The experience of long-term opiate maintenance treatment and reported barriers to recovery: A qualitative systematic review

Background/Aim: To inform understanding of the experience of long-term opiate maintenance and identify barriers to recovery. Methods: A qualitative systematic review. Results: 14 studies in 17 papers, mainly from the USA (65%), met inclusion criteria, involving 1,088 participants. Studies focused on methadone prescribing. Participants reported stability; however, many disliked methadone. Barriers to full recovery were primarily ‘inward focused'. Conclusion: This is the first review of qualitative literature on long-term maintenance, finding that universal service improvements could be made to address reported barriers to recovery, including involving ex-users as positive role models, and increasing access to psychological support. Treatment policies combining harm minimisation and abstinence-orientated approaches may best support individualised recovery

What are the beliefs of pediatricians and dietitians regarding complementary food introduction to prevent allergy?

<p>Abstract</p> <p>Background</p> <p>The timing of complementary food introduction is controversial. Providing information on the timing of dietary introduction is crucial to the primary prevention of food allergy. The American Academy of Pediatrics offers dietary recommendations that were updated in 2008.</p> <p>Objective</p> <p>Identify the recommendations that general pediatricians and registered dietitians provide to parents and delineate any differences in counselling.</p> <p>Methods</p> <p>A 9-item survey was distributed to pediatricians and dietitians online and by mail. Information on practitioner type, gender, length of practice and specific recommendations regarding complementary food introduction and exposure was collected.</p> <p>Results</p> <p>181 surveys were returned with a 54% response rate from pediatricians. It was not possible to calculate a meaningful dietitian response rate due to overlapping email databases. 52.5% of all respondents were pediatricians and 45.9% were dietitians. The majority of pediatricians and dietitians advise mothers that peanut abstinence during pregnancy and lactation is unnecessary. Dietitians were more likely to counsel mothers to breastfeed their infants to prevent development of atopic dermatitis than pediatricians. Hydrolyzed formulas for infants at risk of developing allergy were the top choice of formula amongst both practitioners. For food allergy prevention, pediatricians were more likely to recommend delayed introduction of peanut and egg, while most dietitians recommended no delay in allergenic food introduction.</p> <p>Conclusions</p> <p>In the prophylaxis of food allergy, pediatricians are less aware than dietitians of the current recommendation that there is no benefit in delaying allergenic food introduction beyond 4 to 6 months. More dietitians than pediatricians believe that breastfeeding decreases the risk of atopic dermatitis. Practitioners may benefit from increased awareness of current guidelines.</p

World Allergy Organization (WAO) Diagnosis and Rationale for Action against Cow's Milk Allergy (DRACMA) Guidelines update – I – Plan and definitions

Since the World Allergy Organization (WAO) Diagnosis and Rationale against Cow's Milk Allergy (DRACMA) Guidelines were published 10 years ago, new evidence has accumulated about the diagnosis, therapy, and specific immunotherapy for cow's milk allergy (CMA). For this reason, WAO has felt the need to update the guidelines. We introduce here this update. The new DRACMA guidelines aim to comprehensively address the guidance on diagnosis and therapy of both IgE non-IgE-mediated forms of cow's milk allergy in children and adults. They will be divided into 18 chapters, each of which will be dedicated to an aspect. The focus will be on the meta-analyzes and recommendations that will be expressed for the 3 most relevant clinical aspects: (a) the diagnostic identification of the condition; (b) the choice of the replacement formula in case of CMA in infancy when the mother is not able to breastfeed, and (c) the use of specific immunotherapy for cow's milk protein allergy

Not all shellfish "allergy" is allergy!

The popularity of shellfish has been increasing worldwide, with a consequent increase in adverse reactions that can be allergic or toxic. The approximate prevalence of shellfish allergy is estimated at 0.5-2.5% of the general population, depending on degree of consumption by age and geographic regions. The manifestations of shellfish allergy vary widely, but it tends to be more severe than most other food allergens

Extracorporeal Circuit Sterility after 168 Hours

One of the most important tasks of the perfusionist is the proper assembly of the extracorporeal circuit (ECC) prior to the initiation of cardiopulmonary bypass (CPB). The ECC is usually assembled, primed and debubbled 30 minutes to one hour prior to the patient entering the operating room. But there are occasions when the ECC may have been set up and the previously scheduled procedure cancelled. Perfusionists in this situation have found themselves in a quandary; dispose of the ECC because of required nursing compliance and the sterility question, or keep it and use it later because of the economic impact on the "bottom line". Some hospitals may have satisfactorily answered the question of ECC sterility after 24 hours without observation, but the few reported papers regarding this issue, and our desire to save these circuits, inspired us to find out if they were in fact sterile after having been open for a long period of time. The purpose of this study was to evaluate ECC sterility using an open reservoir oxygenator, over a time period of seven days. After obtaining 792 bacterial cultures from three sites within the ECC, the study was terminated. There were no positive bacterial cultures during the study period. Assuming there is no deliberate contamination, pump circuits assembled in an unused operating room can be maintained sterile for a period of seven days

Test 685: Fordson Power Major (Diesel)

EXPLANATION OF TEST REPORT GENERAL CONDITIONS East tractor is a production model equipped for common usage. Power consuming accessories can be disconnected only when it is convenient for the operator to do so in practice. Additional weight can be added as ballast if the manufacturer regularly supplies it for sale. The static tire loads and the inflation pressures muse conform to recommendations in the Tire Standards published by the Society of Automotive Engineers. PREPARATION FOR PERFORMANCE RUNS The engine crank case is drained and refilled with a measured amount of new oil conforming to specifications in the operator’s manual. The fuel used and the maintenance operations must also conform to the published information delivered with the tractor. The tractor is then limbered-up for 1 hour on drawbar work in accordance with the manufacturers published recommendations. The manufacturer’s representative is present to make appropriate decisions regarding mechanical adjustments. The tractor is equipped with approximately the amount of added ballast that is used during maximum drawbar tests. The tire tread-bar height must be at least 65% of new tread height prior to the maximum power run. BELT OR POWER TAKE-OFF PERFORMANCE Maximum Power and Fuel Consumption. The manufacturer’s representative makes carburetor, fuel pump, ignition and governor control settings which remain unchanged throughout tall subsequent runs. The governor and the manually operated governor control lever is set to provide the high-idle speed specified by the manufacturer for maximum power. Maximum power is measured by connecting the belt pulley or the power take-off to a dynamometer. The dynamometer load is then gradually increased until the engine is operating at the rated speed specified by the manufacturer for maximum power. The corresponding fuel consumption is measured. Varying Power and Fuel Consumption. Six different horsepower levels are used to show corresponding fuel consumption rates and how the governor causes the engine to react to the following changes in dynamometer load: 85% of the dynamometer torque at maximum power; minimum dynamometer torque, ½ the 85% torque; maximum power; ¼ and ¾ of the 85% torque. Since at tractor is generally subjected to varying loads the average of the results in this test serve well for predicting the fuel consumption of a tractor in general usage. DRAWBAR PERFORMANCE All engine adjustments are the same as those used in the belt or power take-off tests. If the manufacturer specifies a different rated crankshaft speed for drawbar operations, then the position of the manually operated governor control is changed to provide the high-idle speed specified by the manufacturer in the operating instructions. Varying Power and Fuel Consumption With Ballast. The varying power runs are made to show the effect of speed-control devices (engine governor, automatic transmissions, etc.) on horsepower, speed and fuel consumption. These runs are made around the entire test course with has two 180 degree turns with a minimum radius of 50 feet. The drawbar pull is set at 3 different levels as follows: (1) as near to the pull a maximum power as possible and still have the tractor maintain the travel speed at maximum horsepower on the straight sections of the test course; (2) 75% of the pull at maximum power; and (3) 50% of the pull at maximum power. Prior to 1958, fuel consumption data (10 hour test) were shown only for the pull obtained at maximum power for tractors having torque converters and at 75% of the pull obtained at maximum power for gear-type tractors. Maximum Power With Ballast. Maximum power is measured on straight level sections of the test course. Data are shown for not more that 12 different gears or travel speeds. Some gears or travel speeds may be omitted because of high slippage of the traction members or because the travel speed may exceed the safe-limit for the test course. The maximum safe speed for the Nebraska Test course has been set at 15 miles per hour. The slippage limits have been set at 15% and 7% for pneumatic tires and steel tracks or lugs, respectively. Higher slippage gives widely varying results. Maximum Power Without Ballast. All added ballast is removed from the tractor. The maximum drawbar power of the tractor is determined by the same procedure used for getting maximum power with ballast. The gear (or travel speed) is the same as that used in the 10-hours test. Varying Power and Travel Speed With Ballast. Travel speeds corresponding to drawbar pulls beyond the maximum power range are obtained to show the “lugging ability” of the tractor. The run starts with the pull at maximum power; then additional drawbar pull is applied to cause decreasing speeds. The run is ended by one of three conditions; (1) maximum pull is obtained, (2) the maximum slippage limit is reached, or (3) some other operating limit is reached