Identification Of Stimulant Misuse And Malingering Of Symptoms Of Attention Deficit Hyperactivity Disorder

It was estimated in 2013 that 54.3 million individuals reported overall lifetime prevalence of prescription drug abuse, and 16.7 million individuals reported misusing or abusing prescription drugs in the past year. This study focuses on the abuse of psychostimulants, popularly used for treatment of Attention Deficit Hyperactivity Disorder (ADHD). It is estimated that 10 to 30% of college students might be abusing stimulants, mostly for academic purposes. The incidence of stimulant related ER visits has nearly doubled in the last decade. It is also estimated that 10 to 50% of ADHD evaluations in a University setting might be exaggerated or malingered. This study, in three parts, explored the feasibility of identification of prescription stimulant abuse using large databases, developed a subtle behavioral self-reported scale, the Subtle ADHD Malingering Screener (SAMS), for use in the primary care setting to identify malingering among individuals reporting symptoms of ADHD, and compared the sensitivity of the SAMS to other existing scales. The first paper identified two latent classes in the stimulant user population based on risk factors for abuse identified from literature. The second paper developed a 10-item 2-factor screener instrument, the SAMS, with satisfactory reliability and factorial validity. The third paper calculated a cut-off score for the SAMS, and estimated a sensitivity of 90.3% and a specificity of 80.1% toward malingering of ADHD symptoms. This dissertation pursued innovative methods to help in the early identification of prescription stimulant abusers and malingerers, in order to reduce overdiagnosis of ADHD, and abuse of prescription stimulants

Phase ambiguity of the threshold amplitude in pp -> pp\pi^0

Measurements of spin observables in pp -> {\vec p}{\vec p}\pi^0 are suggested to remove the phase ambiguity of the threshold amplitude. The suggested measurements complement the IUCF data on {\vec p}{\vec p} -> pp\pi^0 to completely determine all the twelve partial wave amplitudes, taken into consideration by Mayer et.al. [15] and Deepak, Haidenbauer and Hanhart [20].Comment: 4 pages, 1 table

Patterns of Treatment for Psychiatric Disorders Among Children and Adolesecents in Mississippi Medicaid

The nature of services for psychiatric disorders in public health systems has been understudied, particularly with regard to frequency, duration, and costs. The current study examines patterns of service reception and costs among Medicaid-covered youth newly diagnosed with anxiety, depression, or behavioral disturbance in a large data set of provider billing claims submitted between 2015–2016. Eligibility criteria included: 1) identification of an initial diagnosis of a single anxiety, unipolar mood, or specific behavioral disorder; 2) continuous Medicaid eligibility over the duration of the time period studied; and 3) under 18 years of age on the date of initial psychiatric diagnosis. The final cohort included 7,627 cases with a mean age of 10.65 (±4.36), of which 58.04% were male, 57.09% were Black, 38.97% were White, and 3.95% were of other ethnicities. Data indicated that 65.94% of the cohort received at least some follow-up services within a median 18 days of diagnosis. Of those, 54.27% received a combination of medical and psychosocial services, 32.01% received medical services only, and 13.72% received psychosocial services only. Overall median costs for direct treatment were $576.69, with wide discrepancies between the lowest (anxiety =$308.41) and highest (behavioral disturbance = $653.59) diagnostic categories. Across all categories the frequency and duration of psychosocial services were much lower than would be expected in comparison to data from a well-known effectiveness trial. Overall, follow-up to psychiatric diagnosis could be characterized as highly variable, underutilized, and emphasizing biomedical treatment. Understanding more about these patterns may facilitate systematic improvements and greater cost efficiency in the future

Do Formulation and Dose of Long-Term Opioid Therapy Contribute to Risk of Adverse Events among Older Adults?

Background: Chronic non-cancer pain (CNCP) is highly prevalent in older adults and long-term opioid therapy (LTOT) has been used to manage chronic pain. However, the safety of LTOT among older adults with CNCP is not well-established and there is a need to identify therapy-related risk factors of opioid-related adverse events among older adults. Objective: To evaluate the relationship between opioid dose and formulation and the risk of opioid-related adverse events among Medicare-eligible older adults on LTOT. Design: Nested case-control study. Participants: Older Medicare beneficiaries (N=35,189) who received \u3e 3 opioid prescriptions with a total days-supply of \u3e45 days within a 90-day period for CNCP between 2012 and 2016. Main Measures: This study utilized Medicare 5% medical and prescription claims data. Outcome measures included opioid-induced respiratory depression (OIRD), opioid overdose, all-cause mortality, and a composite outcome, defined as the first occurrence of any of the previous three events. Key independent variables were opioid formulation and opioid dose (measured in morphine milligram equivalents (MME)) prescribed during LTOT. Key Results: Seventy-four OIRD, 133 overdose, 982 all-cause mortality, and 1122 composite outcome events were observed during follow-up. In unadjusted analyses, the use of combination opioids (OR: 4.52 [95%CI: 1.51–13.47]) was significantly associated with OIRD compared to short-acting (SA) opioids. In adjusted analyses, opioid-related adverse events were significantly associated with the use of LA (overdose OR: 13.00 [95%CI: 1.30–130.16] and combination opioids (overdose OR: 6.27 [95%CI: 1.91–20.55]; mortality OR: 2.75 [95%CI: 1.87–4.04]; composite OR: 2.82 [95%CI: 2.01–3.96]) when compared to SA opioids. When compared to an average dose of less than 20 MME, outcomes were significantly associated with doses of 20–50 MME (mortality OR: 1.61 [95%CI: 1.24–2.10]; composite OR: 1.59 [95%CI: 1.26–2.01]) and \u3e50 MME (mortality OR: 1.99 [95%CI: 1.28–3.10]; composite OR: 2.09 [95%CI: 1.43–3.04]). Conclusions: Older adults receiving medically prescribed opioids at higher doses and those using LA and combination of LA and SA opioids are at increased risks for opioid-related adverse events, highlighting the need for close patient supervision

Prevalence of and factors associated with violations of a campus smoke-free policy: A cross-sectional survey of undergraduate students on a university campus in the USA

© 2020 Author(s). Objective: The aim of this study is to estimate the prevalence of smoking behaviour on campus and to identify the key factors that influence adherence to a campus smoke-free policy. Design & participants: This study employed a cross-sectional, self-administered survey of undergraduate students at University of Mississippi. A random sample of all available undergraduate classes was recruited for data collection. Students were provided a survey that included questions on demographics, alcohol use, smoking status, policy awareness, policy attitudes, smoking attitudes, policy support, barriers to policy success and policy violations. Results: The prevalence of past 30-day smoking was 23%. More than 63% of current smokers report ever smoking on campus, but less than 10% ever received a warning or a ticket for their violation. Nearly all respondents (92.5%) reported witnessing someone smoking on campus, and 22% reported witnessing someone receiving a ticket. Barriers to policy success include lack of reminders about the policy, lack of support from students and University administrators, and insufficient fines. Smoking behaviour (OR: 7.96; 95% CI: 5.13 to 12.36), beliefs about policy adherence (OR: 0.52; 95% CI: 0.40 to 0.69), support for the policy (OR: 0.71; 95% CI: 0.55 to 0.91) and attitudes against smoking behaviour (OR: 0.35; 95% CI: 0.25 to 0.49) were all significantly associated with self-reported policy violations. Conclusions: This study found that violations of the campus smoke-free policy were fairly frequent and the policy has been largely ineffective, indicating a need for other interventions. Approaches to improve adherence to the policy should address barriers such as reminders about the policy, better policy enforcement and support from the administration

Powder microscopic, physicochemical and chromatographic approach for the quality control of anti-hypertensive drug Rattha Piththathirku Kudinir Chooranam

The present work aims to study powder microscopy, physicochemical and high-performance thin-layer chromatography photo documentation and fingerprint profiles of a Siddha drug, Rattha Piththathirku Kudinir Chooranam (RPK). The raw drugs were collected, authenticated and the RPK was prepared. Then the drug was investigated for powder microscopic characters, physicochemical parameters, Thin Layer Chromatographic photo documentation (TLC), High-Performance Thin-Layer Chromatographic (HPTLC) fingerprint profiles of successive n-hexane, successive chloroform, successive ethanol and hydro alcohol (1:1) extracts. The successive and hydro alcohol extracts of the drug displayed distinct TLC spots and HPTLC peaks which are distinct to this drug

Under what circumstances are physicians prescribing anti-psychotics to our children?

The Physician and Patient Factors influencing the prescription of a typical anti-phychotics and children with mental health disorder

Chemical Standards and HPTLC Finger Print Profiles of a Siddha Polyherbal Formulation - Kadukkai Legiyam

To study physico-chemical, phytochemical and high performance thin layer chromatography of a Siddha drug “Kadukkai Legiyam” (KL). The prepared Kadukkai Legiyam (KL) was prepared as per the standard operating procedures mentioned in literature. Then the drug was subjected to physicochemical parameters, phytochemical screening, thin layer chromatographic photo documentation (TLC), high performance thin layer chromatographic (HPTLC) finger print profile of hexane, chloroform, ethanol and hydro alcohol (1:1) extracts.  Different extracts of the drug showed distinct TLC and HPTLC finger print patterns which will be unique to this drug. This study giving information about physiochemical and phytochemical analysis and HPTLC fingerprint profile of different extracts, the integration spectrum which will useful in standardizing the raw drugs and future comparison studies