bluuebunny/crossref_metadata_2025 huggingface dataset:
Expression and maintenance of ComD–ComE, the two‐component signal‐transduction system that controls competence of Streptococcus pneumoniae
Authors: Martin Bernard , Granadel Chantal , Campo Nathalie , Hénard Vincent , Prudhomme Marc , Claverys Jean‐Pierre
Published: February 2010

A secreted competence‐stimulating peptide (CSP), encoded by comC, constitutes, together with the two‐component system ComD‐ComE, the master switch for competence induction in Streptococcus pneumoniae. Interaction between CSP and its membrane‐bound histidine‐kinase receptor, ComD, is believed to lead to autophosphorylation of ComD, which then transphosphorylates the ComE response regulator to activate transcription of a limited set of genes, including the comCDE operon. This generates a positive feedback loop, amplifying the signal and co‐ordinating competence throughout the population. On the other hand, the promoter(s) and proteins important for basal comCDE expression have not been defined. We now report that CSP‐induced and basal comCDE transcription both initiate from the same promoter, PE; that basal expression necessitates the presence of both ComD and a phosphate‐accepting form of ComE, but not CSP; and that overexpression of ComER120S triggers ComD‐dependent transformation in the absence of CSP. These observations suggest that self‐activation of ComD is required for basal comCDE expression. We also establish that transcriptional readthrough occurs across the tRNAArg5 terminator and contributes significantly to comCDE expression. Finally, we demonstrate by various means, including single‐cell competence analysis with GFP, that readthrough is crucial to avoid the stochastic production of CSP non‐responsive cells lacking ComD or ComE.
The IsdG‐family of haem oxygenases degrades haem to a novel chromophore
Authors: Reniere Michelle L. , Ukpabi Georgia N. , Harry S. Reese , Stec Donald F. , Krull Robert , Wright David W. , Bachmann Brian O. , Murphy Michael E. , Skaar Eric P.
Published: February 2010

Enzymatic haem catabolism by haem oxygenases is conserved from bacteria to humans and proceeds through a common mechanism leading to the formation of iron, carbon monoxide and biliverdin. The first members of a novel class of haem oxygenases were recently identified in Staphylococcus aureus (IsdG and IsdI) and were termed the IsdG‐family of haem oxygenases. Enzymes of the IsdG‐family form tertiary structures distinct from those of the canonical haem oxygenase family, suggesting that IsdG‐family members degrade haem via a unique reaction mechanism. Herein we report that the IsdG‐family of haem oxygenases degrade haem to the oxo‐bilirubin chromophore staphylobilin. We also present the crystal structure of haem‐bound IsdI in which haem ruffling and constrained binding of oxygen is consistent with cleavage of the porphyrin ring at the β‐ or δ‐meso carbons. Combined, these data establish that the IsdG‐family of haem oxygenases degrades haem to a novel chromophore distinct from biliverdin.
Inactivation of a putative flagellar motor switch protein FliG1 prevents Borrelia burgdorferi from swimming in highly viscous media and blocks its infectivity
Authors: Li Chunhao , Xu Hongbin , Zhang Kai , Liang Fang Ting
Published: February 2010

The flagellar motor switch complex protein FliG plays an essential role in flagella biosynthesis and motility. In most motile bacteria, only one fliG homologue is present in the genome. However, several spirochete species have two putative fliG genes (referred to as fliG1 and fliG2) and their roles in flagella assembly and motility remain unknown. In this report, the Lyme disease spirochete Borrelia burgdorferi was used as a genetic model to investigate the roles of these two fliG homologues. It was found that fliG2 encodes a typical motor switch complex protein that is required for the flagellation and motility of B. burgdorferi. In contrast, the function of fliG1 is quite unique. Disruption of fliG1 did not affect flagellation and the mutant was still motile but failed to translate in highly viscous media. GFP‐fusion and motion tracking analyses revealed that FliG1 asymmetrically locates at one end of cells and the loss of fliG1 somehow impacted one bundle of flagella rotation. In addition, animal studies demonstrated that the fliG1− mutant was quickly cleared after inoculation into the murine host, which highlights the importance of the ability to swim in highly viscous media in the infectivity of B. burgdorferi and probably other pathogenic spirochetes.
Beliefs and beyond: what can we learn from qualitative studies of lay people’s understandings of cancer risk?
Authors: Lipworth Wendy L. , Davey Heather M. , Carter Stacy M. , Hooker Claire , Hu Wendy
Published: February 2010

Background  Clinicians and public health professionals are centrally concerned with mediating risk. However, people often resist the risk‐related information that is communicated to them by experts, or have their own models of risk that conflict with expert views. Quantitative studies have clearly demonstrated the importance of health beliefs and various cognitive and emotional processes in shaping risk perception. More recently, a growing body of qualitative research has emerged, exploring lay conceptualizations, experiences and constructions of cancer risk. To date, this literature has not been synthesized.

Objective  We report the findings of a synthesis of qualitative literature regarding the ways in which lay people construct and experience cancer risk.

Design  We identified 87 articles and used the method of ‘thematic synthesis’ to identify and interpret key concepts from existing studies.

Results  Eight analytic categories were developed: (i) perceptions of risk factors; (ii) process of risk perception; (iii) seeking control and taking responsibility (motivational factors); (iv) experiencing cancer directly; (v) constructing risk temporally; (vi) embodying risk; (vii) identifying with risk; and (viii) constructing risk in a social context.

Conclusions  Qualitative enquiry can provide us with a rich and nuanced picture of the ways in which people understand, experience and construct risk and how being ‘at risk’ is managed, and can assist us in our communication with both individual patients and populations.
Diagnostic value of exhaled nitric oxide in childhood asthma and allergy
Authors: Sachs‐Olsen C. , Lødrup Carlsen K. C. , Mowinckel P. , Håland G. , Devulapalli C. S. , Munthe‐Kaas M. C. , Carlsen K.‐H.
Published: February 2010

Sachs‐Olsen C, Lødrup Carlsen KC, Mowinckel P, Håland G, Devulapalli CS, Munthe‐Kaas MC, Carlsen K‐H. Diagnostic value of exhaled nitric oxide in childhood asthma and allergy. Pediatr Allergy Immunol 2010: 21: e213–e221. © 2010 John Wiley & Sons A/S

Fractional exhaled nitric oxide (FENO) has been proposed as a diagnostic test of asthma. We aimed to investigate in a population based birth cohort of children the usefulness of FENO as a diagnostic tool. The 10‐yr follow up of the Environment and Childhood Asthma Study in Oslo included 616 children representative of the prospective birth cohort. Both FENO (single breath technique) and skin prick test (SPT) were measured in 331, limited at the time by equipment availability. Structural parental interview, spirometry, methacholine challenge and exercise test were performed. FENO was significantly elevated in children with current asthma (geometric mean 9.6 (95% confidence interval (CI) (6.9, 13.4) p.p.b.) compared with healthy children (5.8 (5.4, 6.3) p.p.b.; p < 0.001). FENO was highest among children with current allergic asthma (asthma and positive SPT) (14.0 (8.9, 22.1) p.p.b.), whereas children with non‐allergic asthma (6.1 (4.0, 9.2) p.p.b.) had comparable FENO levels to healthy children (p = 0.99). Allergic sensitization was most closely associated with FENO. A FENO cut‐off value of 20.4 p.p.b. had a high specificity (0.97), but a low sensitivity (0.41) and a Positive Likelihood Ratio of 16.1 for current allergic asthma. In the present childhood population‐based study, high FENO levels were closely associated with current allergic asthma and not with current asthma without allergic sensitization. Estimating the individual predictive probability of having asthma by use of FENO, improves the diagnostic utility of the test.
Variation in virulence of Cryphonectria hypovirus 1 in Macedonia
Authors: Sotirovski K. , Rigling D. , Heiniger U. , Milgroom M. G.
Published: February 2010

We investigated variation in virulence of Cryphonectria hypovirus 1 (CHV‐1) to the chestnut blight fungus, Cryphonectria parasitica, in Macedonia by inoculating chestnut stems in the field. We inoculated trees with two isolates of C. parasitica, each infected with one of five isolates of CHV‐1, four of which were the same for both fungal isolates. Two virus isolates, [Sk28] and [Sk47], were significantly more virulent than the others when compared in the same fungal host isolates, as measured by reduced canker growth and increased callus formation. Mycelial growth rate in vitro was weakly correlated to canker growth or callus formation and is therefore not a reliable predictor for virulence. We found significant fungus × virus interactions for canker growth and callus formation, which seems due mainly to one virus isolate. Significant interactions were not expected because the two fungal host isolates are members of the same clone that is dominant in Macedonia and most of southeastern Europe. Phenotypic variation for response to viruses, therefore, is greater than variation revealed by the genetic markers used to define clones. More than half of the trees inoculated with virus‐free controls were dead within 2 years, and the 30% still alive after 5 years had cankers with extensive callus formation, indicating that natural virus transmission had occurred after inoculation. In contrast, only 2% of the trees inoculated with virus‐infected isolates were dead after 5 years. Hypoviruses naturally occurring in Macedonia reduce canker development and tree mortality similarly to those in other parts of southern Europe, and therefore, may have good potential for biological control of chestnut blight.
DNA markers to disentangle complexes of cryptic taxa in mealybugs (Hemiptera: Pseudococcidae)
Authors: Malausa T. , Fenis A. , Warot S. , Germain J.‐F. , Ris N. , Prado E. , Botton M. , Vanlerberghe‐Masutti F. , Sforza R. , Cruaud C. , Couloux A. , Kreiter P.
Published: February 2010

Mealybugs (Hemiptera: Pseudococcidae) are major pests of a wide range of crops and ornamental plants worldwide. Their high degree of morphological similarity makes them difficult to identify and limits their study and management. We aimed to identify a set of markers for the genetic characterization and identification of complexes of taxa in the Pseudococcidae. We surveyed and tested the genetic markers used in previous studies and then identified new markers for particularly relevant genomic regions for which no satisfactory markers were available. We tested all markers on a subset of four taxa distributed worldwide. Five markers were retained after this first screening: two regions of the mitochondrial cytochrome oxidase I gene, 28S‐D2, the entire internal transcriber space 2 locus and the rpS15‐16S region of the primary mealybug endosymbiont Tremblaya princeps. We then assessed the utility of these markers for the characterization and identification of 239 samples from 43 sites in France and Brazil. The five markers studied (i) successfully distinguished all species identified by morphological examination, (ii) disentangled complexes of species by revealing intraspecific genetic variation and identified a set of closely related taxa for which taxonomic status requires clarification through further studies, and (iii) facilitated the inference of phylogenetic relationships between the characterized taxa.
C1 inhibitor level on neonatal sepsis and its relations with clinical findings
Authors: Tapisiz Anil , Ergenekon Ebru , Oktem Murat , Koc Esin , Okumus Nurullah , Zenciroğlu Aysegül , Atalay Yıldız
Published: February 2010

Background:  Generalised oedema is a frequent finding during neonatal sepsis, but its aetiology remains uncertain.

Objective:  The objective of this study was to measure functional C1 inhibitor (fC1 inh) levels in newborns with culture‐proven sepsis, compare the results with age‐ and gestational age (GA)‐matched controls and correlate the results with the clinical course of the patients during infection, with regard to vascular leak and oedema formation.

Methods:  Newborns with blood culture‐proven sepsis were included and samples for C1 inh levels were obtained before the beginning of antibiotic therapy and on the 3rd day of treatment. Body weight, urine output and other treatment modalities including volume boluses were recorded. Oedema formation as a sign of vascular leak was determined by calculating percent weight change over time. Age‐ and GA‐matched newborns without infection were used as controls.

Results:  No difference was observed between the patient and the control groups concerning fC1 inh levels. Percent weight change in the patient group was not correlated with the C1 inh levels.

Conclusion:  Despite studies suggesting the role of C1 inhibitor deficiency in vascular leak during sepsis in adults, there is no information in the literature regarding the C1 inh levels of healthy or septic newborns to date. In this study, fC1 inh levels were no different than controls, necessitating the consideration of other factors causing vascular leak and oedema during neonatal sepsis.
Corticosteroid insensitivity in severe asthma: significance, mechanisms and aetiology
Authors: Hew M. , Chung K. F.
Published: February 2010

Chronic severe asthma remains a challenging clinical problem despite the availability of modern treatments. Relative corticosteroid insensitivity is present in severe asthma and may contribute to continuing disease severity. Advances in the understanding of molecular mechanisms underlying corticosteroid insensitivity may yield new therapeutic targets. Furthermore, aetiological factors for corticosteroid insensitivity have been identified and these may be amenable to modification.
Acute care costs of patients admitted for management of chronic obstructive pulmonary disease exacerbations: contribution of disease severity, infection and chronic heart failure
Authors: Hutchinson A. , Brand C. , Irving L. , Roberts C. , Thompson P. , Campbell D.
Published: February 2010

Background: In 2003, chronic obstructive pulmonary disease (COPD) accounted for 46% of the burden of chronic respiratory disease in the Australian community. In the 65–74‐year‐old age group, COPD was the sixth leading cause of disability for men and the seventh for women.

Aims: To measure the influence of disease severity, COPD phenotype and comorbidities on acute health service utilization and direct acute care costs in patients admitted with COPD.

Methods: Prospective cohort study of 80 patients admitted to the Royal Melbourne Hospital in 2001–2002 for an exacerbation of COPD. Patients were followed for 12 months and data were collected on acute care utilization. Direct hospital costs were derived using Transition II, an activity‐based costing system. Individual patient costs were then modelled to ascertain which patient factors influenced total direct hospital costs.

Results: Direct costs were calculated for 225 episodes of care, the median cost per admission was AU$3124 (interquartile range $1393 to $5045). The median direct cost of acute care management per patient per year was AU$7273 (interquartile range $3957 to $14 448). In a multivariate analysis using linear regression modelling, factors predictive of higher annual costs were increasing age (P= 0.041), use of domiciliary oxygen (P= 0.008) and the presence of chronic heart failure (P= 0.006).

Conclusion: This model has identified a number of patient factors that predict higher acute care costs and awareness of these can be used for service planning to meet the needs of patients admitted with COPD.
World SIVA: the pediatric initiative
Authors: MASON KEIRA P.
Published: February 2010

Total intravenous anesthesia and targeted controlled infusions are emerging and developing techniques that can have a broad range of important clinical applications in future pediatric care.
Which model for propofol TCI in children
Authors: CONSTANT ISABELLE , RIGOUZZO AGNES
Published: February 2010

For several years, total intravenous anesthesia (TIVA) has demonstrated many advantages that allow consideration of propofol anesthesia as an interesting alternative in pediatric anesthesia. TIVA in children requires calculation and validation of pharmacokinetic (PK) models specifically adapted to the pediatric population. Several PK models based on a 3‐compartment approach have been proposed in children: all these models, which integrate only weight as covariable, show increased distribution volumes with a wide interindividual variability. However, as pharmacodynamic (PD) parameters are still debated in children, there is up to now, no PKPD model currently available for pediatric anesthesia. The particular importance to include physiological covariables, as size and age, to describe metabolic processes during growth and maturation in pediatric PKPD models is in agreement with recent allometric scaling works in children. The Schnider’s model, a model described in adults that includes numerous covariables, may be adapted and more efficient than the classical pediatric model to describe propofol–PKPD relationship in children over 5 years. Whatever is the model, a pharmacodynamic feed back such as the bispectral index may be useful to counteract the interindividual variability in the pediatric population.
From the Little Tree, Half a Block Toward the Lake: Popular Geography and Symbolic Discontent in Post‐Sandinista Managua
Authors: Freeman James
Published: February 2010

Abstract: The inhabitants of Managua, Nicaragua have a sophisticated, often bitingly ironic, popular geography that they use to navigate the city. The Nicaraguan capital has been destroyed twice by earthquakes, ravaged by war, left to decay for lack of funds, transformed by the creative destruction of speculative capitalism and subjected to a series of ideological impositions. Few people know the official names of streets, and recent governments have not had the ability to put up signs. So a supple system of popular geography dominates, resisting and ridiculing attempts to impose an official order, and adapting to change while preserving a bottom‐up sense of memory, history and place. Drawing on Allan Pred's classic account of popular geography in late nineteenth century Stockholm, I use Managua's language of spatial orientation as a window into peripheral modernity and the politics of everyday life.
Producing Privatization: Re‐articulating Race, Gender, Class and Space
Authors: Samson Melanie
Published: February 2010

Abstract: This article combines insights into the mutually constituting nature of gender, race, class and space with Marxist analyses that interrogate how social relations both produce and are constrained by institutions to explore waste management privatization in Johannesburg. It argues that the crystallization of racialized, gendered inequalities within bargaining institutions underpinned financial motivations for privatization. The form of privatization varied across the city due to the ways in which the class of the area serviced articulated with the racialization and gendering of capital and labour in these spaces. An array of material conditions and ideologies informed these processes in which workers were active, although not necessarily progressive agents. Focusing on how privatization is produced through spatialized and institutionalized social relations illuminates avenues for struggle hidden from view in both aspatial, ideal‐type feminist political economy analyses and geographic analyses of privatization inattentive to the mutually constituting nature of gender, race and class.
Marginalization, Facilitation, and the Production of Unequal Risk: The 2006 Paso del Norte Floods
Authors: Collins Timothy W.
Published: February 2010

Abstract:  Drawing upon insights from the field of urban political ecology, this article extends the critical hazards concept of marginalization by incorporating a relational focus on facilitation. Facilitation connotes the institutionally mediated process that enables powerful geographical groups of people to minimize negative environmental externalities and appropriate positive environmental externalities in particular places, with unjust socioenvironmental consequences. The article demonstrates the utility of a marginalization/facilitation frame for understanding the production of unequal risk based on a case study of the 2006 El Paso (USA)‐Ciudad Juárez (Mexico) flood disaster. The case study reveals how uneven developments have produced complex sociospatial patterns of exposure to flood hazards and how processes of facilitation and marginalization have created socially disparate flood‐prone landscapes characterized by unequal risks. The paper concludes by outlining how the frame presented helps clarify understanding of the production of unequal risk.
CONTRIBUTIONS TOWARD A THEORY OF STORMS: HISTORICAL KNOWING AND HISTORICAL PROGRESS IN KANT AND BENJAMIN
Authors: PENSKY MAX
Published: February 2010

There is a picture by Klee called Angelus Novus. It shows an angel who seems about to move away from something he stares at. His eyes are wide, his mouth is open, his wings are spread. This is how the angel of history must look. His face is turned toward the past. Where a chain of events appears before us, he sees one single catastrophe, which keeps piling wreckage upon wreckage and hurls it at his feet. The angel would like to stay, awaken the dead, and make whole what has been smashed. But a storm is blowing from Paradise and has got caught in his wings; it is so strong that the angel can no longer close them. This storm drives him irresistibly into the future, to which his back is turned, while the pile of debris before him grows toward the sky. What we call progress is this storm.1
Internet‐based information‐seeking behaviour amongst doctors and nurses: a short review of the literature
Authors: Younger Paula
Published: February 2010

Background:  Reviews of how doctors and nurses search for online information are relatively rare, particularly where research examines how they decide whether to use Internet‐based resources. Original research into their online searching behaviour is also rare, particularly in real world clinical settings. as is original research into their online searching behaviour. This review collates some of the existing evidence, from 1995 to 2009.

Objectives:  To establish whether there are any significant differences in the ways and reasons why doctors and nurses seek out online information; to establish how nurses and doctors locate information online; to establish whether any conclusions can be drawn from the existing evidence that might assist health and medical libraries in supporting users.

Methods:  An initial scoping literature search was carried out on PubMed and CINAHL to identify existing reviews of the subject area and relevant original research between 1995 and 2009. Following refinement, further searches were carried out on Embase (Ovid), LISA and LISTA. Following the initial scoping search, two journals were identified as particularly relevant for further table of contents searching. Articles were exclused where the main focus was on patients searching for information or where the focus was the evaluation of online‐based educational software or tutorials. Articles were included if they were review or meta‐analysis articles, where they reported original research, and where the primary focus of the online search was for participants’ ongoing Continuing Professional Development (CPD). The relevant articles are outlined, with details of numbers of participants, response rates, and the user groups.

Results:  There appear to be no significant differences between the reasons why doctors and nurses seek online Internet‐based evidence, or the ways in which they locate that evidence. Reasons for searching for information online are broadly the same: primarily patient care and CPD (Continuing Professional Development). The perceived barriers to accessing online information are the same in both groups. There is a lack of awareness of the library as a potential online information enabler.

Conclusions:  Libraries need to examine their policy and practice to ensure that they facilitate access to online evidence‐based information, particularly where users are geographically remote or based in the community rather than in a hospital setting. Librarians also need to take into account the fact that medical professionals on duty may not be able to take advantage of the academic model of online information research. Further research is recommended into the difference between the idealised academic model of searching and real world practicalities; and how other user groups search, for example patients.
Effects of low‐intensity resistance exercise with blood flow restriction on coagulation system in healthy subjects
Authors: Madarame Haruhiko , Kurano Miwa , Takano Haruhito , Iida Haruko , Sato Yoshiaki , Ohshima Hiroshi , Abe Takashi , Ishii Naokata , Morita Toshihiro , Nakajima Toshiaki
Published: February 2010

Recent studies have demonstrated that even a low‐intensity resistance exercise can effectively induce muscle hypertrophy and strength increase when combined with moderate blood flow restriction (BFR) into the exercising muscle. Although serious side effects of low‐intensity resistance exercise with BFR have not been reported, a concern of thrombosis has been suggested, because this type of exercise is performed with restricted venous blood flow and pooling of blood in extremities. Thus, the purpose of this study was to investigate the effects of low‐intensity resistance exercise with BFR on coagulation system in healthy subjects. Ten healthy men (25·1 ± 2·8 year) performed four sets of leg press exercises with and without BFR (150–160 mmHg) at an intensity of 30% of one‐repetition maximum (1RM). In each exercise session, one set with 30 repetitions was followed by three sets with 15 repetitions. Blood samples were taken before, and 10 min, 1, 4 and 24 h after the exercise. Prothrombin fragment 1 + 2 (PTF) and thrombin–antithrombin III complex (TAT) were measured as markers of thrombin generation, whereas D‐dimer and fibrin degradation product (FDP) were measured as markers of intravascular clot formation. Changes in plasma volume (PV) were calculated from haemoglobin and hematocrit values. PV reduction was significantly greater after the exercise with BFR than without (P<0·05). However, neither markers of thrombin generation nor intravascular clot formation increased after the exercises. These results suggest that low‐intensity resistance exercise with BFR does not activate coagulation system in healthy subjects.
Modified Group Therapy for Substance Abusers
Authors: Khantzian Edward J. , Halliday Kurt S. , Golden Sarah , McAuliffe William E.
Published: February 2010

The psychological factors that predispose an individual to substance abuse are the same factors involved in relapse, a major threat to recovery from a reliance on substances. Modified Dynamic Group Therapy (MDGT) is a group therapeutic approach that is sufficiently supportive and structured to provide the safety and comfort that such patients require, but unstructured enough to allow a natural unfolding of their vulnerabilities and characterological defenses that need to be identified and modified. MDGT targets and focuses on four areas of self‐regulation vulnerabilities involving difficulties with feeling life (affects), self‐esteem, relationships, and self‐care, and the defensive, characterological traits that compensate for, while they also reveal, these vulnerabilties.
The Case for Case Management
Authors: Mason Susan E. , Siris Samuel G.
Published: February 2010

Implementing appropriate treatment of patients with dual diagnosis is one of the most vexing conundrums in contemporary psychiatry. Surprisingly, however, there have been few reports of the use of case management in treating this patient group, despite its apparent face‐value applicability to this difficult clinical population. The authors report their experience in applying case management to a group of “depressed” and/or “negative‐symptom” schizophrenic patients with substance abuse problems. They found most problematic areas were confidentiality, treatment compliance, and the necessity and timing of abstinence. Discussion of these issues is illustrated with case reports.
Anabolic Steroids
Authors: Brower Kirk J.
Published: February 2010

Anabolic steroids (ASs) are synthetic derivatives of testosterone that have both anabolic (tissue building) and androgenic (masculinizing) effects. ASs are increasingly used for the nonmedical purposes of enhancing athletic performance and physical appearance. As illicit AS abuse patterns increase, so do reports of adverse health consequences, including physical and psychological dependence, major mood disorders, psychoses, and violent aggression. Thus, psychiatrists and other addiction professionals increasingly may be seeing AS users in their practices. The authors review laboratory abnormalities as a means of detecting AS abuse and its adverse effects. Most health consequences resulting from ASs appear to be reversible after cessation of use, but life‐threatening events have been reported. In the absence of well‐controlled, longitudinal studies, neither safety nor catastrophe can be predicted for the chronic abuse of high‐dose ASs.
Clinical Laboratory Tests as an Aid in Distinguishing Cirrhotic From Noncirrhotic Liver Disease in Alcoholic Patients
Authors: Ryback Ralph S. , Dufour Mary C. , Rawlings Robert R. , Eckardt Michael J.
Published: February 2010

Alcoholism‐associated liver disease is a potentially preventable hepatic injury. By use of 25 routinely ordered clinical laboratory tests, alcoholic cirrhosis was distinguishable from noncirrhotic alcoholic liver disease in 53 male inpatients with biopsy‐verified liver disease (31 diagnosed with alcoholic cirrhosis and 22 diagnosed with fatty liver and/or alcoholic hepatitis). Linear discriminant analysis correctly classified 77% of subjects with cirrhotic liver disease and 68% of subjects with noncirrhotic liver disease (overall accuracy of 74%). Quadratic discriminant analysis correctly classified 94% of subjects with cirrhotic liver disease and 68% of subjects with noncirrhotic liver disease (81% overall accuracy). These pattern recognition techniques may allow earlier clinical intervention in alcoholic patients with liver disease.
Modifying the Addiction Severity Index for Use With Pathological Gamblers
Authors: Lesieur Henry R. , Blume Sheila B.
Published: February 2010

The Addiction Severity Index (ASI), an instrument used in the evaluation of program effectiveness in the alcohol and drug dependency field, has been expanded and modified for use in patients with gambling problems. The Gambling Severity Index component of the modified ASI was tested for validity using a sample of 119 inpatient pathological gamblers. The ASI modification retains the reliability and validity of the original instrument while adding gambling‐specific items for evaluation of gambling treatment programs in which there are significant numbers of substance‐abusing patients.
Clinical Implications of the Relationship Between Attention‐Deficit Hyperactivity Disorder and Psychoactive Substance Use Disorders
Authors: Kaminer Yifrah
Published: February 2010

The author explores the nature of the relationship between attention‐deficit hyperactivity disorder (ADHD) and psychoactive substance use disorder (PSUD). Researchers of ADHD in children and adolescents have posited that the development of conduct disorder and antisocial personality disorder is an unavoidable step in the path to PSUD. Some investigators of adult substance abusers do not subscribe to this opinion, and others give considerable weight to the self‐medication theory. The choice of cocaine as a preferred drug for self‐medication by adults with attention deficit disorder has been specifically reported. The author presents a critical review of this issue as well as methodological, nosological, and interpretive problems, and intervention implications.
Effectiveness of Reducing Needle‐Related Risks for HIV Through Indigenous Outreach to Injection Drug Users
Authors: Booth Robert , Wiebel W. Wayne
Published: February 2010

This study assesses the efficacy of an intervention model designed to reduce the behaviors that place injection drug users (IDUs) at risk for contracting the human immunodeficiency virus. The authors obtained pre‐ and postintervention interviews of 566 subjects from three cities where the intervention was tested. By use of indigenous outreach workers who targeted their activities within the social networks of IDUs, the intervention model was conducted simultaneously, but not identically, in each site. Although risk was reduced in the three locations, major differences were observed between cities. The results of this study suggest that although behavioral changes were significant and could endure, providing prevention and educational materials without the reinforcing presence of indigenous outreach workers in the community was insufficient.
Long‐Term Therapy With Benzodiazepines Despite Alcohol Dependence Disorder
Authors: Adinoff Bryon
Published: February 2010

The author describes the long‐term administration of benzodiazepines to seven male patients (58–70 years old), each with at least a 25‐year history of alcohol dependence. Benzodiazepines were prescribed for the treatment of an anxiety disorder or sleep disturbance. All seven patients maintained abstinence during benzodiazepine administration, except for a brief period of relapse in two patients. These patients comprised all of the subjects given benzodiazepines for more than 1 week in a Veterans Affairs substance abuse program over a 3‐year period. These case reports suggest that the long‐term administration of benzodiazepines to carefully selected alcohol‐dependent patients is not necessarily incompatible with abstinence. Guidelines for the use of benzodiazepines in this patient population are reviewed.
Comparison of HIV‐Associated Risk Behaviors of Primary Intravenous Stimulant Users and Opioid‐Addicted Subjects on Methadone Maintenance
Authors: Saxon Andrew J. , Calsyn Donald A.
Published: February 2010

Intravenous drug users (IVDUs) in treatment participated in structured interviews on high‐risk drug use and sex practices. Follow‐up interviews at 18 months assessed behavior change. Primary stimulant users were compared with subjects on methadone who used stimulants and subjects on methadone who did not. At initial interview, stimulant users had more needle sharing and sex partners than did non‐stimulant users. On follow‐up, primary stimulant users had needle‐sharing rates equivalent to non‐stimulant users but were more likely to have multiple sex partners. Stimulant‐preferring IVDUs exhibit considerable risk behavior. Enhanced outpatient programs that address high‐risk behavior are needed for this group.
Peptide T Treatment of Cognitive Impairment in HIV‐Positive Intravenous Drug Users
Authors: Rosen Marc I. , Bridge T. Peter , O'Malley Stephanie S. , Pearsall H. Rowland , Martini Brenda , O'Connor Patrick G. , Brett‐Smith Helena , Thomas Haydn M. , Van Dyck Christopher H. , Woods Scott W. , Kosten Thomas R.
Published: February 2010

Peptide T, an analogue of vasoactive intestinal peptide, has improved cognitive function in patients with AIDS dementia complex in open clinical trials. The authors treated five methadone‐maintained, cognitively impaired, HIV‐positive patients in a double‐blind crossover study for 4 weeks with 5 mg of intranasal peptide T three times a day and with placebo for 4 weeks. The five patients were impaired on at least two of five tests of neuropsychological function, and they had been treated with 3′‐azido‐2′3′‐dideoxythymidine (AZT) for at least 3 months prior to enrollment. These patients showed greater neuropsychological improvement with peptide T than with placebo, suggesting potential utility for peptide T as an adjunct to AZT treatment.
An Open Trial of Sertraline for Cocaine Abuse
Authors: Kosten Therese A. , Kosten Thomas R. , Gawin Frank H. , Gordon Lynn T. , Hogan Izola , Kleber Herbert D.
Published: February 2010

The authors assessed sertraline, a serotonin uptake inhibitor, in an open trial of 11 outpatient cocaine abusers. Cocaine craving decreased and psychological functioning improved. Five subjects abstained from use for 3 weeks. These results suggest sertraline's treatment efficacy for cocaine abuse and support a role for serotonin in this disorder.
Comparative Validity of Five Alcoholism Typologies
Authors: Yates William R. , Meller William H.
Published: February 2010

The objective of this study was to compare and rank the descriptive validity for five alcoholism typologies. Five typology systems were applied. These included the presence or absence of 1) primary alcoholism, 2) drug abuse or dependence, 3) antisocial personality disorder (ASPD), 4) early‐onset alcoholism, and 5) parental alcoholism. The rank order (mean rank) from best to worst typology was presence or absence of ASPD (2.28), drug abuse or dependence (2.44), early‐onset alcoholism (2.94), primary alcoholism (3.30), and parental alcoholism (4.03). Documenting DSM‐III Axis I drug abuse or dependence comorbidity and Axis II ASPD comorbidity is a valid alcoholism typology strategy.
Substance Use Diagnoses in Smokers With Lung Disease
Authors: Kennedy Jane A. , Crowley Thomas J. , Cottler Linda B. , Mager Douglas E.
Published: February 2010

Will medically ill smokers meet criteria for nicotine dependence using current diagnostic criteria (especially concerning tolerance and withdrawal)? The authors interviewed smokers with chronic obstructive pulmonary disease (COPD) to determine the following: 1) Will they meet DSM‐III‐R criteria? 2) Will requiring withdrawal or tolerance change prevalence? 3) Will denial of health consequences due to smoking change prevalence? and 4) How prevalent are comorbid substance use disorders? In 50 COPD smokers, 94% met nicotine dependence criteria. Because all had tolerance or withdrawal, prevalence was unaffected by these symptoms. Denial reduced prevalence by 8%. Lifetime alcohol dependence was 52%; other substance use disorders were uncommon.
Event‐Related Potentials in Substance‐Abusing Individuals After Long‐Term Abstinence
Authors: Branchey Marc H. , Buydens‐Branchey Laure , Horvath Thomas B.
Published: February 2010

Auditory event‐related potentials (ERPs) were recorded in ten men, former cocaine and/or heroin addicts, who had been abstinent for 6 months or more, and in 33 control subjects matched for gender and age. Patients were found to have significantly lower P3 amplitude than controls. Within the population of substance abusers, a low P3 amplitude was significantly associated with a high score on the Barratt Impulsiveness Scale. A low P3 amplitude, previously described in alcohol abusers, was thus also found in drug abusers. This P3 decrement could antedate substance abuse. Trends linking a low P3 to poor impulse control similar to those observed by us in a larger population of alcohol abusers were found in this small sample of drug abusers.
Substance Abuse, Aggression, and Violence
Authors: Moss Howard B. , Tarter Ralph E.
Published: February 2010

The authors review the scientific literature linking the use of specific psychoactive substances with aggressive and violent behavior. In general, the effects of alcohol and other drugs on aggression and violence are influenced through the complex interaction of 1) the particular pharmacological effects and dose of the specific drug, 2) the psychological and biological characteristics of substance‐using individuals, and 3) the situational context in which the drug use occurs. Furthermore, a model is advanced that delineates the relationship between individual dispositional factors promoting aggression and the resultant occurrence of violent behavior. The authors conclude that the multifactorial nature of this problem emphasizes the need for multimodal strategies of intervention and prevention to reduce the societal impact of violence involving alcohol and other drugs.
Carbamazepine vs. Oxazepam for Benzodiazepine Detoxification in Methadone‐Maintained Patients
Authors: Rosen Marc I. , Pearsall H. Rowland , Price Lawrence H. , McDougle Christopher J. , Woods Scott W. , Kosten Thomas R.
Published: February 2010

Six benzodiazepine‐dependent, methadone‐maintained patients were randomized to 2 weeks of either 1) active oxazepam taper or 2) active carbamazepine (200 mg qid). Carbamazepine was associated with more severe withdrawal and complaints of nausea and ataxia.
Antisocial Personality in Alcohol‐ and Drug‐Dependent Individuals
Authors: Randolph Michael J. , Yates William R.
Published: February 2010

This study contrasts the effects of antisocial personality disorder (ASPD) on the phenomenology of alcohol and drug abuse for women compared with men. Eighty‐five women and 116 men in inpatient programs for alcohol and drug treatment were interviewed. Both ASPD men and women displayed an early onset of alcohol problems and amphetamine, marijuana, and cocaine abuse and dependence. However, ASPD in women did not correlate with low socioeconomic status, intravenous drug use, or family history of ASPD. ASPD appears to have some shared and some specific effects on the phenomenology of alcohol and drug abuse in women.
Acupuncture for the Treatment of Cocaine Dependence in Methadone‐Maintained Patients
Authors: Margolin Arthur , Avants S. Kelly , Chang Patrick , Kosten Thomas R.
Published: February 2010

Thirty‐two cocaine‐dependent methadone‐maintained patients received an 8‐week course of auricular acupuncture for the treatment of cocaine dependence. Fifty percent completed treatment; 88% of study completers attained abstinence, defined as providing cocaine‐free urine samples for the last 2 weeks of the study, yielding an overall abstinence rate of 44%. Abstainers reported decreased depression, a shift in self‐definition, decreased craving, and increased aversion to cocaine‐related cues. Post‐hoc comparisons to pharmacotherapy with desipramine (DMI), amantadine (AMA), and placebo revealed a higher abstinence rate for acupuncture (44%) than for AMA (15%) or placebo (13%), but not significantly higher than for DMI (26%).
Gender and Psychiatric Comorbidity in Substance‐Abusing Individuals
Authors: Wilcox James Allen , Yates William R.
Published: February 2010

Significant differences in the phenomenology ofpsychopathology were found between male and female substance abusers. Women reported higher rates of utilization of mental health services (t‐test, P < 0.0026) and had more depressive traits. Male substance abusers had significantly higher rates of sociopathy (t‐test, P < 0.0368). Women had a higher prevalence of benzodiazepine abuse (χ2 = 9.62, P < 0.01). The trend in our findings was that men tended to be antisocial and alcoholic, and women were more likely to express dysphoria and abuse drugs other than alcohol. The gender effect on comorbidity may affect the presentation of individual cases and subsequent treatment strategy.
Acceptance of HIV Testing by Substance‐Abusing Individuals
Authors: Gottheil Edward , Weinstein Stephen P. , Sterling Robert C.
Published: February 2010

Routine HIV (human immunodeficiency virus) testing of high‐risk groups (i.e., substance‐abusing individuals) could help decrease the spread of AIDS (acquired immune deficiency syndrome). Such a policy, however, could deter individuals from entering treatment, paradoxically increasing the likelihood of the disease being spread. The authors examined the willingness of substance‐abusing individuals to consent to HIV testing by randomly assigning patients entering either a drug‐free outpatient program or a methadone maintenance program to one of three informed consent conditions differing in degree of perceived coerciveness. Overall, 69% of the patients agreed to testing. As hypothesized, the proportion of agreement was highest under the most coercive informed consent condition. Although the results tend to support continuation of voluntary testing programs, only 5.5% of patients asked indicated that mandatory testing would have deterred them from entering treatment.
Learning and Memory Capacity in Sons of Alcoholic Men
Authors: Tarter Ralph E. , Jacob Theodore , Laird Susan B.
Published: February 2010

Male offspring, ages 12–17, of alcoholic and normal social‐drinking men were compared on a battery of tests measuring intellectual ability, academic achievement, and learning and memory. The sons of alcoholic men were found to have significantly lower verbal IQ and achievement scores but did not perform more poorly on tests of learning and memory.
Psychiatric Disorders Among Relatives of Cocaine‐Abusing Individuals
Authors: Luthar Suniya S. , Ball Samuel A. , Rounsaville Bruce J.
Published: February 2010

Familial risk for psychiatric disorders was assessed among 673 siblings of cocaine‐abusing individuals. Various indices of familial risk were examined, including those based on the presence/absence of disorders in parents and those reflecting severity (assessed by age at onset) of disorders. Across risk indices, the findings indicated high vulnerability among siblings (1) to substance abuse in relation to paternal alcoholism and (2) to depression and substance abuse in relation to maternal depression. The validity of the Type I/Type II distinction was upheld in the context of alcoholism only among fathers. In the context of affective disorders, risk to offspring was greatest if exposure to parental psychopathology occurred during the early childhood years.
Matching Adolescents Who Abuse Drugs to Treatment
Authors: Friedman Alfred S. , Granick Samuel , Kreisher Cheryl , Terras Arlene
Published: February 2010

This “matching” study attempts to determine characteristics of adolescent drug abuse patients that may determine whether an inpatient or an outpatient treatment setting will be more effective or more suitable for meeting the needs of the patient. Compared to short‐term inpatient treatment, long‐term outpatient treatment was shown to have significantly greater effect in reducing substance use/abuse for patients who had relatively more severe social lifestyle problems, family problems, and employment problems. Outpatient treatment even showed a trend toward a significantly better outcome for patients with more severe psychiatric problems.
Effects of Compliance on Outcome Independent of Pharmacological Efficacy in the Treatment of Opioid Dependence
Authors: Tuma A. Hussain , Siegel Carole , Alexander Mary Jane , Wanderling Joseph
Published: February 2010

In this double‐blind controlled study, 143 opioid‐dependent male subjects were detoxified and randomly assigned to etrafon (amitriptyline 25 mg and perphenazine 2 mg), methadone, or placebo. Subjects were treated, monitored, and evaluated frequently for 1 year. Reported here are assessments carried out at 3‐month intervals after hospital discharge. Treatment effectiveness was defined in terms of improvement of clinical symptoms, employment, and reduction in drug abuse. Data were analyzed on subjects who remained in treatment for at least 3 months (73%). Data analysis used a random regression model. Overall, type of treatment did not significantly affect outcome. An unexpected but significant effect on outcome seemed due to adherence to drug regimen. Those who adhered to their medication, whether etrafon, methadone, or placebo, improved more than noncompliers on most outcome measures regardless of type of drug treatment.