599 research outputs found

    Which substitution pharmacotherapy is most effective in treating opioid dependence?

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    The document attached has been archived with permission from the editor of the Medical Journal of Australia. An external link to the publisher’s copy is included.Design: Randomised controlled trial, double-blind. Setting: Outpatient clinic in Baltimore, United States. Participants: 220 people categorised as opioid dependent by DSM-IV;1 groups similar on demographics and drug use history. Exclusion criteria were medical and psychiatric illness requiring long-term medication, and pregnancy. Interventions: (i) Levo acetyl methadol (LAAM) at 75–115 mg, (ii) buprenorphine at 16–32 mg, (iii) methadone at 60–100 mg ("high dose"), or (iv) methadone at 20 mg ("low dose"). LAAM and buprenorphine were given three times a week, methadone daily. LAAM and methadone were given orally, buprenorphine sublingually. Participants attended the clinic daily for two weeks of dose induction, then thrice weekly with take-home doses. The scheduled duration of the trial was 17 weeks. Main outcome measures: Retention in treatment; illicit drug use; participants' global ratings of their drug problem. Main results: Days retained in the study (mean ± SE) — LAAM (i), 89 ± 6; buprenorphine (ii), 96 ± 4; "high dose" methadone (iii), 105 ± 4; "low dose" methadone (iv) 70 ± 4. Significantly more days retained for groups (i), (ii) and (iii) compared with group (iv) (P < 0.001), and group (iii) compared with group (i) (P = 0.02). Trial was completed by 53% of group (i), 58% of group (ii), 73% of group (iii), and 20% of group (iv), with 4, 3, 6 and 26 of groups (i), (ii), (iii) and (iv), respectively, transferred to rescue treatment (standard methadone maintenance). Twelve or more consecutive opioid-negative urine specimens were obtained in 36% of group (i), 26% of group (ii), 28% of group (iii) and 8% of group (iv) (P < 0.005). Conclusion: Compared with low-dose methadone, LAAM, buprenorphine and high-dose methadone substantially reduce the use of illicit opioids.Linda R. Gowing, Robert L. Ali and Jason M. Whit

    Integrated washland management for flood defence and biodiversity

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    A combination of reform of agricultural policy, changing priorities in the countryside, growing commitment to protect and enhance biodiversity, and concerns about increased flood risk in lowlands have drawn attention to the potential contribution that managed washlands can make to deliver benefits to biodiversity and flood management. In this context, and with funding from Defra and English Nature, the study reported here1 set out to determine the scope for simultaneously achieving flood management and biodiversity objectives, and how this might be achieved in practice. The broad purpose is to inform policy on washland creation and management, including mechanisms for implementation if deemed appropriate

    Pharmacotherapies for cannabis withdrawal

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    ProtocolThis is the protocol for a review and there is no abstract. The objectives are as follows: To assess the effectiveness and safety of pharmacotherapies as compared with each other, placebo or no pharmacotherapy (supportive care) for reducing cannabis withdrawal and promoting cessation.Kushani S Marshall, Linda Gowing, Robert Al

    Woody stem methane emission in mature wetland alder trees

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    Methane (CH4) is an important greenhouse gas that is predominantly emitted to the atmosphere from anoxic wetland ecosystems. Understanding the sources and emissions of CH4 is crucially important for climate change predictions; however, there are significant discrepancies between CH4 source estimates derived via so-called bottom-up and top-down methods. Here we report CH4 emission from the stems of mature wetland alder (Alnus glutinosa) trees in the UK, a common tree of northern hemisphere floodplains and wetlands. The alder stems most likely behave as conduits for soil-produced CH4 either in the gaseous or aqueous phase, and may, therefore, help to reconcile methodological differences in the way the wetland CH4 source is estimated. Alder tree stems emitted average peak CH4 fluxes of 101 μg CH4 m−2 h−1 (on a stem area basis) in early October, a rate that is similar to that obtained from mature Japanese ash (Fraxinus mandshurica var. japonica) in Japan and amounting to approximately 20% of the measured CH4 flux from the soil surface. The finding suggests that trees, which occupy 60% of Earth's wetlands and are normally excluded from the measurement programmes that form the basis for bottom-up estimates of the global wetland source, could be important contributors to overall terrestrial ecosystem CH4 flux

    Acid-dissolution of antigorite, chrysotile and lizardite for ex situ carbon capture and storage by mineralisation

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    Serpentine minerals serve as a Mg donor in carbon capture and storage by mineralisation (CCSM). The acid-treatment of nine comprehensively-examined serpentine polymorphs and polytypes, and the subsequent microanalysis of their post-test residues highlighted several aspects of great importance to the choice of the optimal feed material for CCSM. Compelling evidence for the non-uniformity of serpentine mineral performance was revealed, and the following order of increasing Mg extraction efficiency after three hours of acid-leaching was established: Al-bearing polygonal serpentine (<5%) ≤ Al-bearing lizardite 1T (≈5%) < antigorite (24-29%) < well-ordered lizardite 2H1 (≈65%) ≤ Al-poor lizardite 1T (≈68%) < chrysotile (≈70%) < poorly-ordered lizardite 2H1 (≈80%) < nanotubular chrysotile (≈85%). It was recognised that the Mg extraction efficiency of the minerals depended greatly on the intrinsic properties of crystal structure, chemistry and rock microtexture. On this basis, antigorite and Al-bearing well-ordered lizardite were rejected as potential feedstock material whereas any chrysotile, non-aluminous, widely spaced lizardite and/or disordered serpentine were recommended. The formation of peripheral siliceous layers, tens of microns thick, was not universal and depended greatly upon the intrinsic microtexture of the leached particles. This study provides the first comprehensive investigation of nine, carefully-selected serpentine minerals, covering most varieties and polytypes, under the same experimental conditions. We focused on material characterisation and the identification of the intrinsic properties of the minerals that affect particle’s reactivity. It can therefore serve as a generic basis for any acid-based CCSM pre-treatment
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