Diclofenac gel in the treatment of actinic keratoses

Actinic keratoses are areas of intraepithelial neoplasia for which treatment is necessary. Because they arise in areas of sun damage, it is desirable to treat the entire damaged field to not only treat visible lesions, but also subclinical, emerging malignancies, ie, “field therapy”, 5-fluorouracil, imiquimod, and diclofenac are all treatment options, and are discussed and compared

Handgun carrying among white youth increasing in the United States: new evidence from the national survey on drug use and health 2002–2013

The objective of the present study was to examine trends and correlates of handgun carrying among adolescents ages 12–17 in the United States. Data was derived from the National Survey on Drug Use and Health (NSDUH) involving non-Hispanic White, African American, and Hispanic respondents ages 12–17 (n = 197,313) and spanning the years 2002–2013. Logistic regression was used to examine significance of trend year and correlates of previous 12-month handgun carrying. The overall self-reported prevalence of handgun carrying was 3.4%. The prevalence of handgun carrying during 2004–2005 was significantly higher for African-Americans (4.39%) compared to non-Hispanic Whites (3.03%). However, by 2012–2013, non-Hispanic Whites (4.08%) completely diverged and reported carrying handguns significantly more than both African-American (2.96%) and Hispanic (2.82%) youth. Male gender and a number of externalizing behaviors were significant correlates of handgun carrying; however, we also found evidence of differential correlates with regard to such factors as drug selling, parental affirmation, and income by race/ethnicity. To our knowledge, this is the largest study of handgun carrying among youth in the United States. Findings indicate that although at historically low levels handgun carrying is on the rise but only among non-Hispanic Whites. Differential correlates among racial/ethnic groups suggest prevention programming and policies may need modifications depending on group and geographic locale targeted.R25 DA030310 - National Institute on Drug Abuse at the National Institutes of Healt

Trends and correlates of substance use disorders among probationers and parolees in the United States 2002–2014

BACKGROUND: Substance use and crime/recidivism are irrevocably linked. We explore the nuances of this association by highlighting the prevalence, trends, and correlates of substance use dsorders in a large group of probationers/parolees. METHODS: We examined SUDs among probationers and parolees in the United States using data from the National Study on Drug Use and Health (NSDUH). Logistic regression models were computed to examine eight distinct outcomes: alcohol abuse, illicit drug abuse, marijuana/hashish abuse, comorbid alcohol and illicit drug abuse, alcohol dependence, illicit drug dependence, marijuana/hashish dependence, and comorbid alcohol and illicit drug dependence. RESULTS: Probationers/parolees have high prevalence rates across all SUDs categories and these trends have been relatively constant. Prevalence rates for alcohol abuse and dependence are two to six times higher than for marijuana and other illicit drug abuse and dependence. Key correlates of substance abuse for probationers/parolees include: age, gender, race/ethnicity, education, income, risk propensity, crime/violence measures, and comorbid substance abuse. Similar correlates were found for substance dependence, in addition to employment and mental health treatment. CONCLUSIONS: This study indicates that SUDs are higher among probationer/parolees as compared to their non-supervised counterparts − between four and nine times higher − and these levels have changed little in recent years. Effectively responding to SUDs in this population may enhance adherence to supervision requirements, prevent recidivism, and improve public safety. We may be better served using limited funds for further development of evidence-based policies and programs, such as drug courts, which demonstrate reductions in both drug use and recidivism

Maternal pomegranate juice intake and brain structure and function in infants with intrauterine growth restriction: A randomized controlled pilot study.

Polyphenol-rich pomegranate juice has been shown to have benefit as a neuroprotectant in animal models of neonatal hypoxic-ischemia. No published studies have investigated maternal polyphenol administration as a potential neuroprotectant in at-risk newborns, such as those with intrauterine growth restriction (IUGR). This was a randomized, placebo-controlled, double-blind pilot study to investigate the impact of maternal pomegranate juice intake in pregnancies with IUGR, on newborn brain structure and function at term-equivalent age (TEA). Mothers with IUGR at 24-34 weeks\u27 gestation were recruited from Barnes-Jewish Hospital obstetrical clinic. Consented mothers were randomized to treatment (8 oz. pomegranate juice) or placebo (8 oz. polyphenol-free juice) and continued to take juice daily from enrollment until delivery (mean 20.1 and 27.1 days, respectively). Infants underwent brain MRI at TEA (36-41 weeks\u27 gestation). Brain measures were compared between groups including: brain injury score, brain metrics, brain volumes, diffusion tensor imaging and resting state functional connectivity. Statistical analyses were undertaken as modified intention-to-treat (including randomized participants who received their allocated intervention and whose infants received brain MRI) and per-protocol (including participants who strictly adhered to the protocol, based on metabolite status). Seventy-seven mothers were randomized to treatment (n = 40) or placebo (n = 37). Of these, 28 and 27 infants, respectively, underwent term-equivalent MRI. There were no group differences in brain injury, metrics or volumes. However, treatment subjects displayed reduced diffusivity within the anterior and posterior limbs of the internal capsule compared with placebo. Resting state functional connectivity demonstrated increased correlation and covariance within several networks in treatment subjects, with alterations most apparent in the visual network in per-protocol analyses. Direct effects on health were not found. In conclusion, maternal pomegranate juice intake in pregnancies with known IUGR was associated with altered white matter organization and functional connectivity in the infant brain, suggesting differences in brain structure and function following in utero pomegranate juice exposure, warranting continued investigation. Clinical trial registration. NCT00788866, registered November 11, 2008, initial participant enrollment August 21, 2012

Dim Light Exposure or Melatonin Ingestion Lowers a Type 2 Diabetic\u27s Blood Glucose Removal Rate: A Single Case

International Journal of Exercise Science 12(2): 1161-1168, 2019. The purpose of this case study isto compare a Type 2 diabetic\u27s postprandial glucoregulatory ability under two different room lighting conditions. The subject was a 56-year-old physically active male with well controlled blood glucose levels (HbA1c ≤ 6% for 5 y) from a combination of diet, exercise, and medication. Two hours post evening meal (380 kcal, 18 g fat, 44 g carbohydrate, 12 g protein), a 45 g carbohydrate challenge was given, and blood glucose was measured every 30 minutes for 2.5 hours under three conditions: dim light (\u3c50 lux) (DL), bright light (\u3e40000 lux) (BL), and bright light plus 6 mg melatonin (BLM). Each condition was repeated 3 times over a period of 6 months with each trial a minimum of seven days apart. The area under the average glucose concentration vs.time plot was different between the three conditions (BL = 909 +76; DL = 1078 +106; and BLM = 1130 +45 mmol∙min∙l-1). Visual inspection of the average blood glucose vs.time plot suggested that DL and BLM displayed very similar patterns and magnitude, with both DL and BLM having the blood glucose concentrations at each time point that are noticeably greater than BL. Additionally, the average (± standard deviation) blood glucose concentrations for DL (8.8 ± 0.9 mmol∙l-1) and BLM (9.1 ± 1.1 mmol∙l-1) were respectively 18% and 22% greater than BL (7.5 ± 0.5 mmol∙l-1). Melatonin and/or dim light can reduce a Type 2 diabetic\u27s glucoregulatory ability

Trends and correlates of marijuana use among late middle-aged and older adults in the United States, 2002–2014

BACKGROUND: Recent trend studies suggest that marijuana use is on the rise among the general population of adults ages 18 and older in the United States. However, little is known about the trends in marijuana use and marijuana-specific risk/protective factors among American adults during the latter part of adulthood. METHOD: Findings are based on repeated, cross-sectional data collected from late middle-aged (ages 50–64) and older adults (ages 65 and older) surveyed as part of the National Survey on Drug Use and Health between 2002 and 2014. RESULTS: The prevalence of past-year marijuana use among late middle-aged adults increased significantly from a low of 2.95% in 2003 to a high of 9.08% in 2014. Similarly, the prevalence of marijuana use increased significantly among older adults from a low of 0.15% in 2003 to a high of 2.04% in 2014. Notably, the upward trends in marijuana use remained significant even when accounting for sociodemographic, substance use, behavioral, and health-related factors. We also found that decreases in marijuana-specific protective factors were associated with the observed trend changes in marijuana use among late middle-aged and older adults, and observed a weakening of the association between late-middle aged marijuana use and risk propensity, other illicit drug use, and criminal justice system involvement over the course of the study. CONCLUSIONS: Findings from the present study provide robust evidence indicating that marijuana use among older Americans has increased markedly in recent years, with the most evident changes observed between 2008 and 2014

Infection and Inflammation Leading to Clozapine Toxicity and Intensive Care: A Case Series

Objective: To describe 3 cases of clozapine toxicity associated with infectious and/or inflammatory processes. Case Summaries: 3 patients stable on clozapine therapy prior to a medical hospital admission developed clozapine toxicity. It was suspected that an acute infectious and/or inflammatory process in each patient was related to abrupt mental status changes, onset of sialorrhea, myoclonus, and/or need for ventilatory support. Investigations of altered mental status did not reveal alterative causes and presentations were not consistent with neuroleptic malignant syndrome, other acute neurologic complications, or psychiatric decompensation. All patients improved after clozapine dose reductions allowing for transfer from intensive care units. Using the Naranjo ADR Probability Scale for each case, a probable relation between clozapine toxicity and the infectious and/or inflammatory process was determined. Discussion: Clozapine toxicity may manifest with multiple symptoms including sedation, sialorrhea, and hypotension. In addition to overdose and drug interactions; infection and/or inflammation may precipitate clozapine toxicity. This may be related to cytokine-mediated inhibition of cytochrome P450 1A2. The likelihood of toxicity via this mechanism has not been well-characterized, thus careful monitoring is required for medically ill patient receiving clozapine. Clozapine is extensively bound to the acute phase reactant, alpha-1 acid glycoprotein, which may unpredictably protect against clinical toxicity. C-reactive protein has also been investigated to relate clozapine toxicity to infection and/or inflammation. Conclusion: Clozapine toxicity developed in 3 patients admitted to a medical setting suspected to be related to infection and/or inflammation. Clinicians should be aware of this potential adverse drug event with clozapine

The application of travel demand management initiatives within a university setting

This research was undertaken as part of the UK Energy Research Centre (UKERC) research programme under the ADdressing Valuation of Energy and Nature Together (ADVENT) project, funded by the Natural Environment Research Council (NE/M019691/1) United Kingdom. Funding was also received from the School of Biological Sciences at the University of Aberdeen, United Kingdom. The authors would like to thank Dr Kate Pangbourne, The University of Leeds, for their detailed and constructive feedback on this paper. The authors would also like to acknowledge Dr Alex Douglas for their input in the methodology.Peer reviewedPostprin

Larval therapy for leg ulcers (VenUS II) : randomised controlled trial

Objective To compare the clinical effectiveness of larval therapy with a standard debridement technique (hydrogel) for sloughy or necrotic leg ulcers. Design Pragmatic, three armed randomised controlled trial. Setting Community nurse led services, hospital wards, and hospital outpatient leg ulcer clinics in urban and rural settings, United Kingdom. Participants 267 patients with at least one venous or mixed venous and arterial ulcer with at least 25% coverage of slough or necrotic tissue, and an ankle brachial pressure index of 0.6 or more. Interventions Loose larvae, bagged larvae, and hydrogel. Main outcome measures The primary outcome was time to healing of the largest eligible ulcer. Secondary outcomes were time to debridement, health related quality of life (SF-12), bacterial load, presence of meticillin resistant Staphylococcus aureus, adverse events, and ulcer related pain (visual analogue scale, from 0 mm for no pain to 150 mm for worst pain imaginable). Results Time to healing was not significantly different between the loose or bagged larvae group and the hydrogel group (hazard ratio for healing using larvae v hydrogel 1.13, 95% confidence interval 0.76 to 1.68; P=0.54). Larval therapy significantly reduced the time to debridement (2.31, 1.65 to 3.2; P<0.001). Health related quality of life and change in bacterial load over time were not significantly different between the groups. 6.7% of participants had MRSA at baseline. No difference was found between larval therapy and hydrogel in their ability to eradicate MRSA by the end of the debridement phase (75% (9/12) v 50% (3/6); P=0.34), although this comparison was underpowered. Mean ulcer related pain scores were higher in either larvae group compared with hydrogel (mean difference in pain score: loose larvae v hydrogel 46.74 (95% confidence interval 32.44 to 61.04), P<0.001; bagged larvae v hydrogel 38.58 (23.46 to 53.70), P<0.001). Conclusions Larval therapy did not improve the rate of healing of sloughy or necrotic leg ulcers or reduce bacterial load compared with hydrogel but did significantly reduce the time to debridement and increase ulcer pain. Trial registration Current Controlled Trials ISRCTN55114812 and National Research Register N0484123692