Medication Assisted Treatment: Experiences from the Field

The use of heroin and other opiates has increased considerably in recent years with many users becoming involved with the criminal justice system. Because of this growth, the use of medication assisted treatment is becoming increasingly popular in courts that specialize in opiate addictions. This paper analyzes the experiences of treatment teams in courts that specialize in providing medication assisted treatment. Overall, perceptions of medication assisted treatment were positive although service providers identified some limitations. Recognizing the benefits and limitations of medication assisted treatment is useful for social work practice that focuses on opiate addictions because heroin use continues to rise

Heme metabolism genes Downregulated in COPD Cachexia.

IntroductionCachexia contributes to increased mortality and reduced quality of life in Chronic Obstructive Pulmonary Disease (COPD) and may be associated with underlying gene expression changes. Our goal was to identify differential gene expression signatures associated with COPD cachexia in current and former smokers.MethodsWe analyzed whole-blood gene expression data from participants with COPD in a discovery cohort (COPDGene, N = 400) and assessed replication (ECLIPSE, N = 114). To approximate the consensus definition using available criteria, cachexia was defined as weight-loss > 5% in the past 12 months or low body mass index (BMI) (< 20 kg/m2) and 1/3 criteria: decreased muscle strength (six-minute walk distance < 350 m), anemia (hemoglobin < 12 g/dl), and low fat-free mass index (FFMI) (< 15 kg/m2 among women and < 17 kg/m2 among men) in COPDGene. In ECLIPSE, cachexia was defined as weight-loss > 5% in the past 12 months or low BMI and 3/5 criteria: decreased muscle strength, anorexia, abnormal biochemistry (anemia or high c-reactive protein (> 5 mg/l)), fatigue, and low FFMI. Differential gene expression was assessed between cachectic and non-cachectic subjects, adjusting for age, sex, white blood cell counts, and technical covariates. Gene set enrichment analysis was performed using MSigDB.ResultsThe prevalence of COPD cachexia was 13.7% in COPDGene and 7.9% in ECLIPSE. Fourteen genes were differentially downregulated in cachectic versus non-cachectic COPD patients in COPDGene (FDR < 0.05) and ECLIPSE (FDR < 0.05).DiscussionSeveral replicated genes regulating heme metabolism were downregulated among participants with COPD cachexia. Impaired heme biosynthesis may contribute to cachexia development through free-iron buildup and oxidative tissue damage

Near-Earth initiation of a terrestrial substorm

Despite the characterization of the auroral substorm more than 40 years ago, controversy still surrounds the processes triggering substorm onset initiation. That stretching of the Earth's magnetotail following the addition of new nightside magnetic flux from dayside reconnection powers the substorm is well understood; the trigger for explosive energy release at substorm expansion phase onset is not. Using ground-based data sets with unprecedented combined spatial and temporal coverage, we report the discovery of new localized and contemporaneous magnetic wave and small azimuthal scale auroral signature of substorm onset. These local auroral arc undulations and magnetic field signatures rapidly evolve on second time scales for several minutes in advance of the release of the auroral surge. We also present evidence from a conjugate geosynchronous satellite of the concurrent magnetic onset in space as the onset of magnetic pulsations in the ionosphere, to within technique error. Throughout this time period, the more poleward arcs that correspond to the auroral oval which maps to the central plasma sheet remain undisturbed. There is good evidence that flows from the midtail crossing the plasma sheet can generate north-south auroral structures, yet no such auroral forms are seen in this event. Our observations present a severe challenge to the standard hypothesis that magnetic reconnection in stretched magnetotail fields triggers onset, indicating substorm expansion phase initiation occurs on field lines that are close to the Earth, as bounded by observations at geosynchronous orbit and in the conjugate ionosphere

The GLY2019SER Mutation in LRRK2 is Not Fully Penetrant in Familial Parkinson\u27s Disease: the GenePD Study

Background: We report age-dependent penetrance estimates for leucine-rich repeat kinase 2 (LRRK2)-related Parkinson\u27s disease (PD) in a large sample of familial PD. The most frequently seen LRRK2 mutation, Gly2019Ser (G2019S), is associated with approximately 5 to 6% of familial PD cases and 1 to 2% of idiopathic cases, making it the most common known genetic cause of PD. Studies of the penetrance of LRRK2 mutations have produced a wide range of estimates, possibly due to differences in study design and recruitment, including in particular differences between samples of familial PD versus sporadic PD. Methods: A sample, including 903 affected and 58 unaffected members from 509 families ascertained for having two or more PD-affected members, 126 randomly ascertained PD patients and 197 controls, was screened for five different LRRK2 mutations. Penetrance was estimated in families of LRRK2 carriers with consideration of the inherent bias towards increased penetrance in a familial sample. Results: Thirty-one out of 509 families with multiple cases of PD (6.1%) were found to have 58 LRRK2 mutation carriers (6.4%). Twenty-nine of the 31 families had G2019S mutations while two had R1441C mutations. No mutations were identified among controls or unaffected relatives of PD cases. Nine PD-affected relatives of G2019S carriers did not carry the LRRK2 mutation themselves. At the maximum observed age range of 90 to 94 years, the unbiased estimated penetrance was 67% for G2019S families, compared with a baseline PD risk of 17% seen in the non-LRRK2-related PD families. Conclusion: Lifetime penetrance of LRRK2 estimated in the unascertained relatives of multiplex PD families is greater than that reported in studies of sporadically ascertained LRRK2 cases, suggesting that inherited susceptibility factors may modify the penetrance of LRRK2 mutations. In addition, the presence of nine PD phenocopies in the LRRK2 families suggests that these susceptibility factors may also increase the risk of non-LRRK2-related PD. No differences in penetrance were found between men and women, suggesting that the factors that influence penetrance for LRRK2 carriers are independent of the factors which increase PD prevalence in men

A review of selected research priority setting processes at national level in low and middle income countries: towards fair and legitimate priority setting

<p>Abstract</p> <p>Background</p> <p>It is estimated that more than $130 billion is invested globally into health research each year. Increasingly, there is a need to set priorities in health research investments in a fair and legitimate way, using a sound and transparent methodology. In this paper we review selected priority setting processes at national level in low and middle income countries. We outline a set of criteria to assess the process of research priority setting and use these to describe and evaluate priority setting exercises that have taken place at country level. Based on these insights, recommendations are made regarding the constituents of a good priority setting process.</p> <p>Methods</p> <p>Data were gathered from presentations at a meeting held at the World Health Organization (WHO) in 2008 and a web-based search. Based on this literature review a number of criteria were developed to evaluate the priority setting processes.</p> <p>Results</p> <p>Across the countries surveyed there was a relative lack of genuine stakeholder engagement; countries varied markedly in the extent to which the priority setting processes were documented; none of the countries surveyed had a systematic or operational appeals process for outlined priorities; and in all countries (except South Africa) the priorities that were outlined described broad disease categories rather than specific research questions.</p> <p>Conclusions</p> <p>Country level priority setting processes differed significantly in terms of the methods used. We argue that priority setting processes must have in-built mechanisms for publicizing results, effective procedures to enforce decisions as well as processes to ensure that the revision of priorities happens in practice.</p

High-fidelity quantum driving

The ability to accurately control a quantum system is a fundamental requirement in many areas of modern science such as quantum information processing and the coherent manipulation of molecular systems. It is usually necessary to realize these quantum manipulations in the shortest possible time in order to minimize decoherence, and with a large stability against fluctuations of the control parameters. While optimizing a protocol for speed leads to a natural lower bound in the form of the quantum speed limit rooted in the Heisenberg uncertainty principle, stability against parameter variations typically requires adiabatic following of the system. The ultimate goal in quantum control is to prepare a desired state with 100% fidelity. Here we experimentally implement optimal control schemes that achieve nearly perfect fidelity for a two-level quantum system realized with Bose-Einstein condensates in optical lattices. By suitably tailoring the time-dependence of the system's parameters, we transform an initial quantum state into a desired final state through a short-cut protocol reaching the maximum speed compatible with the laws of quantum mechanics. In the opposite limit we implement the recently proposed transitionless superadiabatic protocols, in which the system perfectly follows the instantaneous adiabatic ground state. We demonstrate that superadiabatic protocols are extremely robust against parameter variations, making them useful for practical applications.Comment: 17 pages, 4 figure

It's more than low BMI: prevalence of cachexia and associated mortality in COPD

Background: Cachexia is associated with increased mortality risk among chronic obstructive pulmonary disease (COPD) patients. However, low body mass index (BMI) as opposed to cachexia is often used, particularly when calculating the BODE (BMI, Obstruction, Dyspnea and Exercise) index. For this reason, we examined mortality using a consensus definition and a weight-loss definition of cachexia among COPD cases and compared two new COPD severity indices with BODE. Methods: In the current report, the consensus definition for cachexia incorporated weight-loss > 5% in 12-months or low BMI in addition to 3/5 of decreased muscle strength, fatigue, anorexia, low FFMI and inflammation. The weight-loss definition incorporated weight-loss > 5% or weight-loss > 2% (if low BMI) in 12-months. The low BMI component in BODE was replaced with the consensus definition to create the CODE (Consensus cachexia, Obstruction, Dyspnea and Exercise) index and the weight-loss definition to create the WODE (Weight loss, Obstruction, Dyspnea and Exercise) index. Mortality was assessed using Kaplan-Meier survival and Cox Regression. Performance of models was compared using C-statistics. Results: Among 1483 COPD cases, the prevalences of cachexia by the consensus and weight-loss definitions were 4.7 and 10.4%, respectively. Cachectic patients had a greater than three-fold increased mortality by either the consensus or the weight-loss definition of cachexia independent of BMI and lung function. The CODE index predicted mortality slightly more accurately than the BODE and WODE indices. Conclusions: Cachexia is associated with increased mortality among COPD patients. Monitoring cachexia using weight-loss criteria is relatively simple and predictive of mortality among COPD cases who may be missed if only low BMI is used

Scientific Opportunities with an X-ray Free-Electron Laser Oscillator

An X-ray free-electron laser oscillator (XFELO) is a new type of hard X-ray source that would produce fully coherent pulses with meV bandwidth and stable intensity. The XFELO complements existing sources based on self-amplified spontaneous emission (SASE) from high-gain X-ray free-electron lasers (XFEL) that produce ultra-short pulses with broad-band chaotic spectra. This report is based on discussions of scientific opportunities enabled by an XFELO during a workshop held at SLAC on June 29 - July 1, 2016Comment: 21 pages, 12 figure

The ethics of practical reasoning : exploring the terrain

Social work has been under sustained scrutiny regarding the quality of decision-making. The assumption is that social workers make poor quality decisions. And yet our knowledge and understanding of how social workers make decisions is, at best, partial. In our view, examination of practitioner decision-making will be enhanced by considering the role that ethics plays in practical judgement in practice. Although there has been significant work regarding the role of values and ethics in practice, this work tends to idealise morality setting up external standards by which practice is judged. In this paper, we will argue that ethics in practice needs to be understood as more than simply operationalise ideal standards, ethics also entails critical engagement with social and ethical issues and can challenge idealised statements of values. We outline the idea of the ethical dimension of practical reasoning, consider its relationship to professional discretion, judgments and decision-making in order to provide a clear focus for this research agenda, and identify the practical challenges researching ethics in professional decision-making entails