An inevitable wave of prescription drug monitoring programs in the context of prescription opioids: pros, cons and tensions

BACKGROUND: In an effort to control non-medical use and/or medical abuse of prescription drugs, particularly prescription opioids, electronic prescription drug monitoring programs (PDMP) have been introduced in North-American countries, Australia and some parts of Europe. Paradoxically, there are simultaneous pressures to increase opioid prescribing for the benefit of individual patients and to reduce it for the sake of public health, and this pressure warrants a delicate balance of appropriate therapeutic uses of these drugs with the risk of developing dependence. This article discusses pros and cons of PDMP in reducing diversion of prescription opioids, without hampering access to those medications for those with genuine needs, and highlights tensions around PDMP implementation. DISCUSSION: PDMPs may help alleviate diversion, over-prescription and fraudulent prescribing/dispensing; prompt drug treatment referrals; avoid awkward drug urine test; and inform spatial changes in prescribing practices and help designing tailored interventions. Fear of legal retribution, privacy and data security, potential confusion about addiction and pseudo-addiction, and potential undue pressure of detecting misuse/diversion - are the major problems. There are tensions about unintended consequence of excessive regulatory enforcements, corresponding collateral damages particularly about inadequate prescribing for patients with genuine needs, and mandatory consultation requirements of PDMP. SUMMARY: In this era of information technology PDMP is likely to flourish and remain with us for a long time. A clear standard of practice against which physicians' care will be judged may expedite the utilisation of PDMP. In addition, adequate training on addiction and pain management along with public awareness, point-of-supply data entry from pharmacy, point-of-care real-time access to data, increasing access to addiction treatment and appropriate regulatory enforcement preferably through healthcare administration, together, may help remove barriers to PDMP use

Geology of the Northern Part of the Ortiz Mountains, Santa Fe County, New Mexico

The northern part of the Ortiz Mountains of north-central New Mexico consists of a tilted fault block of Cretaceous Mancos shale and Mesaverde formation intruded by latite-andesite porphyry sills and laccoliths and a nepheline-bearing augite manzonite stock. Igneous activity started with the development of a volcanic vent in what is now the central part of the mountains. Volcanic debris from the vent want removed from the area by erosion and provided sedimentary material for the late [ ] Espinaso volcanics of the adjoining areas. Intrusion of the latite-andesite porphyry sills and laccolite followed extrusive igneous activity, as demonstrated by the fact that porphyritic rocks intrude the Espinaso volcanics in the adjacent areas. Igneous acitivity was concluded by the intrusion of the nepheline-bearing augite monzonite which cuts across the earlier rocks. Normal faulting along the eastern border of the adjoining Rio Grande depression uplifted the area in the late Pliocene or early Pleistocene time

Giant Electron-hole Charging Energy Asymmetry in Ultra-short Carbon Nanotubes

Making full usage of bipolar transport in single-wall carbon nanotube (SWCNT) transistors could permit the development of two-in-one quantum devices with ultra-short channels. We report on clean $\sim$10 to 100 nm long suspended SWCNT transistors which display a large electron-hole transport asymmetry. The devices consist of naked SWCNT channels contacted with sections of SWCNT-under-annealed-gold. The annealed gold acts as an n-doping top gate which creates nm-sharp barriers at the junctions between the contacts and naked channel. These tunnel barriers define a single quantum dot (QD) whose charging energies to add an electron or a hole are vastly different ($e-h$ charging energy asymmetry). We parameterize the $e-h$ transport asymmetry by the ratio of the hole and electron charging energies $\eta_{e-h}$. We show that this asymmetry is maximized for short channels and small band gap SWCNTs. In a small band gap SWCNT device, we demonstrate the fabrication of a two-in-one quantum device acting as a QD for holes, and a much longer quantum bus for electrons. In a 14 nm long channel, $\eta_{e-h}$ reaches up to 2.6 for a device with a band gap of 270 meV. This strong $e-h$ transport asymmetry survives even at room temperature

The relationship between cell size and cell fate in Volvox carteri

In Volvox carteri development, visibly asymmetric cleavage divisions set apart large embryonic cells that will become asexual reproductive cells (gonidia) from smaller cells that will produce terminally differentiated somatic cells. Three mechanisms have been proposed to explain how asymmetric division leads to cell specification in Volvox: (a) by a direct effect of cell size (or a property derived from it) on cell specification, (b) by segregation of a cytoplasmic factor resembling germ plasm into large cells, and (c) by a combined effect of differences in cytoplasmic quality and cytoplasmic quantity. In this study a variety of V. carteri embryos with genetically and experimentally altered patterns of development were examined in an attempt to distinguish among these hypotheses. No evidence was found for regionally specialized cytoplasm that is essential for gonidial specification. In all cases studied, cells with a diameter > approximately 8 microns at the end of cleavage--no matter where or how these cells had been produced in the embryo--developed as gonidia. Instructive observations in this regard were obtained by three different experimental interventions. (a) When heat shock was used to interrupt cleavage prematurely, so that presumptive somatic cells were left much larger than they normally would be at the end of cleavage, most cells differentiated as gonidia. This result was obtained both with wild-type embryos that had already divided asymmetrically (and should have segregated any cytoplasmic determinants involved in cell specification) and with embryos of a mutant that normally produces only somatic cells. (b) When individual wild-type blastomeres were isolated at the 16-cell stage, both the anterior blastomeres that normally produce two gonidia each and the posterior blastomeres that normally produce no gonidia underwent modified cleavage patterns and each produced an average of one large cell that developed as a gonidium. (c) When large cells were created microsurgically in a region of the embryo that normally makes only somatic cells, these large cells became gonidia. These data argue strongly for a central role of cell size in germ/soma specification in Volvox carteri, but leave open the question of how differences in cell size are actually transduced into differences in gene expression

Response to Teladorsagia circumcincta infection in Scottish Blackface lambs with divergent phenotypes for nematode resistance

peer-reviewedThe objective of this study was to identify Scottish Blackface lambs that were at the extremes of the spectrum of resistance to gastrointestinal nematodes and characterise their response to an experimental nematode challenge. Lambs (n = 90) were monitored for faecal egg count (FEC) (2 samples from each of 2 independent natural infections). The most resistant (n = 10) and susceptible (n = 10) individuals were selected and challenged with 30,000 Teladorsagia circumcincta larvae (L3) at 9 months of age. Response to infection was monitored by measuring FEC, plasma pepsinogen, serum antibodies against nematode larval antigens and haematology profile, until necropsy at 71 days post infection. Worm burden, worm fecundity and the level of anti-nematode antibodies in abomasal mucosa were determined at necropsy. FEC was consistently higher in susceptible animals (P < 0.05), validating the selection method. Worm fecundity was significantly reduced in resistant animals (P = 0.03). There was also a significant correlation (r = 0.88; P < 0.001) between the number of adult worms and FEC at slaughter. There was no effect of phenotype (resistance/susceptibility) on plasma pepsinogen or on haematology profile. Phenotype had a significant effect on the level of anti-nematode IgA antibodies in serum (P < 0.01), reflecting a higher peak in resistant animals at day 7 post infection. It is concluded that significant variation in the response to gastrointestinal nematode challenge exists within the Scottish Blackface population with resistant animals displaying significantly lower FEC, lower worm fecundity and higher concentration of anti-nematode IgA antibodies in serum.Kathryn McRae was supported by a Teagasc Walsh fellowship and the Allan and Grace Kay Overseas Scholarship

Adolescents' attitudes toward talking about books: Implications for educators

Young people's frequency of engagement in reading books for pleasure markedly decreases as they move through the schooling years, reducing their exposure to this beneficial literacy practice. Young people's perceptions of the value of reading can be socially mediated, and positive perception of the value of reading is associated with frequency of engagement in reading. As such, considering how to generate positive social interactions around reading is an important concern when seeking to increase young people's reading frequency. We sought to investigate adolescents' attitudes toward talking about books in order to identify reasons for engagement in discussion about books, as well as factors that constrained engagement in such discussions, with a view to informing best practice for educators seeking to engage adolescents in reading. The findings suggest that adolescents' enjoyment of discussion about books may be related to common interests, enjoyment of discussion to facilitate critical exploration and comprehension, and the possibilities provided for recommendations and access. Adolescents' interests in and ability to engage in book discussions was shaped by mutual text exposure, opportunity, personal preference, disinterested peers and social status maintenance. Findings are considered in relation to classroom practice; the formation of Special Interest Reading Groups within the classroom is considered

International Legal Scholarship in Canada

International law scholarship in Canada is largely limited to a small group of decentralized writers facing a vast and ill-defined field. In those areas in which significant work has been undertaken - the law of the sea, for example - Canadian scholarship is limited by a commitment to a national perspective rather than a recognition of the interests of the global community. The work is largely descriptive, and avoids a deeper theoretical analysis. International law is seen as a fringe discipline, and is presently unable to support the specialized effort necessary to produce the fundamental research that is badly needed if the significance of the area is to be recognize