Which substitution pharmacotherapy is most effective in treating opioid dependence?

The document attached has been archived with permission from the editor of the Medical Journal of Australia.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

Scaling Experiments on the Dynamics and Acoustics of Travelling Bubble Cavitation

Ceccio and Brennen (1991 and 1989) recently examined the interaction between individual cavitation bubbles and the structure of the boundary layer and flow field in which the bubble is growing and collapsing. They were able to show that individual bubbles are often fissioned by the fluid shear and that this process can significantly effect the acoustic signal produced by the collapse. More recently Kumar and Brennen (1991-1992) have closely examined further statistical properties of the acoustical signals from individual cavitation bubbles on two different headforms in order to learn more about the bubble/flow interactions. All of these experiments were, however, conducted in the same facility with the same size of headform (5.08cm in diameter) and over a fairly narrow range of flow velocities (around 9m/s). Clearly this raises the issue of how the phenomena identified change with speed, scale and facility. The present paper describes experiments conducted in order to try to answer some of these important questions regarding the scaling of the cavitation phenomena. The experiments were conducted in the Large Cavitation Channel of the David Taylor Research Center in Memphis Tennessee, on similar Schiebe headforms which are 5.08, 25.4 and 50.8cm in diameter for speeds ranging up to 15m/s and for a range of cavitation numbers

Maintenance drugs to treat opioid dependence

Extent: 5p.Michael Farrell, Alex Wodak and Linda Gowin

Pharmacotherapies for cannabis withdrawal

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

Characterisation of LV myocardial exercise function by 2-D strain deformation imaging in elite adolescent footballers

This is the final version. Available on open access from Springer via the DOI in this recordPurpose: Few data exist on the descriptions of LV myocardial mechanics and reserve during dynamic exercise of adolescent athletes. The aim of this study was to describe the LV myocardial and cardiopulmonary changes during exercise using 2-D strain deformation imaging. Methods: Elite adolescent male football players (n = 42) completed simultaneous cardiopulmonary exercise testing (CPET) and exercise echocardiography measurement of LV myocardial deformation by 2-D strain imaging. LV longitudinal and circumferential 2-D strain and strain rates were analyzed at each stage during incremental exercise to a work rate of 150 W. Additionally, exercise LV myocardial deformation and its relation to metabolic exercise parameters were evaluated at each exercise stage and in recovery using repeated measures ANOVA, linear regression and paired t tests. Results: LV peak systolic baseline 2-D strain (longitudinal: − 15.4 ± 2.5%, circumferential: − 22.5 ± 3.1%) increased with each exercise stage, but longitudinal strain plateaued at 50 W (mean strain reserve − 7.8 ± 3.0) and did not significantly increase compared to subsequent exercise stages (P > 0.05), whilst circumferential strain (mean strain reserve − 11.6 ± 3.3) significantly increased (P < 0.05) throughout exercise up to 150 W as the dominant mechanism of exercise LV contractility increase. Regression analyses showed LV myocardial strain increased linearly relative to HR, VO2 and O2 pulse (P < 0.05) for circumferential deformation, but showed attenuation for longitudinal deformation. Conclusion: This study describes LV myocardial deformation dynamics by 2-D strain and provides reference values for LV myocardial strain and strain rate during exercise in adolescent footballers. It found important differences between LV longitudinal and circumferential myocardial mechanics during exercise and introduces a methodology that can be used to quantify LV function and cardiac reserve during exercise in adolescent athletes.National Institute for Health Research (NIHR

TESSA: A toolkit for rapid assessment of ecosystem services at sites of biodiversity conservation importance

Sites that are important for biodiversity conservation can also provide significant benefits (i.e. ecosystem services) to people. Decision-makers need to know how change to a site, whether development or restoration, would affect the delivery of services and the distribution of any benefits among stakeholders. However, there are relatively few empirical studies that present this information. One reason is the lack of appropriate methods and tools for ecosystem service assessment that do not require substantial resources or specialist technical knowledge, or rely heavily upon existing data. Here we address this gap by describing the Toolkit for Ecosystem Service Site-based Assessment (TESSA). It guides local non-specialists through a selection of relatively accessible methods for identifying which ecosystem services may be important at a site, and for evaluating the magnitude of benefits that people obtain from them currently, compared with those expected under alternative land-uses. The toolkit recommends use of existing data where appropriate and places emphasis on enabling users to collect new field data at relatively low cost and effort. By using TESSA, the users could also gain valuable information about the alternative land-uses; and data collected in the field could be incorporated into regular monitoring programmes

The State-Moro Armed Conflict in the Philippines: Unresolved national question or question of governance?

The continuing struggle of the Moro secessionist movement in the Philippines is one of Southeast Asia’s longest armed conflicts. The tenacity of the conflict lies in two competing concerns: the assertion of self-determination rights of the Moro separatist movement; and the affirmation of the Philippines’ sovereign right to territorial integrity. However, beneath these rights are crucial issues that remain unanswered both by the contending forces—problems where internecine violence and conflict emanate from. This article argues that self-determination rights can be adequately exercised by people who have clearly defined their national identity and concept of a nation. Unfortunately, the Moro multi-ethnic national identity has yet to be crystallised while the idea of a Bangsamoro (Bangsa Nation) remains weak. On the other hand, the state has yet to address the Moros’ legitimate demands of political autonomy, socio-economic development, and social justice and discrimination. Without underestimating the ethnic component of secessionism, the article concludes that poor governance has prolonged, complicated, and further justified the Moros’ quest to secede from the Republic