra A. [Indian Institute of Tropical Meteorology, Pune (India); Ajayamohan, R.S. [University of Victoria, Canadian Centre for Climate Modelling and Analysis, Victoria, BC (Canada); Murtugudde, Raghu [University of Maryland, Earth System Science Interdisciplinary Center, College Park, MD (United States)

    2012-08-15

    A clear shift in the withdrawal dates of the Indian Summer Monsoon is observed in the long term time series of rainfall data. Prior (posterior) to the 1976/1977 climate shift most of the withdrawal dates are associated with a late (an early) withdrawal. As a result, the length of the rainy season (LRS) over the Indian land mass has also undergone similar changes (i.e., longer (shorter) LRS prior (posterior) to the climate shift). In this study, probable reasons for this significant shift in withdrawal dates and the LRS are investigated using reanalysis/observed datasets and also with the help of an atmospheric general circulation model. Reanalysis/observational datasets indicate that prior to the climate shift the sea surface temperature (SST) anomalies in the eastern equatorial Pacific Ocean and the Arabian Sea exerted a strong influence on both the withdrawal and the LRS. After the climate shift, the influence of the eastern equatorial Pacific Ocean SST has decreased and surprisingly, the influence of the Arabian Sea SST is almost non-existent. On the other hand, the influence of the southeastern equatorial Indian Ocean has increased significantly. It is observed that the upper tropospheric temperature gradient over the dominant monsoon region has decreased and the relative influence of the Indian Ocean SST variability on the withdrawal of the Indian Summer Monsoon has increased in the post climate shift period. Sensitivity experiments with the contrasting SST patterns on withdrawal dates and the LRS in the pre- and post- climate shift scenarios, confirm the observational evidences presented above. (orig.)

  18. Catatonia and alcohol withdrawal: a complex and underestimated syndrome.

    Science.gov (United States)

    Geoffroy, Pierre Alexis; Rolland, Benjamin; Cottencin, Olivier

    2012-01-01

    Catatonia is a neuropsychiatric syndrome characterized by alterations in motor behavior, vigilance, thought and mood. Catatonia syndrome occurs in many neuropsychiatric and medical conditions, but it is very rarely mentioned as occurring during alcohol withdrawal. We think that this co-occurrence could be underestimated in clinics because alcohol withdrawal symptoms may distract from its identification. We report the case of a patient presenting with catatonia during the benzodiazepine reduction period of alcohol detoxification. A 65-year-old woman presented with a 15-year history of alcohol dependence and developed catatonic episodes several times during alcohol withdrawal treatment. Misdiagnosis delayed specific treatment. Symptoms of episodes dramatically improved 48 h after treatment with diazepam and revealed an anxiety disorder. This report confirms that catatonia is a non-specific response to psychological, physical and psychosocial stress factors. Recent alcohol withdrawal may sensitize the patient to benzodiazepine withdrawal catatonia, and this phenomenon is probably underestimated. Catatonia Rating Scales can be useful when diagnosis is complicated as in alcohol and benzodiazepine withdrawal. In that situation, misdiagnosis is common and may delay specific treatment.

  19. Water withdrawals, use, and trends in Florida, 1985

    Science.gov (United States)

    Marella, R.L.

    1988-01-01

    Total water withdrawn for use in Florida for 1985, in million gal/day, was 17,057 of which 6,259, or nearly 37%, was freshwater and 10,798 was saline. The majority of freshwater withdrawn was groundwater (64%) and the majority of saline water withdrawn was surface water (99%). Thermoelectric power generation accounted for more than 99% of saline water withdrawals. Agricultural irrigation accounted for the majority of freshwater withdrawals for both groundwater (41%) and surface water (60%) in 1985. Between 1975-85, Florida 's population increased by nearly 3 million people; tourism increased by nearly 13 million visitors; irrigated agricultural acreage increased by 70,000; freshwater used to support those activities increased by almost 388 million gal/day (excluding fresh surface-water withdrawals for thermoelectric power generation); and fresh groundwater withdrawals increased 718 million gal/day. Groundwater accounted for 64% of Florida 's total freshwater use , up from 51% in 1980 and 48% in 1975. Florida ranked sixth in the Nation in groundwater withdrawals for 1985 with more than 4 ,000 million gal/day withdrawn. Groundwater is the primary source of freshwater in Florida because it is readily available and generally is suitable for most uses. The Floridan aquifer system, which underlies the entire State, supplied the majority (62%) of groundwater in Florida for 1985. In contrast to groundwater, withdrawals of surface water declined between 1975-85. (USGS)

  20. Topical corticosteroid addiction and withdrawal - An overview for GPs.

    Science.gov (United States)

    Sheary, Belinda

    2016-06-01

    Topical corticosteroid (TCS) withdrawal (addiction) is a potential complication of TCS treatment, particularly where there has been an inappropriate long-term use of moderate-to-potent TCS on the face or genital area. TCS addiction and withdrawal is increasingly being discussed in social and mainstream media; however, it has received little attention in medical publications. Australian general practitioners (GPs) may come into contact with patients who have read material or watched videos about this condition. The objective of this article is to provide a succinct, evidence-based overview of TCS addiction and withdrawal for GPs. TCSs are indicated in the management of many patients with eczema. By being aware of TCS addiction and withdrawal, practitioners may be better able to help prevent this adverse effect and offer supportive care to patients in TCS withdrawal. It would also be useful for GPs to be able to discuss TCS addiction and withdrawal with patients who seek to clarify information they glean from non-medical sources.

  1. Measurement of nicotine withdrawal symptoms: linguistic validation of the Wisconsin Smoking Withdrawal Scale (WSWS) in Malay

    Science.gov (United States)

    2010-01-01

    Background The purpose of the linguistic validation of the Wisconsin Smoking Withdrawal Scale (WSWS) was to produce a translated version in Malay language which was "conceptually equivalent" to the original U.S. English version for use in clinical practice and research. Methods A seven-member translation committee conducted the translation process using the following methodology: production of two independent forward translations; comparison and reconciliation of the translations; backward translation of the first reconciled version; comparison of the original WSWS and the backward version leading to the production of the second reconciled version; pilot testing and review of the translation, and finalization. Results Linguistic and conceptual issues arose during the process of translating the instrument, particularly pertaining to the title, instructions, and some of the items of the scale. In addition, the researchers had to find culturally acceptable equivalents for some terms and idiomatic phrases. Notable among these include expressions such as "irritability", "feeling upbeat", and "nibbling on snacks", which had to be replaced by culturally acceptable expressions. During cognitive debriefing and clinician's review processes, the Malay translated version of WSWS was found to be easily comprehensible, clear, and appropriate for the smoking withdrawal symptoms intended to be measured. Conclusions We applied a rigorous translation method to ensure conceptual equivalence and acceptability of WSWS in Malay prior to its utilization in research and clinical practice. However, to complete the cultural adaptation process, future psychometric validation is planned to be conducted among Malay speakers. PMID:20492717

  2. Measurement of nicotine withdrawal symptoms: linguistic validation of the Wisconsin Smoking Withdrawal Scale (WSWS in Malay

    Directory of Open Access Journals (Sweden)

    Shafie Asrul A

    2010-05-01

    Full Text Available Abstract Background The purpose of the linguistic validation of the Wisconsin Smoking Withdrawal Scale (WSWS was to produce a translated version in Malay language which was "conceptually equivalent" to the original U.S. English version for use in clinical practice and research. Methods A seven-member translation committee conducted the translation process using the following methodology: production of two independent forward translations; comparison and reconciliation of the translations; backward translation of the first reconciled version; comparison of the original WSWS and the backward version leading to the production of the second reconciled version; pilot testing and review of the translation, and finalization. Results Linguistic and conceptual issues arose during the process of translating the instrument, particularly pertaining to the title, instructions, and some of the items of the scale. In addition, the researchers had to find culturally acceptable equivalents for some terms and idiomatic phrases. Notable among these include expressions such as "irritability", "feeling upbeat", and "nibbling on snacks", which had to be replaced by culturally acceptable expressions. During cognitive debriefing and clinician's review processes, the Malay translated version of WSWS was found to be easily comprehensible, clear, and appropriate for the smoking withdrawal symptoms intended to be measured. Conclusions We applied a rigorous translation method to ensure conceptual equivalence and acceptability of WSWS in Malay prior to its utilization in research and clinical practice. However, to complete the cultural adaptation process, future psychometric validation is planned to be conducted among Malay speakers.

  3. [Can alcoholic withdrawal delirium be prevented?].

    Science.gov (United States)

    Hensel, M; Kox, W J

    2003-01-01

    In alcohol-dependent in-patients, an adequate drug prophylaxis should be made in order to lower the degree of a developing alcohol withdrawal syndrome (AWS) or to prevent a life-threatening delirium tremens. Pre-condition of successful therapy is a precise diagnosis. In patients, the beginning of whose abstinence is known, carefully-targeted pharmacological interventions can prevent severe imbalances of neurotransmitters. Typical time courses of destabilisation of neural balances should be considered. Since there is no single drug which is able to influence various transmitter systems, normally the use of drug combinations is necessary. In ENT-patients, traumatologic patients and patients from the department of maxillo-facial surgery, screening methods based on a simply-structured questionnaire relating to information from the patient and his surroundings and selected laboratory parameters should be used. High-risk patients who could get an AWS or delirium tremens should be treated prophylactically during their oral premedication period. Important drugs for successful prophylaxis of an AWS are benzodiazepines, clonidin, magnesium and vitamin B 1. A close-meshed control of the glucose metabolism, electrolyte and acid-base balance should be performed. Neuroleptica can be used if there is any indication for their adjuvant use. In severe cases that require deep sedation or hypnosis, propofol or gamma-hydroxy-butyric acid should be used. Perioperative infusion of alcohol as a prophylactic agent against delirium tremens is regarded as an obsolete therapeutic measure for ethical reasons and because equally good or better results can be achieved by carefully-targeted drug therapy. Due to its easy use, however, the application of alcohol has not yet completely disappeared from the therapeutic spectrum.

  4. Time to Death after Terminal Withdrawal of Mechanical Ventilation: Specific Respiratory and Physiologic Parameters May Inform Physician Predictions.

    Science.gov (United States)

    Long, Ann C; Muni, Sarah; Treece, Patsy D; Engelberg, Ruth A; Nielsen, Elizabeth L; Fitzpatrick, Annette L; Curtis, J Randall

    2015-12-01

    Discussions about withdrawal of life-sustaining therapies often include family members of critically ill patients. These conversations should address essential components of the dying process, including expected time to death after withdrawal. The study objective was to aid physician communication about the dying process by identifying predictors of time to death after terminal withdrawal of mechanical ventilation. We conducted an observational analysis from a single-center, before-after evaluation of an intervention to improve palliative care. We studied 330 patients who died after terminal withdrawal of mechanical ventilation. Predictors included patient demographics, laboratory, respiratory, and physiologic variables, and medication use. The median time to death for the entire cohort was 0.58 hours (interquartile range (IQR) 0.22-2.25 hours) after withdrawal of mechanical ventilation. Using Cox regression, independent predictors of shorter time to death included higher positive end-expiratory pressure (per 1 cm H2O hazard ratio [HR], 1.07; 95% CI 1.04-1.11); higher static pressure (per 1 cm H2O HR, 1.03; 95% CI 1.01-1.04); extubation prior to death (HR, 1.41; 95% CI 1.06-1.86); and presence of diabetes (HR, 1.75; 95% CI 1.25-2.44). Higher noninvasive mean arterial pressure predicted longer time to death (per 1 mmHg HR, 0.98; 95% CI 0.97-0.99). Comorbid illness and key respiratory and physiologic parameters may inform physician predictions of time to death after withdrawal of mechanical ventilation. An understanding of the predictors of time to death may facilitate discussions with family members of dying patients and improve communication about end-of-life care.

  5. Manned Spacecraft Landing and Recovery

    Science.gov (United States)

    Hammel, Don

    2004-01-01

    As recent history has tragically demonstrated, a successful space mission is not complete until the crew has safely returned to earth and has been successfully recovered. It is noted that a safe return to earth does not guarantee a successful recovery. The focus of this presentation will be a discussion of the ground operation assets involved in a successful recovery. The author's experience in land and water-based recovery of crewed vehicles and flight hardware at Kennedy Space Center (KSC), Edwards Air Force Base, international landing sites, and the Atlantic Ocean provides for some unique insight into this topic. He has participated in many aspects of Space Shuttle landing and recovery operations including activation of Transatlantic Abort Landing (TAL) sites and Emergency Landing Sites (ELS) as an Operations Test Director, execution of post landing convoy operations as an Orbiter Move Director, Operations Test Director, and Landing and Recovery Director, and recovery of solid rocket boosters, frustum and their parachutes 140 miles offshore in a wide range of sea states as a Retrieval Diver/Engineer. The recovery operations for the Mercury, Gemini, and Apollo were similar from a landing and recovery perspective in th t they all were capsules with limited "flying" capability and had a planned End of Mission (EOM) in an ocean with a descent slowed by parachutes. The general process was to deploy swim teams via helicopters to prepare the capsule for recovery and assist with crew extraction when required. The capsule was then hoisted onto the deck of a naval vessel. This approach required the extensive use and deployment of military assets to support the primary landing zone as well as alternate and contingency locations. The Russian Soyuz capsule also has limited "flying" capability; however, the planned EOM is terrestrial. In addition to use of parachutes to slow the reentry descent, soft-landing rockets on the bottom of the vehicle are employed to cushion the

  6. Withdrawal periods and tissue tolerance after intramammary antibiotic treatment of dairy goats with clinical mastitis

    Directory of Open Access Journals (Sweden)

    J. Karzis

    2007-09-01

    Full Text Available The aim of this study was to determine withdrawal periods (WP and tissue irritation after administration of three intramammary antibiotics [Curaclox LC (Norbrook (ARK AH], Spectrazol Milking Cow (Schering-Plough AH and Rilexine 200 LC [Logos Agvet (Virbac] in goats with clinical mastitis.Withdrawal periods in goats with clinical mastitis treated with Curaclox LC, were not significantly different from those recommended for use in cows (72 h with (67 h or without (48 h the 24 h mandatory safety margin while Spectrazol caused a significantly longer withdrawal period (122 h than that recommended for use in cattle with (60 h and without (36 h the 24h safety margin. The withdrawal period of clinical mastitis cases treated with Rilexine 200 LC was 48 h compared to the 96 h recommended for use in cows.A linear model of regression with factors influencing the WP in goats with clinical mastitis was as follows : WP = 30.21 + 4.692 (sampling time + 22.11 (udder pathology - 13.6 (floccules - 0.00649 (milk yield.Somatic Cell Counts (SCC of milk from udder halves with clinical mastitis ranged from 7 053 x 103 to 7 948 x 103 cells per mℓ without isolations of bacteria and between 6 476 x 103 and 8 479 x 103 cells per mℓ with isolations of bacteria. Most of the variation in SCC could not be explained and the California Milk Cell Test (CMCT and SCC on their own were not reliable methods for mastitis diagnosis. However, CMCT and SCC were indicators of udder irritation. In goats without clinical mastitis, Spectrazol Milking Cow caused the least tissue irritation followed by Rilexine 200 LC and Curaclox LC. For goats with clinical mastitis, Rilexine 200 LC caused the least irritation, followed by Curaclox LC while Spectrazol Milking Cow caused the most irritation.

  7. Living Lands

    DEFF Research Database (Denmark)

    Christensen, Suna Møller

    2015-01-01

    , hunters attended to questions like safe-journeying on ice or the role of natural surroundings in children’s education, in ways revealing a relational perception of ‘nature’ and dissolving culture-nature dualisms. Hunters’ experiences in living the land afforded children a dwelling position from which......In this presentation I draw on fieldtrips on dog sledge in Northern Greenland in 2012 and fieldtrips among caribou hunters in West Greenland in 2010 and 2012. I carried out fieldtrips through snow and ice to explore how these landscapes play a role in the life of modern Greenlanders. Fieldtrips...... to grow with the features of the land. Framed this way, ‘nature’ was regarded as part of the social world. I suggest that learning among Arctic hunters is social and twofold. First, we can learn how human-environment relations influence individual life trajectories. Secondly, ‘nature’ as part...

  8. The role of carbamazepine and oxcarbazepine in alcohol withdrawal syndrome.

    Science.gov (United States)

    Barrons, R; Roberts, N

    2010-04-01

    The goal of this review is to evaluate the efficacy and safety of carbamazepine and oxcarbazepine in treatment of alcohol withdrawal syndrome (AWS) and determine the role in therapy of both agents. Relevant literature was identified through a search of MEDLINE (1966-June 2008), PubMed (1966-June 2008); Cochrane database was performed to identify English-language publications. Search terms included carbamazepine, oxcarbazepine, AWS, alcoholism, substance syndrome withdrawal. In seven studies, including 612 patients, carbamazepine demonstrated significant reduction in alcohol withdrawal scores. However, in comparative trials with a benzodiazepine agent, carbamazepine's ability to prevent alcohol withdrawal seizures (OR = 0.93; 95% CI = 0.06-14.97, P = NS) and delirium tremens (DTs; OR = 1.25; 95% CI = 0.28-5.64, P = NS) was uncertain as a result of insufficient patient enrollment. In three trials, carbamazepine failed to reduce alcohol withdrawal symptoms possibly as a result of delayed administration, inadequate dosage or inadequate sample size. At daily doses of 800 mg either fixed or tapered over 5-9 days, carbamazepine was well tolerated, and safely administered when blood alcohol concentration dropped below 0.15%. The role of oxcarbazepine in AWS is undefined because of inconsistent findings in two trials. Carbamazepine has demonstrated safety, tolerability and efficacy in treatment of moderate to severe symptoms of alcohol withdrawal in the inpatient setting. However, trials of carbamazepine provide inconclusive evidence for prevention of alcohol withdrawal seizures and DTs in comparison with benzodiazepines. Benzodiazepines remain the primary treatment of moderate to severe AWS.

  9. The Role of Barbiturates for Alcohol Withdrawal Syndrome.

    Science.gov (United States)

    Martin, Katherine; Katz, Andrew

    2016-01-01

    Benzodiazepine-resistant cases of alcohol withdrawal syndrome are common, and therefore alternate treatments are needed. Our aim was to conduct a systematic review of published reports on the use of barbiturates for alcohol withdrawal syndrome. We performed a systematic literature search of PUBMED for relevant citations that described the use of barbiturates either alone or in conjunction with other pharmacological agents to treat alcohol withdrawal syndrome. A total of 15 citations were identified; 2 citations looked at barbiturates alone; 1 found barbiturates effective in an emergency department setting at treating seizures and preventing return visits. A second showed that barbiturates caused a relatively low rate of respiratory depression. Further, 5 citations compared barbiturates with benzodiazepines; 1 suggested that they were better at treating severe withdrawal, and another showed they were more effective at preventing seizures; 4 citations found they were as effective as benzodiazepines, but 1 found a higher rate of respiratory depression. Also, 3 citations compared a combination of barbiturates and benzodiazepines to benzodiazepines alone; 1 showed decreased ventilation, another showed fewer intensive care unit admissions, and a third showed better symptom control; 3 citations described detailed reports of barbiturate protocols. Lastly, 2 citations compared barbiturates with other agents and found them equivalent. Barbiturates provide effective treatment for alcohol withdrawal syndrome. In particular, they show promise for use in the emergency department and for severe withdrawal in the intensive care unit. Respiratory depression does not appear to be exceedingly common. Additional studies are needed to clarify the role of barbiturates in alcohol withdrawal syndrome. Copyright © 2016 The Academy of Psychosomatic Medicine. Published by Elsevier Inc. All rights reserved.

  10. A Simplified Protocol for the Treatment of Alcohol Withdrawal.

    Science.gov (United States)

    Feeney, Colin; Alter, Harrison J; Jacobsen, Elke; Rehrer, Matthew; Shao, Shirley; Subramanian, Indhu; Clements, R Carter

    2015-01-01

    The aim of the study was to evaluate a novel simplified tool for symptom-triggered treatment of alcohol withdrawal. This retrospective cohort study involved inpatients in a county hospital with an International Classification of Diseases, Ninth Revision, Clinical Modification discharge diagnosis of alcohol withdrawal syndrome (AWS) or delirium tremens between January 1, 2007 and December 31, 2008. The study used the Highland Alcohol Withdrawal Protocol (HAWP)-a simplified derivative of the Revised Clinical Institute Withdrawal Assessment for Alcohol. Multivariable regression analysis was performed to compare severity of withdrawal to hospital length of stay, total dose of sedative given, and risk of complications. The study identified 442 patients with a primary diagnosis of AWS or delirium tremens, and those with another primary medical diagnosis complicated by alcohol withdrawal. After adjusting for demographic variables, each one-point increase in the initial and maximum HAWP scores correlated with an increase in the hospital length of stay of 0.3 days [95% confidence interval (95% CI), 0.17 to 0.43 days] and 0.45 days (95% CI, 0.32-0.57 days), and a 15.8 mg (95% CI, 6.6-25.1 mg) and 19.8 mg (95% CI, 11.1-28.5 mg) increase in the total dose of lorazepam given, respectively. The complication rate of seizures, intubations, pneumonia, and death was 13.1%, 12.9%, 6.1% and 0.9%, respectively; a composite endpoint of these outcomes also correlated with initial and maximum HAWP scores (odds ratio 1.09, 95% CI, 1.03%-1.14%). The HAWP correlates with medication received and complications, and as such appears to give an indication of AWS severity. It is feasible and shorter than prior scales, and merits further study to confirm its effectiveness as part of symptom-triggered protocols to manage alcohol withdrawal in the hospital.

  11. 25 CFR 161.203 - Are range management plans required?

    Science.gov (United States)

    2010-04-01

    ... 25 Indians 1 2010-04-01 2010-04-01 false Are range management plans required? 161.203 Section 161... LANDS GRAZING PERMITS General Provisions § 161.203 Are range management plans required? Yes. BIA will... range restoration activities for the Navajo Partitioned Lands. (b) Develop range management plans with...

  12. Ethanol withdrawal increases glutathione adducts of 4-hydroxy-2-hexenal but not 4-hydroxyl-2-nonenal in the rat cerebral cortex.

    Science.gov (United States)

    Long, Eric K; Rosenberger, Thad A; Picklo, Matthew J

    2010-02-01

    Ethanol withdrawal increases lipid peroxidation of the polyunsaturated fatty acid (PUFA) docosahexaenoate (22:6; n-3) in the CNS. To further define the role of oxidative damage of PUFAs during ethanol withdrawal, we measured the levels of glutathione adducts of 4-hydroxy-2-hexenal (GSHHE) and 4-hydroxy-2-nonenal (GSHNE) as biomarkers of brain lipid peroxidation of n-3 and n-6 PUFAs, respectively. In this study rats received an ethanol-containing diet for 6 weeks followed by withdrawal ranging from 0 to 7 days. GSHHE content was elevated (>350%) in the cerebral cortex after 2 days of withdrawal with no change in GSHNE. The levels of GSHHE were significantly greater (2- to 20-fold) than those of GSHNE in multiple brain regions. Experiments demonstrated that intoxication and withdrawal did not alter the enzymatic rate of formation of GSHHE or GSHNE, but the rate of formation of GSHHE was higher (approximately 50%) than that of GSHNE. These results indicate that selective oxidative damage to n-3 PUFAs occurs in the cerebral cortex as a result of ethanol withdrawal and that 4-hydroxy-2-hexenal is metabolized to the GSH adduct more efficiently than HNE. Copyright 2009. Published by Elsevier Inc.

  13. Remifentanil-induced tolerance, withdrawal or hyperalgesia in infants: a randomized controlled trial. RAPIP trial: remifentanil-based analgesia and sedation of paediatric intensive care patients.

    Science.gov (United States)

    Welzing, Lars; Link, Florian; Junghaenel, Shino; Oberthuer, Andre; Harnischmacher, Urs; Stuetzer, Hartmut; Roth, Bernhard

    2013-01-01

    Short-acting opioids like remifentanil are suspected of an increased risk for tolerance, withdrawal and opioid-induced hyperalgesia (OIH). These potential adverse effects have never been investigated in neonates. To compare remifentanil and fentanyl concerning the incidence of tolerance, withdrawal and OIH. 23 mechanically ventilated infants received up to 96 h either a remifentanil- or fentanyl-based analgesia and sedation regimen with low-dose midazolam. We compared the required opioid doses and the number of opioid dose adjustments. Following extubation, withdrawal symptoms were assessed by a modification of the Finnegan score. OIH was evaluated by the CHIPPS scale and by testing the threshold of the flexion withdrawal reflex with calibrated von Frey filaments. Remifentanil had to be increased by 24% and fentanyl by 47% to keep the infants adequately sedated during mechanical ventilation. Following extubation, infants revealed no pronounced opioid withdrawal and low average Finnegan scores in both groups. Only 1 infant of the fentanyl group and 1 infant of the remifentanil group required methadone for treatment of withdrawal symptoms. Infants also revealed no signs of OIH and low CHIPPS scores in both groups. The median threshold of the flexion withdrawal reflex was 4.5 g (IQR = 2.3) in the fentanyl group and 2.7 g (IQR = 3.3) in the remifentanil group (p = 0.312), which is within the physiologic range of healthy infants. Remifentanil does not seem to be associated with an increased risk for tolerance, withdrawal or OIH. Copyright © 2013 S. Karger AG, Basel.

  14. 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.

  15. 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.

  16. Withdrawal of antihypertensive therapy in people with dementia: feasibility study.

    Science.gov (United States)

    van der Wardt, Veronika; Burton, Jennifer K; Conroy, Simon; Welsh, Tomas; Logan, Pip; Taggar, Jaspal; Tanajewski, Lukasz; Gladman, John

    2018-01-01

    This study explored the feasibility of a randomised controlled withdrawal trial of antihypertensive medication in normotensive people with dementia. Feasibility aspects included response, recruitment, exclusion and drop-out rates, suitability of outcome measures, acceptability of study procedures and an indicative economic evaluation for a randomised controlled trial. A cohort study attempting the withdrawal of antihypertensive drugs where appropriate and a feasibility study of home-based blood pressure monitoring, in people with dementia treated for hypertension, was undertaken. Interviews with participants and carers and an indicative economic evaluation were also undertaken. Three hundred and sixty-two primary care practices in the East Midlands were contacted of which only 41 (11% (95%CI 8-15%)) agreed to support the study. These 41 practices posted 940 letters to potential participants. Thirty participants were enrolled in the cohort study of whom 9 were eligible for the antihypertensive withdrawal programme, 20 participated in a home blood pressure monitoring sub-group analysis and 12 took part in an interview study. Twenty-two of those enrolled in the cohort study were followed up at 6 months. The withdrawal programme was acceptable to participants and general practitioners (GPs). The study procedures including assessments and home blood pressure monitoring were acceptable to the participants and their carers. The economic evaluation was not possible. A withdrawal trial of antihypertensive medication in normotensive people with dementia may not be feasible in the UK because of low recruitment rates.

  17. 77 FR 70463 - Public Land Order No. 7801; Withdrawal of Public Lands for Protection of Proposed Expansion of...

    Science.gov (United States)

    2012-11-26

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF THE INTERIOR... 11, inclusive; Sec. 14, that portion lying north and west of the boundary of the Cleghorn Lakes Wilderness Area; Sec. 15 and 17 to 22, inclusive; Sec. 23, that portion lying west of the boundary of the...

  18. 78 FR 40499 - Public Land Order No. 7818; Withdrawal of Public Lands for the Protection and Preservation of...

    Science.gov (United States)

    2013-07-05

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF THE INTERIOR.../2\\N\\1/2\\NE\\1/4\\, and NE\\1/4\\NE\\1/ 4\\NW\\1/4\\, lying northerly of the northern right-of-way boundary...\\, and E\\1/2\\SE\\1/4\\; Sec. 4, that portion lying northerly of the northern right-of- way of CARI 05498...

  19. 77 FR 58864 - Public Land Order No. 7801; Withdrawal of Public Lands for Protection of Proposed Expansion of...

    Science.gov (United States)

    2012-09-24

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF THE INTERIOR... lying north and west of the boundary of the Cleghorn Lakes Wilderness Area; Sec. 15 and 17 to 22, inclusive; Sec. 23, that portion lying west of the boundary of the Cleghorn Lakes Wilderness Area; Sec. 26...

  20. 77 FR 2563 - Public Land Order No. 7787; Withdrawal of Public and National Forest System Lands in the Grand...

    Science.gov (United States)

    2012-01-18

    .... Persons who use a telecommunications device for the deaf (TDD) may call the Federal Information Relay... National Game Preserve and Kanab Creek Wilderness; Sec. 5; Secs. 6 to 11, inclusive, excluding that part within the Grand Canyon National Game Preserve and Kanab Creek Wilderness. T. 39 N., R. 1 W., Secs. 2 to...

  1. Water withdrawals for irrigation, municipal, mining, thermoelectric-power, and drainage uses in Arizona outside of active management areas, 1991-2000

    Science.gov (United States)

    Tadayon, Saeid

    2005-01-01

    thermoelectric-power generation generally increased owing to an increase in production of electricity. Ground-water withdrawals for drainage of agricultural lands in the Lower Gila and Yuma Basins varied irregularly from year to year. Annual total water withdrawals are not presented in this report because for some years irrigation values for some of the basins are reported as 'less than 1,000 acre-feet,' and municipal and mining values for some of the basins are reported as 'less than 300 acre-feet.'

  2. Final Range Wide Environmental Impact Statement

    National Research Council Canada - National Science Library

    Botdorf, Charles

    2001-01-01

    This Final Range Wide Environmental Impact Statement presents the impacts associated with the direct, indirect, and cumulative effects of mission diversification and changes to land use for Yuma Proving Ground, Arizona...

  3. Data withdrawal in randomized controlled trials: Defining the problem and proposing solutions: a commentary.

    Science.gov (United States)

    Ye, Chenglin; Giangregorio, Lora; Holbrook, Anne; Pullenayegum, Eleanor; Goldsmith, Charlie H; Thabane, Lehana

    2011-05-01

    It is not uncommon for a participant to withdraw from a randomized controlled trial (RCT). The withdrawal of a participant results in missing data and the potential for withdrawal bias. Data withdrawal, or a request from a participant to withdraw all of their previously collected data from a study, is particularly problematic because it leaves little opportunity to characterize or statistically address those that have withdrawn to minimize withdrawal bias. The aim of this commentary is to (1) provide a synthesis of available information on the ethical and methodological issues related to data withdrawal in RCTs and (2) provide some suggestions on how to minimize the impact of data withdrawal during the execution or analysis phases of an RCT. We searched PubMed, EMBASE and JSTOR for published articles on data withdrawal. In addition, we used internet sources as an additional tool to identify content on data withdrawal from research ethics guidelines, legislation, research ethics boards, funding agencies, professional organizations and researchers. We did not find any definitive guidelines for dealing with data withdrawal. We propose recommendations for minimizing the occurrence of data withdrawal, including explicit and clear descriptions in consent forms of how data will be handled after participant withdrawal. We also suggest using imputation techniques to deal with the missing data during analysis. The current commentary can be used to minimize the impact of data withdrawal in RCTs. Copyright © 2011 Elsevier Inc. All rights reserved.

  4. Estimated Withdrawals and Use of Water in Colorado, 2005

    Science.gov (United States)

    Ivahnenko, Tamara; Flynn, Jennifer L.

    2010-01-01

    The future health and economic welfare of the people and environment of Colorado depend on a continuous supply of fresh water. Detailed, comprehensive information on the use of water from Colorado's diverse surface-water and groundwater resources is important to water managers and planners by providing information they need to quantify current stresses and estimate and plan for future water needs. As part of the U.S. Geological Survey's (USGS) National Water Use Information Program (NWUIP), Statewide water withdrawal and water-use data have been collected or estimated and summarized in this report by county and by four-digit hydrologic unit code for the following seven water-use categories: irrigation (crop and golf course), public supply, self-supplied domestic, self-supplied industrial, livestock, mining, and thermoelectric power generation. A summary for instream water use for hydroelectric power generation also is included. This report is published in cooperation with the Colorado Water Conservation Board. In 2005, an estimated 13,581.22 million gallons per day (Mgal/d) was withdrawn from groundwater and surface-water sources in Colorado for the seven water-use categories. Withdrawals from surface water represented about 11,035 Mgal/d, or 81.3 percent of the total, whereas withdrawals from groundwater sources represented an estimated 2,546 Mgal/d or 18.7 percent of the total. Irrigation (combined crop and golf course) totaled 12,362.49 Mgal/d or 91 percent of the total water withdrawals in the State of Colorado. Crop irrigation accounted for 99.7 percent (12,321.85 Mgal/d) of the irrigation, whereas the 243 turf golf courses in Colorado accounted for 0.3 percent (40.64 Mgal/d) of the total irrigation water withdrawals. Total withdrawals for the other water-use categories were public supply, 864.17 Mgal/d; self-supplied domestic, 34.43 Mgal/d; self-supplied industrial, 142.44 Mgal/d; livestock, 33.06 Mgal/d; mining, 21.42 Mgal/d (includes both fresh and saline

  5. 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.

  6. Oxcarbazepine versus carbamazepine in the treatment of alcohol withdrawal.

    Science.gov (United States)

    Schik, G; Wedegaertner, F R; Liersch, J; Hoy, L; Emrich, H M; Schneider, U

    2005-09-01

    In a single-blinded and randomized pilot study efficacy and tolerability of oxcarbazepine versus carbamazepine were investigated in 29 patients during therapy of alcohol withdrawal. No initial differences were found regarding sociodemographic data and alcohol-related parameters, indicating successful randomization. The oxcarbazepine group showed a significant decrease of withdrawal symptoms and reported significantly less 'craving for alcohol' compared to the carbamazepine group. Subjectively experienced side effects, normalization of vegetative parameters and improvement in the cognitive processing speed did not reveal differences for both groups. Therefore, oxcarbazepine might be an interesting alternative to carbamazepine, and having almost no addictive potential, no clinically relevant interaction with alcohol and no prominent sedatory effect, possibly also to other drugs such as benzodiazepines or clomethiazole, in the treatment of alcohol withdrawal syndrome.

  7. Progesterone modulation of diazepam withdrawal syndrome in mice.

    Science.gov (United States)

    Pesce, M E; Acevedo, X; Pinardi, G; Miranda, H F

    1996-12-01

    The influence of progesterone and oestrogens on the benzodiazepine withdrawal syndrome in mice was studied. The intraperitoneal administration of 15 mg/kg of flumazenil induced a withdrawal syndrome in chronic diazepam-treated mice, characterized by jerks, usually accompanied by tail lifts, and seizures. The principal finding of the present work is that the intensity of diazepam withdrawal syndrome was significantly reduced by acute administration of progesterone as revealed by a low incidence of jerks and seizures. The action of progesterone could be due to a modulatory role of the hormone on neuronal activity as an anxiolytic agent. The modulatory activity of progesterone appears to be related to changes in the pharmacological properties of benzodiazepine receptors.

  8. Emplotting Hikikomori: Japanese Parents' Narratives of Social Withdrawal.

    Science.gov (United States)

    Rubinstein, Ellen

    2016-12-01

    Hikikomori, often glossed as "social withdrawal," emerged as a sociomedical condition among Japanese youth at the end of the twentieth century, and it continues to fascinate and concern the public. Explanatory frameworks for hikikomori abound, with different stakeholders attributing it to individual psychopathology, poor parenting, and/or a lack of social support structures. This article takes an interpretive approach to hikikomori by exploring parents' narrative constructions of hikikomori children in support group meetings and in-depth interviews. I argue that some parents were able to find hope in hikikomori by 'emplotting' their children's experiences into a larger narrative about onset, withdrawal, and recovery, which helped them remain invested in the present by maintaining a sense of possibility about the future. Contrary to literature that examines hikikomori as an epidemic of isolated individuals, I demonstrate how parents play a key role in hikikomori through meaning-making activities that have the potential to shape their children's experiences of withdrawal.

  9. A DNA element regulates drug tolerance and withdrawal in Drosophila.

    Directory of Open Access Journals (Sweden)

    Xiaolei Li

    Full Text Available Drug tolerance and withdrawal are insidious responses to drugs of abuse; the first increases drug consumption while the second punishes abstention. Drosophila generate functional tolerance to benzyl alcohol sedation by increasing neural expression of the slo BK-type Ca(2+ activated K(+ channel gene. After drug clearance this change produces a withdrawal phenotype-increased seizure susceptibility. The drug-induced histone modification profile identified the 6b element (60 nt as a drug responsive element. Genomic deletion of 6b produces the allele, slo (Δ6b, that reacts more strongly to the drug with increased induction, a massive increase in the duration of tolerance, and an increase in the withdrawal phenotype yet does not alter other slo-dependent behaviors. The 6b element is a homeostatic regulator of BK channel gene expression and is the first cis-acting DNA element shown to specifically affect the duration of a drug action.

  10. A New Conceptual Model for the Continuum of Land Rights | Whittal ...

    African Journals Online (AJOL)

    Legitimacy, legality and complexity are identified as indicators of land tenure security. These lead to the triple vertical indices of land tenure security in the new model. The range of land rights options in use, their associated land tenure, as well as mobility of people and flexibility of land parcels between land rights types, can ...

  11. Assessment of ground-water withdrawals at municipal industrial parks in Puerto Rico, 2000

    Science.gov (United States)

    Rodriguez, Jose M.

    2004-01-01

    An assessment of ground-water withdrawals at municipal industrial parks throughout Puerto Rico was conducted to investigate the effect of ground-water usage on nearby surface- and ground-water resources. Water-bearing strata were divided into four generalized hydrogeologic units: (1) fissured aquifers (including karst and non-karst limestone); (2) intergranular aquifers; (3) intergranular aquifers overlying fissured rock units; and (4) strata with local or limited ground-water resources. Approximately 49 percent of the municipal industrial parks are located in areas with local or limited ground-water resources, 29 percent overlie intergranular aquifers, 13 percent overlie fissured aquifers, and 9 percent overlie intergranular units that overlie fissured rock units. Hydrogeologic data for the generalized hydrogeologic units were compiled from published U.S. Geological Survey reports. Depths to ground water near industrial parks range from approximately 20 to 400 feet in the fissured aquifers, 6 to 65 feet in coastal intergranular aquifers, 3 to 30 feet in intergranular aquifers overlying fissured rock units, and 1 to 100 feet in strata with local or limited ground-water resources. Aquifer transmissivities near industrial parks range from approximately 100,000 feet squared per day in the fissured aquifers to less than 100 feet squared per day in the strata with local or limited ground-water resources. Well construction data were compiled from published U.S. Geological Survey reports, drillers? logs, and unpublished reports. Specific capacity for wells near industrial parks ranges from approximately 100 gallons per minute per foot of drawdown in the fissured aquifer at Manati to approximately 0.1 gallon per minute per foot of drawdown in strata with local and limited ground-water resources at Bayamon. Reported well yields near industrial parks ranges from 2,800 gallons per minute in the intergranular aquifer at Santa Isabel to approximately 3 gallons per minute in

  12. Diazepam in the Treatment of Moderate to Severe Alcohol Withdrawal.

    Science.gov (United States)

    Weintraub, Steven J

    2017-02-01

    Benzodiazepines ameliorate or prevent the symptoms and complications of moderate to severe alcohol withdrawal, which can include autonomic hyperactivity, agitation, combativeness, hallucinations, seizures, delirium, and death. The benzodiazepines most commonly used for this purpose are lorazepam, chlordiazepoxide, oxazepam, and diazepam. It is widely asserted that no member of this group is superior to the others for treatment of alcohol withdrawal. However, of these, diazepam has the shortest time to peak effect, which facilitates both rapid control of symptoms and accurate titration to avoid over-sedation. Furthermore, diazepam and its active metabolite, desmethyldiazepam, have the longest elimination half-lives, so their levels decrease in a gradual, self-tapering manner, resulting in a smoother withdrawal, i.e., a lower incidence and severity of both breakthrough symptoms and rebound phenomena, including a possibly decreased seizure risk. Importantly, the fear of increased risk of over-sedation with diazepam compared with other benzodiazepines is based on a misunderstanding of its pharmacokinetics and is unfounded. Similarly, the notion that diazepam should be avoided in patients with liver disease and elderly patients to avoid prolonged over-sedation is based on no more than conjecture. In fact, there is clinical evidence that diazepam is safe for the treatment of alcohol withdrawal in these patients when administered using a simple symptom-based approach. There is one instance in which diazepam should not be used: when intramuscular administration is the only option, the lipophilicity of diazepam can result in slow absorption-either lorazepam or, when rapid control of symptoms is required, midazolam should be used. The comparative pharmacokinetics of the benzodiazepines used in the treatment of alcohol withdrawal together with a comprehensive review of the literature on their use strongly suggest that diazepam should be the preferred benzodiazepine for the

  13. Are organisational factors affecting the emotional withdrawal of community nurses?

    Science.gov (United States)

    Karimi, Leila; Leggat, Sandra G; Cheng, Cindy; Donohue, Lisa; Bartram, Timothy; Oakman, Jodi

    2016-12-05

    Objective The aim of the present study was to investigate the effects of work organisation on the emotional labour withdrawal behaviour of Australian community nurses.Methods Using a paper-based survey, a sample of 312 Australian community nurses reported on their emotional dissonance, withdrawal behaviours (i.e. job neglect, job dissatisfaction, stress-related presenteeism) and work organisation. A model to determine the partial mediation effect of work organisation was developed based on a literature review. The fit of the proposed model was assessed via structural equation modelling using Analysis of Moment Structures (AMOS; IMB).Results Community nurses with higher levels of emotional dissonance were less likely to be satisfied with their job and work organisation and had a higher tendency to exhibit withdrawal behaviours. Work organisational factors mediated this relationship.Conclusion Emotional dissonance can be a potential stressor for community nurses that can trigger withdrawal behaviours. Improving work organisational factors may help reduce emotional conflict and its effect on withdrawal behaviours.What is known about the topic? Although emotional labour has been broadly investigated in the literature, very few studies have addressed the effect of the quality of work organisation on nurses' withdrawal behaviours in a nursing setting.What does this paper add? This paper provides evidence that work organisation affects levels of emotional dissonance and has an effect on job neglect through stress-related presenteeism.What are the implications for practitioners? In order to minimise stress-related presenteeism and job neglect, healthcare organisations need to establish a positive working environment, designed to improve the quality of relationships with management, provide appropriate rewards, recognition and effective workload management and support high-quality relationships with colleagues.

  14. Changes in land use and housing on resource lands in Washington state, 1976–2006

    Science.gov (United States)

    Andrew N. Gray; David L. Azuma; Gary J. Lettman; Joel L. Thompson; Neil McKay

    2013-01-01

    Changes in human land use patterns have wide-ranging social, economic and ecological implications. How urban and residential areas develop to accommodate population increase can have varying effects on forest and agricultural production from resource lands. Estimates of the amount and type of land use change differ substantially with definitions and analytical methods...

  15. A successful treatment of buprenorphine withdrawal with the dopamine receptor agonist pramipexole.

    Science.gov (United States)

    Makhinson, Michael; Gomez-Makhinson, Juliana

    2014-01-01

    Buprenorphine, used for treating opioid dependence, may have a withdrawal syndrome requiring treatment. Modulation of the dopamine system, which has been implicated in opioid withdrawal, may be a target for withdrawal for opioids such as buprenorphine. A case is reported of a buprenorphine withdrawal syndrome with predominant symptoms of restlessness that were resistant to clonidine and benzodiazepines. It was successfully treated with the dopamine agonist pramipexole. Dopamine receptor agonists may have a place in the treatment of restlessness associated with opioid withdrawal and may have value for the broader spectrum of opioid withdrawal symptoms. © American Academy of Addiction Psychiatry.

  16. Precipitated withdrawal during maintenance opioid blockade with extended release naltrexone.

    Science.gov (United States)

    Fishman, Marc

    2008-08-01

    Background There has been increasing interest in the use of extended release injectable naltrexone for the treatment of opioid dependence. Case description We report a case of precipitated withdrawal in a 17-year-old adolescent female receiving extended release naltrexone (Vivitrol) for opioid dependence, following her third serial monthly dose of the medication, several days after using oxycodone with mild intoxication. Conclusions This case suggests that, in some circumstances, the opioid blockade may be overcome when naltrexone levels drop towards the end of the dosing interval, producing vulnerability to subsequent naltrexone-induced withdrawal. This may provide cautionary guidance for clinical management and dosing strategies.

  17. Differential change in neuroactive steroid sensitivity during ethanol withdrawal.

    Science.gov (United States)

    Finn, D A; Gallaher, E J; Crabbe, J C

    2000-01-01

    The progesterone metabolite 3alpha-hydroxy-5alpha-pregnan-20-one (3alpha,5alpha-P or allopregnanolone) is a potent positive modulator of gamma-aminobutyric acid(A) (GABA(A)) receptors. Although it is well documented that chronic ethanol (EtOH) administration produces cross-tolerance to the positive modulatory effect of benzodiazepines and GABA at GABA(A) receptors, recent findings suggest that sensitivity to 3alpha,5alpha-P is enhanced during EtOH withdrawal. In addition, EtOH-naive inbred strains of mice, which differ in EtOH withdrawal severity (DBA/2 > C57BL/6), had marked differences in behavioral sensitivity to 3alpha,5alpha-P. Therefore, the present study was conducted to determine whether C57BL/6 (B6) and DBA/2 (D2) mice would be differentially sensitive to several of the pharmacological effects of 3alpha,5alpha-P during EtOH withdrawal. Male mice were exposed to EtOH vapor or air for 72 h. During withdrawal from EtOH, animals were injected with 3alpha,5alpha-P (0, 3.2, 10, or 17 mg/kg i.p.) and tested for activity and anxiolysis on the elevated plus maze, muscle relaxation, ataxia, and seizure protection following pentylenetetrazol. Sensitivity to the anticonvulsant effect of 3alpha,5alpha-P was enhanced during EtOH withdrawal in B6, but not D2 mice. In contrast, sensitivity to the muscle relaxant effects of 3alpha,5alpha-P was reduced in EtOH-withdrawing B6 and D2 mice, with a suggestion of decreased sensitivity to the anxiolytic effect of 3alpha,5alpha-P during EtOH withdrawal in B6. These results suggest that sensitization to the anticonvulsant effect of 3alpha,5alpha-P during EtOH withdrawal does not generalize across all genotypes nor does it generalize to all of the pharmacological effects of 3alpha,5alpha-P.

  18. An alcohol withdrawal tool for use in hospitals.

    Science.gov (United States)

    Benson, George; McPherson, Andrew; Reid, Steven

    An estimated 40% of patients admitted with alcohol-related problems to Glasgow hospitals are at risk of alcohol withdrawal syndrome (AWS). Not managing them effectively can affect the physical and psychological wellbeing of staff and other patients. This article describes the development and implementation of a tool, the Glasgow Modified Alcohol Withdrawal Scale, to manage patients with AWS. It is part of a more comprehensive assessment and management protocol and incorporates a protocol to help nurses decide whether to administer fixed-dose or symptom-triggered benzodiazepine to these patients.

  19. PREDICTION OF RELAPSE FROM HYPERTHYROIDISM FOLLOWING ANTITHYROID MEDICATION WITHDRAWAL USING TECHNETIUM THYROID UPTAKE SCANNING.

    Science.gov (United States)

    Nakhjavani, Manouchehr; Abdollahi, Soraya; Farzanefar, Saeed; Abousaidi, Mohammadtagi; Esteghamati, Alireza; Naseri, Maryam; Eftekhari, Mohamad; Abbasi, Mehrshad

    2017-04-02

    Technetium thyroid uptake (TTU) is not inhibited by antithyroid drugs (ATD) and reflects the degree of thyroid stimulation. We intended to predict the relapse rate from hyperthyroidism based on TTU measurement. Out of 44 initially enrolled subjects, 38 patients aged 41.6 ± 14.6 with Graves disease (duration: 84 ± 78 months) completed the study. TTU was performed with 40-second imaging of the neck and mediastinum 20 minutes after injection of 1 mCi technetium-99m pertechnetate. TTU was measured as the percentage of the count of activity accumulated in the thyroidal region minus the mediastinal background uptake to the count of 1 mCi technetium-99m under the same acquisition conditions. Then methimazole was stopped and patients were followed. The optimal TTU cutoff value for Graves relapse prediction was calculated using Youden's J statistic. Hyperthyroidism relapsed in 11 (28.9%) patients 122 ± 96 (range: 15-290) days post-ATD withdrawal. The subjects in remission were followed for 209 ± 81 days (range: 88-390). TTU was significantly higher in patients with forthcoming relapse (12.0 ± 8.0 vs. 3.9 ± 2.0, P = .007). The difference was significant after adjustment for age, sex, history of previous relapse, disease duration, and thyroid-stimulating hormone (TSH) levels before withdrawal. The area under the receiver operative characteristic (ROC) curve was 0.87. The optimal TTU cutoff value for classification of subjects with relapse and remission was 8.7 with sensitivity, specificity, and positive and negative predictive value of 73%, 100%, 100%, and 90%, respectively (odds ratio [OR] = 10.0; 95% confidence interval [CI]: 3.4-29.3). TTU evaluation in hyperthyroid patients receiving antithyroid medication is an accurate and practical method for predicting relapse after ATD withdrawal. ATD = antithyroid drugs RIU = radio-iodine uptake TSH = thyroid-stimulating hormone TSI = thyroid-stimulating immunoglobulin TTU = technetium thyroid uptake.

  20. Fluid circulation and diagenesis of carbonated and sandstone reservoirs in the fronts and fore-lands of folded chains: the Salt Range case - Poswar (Pakistan); Circulation des fluides et diagenese des reservoirs carbonates et greseux dans les fronts de chaines plissees et leur avant pays: le cas du Salt Range - Poswar (Pakistan)

    Energy Technology Data Exchange (ETDEWEB)

    Benchilla, L.

    2003-05-01

    The Salt Range-Poswar Province is located in the western foothills of the Himalayas, in northern Pakistan. It extends over 170 km from the Main Boundary Thrust (MBT) in the north to the Salt Range in the south. The Salt Range itself is dominantly an ENE-trending structure, but it comprises also a NNW-trending lateral ramp which connects to the west with the Surghar Range. The Salt Range constitutes the frontal part of a detached allochthonous thrust sheet. The sedimentary cover is indeed entirely detached from its substratum along Infracambrian salt horizons. Palaeozoic to Eocene platform series are well exposed in the hanging wall, whereas Neogene molasse has been extensively under-thrust in the footwall of this large over-thrust. The North Potwar Basin is bordered by the Khari-Murat Ridge and coeval back-thrusts in the south, by the northern flank of the Soan syncline in the southeast, and by the MBT in the north. In addition to Neogene outcrops, it also comprises a number of surface anticlines and thrust fronts along which the Eocene platform carbonates are exposed. The Datta Formation is the main Jurassic oil reservoir in the Potwar Basin. It is a fluvio-deltaic deposit which comprises large porous and permeable channels associated to many-calcareous interbeds. The formations crop out well in both the Nammal and Chichali Gorges. The oil field of Toot, located in the western part of the basin, is producing from this reservoir. The petrographic observations show that diagenesis occurred mainly early and was controlled by the fluvio-deltaic environment. (author)

  1. 36 CFR 222.10 - Range betterment fund.

    Science.gov (United States)

    2010-07-01

    ... allocated for range rehabilitation, protection and improvements on National Forest lands within the Forest... also be accomplished through use of the range betterment fund as follows: (a) On National Forest land... 36 Parks, Forests, and Public Property 2 2010-07-01 2010-07-01 false Range betterment fund. 222.10...

  2. Potential effects of existing and proposed groundwater withdrawals on water levels and natural groundwater discharge in Snake Valley and surrounding areas, Utah and Nevada

    Science.gov (United States)

    Masbruch, Melissa D.; Brooks, Lynette E.

    2017-04-14

    discharge, to future stresses at a point in the area represented by the model. In this way, these maps can be used as a tool to determine the source of water to, and potential effects at specific areas from, future well withdrawals.Downward trends in water levels measured in wells indicate that existing groundwater withdrawals in Snake Valley are affecting water levels. The numerical model simulates similar downward trends in water levels; simulated drawdowns in the model, however, are generally less than observed water-level declines. At the groundwater discharge sites of interest to the DOI agencies, simulated drawdowns from existing well withdrawals (projected into the future) range from 0 to about 50 feet. Following the addition of the proposed withdrawals, simulated drawdowns at some sites increase by 25 feet. Simulated drawdown resulting from the proposed withdrawals began in as few as 5 years after 2014 at several of the sites. At the groundwater discharge sites of interest to the DOI agencies, simulated capture of natural discharge resulting from the existing withdrawals ranged from 0 to 87 percent. Following the addition of the proposed withdrawals, simulated capture at several of the sites reached 100 percent, indicating that groundwater discharge at that site would cease. Simulated capture following the addition of the proposed withdrawals increased in as few as 5 years after 2014 at several of the sites.

  3. Developing a methodology for real-time trading of water withdrawal and waste load discharge permits in rivers.

    Science.gov (United States)

    Soltani, Maryam; Kerachian, Reza

    2018-02-13

    In this paper, a new methodology is proposed for the real-time trading of water withdrawal and waste load discharge permits in agricultural areas along the rivers. Total Dissolved Solids (TDS) is chosen as an indicator of river water quality and the TDS load that agricultural water users discharge to the river are controlled by storing a part of return flows in some evaporation ponds. Available surface water withdrawal and waste load discharge permits are determined using a non-linear multi-objective optimization model. Total available permits are then fairly reallocated among agricultural water users, proportional to their arable lands. Water users can trade their water withdrawal and waste load discharge permits simultaneously, in a bilateral, step by step framework, which takes advantage of differences in their water use efficiencies and agricultural return flow rates. A trade that would take place at each time step results in either more benefit or less diverted return flow. The Nucleolus cooperative game is used to redistribute the benefits generated through trades in different time steps. The proposed methodology is applied to PayePol region in the Karkheh River catchment, southwest Iran. Predicting that 1922.7 Million Cubic Meters (MCM) of annual flow is available to agricultural lands at the beginning of the cultivation year, the real-time optimization model estimates the total annual benefit to reach 46.07 million US Dollars (USD), which requires 6.31 MCM of return flow to be diverted to the evaporation ponds. Fair reallocation of the permits, changes these values to 35.38 million USD and 13.69 MCM, respectively. Results illustrate the effectiveness of the proposed methodology in the real-time water and waste load allocation and simultaneous trading of permits. Copyright © 2018 Elsevier Ltd. All rights reserved.

  4. Effects of water use and land use on streamflow and aquatic habitat in the Sudbury and Assabet River Basins, Massachusetts

    Science.gov (United States)

    Zarriello, Phillip J.; Parker, Gene W.; Armstrong, David S.; Carlson, Carl S.

    2010-01-01

    Water withdrawals from surface-water reservoirs and groundwater have affected streamflow in the Sudbury and Assabet River Basins. These effects are particularly evident in the upper Sudbury River Basin, which prompted the need to improve the understanding of water resources and aquatic habitat in these basins. In 2004, the U.S. Geological Survey, in cooperation with the Massachusetts Department of Conservation and Recreation, developed a precipitation-runoff model that uses Hydrologic Simulation Program-FORTRAN (HSPF) to evaluate the effects of water use and projected future water-use and land-use change on streamflow. As part of this study, the aquatic habitat in the basins and the effects of streamflow alteration also were evaluated. Chapter 1 of the report covers the development of the HSPF model that focuses on the upper Sudbury River Basin (106 square miles) but covers the entire Sudbury and Assabet River Basins (339 square miles). The model was calibrated to an 11-year period (1993-2003) using observed or estimated streamflow at four streamgages. The model was then used to simulate long-term (1960-2004) streamflows to evaluate the effects of average 1993-2003 water use and projected 2030 water-use and land-use change over long-term climatic conditions. Simulations indicate that the average 1993-2003 withdrawals most altered streamflow relative to no withdrawals in small headwater subbasins where the ratios of mean annual withdrawals to mean annual streamflow are the highest. The effects of withdrawals are also appreciable in other parts of the upper Sudbury River Basin as a result of the perpetuation of the effects of large withdrawals in upstream reaches or in subbasins that also have a high ratio of withdrawal to streamflow. The simulated effects of potential 2030 water-use and land-use change indicate small decreases in flows as a result of increased water demands, but these flow alterations were offset as a result of decreased evapotranspiration

  5. Assessing uncertainties in land cover projections.

    Science.gov (United States)

    Alexander, Peter; Prestele, Reinhard; Verburg, Peter H; Arneth, Almut; Baranzelli, Claudia; Batista E Silva, Filipe; Brown, Calum; Butler, Adam; Calvin, Katherine; Dendoncker, Nicolas; Doelman, Jonathan C; Dunford, Robert; Engström, Kerstin; Eitelberg, David; Fujimori, Shinichiro; Harrison, Paula A; Hasegawa, Tomoko; Havlik, Petr; Holzhauer, Sascha; Humpenöder, Florian; Jacobs-Crisioni, Chris; Jain, Atul K; Krisztin, Tamás; Kyle, Page; Lavalle, Carlo; Lenton, Tim; Liu, Jiayi; Meiyappan, Prasanth; Popp, Alexander; Powell, Tom; Sands, Ronald D; Schaldach, Rüdiger; Stehfest, Elke; Steinbuks, Jevgenijs; Tabeau, Andrzej; van Meijl, Hans; Wise, Marshall A; Rounsevell, Mark D A

    2017-02-01

    Understanding uncertainties in land cover projections is critical to investigating land-based climate mitigation policies, assessing the potential of climate adaptation strategies and quantifying the impacts of land cover change on the climate system. Here, we identify and quantify uncertainties in global and European land cover projections over a diverse range of model types and scenarios, extending the analysis beyond the agro-economic models included in previous comparisons. The results from 75 simulations over 18 models are analysed and show a large range in land cover area projections, with the highest variability occurring in future cropland areas. We demonstrate systematic differences in land cover areas associated with the characteristics of the modelling approach, which is at least as great as the differences attributed to the scenario variations. The results lead us to conclude that a higher degree of uncertainty exists in land use projections than currently included in climate or earth system projections. To account for land use uncertainty, it is recommended to use a diverse set of models and approaches when assessing the potential impacts of land cover change on future climate. Additionally, further work is needed to better understand the assumptions driving land use model results and reveal the causes of uncertainty in more depth, to help reduce model uncertainty and improve the projections of land cover. © 2016 John Wiley & Sons Ltd.

  6. Appendicitis in a Patient with Drug Withdrawal Symptoms

    Directory of Open Access Journals (Sweden)

    Viroj Wiwanitkit

    2010-11-01

    Full Text Available Physical disorders can be seen in psychiatric patients. In addition, a delayed diagnosis can cause a serious complication of the physical disorder among such patients. In this report, a case of appendicitis in a psychiatric case with drug withdrawal symptoms was reported.

  7. 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:…

  8. Priapism Associated with MethylphenidateSR (Concerta Withdrawal

    Directory of Open Access Journals (Sweden)

    J Gordon Millichap

    2004-07-01

    Full Text Available A 15-year-old boy with attention deficit hyperactivity disorder, inattention subtype (ADHD, developed stuttering priapism (intermittent, prolonged, painful erections after withdrawal of OROS methylphenidate (ConcertaR 36 mg/day, and is reported from Inova Fairfax Hospital for Children, Falls Church, VA, and Children’s National Medical Center, Washington, DC.

  9. Priapism Associated with MethylphenidateSR (Concerta) Withdrawal

    OpenAIRE

    J Gordon Millichap

    2004-01-01

    A 15-year-old boy with attention deficit hyperactivity disorder, inattention subtype (ADHD), developed stuttering priapism (intermittent, prolonged, painful erections) after withdrawal of OROS methylphenidate (ConcertaR) 36 mg/day, and is reported from Inova Fairfax Hospital for Children, Falls Church, VA, and Children’s National Medical Center, Washington, DC.

  10. Withdrawal or reduction of the dietary vitamin premix on bone ...

    African Journals Online (AJOL)

    p2492989

    However, the withdrawal of vitamin supplements in grower diets has been evaluated in the last few years as a way of reducing the cost of broiler chicken production (Skinner et al.,. 1992). Deyhim & Teeter (1993) reported that the removal of both vitamins and trace elements from the broiler diet when reaching the age of 28 ...

  11. Post-transplant withdrawal of lamivudine results in fatal hepatitis ...

    African Journals Online (AJOL)

    Post-transplant withdrawal of lamivudine results in fatal hepatitis flares in kidney transplant ... Journal Home > Vol 16, No 4 (2016) > ... The PDF file you selected should load here if your Web browser has a PDF reader plug-in installed (for ...

  12. 9 CFR 355.38 - Withdrawal of service.

    Science.gov (United States)

    2010-01-01

    ... 9 Animals and Animal Products 2 2010-01-01 2010-01-01 false Withdrawal of service. 355.38 Section 355.38 Animals and Animal Products FOOD SAFETY AND INSPECTION SERVICE, DEPARTMENT OF AGRICULTURE... INSPECTION AND CERTIFICATION CERTIFIED PRODUCTS FOR DOGS, CATS, AND OTHER CARNIVORA; INSPECTION...

  13. 29 CFR 4281.18 - Outstanding claims for withdrawal liability.

    Science.gov (United States)

    2010-07-01

    ... INSOLVENCY, REORGANIZATION, TERMINATION, AND OTHER RULES APPLICABLE TO MULTIEMPLOYER PLANS DUTIES OF PLAN... in insolvency proceedings. The plan sponsor shall value an outstanding claim for withdrawal liability... title 11, United States Code, or any case or proceeding under similar provisions of state insolvency...

  14. Withdrawal from the International Criminal Court: Does Africa have ...

    African Journals Online (AJOL)

    After a century in the making, the International Criminal Court (ICC) came into existence in 2002 with an overwhelming number of states ratifying the Rome Statute. With 34 signatories, Africa is the largest contributor in the Assembly of State Parties, yet Africa has become its severest critic. As threats of withdrawal become a ...

  15. An Assessment of College and University Course Withdrawal Policies

    Science.gov (United States)

    Romano, John J.

    1978-01-01

    Many issues are involved in the formulation of college and university course and withdrawal policies. Although such policies may be related to grade inflation, other problem areas are evident and require amplification and assessment. This paper reports a study of the issues based on a survey of 30 colleges. (Author)

  16. 75 FR 60113 - Pesticide Science Policy; Notice of Withdrawal

    Science.gov (United States)

    2010-09-29

    ... ) for public comment. This science policy document was developed to explain a particular statistical... Register notice updates the public on the status of one of the Science Policy papers. List of Subjects... AGENCY Pesticide Science Policy; Notice of Withdrawal AGENCY: Environmental Protection Agency (EPA...

  17. [Somatometry and lipid profile in smokers. Modifications after smoking withdrawal].

    Science.gov (United States)

    Aparici, M; Fernández González, A L; Alegría, E

    1991-06-15

    The purpose of this work was to determine the somatometric and lipidic profile in a group of 90 smokers and to carry out a prospective study on modifications due to smoking withdrawal. A somatometric and lipidic profile was performed to 90 smokers and 30 non-smokers. Afterwards smokers were included in a smoking withdrawal program. One year later all subjects who stopped smoking as well as 10 of the smokers who failed in smoking withdrawal underwent a new blood analysis and somatometric study. Initial somatometry showed that smokers had a significantly higher (p less than 0.05) overweight and endomorphic index, based on somatometric characteristics. In addition, smokers showed significant lower level of HDL-cholesterol (high-density lipoprotein) than non-smokers (p less than 0.001). Somatometric and lipidic profile performed one year after smoking cessation showed a statistically significant increase on HDL-cholesterol (p less than 0.05). Somatometric and lipidic profile of the subjects who failed in smoking withdrawal showed no significant changes in relation to the study made the previous year. From these data we suggest that modifications of lipidic profile induced by tobacco consumption can be reverted, at least in part, after smoking cessation. In addition smokers present higher overweight when theoretic weight is based on somatometric characteristics.

  18. 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.

  19. Withdrawal Strength and Bending Yield Strength of Stainless Steel Nails

    Science.gov (United States)

    Douglas R. Rammer; Samuel L. Zelinka

    2015-01-01

    It has been well established that stainless steel nails have superior corrosion performance compared to carbon steel or galvanized nails in treated wood; however, their mechanical fastening behavior is unknown. In this paper, the performance of stainless steel nails is examined with respect to two important properties used in wood connection design: withdrawal strength...

  20. The effect of different dietary fat sources, withdrawal times, and ...

    African Journals Online (AJOL)

    The effect of different dietary fat sources, withdrawal times, and castration on the fatty acid composition of backfat in baconer ... contain 187o protein, 1,07o lysine and 13,5 Mtkg digestible energy. Diet A, the control, was a normal pig .... Autoregressive model as described by Siebrits (1986). Table 2. Experimental treatments.

  1. MDs voice similar rationales for treatment withdrawal and euthanasia.

    Science.gov (United States)

    1994-01-01

    Although the withdrawal of treatment and active euthanasia are viewed as two different processes with two different objectives, the conditions under which these actions are justified by physicians have much in common, as the following articles on two new surveys show.

  2. Tramadole Withdrawal in a Neonate: A Case Report

    Directory of Open Access Journals (Sweden)

    H Borna

    2012-09-01

    Full Text Available Background: Tramadol is a synthetics 4-phenyl-piperidine analogue of codeine used for treating moderate to severe pain. Tramadol is a FDA pregnancy category C medication which induces release of serotonin and inhibits the reuptake of norepinephrine. Chronic use of this drug during pregnancy may lead to physical dependency and withdrawal syndrome in the neonate.Case presentation: We report the newborn of a woman admitted in the delivery ward of Mostafa Khomeini Hospital in Tehran, Iran in 2011. The mother suffered from chronic low back pain and headache and frequently took tramadol during pregnancy. The infant had a gestational age of 38.5 w, a birth weight of 2950 gr and an Apgar score of 9/10 at 1 and 5 minutes after birth. The first signs of withdrawal syndrome occurred after 24 h with nausea, vomiting, poor feeding, and tremor. Later, agitation, tremor, hyprertonicity, and repeated multifocal myoclonus, and generalized tonic-clonic seizures developed. Clinical signs of withdrawal syndrome waned under phenobarbital therapy.Conclusion: Drug withdrawal syndrome should be considered in the neonates of pregnant mothers who chronically take tramadol. Tramadol administration during pregnancy should be restricted to carefully selected cases.

  3. Study of possible reduction or withdrawal of vitamin premix during ...

    African Journals Online (AJOL)

    Jane

    2011-07-06

    Jul 6, 2011 ... meet vitamin requirements (Coelho and McNaughton,. 1995). It has been reported that minerals and vitamins are being added to the diet when they may not be needed (Skinner et al., 1992). The withdrawal of vitamin or mineral supplements in finisher diets has been evalua-. *Corresponding author. E-mail: ...

  4. Study of possible reduction or withdrawal of vitamin premix during ...

    African Journals Online (AJOL)

    The effect of dietary vitamin premix withdrawal or reduction between 29 and 35, 36 and 42, and 29 and 42 days of age on broiler chicken performance and immunocompetence was evaluated. The diets were formulated based on wheat and barley, and the experiment was conducted in floor pens (experiment 1) and battery ...

  5. Withdrawal of valproic acid treatment during pregnancy and seizure outcome

    DEFF Research Database (Denmark)

    Tomson, Torbjörn; Battino, Dina; Bonizzoni, Erminio

    2016-01-01

    Based on data from the EURAP observational International registry of antiepileptic drugs (AEDs) and pregnancy, we assessed changes in seizure control and subsequent AED changes in women who underwent attempts to withdraw valproic acid (VPA) during the first trimester of pregnancy. Applying Bayesi...

  6. A Case Report of Severe Delirium after Amantadine Withdrawal

    Directory of Open Access Journals (Sweden)

    Franz Marxreiter

    2017-03-01

    Full Text Available Amantadine is frequently used in addition to dopaminergic substances like dopamine agonists or L-Dopa in advanced Parkinson disease (PD. However, adverse effects like hallucinations limit its use. PD patients developing severe psychotic symptoms upon treatment with either dopaminergic substances and/or amantadine need to stop intake of any psychotropic substance. Here, we report the case of a 71-year-old PD patient without previously known cognitive impairment. He presented with drug-induced psychotic symptoms due to changes in his therapeutic regimen (increase in COMT inhibitors, newly introduced MAO B inhibitors. Also, amantadine had been part of his long-term medication for more than 2 years. The severity of his psychotic symptoms required a L-Dopa monotherapy. After changing his medication, the patient developed severe delirium that resolved rapidly after i.v. amantadine infusion, suggesting an amantadine withdrawal syndrome. Amantadine withdrawal syndrome is a rare adverse event that may present even in PD patients without cognitive impairment. This case report highlights the need for a gradual withdrawal of amantadine even if acute and severe psychotic symptoms are present. Moreover, this is the first report of a cognitively unimpaired patient developing an amantadine withdrawal syndrome.

  7. 31 CFR 800.507 - Withdrawal of notice.

    Science.gov (United States)

    2010-07-01

    ... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false Withdrawal of notice. 800.507 Section 800.507 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF INVESTMENT SECURITY, DEPARTMENT OF THE TREASURY REGULATIONS PERTAINING TO MERGERS, ACQUISITIONS, AND...

  8. Sports Participation and Withdrawal: A Developmental Motivational Commentary.

    Science.gov (United States)

    Hom, Larry L.

    1996-01-01

    Examines the nature of adolescents' sports involvement as reflected in reasons for participation and withdrawal. Claims that the degree of fun, the motivation to attain competence, and the capacity to distinguish ability from effort are important. Concludes that if the goal of sports is to foster a healthy lifestyle, the issue of maximizing…

  9. A Case Report of Severe Delirium after Amantadine Withdrawal.

    Science.gov (United States)

    Marxreiter, Franz; Winkler, Jürgen; Uhl, Martin; Madžar, Dominik

    2017-01-01

    Amantadine is frequently used in addition to dopaminergic substances like dopamine agonists or L-Dopa in advanced Parkinson disease (PD). However, adverse effects like hallucinations limit its use. PD patients developing severe psychotic symptoms upon treatment with either dopaminergic substances and/or amantadine need to stop intake of any psychotropic substance. Here, we report the case of a 71-year-old PD patient without previously known cognitive impairment. He presented with drug-induced psychotic symptoms due to changes in his therapeutic regimen (increase in COMT inhibitors, newly introduced MAO B inhibitors). Also, amantadine had been part of his long-term medication for more than 2 years. The severity of his psychotic symptoms required a L-Dopa monotherapy. After changing his medication, the patient developed severe delirium that resolved rapidly after i.v. amantadine infusion, suggesting an amantadine withdrawal syndrome. Amantadine withdrawal syndrome is a rare adverse event that may present even in PD patients without cognitive impairment. This case report highlights the need for a gradual withdrawal of amantadine even if acute and severe psychotic symptoms are present. Moreover, this is the first report of a cognitively unimpaired patient developing an amantadine withdrawal syndrome.

  10. Opiate withdrawal syndrome in buprenorphine abusers admitted to ...

    African Journals Online (AJOL)

    Background: Illicit use of high dosage buprenorphine has been well documented in several countries, including Tunisia. Objectives: The aim of this survey is to assess the buprenorphine withdrawal syndrome time course, and how it may be affected by the population characteristics among subjects admitted to a ...

  11. 29 CFR 4044.74 - Withdrawal of employee contributions.

    Science.gov (United States)

    2010-07-01

    ... benefit payments on the date of distribution, the value of the lump sum which returns mandatory employee... of termination to the date of distribution. The rate of interest credited on employee contributions... 29 Labor 9 2010-07-01 2010-07-01 false Withdrawal of employee contributions. 4044.74 Section 4044...

  12. 9 CFR 362.4 - Denial or withdrawal of service.

    Science.gov (United States)

    2010-01-01

    ... 9 Animals and Animal Products 2 2010-01-01 2010-01-01 false Denial or withdrawal of service. 362.4 Section 362.4 Animals and Animal Products FOOD SAFETY AND INSPECTION SERVICE, DEPARTMENT OF AGRICULTURE..., assaults, abuse, or any other improper means; (iv) has knowingly falsely made, issued, altered, forged, or...

  13. Social Withdrawal Subtypes during Early Adolescence in India

    Science.gov (United States)

    Bowker, Julie C.; Raja, Radhi

    2011-01-01

    The overarching goal of this study was to examine the associations between three social withdrawal subtypes (shyness, unsociability, avoidance), peer isolation, peer difficulties (victimization, rejection, exclusion, low acceptance), and loneliness in India during early adolescence. Participants were 194 adolescents in Surat, India (M age=13.35…

  14. Social Anxiety and Adolescents' Friendships: The Role of Social Withdrawal

    Science.gov (United States)

    Biggs, Bridget K.; Vernberg, Eric M.; Wu, Yelena P.

    2012-01-01

    Research indicates social anxiety is associated with lower friendship quality, but little is known about the underlying mechanisms. This 2-month longitudinal study examined social withdrawal as a mediator of the social anxiety-friendship quality link in a sample of 214 adolescents (M[subscript age] = 13.1 years, SD = 0.73) that included an…

  15. 31 CFR 281.6 - Withdrawals from Treasury accounts.

    Science.gov (United States)

    2010-07-01

    ... 31 Money and Finance: Treasury 2 2010-07-01 2010-07-01 false Withdrawals from Treasury accounts. 281.6 Section 281.6 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) FISCAL SERVICE, DEPARTMENT OF THE TREASURY FINANCIAL MANAGEMENT SERVICE FOREIGN EXCHANGE OPERATIONS § 281...

  16. Polymerization catalysts containing electron-withdrawing amide ligands

    Science.gov (United States)

    Watkin, John G.; Click, Damon R.

    2002-01-01

    The present invention describes methods of making a series of amine-containing organic compounds which are used as ligands for group 3-10 and lanthanide metal compounds. The ligands have electron-withdrawing groups bonded to them. The metal compounds, when combined with a cocatalyst, are catalysts for the polymerization of olefins.

  17. Steroid withdrawal in renal transplant patients: the Irish experience.

    LENUS (Irish Health Repository)

    Phelan, P J

    2010-10-29

    BACKGROUND: Steroid therapy is associated with significant morbidity in renal transplant recipients. However, there is concern that steroid withdrawal will adversely affect outcome. METHODS: We report on 241 renal transplant recipients on different doses of corticosteroids at 3 months (zero, ≤5 mg\\/day, >5 mg\\/day). Parameters analysed included blood pressure, lipid profile, weight change, new onset diabetes after transplantation (NODAT), allograft survival and acute rejection. RESULTS: Elimination of corticosteroids had no impact on allograft survival at 1 year. There were no cases of NODAT in the steroid withdrawal group compared with over 7% in each of the steroid groups. There were no significant improvements in weight gain, blood pressure control or total cholesterol with withdrawal of steroids before 3 months. CONCLUSIONS: In renal transplant patients treated with tacrolimus and mycophenolate, early withdrawal of steroids does not appear to adversely affect allograft outcome at 1 year. It may result in less NODAT.

  18. 24 CFR 1003.702 - Reduction or withdrawal of grant.

    Science.gov (United States)

    2010-04-01

    ... Development (Continued) OFFICE OF ASSISTANT SECRETARY FOR PUBLIC AND INDIAN HOUSING, DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT COMMUNITY DEVELOPMENT BLOCK GRANTS FOR INDIAN TRIBES AND ALASKA NATIVE VILLAGES... 24 Housing and Urban Development 4 2010-04-01 2010-04-01 false Reduction or withdrawal of grant...

  19. 15 CFR 10.13 - Withdrawal of a published standard.

    Science.gov (United States)

    2010-01-01

    ... Standards & Technology at any time. Such action will be taken if, after consultation with the Standing... organization, or that lack of government sponsorship would result in significant public disadvantage for legal... advantages and disadvantages of amendment, revision, development of a new standard, or withdrawal with the...

  20. 27 CFR 20.161 - Withdrawals under permit.

    Science.gov (United States)

    2010-04-01

    ... permittee may obtain domestic specially denatured spirits only. The alcohol in domestic denatured spirits... 27 Alcohol, Tobacco Products and Firearms 1 2010-04-01 2010-04-01 false Withdrawals under permit. 20.161 Section 20.161 Alcohol, Tobacco Products and Firearms ALCOHOL AND TOBACCO TAX AND TRADE BUREAU...

  1. 27 CFR 20.162 - Regulation of withdrawals.

    Science.gov (United States)

    2010-04-01

    ... 27 Alcohol, Tobacco Products and Firearms 1 2010-04-01 2010-04-01 false Regulation of withdrawals. 20.162 Section 20.162 Alcohol, Tobacco Products and Firearms ALCOHOL AND TOBACCO TAX AND TRADE BUREAU, DEPARTMENT OF THE TREASURY LIQUORS DISTRIBUTION AND USE OF DENATURED ALCOHOL AND RUM Operations by Dealers...

  2. [Treatment of iatrogenic Cushing syndrome: questions of glucocorticoid withdrawal].

    Science.gov (United States)

    Igaz, Péter; Rácz, Károly; Tóth, Miklós; Gláz, Edit; Tulassay, Zsolt

    2007-02-04

    Iatrogenic Cushing's syndrome is the most common form of hypercortisolism. Glucocorticoids are widely used for the treatment of various diseases, often in high doses that may lead to the development of severe hypercortisolism. Iatrogenic hypercortisolism is unique, as the application of exogenous glucocorticoids leads to the simultaneous presence of symptoms specific for hypercortisolism and the suppression of the endogenous hypothalamic-pituitary-adrenal axis. The principal question of its therapy is related to the problem of glucocorticoid withdrawal. There is considerable interindividual variability in the suppression and recovery of the hypothalamic-pituitary-adrenal axis, therefore, glucocorticoid withdrawal and substitution can only be conducted in a stepwise manner with careful clinical follow-up and regular laboratory examinations regarding endogenous hypothalamic-pituitary-adrenal axis activity. Three major complications which can be associated with glucocorticoid withdrawal are: i. reactivation of the underlying disease, ii. secondary adrenal insufficiency, iii. steroid withdrawal syndrome. Here, the authors summarize the most important aspects of this area based on their clinical experience and the available literature data.

  3. Post-transplant withdrawal of lamivudine results in fatal hepatitis ...

    African Journals Online (AJOL)

    Post-transplant withdrawal of lamivudine results in fatal hepatitis flares in kidney transplant recipients, under immune suppression, with inactive hepatitis B infection. Bin Miao1, Xiang-Ming Lao2, Guo-Li Lin3. 1. Department of Organ Transplantation, The Third Affiliated Hospital of Sun Yat-sen University,. Guangzhou, China.

  4. The impact of withdrawal rofecoxib on NSAIDs utilization

    NARCIS (Netherlands)

    Atthobari, J.; Boersma, C.; Visser, S.T.; Postma, M.J.; De Jong-Van Den Berg, L.T.W.

    2010-01-01

    Background: Pharmacovigilance is an important tool to gather real-life information on effectiveness and adverse effects of drugs. Therefore, post-marketing study can lead to new therapeutic insights or even market withdrawal. In September 2004, rofecoxib was withdrawn from the market for reasons of

  5. Clomipramine concentration and withdrawal symptoms in 10 neonates

    NARCIS (Netherlands)

    ter Horst, Peter G. J.; van der Linde, Susanne; Smit, Jan Pieter; den Boon, Jan; van Lingen, Richard A.; Jansman, Frank G. A.; De Jong-van den Berg, Lolkje T. W.; Wilffert, Bob

    AIM After in utero exposure to tricyclic antidepressants, neonatal withdrawal symptoms have been reported with an estimated incidence between 20 and 50%; however, few data are available for clomipramine. This could also be the case for neonatal pharmacokinetic clomipramine parameters and so this

  6. 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 Section 400.301 Public Welfare Regulations Relating to Public Welfare OFFICE OF REFUGEE RESETTLEMENT, ADMINISTRATION FOR CHILDREN AND FAMILIES, DEPARTMENT OF HEALTH AND HUMAN SERVICES REFUGEE RESETTLEMENT PROGRAM...

  7. Why Iranian married women use withdrawal instead of oral contraceptives? A qualitative study from Iran

    National Research Council Canada - National Science Library

    Rahnama, Parvin; Hidarnia, Alireza; Shokravi, Farkhondeh Amin; Kazemnejad, Anoushiravan; Oakley, Deborah; Montazeri, Ali

    2010-01-01

    Withdrawal as a method of birth control is still used in Iran. The aim of this study was to explore married women's perspectives and attitudes on withdrawal use instead of oral contraceptive (OC) in Tehran, Iran...

  8. Nicotinic Receptors in the Habenulo-Interpeduncular System Are Necessary for Nicotine Withdrawal in Mice

    National Research Council Canada - National Science Library

    Salas, Ramiro; Sturm, Renea; Boulter, Jim; De Biasi, Mariella

    2009-01-01

    .... Nicotine withdrawal symptoms can also be observed in rodents. A major standing question is which nicotinic receptor subtypes and which areas of the brain are necessary for nicotine withdrawal to occur...

  9. A Case Report of Clonazepam Dependence: Utilization of Therapeutic Drug Monitoring During Withdrawal Period

    National Research Council Canada - National Science Library

    Kacirova, Ivana; Grundmann, Milan; Silhan, Petr; Brozmanova, Hana

    2016-01-01

    ...) without any signs of benzodiazepine intoxication. Gradual withdrawal of clonazepam with monitoring of its serum levels and increase of gabapentin dose were used to minimize physical signs and symptoms of clonazepam withdrawal...

  10. Prospective Assessment of Cannabis Withdrawal in Adolescents with Cannabis Dependence: A Pilot Study

    Science.gov (United States)

    Milin, Robert; Manion, Ian; Dare, Glenda; Walker, Selena

    2008-01-01

    A study to identify and assess the withdrawal symptoms in adolescents afflicted with cannabis dependence is conducted. Results conclude that withdrawal symptoms of cannabis were present in adolescents seeking treatment for this substance abuse.

  11. 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...

  12. 75 FR 71559 - Hazardous Waste Management System; Identification and Listing of Hazardous Waste; Withdrawal of...

    Science.gov (United States)

    2010-11-24

    ... From the Federal Register Online via the Government Publishing Office ENVIRONMENTAL PROTECTION AGENCY 40 CFR Part 261 Hazardous Waste Management System; Identification and Listing of Hazardous Waste; Withdrawal of Direct Final Exclusion AGENCY: Environmental Protection Agency (EPA). ACTION: Withdrawal of...

  13. Narcotic and benzodiazepine use after withdrawal of life support: association with time to death?

    National Research Council Canada - National Science Library

    Chan, Jeannie D; Treece, Patsy D; Engelberg, Ruth A; Crowley, Lauren; Rubenfeld, Gordon D; Steinberg, Kenneth P; Curtis, J Randall

    2004-01-01

    To determine whether the dose of narcotics and benzodiazepines is associated with length of time from mechanical ventilation withdrawal to death in the setting of withdrawal of life-sustaining treatment in the ICU...

  14. Steroid avoidance or withdrawal for kidney transplant recipients.

    Science.gov (United States)

    Haller, Maria C; Royuela, Ana; Nagler, Evi V; Pascual, Julio; Webster, Angela C

    2016-08-22

    Steroid-sparing strategies have been attempted in recent decades to avoid morbidity from long-term steroid intake among kidney transplant recipients. Previous systematic reviews of steroid withdrawal after kidney transplantation have shown a significant increase in acute rejection. There are various protocols to withdraw steroids after kidney transplantation and their possible benefits or harms are subject to systematic review. This is an update of a review first published in 2009. To evaluate the benefits and harms of steroid withdrawal or avoidance for kidney transplant recipients. We searched the Cochrane Kidney and Transplant Specialised Register to 15 February 2016 through contact with the Information Specialist using search terms relevant to this review. All randomised and quasi-randomised controlled trials (RCTs) in which steroids were avoided or withdrawn at any time point after kidney transplantation were included. Assessment of risk of bias and data extraction was performed by two authors independently and disagreement resolved by discussion. Statistical analyses were performed using the random-effects model and dichotomous outcomes were reported as relative risk (RR) and continuous outcomes as mean difference (MD) with 95% confidence intervals. We included 48 studies (224 reports) that involved 7803 randomised participants. Of these, three studies were conducted in children (346 participants). The 2009 review included 30 studies (94 reports, 5949 participants). Risk of bias was assessed as low for sequence generation in 19 studies and allocation concealment in 14 studies. Incomplete outcome data were adequately addressed in 22 studies and 37 were free of selective reporting.The 48 included studies evaluated three different comparisons: steroid avoidance or withdrawal compared with steroid maintenance, and steroid avoidance compared with steroid withdrawal. For the adult studies there was no significant difference in patient mortality either in studies

  15. Land surface Verification Toolkit (LVT)

    Science.gov (United States)

    Kumar, Sujay V.

    2017-01-01

    LVT is a framework developed to provide an automated, consolidated environment for systematic land surface model evaluation Includes support for a range of in-situ, remote-sensing and other model and reanalysis products. Supports the analysis of outputs from various LIS subsystems, including LIS-DA, LIS-OPT, LIS-UE. Note: The Land Information System Verification Toolkit (LVT) is a NASA software tool designed to enable the evaluation, analysis and comparison of outputs generated by the Land Information System (LIS). The LVT software is released under the terms and conditions of the NASA Open Source Agreement (NOSA) Version 1.1 or later. Land Information System Verification Toolkit (LVT) NOSA.

  16. Land management and development

    DEFF Research Database (Denmark)

    Enemark, Stig

    2006-01-01

    Land management is the process by which the resources of land are put into good effect. Land management encompasses all activities associated with the management of land that are required to achieve sustainable development. The concept of land includes properties and natural resources and thereby...

  17. Flumazenil in treatment benzodiazepine withdrawal syndrome: Case report

    Directory of Open Access Journals (Sweden)

    Ramah Aleksandar J.

    2015-01-01

    Full Text Available Background: Today in the world and in Serbia is growing number of people who are addicted to benzodiazepine. A particular problem is the process of detoxification and treatment of benzodiazepine withdrawal syndrome due to a recurrence of symptoms of anxiety disorder, availability of benzodiazepines, falling motivation. Standard procedures have often proved unsuccessful and the last decade, and the search for new protocols, including the flumazenil, benzodiazepine receptor antagonist, is actualized. Case report: The patient aged 48 years was admitted to the specialist psychiatric clinic, for treatment of benzodiazepine addiction. Anxiety disorder was diagnosed since adolescence perennial addiction on benzodiazepines and the initial withdrawal syndrome. Former motivated topical treatments for detoxification were unsuccessful. The presence of dual diagnosis, persistence of both disorders in perennial cycle, treatment resistance and actual motivation contributed to the decision to opt rapid detoxification from benzodiazepines by flumazenil application protocol, for hospital treatment by adjuvant therapy with lamotrigine. After discharge from hospital in stable condition it was with no signs of withdrawal syndrome and a rebound of anxiety symptoms. Lamotrigine medication continued including CBT, held during the one-year abstinence monitoring, with sufficient social functionality. Discussion: The efficacy and safety of flumazenil in the treatment of benzodiazepine withdrawal syndrome was investigated in numerous clinical trials, and the mechanism of action is complex, from the benzodiazepine antagonist to inverse agonist in certain circumstances, as well as 'up-regulation' receptors, which together leads to a reduction in symptoms of abstinence syndrome and anxiety in the longer term after treatment, thereby acting favorably to the adherence and remission. Conclusions: Flumazenil protocol is an efficient method in the treatment of the benzodiazepine

  18. Genome-wide examination of myoblast cell cycle withdrawal duringdifferentiation

    Energy Technology Data Exchange (ETDEWEB)

    Shen, Xun; Collier, John Michael; Hlaing, Myint; Zhang, Leanne; Delshad, Elizabeth H.; Bristow, James; Bernstein, Harold S.

    2002-12-02

    Skeletal and cardiac myocytes cease division within weeks of birth. Although skeletal muscle retains limited capacity for regeneration through recruitment of satellite cells, resident populations of adult myocardial stem cells have not been identified. Because cell cycle withdrawal accompanies myocyte differentiation, we hypothesized that C2C12 cells, a mouse myoblast cell line previously used to characterize myocyte differentiation, also would provide a model for studying cell cycle withdrawal during differentiation. C2C12 cells were differentiated in culture medium containing horse serum and harvested at various time points to characterize the expression profiles of known cell cycle and myogenic regulatory factors by immunoblot analysis. BrdU incorporation decreased dramatically in confluent cultures 48 hr after addition of horse serum, as cells started to form myotubes. This finding was preceded by up-regulation of MyoD, followed by myogenin, and activation of Bcl-2. Cyclin D1 was expressed in proliferating cultures and became undetectable in cultures containing 40 percent fused myotubes, as levels of p21(WAF1/Cip1) increased and alpha-actin became detectable. Because C2C12 myoblasts withdraw from the cell cycle during myocyte differentiation following a course that recapitulates this process in vivo, we performed a genome-wide screen to identify other gene products involved in this process. Using microarrays containing approximately 10,000 minimally redundant mouse sequences that map to the UniGene database of the National Center for Biotechnology Information, we compared gene expression profiles between proliferating, differentiating, and differentiated C2C12 cells and verified candidate genes demonstrating differential expression by RT-PCR. Cluster analysis of differentially expressed genes revealed groups of gene products involved in cell cycle withdrawal, muscle differentiation, and apoptosis. In addition, we identified several genes, including DDAH2 and Ly

  19. Why glucocorticoid withdrawal may sometimes be as dangerous as the treatment itself

    DEFF Research Database (Denmark)

    Dinsen, Stina; Baslund, Bo; Klose, Marianne

    2013-01-01

    Glucocorticoid therapy is widely used, but withdrawal from glucocorticoids comes with a potential life-threatening risk of adrenal insufficiency. Recent case reports document that adrenal crisis after glucocorticoid withdrawal remains a serious problem in clinical practice. Partly due to difficul......Glucocorticoid therapy is widely used, but withdrawal from glucocorticoids comes with a potential life-threatening risk of adrenal insufficiency. Recent case reports document that adrenal crisis after glucocorticoid withdrawal remains a serious problem in clinical practice. Partly due...

  20. Impacts of Land Cover and Land Use Change on the Hydrology of the US-Mexico Border Region, 1992-2011

    Science.gov (United States)

    Bohn, T. J.; Vivoni, E. R.; Mascaro, G.; White, D. D.

    2016-12-01

    The semi-arid US-Mexico border region has been experiencing rapid urbanization and agricultural expansion over the last several decades, due in part to the lifting of trade barriers of the 1994 North American Free Trade Agreement (NAFTA), placing additional pressures on the region's already strained water resources. Here we examine the effects of changes in land cover/use over the period 1992-2011 on the region's hydrology and water resources, using the Variable Infiltration Capacity (VIC) model with an irrigation module to estimate both natural and anthropogenic water fluxes. Land cover has been taken from the National Land Cover Database (NLCD) over the US, and from the Instituto Nacional de Estadística y Geografía (INEGI) database over Mexico, for three snapshots: 1992/3, 2001/2, and 2011. We have performed 3 simulations, one per land cover snapshot, at 6 km resolution, driven by a gridded observed meteorology dataset and a climatology of land surface characteristics derived from remote sensing products. Urban water withdrawal rates were estimated from literature. The primary changes in the region's water budget over the period 1992-2011 consisted of: (1) a shift in agricultural irrigation water withdrawals from the US to Mexico, accompanied by similar shifts in runoff (via agricultural return flow) and evapotranspiration; and (2) a 50% increase in urban water withdrawals, concentrated in the US. Because groundwater supplied most of the additional agricultural withdrawals, and occurred over already over-exploited aquifers, these changes call into question the sustainability of the region's land and water management. By synthesizing the implications of these hydrologic changes, we present a novel view of how NAFTA has altered the US-Mexico border region, possibly in unintended ways.

  1. The Soviet Withdrawal from Afghanistan: Three Key Decisions that Shaped the 40th Army’s Operational Withdrawal Plan

    Science.gov (United States)

    2014-05-22

    Gorbachev, however, did not fully account for the fact that Pakistan was linked at the hip , policy- wise, with the United States. Any form of government...previous chapter. Military planners could not control the political environment thrust upon them during the second half of the withdrawal. However, the

  2. 42 CFR 426.423 - Withdrawing a complaint regarding an LCD under review.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 3 2010-10-01 2010-10-01 false Withdrawing a complaint regarding an LCD under... LOCAL COVERAGE DETERMINATIONS Review of an LCD § 426.423 Withdrawing a complaint regarding an LCD under review. (a) Circumstance under which an aggrieved party may withdraw a complaint regarding an LCD. An...

  3. 40 CFR 97.86 - Withdrawal from NOX Budget Trading Program.

    Science.gov (United States)

    2010-07-01

    ... 40 Protection of Environment 20 2010-07-01 2010-07-01 false Withdrawal from NOX Budget Trading... PROGRAMS (CONTINUED) FEDERAL NOX BUDGET TRADING PROGRAM AND CAIR NOX AND SO2 TRADING PROGRAMS Individual Unit Opt-ins. § 97.86 Withdrawal from NOX Budget Trading Program. (a) Requesting withdrawal. To...

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

    Science.gov (United States)

    Hesse, Morten; Thylstrup, Birgitte

    2013-10-12

    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 use. Symptoms of withdrawal were assessed through patient self-reports during detoxification in Danish residential rehabilitation centers. Patients (n = 90) completed booklets three times during their first month at the treatment centre. Self-reported withdrawal symptoms was rated using 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. 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. The findings yield strong support to the notion of a cannabis withdrawal syndrome, and gives further evidence for the inclusion of the criterion of vivid, unpleasant dreams. Further, the findings speak against the significance of demand characteristics in determining the course of the symptoms of cannabis withdrawal.

  5. 25 CFR 1200.10 - Who is eligible to withdraw their tribal funds from trust?

    Science.gov (United States)

    2010-04-01

    ... 25 Indians 2 2010-04-01 2010-04-01 false Who is eligible to withdraw their tribal funds from trust... INTERIOR AMERICAN INDIAN TRUST FUND MANAGEMENT REFORM ACT Withdrawing Tribal Funds From Trust § 1200.10 Who is eligible to withdraw their tribal funds from trust? Any tribe for whom we manage funds in trust. ...

  6. 25 CFR 117.18 - Withdrawal and payment of segregated trust funds.

    Science.gov (United States)

    2010-04-01

    ... 25 Indians 1 2010-04-01 2010-04-01 false Withdrawal and payment of segregated trust funds. 117.18... CERTIFICATES OF COMPETENCY § 117.18 Withdrawal and payment of segregated trust funds. The withdrawal and payment of segregated trust funds will be made only upon application and satisfactory evidence that the...

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

    Science.gov (United States)

    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 use. Methods Symptoms of withdrawal were assessed through patient self-reports during detoxification in Danish residential rehabilitation centers. Patients (n = 90) completed booklets three times during their first month at the treatment centre. Self-reported withdrawal symptoms was rated using 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. Conclusions The findings yield strong support to the notion of a cannabis withdrawal syndrome, and gives further evidence for the inclusion of the criterion of vivid, unpleasant dreams. Further, the findings speak against the significance of demand characteristics in determining the course of the symptoms of cannabis withdrawal. PMID:24118963

  8. 77 FR 15378 - Agency Information Collection Activities: Application for Withdrawal of Bonded Stores for Fishing...

    Science.gov (United States)

    2012-03-15

    ... Withdrawal of Bonded Stores for Fishing Vessels and Certificate of Use AGENCY: U.S. Customs and Border...: Application for Withdrawal of Bonded Stores for Fishing Vessels and Certificate of Use (CBP Form 5125). This... forms of information. Title: Application for Withdrawal of Bonded Stores for Fishing Vessels and...

  9. 75 FR 57469 - Guidance on Withdrawal of Subjects From Research: Data Retention and Other Related Issues

    Science.gov (United States)

    2010-09-21

    ... HUMAN SERVICES Guidance on Withdrawal of Subjects From Research: Data Retention and Other Related Issues... availability of a guidance document entitled, ``Guidance on Withdrawal of Subjects From Research: Data... guidance document entitled, ``Guidance on Withdrawal of Subjects From Research: Data Retention and Other...

  10. 32 CFR 150.14 - Waiver or withdrawal of appellate review.

    Science.gov (United States)

    2010-07-01

    ... 32 National Defense 1 2010-07-01 2010-07-01 false Waiver or withdrawal of appellate review. 150.14... PERTAINING TO MILITARY JUSTICE COURTS OF CRIMINAL APPEALS RULES OF PRACTICE AND PROCEDURE § 150.14 Waiver or withdrawal of appellate review. Withdrawals from appellate review, and waivers of appellate review filed...

  11. 42 CFR 426.523 - Withdrawing a complaint regarding an NCD under review.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 3 2010-10-01 2010-10-01 false Withdrawing a complaint regarding an NCD under... LOCAL COVERAGE DETERMINATIONS Review of an NCD § 426.523 Withdrawing a complaint regarding an NCD under review. (a) Circumstance under which an aggrieved party withdraws a complaint regarding an NCD. An...

  12. Land Cover - Minnesota Land Cover Classification System

    Data.gov (United States)

    Minnesota Department of Natural Resources — Land cover data set based on the Minnesota Land Cover Classification System (MLCCS) coding scheme. This data was produced using a combination of aerial photograph...

  13. Land Competition and Land-Use Change:

    DEFF Research Database (Denmark)

    Vongvisouk, Thoumthone

    for commercial agricultural products in neighboring countries (including China and Vietnam) and to the government policies on agricultural development and poverty reduction. The land-use policy aims to improve rural land and resource tenure security, but in practice, it is actually used as a tool for state......Land competition and land-use changes are taking place in many developing countries as the demand for land increases. These changes are leading to changes in the livelihood conditions of rural people. The Government of Laos (GoL), on the one hand, aims to increase forest protection. On the other...... claims on land and forest resources and for increasing forest conservation. Not only do these land-use changes impact rural people’s livelihoods, but they also impact their access to land and natural forest resources. In general, rural people in the study area perceive that they have improved...

  14. Rimonabant-induced Delta9-tetrahydrocannabinol withdrawal in rhesus monkeys: discriminative stimulus effects and other withdrawal signs.

    Science.gov (United States)

    Stewart, Jennifer L; McMahon, Lance R

    2010-07-01

    Marijuana-dependent individuals report using marijuana to alleviate withdrawal, suggesting that pharmacotherapy of marijuana withdrawal could promote abstinence. To identify potential pharmacotherapies for marijuana withdrawal, this study first characterized rimonabant-induced Delta(9)-tetrahydrocannabinol (Delta(9)-THC) withdrawal in rhesus monkeys by using drug discrimination and directly observable signs. Second, drugs were examined for their capacity to modify cannabinoid withdrawal. Monkeys receiving chronic Delta(9)-THC (1 mg/kg/12 h s.c.) discriminated the cannabinoid antagonist rimonabant (1 mg/kg i.v.) under a fixed ratio schedule of stimulus-shock termination. The discriminative stimulus effects of rimonabant were dose-dependent (ED(50) = 0.25 mg/kg) and accompanied by head shaking. In the absence of chronic Delta(9)-THC treatment (i.e., in nondependent monkeys), a larger dose (3.2 mg/kg) of rimonabant produced head shaking and tachycardia. Temporary discontinuation of Delta(9)-THC treatment resulted in increased responding on the rimonabant lever, head shaking, and activity during the dark cycle. The rimonabant discriminative stimulus was attenuated fully by Delta(9)-THC (at doses larger than mg/kg/12 h) and the cannabinoid agonist CP 55940 [5-(1,1-dimethylheptyl)-2-[5-hydroxy-2-(3-hydroxypropyl)cyclohexyl]phenol], and partially by the cannabinoid agonist WIN 55212-2 [(R)-(+)-[2, 3-dihydro-5-methyl-3-(4-morpholinylmethyl)pyrrolo[1,2,3-de]-1,4-benzoxazin-6-yl]-1-naphthalenylmethanone mesylate] and the alpha(2)-adrenergic agonist clonidine. In contrast, a benzodiazepine (diazepam) and monoamine agonist (cocaine) did not attenuate the rimonabant discriminative stimulus. Head shaking was attenuated by all test compounds. These results show that the discriminative stimulus effects of rimonabant in Delta(9)-THC-treated monkeys are a more pharmacologically selective measure of cannabinoid withdrawal than rimonabant-induced head shaking. These results suggest

  15. Rimonabant-Induced Δ9-Tetrahydrocannabinol Withdrawal in Rhesus Monkeys: Discriminative Stimulus Effects and Other Withdrawal Signs

    Science.gov (United States)

    Stewart, Jennifer L.

    2010-01-01

    Marijuana-dependent individuals report using marijuana to alleviate withdrawal, suggesting that pharmacotherapy of marijuana withdrawal could promote abstinence. To identify potential pharmacotherapies for marijuana withdrawal, this study first characterized rimonabant-induced Δ9-tetrahydrocannabinol (Δ9-THC) withdrawal in rhesus monkeys by using drug discrimination and directly observable signs. Second, drugs were examined for their capacity to modify cannabinoid withdrawal. Monkeys receiving chronic Δ9-THC (1 mg/kg/12 h s.c.) discriminated the cannabinoid antagonist rimonabant (1 mg/kg i.v.) under a fixed ratio schedule of stimulus-shock termination. The discriminative stimulus effects of rimonabant were dose-dependent (ED50 = 0.25 mg/kg) and accompanied by head shaking. In the absence of chronic Δ9-THC treatment (i.e., in nondependent monkeys), a larger dose (3.2 mg/kg) of rimonabant produced head shaking and tachycardia. Temporary discontinuation of Δ9-THC treatment resulted in increased responding on the rimonabant lever, head shaking, and activity during the dark cycle. The rimonabant discriminative stimulus was attenuated fully by Δ9-THC (at doses larger than mg/kg/12 h) and the cannabinoid agonist CP 55940 [5-(1,1-dimethylheptyl)-2-[5-hydroxy-2-(3-hydroxypropyl)cyclohexyl]phenol], and partially by the cannabinoid agonist WIN 55212-2 [(R)-(+)-[2, 3-dihydro-5-methyl-3-(4-morpholinylmethyl)pyrrolo[1,2,3-de]-1,4-benzoxazin-6-yl]-1-naphthalenylmethanone mesylate] and the α2-adrenergic agonist clonidine. In contrast, a benzodiazepine (diazepam) and monoamine agonist (cocaine) did not attenuate the rimonabant discriminative stimulus. Head shaking was attenuated by all test compounds. These results show that the discriminative stimulus effects of rimonabant in Δ9-THC-treated monkeys are a more pharmacologically selective measure of cannabinoid withdrawal than rimonabant-induced head shaking. These results suggest that cannabinoid and noncannabinoid (α2

  16. Second meeting of the French CEIP (Centres d'Evaluation et d'Information sur la Pharmacodépendance). Part II: benzodiazepine withdrawal.

    Science.gov (United States)

    Authier, Nicolas; Boucher, Alexandra; Lamaison, Dominique; Llorca, Pierre-Michel; Descotes, Jacques; Eschalier, Alain

    2009-01-01

    The aim of this meeting was to describe the news trends about abuse and addiction of anxiolytics and hypnotics. The part II of this meeting reviewed several aspects of the withdrawing benzodiazepines focusing in particular on clinical symptoms, biological patterns, and strategies for discontinuation. The discontinuation is usually beneficial due to the importance of adverse effects induced by long-term use of benzodiazepines. Several clinicals options have been described including gradual tapering of the current benzodiazepine, substitution with a long acting benzodiazepines or treating the symptoms of withdrawal. Psychological interventions range from a simple support through counselling to expert cognitive-behavioural therapy. However more controlled clinical trials are needed to promote adequate and optimal patient care in management of benzodiazepine withdrawing.

  17. Capo Verde, Land Use Land Cover

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — This series of three-period land use land cover (LULC) datasets (1975, 2000, and 2013) aids in monitoring change in West Africa’s land resources (exception is...

  18. Pharmacological management of alcohol withdrawal. A meta-analysis and evidence-based practice guideline. American Society of Addiction Medicine Working Group on Pharmacological Management of Alcohol Withdrawal.

    Science.gov (United States)

    Mayo-Smith, M F

    1997-07-09

    To provide an evidence-based practice guideline on the pharmacological management of alcohol withdrawal. English-language articles published before July 1, 1995, identified through MEDLINE search on "substance withdrawal--ethyl alcohol" and review of references from identified articles. Articles with original data on human subjects. Structured review to determine study design, sample size, interventions used, and outcomes of withdrawal severity, delirium, seizures, completion of withdrawal, entry into rehabilitation, adverse effects, and costs. Data from prospective controlled trials with methodologically sound end points corresponding to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, were abstracted by 2 independent reviewers and underwent meta-analysis. Benzodiazepines reduce withdrawal severity, reduce incidence of delirium (-4.9 cases per 100 patients; 95% confidence interval, -9.0 to -0.7; P=.04), and reduce seizures (-7.7 seizures per 100 patients; 95% confidence interval, -12.0 to -3.5; P=.003). Individualizing therapy with withdrawal scales results in administration of significantly less medication and shorter treatment (Pclonidine, and carbamazepine ameliorate withdrawal severity, but evidence is inadequate to determine their effect on delirium and seizures. Phenothiazines ameliorate withdrawal but are less effective than benzodiazepines in reducing delirium (P=.002) or seizures (PBenzodiazepines are suitable agents for alcohol withdrawal, with choice among different agents guided by duration of action, rapidity of onset, and cost. Dosage should be individualized, based on withdrawal severity measured by withdrawal scales, comorbid illness, and history of withdrawal seizures. beta-Blockers, clonidine, carbamazepine, and neuroleptics may be used as adjunctive therapy but are not recommended as monotherapy.

  19. Military Training Lands Historic Context: Large Arms Ranges

    Science.gov (United States)

    2010-03-01

    feeder . The gunner closed the top cover and charged the weapon. The gunner pressed the trigger, which placed the lead round in the bolt extractor. He...or pentachlorophenol), where appropriate (e.g., areas with termite infestations or excessive rainfall). Concrete para- pets on temporary projects were...creosote, various salts, or pentachlorophenol), where appropriate (e.g., areas with termite infestations or excessive rainfall). Concrete para- pets on

  20. Land-based approach to evaluate sustainable land management and adaptive capacity of ecosystems/lands

    Science.gov (United States)

    Kust, German; Andreeva, Olga

    2015-04-01

    A number of new concepts and paradigms appeared during last decades, such as sustainable land management (SLM), climate change (CC) adaptation, environmental services, ecosystem health, and others. All of these initiatives still not having the common scientific platform although some agreements in terminology were reached, schemes of links and feedback loops created, and some models developed. Nevertheless, in spite of all these scientific achievements, the land related issues are still not in the focus of CC adaptation and mitigation. The last did not grow much beyond the "greenhouse gases" (GHG) concept, which makes land degradation as the "forgotten side of climate change" The possible decision to integrate concepts of climate and desertification/land degradation could be consideration of the "GHG" approach providing global solution, and "land" approach providing local solution covering other "locally manifesting" issues of global importance (biodiversity conservation, food security, disasters and risks, etc.) to serve as a central concept among those. SLM concept is a land-based approach, which includes the concepts of both ecosystem-based approach (EbA) and community-based approach (CbA). SLM can serve as in integral CC adaptation strategy, being based on the statement "the more healthy and resilient the system is, the less vulnerable and more adaptive it will be to any external changes and forces, including climate" The biggest scientific issue is the methods to evaluate the SLM and results of the SLM investments. We suggest using the approach based on the understanding of the balance or equilibrium of the land and nature components as the major sign of the sustainable system. Prom this point of view it is easier to understand the state of the ecosystem stress, size of the "health", range of adaptive capacity, drivers of degradation and SLM nature, as well as the extended land use, and the concept of environmental land management as the improved SLM approach

  1. Range management research, Fort Valley Experimental Forest

    Science.gov (United States)

    Henry A. Pearson; Warren P. Clary; Margaret M. Moore; Carolyn Hull Sieg

    2008-01-01

    Range management research at the Fort Valley Experimental Forest during the past 100 years has provided scientific knowledge for managing ponderosa pine forests and forest-range grazing lands in the Southwest. Three research time periods are identified: 1908 to 1950, 1950 to 1978, and 1978 to 2008. Early research (1908-1950) addressed ecological effects of livestock...

  2. Selected Bibliography On Southern Range Management

    Science.gov (United States)

    R. S. Campbell; L. K. Halls; H. P. Morgan

    1963-01-01

    The purpose of this bibliography is to list important publications relating directly to southern ranges, the domestic livestock and wildlife produced thereon, and the management of these lands, livestock, and wildlife. Range is defined as natural grassland, savannah, or forest that supports native grasses, forbs, or shrubs suitable as forage for livestock and game....

  3. Solving problems of modern land relations on the way of formation of competitive agrarian production in Ukraine

    Directory of Open Access Journals (Sweden)

    Skoruk Olena P.

    2014-01-01

    Full Text Available The goal of the article is identification of modern problems of conduct of the land reform and ways of their solution in the context of economic consequences for development of the competitive agrarian production in Ukraine. It identifies that the main task of completion of the land reform is creation of the land market, which would ensure transition of the right of ownership on land lots to an efficient land owner. The basis of this development are farms that combine the owner and master of land in one entity. The article shows that adoption of the Draft Law “On Agricultural Land Turnover” would facilitate development of this form of management. The article identifies main problems of the moratorium on agricultural land sales, namely: land black market activity, withdrawal from market turnover of land of about USD 40 thousand million cost and, as a result, impossibility for agrarians to apply mortgage. The article identifies gaps in the legislation with respect to state control over unclaimed shares and escheats, due to which the state budget does not receive significant amounts of money. It offers ways of solution of these problems through empowering the founded Goszembank, which should become a partner and support for development of small and medium farms after withdrawal of the moratorium on agricultural land sales, with relevant authorities.

  4. The most common factors influencing on quality of life of thyroid cancer patients after thyroid hormone withdrawal.

    Science.gov (United States)

    Rubic, Mateja; Kuna, Sanja Kusacic; Tesic, Vanja; Samardzic, Tatjana; Despot, Marija; Huic, Drazen

    2014-12-01

    The aim of study was to evaluate which factors impact mostly on life-quality of patients with differentiated thyroid carcinoma after thyroid hormone withdrawal. 150 patients were enrolled in the study by using Quality of life- Thyroid version questionnaire in which they expressed their physical, psychological, social and spiritual well-being. The answers have been interpreted on a scale from 0 to 10. All patients underwent four weeks levothyroxine withdrawal in preparation for I-131 procedures and thyroglobulin testing. Individual statements on the physical subscale showed that patients had most difficulties with fatigue, intolerance to cold and heat, sleep changes and weight gain, but with higher average values than expected. Fatigue was one of the most common physical difficulties. Female patients had significantly more difficulties than male respondents. Five most expressed psychological difficulties have been stress caused by initial diagnosis, followed by stress caused by surgical treatment, fear of metastases, stress caused by initial radioiodine ablation treatment and fear of cancer recurrence. Generally, results revealed troubles mostly in physical symptoms relating to thyroid hormone withdrawal, as well as psychological distress caused by initial diagnosis. Respondents with higher educational level achieved a significantly higher score than less educated patients (p=0.026, Mann-Whitney U test). Illness was very distressing for their families (median value 1, range: 0 to 10) and they reported insufficient support from others (1, range: 0 to 10), but they did not feel isolated. Family and work consequences were less apparent. The results of QOL-Thyroid questionnaire help to identify high-risk areas in patients' lives that are negatively affected by hormone withdrawal. Regarding the wide definition of quality of life, a positive impact on patients' recovery could be achieved by directing attention to most expressed difficulties noted in this questionnaire.

  5. [Social aspects of epilepsy: marriage, pregnancy, driving, antiepileptic drug withdrawal and against social stigma].

    Science.gov (United States)

    Tsuji, Sadatoshi

    2004-11-01

    Persons with epilepsy need adequate advice and effective counselling about issues such as marriage, pregnancy, risks of inheriting epilepsy, driving, employment and antiepileptic drug withdrawal, because these persons are not receiving important information and education about their condition and possible adverse effects of treatment. Furthermore, women with epilepsy have increased rates of pregnancy complications and poor fetal outcomes including congenital malformations and developmental delay related to both their epilepsy and antiepileptic drugs. However, approximately 90% of all women with epilepsy undergo normal pregnancy and give birth to children free of birth defects. Pregnancy is generally safe in women with epilepsy. The study of long-term prognosis of childhood-onset epilepsy in Japan shows that the majority of these patients have lower levels of educational background as well as employment and marital status compared with the general population (Wakamoto H. et al). Of patients with epilepsy, 60% to 70% achieve control with antiepileptic medication. However, several antiepileptic drug withdrawal studies show variable rates of success, with relapse rates ranging from 12% to 63% (Britton J.W.). Driving is listed as major problem in persons with epilepsy. However, the patients with seizure-free more than two years have been able to get the driver's license since June, 2002. Social attitudes towards epilepsy cause more distress to the patient than the disease itself. We should realize that persons with epilepsy are normal or near-normal. To ameliorate the social stigma against epilepsy, continuous and repetitive educational efforts would be needed.

  6. "Is That A Method of Birth Control?" A Qualitative Exploration of Young Women's Use of Withdrawal.

    Science.gov (United States)

    Arteaga, Stephanie; Gomez, Anu Manchikanti

    2016-01-01

    Despite its ubiquity, withdrawal is understudied as a family planning method. We investigated the context of and decision making around withdrawal use, drawing on in-depth, qualitative interviews with 38 Black and Latina women (ages 18 to 24). We examined contraceptive use histories to understand when and why participants used withdrawal. The majority of participants (n = 29; 76%) had used withdrawal in their lifetimes, though two-thirds of users mentioned withdrawal in their contraceptive histories only after interviewer prompts. Withdrawal was primarily used during transitions between contraceptive methods and when other methods were not desired. Relationship context was also an important factor, as many used withdrawal to increase intimacy with their partners; because they felt condoms were no longer necessary due to monogamy; or to fulfill their partners' preferences to increase sexual pleasure. Our findings indicate that decision making around withdrawal is embedded in situational and relational contexts. Future research should explore how health care providers and sex educators can engage young women in discussions of withdrawal's benefits and constraints. A harm reduction framework, which recognizes that optimal use of withdrawal is preferable to not using a pregnancy prevention method at all, may inform the ways that withdrawal can be addressed in clinical and educational settings.

  7. [Dexmedetomidine in the treatment of acute alcohol withdrawal delirium].

    Science.gov (United States)

    Gerresheim, G; Brederlau, J; Schwemmer, U

    2016-07-01

    Alcohol withdrawal syndrome has a high clinical prevalence. Severe cases must be treated in an intensive care unit and are associated with a high mortality rate, depending on patient comorbidities. Clinical requirements include sedation, control of vegetative symptoms, treatment of hallucinations and, when necessary, anticonvulsive therapy. Currently, there is no single substance that fulfills these requirements. National and international guidelines recommend a combination of various substances. The central α2-adrenergic receptor agonist clonidine is used as a therapeutic adjuvant. In consideration of its pharmacological characteristics, dexmedetomidine is assumed to be more advantageous compared to clondine. Case studies with dexmedetomidine in alcohol withdrawal syndrome show the safety of its application and a benzodiazepine-sparing effect. Its incorporation in escalating intensive care therapy of severe cases could be appropriate.

  8. Infusion of intrathecal baclofen for acute withdrawal. Technical note.

    Science.gov (United States)

    Duhon, Bradley S; MacDonald, Joel D

    2007-10-01

    Acute baclofen withdrawal syndrome is a life-threatening situation that demands early recognition and urgent treatment. The current therapy of choice for this syndrome is administration of intravenous benzodiazepines, propofol, and chemical paralytic drugs until the intrathecal system can be restored. The authors present a novel technique for administering baclofen intrathecally using a lumbar drain and a standard patient-controlled analgesia pump (in continuous infusion mode). In one case, this method was used to wean the patient from high-dose intrathecal baclofen treatment. In a second case, this method was used as a temporizing measure until the indwelling pump system could be repaired. In both cases, the patients recovered to their neurological baseline level, and lasting consequences of serious withdrawal were avoided.

  9. Phenobarbital compared to benzodiazepines in alcohol withdrawal treatment

    DEFF Research Database (Denmark)

    Askgaard, Gro; Hallas, Jesper; Fink-Jensen, Anders

    2016-01-01

    , possibly with the drawback of a more pronounced acute toxicity. We evaluated if phenobarbital compared to chlordiazepoxide decreased the risk of subsequent use of benzodiazepines, alcohol recidivism and mortality. Methods: The study was a register-based cohort study of patients admitted for alcohol...... withdrawal 1998-2013 and treated with either phenobarbital or chlordiazepoxide. Patients were followed for one year. We calculated hazard ratios (HR) for benzodiazepine use, alcohol recidivism and mortality associated with alcohol withdrawal treatment, while adjusting for confounders. Results: A total...... of 1063 patients treated with chlordiazepoxide and 1365 patients treated with phenobarbital were included. After one year, the outcome rates per 100 person-years in the phenobarbital versus the chlordiazepoxide cohort were 9.20 vs. 5.13 for use of benzodiazepine, 37.9 vs. 37.9 for alcohol recidivism...

  10. Something old, something new: a successful case of meprobamate withdrawal.

    Science.gov (United States)

    James, Alexander Owen; Nicholson, Timothy R; Hill, Robert; Bearn, Jennifer

    2016-02-29

    Meprobamate, a benzodiazepine-like drug, was commonly prescribed for anxiety in the 1960s and 1970s, but fell out of favour, at least in part, due to the risk of dependence, for which there is little published evidence to guide clinical management. We discuss a 70-year-old man with a 45-year history of meprobamate dependency and multiple failed previous withdrawal attempts who was successfully withdrawn from meprobamate using diazepam during a 2-week inpatient stay on a specialist Addictions ward. An appropriate diazepam dose was established using the Clinical Institute Withdrawal Assessment scale for benzodiazepines (CIWA-B). This dose was then slowly reduced over 12 days. Multidisciplinary input, especially psychological therapy tackling his underlying anxiety disorder during his admission, was thought to be particularly helpful. 2016 BMJ Publishing Group Ltd.

  11. Withdrawal of immunosuppression following pediatric liver transplantation: a Markov analysis.

    Science.gov (United States)

    Mohammad, Saeed; Li, Zhe; Englesbe, Michael; Skaro, Anton; Alonso, Estella

    2014-08-01

    Survivors of pediatric liver transplantation are at risk for developing complications related to posttransplant immunosuppressive medications. Withdrawal is possible in selected patients but carries the risk of graft rejection and loss. We modeled the effect of withdrawing immunosuppressive medications on survival, cost, and quality-adjusted life-years (QALYs) in a hypothetical cohort of pediatric patients who received transplantation for biliary atresia with stable liver enzymes and no recent episodes of rejection, and who were free from immunosuppression-related adverse effects. A decision analysis tree was developed, and Monte Carlo simulations were used to track patients through the model during a 10-year time course with 1-year cycles. Data from the literature were used to assign probabilities to major clinical events and preference-based utility scores to the values of health outcomes. One-way and probabilistic sensitivity analyses were used to evaluate the impact of uncertainty. Patients following the withdrawal strategy had a 10-year survival rate of 95.8% and experienced 8.61 QALYs versus 88.6% survival and 8.01 QALYs for those taking immunosuppressive medications. Each additional QALY is attained at a cost of -$18,992.41 and was therefore cost saving. Patients in our model who had their immunosuppression withdrawn had improved survival and QALYs with lower costs. Although every effort was made to validate the model, it is limited by the accuracy of the underlying assumptions. Therefore, clinical trials are needed to determine predictors of successful immunosuppression withdrawal to allow for personalization of medication regimens.

  12. Subacute cannabinoid treatment: anticonvulsant activity and withdrawal excitability in mice.

    OpenAIRE

    Karler, R.; Turkanis, S. A.

    1980-01-01

    1 The effects of subacute treatment with cannabidiol, delta 9-tetrahydrocannabinol (delta 9-THC), phenytoin and phenobarbitone on anticonvulsant activity and on withdrawal excitability in mice were compared in three electrically induced seizure-threshold tests. 2 In the maximal electroshock-threshold test, subacute treatment did not alter the anticonvulsant activity of cannabidiol, phenytoin or phenobarbitone, but tolerance developed to delta 9-THC. 3 In the 60 Hz electroshock-threshold test,...

  13. Flumazenil in treatment benzodiazepine withdrawal syndrome: Case report

    OpenAIRE

    Ramah Aleksandar J.; Todorović Mirjana M.; Crnić Katarina B.

    2015-01-01

    Background: Today in the world and in Serbia is growing number of people who are addicted to benzodiazepine. A particular problem is the process of detoxification and treatment of benzodiazepine withdrawal syndrome due to a recurrence of symptoms of anxiety disorder, availability of benzodiazepines, falling motivation. Standard procedures have often proved unsuccessful and the last decade, and the search for new protocols, including the flumazenil, benzodiazepine receptor antagonist, is actua...

  14. Gabapentin withdrawal syndrome in the presence of a taper.

    Science.gov (United States)

    Tran, Kien T; Hranicky, Diane; Lark, Tracey; Jacob, Nj

    2005-06-01

    To report a case report of a geriatric patient with a 5-year history of gabapentin use for enhanced bipolar control, who was tapered off of gabapentin over 1 week. The patient displayed unique withdrawal symptoms after the taper of gabapentin. The patient is an 81-year-old white female with a life-long history of schizoaffective disorder with bipolar type I tendencies who had been prescribed gabapentin for 5 years. The patient displayed moderate upper respiratory tract infection symptoms and somatic complaints 1 day after termination of gabapentin. These symptoms gradually worsened until 10 days after, at which time she acutely developed severe mental status changes, severe somatic chest pain, and hypertension. Physical examination, electrolytes, electrocardiogram, computerized tomography, magnetic resonance imaging, and magnetic resonance angiography were all normal. Upon reintroduction of gabapentin, the patient returned to baseline within 1-2 days. Gabapentin is widely utilized currently for the chronic treatment of recalcitrant migraines, bipolar illness, pain, and epilepsy. It has a wide therapeutic index with few side effects and drug interactions, is not hepatically metabolized, and is excreted by the kidneys. Past reports have suggested that some withdrawal symptoms can present after 1-2 days upon abrupt discontinuation of gabapentin after chronic use within young to middle-aged patients. These symptoms mimic that of alcohol and benzodiazepine withdrawal purportedly due to a similar mechanism of action. Unique to this case is that this geriatric patient developed debilitating withdrawal symptoms after a gradual, week-long taper of gabapentin along with flu-like symptoms. It is proposed herein that a gabapentin taper should follow a course similar to that of a benzodiazepine taper -- slowly and over a period of weeks to months.

  15. Methyl Parathion Masks Withdrawal from Physical Dependence on Morphine

    Directory of Open Access Journals (Sweden)

    Robin W. Rockhold

    2002-10-01

    Full Text Available Abstract: The cholinergic system has been proposed to participate in the development of dependence on opioids. The present study examined effects of dermal pretreatment with methyl parathion (MP, an acetylcholinesterase inhibitor, on the development of physical dependence on morphine. Opioid dependence was induced by continuous intracerebroventricular (i.c.v. infusion of morphine (26 nmol/μl/h for 3 days in adult male Sprague-Dawley rats. Each rat received two doses of MP, 12.5 mg/kg, dermally, initially, 3 days prior to initiation of i.c.v. morphine infusion and again on the first day of infusion. Withdrawal was precipitated after 3 days of infusion by administering an opioid antagonist, naloxone (48 nmol/5 μl, i.c.v.. Twelve of 23 MP-treated rats exhibited signs of acetylcholinesterase inhibitor intoxication (mild tremors and showed reduced spontaneous locomotor activity (tested by an open field test, prior to naloxone. The brain cholinesterase activity in these 12 rats was 13% of levels in control rats. Eleven rats that did not show toxic signs, exhibited cholinesterase activities that were 20% of control (not significant versus toxic group. The group that showed signs of MP intoxication exhibited a significantly lower incidence of opioid withdrawal jumping, rearing and wet dog shakes compared with the non-toxic group. No differences between quantal withdrawal signs (ptosis, penis-licking, and vocalization were noted between the two groups. The results suggest that toxic inhibition of acetylcholinesterase non-specifically reduces locomotor activity and may obscure certain behavioral signs of withdrawal from opioid dependence. This indicates that caution should be used in interpreting a direct involvement of acetylcholinesterase inhibition in preventing opioid dependence.

  16. Steroid withdrawal after renal transplantation: a retrospective cohort study.

    Science.gov (United States)

    Haller, Maria C; Kammer, Michael; Kainz, Alexander; Baer, Heather J; Heinze, Georg; Oberbauer, Rainer

    2017-01-12

    Immunosuppressive regimens in renal transplantation frequently contain corticosteroids, but many centers withdraw steroids as a consequence of unwanted side effects of steroids. The optimal timing to withdraw steroids after transplantation, however, remains unclear. The aim of this study was to determine an optimal time point following kidney transplantation that is associated with reduced mortality without jeopardizing the allograft to allow safe discontinuation of steroids. We conducted a retrospective cohort study and computed a concatenated landmark-stratified Cox supermodel to estimate hazard ratios and 95% confidence intervals for mortality and graft loss using dynamic propensity score matching to adjust for confounding by indication. A total of 6070 first kidney transplant recipients in the Austrian Dialysis and Transplant Registry who were transplanted between 1990 and 2012 were evaluated and classified according to steroid treatment status throughout follow-up after kidney transplantation; 2142 patients were withdrawn from steroids during the study period. Overall, 1131 patients lost their graft and 821 patients in the study cohort died. Steroid withdrawal within 18 months after transplantation was associated with an increased rate of graft loss compared to steroid maintenance during that time (6 months after transplantation: HR = 1.8; 95% CI, 1.3 to 2.6; 18 months after transplantation: HR = 1.3; 95% CI, 1.1 to 1.6; 24 months after transplantation: HR = 1.2; 95% CI, 0.9 to 1.5), while mortality was not different between groups. Our findings suggest that steroid withdrawal after anti-IL-2 induction in the first 18 months after transplantation is associated with an increased risk of allograft loss.

  17. A critical period of progesterone withdrawal precedes menstruation in macaques

    Science.gov (United States)

    Slayden, Ov D; Brenner, Robert M

    2006-01-01

    Macaques are menstruating nonhuman primates that provide important animal models for studies of hormonal regulation in the uterus. In women and macaques the decline of progesterone (P) at the end of the cycle triggers endometrial expression of a variety of matrix metalloproteinase (MMP) enzymes that participate in tissue breakdown and menstrual sloughing. To determine the minimal duration of P withdrawal required to induce menses, we assessed the effects of adding P back at various time points after P withdrawal on both frank bleeding patterns and endometrial MMP expression. Artificial menstrual cycles were induced by treating the animals sequentially with implants releasing estradiol (E2) and progesterone (P). To assess bleeding patterns, P implants were removed at the end of a cycle and then added back at 12, 24, 30, 36, 40, 48, 60, or 72 hours (h) after the initial P withdrawal. Observational analysis of frank bleeding patterns showed that P replacement at 12 and 24 h blocked menses, replacement at 36 h reduced menses but replacement after 36 h failed to block menses. These data indicate that in macaques, a critical period of P withdrawal exists and lasts approximately 36 h. In other similarly cycled animals, we withdrew P and then added P back either during (12–24 h) or after (48 h) the critical period, removed the uterus 24 h after P add back and evaluated endometrial MMP expression. Immunocytochemistry showed that replacement of P during the critical period suppressed MMP-1, -2 and -3 expression along with menses, but replacement of P at 48 h, which failed to suppress mense, suppressed MMP-1 and MMP-3 but did not block MMP-2. We concluded that upregulation of MMPs is essential to menses induction, but that after the critical period, menses will occur even if some MMPs are experimentally blocked. PMID:17118170

  18. Zolpidem dependence, abuse and withdrawal: A case report

    Science.gov (United States)

    Heydari, Mostafa; Isfeedvajani, Mohsen Saberi

    2013-01-01

    Zolpidem, a nonbenzodiazepine hypnotic, binds to the benzodiazepine binding site on the gamma-aminobutyric acid type A (GABA-A) receptors. Many studies have reported efficacy and safety of zolpidem in treatment of insomnia, low abuse, and dependence capability. However, many cases of zolpidem abuse and dependence were reported around the world. This case showed that zolpidem can exert abuse capability, euphoric mood, tolerance, and withdrawal syndrome. PMID:24520235

  19. Zolpidem dependence, abuse and withdrawal: A case report

    Directory of Open Access Journals (Sweden)

    Mostafa Heydari

    2013-01-01

    Full Text Available Zolpidem, a nonbenzodiazepine hypnotic, binds to the benzodiazepine binding site on the gamma-aminobutyric acid type A (GABA-A receptors. Many studies have reported efficacy and safety of zolpidem in treatment of insomnia, low abuse, and dependence capability. However, many cases of zolpidem abuse and dependence were reported around the world. This case showed that zolpidem can exert abuse capability, euphoric mood, tolerance, and withdrawal syndrome.

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

    OpenAIRE

    Peng, Teng J.; Patchett, Nicholas D.; Bernard, Sheilah A.

    2016-01-01

    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 m...

  1. Prolonged-release melatonin for insomnia – an open-label long-term study of efficacy, safety, and withdrawal

    Directory of Open Access Journals (Sweden)

    Lemoine P

    2011-07-01

    Full Text Available Patrick Lemoine1, Doron Garfinkel2, Moshe Laudon3, Tali Nir3, Nava Zisapel3,41The Clinique Lyon-Lumière, Meyzieu, France; 2Geriatric-Palliative Department, Shoham Geriatric Medical Center, Pardes Hanna, Israel; 3Neurim Pharmaceuticals Ltd, Tel-Aviv, Israel; 4Department of Neurobiology Faculty of Life Sciences, Tel Aviv University, Tel Aviv, IsraelBackground: Prolonged-release melatonin (PRM 2 mg is indicated for insomnia in patients aged 55 years and older. A recent double-blind placebo-controlled study demonstrated 6-month efficacy and safety of PRM in insomnia patients aged 18–80 and lack of withdrawal and rebound symptoms upon discontinuation.Objective: To investigate the efficacy, safety, and withdrawal phenomena associated with 6–12 months PRM treatment.Methods: Data from a prospective 6–12-month open-label study of 244 community dwelling adults with primary insomnia, who had participated in a placebo-controlled, double-blind dose-ranging trial of PRM. Patients received PRM nightly, followed by a 2-week withdrawal period. Main outcome measures were patient-reported sleep quality ratings (diary, adverse events, vital signs, and laboratory tests recorded at each visit, and withdrawal symptoms (CHESS-84 [Check-list Evaluation of Somatic Symptoms]. Nocturnal urinary 6-sulfatoxymelatonin excretion, a measure of the endogenous melatonin production, was assessed upon discontinuing long-term PRM.Results: Of the 244 patients, 36 dropped out, 112 completed 6 months of treatment, and the other 96 completed 12 months of treatment. The mean number of nights by which patients reported sleep quality as "good" or "very good" was significantly higher during PRM than before treatment. There was no evidence of tolerance to PRM. Discontinuation of PRM was not associated with rebound insomnia or withdrawal symptoms; on the contrary, residual benefit was observed. PRM was well tolerated, and there was no suppression of endogenous melatonin production

  2. Risk of neonatal drug withdrawal after intrauterine co-exposure to opioids and psychotropic medications: cohort study.

    Science.gov (United States)

    Huybrechts, Krista F; Bateman, Brian T; Desai, Rishi J; Hernandez-Diaz, Sonia; Rough, Kathryn; Mogun, Helen; Kerzner, Leslie S; Davis, Jonathan M; Stover, Megan; Bartels, Devan; Cottral, Jennifer; Patorno, Elisabetta

    2017-08-02

    Objectives To assess the impact of in utero co-exposure to psychotropic medications and opioids on the incidence and severity of neonatal drug withdrawal.Design Observational cohort study.Setting Nationwide sample of pregnancies in publicly insured women in the US, nested in the Medicaid Analytic eXtract (2000-10).Participants 201 275 pregnant women with public insurance who were exposed to opioids around the time of delivery and their liveborn infants.Interventions In utero exposure to psychotropic medications, in particular antidepressants, atypical antipsychotics, benzodiazepines, gabapentin, and non-benzodiazepine hypnotics (Z drugs), with prescriptions filled within the same time window as prescriptions for opioids.Main outcome measure Diagnosis of neonatal drug withdrawal in infants exposed in utero to opioids and psychotropic medications compared with opioids alone.Results The absolute risk for neonatal drug withdrawal ranged from 1.0% in infants exposed in utero to prescription opioids alone to 11.4% for those exposed to opioids co-prescribed with gabapentin. Among neonates exposed in utero to prescription opioids, the relative risk adjusted for propensity score was 1.34 (95% confidence interval 1.22 to 1.47) with concomitant exposure to antidepressants, 1.49 (1.35 to 1.63) with benzodiazepines, 1.61 (1.26 to 2.06) with gabapentin, 1.20 (0.95 to 1.51) with antipsychotics, and 1.01 (0.88 to 1.15) with Z drugs. In utero exposure to two or more psychotropic medications along with opioids was associated with a twofold increased risk of withdrawal (2.05, 1.77 to 2.37). The severity of the withdrawal seemed increased in neonates exposed to both opioids and psychotropic medications compared with opioids alone.Conclusions During pregnancy, the use of psychotropic medications in addition to prescription opioids is common, despite a lack of safety data. The current findings suggest that these drugs could further increase the risk and severity of neonatal

  3. Pattern and risk factors of alcohol withdrawal delirium.

    Science.gov (United States)

    Burapakajornpong, Natapon; Maneeton, Benchalak; Srisurapanont, Manit

    2011-08-01

    To determine the incidence, prescribing risk factors of alcohol withdrawal delirium (AWD), and factors complicating AWD, in alcohol dependent patients hospitalized for alcohol detoxification. Patients attending the detoxification program at Chiang Mai University Hospital and the Northern drug dependence treatment center between May and September 2005 were assessed. Patients with signs of AWD at baseline were excluded. Incidence, risk factors, and dosage of benzodiazepines of patients with and without subsequent AWD were compared Risk factors that prolonged the course of AWD were analyzed. Nineteen male patients were assessed. Ten patients (52.6%) developed AWD despite receiving benzodiazepine detoxification. Risk factors of age, previous history of AWD and epilepsy, alcohol use history, frequency and quantity of drinking, signs of simple withdrawal at first admission, and dosage of benzodiazepines were not significantly different between the groups. However, patients with systolic blood pressure at first admission (> 120 mmHg) had longer duration of AWD than those without abnormal blood pressure (72.0 +/- 53.7 hr versus 168.0 +/- 24.0 hr, respectively, p = 0.038). The incidence of AWD was relatively high despite treatment. Although the present study did not find any risk factor predicting AWD. AWD patients hypertensive at the first admission had significantly longer duration of delirium. Physicians should be aware of monitor and treat hypertensive state and give early treatment of alcohol withdrawal with adequate doses of benzodiazepines to decrease morbidity and mortality of AWD.

  4. Subacute cannabinoid treatment: anticonvulsant activity and withdrawal excitability in mice.

    Science.gov (United States)

    Karler, R; Turkanis, S A

    1980-03-01

    1 The effects of subacute treatment with cannabidiol, delta 9-tetrahydrocannabinol (delta 9-THC), phenytoin and phenobarbitone on anticonvulsant activity and on withdrawal excitability in mice were compared in three electrically induced seizure-threshold tests. 2 In the maximal electroshock-threshold test, subacute treatment did not alter the anticonvulsant activity of cannabidiol, phenytoin or phenobarbitone, but tolerance developed to delta 9-THC. 3 In the 60 Hz electroshock-threshold test, the activity of delta 9-THC and cannabidiol did not change, but tolerance developed to phenobarbitone, and there was an increase in sensitivity to phenytoin. 4 In the 6 Hz electroshock-threshold test, there was an increase in sensitivity to both delta 9-THC and cannabidiol, there was tolerance to phenobarbitone, while the activity of phenytoin did not change. 5 Although tolerance developed in some of the seizure-threshold tests to delta 9-THC and phenobarbitone, tolerance to cannabidiol and phenytoin did not develop in any of the tests. 6 Hyperexcitability followed withdrawal from only delta 9-THC (6 Hz and 60 Hz electroshock-threshold tests) and phenobarbitone (maximal electroshock-threshold and 60 Hz electroshock-threshold tests). 7 The delta 9-THC withdrawal hyperexcitability suggests that the use of marihuana may jeopardize the control of seizures in epileptics.

  5. Anticonvulsant drugs in the treatment of substance withdrawal.

    Science.gov (United States)

    Zullino, Daniele Fabio; Khazaal, Yasser; Hättenschwiler, Josef; Borgeat, François; Besson, Jacques

    2004-07-01

    Although detoxification cannot, in itself, be considered a treatment for addiction, it is one of the most pivotal phases. In order to facilitate entry into recovery and/or rehabilitation programs, a detoxification treatment has to be experienced as easy and safe by the patient. In consideration of the many inconveniences related to standard withdrawal treatments, there is an interest in developing alternative pharmacological strategies. The main rationales for using anticonvulsants in substance-abuse patients are their lack of addiction potential, evidence support a role of kindling mechanisms in withdrawal syndromes and their efficacy in comorbid psychiatric disorders. The available data currently support the utilization of carbamazepine as a treatment for detoxification from benzodiazepines, alcohol and opiates, and as a useful agent to reduce cocaine consumption. The use of valproate is well corroborated for alcohol detoxification and it seems to be a promising treatment for the reduction of cocaine use; however, it has been found to be ineffective against benzodiazepine withdrawal symptoms. Some preliminary data suggest that lamotrigine could be useful in opiate and cocaine dependence. Gabapentin shows potential as a treatment for cocaine dependence, and some case reports have stimulated interest in this agent for alcohol and benzodiazepine detoxification. Due to its particular pharmacological profile, topiramate is one of the most interesting newer anticonvulsants. It has been found to be efficacious in opiate and possibly benzodiazepine detoxification and also has theoretical potential as a preventive therapy.

  6. Managing Opioid Withdrawal for Hospital Patients in Custody.

    Science.gov (United States)

    Shi, Connie R; Kandola, Manjinder S; Tobey, Matthew; Singer, Elizabeth

    2017-03-01

    Dr. Brown, a hospitalist, admits Mark, a patient transferred from a local jail for management of cellulitis. The patient, who was taken into custody two days prior to hospital admission, has a history of intravenous heroin use. Mark explains that he had been prescribed buprenorphine-naloxone maintenance therapy for opioid use disorder for several years prior to being arrested and had not used other opioids during that time. As a policy, the jail where Mark is detained does not prescribe opioid agonists, and his maintenance therapy was stopped upon his arrival there. Dr. Brown discovers that Mark is diaphoretic and appears distressed. Mark's symptoms suggest to Dr. Brown that, in addition to having cellulitis, Mark is actively withdrawing from opioids. Mark tells Dr. Brown that he has felt "horrible" since his buprenorphine-naloxone therapy was stopped and that he now has intense cravings for opioids. He asks Dr. Brown to help alleviate the withdrawal symptoms. Dr. Brown, who is accustomed to treating opioid withdrawal with opioid replacement therapy, wonders if she should initiate ORT for Mark while he is in the hospital. © 2017 The Hastings Center.

  7. An Engineered Endomorphin-2 Gene for Morphine Withdrawal Syndrome.

    Directory of Open Access Journals (Sweden)

    Fei-Xiang Wu

    Full Text Available An optimal therapeutics to manage opioid withdrawal syndrome is desired for opioid addiction treatment. Down-regulation of endogenous endomorphin-2 (EM2 level in the central nervous system after continuous morphine exposure was observed, which suggested that increase of EM2 could be an alternative novel method for opioid dependence. As a short peptide, the short half-life of EM2 limits its clinical usage through conventional administration. In the present study, we engineered an EM2 gene using a signal peptide of mouse growth factor for an out-secretory expression of EM2 and an adenovirus as a vector, which ultimately sustained the release of EM-2. After administration of the adenovirus in central nervous system, a sustained increase of EM2 level in the cerebral spinal fluid (CSF was observed along with a reduction of morphine withdrawal syndrome. These findings suggest that the engineered EM2 gene delivered to the central nervous system could be a novel therapeutics for withdrawal syndrome in opioid dependent subjects.

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

    Science.gov (United States)

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

    2013-01-01

    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 on the opioid system. Evidence from both animal and clinical studies point towards an interaction between these two systems, and suggest that targeting the endocannabinoid 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 system 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 management of opiate dependence and withdrawal. PMID:23624062

  10. 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.

  11. 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.

  12. 128 EVALUATION OF RANGE CONDITION AND TREND OF ...

    African Journals Online (AJOL)

    2010-03-01

    . Email-mrmbaya@gmail.com GSM-08057884935 ... Range condition is used as a guide to ensure sustainable land use; to determine ... Range trend assessments depend upon evaluation of the general health of individual.

  13. The Standley allotment: a history of range recovery.

    Science.gov (United States)

    Gerald S. Strickler; Wade B. Hall

    1980-01-01

    One of the first range research programs on National Forest lands was conducted by Dr. Arthur W. Sampson in the Wallowa Mountains, Oregon, between 1907 and 1911. This paper reviews the historical perspective of and the basic range management principles and practices developed from Sampson's studies as well as the land and grazing management of the study area to...

  14. Opportunities to Improve Impact, Integration, and Evaluation of Land Change Models

    NARCIS (Netherlands)

    Brown, D.G.; Verburg, P.H.; Pontius, R.G.; Lange, M.D.

    2013-01-01

    Land change modeling supports analyses, assessments, and decisions concerning land management by providing a platform for both encoding mechanisms of land-change processes and making projections of future land-cover and land-use patterns. Approaches have ranged from pattern-based methods, such as

  15. Understanding land administration systems

    DEFF Research Database (Denmark)

    P. Williamson, Ian; Enemark, Stig; Wallace, Judy

    2008-01-01

    This paper introduces basic land administration theory and highlights four key concepts that are fundamental to understanding modern land administration systems - firstly the land management paradigm and its influence on the land administration framework, secondly the role that the cadastre plays...... in contributing to sustainable development, thirdly the changing nature of ownership and the role of land markets, and lastly a land management vision that promotes land administration in support of sustainable development and spatial enablement of society. We present here the first part of the paper. The second...

  16. Effects of lorazepam tolerance and withdrawal on GABA[sub A] receptor operated chloride channels in mice selected for differences in ethanol withdrawal severity

    Energy Technology Data Exchange (ETDEWEB)

    Allan, A.M.; Baier, L.D.; Zhang, Xiaoying (Washington Univ. School of Medicine, St. Louis, MO (United States))

    1992-01-01

    Withdrawal seizure prone (WSP) and withdrawal seizure resistant (WSR) mice were treated with 5 mg/kg lorazepam for 7 days via implanted osmotic mini pumps. Following chronic drug treatment, brains were assayed for GABA-mediated chloride flux (GABA-Cl[sup [minus

  17. Second attempt of Cabergoline withdrawal in patients with prolactinomas after a failed first attempt : is it worthwhile?

    Directory of Open Access Journals (Sweden)

    Lucio eVilar

    2015-02-01

    Full Text Available Successful discontinuation of cabergoline (CAB treatment has been reported in 31 to 74% of prolactinomas patients treated for at least two years. In contrast, it is not well established whether CAB therapy can be successfully withdrawn after a failed first attempt. This prospective open trial was designed to address this topic and to try to identify possible predictor factors.Among 180 patients with prolactinomas on CAB therapy, the authors selected those who fulfilled very strict criteria, particularly additional CAB therapy for at least 2 years, normalization of serum prolactin (PRL levels following CAB restart, no tumor remnant > 10 mm, no previous pituitary radiotherapy or surgery; and current CAB dose ≤1.0 mg/week. Recurrence was defined as an increase of PRL levels above the upper limit of normal.A total of 34 patients (70.6% female treated with CAB for 24-30 months were recruited. Ten patients (29.4 % remained without evidence of recurrence after 24–26 months of follow-up. Twenty-four patients (70.6% recurred within 15 months (75% within 12 months after drug withdrawal and ~80% were restarted CAB. Median time to recurrence was 10.5 months (range, 3–15. Despite overlapping values, non-recurring patients had significantly lower mean PRL levels before withdrawal. Moreover, the recurrence rate was lower in subjects without visible tumor on pituitary MRI than in those with small remnant tumor (60 vs. 79%, though the difference was not statistically significant (P= 0.20. No other characteristic could be identified as a predictor of successful CAB discontinuation.In conclusion, a second attempt of CAB withdrawal after 2 additional years of therapy may be successful, particularly in patients with lower PRL levels and no visible tumor on pituitary MRI. Close monitoring of PRL level is mandatory, especially within the first year after withdrawal, where most recurrences are detected.

  18. Applying a Problem Based Learning Approach to Land Management Education:The Case of Aalborg University, Denmark

    OpenAIRE

    Enemark, Stig

    2016-01-01

    Land management covers a wide range activities associated with the management of land and natural resources that are required to fulfil political objectives and achieve sustainable development. This paper presents an overall understanding of the land management paradigm and the benefits of good land governance to society. A land administration system provides a country with the infrastructure to implement land-related policies and land management strategies. By applying this land management p...

  19. Formation of land administration system and land use as an economic function of the land ownership

    OpenAIRE

    N. Tretiak

    2014-01-01

    This paper deals with manifestation forms of land management and land use as an economic function of the property rights to land. The need to form an integrated system of land management and land use in Ukraine as an economic function of land ownership has been grounded. A model of comprehensive multifunctional system of land management and land use has been suggested

  20. Lorazepam and MK-801 effects on behavioral and electrographic indices of alcohol withdrawal sensitization.

    Science.gov (United States)

    Veatch, Lynn M; Becker, Howard C

    2005-12-14

    Repeated cycles of chronic ethanol exposure and withdrawal result in sensitization of withdrawal-related CNS hyperexcitability that generally reflects an imbalance in activity of GABA and glutamate systems. Many pharmacological treatments for ethanol withdrawal target neuroadaptive changes in GABA and glutamate neurotransmission. The present study utilized a mouse model of repeated withdrawals to evaluate the ability of lorazepam and MK-801 treatments to antagonize behavioral and electroencephalographic (EEG) measures of sensitized withdrawal seizure activity. Adult male C3H/He mice received chronic intermittent ethanol vapor exposure in inhalation chambers (16 h/day) and during each withdrawal cycle, separate groups of mice were evaluated for handling-induced convulsions (HIC) or abnormal EEG (high-voltage "brief spindle episodes" (BSE)) activity. Lorazepam (0.5-1.0 mg/kg) or MK-801 (0.1-0.3 mg/kg) treatment at 1 h into each of three withdrawal cycles reduced behavioral (HIC) and electrographic (BSE) signs of seizure activity in a dose-related fashion compared to vehicle-treated mice. During a subsequent untreated withdrawal, mice previously treated with lorazepam or MK-801 for earlier withdrawals exhibited reduced HIC activity during the acute phase but exacerbated HIC activity during the protracted phase of this final (fourth) withdrawal cycle. Both lorazepam and MK-801 treatment conditions resulted in enhanced BSE activity during the entire fourth (untreated) withdrawal episode. Collectively, these results suggest that while treatment of repeated ethanol withdrawals with a benzodiazepine (lorazepam) or an NMDA receptor antagonist (MK-801) may have some initial benefits in ameliorating the development of sensitized withdrawal excitability, such treatment may also render subjects more vulnerable to seizure activity at later time points.

  1. Youth social withdrawal behavior (hikikomori): A systematic review of qualitative and quantitative studies.

    Science.gov (United States)

    Li, Tim M H; Wong, Paul W C

    2015-07-01

    Acute and/or severe social withdrawal behavior among youth was seen as a culture-bound psychiatric syndrome in Japan, but more youth social withdrawal cases in different countries have been discovered recently. However, due to the lack of a formal definition and diagnostic tool for youth social withdrawal, cross-cultural observational and intervention studies are limited. We aimed to consolidate existing knowledge in order to understand youth social withdrawal from diverse perspectives and suggest different interventions for different trajectories of youth social withdrawal. This review examined the current available scientific information on youth social withdrawal in the academic databases: ProQuest, ScienceDirect, Web of Science and PubMed. We included quantitative and qualitative studies of socially withdrawn youths published in English and academic peer-reviewed journals. We synthesized the information into the following categories: (1) definitions of youth social withdrawal, (2) developmental theories, (3) factors associated with youth social withdrawal and (4) interventions for socially withdrawn youths. Accordingly, there are diverse and controversial definitions for youth social withdrawal. Studies of youth social withdrawal are based on models that lead to quite different conclusions. Researchers with an attachment perspective view youth social withdrawal as a negative phenomenon, whereas those who adopt Erikson's developmental theory view it more positively as a process of seeking self-knowledge. Different interventions for socially withdrawn youths have been developed, mainly in Japan, but evidence-based practice is almost non-existent. We propose a theoretical framework that views youth social withdrawal as resulting from the interplay between psychological, social and behavioral factors. Future validation of the framework will help drive forward advances in theory and interventions for youth social withdrawal as an emerging issue in developed

  2. A genetic perspective on the proposed inclusion of cannabis withdrawal in the DSM-5

    Science.gov (United States)

    Verweij, K.J.H.; Agrawal, A.; Nat, N.O.; Creemers, H.E.; Huizink, A.C.; Martin, N.G.; Lynskey, M.T.

    2013-01-01

    Background Various studies support the inclusion of cannabis withdrawal to the diagnosis of cannabis use disorders in the upcoming DSM-5. The aims of the current study were to (1) estimate the prevalence of DSM-5 cannabis withdrawal (Criterion B), (2) estimate the role of genetic and environmental influences on individual differences in cannabis withdrawal, and (3) determine the extent to which genetic and environmental influences on cannabis withdrawal overlap with those on DSM-IV defined abuse/dependence. Methods The sample included 2276 lifetime cannabis-using adult Australian twins. Cannabis withdrawal was defined in accordance with Criterion B of the proposed DSM-5 revisions. Cannabis abuse/dependence was defined as endorsing one or more DSM-IV criteria of abuse or three or more dependence criteria. The classical twin model was used to estimate the genetic and environmental influences on variation in cannabis withdrawal, as well as its covariation with abuse/dependence. Results Of all cannabis users 11.9% met criteria for cannabis withdrawal. Around 50% of between-individual variation in withdrawal could be attributed to additive genetic variation, and the rest of the variation was mostly due to non-shared environmental influences. Importantly, the genetic influences on cannabis withdrawal almost completely (99%) overlapped with those on abuse/dependence. Conclusions We showed that cannabis withdrawal symptoms exist among cannabis users, and that cannabis withdrawal is moderately heritable. Genetic influences on cannabis withdrawal are the same as those influencing abuse/dependence. These results add to the wealth of literature that recommends the addition of cannabis withdrawal to the diagnosis of DSM-5 cannabis use disorders. PMID:23194657

  3. The prevalence and clinical significance of inhalant withdrawal symptoms among a national sample

    Directory of Open Access Journals (Sweden)

    Vaughn MG

    2011-04-01

    Full Text Available Brian E Perron1, Joseph E Glass2, Brian K Ahmedani3, Michael G Vaughn4, Daniel E Roberts1, Li-Tzy Wu51University of Michigan, Ann Arbor, MI, USA; 2Washington University, St Louis, MO, USA; 3Henry Ford Health System, Detroit, MI, USA; 4St Louis University, St Louis, MO, USA; 5Duke University, Durham, NC, USABackground: Inhalants are among the most common and dangerous forms of substance use, but very little research on inhalant use disorders exist. Unlike other substances, the Diagnostic and Statistical Manual, 4th edition (DSM-IV indicates that inhalants do not have an associated withdrawal syndrome among persons who meet criteria for inhalant dependence.Methods: Using data from the National Epidemiologic Survey on Alcohol and Related Conditions, this study examines the prevalence of withdrawal symptoms among inhalant users. Prevalence of inhalant withdrawal symptoms for inhalants was also compared with the prevalence of cocaine withdrawal symptoms to help determine the presence of an inhalant withdrawal syndrome.Results: Approximately 47.8% of persons who met criteria for inhalant dependence reported experiencing three or more inhalant-related withdrawal symptoms that were clinically significant. Among those with inhalant dependence, almost half of the withdrawal symptoms were as common as the corresponding withdrawal symptoms experienced by persons with cocaine dependence. Furthermore, the percentage of persons with inhalant dependence reporting clinically significant inhalant withdrawal symptoms was almost equal to the percentage of persons with cocaine dependence reporting clinically significant cocaine withdrawal symptoms.Conclusions: These data provide evidence for an inhalant-related withdrawal syndrome among persons with inhalant dependence. Revisions to DSM-IV should consider including inhalant withdrawal as a diagnostic criterion for this disorder.Keywords: Inhalants, volatile solvents, withdrawal, inhalant use disorders

  4. Clinical characteristics and survival outcomes of terminally ill patients undergoing withdrawal of mechanical ventilation.

    Science.gov (United States)

    Hung, Yu-Shin; Lee, Shu-Hui; Hung, Chia-Yen; Wang, Chao-Hui; Kao, Chen-Yi; Wang, Hung-Ming; Chou, Wen-Chi

    2017-10-11

    Withdrawal of mechanical ventilation is an important, but rarely explored issue in Asia during end-of-life care. This study aimed to describe the clinical characteristics and survival outcomes of terminally ill patients undergoing withdrawal of mechanical ventilation in Taiwan. One-hundred-thirty-five terminally ill patients who had mechanical ventilation withdrawn between 2013 and 2016, from a medical center in Taiwan, were enrolled. Patients' clinical characteristics and survival outcomes after withdrawal of mechanical ventilation were analyzed. The three most common diagnoses were organic brain lesion, advanced cancer, and newborn sequelae. The initiator of the withdrawal process was family, medical personnel, and patient him/herself. The median survival time was 45 min (95% confidence interval, 33-57 min) after the withdrawal of mechanical ventilation, and 102 patients (75.6%) died within one day after extubation. The median time from diagnosis of disease to receiving life-sustaining treatment and artificial ventilation support, receiving life-sustaining treatment and artificial ventilation support to "Withdrawal meeting," "Withdrawal meeting" to ventilator withdrawn, and ventilator withdrawn to death was 12.1 months, 19 days, 1 day, and 0 days, respectively. Patients with a diagnosis of advanced cancer and withdrawal initiation by the patients themselves had a significantly shorter time interval between receiving life-sustaining treatment and artificial ventilation support to "Withdrawal meeting" compared to those with non-cancer diseases and withdrawal initiation by family or medical personnel. This study is the first observational study to describe the patients' characteristics and elaborate on the survival outcome of withdrawal of mechanical ventilation in patients who are terminally ill in an Asian population. Understanding the clinical characteristics and survival outcomes of mechanical ventilation withdrawal might help medical personnel provide

  5. 78 FR 58554 - Notice of Application for Withdrawal Extension, and Notification of a Public Meeting, Desert...

    Science.gov (United States)

    2013-09-24

    ... Meeting, Desert National Wildlife Range; Nevada AGENCY: Bureau of Land Management, Interior. ACTION... States mining laws, to protect the wildlife habitat and unique values within the Desert National Wildlife... and last reasonably intact examples of Mojave Desert landscape habitats. The use of a right-of-way...

  6. Kidney function after withdrawal of long-term antihypertensive treatment in diabetic nephropathy

    DEFF Research Database (Denmark)

    Hansen, H P; Nielsen, F S; Rossing, P

    1997-01-01

    Initiation of antihypertensive treatment in hypertensive non-insulin-dependent diabetic (NIDDM) patients with diabetic nephropathy induces a faster initial (0 to 6 months) and slower subsequent (6 months-end) decline in GFR [delta GFR (ml.min-1.1.73 m-2.month-1) approximately 1.5 vs. 0.4]. Whether...... this initial phenomenon is reversible (hemodynamic) or irreversible (structural damage) after prolonged antihypertensive treatment is not known. To elucidate these mechanisms we investigated 40 hypertensive NIDDM patients (age 61 +/- 7 years, mean +/- SD), known duration of diabetes 14 years (2 to 33 years......) [median (range)] with diabetic nephropathy receiving antihypertensive treatment (angiotensin converting enzyme inhibition, N = 30) for 5 years (1 to 20 years). The following variables were measured the last day on antihypertensive treatment and one month after withdrawal of treatment; GFR (51Cr-EDTA), 24...

  7. Transfer and Transition: Interagency Coordination for Managing Public Lands at UMTRCA Title II Sites in Wyoming – 16614

    Energy Technology Data Exchange (ETDEWEB)

    Shafer, David S. [U.S. Dpartment of Energy, Office of Legacy Management; Vanek, Tim [U.S.Department of Energy, Office of Legacy Management; Ribeiro, Tracy [U.S. Department of Energy, Office of Legacy Management; Bahrke, Cheri [Navarro Research and Engineering

    2016-03-06

    By the end of fiscal year 2025, the U.S. Department of Energy (DOE) Office of Legacy Management (LM) is anticipating adding 17 sites remediated under Title II of the Uranium Mill Tailings Radiation Control Act (UMTRCA) to the current inventory of 90 sites that it manages. Among the new sites are ones where federal public lands occur within the proposed long-term care boundary, the boundary determined by the Nuclear Regulatory Commission and LM as necessary to maintain site protectiveness for the entombed uranium mill tailings and residual groundwater contamination. For these sites, public land withdrawals for land and minerals will need to be established. LM’s primary mission at UMTRCA sites is to protect the public and the environment from exposure to contamination at the sites. For the sites with public lands or federally controlled minerals that will be transferring to LM, the Office will apply to the Department of the Interior (DOI) Bureau of Land Management (BLM) for new, public land and mineral withdrawals. At most current LM UMTRCA sites that involved public lands and minerals, DOI granted DOE “full administrative jurisdiction” and permanent withdrawals. Hence, these withdrawals are, permanently, no longer subject to public land, mining, and mineral-leasing laws and regulations. LM is coordinating with DOI/BLM in Wyoming to permanently withdraw full and partial jurisdiction at future UMTRCA Title II sites in that state. This approach would allow LM to fully administer surface lands and minerals, where necessary, and DOI and LM to administer surface lands and leasable minerals where it would not jeopardize sites’ radiological safety and long-term public and environmental protection. This “shared-jurisdiction approach” will meet LM’s strategic goal of protecting human health and the environment but also allow BLM to fulfill their mission to “manage and conserve the lands under the mandate of multiple-use and sustained yield.” In addition, LM

  8. Fourth International Symposium on Land Subsidence

    Science.gov (United States)

    Johnson, A. I.

    Subsidence, or land-surface sinking, is a phenomenon that occurs in many parts of the world. Subsidence results from the heavy withdrawal of groundwater, geothermal fluids, oil, and gas; the extraction of coal, sulphur, and other solids through mining; the hydro-compaction of sediments; oxidation and shrinkage of organic deposits; the catastrophic development of sinkholes in karst terrain; and other phenomena. Over 150 areas of contemporary subsidence are known, some at rates of 10 m in countries such as Mexico, Japan, and the United States, for example. More areas of subsidence are likely to develop in the next few decades due to the accelerated exploitation of natural resources necessary to meet the demands of increasing population and industrial development in many countries.

  9. 18 CFR 367.55 - Land and land rights.

    Science.gov (United States)

    2010-04-01

    ... 18 Conservation of Power and Water Resources 1 2010-04-01 2010-04-01 false Land and land rights... Property Instructions § 367.55 Land and land rights. (a) The accounts for land and land rights must include the cost of land owned in fee by the service company and rights. Interests, and privileges held by the...

  10. Land evaluation by the process of agricultural land consolidation - the case of land consolidation area Berkovci

    OpenAIRE

    Knavs, Alojz

    2008-01-01

    The thesis describes the course of procedure of agricultural land consolidation in Slovenia, based on valid legislation of land consolidation of agricultural land. The main stress is given on approaches to land evaluation of agricultural land consolidation fund, which is an important step at re-distribution of land from the land consolidation fund among the land owners. The main purpose of the thesis is to point out the importance of land evaluation by the process of land consolidation and to...

  11. LAND GOVERNANCE AND LAND DEALS IN AFRICA ...

    African Journals Online (AJOL)

    RAYAN_

    proportion of the smallholders' land for a joint venture with a Chinese company in a wildlife safari ..... governments in Africa which enable these deals to take place; deals .... A great deal of these lands is legally owned by the state and many government authorities see foreign investment as a way to expand the economy.

  12. Landing spot selection for UAV emergency landing

    NARCIS (Netherlands)

    Eendebak, P.T.; Eekeren, A.W.M. van; Hollander, R.J.M. den

    2013-01-01

    We present a robust method for landing zone selection using obstacle detection to be used for UAV emergency landings. The method is simple enough to allow real-time implementation on a UAV system. The method is able to detect objects in the presence of camera movement and motion parallax. Using the

  13. LandSat-Based Land Use-Land Cover (Raster)

    Data.gov (United States)

    Minnesota Department of Natural Resources — Raster-based land cover data set derived from 30 meter resolution Thematic Mapper satellite imagery. Classification is divided into 16 classes with source imagery...

  14. LandSat-Based Land Use-Land Cover (Vector)

    Data.gov (United States)

    Minnesota Department of Natural Resources — Vector-based land cover data set derived from classified 30 meter resolution Thematic Mapper satellite imagery. Classification is divided into 16 classes with source...

  15. Anxiety and depressive symptoms and affective patterns of tobacco withdrawal.

    Science.gov (United States)

    Leventhal, Adam M; Ameringer, Katherine J; Osborn, Elly; Zvolensky, Michael J; Langdon, Kirsten J

    2013-12-01

    The complex concordance and discordance across and within anxiety and depressive symptoms complicates understanding of the relation between emotional symptoms and manifestations of tobacco withdrawal. The goal of this study was to parse the broad variation in anxiety and depressive symptoms into conceptually discrete components and explore their relative predictive influence on affective patterns of acute tobacco withdrawal. We employed a within-participant experimentally manipulated tobacco abstinence design involving: (i) a baseline visit at which past-week depression and anxiety symptoms were assessed and (ii) two counterbalanced experimental visits-one after ad lib smoking and one after 16-h of tobacco abstinence-at which state affect was assessed. Participants were community-dwelling adults (N=187) smoking 10+ cig/day for at least two years without an active mood disorder. Anxiety-related general distress symptoms (e.g., tension, nervousness) predicted greater abstinence-induced increases in various negative affective states but not changes in positive affect (βs .17-.33). Depression-related general distress symptoms (e.g., sadness, worthlessness) predicted greater abstinence-induced increases in acute depressed affect only (βs .24-.25). Anhedonic symptoms (e.g., diminished interest, lack of pleasure) predicted larger abstinence-induced decreases in acute positive affect only (βs .17-.20). Anxious Arousal symptoms (e.g., shakiness, heart racing) predicted larger abstinence-induced increases in fatigue and depressive affect (βs .15-.24). Different components of anxiety and depressive symptoms are associated with unique affective patterns of acute tobacco withdrawal. These results provide insight into the affective mechanisms underlying tobacco dependence and could inform smoking cessation treatment approaches tailored to individuals with emotional distress. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  16. Management of Acute Alcohol Withdrawal Syndrome in Critically Ill Patients.

    Science.gov (United States)

    Dixit, Deepali; Endicott, Jeffrey; Burry, Lisa; Ramos, Liz; Yeung, Siu Yan Amy; Devabhakthuni, Sandeep; Chan, Claire; Tobia, Anthony; Bulloch, Marilyn N

    2016-07-01

    Approximately 16-31% of patients in the intensive care unit (ICU) have an alcohol use disorder and are at risk for developing alcohol withdrawal syndrome (AWS). Patients admitted to the ICU with AWS have an increased hospital and ICU length of stay, longer duration of mechanical ventilation, higher costs, and increased mortality compared with those admitted without an alcohol-related disorder. Despite the high prevalence of AWS among ICU patients, no guidelines for the recognition or management of AWS or delirium tremens in the critically ill currently exist, leading to tremendous variability in clinical practice. Goals of care should include immediate management of dehydration, nutritional deficits, and electrolyte derangements; relief of withdrawal symptoms; prevention of progression of symptoms; and treatment of comorbid illnesses. Symptom-triggered treatment of AWS with γ-aminobutyric acid receptor agonists is the cornerstone of therapy. Benzodiazepines (BZDs) are most studied and are often the preferred first-line agents due to their efficacy and safety profile. However, controversy still exists as to who should receive treatment, how to administer BZDs, and which BZD to use. Although most patients with AWS respond to usual doses of BZDs, ICU clinicians are challenged with managing BZD-resistant patients. Recent literature has shown that using an early multimodal approach to managing BZD-resistant patients appears beneficial in rapidly improving symptoms. This review highlights the results of recent promising studies published between 2011 and 2015 evaluating adjunctive therapies for BZD-resistant alcohol withdrawal such as antiepileptics, baclofen, dexmedetomidine, ethanol, ketamine, phenobarbital, propofol, and ketamine. We provide guidance on the places in therapy for select agents for management of critically ill patients in the presence of AWS. © 2016 Pharmacotherapy Publications, Inc.

  17. [Benzodiazepine withdrawal in subjects on opiate substitution treatment].

    Science.gov (United States)

    Fatséas, Mélina; Lavie, Estelle; Denis, Cécile; Franques-Rénéric, Pascale; Tignol, Jean; Auriacombe, Marc

    2006-04-01

    Benzodiazepines are the most widely used psychotropic agents in the world. Abuse and dependence are reported in the general population and among drug misusers, including those dependent on heroine. Benzodiazepine use by heroine users increases their risk of overdose, not only from heroin but also substitution drugs such as methadone and more recently buprenorphine. Hence, detoxification from benzodiazepines is desirable. The objective of this paper was to review the literature and determine the best benzodiazepine detoxification procedure for opiate-dependent individuals receiving substitution treatment. Relevant studies were sought through systematic searches of Medline and Toxibase (a database focusing on substance abuse). There were fewer controlled studies than expected about benzodiazepine detoxification, and all of them excluded subjects who misused opiates or were in opiate substitution treatment. The best evidence supports a procedure where the patient is switched to a long-lasting benzodiazepine and the dose then tapered by 25% of the initial dose each week. Diazepam is the drug most often used in the framework. In opiate users, diazepam may raise special problems of misuse, as suggested by clinical and epidemiologic studies. Nonetheless, diazepam is the only benzodiazepine found to be effective for this withdrawal in controlled studies and some studies indicate that unprescribed diazepam use in heroin users is sometimes motivated by the desire to alleviate withdrawal symptoms and discomfort. Although diazepam appears to have potential for abuse, the available data does not rule out its therapeutic interest for benzodiazepine withdrawal in patients on opiate substitution treatment in an adequate treatment setting. Specific studies of this population are needed.

  18. Alcohol Withdrawal Syndrome in Critically Ill Patients: Identification, Assessment, and Management.

    Science.gov (United States)

    Sutton, Lynsey J; Jutel, Annemarie

    2016-02-01

    Management of alcohol withdrawal in critically ill patients is a challenge. The alcohol consumption histories of intensive care patients are often incomplete, limiting identification of patients with alcohol use disorders. Abrupt cessation of alcohol places these patients at risk for alcohol withdrawal syndrome. Typically benzodiazepines are used as first-line therapy to manage alcohol withdrawal. However, if patients progress to more severe withdrawal or delirium tremens, extra adjunctive medications in addition to benzodiazepines may be required. Sedation and mechanical ventilation may also be necessary. Withdrawal assessment scales such as the Clinical Institute of Withdrawal Assessment are of limited use in these patients. Instead, general sedation-agitation scales and delirium detection tools have been used. The important facets of care are the rapid identification of at-risk patients through histories of alcohol consumption, management with combination therapies, and ongoing diligent assessment and evaluation. (Critical Care Nurse. 2016;36[1]:28-39). ©2016 American Association of Critical-Care Nurses.

  19. Mekong Land Cover Dasboard: Regional Land Cover Mointoring Systems

    Science.gov (United States)

    Saah, D. S.; Towashiraporn, P.; Aekakkararungroj, A.; Phongsapan, K.; Triepke, J.; Maus, P.; Tenneson, K.; Cutter, P. G.; Ganz, D.; Anderson, E.

    2016-12-01

    -quality regional land cover maps on a regular basis that are consistent and continuous across the landscape. The system is being designed to facilitate improved policy, planning, and decision making by a wide range of users (such as government agencies, local community groups, non-profit organizations, and the private sector).

  20. Early steroid withdrawal after liver transplantation for hepatocellular carcinoma

    Science.gov (United States)

    Chen, Zhi-Shui; He, Fan; Zeng, Fan-Jun; Jiang, Ji-Pin; Du, Dun-Feng; Liu, Bin

    2007-01-01

    AIM: To evaluate the impact of early steroid withdrawal on the incidence of rejection, tumor recurrence and complications after liver transplantation for advanced-stage hepatocellular carcinoma. METHODS: Fifty-four patients underwent liver transplantation for advanced-stage hepatocellular carcinoma from April 2003 to June 2005. These cases were divided into a steroid-withdrawal group (group A, n = 28) and a steroid-maintenance group (group B, n = 26). In group A, steroid was withdrawn 3 mo after transplantation. In group B, steroid was continuously used postoperatively. The incidence of rejection, 6-mo and 1-year recurrence rate of carcinoma, 1-year survival rate, mean serum tacrolimus trough level, and liver and kidney function were compared between the two groups. RESULTS: In the two groups, no statistical difference was observed in the incidence of rejection (14.3 vs 11.5%, P > 0.05), mean serum tacrolimus trough levels (6.9 ± 1.4 vs 7.1 ± 1.1 μg/L, P > 0.05), liver and kidney function after 6 mo [alanine aminotransferase (ALT): 533 ± 183 vs 617 ± 217 nka/L, P > 0.05; creatinine: 66 ± 18 vs 71 ± 19 μmol/L, P > 0.05], 6-mo recurrence rate of carcinoma (25.0 vs 42.3%, P > 0.05), and 1-year survival rate (64.2 vs 46.1%, P > 0.05). The 1-year tumor recurrence rate (39.2 vs 69.2%, P < 0.05), serum cholesterol level (3.9 ± 1.8 vs 5.9 ± 2.6 mmol/L, P < 0.01) and fasting blood sugar (5.1 ± 2.1 vs 8.9 ± 3.6 mmol/L, P < 0.01) were significantly different. These were lower in the steroid-withdrawal group than in the steroid-maintenance group. CONCLUSION: Early steroid withdrawal was safe after liver transplantation in patients with advanced-stage hepatocellular carcinoma. When steroids were withdrawn 3 mo post-operation, the incidence of rejection did not increase, and there was no demand to maintain tacrolimus at a high level. In contrast, the tumor recurrence rate and the potential of adverse effects decreased significantly. This may have led to an increase