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

ACQUIRED STRYCHNINE TOLERANCE BY POCKET GOPHERS

Four adult female Botta\u27s pocket gophers (Thomomys bottae) that had survived many normally potentially lethal doses of strychnine alkaloid in another experiment (Lee 1986) were examined further. These individuals freely consumed 0.5% strychnine bait, and 3 of them also 1% strychnine bait, for long periods without dying, whether or not nontoxic alternate bait was present. After 1 gopher (#5) was taken off its 1% strychnine wheat diet for 44 days, it lost its physiological tolerance to strychnine and died the first day when again exposed to a free choice of nontoxic and 1% strychnine wheat. It consumed only 7 mg/kg of strychnine before dying, whereas another gopher (#42) was able to survive on a mean daily consumption of 275.8 mg/kg of strychnine in a no-choice situation over a period of 28 days. This is almost 40 times the lethal dose of the other animal

DSM-5 criteria for substance use disorders: recommendations and rationale.

Since DSM-IV was published in 1994, its approach to substance use disorders has come under scrutiny. Strengths were identified (notably, reliability and validity of dependence), but concerns have also arisen. The DSM-5 Substance-Related Disorders Work Group considered these issues and recommended revisions for DSM-5. General concerns included whether to retain the division into two main disorders (dependence and abuse), whether substance use disorder criteria should be added or removed, and whether an appropriate substance use disorder severity indicator could be identified. Specific issues included possible addition of withdrawal syndromes for several substances, alignment of nicotine criteria with those for other substances, addition of biomarkers, and inclusion of nonsubstance, behavioral addictions.This article presents the major issues and evidence considered by the work group, which included literature reviews and extensive new data analyses. The work group recommendations for DSM-5 revisions included combining abuse and dependence criteria into a single substance use disorder based on consistent findings from over 200,000 study participants, dropping legal problems and adding craving as criteria, adding cannabis and caffeine withdrawal syndromes, aligning tobacco use disorder criteria with other substance use disorders, and moving gambling disorders to the chapter formerly reserved for substance-related disorders. The proposed changes overcome many problems, while further studies will be needed to address issues for which less data were available

Effects of halofenate and probenecid on serum lipids and uric acid in hyperlipidemic, hyperuricemic adults

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/117081/1/cpt1977223340.pd

Totally Magic Graphs

A total labeling of a graph with v vertices and e edges is defined as a one-to-one map taking the vertices and edges onto the integers 1, 2, · · · , v+e. Such a labeling is vertex magic if the sum of the label on a vertex and the labels on its incident edges is a constant independent of the choice of vertex, and edge magic if the sum of an edge label and the labels of the endpoints of the edge is constant. In this paper we examine graphs possessing a labeling that is simultaneously vertex magic and edge magic. Such graphs appear to be rare

Loss to Follow-Up from HIV Screening to ART Initiation in Rural China.

BackgroundPatients who are newly screened HIV positive by EIA are lost to follow-up due to complicated HIV testing procedures. Because this is the first step in care, it affects the entire continuum of care. This is a particular concern in rural China.Objective(s)To assess the routine HIV testing completeness and treatment initiation rates at 18 county-level general hospitals in rural Guangxi.MethodsWe reviewed original hospital HIV screening records. Investigators also engaged with hospital leaders and key personnel involved in HIV prevention activities to characterize in detail the routine care practices in place at each county.Results699 newly screened HIV-positive patients between January 1 and June 30, 2013 across the 18 hospitals were included in the study. The proportion of confirmatory testing across the 18 hospitals ranged from 14% to 87% (mean of 43%), and the proportion of newly diagnosed individuals successfully initiated antiretroviral treatment across the hospitals ranged from 3% to 67% (mean of 23%). The average interval within hospitals for individuals to receive the Western Blot (WB) and CD4 test results from HIV positive screening (i.e. achieving testing completion) ranged from 14-116 days (mean of 41.7 days) across the hospitals. The shortest interval from receiving a positive EIA screening test result to receiving WB and CD4 testing and counseling was 0 day and the longest was 260 days.ConclusionThe proportion of patients newly screened HIV positive that completed the necessary testing procedures for HIV confirmation and received ART was very low. Interventions are urgently needed to remove barriers so that HIV patients can have timely access to HIV/AIDS treatment and care in rural China