Methadone‐Assisted Opiate Withdrawal and Subsequent Heroin Abstinence: The Importance of Psychological Preparedness

This is the peer reviewed version of the following article: Jones, S., Jack, B., Kirby, J., Wilson, T., Murphy, P. (2020). Methadone‐Assisted Opiate Withdrawal and Subsequent Heroin Abstinence: The Importance of Psychological Preparedness, 30(1), 11-20., which has been published in final form at https://doi.org/10.1111/ajad.13062. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self-ArchivingBackground and Objectives: Treatment guidelines emphasize patients’ readiness for transitioning from opiate substitution treatment (OST) to opiate withdrawal and abstinence. Psychological preparedness indicators for this transition were examined. Methods: Patients (all male) were recruited from three treatment settings: prison, an inpatient detoxification unit, and an outpatient clinic. Time 1 (T1) was admission to methadone‐assisted withdrawal in all settings. Time 2 (T2) was a 6‐month follow‐up. With n = 24 at T1 for each group (N = 72), a battery of instruments relevant to psychological preparedness was administered. Results: At T1, inpatients had higher self‐efficacy beliefs for successful treatment completion than prison patients. For patients contactable at T2, T1 self‐efficacy positively predicted T2 opiate abstinence. No other variable improved prediction. T1 SOCRATES (Stages of Change Readiness and Treatment Eagerness Scale) ambivalence scores, age, and lifetime heroin use duration predicted maintenance of contact or not with treatment services and contactability by the researcher. Measures of mood did not differ between groups at T1 or predict T2 outcomes. Discussion and Conclusions: Self‐efficacy beliefs are a potentially useful indicator of readiness for transitioning from OST to a medically assisted opiate withdrawal and subsequent abstinence. Ambivalence regarding change, age, and lifetime heroin use duration are potentially useful predictors of patients maintaining contact with services, and of being retained in research. Scientific Significance: These findings advance existing literature and knowledge by highlighting the importance of self‐efficacy in psychological preparedness for opiate abstinence, and the predictive utility to clinicians of this and other variables measurable at admission, in the clinical management of opiate user

All the queen's horses: statutory authority and HS2

This article focuses on the potential impact of the statutory authority defence on HS2 once the line is put into operation. The defence was forged in the heat of the railway revolution. It protects operators from liability in nuisance in respect of certain harms resulting from exercising the statutory powers under which the scheme is authorised. However, the nineteenth century case law established that the defence would only operate in respect of harms which are the inevitable consequence of using those powers. In common with its Victorian forebears, the HS2 project has been authorised by way of an Act of Parliament. Arguably, the HS2 Act is one of the longest, most detailed and highly scrutinised pieces of legislation in history. Nevertheless, it is argued that the scheme may cause uncompensated losses which are not inevitable. In this respect common law actions may yet have an important role to play

Impact of the COVID‐19 pandemic on Creutzfeldt–Jakob disease surveillance and patient care in the United Kingdom

BACKGROUND AND PURPOSE: Creutzfeldt–Jakob disease (CJD) is lethal and transmissible. We assessed the impact of the COVID‐19 pandemic on UK CJD surveillance. We hypothesized that (i) disruptions prolonged diagnostic latency; (ii) autopsy rates declined; and (iii) COVID‐19 infection negatively affected diagnosis, care, and survival. METHODS: We retrospectively investigated the first year of the pandemic, using the preceding year as a comparator, quantifying numbers of individuals assessed by the UK National CJD Research & Surveillance Unit for suspected CJD, time to diagnosis, disease duration, and autopsy rates. We evaluated the impact of COVID‐19 status on diagnosis, care, and survival in CJD. RESULTS: A total of 148 individuals were diagnosed with CJD in the pandemic (from a total of 166 individuals assessed) compared to 141 in the comparator (from 145 assessed). No differences were identified in disease duration or time to diagnosis. Autopsy rates were unchanged. Twenty individuals had COVID‐19; 60% were symptomatic, and 10% had severe disease. Disruptions in diagnosis and care were frequently identified. Forty percent of COVID‐19‐positive individuals died; however, COVID‐19 status did not significantly alter survival duration in CJD. CONCLUSIONS: The COVID‐19 pandemic has not impacted UK CJD case ascertainment or survival, but diagnostic evaluation and clinical care of individuals have been affected

Drug withdrawal in the epilepsy monitoring unit – The patsalos table

Investigation of possible candidates for epilepsy surgery will usually require inpatient EEG to capture seizures and allow full operative planning. Withdrawal of antiepileptic drugs increases the yield of this valuable diagnostic information and the benefits of this should justify any increase in the risk of harm associated with these seizures This paper outlines our opinion on what would constitute proposed best practice for management of antiepileptic drug (AED) dosing when patients are admitted for monitoring of seizures to an epilepsy monitoring unit (EMU). In the vast majority of cases EMU admissions are safe and, even if seizures occur, will pass off without complication. Previous guidance has concentrated on ensuring practice around technical aspects of EEG monitoring itself and staffing within the unit. In this guidance we aim to outline optimally safe ways of ensuring that EMUs ensure the minimisation of risk to the patients admitted under their care. We propose an algorithm for enhancing the safety of AED withdrawal in VT admissions while ensuring adequate seizure yields. Risk minimisation requires planned management of drug dosing (with reduction if appropriate), provision of adequate rescue medication, and adequate supervision to allow rapid response to generalised seizures. This algorithm is accompanied by a table which uses knowledge of the clinical and pharmacological properties of each AED to ensure dose withdrawal and reduction is timely and safe taking into account the severity and frequency of the individual’s seizures

The Hubble Space Telescope Survey of M31 Satellite Galaxies. III. Calibrating the Horizontal Branch as an Age Indicator for Nearby Galaxies

We present a new method for measuring the mean age of old/intermediate stellar populations in resolved, metal-poor ($\rm \langle[Fe/H]\rangle \lesssim -1.5$) galaxies using only the morphology of the horizontal branch (HB) and an estimate of the average metallicity. We calculate the ratio of blue-to-red HB stars and the mass-weighted mean ages of 27 M31 satellite galaxies that have star formation histories (SFHs) measured from Hubble Space Telescope-based color-magnitude diagrams (CMDs) that include the oldest Main Sequence Turn-off (MSTO) ages. We find a strong correlation between mean age, metallicity, and HB morphology, for stellar populations older than $\sim6$~Gyr. The correlation allows us to predict a galaxy's mean age from its HB morphology to a precision of $\lesssim 1$~Gyr. We validate our method by recovering the correct ages of Local Group galaxies that have robust MSTO-based ages and are not in our calibration sample. We also use our technique to measure the mean ages of isolated field galaxies KKR25 ($11.21^{+0.70}_{-0.65}$~Gyr) and VV124 ($11.03^{+0.73}_{-0.68}$~Gyr), which indicate that their main star formation episodes may have lasted several Gyr and support the picture that they achieved their early-type characteristics (e.g., low gas content, low star formation activity) in isolation and not through environment. Because the HB is $\sim80\times$ brighter than the oldest MSTO, our method can provide precise characteristic ages of predominantly old galaxies at distances $\sim 9$ times farther. We provide our calibrations in commonly used HST/ACS filters.Comment: 21 pages, 13 figures, 5 tables, submitted to Ap

Entrepreneurial characteristics in SMEs: a rural and remote rural perspective of Lincolnshire businesses [part 2]

Businesses located within remote areas have better‐developed skills and characteristics, which may be termed entrepreneurial in nature. Rural businesses have a better understanding of their customer needs and requirements. SMEs do not see themselves as different in any way from other businesse

Exile Vol. XXIII No. 2

PROSE The End of East by Libby Thomas 3-12 Lilt by Andrew Calabrese 13 The Egg Lady by Nancy Jones 14-20 The International Man by Chip Finefrock 21-31 MUSIC Theme and Variations Op.2, No 1. by J. J. Fuerst 32-38 POETRY Thrown Out Of The Game by Herberto Padilla to Yannis Ritzos in a Greek jail (Translated from the Spanish by José de Armas) 39 Plumb-Creek In Late Sunlight by Lenore Mayhew 40 untitled by Sharon Singleton 41 untitled by Sharon Singleton 42 A Dance Of Stones by Lawrence Weber 43-44 Carp and Crane by William McNaughton 45 Mountain Ash by Dawn Patnode 46-49 untitled by Mary de Rachewiltz 50 Kai Gar Onar Ek Dios Estin by William McNaughton 51 acute angles by Gay Parks 52 Annihilating All Made To A Thought by Tony Stoneburner 53 Dead Fish by Deneise Deter 54 Changing by Deb Allbery 54 Finish Lines by David A. Goldblatt 55 Malinche\u27s Sister by Tona Dickerson 56 Tarde en el hospital by Carlos Peoza Veliz 57 Afternoon in the Hospital by Carlos Peoza Veliz (Tanslated from the Spanish by Joan Straub) 57 Cuadrados Y Angulos by Alfonaina Storni 58 Squares and Angles by Alfonaina Storni (Translated from the Spanish by Joan Straub) 58 INK DRAWINGS untitled by Susan Hoagman 2 Self-Portrait or Darla by Julia Weatherford 59 untitled by Katy Booth 70 ESSAYS On As For Poets by Gary Snyder 60-61 Joseph Heller\u27s Something Happened and the Problem of Community in Modern America by Jack Kirby 62-68 EDITOR\u27S NOTE by Lawrence Weber 69-70 CONTRIBUTORS 71-72 The cover ink drawing by Cathy Ries is entitled, Exercise In Exaggerated Contours

The JWST Resolved Stellar Populations Early Release Science Program VI. Identifying Evolved Stars in Nearby Galaxies

We present an investigation of evolved stars in the nearby star-forming galaxy WLM, using NIRCam imaging from the JWST resolved stellar populations early-release science (ERS) program. We find that various combinations of the F090W, F150W, F250M, and F430M filters can effectively isolate red supergiants (RSGs) and thermally-pulsing asymptotic giant branch (TP-AGB) stars from one another, while also providing a reasonable separation of the primary TP-AGB subtypes: carbon-rich C-type stars and oxygen-rich M-type stars. The classification scheme we present here agrees very well with the well-established Hubble Space Telescope (HST) medium-band filter technique. The ratio of C to M-type stars (C/M) is 0.8$\pm$0.1 for both the new JWST and the HST classifications, which is within one sigma of empirical predictions from optical narrow-band CN and TiO filters. The evolved star colors show good agreement with the predictions from the PARSEC$+$COLIBRI stellar evolutionary models, and the models indicate a strong metallicity dependence that makes stellar identification even more effective at higher metallicity. However, the models also indicate that evolved star identification with NIRCam may be more difficult at lower metallicies. We test every combination of NIRCam filters using the models and present additional filters that are also useful for evolved star studies. We also find that $\approx$90\% of the dusty evolved stars are carbon-rich, suggesting that carbonaceous dust dominates the present-day dust production in WLM, similar to the findings in the Magellanic Clouds. These results demonstrate the usefulness of NIRCam in identifying and classifying dust-producing stars without the need for mid-infrared data.Comment: 15 page, 12 figures, submitted to AAS Journal