Operational definition of precipitated opioid withdrawal

Background Opioid withdrawal can be expressed as both a spontaneous and precipitated syndrome. Although spontaneous withdrawal is well-characterized, there is no operational definition of precipitated opioid withdrawal.MethodsPeople (N = 106) with opioid use disorder maintained on morphine received 0.4 mg intramuscular naloxone and completed self-report (Subjective Opiate Withdrawal Scale, SOWS), visual analog scale (VAS), Bad Effects and Sick, and observer ratings (Clinical Opiate Withdrawal Scale, COWS). Time to peak severity and minimal clinically important difference (MCID) in withdrawal severity were calculated. Principal component analysis (PCA) during peak severity were conducted and analyzed with repeated measures analyses of variance (ANOVA).ResultsWithin 60 min, 89% of people reported peak SOWS ratings and 90% of people had peak COWS scores as made by raters. Self-reported signs of eyes tearing, yawning, nose running, perspiring, hot flashes, and observed changes in pupil diameter and rhinorrhea/lacrimation were uniquely associated with precipitated withdrawal. VAS ratings of Bad Effect and Sick served as statistically significant severity categories (0, 1–40, 41–80, and 81–100) for MCID evaluations and revealed participants' identification with an increase of 10 [SOWS; 15% maximum percent effect (MPE)] and 6 (COWS; 12% MPE) points as meaningful shifts in withdrawal severity indicative of precipitated withdrawal.ConclusionData suggested that a change of 10 (15% MPE) and 6 (12% MPE) points on the SOWS and COWS, respectively, that occurred within 60 min of antagonist administration was identified by participants as a clinically meaningful increase in symptom severity. These data provide a method to begin examining precipitated opioid withdrawal

Footprints- In the Footprints of Squier and Davis: Archeological Fieldwork in Ross County, Ohio

TABLE OF CONTENTS Acknowledgements....................................................................iList of Tables...................................................................vii List of Figures...................................................................ix Contributors .........................................................................xiii Chapter 1 In the Footprints of Squier and Davis : Archeological Fieldwork in Ross County, Ohio Mark J. Lynott................................................................................1 Previous Studies in Ohio ...................................................1 Hopewell Studies Today ................................................................4 Recent Field Research ..........................................................................6 Goal of this Volume ................................................................................12 Chapter 2 In Non-mound Space at the Hopewell Mound Group Jennifer Pederson Weinberger .........................................13 Geophysical Survey .......................................................15Western Village Area.....................................................................16 Near the East Village .....................................................................18 Central Area ............................................................................19 Discussion .......................................................................................19 Chapter 3 Field Studies of the Octagon and Great Circle, High Bank Earthworks Ross County, Ohio N’omi B. Greber and Orrin C. Shane III ..............................................23 Excavations at the Octagon ............................................................25 Geophysics at the Great Circle ............................................................30 Excavations at the Great Circle ..........................................................33 Radiocarbon Assays ...........................................................................41 Comments ....................................................................................44 Addendum ..........................................................................................46 Chapter 4 Spruce Hill Earthworks: The 1995-1996 National Park Service Investigations Bret J. Ruby .............................................................................................49 Background .......................................................................................49 The Spruce Hill Earthworks .......................................................................49 Spruce Hill Revisited ......................................................................53 The 1995-1996 National Park Service Investigations ............................53 Discussion and Conclusions ..............................................................61 Chapter 5 Falling Through a Crack in the Core: The Surprise and Demise of Anderson Earthwork William H. Pickard and Jeffrey W. Weinberger ........................................ 67 History and Setting ..................................................................................68 1993 Excavations ..................................................................................70 Discussion ..............................................................................................72 Conclusion ............................................................................................74 Chapter 6 Middle Woodland and Other Settlement Remains in the Overly Tract Near The Hopeton Earthwork, Ross County, Ohio William S. Dancey .....................................................................................................77 Research Design.............................................................................77 Artifact Categories and their Distributions..............................................80 Discussion............................................................................................92 Chapter 7 Hopewell Occupation at the Hopeton Earthworks: Large Scale Surface Survey Using GPS Technology Jarrod Burks and Dawn Walter Gagliano................................................97 The Survey Area ................................................................................98 Survey Methodology .............................................................................99 Survey Results ...................................................................................99 The Surface Data: A Siteless Approach .................................................103 Discussion and Conclusion .........................................................................106 Notes ...................................................................................................107 Chapter 8 Hopewellian Centers in Context: Investigations In and Around the Hopeton Earthworks Bret J. Ruby And Mark J. Lynott .................................................................109 Surface Survey ......................................................................................110 Redwing Site ...........................................................................................111 Comparisons .........................................................................................118 Conclusions ......................................................................................122 Chapter 9 Searching for Hopewell Settlements: The Triangle Site at the Hopeton Earthworks Mark Lynott ...................................................................................... 125 Field Investigations ............................................................................127 Geophysical Survey ............................................................................128 1998 Season ....................................................................................128 Features, Artifacts and Radiocarbon Dating ........................................130 Animal Remains ...............................................................................137 Plant Remains ................................................................................138 Interpretations ..............................................................................139 Chapter 10 Geophysical Investigations at the Hopeton Earthworks John Weymouth, Bruce Bevan, and Rinita Dalan ...............................145 The Cesium Gradiometer Survey ...........................................................146 Cesium Gradiometer Results ...................................................................146 Geoscan Instrument Surveys ..............................................................148 Comparison of Cesium Magnetic and Resistance Data ........................148 Small Circles...........................................................................................149 Trench Excavations ...................................................................................149 Discussion ................................................................................................152 Conclusions ......................................................................................157 Chapter 11 Archeological and Geoarcheological Study of the Rectangular Enclosure at the Hopeton Works Mark J. Lynott and Rolfe D. Mandel ......................................................159 The Study of the Rectangular Earthwork ................................................161 Geophysical Survey ..............................................................................163 Trench Excavations .............................................................................164 Chronology ........................................................................................170 Geoarcheological Analysis of Trench 1 .................................................172 Interpretations ................................................................................174 Chapter 12 Ohio Hopewell Ritual Craft Production Katherine A. Spielmann ............................................................ 179Raw Material Procurement ....................................................................180 Hopewell Crafting ................................................................................181 Deposition ...........................................................................................186 Conclusions ....................................................................................188 References Cited .....................................................................................................18

Experimental Comparison of Neutrino and Muon Velocities

The velocities of neutrinos and muons originating from π+ and K+ decays have been compared using the California Institute of Technology-Fermilab detector in a narrow-band neutrino beam. A time-of-flight comparison between positive muons and neutrinos, as indicated by the final-state negative muons in neutrino interactions, yields |βν-βμ|<~0.4×10-3 (99% confidence level). We assume that |1-βμ|<10-5 for these muons

Ex vivo drug response profiling detects recurrent sensitivity patterns in drug-resistant acute lymphoblastic leukemia

Drug sensitivity and resistance testing on diagnostic leukemia samples should provide important functional information to guide actionable target and biomarker discovery. We provide proof of concept data by profiling 60 drugs on 68 acute lymphoblastic leukemia (ALL) samples mostly from resistant disease in cocultures of bone marrow stromal cells. Patient-derived xenografts retained the original pattern of mutations found in the matched patient material. Stromal coculture did not prevent leukemia cell cycle activity, but a specific sensitivity profile to cell cycle-related drugs identified samples with higher cell proliferation both in vitro and in vivo as leukemia xenografts. In patients with refractory relapses, individual patterns of marked drug resistance and exceptional responses to new agents of immediate clinical relevance were detected. The BCL2inhibitor venetoclax was highly active below 10 nM in B-cell precursor ALL (BCP-ALL) subsets, including MLL-AF4 and TCF3-HLF ALL, and in some T-cell ALLs (T-ALLs), predicting in vivo activity as a single agent and in combination with dexamethasone and vincristine. Unexpected sensitivity to dasatinib with half maximal inhibitory concentration values below 20 nM was detected in 2 independent T-ALL cohorts, which correlated with similar cytotoxic activity of the SRC inhibitor KX2-391 and inhibition of SRC phosphorylation. A patient with refractory T-ALL was treated with dasatinib on the basis of drug profiling information and achieved a 5-month remission. Thus, drug profiling captures disease-relevant features and unexpected sensitivity to relevant drugs, which warrants further exploration of this functional assay in the context of clinical trials to develop drug repurposing strategies for patients with urgent medical needs.Peer reviewe

KCNQ2 R144 variants cause neurodevelopmental disability with language impairment and autistic features without neonatal seizures through a gain-of-function mechanism

Prior studies have revealed remarkable phenotypic heterogeneity in KCNQ2-related disorders, correlated with effects on biophysical features of heterologously expressed channels. Here, we assessed phenotypes and functional properties associated with KCNQ2 missense variants R144W, R144Q, and R144G. We also explored in vitro blockade of channels carrying R144Q mutant subunits by amitriptyline

NeuroGrid: recording action potentials from the surface of the brain.

Recording from neural networks at the resolution of action potentials is critical for understanding how information is processed in the brain. Here, we address this challenge by developing an organic material-based, ultraconformable, biocompatible and scalable neural interface array (the 'NeuroGrid') that can record both local field potentials(LFPs) and action potentials from superficial cortical neurons without penetrating the brain surface. Spikes with features of interneurons and pyramidal cells were simultaneously acquired by multiple neighboring electrodes of the NeuroGrid, allowing for the isolation of putative single neurons in rats. Spiking activity demonstrated consistent phase modulation by ongoing brain oscillations and was stable in recordings exceeding 1 week's duration. We also recorded LFP-modulated spiking activity intraoperatively in patients undergoing epilepsy surgery. The NeuroGrid constitutes an effective method for large-scale, stable recording of neuronal spikes in concert with local population synaptic activity, enhancing comprehension of neural processes across spatiotemporal scales and potentially facilitating diagnosis and therapy for brain disorders

De novo mutations of KIAA2022 in females cause intellectual disability and intractable epilepsy

Background Mutations in the KIAA2022 gene have been reported in male patients with X-linked intellectual disability, and related female carriers were unaffected. Here, we report 14 female patients who carry a heterozygous de novo KIAA2022 mutation and share a phenotype characterised by intellectual disability and epilepsy. Methods Reported females were selected for genetic testing because of substantial developmental problems and/or epilepsy. X-inactivation and expression studies were performed when possible. Results All mutations were predicted to result in a frameshift or premature stop. 12 out of 14 patients had intractable epilepsy with myoclonic and/or absence seizures, and generalised in 11. Thirteen patients had mild to severe intellectual disability. This female phenotype partially overlaps with the reported male phenotype which consists of more severe intellectual disability, microcephaly, growth retardation, facial dysmorphisms and, less frequently, epilepsy. One female patient showed completely skewed X-inactivation, complete absence of RNA expression in blood and a phenotype similar to male patients. In the six other tested patients, X-inactivation was random, confirmed by a non-significant twofold to threefold decrease of RNA expression in blood, consistent with the expected mosaicism between cells expressing mutant or normal KIAA2022 alleles. Conclusions Heterozygous loss of KIAA2022 expression is a cause of intellectual disability in females. Compared with its hemizygous male counterpart, the heterozygous female disease has less severe intellectual disability, but is more often associated with a severe and intractable myoclonic epilepsy

Subsequent Surgery After Revision Anterior Cruciate Ligament Reconstruction: Rates and Risk Factors From a Multicenter Cohort

BACKGROUND: While revision anterior cruciate ligament reconstruction (ACLR) can be performed to restore knee stability and improve patient activity levels, outcomes after this surgery are reported to be inferior to those after primary ACLR. Further reoperations after revision ACLR can have an even more profound effect on patient satisfaction and outcomes. However, there is a current lack of information regarding the rate and risk factors for subsequent surgery after revision ACLR. PURPOSE: To report the rate of reoperations, procedures performed, and risk factors for a reoperation 2 years after revision ACLR. STUDY DESIGN: Case-control study; Level of evidence, 3. METHODS: A total of 1205 patients who underwent revision ACLR were enrolled in the Multicenter ACL Revision Study (MARS) between 2006 and 2011, composing the prospective cohort. Two-year questionnaire follow-up was obtained for 989 patients (82%), while telephone follow-up was obtained for 1112 patients (92%). If a patient reported having undergone subsequent surgery, operative reports detailing the subsequent procedure(s) were obtained and categorized. Multivariate regression analysis was performed to determine independent risk factors for a reoperation. RESULTS: Of the 1112 patients included in the analysis, 122 patients (11%) underwent a total of 172 subsequent procedures on the ipsilateral knee at 2-year follow-up. Of the reoperations, 27% were meniscal procedures (69% meniscectomy, 26% repair), 19% were subsequent revision ACLR, 17% were cartilage procedures (61% chondroplasty, 17% microfracture, 13% mosaicplasty), 11% were hardware removal, and 9% were procedures for arthrofibrosis. Multivariate analysis revealed that patients aged <20 years had twice the odds of patients aged 20 to 29 years to undergo a reoperation. The use of an allograft at the time of revision ACLR (odds ratio [OR], 1.79; P = .007) was a significant predictor for reoperations at 2 years, while staged revision (bone grafting of tunnels before revision ACLR) (OR, 1.93; P = .052) did not reach significance. Patients with grade 4 cartilage damage seen during revision ACLR were 78% less likely to undergo subsequent operations within 2 years. Sex, body mass index, smoking history, Marx activity score, technique for femoral tunnel placement, and meniscal tearing or meniscal treatment at the time of revision ACLR showed no significant effect on the reoperation rate. CONCLUSION: There was a significant reoperation rate after revision ACLR at 2 years (11%), with meniscal procedures most commonly involved. Independent risk factors for subsequent surgery on the ipsilateral knee included age <20 years and the use of allograft tissue at the time of revision ACLR