A guide to substance misuse for medical professionals.

Contents: Section 1 - drug category Section 2 - recognising drug use Section 3 - facts about drugs Section 4 - drug dangers Section 5 - drugs and the law Section 6 - the jargo

The impact of user-perceived e-procurement quality on system and contract compliance

PurposeWhilst e‐procurement has significant potential to reduce the purchasing costs of an organisation, the realisation of these savings requires user compliance. The purpose of this paper is to examine the extent to which user‐perceived e‐procurement quality (EPQ) (operationalised through the dimensions of professionalism, processing, training, specification, content, and usability) influences both system and contract compliance.Design/methodology/approachUser perceptions of EPQ were examined in four UK organisations using survey data from 274 respondents.FindingsStrong evidence was found of a positive relationship between user‐perceived EPQ and both system and contract compliance. System compliance was most strongly influenced by professionalism and content dimensions, whilst contract compliance was most strongly influenced by processing, specification, and content dimensions.Research limitations/implicationsData were collected from e‐procurement users in four organisations, which may limit the extent to which findings can be generalised.Practical implicationsUser perceptions of e‐procurement provision significantly influence system and contract adoption. Practitioners should pay attention to management of different dimensions of perceived quality as they may have different effects on both contract and system compliance.Originality/valueThis paper is the first to empirically assess the relationship between user‐perceived EPQ and compliance. Its findings challenge the assumption that the monopolistic dynamics common within internal services, such as e‐procurement provision, are sufficient to ensure compliance. Dissatisfied individuals invariably find ways to circumvent mandatory systems and contracts.</jats:sec

Directly Measured Denitrification Reveals Oyster Aquaculture and Restored Oyster Reefs Remove Nitrogen at Comparable High Rates

Coastal systems are increasingly impacted by over-enrichment of nutrients, which has cascading effects for ecosystem functioning. Oyster restoration and aquaculture are both hypothesized to mitigate excessive nitrogen (N) loads via benthic denitrification. The degree to which these management activities perform similar functions for removing N, however, has not been extensively examined in New England, a place where nutrient runoff is high and increasing oyster (Crassostrea virginica) restoration and aquaculture activity is taking place. Here, we use a novel in situ methodology to directly measure net N2 and O2 fluxes across the sediment-water interface in a shallow (~1 m) coastal pond in southern Rhode Island. We collected data seasonally during 2013 and 2014 at restored oyster reefs, oyster aquaculture, oyster cultch (shell), and bare sediment. Restored oyster reefs and aquaculture had the highest mean (±SE) denitrification rates, 581.9 (±164.2) and 346 (±168.6) μmol N2−N m−2 h−1, respectively, and are among the highest recorded for oyster-dominated environments. Denitrification rates at sites with oyster cultch were 60.9 (±44.3) μmol N2−N m−2 h−1, which is substantially less than the sites with active oysters but still more than 50% higher than denitrification rates measured in bare sediment (24.4 ± 10.1 μmol N2–N m−2 h−1). The increase in denitrification rates at treatments, however, varied by season and the greatest rates for restored reefs were in the fall. Overall, the greatest aggregate denitrification rates occurred in the fall. Sediment oxygen demand (SOD) followed similar patterns but with greater overall rates in the summer, and displayed a strong linear relationship with denitrification (R2 = 0.93). Our results demonstrate that habitats associated with live oysters have higher net denitrification rates and that oyster reef restoration and oyster aquaculture may provide similar benefits to the ecosystem in terms of N removal. However, gas fluxes may also be affected where three-dimensional structure is introduced via oyster shell cultch and this appears to be seasonally-dependent. These data will be important for managers as they incorporate oysters into nutrient reduction strategies and consider system-level trade-offs in services provided by oyster reef restoration and aquaculture activities

Directly Measured Denitrification Reveals Oyster Aquaculture and Restored Oyster Reefs Remove Nitrogen at Comparable High Rates

Coastal systems are increasingly impacted by over-enrichment of nutrients, which has cascading effects for ecosystem functioning. Oyster restoration and aquaculture are both hypothesized to mitigate excessive nitrogen (N) loads via benthic denitrification. The degree to which these management activities perform similar functions for removing N, however, has not been extensively examined in New England, a place where nutrient runoff is high and increasing oyster (Crassostrea virginica) restoration and aquaculture activity is taking place. Here, we use a novel in situ methodology to directly measure net N2 and O2 fluxes across the sediment-water interface in a shallow (~1 m) coastal pond in southern Rhode Island. We collected data seasonally during 2013 and 2014 at restored oyster reefs, oyster aquaculture, oyster cultch (shell), and bare sediment. Restored oyster reefs and aquaculture had the highest mean (±SE) denitrification rates, 581.9 (±164.2) and 346 (±168.6) μmol N2−N m−2 h−1, respectively, and are among the highest recorded for oyster-dominated environments. Denitrification rates at sites with oyster cultch were 60.9 (±44.3) μmol N2−N m−2 h−1, which is substantially less than the sites with active oysters but still more than 50% higher than denitrification rates measured in bare sediment (24.4 ± 10.1 μmol N2–N m−2 h−1). The increase in denitrification rates at treatments, however, varied by season and the greatest rates for restored reefs were in the fall. Overall, the greatest aggregate denitrification rates occurred in the fall. Sediment oxygen demand (SOD) followed similar patterns but with greater overall rates in the summer, and displayed a strong linear relationship with denitrification (R2 = 0.93). Our results demonstrate that habitats associated with live oysters have higher net denitrification rates and that oyster reef restoration and oyster aquaculture may provide similar benefits to the ecosystem in terms of N removal. However, gas fluxes may also be affected where three-dimensional structure is introduced via oyster shell cultch and this appears to be seasonally-dependent. These data will be important for managers as they incorporate oysters into nutrient reduction strategies and consider system-level trade-offs in services provided by oyster reef restoration and aquaculture activities

An antitumorigenic role for the IL-33 receptor, ST2L, in colon cancer

Background: Despite the importance of inflammation in cancer, the role of the cytokine IL-33, and its receptor ST2, in colon cancer is unclear. The aim of this study was to investigate the role of IL-33, and its receptor isoforms (ST2 and ST2L), in colon cancer. Methods: Serum levels of IL-33 and sST2 were determined with ELISA. ST2 and IL-33 expression was detected with quantitative real-time PCR (qRT–PCR), western blotting and immunohistochemistry. ST2 expression in CT26 cells was stably suppressed using ST2-specific shRNA. Cytokine and chemokine gene expression was detected with qRT–PCR. Results: Human colon tumours showed lower expression of ST2L as compared with adjacent non-tumour tissue (P<0.01). Moreover, the higher the tumour grade, the lower the expression of ST2L (P=0.026). Colon cancer cells expressed ST2 and IL-33 in vitro. Functional analyses showed that stimulation of tumour cells with IL-33 induced the expression of chemokine (C–C motif) ligand 2 (CCL2). Knockdown of ST2 in murine colon cancer cells resulted in enhanced tumour growth (P<0.05) in BALB/c mice in vivo. This was associated with a decrease in macrophage infiltration, with IL-33-induced macrophage recruitment reduced by antagonising CCL2 in vitro. Conclusion: The IL-33/ST2 signalling axis may have a protective role in colon carcinogenesis

Plasma viral loads during early HIV-1 infection are similar in subtype C- and non-subtype C-infected African seroconverters.

Recent data suggest that infection with human immunodeficiency virus type 1 (HIV-1) subtype C results in prolonged high-level viremia (>5 log10 copies/mL) during early infection. We examined the relationship between HIV-1 subtype and plasma viremia among 153 African seroconverters. Mean setpoint viral loads were similar for C and non-C subtypes: 4.36 vs 4.42 log10 copies/mL (P = .61). The proportion of subtype C-infected participants with viral loads >5 log10 copies/mL was not greater than the proportion for those with non-C infection. Our data do not support the hypothesis that higher early viral load accounts for the rapid spread of HIV-1 subtype C in southern Africa

Characteristics of HIV-1 Discordant Couples Enrolled in a Trial of HSV-2 Suppression to Reduce HIV-1 Transmission: The Partners Study

Background: The Partners HSV-2/HIV-1 Transmission Study (Partners Study) is a phase III, placebo-controlled trial of daily acyclovir for genital herpes (HSV-2) suppression among HIV-1/HSV-2 co-infected persons to reduce HIV-1 transmission to their HIV-1 susceptible partners, which requires recruitment of HIV-1 serodiscordant heterosexual couples. We describe the baseline characteristics of this cohort. Methods: HIV-1 serodiscordant heterosexual couples, in which the HIV-1 infected partner was HSV-2 seropositive, had a CD4 count ≥250 cells/mcL and was not on antiretroviral therapy, were enrolled at 14 sites in East and Southern Africa. Demographic, behavioral, clinical and laboratory characteristics were assessed. Results: Of the 3408 HIV-1 serodiscordant couples enrolled, 67% of the HIV-1 infected partners were women. Couples had cohabitated for a median of 5 years (range 2–9) with 28% reporting unprotected sex in the month prior to enrollment. Among HIV-1 susceptible participants, 86% of women and 59% of men were HSV-2 seropositive. Other laboratory-diagnosed sexually transmitted infections were uncommon (500 relative to <350, respectively, p<0.001). Conclusions: The Partners Study successfully enrolled a cohort of 3408 heterosexual HIV-1 serodiscordant couples in Africa at high risk for HIV-1 transmission. Follow-up of this cohort will evaluate the efficacy of acyclovir for HSV-2 suppression in preventing HIV-1 transmission and provide insights into biological and behavioral factors determining heterosexual HIV-1 transmission. Trial Registration ClinicalTrials.gov NCT0019451