WorldWideScience

Sample records for withdrawal movement due

  1. Subsidence due to geothermal fluid withdrawal

    Energy Technology Data Exchange (ETDEWEB)

    Narasimhan, T. N. [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States). Earth Sciences Division; Univ. of California, Berkeley, CA (United States); Goyal, K. P. [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States). Earth Sciences Division; Univ. of California, Berkeley, CA (United States)

    1984-12-01

    Single-phase and two-phase geothermal reservoirs are currently being exploited for power production in Italy, Mexico, New Zealand, the United States, and elsewhere. Vertical ground displacements of up to 4.5 m and horizontal ground displacements of up to 0.5 m have been observed at Wairakei, New Zealand, that are clearly attributable to the resource exploitation. Similarly, vertical displacements of about 0.13 m have been recorded at The Geysers, California. No significant ground displacements that are attributable to large-scale fluid production have been observed at Larderello, Italy, and Cerro Prieto, Mexico. In this paper, observations show that subsidence due to geothermal fluid production is characterized by such features as an offset of the subsidence bowl from the main area of production, time-lag between production and subsidence, and nonlinear stress-strain relationships. Several plausible conceptual models, of varying degrees of sophistication, have been proposed to explain the observed features. At present, relatively more is known about the physical mechanisms that govern subsidence than the relevant thermal mechanisms. Finally, although attempts have been made to simulate observed geothermal subsidence, the modeling efforts have been seriously limited by a lack of relevant field data needed to sufficiently characterize the complex field system.

  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. Movement disorders due to bilirubin toxicity

    Science.gov (United States)

    Rose, Jessica; Vassar, Rachel

    2015-01-01

    Summary Advances in the care of neonatal hyperbilirubinemia have decreased the incidence of kernicterus. However, neonatal exposure to high levels of bilirubin continues to cause severe motor symptoms and cerebral palsy (CP). Exposure to moderate levels of unconjugated bilirubin may also cause damage to the developing central nervous system, specifically the basal ganglia and cerebellum. Brain lesions identified using magnetic resonance imaging following extreme hyperbilirubinemia have been linked to dyskinetic CP. Newer imaging techniques, such as diffusion tensor imaging or single-photon emission computed tomography, allow quantification of more subtle white matter injury following presumed exposure to unbound bilirubin, and may explain more subtle movement disorders. New categories of bilirubin-induced neurologic dysfunction, either independently or characterized by subtle bilirubin encephalopathy, following moderate hyperbilirubinemia have been implicated in long-term motor function. Further research is needed to identify subtle impairments resulting from moderate to severe neonatal hyperbilirubinemia, understand the influence of perinatal risk factors on bilirubin toxicity, and develop neuroprotective treatment strategies to prevent movement disorders due to bilirubin toxicity. PMID:25524299

  4. 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.

  5. Dynamic Loads Due to Synchronized Movements of People

    DEFF Research Database (Denmark)

    Hansen, S.O.; Sørensen, John Dalsgaard

    2002-01-01

    Structures like sport stadiums, grandstands and arenas for rock concerts become larger and more and more flexible. Therefore dynamic effects due to loads from synchronized movements of people become more important. This paper describes a spectral approach to model the structural response...... for implementation in structural codes are presented....

  6. 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.

  7. Antiepileptic drug therapy and recommendations for withdrawal in patients with seizures and epilepsy due to neurocysticercosis.

    Science.gov (United States)

    Bustos, Javier A; García, Héctor H; Del Brutto, Oscar H

    2016-09-01

    Neurocysticercosis (NCC) is a leading causes of secondary epilepsy worldwide. There is increasing evidence on the epileptogenic role of NCC, and the presence of edema, calcified scars, gliosis and hippocampal sclerosis support this phenomenon. We summarized principles of antiepileptic drug (AED) therapy as well as risk factors associated with seizure recurrence after AED withdrawal in patients with NCC. Expert commentary: First-line AED monotherapy is effective as a standard approach to control seizures in most NCC patients. Risks and benefits of AED withdrawal have not been systematically studied, and this decision must be individualized. However, a seizure-free period of at least two years seem prudent before attempting withdrawal. Risk factors for seizure recurrence after AED withdrawal include a history of status epilepticus, poor seizure control during treatment, neuroimaging evidence of perilesional gliosis, hippocampal sclerosis and calcified lesions, as well as persistence of paroxysmal activity in the EEG.

  8. Rapid Death Due to Alcohol Withdrawal Syndrome: Case Report and Review of Literature

    Directory of Open Access Journals (Sweden)

    Rahul Mohanrao Band

    2015-03-01

    Full Text Available Background: Alcohol withdrawal syndrome (AWS is one of the most serious complications associated with chronic alcoholism. Sudden deaths are not uncommon in AWS. In severe stages of AWS, delirium tremens (DT occurs, which is characterized with agitation, global confusion, disorientation, visual and auditory hallucinations in addition to autonomic hyperactivity. Case report: A 30-year old man, chronic and heavy alcohol drinker for 10 years, abstained from alcohol for 3 days. Consequently, he started having palpitations, sweating and tremors. A day later, he was found having hallucinations and delirium. The patient was immediately transferred to the hospital. On admission, he was stuporous and had difficulty in breathing. He developed generalized seizures later on. He was successfully intubated, but there was bleeding through it. The patient’s condition deteriorated very rapidly and he died within two hours. After death, his body was transferred to forensic department. In autopsy, gastrointestinal tract was found to be intact. Massive pulmonary hemorrhage was present on cut section. Liver was found to be with yellowish discoloration and early cirrhotic changes. In heart, left ventricular hypertrophy with narrowed lumen was present and coronary arteries were patent. Discussion: Alcoholism is associated with liver dysfunction and especially in final phases with cirrhosis. Hence and due to resultant coagulopathy, patients are vulnerable to internal bleedings. Hypertrophic cardiomyopathy also occurs in chronic alcoholics. Therefore, we can speculate that our patient developed pulmonary hemorrhage as a result of combined effect of coagulopathy secondary to cirrhosis, alveolar damage (seizure and artificial ventilation and congestive heart failure. Conclusion: For a patient with delirium, convulsions, respiratory distress and coagulopathy, diagnosis of DT should be kept in mind.

  9. Subsidence due to Excessive Groundwater Withdrawal in the San Joaquin Valley, California

    Science.gov (United States)

    Corbett, F.; Harter, T.; Sneed, M.

    2011-12-01

    Francis Corbett1, Thomas Harter1 and Michelle Sneed2 1Department of Land Air and Water Resources, University of California, Davis. 2U.S. Geological Survey Western Remote Sensing and Visualization Center, Sacramento. Abstract: Groundwater development within the Central Valley of California began approximately a century ago. Water was needed to supplement limited surface water supplies for the burgeoning population and agricultural industries, especially within the arid but fertile San Joaquin Valley. Groundwater levels have recovered only partially during wet years from drought-induced lows creating long-term groundwater storage overdraft. Surface water deliveries from Federal and State sources led to a partial alleviation of these pressure head declines from the late 1960s. However, in recent decades, surface water deliveries have declined owing to increasing environmental pressures, whilst water demands have remained steady. Today, a large portion of the San Joaquin Valley population, and especially agriculture, rely upon groundwater. Groundwater levels are again rapidly declining except in wet years. There is significant concern that subsidence due to groundwater withdrawal, first observed at a large scale in the middle 20th century, will resume as groundwater resources continue to be depleted. Previous subsidence has led to problems such as infrastructure damage and flooding. To provide a support tool for groundwater management on a naval air station in the southern San Joaquin Valley (Tulare Lake Basin), a one-dimensional MODFLOW subsidence model covering the period 1925 to 2010 was developed incorporating extensive reconstruction of historical subsidence and water level data from various sources. The stratigraphy used for model input was interpreted from geophysical logs and well completion reports. Gaining good quality data proved problematic, and often values needed to be estimated. In part, this was due to the historical lack of awareness/understanding of

  10. Bias due to withdrawal in long-term randomised trials in COPD

    DEFF Research Database (Denmark)

    Vestbo, Jørgen; Anderson, Julie Anne; Calverley, Peter Mark Anthony

    2011-01-01

    Randomised controlled trials (RCTs) are considered the least biased method for evaluating drug efficacy and several large long-term RCTs in chronic obstructive pulmonary disease have been published. These usually include drugs with symptomatic benefits and have significant withdrawal rates....

  11. Sindrome confusional agudo por abstinencia aguda de nicotina Delirium due to acute nicotine withdrawal

    Directory of Open Access Journals (Sweden)

    Manuel Klein

    2002-08-01

    Full Text Available El síndrome confusional agudo (SCA o delirium en pacientes hospitalizados es un problema frecuente y grave. Se caracteriza por síntomas de comienzo agudo y curso fluctuante con inatención, pensamiento desorganizado, y con distintos niveles de alteración de la conciencia.En la bibliografía consultada, el SCA como manifestación de un síndrome de abstinencia aguda nicotínica fue descripto en solo ocho casos. Presentamos el caso de un tabaquista grave que, internado por una reagudización de su enfermedad pulmonar obstructiva crónica (EPOC, presentó un cuadro de SCA al tercer día de abstinencia tabacal, cediendo los síntomas tras la administración de un parche de nicotina. Lo descripto sugiere que en pacientes internados que presentan SCA y agitación, con fuertes antecedentes de tabaquismo, un simple ensayo con un parche de nicotina puede ofrecer en pocas horas una notable respuesta terapéutica y a su vez un test confirmatorio. El reconocimiento del SCA como forma de presentación de la abstinencia nicotínica permitirá identificar casos habitualmente complejos en los que se podrá implementar una sencilla y eficaz alternativa terapéutica.Delirium or acute confusional state among hospitalized patients is a frequent and serious problem. It is characterized by acute onset symptoms, fluctuating course, impaired attention, unorganized thinking, and altered level of conciousness. Delirium, as a manifestation of acute nicotine withdrawal syndrome has been reported in the reviewed literature only in eight cases. We report the case of a heavy smoker admitted because of a reagudization of his chronic obstructive pulmonary disease. At the third day of nicotine abstinence, he developed delirium with a rapid improvement of his symptoms after treatment with a transdermal nicotine patch. This description suggests that in hospitalized heavy smokers who develop delirium with agitation, a simple trial with a nicotine patch can offer a dramatic

  12. [Psychoanalytic study of social withdrawal: grandiose narcissism and passive aggression due to insufficient maternal containing in childhood].

    Science.gov (United States)

    Ogawa, Toyoaki

    2012-01-01

    Two different types of pathology can cause social withdrawal: the narcissistic--schizoid personality organization (NSPO) type and the mild Asperger's syndrome (mild developmental disorders) type. Only the former type can be treated by psychoanalytic psychotherapy. In the childhood of both types, one may find traumatic family environments which will result in social withdrawal (Hikikomori). In the infancy of the NSPO type, the mother fails to function as a sufficient container of the child's emotion, which encourages formation of a schizoid personality organization i.e. the psychic withdrawal (or "psychic retreat" by Steiner, J.). With only a little failure in life events, this may turn into a physical withdrawal for a long time. And in this type of pathology their aggression takes a passive form that hardens their social withdrawal situation. Moreover, the social withdrawal itself serves to reinforce the pathological narcissism.

  13. Crustal movements due to Iceland's shrinking ice caps mimic magma inflow signal at Katla volcano.

    Science.gov (United States)

    Spaans, Karsten; Hreinsdóttir, Sigrún; Hooper, Andrew; Ófeigsson, Benedikt Gunnar

    2015-05-20

    Many volcanic systems around the world are located beneath, or in close proximity to, ice caps. Mass change of these ice caps causes surface movements, which are typically neglected when interpreting surface deformation measurements around these volcanoes. These movements can however be significant, and may closely resemble movements due to magma accumulation. Here we show such an example, from Katla volcano, Iceland. Horizontal movements observed by GPS on the flank of Katla have led to the inference of significant inflow of magma into a chamber beneath the caldera, starting in 2000, and continuing over several years. We use satellite radar interferometry and GPS data to show that between 2001 and 2010, the horizontal movements seen on the flank can be explained by the response to the long term shrinking of ice caps, and that erratic movements seen at stations within the caldera are also not likely to signify magma inflow. It is important that interpretations of geodetic measurements at volcanoes in glaciated areas consider the effect of ice mass change, and previous studies should be carefully reevaluated.

  14. Model for the prediction of subsurface strata movement due to underground mining

    Science.gov (United States)

    Cheng, Jianwei; Liu, Fangyuan; Li, Siyuan

    2017-12-01

    The problem of ground control stability due to large underground mining operations is often associated with large movements and deformations of strata. It is a complicated problem, and can induce severe safety or environmental hazards either at the surface or in strata. Hence, knowing the subsurface strata movement characteristics, and making any subsidence predictions in advance, are desirable for mining engineers to estimate any damage likely to affect the ground surface or subsurface strata. Based on previous research findings, this paper broadly applies a surface subsidence prediction model based on the influence function method to subsurface strata, in order to predict subsurface stratum movement. A step-wise prediction model is proposed, to investigate the movement of underground strata. The model involves a dynamic iteration calculation process to derive the movements and deformations for each stratum layer; modifications to the influence method function are also made for more precise calculations. The critical subsidence parameters, incorporating stratum mechanical properties and the spatial relationship of interest at the mining level, are thoroughly considered, with the purpose of improving the reliability of input parameters. Such research efforts can be very helpful to mining engineers’ understanding of the moving behavior of all strata over underground excavations, and assist in making any damage mitigation plan. In order to check the reliability of the model, two methods are carried out and cross-validation applied. One is to use a borehole TV monitor recording to identify the progress of subsurface stratum bedding and caving in a coal mine, the other is to conduct physical modelling of the subsidence in underground strata. The results of these two methods are used to compare with theoretical results calculated by the proposed mathematical model. The testing results agree well with each other, and the acceptable accuracy and reliability of the

  15. Validation of neutron flux redistribution factors in JSI TRIGA reactor due to control rod movements.

    Science.gov (United States)

    Kaiba, Tanja; Žerovnik, Gašper; Jazbec, Anže; Štancar, Žiga; Barbot, Loïc; Fourmentel, Damien; Snoj, Luka

    2015-10-01

    For efficient utilization of research reactors, such as TRIGA Mark II reactor in Ljubljana, it is important to know neutron flux distribution in the reactor as accurately as possible. The focus of this study is on the neutron flux redistributions due to control rod movements. For analyzing neutron flux redistributions, Monte Carlo calculations of fission rate distributions with the JSI TRIGA reactor model at different control rod configurations have been performed. Sensitivity of the detector response due to control rod movement have been studied. Optimal radial and axial positions of the detector have been determined. Measurements of the axial neutron flux distribution using the CEA manufactured fission chambers have been performed. The experiments at different control rod positions were conducted and compared with the MCNP calculations for a fixed detector axial position. In the future, simultaneous on-line measurements with multiple fission chambers will be performed inside the reactor core for a more accurate on-line power monitoring system. Copyright © 2015 Elsevier Ltd. All rights reserved.

  16. 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.

  17. Tactical combat movements: inter-individual variation in performance due to the effects of load carriage.

    Science.gov (United States)

    Hunt, Andrew P; Tofari, Paul J; Billing, Daniel C; Silk, Aaron J

    2016-09-01

    An examination into the effects of carried military equipment on the performance of two tactical combat movement simulations was conducted. Nineteen Airfield Defence Guards performed a break contact (five 30-m sprints) and a fire and movement simulation (16 6-m bounds) in five load conditions (10-30 kg). Heavier loads significantly increased movement duration on the break contact (0.8%/kg load) and fire and movement (1.1%/kg). Performance deterioration was observed from the beginning to the end of the series of movements (bounds or sprints) with deterioration becoming significantly greater in heavier load conditions. Inter-individual variation between slower and faster participants showed a range in load effects; 0.6, 0.8%/kg for fast and 1.0, 1.4%/kg for slow (break contact, fire and movement, respectively). Velocity profiles revealed that the initial acceleration and peak velocity were the primary determinants of performance. As the duration of these tactical combat movements reflects periods of heightened vulnerability, these findings highlight important implications for commanders. Practitioner Summary: Increasing amounts of carried military equipment impairs the performance of tactical combat movements. Examination of inter-individual variation in velocity profiles identified that the initial acceleration and the peak velocity achieved during sprints and bounds are key determinants of overall performance.

  18. An Objective Functional Characterisation of Head Movement Impairment in Individuals with Neck Muscle Weakness Due to Amyotrophic Lateral Sclerosis.

    Directory of Open Access Journals (Sweden)

    Silvia Pancani

    Full Text Available Neck muscle weakness and head drop are well recognised in patients with Amyotrophic lateral sclerosis (ALS, but an objective characterisation of the consequent head movement impairment is lacking. The aim of this study was to quantitatively characterise head movements in ALS compared to aged matched controls.We evaluated two groups, one of thirteen patients with ALS and one of thirteen age-matched controls, during the execution of a series of controlled head movements, performed while wearing two inertial sensors attached on the forehead and sternum, respectively. We quantified the differences between the two groups from the sensor data using indices of velocity, smoothness and movement coupling (intended as a measure of undesired out of plane movements.Results confirmed a general limitation in the ability of the ALS patients to perform and control head movements. High inter-patient variability was observed due to a wide range of observed functional impairment levels. The ability to extend the head backward and flex it laterally were the most compromised, with significantly lower angular velocity (P 0.8, reduced smoothness and greater presence of coupled movements with respect to the controls. A significant reduction of angular velocity (P 0.8 in extension, axial rotation and lateral flexion was observed when patients were asked to perform the movements as fast as possible.This pilot study is the first study providing a functional objective quantification of head movements in ALS. Further work involving different body areas and correlation with existing methods of evaluating neuromuscular function, such as dynamometry and EMG, is needed to explore the use of this approach as a marker of disease progression in ALS.

  19. 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.

  20. Weighted-peak assessment of occupational exposure due to MRI gradient fields and movements in a nonhomogeneous static magnetic field.

    Science.gov (United States)

    Andreuccetti, D; Contessa, G M; Falsaperla, R; Lodato, R; Pinto, R; Zoppetti, N; Rossi, P

    2013-01-01

    A procedure for assessing occupational exposure due to magnetic resonance imaging (MRI) gradient magnetic fields and movement-induced effects in the static magnetic field is proposed and tested. The procedure was based on the application of the weighted-peak method in time domain. It was tested in two 1.5 T total-body and one 3 T head-only scanner MRI facilities in Rome (Italy). Exposure due to switched gradient fields was evaluated in locations inside the magnet room where operators usually stay during particular medical procedures (e.g., cardiac examinations of anesthetized patients); MRI sequences were selected to approach as far as possible a representative worst case exposure scenario. Movement-induced effects were evaluated considering the actual movements of volunteer operators during work activity, by measuring the perceived time-varying magnetic field by a head-worn probe. The analysis of results was based on ICNIRP 1998 and 2010 guidelines, following a weighted-peak approach and including an ad hoc extension to the latter ones, needed to verify compliance in the frequency range 0-1 Hz. Exposures due to switched gradient fields in 1.5 T MRI scanners mostly resulted noncompliant with ICNIRP 1998 occupational reference levels, being, at the same time, always compliant with ICNIRP 2010 ones. Gradient field levels and ICNIRP indexes were significantly lower for the 3 T unit, due to its small dimensions, as that unit was a head-only scanner. Movement-induced effects resulted potentially noncompliant only in the case the operator moved the head inside the bore of a 1.5 T scanner. The procedure had proven to be a sound approach to exposure assessment in MRI. Its testing allowed to draw some general considerations about exposures to gradient magnetic fields and movement-induced effects.

  1. Movement changes due to hemiplegia in stroke survivors: a hermeneutic phenomenological study.

    Science.gov (United States)

    Takashima, Risa; Murata, Waka; Saeki, Kazuko

    2016-08-01

    Meanings of movement for stroke survivors could give therapists significant insights, especially during maintenance phase. The purpose of this study was to examine how post-stroke users of a long-term elderly care facility had experienced changes in movement resulting from hemiplegia. The participants of this study were 18 stroke survivors using a long-term elderly care facility. Based on phenomenology, between two and three interviews were conducted with each participant about their experiences with hemiplegia. Data analysis consisted of the following phases: 'data immersion', 'data transformation' and 'thematic analysis'. This study was approved by the ethics committee of the authors' institution. Participants experienced seven themes resulting from hemiplegia, perceiving themselves differently from the way they did before the stroke. The themes were as follows: 'inescapable dependence', 'sense of incompetence', 'lack of autonomy', 'symbol of deviation from normal', 'licence for amae', 'security of self-worth' and 'proof of effort'. The first four themes attempt to express participants' pain and difficulty in living with their present body; the last three attempt to express methods for coping with the present body in the company of others. Results will assist therapists to understand the significant needs of their clients in the maintenance phase. Implications for Rehabilitation Hemiplegia is paralysis of half of the body; it represents one kind of physical disability caused by stroke. Re-interpretation of how patients had experienced the changes of their movements after they had hemiplegia is helpful for the therapists to understand the significant needs for their clients. It may be especially relevant for therapists working with stroke survivors in the maintenance phase, whose functional recovery of physical movements is not expected to occur to a greater extent.

  2. Binocular Fusion and Invariant Category Learning due to Predictive Remapping during Scanning of a Depthful Scene with Eye Movements

    Directory of Open Access Journals (Sweden)

    Stephen eGrossberg

    2015-01-01

    Full Text Available How does the brain maintain stable fusion of 3D scenes when the eyes move? Every eye movement causes each retinal position to process a different set of scenic features, and thus the brain needs to binocularly fuse new combinations of features at each position after an eye movement. Despite these breaks in retinotopic fusion due to each movement, previously fused representations of a scene in depth often appear stable. The 3D ARTSCAN neural model proposes how the brain does this by unifying concepts about how multiple cortical areas in the What and Where cortical streams interact to coordinate processes of 3D boundary and surface perception, spatial attention, invariant object category learning, predictive remapping, eye movement control, and learned coordinate transformations. The model explains data from single neuron and psychophysical studies of covert visual attention shifts prior to eye movements. The model further clarifies how perceptual, attentional, and cognitive interactions among multiple brain regions (LGN, V1, V2, V3A, V4, MT, MST, PPC, LIP, ITp, ITa, SC may accomplish predictive remapping as part of the process whereby view-invariant object categories are learned. These results build upon earlier neural models of 3D vision and figure-ground separation and the learning of invariant object categories as the eyes freely scan a scene. A key process concerns how an object’s surface representation generates a form-fitting distribution of spatial attention, or attentional shroud, in parietal cortex that helps maintain the stability of multiple perceptual and cognitive processes. Predictive eye movement signals maintain the stability of the shroud, as well as of binocularly fused perceptual boundaries and surface representations.

  3. Binocular fusion and invariant category learning due to predictive remapping during scanning of a depthful scene with eye movements

    Science.gov (United States)

    Grossberg, Stephen; Srinivasan, Karthik; Yazdanbakhsh, Arash

    2015-01-01

    How does the brain maintain stable fusion of 3D scenes when the eyes move? Every eye movement causes each retinal position to process a different set of scenic features, and thus the brain needs to binocularly fuse new combinations of features at each position after an eye movement. Despite these breaks in retinotopic fusion due to each movement, previously fused representations of a scene in depth often appear stable. The 3D ARTSCAN neural model proposes how the brain does this by unifying concepts about how multiple cortical areas in the What and Where cortical streams interact to coordinate processes of 3D boundary and surface perception, spatial attention, invariant object category learning, predictive remapping, eye movement control, and learned coordinate transformations. The model explains data from single neuron and psychophysical studies of covert visual attention shifts prior to eye movements. The model further clarifies how perceptual, attentional, and cognitive interactions among multiple brain regions (LGN, V1, V2, V3A, V4, MT, MST, PPC, LIP, ITp, ITa, SC) may accomplish predictive remapping as part of the process whereby view-invariant object categories are learned. These results build upon earlier neural models of 3D vision and figure-ground separation and the learning of invariant object categories as the eyes freely scan a scene. A key process concerns how an object's surface representation generates a form-fitting distribution of spatial attention, or attentional shroud, in parietal cortex that helps maintain the stability of multiple perceptual and cognitive processes. Predictive eye movement signals maintain the stability of the shroud, as well as of binocularly fused perceptual boundaries and surface representations. PMID:25642198

  4. Evidence for Startle Effects due to Externally Induced Lower Limb Movements: Implications in Neurorehabilitation

    Directory of Open Access Journals (Sweden)

    Juan M. Castellote

    2017-01-01

    Full Text Available Passive limb displacement is routinely used to assess muscle tone. If we attempt to quantify muscle stiffness using mechanical devices, it is important to know whether kinematic stimuli are able to trigger startle reactions. Whether kinematic stimuli are able to elicit a startle reflex and to accelerate prepared voluntary movements (StartReact effect has not been studied extensively to date. Eleven healthy subjects were suspended in an exoskeleton and were exposed to passive left knee flexion (KF at three intensities, occasionally replaced by fast right KF. Upon perceiving the movement subjects were asked to perform right wrist extension (WE, assessed by extensor carpi radialis (ECR electromyographic activity. ECR latencies were shortest in fast trials. Startle responses were present in most fast trials, yet being significantly accelerated and larger with right versus left KF, since the former occurred less frequently and thus less expectedly. Startle responses were associated with earlier and larger ECR responses (StartReact effect, with the largest effect again upon right KF. The results provide evidence that kinematic stimuli are able to elicit both startle reflexes and a StartReact effect, which depend on stimulus intensity and anticipation, as well as on the subjects’ preparedness to respond.

  5. Occupational exposure in MR facilities due to movements in the static magnetic field.

    Science.gov (United States)

    Andreuccetti, Daniele; Biagi, Laura; Burriesci, Giancarlo; Cannatà, Vittorio; Contessa, Gian Marco; Falsaperla, Rosaria; Genovese, Elisabetta; Lodato, Rossella; Lopresto, Vanni; Merla, Caterina; Napolitano, Antonio; Pinto, Rosanna; Tiberi, Gianluigi; Tosetti, Michela; Zoppetti, Nicola

    2017-11-01

    The exposure of operators moving in the static field of magnetic resonance (MR) facilities was assessed through measurements of the magnetic flux density, which is experienced as variable in time because of the movement. Collected data were processed to allow the comparison with most recent and authoritative safety standards. Measurements of the experienced magnetic flux density B were performed using a probe worn by volunteers moving in MR environments. A total of 55 datasets were acquired nearby a 1.5 T, 3 T, and 7 T whole body scanners. Three different metrics were applied: the maximum intensity of B, to be compared with 2013/35/EU Directive exposure limit values for static fields; the maximum variation of the vector B on every 3s-interval, for comparison with the ICNIRP-2014 basic restriction aimed at preventing vertigo effects; two weighted-peak indices (for "sensory" and "health" effects: SENS-WP, HLTH-WP), assessing compliance with ICNIRP-2014 and EU Directive recommendations intended to prevent stimulation effects. Peak values of |B| were greater than 2 T in nine of the 55 datasets. All the datasets at 1.5 T and 3 T were compliant with the limit for vertigo effects, whereas six datasets at 7 T turned out to be noncompliant. At 7 T, all 36 datasets were noncompliant for the SENS-WP index and 26 datasets even for the HLTH-WP one. Results demonstrate that compliance with EU Directive limits for static fields does not guarantee compliance with ICNIRP-2014 reference levels and clearly show that movements in the static field could be the key component of the occupational exposure to EMF in MR facilities. © 2017 American Association of Physicists in Medicine.

  6. Eye movements discriminate fatigue due to chronotypical factors and time spent on task--a double dissociation.

    Directory of Open Access Journals (Sweden)

    Dario Cazzoli

    Full Text Available Systematic differences in circadian rhythmicity are thought to be a substantial factor determining inter-individual differences in fatigue and cognitive performance. The synchronicity effect (when time of testing coincides with the respective circadian peak period seems to play an important role. Eye movements have been shown to be a reliable indicator of fatigue due to sleep deprivation or time spent on cognitive tasks. However, eye movements have not been used so far to investigate the circadian synchronicity effect and the resulting differences in fatigue. The aim of the present study was to assess how different oculomotor parameters in a free visual exploration task are influenced by: a fatigue due to chronotypical factors (being a 'morning type' or an 'evening type'; b fatigue due to the time spent on task. Eighteen healthy participants performed a free visual exploration task of naturalistic pictures while their eye movements were recorded. The task was performed twice, once at their optimal and once at their non-optimal time of the day. Moreover, participants rated their subjective fatigue. The non-optimal time of the day triggered a significant and stable increase in the mean visual fixation duration during the free visual exploration task for both chronotypes. The increase in the mean visual fixation duration correlated with the difference in subjectively perceived fatigue at optimal and non-optimal times of the day. Conversely, the mean saccadic speed significantly and progressively decreased throughout the duration of the task, but was not influenced by the optimal or non-optimal time of the day for both chronotypes. The results suggest that different oculomotor parameters are discriminative for fatigue due to different sources. A decrease in saccadic speed seems to reflect fatigue due to time spent on task, whereas an increase in mean fixation duration a lack of synchronicity between chronotype and time of the day.

  7. Differences in the regional stratigraphy of NE Poland caused by vertical movements due to glacioisostasy

    Science.gov (United States)

    Morawski, Wojciech

    2009-12-01

    Geological mapping in combination with geophysical investigations and borehole analyses show differences of the Pleistocene between the Warmia and Mazury palaeogeographic provinces in NE Poland. The (more western) Warmia province has a crystalline basement that is covered by a folded sedimentary succession of 2-4 km thick. The (more eastern) Mazury province (eastern) has a basement that forms part of the rigid East European crystalline craton, which is covered by a sedimentary cover of only 1-1.5 km thick. Cyclic loading by the Pleistocene ice sheets in this area induced glacioisostatic processes of different intensities, resulting in changing palaeogeographic conditions. The changes were increased by intense neotectonic activity that was induced by the ice sheets in the intermediate zone between the two provinces, stretching along the western slope of the crystalline craton. Significant part of intermediate zone forms a belt of crevasse-infill landforms deposited between the Warmia and Mazury lobes of the last glaciation. Studied deposits reveal a cyclic reactivation of the interlobe zone during the successive Pleistocene glaciations. Considerable variations of the relief of the top-Neogene, vertical discontinuities cutting the Pleistocene and Neogene, stratigraphic gaps within the Pleistocene succession, and thick glaciolacustrine successions result from the vertical neotectonic movements in the intermediate area between the two provinces.

  8. Experimental analysis of thread movement in bolted connections due to vibrations

    Science.gov (United States)

    Ramsey, G. ED; Jenkins, Robert C.

    1995-01-01

    This is the final report of research project NAS8-39131 #33 sponsored by NASA's George C. Marshall Space Flight Center (MSFC) and carried out by the Civil Engineering Department of Auburn University (Auburn, Alabama) and personnel of MSFC. The objective of this study was to identify the main design parameters contributing to the loosening of bolts due to vibration and to identify their relative importance and degree of contribution to bolt loosening. Vibration testing was conducted on a shaketable with a controlled-random input in the dynamic testing laboratory of the Structural Test Division of MSFC. Test specimens which contained one test bolt were vibrated for a fixed amount of time and a percentage of pre-load loss was measured. Each specimen tested implemented some combination of eleven design parameters as dictated by the design of experiment methodology employed. The eleven design parameters were: bolt size (diameter), lubrication on bolt, hole tolerance, initial pre-load, nut locking device, grip length, thread pitch, lubrication between mating materials, class of fit, joint configuration, and mass of configuration. These parameters were chosen for this experiment because they are believed to be the design parameters having the greatest impact on bolt loosening. Two values of each design parameter were used and each combination of parameters tested was subjected to two different directions of vibration and two different g-levels of vibration. One replication was made for each test to gain some indication of experimental error and repeatability and to give some degree of statistical credibility to the data, resulting in a total of 96 tests being performed. The results of the investigation indicated that nut locking devices, joint configuration, fastener size, and mass of configuration were significant in bolt loosening due to vibration. The results of this test can be utilized to further research the complex problem of bolt loosening due to vibration.

  9. The risk of musculoskeletal disorders due to repetitive movements of upper limbs for workers employed in hazelnut sorting

    Directory of Open Access Journals (Sweden)

    Andrea Colantoni

    2013-09-01

    Full Text Available In the agro-industrial sector there are many activities whose urgent rhythms can cause a considerable exposure to bio-mechanical risk factors. In the hazelnut sorting, the workers are subject to several biomechanical risks, with repetitive movements, and operations that require a remarkable degree of strength. A thorough study of the workers’ exposure to repetitive manual movements has been carried out, with the aim of setting up the necessary measures to reduce the risk factors. The aim of the research is to assess the risk of work-related musculo-skeletal disorders (WMSDs due to repetitive work, for workers employed to hazelnut shells sorting. The research was carried out in an agricultural cooperative in the Viterbo’s area. For risk assessment authors used a method (Occupational Repetitive Actions “OCRA” index according to ISO 11228- 3:2009, Ergonomics - Manual handling - Part 3: Handling of low loads at high frequency which keeps into consideration several risk factors (such as repetitiveness, prehension force, posture. The risk was assessed for 16 female workers (in eight workplaces and in two different shifts through this classification: workers with experience less than 1 year, from 1 to 10 years and more than 10 years. This classification is very important for knowing if the professional experience could be considered a “prevention measure” for the risk reduction. The results show a high risk level for the right and left limb. The factors which more have contributed to reach such risk level are the great number of movements and the lack of recovering time.

  10. Center of Pressure Displacement of Standing Posture during Rapid Movements Is Reorganised Due to Experimental Lower Extremity Muscle Pain.

    Directory of Open Access Journals (Sweden)

    Shinichiro Shiozawa

    Full Text Available Postural control during rapid movements may be impaired due to musculoskeletal pain. The purpose of this study was to investigate the effect of experimental knee-related muscle pain on the center of pressure (CoP displacement in a reaction time task condition.Nine healthy males performed two reaction time tasks (dominant side shoulder flexion and bilateral heel lift before, during, and after experimental pain induced in the dominant side vastus medialis or the tibialis anterior muscles by hypertonic saline injections. The CoP displacement was extracted from the ipsilateral and contralateral side by two force plates and the net CoP displacement was calculated.Compared with non-painful sessions, tibialis anterior muscle pain during the peak and peak-to-peak displacement for the CoP during anticipatory postural adjustments (APAs of the shoulder task reduced the peak-to-peak displacement of the net CoP in the medial-lateral direction (P<0.05. Tibialis anterior and vastus medialis muscle pain during shoulder flexion task reduced the anterior-posterior peak-to-peak displacement in the ipsilateral side (P<0.05.The central nervous system in healthy individuals was sufficiently robust in maintaining the APA characteristics during pain, although the displacement of net and ipsilateral CoP in the medial-lateral and anterior-posterior directions during unilateral fast shoulder movement was altered.

  11. 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.

  12. 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

  13. 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.

  14. 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.

  15. Congenital Mirror Movements Due to RAD51: Cosegregation with a Nonsense Mutation in a Norwegian Pedigree and Review of the Literature

    Directory of Open Access Journals (Sweden)

    Oriane Trouillard

    2016-11-01

    Full Text Available Background: Autosomal dominant congenital mirror movements (CMM is a neurodevelopmental disorder characterized by early onset involuntary movements of one side of the body that mirror intentional movements on the contralateral side; these persist throughout life in the absence of other neurological symptoms. The main culprit genes responsible for this condition are RAD51 and DCC. This condition has only been reported in a few families, and the molecular mechanisms linking RAD51 mutations and mirror movements (MM are poorly understood. Methods: We collected demographic, clinical, and genetic data of a new family with CMM due to a truncating mutation of RAD51. We reviewed the literature to identify all reported patients with CMM due to RAD51 mutations. Results: We identified a heterozygous nonsense mutation c.760C>T (p.Arg254∗ in eight subjects: four with obvious and disabling MM, and four with a mild phenotype. Including our new family, we identified 32 patients from 6 families with CMM linked to RAD51 variants. Discussion: Our findings further support the involvement of RAD51 in CMM pathogenesis. Possible molecular mechanisms involved in CMM pathogenesis are discussed.

  16. 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

  17. The Effect of Sensory Uncertainty Due to Amblyopia (Lazy Eye) on the Planning and Execution of Visually-Guided 3D Reaching Movements

    Science.gov (United States)

    Niechwiej-Szwedo, Ewa; Goltz, Herbert C.; Chandrakumar, Manokaraananthan; Wong, Agnes M. F.

    2012-01-01

    Background Impairment of spatiotemporal visual processing in amblyopia has been studied extensively, but its effects on visuomotor tasks have rarely been examined. Here, we investigate how visual deficits in amblyopia affect motor planning and online control of visually-guided, unconstrained reaching movements. Methods Thirteen patients with mild amblyopia, 13 with severe amblyopia and 13 visually-normal participants were recruited. Participants reached and touched a visual target during binocular and monocular viewing. Motor planning was assessed by examining spatial variability of the trajectory at 50–100 ms after movement onset. Online control was assessed by examining the endpoint variability and by calculating the coefficient of determination (R2) which correlates the spatial position of the limb during the movement to endpoint position. Results Patients with amblyopia had reduced precision of the motor plan in all viewing conditions as evidenced by increased variability of the reach early in the trajectory. Endpoint precision was comparable between patients with mild amblyopia and control participants. Patients with severe amblyopia had reduced endpoint precision along azimuth and elevation during amblyopic eye viewing only, and along the depth axis in all viewing conditions. In addition, they had significantly higher R2 values at 70% of movement time along the elevation and depth axes during amblyopic eye viewing. Conclusion Sensory uncertainty due to amblyopia leads to reduced precision of the motor plan. The ability to implement online corrections depends on the severity of the visual deficit, viewing condition, and the axis of the reaching movement. Patients with mild amblyopia used online control effectively to compensate for the reduced precision of the motor plan. In contrast, patients with severe amblyopia were not able to use online control as effectively to amend the limb trajectory especially along the depth axis, which could be due to their

  18. 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.

  19. 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

  20. 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.

  1. 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...

  2. [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.

  3. Treatment of neonatal withdrawal with clonidine after long-term, high-dose maternal use of tramadol.

    Science.gov (United States)

    O'Mara, Keliana; Gal, Peter; Davanzo, Christie

    2010-01-01

    To describe a case of tramadol withdrawal in a neonate and treatment with clonidine after exposure to long-term maternal use of high-dose tramadol. A 34-week gestational age neonate displayed symptoms of tramadol withdrawal within 48 hours of delivery. Due to a confusing initial clinical picture, including presumed congenital Chlamydia, questionable seizures, and an original report of maternal use of ketorolac (Toradol), diagnosis was delayed until day of life 5. Symptoms included jitteriness, myoclonic movements, and irritability. Upon further questioning of the mother, it was revealed that she was actually taking tramadol 600-800 mg daily. The infant was placed on maintenance therapy with oral clonidine (from 1 to 3 microg/kg orally every 3 hours) until discontinuation on day of life 11. After 3 days off treatment, he began to display symptoms of withdrawal again. Clonidine was restarted at 1 microg/kg orally every 8 hours and he was discharged home on maintenance clonidine therapy at 18 days postnatal age. A 7-day tapering regimen was initiated 2 weeks after discharge, and no further withdrawal symptoms occurred. Few published articles are available to guide clinicians on the clinical course and treatment strategies for tramadol dependence and withdrawal. In neonates, the reports are particularly sparse. Traditional agents used in neonatal opioid withdrawal are narcotics (morphine, tincture of opium, methadone), benzodiazepines (diazepam, lorazepam), and phenobarbital. Clonidine use for neonatal abstinence syndrome from narcotics has been shown to be effective alone or in combination with agents such as other opiates and chloral hydrate. Potential benefits of clonidine therapy include shorter duration of therapy, reduced withdrawal symptoms, and decreased length of hospital stay. Withdrawal can be prolonged in infants exposed to maternal tramadol use. Clonidine may be a safe and effective option for managing symptoms of neonatal tramadol abstinence.

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

    Science.gov (United States)

    Becker, Howard C; Veatch, Lynn M

    2002-03-01

    for changes in pentylenetetrazol seizure threshold dosage. These results do not seem to be due to pharmacokinetic factors, because peak blood ethanol levels, rate of ethanol elimination, and plasma levels of lorazepam did not significantly differ among groups during the final test withdrawal cycle. Blocking central nervous system hyperexcitability during repeated ethanol withdrawals with lorazepam effectively blunts the development and expression of sensitized seizure activity during the acute phase of a subsequent unmedicated withdrawal episode. At later time points, withdrawal-related seizure activity was exacerbated, and this is possibly reflective of an interaction between protracted ethanol withdrawal and withdrawal from the benzodiazepine. The clinical implications of these findings suggest that repeated use of benzodiazepines for treatment of multiple ethanol withdrawals may have some initial beneficial effects, but such treatment may also place patients at increased risk of seizures at later time points.

  5. An Autopsy Case of Respiratory Failure Induced by Repetitive Cervical Spinal Cord Damage due to Abnormal Movement of the Neck in Athetoid Cerebral Palsy.

    Science.gov (United States)

    Takei, Yo-Ichi; Koshihara, Hiroshi; Oguchi, Kenya; Oyanagi, Kiyomitsu; Ohara, Shinji

    2017-01-01

    We herein report the clinical and autopsy findings of a 48-year-old right-handed man with athetoid cerebral palsy who suffered from cervical myelopathy due to abnormal neck movement, and who died of respiratory failure. Pathologically, the external appearance of the ventral surface of the cervical spinal cord revealed a linear indentation running obliquely at the level between the C4 and C5 segments. In the most severely compressed lesion, the gray matter was predominantly affected and severely atrophic. Microscopically, clusters of oligodendrocytes associated with thinly myelinated axons were also observed in the lateral funiculus. The latter findings are unique, and could be interpreted as regenerative and/or restorative phenomena of the central nervous system following chronic repetitive spinal cord compression.

  6. 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.

  7. 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.

  8. 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- ...

  9. 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.

  10. 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 ...

  11. 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.

  12. 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.

  13. [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.

  14. 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...

  15. 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.

  16. The risks of aorta impingement from pedicle screw may increase due to aorta movement during posterior instrumentation in Lenke 5C curve: a computed tomography study.

    Science.gov (United States)

    Chen, Ling; Xu, Leilei; Qiu, Yong; Qiao, Jun; Wang, Fei; Liu, Zhen; Shi, Benglong; Qian, Bang-ping; Zhu, Zezhang

    2015-07-01

    evaluation could be insufficient for clinical practice due to aorta movement following correction surgery. Surgeons should be aware of the potential risk of aorta impingement, especially when placing PS in patients with right-sided curves.

  17. 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.

  18. 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.

  19. 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

  20. 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.

  1. 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.

  2. Buprenorphine for managing opioid withdrawal.

    Science.gov (United States)

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

    2017-02-21

    ameliorate opioid withdrawal, without clinically significant adverse effects. The meta-analyses that were possible support a conclusion of no difference between buprenorphine and methadone in terms of average treatment duration (mean difference (MD) 1.30 days, 95% confidence interval (CI) -8.11 to 10.72; N = 82; studies = 2; low quality) or treatment completion rates (risk ratio (RR) 1.04, 95% CI 0.91 to 1.20; N = 457; studies = 5; moderate quality).Relative to clonidine or lofexidine, buprenorphine was associated with a lower average withdrawal score (indicating less severe withdrawal) during the treatment episode, with an effect size that is considered to be small to moderate (standardised mean difference (SMD) -0.43, 95% CI -0.58 to -0.28; N = 902; studies = 7; moderate quality). Patients receiving buprenorphine stayed in treatment for longer, with an effect size that is considered to be large (SMD 0.92, 95% CI 0.57 to 1.27; N = 558; studies = 5; moderate quality) and were more likely to complete withdrawal treatment (RR 1.59, 95% CI 1.23 to 2.06; N = 1264; studies = 12; moderate quality). At the same time there was no significant difference in the incidence of adverse effects, but dropout due to adverse effects may be more likely with clonidine (RR 0.20, 95% CI 0.04 to 1.15; N = 134; studies = 3; low quality). The difference in treatment completion rates translates to a number needed to treat for an additional beneficial outcome of 4 (95% CI 3 to 6), indicating that for every four people treated with buprenorphine, we can expect that one additional person will complete treatment than with clonidine or lofexidine.For studies comparing different rates of reduction of the buprenorphine dose, meta-analysis was possible only for treatment completion, with separate analyses for inpatient and outpatient settings. The results were diverse, and we assessed the quality of evidence as being very low. It remains very uncertain what effect the rate of dose taper has on treatment

  3. A detailed analysis of the planning and execution of prehension movements by three adolescents with spastic hemiparesis due to cerebral palsy

    NARCIS (Netherlands)

    Mutsaarts, M.J.H.; Steenbergen, B.; Meulenbroek, R.G.J.

    2004-01-01

    Assuming that primary symptoms of motor disorders can best be distinguished from signs of adaptation through behavioral analyses on an individual basis, the present study provides a detailed analysis of the prehension movements of three adolescents with mild spastic hemiparesis of different

  4. 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.

  5. Internal damping due to dislocation movements induced by thermal expansion mismatch between matrix and particles in metal matrix composites. [Al/SiC

    Energy Technology Data Exchange (ETDEWEB)

    Girand, C.; Lormand, G.; Fougeres, R.; Vincent, A. (GEMPPM, Villeurbanne (France))

    1993-05-01

    In metal matrix composites (MMCs), the mechanical 1 of the reinforcement-matrix interface is an important parameter because it governs the load transfer from matrix to particles, from which the mechanical properties of these materials are derived. Therefore, it would be useful to set out an experimental method able to characterize the interface and the adjacent matrix behaviors. Thus, a study has been undertaken by means of internal damping (I.D.) measurements, which are well known to be very sensitive for studying irreversible displacements at the atomic scale. More especially, this investigation is based on the fact that, during cooling of MMC's, stress concentrations originating from differences in coefficients of thermal expansion (C.T.E.) of matrix and particles should induce dislocation movements in the matrix surrounding the reinforcement; that is, local microplastic strains occur. Therefore, during I.D. measurements vs temperature these movements should contribute to MMCs I.D. in a process similar to those involved around first order phase transitions in solids. The aim of this paper is to present, in the case of Al/SiC particulate composites, new developments of this approach that has previously led to promising results in the case of Al-Si alloys.

  6. Explicit topographic expressions of neotectonic movements along the Tønder Graben structure, Denmark - an example of fault reactivation due to deglaciation

    Science.gov (United States)

    Sandersen, Peter B. E.; Jørgensen, Flemming; Møller, Rasmus R.

    2013-04-01

    The topography in southern Denmark is dominated by Late Glacial outwash plains surrounding remnants of older Saalian hills. The outwash plains were formed outside the Last Glacial Maximum (LGM) with a gently sloping surface averaging 1 m per 1.000 m. Formed in a proglacial environment the outwash plains have largely remained undisturbed by glacier ice and we would thus expect any topographic irregularities to relate to postglacial events. In that sense, the outwash plains constitute an ideal landform for identifying tectonic events during the late and postglacial periods. Irregularities in the present day glacial topography, such as kettle holes and other types of depressions are commonly linked to decay of dead ice. But this perception needs in many instances a further examination especially because of the recent availability of highly detailed LiDAR data. The investigation area is situated above the Tønder Graben structure at the northern margin of the North German Basin. The Tønder Graben was formed along the WNW-ESE trending Rømø Fault Zone and mobilization of Zechstein salt added to the evolution of the graben. The Tønder Graben has caused a significant impact on the Mesozoic and Cenozoic sedimentary successions and is for instance clearly expressed as large elongate depressions in the Top Chalk surface. On the larger scale, no clear signs of the outline of the graben structure can be seen in the present day topography to indicate movements during the Quaternary. However, when high resolution LiDAR data is investigated carefully signatures of neotectonic movements emerges on the outwash plain. Among these are morphological features such as: 1) Significant level changes along distinct lineaments, 2) frequent slope changes of neighboring areas, 3) 180 degree changes in dip direction and 4) presence of close lying polygonal areas with marked shifts in terrain level. All these morphological features are found right on top of the Tønder Graben. In addition to

  7. 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.

  8. 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 ...

  9. Smooth pursuit adaptation (SPA) exhibits features useful to compensate changes in the properties of the smooth pursuit eye movement system due to usage.

    Science.gov (United States)

    Dash, Suryadeep; Thier, Peter

    2013-01-01

    Smooth-pursuit adaptation (SPA) refers to the fact that pursuit gain in the early, still open-loop response phase of the pursuit eye movement can be adjusted based on experience. For instance, if the target moves initially at a constant velocity for ~100-200 ms and then steps to a higher velocity, subjects learn to up-regulate the pursuit gain associated with the initial target velocity (gain-increase SPA) in order to reduce the retinal error resulting from the velocity step. Correspondingly, a step to a lower target velocity leads to a decrease in gain (gain-decrease SPA). In this study we demonstrate that the increase in peak eye velocity during gain-increase SPA is a consequence of expanding the duration of the eye acceleration profile while the decrease in peak velocity during gain-decrease SPA results from reduced peak eye acceleration but unaltered duration. Furthermore, we show that carrying out stereotypical smooth pursuit eye movements elicited by constant velocity target ramps for several hundred trials (=test of pursuit resilience) leads to a clear drop in initial peak acceleration, a reflection of oculomotor and/or cognitive fatigue. However, this drop in acceleration gets compensated by an increase in the duration of the acceleration profile, thereby keeping initial pursuit gain constant. The compensatory expansion of the acceleration profile in the pursuit resilience experiment is reminiscent of the one leading to gain-increase SPA, suggesting that both processes tap one and the same neuronal mechanism warranting a precise acceleration-duration trade-off. Finally, we show that the ability to adjust acceleration duration during pursuit resilience depends on the integrity of the oculomotor vermis (OMV) as indicated by the complete loss of the duration adjustment following a surgical lesion of the OMV in one rhesus monkey we could study.

  10. The role of the carotid sinus in the reduction of arterial wall stresses due to head movements--potential implications for cervical artery dissection.

    Science.gov (United States)

    Callaghan, F M; Soellinger, M; Baumgartner, R W; Poulikakos, D; Boesiger, P; Kurtcuoglu, V

    2009-04-16

    Spontaneous dissection of the cervical internal carotid artery (sICAD) is a major cause of stroke in young adults. A tear in the inner part of the vessel wall triggers sICAD as it allows the blood to enter the wall and develop a transmural hematoma. The etiology of the tear is unknown but many patients with sICAD report an initiating trivial trauma. We thus hypothesised that the site of the tear might correspond with the location of maximal stress in the carotid wall. Carotid artery geometries segmented from magnetic resonance images of a healthy subject at different static head positions were used to define a path of motion and deformation of the right cervical internal carotid artery (ICA). Maximum head rotation to the left and rotation to the left combined with hyperextension of the neck were investigated using a structural finite element model. A role of the carotid sinus as a geometrically compliant feature accommodating extension of the artery is shown. At the extreme range of the movements, the geometrical compliance of the carotid sinus is limited and significant stress concentrations appear just distal to the sinus with peak stresses at the internal wall on the posterior side of the vessel following maximum head rotation and on the anteromedial portion of the vessel wall following rotation and hyperextension. Clinically, the location of sICAD initiation is 10-30 mm distal to the origin of the cervical ICA, which corresponds with the peak stress locations observed in the model, thus supporting trivial trauma from natural head movements as a possible initiating factor in sICAD.

  11. 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.

  12. Dexmedetomidine for acute clonidine withdrawal following intrathecal pump removal: A drug beginning to find its expanding niche

    National Research Council Canada - National Science Library

    Bowcock, Emma; Morris, Idunn; Lane, Andrew

    2016-01-01

    ... have described the use of intravenous clonidine and benzodiazepines to manage the acute withdrawal syndrome.3 We admitted a patient to the intensive care unit (ICU) due to life-threatening sequelae of acute clonidine and opioid withdrawal following the removal of an infected intrathecal pump 48 h prior. The withdrawal was characterised by hyperacti...

  13. Maternal Perception of Decreased Fetal Movement in One Twin: A Clue Leading to the Early Detection of Absent Variability due to Acute Twin-to-Twin Transfusion Syndrome

    Directory of Open Access Journals (Sweden)

    Hirotada Suzuki

    2013-01-01

    Full Text Available Decreased fetal movement (DFM perceived by pregnant women sometimes indicates imminent fetal jeopardy. It is unknown whether this also holds true for twin pregnancy. A 27-year-old primiparous woman with monochorionic diamniotic (MD pregnancy had a slight difference of amniotic fluid volume at 312/7 weeks of gestation. DFM only in one twin at 314/7 weeks of gestation prompted her to receive urgent consultation. Since cardiotocogram indicated absent variability of one twin, we performed Cesarean section. Male infants weighing 2060 g and 1578 g were delivered; hemoglobin was 20.7 versus 10.8 g/dL, respectively; cardiothoracic ratio was 70% versus 44%, respectively, indicating acute twin-to-twin transfusion syndrome (TTTS. The recipient infant had heart failure, which was still observed at 1 month postpartum. In conclusion, maternal perception of DFM indicated imminent fetal death or jeopardy caused by acute TTTS, suggesting that education regarding DFM for women with twin pregnancy may be clinically important.

  14. "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.

  15. Complete genome analysis of 33 ecologically and biologically diverse Rift Valley fever virus strains reveals widespread virus movement and low genetic diversity due to recent common ancestry.

    Science.gov (United States)

    Bird, Brian H; Khristova, Marina L; Rollin, Pierre E; Ksiazek, Thomas G; Nichol, Stuart T

    2007-03-01

    Rift Valley fever (RVF) virus is a mosquito-borne RNA virus responsible for large explosive outbreaks of acute febrile disease in humans and livestock in Africa with significant mortality and economic impact. The successful high-throughput generation of the complete genome sequence was achieved for 33 diverse RVF virus strains collected from throughout Africa and Saudi Arabia from 1944 to 2000, including strains differing in pathogenicity in disease models. While several distinct virus genetic lineages were determined, which approximately correlate with geographic origin, multiple exceptions indicative of long-distance virus movement have been found. Virus strains isolated within an epidemic (e.g., Mauritania, 1987, or Egypt, 1977 to 1978) exhibit little diversity, while those in enzootic settings (e.g., 1970s Zimbabwe) can be highly diverse. In addition, the large Saudi Arabian RVF outbreak in 2000 appears to have involved virus introduction from East Africa, based on the close ancestral relationship of a 1998 East African virus. Virus genetic diversity was low (approximately 5%) and primarily involved accumulation of mutations at an average of 2.9 x 10(-4) substitutions/site/year, although some evidence of RNA segment reassortment was found. Bayesian analysis of current RVF virus genetic diversity places the most recent common ancestor of these viruses in the late 1800s, the colonial period in Africa, a time of dramatic changes in agricultural practices and introduction of nonindigenous livestock breeds. In addition to insights into the evolution and ecology of RVF virus, these genomic data also provide a foundation for the design of molecular detection assays and prototype vaccines useful in combating this important disease.

  16. 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.

  17. 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.

  18. Areas of ground subsidence due to geofluid withdrawal

    Energy Technology Data Exchange (ETDEWEB)

    Grimsrud, G.P.; Turner, B.L.; Frame, P.A.

    1978-08-01

    Detailed information is provided on four geothermal areas with histories of subsidence. These were selected on the basis of: physical relevance of subsidence areas to high priority US geothermal sites in terms of withdrawn geofluid type, reservoir depth, reservoir geology and rock characteristics, and overburden characteristics; and data completeness, quality, and availability. The four areas are: Chocolate Bayou, Raft River Valley, Wairakei, and the Geysers. (MHR)

  19. 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

  20. 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.

  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. [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.

  4. Bowel Movement

    Science.gov (United States)

    ... passes through the large intestine too slowly. Bowel incontinence is a problem controlling your bowel movements. Other abnormalities with bowel movements may be a sign of a digestive problem. NIH: National Institute of Diabetes and Digestive and Kidney Diseases

  5. 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

  6. 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…

  7. 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

  8. 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

  9. 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.

  10. 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.

  11. Characterization of fluoxetine effects on ethanol withdrawal-induced cortical hyperexcitability by EEG spectral power in rats.

    Science.gov (United States)

    Cheaha, Dania; Sawangjaroen, Kitja; Kumarnsit, Ekkasit

    2014-02-01

    Antidepressants have been used for treatment of ethanol withdrawal symptoms mainly in observational studies. However, cortical frequency oscillation of ethanol withdrawal treatment with antidepressants remained to be elucidated. This study aimed to identify surrogate biomarkers that represent intact biological or ethanol withdrawal processes and response to pretreatment with fluoxetine, a selective serotonin reuptake inhibitor, with quantitative methods. Adult male Wistar rats implanted with electrodes over the frontal and parietal cortices were rendered dependent on ethanol via modified liquid diet (MLD) containing ethanol. Then, ethanol-containing MLD was replaced with isocaloric ethanol-free MLD to induce ethanol withdrawal symptoms. Locomotor activity, sleep-wakefulness and spectral frequencies of electroencephalographic (EEG) pattern during ethanol-withdrawal period were analyzed. One-way ANOVA confirmed significant increases in locomotor activity and time spent in awake state and decreases time spent in non-rapid eye movement (NREM) sleep and REM-sleep during ethanol withdrawal period. Fast Fourier Transformation also revealed predominant increases in gamma spectral powers within both the frontal and parietal cortices during ethanol withdrawal. However, these changes, except sleep-wake disturbances, were significantly attenuated by fluoxetine pretreatment (10 mg/kg). The present study supports the hypothesis that serotonergic hypofunction may underlie most of ethanol withdrawal symptoms and proposes that electroencephalographic patterns are valid biomarkers for ethanol withdrawal evaluation and treatment. Copyright © 2013 Elsevier Ltd. All rights reserved.

  12. [Gabapentin treatment in a female patient with panic disorder and adverse effects under carbamazepine during benzodiazepine withdrawal].

    Science.gov (United States)

    Himmerich, Hubertus; Nickel, Thomas; Dalal, Mira A; Müller, Marianne B

    2007-03-01

    Despite their addictive potential, benzodiazepines belong to the most often prescribed drugs. We report on a patient with alprazolam dependence, who initially was treated with carbamazepine because of severe withdrawal symptoms. Due to liver enzyme elevation related to carbamazepine, we had to stop this treatment and instead of that started gabapentin treatment. Under this new therapy, the patient showed a dramatic relief of withdrawal symptoms and of the panic attacks recurring during withdrawal. Hence, due to their effectiveness and tolerability, newer anticonvulsants could be considered as medication for benzodiazepine withdrawal and as an alternative for benzodiazepine treatment in panic disorders.

  13. Enhanced Anticonvulsant Activity of Ganaxolone after Neurosteroid Withdrawal in a Rat Model of Catamenial Epilepsy

    National Research Council Canada - National Science Library

    Doodipala S. Reddy; Michael A. Rogawski

    2000-01-01

    Perimenstrual catamenial epilepsy, the exacerbation of seizures in association with menstruation, may in part be due to withdrawal of the progesterone metabolite allopregnanolone (3α-hydroxy-5α-pregnan-20-one...

  14. [Stereotypic movements].

    Science.gov (United States)

    Fernández-Alvarez, E

    2003-02-01

    Stereotypic movements are repetitive patterns of movement with certain peculiar features that make them especially interesting. Their physiopathology and their relationship with the neurobehavioural disorders they are frequently associated with are unknown. In this paper our aim is to offer a simple analysis of their dominant characteristics, their differentiation from other processes and a hypothesis of the properties of stereotypic movements, which could all set the foundations for research work into their physiopathology.

  15. 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.

  16. Review of adjunctive dexmedetomidine in the management of severe acute alcohol withdrawal syndrome.

    Science.gov (United States)

    Wong, Adrian; Smithburger, Pamela L; Kane-Gill, Sandra L

    2015-01-01

    The primary management of alcohol withdrawal involves the administration of a γ-aminobutyric acid agonist, such as benzodiazepines, for management of symptoms and to prevent further progression to seizure or delirium tremens. Despite escalating doses of benzodiazepines, published literature indicates that some patient's alcohol withdrawal syndrome symptoms do not respond, and that the use of adjunctive agents may be beneficial in these patients. Dexmedetomidine, an α2-agonist, serves as a potential adjunctive agent through management of associated autonomic symptoms. Understanding of recent literature evaluating its use is necessary for appropriate selection. To review available literature supporting the use of adjunctive dexmedetomidine for management of severe alcohol withdrawal syndrome. A total of 13 published articles evaluating the efficacy and safety of dexmedetomidine as an adjunctive agent for the treatment of alcohol withdrawal in adult patients were identified from a MEDLINE search using the key words alcohol withdrawal, delirium tremens and dexmedetomidine. Evaluation of the literature indicates that dexmedetomidine is associated with a decrease in short-term benzodiazepine requirements after initiation, and improvement in hemodynamic parameters in relation to the adrenergic drive present in alcohol withdrawal. The use of dexmedetomidine in the management of severe alcohol withdrawal should be considered as an adjunctive agent. Dexmedetomidine appears to be well tolerated, with an expected decrease in blood pressure and heart rate. Seizures have occurred in patients with alcohol withdrawal despite the use of dexmedetomidine, with and without benzodiazepines, due to lack of γ-aminobutyric acid agonist administration.

  17. 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 ...

  18. 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.

  19. 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.

  20. 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.

  1. 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.

  2. 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.

  3. [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.

  4. 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.

  5. 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.

  6. Personality and symptom sensitivity predictors of alprazolam withdrawal in panic disorder.

    Science.gov (United States)

    Roy-Byrne, P; Russo, J; Pollack, M; Stewart, R; Bystrisky, A; Bell, J; Rosenbaum, J; Corrigan, M H; Stolk, J; Rush, A J; Ballenger, J

    2003-04-01

    Discontinuation of benzodiazepine (BZ) treatment results in a well-characterized withdrawal syndrome in 40-50% of anxious patients. While numerous studies have established the role of BZ dose, treatment duration, half-life, potency, rate of withdrawal and severity of underling anxiety disorder in predicting severity of withdrawal symptoms, fewer studies have examined the role of psychological and personality factors. In 123 panic disorder patients undergoing gradual tapered discontinuation of alprazolam in conjunction with pre-treatment with carbamazepine or placebo, the relationship between measures of 'symptom sensitivity' and 'harm avoidance', and severity of withdrawal symptoms measured as peak severity of symptoms, time before taper needed to be slowed due to symptoms, and ability to complete taper, was examined. After controlling for the less substantial effects of dose, treatment duration, pre-taper anxiety and panic attack frequency, measures of symptom sensitivity and harm avoidance accounted for an additional 3-6% of withdrawal variance. These results show an effect of symptom sensitivity and harm avoidance on BZ withdrawal symptoms, comparable to prior findings linking dependent personality characteristics to withdrawal severity. Failure to show the expected effect on ability to complete taper may be due to either the more symptomatic nature of the patients in this study.

  7. 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.

  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. 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...

  10. 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...

  11. 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

  12. 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...

  13. 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...

  14. 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...

  15. Withdrawal rates as a consequence of disclosure of risk associated with manipulation of the cervical spine

    OpenAIRE

    Forrest Lianne; Langworthy Jennifer M

    2010-01-01

    Abstract Background The risk associated with cervical manipulation is controversial. Research in this area is widely variable but as yet the risk is not easily quantifiable. This presents a problem when informing the patient of risks when seeking consent and information may be withheld due to the fear of patient withdrawal from care. As yet, there is a lack of research into the frequency of risk disclosure and consequent withdrawal from manipulative treatment as a result. This study seeks to ...

  16. [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.

  17. 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

  18. Mixed Movements

    DEFF Research Database (Denmark)

    Brabrand, Helle

    2010-01-01

    levels than those related to building, and this exploration is a special challenge and competence implicit artistic development work. The project Mixed Movements generates drawing-material, not primary as representation, but as a performance-based media, making the body being-in-the-media felt and appear......Mixed Movements is a research project engaged in performance-based architectural drawing. Architectonic implementation questions relations between the human body and a body of architecture by the different ways we handle drawing materials. A drawing may explore architectonic problems at other...

  19. 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.

  20. Striking movements

    DEFF Research Database (Denmark)

    Dahl, Sofia

    2011-01-01

    Like all music performance, percussion playing requires high control over timing and sound properties. Specific to percussionists, however, is the need to adjust the movement to different instruments with varying physical properties and tactile feedback to the player. Furthermore, the well defined...

  1. Psychodynamic Movement

    DEFF Research Database (Denmark)

    Pedersen, Inge Nygaard

    2002-01-01

    This chapter/article describes the historical development of the disciplin Psychodynamic Movement. The importance of this disciplin for self-experience and for training in developing a therapist identy for the music therapy students are emphasized. Prototypeexercises developed and simplified...

  2. 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

  3. 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

  4. [Carbamazepine in treatment of alcohol withdrawal syndrome--an overview of current research].

    Science.gov (United States)

    Thome, J; Wiesbeck, G A; Vince, G H

    1994-04-01

    Originally only intended as an anti-epileptic carbamazepine has nowadays a multitude of applications in the treatment of neurological and psychiatric diseases. It is also being used for the treatment of alcohol withdrawal symptoms. Its pharmacological properties and side-effects are well known and very effective dosage schedules already exist. The exact physiological action of carbamazepine, however, as well as the pathophysiological basis of withdrawal itself have not been entirely discovered. Evidence exists that "anti-kindling-effects" are of particular importance. A number of controlled clinical studies were able to demonstrate the effectiveness of carbamazepine in the treatment of alcohol withdrawal symptoms and have also compared its properties to other substances such as clomethiazole and benzodiazepine. Due to its effectiveness and the lack of additive potential carbamazepine offers a useful alternative to conventional therapeutic approaches, especially in the treatment of mild and moderately severe alcohol withdrawal symptoms.

  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

    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

  6. Gracious Movement

    Directory of Open Access Journals (Sweden)

    Lev Kreft

    2012-07-01

    Full Text Available In 1984 Christopher Cordner offered a critical view on theories of graceful movement in sport developed by Ng. G. Wulk, David Best and Joseph Kupfer. In 2001 Paul Davis criticized his view. Cordner responded, rejecting all the criticism. More than a century before, Herbert Spencer and Jean-Marie Guyau had a similar controversy over grace. Both exchanges of opinion involve three positions: that grace is the most efficient movement and therefore something quantitative and measurable; that grace is expression of the wholeness of person and the world; and that grace is something which neither science nor philosophy can explain. To clarify these conflicting issues, this article proposes to examine the history of the notion which goes back to the Latin gratia and has root in the Ancient Greek charis, and to apply the concepts of cultural anchor and thin coherence, following John R. Searle’s explanation that we produce epistemically objective accounts of ontologically subjective reality.

  7. Psychostimulants and movement disorders.

    Directory of Open Access Journals (Sweden)

    Andres eAsser

    2015-04-01

    Full Text Available Psychostimulants are a diverse group of substances with their main psychomotor effects resembling those of amphetamine, methamphetamine, cocaine or cathinone. Due to their potential as drugs of abuse, recreational use of most of these substances is illegal since the 1971 Convention on Psychotropic Substances. In recent years, new psychoactive substances have emerged mainly as synthetic cathinones with new molecules frequently complementing the list.Psychostimulant related movement disorders are a known entity often seen in emergency rooms around the world. These admissions are becoming more frequent as are fatalities associated with drug abuse. Still the legal constraints of the novel synthetic molecules are bypassed. At the same time chronic and permanent movement disorders are much less frequently encountered. These disorders frequently manifest as a combination of movement disorders. The more common symptoms include agitation, tremor, hyperkinetic and stereotypical movements, cognitive impairment, and also hyperthermia and cardiovascular dysfunction.The pathophysiological mechanisms behind the clinical manifestations have been researched for decades. The common denominator is the monoaminergic signaling. Dopamine has received the most attention but further research has demonstrated involvement of other pathways. Common mechanisms linking psychostimulant use and several movement disorders exist.

  8. Psychostimulants and Movement Disorders

    Science.gov (United States)

    Asser, Andres; Taba, Pille

    2015-01-01

    Psychostimulants are a diverse group of substances with their main psychomotor effects resembling those of amphetamine, methamphetamine, cocaine, or cathinone. Due to their potential as drugs of abuse, recreational use of most of these substances is illegal since 1971 Convention on Psychotropic Substances. In recent years, new psychoactive substances have emerged mainly as synthetic cathinones with new molecules frequently complementing the list. Psychostimulant related movement disorders are a known entity often seen in emergency rooms around the world. These admissions are becoming more frequent as are fatalities associated with drug abuse. Still the legal constraints of the novel synthetic molecules are bypassed. At the same time, chronic and permanent movement disorders are much less frequently encountered. These disorders frequently manifest as a combination of movement disorders. The more common symptoms include agitation, tremor, hyperkinetic and stereotypical movements, cognitive impairment, and also hyperthermia and cardiovascular dysfunction. The pathophysiological mechanisms behind the clinical manifestations have been researched for decades. The common denominator is the monoaminergic signaling. Dopamine has received the most attention but further research has demonstrated involvement of other pathways. Common mechanisms linking psychostimulant use and several movement disorders exist. PMID:25941511

  9. 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.

  10. 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.

  11. 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.

  12. 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.

  13. 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.

  14. Computational movement analysis

    CERN Document Server

    Laube, Patrick

    2014-01-01

    This SpringerBrief discusses the characteristics of spatiotemporal movement data, including uncertainty and scale. It investigates three core aspects of Computational Movement Analysis: Conceptual modeling of movement and movement spaces, spatiotemporal analysis methods aiming at a better understanding of movement processes (with a focus on data mining for movement patterns), and using decentralized spatial computing methods in movement analysis. The author presents Computational Movement Analysis as an interdisciplinary umbrella for analyzing movement processes with methods from a range of fi

  15. Pest Movement

    Directory of Open Access Journals (Sweden)

    Rod Bhar

    1998-12-01

    Full Text Available Maintenance of woody borders surrounding crop fields is desirable for biodiversity conservation. However, for crop pest management, the desirability of woody borders depends on the trade-off between their effects at the local field scale and the landscape scale. At the local scale, woody borders can reduce pest populations by increasing predation rates, but they can also increase pest populations by providing complementary habitats and reducing movement rate of pests out of crop fields. At the regional scale, woody borders can reduce pest populations by reducing colonization of newly planted crop fields. Our objective was to develop guidelines for maximizing pest control while maintaining woody borders in the landscape. We wished to determine the conditions under which the regional effect of borders on colonization can outweigh local enhancement effects of borders on pest populations. We built a stochastic, individual-based, spatially implicit simulation model of a specialist insect population in a landscape divided into a number of crop fields. We conducted simulations to determine the conditions under which woody borders enhance vs. reduce the regional pest population size. The following factors were considered: landscape fragmentation, crop rotation period, barrier effect of woody borders, disperser success rate, and effect of woody borders on local survival. The simulation results suggest that woody borders are most likely to enhance regional control of crop pests if (1 the woody borders are very effective in reducing insect movement from one crop field to another, and (2 crop rotation is on a very short cycle. Based on these results, our preliminary recommendations are that woody borders should contain dense, tall vegetation to reduce insect movement, and crops should be rotated on as short a cycle as possible. These conditions should ensure that woody borders can be maintained for their conservation value without enhancing crop pest

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

    Science.gov (United States)

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

    2013-01-01

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

  17. Latino Movement: A Target for Harassment?

    Science.gov (United States)

    Rodriguez, Roberto

    1996-01-01

    Members of the Movimiento Estudiantil Chicano de Aztlan (MEChA), which translates to Chicano Student Movement of Aztlan, report that their movement is being targeted by school administrators across the country due to its demands for Chicano/Latino studies programs and protests against anti-immigration and anti-affirmative action movements.…

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

    Science.gov (United States)

    Babaeian, Iman; Rezazadeh, Parviz

    2017-09-01

    Indian monsoon is the most prominent of the world's monsoon systems which primarily affects synoptic patterns of India and adjacent countries such as Iran in interaction with large-scale weather systems. In this article, the relationship between the withdrawal date of the Indian monsoon and the onset of fall precipitation in Iran has been studied. Data included annual time series of withdrawal dates of the Indian monsoon prepared by the Indian Institute for Tropical Meteorology, and time series of the first date of 25 mm accumulated precipitation over Iran's synoptic weather stations in a 10-day period which is the basis for the cultivation date. Both time series were considered in Julian calendar with the starting date on August 1. The studied period is 1960-2014 which covers 55 years of data from 36 meteorological stations in Iran. By classifying the withdrawal dates of the Indian monsoon in three stages of late, normal, and early withdrawals, its relation with the onset of fall precipitation in western, southwestern, southern, eastern, central, and northern regions of Iran was studied. Results demonstrated that in four out of the six mentioned regions, the late withdrawal of the Indian monsoon postpones the onset of fall precipitation over Iran. No significant relation was found between the onset of fall precipitation in central region of Iran and the monsoon's withdrawal date. In the western, southwestern, southern, and eastern regions of Iran, the late monsoon delays the onset of fall's precipitation; while in the south Caspian Sea coastal area, it causes the early onset of autumnal precipitation. The lag in onset of fall precipitation in Iran which is coordinated with the late withdrawal of monsoon is accompanied with prolonged subtropical high settling over Iran's plateau that prevents the southward movement of polar jet frontal systems. Such conditions enhance northerly wind currents over the Caspian Sea which, in turn, increase the precipitation in Caspian

  19. 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.

  20. [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.

  1. The effects of lisuride on mood and sleep during acute withdrawal in stimulant abusers: a preliminary report.

    Science.gov (United States)

    Gillin, J C; Pulvirenti, L; Withers, N; Golshan, S; Koob, G

    1994-06-01

    Psychostimulant abusers often experience anhedonia, depression, fatigue, craving, and hypersomnia and increased propensity for rapid eye movement (REM) sleep during periods of acute and subacute withdrawal from cocaine and amphetamine. These signs and symptoms may reflect a state of relative functional dopamine depletion in the brain during abstinence. Lisuride, which has dopaminergic agonist effects, has been reported to reduce signs of psychostimulant withdrawal in rodent models of stimulant abuse. These observations prompted us to test the effects of oral administration of lisuride for 3 weeks (up to 4.0 mg daily) on mood and craving ratings in a double-blind, parallel design, controlled study in hospitalized stimulant abusers during acute withdrawal from cocaine or amphetamine. Although administration of lisuride significantly prolonged REM latency and reduced REM time, amelioration of other signs of withdrawal was not significantly greater in lisuride as compared with placebo treated patients. Self-rated craving ratings, however, were low in both groups throughout the hospital stay. Further studies, perhaps in patients with more severe symptoms during withdrawal, are needed to fully test the efficacy of lisuride in the treatment of stimulant withdrawal.

  2. [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.

  3. 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.

  4. 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.

  5. 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.

  6. 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.

  7. 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.

  8. 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.

  9. Movement: A Clinical Investigation

    Directory of Open Access Journals (Sweden)

    Kazem Dalaie

    2015-10-01

    Full Text Available Objectives: One major drawback of orthodontic treatment is its long duration due to slow tooth movement and the pain at the onset of treatment following application of forces. There is controversy regarding the efficacy of laser for decreasing the treatment time and pain of orthodontic treatment. The purpose of this study was to investigate the effect of low level diode laser on the rate of orthodontic tooth movement and the associated pain.Materials and Methods: In this double blind randomized controlled clinical trial, 12 or- thodontic patients referring to Shahid Beheshti School of Dentistry for first premolar ex- traction were randomly selected and allocated to gallium aluminum-arsenide laser (Ga,Al,As diode laser, 880 nm, 100 mW, 5 j/cm2, 8 points, 80 seconds, continuous mode or control group. The patients initially underwent leveling and alignment using the sectional system. Force (150 gr was applied to each canine tooth via sectional closing loops. The loops were activated every month. The rate of tooth movement and pain were monitored over the treatment period and recorded on days 1, 3, 7, 30, 33, 37, 60, 63 and 67. Two-way ANOVA was used for comparison of groups.Results: There was no significant difference in terms of tooth movement and pain scores between the irradiated and non-irradiated sides at any time point (P>0.05.Conclusion: Although laser enhanced orthodontic tooth movement in the upper jaw, we failed to provide solid evidence to support the efficacy of laser for expediting tooth move- ment or reducing the associated pain.

  10. Movement disorders.

    Science.gov (United States)

    Stoessl, A Jon; Mckeown, Martin J

    2016-01-01

    Movement disorders can be hypokinetic (e.g., parkinsonism), hyperkinetic, or dystonic in nature and commonly arise from altered function in nuclei of the basal ganglia or their connections. As obvious structural changes are often limited, standard imaging plays less of a role than in other neurologic disorders. However, structural imaging is indicated where clinical presentation is atypical, particularly if the disorder is abrupt in onset or remains strictly unilateral. More recent advances in magnetic resonance imaging (MRI) may allow for differentiation between Parkinson's disease and atypical forms of parkinsonism. Functional imaging can assess regional cerebral blood flow (functional MRI (fMRI), positron emission tomography (PET), or single-photon emission computed tomography (SPECT)), cerebral glucose metabolism (PET), neurochemical and neuroreceptor status (PET and SPECT), and pathologic processes such as inflammation or abnormal protein deposition (PET) (Table 49.1). Cerebral blood flow can be assessed at rest, during the performance of motor or cognitive tasks, or in response to a variety of stimuli. In appropriate situations, the correct imaging modality and/or combination of modalities can be used to detect early disease or even preclinical disease, and to monitor disease progression and the effects of disease-modifying interventions. Various approaches are reviewed here. © 2016 Elsevier B.V. All rights reserved.

  11. Glucose transporter type 1 deficiency due to SLC2A1 gene mutations--a rare but treatable cause of metabolic epilepsy and extrapyramidal movement disorder; own experience and literature review.

    Science.gov (United States)

    Szczepanik, Elżbieta; Terczyńska, Iwona; Kruk, Małgorzata; Lipiec, Agata; Dudko, Ewa; Tryfon, Jolanta; Jurek, Marta; Hoffman-Zacharska, Dorota

    2015-01-01

    To present the molecular and clinical characteristics of three children with glucose deficiency syndrome, an inborn rare metabolic disease, caused by mutations in the SLC2A1 gene. The investigation was carried out in three children: two girls and one boy showing symptoms of GLUT1 deficiency syndrome (GLUT1-DS). They were referred for SLC2A1 gene analysis. The presence of mutations in all of them was confirmed. Only point mutations were identified, two missenses p.Gly132Ser, p.Arg212Cys and amino acid insertion p.Ser_Val227insValProPro. In two cases the mutations arose de novo, one was heritable of paternal origin. GLUT1-DS shows high clinical variability. It should be suspected in children of any age presenting with single features or a combination of any form of intractable epilepsy with seizures of various types, movement disorders and paroxysmal events, especially triggered by exercise, exertion, or fasting, and any unexplainable neurological deterioration. The basic diagnostic hallmarks of GLUT1-DS are CSF hypoglycorrhachia and lowered CSF/Blood serum glucose ratio. This is why lumbar punction should be considered more frequently than it is in practice being performed nowadays. Antiepileptic drug treatment may be ineffective or even potentially detrimental. Early identification and molecular confirmation of GLUT1-DS is important, because this is a metabolic disorder and patients should as soon as possible primarily be treated with a ketogenic diet.

  12. 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…

  13. 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...

  14. 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.

  15. 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.

  16. 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.

  17. 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.

  18. 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...

  19. 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)....

  20. 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.

  1. 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

  2. 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.

  3. 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.

  4. Intrathecal baclofen withdrawal syndrome- a life-threatening complication of baclofen pump: a case report.

    Science.gov (United States)

    Mohammed, Imran; Hussain, Asif

    2004-08-09

    Intrathecal baclofen pump has been used effectively with increasing frequency in patients with severe spasticity, particularly for those patients who are unresponsive to conservative pharmacotherapy or develop intolerable side effects at therapeutic doses of oral baclofen. Drowsiness, nausea, headache, muscle weakness, light-headedness and return of pretreatment spasticity can be caused by intrathecal pump delivering an incorrect dose of baclofen. Intrathecal baclofen withdrawal syndrome is a very rare, potentially life-threatening complication of baclofen pump caused by an abrupt cessation of intrathecal baclofen. A 24-year-old man with a past medical history of cerebral palsy and spastic quadriparesis developed hyperthermia, disseminated intravascular coagulation, rhabdomyolysis, acute renal failure and multisystem organ failure leading to a full-blown intrathecal baclofen withdrawal syndrome. Intrathecal baclofen pump analysis revealed that it was stopped due to some programming error. He was treated effectively with supportive care, high-dose benzodiazepines and reinstitution of baclofen pump. The episodes of intrathecal baclofen withdrawal syndrome are mostly caused by preventable human errors or pump malfunction. Educating patients and their caregivers about the syndrome, and regular check-up of baclofen pump may decrease the incidence of intrathecal baclofen withdrawal syndrome. Oral baclofen replacement may not be an effective method to treat or prevent intrathecal baclofen withdrawal syndrome. Management includes an early recognition of syndrome, proper intensive care management, high-dose benzodiazepines and prompt analysis of intrathecal pump with reinstitution of baclofen.

  5. An integrative analysis of ethanol tolerance and withdrawal in zebrafish (Danio rerio)

    Science.gov (United States)

    Tran, Steven; Chatterjee, Diptendu; Gerlai, Robert

    2014-01-01

    The zebrafish is emerging as a popular animal model for alcohol (ethanol or EtOH) addiction due to its simplicity and practical advantages. Two phenomena associated with ethanol addiction are the development of tolerance and withdrawal. Using a multi-level approach in the current study, we characterize ethanol tolerance and withdrawal in zebrafish. We first investigate the temporal trajectory of ethanol concentration in the zebrafish brain in response to an acute exposure and during withdrawal. We report that ethanol concentrations approach a steady state within 60 minutes of exposure to 0.50% and 1.00% v/v ethanol and rapidly decline and return to zero within 60 minutes following withdrawal from chronic ethanol exposure (0.50% v/v). We characterize the changes associated with ethanol tolerance and withdrawal in zebrafish by focusing on 3 domains relevant to ethanol addiction: motor patterns, physiological responses (i.e. cortisol levels), and neurochemical alterations. The use of multiple domains of investigation allowed an in-depth analysis of ethanol induced changes in zebrafish. PMID:24598276

  6. 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...

  7. 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...

  8. 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...

  9. 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...

  10. 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…

  11. 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...

  12. 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...

  13. A due

    DEFF Research Database (Denmark)

    to acknowledge the excellence of these two scholars by a double Festschrift, "A due". Both have been working at the Music Department of the University of Copenhagen and have collaborated with The Royal Library on various projects. This publication contains contributions from 44 colleagues, who thus - in topics...

  14. Stories of Hell and Healing: Internet Users' Construction of Benzodiazepine Distress and Withdrawal.

    Science.gov (United States)

    Fixsen, Alison M; Ridge, Damien

    2017-11-01

    Benzodiazepines are a group of drugs used mainly as sedatives, hypnotics, antiepileptics, and muscle relaxants. Consumption is recommended for 2 to 4 weeks only, due to fast onset of dependency and potentially distressing withdrawal symptoms. Few peer-review studies have drawn on the user experiences and language to appreciate firsthand experiences of benzodiazepine withdrawal or discontinuation syndrome. We looked extensively at patient stories of benzodiazepine withdrawal and recovery on Internet support sites and YouTube. Our analysis indicated that users employ rich metaphors to portray the psychologically disturbing and protracted nature of their suffering. We identified seven major themes: hell and isolation, anxiety and depression, alienation, physical distress, anger and remorse, waves and windows, and healing and renewal. By posting success stories, ex-users make known that "healing" can be a long, unpredictable process, but distress does lessen, and recovery can happen.

  15. Method and system for formation and withdrawal of a sample from a surface to be analyzed

    Science.gov (United States)

    Van Berkel, Gary J.; Kertesz, Vilmos

    2017-10-03

    A method and system for formation and withdrawal of a sample from a surface to be analyzed utilizes a collection instrument having a port through which a liquid solution is conducted onto the surface to be analyzed. The port is positioned adjacent the surface to be analyzed, and the liquid solution is conducted onto the surface through the port so that the liquid solution conducted onto the surface interacts with material comprising the surface. An amount of material is thereafter withdrawn from the surface. Pressure control can be utilized to manipulate the solution balance at the surface to thereby control the withdrawal of the amount of material from the surface. Furthermore, such pressure control can be coordinated with the movement of the surface relative to the port of the collection instrument within the X-Y plane.

  16. GABA(A) receptor alpha4 subunit suppression prevents withdrawal properties of an endogenous steroid.

    Science.gov (United States)

    Smith, S S; Gong, Q H; Hsu, F C; Markowitz, R S; ffrench-Mullen, J M; Li, X

    1998-04-30

    The hormone progesterone is readily converted to 3alpha-OH-5alpha-pregnan-20-one (3alpha,5alpha-THP) in the brains of males and females. In the brain, 3alpha,5alpha-THP acts like a sedative, decreasing anxiety and reducing seizure activity, by enhancing the function of GABA (gamma-aminobutyric acid), the brain's major inhibitory neurotransmitter. Symptoms of premenstrual syndrome (PMS), such as anxiety and seizure susceptibility, are associated with sharp declines in circulating levels of progesterone and, consequently, of levels of 3alpha,5alpha-THP in the brain. Abrupt discontinuation of use of sedatives such as benzodiazepines and ethanol can also produce PMS-like withdrawal symptoms. Here we report a progesterone-withdrawal paradigm, designed to mimic PMS and post-partum syndrome in a rat model. In this model, withdrawal of progesterone leads to increased seizure susceptibility and insensitivity to benzodiazepine sedatives through an effect on gene transcription. Specifically, this effect was due to reduced levels of 3alpha,5alpha-THP which enhance transcription of the gene encoding the alpha4 subunit of the GABA(A) receptor. We also find that increased susceptibility to seizure after progesferone withdrawal is due to a sixfold decrease in the decay time for GABA currents and consequent decreased inhibitory function. Blockade of the alpha4 gene transcript prevents these withdrawal properties. PMS symptoms may therefore be attributable, in part, to alterations in expression of GABA(A) receptor subunits as a result of progesterone withdrawal.

  17. Variação do movimento da água do solo devido à atividade de minhocas: simulação numérica Chance of soil-water movement due to eartworms activity: numerical simulation

    Directory of Open Access Journals (Sweden)

    Masato Kobiyama

    1996-08-01

    Full Text Available Este trabalho teve o objetivo de avaliar a influência das minhocas sobre o movimento da água no solo. O fluxo da água unidimensional, vertical e não saturada foi expresso com base na equação de Picharas, que foi resolvida pelo método de diferenças finitas. As propriedades hidráulicas dos solos com e sem minhocas, que foram medidas no campo, foram utilizadas e expressas com as equações de VAN GENUCHTEN (1980. Os resultados mostram que a atividade das minhocas aumenta o pico do hidrograma no solo onde a água subsuperficial é dominante no processo chuva-vazão. Entretanto, o fenômeno do aumento do pico depende da relação entre os aumentos da condutividade hidráulica saturada (Ks e da umidade saturada (tetas. Se as minhocas provocarem um pequeno aumento em Ks ou um elevado aumento em tetas, haverá uma redução do pico. Caso ocorra contrário, um elevado aumento em Ks ou um pequeno aumento em tetas, este pico aumenta.The objective of this study was to evaluate, with a numerical method, the influence of earth worms on the soil-water movement. The one-dimensional, vertical, saturated and unsaturated water flow was expressed by the Richards equation. The generated equations were solved with a fïnite difference method. The hydraulic properties of soils with and without earthworms, which were measured on field, were utilized and expressed with VAN GENUCHTEN (1980 equations. The results demonstrated that the eathworms activity increased a peak of hydrograph of soil where the subsurface flow is dominant in the rainfall-runoff process. However, the phenomenon of this increase depenas on the relation between the increases of the saturated hydraulic conductivity (Ks and the saturated water content (thetas. When the earthworms provide a small increase of Ks and a large increase of thetas, the peak would decrease. In the contrary case where Ks increases a lot and thetas increases a little, the peak would increase.

  18. Withdrawal from the endogenous steroid progesterone results in GABAA currents insensitive to benzodiazepine modulation in rat CA1 hippocampus.

    Science.gov (United States)

    Costa, A M; Spence, K T; Smith, S S; ffrench-Mullen, J M

    1995-07-01

    1. The withdrawal properties of the endogenous steroid progesterone (P) were tested in female rats as a function of benzodiazepine modulation of gamma-aminobutyric acid-A (GABAA)-gated current with the use of the whole cell patch-clamp technique on acutely dissociated CA1 hippocampal neurons. In a previous study, this steroid was shown to exhibit withdrawal properties, behaviorally. 2. One day withdrawal from in vivo administration of physiological doses of P (5 mg ip, 5 days/wk for 3 withdrawal cycles) or its metabolite, the GABAA modulator 3 alpha-hydroxy-5 alpha-pregnan-20-one (3 alpha,5 alpha-THP or allopregnanolone, 20 mg/kg ip) prevented the normally potentiating effect of lorazepam (LZM; 10(-7)-10(-4) M) on GABAA-gated current. Withdrawal from 500 micrograms P administered concomitantly with 2 micrograms 17 beta-estradiol also markedly diminished LZM potentiation of GABAA current. This effect was seen only after three withdrawal cycles. 3. P withdrawal produced no inhibitory effect on either basal levels of GABAA-evoked current, the GABAA EC50, or barbiturate (+/-Pentobarbital, 10(-7)-10(-4) M) modulation of this parameter. 4. The effect of steroid withdrawal on LZM modulation of GABAA-evoked current was blocked by picrotoxin as well as by indomethacin, a drug that prevents conversion of P to its metabolite, the GABAA modulator 3 alpha,5 alpha-THP. These results suggest that the withdrawal properties of P may be due to changes in GABAA receptor function produced by 3 alpha,5 alpha-THP.

  19. Tramadol versus buprenorphine for the management of acute heroin withdrawal: a retrospective matched cohort controlled study.

    Science.gov (United States)

    Threlkeld, Melinda; Parran, Theodore V; Adelman, Christopher A; Grey, Scott F; Yu, Jaehak

    2006-01-01

    Many medications have been used over the past thirty years for the treatment of opioid withdrawal, including propoxyphene, methadone, clonidine, parenteral buprenorphine, and, more recently, sublingual buprenorphine. Each has been found to have clinical strengths and limitations. Tramadol is a centrally acting synthetic analgesic with opiate activity primarily due to the binding of a metabolite to the micro receptor. Despite this micro receptor activity, tramadol appears to have low abuse potential and is a non-scheduled analgesic. The pharmacologic profile of tramadol makes it a candidate for opiate withdrawal treatment. A chart review was undertaken to retrospectively compare treatment outcomes of heroin-dependent patients when detoxified with parenteral buprenorphine (1996-1997) versus tramadol (1999-2000). Inclusion criteria for this study were heroin as drug of choice, current opioid physical dependence (ie, withdrawal symptoms), no current abuse of oral opioid analgesics, and no alcohol or benzodiazepine withdrawal symptoms. Patient cases that met inclusion criteria were group-matched between buprenorphine and tramadol on the basis of age, sex, and amount of heroin used (bags/day). Charts were audited for patient demographics, daily heroin use at admission, withdrawal symptoms, and discharge status. In total, 129 patient charts were reviewed, and 115 met all inclusion criteria and were group-matched (45 patients in the buprenorphine group, seventy in the tramadol group). There were no differences in demographics between the two groups of patients. Fifty-six percent of the buprenorphine group and 71% of the tramadol group completed detoxification; tramadol-treated patients had significantly higher average withdrawal symptoms when compared to the buprenorphine group and a greater reduction in withdrawal symptoms over time. Finally, the number of side effects was small and did not differ between the groups. The results of this study are consistent with previous

  20. 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

  1. 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

  2. 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.

  3. 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.

  4. 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).

  5. 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.

  6. 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.

  7. 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.

  8. [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.

  9. CONTROLS ON CAPITAL MOVEMENTS

    Directory of Open Access Journals (Sweden)

    Petris Sorina

    2012-12-01

    Full Text Available Until recently, capital mobility was encouraged across national borders, because it was considered that such capital can seek the highest rate of return. However, recent global financial developments have shown that, due to contagion, the mobility of capital flows can cause severe financial imbalances. In the context of globalization, liberalization or maintaining controls on capital flows is a current topic, more debated by economists. This topic is very important, due to the impact of liberalization decision or maintaining controls on capital flows has on the overall macroeconomic framework. The paper analyzes the relationship between capital flows’ control and the income per capita, the degree of central bank independence, democracy country, the foreign exchange regime. Also, it analyzes the effectiveness in time of capital controls, taking account of financial system development and potential risks of instability. Over time, it was observed that a period in which they have imposed restrictions on capital movements was followed by a removal of such restrictions, and vice versa. Cyclic change of capital movements regime corresponds to the cyclic evolution of the global economy. Full capital account liberalization led to the emergence of currency and financial crises, so that the idea of maintaining controls on capital is not rejected by economists. After a full liberalization of capital flows, there is a change in the mentality of an increasing number of economists, who support the maintenance of controls, in a gradual liberalization.

  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. Opioid withdrawal presenting only nausea during tapering of oxycodone after celiac plexus block: a case report.

    Science.gov (United States)

    Sakamoto, Akiyuki; Takayama, Hiroto; Mamiya, Keiko; Koizumi, Tomonobu

    2016-01-01

    Celiac plexus block (CPB) is an effective treatment for patients suffering pain. CPB may allow for a reduction in opioid dosage, and may alleviate some of the unwanted side effects of these drugs. However, there is a substantial risk of withdrawal symptoms after reduction of opioid dose. We describe a case of pancreatic cancer developing opioid withdrawal after CPB, who presented only nausea. A 70-year-old man was referred to our hospital due to severe pancreatic cancer pain. He was administered oxycodone (oxycontin®) at 240 mg per day, and presented nausea and anorexia as side effects. CPB was performed due to insufficient pain relief. His pain disappeared on the same day as treatment. Oxycodone was reduced to 160 mg/day, and further reduced two days later to 80 mg/day. However, he complained of more severe nausea and loss of appetite even after tapering of oxycodone. Physical examination, blood chemistry examination, and brain computed tomography (CT) showed no abnormalities. Administration of fast-release oxycodone (Oxinome®) at a dose of 10 mg immediately improved his nausea. There have been no previous reports of nausea as the sole symptom of opioid withdrawal. The present case indicates that unless opioid side effects improve after dosage reduction, the possibility that they may be withdrawal symptoms should also be considered.

  12. Maintenance treatment with azathioprine in ulcerative colitis: outcome and predictive factors after drug withdrawal.

    Science.gov (United States)

    Cassinotti, Andrea; Actis, Giovanni C; Duca, Piergiorgio; Massari, Alessandro; Colombo, Elisabetta; Gai, Elisa; Annese, Vito; D'Albasio, Giuseppe; Manes, Gianpiero; Travis, Simon; Porro, Gabriele Bianchi; Ardizzone, Sandro

    2009-11-01

    Whether the duration of maintenance treatment with azathioprine (AZA) affects the outcome of ulcerative colitis (UC) is unclear. We investigated clinical outcomes and any predictive factors after withdrawal of AZA in UC. In this multicenter observational retrospective study, 127 Italian UC patients, who were in steroid-free remission at the time of withdrawal of AZA, were followed-up for a median of 55 months or until relapse. The frequency of clinical relapse or colectomy after AZA withdrawal was analyzed according to demographic, clinical, and endoscopic variables. After drug withdrawal, a third of the patients relapsed within 12 months, half within 2 years and two-thirds within 5 years. After multivariable analysis, predictors of relapse after drug withdrawal were lack of sustained remission during AZA maintenance (hazard ratio, HR 2.350, confidence interval, CI 95% 1.434-3.852; P=0.001), extensive colitis (HR 1.793, CI 95% 1.064-3.023, P=0.028 vs. left-sided colitis; HR 2.024, CI 95% 1.103-3.717, P=0.023 vs. distal colitis), and treatment duration, with short treatments (3-6 months) more disadvantaged than >48-month treatments (HR 2.783, CI 95% 1.267-6.114, P=0.008). Concomitant aminosalicylates were the only predictors of sustained remission during AZA therapy (P=0.009). The overall colectomy rate was 10%. Predictors of colectomy were drug-related toxicity as the cause of AZA withdrawal (P=0.041), no post-AZA drug therapy (P=0.031), and treatment duration (P<0.0005). Discontinuation of AZA while UC is in remission is associated with a high relapse rate. Disease extent, lack of sustained remission during AZA, and discontinuation due to toxicity could stratify relapse risk. Concomitant aminosalicylates were advantageous. Prospective randomized controlled trials are needed to confirm whether treatment duration is inversely associated with outcome.

  13. 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

  14. [Cardiac tamponade after withdrawal of a peripheral access central catheter].

    Science.gov (United States)

    García-Galiana, E; Sanchis-Gil, V; Martínez-Navarrete, M Á

    2015-03-01

    Central venous catheterization is a very common technique, although its complications can be multiple and sometimes fatal. A case is presented of cardiac tamponade by parenteral nutrition a few hours after moving a central venous catheter peripherally inserted a few days before. The diagnosis was made by echocardiography, and an emergency pericardiocentesis was performed, achieving complete recovery of the patient. Peripherally inserted central venous catheters are more likely to change their position secondary to the movements of the patient's arm, thus it is important to use soft catheters, make sure the tip lies above the carina to avoid perforation of the pericardial reflexion, and fix it well to the skin. Diagnosis must be made as soon as possible, given the high mortality rate of this complication, and the essential diagnostic tool is echocardiography. Elective treatment consists of early catheter withdrawal and emergency pericardiocentesis. Copyright © 2013 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.

  15. 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.

  16. 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.

  17. 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.

  18. Impaired hypothalamic-pituitary-adrenocortical (HPA) system is related to severity of benzodiazepine withdrawal in patients with depression.

    Science.gov (United States)

    Wichniak, Adam; Brunner, Hans; Ising, Marcus; Pedrosa Gil, Francisco; Holsboer, Florian; Friess, Elisabeth

    2004-10-01

    A concatenation of data indicates that the pathogenesis of depression is related to an increased production and secretion of corticotropin-releasing hormone (CRH). Benzodiazepines profoundly suppress the basal and stress-related activation of the hypothalamic-pituitary-adrenocortical (HPA) system and discontinuation of these drugs results in rebound activation. We therefore investigated whether the extent of HPA system dysregulation is related to the severity of benzodiazepine withdrawal in patients with depression. We performed the combined dexamethasone/CRH test before benzodiazepine discontinuation (taper-off max. 5 mg diazepam-equivalents/week) in 14 depressed patients (13 f, 1 m, mean age 54.6 +/- 14.6) who responded to the antidepressant treatment. The severity of withdrawal symptoms was measured using the Clinical Institute Withdrawal Assessment-Benzodiazepines (CIWA-B) questionnaire. The depressive psychopathology was monitored using the Hamilton Depression Rating Scale, Montgomery Asberg Depression Rating Scale and Beck Depression Inventory. Patients with more severe benzodiazepine withdrawal (CIWA-B-increase > 14 pts; n = 7) showed a significant higher cortisol and ACTH response in the dexamethasone/CRH test preceding the discontinuation of benzodiazepines than patients displaying less severe withdrawal symptoms (CIWA-B-increase benzodiazepine withdrawal symptoms may be partly due to a disinhibition of the HPA system during discontinuation of benzodiazepines.

  19. Effect of withdrawal rate on microstructure of a hypoeutectic Al-Si alloy by low superheat DC casting

    Directory of Open Access Journals (Sweden)

    Zhao Dazhi

    2013-05-01

    Full Text Available To obtain the billet with homogeneous and spheroidized primary grains is the key step in the semi-solid forming process. Among the semi-solid billet preparation methods, the process of low-superheat direct chill (DC casting is simpler and more effective. In this study, the billets of AlSi7Mg alloy were prepared by low-superheat DC casting at various withdrawal rates. The effect of withdrawal rate on the surface quality of the billets was investigated, and the evolution mechanism of the microstructural morphology in the billets was analyzed. The results show that the periodic corrugations and a large quantity of fine shrinkage pits appear in the billet surface when the withdrawal rate is 100 mm·min-1, and the above defects in the billet surface can be eliminated completely when the withdrawal rate is above 150 mm·min-1. But when the withdrawal rate is too fast (250 mm·min-1, the primary α grains, except the ones in the billet center, have not enough time for ripening due to the high silidification rate, and will solidify as the dendrite structure. When the withdrawal rate is between 150 – 200 mm·min-1, the dendritic growth of the primary α grains is effectively inhibited, and a billet of AlSi7Mg alloy with a smooth surface and homogeneous, fine, non-dendritic grains can be obtained.

  20. [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.

  1. 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...

  2. 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.

  3. 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.

  4. Withdrawal rates as a consequence of disclosure of risk associated with manipulation of the cervical spine

    Directory of Open Access Journals (Sweden)

    Forrest Lianne

    2010-10-01

    Full Text Available Abstract Background The risk associated with cervical manipulation is controversial. Research in this area is widely variable but as yet the risk is not easily quantifiable. This presents a problem when informing the patient of risks when seeking consent and information may be withheld due to the fear of patient withdrawal from care. As yet, there is a lack of research into the frequency of risk disclosure and consequent withdrawal from manipulative treatment as a result. This study seeks to investigate the reality of this and to obtain insight into the attitudes of chiropractors towards informed consent and disclosure. Methods Questionnaires were posted to 200 UK chiropractors randomly selected from the register of the General Chiropractic Council. Results A response rate of 46% (n = 92 was achieved. Thirty-three per cent (n = 30 respondents were female and the mean number of years in practice was 10. Eighty-eight per cent considered explanation of the risks associated with any recommended treatment important when obtaining informed consent. However, only 45% indicated they always discuss this with patients in need of cervical manipulation. When asked whether they believed discussing the possibility of a serious adverse reaction to cervical manipulation could increase patient anxiety to the extent there was a strong possibility the patient would refuse treatment, 46% said they believed this could happen. Nonetheless, 80% said they believed they had a moral/ethical obligation to disclose risk associated with cervical manipulation despite these concerns. The estimated number of withdrawals throughout respondents' time in practice was estimated at 1 patient withdrawal for every 2 years in practice. Conclusion The withdrawal rate from cervical manipulation as a direct consequence of the disclosure of associated serious risks appears unfounded. However, notwithstanding legal obligations, reluctance to disclose risk due to fear of increasing patient

  5. Withdrawal rates as a consequence of disclosure of risk associated with manipulation of the cervical spine.

    Science.gov (United States)

    Langworthy, Jennifer M; Forrest, Lianne

    2010-10-26

    The risk associated with cervical manipulation is controversial. Research in this area is widely variable but as yet the risk is not easily quantifiable. This presents a problem when informing the patient of risks when seeking consent and information may be withheld due to the fear of patient withdrawal from care. As yet, there is a lack of research into the frequency of risk disclosure and consequent withdrawal from manipulative treatment as a result. This study seeks to investigate the reality of this and to obtain insight into the attitudes of chiropractors towards informed consent and disclosure. Questionnaires were posted to 200 UK chiropractors randomly selected from the register of the General Chiropractic Council. A response rate of 46% (n = 92) was achieved. Thirty-three per cent (n = 30) respondents were female and the mean number of years in practice was 10. Eighty-eight per cent considered explanation of the risks associated with any recommended treatment important when obtaining informed consent. However, only 45% indicated they always discuss this with patients in need of cervical manipulation. When asked whether they believed discussing the possibility of a serious adverse reaction to cervical manipulation could increase patient anxiety to the extent there was a strong possibility the patient would refuse treatment, 46% said they believed this could happen. Nonetheless, 80% said they believed they had a moral/ethical obligation to disclose risk associated with cervical manipulation despite these concerns. The estimated number of withdrawals throughout respondents' time in practice was estimated at 1 patient withdrawal for every 2 years in practice. The withdrawal rate from cervical manipulation as a direct consequence of the disclosure of associated serious risks appears unfounded. However, notwithstanding legal obligations, reluctance to disclose risk due to fear of increasing patient anxiety still remains, despite acknowledgement of moral and

  6. [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.

  7. 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.

  8. [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.

  9. 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...

  10. 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...

  11. 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

  12. 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.

  13. 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.

  14. 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...

  15. [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.

  16. 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.

  17. Carbamazepine versus oxazepam in the treatment of alcohol withdrawal: a double-blind study.

    Science.gov (United States)

    Stuppaeck, C H; Pycha, R; Miller, C; Whitworth, A B; Oberbauer, H; Fleischhacker, W W

    1992-03-01

    The use of more than 130 drugs and drug combinations against the alcohol withdrawal syndrome reflects the fact that views on its treatment are far from being unequivocal. Benzodiazepines are the first choice treatment but it should not be disregarded that they have side effects and, above all, a varying risk of dependency themselves. In recent years many trials have focused on carbamazepine in this respect. Its efficacy was proven in various open and double-blind studies, most of them using concomitant sedative drugs, thereby diminishing the reliability of the results. In a double-blind study we compared the efficacy of carbamazepine with that of oxazepam, in 60 in-patients suffering from alcohol withdrawal syndrome. The main rating instrument was the Clinical Institute Withdrawal Scale--Alcohol (CIWA-A). The 7-day trial showed equal efficacy of carbamazepine and oxazepam during the first 5 days and a statistically significant superiority of carbamazepine on days 6 and 7. Four patients in each group had to be dropped from the study due to side effects or after having withdrawn informed consent. There was no decrease in white blood counts under carbamazepine. The experiences with carbamazepine up to now suggest a more widespread use, especially in non-delirious withdrawal states.

  18. Jogging Therapy for Hikikomori Social Withdrawal and Increased Cerebral Hemodynamics: A Case Report.

    Science.gov (United States)

    Nishida, Masaki; Kikuchi, Senichiro; Fukuda, Kazuhito; Kato, Satoshi

    2016-01-01

    Severe social withdrawal, called hikikomori, has drawn increased public attention. However, an optimal clinical approach and strategy of treatment has not been well established. Here, we report a case of hikikomori for which an exercise intervention using jogging therapy was effective, showing cerebral hemodynamic improvement. The patient was a 20 year old Japanese male who was hospitalized in order to evaluate and treat severe social withdrawal. Although depressive and anxiety symptoms partially subsided with sertraline alone, social withdrawal persisted due to a lack of self confidence. With his consent, we implemented exercise therapy with 30 minutes of jogging three times a week for three months. We did not change the pharmacotherapy, and his social withdrawal remarkably improved with continuous jogging exercise. Using near infrared spectroscopy to evaluate hemodynamic alteration, bilateral temporal hemodynamics considerably increased after the three-month jogging therapy. Regarding exercise therapy for mental illness, numerous studies have reported the effectiveness of exercise therapy for major depression. This case implied, however, that the applicability of exercise therapy is not limited to major depressive disorder. Jogging therapy may contribute to reinforcing self confidence associated with "resilience" in conjunction with neurophysiological modulation of neural networks.

  19. 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.

  20. [Evaluation of selected socioeconomic factors in patients with acute ethanol intoxication and alcohol withdrawal syndrome].

    Science.gov (United States)

    Lukasik-Głębocka, Magdalena; Sommerfeld, Karina

    2014-01-01

    Ethanol is commonly overused psychoactive substance in Poland and all around the world. It causes addiction, which occurs as a result of its chronic administration. One of the main symptoms of addiction is hunger due to psychoactive substance that prevents interruption of its adoption and contributes to relapse drinking. Acute poisoning with ethyl alcohol and alcohol withdrawal syndrome are diseases causing a potential danger to life. The prevalence of use and abuse of alcoholic beverages is a potential risk, causing health problems, including permanent damage of the central and peripheral nervous system and socio-economic problems. The aim of this study is to analyze certain aspects of the socio-economic situation of the patients hospitalized in the Department of Toxicology in Raszeja City Hospital in Poznan due to acute ethanol intoxication or alcohol withdrawal syndrome in 2010. 299 patients history was evaluated, among which 161 were treated for acute intoxication with ethanol and 138 due to alcohol withdrawal syndrome. Objects of interest were elements of subjective tests including: marital status of patients, their education and professional activity and the problem of homelessness. The study group consisted of 299 patients in age from 16 to 77 years, hospitalized in the Department of Toxicology in Raszeja City Hospital in Poznan due to acute ethanol intoxication or alcohol withdrawal syndrome. It was found that the largest group consisted of patients remaining married (42.81%) and unmarried (30.43%). Alcohol abuse affects people of all levels of education. In the present study, most patients had a vocational education (37.79%) and medium (23.08%). Patients were analyzed in terms of economic activity, among which about 40% were unemployed. In the whole group more than 10% of those were homeless. Ethyl alcohol intoxication and alcohol withdrawal represents a significant hazard. As a result of reliance, patients lose control of alcohol consumption and they

  1. Tectonic Plate Movement.

    Science.gov (United States)

    Landalf, Helen

    1998-01-01

    Presents an activity that employs movement to enable students to understand concepts related to plate tectonics. Argues that movement brings topics to life in a concrete way and helps children retain knowledge. (DDR)

  2. Stereotypic movement disorder

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/article/001548.htm Stereotypic movement disorder To use the sharing features on this page, please enable JavaScript. Stereotypic movement disorder is a condition in which a person makes ...

  3. Eye Movement Disorders

    Science.gov (United States)

    ... t work properly. There are many kinds of eye movement disorders. Two common ones are Strabismus - a disorder ... of the eyes, sometimes called "dancing eyes" Some eye movement disorders are present at birth. Others develop over ...

  4. 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...

  5. 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

  6. Movement and Space

    DEFF Research Database (Denmark)

    Riisgaard Hansen, Thomas; Eriksson, Eva; Lykke-Olesen, Andreas

    2005-01-01

    In this paper we explore the space in which movement based interaction takes place. We have in several projects explored how fixed and mobile cameras can be used in movement based interaction and will shortly describe these projects. Based on our experience with working with movement...

  7. Linking Literacy and Movement

    Science.gov (United States)

    Pica, Rae

    2010-01-01

    There are many links between literacy and movement. Movement and language are both forms of communication and self-expression. Rhythm is an essential component of both language and movement. While people may think of rhythm primarily in musical terms, there is a rhythm to words and sentences as well. Individuals develop an internal rhythm when…

  8. Social movements and science

    DEFF Research Database (Denmark)

    Jamison, Andrew

    2006-01-01

    The article examines the role of social movements in the development of scientific knowledge. Interactions between social movements and science in broad, historical terms are discussed. The relations between the new social movements of the 1960s and 1970s and changes in the contemporary scientific...

  9. 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.

  10. 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…

  11. 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...

  12. 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…

  13. 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...

  14. 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...

  15. 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.

  16. 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...

  17. 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...

  18. 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...

  19. 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...

  20. 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.

  1. 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 ...

  2. 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...

  3. 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...

  4. Saltwater movement in the upper Floridan aquifer beneath Port Royal Sound, South Carolina

    Science.gov (United States)

    Smith, Barry S.

    1994-01-01

    Freshwater for Hilton Head Island, South Carolina, is supplied by withdrawals from the Upper Floridan aquifer. Freshwater for the nearby city of Savannah, Georgia, and for the industry that has grown adjacent to the city, has also been supplied, in part, by withdrawal from the Upper Floridan aquifer since 1885. The withdrawal of ground water has caused water levels in the Upper Floridan aquifer to decline over a broad area, forming a cone of depression in the potentiometric surface of the aquifer centered near Savannah. In 1984, the cone of depression extended beneath Hilton Head Island as far as Port Royal Sound. Flow in the aquifer, which had previously been toward Port Royal Sound, has been reversed, and, as a result, saltwater in the aquifer beneath Port Royal Sound has begun to move toward Hilton Head Island. The Saturated-Unsaturated Transport (SUTRA) model of the U.S. Geological Survey was used for the simulation of density-dependent ground-water flow and solute transport for a vertical section of the Upper Floridan aquifer and upper confining unit beneath Hilton Head Island and Port Royal Sound. The model simulated a dynamic equilibrium between the flow of seawater and freshwater in the aquifer near the Gyben-Herzberg position estimated for the period before withdrawals began in 1885; it simulated reasonable movements of brackish water and saltwater from that position to the position determined by chemical analyses of samples withdrawn from the aquifer in 1984, and it approximated hydraulic heads measured in the aquifer in 1976 and 1984. The solute-transport simulations indicate that the transition zone would continue to move toward Hilton Head Island even if pumping ceased on the island. Increases in existing withdrawals or additional withdrawals on or near Hilton Head Island would accelerate movement of the transition zone toward the island, but reduction in withdrawals or the injection of freshwater would slow movement toward the island, according to the

  5. 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 .

  6. 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.

  7. 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.

  8. 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.

  9. 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.

  10. 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...

  11. 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...

  12. 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.

  13. 75 FR 61121 - Interstate Movement of Garbage From Hawaii; Withdrawal of Finding of No Significant Impact

    Science.gov (United States)

    2010-10-04

    ... Animal and Plant Health Inspection Service prepared an environmental assessment and a finding of no... environmental assessment's analysis of cumulative effects. On May 27, 2010, we published in the Federal Register... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF AGRICULTURE...

  14. 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…

  15. 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.

  16. Plant nuclear photorelocation movement.

    Science.gov (United States)

    Higa, Takeshi; Suetsugu, Noriyuki; Wada, Masamitsu

    2014-06-01

    Organelle movement and positioning are essential for proper cellular function. A nucleus moves dynamically during cell division and differentiation and in response to environmental changes in animal, fungal, and plant cells. Nuclear movement is well-studied and the mechanisms have been mostly elucidated in animal and fungal cells, but not in plant cells. In prothallial cells of the fern Adiantum capillus-veneris and leaf cells of the flowering plant Arabidopsis thaliana, light induces nuclear movement and nuclei change their position according to wavelength, intensity, and direction of light. This nuclear photorelocation movement shows some common features with the photorelocation movement of chloroplasts, which is one of the best-characterized plant organelle movements. This review summarizes nuclear movement and positioning in plant cells, especially plant-specific nuclear photorelocation movement and discusses the relationship between nuclear photorelocation movement and chloroplast photorelocation movement. © The Author 2013. Published by Oxford University Press on behalf of the Society for Experimental Biology. All rights reserved. For permissions, please email: journals.permissions@oup.com.

  17. Social Movement Literature and U.S. Labour: A Reassessment

    Directory of Open Access Journals (Sweden)

    Keith Mann

    2014-04-01

    Full Text Available Largely due to its conservative profile at the time, the U.S. labour movement was largely absent from modern social movement literature as it developed in response to the new social movements of the 1960s and 1970s. Recent labour mobilizations such as the Wisconsin uprising and the Chicago Teachers’ strike have been part of the current international cycle of protest that includes the Arab Spring, the antiausterity movements in Greece and Spain, and Occupy Wall Street. These struggles suggest that a new labour movement is emerging that shares many common features with new social movements. This article offers a general analysis of these and other contemporary labour struggles in light of contemporary modern social movement literature. It also critically reviews assumptions about the labour movement of the 1960s and 1970s and reexamines several social movement concepts.

  18. [Sleep related movement disorders].

    Science.gov (United States)

    Suzuki, Keisuke; Miyamoto, Masayuki; Miyamoto, Tomoyuki; Hirata, Koichi

    2015-06-01

    Sleep related movement disorders (SRMD) are characterized by simple, stereotyped movements occur during sleep, with the exception of restless legs syndrome (RLS). RLS has the following essential features; an urge to move the legs usually accompanied by uncomfortable sensation in the legs, improvement of symptoms after movement (non-stereotypical movements, such as walking and stretching, to reduce symptoms), and symptoms occur or worsen during periods of rest and in the evening and night. However, RLS is closely associated with periodic limb movement, which shows typical stererotyped limb movements. In the International Classification of Sleep Disorders, 3rd edition, sleep disturbances or daytime symptoms are prerequiste for a diagnosis of SRMD. We here review diagnosis and treatment of SRMD.

  19. 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.

  20. 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.

  1. 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.

  2. 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.

  3. 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

  4. 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

  5. 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.

  6. 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).

  7. The mathematics of movement

    Science.gov (United States)

    Johnson, D.H.

    1999-01-01

    Review of: Quantitative Analysis of Movement: Measuring and Modeling Population Redistribution in Animals and Plants. Peter Turchin. 1998. Sinauer Associates, Sunderland, MA. 306 pages. $38.95 (paper).

  8. Sensation of Movement

    DEFF Research Database (Denmark)

    Sensation of Movement will discuss the role of sensation in the control of action, bodily self-recognition, and sense of agency. Sensing movement is dependent on a range of information received by the brain, from signalling in the peripheral sensory organs to the establishment of higher order goals....... This volume will question whether one type of information is more relevant for the ability to sense and control movements, and demonstrate the importance of integrating neuroscientific knowledge with philosophical perspectives, in order to arrive at new insights into how sensation of movement can be studied...

  9. 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

  10. 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

  11. 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.

  12. 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.

  13. 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.

  14. 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....

  15. Fetal eye movements on magnetic resonance imaging.

    Science.gov (United States)

    Woitek, Ramona; Kasprian, Gregor; Lindner, Christian; Stuhr, Fritz; Weber, Michael; Schöpf, Veronika; Brugger, Peter C; Asenbaum, Ulrika; Furtner, Julia; Bettelheim, Dieter; Seidl, Rainer; Prayer, Daniela

    2013-01-01

    Eye movements are the physical expression of upper fetal brainstem function. Our aim was to identify and differentiate specific types of fetal eye movement patterns using dynamic MRI sequences. Their occurrence as well as the presence of conjugated eyeball motion and consistently parallel eyeball position was systematically analyzed. Dynamic SSFP sequences were acquired in 72 singleton fetuses (17-40 GW, three age groups [17-23 GW, 24-32 GW, 33-40 GW]). Fetal eye movements were evaluated according to a modified classification originally published by Birnholz (1981): Type 0: no eye movements; Type I: single transient deviations; Type Ia: fast deviation, slower reposition; Type Ib: fast deviation, fast reposition; Type II: single prolonged eye movements; Type III: complex sequences; and Type IV: nystagmoid. In 95.8% of fetuses, the evaluation of eye movements was possible using MRI, with a mean acquisition time of 70 seconds. Due to head motion, 4.2% of the fetuses and 20.1% of all dynamic SSFP sequences were excluded. Eye movements were observed in 45 fetuses (65.2%). Significant differences between the age groups were found for Type I (p = 0.03), Type Ia (p = 0.031), and Type IV eye movements (p = 0.033). Consistently parallel bulbs were found in 27.3-45%. In human fetuses, different eye movement patterns can be identified and described by MRI in utero. In addition to the originally classified eye movement patterns, a novel subtype has been observed, which apparently characterizes an important step in fetal brainstem development. We evaluated, for the first time, eyeball position in fetuses. Ultimately, the assessment of fetal eye movements by MRI yields the potential to identify early signs of brainstem dysfunction, as encountered in brain malformations such as Chiari II or molar tooth malformations.

  16. 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

  17. 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.

  18. 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.

  19. [Dance/Movement Therapy.

    Science.gov (United States)

    Fenichel, Emily, Ed.

    1994-01-01

    This newsletter theme issue focuses on dance, play, and movement therapy for infants and toddlers with disabilities. Individual articles are: "Join My Dance: The Unique Movement Style of Each Infant and Toddler Can Invite Communication, Expression and Intervention" (Suzi Tortora); "Dynamic Play Therapy: An Integrated Expressive Arts Approach to…

  20. Dynamics of human movement

    NARCIS (Netherlands)

    Koopman, Hubertus F.J.M.

    2010-01-01

    The part of (bio)mechanics that studies the interaction of forces on the human skeletal system and its effect on the resulting movement is called rigid body dynamics. Some basic concepts are presented: A mathematical formulation to describe human movement and how this relates on the mechanical loads

  1. 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.

  2. 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...

  3. [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.

  4. 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...

  5. 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.

  6. 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.

  7. 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

  8. 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 ...

  9. 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.

  10. 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.

  11. 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].

  12. 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.

  13. 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.

  14. 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 ...

  15. 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...

  16. 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

  17. 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

  18. 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.

  19. 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

  20. 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)....

  1. 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.

  2. 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.

  3. 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.

  4. Action history influences subsequent movement via two distinct processes

    Science.gov (United States)

    Poh, Eugene; de Rugy, Aymar

    2017-01-01

    The characteristics of goal-directed actions tend to resemble those of previously executed actions, but it is unclear whether such effects depend strictly on action history, or also reflect context-dependent processes related to predictive motor planning. Here we manipulated the time available to initiate movements after a target was specified, and studied the effects of predictable movement sequences, to systematically dissociate effects of the most recently executed movement from the movement required next. We found that directional biases due to recent movement history strongly depend upon movement preparation time, suggesting an important contribution from predictive planning. However predictive biases co-exist with an independent source of bias that depends only on recent movement history. The results indicate that past experience influences movement execution through a combination of temporally-stable processes that are strictly use-dependent, and dynamically-evolving and context-dependent processes that reflect prediction of future actions. PMID:29058670

  5. Modulation of heart activity during withdrawal reflexes in the snail Helix aspersa.

    Science.gov (United States)

    Weatherill, Daniel; Chase, Ronald

    2005-04-01

    The beating activity of the molluscan heart is myogenic, but it is influenced by nervous signals of central origin. Previous studies have demonstrated changes in cardiac output during feeding and other behaviors. Here, we describe a short latency, transient cardiac response that accompanies withdrawal reflexes. When evoked by electrical stimulation of peripheral nerves, the response was detected within one or two heartbeats. Beat amplitudes increased on average 11.6%, and inter-beat intervals decreased on average 2.1%. The mean duration of the response was 28.1 s. A transient inhibitory phase often preceded the excitatory response. Results from testing various nerves and tissues show that the cardiac responses invariably occur whenever contractions of the tentacle retractor muscle are elicited. Even stimulation of the ovotestis and the kidney elicit responses despite their protected locations within the mantle cavity. Three excitatory cardioactive neurons are identified in the central nervous system of Helix aspersa, and their involvement in the reflex response is documented. The results suggest that the heart output is initially inhibited to relax the hydroskeleton and thereby aid withdrawal movements. A delayed increase in cardiac output then facilitates the re-inflation, hence eversion, of the withdrawn body parts.

  6. 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.

  7. 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)

  8. 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.

  9. 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.

  10. Attenuation of Morphine Withdrawal Syndrome by Various Dosages of Curcumin in Comparison with Clonidine in Mouse: Possible Mechanism

    Directory of Open Access Journals (Sweden)

    Majid Motaghinejad

    2015-03-01

    Full Text Available Background: Herbal medical compounds and their major constituent have been used in the management and treatment of opioid withdrawal syndrome and pain. This study was carried out to clarify the effect of curcumin, the major compound of turmeric, on morphine withdrawal syndrome in mouse model and its possible mechanisms of pain relieving activity by assessing in writhing test as a model of visceral pain. Methods: Due to two separate protocols (withdrawal syndrome and pain, 144 male albino mice were divided in two major groups. In withdrawal syndrome group, test effect of various dosages of curcumin (10, 20, and 40 mg/kg was assessed on withdrawal signs and compared with positive and negative control and standard treatment (clonidine 0.4 mg/kg groups. In pain groups, to determine the mechanism of pain relieving activity of curcumin, various dosages of curcumin (10, 20, and 40 mg/kg in three separated groups, were used against acetic acid induced writhing (which is a constriction test. The most effective dose (40 mg/kg was used in writhing test and compared with groups pretreated with antagonist of major neurotransmitters involved in pain; and compared with group pretreated with vehicle (DMSO, 0.05% as control. Results: Curcumin attenuates withdrawal syndrome in a dose dependent manner in comparison with the dependent positive control group (P<0.05. It also indicated that pretreatment with naloxone and cyproheptadine significantly attenuate antinociception effect of curcumin (P<0.05. Conclusion: This study advocate that antinociception of curcumin was mediated by opioidergic and adrenergic system.

  11. 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

  12. 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.

  13. Partial Loss of Anabolic Effect of Prostaglandin E2 on Bone After Its Withdrawal in Rats

    Science.gov (United States)

    Ke, H. Z.; Li, X. J.; Jee, Webster S. S.

    1991-01-01

    The object of this study was to determine the fate of PGE(sub 2)-induced new bone mass after withdrawal of PGE(sub 2) administration. Seven-month-old male Sprague-Dawley rats were given subcutaneous injections of 1, 3, and 6 mg PGE(sub 2)/kg/d for 60 days and then withdrawn for 60 and 120 days. Histomorphometric analyses were performed on double fluorescent labeled undecalcified proximal tibial bone specimens. After 60 days of PGE(sub 2) treatment, a new steady state of increased trabecular bone area (+67% and +81% with 3 and 6 mg PGE(sub 2)/kg/d) from woven bone and stimulated lamellar bone formation, elevated bone turnover, and shortened remodeling periods were achieved compared to age-matched controls. In contrast, after 60 and 120 days withdrawal of PGE(sub 2), a new steady state characterized by less trabecular bone area (+40% to +60% of controls with 3 and 6 mg/kg/d doses), normal lamellar bone formation, no woven bone formation from controls, and eroded surface greater than those seen in controls and previously in 60-day PGE(sub 2) treated rats. The decrease in new bone mass after withdrawal of PGE(sub 2) was due to a further elevation of bone resorption above that induced by the PGE(sub 2) treatment and a reduction in PGE(sub 2) stimulated bone formation activities. Although there is more trabecular bone than in controls after 120 days' withdrawal of PGE(sub 2), we postulate that the skeletal adaptation to mechanical usage will eventually reduce the bone mass to control levels. Thus, it is conservative to conclude that the anabolic effect of PGE(sub 2) was dependent upon continuous daily administration of PGE(sub 2) in these older rats.

  14. Auxin and chloroplast movements.

    Science.gov (United States)

    Eckstein, Aleksandra; Krzeszowiec, Weronika; Waligórski, Piotr; Gabryś, Halina

    2016-03-01

    Auxin is involved in a wide spectrum of physiological processes in plants, including responses controlled by the blue light photoreceptors phototropins: phototropic bending and stomatal movement. However, the role of auxin in phototropin-mediated chloroplast movements has never been studied. To address this question we searched for potential interactions between auxin and the chloroplast movement signaling pathway using different experimental approaches and two model plants, Arabidopsis thaliana and Nicotiana tabacum. We observed that the disturbance of auxin homeostasis by shoot decapitation caused a decrease in chloroplast movement parameters, which could be rescued by exogenous auxin application. In several cases, the impairment of polar auxin transport, by chemical inhibitors or in auxin carrier mutants, had a similar negative effect on chloroplast movements. This inhibition was not correlated with changes in auxin levels. Chloroplast relocations were also affected by the antiauxin p-chlorophenoxyisobutyric acid and mutations in genes encoding some of the elements of the SCF(TIR1)-Aux/IAA auxin receptor complex. The observed changes in chloroplast movement parameters are not prominent, which points to a modulatory role of auxin in this process. Taken together, the obtained results suggest that auxin acts indirectly to regulate chloroplast movements, presumably by regulating gene expression via the SCF(TIR1)-Aux/IAA-ARF pathway. Auxin does not seem to be involved in controlling the expression of phototropins. © 2015 Scandinavian Plant Physiology Society.

  15. Subsystems of sensory attention for skilled reaching: vision for transport and pre-shaping and somatosensation for grasping, withdrawal and release.

    Science.gov (United States)

    Sacrey, Lori-Ann R; Whishaw, Ian Q

    2012-06-01

    Skilled reaching is a forelimb movement in which a subject reaches for a piece of food that is placed in the mouth for eating. It is a natural movement used by many animal species and is a routine, daily activity for humans. Its prominent features include transport of the hand to a target, shaping the digits in preparation for grasping, grasping, and withdrawal of the hand to place the food in the mouth. Studies on normal human adults show that skilled reaching is mediated by at least two sensory attention processes. Hand transport to the target and hand shaping are temporally coupled with visual fixation on the target. Grasping, withdrawal, and placing the food into the mouth are associated with visual disengagement and somatosensory guidance. Studies on nonhuman animal species illustrate that shared visual and somatosensory attention likely evolved in the primate lineage. Studies on developing infants illustrate that shared attention requires both experience and maturation. Studies on subjects with Parkinson's disease and Huntington's disease illustrate that decomposition of shared attention also features compensatory visual guidance. The evolutionary, developmental, and neural control of skilled reaching suggests that associative learning processes are importantly related to normal adult attention sharing and so can be used in remediation. The economical use of sensory attention in the different phases of skilled reaching ensures efficiency in eating, reduces sensory interference between sensory reference frames, and provides efficient neural control of the advance and withdrawal components of skilled reaching movements. Copyright © 2011 Elsevier B.V. All rights reserved.

  16. Music and movement

    OpenAIRE

    Nasev, Lence

    2012-01-01

    Rhythm is one of the fundamental elements without which music would not exist. In plays with singing, a child learns to synchronize its movements with the rhythm of music from a very early age. The skill of movement plays a major role in the learning of music and thus deserves an important place in the school curriculum. In this paper, an overview is made of the most important music pedagogues who introduced movement, and at the same time perceived its importance in learning musical conte...

  17. Young Activists and the Anti-Patriotic Education Movement in Post-Colonial Hong Kong: Some Insights from Twitter

    Science.gov (United States)

    Chan, Chitat

    2013-01-01

    An extraordinary large-scale student movement in Hong Kong successfully forced the government to withdraw a patriotic education proposal in 2012. The student group has attracted serious scrutiny from the pro-government camp because of the students' unusually young age and remarkable mobilising power. This study aims to explore the community…

  18. Gender and Awa Dance Movements

    OpenAIRE

    Nakamura, Hisako

    2000-01-01

    At around the period when Japanese women began to seek the liberation from sexual segregation, the sex diffreence in the movements of the Awa Dance gradually widened, due to obtaining more attractive performance as tourism resources. Women danced a female dance and men danced a male dance. Despite clear differences in movements,some women came to challenge the male dance.This article attempts to make clear,through interviews, who began to dance the male dance and when and tries to describe th...

  19. Reduced emotional signs of opiate withdrawal in rats selectively bred for low (LoS) versus high (HiS) saccharin intake.

    Science.gov (United States)

    Radke, Anna K; Holtz, Nathan A; Gewirtz, Jonathan C; Carroll, Marilyn E

    2013-05-01

    Rats bred for high (HiS) and low (LoS) saccharin intake exhibit divergent behavioral responses to multiple drugs of abuse, with HiS rats displaying greater vulnerability to drug taking. Previous research indicates that this effect may be due to increased sensitivity to reward in HiS rats and to the aversive effects of acute drug administration in LoS rats. The current study investigated whether HiS and LoS rats also exhibit different behavioral signs of withdrawal following one or repeated opiate exposures. Emotional signs of opiate withdrawal were assessed with potentiation of the acoustic startle reflex and conditioned place aversion (CPA) in male and female HiS and LoS rats. Startle was measured before and 4 h after a 10-mg/kg injection of morphine on days 1, 2, and 7 of opiate exposure. CPA was induced with a 2-day, naloxone-precipitated conditioning paradigm. Somatic signs of withdrawal and weight loss were also measured. Male and female LoS rats exhibited lower startle potentiation than HiS rats on the seventh day of morphine exposure. LoS male rats also failed to develop a CPA to morphine withdrawal. No differences in physical withdrawal signs were observed between HiS and LoS rats, but males of both lines had more physical signs of withdrawal than females. These results suggest that LoS rats are less vulnerable to the negative emotional effects of morphine withdrawal than HiS rats. A less severe withdrawal syndrome may contribute to decreased levels of drug taking in the LoS line.

  20. 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.

  1. Movements and feelings

    Directory of Open Access Journals (Sweden)

    Anna Maria Fernandez Poncela

    2013-12-01

    Full Text Available This text reviews the theory of recognition and focuses on the study of the role of emotions in collective action and social movements. It shows how emotion becomes feeling and creates a need to be met, leading to action. Anger, for example, as emotion, moves on to the feeling of indignation, and it is expressed in many forms, including the pursuit of justice and recognition. This point lands and deepens the study with the experience of the student movement in Mexico #YoSoy132 in 2012. The research is based on interviews with members of the movement. The presence and importance of feelings in collective action and social movements through the proposed case study is finally shown.

  2. Movement coordination during conversation.

    Directory of Open Access Journals (Sweden)

    Nida Latif

    Full Text Available Behavioral coordination and synchrony contribute to a common biological mechanism that maintains communication, cooperation and bonding within many social species, such as primates and birds. Similarly, human language and social systems may also be attuned to coordination to facilitate communication and the formation of relationships. Gross similarities in movement patterns and convergence in the acoustic properties of speech have already been demonstrated between interacting individuals. In the present studies, we investigated how coordinated movements contribute to observers' perception of affiliation (friends vs. strangers between two conversing individuals. We used novel computational methods to quantify motor coordination and demonstrated that individuals familiar with each other coordinated their movements more frequently. Observers used coordination to judge affiliation between conversing pairs but only when the perceptual stimuli were restricted to head and face regions. These results suggest that observed movement coordination in humans might contribute to perceptual decisions based on availability of information to perceivers.

  3. 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.

  4. 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.

  5. 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.

  6. 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.

  7. Rooted in Movement

    DEFF Research Database (Denmark)

    The result of the synergy between four doctoral projects and an advanced MA-level course on Bronze Age Europe, this integrated assemblage of articles represents a variety of different subjects united by a single theme: movement. Ranging from theoretical discussion of the various responses...... period of European prehistory. In so doing, the text not only addresses transmission and reception, but also the conceptualization of mobility within a world which was literally Rooted in Movement....

  8. Spiraldynamik - intelligent movement

    OpenAIRE

    Wippert, Jens

    2014-01-01

    Spiraldynamik ® is an anatomically based movement and therapy concept. It was founded by the physiotherapist Yolanda Deswarte, and Dr. med. Christian Larsen. During the time that he was professionally active as a pediatrician, Christian Larsen repeatedly wondered: “is the universal principle of organization, the spiral, also embodied in man?” Observing the babies and toddlers that he worked with inspired him to research further into movement sequences. International interdisciplinary research...

  9. Nuclear movement in fungi.

    Science.gov (United States)

    Xiang, Xin

    2017-12-11

    Nuclear movement within a cell occurs in a variety of eukaryotic organisms including yeasts and filamentous fungi. Fungal molecular genetic studies identified the minus-end-directed microtubule motor cytoplasmic dynein as a critical protein for nuclear movement or orientation of the mitotic spindle contained in the nucleus. Studies in the budding yeast first indicated that dynein anchored at the cortex via its anchoring protein Num1 exerts pulling force on an astral microtubule to orient the anaphase spindle across the mother-daughter axis before nuclear division. Prior to anaphase, myosin V interacts with the plus end of an astral microtubule via Kar9-Bim1/EB1 and pulls the plus end along the actin cables to move the nucleus/spindle close to the bud neck. In addition, pushing or pulling forces generated from cortex-linked polymerization or depolymerization of microtubules drive nuclear movements in yeasts and possibly also in filamentous fungi. In filamentous fungi, multiple nuclei within a hyphal segment undergo dynein-dependent back-and-forth movements and their positioning is also influenced by cytoplasmic streaming toward the hyphal tip. In addition, nuclear movement occurs at various stages of fungal development and fungal infection of plant tissues. This review discusses our current understanding on the mechanisms of nuclear movement in fungal organisms, the importance of nuclear positioning and the regulatory strategies that ensure the proper positioning of nucleus/spindle. Published by Elsevier Ltd.

  10. Changes in vergence dynamics due to repetition.

    Science.gov (United States)

    Jainta, Stephanie; Bucci, Maria Pia; Wiener-Vacher, Sylvette; Kapoula, Zoï

    2011-08-15

    Vergence insufficiency is frequent in many populations including children with vertigo in the absence of measurable vestibular dysfunction. Orthoptic exercises are typically used to improve vergence and the clinical practice suggests that simple repetition of vergence movements improves it. Objective eye movement recordings were used to asses the dynamics and spatial-temporal properties of convergence (8.7°) and divergence (2.7°) along the midline while these movements were repeated 80 times. Eight children, aged on average 13years and showing vertigo symptoms accompanied with vergence insufficiency, participated. For both, convergence and divergence the velocity increased and the overall duration decreased; the amplitude of the mean transient component of the response changed significantly. These findings are compatible with models of double mode control of vergence eye movements (transient - open-loop vs. sustained - closed loop). Due to simple repetitions a real improvement in the dynamics of vergence along the midline occurred. Copyright © 2011 Elsevier Ltd. All rights reserved.

  11. Impact of Water Withdrawals from Groundwater and Surface Water on Continental Water Storage Variations

    Science.gov (United States)

    Doell, Petra; Hoffmann-Dobrev, Heike; Portmann, Felix T.; Siebert, Stefan; Eicker, Annette; Rodell, Matthew; Strassberg, Gil

    2011-01-01

    Humans have strongly impacted the global water cycle, not only water flows but also water storage. We have performed a first global-scale analysis of the impact of water withdrawals on water storage variations, using the global water resources and use model WaterGAP. This required estimation of fractions of total water withdrawals from groundwater, considering five water use sectors. According to our assessment, the source of 35% of the water withdrawn worldwide (4300 cubic km/yr during 1998-2002) is groundwater. Groundwater contributes 42%, 36% and 27% of water used for irrigation, households and manufacturing, respectively, while we assume that only surface water is used for livestock and for cooling of thermal power plants. Consumptive water use was 1400 cubic km/yr during 1998-2002. It is the sum of the net abstraction of 250 cubic km/yr of groundwater (taking into account evapotranspiration and return flows of withdrawn surface water and groundwater) and the net abstraction of 1150 km3/yr of surface water. Computed net abstractions indicate, for the first time at the global scale, where and when human water withdrawals decrease or increase groundwater or surface water storage. In regions with extensive surface water irrigation, such as Southern China, net abstractions from groundwater are negative, i.e. groundwater is recharged by irrigation. The opposite is true for areas dominated by groundwater irrigation, such as in the High Plains aquifer of the central USA, where net abstraction of surface water is negative because return flow of withdrawn groundwater recharges the surface water compartments. In intensively irrigated areas, the amplitude of seasonal total water storage variations is generally increased due to human water use; however, in some areas, it is decreased. For the High Plains aquifer and the whole Mississippi basin, modeled groundwater and total water storage variations were compared with estimates of groundwater storage variations based on

  12. 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.

  13. Ethical Analysis of Withdrawing Total Artificial Heart Support.

    Science.gov (United States)

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

    2017-05-01

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

  14. 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.

  15. Seventy years of pallidotomy for movement disorders.

    Science.gov (United States)

    Cif, Laura; Hariz, Marwan

    2017-07-01

    The year 2017 marks the 70th anniversary of the birth of human stereotactic neurosurgery. The first procedure was a pallidotomy for Huntington's disease. However, it was for Parkinson's disease that pallidotomy was soon adopted worldwide. Pallidotomy was abandoned in the late 1950s in favor of thalamotomy because of the latter's more striking effect on tremor. The advent of levodopa put a halt to all surgery for PD. In the mid-1980s, Laitinen reintroduced the posteroventral pallidotomy of Leksell, and this procedure spread worldwide thanks to its efficacy on most parkinsonian symptoms including levodopa-induced dyskinesias and thanks to basic scientific work confirming the role of the globus pallidus internus in the pathophysiology of PD. With the advent of deep brain stimulation of the subthalamic nucleus, pallidotomy was again abandoned, and even DBS of the GPi has been overshadowed by STN DBS. The GPi reemerged in the late 1990s as a major stereotactic target for DBS in dystonia and, recently, in Tourette syndrome. Lately, lesioning of the GPI is being proposed to treat refractory status dystonicus or to treat DBS withdrawal syndrome in PD patients. Hence, the pallidum as a stereotactic target for either lesioning or DBS has been the phoenix of functional stereotactic neurosurgery, constantly abandoned and then rising again from its ashes. This review is a tribute to the pallidum on its 70th anniversary as a surgical target for movement disorders, analyzing its ebbs and flows and highlighting its merits, its versatility, and its resilience. © 2017 International Parkinson and Movement Disorder Society. © 2017 International Parkinson and Movement Disorder Society.

  16. [Scenes in movement. Movement disorders on film].

    Science.gov (United States)

    Olivares Romero, J

    2010-03-01

    There are publications in which various neurological diseases are analysed on film. However, no references have been found on movement disorders in this medium. A total of 104 documents were collected and reviewed using the internet movie data base (IMDb). The majority were associated with dystonia, Parkinson's and tics, were American commercial productions, and the most common genre was drama. The cinema usually depicts old men with developed Parkinson's disease. However, motor complications only appear in 19% and non-motor symptoms in 14%. The image of dystonia is generally that of a young man, with disabling dystonia secondary to childhood cerebral palsy. Tics appear associated with Tourette's syndrome, with the excessive use of obscene expressions and with very few references to other important aspects of this syndrome, such as mood and behavioural changes. The majority of tremors portrayed on film are associated with Parkinsonism and are not pathological. Myoclonus appears anecdotically and is normally symptomatic. Parkinson's disease is the type of movement disorder that the cinema portrays with greater neurological honesty and in a more dignified manner.

  17. Eye movements and poor reading: does the Developmental Eye Movement test measure cause or effect?

    Science.gov (United States)

    Medland, Coraley; Walter, Helen; Woodhouse, J Margaret

    2010-11-01

    The literature concerning subjects who have reading difficulties has repeatedly noted their abnormal eye movements. The Developmental Eye Movement (DEM) test was developed on the assumption that poor eye movement control is a major cause of reading difficulties. The hypothesis tested by this study was that practice in fluent reading trains the eye movements that result in a good DEM score, whilst poor readers will exhibit low DEM scores due to insufficient training. English readers (43 children, 20 adults), and Arabic readers (six children, five adults) were recruited. The DEM test was administered twice, performed once reading the horizontal section in the habitual reading direction and secondly in the opposite direction, thus enabling the subjects' eye movements to be compared when reading in their habitual direction and when reading in a direction which is relatively unpracticed. Paired t-tests showed that the difference in eye movements (quantified via the DEM test ratio) between the two opposing reading directions was significant in English reading adults, English reading children and Arabic reading children, but not significant in the Arabic adults, who were equally practised in reading in the two directions. The results support the hypothesis that abnormal eye movements are more likely to be an effect and not the cause of reading difficulties. The DEM test should not be used to diagnose eye movement difficulties in a patient with poor reading ability. © 2010 The Authors. Ophthalmic and Physiological Optics © 2010 The College of Optometrists.

  18. 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.

  19. 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

  20. Pursuit Eye Movements

    Science.gov (United States)

    Krauzlis, Rich; Stone, Leland; Null, Cynthia H. (Technical Monitor)

    1998-01-01

    When viewing objects, primates use a combination of saccadic and pursuit eye movements to stabilize the retinal image of the object of regard within the high-acuity region near the fovea. Although these movements involve widespread regions of the nervous system, they mix seamlessly in normal behavior. Saccades are discrete movements that quickly direct the eyes toward a visual target, thereby translating the image of the target from an eccentric retinal location to the fovea. In contrast, pursuit is a continuous movement that slowly rotates the eyes to compensate for the motion of the visual target, minimizing the blur that can compromise visual acuity. While other mammalian species can generate smooth optokinetic eye movements - which track the motion of the entire visual surround - only primates can smoothly pursue a single small element within a complex visual scene, regardless of the motion elsewhere on the retina. This ability likely reflects the greater ability of primates to segment the visual scene, to identify individual visual objects, and to select a target of interest.

  1. 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.

  2. 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.

  3. 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.

  4. 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.

  5. 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.

  6. 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

  7. 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.

  8. Behavioral Objectives and Standards Movement Revisited

    Science.gov (United States)

    Shakouri, Nima; Mirzaee, Sepideh

    2014-01-01

    The present paper sparks a complementary argument that the development of standards movement must not be at the expense of sacrificing the achievement of behavioral objectives. Furthermore, due to the systemic and dynamic nature of standards, standards need to be revised off and on. Besides, the present writers taking a more or less relativist…

  9. Arabic Determinative Phrase: DP Movement or Scrambling?

    Science.gov (United States)

    AlBzour, Baseel Ali

    2015-01-01

    Arabic varieties show explicit linguistic behavior, especially at the syntactic level. This apparent diversity is mainly due to how syntactic rules confine the scope and the flexibility of movement of certain constituents inside and outside their syntactic domains. This paper examines solely how the mother tongue from which all these varieties…

  10. Unifying the Algebra for All Movement

    Science.gov (United States)

    Eddy, Colleen M.; Quebec Fuentes, Sarah; Ward, Elizabeth K.; Parker, Yolanda A.; Cooper, Sandi; Jasper, William A.; Mallam, Winifred A.; Sorto, M. Alejandra; Wilkerson, Trena L.

    2015-01-01

    There exists an increased focus on school mathematics, especially first-year algebra, due to recent efforts for all students to be college and career ready. In addition, there are calls, policies, and legislation advocating for all students to study algebra epitomized by four rationales of the "Algebra for All" movement. In light of this…

  11. Movement as utopia.

    Science.gov (United States)

    Couton, Philippe; López, José Julián

    2009-10-01

    Opposition to utopianism on ontological and political grounds has seemingly relegated it to a potentially dangerous form of antiquated idealism. This conclusion is based on a restrictive view of utopia as excessively ordered panoptic discursive constructions. This overlooks the fact that, from its inception, movement has been central to the utopian tradition. The power of utopianism indeed resides in its ability to instantiate the tension between movement and place that has marked social transformations in the modern era. This tension continues in contemporary discussions of movement-based social processes, particularly international migration and related identity formations, such as open borders transnationalism and cosmopolitanism. Understood as such, utopia remains an ongoing and powerful, albeit problematic instrument of social and political imagination.

  12. 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.

  13. 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.

  14. 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.

  15. 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.

  16. Temporal alignment of electrocorticographic recordings for upper limb movement

    Directory of Open Access Journals (Sweden)

    Omid eTalakoub

    2015-01-01

    Full Text Available The detection of movement-related components of the brain activity is useful in the design of brain machine interfaces. A common approach is to classify the brain activity into a number of templates or states. To find these templates, the neural responses are averaged over each movement task. For averaging to be effective, one must assume that the neural components occur at identical times over repeated trials. However, complex arm movements such as reaching and grasping are prone to cross-trial variability due to the way movements are performed. Typically initiation time, duration of movement and movement speed are variable even as a subject tries to reproduce the same task identically across trials. Therefore, movement-related neural activity will tend to occur at different times across each trial. Due to this mismatch, the averaging of neural activity will not bring into salience movement-related components. To address this problem, we present a method of alignment that accounts for the variabilities in the way the movements are conducted. In this study, arm speed was used to align neural activity. Four subjects had electrocorticographic (ECoG electrodes implanted over their primary motor cortex and were asked to perform reaching and retrieving tasks using the upper limb contralateral to the site of electrode implantation. The arm speeds were aligned using a nonlinear transformation of the temporal axes resulting in averaged spectrograms with superior visualization of movement-related neural activity when compared to averaging without alignment.

  17. Movement Without Boundaries

    Directory of Open Access Journals (Sweden)

    Jennifer Fortuna

    2017-10-01

    Full Text Available Johnson Simon, an artist based in West Palm Beach, FL, provided the cover art for the Fall 2017 edition of The Open Journal of Occupational Therapy (OJOT. “Dancing in Motion” is a 36” x 60” painting made from acrylic on canvas. Johnson always wanted to become a dancer. He was born with cerebral palsy, and therefore physical limitations make it difficult for Johnson to coordinate his body movements. Through use of vibrant colors and bold strokes, Johnson’s expressionist paintings evoke movement and motion. Occupational therapy helped Johnson discover his artistic abilities. Painting empowered him to move without limitations

  18. 21 CFR 314.530 - Withdrawal procedures.

    Science.gov (United States)

    2010-04-01

    ... chapter, as modified by this section, if: (1) A postmarketing clinical study fails to verify clinical benefit; (2) The applicant fails to perform the required postmarketing study with due diligence; (3) Use... applicant must first submit a petition for a stay of action under § 10.35 of this chapter. [57 FR 58958, Dec...

  19. 21 CFR 601.43 - Withdrawal procedures.

    Science.gov (United States)

    2010-04-01

    ...) A postmarketing clinical study fails to verify clinical benefit; (2) The applicant fails to perform the required postmarketing study with due diligence; (3) Use after marketing demonstrates that... pending review, an applicant must first submit a petition for a stay of action under § 10.35 of this...

  20. Effects of flapless bur decortications on movement velocity of dogs′ teeth

    Directory of Open Access Journals (Sweden)

    Seyed Mohammadreza Safavi

    2012-01-01

    Conclusion: (1 Corticotomy facilitated orthodontic tooth movement is achievable with flapless bur decortication technique. (2 Velocity of tooth movement decreases in later stages of treatment due to maturation of newly formed bone at decortication sites.

  1. The Relationship Between Arm Movement and Walking Stability in Bipedal Walking

    National Research Council Canada - National Science Library

    Shibukawa, Miki

    2001-01-01

    ... analysis of walking for use in rehabilitation programs. The analysis of walking movement has generally focused on the legs rather than the arms, probably due to a perception that the arms do not play an essential role in this movement...

  2. Neurosteroid coadministration prevents development of tolerance and augments recovery from benzodiazepine withdrawal anxiety and hyperactivity in mice.

    Science.gov (United States)

    Reddy, D S; Kulkarni, S K

    1997-01-01

    Neurosteroids are potent and specific modulators of the GABAA receptors which regulate the neuronal activity through diverse neurotransmitter mechanisms. In the present study we investigated the effects of concomitant treatment with various neurosteroids on the development of tolerance and recovery from withdrawal anxiety and hyperactivity to chronic benzodiazepines. Long-term treatment of mice with full allosteric modulator (triazolam 0.25 mg/kg/day for 8 days) or selective allosteric modulator (diazepam 20 mg/kg/day for 21 days) of GABAA receptor induced tolerance to behavioral sedation on actimeter and anxiolytic effects on plus-maze, and produced a marked withdrawal anxiety and hyperactivity syndrome upon abrupt cessation of treatment, respectively. Concomitant progesterone (10 mg/kg, s.c.), a neurosteroid precursor, of 4'-chlordiazepam (0.25 mg/kg, i.p.), a mitochondrial diazepam binding inhibitor (DBI) receptor (MDR) ligand, prevented the development of tolerance and significantly augmented the recovery from withdrawal-induced anxiety and hyperlocomotion to diazepam. When administered alone for 21 days, neither progesterone nor 4'-chlordiazepam produced any per se effects on actimeter or plus-maze when tested on post-withdrawal days. Coadministration of neurosteroid allopregnanolone (AP) (0.25 and 0.5 mg/kg), or pregnenolone sulfate (PS) (2 mg/kg), but not dehydroepiandrosterone sulfate (2 mg/kg), abolished the development of tolerance and attenuated withdrawal-induced anxiety and hyperlocomotion due to triazolam, without producing any per se behavioral effects when tested at 1 and 2 days after the last injection. Coadministration of flumazenil (5 mg/kg), progesterone (10 mg/kg), 4'-chlordiazepam (0.25 mg/kg), hydrocortisone (100 mg/kg) or nifedipine (2 mg/kg) also prevented the development of tolerance and suppressed the triazolam withdrawal syndrome. However, pretreatment with PK11195 (2 mg/kg), a MDR partial antagonist, reversed the effects of 4

  3. A movement ecology paradigm for unifying organismal movement research

    Science.gov (United States)

    Nathan, Ran; Getz, Wayne M.; Revilla, Eloy; Holyoak, Marcel; Kadmon, Ronen; Saltz, David; Smouse, Peter E.

    2008-01-01

    Movement of individual organisms is fundamental to life, quilting our planet in a rich tapestry of phenomena with diverse implications for ecosystems and humans. Movement research is both plentiful and insightful, and recent methodological advances facilitate obtaining a detailed view of individual movement. Yet, we lack a general unifying paradigm, derived from first principles, which can place movement studies within a common context and advance the development of a mature scientific discipline. This introductory article to the Movement Ecology Special Feature proposes a paradigm that integrates conceptual, theoretical, methodological, and empirical frameworks for studying movement of all organisms, from microbes to trees to elephants. We introduce a conceptual framework depicting the interplay among four basic mechanistic components of organismal movement: the internal state (why move?), motion (how to move?), and navigation (when and where to move?) capacities of the individual and the external factors affecting movement. We demonstrate how the proposed framework aids the study of various taxa and movement types; promotes the formulation of hypotheses about movement; and complements existing biomechanical, cognitive, random, and optimality paradigms of movement. The proposed framework integrates eclectic research on movement into a structured paradigm and aims at providing a basis for hypothesis generation and a vehicle facilitating the understanding of the causes, mechanisms, and spatiotemporal patterns of movement and their role in various ecological and evolutionary processes. ”Now we must consider in general the common reason for moving with any movement whatever.“ (Aristotle, De Motu Animalium, 4th century B.C.) PMID:19060196

  4. Managing Movement as Partnership

    Science.gov (United States)

    Kimbrell, Sinead

    2011-01-01

    The associate director of education at Hubbard Street Dance Chicago recounts her learning and teaching through managing the Movement as Partnership program. Included are detailed descriptions of encounters with teachers and students as they create choreography reflective of their inquiry into integrating dance and literacy arts curriculum in the…

  5. Psychogenic Movement Disorders

    Directory of Open Access Journals (Sweden)

    Chakravarty Ambar

    2004-01-01

    Full Text Available Psychogenic movement Disorders (PMD may result from somatoform disorders, factitious disorders, malingering, depression anxiety disorders and less frequently, histrionic personality disorders. First recognized by Henry Head in early twentieth century, PMD s commonly encountered and clues to their differentiation from organic disease. A generally accepted management protocol has been outlined.

  6. Rhythm Training through Movement.

    Science.gov (United States)

    Riveire, Janine H.

    1995-01-01

    Maintains that string playing, rhythm, pitch, and tone quality are all dependent on the movement and coordination of the player. Presents a rhythmic focus lesson plan for students who need improvement in rhythm skills. Includes a lesson plan diagram and suggested teacher resources. (CFR)

  7. Material and Affective Movements

    DEFF Research Database (Denmark)

    Rasmussen, Lisa Rosén

    2014-01-01

    . The chapter traces the former pupil’s memories of physical and affective movements within the larger context of school and discovers surprisingly diverse modes of knowing, relating, and attending to things, teachers and classmates among and between the three generations. It thus taps into the rich realms...

  8. The Mastery of Movement.

    Science.gov (United States)

    Laban, Rudolf; Ullmann, Lisa

    In this third edition, some amendments and additions have been made to the original text, first published in 1950. As in past editions, the relationship between the inner motivation of movement and the outer functioning of the body is explored. Acting and dancing are shown as activities deeply concerned with man's urge to establish values and…

  9. [Architecture and movement].

    Science.gov (United States)

    Rivallan, Armel

    2012-01-01

    Leading an architectural project means accompanying the movement which it induces within the teams. Between questioning, uncertainty and fear, the organisational changes inherent to the new facility must be subject to constructive and ongoing exchanges. Ethics, safety and training are revised and the unit projects are sometimes modified.

  10. Music, Movement, and Poetry.

    Science.gov (United States)

    Carmichael, Karla D.

    This paper's premise is that music, movement, and poetry are unique and creative methods to be used by the counselor in working with both children and adults. Through these media, the counselor generates material for the counseling session that may not be available through more traditional "talk therapies." The choice of music as a counseling…

  11. Editorial: Body Movements

    Directory of Open Access Journals (Sweden)

    Carina Assuncao

    2018-01-01

    Full Text Available Today, the juxtaposition between physical bodies and the gameworld is ever more fluid. Virtual Reality headsets are available at game stores with more AAA games being created for the format. The release of the Nintendo Switch and its dynamic JoyCon controllers reintroduce haptic movement based controls.  Pokémon GO’s augmented reality took gamers outdoors and has encouraged the Harry Potter franchise to follow in its mobile footsteps. Each development encourages a step further into the digital world. At the same time, the movement of bodies always has political dimensions. We live in a world where walls seem like solutions to the movement of bodies, while the mere meeting of bodies elsewhere – for sex, marriage and other reasons – is still forbidden by many states’ rules. Games and game-like interfaces have shown the ability to bend those rules, and to sometimes project other worlds and rule systems over our world in order to make bodies move and meet. For this special issue on ‘Body Movements’, Press Start invited authors to focus on embodiment, body movements, political bodies, community bodies, virtual bodies, physical bodies, feminine, masculine, trans- bodies, agency or its lack, and anything else in between. The response to this invitation was variegated, and provocative, as outlined here.

  12. Studying Social Movements

    DEFF Research Database (Denmark)

    Uldam, Julie; McCurdy, Patrick

    2013-01-01

    and then draws specific links to how the method has been used in the study of activism and social movements. In doing so, this article brings together key academic debates on participant observation, which have been considered separately, such as insider/outsider and overt/covert, but not previously been brought...

  13. Measuring Facial Movement

    Science.gov (United States)

    Ekman, Paul; Friesen, Wallace V.

    1976-01-01

    The Facial Action Code (FAC) was derived from an analysis of the anatomical basis of facial movement. The development of the method is explained, contrasting it to other methods of measuring facial behavior. An example of how facial behavior is measured is provided, and ideas about research applications are discussed. (Author)

  14. Cutaneous reactions due to antihypertensive drugs

    Directory of Open Access Journals (Sweden)

    Upadhayai J

    2006-01-01

    Full Text Available Out of a total of 1147 patients on antihypertensive drugs, 23 (2.04% developed adverse cutaneous drug reactions (ACDR. The commonest antihypertensive drug group causing ACDR was beta-blockers of which atenolol was the commonest culprit. The second most common group was calcium channel blockers with amlodipine as the commonest offender. The most common patterns of ACDR observed included urticaria followed by lichenoid drug eruption (LDE. We noted 2 new patterns of reactions; (i one patient developed brownish blue pigmentation of nails while on atenolol for 3 years, which resolved in 4 months after withdrawal and (ii another patient on amlodipine for 8 years developed Schamberg′s like purpuric pigmentation, which resolved on withdrawal of drug within 3 months. These findings have not been reported in the literature earlier. This study is presented for paucity of Indian data on ACDR due to antihypertensive drugs, and remarkable advancement in area of cardiovascular and antihypertensive pharmacology and a large number of population taking antihypertensive drugs.

  15. Fatal poisonings involving propoxyphene before and after voluntary withdrawal from the United States' market: An analysis from the state of Florida.

    Science.gov (United States)

    Delcher, Chris; Chen, Guanming; Wang, Yanning; Slavova, Svetla; Goldberger, Bruce A

    2017-11-01

    The synthetic opioid propoxyphene was a schedule IV controlled substance with multiple reported health risks before the US Food and Drug Administration issued a request for voluntary market withdrawal in November 2010. The purpose of this study is to investigate the characteristics and occurrences of propoxyphene-related deaths in Florida before and after voluntary market removal. Decedent-level toxicology data from Florida's Medical Examiners Commission was used to compare the temporal, polysubstance use, sociodemographic, and geographic profiles associated with propoxyphene-involved deaths for a pre-withdrawal (November 2008-November 2010) and post-withdrawal (December 2010-December 2012) period. Sensitivity analyses using multiple data sources, including Florida's Prescription Drug Monitoring Program and other states' data, were conducted to examine potential reporting bias. Results showed that the number of propoxyphene-involved deaths declined by 84% from 580 deaths to 92 deaths after market withdrawal. The co-occurrence of other prevalent drugs, such as oxycodone (17.2% to 26.1%, p=0.0422) increased significantly in the post-withdrawal study period. A larger proportion of the propoxyphene-related deaths were reported from South Florida after the withdrawal (28.4% to 56.5%, pmarket withdrawal, as recently as 2016. Our findings are consistent with previous studies that propoxyphene was still available after removal from the US market. Continued surveillance is recommended after highly abused opioids are withdrawn from the market due to on-going safety risks. Copyright © 2017 Elsevier B.V. All rights reserved.

  16. 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.

  17. 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:…

  18. 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.

  19. 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.

  20. 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 ...

  1. 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.

  2. 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 ...

  3. 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...

  4. 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...

  5. 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 ...

  6. 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)

  7. 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...

  8. 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.

  9. 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...

  10. 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.

  11. 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...

  12. 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.

  13. 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.

  14. 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: ...

  15. 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 ...

  16. 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...

  17. 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...

  18. 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…

  19. 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 ...

  20. 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...

  1. 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...

  2. 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…

  3. 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…

  4. 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...

  5. 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.

  6. 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.

  7. 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...

  8. 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...

  9. 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...

  10. 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...

  11. [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.

  12. 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.

  13. 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

  14. 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

  15. 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...

  16. 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...

  17. 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...

  18. 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...

  19. 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.

  20. 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...

  1. 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...

  2. 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...

  3. 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

  4. Overlap of movement planning and movement execution reduces reaction time.

    Science.gov (United States)

    Orban de Xivry, Jean-Jacques; Legrain, Valéry; Lefèvre, Philippe

    2017-01-01

    Motor planning is the process of preparing the appropriate motor commands in order to achieve a goal. This process has largely been thought to occur before movement onset and traditionally has been associated with reaction time. However, in a virtual line bisection task we observed an overlap between movement planning and execution. In this task performed with a robotic manipulandum, we observed that participants (n = 30) made straight movements when the line was in front of them (near target) but often made curved movements when the same target was moved sideways (far target, which had the same orientation) in such a way that they crossed the line perpendicular to its orientation. Unexpectedly, movements to the far targets had shorter reaction times than movements to the near targets (mean difference: 32 ms, SE: 5 ms, max: 104 ms). In addition, the curvature of the movement modulated reaction time. A larger increase in movement curvature from the near to the far target was associated with a larger reduction in reaction time. These highly curved movements started with a transport phase during which accuracy demands were not taken into account. We conclude that an accuracy demand imposes a reaction time penalty if processed before movement onset. This penalty is reduced if the start of the movement consists of a transport phase and if the movement plan can be refined with respect to accuracy demands later in the movement, hence demonstrating an overlap between movement planning and execution. In the planning of a movement, the brain has the opportunity to delay the incorporation of accuracy requirements of the motor plan in order to reduce the reaction time by up to 100 ms (average: 32 ms). Such shortening of reaction time is observed here when the first phase of the movement consists of a transport phase. This forces us to reconsider the hypothesis that motor plans are fully defined before movement onset. Copyright © 2017 the American Physiological Society.

  5. Coordination of head movements and speech in first encounter dialogues

    DEFF Research Database (Denmark)

    Paggio, Patrizia

    2015-01-01

    slightly after, but also that there are delays in both directions in the range of -/+ 1s. Various factors that may influence delay duration are investigated. Correlations are found between delay length and the duration of the speech sequences associated with the head movements. Effects due to the different......This paper presents an analysis of the temporal alignment be- tween head movements and associated speech segments in the NOMCO corpus of first encounter dialogues [1]. Our results show that head movements tend to start slightly before the onset of the corresponding speech sequence and to end...... head movement types are also discussed....

  6. Dexmedetomidine infusion as adjunctive therapy to benzodiazepines for acute alcohol withdrawal.

    Science.gov (United States)

    Darrouj, Jamil; Puri, Nitin; Prince, Erin; Lomonaco, Anthony; Spevetz, Antoinette; Gerber, David R

    2008-11-01

    To report a case of alcohol withdrawal and delirium tremens successfully treated with adjunctive dexmedetomidine. A 30-year-old man with a history of alcohol abuse was admitted to the general medical unit because of altered mental status and agitation. He was initially treated for alcohol withdrawal with benzodiazepines; his condition then deteriorated and he was transferred to the intensive care unit. Because of the patient's poor response to benzodiazepines (oxazepam and lorazepam, with midazolam the last one used), intravenous dexmedetomidine was started at an initial dose of 0.2 microg/kg/h and titrated to 0.7 microg/kg/h to the patient's comfort. Midazolam was subsequently tapered to discontinuation due to excessive sedation. In the intensive care unit, the patient's symptoms remained controlled with use of dexmedetomidine alone. He remained in the intensive care unit for 40 hours; dexmedetomidine was then tapered to discontinuation and the patient was transferred back to the general medical unit on oral oxazepam and thiamine, which had been started in the emergency department. He was discharged after 5 days. A review of the PubMed database (1989-2007) failed to identify any other instances of dexmedetomidine having been used as the principal agent to treat alcohol withdrawal. The use of sedative to treat delirium tremens is well documented, with benzodiazepines being the agents of choice. The clinical utility of benzodiazepines is limited by their stimulation of the gamma-aminobutyric acid receptors, an effect not shared by dexmedetomidine, a central alpha(2)-receptor agonist that induces a state of cooperative sedation and does not suppress respiratory drive. In patients with delirium tremens, dexmedetomidine should be considered as an option for primary treatment. This case illustrates the need for further studies to investigate other potential uses for dexmedetomidine.

  7. Withdrawal of inhaled corticosteroids in individuals with COPD - a systematic review and comment on trial methodology

    Directory of Open Access Journals (Sweden)

    Eldridge Sandra M

    2011-08-01

    Full Text Available Abstract Inhaled corticosteroids (ICS reduce COPD exacerbation frequency and slow decline in health related quality of life but have little effect on lung function, do not reduce mortality, and increase the risk of pneumonia. We systematically reviewed trials in which ICS have been withdrawn from patients with COPD, with the aim of determining the effect of withdrawal, understanding the differing results between trials, and making recommendations for improving methodology in future trials where medication is withdrawn. Trials were identified by two independent reviewers using MEDLINE, EMBASE and CINAHL, citations of identified studies were checked, and experts contacted to identify further studies. Data extraction was completed independently by two reviewers. The methodological quality of each trial was determined by assessing possible sources of systematic bias as recommended by the Cochrane collaboration. We included four trials; the quality of three was adequate. In all trials, outcomes were generally worse for patients who had had ICS withdrawn, but differences between outcomes for these patients and patients who continued with medication were mostly small and not statistically significant. Due to data paucity we performed only one meta-analysis; this indicated that patients who had had medication withdrawn were 1.11 (95% CI 0.84 to 1.46 times more likely to have an exacerbation in the following year, but the definition of exacerbations was not consistent between the three trials, and the impact of withdrawal was smaller in recent trials which were also trials conducted under conditions that reflected routine practice. There is no evidence from this review that withdrawing ICS in routine practice results in important deterioration in patient outcomes. Furthermore, the extent of increase in exacerbations depends on the way exacerbations are defined and managed and may depend on the use of other medication. In trials where medication is

  8. [Clonidine as adjuvant therapy for alcohol withdrawal syndrome in intensive care unit: case report.].

    Science.gov (United States)

    Braz, Leandro Gobbo; Camacho Navarro, Lais Helena; Braz, José Reinaldo Cerqueira; Silva, Ubirajara Teixeira da; Yamaguti, Fábio Akio; Cristovan, José Carlos

    2003-12-01

    Sedation of patients with past history of alcohol and drug abuse in Intensive Care Units (ICU) is a challenge due to the high incidence of sedative drugs tolerance and withdrawal syndromes. This report aimed at describing a case of a young patient admitted to the ICU who developed alcohol withdrawal syndrome and tolerance to sedatives, resolved only after clonidine administration. Male patient, 18 years old, alcohol, tobacco, cocaine and marijuana abuser, victim of firearm accident, who was admitted to the ICU in the first post-enterectomy day, after gastric content aspiration during tracheal re-intubation. Clinical evolution was: vasoactive drugs up to the 4th day; bilateral bronchopneumonia with pleural effusion and need for artificial ventilation up to the 15th day. Initial sedation scheme was the association of midazolam and fentanyl. As from the 4th day, patient presented with several psychomotor agitation episodes, even after the association of lorazepam in the 6th day. In the 9th day, patient received the largest doses but remained agitated. Dexmedetomidine was associated, which has decreased other drug doses in 35% and has improved agitation. In the 12th day, midazolam and dexmedetomidine were replaced by propofol infusion with worsening of agitation. In the 13th day, clonidine was associated to the sedation scheme with total resolution of agitation. Propofol was withdrawn in the 14th day, fentanyl was maintained and midazolam infusion was restarted, with doses 75% and 65% lower as compared to peak doses of such drugs. Patient was extubated in the 15th day and was discharged from ICU. Benzodiazepines should remain the drugs of choice for the treatment of acute alcohol withdrawal syndrome. However in this report, only adjuvant clonidine was able to adequately treat the patient.

  9. 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

  10. Stereotypic movement disorder: easily missed.

    Science.gov (United States)

    Freeman, Roger D; Soltanifar, Atefeh; Baer, Susan

    2010-08-01

    grimacing in 15 children and vocalization in 22 contributed to diagnostic confusion. SMD occurs in children without ASD or intellectual disability. The generally favorable clinical course is largely due to a gradual increase in private expression of the movements. Severity of the stereotypy is associated with sensory differences and psychopathology. Differentiation of SMD from tics and ASD is important to avoid misdiagnosis and unnecessary treatment.

  11. Simulation of groundwater withdrawal scenarios for the Redwall-Muav and Coconino Aquifer Systems of northern and central Arizona

    Science.gov (United States)

    Pool, D.R.

    2016-09-23

    stresses that occurred since the beginning of the initial stresses in the early 1900s through 2005. Withdrawal scenario 1 produced a broad region on the Coconino Plateau where water-levels declined 3–5 feet by 2105, and local areas with water-level declines of 100 feet or more where groundwater withdrawals are concentrated, near the City of Flagstaff Woody Mountain and Lake Mary well fields, and the towns of Tusayan, Williams, and Moenkopi. Water-level rises of 100 feet or more were simulated at areas of incidental recharge near wastewater treatment facilities near Flagstaff, Tusayan, Grand Canyon South Rim, Williams, and Munds Park.Simulated water-level change from 2006 through 2105 for scenarios 2 and 3 is mostly different from water-level change simulated for scenario 1 at the local level. For scenarios 2 and 3, water levels near Cameron in 2105 where 1–3 feet higher than simulated for scenario 1. Water levels at Moenkopi are more than 100 feet higher due to the elimination of a proposed withdrawal well that was simulated in scenario 1. Scenario 3 eliminates more groundwater withdrawals in the Flagstaff and Williams areas, simulates 1–3 feet less water-level decline than scenario 1 across much of the Coconino Plateau, and water levels that are as much as 50 feet higher than simulated by scenario 1 near withdrawal wells in the Williams and Flagstaff areas.Scenario 1 simulated the most change in groundwater discharge for the Little Colorado River below Cameron and for Oak Creek above Page Springs where declines in discharge of about 1.3 and 0.9 cubic feet per second (ft3/s), respectively, were simulated. Other simulated changes in discharge through 2105 in scenario 1 are losses of less than 0.4 ft3/s at the Upper Verde River, losses of less than 0.3 ft3/s at Havasu Creek and at Colorado River below Havasu Creek, losses of less than 0.1 ft3/s at Clear Creek, and increases in flow at the south rim springs and Chevelon Creek of less than 0.1 and 0.3 ft3/s, respectively

  12. Demographics of cattle movements in the United Kingdom

    Directory of Open Access Journals (Sweden)

    Vernon Matthew C

    2011-06-01

    Full Text Available Abstract Background The United Kingdom (UK government has been recording the births, deaths, and movements of cattle for the last decade. Despite reservations about the accuracy of these data, they represent a large and valuable body of information about the demographics of the UK cattle herd and its contact structure. In this article, a range of demographic data about UK cattle, and particularly their movements, are presented, as well as yearly trends in the patterns of movements. Results A clear seasonal pattern is evident in the number of movements of cattle, as are the reductions in movement volume due to foot and mouth disease outbreaks in 2001 and 2007. The distribution of ages of cattle at their time of death is multimodal, and the impact of the over thirty months rule is marked. Most movements occur between agricultural holdings, markets, and slaughterhouses, and there is a non-random pattern to the types of holdings movements occur between. Most animals move only a short distance and a few times in their life. Most movements between any given pair of holdings only occurred once in the last 10 years, but about a third occurred between 2 and 10 times in that period. There is no clear trend to movement patterns in the UK since 2002. Conclusions Despite a substantial number of regulatory interventions during the last decade, movement patterns show no clear trend since 2002. The observed patterns in the repeatability of movements, the types of holdings involved in movements, the distances and frequencies of cattle movements, and the batch sizes involved give an insight into the structure of the UK cattle industry, and could act as the basis for a predictive model of livestock movements in the UK.

  13. 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

  14. The improvement of movement and speech during rapid eye movement sleep behaviour disorder in multiple system atrophy.

    Science.gov (United States)

    De Cock, Valérie Cochen; Debs, Rachel; Oudiette, Delphine; Leu, Smaranda; Radji, Fatai; Tiberge, Michel; Yu, Huan; Bayard, Sophie; Roze, Emmanuel; Vidailhet, Marie; Dauvilliers, Yves; Rascol, Olivier; Arnulf, Isabelle

    2011-03-01

    atrophy revealed more expressive faces, and movements that were faster and more ample in comparison with facial expression and movements during wakefulness. These movements were still somewhat jerky but lacked any visible parkinsonism. Cerebellar signs were not assessable. We conclude that parkinsonism also disappears during rapid eye movement sleep behaviour disorder in patients with multiple system atrophy, but this improvement is not due to enhanced dopamine transmission because these patients are not levodopa-sensitive. These data suggest that these movements are not influenced by extrapyramidal regions; however, the influence of abnormal cerebellar control remains unclear. The transient disappearance of parkinsonism here is all the more surprising since no treatment (even dopaminergic) provides a real benefit in this disabling disease.

  15. 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...

  16. 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...

  17. 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.

  18. 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. ...

  19. 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...

  20. 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

  1. 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...

  2. 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...

  3. 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...

  4. 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...

  5. 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.

  6. 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

  7. 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

  8. Mindfulness-Based Movement.

    Science.gov (United States)

    Lucas, Alexander R; Klepin, Heidi D; Porges, Stephen W; Rejeski, W Jack

    2016-12-01

    Compelling evidence suggests that physical activity is an effective intervention for cancer survivors, including for those undergoing active cancer treatments. However, to date most evidence has emerged from interventions that have promoted moderate to vigorous physical activity. In this conceptual review, we argue that attention should be given to the entire continuum of physical activity from reducing sedentary behavior to increasing higher levels of physical activity when possible. In addition, considerable evidence in the cancer literature supports the value of mindfulness-based interventions as a means of helping patients and survivors cope with the variety of threats that accompany this disease. Based on the success of these two areas of research, we argue for conceptualizing and promoting physical activity as Mindfulness-Based Movement, using Polyvagal Theory as a theoretical framework to understand the role and value of Mindfulness-Based Movement as a potential intervention for cancer care and control.

  9. [Neuropsychiatry Of Movement Disorders].

    Science.gov (United States)

    Orjuela-Rojas, Juan Manuel; Barrios Vincos, Gustavo Adolfo; Martínez Gallego, Melisa Alejandra

    2017-10-01

    Movement disorders can be defined as neurological syndromes presenting with excessive or diminished automatic or voluntary movements not related to weakness or spasticity. Both Parkinson's disease (PD) and Huntington's disease (HD) are well-known examples of these syndromes. The high prevalence of comorbid psychiatric symptoms like depression, anxiety, obsessive-compulsive symptoms, hallucinations, delusions, impulsivity, sleep disorders, apathy and cognitive impairment mean that these conditions must be regarded as neuropsychiatric diseases. In this article, we review neuroanatomical (structural and functional), psychopathological and neuropsychological aspects of PD and HD. The role of fronto-subcortical loops in non-motor functions is particularly emphasised in order to understand the clinical spectrum of both diseases, together with the influence of genetic, psychological and psychosocial aspects. A brief description of the main psychopharmacological approaches for both diseases is also included. Copyright © 2017 Asociación Colombiana de Psiquiatría. Publicado por Elsevier España. All rights reserved.

  10. Studying frozen movement

    Directory of Open Access Journals (Sweden)

    Jeremy White

    2015-12-01

    Full Text Available Review of Spyros Papapetros, On the Animation of the Inorganic: Art, Architecture, and the Extension of Life: Spyros Papapetros examines ideas about simulated movement and inorganic life during and after the turn of the twentieth century. Exploring works of a selection of important art historians as well as artists and architects of the period, the author maintains that the ability to identify with material objects was repressed by modernist culture, and yet found expression stylistically through depictions of inorganic forms. That expression is shown to have continuity with older medieval and renaissance depictions. The book is organized by a narrative that evokes the modes of inquiry documented and critiqued by the content of the book, employing movement as a narrative device, a metaphor, while serving as a subject of inquiry.

  11. UAVs and Patient Movement

    Science.gov (United States)

    2016-04-01

    space.”62 UAVs were initially utilized for intelligence, surveillance, reconnaissance , and targeting missions.63 However, UAVs are now being designed...AIR COMMAND AND STAFF COLLEGE AIR UNIVERSITY UAVs and PATIENT MOVEMENT by Brian R Blanchard, Major, USAF Doctor...time to care for wounded Soldiers, Sailors, Airmen and Marines lies in the use of Unmanned Aerial Vehicles ( UAVs ) for patient transport. An

  12. Confronting Islamic Jihadist Movements

    Directory of Open Access Journals (Sweden)

    M. Afzal Upal

    2015-05-01

    Full Text Available This paper argues that in order to win the long-term fight against Islamic Jihadist movements, we must confront their ideological foundations and provide the majority of Muslims with an alternative narrative that satisfies their social identity needs for a positive esteem.  By analysing social identity dynamics of Western-Muslim interactions, this paper presents some novel ideas that can lead to the creation of such a narrative.

  13. Monitoring underground movements

    CERN Multimedia

    Antonella Del Rosso

    2015-01-01

    On 16 September 2015 at 22:54:33 (UTC), an 8.3-magnitude earthquake struck off the coast of Chile. 11,650 km away, at CERN, a new-generation instrument – the Precision Laser Inclinometer (PLI) – recorded the extreme event. The PLI is being tested by a JINR/CERN/ATLAS team to measure the movements of underground structures and detectors.   The Precision Laser Inclinometer during assembly. The instrument has proven very accurate when taking measurements of the movements of underground structures at CERN.    The Precision Laser Inclinometer is an extremely sensitive device capable of monitoring ground angular oscillations in a frequency range of 0.001-1 Hz with a precision of 10-10 rad/Hz1/2. The instrument is currently installed in one of the old ISR transfer tunnels (TT1) built in 1970. However, its final destination could be the ATLAS cavern, where it would measure and monitor the fine movements of the underground structures, which can affect the precise posi...

  14. Movement Disorders and Neuromodulation

    Directory of Open Access Journals (Sweden)

    Edward A. Shipton

    2012-01-01

    Full Text Available Movement disorders are neurological conditions affecting speed, fluency, quality, and ease of movement. Deep brain stimulation (DBS is used to treat advanced Parkinson’s disease, essential tremor, and dystonia. Possible target sites for DBS include the ventral intermediate nucleus of the thalamus, the globus pallidus internus, and the subthalamic nucleus. High-frequency DBS leads to a kind of functional deafferentation of the stimulated structure and to the modulation of cortical activity. This has a profound effect on the efficiency of movement. Indications for the use of DBS include the need to improve function, reduce medication dependency, and avoid ablative neurosurgery. Appropriate patient selection is critical for success. The implantation technique is briefly described. Programming stimulation parameters are performed via telemetry. The adverse effects of DBS are discussed. The future should see the development of “closed-loop” systems. Its use has promoted interdisciplinary team work and provided an improved understanding of the complex neurocircuitry associated with these disorders. DBS is a highly effective, safe, and reversible surgical treatment for advanced Parkinson’s disease, tremor, and dystonia. It is a useful therapeutic option in carefully selected patients that significantly improves motor symptoms, functional status, and quality of life.

  15. Optimization of ground-water withdrawal in the lower Fox River communities, Wisconsin

    Science.gov (United States)

    Walker, J.F.; Saad, D.A.; Krohelski, J.T.

    1998-01-01

    Pumping from closely spaced wells in the Central Brown County area and the Fox Cities area near the north shore of Lake Winnebago has resulted in the formation of deep cones of depression in the vicinity of the two pumping centers. Water-level measurements indicate there has been a steady decline in water levels in the vicinity of these two pumping centers for the past 50 years. This report describes the use of ground-water optimization modeling to efficiently allocate the ground-water resources in the Lower Fox River Valley. A 3-dimensional ground-water flow model was used along with optimization techniques to determine the optimal withdrawal rates for a variety of management alternatives. The simulations were conducted separately for the Central Brown County area and the Fox Cities area. For all simulations, the objective of the optimization was to maximize total ground-water withdrawals. The results indicate that ground water can supply nearly all of the projected 2030 demand for Central Brown County municipalities if all of the wells are managed (including the city of Green Bay), 8 new wells are installed, and the water-levels are allowed to decline to 100 ft below the bottom of the confining unit. Ground water can supply nearly all of the projected 2030 demand for the Fox Cities if the municipalities in Central Brown County convert to surface water; if Central Brown County municipalities follow the optimized strategy described above, there will be a considerable shortfall of available ground water for the Fox Cities communities. Relaxing the water-level constraint in a few wells, however, would likely result in increased availability of water. In all cases examined, optimization alternatives result in a rebound of the steady-state water levels due to projected 2030 withdrawal rates to levels at or near the bottom of the confining unit, resulting in increased well capacity. Because the simulations are steady-state, if all of the conditions of the model remain

  16. Life-cycle and freshwater withdrawal impact assessment of water supply technologies.

    Science.gov (United States)

    Godskesen, B; Hauschild, M; Rygaard, M; Zambrano, K; Albrechtsen, H-J

    2013-05-01

    Four alternative cases for water supply were environmentally evaluated and compared based on the standard environmental impact categories from the life-cycle assessment (LCA) methodology extended with a freshwater withdrawal category (FWI). The cases were designed for Copenhagen, a part of Denmark with high population density and relatively low available water resources. FWI was applied at local groundwater catchments based on data from the national implementation of the EU Water Framework Directive. The base case of the study was the current practice of groundwater abstraction from well fields situated near Copenhagen. The 4 cases studied were: Rain & stormwater harvesting from several blocks in the city; Today's groundwater abstraction with compensating actions applied in the affected freshwater environments to ensure sufficient water flow in water courses; Establishment of well fields further away from the city; And seawater desalination. The standard LCA showed that the Rain & stormwater harvesting case had the lowest overall environmental impact (81.9 μPET/m(3)) followed by the cases relying on groundwater abstraction (123.5-137.8 μPET/m(3)), and that desalination had a relatively small but still important increase in environmental impact (204.8 μPET/m(3)). Rain & stormwater harvesting and desalination had a markedly lower environmental impact compared to the base case, due to the reduced water hardness leading to e.g. a decrease in electricity consumption in households. For a relevant comparison, it is therefore essential to include the effects of water hardness when comparing the environmental impacts of water systems of different hardness. This study also emphasizes the necessity of including freshwater withdrawal respecting the relevant affected geographical scale, i.e. by focusing the assessment on the local groundwater catchments rather than on the regional catchments. Our work shows that freshwater withdrawal methods previously used on a regional

  17. 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.

  18. Paralyzed Patients Regain Voluntary Movement

    Science.gov (United States)

    ... of this page please turn JavaScript on. Feature: Spinal Cord Stimulation Paralyzed Patients Regain Voluntary Movement Past Issues / Summer ... a lifelong sentence of permanent paralysis." Read More "Spinal Cord Stimulation" Articles Paralyzed Patients Regain Voluntary Movement / Progress in ...

  19. Human preference for air movement

    DEFF Research Database (Denmark)

    Toftum, Jørn; Melikov, Arsen Krikor; Tynel, A.

    2002-01-01

    Human preference for air movement was studied at slightly cool, neutral, and slightly warm overall thermal sensations and at temperatures ranging from 18 deg.C to 28 deg.C. Air movement preference depended on both thermal sensation and temperature, but large inter-individual differences existed...... between subjects. Preference for less air movement was linearly correlated with draught discomfort, but the percentage of subjects who felt draught was lower than the percentage who preferred less air movement....

  20. Antiglobalization movements and their critics

    DEFF Research Database (Denmark)

    Corry, Olaf

    2012-01-01

    Antiglobalization movements are transnational social movements that challenge what they perceive as a monolithic global laissez-faire economic regime. From the 1990s, these movements have accused global political and economic networks of delivering too much power to dominant elites at the expense...... of ideological incoherence, self-interested protectionism, and illiberal and undemocratic political methods, and point to Western liberal elite dominance within the movements. The debate has ...

  1. Eye movements when viewing advertisements

    OpenAIRE

    Emily eHiggins; Mallorie eLeinenger; Keith eRayner

    2014-01-01

    In this selective review, we examine key findings on eye movements when viewing advertisements. We begin with a brief, general introduction to the properties and neural underpinnings of saccadic eye movements. Next, we provide an overview of eye movement behavior during reading, scene perception, and visual search, since each of these activities is, at various times, involved in viewing ads. We then review the literature on eye movements when viewing print ads and warning labels (of the kind ...

  2. Social Movements and Institutions

    Directory of Open Access Journals (Sweden)

    Maria Francisca Pinheiro Coelho

    2017-04-01

    Full Text Available Abstract This study approaches the relationship between social movements and institutions in Brazil concerning three different stages of the process of re-democratization: the political transition; the National Constituent Assembly; and the new Constitutional Order. The general question is: what is the interface, reciprocity or conflict, between social movements and institutions in this context of social change? The paper examines the different roles of social movements and institutions in each specific period: in the pre-democratization moment, the movement for direct elections for president, Diretas-Já, is analyzed; in the National Constituent Assembly, the movement in defense for free public education is examined;  in the new constitutional order, the pro-reform political movement is studied.  The work focuses on the scope of the studies on social movements and democracy.  It belongs to the field of the studies about the representativeness and legitimacy of the demands of social movements in the context of democracy and its challenges. Key words: social movement, institution, reciprocity, conflict, democracy.   Social Movements and Institutions                               Resumen El estudio aborda la relación entre los movimientos sociales e instituciones en Brasil en tres etapas diferentes del proceso de redemocratización en las últimas décadas: la transición política; la Asamblea Nacional Constituyente; y el nuevo orden constitucional. La pregunta general es: ¿cuál es la relación, la reciprocidad o el conflito, entre los movimientos sociales y las instituciones en este contexto de cambio social? El artículo examina los diferentes roles de los movimientos sociales e instituciones en cada período específico: en el momento de la transición política analiza el movimiento de las elecciones directas para presidente, las Diretas-Já; en la Asamblea Nacional Constituyente aborda el movimiento en

  3. Preclinical and clinical pharmacology of cyamemazine: anxiolytic effects and prevention of alcohol and benzodiazepine withdrawal syndrome.

    Science.gov (United States)

    Bourin, Michel; Dailly, Eric; Hascöet, Martine

    2004-01-01

    Several studies have suggested that the antipsychotic compound, cyamemazine, possesses anxiolytic properties in humans. The original pharmacological profile of cyamemazine (D(2), 5-HT(2A), 5-HT(2C), and 5-HT(3) receptor antagonist), which was established by binding, microdialysis and behavioral studies, is consistent with these observations. In the light/dark exploration test, cyamemazine demonstrated anxiolytic-like activity by acute, but not chronic administration. By chronic administration, however, cyamemazine increased the time spent in the open arms of the elevated plus maze (EPM) test demonstrating anxiolytic-like activity. The discrepancy between the results obtained in these tests by acute and chronic administration, could be due to a combination of dopamine D(2) receptor antagonism with antagonism of the 5-HT(2C) and 5-HT(3) receptors. The action of cyamemazine on both the dopaminergic system and 5-HT(3) receptors could also explain the activity of cyamemazine in the management of alcohol withdrawal demonstrated in preclinical studies. This potential indication for cyamemazine and its activity in benzodiazepine withdrawal syndrome have recently been investigated in clinical trials and the results of these studies are presented in this review.

  4. 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

    Economic development in Arizona is largely influenced by access to adequate water supplies owing to the State's predominantly semiarid to arid climate. Water demand is met by pumping ground water from aquifers or by con-veying surface water through a system of reservoirs and canals. Water-withdrawal data provide important information on how water demand affects the State's water resources. Information on water withdrawals also can help planners and managers assess the effectiveness of water-management policies, regulations, and conservation activities. This report includes water-withdrawal data for irrigation, municipal, mining, thermoelectric-power, and drainage uses for 1991-2000, and describes the methods used to collect, compile, and estimate the data. Data are reported for the Arizona Department of Water Resources ground-water basins outside of Active Management Areas. Because of the climate, ground water and surface water are used to irrigate nearly all agricultural fields in Arizona. Irrigation accounted for the largest use of water in the study area during 1991-2000. The amount of water withdrawn for irrigation varies greatly from year to year for some of the basins, primarily because of differences in the consumptive water requirement for different crops and because of changes in irrigated acreage. The population of Arizona increased about 35 percent from 1991 to 2000-from about 3.79 million in 1991 to about 5.13 million in 2000. Correspondingly, water withdrawal for municipal use increased steadily in most of the basins during 1991-2000. Ground-water withdrawals for mining did not show any consistent trends during 1991-2000. Increases and decreases in withdrawals for mining were most likely due to variations in mineral production. Mineral prices and competition from mining in other States and foreign countries probably result in annual increases or decreases in mineral production in Arizona. Between 1991 and 2000, ground-water withdrawals for

  5. [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.

  6. 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.

  7. 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...

  8. 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.

  9. 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,...

  10. 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.

  11. 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.

  12. 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.

  13. 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

  14. 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

  15. 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.

  16. 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...

  17. Effects of an alkaloid-rich extract from Mitragyna speciosa leaves and fluoxetine on sleep profiles, EEG spectral frequency and ethanol withdrawal symptoms in rats.

    Science.gov (United States)

    Cheaha, Dania; Keawpradub, Niwat; Sawangjaroen, Kitja; Phukpattaranont, Pimpimol; Kumarnsit, Ekkasit

    2015-10-15

    Many antidepressants are effective in alleviating ethanol withdrawal symptoms. However, most of them suppress rapid eye movement (REM) sleep. Thus, development of antidepressants without undesirable side effects would be preferable. Previously, crude alkaloid extract from Mitragyna speciosa (MS) Korth was found to produce antidepressant activities. It was hypothesized that the alkaloid extract from MS may attenuate ethanol withdrawal without REM sleep disturbance. Adult male Wistar rats implanted with electrodes over the frontal and parietal cortices were used for two separated studies. For an acute study, 10 mg/kg fluoxetine or 60 mg/kg alkaloid extract from MS were administered intragastrically. Electroencephalographic (EEG) signals were recorded for 3 h to examine sleep profiles and EEG fingerprints. Another set of animal was used for an ethanol withdrawal study. They were rendered dependent on ethanol via a modified liquid diet (MLD) containing ethanol ad libitum for 28 days. On day 29, fluoxetine (10 mg/kg) or alkaloid extract from MS (60 mg/kg) were administered 15 min before the ethanol-containing MLD was replaced with an isocaloric ethanol-free MLD to induced ethanol withdrawal symptoms. The sleep analysis revealed that alkaloid extract from MS did not change any REM parameters which included average duration of each REM episode, total REM time, number of REM episode and REM latency whereas fluoxetine significantly suppressed all REM parameters and delayed REM latency. However, power spectral analysis revealed similar fingerprints for fluoxetine and alkaloid extract from MS characterized by decreasing powers in the slow frequency range in frontal and parietal cortical EEG. Neither treatment affected spontaneous motor activity. Finally, both alkaloid extract from MS and fluoxetine were found to significantly attenuate ethanol withdrawal-induced hyperexcitability (increases gamma activity) in both cortices and to reduce locomotor activity. The present study

  18. Diagnosing disconjugate eye movements

    Science.gov (United States)

    Serra, Alessandro; Liao, Ke; Matta, Manuela; Leigh, R John

    2008-01-01

    Background: Saccades are fast eye movements that conjugately shift the point of fixation between distant features of interest in the visual environment. Several disorders, affecting sites from brainstem to extraocular muscle, may cause horizontal saccades to become disconjugate. Prior techniques for detection of saccadic disconjugacy, especially in internuclear ophthalmoparesis (INO), have compared only one point in abducting vs adducting saccades, such as peak velocity. Methods: We applied a phase-plane technique that compared each eye’s velocity as a function of change in position (normalized displacement) in 22 patients with disease variously affecting the brainstem reticular formation, the abducens nucleus, the medial longitudinal fasciculus, the oculomotor nerve, the abducens nerve, the neuromuscular junction, or the extraocular muscles; 10 age-matched subjects served as controls. Results: We found three different patterns of disconjugacy throughout the course of horizontal saccades: early abnormal velocity disconjugacy during the first 10% of the displacement in patients with INO, oculomotor or abducens nerve palsy, and advanced extraocular muscle disease; late disconjugacy in patients with disease affecting the neuromuscular junction; and variable middle-course disconjugacy in patients with pontine lesions. When normal subjects made disconjugate saccades between two targets aligned on one eye, the initial part of the movement remained conjugate. Conclusions: Along with conventional measures of saccades, such as peak velocity, phase planes provide a useful tool to determine the site, extent, and pathogenesis of disconjugacy. We hypothesize that the pale global extraocular muscle fibers, which drive the high-acceleration component of saccades, receive a neural command that ensures initial ocular conjugacy. GLOSSARY Abd. = abducens; CN = cranial nerve; CPEO = chronic progressive external ophthalmoplegia; EM = eye movement; H = horizontal; INO = internuclear

  19. Knowledge through movement

    DEFF Research Database (Denmark)

    Jensen, Søren Kjær; Moser, T.

    2003-01-01

    In: Children and adolescents in movement - perspectives and ideas. The Danish Ministry of Culture, pages 150 - 162. 2003 Short description: the article debunks a lot of the myths surrounding body and learning, and replace them with a vision about another kind of learning. The aim is to reintroduce....... The current focus on the head and lack of attention to the body unifies society to focus on cognitive learning. This has implications for the values created by this system. Learning Lab Denmark aims to examine new ways of reintroducing the body into learning....

  20. Mungiki as Youth Movement

    DEFF Research Database (Denmark)

    Rasmussen, Jacob

    2010-01-01

    Like many other African countries, Kenya has a large and growing youth population. Some of the youths are mobilized into militant and political networks; one of these is the Mungiki movement. The article explores Mungiki’s combination of politics, religion and Kikuyu traditions. Using the examples...... of snuff tobacco, revolutionary talk and generational exclusion, it is argued that one way of understanding the connection between the various elements is to look at specific youth practices that cut across apparently separate activities. This reveals that youth in the Mungiki discourse is a highly...

  1. The Matter of Movement

    DEFF Research Database (Denmark)

    Ayres, Phil

    2015-01-01

    This contribution concerns itself with the design and realisation of architectures that operate with material dynamics. It presents this concern as a counter to the consideration of movement in architecture as something conceptualised from the position of the observer. The contribution draws upon...... research from the Centre for Information Technology and Architecture (CITA) which has recently focused upon the investigation of materially active systems ranging from textile logics at architectural scale to bending active structures in both natural and synthetic fibre-based composites...... at the intersection between architecture (considered as both practice and spatial construct) and digital technologies....

  2. West African Antislavery Movements

    DEFF Research Database (Denmark)

    Hahonou, Eric Komlavi; Pelckmans, Lotte

    2011-01-01

    the penal code of Mali. Anti-slavery activists not only address their claims to their national governments but also intend to initiate change at local level. In that respect the democratic decentralization reforms were significant because they allowed educated anti-slavery activists to appeal their brethren...... to unite, mobilize and struggle. Members of anti-slavery movements with slave origins accessed power positions through peaceful electoral processes in Benin, mali, Niger and Mauritania. People of slave origins gained ground in local politics of a number of municipalities. In localities where anti...

  3. Stereotypic movement disorders.

    Science.gov (United States)

    Singer, Harvey S

    2011-01-01

    Stereotypic movements are repetitive, rhythmic, fixed, patterned in form, amplitude, and localization, but purposeless (e.g., hand shaking, waving, body rocking, head nodding). They are commonly seen in children; both in normal children (primary stereotypy) and in individuals with additional behavioral or neurological signs and symptoms (secondary stereotypy). They should be differentiated from compulsions (OCD), tics (tic disorders), trichotillomania, skin picking disorder, or the direct physiological effect of a substance. There is increasing evidence to support a neurobiological mechanism. Response to behavioral and pharmacological therapies is variable. Copyright © 2011 Elsevier B.V. All rights reserved.

  4. Energy and Movement

    CERN Document Server

    90, Sol

    2011-01-01

    Updated for 2011, Energy and Movement, is one book in the Britannica Illustrated Science Library Series that covers today's most popular science topics, from digital TV to microchips to touchscreens and beyond. Perennial subjects in earth science, life science, and physical science are all explored in detail. Amazing graphics-more than 1,000 per title-combined with concise summaries help students understand complex subjects. Correlated to the science curriculum in grades 5-9, each title also contains a glossary with full definitions for vocabulary.

  5. 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.

  6. 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.

  7. 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.

  8. 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.

  9. 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.

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

    Science.gov (United States)

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

    2013-01-01

    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

  11. 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.

  12. 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.

  13. Locomotor-like leg movements evoked by rhythmic arm movements in humans.

    Directory of Open Access Journals (Sweden)

    Francesca Sylos-Labini

    Full Text Available Motion of the upper limbs is often coupled to that of the lower limbs in human bipedal locomotion. It is unclear, however, whether the functional coupling between upper and lower limbs is bi-directional, i.e. whether arm movements can affect the lumbosacral locomotor circuitry. Here we tested the effects of voluntary rhythmic arm movements on the lower limbs. Participants lay horizontally on their side with each leg suspended in an unloading exoskeleton. They moved their arms on an overhead treadmill as if they walked on their hands. Hand-walking in the antero-posterior direction resulted in significant locomotor-like movements of the legs in 58% of the participants. We further investigated quantitatively the responses in a subset of the responsive subjects. We found that the electromyographic (EMG activity of proximal leg muscles was modulated over each cycle with a timing similar to that of normal locomotion. The frequency of kinematic and EMG oscillations in the legs typically differed from that of arm oscillations. The effect of hand-walking was direction specific since medio-lateral arm movements did not evoke appreciably leg air-stepping. Using externally imposed trunk movements and biomechanical modelling, we ruled out that the leg movements associated with hand-walking were mainly due to the mechanical transmission of trunk oscillations. EMG activity in hamstring muscles associated with hand-walking often continued when the leg movements were transiently blocked by the experimenter or following the termination of arm movements. The present results reinforce the idea that there exists a functional neural coupling between arm and legs.

  14. Movement of Solid Particles in Swirling Flow

    Directory of Open Access Journals (Sweden)

    A. M. Volk

    2009-01-01

    Full Text Available The mathematical model has been developed and calculation of solid particle movement due to the action of swirling gas flow in a cylindrical element has been made in the paper. The paper investigates hydrodynamics of gas flow and forces influencing on a solid particle, both in the basic flow and during a contact with cylindrical surface. He obtained data can be used for research of processes pertaining to division of two-phase flows in a vortical device.

  15. [History and future of population movements].

    Science.gov (United States)

    Chesnais, J

    1994-01-01

    This is a general historical review of global migration trends in the modern era. "The emigration to the New Worlds was in large part due to the demographic pressure within the European continent from the eighteenth century onwards. Up until the thirties a 'Europeanisation' of the planet took place. From this time onwards, migratory movements have tended to reverse, and Europe, as well as East Asian countries with low birth rates, have in turn become territories of immigration." (SUMMARY IN ENG) excerpt

  16. Embodied health movements: new approaches to social movements in health.

    Science.gov (United States)

    Brown, Phil; Zavestoski, Stephen; McCormick, Sabrina; Mayer, Brian; Morello-Frosch, Rachel; Gasior Altman, Rebecca

    2004-01-01

    Social movements organised around health-related issues have been studied for almost as long as they have existed, yet social movement theory has not yet been applied to these movements. Health social movements (HSMs) are centrally organised around health, and address: (a) access to or provision of health care services; (b) health inequality and inequity based on race, ethnicity, gender, class and/or sexuality; and/or (c) disease, illness experience, disability and contested illness. HSMs can be subdivided into three categories: health access movements seek equitable access to health care and improved provision of health care services; constituency-based health movements address health inequality and health inequity based on race, ethnicity, gender, class and/or sexuality differences; and embodied health movements (EHMs) address disease, disability or illness experience by challenging science on etiology, diagnosis, treatment and prevention. These groups address disproportionate outcomes and oversight by the scientific community and/or weak science. This article focuses on embodied health movements, primarily in the US. These are unique in three ways: 1) they introduce the biological body to social movements, especially with regard to the embodied experience of people with the disease; 2) they typically include challenges to existing medical/scientific knowledge and practice; and 3) they often involve activists collaborating with scientists and health professionals in pursuing treatment, prevention, research and expanded funding. This article employs various elements of social movement theory to offer an approach to understanding embodied health movements, and provides a capsule example of one such movement, the environmental breast cancer movement.

  17. Supranuclear eye movement disorders.

    Science.gov (United States)

    Lemos, João; Eggenberger, Eric

    2014-11-01

    This work reviews supranuclear ocular motor disorders, highlighting new data published during the past year. Perceptional adaptative mechanisms may explain recent research concerning the discrepancy between objective measurement of saccade abnormalities and their putative functional visual impairment. Eye movement classes seem to be selectively disrupted by different neurodegenerative disorders. Deep brain stimulation in Parkinson's disease patients may improve pursuit deficits, highlighting the role of basal ganglia in the control of smooth pursuit. Subcortical optokinetic pathways seem to play an important role in maintaining the monocular nasotemporal optokinetic asymmetry seen in patients with infantile esotropia. Vergence-vestibular interaction has been further delineated in patients with idiopathic bilateral vestibular failure. Pharmacological treatment of central vestibular disorders with 4-aminopyridine has been extended to patients with ataxia-telangiectasia in whom it seems to reduce slow-phase velocity of nystagmus. Recent data derived from anatomic and functional imaging studies are providing new insights into supranuclear ocular motor circuitry. Novel pharmacological and surgical therapies may have future implications in visual and vestibular rehabilitation of patients with supranuclear eye movement disorders.

  18. Changes in the kinematic structure and non-kinematic features of movements during skilled reaching after stroke: a Laban Movement Analysis in two case studies.

    Science.gov (United States)

    Foroud, Afra; Whishaw, Ian Q

    2006-11-15

    The purpose of this study was to adapt a universal language for human movement, Laban Movement Analysis (LMA), to capture the kinematic and non-kinematic aspects of movement in a reach-for-food task by subjects whose movements had been affected by stroke. Two control subjects, one stroke subject with internal capsule damage, and one subject with right posterior parietal stroke were video recorded while performing the reaching task. The movements of limb advancement, grasping the food, and limb withdrawal to place the food in the mouth, were notated using LMA. A scale, the Expressive Reaching Scale (ERS), was derived from the notation. All subjects completed the task; however, the stroke subjects displayed abnormalities in both the kinematic and non-kinematic aspects of movements during reaching with either limb. The most extensive impairments were in the contralateral-to-stroke limb and were most severe in the subject with internal capsule damage. The ERS rating scale may be a useful diagnosis and assessment tool.

  19. Potential role of cortical 5-HT(2A) receptors in the anxiolytic action of cyamemazine in benzodiazepine withdrawal.

    Science.gov (United States)

    Benyamina, Amine; Naassila, Mickaël; Bourin, Michel

    2012-07-30

    The antipsychotic cyamemazine is a potent serotonin 5-HT(2A) receptor (5-HT(2AR)) antagonist. A positron emission tomography (PET) study in human patients showed that therapeutic doses of cyamemazine produced near saturation of 5-HT(2AR) occupancy in the frontal cortex, whereas dopamine D(2) occupancy remained below the level for motor side effects observed with typical antipsychotics. Recently, numerous studies have revealed the involvement of 5-HT(2AR) in the pathophysiology of anxiety and a double-blind, randomized clinical trial showed similar efficacy of cyamemazine and bromazepam in reducing the anxiety associated with benzodiazepine withdrawal. Therefore, we reviewed the above articles about 5-HT(2AR) and anxiety in order to understand better the anxiolytic mechanisms of cyamemazine in benzodiazepine withdrawal. The 5-HT(2AR) is the most abundant serotonin receptor subtype in the cortex. Non-pharmacological studies with antisense oligodeoxynucleotides and genetically modified mice clearly showed that cortical 5-HT(2AR) signaling positively modulates anxiety-like behavior. With a few exceptions, most other studies reviewed here further support this view. Therefore, the anxiolytic efficacy of cyamemazine in benzodiazepine withdrawal can be due to a 5-HT(2AR) antagonistic activity at the cortical level. Copyright © 2012 Elsevier Ltd. All rights reserved.

  20. 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