Selective review and commentary on emerging pharmacotherapies for opioid addiction.

Pharmacotherapies for opioid addiction under active development in the US include lofexidine (primarily for managing withdrawal symptoms) and Probuphine®, a distinctive mode of delivering buprenorphine for six months, thus relieving patients, clinicians, and regulatory personnel from most concerns about diversion, misuse, and unintended exposure in children. In addition, two recently approved formulations of previously proven medications are in early phases of implementation. The sublingual film form of buprenorphine + naloxone (Suboxone®) provides a less divertible, more quickly administered, more child-proof version than the buprenorphine + naloxone sublingual tablet. The injectable depot form of naltrexone (Vivitrol®) ensures consistent opioid receptor blockade for one month between administrations, removing concerns about medication compliance. The clinical implications of these developments have attracted increasing attention from clinicians and policymakers in the US and around the world, especially given that human immunodeficiency virus/acquired immunodeficiency syndrome and other infectious diseases are recognized as companions to opioid addiction, commanding more efforts to reduce opioid addiction. While research and practice improvement efforts continue, reluctance to adopt new medications and procedures can be expected, especially considerations in the regulatory process and in the course of implementation. Best practices and improved outcomes will ultimately emerge from continued development efforts that reflect input from many quarters

An Army Transformed: The U.S. Army\u27s Post-Vietnam Recovery and the Dynamics of Change in Military Organizations

During the 2 decades preceding the Persian Gulf War in 1991, the U.S. Army went through tremendous reform and rejuvenation. In explaining this important case of military change, this paper makes four central arguments. First, leaders within military organizations are essential; external developments most often have an indeterminate impact on military change. Second, military reform is about more than changing doctrine. To implement its doctrine, an organization must have appropriate training practices, personnel policies, organizations, equipment, and leader development programs. Third, the implementation of comprehensive change requires an organizational entity with broad authority able to craft, evaluate, and execute an integrated program of reforms. In the case of the U.S. Army in the 1970s and 1980s, this organization was the U.S. Army Training and Doctrine Command (TRADOC). To an unprecedented degree, TRADOC was able to ensure that changes in personnel policies, organizations, doctrine, training practices, and equipment were integrated and mutually reinforcing. Fourth and finally, the process of developing, implementing, and institutionalizing complementary reforms can take several decades. While today’s demands differ from those of the past, this report suggests questions that may be useful in thinking about change today. Knowing the answers to these questions would enable informed judgment about the prospects for the successful implementation of a program of reforms. The consequences, for good or for ill, could be quite significant in terms of resources, lives, and the national interest.https://press.armywarcollege.edu/monographs/1342/thumbnail.jp

Trends and characteristics of accidental and intentional codeine overdose deaths in Australia

Examines trends in codeine-related mortality rates in Australia, and the clinical and toxicological characteristics of codeine-related deaths. Abstract Objectives: To examine trends in codeine-related mortality rates in Australia, and the clinical and toxicological characteristics of codeine-related deaths. Design and setting: Analysis of prospectively collected data from the National Coronial Information System on deaths where codeine toxicity was determined to be an underlying or contributory cause of death. The study period was 2000–2013. Main outcome measures: Population-adjusted numbers (per million persons) of (1) codeine-related deaths, classified by intent (accidental or intentional); and (2) heroin- and Schedule 8 opioid-related deaths (as a comparator). Results: The overall rate of codeine-related deaths increased from 3.5 per million in 2000 to 8.7 per million in 2009. Deaths attributed to accidental overdoses were more common (48.8%) than intentional deaths (34.7%), and their proportion increased during the study period. High rates of prior comorbid mental health (53.6%), substance use (36.1%) and chronic pain (35.8%) problems were recorded for these deaths. For every two Schedule 8 opioid-related deaths in 2009, there was one codeine-related death. Most codeine-related deaths (83.7%) were the result of multiple drug toxicity. Conclusions: Codeine-related deaths (with and without other drug toxicity) are increasing as the consumption of codeine-based products increases. Educational messages are needed to better inform the public about the potential harms of chronic codeine use, especially in the context of polypharmacy

The ageing society: analyzing the coverage of the population ageing in a Belgian quality newspaper

This study has examined how the ‘Ageing Society’ -a society with a rapidly ageing population, a growing share of older persons and a decreasing share of younger persons- and its implications for the Belgian population are represented in the Belgian quality newspaper De Standaard (2011-2013). As such, the study delivered first-time Belgian empirical findings about the coverage of the Ageing Society. For most people, media are a central information source and an important factor in their opinion building. It is therefore highly important to increase the knowledge regarding the Ageing Society-media coverage they are provided with, and will possibly act upon. The study has applied a mixed methods approach. First, a qualitative content analysis inductively identified the labels and frames in the Ageing Society-coverage. Subsequently the frequencies of these labels and frames have been assessed. This two-step approach allowed identifying new labels and frames while considering their individual importance in the coverage as well. The Ageing Society mostly appeared in the newspaper De Standaard as a threat for the public budget, labour market and health- and social systems. The newspaper dominantly applied political- and economic frames to cover the Ageing Society, and hence established the Ageing Society mainly as a political-economic concern. Frequently applied as well in the coverage of the Ageing Society was the health frame. To a much lesser extent, the Ageing Society was also framed in terms of education and awareness. Several Ageing Society-related topics appeared seldom in the coverage; e.g. the (non- financial) contributions of older persons to society, the connectedness between the various generations, the implications of the Ageing Society for the individual and the human-made element in population ageing. Also, the dominant normative perspective of the Ageing Society as threat for the welfare state excluded other, more positive perspectives. Such perspectives could nevertheless complement the existing coverage by exploring the opportunities of the Ageing Society, and reporting about alternative policies to address its implications. The policies to address the Ageing Society were critically reflected upon in the newspaper’s comments and opinion articles. Most of these opinionating articles nevertheless did not attribute responsibility to specific persons or instances deemed accountable for addressing the Ageing Society. Sources for the Ageing Society-coverage in De Standaard were mainly professional experts, such as politicians or researchers. Other potential non-professional expert sources, such as representatives from the civil society, communities or individual (possibly ageing) persons were less represented. The research findings and theoretical insights have been translated into journalistic recommendations for a more varied and balanced media coverage of the Ageing Society

Cluster state quantum computing in optical fibers

A scheme for the implementation of the cluster state model of quantum computing in optical fibers, which enables the feedforward feature, is proposed. This scheme uses the time-bin encoding of qubits. Following previously suggested methods of applying arbitrary one-qubit gates in optical fibers, two different ways for the realization of fusion gate types I and II for cluster production are proposed: a fully time-bin based encoding scheme and a combination of time-bin and polarization based encoding scheme. Also the methods of measurement in any desired bases for the purpose of the processing of cluster state computing for both these encodings are explained.Comment: 6 pages, 11 figures, submitted to the Optical Quantum-Information Science focus issue of JOSA

Preschoolers’ Psychosocial Problems: In the Eyes of the Beholder? Adding Teacher Characteristics as Determinants of Discrepant Parent–Teacher Reports

In this study, we explored informant characteristics as determinants of parent–teacher disagreement on preschoolers’ psychosocial problems. Teacher characteristics were included in the analyses, in addition to child and parent factors. Psychosocial problems of 732 4-year olds from a Norwegian community sample were assessed by parents and teachers (CBCL-TRF). Furthermore, teachers reported on their education, experience and relationship to the child. Parental stress and psychopathology were also measured. Teachers rated children considerably lower than their parents did, especially on internalizing problems. When teachers rated more child problems, this was strongly associated with conflict in the teacher–child relationship, which predicted disagreement more than other factors. The highest agreement was on boys’ externalizing problems. Girls’ behavior was rated much lower by teachers than boys’ behavior compared to parents’ ratings. Possible teacher perception biases are discussed, such as teacher–child conflict, non-identification of internalizing problems, and same-gender child preference

Risk of discharge against medical advice among hospital inpatients with a history of opioid agonist therapy in New South Wales, Australia:a cohort study and nested crossover-cohort analysis

BACKGROUND: People who use illicit opioids have high rates of hospital admission. We aimed to measure the risk of discharge against medical advice among inpatients with a history of opioid agonist therapy (OAT), and test whether OAT is associated with lower risk of discharge against medical advice. METHODS: We conducted a cohort study including all emergency hospital admissions between 1 August 2001 and 30 April 2018 in New South Wales, Australia, among patients with a previous episode of OAT in the community. The main outcome was discharge against medical advice, and the main exposure was whether patients had an active OAT permit at the time of admission. RESULTS: 14,035/116,957 (12.0%) admissions ended in discharge against medical advice. Admissions during periods of OAT had 0.79 (0.76-0.83; p<0.001) times the risk of discharge against medical advice, corresponding to an absolute risk reduction of 3.3 percentage points. Risk of discharge against medical advice was higher among patients who were younger, male, identified as Aboriginal and/or Torres Strait Islanders, admitted for accidents, drug-related reasons, or injecting-related injuries (such as cutaneous abscesses), and those discharged at the weekend. In a subsample of 7,793 patients included in a crossover-cohort analysis, OAT was associated with 0.84 (95% CI 0.76-0.93; p<0.001) times the risk of discharge against medical advice. CONCLUSIONS: Among patients with a history of OAT, one in eight emergency hospital admissions ends in discharge against medical advice. OAT enrolment at the time of admission is associated with a reduction of this risk