Sample records for abuse liability assessment

  1. Guidelines and methodological reviews concerning drug abuse liability assessment.

    PubMed

    Balster, Robert L; Bigelow, George E

    2003-06-05

    Regulatory control of drugs with abuse liability is an important component of drug control policy and is believed to help prevent nonmedical use. To be maximally effective, this requires a scientific assessment of abuse liability of drugs considered for regulatory control. These assessments have relied extensively on laboratory-based animal and human testing, but also utilize information from clinical trials, actual abuse and other sources. Here, we discuss recommendations and guidelines that have been proposed for abuse liability assessment and describe important review papers and conference proceedings that have addressed this matter, focusing primarily on drugs with medical usefulness. Historically, there is substantial consensus about how to approach abuse liability evaluation of drugs with actions similar to those of abused opiates, stimulants, depressants, and to a somewhat lesser extent, cannabinoids and hallucinogens, and much of what has been recommended for abuse potential assessment in the past remains valid and useful. On the other hand, novel CNS-active medications which cannot be readily classified with these traditional drugs of abuse are increasingly under development. In addition, advances in the science of abuse liability assessment need to be incorporated into future guidelines and recommendations on this subject. Developers of new medications need guidance on how to utilize scientific research to maximize therapeutic benefit while minimizing risk for abuse. Thus, another goal of this review has been to identify areas where critical thinking and new guideline development are needed.

  2. Principles of laboratory assessment of drug abuse liability and implications for clinical development

    PubMed Central

    Carter, Lawrence P.; Griffiths, Roland R.

    2009-01-01

    Abuse liability testing plays an important role in informing drug development, regulatory processes, and clinical practice. This paper describes the current “gold standard” methodologies that are used for laboratory assessments of abuse liability in non-human and human subjects. Particular emphasis is given to procedures such as non-human drug discrimination, self-administration, and physical dependence testing, and human dose effect abuse liability studies that are commonly used in regulatory submissions to governmental agencies. The potential benefits and risks associated with the inclusion of measures of abuse liability in industry-sponsored clinical trials is discussed. Lastly, it is noted that many factors contribute to patterns of drug abuse and dependence outside of the laboratory setting and positive or negative signals in abuse liability studies do not always translate to high or low levels of actual abuse or dependence. Well-designed patient and physician education, pharmacovigilance, and postmarketing surveillance can reduce the diversion and misuse of drugs with abuse liability and can effectively foster the protection and promotion of public health. PMID:19443137

  3. Assessment of substance abuse liability in rodents: self-administration, drug discrimination, and locomotor sensitization.

    PubMed

    Paterson, Neil E

    2012-09-01

    Assessing abuse liability is a crucial step in the development of a novel chemical entity (NCE) with central nervous system (CNS) activity or with chemical or pharmacological properties in common with known abused substances. Rodent assessment of abuse liability is highly attractive due to its relatively low cost and high predictive validity. Described in this unit are three rodent assays commonly used to provide data on the potential for abuse liability based on the acute effects of NCEs: specifically, self-administration, drug discrimination, and locomotor sensitization. As these assays provide insight into the potential abuse liability of NCEs as well as in vivo pharmacological mechanism(s) of action, they should form a key part of the development process for novel therapeutics aimed at treating CNS disorders.

  4. Human abuse liability assessment of oxycodone combined with ultra-low-dose naltrexone.

    PubMed

    Tompkins, David Andrew; Lanier, Ryan K; Harrison, Joseph A; Strain, Eric C; Bigelow, George E

    2010-07-01

    Prescription opioid abuse has risen dramatically in the United States as clinicians have increased opioid prescribing for alleviation of both acute and chronic pain. Opioid analgesics with decreased risk for abuse are needed. Preclinical and clinical studies have shown that opioids combined with ultra-low-dose naltrexone (NTX) may have increased analgesic potency and have suggested reduced abuse or dependence liability. This study addressed whether addition of ultra-low-dose naltrexone might decrease the abuse liability of oxycodone (OXY) in humans. This double-blind, placebo-controlled study systematically examined the subjective and physiological effects of combining oral OXY and ultra-low NTX doses in 14 experienced opioid abusers. Seven acute drug conditions given at least 5 days apart were compared in a within-subject crossover design: placebo, OXY 20 mg, OXY 40 mg, plus each of the active OXY doses combined with 0.0001 and 0.001 mg NTX. The methods were sensitive to detecting opioid effects on abuse liability indices, with significant differences between all OXY conditions and placebo as well as between 20 and 40 mg OXY doses on positive subjective ratings (e.g., "I feel a good drug effect" or "I like the drug"), on observer- and participant-rated opioid agonist effects, and on a drug-versus-money value rating. There were no significant differences or evident trends associated with the addition of either NTX dose on any abuse liability indices. The addition of ultra-low-dose NTX to OXY did not decrease abuse liability of acutely administered OXY in experienced opioid abusers.

  5. Abuse liability assessment of an e-cigarette refill liquid using intracranial self-stimulation and self-administration models in rats

    PubMed Central

    LeSage, MG; Staley, M; Muelken, P; Smethells, JR; Stepanov, I; Vogel, RI; Pentel, PR; Harris, AC

    2016-01-01

    Background The popularity of electronic cigarettes (ECs) has increased dramatically despite their unknown health consequences. Because the abuse liability of ECs is one of the leading concerns of the Food and Drug Administration (FDA), models to assess it are urgently needed to inform FDA regulatory decisions regarding these products. The purpose of this study was to assess the relative abuse liability of an EC liquid compared to nicotine alone in rats. Because this EC liquid contains non-nicotine constituents that may enhance its abuse liability, we hypothesized that it would have greater abuse liability than nicotine alone. Methods Nicotine alone and nicotine dose-equivalent concentrations of EC liquid were compared in terms of their acute effects on intracranial self-stimulation (ICSS) thresholds, acquisition of self-administration, reinforcing efficacy (i.e., elasticity of demand), blockade of these behavioral effects by mecamylamine, nicotine pharmacokinetics and nicotinic acetylcholine receptor binding and activation. Results There were no significant differences between formulations on any measure, except that EC liquid produced less of an elevation in ICSS thresholds at high nicotine doses. Conclusions Collectively, these findings suggest that the relative abuse liability of this EC liquid is similar to that of nicotine alone in terms of its reinforcing and reinforcement-enhancing effects, but that it may have less aversive/anhedonic effects at high doses. The present methods may be useful for assessing the abuse liability of other ECs to inform potential FDA regulation of those products. PMID:27627814

  6. Preclinical assessment of abuse liability of biologics: In defense of current regulatory control policies.

    PubMed

    Gauvin, David V; Zimmermann, Zachary J; Baird, Theodore J

    2015-10-01

    Current regulatory policies of both the US Food and Drug Administration and Drug Enforcement Administration do not delineate automatic exceptions for biologics with respect to preclinical assessments for abuse liability of all new entities. As defined in current guidance documents and drug control policies, an exception may be given upon thorough review of available data, therapeutic target and in consultation with the Controlled Substances Staff within the Center for Drug Evaluation and Research of the FDA, but a blanket exception for all biological entities is not currently available. We review the abuse liability testing of four known biologics with definitive positive abuse liability signals in the three core abuse liability assays, self-administration, drug discrimination, and dependence potential described in the FDA draft guidance document. Interestingly, while all four examplars have positive abuse liability signals in all three assays, two of these biologics are controlled under the Comprehensive Drug Abuse and Control Act (CSA, 1970) and the other two are not currently controlled. Admittedly, these four biologics are small molecule entities. However, there is no reference to "molecular size" in the legally-binding statutory definition of biologics under the FD&C act or in the Controlled Substances Act. Neither of these drug control policy mandates have a bifurcated control status in which to make exceptions based solely on molecular size. With the current pharmaceutical focus on new technologies, such as "Trojan Horses", targeting the active transport of large molecule entities directly into the CNS, an argument to automatically exempt new molecular entities solely on molecular size is untenable. We argue that for the safety and health of general public the current regulatory control status be maintained until definitive criteria for exceptions can be identified and amended to both the FD&CA and CSA, if warranted. Copyright © 2015 Elsevier Inc. All

  7. Flavor improvement does not increase abuse liability of nicotine chewing gum.

    PubMed

    Houtsmuller, Elisabeth J; Fant, Reginald V; Eissenberg, Thomas E; Henningfield, Jack E; Stitzer, Maxine L

    2002-06-01

    Because the taste of nicotine gum has impeded compliance with dosing recommendations, nicotine gum with improved taste (mint, orange) was developed and marketed. Prior to marketing, the Food and Drug Administration (FDA) required a rigorous abuse liability assessment to examine whether enhanced palatability of nicotine gum would increase its abuse liability. Subjective, physiological, and psychomotor effects of mint flavor and original nicotine gum were tested in adult smokers (22-55 years old); a group of younger subjects (18-21 years old) was also included to allow for assessment of abuse liability in young adults specifically. Amphetamine and confectionery gum served as positive controls for abuse liability and palatability. Subjects rated palatability of mint gum higher than original nicotine gum, but substantially lower than confectionery gum. Palatability decreased with increasing dose of nicotine. Neither original nor mint gum increased ratings of traditional abuse liability predictors [Good Effect, Like Effect, Morphine-Benzedrine Group (MBG) scales of Addiction Research Center Inventory (ARCI)], while amphetamine increased ratings of all these measures. Both flavors of nicotine gum decreased craving during 2 h of abstinence. These effects were more pronounced in the adult group and mint gum was more effective than original gum. Younger subjects reported fewer withdrawal symptoms and lower ratings for drug effects and flavor. Improved flavor of nicotine gum does not increase abuse liability, but may be associated with enhanced craving reduction.

  8. The evaluation of the abuse liability of drugs.

    PubMed

    Johanson, C E

    1990-01-01

    In order to place appropriate restrictions upon the availability of certain therapeutic agents to limit their abuse, it is important to assess abuse liability, an important aspect of drug safety evaluation. However, the negative consequences of restriction must also be considered. Drugs most likely to be tested are psychoactive compounds with therapeutic indications similar to known drugs of abuse. Methods include assays of pharmacological profile, drug discrimination procedures, self-administration procedures, and measures of drug-induced toxicity including evaluations of tolerance and physical dependence. Furthermore, the evaluation of toxicity using behavioural end-points is an important component of the assessment, and it is generally believed that the most valid procedure in this evaluation is the measurement of drug self-administration. However, even this method rarely predicts the extent of abuse of a specific drug. Although methods are available which appear to measure relative abuse liability, these procedures are not validated for all drug classes. Thus, additional strategies, including abuse liability studies in humans, modelled after those used with animals, must be used in order to make a more informed prediction. Although there is pressure to place restrictions on new drugs at the time of marketing, in light of the difficulty of predicting relative abuse potential, a better strategy might be to market a drug without restrictions, but require postmarketing surveillance in order to obtain more accurate information on which to base a final decision.

  9. Assessment of Tapentadol API Abuse Liability With the Researched Abuse, Diversion and Addiction-Related Surveillance System.

    PubMed

    Vosburg, Suzanne K; Severtson, S Geoffrey; Dart, Richard C; Cicero, Theodore J; Kurtz, Steven P; Parrino, Mark W; Green, Jody L

    2018-04-01

    Tapentadol, a Schedule II opioid with a combination of µ-opioid activity and norepinephrine reuptake inhibition, is used for the management of moderate to severe acute and chronic pain. Its dual mechanism of action is thought to reduce opioid-related side effects that can complicate pain management. Since approval, tapentadol has been tracked across multiple outcomes suggesting abuse liability, and a pattern of relatively low, although not absent, abuse liability has been found. This retrospective cohort study further details the abuse liability of tapentadol as an active pharmaceutical ingredient (API) when immediate-release as well as extended-release formulations were on the market together (fourth quarter of 2011 to second quarter of 2016). Tapentadol (API) was compared with tramadol, hydrocodone, morphine, oxycodone, hydromorphone, and oxymorphone across Poison Center, Drug Diversion, and Treatment Center Programs Combined data streams from the Researched Abuse, Diversion and Addiction-Related Surveillance system. Findings suggest the public health burden related to tapentadol to date is low, but present. Event rates of abuse per population-level denominators were significantly lower than all other opioids examined. However, when adjusted for drug availability, event rates of abuse were lower than most Schedule II opioids studied, but were not the lowest. Disentangling these 2 sets of findings further by examining various opioid formulations, such as extended-release and the role of abuse-deterrent formulations, is warranted. This article presents the results from an examination of tapentadol API across the Researched Abuse, Diversion and Addiction-Related Surveillance System: a broad and carefully designed postmarketing mosaic. Data to date from Poison Center, Drug Diversion, and Treatment Centers combined suggest a low, but present public health burden related to tapentadol. Copyright © 2018. Published by Elsevier Inc.

  10. Pharmacodynamic and pharmacokinetic assessment of electronic cigarettes, combustible cigarettes, and nicotine gum: implications for abuse liability.

    PubMed

    Stiles, Mitchell F; Campbell, Leanne R; Graff, Donald W; Jones, Bobbette A; Fant, Reginald V; Henningfield, Jack E

    2017-09-01

    Electronic cigarettes (ECs) are becoming popular alternatives for smokers, but there has been limited study of their abuse liability. The objective of this study was to evaluate the abuse liability of three Vuse Solo ECs, ranging from 14 to 36 mg in nicotine content, relative to high- and low-abuse liability comparator products (usual brand combustible cigarettes and nicotine gum, respectively) in a group of 45 EC-naïve smokers. Enrolled subjects' ratings of subjective effects and nicotine uptake over 6 h were used to measure abuse liability and pharmacokinetics following in-clinic use of each EC. Use of Vuse Solo resulted in subjective measures and nicotine uptake that were between those of combustible cigarettes and nicotine gum, although generally closer to nicotine gum. Compared to combustible cigarettes, use of Vuse Solo resulted in significantly lower scores in measures of product liking, positive effects, and intent to use again. These pharmacodynamic findings were consistent with the pharmacokinetic data, showing that cigarettes produced substantially faster and higher levels of nicotine uptake as compared to Vuse Solo and nicotine gum. Vuse Solo resulted in more rapid initial uptake of nicotine compared to nicotine gum, but peak concentration and long-term extent of uptake were not different or were lower with Vuse. Collectively, these findings suggest that Vuse Solo likely has an abuse liability that is somewhat greater than nicotine gum but lower than cigarettes. ClinicalTrials.gov identifier: NCT02269514.

  11. Electronic cigarettes: abuse liability, topography and subjective effects.

    PubMed

    Evans, Sarah E; Hoffman, Allison C

    2014-05-01

    To review the available evidence evaluating the abuse liability, topography, subjective effects, craving and withdrawal suppression associated with e-cigarette use in order to identify information gaps and provide recommendations for future research. Literature searches were conducted between October 2012 and January 2014 using five electronic databases. Studies were included in this review if they were peer-reviewed scientific journal articles evaluating clinical laboratory studies, national surveys or content analyses. A total of 15 peer-reviewed articles regarding behavioural use and effects of e-cigarettes published between 2010 and 2014 were included in this review. Abuse liability studies are limited in their generalisability. Topography (consumption behaviour) studies found that, compared with traditional cigarettes, e-cigarette average puff duration was significantly longer, and e-cigarette use required stronger suction. Data on e-cigarette subjective effects (such as anxiety, restlessness, concentration, alertness and satisfaction) and withdrawal suppression are limited and inconsistent. In general, study data should be interpreted with caution, given limitations associated with comparisons of novel and usual products, as well as the possible effects associated with subjects' previous experience/inexperience with e-cigarettes. Currently, very limited information is available on abuse liability, topography and subjective effects of e-cigarettes. Opportunities to examine extended e-cigarette use in a variety of settings with experienced e-cigarette users would help to more fully assess topography as well as behavioural and subjective outcomes. In addition, assessment of 'real-world' use, including amount and timing of use and responses to use, would clarify behavioural profiles and potential adverse health effects.

  12. Foods are differentially associated with subjective effect report questions of abuse liability.

    PubMed

    Schulte, Erica M; Smeal, Julia K; Gearhardt, Ashley N

    2017-01-01

    The current study investigates which foods may be most implicated in addictive-like eating by examining how nutritionally diverse foods relate to loss of control consumption and various subjective effect reports. Subjective effect reports assess the abuse liabilities of substances and may similarly provide insight into which foods may be reinforcing in a manner that triggers an addictive-like response for some individuals. Cross-sectional. Online community. 507 participants (n = 501 used in analyses) recruited through Amazon MTurk. Participants (n = 501) self-reported how likely they were to experience a loss of control over their consumption of 30 nutritionally diverse foods and rated each food on five subjective effect report questions that assess the abuse liability of substances (liking, pleasure, craving, averseness, intensity). Hierarchical cluster analytic techniques were used to examine how foods grouped together based on each question. Highly processed foods, with added fats and/or refined carbohydrates, clustered together and were associated with greater loss of control, liking, pleasure, and craving. The clusters yielded from the subjective effect reports assessing liking, pleasure, and craving were most similar to clusters formed based on loss of control over consumption, whereas the clusters yielded from averseness and intensity did not meaningfully differentiate food items. The present work applies methodology used to assess the abuse liability of substances to understand whether foods may vary in their potential to be associated with addictive-like consumption. Highly processed foods (e.g., pizza, chocolate) appear to be most related to an indicator of addictive-like eating (loss of control) and several subjective effect reports (liking, pleasure, craving). Thus, these foods may be particularly reinforcing and capable of triggering an addictive-like response in some individuals. Future research is warranted to understand whether highly processed

  13. Abuse liability assessment in preclinical drug development: predictivity of a translational approach for abuse liability testing using methylphenidate in four standardized preclinical study models.

    PubMed

    Teuns, Greet B A; Geys, Helena M; Geuens, Sonja M A; Stinissen, Piet; Meert, Theo F

    2014-01-01

    Preclinical abuse liability assessment of novel clinical CNS-active candidates involves several tests, addressing different aspects characteristic for abuse potential, which are considered predictive for substance abuse of these candidates, thus ensuring an appropriate translational approach. To demonstrate how such a strategy could work, a known drug of abuse, methylphenidate was evaluated in a full rodent test battery, comprising four test models, and in accordance with the requirements of the FDA, ICH and EMA guidelines. Methylphenidate was tested orally at 2.5, 5 or 10mg/kg for its physical dependence potential in a repeated dose non-precipitated withdrawal test, for its drug profiling in a drug discrimination learning procedure (single escalating doses), and for its reinforcing properties in a conditioned place preference test (alternate dosing days) and an intravenous self-administration procedure (0.05 to 1mg/kg/IV infusion during 5 daily 1-h test sessions). The stimulant d-amphetamine served as positive control and was administered subcutaneously at 0.8mg/kg in the first three test models. In the intravenous self-administration procedure rats were habituated to intravenously self-administer d-amphetamine at 0.06mg/kg/IV infusion prior to methylphenidate substitution. Cessation of subchronic dosing up to 10mg/kg methylphenidate led to sustained or even exacerbated effects on locomotion and behavior, body temperature, body weight, food consumption, and alteration of the diurnal rhythm during withdrawal. Clear generalization to d-amphetamine was obtained in the drug discrimination test at 5 and 10mg/kg. Distinct reinforcing properties were present in the conditioned place preference test at 10mg/kg and in the intravenous self-administration study from 0.05mg/kg/IV infusion onwards. The maximum plasma exposure after oral administration of methylphenidate over the dose ranges tested in the present rat studies covered at least 1.9-fold to 18.9-fold the

  14. Abuse liability assessment of tobacco products including potential reduced exposure products.

    PubMed

    Carter, Lawrence P; Stitzer, Maxine L; Henningfield, Jack E; O'Connor, Rich J; Cummings, K Michael; Hatsukami, Dorothy K

    2009-12-01

    The harm produced by tobacco products is a result of frequent use of a highly toxic product. Reducing the adverse public health impact of tobacco products might be most effectively achieved by reducing the likelihood of their use and the toxicity of the products. Products that retain some characteristics of cigarettes but have been altered with the intention of reducing toxicity have been referred to as modified risk tobacco products or potential reduced exposure products (MRTP/PREP). Evaluation of their content, emission, and toxicity is discussed in other articles in this special issue. Here, we discuss the methodology that has been used to examine the likelihood of abuse or addiction. Abuse liability assessment (ALA) methodology has been used by the Food and Drug Administration (FDA) and other drug regulatory agencies world-wide for decades to assess the risks posed by a wide variety of pharmacologically active substances. ALA is routinely required among other evaluations of safety during the pre-market assessment of new drugs, and is continually adapted to meet the challenges posed by new drug classes and drug formulations. In the 2009 law giving FDA regulation over tobacco products, FDA is now required to evaluate new tobacco products including MRTP/PREPs to determine their risk for abuse and toxicity at the population level. This article describes the traditional tools and methods of ALA that can be used to evaluate new tobacco and nicotine products including MRTP/PREPs. Such ALA data could contribute to the scientific foundation on which future public policy decisions are based.

  15. Reinforcer Pathology: The Behavioral Economics of Abuse Liability Testing.

    PubMed

    Bickel, W K; Snider, S E; Quisenberry, A J; Stein, J S

    2017-02-01

    Understanding the abuse liability of novel drugs is critical to understanding the risk these new compounds pose to society. Behavioral economics, the integration of psychology and economics, can be used to predict abuse liability of novel substances. Here, we describe the behavioral economic concept of reinforcer pathology and how it may predict the use of novel drugs in existing drug-users and initiation of use in the drug-naive. © 2016 American Society for Clinical Pharmacology and Therapeutics.

  16. Abuse Liability and Reinforcing Efficacy of Oral Tramadol in Humans

    PubMed Central

    Babalonis, Shanna; Lofwall, Michelle R.; Nuzzo, Paul A.; Siegel, Anthony J.; Walsh, Sharon L.

    2012-01-01

    BACKGROUND Tramadol, a monoaminergic reuptake inhibitor, is hepatically metabolized to an opioid agonist (M1). This atypical analgesic is generally considered to have limited abuse liability. Recent reports of its abuse have increased in the U.S., leading to more stringent regulation in some states, but not nationally. The purpose of this study was to examine the relative abuse liability and reinforcing efficacy of tramadol in comparison to a high (oxycodone) and low efficacy (codeine) opioid agonist. METHODS Nine healthy, non-dependent prescription opioid abusers (6 male, 3 female) participated in this within-subject, randomized, double blind, placebo-controlled study. Participants completed 14 paired sessions (7 sample, 7 self-administration). During each sample session, an oral dose of tramadol (200, 400 mg), oxycodone (20, 40 mg), codeine (100, 200 mg) or placebo was administered, and a full array of abuse liability measures was collected. During self-administration sessions, volunteers were given the opportunity to work (via progressive ratio) for the sample dose or money. RESULTS All active doses were self-administered; placebo engendered no responding. The high doses of tramadol and oxycodone were readily self-administered (70%, 59% of available drug, respectively); lower doses and both codeine doses maintained intermediate levels of drug taking. All three drugs dose-dependently increased measures indicative of abuse liability, relative to placebo; however, the magnitude and time course of these and other pharmacodynamic effects varied qualitatively across drugs. CONCLUSIONS This study demonstrates that, like other mu opioids, higher doses of tramadol function as reinforcers in opioid abusers, providing new empirical data for regulatory evaluation. PMID:23098678

  17. Impact of co-administration of oxycodone and smoked cannabis on analgesia and abuse liability.

    PubMed

    Cooper, Ziva D; Bedi, Gillinder; Ramesh, Divya; Balter, Rebecca; Comer, Sandra D; Haney, Margaret

    2018-02-05

    Cannabinoids combined with opioids produce synergistic antinociceptive effects, decreasing the lowest effective antinociceptive opioid dose (i.e., opioid-sparing effects) in laboratory animals. Although pain patients report greater analgesia when cannabis is used with opioids, no placebo-controlled studies have assessed the direct effects of opioids combined with cannabis in humans or the impact of the combination on abuse liability. This double-blind, placebo-controlled, within-subject study determined if cannabis enhances the analgesic effects of low dose oxycodone using a validated experimental model of pain and its effects on abuse liability. Healthy cannabis smokers (N = 18) were administered oxycodone (0, 2.5, and 5.0 mg, PO) with smoked cannabis (0.0, 5.6% Δ 9 tetrahydrocannabinol [THC]) and analgesia was assessed using the Cold-Pressor Test (CPT). Participants immersed their hand in cold water (4 °C); times to report pain (pain threshold) and withdraw the hand from the water (pain tolerance) were recorded. Abuse-related effects were measured and effects of oxycodone on cannabis self-administration were determined. Alone, 5.0 mg oxycodone increased pain threshold and tolerance (p ≤ 0.05). Although active cannabis and 2.5 mg oxycodone alone failed to elicit analgesia, combined they increased pain threshold and tolerance (p ≤ 0.05). Oxycodone did not increase subjective ratings associated with cannabis abuse, nor did it increase cannabis self-administration. However, the combination of 2.5 mg oxycodone and active cannabis produced small, yet significant, increases in oxycodone abuse liability (p ≤ 0.05). Cannabis enhances the analgesic effects of sub-threshold oxycodone, suggesting synergy, without increases in cannabis's abuse liability. These findings support future research into the therapeutic use of opioid-cannabinoid combinations for pain.

  18. Abuse Liability Assessment of Tobacco Products Including Potential Reduced Exposure Products (PREPs)

    PubMed Central

    Carter, Lawrence P.; Stitzer, Maxine L.; Henningfield, Jack E.; O'Connor, Rich J.; Cummings, K. Michael; Hatsukami, Dorothy K.

    2009-01-01

    The harm produced by tobacco products is a result of frequent use of a highly toxic product. Reducing the adverse public health impact of tobacco products might be most effectively achieved by reducing the likelihood of their use and the toxicity of the products. Products that retain some characteristics of cigarettes, but have been altered with the intention of reducing toxicity have been referred to as modified risk tobacco products or potential reduced exposure products (MRTP/PREPS). Evaluation of their content, emission, and toxicity is discussed in other articles in this special issue. Here, we discuss the methodology that has been used to examine the likelihood of abuse or addiction. Abuse liability assessment (ALA) methodology has been used by the Food and Drug Administration (FDA) and other drug regulatory agencies world-wide for decades to assess the risks posed by a wide variety of pharmacologically active substances. ALA is routinely required among other evaluations of safety during the premarket assessment of new drugs, and is continually adapted to meet the challenges posed by new drug classes and drug formulations. In the 2009 law giving FDA regulation over tobacco products, FDA is now required to evaluate new tobacco products including MRTP/PREPs to determine their risk for abuse and toxicity at the population level. This paper describes the traditional tools and methods of ALA that can be used to evaluate new tobacco and nicotine products including MRTP/PREPs. Such ALA data could contribute to the scientific foundation on which future public policy decisions are based. PMID:19959676

  19. Assessment of the abuse liability of three menthol Vuse Solo electronic cigarettes relative to combustible cigarettes and nicotine gum.

    PubMed

    Stiles, Mitchell F; Campbell, Leanne R; Jin, Tao; Graff, Donald W; Fant, Reginald V; Henningfield, Jack E

    2018-05-03

    We previously reported that following a short-term product use period, use of non-menthol Vuse Solo electronic cigarettes (ECs) resulted in product effect-related subjective responses and nicotine uptake between those of combustible cigarettes (high-abuse liability comparator) and nicotine gum (low-abuse liability comparator); the results were generally closer to those of nicotine gum. Using a similar design to the previous study, we evaluated the abuse liability of three menthol-flavored Vuse Solo ECs with the same nicotine contents (14, 29, and 36 mg) in a group of EC-naïve, menthol cigarette smokers, relative to comparator products. Six-hour nicotine uptake and ratings of subjective effects were used to determine abuse liability and pharmacokinetics. Use of menthol Vuse Solo resulted in significantly lower responses to subjective measurements (product liking, intent to use product again, and liking of positive product effects), higher urge to smoke responses, and a lower peak (C max ) and overall extent (AUC 0-360 ) of nicotine uptake compared to smoking the usual brand menthol cigarette. When compared with use of nicotine gum, subjective responses to use of menthol Vuse ECs were in the same direction as those resulting from smoking cigarettes but were more similar to nicotine gum use in magnitude than they were to cigarettes. These findings are concordant with our previous results and provide evidence that menthol Vuse Solo ECs have abuse liability that is lower than menthol cigarettes and potentially greater than that of nicotine gum. ClinicalTrials.gov identifier: NCT02664012.

  20. Core outcome measures for opioid abuse liability laboratory assessment studies in humans: IMMPACT recommendations

    PubMed Central

    Comer, Sandra D.; Zacny, James P.; Dworkin, Robert H.; Turk, Dennis C.; Bigelow, George E.; Foltin, Richard W.; Jasinski, Donald R.; Sellers, Edward M.; Adams, Edgar H.; Balster, Robert; Burke, Laurie B.; Cerny, Igor; Colucci, Robert D.; Cone, Edward; Cowan, Penney; Farrar, John T.; Haddox, J. David; Haythornthwaite, Jennifer A.; Hertz, Sharon; Jay, Gary W.; Johanson, Chris-Ellyn; Junor, Roderick; Katz, Nathaniel P.; Klein, Michael; Kopecky, Ernest A.; Leiderman, Deborah B.; McDermott, Michael P.; O’Brien, Charles; O’Connor, Alec B.; Palmer, Pamela P.; Raja, Srinivasa N.; Rappaport, Bob A.; Rauschkolb, Christine; Rowbotham, Michael C.; Sampaio, Cristina; Setnik, Beatrice; Sokolowska, Marta; Stauffer, Joseph W.; Walsh, Sharon L.

    2012-01-01

    A critical component in development of opioid analgesics is assessment of their abuse liability (AL). Standardization of approaches and measures used in assessing AL has the potential to facilitate comparisons across studies, research laboratories, and drugs. The goal of this report is to provide consensus recommendations regarding core outcome measures for assessing abuse potential of opioid medications in humans in a controlled laboratory setting. Although many of the recommended measures are appropriate for assessing the AL of medications from other drug classes, the focus here is on opioid medications because they present unique risks from both physiological (e.g., respiratory depression, physical dependence) and public health (e.g., individuals in pain) perspectives. A brief historical perspective on AL testing is provided and then those measures that can be considered primary and secondary outcomes and possible additional outcomes in AL assessment are discussed. These outcome measures include: (1) subjective effects (some of which comprise the primary outcome measures, including drug liking); (2) physiological responses; (3) drug self-administration behavior; and (4) cognitive and psychomotor performance. Prior to presenting recommendations for standardized approaches and measures to be used in AL assessments, the appropriateness of using these measures in clinical trials with patients in pain is discussed. PMID:22998781

  1. Securing insurance protection against fraud and abuse liability.

    PubMed

    Callison, S

    1999-07-01

    Healthcare organizations concerned about corporate compliance need to review securing appropriate insurance coverage as part of their corporate compliance program. Provider organizations often mistakenly expect that their directors and officers liability (D&O), malpractice, or standard errors and omissions (E&O) insurance policies will cover the cost of Medicare fraud and abuse fines. The insurance industry has developed a specific billing E&O insurance product to cover providers that run afoul of government fraud and abuse statutes.

  2. Alprazolam absorption kinetics affects abuse liability.

    PubMed

    Mumford, G K; Evans, S M; Fleishaker, J C; Griffiths, R R

    1995-03-01

    To evaluate the behavioral, subjective, and reinforcing effects of immediate-release (IR) alprazolam and extended-release (XR) alprazolam to assess the effect of release rate on laboratory measures of abuse liability. Fourteen healthy men with histories of sedative abuse participated as subjects in a double-blind crossover study. All subjects received placebo, 1 and 2 mg immediate-release alprazolam, and 2 and 3 mg extended-release alprazolam in random order. Behavioral performance, subjective effects, and alprazolam plasma concentrations were assessed repeatedly 1/2 hour before and 1/2, 1, 3, 5, 7, 9, 12, and 24 hours after drug administration. Mean peak alprazolam plasma concentrations occurred 1.7 and 9.2 hours after immediate-release alprazolam and extended-release alprazolam, respectively. Compared to placebo, 2 mg immediate-release alprazolam impaired all measures of psychomotor and cognitive performance (Digit Symbol Substitution Test), motor coordination (circular lights and balance), and memory (digit entry and recall); 2 mg extended-release alprazolam did not affect any of these measures and 3 mg extended-release alprazolam impaired circular lights only. Immediate-release alprazolam, 2 mg, increased all six measures of positive drug effects (e.g., ratings of liking or good effects); none of these measures were increased by 2 mg extended-release alprazolam and only three of the six measures were increased by 3 mg extended-release alprazolam. A drug versus money multiple-choice procedure designed to assess the relative reinforcing effects of each condition was administered 24 hour after the drug. The amount of money subjects were willing to "pay" to take the drug was significantly greater than placebo for both doses of immediate-release alprazolam but for neither dose of extended-release alprazolam. These data indicate that extended-release alprazolam has less potential for abuse than immediate-release alprazolam.

  3. Human abuse liability evaluation of CNS stimulant drugs.

    PubMed

    Romach, Myroslava K; Schoedel, Kerri A; Sellers, Edward M

    2014-12-01

    Psychoactive drugs that increase alertness, attention and concentration and energy, while also elevating mood, heart rate and blood pressure are referred to as stimulants. Despite some overlapping similarities, stimulants cannot be easily categorized by their chemical structure, mechanism of action, receptor binding profile, effects on monoamine uptake, behavioral pharmacology (e.g., effects on locomotion, temperature, and blood pressure), therapeutic indication or efficacy. Because of their abuse liability, a pre-market assessment of abuse potential is required for drugs that show stimulant properties; this review article focuses on the clinical aspects of this evaluation. This includes clinical trial adverse events, evidence of diversion or tampering, overdoses and the results of a human abuse potential study. While there are different types of human experimental studies that can be employed to evaluate stimulant abuse potential (e.g., drug discrimination, self-administration), only the human abuse potential study and clinical trial adverse event data are required for drug approval. The principal advances that have improved human abuse potential studies include using study enrichment strategies (pharmacologic qualification), larger sample sizes, better selection of endpoints and measurement strategies and more carefully considered interpretation of data. Because of the methodological advances, comparisons of newer studies with historical data is problematic and may contribute to a biased regulatory framework for the evaluation of newer stimulant-like drugs, such as A2 antagonists. This article is part of the Special Issue entitled 'CNS Stimulants'. Copyright © 2014 Elsevier Ltd. All rights reserved.

  4. Conference on abuse liability and appeal of tobacco products: conclusions and recommendations.

    PubMed

    Henningfield, Jack E; Hatsukami, Dorothy K; Zeller, Mitch; Peters, Ellen

    2011-07-01

    The rate of initiation and progression to dependence and premature mortality are higher for tobacco products than for any other dependence producing substance. This is not explained simply by the addictiveness ("abuse liability") or by enticing product designs ("product appeal") alone, but rather by both of these factors in combination with marketing and social influences that also influence "product appeal". A working meeting of leading experts in abuse liability (AL) and product appeal was convened to examine how these disciplines could be more effectively applied to the evaluation of tobacco products for the purposes of regulation that would include setting standards for designs and contents intended to reduce the risk of initiation and dependence. It was concluded that abuse liability assessment (ALA) is a validated approach to testing pharmaceutical products but has not been extensively applied to tobacco products: such application has demonstrated feasibility, but special challenges include the diverse range of products, product complexity, and the absence of satisfactory placebo products. Consumer testing for product appeal is widely used by consumer product marketers as well as by researchers in their efforts to understand consumer product preferences and use but has not been extensively applied to tobacco products except by the tobacco industry. Recommendations for testing, methods development, and research were developed. A major recommendation was that tobacco products should be tested for AL and product appeal, and the results integrated and evaluated so as to more accurately predict risk of initiation, dependence, and persistence of use. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

  5. The Therapeutic Potential of Nociceptin/Orphanin FQ Receptor Agonists as Analgesics without Abuse Liability

    PubMed Central

    2012-01-01

    Although mu opioid (MOP) receptor agonists are the most commonly used analgesics for the treatment of moderate to severe pain in the clinic, the side effects of MOP agonists such as abuse liability limit their value as a medication. Research to identify novel analgesics without adverse effects is pivotal to advance the health care of humans. The nociceptin/orphanin FQ peptide (NOP) receptor, the fourth opioid receptor subtype, mediates distinctive actions in nonhuman primates which suggests the possibility that activity at this receptor may result in strong analgesia in the absence of virtually all of the side effects associated with MOP agonists. The present review highlights the recent progress of pharmacological studies of NOP-related ligands in primates. Selective NOP agonists, either peptidic or nonpeptidic, produce full analgesia in various assays in primates, when delivered systemically or intrathecally. Yet small molecule NOP agonists do not serve as reinforcers, indicating a lack of abuse liability. Given that NOP agonists have low abuse liability and that coactivation of NOP and MOP receptors produces synergistic antinociception, it is worth developing bifunctional NOP/MOP ligands. The outcomes of these studies and recent developments provide new perspectives to establish a translational bridge for understanding the biobehavioral functions of NOP receptors in primates and for facilitating the development of NOP-related ligands as a new generation of analgesics without abuse liability in humans. PMID:23421672

  6. Conference on Abuse Liability and Appeal of Tobacco Products: Conclusions and Recommendations*

    PubMed Central

    Hatsukami, Dorothy K.; Zeller, Mitch; Peters, Ellen

    2011-01-01

    The rate of initiation and progression to dependence and premature mortality are higher for tobacco products than for any other dependence producing substance. This is not explained simply by the addictiveness (“abuse liability”) or by enticing product designs (“product appeal”) alone, but rather by both of these factors in combination with marketing and social influences that also influence “product appeal”. A working meeting of leading experts in abuse liability (AL) and product appeal was convened to examine how these disciplines could be more effectively applied to the evaluation of tobacco products for the purposes of regulation that would include setting standards for designs and contents intended to reduce the risk of initiation and dependence. It was concluded that abuse liability assessment (ALA) is a validated approach to testing pharmaceutical products but has not been extensively applied to tobacco products: such application has demonstrated feasibility, but special challenges include the diverse range of products, product complexity, and the absence of satisfactory placebo products. Consumer testing for product appeal is widely used by consumer products marketers as well as by researchers in their efforts to understand consumer product preferences and use but has not been extensively applied to tobacco products except by the tobacco industry. Recommendations for testing, methods development, and research were developed. A major recommendation was that tobacco products should be tested for AL and product appeal, and the results integrated and evaluated so as to more accurately predict risk of initiation, dependence, and persistence of use. PMID:21376479

  7. Oral cannabidiol does not produce a signal for abuse liability in frequent marijuana smokers

    PubMed Central

    Babalonis, Shanna; Haney, Margaret; Malcolm, Robert J.; Lofwall, Michelle R.; Votaw, Victoria R.; Sparenborg, Steven; Walsh, Sharon L.

    2017-01-01

    Background Cannabidiol (CBD) is a naturally occurring constituent of the marijuana plant. In the past few years, there has been great interest in the therapeutic effects of isolated CBD and it is currently being explored for numerous disease conditions (e.g., pain, epilepsy, cancer, various drug dependencies). However, CBD remains a Schedule I drug on the U.S. Controlled Substances Act (CSA). Despite its status, there are no well-controlled data available regarding its abuse liability. Methods Healthy, frequent marijuana users (n=31) were enrolled in this within subject, randomized, placebo-controlled, double-blind, multisite study that administered oral cannabidiol (0, 200, 400, 800 mg) alone and in combination with smoked marijuana (0.01%, 5.3-5.8% THC). Participants received one dose combination across 8 once-weekly outpatient sessions (7.5 hrs). The primary findings on the drug interaction effects were previously reported (Haney et al., 2016). The present study is a secondary analysis of the data to examine the abuse liability profile of oral cannabidiol (200, 400, 800 mg) in comparison to oral placebo and active smoked marijuana (5.3-5.8% THC). Results Active marijuana reliably produced abuse-related subjective effects (e.g., high) (p<.05). However, CBD was placebo-like on all measures collected (p>.05). Conclusions Overall, CBD did not display any signals of abuse liability at the doses tested and these data may help inform U.S. regulatory decisions regarding CBD schedule on the CSA. PMID:28088032

  8. Factors associated with the transition from abuse to dependence among substance abusers: Implications for a measure of addictive liability

    PubMed Central

    Ridenour, Ty A.; Maldonado-Molina, Mildred; Compton, Wilson M.; Spitznagel, Edward L.; Cottler, Linda B.

    2005-01-01

    This study was conducted to test the validity of a measure that has potential to bridge research on the addictive liability of drugs and on individuals' liability to addiction, which to date have evolved in largely parallel arenas. The length of time between onset of abuse and dependence (LOTAD) has evolved from recent findings on transitions through levels of addiction; it was hypothesized that shorter LOTAD is indicative of greater addictive liability. Hypotheses were based on animal studies and human studies. Retrospective data from the DSM-IV Substance Use Disorders Work Group were reanalyzed using configural frequency analysis, survival curves, bivariate Kendall's tau associations, and linear regression. The sample consisted of participants recruited from community and clinical settings. The measure was the Composite International Diagnostic Interview-Substance Abuse Module (CIDI-SAM). The shortest LOTADs were observed for disorders related to use of cocaine and opiates, followed by cannabis and then alcohol regardless of the subsample that was analyzed. As hypothesized, females and early initiators of drug use had shorter LOTADs compared to men and other initiators of drug use; no consistent differences in LOTAD were observed between African-Americans and Caucasians. None of the LOTAD variance associated with differences between drugs could be accounted for by gender, early use of the drug, or ethnicity. Specific areas of research where LOTAD might be useful as well as how LOTAD might be improved are discussed. PMID:16157227

  9. Research design strategies to evaluate the impact of formulations on abuse liability.

    PubMed

    McColl, Shelley; Sellers, Edward M

    2006-06-01

    Scheduling of a chemical drug substance under the Controlled Substances Act (CSA) includes an evaluation of preclinical and clinical safety, and experimental abuse liability studies, as well as information on diversion and overdose. Formulations that mitigate abuse liability, dependence potential and public health risks (e.g., altered absorption rate and tamperability, long half-life, pro-drugs and combination products) are amenable to preclinical and clinical studies to compare their abuse potential to reference compounds. For new formulations (NF) as marketed agents, direct comparison to the immediate release (IR) formulation of the reference compound is typically needed across the full range of potential studies. While the public health advantage of formulation changes in the marketplace can be conceptualized in behavioral economic terms, generating persuasive data is challenging. Study complexity increases because of additional conditions (e.g., placebo, 2-3 doses of the IR formulation, 2-3 doses of the new formulation, and 2-3 doses of the unscheduled or negative control drug), larger sample sizes (study power driven by the comparison of the new formulation versus the IR or placebo), and associated increases in study duration. However, the use of single maximal doses of well-characterized controls can reduce the number of study arms, and using incomplete block designs can reduce study duration. Less typical experimental approaches may also be useful, such as human choice or discrimination procedures, or pre-marketing consumer studies among experienced drug tamperers. New formulations that demonstrate a substantial difference from marketed or reference products have a potential marketing advantage and should require less onerous risk management. Post-marketing epidemiological data demonstrating the lack of abuse will carry the most weight from a public health and physician perspective.

  10. Mu/Kappa Opioid Interactions in Rhesus Monkeys: Implications for Analgesia and Abuse Liability

    PubMed Central

    Negus, S. Stevens; Katrina Schrode, KA; Stevenson, Glenn W.

    2008-01-01

    Mu opioid receptor agonists are clinically valuable as analgesics; however, their use is limited by high abuse liability. Kappa opioid agonists also produce antinociception, but they do not produce mu agonist-like abuse-related effects, suggesting that they may enhance the antinociceptive effects and/or attenuate the abuse-related effects of mu agonists. To evaluate this hypothesis, the present study examined interactions between the mu agonist fentanyl and the kappa agonist U69,593 in three behavioral assays in rhesus monkeys. In an assay of schedule-controlled responding, monkeys responded under a fixed-ratio 30 (FR 30) schedule of food presentation. Fentanyl and U69,593 each produced rate-decreasing effects when administered alone, and mixtures of 0.22:1, 0.65:1 and 1.96:1 U69,593/fentanyl usually produced subadditive effects. In an assay of thermal nociception, tail withdrawal latencies were measured from water heated to 50°C. Fentanyl and U69,593 each produced dose-dependent antinociception, and effects were additive for all mixtures. In an assay of drug self-administration, rhesus monkeys responded for i.v. drug injection, and both dose and FR values were manipulated. Fentanyl maintained self-administration, whereas U69,593 did not. Addition of U69,593 to fentanyl produced a proportion-dependent decrease in both rates of fentanyl self-administration and behavioral economic measures of the reinforcing efficacy of fentanyl. Taken together, these results suggest that simultaneous activation of mu and kappa receptors, either with a mixture of selective drugs or with a single drug that targets both receptors, may reduce abuse liability without reducing analgesic effects relative to selective mu agonists administered alone. PMID:18837635

  11. Risk evaluation and mitigation strategies for drugs with abuse liability: public interest, special interest, conflicts of interest, and the industry perspective.

    PubMed

    Wright, Curtis; Schnoll, Sidney; Bernstein, David

    2008-10-01

    Risk evaluation and mitigation strategies (REMS) formerly known as Risk Minimization Action Plans (RiskMAPs) are a regulatory technique for dealing with anticipated risks of new medications and are especially important for new drugs with abuse potential. This paper describes the origin and history of risk-management plans for drugs that might be abused, the proper use of these plans in minimizing the risk to the public, and the special difficulties inherent in managing risks for drugs with abuse potential. Drugs with abuse liability are distinctive since the risks inherent in manufacture and distribution include not only risks to patients prescribed the medications, but also risks to the general public including subgroups in the population not intended to get the drug and who receive no medical benefit from the medication. The crafting of risk-management plans intended to protect nonpatient populations is unique for these products. The content, extent, and level of intensity of these plans affect areas of medical ethics, civil liability, and criminal prosecution. The need for risk-management plans for drugs with abuse liability can potentially act as a deterrent to investment and is a factor in decisions concerning the development of new medications for the treatments of pain, ADHD, anxiety disorders, and addictions. This paper provides a framework for moving the process of REMS development forward and criteria for evaluating the probity and adequacy of such programs.

  12. Assessment of the abuse liability of a dual orexin receptor antagonist: a crossover study of almorexant and zolpidem in recreational drug users.

    PubMed

    Cruz, Hans G; Hoever, Petra; Chakraborty, Bijan; Schoedel, Kerri; Sellers, Edward M; Dingemanse, Jasper

    2014-04-01

    Dual orexin receptor antagonists (DORAs) enable initiation and maintenance of sleep in patients with primary insomnia. Blockade of the orexin system has shown reduction of drug-seeking behavior in animal studies, supporting the role of orexin antagonism as a novel approach for treating substance abuse. Since hypnotics are traditionally associated with misuse, a lack of abuse liability of DORAs would offer significant benefits over current therapies for sleep disorders. In this randomized, crossover, proof-of-concept study, single oral doses of the DORA almorexant (200, 400, and 1,000 mg) were administered to healthy subjects with previous non-therapeutic experience with central nervous system depressants and were compared with placebo and single oral doses of zolpidem (20 and 40 mg), a benzodiazepine-like drug. Subjective measures of abuse potential (visual analog scales [VAS], Addiction Research Center Inventory, and Subjective Drug Value) and objective measures (divided attention [DA]) were evaluated over 24 h post-dose in 33 evaluable subjects. Drug Liking VAS peak effect (E max; primary endpoint) was significantly higher for all doses of almorexant and zolpidem compared with placebo (p<0.001). Almorexant 200 mg showed significantly less 'Drug Liking' than both zolpidem doses (p<0.01), and almorexant 400 mg had smaller effects than zolpidem 20 mg (p<0.05), while almorexant 1,000 mg was not different from either zolpidem dose. Results were similar for other subjective measures, although almorexant generally showed smaller negative and perceptual effects compared with zolpidem. Almorexant also showed less cognitive impairment compared with zolpidem on most DA endpoints. This study in humans investigating single doses of almorexant is the first to explore and show abuse liability of a DORA, a class of compounds that is not only promising for the treatment of sleep disorders, but also of addiction.

  13. The Liability of Colleges and Universities for Fraud, Waste, and Abuse in Federally Funded Grants and Projects.

    ERIC Educational Resources Information Center

    Gordon, Steven D.

    1996-01-01

    The federal government's war on fraud, waste, and abuse in expenditure of federal funds has reached college campuses. Institutions that fail to heed this development are vulnerable to harsh sanctions. They must tighten accounting practices and recognize their liability for fraudulent practices of faculty and students. Internal investigations and…

  14. Dopamine transporter-dependent and -independent striatal binding of the benztropine analog JHW 007, a cocaine antagonist with low abuse liability

    USDA-ARS?s Scientific Manuscript database

    The benztropine analog JHW 007 displays high affinity for the dopamine transporter (DAT), but unlike typical DAT ligands, has relatively low abuse liability and blocks effects of cocaine,including its self-administration. To determine sites responsible for the cocaine-antagonist effects of JHW 007, ...

  15. The opioid receptor triple agonist DPI-125 produces analgesia with less respiratory depression and reduced abuse liability.

    PubMed

    Yi, Shou-Pu; Kong, Qing-Hong; Li, Yu-Lei; Pan, Chen-Ling; Yu, Jie; Cui, Ben-Qiang; Wang, Ying-Fei; Wang, Guan-Lin; Zhou, Pei-Lan; Wang, Li-Li; Gong, Ze-Hui; Su, Rui-Bin; Shen, Yue-Hai; Yu, Gang; Chang, Kwen-Jen

    2017-07-01

    Opioid analgesics remain the first choice for the treatment of moderate to severe pain, but they are also notorious for their respiratory depression and addictive effects. This study focused on the pharmacology of a novel opioid receptor mixed agonist DPI-125 and attempted to elucidate the relationship between the δ-, μ- and κ-receptor potency ratio and respiratory depression and abuse liability. Five diarylmethylpiperazine compounds (DPI-125, DPI-3290, DPI-130, KUST202 and KUST13T02) were selected for this study. PKA fluorescence redistribution assays in CHO cells individually expressing δ-, μ- or κ-receptors were used to measure the agonist potency. The respiratory safety profiles were estimated in rats by the ratio of ED 50 (pCO 2 increase)/ED 50 (antinociception). The abuse liability of DPI-125 was evaluated with a self-administration model in rhesus monkeys. The observed agonist potencies of DPI-125 for δ-, μ- and κ-opioid receptors were 4.29±0.36, 11.10±3.04, and 16.57±4.14 nmol/L, respectively. The other four compounds were also mixed agonists with varying potencies. DPI-125 exhibited a high respiratory safety profile, clearly related to its high δ-receptor potency. The ratio of the EC 50 potencies for the μ- and δ-receptors was found to be positively correlated with the respiratory safety ratio. DPI-125 has similar potencies for μ- and κ-receptors, which is likely the reason for its reduced abuse potential. Our results demonstrate that the opioid receptor mixed agonist DPI-125 is safer and less addictive than traditional μ-agonist analgesics. These findings suggest that the development of δ>μ∼κ opioid receptor mixed agonists is feasible, and such compounds could represent a promising class of potent analgesics with wider therapeutic windows.

  16. Evidence of clonazepam abuse liability: results of the tools developed by the French Centers for Evaluation and Information on Pharmacodependence (CEIP) network.

    PubMed

    Frauger, Elisabeth; Pauly, Vanessa; Pradel, Vincent; Rouby, Frank; Arditti, Jocelyne; Thirion, Xavier; Lapeyre Mestre, Maryse; Micallef, Joëlle

    2011-10-01

    Recent observations suggest the existence of clonazepam abuse. To determine its importance in France, a quantitative and systematic synthesis of all clonazepam data of several epidemiological tools of the Centers for Evaluation and Information on Pharmacodependence (CEIP) network has been performed in comparison with data on others benzodiazepines (BZD). Data on clonazepam and other BZD have been analysed from different epidemiological tools: OSIAP survey that identifies drugs obtained by means of falsified prescriptions, Observation of Illegal Drugs and Misuse of Psychotropic Medications (OPPIDUM) survey that describes modalities of use and data from regional French health reimbursement system. In OSIAP survey, the proportion of clonazepam falsified prescriptions among all BZD falsified prescriptions increased. During the 2006 OPPIDUM survey, the analysis of the BZD modalities of use highlights clonazepam abuse liability (for example 23% of illegal acquisition), in second rank after flunitrazepam. Studies based on data from the French health reimbursed system show that 1.5% of subjects with clonazepam dispensing had a deviant behaviour. Among BZD, clonazepam has the second most important doctor-shopping indicator (3%) after flunitrazepam. All these data provide some arguments in favour of clonazepam abuse liability in real life and the necessity to reinforce its monitoring. © 2010 The Authors Fundamental and Clinical Pharmacology © 2010 Société Française de Pharmacologie et de Thérapeutique.

  17. Toward quantifying the abuse liability of ultraviolet tanning: A behavioral economic approach to tanning addiction.

    PubMed

    Reed, Derek D; Kaplan, Brent A; Becirevic, Amel; Roma, Peter G; Hursh, Steven R

    2016-07-01

    Many adults engage in ultraviolet indoor tanning despite evidence of its association with skin cancer. The constellation of behaviors associated with ultraviolet indoor tanning is analogous to that in other behavioral addictions. Despite a growing literature on ultraviolet indoor tanning as an addiction, there remains no consensus on how to identify ultraviolet indoor tanning addictive tendencies. The purpose of the present study was to translate a behavioral economic task more commonly used in substance abuse to quantify the "abuse liability" of ultraviolet indoor tanning, establish construct validity, and determine convergent validity with the most commonly used diagnostic tools for ultraviolet indoor tanning addiction (i.e., mCAGE and mDSM-IV-TR). We conducted a between-groups study using a novel hypothetical Tanning Purchase Task to quantify intensity and elasticity of ultraviolet indoor tanning demand and permit statistical comparisons with the mCAGE and mDSM-IV-TR. Results suggest that behavioral economic demand is related to ultraviolet indoor tanning addiction status and adequately discriminates between potential addicted individuals from nonaddicted individuals. Moreover, we provide evidence that the Tanning Purchase Task renders behavioral economic indicators that are relevant to public health research. The present findings are limited to two ultraviolet indoor tanning addiction tools and a relatively small sample of high-risk ultraviolet indoor tanning users; however, these pilot data demonstrate the potential for behavioral economic assessment tools as diagnostic and research aids in ultraviolet indoor tanning addiction studies. © 2016 Society for the Experimental Analysis of Behavior.

  18. Abuse potential assessment of propofol by its subjective effects after sedation.

    PubMed

    Tezcan, Aysu Hayriye; Ornek, Dilsen Hatice; Ozlu, Onur; Baydar, Mustafa; Yavuz, Nurcan; Ozaslan, Nihal Gokbulut; Dilek, Kevser; Keske, Aylin

    2014-01-01

    In this study, we examined the euphoric effect of propofol and its high satisfaction ratio regarding its liability to be abused, particularly in painless procedures, such as colonoscopy. Fifty subjects aged between 18 and 65 years who fulfilled the criteria for ASA 1-2 and were prepared for colonoscopy were enrolled into this study. For intravenous sedation induction, 2 mg/kg propofol was used, and additional injections were administered according to BIS values. After colonoscopy, the subjects were taken to a recovery room and observed for 30 minutes. Patients were interviewed with the modified Brice questionnare regarding the incidence and the content of dreams. A 5-point Likert scale was used to classify their dreams, and the content of the dreams was also recorded. To assess the subjective effects of propofol, the patients were asked to use the Hall and Van der Castle emotion scale; their biological states were also assessed. The patients' feelings regarding propofol were each rated as absent or present. We used the Morphine-Benzedrine Group scale to measure the euphoric effects of propofol. At the end of the study, subjects scored their satisfaction on a five-point scale. There were no statistically significant differences in sex age, weight, propofol dose, or satisfaction ratio (p>0.05) in the groups, although male patients received a higher dose of propofol and had higher satisfaction ratio. Patients reported no residual after-effects. The incidence of dreaming was 42%. There was no statistically significant difference in dreaming between the sexes, but male patients had a higher dreaming ratio. Dreamers received higher propofol doses and had a higher satisfaction ratio (p>0.05). All dreamers reported happy dreams regarding daily life, and their mean MBG score was 10.5. There was no correlation between MBG scores and propofol doses (r= -0.044, p= 0.761). We conclude that propofol functions as a reward; that patients enjoy its acute effects; and that no

  19. Providing long term care for sex offenders: liabilities and responsibilities.

    PubMed

    Corson, Tyler Rogers; Nadash, Pamela

    2013-11-01

    The high risk for recidivism among sex offenders who need long term care (LTC) raises serious issues when they are cared for alongside frail, vulnerable adults. LTC providers must balance offenders' right to access care with other residents' right to be free from abuse and must assess and manage the risks associated with admitting offenders. This article identifies sources of legal liability that derive from sex offender management and discusses the need for the LTC community to develop reasonable, balanced guidance on how best to mitigate the risks associated with sex offenders, protect the rights of all residents, and reduce provider liabilities. Copyright © 2013 American Medical Directors Association, Inc. Published by Elsevier Inc. All rights reserved.

  20. Assessment of abuse liability of Tramadol among experienced drug users: Double-blind crossover randomized controlled trial.

    PubMed

    Das, Mrinmay; Jain, Raka; Dhawan, Anju; Kaur, Amandeep

    Tramadol is a widely used opioid analgesic. Different preclinical, clinical, and postmarketing surveillance studies show conflicting results regarding abuse potential of this drug. A randomized double-blind complete crossover study was conducted at National Drug Dependence Treatment Centre, All India Institute of Medical Sciences, New Delhi. Total subjects were 10, comprising total 120 observations (each subject assessed at baseline, 5, 45, and 240 minutes). Subjects with history of substance abuse were included after detoxification and informed consent. Assessment was done using modified single dose opiate questionnaire, morphine benzedrine group (MBG), pentobarbital chlorpromazine alcohol group (PCAG), and two bipolar visual analogue scales (VAS) after administration of three drugs-Tramadol (100 mg), Buprenorphine (0.6 mg), and Placebo (Normal Saline) intramuscularly, at 5-day interval. In intra-group analysis, there was statistically significant increase in scores of all four scales from baseline to all three time points after Tramadol and Buprenorphine administration. In inter-group analysis, statistically higher scores were seen for Buprenorphine in comparison to Tramadol at 5, 45, and 240 minutes for MBG scale; the score was significantly higher for Buprenorphine in VAS for pleasurable effect at 45 and 240 minutes, but not at baseline and 5 minutes. There was no significant difference in score at any point of time between Tramadol and Buprenorphine in PCAG scale and VAS for sedative/alertness effect. The scores were statistically insignificant in case of Placebo. All the subjects liked Buprenorphine most and then Tramadol followed by Placebo. Tramadol has abuse potential (even in therapeutic doses) more than Placebo but less than or comparable to Buprenorphine.

  1. Abuse potential assessment of propofol by its subjective effects after sedation

    PubMed Central

    Tezcan, Aysu Hayriye; Ornek, Dilsen Hatice; Ozlu, Onur; Baydar, Mustafa; Yavuz, Nurcan; Ozaslan, Nihal Gokbulut; Dilek, Kevser; Keske, Aylin

    2014-01-01

    Objective: In this study, we examined the euphoric effect of propofol and its high satisfaction ratio regarding its liability to be abused, particularly in painless procedures, such as colonoscopy. Methods: Fifty subjects aged between 18 and 65 years who fulfilled the criteria for ASA 1-2 and were prepared for colonoscopy were enrolled into this study. For intravenous sedation induction, 2 mg/kg propofol was used, and additional injections were administered according to BIS values. After colonoscopy, the subjects were taken to a recovery room and observed for 30 minutes. Patients were interviewed with the modified Brice questionnare regarding the incidence and the content of dreams. A 5-point Likert scale was used to classify their dreams, and the content of the dreams was also recorded. To assess the subjective effects of propofol, the patients were asked to use the Hall and Van der Castle emotion scale; their biological states were also assessed. The patients’ feelings regarding propofol were each rated as absent or present. We used the Morphine-Benzedrine Group scale to measure the euphoric effects of propofol. At the end of the study, subjects scored their satisfaction on a five-point scale. Results: There were no statistically significant differences in sex age, weight, propofol dose, or satisfaction ratio (p>0.05) in the groups, although male patients received a higher dose of propofol and had higher satisfaction ratio. Patients reported no residual after-effects. The incidence of dreaming was 42%. There was no statistically significant difference in dreaming between the sexes, but male patients had a higher dreaming ratio. Dreamers received higher propofol doses and had a higher satisfaction ratio (p>0.05). All dreamers reported happy dreams regarding daily life, and their mean MBG score was 10.5. There was no correlation between MBG scores and propofol doses (r= -0.044, p= 0.761). Conclusions: We conclude that propofol functions as a reward; that patients

  2. OPPIDUM surveillance program: 20 years of information on drug abuse in France.

    PubMed

    Frauger, Elisabeth; Moracchini, Christophe; Le Boisselier, Reynald; Braunstein, David; Thirion, Xavier; Micallef, Joëlle

    2013-12-01

    It is important to assess drug abuse liability in 'real life' using different surveillance systems. Some are based on specific population surveys, such as individuals with drug abuse or dependence, or under opiate maintenance treatment, because this population is very familiar with drugs and is more likely to divert or abuse them. In France, an original surveillance system based on this specific population and called 'Observation of illegal drugs and misuse of psychotropic medications (OPPIDUM) survey' was set up in 1990 as the first of its kind. The aim of this article is to describe this precursor of French drug abuse surveillance using different examples, to demonstrate its ability to effectively give health authorities and physicians interesting data on drug abuse. OPPIDUM is an annual, cross-sectional survey that anonymously collects information on abuse and dependence observed in patients recruited in specialized care centers dedicated to drug dependence. From 1990 to 2010, a total of 50,734 patients were included with descriptions of 102,631 psychoactive substance consumptions. These data have outlined emergent behaviors such as the misuse of buprenorphine by intravenous or nasal administration. It has contributed to assess abuse liability of emergent drugs such as clonazepam or methylphenidate. This surveillance system was also able to detect the decrease of flunitrazepam abuse following implementation of regulatory measures. OPPIDUM's twenty years of experience clearly demonstrate that collection of valid and useful data on drug abuse is possible and can provide helpful information for physicians and health authorities. © 2013 The Authors Fundamental and Clinical Pharmacology © 2013 Société Française de Pharmacologie et de Thérapeutique.

  3. Assessing Employee Potentials for Abuse.

    ERIC Educational Resources Information Center

    Haddock, M. Dean; McQueen, William M.

    1983-01-01

    Administered questionnaires to abusive (N=21) and nonabusive (N=21) employees to identify potential for institutional child abuse. Results corroborated earlier findings of institutional child abuse and demonstrated an attempt at developing an assessment tool needed to screen staff who are working with the developmentally disabled and children in…

  4. Instruments for Assessing Substance Abuse: A Review.

    ERIC Educational Resources Information Center

    Lambert, Matthew E.; Plescia, Joanne

    A review of the assessment literature on substance abuse has revealed 27 separate instruments for assessing substance abuse. These include 22 alcohol instruments and five instruments for assessing other drug abuse. The instruments are listed in a table that provides the title, source, description, population, and psychometric properties of each…

  5. Minimizing liability during internal investigations.

    PubMed

    Morris, Cole

    2010-01-01

    Today's security professional must appreciate the potential landmines in any investigative effort and work collaboratively with others to minimize liability risks, the author points out. In this article he examines six civil torts that commonly arise from unprofessionally planned or poorly executed internal investigations-defamation, false imprisonment. intentional infliction of emotional distress, assault and battery, invasion of privacy, and malicious prosecution and abuse of process.

  6. Abuse liability assessment of eslicarbazepine acetate in healthy male and female recreational sedative users: A Phase I randomized controlled trial.

    PubMed

    Levy-Cooperman, Naama; Schoedel, Kerri A; Chakraborty, Bijan; Blum, David; Cheng, Hailong

    2016-08-01

    Eslicarbazepine acetate (ESL) is a once-daily oral antiepileptic drug for the treatment of partial-onset seizures. Adverse events such as dizziness and somnolence reported in clinical studies suggest that ESL has detectable central nervous system (CNS) effects in addition to its antiepileptic effects. This Phase I study evaluated the abuse liability of ESL compared with that of alprazolam (ALP) and placebo (PBO) in recreational CNS depressant users. In this single-dose, randomized, double-blind, PBO- and active-controlled crossover study, healthy recreational CNS depressant users who could discern between ALP 2mg and PBO received single oral doses of each of the following treatments with a washout interval of ≥7days between each treatment: ESL (800mg, 1600mg, 2000mg, and 2400mg); ALP (1.5mg and 3.0mg); and PBO. Subjective measures, including visual analog scales (VASs) e.g., Drug-Liking (primary endpoint), and Addiction Research Center Inventory (ARCI) Morphine-Benzedrine Group (MBG), Pentobarbital Chlorpromazine Alcohol Group (PCAG), and Lysergic Acid Diethylamide Group scales were evaluated at multiple time points up to 24h postdose. Cognitive effects were evaluated using the Choice Reaction Time (CRT), Divided Attention (DAT) and Hopkins Verbal Learning Task-Revised tests. Peak scores for Drug-Liking VAS (maximum effect [Emax]) were significantly higher for both ALP doses than for PBO (p<0.0001), thereby confirming study validity. Drug-Liking VAS Emax was significantly lower for all ESL doses than both ALP doses (p<0.0001). Drug-Liking VAS Emax for ESL 800mg was similar to that for PBO (least squares [LS] mean difference: 3.6; p=0.19). At the three higher ESL doses (1600mg and the supratherapeutic doses of 2000mg and 2400mg), Drug-Liking VAS Emax was significantly higher than for PBO, although the differences were minimal (LS mean difference: 9.3-13.3 out of 100). For most secondary subjective endpoints (i.e., Good Effects VAS and High VAS, ARCI-MBG, Take Drug

  7. Research design considerations for clinical studies of abuse-deterrent opioid analgesics: IMMPACT recommendations

    PubMed Central

    Turk, Dennis C.; O’Connor, Alec B.; Dworkin, Robert H.; Chaudhry, Amina; Katz, Nathaniel P.; Adams, Edgar H.; Brownstein, John S.; Comer, Sandra D.; Dart, Richard; Dasgupta, Nabarun; Denisco, Richard A.; Klein, Michael; Leiderman, Deborah B.; Lubran, Robert; Rappaport, Bob A.; Zacny, James P.; Ahdieh, Harry; Burke, Laurie B.; Cowan, Penney; Jacobs, Petra; Malamut, Richard; Markman, John; Michna, Edward; Palmer, Pamela; Peirce-Sandner, Sarah; Potter, Jennifer S.; Raja, Srinivasa N.; Rauschkolb, Christine; Roland, Carl L.; Webster, Lynn R.; Weiss, Roger D.; Wolf, Kerry

    2013-01-01

    Opioids are essential to the management of pain in many patients, but they also are associated with potential risks for abuse, overdose, and diversion. A number of efforts have been devoted to the development of abuse-deterrent formulations of opioids to reduce these risks. This article summarizes a consensus meeting that was organized to propose recommendations for the types of clinical studies that can be used to assess the abuse deterrence of different opioid formulations. Due to the many types of individuals who may be exposed to opioids, an opioid formulation will need to be studied in several populations using various study designs in order to determine its abuse-deterrent capabilities. It is recommended that the research conducted to evaluate abuse deterrence should include studies assessing: (1) abuse liability; (2) the likelihood that opioid abusers will find methods to circumvent the deterrent properties of the formulation; (3) measures of misuse and abuse in randomized clinical trials involving pain patients with both low risk and high risk of abuse; and (4) post-marketing epidemiological studies. PMID:22770841

  8. Dimethyltryptamine (DMT): prevalence, user characteristics and abuse liability in a large global sample.

    PubMed

    Winstock, Adam R; Kaar, Stephen; Borschmann, Rohan

    2014-01-01

    This paper presents original research on prevalence, user characteristics and effect profile of N,N-dimethyltryptamine (DMT), a potent hallucinogenic which acts primarily through the serotonergic system. Data were obtained from the Global Drug Survey (an anonymous online survey of people, many of whom have used drugs) conducted between November and December 2012 with 22,289 responses. Lifetime prevalence of DMT use was 8.9% (n=1980) and past year prevalence use was 5.0% (n=1123). We explored the effect profile of DMT in 472 participants who identified DMT as the last new drug they had tried for the first time and compared it with ratings provided by other respondents on psilocybin (magic mushrooms), LSD and ketamine. DMT was most often smoked and offered a strong, intense, short-lived psychedelic high with relatively few negative effects or "come down". It had a larger proportion of new users compared with the other substances (24%), suggesting its popularity may increase. Overall, DMT seems to have a very desirable effect profile indicating a high abuse liability that maybe offset by a low urge to use more.

  9. Research design considerations for clinical studies of abuse-deterrent opioid analgesics: IMMPACT recommendations.

    PubMed

    Turk, Dennis C; O'Connor, Alec B; Dworkin, Robert H; Chaudhry, Amina; Katz, Nathaniel P; Adams, Edgar H; Brownstein, John S; Comer, Sandra D; Dart, Richard; Dasgupta, Nabarun; Denisco, Richard A; Klein, Michael; Leiderman, Deborah B; Lubran, Robert; Rappaport, Bob A; Zacny, James P; Ahdieh, Harry; Burke, Laurie B; Cowan, Penney; Jacobs, Petra; Malamut, Richard; Markman, John; Michna, Edward; Palmer, Pamela; Peirce-Sandner, Sarah; Potter, Jennifer S; Raja, Srinivasa N; Rauschkolb, Christine; Roland, Carl L; Webster, Lynn R; Weiss, Roger D; Wolf, Kerry

    2012-10-01

    Opioids are essential to the management of pain in many patients, but they also are associated with potential risks for abuse, overdose, and diversion. A number of efforts have been devoted to the development of abuse-deterrent formulations of opioids to reduce these risks. This article summarizes a consensus meeting that was organized to propose recommendations for the types of clinical studies that can be used to assess the abuse deterrence of different opioid formulations. Because of the many types of individuals who may be exposed to opioids, an opioid formulation will need to be studied in several populations using various study designs to determine its abuse-deterrent capabilities. It is recommended that the research conducted to evaluate abuse deterrence should include studies assessing: (1) abuse liability, (2) the likelihood that opioid abusers will find methods to circumvent the deterrent properties of the formulation, (3) measures of misuse and abuse in randomized clinical trials involving pain patients with both low risk and high risk of abuse, and (4) postmarketing epidemiological studies. Copyright © 2012 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.

  10. Evaluating the Risk of Child Abuse: The Child Abuse Risk Assessment Scale (CARAS)

    ERIC Educational Resources Information Center

    Chan, Ko Ling

    2012-01-01

    The present study developed the Child Abuse Risk Assessment Scale (CARAS), an actuarial instrument for the assessment of the risk of physical child abuse. Data of 2,363 Chinese parents (47.7% male) living in Hong Kong were used in the analyses. Participants were individually interviewed with a questionnaire assessing their perpetration of child…

  11. Monoamine Transporter Inhibitors and Substrates as Treatments for Stimulant Abuse

    PubMed Central

    Howell, Leonard L.; Negus, S. Stevens

    2015-01-01

    The acute and chronic effects of abused psychostimulants on monoamine transporters and associated neurobiology have encouraged development of candidate medications that target these transporters. Monoamine transporters in general, and dopamine transporters in particular, are critical molecular targets that mediate abuse-related effects of psychostimulants such as cocaine and amphetamine. Moreover, chronic administration of psychostimulants can cause enduring changes in neurobiology reflected in dysregulation of monoamine neurochemistry and behavior. The current review will evaluate evidence for the efficacy of monoamine transporter inhibitors and substrates to reduce abuse-related effects of stimulants in preclinical assays of stimulant self-administration, drug discrimination and reinstatement. In considering deployment of monoamine transport inhibitors and substrates as agonist-type medications to treat stimulant abuse, the safety and abuse liability of the medications are an obvious concern, and this will also be addressed. Future directions in drug discovery should identify novel medications that retain efficacy to decrease stimulant use but possess lower abuse liability, and evaluate the degree to which efficacious medications can attenuate or reverse neurobiological effects of chronic stimulant use. PMID:24484977

  12. Supervised extensions of chemography approaches: case studies of chemical liabilities assessment

    PubMed Central

    2014-01-01

    Chemical liabilities, such as adverse effects and toxicity, play a significant role in modern drug discovery process. In silico assessment of chemical liabilities is an important step aimed to reduce costs and animal testing by complementing or replacing in vitro and in vivo experiments. Herein, we propose an approach combining several classification and chemography methods to be able to predict chemical liabilities and to interpret obtained results in the context of impact of structural changes of compounds on their pharmacological profile. To our knowledge for the first time, the supervised extension of Generative Topographic Mapping is proposed as an effective new chemography method. New approach for mapping new data using supervised Isomap without re-building models from the scratch has been proposed. Two approaches for estimation of model’s applicability domain are used in our study to our knowledge for the first time in chemoinformatics. The structural alerts responsible for the negative characteristics of pharmacological profile of chemical compounds has been found as a result of model interpretation. PMID:24868246

  13. Evaluating the abuse potential of opioids and abuse-deterrent -opioid formulations: A review of clinical study methodology.

    PubMed

    Setnik, Beatrice; Schoedel, Kerri A; Levy-Cooperman, Naama; Shram, Megan; Pixton, Glenn C; Roland, Carl L

    With the development of opioid abuse-deterrent formulations (ADFs), there is a need to conduct well-designed human abuse potential studies to evaluate the effectiveness of their deterrent properties. Although these types of studies have been conducted for many years, largely to evaluate inherent abuse potential of a molecule and inform drug scheduling, methodological approaches have varied across studies. The focus of this review is to describe current "best practices" and methodological adaptations required to assess abuse-deterrent opioid formulations for regulatory submissions. A literature search was conducted in PubMed® to review methodological approaches (study conduct and analysis) used in opioid human abuse potential studies. Search terms included a combination of "opioid," "opiate," "abuse potential," "abuse liability," "liking," AND "pharmacodynamic," and only studies that evaluated single doses of opioids in healthy, nondependent individuals with or without prior opioid experience were included. Seventy-one human abuse potential studies meeting the prespecified criteria were identified, of which 21 studies evaluated a purported opioid ADF. Based on these studies, key methodological considerations were reviewed and summarized according to participant demographics, study prequalification, comparator and dose selection, route of administration and drug manipulation, study blinding, outcome measures and training, safety, and statistical analyses. The authors recommend careful consideration of key elements (eg, a standardized definition of a "nondependent recreational user"), as applicable, and offer key principles and "best practices" when conducting human abuse potential studies for opioid ADFs. Careful selection of appropriate study conditions is dependent on the type of ADF technology being evaluated.

  14. Preventing Alcohol and Drug Abuse through Programs at the Workplace. WBGH Worksite Wellness Series.

    ERIC Educational Resources Information Center

    Walsh, Diana Chapman; Kelleher, Susan E.

    Alcohol and drug abuse have serious physical, psychological, and social consequences, and employees who abuse alcohol and/or drugs ultimately reduce their companies' profits. Employee substance abuse leads to reduced productivity as well as to increased absenteeism, health care and health insurance costs, and liability claims against employers of…

  15. A novel orvinol analog, BU08028, as a safe opioid analgesic without abuse liability in primates.

    PubMed

    Ding, Huiping; Czoty, Paul W; Kiguchi, Norikazu; Cami-Kobeci, Gerta; Sukhtankar, Devki D; Nader, Michael A; Husbands, Stephen M; Ko, Mei-Chuan

    2016-09-13

    Despite the critical need, no previous research has substantiated safe opioid analgesics without abuse liability in primates. Recent advances in medicinal chemistry have led to the development of ligands with mixed mu opioid peptide (MOP)/nociceptin-orphanin FQ peptide (NOP) receptor agonist activity to achieve this objective. BU08028 is a novel orvinol analog that displays a similar binding profile to buprenorphine with improved affinity and efficacy at NOP receptors. The aim of this preclinical study was to establish the functional profile of BU08028 in monkeys using clinically used MOP receptor agonists for side-by-side comparisons in various well-honed behavioral and physiological assays. Systemic BU08028 (0.001-0.01 mg/kg) produced potent long-lasting (i.e., >24 h) antinociceptive and antiallodynic effects, which were blocked by MOP or NOP receptor antagonists. More importantly, the reinforcing strength of BU08028 was significantly lower than that of cocaine, remifentanil, or buprenorphine in monkeys responding under a progressive-ratio schedule of drug self-administration. Unlike MOP receptor agonists, BU08028 at antinociceptive doses and ∼10- to 30-fold higher doses did not cause respiratory depression or cardiovascular adverse events as measured by telemetry devices. After repeated administration, the monkeys developed acute physical dependence on morphine, as manifested by precipitated withdrawal signs, such as increased respiratory rate, heart rate, and blood pressure. In contrast, monkeys did not show physical dependence on BU08028. These in vivo findings in primates not only document the efficacy and tolerability profile of bifunctional MOP/NOP receptor agonists, but also provide a means of translating such ligands into therapies as safe and potentially abuse-free opioid analgesics.

  16. NKTR-181: A Novel Mu-Opioid Analgesic with Inherently Low Abuse Potential.

    PubMed

    Miyazaki, Takahiro; Choi, Irene Y; Rubas, Werner; Anand, Neel K; Ali, Cherie; Evans, Juli; Gursahani, Hema; Hennessy, Marlene; Kim, Grace; McWeeney, Daniel; Pfeiffer, Juergen; Quach, Phi; Gauvin, David; Riley, Timothy A; Riggs, Jennifer A; Gogas, Kathleen; Zalevsky, Jonathan; Doberstein, Stephen K

    2017-10-01

    The increasing availability of prescription opioid analgesics for the treatment of pain has been paralleled by an epidemic of opioid misuse, diversion, and overdose. The development of abuse-deterrent formulations (ADFs) of conventional opioids such as oxycodone and morphine represents an advance in the field and has had a positive but insufficient impact, as most opioids are still prescribed in highly abusable, non-ADF forms, and abusers can tamper with ADF medications to liberate the abusable opioid within. The abuse liability of mu-opioid agonists appears to be dependent on their rapid rate of entry into the central nervous system (CNS), whereas analgesic activity appears to be a function of CNS exposure alone, suggesting that a new opioid agonist with an inherently low rate of influx across the blood-brain barrier could mediate analgesia with low abuse liability, regardless of formulation or route of administration. NKTR-181 is a novel, long-acting, selective mu-opioid agonist with structural properties that reduce its rate of entry across the blood-brain barrier compared with traditional mu-opioid agonists. NKTR-181 demonstrated maximum analgesic activity comparable to that of oxycodone in hot-plate latency and acetic-acid writhing models. NKTR-181 was distinguishable from oxycodone by its reduced abuse potential in self-administration and progressive-ratio break point models, with behavioral effects similar to those of saline, as well as reduced CNS side effects as measured by the modified Irwin test. The in vitro and in vivo studies presented here demonstrate that NKTR-181 is the first selective mu-opioid agonist to combine analgesic efficacy and reduced abuse liability through the alteration of brain-entry kinetics. Copyright © 2017 by The American Society for Pharmacology and Experimental Therapeutics.

  17. 22 CFR 13.3 - Liability for neglect of duty or for malfeasance generally; action on bond; penalty.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... of any willful malfeasance or abuse of power, or of any corrupt conduct in his or her office, he or... of any malversation or abuse of power, he or she shall be liable to any injured person for all damage... 22 Foreign Relations 1 2010-04-01 2010-04-01 false Liability for neglect of duty or for...

  18. Drug discrimination: A versatile tool for characterization of CNS safety pharmacology and potential for drug abuse.

    PubMed

    Swedberg, Michael D B

    2016-01-01

    Drug discrimination studies for assessment of psychoactive properties of drugs in safety pharmacology and drug abuse and drug dependence potential evaluation have traditionally been focused on testing novel compounds against standard drugs for which drug abuse has been documented, e.g. opioids, CNS stimulants, cannabinoids etc. (e.g. Swedberg & Giarola, 2015), and results are interpreted such that the extent to which the test drug causes discriminative effects similar to those of the standard training drug, the test drug would be further characterized as a potential drug of abuse. Regulatory guidance for preclinical assessment of abuse liability by the European Medicines Agency (EMA, 2006), the U.S. Food and Drug Administration (FDA, 2010), the International Conference of Harmonization (ICH, 2009), and the Japanese Ministry of Health Education and Welfare (MHLW, 1994) detail that compounds with central nervous system (CNS) activity, whether by design or not, need abuse and dependence liability assessment. Therefore, drugs with peripheral targets and a potential to enter the CNS, as parent or metabolite, are also within scope (see Swedberg, 2013, for a recent review and strategy). Compounds with novel mechanisms of action present a special challenge due to unknown abuse potential, and should be carefully assessed against defined risk criteria. Apart from compounds sharing mechanisms of action with known drugs of abuse, compounds intended for indications currently treated with drugs with potential for abuse and or dependence are also within scope, regardless of mechanism of action. Examples of such compounds are analgesics, anxiolytics, cognition enhancers, appetite control drugs, sleep control drugs and drugs for psychiatric indications. Recent results (Swedberg et al., 2014; Swedberg & Raboisson, 2014; Swedberg, 2015) on the metabotropic glutamate receptor type 5 (mGluR5) antagonists demonstrate that compounds causing hallucinatory effects in humans did not exhibit

  19. Risk Assessment in Child Sexual Abuse Cases

    ERIC Educational Resources Information Center

    Levenson, Jill S.; Morin, John W.

    2006-01-01

    Despite continuing improvements in risk assessment for child protective services (CPS) and movement toward actuarial prediction of child maltreatment, current models have not adequately addressed child sexual abuse. Sexual abuse cases present unique and ambiguous indicators to the investigating professional, and risk factors differ from those…

  20. A population-based Swedish Twin and Sibling Study of cannabis, stimulant and sedative abuse in men.

    PubMed

    Kendler, Kenneth S; Ohlsson, Henrik; Maes, Hermine H; Sundquist, Kristina; Lichtenstein, Paul; Sundquist, Jan

    2015-04-01

    Prior studies, utilizing interview-based assessments, suggest that most of the genetic risk factors for drug abuse (DA) are non-specific with a minority acting specifically on risk for abuse of particular psychoactive substance classes. We seek to replicate these findings using objective national registry data. We examined abuse of cannabis, stimulants (including cocaine) and sedatives ascertained from national Swedish registers in male-male monozygotic (1720 pairs) and dizygotic twins (1219 pairs) combined with near-age full siblings (76,457 pairs) to provide sufficient power. Modeling was performed using Mx. A common pathway model fitted better than an independent pathway model. The latent liability to DA was highly heritable but also influenced by shared environment. Cannabis, stimulant and sedative abuse all loaded strongly on the common factor. Estimates for the total heritability for the three forms of substance abuse ranged from 64 to 70%. Between 75 and 90% of that genetic risk was non-specific, coming from the common factor with the remainder deriving from substance specific genetic risk factors. By contrast, all of the shared environmental effects, which accounted for 18-20% of the variance in liability, were non-specific. In accord with prior studies based on personal interviews, the large preponderance of genetic risk factors for abuse of specific classes of psychoactive substance are non-specific. These results suggest that genetic variation in the primary sites of action of the psychoactive drugs, which differ widely across most drug classes, play a minor role in human individual differences in risk for DA. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  1. Improving detection and quality of assessment of child abuse and partner abuse is achievable with a formal organisational change approach.

    PubMed

    Wills, Russell; Ritchie, Miranda; Wilson, Mollie

    2008-03-01

    To improve detection and quality of assessment of child and partner abuse within a health service. A formal organisational change approach was used to implement the New Zealand Family Violence Intervention Guidelines in a mid-sized regional health service. The approach includes obtaining senior management support, community collaboration, developing resources to support practice, research, evaluation and training. Formal pre-post evaluations were conducted of the training. Barriers and enablers of practice change were assessed through 85 interviews with 60 staff. More than 6000 clinical records were audited to assess rates of questioning for partner abuse. Identifications of partner abuse and referrals made were counted through the Family Violence Accessory File. Referrals to the Department of Child, Youth and Family Services (CYFS) were recorded routinely by the CYFS. Audits assessed quality of assessment of child and partner abuse, when identified. More than 700 staff were trained in dual assessment for child and partner abuse. Evaluations demonstrate improved confidence following training, though staff still need support. Barriers and enablers to asking about partner abuse were identified. Referrals from the health service to the CYFS increased from 10 per quarter to 70 per quarter. Identification of partner abuse increased from 30 to 80 per 6-month period. Routine questioning rates for partner abuse vary between services. Achieving and sustaining improved rates of identification and quality of assessment of child and partner abuse is possible with a formal organisational change approach.

  2. Legal liability perspectives on abuse-deterrent opioids in the treatment of chronic pain.

    PubMed

    Brushwood, David B; Rich, Ben A; Coleman, John J; Bolen, Jennifer; Wong, Winston

    2010-12-01

    Abuse-deterrent opioid analgesic formulations can help reduce the risk of opioid diversion and abuse. Not all opioid analgesics are available as both extended- and immediate-release dosage forms in abuse-deterrent formulations. Clinicians may have to balance the clinical benefit of a product that does not use abuse-deterrent technology versus the regulatory benefit of using a product with this technology. There is the possibility that a health care professional may be held legally liable when a product without abuse-deterrent qualities is used and a person suffers harm that would not have occurred had an abuse-deterrent formulation been provided. This article reviews legal precedents that inform an understanding of the need to reduce malpractice exposure by identifying patients who are at high risk of opioid diversion and/or abuse and considering the use of an abuse-deterrent formulation for these patients.

  3. Child Abuse: What Teachers in the '90s Know, Think, and Do.

    ERIC Educational Resources Information Center

    Hinson, Janice; Fossey, Richard

    2000-01-01

    Investigated elementary teachers' ability to recognize signs of abuse, perceptions of the reporting process, and understanding of liability. Teachers often could not recognize signs of abuse and were confused about reporting procedures. Some chose not to report because they believed child welfare agencies would not help; some were ignorant of laws…

  4. Associations of beta-endorphin with HVA and MHPG in the plasma of prepubertal boys: effects of familial drug abuse and antisocial personality disorder liability.

    PubMed

    Moss, H B; Yao, J K

    1996-06-01

    It is well-established that the secretion of the opioid neuropeptide beta-endorphin is perturbed by the administration of various drugs of abuse. Several investigators have speculated that variations in beta-endorphin secretory regulation may precede the development of a substance use disorder, and thus be a component of the liability for substance abuse. In order to test this hypothesis, we examined fasting, morning plasma concentrations of beta-endorphin and two catecholamine metabolites in prepubertal boys naive to drugs of abuse and at elevated familial risk for a substance use disorder (SA+), and in controls (SA-). Specifically, the dopaminergic metabolite homovanillic acid (pHVA), and the noradrenergic metabolite, 3-methoxy-4-hydroxy-phenylglycol (pMHPG) were measured. Between-group differences were not found for beta-endorphin, pHVA, or pMHPG. Similarly, such differences did not differentiate sons of fathers with Antisocial Personality Disorder and controls. However, regression analysis revealed that although both pHVA and pMHPG predicted beta-endorphin concentrations to similar degrees, the directions of influence were the opposite. pHVA was found to be positively associated with beta-endorphin while pMHPG was found to be negatively associated with beta-endorphin. No between-group differences in these relationships were found. The results suggest an opponent process in catecholaminergic regulation of beta-endorphin in humans, and are consistent with observations in the central nervous system of animal models.

  5. [Biodiversity and civil liability: the role of assessment].

    PubMed

    Boutonnet, Mathilde

    2014-03-01

    The purpose of this paper is to make the link between expertise and biodiversity through the civil liability Law. Indeed, since Erika Case (Cour de Cassation, Crim. 25 septembre 2012), this Law recognised the ecological damage. This one is defined as an damage caused to Nature and especially Biodiversity. Thus, the expertise has to play a major role. In this paper, two roles are studied: first all all, the expertise allows to assess the damage of Biodiversity itself, to define and to prove it. Secondly, the expertise is an instrument which is very important for prescribing the measures of compensation, in kind or pecuniary compensation.

  6. THE LIABILITY FORMS OF THE MEDICAL PERSONNEL.

    PubMed

    Bărcan, Cristian

    2015-01-01

    Current legislation, namely Law no. 95/2006 on healthcare reform in the medical malpractice domain stipulates that medical staff can be held accountable in the following forms: disciplinary liability, administrative liability, civil liability and criminal liability. Each form of legal liability presents its features, aspects that are found mainly in the procedural rules. However, the differences between the various legal forms of liability are not met only in the procedural rules but also in their effects and consequences. It is necessary to know what the procedure for disciplinary responsibility, administrative liability, civil liability, or criminal liability is. In addition to the differentiation determined by the consequences that may arise from the different forms of legal liability, it is important to know the competent authorities to investigate a case further and the solutions which various public institutions can take regarding the medical staff. Depending on the type of legal liability, authorities have a specialized authority. If the Disciplinary Committee is encountered at the College of Physicians, it may not intervene in cases before the monitoring and competence for malpractice cases Committee. The latter two committees cannot intervene directly in the legal assessment of civil or criminal cases, as no criminal investigation authorities cannot intervene in strictly civilian cases. Therefore, the importance of knowing the competent institutions is imperative.

  7. Assessing Historical Abuse Allegations and Damages

    ERIC Educational Resources Information Center

    Wolfe, David A.; Jaffe, Peter G.; Leschied, Alan W.; Legate, Barbara L.

    2010-01-01

    Practitioners may be called upon to assess adults who have alleged child abuse as a minor and are seeking reparations. Such assessments may be used by the courts to determine harm and assess damages related to their claim or testimony. Our clinical/research team has conducted many such evaluations and reported the findings pertaining to the…

  8. Development and validation of an Opioid Attractiveness Scale: a novel measure of the attractiveness of opioid products to potential abusers

    PubMed Central

    Butler, Stephen F; Benoit, Christine; Budman, Simon H; Fernandez, Kathrine C; McCormick, Cynthia; Venuti, Synne Wing; Katz, Nathaniel

    2006-01-01

    Background The growing trends in opioid abuse, assessment of the abuse liability of prescription opioid products, and growing efforts by the pharmaceutical industry to develop 'abuse-resistant' formulations highlight a need to understand the features that make one product more 'attractive' than another to potential abusers. We developed a scale to measure the 'attractiveness' of prescription opioids to potential abusers, and used the scale to measure the relative attractiveness of 14 opioid analgesic products. Methods First, the concept of attractiveness was empirically defined with a group of prescription opioid abusers and experts in opioid abuse using a process called Concept Mapping. Abuse liability consisted of two components: factors intrinsic to the drug formulation (e.g., speed of onset, duration) and factors extrinsic to drug formulation (e.g., availability, availability of alternatives, cost). A 17-item Opioid Attractiveness Scale (OAS) was constructed, focusing on factors intrinsic to the drug product. Results A total of 144 individuals participated in tests of validity and reliability. Internal consistency was excellent (Cronbach's α = 0.85–0.94). Drug rankings based on OAS scores achieved good inter-rater agreement (Kendall's W 0.37, p < 0.001). Agreement on drug OAS scores between the developmental sample and a confirmation sample was good (IntraClass Correlations [ICC] of 0.65–0.69). Global ratings of overall attractiveness of the 14 selected opioid products by substance abuse counselors corresponded with the rankings based on OAS ratings of the abuser group. Finally, substance abuse counselors completed the OAS, yielding a high level of correspondence with ratings by the abuser group (ICC = 0.83, p = 0.002). The OAS differentiated attractiveness among 14 selected pharmaceutical opioid products. OxyContin, Dilaudid, and Percocet were ranked highest (most attractive); Talwin NX and Duragesic were ranked lowest (least attractive). Conclusion An

  9. Development and validation of an Opioid Attractiveness Scale: a novel measure of the attractiveness of opioid products to potential abusers.

    PubMed

    Butler, Stephen F; Benoit, Christine; Budman, Simon H; Fernandez, Kathrine C; McCormick, Cynthia; Venuti, Synne Wing; Katz, Nathaniel

    2006-02-02

    The growing trends in opioid abuse, assessment of the abuse liability of prescription opioid products, and growing efforts by the pharmaceutical industry to develop 'abuse-resistant' formulations highlight a need to understand the features that make one product more 'attractive' than another to potential abusers. We developed a scale to measure the 'attractiveness' of prescription opioids to potential abusers, and used the scale to measure the relative attractiveness of 14 opioid analgesic products. First, the concept of attractiveness was empirically defined with a group of prescription opioid abusers and experts in opioid abuse using a process called Concept Mapping. Abuse liability consisted of two components: factors intrinsic to the drug formulation (e.g., speed of onset, duration) and factors extrinsic to drug formulation (e.g., availability, availability of alternatives, cost). A 17-item Opioid Attractiveness Scale (OAS) was constructed, focusing on factors intrinsic to the drug product. A total of 144 individuals participated in tests of validity and reliability. Internal consistency was excellent (Cronbach's alpha = 0.85-0.94). Drug rankings based on OAS scores achieved good inter-rater agreement (Kendall's W 0.37, p < 0.001). Agreement on drug OAS scores between the developmental sample and a confirmation sample was good (IntraClass Correlations [ICC] of 0.65-0.69). Global ratings of overall attractiveness of the 14 selected opioid products by substance abuse counselors corresponded with the rankings based on OAS ratings of the abuser group. Finally, substance abuse counselors completed the OAS, yielding a high level of correspondence with ratings by the abuser group (ICC = 0.83, p = 0.002). The OAS differentiated attractiveness among 14 selected pharmaceutical opioid products. OxyContin, Dilaudid, and Percocet were ranked highest (most attractive); Talwin NX and Duragesic were ranked lowest (least attractive). An initial examination of the psychometric

  10. Abuse potential of propofol used for sedation in gastric endoscopy and its correlation with subject characteristics.

    PubMed

    Kim, Ja Hyun; Byun, Heewon; Kim, Jun Hyun

    2013-11-01

    Propofol has been widely used for an induction and/or maintenance of general anesthesia, or for sedation for various procedures. Although it has many ideal aspects, there have been several cases of drug abuse and addiction. The authors investigated whether there are abuse liable groups among the general population. We surveyed 169 patients after gastric endoscopic examination, which used propofol as a sedative, with the Addiction Research Center Inventory (ARCI) questionnaire. Other characteristics of the patients, such as past history, smoking habits, depression, anxiety, alcohol abuse liability and sleep disturbance, were recorded by history taking and several questionnaires before the exam. Propofol had a high Morphine-Benzedrine Group (MBG) score (representative value for euphoria) of 6.3, which is higher than marijuana, and a Pentobarbital-Chlorpromazine-Alcohol Group (PCAG) score (representative value of sedation) of 8.1, which is lower than most opioids. The MBG score showed no statistically significant correlation between any of the characteristics of the groups. In females, the PCAG score showed a correlation with age, and in males, it showed a correlation with a sleeping problem. Propofol had relatively high euphoria and low residual sedative effects. It had a more potent sedative effect in the female group who were young, and in the male group who had a low sleep quality index. There were differences in the abuse liability from a single exposure to propofol in the general population. Further study is needed to evaluate the abuse liability of repeated exposure.

  11. Pharmacy waste, fraud, and abuse in health care reform.

    PubMed

    Carpenter, Laura A; Edgar, Zachary; Dang, Christopher

    2011-01-01

    To describe the new Medicare and Medicaid waste, fraud, and abuse provisions of the Affordable Care Act (H. R. 3590) and Health Care and Education Affordability Reconciliation Act of 2010 (H. R. 4872), the preexisting law modified by H. R. 3590 and H. R. 4872, and applicable existing and proposed regulations. Waste, fraud, and abuse are substantial threats to the efficiency of the health care system. To combat these activities, the Department of Health and Human Services and Centers for Medicare & Medicaid Services promulgate and enforce guidelines governing the proper assessment and billing for Medicare and Medicaid services. These guidelines have a number of provisions that can catch even well-intentioned providers off guard, resulting in substantial fines. H. R. 3590 and H. R. 4872 augment preexisting waste, fraud, and abuse laws and regulations. This article reviews the new waste, fraud, and abuse laws and regulations to apprise pharmacists of the substantial changes affecting their practice. H. R. 3590 and H. R. 4872 modify screening requirements for providers; modify liability and penalties for the antikickback statute, federal False Claims Act, remuneration, and Stark Law; and create or extend auditing and management programs. Properly navigating these changes will be important in keeping pharmacies in compliance.

  12. A Child Abuse Assessment Center: Alternative Investigative Approaches.

    ERIC Educational Resources Information Center

    Hiester, Douglas S.

    A child abuse assessment center was created in Dade County, Florida, and was funded by state and local government sources. Staff includes a project director, two clinical social workers, a follow-up case monitor, clerical support, and a psychologist. The center attempts to minimize trauma to the child victim of sexual and physical abuse by a…

  13. Perception of legal liability by registered nurses in Korea.

    PubMed

    Kim, Ki-Kyong; Kim, In-Sook; Lee, Won-Hee

    2007-08-01

    Liability to the nursing profession is imperative if nurses are to act as an autonomous body. Assessing and communicating effectively is a vital part of nursing for patient safety. This study was designed to identify the attitudes of Korean nurses toward liability in assessment and communication and to investigate the relationship among the variables (i.e., legal awareness, attitudes toward doctor's duty to supervise nurses). The attitudes toward doctor's duty reflect the status of nurses' dependency on doctor's supervision. The study participants were 288 registered nurses in RN-BSN courses at two colleges in Korea. The level of legal awareness was measured using a 25-item Legal Awareness Questionnaire developed by the authors. The measuring instrument for attitudes toward doctor's duty to supervise nurses and nurses' liability was the Attitude toward Duty and Liability Questionnaire, which was modified by the authors. There were significant correlation between attitude toward doctor's duty and nurses' liability, but not between legal awareness and liability attitude. The results of this study suggest that the present educational content aimed at improving liability attitudes of nurses should be refocused with attitude-oriented education and should include an understanding of the increased accountability that comes with greater autonomy in nursing practice.

  14. An Elder Abuse Assessment Team in an Acute Hospital Setting.

    ERIC Educational Resources Information Center

    The Beth Israel Hospital Elder Assessment Team

    1986-01-01

    Describes a hospital-based multidisciplinary team designed to assess and respond to cases of suspected abuse or neglect of elders from both institutional and community settings. Presence of the team has increased the hospital staff's awareness of elder abuse and neglect, as well as their willingness to refer suspected cases for further assessment.…

  15. Animal Models of Substance Abuse and Addiction: Implications for Science, Animal Welfare, and Society

    PubMed Central

    Lynch, Wendy J; Nicholson, Katherine L; Dance, Mario E; Morgan, Richard W; Foley, Patricia L

    2010-01-01

    Substance abuse and addiction are well recognized public health concerns, with 2 NIH institutes (the National Institute on Drug Abuse and the National Institute on Alcohol Abuse and Alcoholism) specifically targeting this societal problem. As such, this is an important area of research for which animal experiments play a critical role. This overview presents the importance of substance abuse and addiction in society; reviews the development and refinement of animal models that address crucial areas of biology, pathophysiology, clinical treatments, and drug screening for abuse liability; and discusses some of the unique veterinary, husbandry, and IACUC challenges associated with these models. PMID:20579432

  16. Animal models of substance abuse and addiction: implications for science, animal welfare, and society.

    PubMed

    Lynch, Wendy J; Nicholson, Katherine L; Dance, Mario E; Morgan, Richard W; Foley, Patricia L

    2010-06-01

    Substance abuse and addiction are well recognized public health concerns, with 2 NIH institutes (the National Institute on Drug Abuse and the National Institute on Alcohol Abuse and Alcoholism) specifically targeting this societal problem. As such, this is an important area of research for which animal experiments play a critical role. This overview presents the importance of substance abuse and addiction in society; reviews the development and refinement of animal models that address crucial areas of biology, pathophysiology, clinical treatments, and drug screening for abuse liability; and discusses some of the unique veterinary, husbandry, and IACUC challenges associated with these models.

  17. 7 CFR 1400.204 - Limited partnerships, limited liability partnerships, limited liability companies, corporations...

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 7 Agriculture 10 2010-01-01 2010-01-01 false Limited partnerships, limited liability partnerships..., limited liability partnerships, limited liability companies, corporations, and other similar legal entities. (a) A limited partnership, limited liability partnership, limited liability company, corporation...

  18. Evaluation of the Relative Abuse of an OROS® Extended-release Hydromorphone HCI Product: Results from three Post-market Surveillance Studies.

    PubMed

    Butler, Stephen F; McNaughton, Emily C; Black, Ryan A; Cassidy, Theresa A

    2018-01-02

    Formulating prescription opioids to limit abuse remains a priority. OROS® extended-release (ER) hydromorphone HCl (EXALGO®) may have low abuse potential. Three post-marketing studies of the relative abuse liability of OROS hydromorphone ER were conducted. Estimates of abuse, unadjusted and adjusted for prescription volume, were generated for OROS hydromorphone ER and comparators from Q2 2010 through Q2 2014 for a high-risk, substance abuse treatment population and the general population using poison control center data. Comparators were selected for compound, market penetration, and route of administration (ROA) profile. ROA comparisons were made among the substance abuse treatment population. Internet discussion was examined to determine abusers' interest in and desire for the OROS formulation. Examination of abuse prevalence among adults within substance abuse treatment, intentional poison exposures and Internet discussion levels generally support the hypothesis that OROS hydromorphone ER may have lower abuse potential than many other opioid products. OROS hydromorphone ER also appears to be abused less often by alternate ROAs (e.g., snorting and injection). Lower levels of online discussion were observed along with relatively low endorsement for abuse. Abuse of OROS hydromorphone ER was observed in high-risk substance abuse and general population samples but at a very low relative prevalence. Evidence suggests it may be less often abused by alternate ROAs than some comparators. Online data did not find evidence of high levels of desire for OROS hydromorphone ER by recreational abusers. Continued monitoring of this product's abuse liability is warranted.

  19. Experience with an extended-release opioid formulation designed to reduce abuse liability in a community-based pain management clinic

    PubMed Central

    Rubino, Daniel

    2011-01-01

    Context With the growing public health concern over rising rates of opioid abuse, physicians have a responsibility to incorporate safeguards into their practice to minimize the potential for opioid misuse, abuse, and diversion. Patient-specific treatment regimens should include steps to monitor treatment success with regard to optimal pain management as well as inappropriate use of opioids and other substances. Opioid formulations designed to be less attractive for abuse are also being developed. While future studies are needed to determine the impact of such formulations in addressing the issue of opioid misuse in the community as a whole, the experience of practitioners who have utilized these formulations can highlight the practical steps to incorporate such formulations into the everyday patient-care setting. Purpose The purpose of this report is to describe experience in managing patients with chronic, moderate-to-severe pain using morphine sulfate and naltrexone hydrochloride extended release capsules (MS-sNT) (EMBEDA®, King Pharmaceuticals® Inc, Bristol, TN, which was acquired by Pfizer Inc, New York, NY, in March 2011), a formulation designed with features to deter abuse/misuse, in a community-based pain management clinic. Case presentations Case reports demonstrating a clinical management plan for assessment, initial interview procedures, explanation/discussion of proposed therapies, patients’ treatment goals, conversion to MS-sNT, and titration and treatment outcomes are provided. Results The management approach yielded successful outcomes including pain relief, improved quality of life, treatment satisfaction, and patient acceptance of a formulation designed to deter abuse/misuse. Discussion The cases presented demonstrate that the communication accompanying complete pretreatment assessment, goal-setting and expectations, and attention to individual patient needs can enable optimization of pain-related outcomes, resulting in improved quality of life

  20. Liability.

    ERIC Educational Resources Information Center

    Hollander, Patricia A.

    This chapter on liability covers a number of cases alleging negligence by colleges, universities, and university hospitals filed by patients and injured students. Liability issues are also part of defamation of character suits. Oral statements are known as slander, while written statements which defame are called libel. In certain situations,…

  1. Psychometric modeling of abuse and dependence symptoms across six illicit substances indicates novel dimensions of misuse

    PubMed Central

    Clark, Shaunna L.; Gillespie, Nathan A.; Adkins, Daniel E.; Kendler, Kenneth S.; Neale, Michael C.

    2015-01-01

    Aims This study explored the factor structure of DSM III-R/IV symptoms for substance abuse and dependence across six illicit substance categories in a population-based sample of males. Method DSM III-R/IV drug abuse and dependence symptoms for cannabis, sedatives, stimulants, cocaine, opioids and hallucinogens from 4179 males born 1940-1970 from the population-based Virginia Adult Twin Study of Psychiatric and Substance Use Disorders were analyzed. Confirmatory factor analyses tested specific hypotheses regarding the latent structure of substance misuse for a comprehensive battery of 13 misuse symptoms measured across six illicit substance categories (78 items). Results Among the models fit, the latent structure of substance misuse was best represented by a combination of substance-specific factors and misuse symptom-specific factors. We found no support for a general liability factor to illicit substance misuse. Conclusions Results indicate that liability to misuse illicit substances is drug class specific, with little evidence for a general liability factor. Additionally, unique dimensions capturing propensity toward specific misuse symptoms (e.g., tolerance, withdrawal) across substances were identified. While this finding requires independent replication, the possibility of symptom-specific misuse factors, present in multiple substances, raises the prospect of genetic, neurobiological and behavioral predispositions toward distinct, narrowly defined features of drug abuse and dependence. PMID:26517709

  2. Credibility assessment in child sexual abuse investigations: A descriptive analysis.

    PubMed

    Melkman, Eran P; Hershkowitz, Irit; Zur, Ronit

    2017-05-01

    A major challenge in cases of child sexual abuse (CSA) is determining the credibility of children's reports. Consequently cases may be misclassified as false or deemed 'no judgment possible'. Based on a large national sample of reports of CSA made in Israel in 2014, the study examines child and event characteristics contributing to the probability that reports of abuse would be judged credible. National data files of all children aged 3-14, who were referred for investigation following suspected victimization of sexual abuse, and had disclosed sexual abuse, were analyzed. Cases were classified as either 'credible' or 'no judgment possible'. The probability of reaching a 'credible' judgment was examined in relation to characteristics of the child (age, gender, cognitive delay, marital status of the parents,) and of the abusive event (abuse severity, frequency, perpetrator-victim relationship, perpetrator's use of grooming, and perpetrator's use of coercion), controlling for investigator's identity at the cluster level of the analysis. Of 1563 cases analyzed, 57.9% were assessed as credible. The most powerful predictors of a credible judgment were older age and absence of a cognitive delay. Reports of children to married parents, who experienced a single abusive event that involved perpetrator's use of grooming, were also more likely to be judged as credible. Rates of credible judgments found are lower than expected suggesting under-identification of truthful reports of CSA. In particular, those cases of severe and multiple abuse involving younger and cognitively delayed children are the ones with the lowest chances of being assessed as credible. Copyright © 2017 Elsevier Ltd. All rights reserved.

  3. Can MDMA play a role in the treatment of substance abuse?

    PubMed

    Jerome, Lisa; Schuster, Shira; Yazar-Klosinski, B Berra

    2013-03-01

    A wider array of treatments are needed for people with substance abuse disorders. Some psychedelic compounds have been assessed as potential substance abuse treatments with promising results. MDMA may also help treat substance abuse based on shared features with psychedelic compounds and recent reports indicating that MDMAassisted psychotherapy can reduce symptoms of PTSD. Narrative reports and data from early investigations found that some people reduced or eliminated their substance use after receiving MDMA, especially in a therapeutic setting. MDMA is a potent monoamine releaser with sympathomimetic effects that may indirectly activate 5-HT2A receptors. It increases interpersonal closeness and prosocial feelings, potentially through oxytocin release. Findings suggest that ecstasy, material represented as containing MDMA, is associated with deleterious long-term effects after heavy lifetime use, including fewer serotonin transporter sites and impaired verbal memory. Animal and human studies demonstrate moderate abuse liability for MDMA, and this effect may be of most concern to those treating substance abuse disorders. However, subjects who received MDMA-assisted psychotherapy in two recent clinical studies were not motivated to seek out ecstasy, and tested negative in random drug tests during follow-up in one study. MDMA could either directly treat neuropharmacological abnormalities associated with addiction, or it could indirectly assist with the therapeutic process or reduce symptoms of comorbid psychiatric conditions, providing a greater opportunity to address problematic substance use. Studies directly testing MDMA-assisted psychotherapy in people with active substance abuse disorder may be warranted.

  4. Liability.

    ERIC Educational Resources Information Center

    Hollander, Patricia A.

    Tort liability covers most injurious, civil, wrongful acts that occur between individuals. For tort liability to exist, four elements must be present: a duty to use due care, a breach of that duty, a direct causal relationship between the conduct complained of and the injury suffered, and proof of actual injury. Recent court cases involving tort…

  5. Abuse history and premenstrual symptomatology: assessing the mediating role of perceived stress.

    PubMed

    Lustyk, M Kathleen B; Widman, Laura; Becker, Linda de Laveaga

    2007-01-01

    The present study assessed the interrelationships among abuse history (Abuse), perceived stress (Stress), and premenstrual symptom severity reports (PMSR) among female college students (N = 91, 18-25 years old), and determined if Stress mediated the relationship between Abuse and PMSR. Abuse history was noted by 44% of women in this sample, including sexual (25%), physical (11%), or both sexual and physical (8%) abuse. Importantly, results showed significant positive relationships between Abuse, Stress, and PMSR, suggesting Abuse affects psychological and physical aspects of women's health. Overall, women rated PMSR affect symptoms highest, and abused women rated pain and water retention higher than non-abused women. Stress did not fully mediate the relationship between Abuse and PMSR in this study, but accounted for 24% of the variance between these variables. The health implications of these findings are discussed.

  6. True and False Allegations of Child Sexual Abuse: Assessment and Case Management.

    ERIC Educational Resources Information Center

    Ney, Tara, Ed.

    This book addresses the clinical, legal, and ethical issues arising in child sexual abuse cases; the assessment and case management of allegations; research issues; and practice recommendations. Chapter titles are as follows: "Assessing Allegations in Child Sexual Abuse: An Overview" (Tara Ney); "The Nature of Allegations of Child…

  7. Common and specific liability to addiction: approaches to association studies of opioid addiction.

    PubMed

    Nielsen, David A; Kreek, Mary Jeanne

    2012-06-01

    Opioid addiction, whether to opiates such as heroin and morphine, and/or to non-medical use of opioids, is a major problem worldwide. Although drug-induced and environmental factors are essential for the liability to develop opioid addiction, the genetic background of an individual is now known also to play a substantial role. The overall goal of this article is to address the common and specific liabilities to addiction in the context of approaches to studies of one addiction, opioid addiction. Literature on identifying genetic variants that may play a role in the development of opioid addiction was reviewed. A substantial number of genetic variants have been reported to be associated with opioid addiction. No single variant has been found in any of the reported GWAS studies with a substantial effect size on the liability to develop heroin addiction. It appears that there is a complex interaction of a large number of variants, some rare, some common, which interact with the environment and in response to specific drugs of abuse to increase the liability of developing opioid addiction. In spite of the inherent difficulties in obtaining large well-phenotyped cohorts for genetic studies, new findings have been reported that are being used to develop testable hypotheses into the biological basis of opioid addiction. Copyright © 2012. Published by Elsevier Ireland Ltd.

  8. Assessment of classification instruments designed to detect alcohol abuse

    DOT National Transportation Integrated Search

    1988-12-01

    The report summarizes an effort to identify and evaluate instruments currently in use to assess substance abuse problems in driving while impaired (DWI) offenders. The results of a national survey of DWI assessment practices in the United States are ...

  9. [Child psychiatric assessment and the debate regarding the abuse of abuse].

    PubMed

    Fegert, J M

    1995-03-01

    The current discussion on false allegations in sexual abuse cases has led to a polarization in the views expressed about the credibility of children. Some authors even speak of a "child sexual accuse syndrome" or of a "sexual abuse allegation in divorce" (SAID) syndrome. A phenomenological analysis of the multiple reasons for misinterpretations is presented. Instead of stressing the importance only of false positives in child sexual abuse questions, an attempt is made to describe reasons for false negatives. Based on a retrospective analysis of 50 consecutive child psychiatric experts in connection with court cases, there does not appear to be an increase in false accusations. Rather, only about one third of the cases even involved suspected sexual abuse. Sexual abuse allegations were much more frequent in girls than in boys. Of 20 abuse allegations we judge four to be false allegations. In only one of these cases, that of an adolescent girl who had been abused in childhood, was the false allegation intended.

  10. Grounding the Management of Liabilities in the Risk Analysis Framework

    ERIC Educational Resources Information Center

    Phillips, Peter W. B.; Smyth, Stuart

    2007-01-01

    Discussions of socioeconomic liability and compensation must necessarily start from an understanding of the socioeconomic, legal, and scientific basis for identifying, assessing, managing, and apportioning blame for hazards related to innovations. Public discussions about the nature of the liability challenge related to genetically modified (GM)…

  11. Development of the System on the Internet for Pre-Assessment of Child Abuse Prevention

    NASA Astrophysics Data System (ADS)

    Honma, Satoru; Wakamatsu, Hidetoshi; Ueda, Reiko

    Some assessments have been applied to find possible factors that might lead to child abuse. PACAP is a new method proposed by Ueda and others as a pre-assessment of the concerning child abuse, which reduces its false-positive misclassification. The Internet PACAP is developed to reduce the laborious work of nurses and health care workers for the necessary processing and classifying the scores of the pre-assessment. The present system is expected to prevent the child abuse more effectively.

  12. Men Who Abuse Their Spouses: An Approach to Assessing Future Risk.

    ERIC Educational Resources Information Center

    Goldsmith, Herbert R.

    1990-01-01

    Studied risk assessment for abuse cases by examining cases (N=20) referred to local spouse treatment center. Focused on woman's perception of mate's personality/behavioral characteristics and relationship plus other situational factors. Confirmed majority of risk factors associated with spouse abuse as reported in the literature. Presents pilot…

  13. Expanded managed care liability: what impact on employer coverage?

    PubMed

    Studdert, D M; Sage, W M; Gresenz, C R; Hensler, D R

    1999-01-01

    Policymakers are considering legislative changes that would increase managed care organizations' exposure to civil liability for withholding coverage or failing to deliver needed care. Using a combination of empirical information and theoretical analysis, we assess the likely responses of health plans and Employee Retirement Income Security Act (ERISA) plan sponsors to an expansion of liability, and we evaluate the policy impact of those moves. We conclude that the direct costs of liability are uncertain but that the prospect of litigation may have other important effects on coverage decision making, information exchange, risk contracting, and the extent of employers' involvement in health coverage.

  14. Urgent Medical Assessment after Child Sexual Abuse

    ERIC Educational Resources Information Center

    Palusci, Vincent J.; Cox, Edward O.; Shatz, Eugene M.; Schultze, Joel M.

    2006-01-01

    Background: Immediate medical assessment has been recommended for children after sexual abuse to identify physical injuries, secure forensic evidence, and provide for the safety of the child. However, it is unclear whether young children seen urgently within 72 hours of reported sexual contact would have higher frequencies of interview or…

  15. Malpractice Liability Risk and Use of Diagnostic Imaging Services: A Systematic Review of the Literature.

    PubMed

    Li, Suhui; Brantley, Erin

    2015-12-01

    A widespread concern among physicians is that fear of medical malpractice liability may affect their decisions for diagnostic imaging orders. The purpose of this article is to synthesize evidence regarding the defensive use of imaging services. A literature search was conducted using a number of databases. The review included peer-reviewed publications that studied the link between physician orders of imaging tests and malpractice liability pressure. We identified 13 peer-reviewed studies conducted in the United States. Five of the studies reported physician assessments of the role of defensive medicine in imaging-order decisions; five assessed the association between physicians' liability risk and imaging ordering, and three assessed the impact of liability risk on imaging ordering at the state level. Although the belief that medical liability risk could influence decisions is highly prevalent among physicians, findings are mixed regarding the impact of liability risk on imaging orders at both the state and physician level. Inconclusive evidence suggests that physician ordering of imaging tests is affected by malpractice liability risk. Further research is needed to disentangle defensive medicine from other reasons for inefficient use of imaging. Copyright © 2015 American College of Radiology. Published by Elsevier Inc. All rights reserved.

  16. The College Professor's Professional Liability

    ERIC Educational Resources Information Center

    Griggs, Walter S.; Rubin, Harvey W.

    1977-01-01

    The growing number of professional liability suits against professors warrants a close examination of the need for and provisions of available insurance coverage. The evolution of tort liability, the question of negligence, and the professional liability policy are discussed. (LBH)

  17. Telemetry video-electroencephalography (EEG) in rats, dogs and non-human primates: methods in follow-up safety pharmacology seizure liability assessments.

    PubMed

    Bassett, Leanne; Troncy, Eric; Pouliot, Mylene; Paquette, Dominique; Ascah, Alexis; Authier, Simon

    2014-01-01

    Non-clinical seizure liability studies typically aim to: 1) confirm the nature of EEG activity during abnormal clinical signs, 2) identify premonitory clinical signs, 3) measure plasma levels at seizure onset, 4) demonstrate that drug-induced seizures are self-limiting, 5) confirm that conventional drugs (e.g. diazepam) can treat drug-induced seizures and 6) confirm the no observed adverse effect level (NOAEL) at EEG. Our aim was to originally characterize several of these items in a three species comparative study. Cynomolgus monkey, Beagle dog and Sprague-Dawley rat with EEG telemetry transmitters were used to obtain EEG using the 10-20 system. Pentylenetetrazol (PTZ) was used to determine seizure threshold or as a positive seizurogenic agent. Clinical signs were recorded and premonitory signs were evaluated. In complement, other pharmacological agents were used to illustrate various safety testing strategies. Intravenous PTZ doses required to induce clonic convulsions were 36.1 (3.8), 56.1 (12.7) and 49.4 (11.7) mg/kg, in Beagle dogs, cynomolgus monkeys and Sprague-Dawley rats, respectively. Premonitory clinical signs typically included decreased physical activity, enhanced physiological tremors, hypersalivation, ataxia, emesis (except in rats) and myoclonus. In Sprague-Dawley rats, amphetamine (PO) increased high (approximately 40-120Hz), and decreased low (1-14Hz) frequencies. In cynomolgus monkeys, caffeine (IM) increased power in high (14-127Hz), and attenuated power in low (1-13Hz) frequencies. In the rat PTZ infusion seizure threshold model, yohimbine (SC and IV) and phenobarbital (IP) confirmed to be reliable positive controls as pro- and anticonvulsants, respectively. Telemetry video-EEG for seizure liability investigations was characterized in three species. Rats represent a first-line model in seizure liability assessments. Beagle dogs are often associated with overt susceptibility to seizure and are typically used in seizure liability studies only if

  18. Parents of minors who have sexually abused: legal liability and clinical interventions.

    PubMed

    Oz, Sheri

    2013-01-01

    While children and adolescents generally do not have the right to vote, marry, or sign contracts independently, they are often held responsible for their crimes. In spite of this, some parents of minor victims file civil suits against parents of the youth responsible for the harm. The courts must then decide to what extent, if any, parents are legally liable when their minor children commit offenses. Since parents are essential to the successful rehabilitation of minors who have sexually offended, the impact of legal liability on parental engagement in therapy must be examined. This article will explore the conflicting issues of age, legal responsibility, parental responsibility, and therapeutic effectiveness in the Israeli context and propose a means for resolution.

  19. The ‘Maltreatment and Abuse Chronology of Exposure’ (MACE) Scale for the Retrospective Assessment of Abuse and Neglect During Development

    PubMed Central

    Teicher, Martin H.; Parigger, Angelika

    2015-01-01

    There is increasing interest in childhood maltreatment as a potent stimulus that may alter trajectories of brain development, induce epigenetic modifications and enhance risk for medical and psychiatric disorders. Although a number of useful scales exist for retrospective assessment of abuse and neglect they have significant limitations. Moreover, they fail to provide detailed information on timing of exposure, which is critical for delineation of sensitive periods. The Maltreatment and Abuse Chronology of Exposure (MACE) scale was developed in a sample of 1051 participants using item response theory to gauge severity of exposure to ten types of maltreatment (emotional neglect, non-verbal emotional abuse, parental physical maltreatment, parental verbal abuse, peer emotional abuse, peer physical bullying, physical neglect, sexual abuse, witnessing interparental violence and witnessing violence to siblings) during each year of childhood. Items included in the subscales had acceptable psychometric properties based on infit and outfit mean square statistics, and each subscale passed Andersen’s Likelihood ratio test. The MACE provides an overall severity score and multiplicity score (number of types of maltreatment experienced) with excellent test-retest reliability. Each type of maltreatment showed good reliability as did severity of exposure across each year of childhood. MACE Severity correlated 0.738 with Childhood Trauma Questionnaire (CTQ) score and MACE Multiplicity correlated 0.698 with the Adverse Childhood Experiences scale (ACE). However, MACE accounted for 2.00- and 2.07-fold more of the variance, on average, in psychiatric symptom ratings than CTQ or ACE, respectively, based on variance decomposition. Different types of maltreatment had distinct and often unique developmental patterns. The 52-item MACE, a simpler Maltreatment Abuse and Exposure Scale (MAES) that only assesses overall exposure and the original test instrument (MACE-X) with several

  20. An Examination of Immunity Statutes Regarding the Liability of Recreational Youth Sport Organizations for the Pedophilic Actions of Coaches, Administrators, and Officials

    ERIC Educational Resources Information Center

    Baker, Thomas A., III; Connaughton, Daniel P.; Zhang, James J.

    2010-01-01

    Millions of children in the United States participate in youth sports. The literature demonstrates that sexual abuse is a problem in sports. This study examined voluntary immunity statutes for all 50 states and the District of Columbia with the purpose of determining potential liability for recreational youth sport organizations for the pedophilic…

  1. Understanding legacy liabilities

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Ossi, G.J.

    2005-08-01

    Among the most immediate issues facing operations with a workforce represented by the United Mine Workers of America (UMWA) are the so-called 'legacy liabilities'. Legacy liabilities fall under two categories: retiree health care and pension. The retiree health benefit obligations fall into two categories; statutory - those created under the Coal Industry Retiree Health Benefit Act of 1992 and contractual - the 1993 Employer Benefit Plan and the Individual Employer Plans. The pension liabilities are more straightforward; there are three different retirement plans in the NBCWA; the UMWA 1950 Pension Plan, the UMWA 1974 Pension Plan and the UMWA Cashmore » Deferred Savings Plan of 1988.« less

  2. Association of Drug Abuse and Child Abuse.

    ERIC Educational Resources Information Center

    Jaudes, Paula Kienberger; And Others

    1995-01-01

    Children born to mothers who used illicit drugs during pregnancy were assessed for subsequent abuse or neglect. Of the 513 children exposed inutero to drugs, 102 were substantiated as abused or neglected. Infants exposed inutero to drugs had a higher than expected risk of subsequent abuse compared to children in the general population. (Author/SW)

  3. The treatment of chronic insomnia: drug indications, chronic use and abuse liability. Summary of a 2001 New Clinical Drug Evaluation Unit meeting symposium.

    PubMed

    Mendelson, Wallace B; Roth, Thomas; Cassella, James; Roehrs, Timothy; Walsh, James K; Woods, James H; Buysse, Daniel J; Meyer, Roger E

    2004-02-01

    This paper summarizes a group of presentations and panel discussions on chronic insomnia at the 2001 NCDEU meeting. The presentations and discussions focused on the twin issues of efficacy and concerns of abuse liability with long-term hypnotic therapy. The panel concluded that insomnia may be an epidemiological marker for a variety of difficulties including accidents, increased health care utilization and subsequent development of major depression. Whether or not treatment of insomnia will prevent these long-term problems has not yet been determined. Since the mid-1980s there has been a rapid rise in the off-label use of antidepressants, particularly trazodone, for treating insomnia. Some participants expressed concern at the lack of data for this practice, particularly the absence of dose-response and tolerance information, and noted that the small amount of efficacy data available is not encouraging. Similarly, there are minimal data to support the use of antihistamines as sleep aids; moreover, their side effect profile and interactions with other drugs may be under appreciated. The limited data available on nightly long-term usage of the newer non-benzodiazepine hypnotics, primarily of six-months' duration, suggest an absence of tolerance, but more data for both nightly and non-nightly administration are needed. Insomniacs tend to show therapy-seeking, rather than drug-seeking behavior, and patients without histories of drug abuse are unlikely to self-escalate dosage of currently available hypnotics. There is fairly good agreement on the characteristics of an ideal hypnotic. All currently available agents, while effective and safe, do not achieve this ideal. The next few years are likely to see the appearance of a variety of agents with new and promising mechanisms of action.

  4. Assessment for self-blame and trauma symptoms during the medical evaluation of suspected sexual abuse.

    PubMed

    Melville, John D; Kellogg, Nancy D; Perez, Nadia; Lukefahr, James L

    2014-05-01

    The purpose of this study was to describe behavioural and emotional symptoms and to examine the effect of abuse-related factors, family responses to disclosure, and child self-blame on these symptoms in children presenting for medical evaluations after disclosure of sexual abuse. A retrospective review was conducted of 501 children ages 8-17. Trauma symptoms were determined by two sets of qualitative measures. Abstracted data included gender, ethnicity, and age; severity of abuse and abuser relationship to child; child responses regarding difficulty with sleep, school, appetite/weight, sadness, or self-harm, parent belief in abuse disclosure, and abuse-specific self-blame; responses to the Trauma Symptom Checklist in Children-Alternate; and the parent's degree of belief in the child's sexual abuse disclosure. Overall, 83% of the children had at least one trauma symptom; 60% had difficulty sleeping and one-third had thoughts of self-harm. Child age and abuse severity were associated with 3 of 12 trauma symptoms, and abuse-specific self-blame was associated with 10 trauma symptoms, after controlling for other variables. The children of parents who did not completely believe the initial disclosure of abuse were twice as likely to endorse self-blame as children of parents who completely believed the initial disclosure. Screening for behavioural and emotional problems during the medical assessment of suspected sexual abuse should include assessment of self-blame and family responses to the child's disclosures. In addition, parents should be informed of the importance of believing their child during the initial disclosure of abuse and of the impact this has on the child's emotional response to the abuse. Copyright © 2014 Elsevier Ltd. All rights reserved.

  5. Risk based In Vitro Performance Assessment of Extended Release Abuse Deterrent Formulations

    PubMed Central

    Xu, Xiaoming; Gupta, Abhay; Al-Ghabeish, Manar; Calderon, Silvia N.; Khan, Mansoor A.

    2016-01-01

    High strength extended release opioid products, which are indispensable tools in the management of pain, are associated with serious risks of unintentional and potentially fatal overdose, as well as of misuse and abuse that might lead to addiction. The issue of drug abuse becomes increasingly prominent when the dosage forms can be readily manipulated to release a high amount of opioid or to extract the drug in certain products or solvents. One approach to deter opioid drug abuse is by providing novel abuse deterrent formulations (ADF), with properties that may be viewed as barriers to abuse of the product. However, unlike regular extended release formulations, assessment of ADF technologies are challenging, in part due to the great variety of formulation designs available to achieve deterrence of abuse by oral, parenteral, nasal and respiratory routes. With limited prior history or literature information, and lack of compendial standards, evaluation and regulatory approval of these novel drug products become increasingly difficult. The present article describes a risk-based standardized in-vitro approach that can be utilized in general evaluation of abuse deterrent features for all ADF products. PMID:26784976

  6. 26 CFR 1.461-2 - Contested liabilities.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... property taxes are assessed and become a lien on December 1, but are not payable until March 1 of the... assessed and became a lien on December 1, 1964. On March 1, 1965, Y pays the entire $100 to the taxing... and a bill received for services may represent asserted liabilities. (2) Definition of the term...

  7. 26 CFR 1.461-2 - Contested liabilities.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... property taxes are assessed and become a lien on December 1, but are not payable until March 1 of the... assessed and became a lien on December 1, 1964. On March 1, 1965, Y pays the entire $100 to the taxing... and a bill received for services may represent asserted liabilities. (2) Definition of the term...

  8. 26 CFR 1.461-2 - Contested liabilities.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... property taxes are assessed and become a lien on December 1, but are not payable until March 1 of the... assessed and became a lien on December 1, 1964. On March 1, 1965, Y pays the entire $100 to the taxing... and a bill received for services may represent asserted liabilities. (2) Definition of the term...

  9. 26 CFR 1.461-2 - Contested liabilities.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... property taxes are assessed and become a lien on December 1, but are not payable until March 1 of the... assessed and became a lien on December 1, 1964. On March 1, 1965, Y pays the entire $100 to the taxing... and a bill received for services may represent asserted liabilities. (2) Definition of the term...

  10. Effects of child maltreatment and inherited liability on antisocial development: an official records study.

    PubMed

    Jonson-Reid, Melissa; Presnall, Ned; Drake, Brett; Fox, Louis; Bierut, Laura; Reich, Wendy; Kane, Phyllis; Todd, Richard D; Constantino, John N

    2010-04-01

    Evidence is steadily accumulating that a preventable environmental hazard, child maltreatment, exerts causal influences on the development of long-standing patterns of antisocial behavior in humans. The relationship between child maltreatment and antisocial outcome, however, has never previously been tested in a large-scale study in which official reports (rather than family member reports) of child abuse and neglect were incorporated, and genetic influences comprehensively controlled for. We cross-referenced official report data on child maltreatment from the Missouri Division of Social Services (DSS) with behavioral data from 4,432 epidemiologically ascertained Missouri twins from the Missouri Twin Registry (MOTWIN). We performed a similar procedure for a clinically ascertained sample of singleton children ascertained from families affected by alcohol dependence participating in the Collaborative Study on the Genetics of Alcoholism (COGA; n = 428) to determine whether associations observed in the general population held true in an "enriched" sample at combined inherited and environmental risk for antisocial development. For both the twin and clinical samples, the additive effects (not interactive effects) of maltreatment and inherited liability on antisocial development were confirmed and were highly statistically significant. Child maltreatment exhibited causal influence on antisocial outcome when controlling for inherited liability in both the general population and in a clinically ascertained sample. Official report maltreatment data represents a critical resource for resolving competing hypotheses on genetic and environmental causation of child psychopathology, and for assessing intervention outcomes in efforts to prevent antisocial development.

  11. Prescription Opioid Abuse: Challenges and Opportunities for Payers

    PubMed Central

    Katz, Nathaniel P.; Birnbaum, Howard; Brennan, Michael J.; Freedman, John D.; Gilmore, Gary P.; Jay, Dennis; Kenna, George A.; Madras, Bertha K.; McElhaney, Lisa; Weiss, Roger D.; White, Alan G.

    2013-01-01

    Objective Prescription opioid abuse and addiction are serious problems with growing societal and medical costs, resulting in billions of dollars of excess costs to private and governmental health insurers annually. Though difficult to accurately assess, prescription opioid abuse also leads to increased insurance costs in the form of property and liability claims, and costs to state and local governments for judicial, emergency, and social services. This manuscript’s objective is to provide payers with strategies to control these costs, while supporting safe use of prescription opioid medications for patients with chronic pain. Method A Tufts Health Care Institute Program on Opioid Risk Management meeting was convened in June 2010 with private and public payer representatives, public health and law enforcement officials, pain specialists, and other stakeholders to present research, and develop recommendations on solutions that payers might implement to combat this problem. Results While protecting access to prescription opioids for patients with pain, private and public payers can implement strategies to mitigate financial risks associated with opioid abuse, using internal strategies, such as formulary controls, claims data surveillance, and claims matching; and external policies and procedures that support and educate physicians on reducing opioid risks among patients with chronic pain. Conclusion Reimbursement policies, incentives, and health technology systems that encourage physicians to use universal precautions, to consult prescription monitoring program (PMP) data, and to implement Screening, Brief Intervention, and Referral to6Treatment protocols, have a high potential to reduce insurer risks while addressing a serious public health problem. PMID:23725361

  12. Commercial host (dram shop) liability: current status and trends.

    PubMed

    Mosher, James F; Cohen, Elena N; Jernigan, David H

    2013-09-01

    Commercial host liability (CHL, also called dram shop liability) holds alcohol retailers liable for alcohol-attributable harm caused by serving alcohol, illegally, to a patron who is already intoxicated (adult liability) or underage (underage liability). The Community Preventive Services Task Force, based on a systematic research literature review, concluded that CHL is an effective strategy for reducing excessive alcohol consumption. The current article describes the key components of CHL, its grounding in American jurisprudence, its adoption in the 50 states, and changes since 1989, when a similar assessment of these policies was conducted. The current paper focuses on three legislatively enacted restrictions: (1) increased evidentiary requirements; (2) limitations on damage awards; and (3) limitations on who may be sued. Data were collected in 2011 and analyzed in 2012 and 2013. There has been substantial erosion of CHL during the past 2 decades. Fewer states recognized CHL in 2011 than in 1989, and more statutory restrictions were imposed during the study period among states that did recognize CHL; states are more likely to recognize underage than adult liability; and six states recognized a Responsible Beverage Services Practices affirmative defense in both 1989 and 2011. Implications of these findings for public health practitioners are discussed. Copyright © 2013 American Journal of Preventive Medicine. All rights reserved.

  13. Polydrug abuse: A review of opioid and benzodiazepine combination use

    PubMed Central

    Jones, Jermaine D.; Mogali, Shanthi; Comer, Sandra D.

    2012-01-01

    This paper reviews studies examining the pharmacological interactions and epidemiology of the combined use of opioids and benzodiazepines (BZD). A search of English language publications from 1970 - 2012 was conducted using PubMed and PsycINFO®. Our search found approximately 200 articles appropriate for inclusion in this paper. While numerous reports indicate that the co-abuse of opioids and BZDs is ubiquitous around the world, the reasons for the co-abuse of these medications are not entirely clear. Though the possibility remains that opioid (ab)users are using BZDs therapeutically to self-medicate anxiety, mania or insomnia, the data reviewed in this paper suggest that BZD use is primarily recreational. For example, co-users report seeking BZD prescriptions for the purpose of enhancing opioid intoxication or “high,” and use doses that exceed the therapeutic range. Since there are few clinical studies investigating the pharmacological interaction and abuse liability of their combined use, this hypothesis has not been extensively evaluated in clinical settings. As such, our analysis encourages further systematic investigation of BZD abuse among opioid users. The co-abuse of BZDs and opioids is substantial and has negative consequences for general health, overdose lethality, and treatment outcome. Physicians should address this important and underappreciated problem with more cautious prescribing practices, and increased vigilance for abusive patterns of use. PMID:22857878

  14. Glial and Neuroimmune Mechanisms as Critical Modulators of Drug Use and Abuse.

    PubMed

    Lacagnina, Michael J; Rivera, Phillip D; Bilbo, Staci D

    2017-01-01

    Drugs of abuse cause persistent alterations in synaptic plasticity that may underlie addiction behaviors. Evidence suggests glial cells have an essential and underappreciated role in the development and maintenance of drug abuse by influencing neuronal and synaptic functions in multifaceted ways. Microglia and astrocytes perform critical functions in synapse formation and refinement in the developing brain, and there is growing evidence that disruptions in glial function may be implicated in numerous neurological disorders throughout the lifespan. Linking evidence of function in health and under pathological conditions, this review will outline the glial and neuroimmune mechanisms that may contribute to drug-abuse liability, exploring evidence from opioids, alcohol, and psychostimulants. Drugs of abuse can activate microglia and astrocytes through signaling at innate immune receptors, which in turn influence neuronal function not only through secretion of soluble factors (eg, cytokines and chemokines) but also potentially through direct remodeling of the synapses. In sum, this review will argue that neural-glial interactions represent an important avenue for advancing our understanding of substance abuse disorders.

  15. Substance Abuse Prevention, Assessment, and Treatment for Lesbian, Gay, Bisexual, and Transgender Youth.

    PubMed

    Aromin, Romulo Alcalde

    2016-12-01

    Knowing how to manage substance abuse in all youth is an important aspect of pediatric care, including providing clinically appropriate anticipatory guidance, monitoring, assessment, and treatment. Although most lesbian, gay, bisexual, and transgender (LGBT) youth do not abuse substances, as a group they experience unique challenges in self-identity development that put them at an increased risk for substance abuse. This article addresses prevention and management of substance use in LGBT youth relevant to pediatrics and allied professions as an aspect of their overall health care. It reviews basic information about substance abuse in youth and special considerations for LGBT youth. Copyright © 2016 Elsevier Inc. All rights reserved.

  16. Personality Assessment Screener, Childhood Abuse, and Adult Partner Violence in African American Women Using Primary Care.

    PubMed

    Porcerelli, John H; Hurrell, Kristen; Cogan, Rosemary; Jeffries, Keturah; Markova, Tsveti

    2015-12-01

    This study assessed the relationship between psychopathology with the Personality Assessment Screener (PAS) and childhood physical and sexual abuse and adult physical and sexual partner violence in a primary care sample of 98 urban-dwelling African American women. Patients completed the PAS, the Childhood Trauma Questionnaire, and the Conflict Tactics Scale. The PAS total score significantly correlated with all measures of childhood and adult abuse. Stepwise regression analyses revealed that PAS element scores of Suicidal Thinking and Hostile Control significantly predicted a history of childhood physical abuse; Suicidal Thinking, Hostile Control, and Acting Out significantly predicted a history of childhood sexual abuse; Suicidal Thinking, Negative Affect, and Alienation significantly predicted current adult partner physical violence; and Psychotic Features, Alcohol Problems, and Anger Control significantly predicted current adult sexual partner violence. The PAS appears to be a useful measure for fast-paced primary care settings for identifying patients who need a more thorough assessment for abuse. © The Author(s) 2015.

  17. A Bivariate Genetic Analysis of Drug Abuse ascertained through medical and criminal registries in Swedish Twins, Siblings and Half-Siblings

    PubMed Central

    Maes, Hermine H.; Neale, Michael C.; Ohlsson, Henrik; Zahery, Mahsa; Lichtenstein, Paul; Sundquist, Kristina; Sundquist, Jan; Kendler, Kenneth S.

    2016-01-01

    Objective Using Swedish nationwide registry data, the authors investigated the correlation of genetic and environmental risk factors in the etiology of drug abuse as ascertained from medical and criminal registries by modeling twin and sibling data. Methods Medical drug abuse was defined using public inpatient and outpatient records, while criminal drug abuse was ascertained through legal records. Twin, full and half sibling pairs were obtained from the national twin and genealogical registers. Information about sibling pair residence within the same household was obtained from Statistics Sweden. Standard bivariate genetic structural equation modeling was applied to the population-based data on drug abuse ascertained through medical and crime registries, using OpenMx. Results Analyses of all possible pairs of twins (MZ: N=4,482; DZ: N=9,838 pairs), full- (N=1,278,086) and half-siblings (paternal: N=7,767; maternal N=70,553) who grew up together suggested that factors explaining familial resemblance for drug abuse as defined through medical or criminal registries were mostly the same. Results showed substantial heritability and moderate contributions of shared environmental factors to drug abuse; both were higher in males versus females, and higher for drug abuse ascertained through criminal than medical records. Because of the low prevalence of both assessments of drug abuse, having access to population data was crucial to obtain stable estimates. Conclusions Using objective registry data, the authors found that drug abuse - whether ascertained through medical versus criminal records - was highly heritable. Furthermore, shared environmental factors contributed significantly to the liability of drug abuse. Genetic and shared environmental risk factors for these two forms of drug abuse were highly correlated. PMID:27480873

  18. A Bivariate Genetic Analysis of Drug Abuse Ascertained Through Medical and Criminal Registries in Swedish Twins, Siblings and Half-Siblings.

    PubMed

    Maes, Hermine H; Neale, Michael C; Ohlsson, Henrik; Zahery, Mahsa; Lichtenstein, Paul; Sundquist, Kristina; Sundquist, Jan; Kendler, Kenneth S

    2016-11-01

    Using Swedish nationwide registry data, the authors investigated the correlation of genetic and environmental risk factors in the etiology of drug abuse as ascertained from medical and criminal registries by modeling twin and sibling data. Medical drug abuse was defined using public inpatient and outpatient records, while criminal drug abuse was ascertained through legal records. Twin, full and half sibling pairs were obtained from the national twin and genealogical registers. Information about sibling pair residence within the same household was obtained from Statistics Sweden. Standard bivariate genetic structural equation modeling was applied to the population-based data on drug abuse ascertained through medical and crime registries, using OpenMx. Analyses of all possible pairs of twins (MZ: N = 4482; DZ: N = 9838 pairs), full- (N = 1,278,086) and half-siblings (paternal: N = 7767; maternal N = 70,553) who grew up together suggested that factors explaining familial resemblance for drug abuse as defined through medical or criminal registries were mostly the same. Results showed substantial heritability and moderate contributions of shared environmental factors to drug abuse; both were higher in males versus females, and higher for drug abuse ascertained through criminal than medical records. Because of the low prevalence of both assessments of drug abuse, having access to population data was crucial to obtain stable estimates. Using objective registry data, the authors found that drug abuse-whether ascertained through medical versus criminal records-was highly heritable. Furthermore, shared environmental factors contributed significantly to the liability of drug abuse. Genetic and shared environmental risk factors for these two forms of drug abuse were highly correlated.

  19. Adolescent tramadol use and abuse in Egypt.

    PubMed

    Bassiony, Medhat M; Salah El-Deen, Ghada M; Yousef, Usama; Raya, Yasser; Abdel-Ghani, Mohamed M; El-Gohari, Hayam; Atwa, Samar A

    2015-05-01

    Tramadol abuse liability is underestimated and the evidence of abuse and dependence is emerging. It has many health and social consequences especially in adolescents. Tramadol abuse has not been well studied in Egypt. The aim of this study was to estimate the prevalence and associated correlates of tramadol use and abuse among school students in Egypt. A total of 204 students, aged 13-18 years, from six schools in Zagazig, Egypt, were screened for tramadol use using The Drug Use Disorders Identification Test and a urine screen for tramadol. The prevalence of tramadol use was 8.8% among school students and the average age at onset of tramadol use was 16.5 ± 1.1. Some 83% of the users were using tramadol alone while the rest (17%) were using a combination of tramadol, alcohol, and cannabis. Two-thirds of these students started with tramadol as the first drug after the onset of tobacco smoking. Over one third of tramadol users had drug-related problems and 6% had dependence. There was a significant association between tramadol use and older age, male gender, and smoking. Drug-related problems were negatively correlated with age at onset of tramadol use. Tramadol use was common among adolescents and over one third of tramadol users had drug-related problems. Population-based longitudinal studies are needed to investigate tramadol use and the possible role of tramadol as a gateway drug in the development of substance abuse in Egypt.

  20. Liability concerns and shared use of school recreational facilities in underserved communities.

    PubMed

    Spengler, John O; Connaughton, Daniel P; Maddock, Jason E

    2011-10-01

    In underserved communities, schools can provide the physical structure and facilities for informal and formal recreation as well as after-school, weekend, and summer programming. The importance of community access to schools is acknowledged by authoritative groups; however, fear of liability is believed to be a key barrier to community access. The purpose of this study was to investigate perceptions of liability risk and associated issues among school administrators in underserved communities. A national survey of school administrators in underserved communities (n=360, response rate of 21%) was conducted in 2009 and analyzed in 2010. Liability perceptions in the context of community access were assessed through descriptive statistics. The majority of respondents (82.2%) indicated concern for liability should someone be injured on school property after hours while participating in a recreational activity. Among those that did not allow community access, 91% were somewhat to very concerned about liability and 86% believed that stronger legislation was needed to better protect schools from liability for after-hours recreational use. Among those who claimed familiarity with a state law that offered them limited liability protection, nearly three fourths were nevertheless concerned about liability. Liability concerns are prevalent among this group of school administrators, particularly if they had been involved in prior litigation, and even if they indicated they were aware of laws that provide liability protection where use occurs after hours. Reducing these concerns will be important if schools are to become locations for recreational programs that promote physical activity outside of regular school hours. Copyright © 2011 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

  1. Cognitive and emotional differences between abusive and non-abusive fathers.

    PubMed

    Francis, Karen J; Wolfe, David A

    2008-12-01

    Abusive fathers perpetrate a substantial portion of child physical abuse. Despite this, little is known about how they differ from non-abusive fathers. This study compared a broad range of cognitive and affective factors between physically abusive and non-abusive fathers. Abusive (n=24) and non-abusive (n=25) fathers completed standard measures assessing their experience and expression of anger, mental health, parenting stress, and their empathy and perceptions of children's socio-emotional signals. Abusive fathers differed from comparisons on almost all constructs. They experienced more anger and were more likely to express that anger aggressively. They reported more mental health concerns (such as depression, hostility, and paranoid ideation), more stress in parenting, and significantly less empathy for their children. They were also more likely to perceive children's emotional expressions as depicting negative emotions, such as anger and disgust. Abusive fathers struggle with a myriad of difficulties that likely contribute to their problematic parenting. These difficulties are both inter- and intra-personal in nature. The findings suggest that abusive fathers require comprehensive assessment that includes mental health screening. Interventions should be selected carefully to target abusive fathers' high levels of negative affect and negative perceptions. Treatment strategies should address problems related to parenting style (e.g., managing stress and interpretation of children's socioemotional signals) as well as their personal adjustment (e.g., cognitive behavioral strategies for regulating affect and cognitive distortions).

  2. Liability for Student Workers.

    ERIC Educational Resources Information Center

    Tryon, Jonathan S.

    1994-01-01

    Examines liability issues for academic libraries=FE student workers. Discussion includes staff training; hiring practices; supervision; negligence; emergency procedures; the use of reasonable care; and knowledge of library rules. Specific nonlibrary liability cases are cited as examples of the importance of employee screening, training, and danger…

  3. Protocols for the Assessment of Elder Abuse.

    ERIC Educational Resources Information Center

    Fulmer, Terry; Wetle, Terrie

    The fact that many states have passed elder abuse reporting laws has left care providers with a dilemma. If suspected abuse is reported, the relationship between caregiver and patient may change and the family's difficulties may increase. Indicators of abuse are not easy to differentiate from health problems, especially in the frail elderly. An…

  4. Spouse Abuse, Child Abuse, and Substance Abuse Among Army Facilities: Co-Occurrence, Correlations and Service Delivery Issues

    DTIC Science & Technology

    2006-03-01

    refer spouse abuse or child abuse offenders with identified alcohol or other drug involvement to the on-base counseling center for a substance...abuse assessment. The military’s response to combat substance abuse involves a combination of education, prevention, random testing for illicit drug ...data from three Army sources: the Army Central Registry (ACR), the Drug and Alcohol Management Information System (DAMIS), and Army personnel data

  5. Exploring the Factor Structure of a Recovery Assessment Measure among Substance-Abusing Youth.

    PubMed

    Gonzales, Rachel; Hernandez, Mayra; Douglas, Samantha B; Yu, Chong Ho

    2015-01-01

    To date, the measurement of recovery in the field of substance abuse is limited. Youth recovery from substance abuse is an important area to consider, given the complexities of such issues. The Recovery Assessment Scale (RAS) has been validated with mental health patient populations; however, its measurement characteristics have not been examined for individuals in substance abuse treatment. The current study explored the factor structure of the RAS with a sample of 80 substance-abusing youth who participated in a pilot aftercare study (Mage 20.5, SD=3.5; 71.3% male). Reliability analysis showed an internal consistency of α=.90 for the entire RAS measure among the youth sample. Results of exploratory factor analysis identified the following four factors: personal determination, skills for recovery, self-control in recovery, and social support/moving beyond recovery among the substance-abusing youth sample. The RAS also demonstrated sound convergent and divergent validity in comparison to other validated measures of functioning, sobriety, and well-being. Collectively, results support that the RAS has adequate psychometric properties for measuring recovery among substance-abusing youth.

  6. 12 CFR 965.2 - Authorized liabilities.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 12 Banks and Banking 7 2010-01-01 2010-01-01 false Authorized liabilities. 965.2 Section 965.2 Banks and Banking FEDERAL HOUSING FINANCE BOARD FEDERAL HOME LOAN BANK LIABILITIES SOURCE OF FUNDS § 965.2 Authorized liabilities. As a source of funds for business operations, each Bank is authorized to...

  7. 12 CFR 229.21 - Civil liability.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 12 Banks and Banking 3 2014-01-01 2014-01-01 false Civil liability. 229.21 Section 229.21 Banks and Banking FEDERAL RESERVE SYSTEM (CONTINUED) BOARD OF GOVERNORS OF THE FEDERAL RESERVE SYSTEM... Disclosure of Funds Availability Policies § 229.21 Civil liability. (a) Civil liability. A bank that fails to...

  8. 12 CFR 229.21 - Civil liability.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 12 Banks and Banking 3 2011-01-01 2011-01-01 false Civil liability. 229.21 Section 229.21 Banks and Banking FEDERAL RESERVE SYSTEM (CONTINUED) BOARD OF GOVERNORS OF THE FEDERAL RESERVE SYSTEM... Availability Policies § 229.21 Civil liability. (a) Civil liability. A bank that fails to comply with any...

  9. 12 CFR 229.21 - Civil liability.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 12 Banks and Banking 3 2012-01-01 2012-01-01 false Civil liability. 229.21 Section 229.21 Banks and Banking FEDERAL RESERVE SYSTEM (CONTINUED) BOARD OF GOVERNORS OF THE FEDERAL RESERVE SYSTEM... Availability Policies § 229.21 Civil liability. (a) Civil liability. A bank that fails to comply with any...

  10. 12 CFR 229.21 - Civil liability.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 12 Banks and Banking 3 2010-01-01 2010-01-01 false Civil liability. 229.21 Section 229.21 Banks and Banking FEDERAL RESERVE SYSTEM (CONTINUED) BOARD OF GOVERNORS OF THE FEDERAL RESERVE SYSTEM... Availability Policies § 229.21 Civil liability. (a) Civil liability. A bank that fails to comply with any...

  11. 12 CFR 229.21 - Civil liability.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 12 Banks and Banking 3 2013-01-01 2013-01-01 false Civil liability. 229.21 Section 229.21 Banks and Banking FEDERAL RESERVE SYSTEM (CONTINUED) BOARD OF GOVERNORS OF THE FEDERAL RESERVE SYSTEM... Disclosure of Funds Availability Policies § 229.21 Civil liability. (a) Civil liability. A bank that fails to...

  12. 75 FR 76946 - Demurrage Liability

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-12-10

    ... because the warehouseman--which otherwise has no incentive to agree to liability--can avoid liability... based on an unjust enrichment theory? The court rejected such an approach in Middle Atlantic, 353 F...

  13. Assessing the level of elder abuse knowledge preprofessionals possess: implications for the further development of university curriculum.

    PubMed

    Policastro, Christina; Payne, Brian K

    2014-01-01

    Elder abuse is a multifaceted problemthat requires interdisciplinary prevention and intervention strategies. An important question that arises is whether professionals are adequately prepared to address elder abuse in this collaborative network. Unfortunately, no studies have been conducted to assess the varying levels of knowledge that preprofessionals enrolled in university courses possess with regard to elder abuse. To fill this void, this study assesses the levels of elder abuse awareness among social work, nursing, health professions, and criminal justice students. Specific attention is given to determining whether there are differences in the amount of exposure to elder abuse literature across the disciplines. The study involves the analysis of survey data collected from 202 students enrolled in health and human sciences classes at a large university. Results show that none of the preprofessional groups, on average, reported knowing enough about elder abuse. Implications for future practice and research are provided.

  14. Training Needs for Substance Abuse Treatment and Assessment among Rehabilitation Counselors: California State Project

    ERIC Educational Resources Information Center

    Ong, Lee Za; Lee, Dal-Yob; Cha, Grace; Arokiasamy, Charles

    2008-01-01

    One hundred rehabilitation counselors in California reported that about 90% of consumers with whom they worked with had substance abuse and cooccurring issues, yet about half rated their graduate training in substance abuse treatment and assessment as poor and their practices as marginally proficient. The correlation analysis revealed that…

  15. Teacher Liability in School-Shop Accidents.

    ERIC Educational Resources Information Center

    Kegin, Denis J.

    The intent of the book is to stimulate interest in the problem of shop-teacher liability and to identify certain needs which have not been adequately met by existing laws and statutes. Chapter 1, The Significance of Teacher Liability, discusses basic legal considerations, the environment of the school shop, and the possibility of liability.…

  16. Stress- and glucocorticoid-induced priming of neuroinflammatory responses: potential mechanisms of stress-induced vulnerability to drugs of abuse.

    PubMed

    Frank, Matthew G; Watkins, Linda R; Maier, Steven F

    2011-06-01

    Stress and stress-induced glucocorticoids (GCs) sensitize drug abuse behavior as well as the neuroinflammatory response to a subsequent pro-inflammatory challenge. Stress also predisposes or sensitizes individuals to develop substance abuse. There is an emerging evidence that glia and glia-derived neuroinflammatory mediators play key roles in the development of drug abuse. Drugs of abuse such as opioids, psychostimulants, and alcohol induce neuroinflammatory mediators such as pro-inflammatory cytokines (e.g. interleukin (IL)-1β), which modulate drug reward, dependence, and tolerance as well as analgesic properties. Drugs of abuse may directly activate microglial and astroglial cells via ligation of Toll-like receptors (TLRs), which mediate the innate immune response to pathogens as well as xenobiotic agents (e.g. drugs of abuse). The present review focuses on understanding the immunologic mechanism(s) whereby stress primes or sensitizes the neuroinflammatory response to drugs of abuse and explores whether stress- and GC-induced sensitization of neuroimmune processes predisposes individuals to drug abuse liability and the role of neuroinflammatory mediators in the development of drug addiction. Copyright © 2011 Elsevier Inc. All rights reserved.

  17. Assessing Sexual Abuse/Attack Histories with Bariatric Surgery Patients

    ERIC Educational Resources Information Center

    Mahony, David

    2010-01-01

    This study assessed sexual abuse/attack histories in 537 bariatric surgery patients using the PsyBari. The prevalence rates found were lower (15.5%, 19.3% of women, 5.2% of men) than other studies that used bariatric surgery patients but consistent with studies that used nonbariatric obese subjects. Furthermore, bariatric surgery patients who…

  18. Integrating legal liabilities in nanomanufacturing risk management.

    PubMed

    Mohan, Mayank; Trump, Benjamin D; Bates, Matthew E; Monica, John C; Linkov, Igor

    2012-08-07

    Among other things, the wide-scale development and use of nanomaterials is expected to produce costly regulatory and civil liabilities for nanomanufacturers due to lingering uncertainties, unanticipated effects, and potential toxicity. The life-cycle environmental, health, and safety (EHS) risks of nanomaterials are currently being studied, but the corresponding legal risks have not been systematically addressed. With the aid of a systematic approach that holistically evaluates and accounts for uncertainties about the inherent properties of nanomaterials, it is possible to provide an order of magnitude estimate of liability risks from regulatory and litigious sources based on current knowledge. In this work, we present a conceptual framework for integrating estimated legal liabilities with EHS risks across nanomaterial life-cycle stages using empirical knowledge in the field, scientific and legal judgment, probabilistic risk assessment, and multicriteria decision analysis. Such estimates will provide investors and operators with a basis to compare different technologies and practices and will also inform regulatory and legislative bodies in determining standards that balance risks with technical advancement. We illustrate the framework through the hypothetical case of a manufacturer of nanoscale titanium dioxide and use the resulting expected legal costs to evaluate alternative risk-management actions.

  19. Environmental liability and redevelopment of old industrial land.

    PubMed

    Sigman, Hilary

    2010-01-01

    Many communities are concerned about the reuse of potentially contaminated land (brownfields) and believe that environmental liability is a hindrance to redevelopment. However, with land price adjustments, liability might not impede the reuse of this land. This article studies state liability rules-specifically, strict liability and joint and several liability-that affect the level and distribution of expected costs of private cleanup. It explores the effects of this variation on industrial land prices and vacancy rates and on reported brownfields in a panel of cities across the United States. In the estimated equations, joint and several liability reduces land prices and increases vacancy rates in central cities. The results suggest that liability is at least partly capitalized but does still deter redevelopment.

  20. Treatment barriers identified by substance abusers assessed at a centralized intake unit.

    PubMed

    Rapp, Richard C; Xu, Jiangmin; Carr, Carey A; Lane, D Tim; Wang, Jichuan; Carlson, Robert

    2006-04-01

    The 59-item Barriers to Treatment Inventory (BTI) was administered to 312 substance abusers at a centralized intake unit following assessment but before treatment entry to assess their views on barriers to treatment. Factor analysis identified 25 items in 7 well-defined latent constructs: Absence of Problem, Negative Social Support, Fear of Treatment, Privacy Concerns, Time Conflict, Poor Treatment Availability, and Admission Difficulty. The factorial structure of the barriers is consistent with the findings of other studies that asked substance abusers about barriers to treatment and is conceptually compatible with Andersen's model of health care utilization. Factors were moderately to highly correlated, suggesting that they interact with one another. Selected characteristics were generally not predictive of barrier factors. Overall, results indicate that the BTI has good content validity and is a reliable instrument for assessing barriers to drug treatment. The potential utility of the BTI in assessment settings is discussed.

  1. Liability and Insurance for Suborbital Flights

    NASA Astrophysics Data System (ADS)

    Masson-Zwaan, T.

    2012-01-01

    This paper analyzes and compares liability and liability insurance in the fields of aviation and spaceflight in order to propose solutions for a liability regime and insurance options for suborbital flights. Suborbital flights can be said to take place in the grey zone between air and space, between air law and space law, as well as between aviation insurance and space insurance. In terms of liability, the paper discusses air law and space law provisions in the fields of second and third party liability for damage to passengers and 'innocent bystanders' respectively, touching upon international treaties, national law and EU law, and on insurance to cover those risks. Although the insurance market is currently not ready to provide tailor-made products for operators of suborbital flights, it is expected to adapt rapidly once such flights will become reality. A hybrid approach will provide the best solution in the medium term.

  2. Forensic child sexual abuse evaluations: assessing subjectivity and bias in professional judgements.

    PubMed

    Everson, Mark D; Sandoval, Jose Miguel

    2011-04-01

    Evaluators examining the same evidence often arrive at substantially different conclusions in forensic assessments of child sexual abuse (CSA). This study attempts to identify and quantify subjective factors that contribute to such disagreements so that interventions can be devised to improve the reliability of case decisions. Participants included 1106 professionals in the field of child maltreatment representing a range of professional positions or job titles and years of experience. Each completed the Child Forensic Attitude Scale (CFAS), a 28-item survey assessing 3 forensic attitudes believed to influence professional judgments about CSA allegations: emphasis-on-sensitivity (i.e., a focus on minimizing false negatives or errors of undercalling abuse); emphasis-on-specificity (i.e., a focus on minimizing false positives or errors of overcalling abuse); and skepticism toward child and adolescent reports of CSA. A subset of 605 professionals also participated in 1 of 3 diverse decision exercises to assess the influence of the 3 forensic attitudes on ratings of case credibility. Exploratory factor analysis identified 4 factors or attitude subscales that corresponded closely with the original CFAS scales: 2 subscales for emphasis-on-sensitivity and 1 each for emphasis-on-specificity and skepticism. Attitude subscale scores differed significantly by sample source (in-state trainings vs. national conferences), gender, years of experience, and professional position, with Child Protective Service workers unexpectedly more concerned about overcalling abuse and more skeptical of child disclosures than other professionals-a pattern of scores associated with an increased probability of disbelieving CSA allegations. The 3 decision exercises offered validation of the attitude subscales as predictors of professional ratings of case credibility, with adjusted R(2)s for the three exercises ranging from .06 to .24, suggesting highly variable effect sizes. Evaluator disagreements

  3. Psychological abuse, substance abuse distress, dissatisfaction with friendships, and incident psychiatric problems.

    PubMed

    Sheikh, Mashhood Ahmed

    2018-05-01

    The aim of this study was to assess the mediating role of dissatisfaction with friendships in adulthood in the associations between psychological abuse in childhood, substance abuse distress in childhood, and incident psychiatric problems (IPPs) in adulthood over 13 years of follow-up. We used data collected from 1994 to 2008 within the framework of the Tromsø Study (N = 9502), a representative, longitudinal, prospective cohort study. Poisson regression analysis was used to assess the associations between psychological abuse, substance abuse distress, dissatisfaction with friendships in adulthood, and IPPs in adulthood. Indirect effects and proportion mediated (%) were assessed with the difference-in-coefficients method. Psychological abuse (relative risk [RR] = 1.66, 95% confidence interval [CI]: 1.45-1.89) and substance abuse distress in childhood (RR = 1.38, 95% CI: 1.18-1.62) were associated with an increased risk of dissatisfaction with friendships in adulthood. Dissatisfaction with friendships in adulthood was associated with an increased risk of IPPs in adulthood (RR = 1.71, 95% CI: 1.33-2.20). Moreover, dissatisfaction with friendships in adulthood mediated 9.31% (95% CI: 4.25-14.57) of the association between psychological abuse in childhood and IPPs in adulthood, and 9.17% (95% CI: 4.35-16.33) of the association between substance abuse distress in childhood and IPPs in adulthood. Dissatisfaction with friendships in adulthood mediates a minor proportion of the associations between psychological abuse, substance abuse distress, and IPPs in adulthood. Interventions aimed at decreasing dissatisfaction with friendships may dampen some of the effect of psychological abuse and substance abuse distress in childhood on IPPs in adulthood. Copyright © 2018 Elsevier Inc. All rights reserved.

  4. Liability for Off-Campus Injuries.

    ERIC Educational Resources Information Center

    Zirkel, Perry A.; Gluckman, Ivan B.

    1984-01-01

    Liability in cases involving students injured off school property generally hinges on whether districts fail to exercise due care in supervising students while on school premises. Typical activities that may occasion liability for negligence and possible defenses are listed. (MJL)

  5. Prior childhood sexual abuse in mothers of sexually abused children.

    PubMed

    Oates, R K; Tebbutt, J; Swanston, H; Lynch, D L; O'Toole, B I

    1998-11-01

    To see if mothers who were sexually abused in their own childhood are at increased risk of their children being sexually abused and to see if prior sexual abuse in mothers affects their parenting abilities. Sixty-seven mothers whose children had been sexually abused by others and 65 control mothers were asked about sexual abuse in their own childhood. The sexually abused children of mothers who had been sexually abused in their own childhood were compared with the sexually abused children of mothers who had not suffered child sexual abuse as children. Comparisons were made on self-esteem, depression and behavior in the children. Thirty-four percent of mothers of sexually abused children gave a history of sexual abuse in their own childhoods, compared with 12% of control mothers. Assessment of the sexually abused children for self-esteem, depression and behavior at the time of diagnosis, after 18 months and after 5 years showed no difference in any of these measures at any of the three time intervals between those whose mothers had suffered child sexual abuse and those whose mothers had not been abused. In this study, sexual abuse in a mother's own childhood was related to an increased risk of sexual abuse occurring in the next generation, although prior maternal sexual abuse did not effect outcome in children who were sexually abused.

  6. Confidence and Professional Judgment in Assessing Children's Risk of Abuse

    ERIC Educational Resources Information Center

    Regehr, Cheryl; Bogo, Marion; Shlonsky, Aron; LeBlanc, Vicki

    2010-01-01

    Objective: Child welfare agencies have moved toward standardized risk assessment measures to improve the reliability with which child's risk of abuse is predicted. Nevertheless, these tools require a degree of subjective judgment. Research to date has not substantially investigated the influence of specific context and worker characteristics on…

  7. Assessing abuse risk beyond self-report: analog task of acceptability of parent-child aggression.

    PubMed

    Rodriguez, Christina M; Russa, Mary Bower; Harmon, Nancy

    2011-03-01

    The present investigation reports on the development and initial validation of a new analog task, the Parent-Child Aggression Acceptability Movie Task (P-CAAM), intended to assess respondents' acceptance of parent-child aggression, including both physical discipline and physical abuse. Two independent samples were utilized to develop and evaluate the P-CAAM: an undergraduate sample to initially pilot the task and a separate sample of normative parents for additional assessment of validity. Scores from the P-CAAM were compared to related measures, including measures of self-reported disciplinary attitudes, child abuse potential, harsh parenting style, and use and escalation of physical discipline practices on another analog parenting task. Across the studies, the P-CAAM demonstrated acceptable internal consistency and construct validity, evidencing mild to moderate associations with both self-report and analog measures. Participants demonstrating increased acceptance of physical discipline and physical abuse on the P-CAAM analog task also reported greater approval of physical discipline, greater use of and escalation of physical discipline, harsher parenting styles, and higher child abuse potential on two separate measures. The P-CAAM analog appears to offer a promising alternative and/or supplement to conventional self-report measures, assessing attitudes regarding the acceptability of parent-child aggression in a way that is less likely to be influenced by social desirability. Suggestions for future evaluations with alternative samples, as well as possible implications of the data for disciplinary reactions are discussed. The development of alternatives to self-report measurement may lead to clarification of theoretical models of abuse in ways that lead to improvements in intervention programming; analogs may also provide a useful means to assess intervention programming outcomes. Copyright © 2011 Elsevier Ltd. All rights reserved.

  8. Abuse of reformulated OxyContin: Updated findings from a sentinel surveillance sample of individuals assessed for substance use disorder.

    PubMed

    Cassidy, Theresa A; Thorley, Eileen; Black, Ryan A; DeVeaugh-Geiss, Angela; Butler, Stephen F; Coplan, Paul

    To examine abuse prevalence for OxyContin and comparator opioids over a 6-year period prior to and following market entry of reformulated OxyContin and assess consistency in abuse across treatment settings and geographic regions. An observational study examining longitudinal changes using cross-sectional data from treatment centers for substance use disorder. A total of 874 facilities in 39 states in the United States within the National Addictions Vigilance Intervention and Prevention Program (NAVIPPRO®) surveillance system. Adults (72,060) assessed for drug problems using the Addiction Severity Index-Multimedia Version (ASI-MV®) from January 2009 through December 2015 who abused prescription opioids. Percent change in past 30-day abuse. OxyContin had significantly lower abuse 5 years after reformulation compared to levels for original OxyContin. Consistency of magnitude in OxyContin abuse reductions across geographic regions, ranging from 41 to 52 percent with differences in abuse reductions in treatment setting categories occurred. Changes in geographic region and treatment settings across study years did not bias the estimate of lower OxyContin abuse through confounding. In the postmarket setting, limitations and methodologic challenges in abuse measurement exist and it is difficult to isolate singular impacts of any one intervention given the complexity of prescription opioid abuse. Expectations for a reasonable threshold of abuse for any one ADF product or ADF opioids as a class are still uncertain and undefined. A significant decline in abuse prevalence of reformulated OxyContin was observed 5 years after its reformulation among this treatment sample of individuals assessed for substance use disorder that was lower historically for the original formulation of this product.

  9. Liability.

    ERIC Educational Resources Information Center

    Hollander, Patricia A.

    Recent court cases involving tort liabilities of institutions of higher education are discussed in this chapter. Issues addressed include negligence citations for injuries in physical education classes, a wrongful death suit, medical malpractice cases, and slip and fall accidents. Other cases included fraudulent misrepresentation, defamation of…

  10. Medical Liability Reform Crisis 2008

    PubMed Central

    2008-01-01

    The crisis of medical liability has resulted in drastic increases in insurance premiums and reduced access for patients to specialty care, particularly in areas such as obstetrics/gynecology, neurosurgery, and orthopaedic surgery. The current liability environment neither effectively compensates persons injured from medical negligence nor encourages addressing system errors to improve patient safety. The author reviews trends across the nation and reports on the efforts of an organization called “Doctors for Medical Liability Reform” to educate the public and lawmakers on the need for solutions to the chaotic process of adjudicating medical malpractice claims in the United States. PMID:18989732

  11. 26 CFR 1.461-2 - Contested liabilities.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... are assessed and become a lien on December 1, but are not payable until March 1 of the following year... became a lien on December 1, 1964. On March 1, 1965, Y pays the entire $100 to the taxing authority. In... bill received for services may represent asserted liabilities. (2) Definition of the term “contest...

  12. Substance abuse among high-risk sexual offenders: do measures of lifetime history of substance abuse add to the prediction of recidivism over actuarial risk assessment instruments?

    PubMed

    Looman, Jan; Abracen, Jeffrey

    2011-03-01

    There has been relatively little research on the degree to which measures of lifetime history of substance abuse add to the prediction of risk based on actuarial measures alone among sexual offenders. This issue is of relevance in that a history of substance abuse is related to relapse to substance using behavior. Furthermore, substance use has been found to be related to recidivism among sexual offenders. To investigate whether lifetime history of substance abuse adds to prediction over and above actuarial instruments alone, several measures of substance abuse were administered in conjunction with the Sex Offender Risk Appraisal Guide (SORAG). The SORAG was found to be the most accurate actuarial instrument for the prediction of serious recidivism (i.e., sexual or violent) among the sample included in the present investigation. Complete information, including follow-up data, were available for 250 offenders who attended the Regional Treatment Centre Sex Offender Treatment Program (RTCSOTP). The Michigan Alcohol Screening Test (MAST) and the Drug Abuse Screening Test (DAST) were used to assess lifetime history of substance abuse. The results of logistic regression procedures indicated that both the SORAG and the MAST independently added to the prediction of serious recidivism. The DAST did not add to prediction over the use of the SORAG alone. Implications for both the assessment and treatment of sexual offenders are discussed.

  13. Negligent Liability of College Counselors

    ERIC Educational Resources Information Center

    Sampson, James P., Jr.

    1977-01-01

    Discusses college counselors' liability for negligence in the performance of their duties, citing the only two court decisions involving college counselor negligence. Summarizes the circumstances in which college counselors may or may not be held negligent, and identifies present and future trends in counselor liability. (JG)

  14. [Professional liability claims against dentists].

    PubMed

    Moscoso Matus, Karla; Smok Vásquez, Pía

    2015-03-01

    The frequency and features of malpractice lawsuits against dentists in Chile are not well known. To determine the magnitude and frequency of professional liability claims against dentists. A retrospective analysis of the Medical Liability Unit of the Legal Medical Service of Chile database. This public organization deals with most professional liability claims in Chile. Between 2007 and 2012, 3,990 expert opinions about liability of health care professionals were requested. Odontology was the fifth specialty most commonly sued and dentists, the second most frequently sued professionals. Sixty nine percent of cases originated in private clinics, which is coincident with a higher frequency of dentists working in private practice. Most petitioners were adult women and most claims originated from surgical interventions and infections. In 35% of claims against dentists, a violation of Lex Artis was confirmed, compared with 9% of all expert opinions that generated in the unit. Claims against dentists are more common than previously thought and these professionals should adopt preventive measures to avoid them.

  15. The Abuse-Related Beliefs Questionnaire for Survivors of Childhood Sexual Abuse

    ERIC Educational Resources Information Center

    Ginzburg, Karni; Arnow, Bruce; Hart, Stacey; Gardner, William; Koopman, Cheryl; Classen, Catherine C.; Giese-Davis, Janine; Spiegel, David

    2006-01-01

    Objective: To evaluate the psychometric properties of a new measure, the Abuse-Related Beliefs Questionnaire (ARBQ), designed to assess abuse-related beliefs among adult survivors of childhood sexual abuse (CSA). Study 1 examined the structure of the scale, and Study 2 evaluated its reliability and validity. Method: One hundred and seventy female…

  16. 7 CFR 1773.45 - Regulatory liabilities.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... § 1773.45 Regulatory liabilities. The CPA's workpapers must document whether all regulatory liabilities comply with the requirements of SFAS No. 71. For electric borrowers only, the CPA's workpapers must...

  17. 7 CFR 1773.45 - Regulatory liabilities.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... § 1773.45 Regulatory liabilities. The CPA's workpapers must document whether all regulatory liabilities comply with the requirements of SFAS No. 71. For electric borrowers only, the CPA's workpapers must...

  18. 7 CFR 1773.45 - Regulatory liabilities.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... § 1773.45 Regulatory liabilities. The CPA's workpapers must document whether all regulatory liabilities comply with the requirements of SFAS No. 71. For electric borrowers only, the CPA's workpapers must...

  19. 7 CFR 1773.45 - Regulatory liabilities.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... § 1773.45 Regulatory liabilities. The CPA's workpapers must document whether all regulatory liabilities comply with the requirements of SFAS No. 71. For electric borrowers only, the CPA's workpapers must...

  20. 7 CFR 1773.45 - Regulatory liabilities.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... § 1773.45 Regulatory liabilities. The CPA's workpapers must document whether all regulatory liabilities comply with the requirements of SFAS No. 71. For electric borrowers only, the CPA's workpapers must...

  1. Opiate Drugs with Abuse Liability Hijack the Endogenous Opioid System to Disrupt Neuronal and Glial Maturation in the Central Nervous System.

    PubMed

    Hauser, Kurt F; Knapp, Pamela E

    2017-01-01

    The endogenous opioid system, comprised of multiple opioid neuropeptide and receptor gene families, is highly expressed by developing neural cells and can significantly influence neuronal and glial maturation. In many central nervous system (CNS) regions, the expression of opioid peptides and receptors occurs only transiently during development, effectively disappearing with subsequent maturation only to reemerge under pathologic conditions, such as with inflammation or injury. Opiate drugs with abuse liability act to modify growth and development by mimicking the actions of endogenous opioids. Although typically mediated by μ-opioid receptors, opiate drugs can also act through δ- and κ-opioid receptors to modulate growth in a cell-type, region-specific, and developmentally regulated manner. Opioids act as biological response modifiers and their actions are highly contextual, plastic, modifiable, and influenced by other physiological processes or pathophysiological conditions, such as neuro-acquired immunodeficiency syndrome. To date, most studies have considered the acute effects of opiates on cellular maturation. For example, activating opioid receptors typically results in acute growth inhibition in both neurons and glia. However, with sustained opioid exposure, compensatory factors become operative, a concept that has been largely overlooked during CNS maturation. Accordingly, this article surveys prior studies on the effects of opiates on CNS maturation, and also suggests new directions for future research in this area. Identifying the cellular and molecular mechanisms underlying the adaptive responses to chronic opiate exposure (e.g., tolerance) during maturation is crucial toward understanding the consequences of perinatal opiate exposure on the CNS.

  2. Substitutability of nicotine alone and an electronic cigarette liquid using a concurrent choice assay in rats: A behavioral economic analysis.

    PubMed

    Smethells, John R; Harris, Andrew C; Burroughs, Danielle; Hursh, Steven R; LeSage, Mark G

    2018-04-01

    For the Food and Drug Administration to effectively regulate tobacco products, the contribution of non-nicotine tobacco constituents to the abuse liability of tobacco must be well understood. Our previous work compared the abuse liability of electronic cigarette refill liquids (EC liquids) and nicotine (Nic) alone when each was available in isolation and found no difference in abuse liability (i.e., demand elasticity). Another, and potentially more sensitive measure, would be to examine abuse liability in a choice context, which also provides a better model of the tobacco marketplace. Demand elasticity for Nic alone and an EC liquid were measured when only one formulation was available (alone-price demand) and when both formulations were concurrently available (own-price demand), allowing an assessment of the degree to which each formulation served as a substitute (cross-price demand) when available at a low fixed-price. Own-price demand for both formulations were more elastic compared to alone-price demand, indicating that availability of a substitute increased demand elasticity. During concurrent access, consumption of the fixed-price formulation increased as the unit-price of the other formulation increased. The rate of increase was similar between formulations, indicating that they served as symmetrical substitutes. The cross-price model reliably quantified the substitutability of both nicotine formulations and indicated that the direct CNS effects of non-nicotine constituents in EC liquid did not alter its abuse liability compared to Nic. These data highlight the sensitivity of this model and its potential utility for examining the relative abuse liability and substitutability of tobacco products. Copyright © 2018 Elsevier B.V. All rights reserved.

  3. Assessing Quality of Care and Elder Abuse in Nursing Homes via Google Reviews.

    PubMed

    Mowery, Jared; Andrei, Amanda; Le, Elizabeth; Jian, Jing; Ward, Megan

    2016-01-01

    It is challenging to assess the quality of care and detect elder abuse in nursing homes, since patients may be incapable of reporting quality issues or abuse themselves, and resources for sending inspectors are limited. This study correlates Google reviews of nursing homes with Centers for Medicare and Medicaid Services (CMS) inspection results in the Nursing Home Compare (NHC) data set, to quantify the extent to which the reviews reflect the quality of care and the presence of elder abuse. A total of 16,160 reviews were collected, spanning 7,170 nursing homes. Two approaches were tested: using the average rating as an overall estimate of the quality of care at a nursing home, and using the average scores from a maximum entropy classifier trained to recognize indications of elder abuse. The classifier achieved an F-measure of 0.81, with precision 0.74 and recall 0.89. The correlation for the classifier is weak but statistically significant: = 0.13, P < .001, and 95% confidence interval (0.10, 0.16). The correlation for the ratings exhibits a slightly higher correlation: = 0.15, P < .001. Both the classifier and rating correlations approach approximately 0.65 when the effective average number of reviews per provider is increased by aggregating similar providers. These results indicate that an analysis of Google reviews of nursing homes can be used to detect indications of elder abuse with high precision and to assess the quality of care, but only when a sufficient number of reviews are available.

  4. Trichobezoar in Vagina: Assessment for Child Sexual Abuse and Diagnostic Result of Forensic Science.

    PubMed

    Bağ, Özlem; Acar, Buğra Han; Öztürk, Şenol; Alşen, Sevay; Ecevit, Çiğdem

    2017-03-01

    Vaginal discharge and bleeding in children require a through and thoughtful evaluation to diagnose the underlying problem including infections, sexual abuse, and vaginal foreign bodies. We report a 6-year-old girl presenting with bloody vaginal discharge, carefully evaluated for sexual abuse, and finally diagnosed as a vaginal foreign body after vaginoscopy. A rolling hair ball was extracted from the vagina and was diagnosed as trichobezoar pathologically without any endo-ecto-mesodermal residual tissue. The hair ball was genetically detected and diagnosed to belong herself by containing no foreign structure. Child sexual abuse was ruled out by forensic interview at CAC and report of forensic science that reported genetic structure belonging to the child. Medicolegal assessment helped in final diagnosis to exclude child sexual abuse. © 2016 American Academy of Forensic Sciences.

  5. Practitioner review: The victims and juvenile perpetrators of child sexual abuse--assessment and intervention.

    PubMed

    Vizard, Eileen

    2013-05-01

    The assessment of victims of child sexual abuse (CSA) is now a recognized aspect of clinical work for both CAMH and adult services. As juvenile perpetrators of CSA are responsible for a significant minority of the sexual assaults on other children, CAMH services are increasingly approached to assess these oversexualized younger children or sexually abusive adolescents. A developmental approach to assessment and treatment intervention is essential in all these cases. This review examines research on the characteristics of child victims and perpetrators of CSA. It describes evidence-based approaches to assessment and treatment of both groups of children. A selective review of MEDLINE, Psycinfo, Cochrane Library, and other databases was undertaken. Recommendations are made for clinical practice and future research. The characteristics of CSA victims are well known and those of juvenile perpetrators of sexual abuse are becoming recognized. Assessment approaches for both groups of children should be delivered within a safeguarding context where risk to victims is minimized. Risk assessment instruments should be used only as adjuncts to a full clinical assessment. Given high levels of psychiatric comorbidity, assessment, treatment, and other interventions should be undertaken by mental health trained staff. Victims and perpetrators of CSA present challenges and opportunities for professional intervention. Their complex presentations mean that their needs should be met by highly trained staff. However, their youth and developmental immaturity also give an opportunity to nip problem symptoms and behaviors in the bud. The key is in the earliest possible intervention with both groups. Future research should focus on long-term adult outcomes for both child victims and children who perpetrate CSA. Adult outcomes of treated children could identify problems and/or strengths in parenting the next generation and also the persistence and/or desistence of sexualized or abusive

  6. National Costs Of The Medical Liability System

    PubMed Central

    Mello, Michelle M.; Chandra, Amitabh; Gawande, Atul A.; Studdert, David M.

    2011-01-01

    Concerns about reducing the rate of growth of health expenditures have reignited interest in medical liability reforms and their potential to save money by reducing the practice of defensive medicine. It is not easy to estimate the costs of the medical liability system, however. This article identifies the various components of liability system costs, generates national estimates for each component, and discusses the level of evidence available to support the estimates. Overall annual medical liability system costs, including defensive medicine, are estimated to be $55.6 billion in 2008 dollars, or 2.4 percent of total health care spending. PMID:20820010

  7. Comparison of early maladaptive schemas and parenting origins in patients with opioid abuse and non-abusers.

    PubMed

    Jalali, Mohammad Reza; Zargar, Mohammad; Salavati, Mojgan; Kakavand, Ali Reza

    2011-01-01

    The aim of this study was to examine the difference of early maladaptive schemas and parenting origins in opioid abusers and non-opioid abusers. The early maladaptive schemas and parenting origins were compared in 56 opioid abusers and 56 non-opioids abusers. Schemas were assessed by the Young Schema Questionnaire 3rd (short form); and parenting origins were assessed by the Young Parenting Inventory. Data were analyzed by multivariate analysis of variance (MANOVA). The analysis showed that the means for schemas between opioid abusers and non-opioid abusers were different. Chi square test showed that parenting origins were significantly associated with their related schemas. The early maladaptive schemas and parenting origins in opioid abusers were more than non-opioid abusers; and parenting origins were related to their Corresponding schemas.

  8. [Beginners' operations and medical specialist standards : Avoidance of criminal liability and civil liability].

    PubMed

    Schneider, H

    2018-05-16

    In all phases, patients are entitled to receive medical treatment according to medical specialist standards. This does not mean that patients necessarily have to be treated by a medical specialist. Operations performed by "beginners", e. g. assistant physicians, are permitted. However, there are increased liability risks, both for the specialist and the assistant physician. Furthermore, there are risks of criminal responsibility for causing bodily harm by negligence or negligent manslaughter. This article portrays the requirements of civil liability and criminal responsibility concerning beginners' operations on the basis of cases and judgments of the Federal Court and the Higher Regional Courts in Germany. Additionally, the reception of the jurisprudence by the relevant legal literature will be discussed. Jurisprudence and legal literature categorize breaches of duty of care. Assistant physicians can be subject to contributory negligence liabilities, while specialists can bear liabilities for negligent selection, organization or supervision. Responsible specialist and assistant physicians can protect themselves (and the patient) and avoid legal risks by only performing operations adequate to their educational level or by delegating operations to beginners and ensuring intervention by a specialist by supervision of the operation which is suitable to the assistant physician's level of education.

  9. What Is Your Aquatics Liability IQ?

    ERIC Educational Resources Information Center

    Johnson, Ralph L.

    1984-01-01

    The author presents three court case studies and questions related to the cases, so that aquatic facility owners can test their liability perception. Recommendations are made in seven areas as defenses against aquatic liability. (JMK)

  10. Homicide committed by psychiatric patients: Psychiatrists' liability in Italian law cases.

    PubMed

    Terranova, Claudio; Rocca, Gabriele

    2016-01-01

    Interest in psychiatrists' professional liability in Italy has increased in recent years because of the number of medical malpractice claims. Professional liability for failure to prevent violent behaviour by psychiatric patients is particularly debated. This study describes three Italian cases in which health professionals - physicians and nurses - were found guilty of manslaughter for murders committed by psychiatric patients. Examination of the cases focuses on claims of malpractice, patients' characteristics, the circumstances of the homicide and the reasons for the court's judgment. In particular, the predictability of violent behaviour and the concept of causal links are examined in detail. The cases provide an opportunity for a study of comparative jurisprudence. The topics discussed are relevant not only to practicing psychiatrists but also to experts assessing medical liability in cases of criminal acts committed by psychiatric patients. © The Author(s) 2015.

  11. 29 CFR 4219.11 - Withdrawal liability upon mass withdrawal.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 29 Labor 9 2010-07-01 2010-07-01 false Withdrawal liability upon mass withdrawal. 4219.11 Section... Redetermination of Withdrawal Liability Upon Mass Withdrawal § 4219.11 Withdrawal liability upon mass withdrawal. (a) Initial withdrawal liability. The plan sponsor of a multiemployer plan that experiences a mass...

  12. 29 CFR 4219.11 - Withdrawal liability upon mass withdrawal.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 29 Labor 9 2011-07-01 2011-07-01 false Withdrawal liability upon mass withdrawal. 4219.11 Section... Redetermination of Withdrawal Liability Upon Mass Withdrawal § 4219.11 Withdrawal liability upon mass withdrawal. (a) Initial withdrawal liability. The plan sponsor of a multiemployer plan that experiences a mass...

  13. Child sexual abuse, attachment style, and depression: the role of the characteristics of abuse.

    PubMed

    Cantón-Cortés, David; Cortés, María Rosario; Cantón, José

    2015-02-01

    The aim of the current study was to examine the effects of secure, avoidant, and anxious attachment styles on depressive symptomatology in child sexual abuse (CSA) among young female adult victims. The role of attachment style was studied by considering possible interactive effects with the type of abuse, the relationship with the perpetrator, and the continuity of abuse. Participants were 168 female victims of CSA. Information about the abuse was obtained from a self-reported questionnaire. Attachment style was assessed with the Attachment Style Measure (ASM), and the Beck Depression Inventory (BDI) was used to assess depressive symptomatology. Secure and anxious attachment styles were correlated with low and high depression scores respectively. The effects of attachment style were stronger in cases where the abuse consisted of oral sex/penetration, a non-family member as perpetrator, and in isolated, compared with continued, abuse. These results confirm that characteristics of CSA (type of abuse, relationship with the perpetrator, and continuity of abuse) can affect the impact of attachment style on depressive symptomatology. © The Author(s) 2014.

  14. Liability of physicians supervising nonphysician clinicians.

    PubMed

    Paterick, Barbara B; Waterhouse, Blake E; Paterick, Timothy E; Sanbar, Sandy S

    2014-01-01

    Physicians confront a variety of liability issues when supervising nonphysician clinicians (NPC) including: (1) direct liability resulting from a failure to meet the state-defined standards of supervision/collaboration with NPCs; (2) vicarious liability, arising from agency law, where physicians are held accountable for NPC clinical care that does not meet the national standard of care; and (3) responsibility for medical errors when the NPC and physician are co-employees of the corporate enterprise. Physician-NPC co-employee relationships are highlighted because they are new and becoming predominant in existing healthcare models. Because of their novelty, there is a paucity of judicial decisions determining liability for NPC errors in this setting. Knowledge of the existence of these risks will allow physicians to make informed decisions on what relationships they will enter with NPCs and how these relationships will be structured and monitored.

  15. Liability exposure for surgical robotics instructors.

    PubMed

    Lee, Yu L; Kilic, Gokhan; Phelps, John Y

    2012-01-01

    Surgical robotics instructors provide an essential service in improving the competency of novice gynecologic surgeons learning robotic surgery and advancing surgical skills on behalf of patients. However, despite best intentions, robotics instructors and the gynecologists who use their services expose themselves to liability. The fear of litigation in the event of a surgical complication may reduce the availability and utility of robotics instructors. A better understanding of the principles of duty of care and the physician-patient relationship, and their potential applicability in a court of law likely will help to dismantle some concerns and uncertainties about liability. This commentary is not meant to discourage current and future surgical instructors but to raise awareness of liability issues among robotics instructors and their students and to recommend certain preventive measures to curb potential liability risks. Published by Elsevier Inc.

  16. Limited liability and the public's health.

    PubMed

    Rutkow, Lainie; Teret, Stephen P

    2007-01-01

    Corporations, through their products and behaviors, exert a strong effect on the well-being of populations. Industries including firearms, motor vehicles, tobacco, and alcohol produce and market products negatively impact public health. All of these industries are composed of corporations, which are legal fictions designed to provide limited exposure to liability, through a variety of mechanisms, for their investors and directors. This means that when actions are taken on behalf of a corporate entity, the individuals responsible generally will not face personal liability for the negative results of those actions. To illustrate this point, this article considers corporate products or practices that have caused harm in varied settings, and analyzes the role that limited liability played in these cases. In addition, the article identifies ways to modify or eliminate some of the principles and practices that accompany limited liability.

  17. Assessing abuse potential of new analgesic medications following market release: an evaluation of Internet discussion of tapentadol abuse.

    PubMed

    McNaughton, Emily C; Black, Ryan A; Weber, Sarah E; Butler, Stephen F

    2015-01-01

    Research on substance abusers in treatment suggests that tapentadol, a prescription analgesic, may have relatively low abuse potential. Messages posted by recreational drug abusers on online forums were examined for amount of discussion and endorsement for abuse of tapentadol and comparator drugs. Internet messages posted between January 1, 2011 and September 30, 2012 on seven drug-abuse web forums were evaluated. Proportions of posts and unique authors discussing tapentadol were compared with eight comparator compounds. Postcontent was coded to compare endorsement for abuse of tapentadol with two comparators, one drug with high desirability for abuse and one with low desirability for abuse. A total of 1,940,121 messages posted during the study period were copied from selected web forums. The proportion of all posts discussing tapentadol (proportion = 0.0003) was significantly lower than any of the comparator compounds (range of odds ratios from 16.6 to 104.3; P < 0.001). The proportion of unique authors was also lower. Posts coded for endorsement (N =  2,117) yielded an endorsement ratio (Ero) of 2.14 for tapentadol, which was significantly lower than the highly desirable for abuse oxymorphone (ERo = 5.08; P = 0.0011) and was as low as tramadol (ERo = 1.66), which has a long-established profile of low abuse and desirability for abuse. Recreational abusers posting on web forums appear to be less interested in abusing tapentadol when compared with other, selected prescription analgesics based on the amount of discussion (i.e., fewer posts and authors mentioning tapentadol). Endorsement of the product for abuse was also low. Wiley Periodicals, Inc.

  18. Opioid abusers’ ability to differentiate an opioid from placebo in laboratory challenge testing*

    PubMed Central

    Antoine, Denis G.; Strain, Eric C.; Tompkins, D. Andrew; Bigelow, George E.

    2013-01-01

    Background Abuse liability assessments influence drug development, federal regulation, and clinical care. One suggested procedure to reduce variability of assessments is a qualification phase, which assesses whether study applicants adequately distinguish active drug from placebo; applicants failing to make this distinction are disqualified. The present analyses assessed differences between qualification phase qualifiers and non-qualifiers. Methods Data were collected from 23 completers of the qualification phase of an abuse liability study. Opioid abusing participants received 30 mg oxycodone and placebo orally on separate days, and were characterized as qualifiers (vs. non-qualifiers) if their peak visual analog scale liking rating for oxycodone was at least 20 points higher than placebo’s peak rating. Groups were compared on demographic characteristics, drug history, and physiologic, subject and observer ratings. Results 61% of participants were qualifiers and 39% were non-qualifiers. Groups had similar demographic characteristics, drug use histories, and pupillary constriction responses. However, unlike qualifiers, non-qualifiers had an exaggerated placebo response for the liking score (p=0.03) and an attenuated oxycodone response for the liking score (p<.0001). Non-qualifiers’ failure to differentiate oxycodone versus placebo was evident for subject and observer ratings. Conclusion Different subjective responses to identical stimuli support the use of a qualification phase in abuse liability assessments. Further research should explore objective measures that may better account for these differences, determine optimal qualification criteria, and explore the developmental course of drug use. This study also documents certain opioid abusers fail to differentiate 30 mg of oxycodone from placebo, a phenomenon deserving further study. PMID:23369645

  19. Residential Treatment for Sexually Abusive Youth: An Assessment of Treatment Outcomes

    ERIC Educational Resources Information Center

    Jones, Christopher D.; Chancey, Roy; Lowe, Laura A.; Risler, Edwin A.

    2010-01-01

    Objective: This research study assesses the effectiveness of participation in a multimodal/holistic residential treatment program on changing deviant sexual interests and functional impairment among sexually abusive youth. Method: A one-group pretest posttest design was utilized to examine pretest (intake) and posttest (discharge) scores for 58…

  20. Assessing the Relationship between Campus Programs, Student Self-Efficacy, Stress, and Substance Abuse

    ERIC Educational Resources Information Center

    DiRamio, David; Payne, Ruthanna

    2007-01-01

    Student life educators continue searching for ways to assess campus programs. This is an exploratory study for an alternative assessment approach based on a hypothesized relationship between participation in campus activities, student self-efficacy, and student dispositions toward aspects of mental health and substance abuse. Focusing on the…

  1. 46 CFR 5.69 - Evidence of criminal liability.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... INVESTIGATION REGULATIONS-PERSONNEL ACTION Statement of Policy and Interpretation § 5.69 Evidence of criminal liability. Evidence of criminal liability discovered during an investigation or hearing conducted pursuant... 46 Shipping 1 2010-10-01 2010-10-01 false Evidence of criminal liability. 5.69 Section 5.69...

  2. 14 CFR 1260.61 - Allocation of risk/liability.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 14 Aeronautics and Space 5 2010-01-01 2010-01-01 false Allocation of risk/liability. 1260.61 Section 1260.61 Aeronautics and Space NATIONAL AERONAUTICS AND SPACE ADMINISTRATION GRANTS AND COOPERATIVE AGREEMENTS General Special Conditions § 1260.61 Allocation of risk/liability. Allocation of Risk/Liability...

  3. Abuse of Prescription Drugs in the Context of Novel Psychoactive Substances (NPS): A Systematic Review

    PubMed Central

    Schifano, Fabrizio; Corkery, John M.; Guirguis, Amira

    2018-01-01

    Recently, a range of prescription and over-the-counter drugs have been reportedly used as Novel Psychoactive Substances (NPS), due to their potential for abuse resulting from their high dosage/idiosyncratic methods of self-administration. This paper provides a systematic review of the topic, focusing on a range of medications which have emerged as being used recreationally, either on their own or in combination with NPS. Among gabapentinoids, pregabalin may present with higher addictive liability levels than gabapentin, with pregabalin being mostly identified in the context of opioid, polydrug intake. For antidepressants, their dopaminergic, stimulant-like, bupropion activities may explain their recreational value and diversion from the therapeutic intended use. In some vulnerable clients, a high dosage of venlafaxine (‘baby ecstasy’) is ingested for recreational purposes, whilst the occurrence of a clinically-relevant withdrawal syndrome may be a significant issue for all venlafaxine-treated patients. Considering second generation antipsychotics, olanzapine appears to be ingested at very large dosages as an ‘ideal trip terminator’, whilst the immediate-release quetiapine formulation may possess proper abuse liability levels. Within the image- and performance- enhancing drugs (IPEDs) group, the beta-2 agonist clenbuterol (‘size zero pill’) is reported to be self-administered for aggressive slimming purposes. Finally, high/very high dosage ingestion of the antidiarrhoeal loperamide has shown recent increasing levels of popularity due to its central recreational, anti-withdrawal, opiatergic effects. The emerging abuse of prescription drugs within the context of a rapidly modifying drug scenario represents a challenge for psychiatry, public health and drug-control policies. PMID:29690558

  4. College and University Liability under Superfund.

    ERIC Educational Resources Information Center

    Manderfeld, Donald J.

    1988-01-01

    A discussion of the Comprehensive Environmental Response, Compensation, and Liability Act of 1980 concerning responsibility for toxic waste disposal looks at college and university liability under the act, institutional defenses that could be raised under the act, and the settlement process. (MSE)

  5. 12 CFR 704.8 - Asset and liability management.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... CORPORATE CREDIT UNIONS § 704.8 Asset and liability management. (a) Policies. A corporate credit union must...) The purpose and objectives of the corporate credit union's asset and liability activities; (2) The... used as a basis of estimation. (b) Asset and liability management committee (ALCO). A corporate credit...

  6. 12 CFR 704.8 - Asset and liability management.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... CORPORATE CREDIT UNIONS § 704.8 Asset and liability management. (a) Policies. A corporate credit union must...) The purpose and objectives of the corporate credit union's asset and liability activities; (2) The... used as a basis of estimation. (b) Asset and liability management committee (ALCO). A corporate credit...

  7. [Surveillance system on drug abuse: Interest of the French national OPPIDUM program of French addictovigilance network].

    PubMed

    Frauger, Elisabeth; Pochard, Liselotte; Boucherie, Quentin; Giocanti, Adeline; Chevallier, Cécile; Daveluy, Amélie; Gibaja, Valérie; Caous, Anne-Sylvie; Eiden, Céline; Authier, Nicolas; Le Boisselier, Reynald; Guerlais, Marylène; Jouanjus, Émilie; Lepelley, Marion; Pizzoglio, Véronique; Pain, Stéphanie; Richard, Nathalie; Micallef, Joëlle

    2017-09-01

    It is important to assess drug abuse liability in 'real life' using different surveillance systems. OPPIDUM ('Observation of illegal drugs and misuse of psychotropic medications') surveillance system anonymously collects information on drug abuse and dependence observed in patients recruited in specialized care centers dedicated to drug dependence. The aim of this article is to demonstrate the utility of OPPIDUM system using 2015 data. OPPIDUM is a cross-sectional survey repeated each year since 1995. In 2015, 5003 patients described the modality of use of 10,159 psychoactive drugs. Among them, 77% received an opiate maintenance treatment: 68% methadone (half of them consumed capsule form) and 27% buprenorphine (39% consumed generic form). Brand-name buprenorphine is more often injected than generic buprenorphine (10% vs. 2%) and among methadone consumers 7% of methadone capsule consumers have illegally obtained methadone (vs. 9% for syrup form). The proportion of medications among psychoactive drugs injected is important (42%), with morphine representing 21% of the total psychoactive drugs injected and buprenorphine, 16%. OPPIDUM highlighted emergent behaviors of abuse with some analgesic opioids (like tramadol, oxycodone or fentanyl), pregabalin, or quetiapine. OPPIDUM highlighted variations of drugs use regarding geographic approaches or by drug dependence care centers (like in harm reduction centers). OPPIDUM clearly demonstrated that collection of valid and useful data on drug abuse is possible, these data have an interest at regional, national and international levels. Copyright © 2017 Société française de pharmacologie et de thérapeutique. Published by Elsevier Masson SAS. All rights reserved.

  8. Revision of the Word Association Test for assessing associations of patients reporting satanic ritual abuse in childhood.

    PubMed

    Leavitt, F; Labott, S M

    1998-11-01

    A growing number of psychiatric patients report satanic ritual abuse, prompting research into this controversial area. In the current study, the Word Association Test (WAT) was modified to assess experience with satanic abuse. Pilot work resulted in norms for two domains: normative and satanic. Female psychiatric patients were compared on their associations in two studies. Based on a sexual history, they were grouped into those reporting sexual abuse, those reporting satanic ritual abuse (SRA), and those without a history of sexual abuse (controls). In both studies, SRA patients gave significantly more total associations, significantly fewer normative associations, and significantly more satanic associations than did the other two groups. These results suggest that an experience base is shared by individuals reporting SRA that is not found in individuals who do not report satanic abuse (even if they do report sexual abuse). The implications of these findings are discussed from the perspective of arguments advanced by advocates and critics of SRA.

  9. State Liability for Abuse in Primary Schools: Systemic Failure and "O'Keeffe" v. "Hickey"

    ERIC Educational Resources Information Center

    O'Mahony, Conor

    2009-01-01

    Due to the historical arrangement between Church and State, the Irish State has always discharged its duty to provide for free primary education exclusively through the provision of funding to privately owned and managed schools. Consequently, in "O'Keeffe" v. "Hickey," where a woman sued the State in respect of sex abuse she…

  10. 37 CFR 10.78 - Limiting liability to client.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 37 Patents, Trademarks, and Copyrights 1 2010-07-01 2010-07-01 false Limiting liability to client... Office Code of Professional Responsibility § 10.78 Limiting liability to client. A practitioner shall not attempt to exonerate himself or herself from, or limit his or her liability to, a client for his or her...

  11. 48 CFR 47.207-7 - Liability and insurance.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... liability for injury to persons or damage to property other than the freight being transported; (2) The contractor's liability for loss of and/or damage to the freight being transported; and (3) The amount of... damage to the freight being transported is not specified, the usual measure of liability as prescribed in...

  12. 48 CFR 47.207-7 - Liability and insurance.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... liability for injury to persons or damage to property other than the freight being transported; (2) The contractor's liability for loss of and/or damage to the freight being transported; and (3) The amount of... damage to the freight being transported is not specified, the usual measure of liability as prescribed in...

  13. 48 CFR 47.207-7 - Liability and insurance.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... liability for injury to persons or damage to property other than the freight being transported; (2) The contractor's liability for loss of and/or damage to the freight being transported; and (3) The amount of... damage to the freight being transported is not specified, the usual measure of liability as prescribed in...

  14. 48 CFR 47.207-7 - Liability and insurance.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... liability for injury to persons or damage to property other than the freight being transported; (2) The contractor's liability for loss of and/or damage to the freight being transported; and (3) The amount of... damage to the freight being transported is not specified, the usual measure of liability as prescribed in...

  15. 48 CFR 47.207-7 - Liability and insurance.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... liability for injury to persons or damage to property other than the freight being transported; (2) The contractor's liability for loss of and/or damage to the freight being transported; and (3) The amount of... damage to the freight being transported is not specified, the usual measure of liability as prescribed in...

  16. Routes of abuse of prescription opioid analgesics: a review and assessment of the potential impact of abuse-deterrent formulations.

    PubMed

    Gasior, Maciej; Bond, Mary; Malamut, Richard

    2016-01-01

    Prescription opioid analgesics are an important treatment option for patients with chronic pain; however, misuse, abuse and diversion of these medications are a major global public health concern. Prescription opioid analgesics can be abused via intended and non-intended routes of administration, both intact or after manipulation of the original formulation to alter the drug-delivery characteristics. Available data indicate that ingestion (with or without manipulation of the prescribed formulation) is the most prevalent route of abuse, followed by inhalation (snorting, smoking and vaping) and injection. However, reported routes of abuse vary considerably between different formulations. A number of factors have been identified that appear to be associated with non-oral routes of abuse, including a longer duration of abuse, younger age, male sex and a rural or socially deprived location. The development of abuse-deterrent formulations of prescription opioid analgesics is an important step toward reducing abuse of these medications. Available abuse-deterrent formulations aim to hinder extraction of the active ingredient, prevent administration through alternative routes and/or make abuse of the manipulated product less attractive, less rewarding or even aversive. There are currently five opioid analgesics with a Food and Drug Administration abuse-deterrent label, and a number of other products are under review. A growing body of evidence suggests that introduction of abuse-deterrent opioid analgesics in the USA has been associated with decreased rates of abuse of these formulations. The availability of abuse-deterrent formulations therefore appears to represent an important step toward curbing the epidemic of abuse of prescription opioid analgesics, while ensuring the availability of effective pain medications for patients with legitimate medical need.

  17. 26 CFR 50.5 - Liability for the tax.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 26 Internal Revenue 17 2011-04-01 2011-04-01 false Liability for the tax. 50.5 Section 50.5... TAXES (CONTINUED) REGULATIONS RELATING TO THE TAX IMPOSED WITH RESPECT TO CERTAIN HYDRAULIC MINING § 50.5 Liability for the tax. Liability for tax attaches to any person engaged at any time during the...

  18. 26 CFR 50.5 - Liability for the tax.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 26 Internal Revenue 17 2010-04-01 2010-04-01 false Liability for the tax. 50.5 Section 50.5... TAXES (CONTINUED) REGULATIONS RELATING TO THE TAX IMPOSED WITH RESPECT TO CERTAIN HYDRAULIC MINING § 50.5 Liability for the tax. Liability for tax attaches to any person engaged at any time during the...

  19. 31 CFR 50.90 - Cap on annual liability.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 31 Money and Finance: Treasury 1 2010-07-01 2010-07-01 false Cap on annual liability. 50.90 Section 50.90 Money and Finance: Treasury Office of the Secretary of the Treasury TERRORISM RISK INSURANCE PROGRAM Cap on Annual Liability § 50.90 Cap on annual liability. Pursuant to Section 103 of the Act, if...

  20. Abuse potential and psychoactive effects of δ-9-tetrahydrocannabinol and cannabidiol oromucosal spray (Sativex), a new cannabinoid medicine.

    PubMed

    Robson, Philip

    2011-09-01

    There is a growing consensus that cannabis dependence is a substantial and underappreciated problem. The key component responsible for the euphoric effects of cannabis and its dependence potential is δ-9-tetrahydrocannabinol (THC). THC-containing cannabinoid medicines theoretically pose a risk of abuse and dependence. In order to evaluate the potential of Sativex to cause cannabis-like psychoactivity, abuse or dependence relevant data from all published papers have been reviewed along with the integrated safety analysis for Sativex use in multiple sclerosis (MS) patients on file at GW Pharmaceuticals. In clinical trials, intoxication scores have been low and euphoria reported by only 2.2% of patients. Tolerance has not occurred, abrupt withdrawal has not resulted in a formal withdrawal syndrome, and no cases of abuse or diversion have been reported to date. A formal abuse liability study of Sativex in experienced cannabis smokers showed some abuse potential in comparison with placebo at higher doses, but scores were consistently lower than equivalent doses of THC. Evidence to date suggests that abuse or dependence on Sativex is likely to occur in only a very small proportion of recipients.

  1. A Life History Assessment of Early Childhood Sexual Abuse in Women

    ERIC Educational Resources Information Center

    Vigil, Jacob M.; Geary, David C.; Byrd-Craven, Jennifer

    2005-01-01

    Life history theory provided a framework for examining the relations among child sexual abuse (CSA), childhood adversity, and patterns of reproductive development and behavior. A community survey that assessed CSA, life history variables (e.g., age of menarche), and social and family background was administered to 623 women (mean age=26.9 years).…

  2. Multidimensional Assessment of Resilience in Mothers Who Are Child Sexual Abuse Survivors

    ERIC Educational Resources Information Center

    Wright, Margaret O'Dougherty; Fopma-Loy, Joan; Fischer, Stephanie

    2005-01-01

    Objective: There has been relatively little attention given to positive adaptation following childhood sexual abuse (CSA), and typically such resilience has been explored primarily in the intrapersonal domain. This study explored questions about later resilience following CSA within a multidimensional framework by assessing resilience across…

  3. 26 CFR 1.312-3 - Liabilities.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 26 Internal Revenue 4 2011-04-01 2011-04-01 false Liabilities. 1.312-3 Section 1.312-3 Internal Revenue INTERNAL REVENUE SERVICE, DEPARTMENT OF THE TREASURY (CONTINUED) INCOME TAX (CONTINUED) INCOME TAXES Effects on Corporation § 1.312-3 Liabilities. The amount of any reductions in earnings and profits...

  4. 26 CFR 1.312-3 - Liabilities.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 26 Internal Revenue 4 2010-04-01 2010-04-01 false Liabilities. 1.312-3 Section 1.312-3 Internal Revenue INTERNAL REVENUE SERVICE, DEPARTMENT OF THE TREASURY (CONTINUED) INCOME TAX (CONTINUED) INCOME TAXES Effects on Corporation § 1.312-3 Liabilities. The amount of any reductions in earnings and profits...

  5. Liability Insurance in California Public Schools.

    ERIC Educational Resources Information Center

    California State Dept. of Education, Sacramento.

    In the mid-1970s, an increased number of high-cost liability lawsuits combined with other financial difficulties insurance companies were experiencing to cause drastic increases in insurance rates for schools and a reluctance on the part of insurance carriers to provide liability coverage. Questionnaires returned by county and district school…

  6. Types of abuse and risk factors associated with elder abuse.

    PubMed

    Simone, Lacher; Wettstein, Albert; Senn, Oliver; Rosemann, Thomas; Hasler, Susann

    2016-01-01

    Detecting elder abuse is challenging because it is a taboo, and many cases remain unreported. This study aimed to identify types of elder abuse and to investigate its associated risk factors. Retrospective analyses of 903 dossiers created at an Independent Complaints Authority for Old Age in the Canton of Zurich, Switzerland, from January 1, 2008 to October 31, 2012. Characteristics of victims and perpetrators, types of abuse, and associated risk factors related to the victim or the perpetrator were assessed. Bi- and multivariate analysis were used to identify abuse and neglect determinants. A total of 150 cases reflected at least one form of elder abuse or neglect; 104 cases were categorised as abuse with at least one type of abuse (overall 135 mentions), 46 cases were categorised as neglect (active or passive). Psychological abuse was the most reported form (47%), followed by financial (35%), physical (30%) and anticonstitutional abuse (18%). In 81% of the 150 cases at least two risk factors existed. In 13% no associated risk factor could be identified. Compared with neglect, elders with abuse were less likely to be a nursing home resident than living at home (odds ratio [OR] 0.02, 95% confidence interval [CI] 0.00-0.19). In addition, they were more likely to be cohabiting with their perpetrators (OR 18.01, 95% CI 4.43-73.19). For the majority of the reported elder abuse cases at least two associated risk factors could be identified. Knowledge about these red flags and a multifaceted strategy are needed to identify and prevent elder abuse.

  7. Investigating heterogeneity in violent offending liability among injection drug users from a developmental perspective.

    PubMed

    Torok, Michelle; Darke, Shane; Shand, Fiona; Kaye, Sharlene

    2016-09-01

    Violence is a major burden of harm among injecting drug users (IDU), however, the liability to violent offending is not well understood. The current study aimed to better understand differences in the liability to violence by determining whether IDU could be disaggregated into distinct violent offending classes, and determining the correlates of class membership. A total of 300 IDU from Sydney, Australia were administered a structured interview examining the prevalence and severity of drug use and violent offending histories, as well as early life risk factors (maltreatment, childhood mental disorder, trait personality). IDU were disaggregated into four distinct latent classes, comprising a non-violent class (24%), an adolescent-onset persistent class (33%), an adult-onset transient class (24%) and an early-onset, chronic class (19%). Pairwise and group comparisons of classes on predispositional and substance use risks showed that the EARLY class had the poorest psychosocial risk profile, while the NON class had the most favourable. Multinomial logistic regression revealed that higher trait impulsivity and aggression scores, having a history of conduct disorder, frequent childhood abuse, and more problematic alcohol use, were independently associated with more temporally stable and severe violent offending. The model explained 67% of variance in class membership (χ(2)=207.7, df=51, p<0.001). IDU can be meaningfully disaggregated into distinct violent offending classes using developmental criteria. The age of onset of violence was indicative of class membership insomuch as that the extent of early life risk exposure was differentially associated with greater long-term liability to violence and drug use. Copyright © 2016 Elsevier Ltd. All rights reserved.

  8. 75 FR 35456 - Comprehensive Environmental Response, Compensation and Liability Act (CERCLA) or Superfund...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-06-22

    ... and Liability Act (CERCLA) or Superfund, Brownfields Amendments, Section 104(k); Notice of Revisions to FY2011 Guidelines for Brownfields Assessment, Revolving Loan Fund, and Cleanup Grants AGENCY... applicants in preparing proposals for grants to assess and clean up brownfield sites. EPA's Brownfields...

  9. The Association Between Childhood Abuse and Elder Abuse Among Chinese Adult Children in the United States.

    PubMed

    Dong, XinQi; Li, Ge; Simon, Melissa A

    2017-07-01

    The previous researchers have postulated that an abused child may abuse his or her abuser parent when the parent is getting old, also known as the intergenerational transmission of violence. However, few studies use data to support this model, and it has yet to be examined in the U.S. Chinese community. This study aims to examine the association between childhood abuse and elder abuse reported by Chinese adult children in the United States. Guided by a community-based participatory research approach, 548 Chinese adult children aged 21 years and older participated in this study. Childhood abuse was assessed by four-item Hurt-Insult-Threaten-Scream (HITS) scale. Elder abuse was assessed by a 10-item instrument derived from the Caregiver Abuse Screen (CASE). Logistic regression analysis was performed. Childhood abuse was associated with caregiver abuse screen results (odds ratio = 1.92, 95% confidence interval = 1.24-2.95). Being physically hurt (r = .13, p < .01), insulted (r = .15, p < .001), threatened (r = .12, p < .01), and screamed at (r = .18, p < .001) as a child were significantly correlated with caregiver abuse screen results. This study suggests that childhood abuse is associated with increased risk of elder abuse among Chinese adult children in the United States. Longitudinal research should be conducted to explore the mechanisms through which childhood abuse and its subtypes links with elder abuse. © The Author 2017. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  10. Malpractice liability, technology choice and negative defensive medicine.

    PubMed

    Feess, Eberhard

    2012-04-01

    We extend the theoretical literature on the impact of malpractice liability by allowing for two treatment technologies, a safe and a risky one. The safe technology bears no failure risk, but leads to patient-specific disutility since it cannot completely solve the health problems. By contrast, the risky technology (for instance a surgery) may entirely cure patients, but fail with some probability depending on the hospital's care level. Tight malpractice liability increases care levels if the risky technology is chosen at all, but also leads to excessively high incentives for avoiding the liability exposure by adopting the safe technology. We refer to this distortion toward the safe technology as negative defensive medicine. Taking the problem of negative defensive medicine seriously, the second best optimal liability needs to balance between the over-incentive for the safe technology in case of tough liability and the incentive to adopt little care for the risky technology in case of weak liability. In a model with errors in court, we find that gross negligence where hospitals are held liable only for very low care levels outperforms standard negligence, even though standard negligence would implement the first best efficient care level.

  11. Assessing fidelity in individual and family therapy for adolescent substance abuse.

    PubMed

    Hogue, Aaron; Dauber, Sarah; Chinchilla, Priscilla; Fried, Adam; Henderson, Craig; Inclan, Jaime; Reiner, Robert H; Liddle, Howard A

    2008-09-01

    This study introduces an observational measure of fidelity in evidence-based practices for adolescent substance abuse treatment. The Therapist Behavior Rating Scale-Competence (TBRS-C) measures adherence and competence in individual cognitive-behavioral therapy and multidimensional family therapy for adolescent substance abuse. The TBRS-C assesses fidelity to the core therapeutic goals of each approach and also contains global ratings of therapist competence. Study participants were 136 clinically referred adolescents and their families observed in 437 treatment sessions. The TBRS-C demonstrated strong interrater reliability for goal-specific ratings of treatment adherence, and modest reliability for goal-specific and global ratings of therapist competence, evidence of construct validity, and discriminant validity with an observational measure of therapeutic alliance. The utility of the TBRS-C for evaluating treatment fidelity in field settings is discussed.

  12. Professional liability insurance and medical error disclosure.

    PubMed

    McLennan, Stuart; Shaw, David; Leu, Agnes; Elger, Bernice

    2015-01-01

    To examine medicolegal stakeholders' views about the impact of professional liability insurance in Switzerland on medical error disclosure. Purposive sample of 23 key medicolegal stakeholders in Switzerland from a range of fields between October 2012 and February 2013. Data were collected via individual, face-to-face interviews using a researcher-developed semi-structured interview guide. Interviews were transcribed and analysed using conventional content analysis. Participants, particularly those with a legal or quality background, reported that concerns relating to professional liability insurance often inhibited communication with patients after a medical error. Healthcare providers were reported to be particularly concerned about losing their liability insurance cover for apologising to harmed patients. It was reported that the attempt to limit the exchange of information and communication could lead to a conflict with patient rights law. Participants reported that hospitals could, and in some case are, moving towards self-insurance approaches, which could increase flexibility regarding error communication The reported current practice of at least some liability insurance companies in Switzerland of inhibiting communication with harmed patients after an error is concerning and requires further investigation. With a new ethic of transparency regarding medical errors now prevailing internationally, this approach is increasingly being perceived to be misguided. A move away from hospitals relying solely on liability insurance may allow greater transparency after errors. Legalisation preventing the loss of liability insurance coverage for apologising to harmed patients should also be considered.

  13. Peer Deviance, Parental Divorce, and Genetic Risk in the Prediction of Drug Abuse in a Nationwide Swedish Sample

    PubMed Central

    Kendler, Kenneth S.; Ohlsson, Henrik; Sundquist, Kristina; Sundquist, Jan

    2014-01-01

    IMPORTANCE Peer deviance (PD) strongly predicts externalizing psychopathologic conditions but has not been previously assessable in population cohorts. We sought to develop such an index of PD and to clarify its effects on risk of drug abuse (DA). OBJECTIVES To examine how strongly PD increases the risk of DA and whether this community-level liability indicator interacts with key DA risk factors at the individual and family levels. DESIGN, SETTING, AND PARTICIPANTS Studies of future DA registration in 1 401 698 Swedish probands born from January 1, 1970, through December 31, 1985, and their adolescent peers in approximately 9200 small community areas. Peer deviance was defined as the proportion of individuals born within 5 years of the proband living in the same small community when the proband was 15 years old who eventually were registered for DA. MAIN OUTCOMES AND MEASURES Drug abuse recorded in medical, legal, or pharmacy registry records. RESULTS Peer deviance was associated with future DA in the proband, with rates of DA in older and male peers more strongly predictive than in younger or female peers. The predictive power of PD was only slightly attenuated by adding measures of community deprivation, collective efficacy, or family socioeconomic status. Probands whose parents were divorced were more sensitive to the pathogenic effects of high PD environments. A robust positive interaction was also seen between genetic risk of DA (indexed by rates of DA in first-, second-, and third-degree relatives) and PD exposure. CONCLUSIONS AND RELEVANCE With sufficient data, PD can be measured in populations and strongly predicts DA. In a nationwide sample, risk factors at the level of the individual (genetic vulnerability), family (parental loss), and community (PD) contribute substantially to risk of DA. Individuals at elevated DA risk because of parental divorce or high genetic liability are more sensitive to the pathogenic effects of PD. Although the effect of our PD

  14. Computers in medicine: liability issues for physicians.

    PubMed

    Hafner, A W; Filipowicz, A B; Whitely, W P

    1989-07-01

    Physicians routinely use computers to store, access, and retrieve medical information. As computer use becomes even more widespread in medicine, failure to utilize information systems may be seen as a violation of professional custom and lead to findings of professional liability. Even when a technology is not widespread, failure to incorporate it into medical practice may give rise to liability if the technology is accessible to the physician and reduces risk to the patient. Improvement in the availability of medical information sources imposes a greater burden on the physician to keep current and to obtain informed consent from patients. To routinely perform computer-assisted literature searches for informed consent and diagnosis is 'good medicine'. Clinical and diagnostic applications of computer technology now include computer-assisted decision making with the aid of sophisticated databases. Although such systems will expand the knowledge base and competence of physicians, malfunctioning software raises a major liability question. Also, complex computer-driven technology is used in direct patient care. Defective or improperly used hardware or software can lead to patient injury, thus raising additional complicated questions of professional liability and product liability.

  15. 14 CFR 291.22 - Aircraft accident liability insurance requirement.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 14 Aeronautics and Space 4 2011-01-01 2011-01-01 false Aircraft accident liability insurance... for All-Cargo Air Transportation § 291.22 Aircraft accident liability insurance requirement. No air... and maintains in effect aircraft accident liability coverage that meets the requirements of part 205...

  16. Forensic Child Sexual Abuse Evaluations: Assessing Subjectivity and Bias in Professional Judgements

    ERIC Educational Resources Information Center

    Everson, Mark D.; Sandoval, Jose Miguel

    2011-01-01

    Objectives: Evaluators examining the same evidence often arrive at substantially different conclusions in forensic assessments of child sexual abuse (CSA). This study attempts to identify and quantify subjective factors that contribute to such disagreements so that interventions can be devised to improve the reliability of case decisions. Methods:…

  17. Training family therapists to assess for and intervene in partner abuse: a curriculum for graduate courses, professional workshops, and self-study.

    PubMed

    Haddock, Shelley A

    2002-04-01

    Partner abuse is an epidemic with potentially dire consequences for individuals, families, and society. Family therapists must be able to competently assess for and intervene in abuse situations. This article presents a curriculum designed to provide family therapists with introductory knowledge and skills for the assessment and intervention of partner abuse. The curriculum, which is informed primarily by feminist and multicultural theories and practices, can be used in graduate courses, professional workshops, and for self-study.

  18. Comorbid psychiatric and alcohol abuse/dependence disorders: psychosocial stress, abuse, and personal history factors of those in treatment.

    PubMed

    De Bernardo, Gina L; Newcomb, Michael; Toth, Amanda; Richey, Gary; Mendoza, Richard

    2002-01-01

    Factors related to comorbid versus only substance disorders are essential to understanding and treating these complex problems. Medical records of sixty-nine inpatients at a private rehabilitation hospital in Southern California were reviewed to determine the associations between personal history factors and (1) comorbid psychiatric and substance abuse disorders and (2) participant's self-assessed progress in treatment. Results revealed significant differences between dual diagnosis patients (alcohol abuse/dependence and an affective disorder) and alcohol abuse/dependence only in regard to gender, previous diagnosis, length of illness, suicide attempts, psychotropic medication history, maternal emotional, physical and sexual abuse, paternal abuse, legal difficulties, and psychosocial stressors. No significant differences between substance abusing patients and dually diagnosed patients were found in terms of self-assessment of progress in treatment. Significant correlations were found between self-assessed progress in treatment and major depression (versus bipolar disorder), use of psychotropic medication, and less abuse from mother or primary caretaker. Identification of these personal history factors may be useful in developing and implementing treatment plans.

  19. 14 CFR 1274.916 - Liability and risk of loss.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 14 Aeronautics and Space 5 2010-01-01 2010-01-01 false Liability and risk of loss. 1274.916... AGREEMENTS WITH COMMERCIAL FIRMS Other Provisions and Special Conditions § 1274.916 Liability and risk of..., or indemnification of, developers of experimental aerospace vehicles. Liability and Risk of Loss July...

  20. Training Needs of Rehabilitation Counselors concerning Alcohol and Other Drugs Abuse Assessment and Treatment

    ERIC Educational Resources Information Center

    Ong, Lee Za; Cardoso, Elizabeth; Chan, Fong; Chronister, Julie; Chou, Chih Chin

    2007-01-01

    Forty-two rehabilitation counselors participated in a study regarding perceived training needs concerning alcohol and other drug abuse (AODA) treatment and assessment. Participants reported that 85% of consumers with whom they worked had AODA issues, yet over half rated their graduate training in AODA treatment and assessment as poor, and their…

  1. Interplay Between Childhood Physical Abuse and Familial Risk in the Onset of Psychotic Disorders

    PubMed Central

    Fisher, Helen L.; McGuffin, Peter; Boydell, Jane; Fearon, Paul; Craig, Thomas K.; Dazzan, Paola; Morgan, Kevin; Doody, Gillian A.; Jones, Peter B.; Leff, Julian; Murray, Robin M.; Morgan, Craig

    2014-01-01

    Background: Childhood abuse is considered one of the main environmental risk factors for the development of psychotic symptoms and disorders. However, this association could be due to genetic factors influencing exposure to such risky environments or increasing sensitivity to the detrimental impact of abuse. Therefore, using a large epidemiological case-control sample, we explored the interplay between a specific form of childhood abuse and family psychiatric history (a proxy for genetic risk) in the onset of psychosis. Methods: Data were available on 172 first presentation psychosis cases and 246 geographically matched controls from the Aetiology and Ethnicity of Schizophrenia and Other Psychoses study. Information on childhood abuse was obtained retrospectively using the Childhood Experience of Care and Abuse Questionnaire and occurrence of psychotic and affective disorders in first degree relatives with the Family Interview for Genetic Studies. Results: Parental psychosis was more common among psychosis cases than unaffected controls (adjusted OR = 5.96, 95% CI: 2.09–17.01, P = .001). Parental psychosis was also associated with physical abuse from mothers in both cases (OR = 3.64, 95% CI: 1.06–12.51, P = .040) and controls (OR = 10.93, 95% CI: 1.03–115.90, P = .047), indicative of a gene-environment correlation. Nevertheless, adjusting for parental psychosis did not measurably impact on the abuse-psychosis association (adjusted OR = 3.31, 95% CI: 1.22–8.95, P = .018). No interactions were found between familial liability and maternal physical abuse in determining psychosis caseness. Conclusions: This study found no evidence that familial risk accounts for associations between childhood physical abuse and psychotic disorder nor that it substantially increases the odds of psychosis among individuals reporting abuse. PMID:24399191

  2. Interplay between childhood physical abuse and familial risk in the onset of psychotic disorders.

    PubMed

    Fisher, Helen L; McGuffin, Peter; Boydell, Jane; Fearon, Paul; Craig, Thomas K; Dazzan, Paola; Morgan, Kevin; Doody, Gillian A; Jones, Peter B; Leff, Julian; Murray, Robin M; Morgan, Craig

    2014-11-01

    Childhood abuse is considered one of the main environmental risk factors for the development of psychotic symptoms and disorders. However, this association could be due to genetic factors influencing exposure to such risky environments or increasing sensitivity to the detrimental impact of abuse. Therefore, using a large epidemiological case-control sample, we explored the interplay between a specific form of childhood abuse and family psychiatric history (a proxy for genetic risk) in the onset of psychosis. Data were available on 172 first presentation psychosis cases and 246 geographically matched controls from the Aetiology and Ethnicity of Schizophrenia and Other Psychoses study. Information on childhood abuse was obtained retrospectively using the Childhood Experience of Care and Abuse Questionnaire and occurrence of psychotic and affective disorders in first degree relatives with the Family Interview for Genetic Studies. Parental psychosis was more common among psychosis cases than unaffected controls (adjusted OR = 5.96, 95% CI: 2.09-17.01, P = .001). Parental psychosis was also associated with physical abuse from mothers in both cases (OR = 3.64, 95% CI: 1.06-12.51, P = .040) and controls (OR = 10.93, 95% CI: 1.03-115.90, P = .047), indicative of a gene-environment correlation. Nevertheless, adjusting for parental psychosis did not measurably impact on the abuse-psychosis association (adjusted OR = 3.31, 95% CI: 1.22-8.95, P = .018). No interactions were found between familial liability and maternal physical abuse in determining psychosis caseness. This study found no evidence that familial risk accounts for associations between childhood physical abuse and psychotic disorder nor that it substantially increases the odds of psychosis among individuals reporting abuse. © The Author 2014. Published by Oxford University Press on behalf of the Maryland Psychiatric Research Center.

  3. Cost vs. Risk: Determining the Correct Liability Insurance Limit.

    ERIC Educational Resources Information Center

    Klinksiek, Glenn

    1996-01-01

    Presents a model for evaluating liability insurance limits and selecting the correct limit for an individual institution. Argues that many colleges and universities may be making overly conservative decisions that lead to the purchase of too much liability insurance. Also discusses the financial consequences of an uninsured large liability loss.…

  4. 46 CFR 298.38 - Partnership agreements and limited liability company agreements.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 46 Shipping 8 2010-10-01 2010-10-01 false Partnership agreements and limited liability company... liability company agreements. Partnership and limited liability company agreements must be in form and...) Duration of the entity; (b) Adequate partnership or limited liability company funding requirements and...

  5. Practitioner Review: The Victims and Juvenile Perpetrators of Child Sexual Abuse -- Assessment and Intervention

    ERIC Educational Resources Information Center

    Vizard, Eileen

    2013-01-01

    Background: The assessment of victims of child sexual abuse (CSA) is now a recognized aspect of clinical work for both CAMH and adult services. As juvenile perpetrators of CSA are responsible for a significant minority of the sexual assaults on other children, CAMH services are increasingly approached to assess these oversexualized younger…

  6. Cognitive deterioration from long-term abuse of dextromethorphan: a case report.

    PubMed Central

    Hinsberger, A; Sharma, V; Mazmanian, D

    1994-01-01

    Dextromethorphan (DM), the dextrorotatory isomer of 3-hydroxy-N-methylmorphinan, is the main ingredient in a number of widely available, over-the-counter antitussives. Initial studies (Bornstein 1968) showed that it possessed no respiratory suppressant effects and no addiction liability. Subsequently, however, several articles reporting abuse of this drug have appeared in the literature. The drug is known to cause a variety of acute toxic effects, ranging from nausea, restlessness, insomnia, ataxia, slurred speech and nystagmus to mood changes, perceptual alterations, inattention, disorientation and aggressive behavior (Rammer et al 1988; Katona and Watson 1986; Isbell and Fraser 1953; Devlin et al 1985; McCarthy 1971; Dodds and Revai 1967; Degkwitz 1964; Hildebrand et al 1989). There have also been two reported fatalities from DM overdoses (Fleming 1986). However, there are no reports describing the effects of chronic abuse. This report describes a case of cognitive deterioration resulting from prolonged use of DM. PMID:7803371

  7. [The characteristics of sexual offenders abusing alcohol in view of forensic-psychiatric assessments].

    PubMed

    Juszczak, Dariusz; Korzeniewski, Krzysztof; Czupryńska, Katarzyna; Furs, Maciej

    2015-06-01

    The relationship between alcohol consumption and sexual crime appears to be unquestionable. However, the mechanisms that lead to violence and aggression under the influence of alcohol are not entirely understood in this group of offenders. The aim of this paper was to attempt answering the question: what are the features characterizing sexual offenders declaring alcohol abuse. The research material consisted of 180 forensic psychiatric- sexology assessments issued by experts from Outpatient Psychiatric Clinic in 10 Military Hospital Clinic in Bydgoszcz between 2004 to 2012. A specially designed questionnaire titled "Charter of Diagnosis of Factors Determining Criminal Sexual Activity" has been used. Relevant statistical dependences were observed. The obtained results show that, a alcohol abuse has a sexual criminogenic effect especially in the coincidence that there are sustainable personality abnormalities and organic CNS damage. The conducted study prove that the sexual perpetrators who abuse alcohol have a poor level of social functioning and brought up in dysfunction families having alcoholic problems. © 2015 MEDPRESS.

  8. The Welfare Effects of Medical Malpractice Liability

    PubMed Central

    Lakdawalla, Darius N.; Seabury, Seth A.

    2013-01-01

    We use variation in the generosity of local juries to identify the causal impact of medical malpractice liability on social welfare. Growth in malpractice payments contributed at most 5 percentage points to the 33% total real growth in medical expenditures from 1990-2003. On the other hand, malpractice leads to modest mortality reductions; the value of these more than likely exceeds the costs of malpractice liability. Therefore, reducing malpractice liability is unlikely to have a major impact on health care spending, and unlikely to be cost-effective over conventionally accepted values of a statistical life. PMID:23526860

  9. Tort Liability.

    ERIC Educational Resources Information Center

    Hudgins, H. C., Jr.

    This chapter summarizes recent state supreme court and federal court decisions involving the tort liability of school districts and school personnel. The cases discussed are generally limited to those decided during 1975 and reported in the General Digest as of March 1976, although a few 1974 cases not treated in the 1975 yearbook are also…

  10. Tort Liability.

    ERIC Educational Resources Information Center

    Hudgins, H. C., Jr.

    This chapter summarices and analyzes all state supreme court and federal court decisions as well as other significant court decisions involving the tort liability of school districts and school personnel. The cases discussed are generally limited to those decided during 1974 and reported in the General Digest on or before March 1, 1975. In his…

  11. [The characteristics of offenders abusing alcohol in view of forensic-psychiatric assessments].

    PubMed

    Juszczak, Dariusz; Talarowska, Monika

    2009-09-01

    The relationship between alcohol consumption and crime appears to be unquestionable. However, the mechanisms that lead to violence and aggression under the influence of alcohol are not entirely understood. To attempt answering the question: what are the features characterizing offenders declaring alcohol abuse. The research material consisted of 581 forensic-psychiatric assessments issued by experts from Psychiatric Ward of 107 Military Hospital in Walcz between 1990 and 2000. A specially designed questionnaire titled "Charter of Diagnosis of Factors Determining Criminal Activity" has been used. Results. Relevant statistical dependencies were observed. (1) Alcohol consumption has a criminogenic effect and is characteristic for offences against life and health and family. (2) Alcohol abuse is a trigger mechanism for psychiatric disturbances, particularly those with underlying organic damage to CNS.

  12. Development of liability syndromes for schizophrenia: where did they come from and where are they going?

    PubMed

    Stone, William S; Giuliano, Anthony J

    2013-10-01

    Three decades after Paul Meehl proposed the term "schizotaxia" to describe a conceptual framework for understanding the liability to schizophrenia, Ming Tsuang et al. at Harvard University reformulated the concept as a clinical syndrome with provisional research criteria. The reformulated view relied heavily on more recent data showing that many non-psychotic, un-medicated biological relatives of individuals with schizophrenia showed difficulties in cognitive and other clinical functions that resembled those seen in their ill relatives. The reformulation raised questions about both whether and when liability could be assessed validly in the absence of psychosis, and about the extent to which symptoms of liability are reversible. Both questions bear on the larger issue of early intervention in schizophrenia. This article reviews the efforts of Tsuang et al. to conceptualize and validate schizotaxia as one such syndrome of liability. Towards this end, liability is considered first more generally as an outcome of interactive genetic and environmental factors. Liability is then considered in the context of endophenotypes as a concept that is both broader and is potentially more specific (and predictive) than many DSM or ICD diagnostic symptoms. Liability syndromes are then considered in the context of their proximity to illness, first by reviewing prodromal syndromes (which are more proximal), and then by considering schizotaxia, which, as it is currently formulated, is pre-prodromal and, therefore, less proximal. Finally, challenges to validation and future directions for research are considered. © 2013 Wiley Periodicals, Inc.

  13. Assessment of tort liability risk management in the Virginia Department of Transportation : final report.

    DOT National Transportation Integrated Search

    1988-01-01

    The Virginia Department of Transportation (VDOT) faces a growing tort liability problem. Under the Virginia Tort Claims Act, VOOT is liable for up to $75,000 for negligent or wrongful acts or omissions committed by its employees within the scope of t...

  14. The role of human drug self-administration procedures in the development of medications

    PubMed Central

    Comer, SD; Ashworth, JB; Foltin, RW; Johanson, CE; Zacny, JP; Walsh, SL

    2008-01-01

    The purpose of this review is to illustrate the utility and value of employing human self-administration procedures in medication development, including abuse liability assessments of novel medications and evaluation of potential pharmacotherapies for substance use disorders. Traditionally, human abuse liability testing has relied primarily on subjective reports describing drug action by use of questionnaires; similarly, drug interactions between putative treatment agents and the drugs of abuse have relied on these measures. Subjective reports are highly valued because they provide qualitative and quantitative information about the characteristics of central and peripheral pharmacodynamic effects as well as safety and tolerability. However, self-administration procedures directly examine the behavior of interest – that is, drug taking. The present paper 1) reviews the most commonly used human self-administration procedures, 2) discusses the concordance of subjective reports and self-administration within the context of medications development for substance use disorders, focusing primarily on illustrative examples from development efforts with opioid and cocaine dependence, and 3) explores the utility of applying self-administration procedures to assess the abuse liability of novel compounds, including “abuse deterrent” formulations (ADFs). The review will focus on opioid and cocaine dependence because a rich database from both clinical laboratory and clinical trial research exists for these two drug classes. The data reviewed suggest that drug-induced changes in self-administration and subjective effects are not always concordant. Therefore, assessment of self-administration in combination with subjective effects provides a more comprehensive picture that may have improved predictive validity for translating to the clinical setting. PMID:18436394

  15. 42 CFR 438.106 - Liability for payment.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 4 2010-10-01 2010-10-01 false Liability for payment. 438.106 Section 438.106 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS MANAGED CARE Enrollee Rights and Protections § 438.106 Liability for...

  16. Sexual maturation and control issues among sexually abused and non-abused anorexia patients.

    PubMed

    Walsh, J; Burns, F

    2000-09-01

    To assess the relative salience of the maintenance of control and the avoidance of sexual maturation as sources of motivation for maintaining pathological eating behaviours among sexually abused anorexic patients. A two-factor mixed experimental design was employed. Three independent groups (sexually abused anorexics (N = 12); non-abused anorexics (N = 9); non-anorexic/non-abused controls (N = 12)) constituted the between-subjects factor. Allocation to abuse/non-abuse group was dependent upon replies to a questionnaire-based measure of unwanted sexual experience. The within-subjects factor comprised three conditions in which words of various colours were presented to participants for colour-naming (Stroop, 1935). The conditions were represented by lists of neutral words, sexual maturation words, and control-related words. Two trials were carried out in each condition and mean response times were measured. Within-group analyses revealed that interference was greater from sexual maturation words than from control-related words among the sexually-abused anorexics, but of equal magnitude among non-abused counterparts. Between-groups analyses found that abused patients experienced marginally greater cognitive interference from sexual maturation words than the non-abused patients. Theoretically, support is offered for elaborated schematic models of cognitive processing. Clinically, treatment interventions may need to pay particular attention to issues of sexual maturation among sexually abused anorexic patients.

  17. The Vesicular Monoamine Transporter-2: An Important Pharmacological Target for the Discovery of Novel Therapeutics to Treat Methamphetamine Abuse

    PubMed Central

    Nickell, Justin R.; Siripurapu, Kiran B.; Vartak, Ashish; Crooks, Peter A.; Dwoskin, Linda P.

    2014-01-01

    Methamphetamine abuse escalates, but no approved therapeutics are available to treat addicted individuals. Methamphetamine increases extracellular dopamine in reward-relevant pathways by interacting at vesicular monoamine transporter-2 (VMAT2) to inhibit dopamine uptake and promote dopamine release from synaptic vesicles, increasing cytosolic dopamine available for reverse transport by the dopamine transporter (DAT). VMAT2 is the target of our iterative drug discovery efforts to identify pharmacotherapeutics for methamphetamine addiction. Lobeline, the major alkaloid in Lobelia inflata, potently inhibited VMAT2, methamphetamine-evoked striatal dopamine release, and methamphetamine self-administration in rats but exhibited high affinity for nicotinic acetylcholine receptors (nAChRs). Defunctionalized, unsaturated lobeline analog, meso-transdiene (MTD), exhibited lobeline-like in vitro pharmacology, lacked nAChR affinity, but exhibited high affinity for DAT, suggesting potential abuse liability. The 2,4-dicholorophenyl MTD analog, UKMH-106, exhibited selectivity for VMAT2 over DAT, inhibited methamphetamine-evoked dopamine release, but required a difficult synthetic approach. Lobelane, a saturated, defunctionalized lobeline analog, inhibited the neurochemical and behavioral effects of methamphetamine; tolerance developed to the lobelane-induced decrease in methamphetamine self-administration. Improved drug-likeness was afforded by the incorporation of a chiral N-1,2-dihydroxypropyl moiety into lobelane to afford GZ-793A, which inhibited the neurochemical and behavioral effects of methamphetamine, without tolerance. From a series of 2,5-disubstituted pyrrolidine analogs, AV-2-192 emerged as a lead, exhibiting high affinity for VMAT2 and inhibiting methamphetamine-evoked dopamine release. Current results support the hypothesis that potent, selective VMAT2 inhibitors provide the requisite preclinical behavioral profile for evaluation as pharmacotherapeutics for

  18. Cargo liability regimes

    DOT National Transportation Integrated Search

    2001-01-01

    There are at present at least three international regimes of maritime cargo liability in force in different countries of the world - the original Hague rules (1924), the updated version known as the Hague-Visby rules (1968, further amended 1979), and...

  19. Safety and Liability.

    ERIC Educational Resources Information Center

    Berthelot, Ronald J.; And Others

    1982-01-01

    This series of five articles highlights Pensacola Junior College's occupational safety course, involving simulated emergencies, Florida's standards for teacher liability, electrical safety in the classroom and laboratory, color coding for machine safety, and Florida industrial arts safety instructional materials. (SK)

  20. Selection and utilization of assessment instruments in substance abuse treatment trials: the National Drug Abuse Treatment Clinical Trials Network experience.

    PubMed

    Rosa, Carmen; Ghitza, Udi; Tai, Betty

    2012-07-17

    Based on recommendations from a US Institute of Medicine report, the National Institute on Drug Abuse established the National Drug Abuse Treatment Clinical Trials Network (CTN) in 1999, to accelerate the translation of science-based addiction treatment research into community-based practice, and to improve the quality of addiction treatment, using science as the vehicle. One of the CTN's primary tasks is to serve as a platform to forge bi-directional communications and collaborations between providers and scientists, to enhance the relevance of research, which generates empirical results that impact practice. Among many obstacles in moving research into real-world settings, this commentary mainly describes challenges and iterative experiences in regard to how the CTN develops its research protocols, with focus on how the CTN study teams select and utilize assessment instruments, which can reasonably balance the interests of both research scientists and practicing providers when applied in CTN trials. This commentary also discusses the process by which the CTN further selects a core set of common assessment instruments that may be applied across all trials, to allow easier cross-study analyses of comparable data.

  1. 26 CFR 1.704-2 - Allocations attributable to nonrecourse liabilities.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... disparity. (4) Special rule for year of revaluation. (e) Requirements to be satisfied. (f) Minimum gain... encumbers, a disposition of that property will generate gain that at least equals that excess (“partnership.... (3) Definition of nonrecourse liability. Nonrecourse liability means a nonrecourse liability as...

  2. Dopamine Transporter-Dependent and -Independent Striatal Binding of the Benztropine Analog JHW 007, a Cocaine Antagonist with Low Abuse Liability

    PubMed Central

    Kopajtic, Theresa A.; Liu, Yi; Surratt, Christopher K.; Donovan, David M.; Newman, Amy H.; Katz, Jonathan L.

    2010-01-01

    The benztropine analog N-(n-butyl)-3α-[bis(4′-fluorophenyl)methoxy]-tropane (JHW 007) displays high affinity for the dopamine transporter (DAT), but unlike typical DAT ligands, has relatively low abuse liability and blocks the effects of cocaine, including its self-administration. To determine sites responsible for the cocaine antagonist effects of JHW 007, its in vitro binding was compared with that of methyl (1R,2S,3S,5S)-3-(4-fluorophenyl)-8-methyl-8-azabicyclo[3.2.1]octane-2-carboxylate (WIN 35428) in rats, mice, and human DAT (hDAT)-transfected cells. A one-site model, with Kd values of 4.21 (rat) and 8.99 nM (mouse) best fit the [3H]WIN 35428 data. [3H]JHW 007 binding best fit a two-site model (rat, 7.40/4400 nM; mouse, 8.18/2750 nM), although a one-site fit was observed with hDAT membranes (43.7 nM). Drugs selective for the norepinephrine and serotonin transporters had relatively low affinity in competition with [3H]JHW 007 binding, as did drugs selective for other sites identified previously as potential JHW 007 binding sites. The association of [3H]WIN 35428 best fit a one-phase model, whereas the association of [3H]JHW 007 best fit a two-phase model in all tissues. Because cocaine antagonist effects of JHW 007 have been observed previously soon after injection, its rapid association observed here may contribute to those effects. Multiple [3H]JHW 007 binding sites were obtained in tissue from mice lacking the DAT, suggesting these as yet unidentified sites as potential contributors to the cocaine antagonist effects of JHW 007. Unlike WIN 35428, the binding of JHW 007 was Na+-independent. This feature of JHW 007 has been linked to the conformational status of the DAT, which in turn may contribute to the antagonism of cocaine. PMID:20855444

  3. Maternal sexual abuse of male children.

    PubMed

    Elliott, Andrew J; Peterson, Linda W

    1993-07-01

    Preview Sexual abuse of boys by their mothers is being increasingly reported and must be considered in the course of history taking and physical examination. Often there is little objective evidence of such abuse, and only a cluster of signs and risk factors may reveal the victimization. Drs Elliott and Peterson list characteristics that can help physicians identify sexually abusive mothers and sexually abused children; they also discuss how to retrieve a report of abuse from a child and assess its credibility.

  4. Meta-analysis of studies assessing the efficacy of projective techniques in discriminating child sexual abuse.

    PubMed

    West, M M

    1998-11-01

    This meta-analysis of 12 studies assesses the efficacy of projective techniques to discriminate between sexually abused children and nonsexually abused children. A literature search was conducted to identify published studies that used projective instruments with sexually abused children. Those studies that reported statistics that allowed for an effect size to be calculated, were then included in the meta-analysis. There were 12 studies that fit the criteria. The projectives reviewed include The Rorschach, The Hand Test, The Thematic Apperception Test (TAT), the Kinetic Family Drawings, Human Figure Drawings, Draw Your Favorite Kind of Day, The Rosebush: A Visualization Strategy, and The House-Tree-Person. The results of this analysis gave an over-all effect size of d = .81, which is a large effect. Six studies included only a norm group of nondistressed, nonabused children with the sexual abuse group. The average effect size was d = .87, which is impressive. Six studies did include a clinical group of distressed nonsexually abused subjects and the effect size lowered to d = .76, which is a medium to large effect. This indicates that projective instruments can discriminate distressed children from nondistressed subjects, quite well. In the studies that included a clinical group of distressed children who were not sexually abused, the lower effect size indicates that the instruments were less able to discriminate the type of distress. This meta-analysis gives evidence that projective techniques have the ability to discriminate between children who have been sexually abused and those who were not abused sexually. However, further research that is designed to include clinical groups of distressed children is needed in order to determine how well the projectives can discriminate the type of distress.

  5. 31 CFR 321.15 - Liability for losses.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 31 Money and Finance: Treasury 2 2010-07-01 2010-07-01 false Liability for losses. 321.15 Section... INSTITUTIONS OF UNITED STATES SAVINGS BONDS AND UNITED STATES SAVINGS NOTES (FREEDOM SHARES) Losses Resulting From Erroneous Payments § 321.15 Liability for losses. Under the governing statute, as amended (31 U.S...

  6. Proarrhythmia liability assessment and the comprehensive in vitro Proarrhythmia Assay (CiPA): An industry survey on current practice.

    PubMed

    Authier, Simon; Pugsley, Michael K; Koerner, John E; Fermini, Bernard; Redfern, William S; Valentin, Jean-Pierre; Vargas, Hugo M; Leishman, Derek J; Correll, Krystle; Curtis, Michael J

    2017-07-01

    The Safety Pharmacology Society (SPS) has conducted a survey of its membership to identify industry practices related to testing considered in the Comprehensive In vitro Proarrhythmia Assay (CiPA). Survey topics included nonclinical approaches to address proarrhythmia issues, conduct of in silico studies, in vitro ion channel testing methods used, drugs used as positive controls during the conduct of cardiac ion channel studies, types of arrhythmias observed in non-clinical studies and use of the anticipated CiPA ion channel assay. In silico studies were used to evaluate effects on ventricular action potentials by only 15% of responders. In vitro assays were used mostly to assess QT prolongation (95%), cardiac Ca 2+ and Na + channel blockade (82%) and QT shortening or QRS prolongation (53%). For de-risking of candidate drugs for proarrhythmia, those assays most relevant to CiPA including cell lines stably expressing ion channels used to determine potency of drug block were most frequently used (89%) and human stem cell-derived or induced pluripotent stem cell cardiomyocytes (46%). Those in vivo assays related to general proarrhythmia derisking include ECG recording using implanted telemetry technology (88%), jacketed external telemetry (62%) and anesthetized animal models (53%). While the CiPA initiative was supported by 92% of responders, there may be some disconnect between current practice and future expectations, as explained. Proarrhythmia liability assessment in drug development presently includes study types consistent with CiPA. It is anticipated that CiPA will develop into a workable solution to the concern that proarrhythmia liability testing remains suboptimal. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

  7. Law, liability, and public health emergencies.

    PubMed

    Hoffman, Sharona; Goodman, Richard A; Stier, Daniel D

    2009-06-01

    According to many experts, a public health emergency arising from an influenza pandemic, bioterrorism attack, or natural disaster is likely to develop in the next few years. Meeting the public health and medical response needs created by such an emergency will likely involve volunteers, health care professionals, public and private hospitals and clinics, vaccine manufacturers, governmental authorities, and many others. Conducting response activities in emergency circumstances may give rise to numerous issues of liability, and medical professionals and other potential responders have expressed concern about liability exposure. Providers may face inadequate resources, an insufficient number of qualified personnel, overwhelming demand for services, and other barriers to providing optimal treatment, which could lead to injury or even death in some cases. This article describes the different theories of liability that may be used by plaintiffs and the sources of immunity that are available to public health emergency responders in the public sector, private sector, and as volunteers. It synthesizes the existing immunity landscape and analyzes its gaps. Finally, the authors suggest consideration of the option of a comprehensive immunity provision that addresses liability protection for all health care providers during public health emergencies and that, consequently, assists in improving community emergency response efforts.

  8. Safety and Liability Aspects of Solar Power Satellites

    NASA Astrophysics Data System (ADS)

    Jakhu, Ram S.; Howard, Diane

    2010-09-01

    It is an undisputed fact that the global need for energy will grow exponentially in the future and the search for alternative energy sources will intensify. One alternative source will be space based solar power(SSP), to be collected in space and transmitted to Earth by solar power satellites(SPS). As the appropriate technology becomes proven, the economic and operational viability for the launch of SPS system(s) will, to a large extent, depend upon favorable political and legal determinants. One of such determinants relates to safety risks and possible liability of the operator(s) of SPS system(s). This paper identifies safety risks of, and analyses liability for, damage caused by SPS. Issues, specifically analyzed mainly under international law, include damage caused(in outer space, in the air and on the Earth) by electronic transmission, and mechanisms to manage liability including inter alia insurance coverage, waivers of liability, and dispute settlement mechanisms. The paper contains recommendations for the concerned governments(and their respective private entities) to take regulatory precautions in order to avoid the risks of possible liability and thereby enhances the chances for launch and operation of SPS system(s).

  9. Exploring the Correlates to Depression in Elder Abuse Victims: Abusive Experience or Individual Characteristics?

    PubMed

    Santos, Ana João; Nunes, Baltazar; Kislaya, Irina; Gil, Ana Paula; Ribeiro, Oscar

    2017-09-01

    Depression and depressive symptoms have been studied both as risk factors and consequences of elder abuse, even though the most common cross-sectional design of the studies does not allow inferring cause or consequence relationships. This study estimates the proportion of older adults who screened positive for depressive symptoms among those self-reporting elder abuse and examines whether individual characteristics and/or abusive experience aspects are associated with self-reported depressive symptoms. Participants were 510 older adults self-reporting experiences of abuse in family setting enrolled in the cross-sectional victims' survey of the Aging and Violence Study. Depressive symptoms were assessed through the abbreviated version of the Geriatric Depression Scale (GDS-5). Poisson regression was used to determine the prevalence ratio (PR) of screening depressive symptoms according to individual and abusive experience covariates: sex, age group, cohabitation, perceived social support, chronic diseases, functional status, violence type, perpetrator, and number of conducts. Women (PR = 1.18, 95% confidence interval [CI] = [1.04, 1.35]) individuals perceiving low social support level (PR = 1.36, 95% CI = [1.16, 1.60]) and with long-term illness (PR = 1.17, 95% CI = [1.02, 1.33]) were found to be associated with increased risk for screening depressive symptoms. In regard to abusive experience, only the number of abusive conducts increased the PR (PR = 1.07, 95% CI = [1.05, 1.09]). Routine screening for elder abuse should include psychological well-being assessment. Interventions toward risk alleviation for both mental health problems and elder abuse should target women perceiving low social support level and with long-term illness.

  10. Analog assessment of frustration tolerance: association with self-reported child abuse risk and physiological reactivity.

    PubMed

    Rodriguez, Christina M; Russa, Mary Bower; Kircher, John C

    2015-08-01

    Although frustration has long been implicated in promoting aggression, the potential for poor frustration tolerance to function as a risk factor for physical child abuse risk has received minimal attention. Instead, much of the extant literature has examined the role of anger in physical abuse risk, relying on self-reports of the experience or expression of anger, despite the fact that this methodology is often acknowledged as vulnerable to bias. Therefore, the present investigation examined whether a more implicit, analog assessment of frustration tolerance specifically relevant to parenting would reveal an association with various markers of elevated physical child abuse risk in a series of samples that varied with regard to age, parenting status, and abuse risk. An analog task was designed to evoke parenting-relevant frustration: the task involved completing an unsolvable task while listening to a crying baby or a toddler's temper tantrum; time scores were generated to gauge participants' persistence in the task when encountering such frustration. Across these studies, low frustration tolerance was associated with increased physical child abuse potential, greater use of parent-child aggression in discipline encounters, dysfunctional disciplinary style, support for physical discipline use and physical discipline escalation, and increased heart rate. Future research directions that could better inform intervention and prevention programs are discussed, including working to clarify the processes underlying frustration intolerance and potential interactive influences that may exacerbate physical child abuse. Copyright © 2015 Elsevier Ltd. All rights reserved.

  11. [Legal quality criteria of expert opinions in liability for medical malpractice].

    PubMed

    Neu, Johann

    2017-09-01

    In litigation regarding to liability for medical malpractice the court itself for lack of medical expert knowledge cannot judge a claimed error in treatment. That applies too for the question if there is causation between the error in treatment and claimed damage to patient's health. In this respect, the court is dependent on a medical expert and is bound to his assessment, unless there is no quality deficit in respect of medical and/or legal criteria. The more the medical expert knows the legal background of physician's liability for medical malpractice, the less is the risk of legal quality deficits in his expert opinion and thereby also of judicial errors by court. Georg Thieme Verlag KG Stuttgart · New York.

  12. Peer deviance, parental divorce, and genetic risk in the prediction of drug abuse in a nationwide Swedish sample: evidence of environment-environment and gene-environment interaction.

    PubMed

    Kendler, Kenneth S; Ohlsson, Henrik; Sundquist, Kristina; Sundquist, Jan

    2014-04-01

    Peer deviance (PD) strongly predicts externalizing psychopathologic conditions but has not been previously assessable in population cohorts. We sought to develop such an index of PD and to clarify its effects on risk of drug abuse (DA). To examine how strongly PD increases the risk of DA and whether this community-level liability indicator interacts with key DA risk factors at the individual and family levels. Studies of future DA registration in 1,401,698 Swedish probands born from January 1, 1970, through December 31, 1985, and their adolescent peers in approximately 9200 small community areas. Peer deviance was defined as the proportion of individuals born within 5 years of the proband living in the same small community when the proband was 15 years old who eventually were registered for DA. Drug abuse recorded in medical, legal, or pharmacy registry records. Peer deviance was associated with future DA in the proband, with rates of DA in older and male peers more strongly predictive than in younger or female peers. The predictive power of PD was only slightly attenuated by adding measures of community deprivation, collective efficacy, or family socioeconomic status. Probands whose parents were divorced were more sensitive to the pathogenic effects of high PD environments. A robust positive interaction was also seen between genetic risk of DA (indexed by rates of DA in first-, second-, and third-degree relatives) and PD exposure. With sufficient data, PD can be measured in populations and strongly predicts DA. In a nationwide sample, risk factors at the level of the individual (genetic vulnerability), family (parental loss), and community (PD) contribute substantially to risk of DA. Individuals at elevated DA risk because of parental divorce or high genetic liability are more sensitive to the pathogenic effects of PD. Although the effect of our PD measure on DA liability cannot be explained by standard measures of community or family risk, we cannot, with

  13. Liability in the Laboratory.

    ERIC Educational Resources Information Center

    Purvis, Johnny; And Others

    1986-01-01

    Presents two scenarios to illustrate the difference between liability and negligence. Also presents highlights of four actual cases related to laboratory security, appropriate facilities, proper instructions, and protective gear. (JN)

  14. The Relationship between Bullying and Animal Abuse Behaviors in Adolescents: The Importance of Witnessing Animal Abuse

    ERIC Educational Resources Information Center

    Gullone, Eleonora; Robertson, Nerida

    2008-01-01

    Children's abuse of animals may be predictive of aggression towards humans. This study assessed concurrent engagement in animal abuse and bullying behaviour in 241 adolescents aged 12 to 16 years. A total of 20.6% of youths reported abusing animals at least "sometimes" and 17.8% reported bullying others on at least one occasion in the past year.…

  15. Psychostimulant-like discriminative stimulus and locomotor sensitization properties of the wake-promoting agent modafinil in rodents.

    PubMed

    Paterson, Neil E; Fedolak, Allison; Olivier, Berend; Hanania, Taleen; Ghavami, Afshin; Caldarone, Barbara

    2010-06-01

    The present studies assessed the potential abuse liability and likely mechanism(s) of action of the wake-promoting agent modafinil. Experiments assessed the locomotor sensitization (LS) and discriminative stimulus (DS) properties of modafinil in mouse and rat, respectively. Comparative data were generated with a range of psychostimulants and monoamine reuptake inhibitors. Repeated administration of d-amphetamine and cocaine, psychostimulants with high abuse liability, resulted in the induction and expression of LS in mice. Bupropion and caffeine, two psychostimulants not abused in humans, were not associated with LS. GBR12909 induced LS during repeated exposure, but there was no evidence of expression of LS after acute challenge following withdrawal. In contrast, repeated administration of modafinil resulted in the expression, but not induction, of LS. d-amphetamine, but not the mu-opioid agonist morphine or the nAChR agonist nicotine, fully substituted for the cocaine DS in rats. The selective dopamine transporter (DAT) inhibitor GBR12909 fully substituted, the preferential norepinephrine transporter (NET) inhibitor desipramine partially substituted, and the selective serotonin reuptake inhibitor citalopram failed to substitute for cocaine. Modafinil fully substituted for cocaine, similar to the mixed DAT/NET inhibitor bupropion. Two preclinical assays indicated potential abuse liability of modafinil; drug discrimination studies suggest DAT blockade by modafinil is a likely mechanism of action in vivo. Copyright 2010 Elsevier Inc. All rights reserved.

  16. Elder Abuse and Neglect: Assessment Tools, Interventions, and Recommendations for Effective Service Provision

    ERIC Educational Resources Information Center

    Imbody, Bethany; Vandsburger, Etty

    2011-01-01

    With our communities rapidly aging, there is always a clear need for greater knowledge on how to serve elders. Professionals must be able to recognize cases of abuse and neglect and provide appropriate follow up services. Through reviewing recent literature, this paper surveys existing assessment tools and interventions, describes characteristics…

  17. 25 CFR 141.57 - Procedures to cancel liability on bond.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 25 Indians 1 2010-04-01 2010-04-01 false Procedures to cancel liability on bond. 141.57 Section 141.57 Indians BUREAU OF INDIAN AFFAIRS, DEPARTMENT OF THE INTERIOR FINANCIAL ACTIVITIES BUSINESS... Procedures to cancel liability on bond. (a) Any surety who wishes to be relieved from liability arising on a...

  18. Insomnia, Nightmare Frequency, and Nightmare Distress in Victims of Sexual Abuse: The Role of Perceived Social Support and Abuse Characteristics

    ERIC Educational Resources Information Center

    Steine, Iris M.; Krystal, John H.; Nordhus, Inger H.; Bjorvatn, Bjorn; Harvey, Allison G.; Eid, Jarle; Gronli, Janne; Milde, Anne M.; Pallesen, Stale

    2012-01-01

    In this study of victims of sexual abuse, the aim was to investigate the role of perceived social support and abuse characteristics in self-reported insomnia, nightmare frequency, and nightmare distress. Four hundred sixty Norwegian victims of sexual abuse completed a questionnaire assessing perceived social support, abuse characteristics,…

  19. Child abuse and performance task assessments of executive functions in boys.

    PubMed

    Mezzacappa, E; Kindlon, D; Earls, F

    2001-11-01

    We examined executive functions using performance tasks in 126 boys aged 6 to 16 years. who attended public schools and therapeutic schools for children with emotional and behavioral problems. Children were further grouped based on the presence or absence of substantiated abuse histories. Based on their abuse histories and schools of origin, children were classified as Therapeutic, Abused (TA, N = 25). Therapeutic, Nonabused (TN, N = 52), and Public School (PS, N = 48). Controlling IQ and medication status, we compared children in the three groups on teacher ratings of behavior, on experimenter observations of behavior during testing, and on performance tasks challenging the capacities to inhibit an act in progress, and to passively avoid responses associated with adverse consequences. We examined mean group differences in symptoms, behaviors, and task performance, as well as differential age-dependent changes in these dimensions. Independent of abuse history, therapeutic school children demonstrated comparable levels of internalizing and externalizing symptoms, and comparable levels of redirections to task during testing-sessions, that were significantly higher than those of the public school children. Both groups of therapeutic school children also showed comparable overall performance on the capacities to inhibit an act in progress, and to passively avoid responses associated with adverse consequences that were poorer than the performance of children from the public school. Children with histories of substantiated abuse showed diminished improvement with increasing age in the capacity to passively avoid responses associated with adverse consequences when compared not only to the public school children, but also to the children from the therapeutic schools without histories of abuse. Our findings complement reports of behavioral observations of abused children, and reports associating child abuse with altered cognitive development in other areas of competence

  20. 32 CFR 750.25 - Scope of liability.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 32 National Defense 5 2011-07-01 2011-07-01 false Scope of liability. 750.25 Section 750.25... Federal Tort Claims Act § 750.25 Scope of liability. (a) Territorial limitations. The FTCA does not apply... 46 U.S.C. 741-752 or 781-790. Claims under the Death on the High Seas Act (46 U.S.C. 761), however...

  1. 75 FR 16645 - Increase in the Primary Nuclear Liability Insurance Premium

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-04-02

    ... Primary Nuclear Liability Insurance Premium AGENCY: Nuclear Regulatory Commission. ACTION: Final rule... impractical. The NRC is amending its regulations to increase the primary premium for liability insurance... protection requirements and indemnity agreements to increase the primary nuclear liability insurance layer...

  2. Assessment of AIDS Risk among Treatment Seeking Drug Abusers.

    ERIC Educational Resources Information Center

    Black, John L.; And Others

    Intravenous (IV) drug abusers are at risk for contracting transmittable diseases such as acquired immunodeficiency syndrome (AIDS) and hepatitis B. This study was conducted to investigate the prevalence of risk behaviors for acquiring and transmitting AIDS and hepatitis B among treatment-seeking drug abusers (N=168). Subjects participated in a…

  3. The Role of Sexual Abuse and Dysfunctional Attitudes in Perceived Stress and Negative Mood in Pregnant Adolescents: An Ecological Momentary Assessment Study

    PubMed Central

    Walsh, Kate; Basu, Archana; Monk, Catherine

    2014-01-01

    Study Objective Latinas have the highest rates of adolescent pregnancy in the US. Identifying means to improve the well-being among these young women is critical. The current study examined whether a history of child sexual abuse — itself a risk factor for adolescent pregnancy — was associated with more perceived stress and negative mood over the course of pregnancy and whether dysfunctional attitudes explained these associations. Design and Setting This mixed methods study involved lab-based assessments of perceived stress, sexual abuse history, and dysfunctional attitudes as well as Ecological Momentary Assessments (EMA) of mood states every 30 minutes during a 24-hour period once during each trimester of pregnancy. Participants Pregnant adolescents (n = 204, 85% Latina). Main Outcome Measures EMA mood states and lab-based retrospective self–reports of perceived stress. Results One in four pregnant adolescents had a history of sexual abuse. Sexually abused adolescents reported greater perceived stress during the first trimester relative to those without, though the groups did not differ on EMA negative mood ratings. Dysfunctional attitudes explained associations between sexual abuse and perceived stress. Sexual abuse was indirectly associated with the intercept and slope of negative mood through dysfunctional attitudes. Findings were circumscribed to sexual abuse and not other types of child abuse. Conclusions Identifying sexually abused pregnant adolescents and providing support and cognitive therapy to target dysfunctional beliefs may decrease stress during the first trimester as well as negative affect throughout pregnancy. PMID:26130137

  4. Assessment of knowledge and attitudes of dental students in regard to child abuse in Turkey.

    PubMed

    Hazar Bodrumlu, E; Avşar, A; Arslan, S

    2018-02-01

    Child abuse is a serious public problem. Signs of abuse are often present in the oro-facial region and dentists are in a strategic position to recognise and report suspected cases. The aim of this study was to investigate dental students' knowledge about and attitudes towards child abuse. This study was performed at the Faculty of Dentistry of the Ondokuz Mayis University. The data were collected through a self-report questionnaire administered to dental students (137 female/111 male) in three different dental classes (third, fourth and fifth study years) and grouped by considering those students who have been training in the school year of 2013. The definition of physical and social indicators of abuse, awareness regarding legal and ethical responsibilities, students' experience and requests made by students were evaluated by the students' response to questions put in the questionnaire. Descriptive statistics and chi-square tests were performed to analyse the questionnaire data. The questionnaire completion rate was 100%. About 67.74% of the third year, 40.71% of the fourth year and 16.67% of the fifth year believed that they could detect child abuse cases. However, results indicated a major lack of knowledge of social indicators, signs of physical abuse and reporting procedure amongst all respondents. The assessment of the total correct answers exhibited significant differences amongst third-, fourth- and fifth-year students' answers. Fifth-year students had the highest rate of correct responses (P < 0.05). Most students wanted to receive more knowledge about this topic. Dental students in Turkey are not sufficiently prepared for their role in diagnosing suspected cases of child abuse. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  5. Prescription Opioid Abuse and Dependence: Assessment Strategies for Counselors

    ERIC Educational Resources Information Center

    Weigel, Daniel J.; Donovan, Kimberly A.; Krug, Kevin S.; Dixon, Wayne A.

    2007-01-01

    The authors review the article "Prescription Drug Use and Abuse: Risk Factors, Red Flags, and Prevention Strategies" (J. H. Isaacson, J. A. Hopper, D. P. Alford, & T. Parran, 2005), which provides an overview of the recent increase in prescription opioid abuse and dependence from the physician's perspective. In the present article, the authors…

  6. Treating Women Drug Abusers: Action Therapy and Trauma Assessment

    PubMed Central

    Uhler, Ann S.; Parker, Olga V.

    2002-01-01

    The authors suggest that action therapy, a group of techniques including psychodrama, drama therapy, and role training, warrants research attention to determine whether it is well suited to the special characteristics and needs of women clients. In addition, the authors call on researchers to develop a new standardized tool for counselors to use during initial interviews to determine whether women presenting for drug abuse treatment also have significant issues related to trauma. The authors believe the use of unassisted clinical judgment for trauma assessment in first interviews may drive patients away by probing for painful information that clients are not yet ready to confront or divulge. PMID:18567963

  7. Treating women drug abusers: action therapy and trauma assessment.

    PubMed

    Uhler, Ann S; Parker, Olga V

    2002-07-01

    The authors suggest that action therapy, a group of techniques including psychodrama, drama therapy, and role training, warrants research attention to determine whether it is well suited to the special characteristics and needs of women clients. In addition, the authors call on researchers to develop a new standardized tool for counselors to use during initial interviews to determine whether women presenting for drug abuse treatment also have significant issues related to trauma. The authors believe the use of unassisted clinical judgment for trauma assessment in first interviews may drive patients away by probing for painful information that clients are not yet ready to confront or divulge.

  8. Familial liability for metoprolol-induced psychosis.

    PubMed

    Rietveld, L; van der Hoek, T; van Beek, M H C T; Schellekens, A F A

    2015-01-01

    Beta-blockers are commonly used in the treatment of hypertension and cardiac arrhythmias. The incidence of neuropsychiatric side effects is generally low. This case report shows the potential familial liability of a metoprolol-induced psychosis. We report a case of metoprolol-induced psychosis. Potential pharmocogenetic factors mediating this familial metoprolol-induced psychosis are discussed. A middle-aged man developed psychosis after starting metoprolol, which diminished after ceasing the medication. Two of his family members experienced similar symptoms after using metoprolol. All family members were genotyped as CYP2D6*4 allele carriers indicating reduced CYP2D6 enzyme activity. The case presented here suggests a potential familial liability for metoprolol- induced psychosis. Pharmacokinetic mechanisms are hypothesized to mediate this familial liability through genetic variation in the CYP2D6 genotype. A family history of psychotic symptoms after treatment with beta-blockers should be taken into account, when prescribing this beta-blocker. Copyright © 2015 Elsevier Inc. All rights reserved.

  9. Prediction of pH dependent absorption using in vitro, in silico, and in vivo rat models: Early liability assessment during lead optimization.

    PubMed

    Saxena, Ajay; Shah, Devang; Padmanabhan, Shweta; Gautam, Shashyendra Singh; Chowan, Gajendra Singh; Mandlekar, Sandhya; Desikan, Sridhar

    2015-08-30

    Weakly basic compounds which have pH dependent solubility are liable to exhibit pH dependent absorption. In some cases, a subtle change in gastric pH can significantly modulate the plasma concentration of the drug and can lead to sub-therapeutic exposure of the drug. Evaluating the risk of pH dependent absorption and potential drug-drug interaction with pH modulators are important aspects of drug discovery and development. In order to assess the risk around the extent of decrease in the systemic exposure of drugs co-administered with pH modulators in the clinic, a pH effect study is carried out, typically in higher species, mostly dog. The major limitation of a higher species pH effect study is the resource and material requirement to assess this risk. Hence, these studies are mostly restricted to promising or advanced leads. In our current work, we have used in vitro aqueous solubility, in silico simulations using GastroPlus™ and an in vivo rat pH effect model to provide a qualitative assessment of the pH dependent absorption liability. Here, we evaluate ketoconazole and atazanavir with different pH dependent solubility profiles and based on in vitro, in silico and in vivo results, a different extent of gastric pH effect on absorption is predicted. The prediction is in alignment with higher species and human pH effect study results. This in vitro, in silico and in vivo (IVISIV) correlation is then extended to assess pH absorption mitigation strategy. The IVISIV predicts pH dependent absorption for BMS-582949 whereas its solubility enhancing prodrug, BMS-751324 is predicted to mitigate this liability. Overall, the material requirement for this assessment is substantially low which makes this approach more practical to screen multiple compounds during lead optimization. Copyright © 2015 Elsevier B.V. All rights reserved.

  10. Managing 'tail liability'.

    PubMed

    Frese, Richard C; Weber, Ryan J

    2013-11-01

    To reduce and control their level of tail liability, hospitals should: Utilize a self-insurance vehicle; Consider combined limits between the hospital and physicians; Communicate any program changes to the actuary, underwriter, and auditor; Continue risk management and safety practices; Ensure credit is given to the organization's own medical malpractice program.

  11. Epidemiology of dental professional liability.

    PubMed

    Montagna, F; Cortesini, C; Manca, R; Montagna, L; Piras, A; Manfredini, D

    2011-04-01

    The aim of this article is to collect data relating to dental professional liability in Italy and provide a common platform for discussions among clinicians, legal medicine practitioners, and experts in law. On the basis of two different dental-legal statistical samples (1,670 reports of legal dental experts and 320 civil court decisions) we analyzed the dental professional liability lawsuit in the areas of distribution of lawsuits among the different dental specialties, recurrence and type of errors, outcome of civil suits, parameters of compensation. Some ideas are also proposed for possible strategies in the management of clinical risk (prevention of errors) and court proceedings.

  12. Liability and ophthalmic drug use.

    PubMed

    Classé, J G

    1992-01-01

    Ophthalmic drug use has been an aspect of optometry for more than two decades. Although utilization of these drugs has produced significant changes in the clinical and legal responsibilities of optometrists, the liability posture of the profession has remained unaltered. Studies of malpractice claims against optometrists and ophthalmologists have demonstrated that ophthalmologists are much more likely to be charged with negligence for adverse drug reactions and that drug-related malpractice claims are not a liability issue for optometrists. Based on the experiences of both professions, this paper describes the adverse effects of common ophthalmic drugs, with emphasis on those drug reactions that have resulted in litigation.

  13. Ecological Assessment of Substance-abuse Experiences (EASE): findings from a new instrument development pilot study.

    PubMed

    Matto, Holly C; Miller, Keith; Spera, Christopher

    2005-08-01

    A newly developed instrument that assesses a client's orientation to addiction or recovery communities using social context referents was pilot tested with a sample of 103 adults seeking treatment for substance abuse at outpatient and residential treatment facilities on the East Coast. Preliminary findings show promising subscale reliabilities, and suggest that drug- and recovery-related social identities are related to drug-use severity and drug-use concern; and drug-related attitudinal congruence between the treatment-seeker and family and treatment-seeker and other significant persons are related to intention to make behavioral changes in reducing substance abuse.

  14. Hypnotizability and Dissociativity in Sexually Abused Girls.

    ERIC Educational Resources Information Center

    Putnam, Frank W.; And Others

    1995-01-01

    This study assessed the relationships among hypnotizability, clinical dissociation and traumatic antecedents in 54 sexually abused girls, ages 6 to 15 years, and 51 matched controls. There were no significant differences in hypnotizability between abuse and control subjects. However, in the abuse group, highly hypnotizable subjects were…

  15. Adolescent substance abuse. Assessment in the office.

    PubMed

    Dias, Philomena J

    2002-04-01

    There are no gold-standard tests for evaluating a teen suspected of abusing substances. Awareness of the high prevalence of substance abuse in youth, a high index of suspicion, and a firm desire to be a part of the solution are all that is required to address the problem of substance abuse in youth. In an age of "dotcoms" and societal complexity that fosters an emotionally "disconnected" atmosphere by uniting adolescents only by what they buy, plug into, click on, or blast away, teens need trusted medical homes where caring pediatricians are available to give youth accurate and authoritative facts and care to help them build inner resilience and connect them to the pain and hurt of the people in their lives. Until now, the "three strikes and you're out" maxim has been applied in medical care. This maxim may work for baseball, Clintonomics, and practical office management strategies but is not recommended for addressing the needs of substance using or abusing youth who are prey to advertising strategies. The size of the marketing and advertising budgets of the alcohol and cigarette industries is an indication of the relentless marketing directed toward vulnerable youth. Pediatricians would be doing teens a disservice if they fail to countermand this marketing effect by not using the "rule of seven"--the "seven 'S' screen," seven education attempts, seven different ways over 7 years, and persistence over seven attempts of chemically dependent adolescents to quit. It has been said by Osler that "These are our methods--to carefully observe the phenomena of life in all its stages, to cultivate the reasoning of the faculty so as to be able to know the true from the false. This is our work--to prevent disease, to relieve suffering, to heal the sick," and provide HOPE always.

  16. Girl child abuse: violation of her human rights.

    PubMed

    Kapur, P

    1995-01-01

    The human rights of female children in India and elsewhere, even when protected on paper, are violated in practice. An equitable and egalitarian world order must be established. A comprehensive campaign is needed that combats gender-based inequalities, discrimination, exploitation, oppression, abuse, violence, inhuman values, and violations of human rights, particularly against female children. People must radically change their attitudes and actions towards female children. Female children are not a commodity or sex-object but "an equally worthy human being to be loved, respected, and cared for." Strategies that accomplish these ends include the promotion of human and spiritual values of love, compassion, and nonviolence, and discouragement of values of consumerism and materialism and worthlessness of human beings. Effective education and mass media should counter corruption, dishonesty, selfishness, and inhuman actions. Family structures need to strengthened and enriched. The abuse of female children occurs due to the following interrelated factors: entrenched patriarchal value systems, the perpetuation of traditions and practices that identify girls as inferior to boys, the gender-biased and discriminatory attitude that identifies girl children as a burden or liability and as a sex-object or commodity, and prevalent illiteracy, poverty, and negative parenting life style patterns. Other factors include the low status of women, the reduction in human and spiritual values, and the rise of consumerism and corruption. Girls are subjected to female infanticide, feticide, lack of social and economic development, burdensome domestic work, early marriage and childbearing, neglect and denial of healthy living conditions, sexual abuse and exploitation, prostitution, rape, and a denial of their right to protection.

  17. 7 CFR 1767.19 - Liabilities and other credits.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... furnish complete information concerning each note and open account. 224Other Long-Term Debt A. This... this account shall be kept in such a manner that the utility can furnish full information as to the... Accounts § 1767.19 Liabilities and other credits. The liabilities and other credit accounts identified in...

  18. 31 CFR 315.56 - General instructions and liability.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 31 Money and Finance: Treasury 2 2010-07-01 2010-07-01 false General instructions and liability. 315.56 Section 315.56 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued... and, where one is available, a corporate stamp or issuing or paying agent's stamp. (b) Liability. The...

  19. Toward enhancing estimates of Kentucky's heavy truck tax liabilities.

    DOT National Transportation Integrated Search

    2002-08-01

    The focus of this report is the effectiveness and reliability of the current models employed to calculate the weight-distance tax and fuel surtax liabilities. This report examines the current methodology utilized to estimate potential tax liabilities...

  20. Base Rates, Multiple Indicators, and Comprehensive Forensic Evaluations: Why Sexualized Behavior Still Counts in Assessments of Child Sexual Abuse Allegations

    ERIC Educational Resources Information Center

    Everson, Mark D.; Faller, Kathleen Coulborn

    2012-01-01

    Developmentally inappropriate sexual behavior has long been viewed as a possible indicator of child sexual abuse. In recent years, however, the utility of sexualized behavior in forensic assessments of alleged child sexual abuse has been seriously challenged. This article addresses a number of the concerns that have been raised about the…

  1. Assessing Abuse Risk beyond Self-Report: Analog Task of Acceptability of Parent-Child Aggression

    ERIC Educational Resources Information Center

    Rodriguez, Christina M.; Russa, Mary Bower; Harmon, Nancy

    2011-01-01

    Objectives: The present investigation reports on the development and initial validation of a new analog task, the Parent-Child Aggression Acceptability Movie Task (P-CAAM), intended to assess respondents' acceptance of parent-child aggression, including both physical discipline and physical abuse. Methods: Two independent samples were utilized to…

  2. Cumulative environmental risk in substance abusing women: early intervention, parenting stress, child abuse potential and child development☆

    PubMed Central

    Schuler, Maureen E.; Black, Maureen M.; Kettinger, Laurie; Harrington, Donna

    2011-01-01

    Objective To assess the relationship between cumulative environmental risks and early intervention, parenting attitudes, potential for child abuse and child development in substance abusing mothers. Method We studied 161 substance-abusing women, from a randomized longitudinal study of a home based early intervention, who had custody of their children through 18 months. The intervention group received weekly home visits in the first 6 months and biweekly visits from 6 to 18 months. Parenting stress and child abuse potential were assessed at 6 and 18 months postpartum. Children’s mental and motor development (Bayley MDI and PDI) and language development (REEL) were assessed at 6, 12, and 18 months postpartum. Ten maternal risk factors were assessed: maternal depression, domestic violence, nondomestic violence, family size, incarceration, no significant other in home, negative life events, psychiatric problems, homelessness, and severity of drug use. Level of risk was recoded into four categories (2 or less, 3, 4, and 5 or more), which had adequate cell sizes for repeated measures analysis. Data analysis Repeated measures analyses were run to examine how level of risk and group (intervention or control) were related to parenting stress, child abuse potential, and children’s mental, motor and language development over time. Results Parenting stress and child abuse potential were higher for women with five risks or more compared with women who had four or fewer risks; children’s mental, motor, and language development were not related to level of risk. Children in the intervention group had significantly higher scores on the PDI at 6 and 18 months (107.4 vs. 103.6 and 101.1 vs. 97.2) and had marginally better scores on the MDI at 6 and 12 months (107.7 vs. 104.2 and 103.6 vs. 100.1), compared to the control group. Conclusion Compared to drug-abusing women with fewer than five risks, women with five or more risks found parenting more stressful and indicated greater

  3. 27 CFR 26.193 - Notification of tax liability.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 27 Alcohol, Tobacco Products and Firearms 1 2011-04-01 2011-04-01 false Notification of tax liability. 26.193 Section 26.193 Alcohol, Tobacco Products and Firearms ALCOHOL AND TOBACCO TAX AND TRADE... Rico § 26.193 Notification of tax liability. (a) If the chemist of the Treasury of Puerto Rico finds...

  4. 43 CFR 3733.2 - Liability of United States.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 43 Public Lands: Interior 2 2011-10-01 2011-10-01 false Liability of United States. 3733.2 Section... WITHDRAWALS: GENERAL Risk of Operation § 3733.2 Liability of United States. The Act in section 3 provides in part as follows: Provided, That the United States, its permittees and licensees shall not be...

  5. 43 CFR 3733.2 - Liability of United States.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 43 Public Lands: Interior 2 2013-10-01 2013-10-01 false Liability of United States. 3733.2 Section... WITHDRAWALS: GENERAL Risk of Operation § 3733.2 Liability of United States. The Act in section 3 provides in part as follows: Provided, That the United States, its permittees and licensees shall not be...

  6. 43 CFR 3733.2 - Liability of United States.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 43 Public Lands: Interior 2 2014-10-01 2014-10-01 false Liability of United States. 3733.2 Section... WITHDRAWALS: GENERAL Risk of Operation § 3733.2 Liability of United States. The Act in section 3 provides in part as follows: Provided, That the United States, its permittees and licensees shall not be...

  7. 43 CFR 3733.2 - Liability of United States.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 43 Public Lands: Interior 2 2012-10-01 2012-10-01 false Liability of United States. 3733.2 Section... WITHDRAWALS: GENERAL Risk of Operation § 3733.2 Liability of United States. The Act in section 3 provides in part as follows: Provided, That the United States, its permittees and licensees shall not be...

  8. 12 CFR 704.8 - Asset and liability management.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... CORPORATE CREDIT UNIONS § 704.8 Asset and liability management. (a) Policies. A corporate credit union must...) The purpose and objectives of the corporate credit union's asset and liability activities; (2) The... corporate credit union's ALCO must have at least one member who is also a member of the board of directors...

  9. 12 CFR 704.8 - Asset and liability management.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... CORPORATE CREDIT UNIONS § 704.8 Asset and liability management. (a) Policies. A corporate credit union must...) The purpose and objectives of the corporate credit union's asset and liability activities; (2) The... corporate credit union's ALCO must have at least one member who is also a member of the board of directors...

  10. 12 CFR 704.8 - Asset and liability management.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... CORPORATE CREDIT UNIONS § 704.8 Asset and liability management. (a) Policies. A corporate credit union must...) The purpose and objectives of the corporate credit union's asset and liability activities; (2) The... corporate credit union's ALCO must have at least one member who is also a member of the board of directors...

  11. 10 CFR 1015.304 - Joint and several liability.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 10 Energy 4 2011-01-01 2011-01-01 false Joint and several liability. 1015.304 Section 1015.304 Energy DEPARTMENT OF ENERGY (GENERAL PROVISIONS) COLLECTION OF CLAIMS OWED THE UNITED STATES Standards for the Compromise of Claims § 1015.304 Joint and several liability. (a) When two or more debtors are...

  12. 45 CFR 30.24 - Joint and several liability.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 45 Public Welfare 1 2010-10-01 2010-10-01 false Joint and several liability. 30.24 Section 30.24 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION CLAIMS COLLECTION Debt Compromise § 30.24 Joint and several liability. (a) When two or more debtors are jointly and severally liable...

  13. Is early detection of abused children possible?: a systematic review of the diagnostic accuracy of the identification of abused children

    PubMed Central

    2013-01-01

    Background Early detection of abused children could help decrease mortality and morbidity related to this major public health problem. Several authors have proposed tools to screen for child maltreatment. The aim of this systematic review was to examine the evidence on accuracy of tools proposed to identify abused children before their death and assess if any were adapted to screening. Methods We searched in PUBMED, PsycINFO, SCOPUS, FRANCIS and PASCAL for studies estimating diagnostic accuracy of tools identifying neglect, or physical, psychological or sexual abuse of children, published in English or French from 1961 to April 2012. We extracted selected information about study design, patient populations, assessment methods, and the accuracy parameters. Study quality was assessed using QUADAS criteria. Results A total of 2 280 articles were identified. Thirteen studies were selected, of which seven dealt with physical abuse, four with sexual abuse, one with emotional abuse, and one with any abuse and physical neglect. Study quality was low, even when not considering the lack of gold standard for detection of abused children. In 11 studies, instruments identified abused children only when they had clinical symptoms. Sensitivity of tests varied between 0.26 (95% confidence interval [0.17-0.36]) and 0.97 [0.84-1], and specificity between 0.51 [0.39-0.63] and 1 [0.95-1]. The sensitivity was greater than 90% only for three tests: the absence of scalp swelling to identify children victims of inflicted head injury; a decision tool to identify physically-abused children among those hospitalized in a Pediatric Intensive Care Unit; and a parental interview integrating twelve child symptoms to identify sexually-abused children. When the sensitivity was high, the specificity was always smaller than 90%. Conclusions In 2012, there is low-quality evidence on the accuracy of instruments for identifying abused children. Identified tools were not adapted to screening because of

  14. 26 CFR 1.404(g)-1 - Deduction of employer liability payments.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 26 Internal Revenue 5 2012-04-01 2011-04-01 true Deduction of employer liability payments. 1.404(g)-1 Section 1.404(g)-1 Internal Revenue INTERNAL REVENUE SERVICE, DEPARTMENT OF THE TREASURY.... § 1.404(g)-1 Deduction of employer liability payments. (a) General rule. Employer liability payments...

  15. Prescription opioid abuse and diversion in an urban community: the results of an ultrarapid assessment.

    PubMed

    Inciardi, James A; Surratt, Hilary L; Cicero, Theodore J; Beard, Ronald A

    2009-04-01

    Prescription-drug diversion is a topic about which comparatively little is known, and systematic information garnered from prescription-drug abusers and dealers on the specific mechanisms of diversion is extremely limited. A pilot ultrarapid assessment was carried out in Wilmington, Delaware, during December 2006 to better understand the scope and dynamics of prescription-drug abuse and diversion. This involved focus groups with prescription-drug abusers and key informant interviews with police, regulatory officials, prescription-drug dealers, and pill brokers. The research team recruited focus group participants from the two residential substance abuse treatment programs in Wilmington reporting the highest proportions of prescription drug abusing clients. A total of six focus groups were conducted with 32 patients in these two programs. Dealers were recruited from the same treatment facilities, and three in-depth interviews were completed. In-depth interviews were also conducted with two prescription pill brokers recruited through the authors' existing contacts in the drug abusing community. Six in-depth interviews were conducted with representatives from a number of Delaware agencies-the Attorney General's Office, the Department of Professional Regulation, the State Police; the Wilmington Police Department, and the Newark Police Department. In-depth interview and focus group guides were developed for each of the target populations. The in-depth interviews with police and regulatory officials focused on the extent of prescription drug abuse and diversion in the community, the types of drugs most commonly diverted, and mechanisms being used to channel the drugs to the illicit market. The focus group areas of inquiry with prescription drug abusers included general perceptions of the prescription drug problem in Delaware, sources and mechanisms of access to prescription drugs, popularity and prices of prescription medications on the street, as well as the initiation

  16. Student perceptions of methylphenidate abuse at a public liberal arts college.

    PubMed

    Babcock, Q; Byrne, T

    2000-11-01

    With the ever-increasing diagnosis of attention deficit hyperactivity disorder, methylphenidate has become readily accessible in the college environment. Several properties of methylphenidate indicate abuse liability. A survey regarding the recreational use of methylphenidate was distributed to the student body at a public, liberal arts college. More than 16% of the students reported they had tried methylphenidate recreationally, and 12.7% reported they had taken the drug intranasally. Use of the drug was more common among traditional students than among nontraditional students. Among traditional-age students, reports of methylphenidate use were roughly equivalent to reports of cocaine and amphetamine use. Environmental conditions characteristic of college student life may influence the recreational use of the drug.

  17. Analysis of Your Professional Liability Insurance Policy

    PubMed Central

    Sadusk, Joseph F.; Hassard, Howard; Waterson, Rollen

    1958-01-01

    The most important lessons for the physician to learn in regard to his professional liability insurance coverage are the following: 1. The physician should carefully read his professional liability policy and should secure the educated aid of his attorney and his insurance broker, if they are conversant with this field. 2. He should particularly read the definition of coverage and carefully survey the exclusion clauses which may deny him coverage under certain circumstances. 3. If the physician is in partnership or in a group, he should be certain that he has contingent partnership coverage. 4. The physician should accept coverage only from an insurance carrier of sufficient size and stability that he can be sure his coverage will be guaranteed for “latent liability” claims as the years go along—certainly for his lifetime. 5. The insurance carrier offering the professional liability policy should be prepared to offer coverages up to at least $100,000/$300,000. 6. The physician should be assured that the insurance carrier has claims-handling personnel and legal counsel who are experienced and expert in the professional liability field and who are locally available for service. 7. The physician is best protected by a local or state group program, next best by a national group program, and last, by individual coverage. 8. The physician should look with suspicion on a cancellation clause in which his policy may be summarily cancelled on brief notice. 9. The physician should not buy professional liability insurance on the basis of price alone; adequacy of coverage and service and a good insurance company for his protection should be the deciding factors. PMID:13489519

  18. Identifying and Assessing Substance Abuse Problems with Deaf, Deafened, and Hard of Hearing Individuals.

    ERIC Educational Resources Information Center

    Guthmann, Debra

    This report provides an overview of chemical dependency, communication barriers, and assessment/treatment considerations for individuals who are deaf or have hearing impairments and have drug or alcohol problems. Following a discussion of the pattern of substance abuse, risk factors, and signs and symptoms, the report describes a model treatment…

  19. Theories and measures of elder abuse.

    PubMed

    Abolfathi Momtaz, Yadollah; Hamid, Tengku Aizan; Ibrahim, Rahimah

    2013-09-01

    Elder abuse is a pervasive phenomenon around the world with devastating effects on the victims. Although it is not a new phenomenon, interest in examining elder abuse is relatively new. This paper aims to provide an overview of the aetiological theories and measures of elder abuse. The paper briefly reviews theories to explain causes of elder abuse and then discusses the most commonly used measures of elder abuse. Based on the reviewed theories, it can be concluded that elder abuse is a multifactorial problem that may affect elderly people from different backgrounds and involve a wide variety of potential perpetrators, including caregivers, adult children, and partners. The review of existing measurement instruments notes that many different screening and assessment instruments have been developed to identify elders who are at risk for or are victims of abuse. However, there is a real need for more measurements of elder abuse, as the current instruments are limited in scope. © 2013 The Authors. Psychogeriatrics © 2013 Japanese Psychogeriatric Society.

  20. Increasing Liability Premiums in Obstetrics - Analysis, Effects and Options.

    PubMed

    Soergel, P; Schöffski, O; Hillemanns, P; Hille-Betz, U; Kundu, S

    2015-04-01

    Whenever people act, mistakes are made. In Germany, it is thought that a total of 40 000 cases of malpractice occur per year. In recent years, costs for liability insurance have risen significantly in almost all spheres of medicine as a whole. Liability in the health care sector is founded on the contractual relationship between doctor and patient. Most recently, case law developed over many years has been codified with the Patients' Rights Act. In obstetrics, the focus of liability law is on brain damage caused by hypoxia or ischemia as a result of management errors during birth. The costs per claim are made up of various components together with different shares of damage costs (increased needs, in particular therapy costs and nursing fees, acquisition damage, treatment costs, compensation). In obstetrics in particular, recent focus has been on massively increased liability payments, also accompanied by higher liability premiums. This causes considerable financial burdens on hospitals as well as on midwives and attending physicians. The premiums are so high, especially for midwives and attending physicians, that professional practice becomes uneconomical in some cases. In recent years, these circumstances have also been intensely debated in the public sphere and in politics. However, the focus here is on the occupation of midwife. In 2014, in the GKV-FQWG (Statutory Health Insurance - Quality and Further Development Act), a subsidy towards the occupational liability premium was defined for midwives who only attended a few deliveries. However, to date, a complete solution to the problem has not been found. A birth will never be a fully controllable risk, but in rare cases will always end with injury to the child. The goal must be to minimise this risk, through good education and continuous training, as well as constant critical analysis of one's own activities. Furthermore, it seems sensible, especially in non-clinical Obstetrics, to look at the current study

  1. Motivational versus confrontational interviewing: a comparison of substance abuse assessment practices at employee assistance programs.

    PubMed

    Schneider, R J; Casey, J; Kohn, R

    2000-02-01

    The aim of this study was to conduct a quasi-experimental comparison of two employee assistance program (EAP) assessment approaches with substance abusers: confrontational interviewing (CI) and motivational interviewing (MI). A total of 176 EAP clients from 14 study sites met the study criteria, and 89 (51%) agreed to participate in the study. At three and nine months postassessment, both the MI and CI groups showed similar changes in readiness for change, completion of initial treatment plans, and subsequent treatment. Most important, both the MI and CI participants showed significant and comparable improvement on all of the substance abuse baseline measures as well as measures of family-social well-being and effects of drinking/drugging on work performance. The results open the door for EAP counselors to use an empirically supported assessment style that is at least as effective as the traditional confrontational approach.

  2. Assessment of Navy Alcohol and Drug Abuse Education and Training Curricula, Revision Requirements

    DTIC Science & Technology

    1986-02-01

    include the following: Introduction to Psychology Adolescent Psychology Maslow’s Hierarchy Abnormal Psychology Defense Mechanisms Anxiety... abnormal psychological development and behavior, techniques of psychological assessment and treatment, and the application of these skills in a variety...block number) The Chief of Naval Operations has taken a firm, constructive approach to drug and alcohol abuse problems in the Navy. Navy policy

  3. Prevalence of substance abuse and socio-economic differences in substance abuse in an Australian community-dwelling elderly sample

    PubMed Central

    Li, Wendy; Caltabiano, Nerina

    2017-01-01

    A sample of 324 55–90-year-old Australian adults participated in a survey on elderly substance abuse using the Clinical Assessment Scales for the Elderly. Overall, males had a higher prevalence rate of substance abuse than females. Significant differences in substance abuse mean scores were found for gender, age, income, community involvement, and retirement. The findings also reveal that being a female, involved in community groups, being a retiree, and being a non-baby boomer are protective factors of substance abuse. Being an upper medium income earner appears to be a risk factor of substance abuse. PMID:28567302

  4. 42 CFR 455.202 - Limitation on contractor liability.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 4 2010-10-01 2010-10-01 false Limitation on contractor liability. 455.202 Section... § 455.202 Limitation on contractor liability. (a) A program contractor, a person, or an entity employed... contractor will not be held to have violated any criminal law and will not be held liable in any civil action...

  5. Evaluation of suspected child physical abuse.

    PubMed

    Kellogg, Nancy D

    2007-06-01

    This report provides guidance in the clinical approach to the evaluation of suspected physical abuse in children. The medical assessment is outlined with respect to obtaining a history, physical examination, and appropriate ancillary testing. The role of the physician may encompass reporting suspected abuse; assessing the consistency of the explanation, the child's developmental capabilities, and the characteristics of the injury or injuries; and coordination with other professionals to provide immediate and long-term treatment and follow-up for victims. Accurate and timely diagnosis of children who are suspected victims of abuse can ensure appropriate evaluation, investigation, and outcomes for these children and their families.

  6. Decision support system and medical liability.

    PubMed Central

    Allaërt, F. A.; Dusserre, L.

    1992-01-01

    Expert systems, which are going to be an essential tool in Medicine, are evolving in terms of sophistication of both knowledge representation and types of reasoning models used. The more efficient they are, the more often they will be used and professional liability will be involved. So after giving a short survey of configuration and working of expert systems, the authors will study the liabilities of people building and the using expert systems regarding some various dysfunctions. Of course the expert systems have to be considered only for human support and they should not possess any authority themselves, therefore the doctors must keep in mind that it is their own responsibility and as such keep their judgment and criticism. However other professionals could be involved, if they have participated in the building of expert systems. The different liabilities and the burden of proof are discussed according to some possible dysfunctions. In any case the final proof is inside the expert system by itself through re-computation of data. PMID:1482972

  7. 29 CFR 4219.13 - Amount of liability for de minimis amounts.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 29 Labor 9 2011-07-01 2011-07-01 false Amount of liability for de minimis amounts. 4219.13 Section... Redetermination of Withdrawal Liability Upon Mass Withdrawal § 4219.13 Amount of liability for de minimis amounts. An employer that is liable for de minimis amounts shall be liable to the plan for the amount by which...

  8. 29 CFR 4219.13 - Amount of liability for de minimis amounts.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 29 Labor 9 2010-07-01 2010-07-01 false Amount of liability for de minimis amounts. 4219.13 Section... Redetermination of Withdrawal Liability Upon Mass Withdrawal § 4219.13 Amount of liability for de minimis amounts. An employer that is liable for de minimis amounts shall be liable to the plan for the amount by which...

  9. Self Concept of Adolescent Sexual Abuse Victims.

    ERIC Educational Resources Information Center

    Orr, Donald P.; Downes, Maureen C.

    1985-01-01

    To assess the self-concept and psychological profile associated with sexual abuse, 20 young female victims evaluated in a sexual abuse clinic completed the Offer Self-Image Questionnaire. (Author/LMO)

  10. Drugs of abuse and Parkinson's disease.

    PubMed

    Mursaleen, Leah R; Stamford, Jonathan A

    2016-01-04

    The term "drug of abuse" is highly contextual. What constitutes a drug of abuse for one population of patients does not for another. It is therefore important to examine the needs of the patient population to properly assess the status of drugs of abuse. The focus of this article is on the bidirectional relationship between patients and drug abuse. In this paper we will introduce the dopaminergic systems of the brain in Parkinson's and the influence of antiparkinsonian drugs upon them before discussing this synergy of condition and medication as fertile ground for drug abuse. We will then examine the relationship between drugs of abuse and Parkinson's, both beneficial and deleterious. In summary we will draw the different strands together and speculate on the future merit of current drugs of abuse as treatments for Parkinson's disease. Copyright © 2015 Elsevier Inc. All rights reserved.

  11. Overcoming Legal Liability Concerns for School-Based Physical Activity Promotion

    PubMed Central

    Zimmerman, Sara; Kramer, Karen

    2013-01-01

    Schools have been identified as a priority environment for physical activity promotion as a component of efforts to help prevent childhood obesity. A variety of school-based environmental and programmatic strategies have been proven effective in promoting physical activity both on-site and in the surrounding community. However, many schools are deterred by fears of increased risk of legal liability for personal injuries. We examine 3 school-based strategies for promoting physical activity—Safe Routes to School programs, joint use agreements, and playground enhancement—from a tort liability perspective, and describe how schools can substantially minimize any associated liability risk through injury prevention and other strategies. We also recommend approaches to help schools overcome their liability concerns and adopt these critically needed healthy school policies. PMID:24028226

  12. 15 CFR 996.4 - Liability.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... REQUIREMENTS FOR NOAA HYDROGRAPHIC PRODUCTS AND SERVICES QUALITY ASSURANCE AND CERTIFICATION REQUIREMENTS FOR NOAA HYDROGRAPHIC PRODUCTS AND SERVICES General § 996.4 Liability. The Government of the United States...

  13. 15 CFR 996.4 - Liability.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... REQUIREMENTS FOR NOAA HYDROGRAPHIC PRODUCTS AND SERVICES QUALITY ASSURANCE AND CERTIFICATION REQUIREMENTS FOR NOAA HYDROGRAPHIC PRODUCTS AND SERVICES General § 996.4 Liability. The Government of the United States...

  14. 15 CFR 996.4 - Liability.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... REQUIREMENTS FOR NOAA HYDROGRAPHIC PRODUCTS AND SERVICES QUALITY ASSURANCE AND CERTIFICATION REQUIREMENTS FOR NOAA HYDROGRAPHIC PRODUCTS AND SERVICES General § 996.4 Liability. The Government of the United States...

  15. 15 CFR 996.4 - Liability.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... REQUIREMENTS FOR NOAA HYDROGRAPHIC PRODUCTS AND SERVICES QUALITY ASSURANCE AND CERTIFICATION REQUIREMENTS FOR NOAA HYDROGRAPHIC PRODUCTS AND SERVICES General § 996.4 Liability. The Government of the United States...

  16. 76 FR 62419 - Science of Abuse Liability Assessment; Public Workshop

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-10-07

    ... Federal Register.) If you need special accommodations due to a disability, please contact Ellen B. Geller... workshop will center on status, needs, new approaches, and paradigms regarding preclinical studies...

  17. Does the impact of child sexual abuse differ from maltreated but non-sexually abused children? A prospective examination of the impact of child sexual abuse on internalizing and externalizing behavior problems.

    PubMed

    Lewis, Terri; McElroy, Erika; Harlaar, Nicole; Runyan, Desmond

    2016-01-01

    Child sexual abuse (CSA) continues to be a significant problem with significant short and long term consequences. However, extant literature is limited by the reliance on retrospective recall of adult samples, single-time assessments, and lack of longitudinal data during the childhood and adolescent years. The purpose of this study was to compare internalizing and externalizing behavior problems of those with a history of sexual abuse to those with a history of maltreatment, but not sexual abuse. We examined whether gender moderated problems over time. Data were drawn from the Longitudinal Studies of Child Abuse and Neglect (LONGSCAN) at ages 4, 6, 8, 10, 12, 14, and 16 (N=977). The Child Behavior Checklist was used to assess internalizing and externalizing problems. Maltreatment history and types were obtained from official Child Protective Services (CPS) records. Generalized Estimating Equations (GEE) were used to assess behavior problems over time by maltreatment group. Findings indicated significantly more problems in the CSA group than the maltreated group without CSA over time. Internalizing problems were higher for sexually abused boys compared to girls. For sexually abused girls internalizing problems, but not externalizing problems increased with age relative to boys. This pattern was similar among maltreated but not sexually abused youth. Further efforts are needed to examine the psychological effects of maltreatment, particularly CSA longitudinally as well as better understand possible gender differences in order to best guide treatment efforts. Copyright © 2015 Elsevier Ltd. All rights reserved.

  18. Warning! Slippery Road Ahead: Internet Access and District Liability.

    ERIC Educational Resources Information Center

    Mazur, Joan M.

    1995-01-01

    As schools merge onto the information highway, districts must address their liability associated with Internet access. Schools need a practical policy supporting high access to global educational resources while limiting district liability. USENET provides easy access to controversial and pornographic materials. This article outlines federal…

  19. Personal Malpractice Liability of Reference Librarians and Information Brokers.

    ERIC Educational Resources Information Center

    Gray, John A.

    1988-01-01

    Reviews common law contract and tort bases for malpractice liability and their applicability to reference librarians, special librarians, and information brokers. The discussion covers the legal bases for professional malpractice liability, the librarian-patron relationship, the likelihood of lawsuits, and the need for personal liability…

  20. EMAC Volunteers: Liability and Workers’ Compensation

    PubMed Central

    Lopez, Wilfredo; Kershner, Stacie P.; Penn, Matthew S.

    2015-01-01

    The Emergency Management Assistance Compact (EMAC) provides a mechanism for states to assist each other during natural disasters and other emergencies. Congress ratified EMAC in 1996, and all 50 states and 3 territories have adopted it. EMAC allows a state affected by a disaster to request personnel and materiel from another state. For personnel requests, EMAC provides that the requesting state cover the tort liability and the responding state cover the workers’ compensation liability. This article discusses the limitations of EMAC in deploying volunteers and how the Uniform Emergency Volunteer Health Practitioners Act and other provisions address those limitations. PMID:24041195

  1. Trends in liability affecting technical writers

    NASA Technical Reports Server (NTRS)

    Driskill, L. P.

    1981-01-01

    Liability of technical writers for defective products is explored. Documents generated during a product's life cycle (including design memos, design tests, clinical trials, trial use reports, letters, and proposals) become relevant because they are likely to become the only available means of showing that the product was not defectively designed. These documents become the evidence that the product underwent balanced and well considered planning, development, testing, quality control, and field testing. The predicted increased involvement of technical writers in the prevention and defense of product liability claims is cited in view of a greater number of cases turning on "failure to warn".

  2. Assessment of the abuse of tapentadol immediate release: the first 24 months.

    PubMed

    Dart, Richard C; Cicero, Theodore J; Surratt, Hilary L; Rosenblum, Andrew; Bartelson, Becki Bucher; Adams, Edgar H

    2012-01-01

    Prescription opioid analgesics play an important role in the management of moderate to severe pain. An unintended consequence of prescribing opioid analgesics is the abuse and diversion of these medications. The authors estimated abuse and diversion rates for tapentadol immediate release (IR) compared with oxycodone, hydrocodone, and tramadol during the first 24 months of tapentadol IR availability. The Researched Abuse, Diversion and Addiction-Related Surveillance (RADARS®) System measures rates of prescription opioid abuse and diversion throughout the United States. Quarterly data from the Poison Center, Drug Diversion, Opioid Treatment, and Survey of Key Informants' Patients (SKIP) programs were plotted to visually compare the rates of tapentadol IR abuse and diversion with those of other opioid analgesics from July 2009 through June 2011 using both cases per 100,000 population and per 1,000 unique recipients of dispensed drug (URDD) as denominators. Trends in abuse and diversion rates over time were determined using a linear regression model of rate versus time. During the 24 months following its introduction, tapentadol IR had very low population-based rates of abuse and diversion that were similar to rates for tramadol and lower than rates for oxycodone and hydrocodone. Rates of tapentadol IR abuse and diversion based on URDD were variable by program due to changes in market share and had not stabilized as of June 2011. Rates of tapentadol IR abuse and diversion have been low during the first 24 months after its launch. Continued monitoring of trends in these data is warranted.

  3. Medico-legal notes for a new set of standards in the assessment of penal liability in psychiatry.

    PubMed

    Montanari Vergallo, Gianluca; Rinaldi, Raffaella; Bersani, Giuseppe; Marinelli, Enrico

    2017-01-01

    Negligence liability on the part of a psychiatrist belongs among high-complexity fields, for both the judge and his or her technical consultants. In most instances, there are no scientific grounds in order to ascribe with reasonable certainty liability to medical personnel and nursing staff, while often judges tend to stretch the concept of “protection” to a degree to which the psychiatrist is deemed to have a legal obligation to stave off the development of any adverse consequence which psychic distress may bring upon the patient. The case-records pertaining to suicide are symptomatic of such a tendency on the part of the Supreme Court as to convict healthcare professionals, the lack of incontrovertible evidence notwithstanding. The authors of this paper expound and elaborate on the conditions needed to ascribe liability to the psychiatrist, and the cause and effect relationship between the doctor’s professional behavior and the patient’s eventual suicide. On such basis, several sentences are perused in which the failure to institutionalize, the discharging of a patient, the granting of leaves and an obligation to supervise all come into play, highlighting how suicide is far too complex an outcome to be rationalized into the principle of causality beyond the reasonable doubt, as dictated by the criminal procedure codes, neither can it be kept from happening through the patients’ loss of personal liberty. Within such a legal framework, what becomes apparent is the inadequateness of any set of standardized rules and laws regulating professional liability, and its inability to properly take into account the complexities and peculiarities inherent to psychiatry. Consequently, a proper overhaul of such proceedings appears to be urgent, via a newly devised set of provisions, crafted to provide a new array of undisputable, basic behavioral standards, the breaching of which would entail the sanctioning on the part of the lawful authorities of such violations

  4. Understanding Tort Liability and Its Relationship to Extension Professionals.

    ERIC Educational Resources Information Center

    Long, Norman D.; And Others

    This study focuses on tort liability and its relationship to extension professionals working with 4-H programs. Tort liability as related to extension professionals consists of ten components: due care, physical defects (inspection of premises), instruction and supervision, first aid and medical treatment, foreseeability, causation, defamation,…

  5. Liability Insurance: A Primer for College and University Counsel.

    ERIC Educational Resources Information Center

    Ende, Howard; Anderson, Eugene R.; Crego, Susannah

    1997-01-01

    Because of the rise in litigation involving colleges and universities, basic information about liability insurance is provided. Administrators are warned that previously purchased liability insurance may not cover damages and losses incurred today, and that insurance companies often benefit from extended litigation. College counsel must understand…

  6. 14 CFR 1274.916 - Liability and risk of loss.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 14 Aeronautics and Space 5 2011-01-01 2010-01-01 true Liability and risk of loss. 1274.916 Section 1274.916 Aeronautics and Space NATIONAL AERONAUTICS AND SPACE ADMINISTRATION COOPERATIVE AGREEMENTS..., or indemnification of, developers of experimental aerospace vehicles. Liability and Risk of Loss July...

  7. Interventions for preventing abuse in the elderly.

    PubMed

    Baker, Philip R A; Francis, Daniel P; Hairi, Noran N; Othman, Sajaratulnisah; Choo, Wan Yuen

    2016-08-16

    Maltreatment of older people (elder abuse) includes psychological, physical, sexual abuse, neglect and financial exploitation. Evidence suggests that 10% of older adults experience some form of abuse, and only a fraction of cases are actually reported or referred to social services agencies. Elder abuse is associated with significant morbidity and premature mortality. Numerous interventions have been implemented to address the issue of elder maltreatment. It is, however, unclear which interventions best serve to prevent or reduce elder abuse. The objective of this review was to assess the effectiveness of primary, secondary and tertiary intervention programmes used to reduce or prevent abuse of the elderly in their own home, in organisational or institutional and community settings. The secondary objective was to investigate whether intervention effects are modified by types of abuse, types of participants, setting of intervention, or the cognitive status of older people. We searched 19 databases (AgeLine, CINAHL, Psycinfo, MEDLINE, Embase, Proquest Central, Social Services Abstracts‎, ASSIA, Sociological Abstracts, ProQuest Dissertations & Theses Global, Web of Science, LILACS, EPPI, InfoBase, CENTRAL, HMIC, Opengrey and Zetoc) on 12 platforms, including multidisciplinary disciplines covering medical, health, social sciences, social services, legal, finance and education. We also browsed related organisational websites, contacted authors of relevant articles and checked reference lists. Searches of databases were conducted between 30 August 2015 and 16 March 2016 and were not restricted by language. We included randomised controlled trials (RCTs), cluster-randomised trials, and quasi-RCTs, before-and-after studies, and interrupted time series. Only studies with at least 12 weeks of follow-up investigating the effect of interventions in preventing or reducing abuse of elderly people and those who interact with the elderly were included. Two review authors

  8. Childhood Sexual Abuse among University Students in Tanzania

    ERIC Educational Resources Information Center

    McCrann, Denis; Lalor, Kevin; Katabaro, Joviter Kamugisha

    2006-01-01

    Objectives: There are no prevalence data for childhood sexual abuse among Tanzanian university students. This investigation addressed this paucity. The nature of sexual abuse was also investigated. Method: Participants (N=487) from a university in Tanzania completed a questionnaire which assessed abusive childhood sexual experiences, gathering…

  9. Ambulatory surgery: is the liability risk lower?

    PubMed

    Metzner, Julia; Kent, Christopher D

    2012-12-01

    To summarize the currently available data on malpractice claims related to ambulatory anesthesia and provide an insight into the emerging patterns of anesthesia liability in this practice setting. At present, studies are mixed about how the continued growth of outpatient surgery will impact liability for anesthesiologists. Data derived from the ASA Closed Claims Project suggests that malpractice claims for major damaging events are less common in the outpatient settings than in inpatient settings. Correspondingly, the payment amounts for outpatient claims are significantly lower than those for inpatients. Nevertheless, nondisabling adverse events are common and involve respiratory, cardiac, equipment-related, and drug errors. In addition, the vast majority of injuries in outpatient claims was the result of substandard care and judged preventable by better monitoring. Although major incidents leading to malpractice suits are less, new liability exposure may be on the horizon, due to the changing landscape of ambulatory practice that permits care for sicker patients who require more complex surgeries. The areas of potential concern include postoperative discharge criteria, care for the obstructive sleep apnea patient, and the choice of anesthetic techniques such as neuraxial blocks and monitored anesthesia care. With steady increase in outpatient surgery, anesthesiologists are confronted with new areas of liability. More data are needed to identify these risks and reduce exposure to malpractice claims.

  10. Liability: the complicated task of licensing law enforcement technologies

    NASA Astrophysics Data System (ADS)

    Hops, Larry W.; Overlin, Trudy K.

    1997-01-01

    This paper discusses a situation where a company (licensor) requires a liability policy as a condition of a license agreement, when licensing law enforcement technologies. The purpose of this discussion is to evaluate the reasons behind the need for extensive liability policies to protect licensors when marketing their law enforcement technologies to private industry. Finding a solution to the problem, therefore reducing the potential for high liability insurance costs, would be desirable. Since the risks associated with most technologies are virtually unknown, and because such technologies are used in very unpredictable legal environments, alternative ways of guaranteeing research and development enterprises that they will be covered against product liability are needed. Without such protection, licensors may require licensees to indemnify them beyond the usual guarantees provided in a licensing agreement, which may make the license too costly for smaller businesses. When the share of the market is limited to larger corporations, competition suffers and ultimately the cost to law enforcement agencies increases.

  11. 24 CFR 203.422 - Right and liability under Mutual Mortgage Insurance Fund.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... Mortgage Insurance Fund and Distributive Shares § 203.422 Right and liability under Mutual Mortgage... to any liability arising under the mutuality of the Mutual Mortgage Insurance Fund. ... 24 Housing and Urban Development 2 2010-04-01 2010-04-01 false Right and liability under Mutual...

  12. 24 CFR 203.422 - Right and liability under Mutual Mortgage Insurance Fund.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... Mortgage Insurance Fund and Distributive Shares § 203.422 Right and liability under Mutual Mortgage... to any liability arising under the mutuality of the Mutual Mortgage Insurance Fund. ... 24 Housing and Urban Development 2 2011-04-01 2011-04-01 false Right and liability under Mutual...

  13. Understanding elder abuse in family practice

    PubMed Central

    Yaffe, Mark J.; Tazkarji, Bachir

    2012-01-01

    Abstract Objective To discuss what constitutes elder abuse, why family physicians should be aware of it, what signs and symptoms might suggest mistreatment of older adults, how the Elder Abuse Suspicion Index might help in identification of abuse, and what options exist for responding to suspicions of abuse. Sources of information MEDLINE, PsycINFO, and Social Work Abstracts were searched for publications in English or French, from 1970 to 2011, using the terms elder abuse, elder neglect, elder mistreatment, seniors, older adults, violence, identification, detection tools, and signs and symptoms. Relevant publications were reviewed. Main message Elder abuse is an important cause of morbidity and mortality in older adults. While family physicians are well placed to identify mistreatment of seniors, their actual rates of reporting abuse are lower than those in other professions. This might be improved by an understanding of the range of acts that constitute elder abuse and what signs and symptoms seen in the office might suggest abuse. Detection might be enhanced by use of a short validated tool, such as the Elder Abuse Suspicion Index. Conclusion Family physicians can play a larger role in identifying possible elder abuse. Once suspicion of abuse is raised, most communities have social service or law enforcement providers available to do additional assessments and interventions. PMID:23242889

  14. 48 CFR 1852.228-80 - Insurance-Immunity From Tort Liability.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ..., Insurance—Liability to Third Persons, and the associated NFS clause 1852.228-81, Insurance—Partial Immunity... clause at NFS 1852.228-82 Insurance—Total Immunity From Tort Liability, will be included in the contract...

  15. 48 CFR 1852.228-80 - Insurance-Immunity From Tort Liability.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ..., Insurance—Liability to Third Persons, and the associated NFS clause 1852.228-81, Insurance—Partial Immunity... clause at NFS 1852.228-82 Insurance—Total Immunity From Tort Liability, will be included in the contract...

  16. 48 CFR 1852.228-80 - Insurance-Immunity From Tort Liability.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ..., Insurance—Liability to Third Persons, and the associated NFS clause 1852.228-81, Insurance—Partial Immunity... clause at NFS 1852.228-82 Insurance—Total Immunity From Tort Liability, will be included in the contract...

  17. 48 CFR 1852.228-80 - Insurance-Immunity From Tort Liability.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ..., Insurance—Liability to Third Persons, and the associated NFS clause 1852.228-81, Insurance—Partial Immunity... clause at NFS 1852.228-82 Insurance—Total Immunity From Tort Liability, will be included in the contract...

  18. 48 CFR 1852.228-80 - Insurance-Immunity From Tort Liability.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ..., Insurance—Liability to Third Persons, and the associated NFS clause 1852.228-81, Insurance—Partial Immunity... clause at NFS 1852.228-82 Insurance—Total Immunity From Tort Liability, will be included in the contract...

  19. Unresolved legal questions in cross-border health care in Europe: liability and data protection.

    PubMed

    van der Molen, I N; Commers, M J

    2013-11-01

    Directive 2011/24/EU was designed to clarify the rights of EU citizens in evaluating, accessing and obtaining reimbursement for cross-border care. Based on three regional case studies, the authors attempted to assess the added value of the Directive in helping clarify issues in to two key areas that have been identified as barriers to cross-border care: liability and data protection. Qualitative case study employing secondary data sources including research of jurisprudence, that set up a Legal framework as a base to investigate liability and data protection in the context of cross-border projects. By means of three case studies that have tackled liability and data protection hurdles in cross-border care implementation, this article attempts to provide insight into legal certainty and uncertainty regarding cross-border care in Europe. The case studies reveal that the Directive has not resolved core uncertainties related to liability and data protection issues within cross-border health care. Some issues related to the practice of cross-border health care in Europe have been further clarified by the Directive and some direction has been given to possible solutions for issues connected to liability and data protection. Directive 2011/24/EU is clearly a transposition of existing regulations on data protection and ECJ case law, plus a set of additional, mostly, voluntary rules that might enhance regional border cooperation. Therefore, as shown in the case studies, a practical and case by case approach is still necessary in designing and providing cross-border care. © 2013 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

  20. Medical student abuse: perceptions and experience.

    PubMed

    Bourgeois, J A; Kay, J; Rudisill, J R; Bienenfeld, D; Gillig, P; Klykylo, W M; Markert, R J

    1993-07-01

    A questionnaire containing 18 vignettes of common clinical educational situations with potentially abusive treatment of medical students and a 10-item attitude assessment about abusive behaviour were administered to the first- and fourth-year medical students at a mid-west US university medical school. The first- and fourth-year groups did not differ significantly on perceived abusiveness of most of the vignettes, although several of the individual vignettes were perceived significantly differently by the two groups. As hypothesized, the fourth-year students had experienced such situations more frequently. Attitudes towards abusive behaviour did not differ between the two groups. The authors contrast teaching interactions perceived as educationally useful and not abusive with those seen as abusive and not useful and offer explanations for the differences observed. Finally, the possible implications of the results for medical education are discussed.

  1. 18 CFR 367.2440 - Account 244, Derivative instrument liabilities.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 18 Conservation of Power and Water Resources 1 2012-04-01 2012-04-01 false Account 244, Derivative instrument liabilities. 367.2440 Section 367.2440 Conservation of Power and Water Resources FEDERAL ENERGY..., Derivative instrument liabilities. This account must include the change in the fair value of all derivative...

  2. 18 CFR 367.2440 - Account 244, Derivative instrument liabilities.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 18 Conservation of Power and Water Resources 1 2010-04-01 2010-04-01 false Account 244, Derivative instrument liabilities. 367.2440 Section 367.2440 Conservation of Power and Water Resources FEDERAL ENERGY..., Derivative instrument liabilities. This account must include the change in the fair value of all derivative...

  3. 78 FR 49242 - Relief From Joint and Several Liability

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-08-13

    ... Relief From Joint and Several Liability AGENCY: Internal Revenue Service (IRS), Treasury. ACTION: Notice... joint and several tax liability under section 6015 of the Internal Revenue Code (Code) and relief from... are husband and wife to file a joint Federal income tax return. Married individuals who choose to file...

  4. 27 CFR 31.234 - Liability for special (occupational) tax.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... special (occupational) tax in accordance with the laws and regulations in effect at that time. The tax... 27 Alcohol, Tobacco Products and Firearms 1 2010-04-01 2010-04-01 false Liability for special... Liability for special (occupational) tax. The special (occupational) tax on alcohol beverage dealers was...

  5. The Duke Endowment Child Abuse Prevention Initiative: A Midpoint Assessment

    ERIC Educational Resources Information Center

    Daro, Deborah; Huang, Lee Ann; English, Brianna

    2009-01-01

    The Duke Endowment launched its Child Abuse Prevention Initiative in 2002 by funding two program sites, the Durham Family Initiative in Durham, North Carolina, and Strong Communities in Greenville, South Carolina. Both sites aimed to reduce rates of child abuse, improve parenting practices and behaviors, strengthen community service systems, and…

  6. The impact on pension liabilities of Malaysian government pension scheme from remarriage due to removal of pension clause

    NASA Astrophysics Data System (ADS)

    Ibrahim, Rose Irnawaty; Siri, Zailan

    2014-12-01

    In the event of death of any government employee, their monthly pension will be given to their widow and their child. The government will stop paying that pension when the widow died and when the widow chooses to remarry. However, in 1st January 2002, the remarriage clause has been removed from the regulations. This would allow all widows who remarried to receive pension as usual. In view of this, there are possibilities that those widows who are still young might remarried. If many of the widows choose to remarry, it will be a burden to the government as it would increase the pension liabilities. However, we do not know how many of the widow will remarry. In view of this, the purpose of the study is to assess the impact to pension liabilities of government pension schemes on individual life due to removal clause of the remarriage by determining the pension factor and to assess to what extent the pension liabilities of government pension schemes would be affected.

  7. Development and psychometric testing the Health of Body, Mind and Spirit Scale for assessing individuals who have drug abuse histories.

    PubMed

    Sun, Fan-Ko; Chiang, Chun-Ying; Lu, Chu-Yun; Yu, Pei-Jane; Liao, Tzu-Chiao; Lan, Chu-Mei

    2018-03-01

    To develop the Health of Body, Mind and Spirit Scale (HBMSS), which was designed to assess drug abusers' health condition. Helping drug abusers to become healthy is important to healthcare professionals. However, no instrument exists to assess drug abusers' state of health. A cross-sectional questionnaire survey was implemented to examine the validity of the HBMSS. Data were collected from 2015-2016 at one drug abuse prevention centre in Taiwan. Participants (N = 320) who had abused drugs were invited to complete a preliminary 64-item version of the HBMSS. An item analysis, criterion-related validity analysis (using the Relapse Prediction Scale [RPS] score), split-half reliability testing and confirmatory factor analysis (CFA) were conducted to examine the psychometric properties of the HBMSS. The final version of the HBMSS contained 15 items that were divided into three subscales: the health of the body, mind and spirit. Cronbach's α and split-half reliability coefficients were all above .85. The factor loading of each item was between .74-.95. The HBMSS had satisfactory criterion-related validity with the RPS score (r = -.50, p < .001). A second-order CFA was conducted on the HBMSS. The fit indexes were good, χ 2  = 184.060, df = 94, χ 2 /df = 1.958 (p = .000). The entire HBMSS and the subscales had satisfactory reliability and validity. Healthcare professionals could use the HBMSS to evaluate the condition of the health of individuals with a drug abuse history. © 2017 John Wiley & Sons Ltd.

  8. Governing Board and Administrator Liability. ERIC/Higher Education Research Report No. 9.

    ERIC Educational Resources Information Center

    Hendrickson, Robert M.; Mangum, Ronald Scott

    Matters of legal liability that are of concern to institutions of higher education are discussed in some detail in language for the layman. Among the subjects discussed are: the development of charitable corporations, and immunity prerogatives; the traditional bases of legal liability; liability for the new torts, including violation of…

  9. 75 FR 4400 - Draft Guidance for Industry on Assessment of Abuse Potential of Drugs; Availability

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-01-27

    ... comments on the draft guidance by March 29, 2010. ADDRESSES: Submit written requests for single copies of...] Draft Guidance for Industry on Assessment of Abuse Potential of Drugs; Availability AGENCY: Food and... psychoactive effects such as sedation, euphoria, or mood change. DATES: Although you can comment on any...

  10. Projecting the cost, utilization, and patient care impact of prescribing extended release non-abuse-deterrent opioids to chronic pain patients.

    PubMed

    Yenikomshian, Mihran Ara; White, Alan G; Carson, Michael E; Garrison, Louis P; Oderda, Gary M; Biskupiak, Joseph E; Hlavacek, Patrick R; Roland, Carl L

    To estimate healthcare resource utilization, associated costs, and number needed to harm (NNH) from a physician's decision to prescribe extended-release (ER) non-abuse-deterrent opioids (non-ADO) as compared to ER ADOs in a chronic pain population. A 12-month probabilistic simulation model was developed to estimate the reduction of misuse and/or abuse from a physician's prescribing decisions for 10,000 patients. Model inputs included probabilities for opioid misuse and/or abuse-related events, opioid discontinuation, and switching from ADO to non-ADO. Estimated reductions in abuse associated with ADOs were obtained from positive subjective measures using human abuse liability studies. The model was run separately for commercial, Medicare, Medicaid, and Veterans Administration (VA) populations. The difference in healthcare resource utilization and associated costs (2015 USD) between the ADO and non-ADO simulations was calculated. NNH for non-ADO was also calculated. Misuse and/or abuse-related events for patients prescribed ER non-ADOs ranged from 223-1,410 and associated costs ranged from $20-$98 per patient for commercial and Medicare populations, respectively. Prescribing ER ADOs were associated with 87, 289, 264, and 417 fewer misuse and/or abuse-related events, saving $8, $35, $21, and $29 per patient in commercial, VA, Medicaid, and Medicare populations, respectively. NNH ranged from 185 in the commercial population to 40 in the Medicare population. Results were sensitive to decreases in the probability of misuse and/or abuse events but showed reductions. A physician's decision to prescribe ER ADOs could lead to large reductions in misuse and/or abuse-related events and associated costs across many patient populations.

  11. 20 CFR 410.563 - Liability of a certifying officer.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 20 Employees' Benefits 2 2011-04-01 2011-04-01 false Liability of a certifying officer. 410.563 Section 410.563 Employees' Benefits SOCIAL SECURITY ADMINISTRATION FEDERAL COAL MINE HEALTH AND SAFETY ACT OF 1969, TITLE IV-BLACK LUNG BENEFITS (1969- ) Payment of Benefits § 410.563 Liability of a...

  12. Colleges' New Liabilities: An Emerging New In Loco Parentis.

    ERIC Educational Resources Information Center

    Gibbs, Annette; Szablewicz, James J.

    1988-01-01

    Describes and documents the changing legal theories about the college-student relationship currently used by the courts. Notes that the most recent legal actions focus on contract law, landowner liability, guest and host, and negligence. Looks specifically at cases involving liability for sexual attacks on students and for alcohol-related…

  13. 33 CFR 153.405 - Liability to the pollution fund.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 33 Navigation and Navigable Waters 2 2010-07-01 2010-07-01 false Liability to the pollution fund... (CONTINUED) POLLUTION CONTROL OF POLLUTION BY OIL AND HAZARDOUS SUBSTANCES, DISCHARGE REMOVAL Administration of the Pollution Fund § 153.405 Liability to the pollution fund. The owner or operator of the vessel...

  14. 33 CFR 153.405 - Liability to the pollution fund.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 33 Navigation and Navigable Waters 2 2011-07-01 2011-07-01 false Liability to the pollution fund... (CONTINUED) POLLUTION CONTROL OF POLLUTION BY OIL AND HAZARDOUS SUBSTANCES, DISCHARGE REMOVAL Administration of the Pollution Fund § 153.405 Liability to the pollution fund. The owner or operator of the vessel...

  15. 33 CFR 153.405 - Liability to the pollution fund.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 33 Navigation and Navigable Waters 2 2012-07-01 2012-07-01 false Liability to the pollution fund... (CONTINUED) POLLUTION CONTROL OF POLLUTION BY OIL AND HAZARDOUS SUBSTANCES, DISCHARGE REMOVAL Administration of the Pollution Fund § 153.405 Liability to the pollution fund. The owner or operator of the vessel...

  16. 33 CFR 153.405 - Liability to the pollution fund.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 33 Navigation and Navigable Waters 2 2014-07-01 2014-07-01 false Liability to the pollution fund... (CONTINUED) POLLUTION CONTROL OF POLLUTION BY OIL AND HAZARDOUS SUBSTANCES, DISCHARGE REMOVAL Administration of the Pollution Fund § 153.405 Liability to the pollution fund. The owner or operator of the vessel...

  17. 33 CFR 153.405 - Liability to the pollution fund.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 33 Navigation and Navigable Waters 2 2013-07-01 2013-07-01 false Liability to the pollution fund... (CONTINUED) POLLUTION CONTROL OF POLLUTION BY OIL AND HAZARDOUS SUBSTANCES, DISCHARGE REMOVAL Administration of the Pollution Fund § 153.405 Liability to the pollution fund. The owner or operator of the vessel...

  18. A comprehensive obstetric patient safety program reduces liability claims and payments.

    PubMed

    Pettker, Christian M; Thung, Stephen F; Lipkind, Heather S; Illuzzi, Jessica L; Buhimschi, Catalin S; Raab, Cheryl A; Copel, Joshua A; Lockwood, Charles J; Funai, Edmund F

    2014-10-01

    Begun in 2003, the Yale-New Haven Hospital comprehensive obstetric safety program consisted of measures to standardize care, improve teamwork and communication, and optimize oversight and quality review. Prior publications have demonstrated improvements in adverse outcomes and safety culture associated with this program. In this analysis, we aimed to assess the impact of this program on liability claims and payments at a single institution. We reviewed liability claims at a single, tertiary-care, teaching hospital for two 5-year periods (1998-2002 and 2003-2007), before and after implementing the safety program. Connecticut statute of limitations for professional malpractice is 36 months from injury. Claims/events were classified by event-year and payments were adjusted for inflation. We analyzed data for trends as well as differences between periods before and after implementation. Forty-four claims were filed during the 10-year study period. Annual cases per 1000 deliveries decreased significantly over the study period (P < .01). Claims (30 vs 14) and payments ($50.7 million vs $2.9 million) decreased in the 5-years after program inception. Compared with before program inception, median annual claims dropped from 1.31 to 0.64 (P = .02), and median annual payments per 1000 deliveries decreased from $1,141,638 to $63,470 (P < .01). Even estimating the monetary awards for the 2 remaining open cases using the median payments for the surrounding 5 years, a reduction in the median monetary amount per case resulting in payment to the claimant was also statistically significant ($632,262 vs $216,815, P = .046). In contrast, the Connecticut insurance market experienced a stable number of claims and markedly increased cost per claim during the same period. We conclude that an obstetric safety initiative can improve liability claims exposure and reduce liability payments. Copyright © 2014 Elsevier Inc. All rights reserved.

  19. Base rates, multiple indicators, and comprehensive forensic evaluations: why sexualized behavior still counts in assessments of child sexual abuse allegations.

    PubMed

    Everson, Mark D; Faller, Kathleen Coulborn

    2012-01-01

    Developmentally inappropriate sexual behavior has long been viewed as a possible indicator of child sexual abuse. In recent years, however, the utility of sexualized behavior in forensic assessments of alleged child sexual abuse has been seriously challenged. This article addresses a number of the concerns that have been raised about the diagnostic value of sexualized behavior, including the claim that when population base rates for abuse are properly taken into account, the diagnostic value of sexualized behavior is insignificant. This article also identifies a best practice comprehensive evaluation model with a methodology that is effective in mitigating such concerns.

  20. Juvenile entry into prostitution: the role of emotional abuse.

    PubMed

    Roe-Sepowitz, Dominique E

    2012-05-01

    This study seeks to assess the nature and extent of childhood emotional abuse among adult women in a residential prostitution-exiting program. Regression analyses were conducted to assess the unique role of childhood emotional abuse in the prediction of age of entry into prostitution. Childhood emotional abuse, a history of running away during childhood, and participating in survival-based exchanges of sex were significantly associated with the commercial sexual exploitation of girls younger than age 18, while childhood emotional abuse contributed to predicting a younger age of entry. Results are discussed regarding policy, prevention, and future research.

  1. 29 CFR 4062.7 - Calculating interest on liability and refunds of overpayments.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... termination date, on any unpaid portion of the liability. Such interest accrues at the rate set forth in... amount of liability under this part, the PBGC shall refund the excess amount, with interest at the rate... compounded daily. (c) Interest rate. The interest rate on liability under this part and refunds thereof is...

  2. Search Engine Liability for Copyright Infringement

    NASA Astrophysics Data System (ADS)

    Fitzgerald, B.; O'Brien, D.; Fitzgerald, A.

    The chapter provides a broad overview to the topic of search engine liability for copyright infringement. In doing so, the chapter examines some of the key copyright law principles and their application to search engines. The chapter also provides a discussion of some of the most important cases to be decided within the courts of the United States, Australia, China and Europe regarding the liability of search engines for copyright infringement. Finally, the chapter will conclude with some thoughts for reform, including how copyright law can be amended in order to accommodate and realise the great informative power which search engines have to offer society.

  3. A Population-Based Assessment of Human Rights Abuses Committed Against Ethnic Albanian Refugees From Kosovo

    PubMed Central

    Iacopino, Vincent; Frank, Martina W.; Bauer, Heidi M.; Keller, Allen S.; Fink, Sheri L.; Ford, Doug; Pallin, Daniel J.; Waldman, Ronald

    2001-01-01

    Objectives. This study assessed patterns of displacement and human rights abuses among Kosovar refugees in Macedonia and Albania. Methods. Between April 19 and May 3, 1999, 1180 ethnic Albanian refugees living in 31 refugee camps and collective centers in Macedonia and Albania were interviewed. Results. The majority (68%) of participants reported that their families were directly expelled from their homes by Serb forces. Overall, 50% of participants saw Serb police or soldiers burning the houses of others, 16% saw Serb police or soldiers burn their own home, and 14% witnessed Serb police or soldiers killing someone. Large percentages of participants saw destroyed mosques, schools, or medical facilities. Thirty-one percent of respondents reported human rights abuses committed against their household members, including beatings, killings, torture, forced separation and disappearances, gunshot wounds, and sexual assault. Conclusions. The present findings confirm that Serb forces engaged in a systematic and brutal campaign to forcibly expel the ethnic Albanian population of Kosovo. In the course of these mass deportations, Serb forces committed widespread abuses of human rights against ethnic Albanians. PMID:11726386

  4. Pathways to PTSD, Part II: Sexually Abused Children

    PubMed Central

    Kaplow, Julie B.; Dodge, Kenneth A.; Amaya-Jackson, Lisa; Saxe, Glenn N.

    2009-01-01

    Objective The goal of this research was to develop and test a prospective model of posttraumatic stress symptoms in sexually abused children that includes pretrauma, trauma, and disclosure-related pathways. Method At time 1, several measures were used to assess pretrauma variables, trauma variables, and stress reactions upon disclosure for 156 sexually abused children ages 8 to 13 years. At the time 2 follow-up (7 to 36 months following the initial interview), the children were assessed for posttraumatic stress disorder (PTSD) symptoms. Results A path analysis involving a series of hierarchically nested ordinary least squares multiple regression analyses indicated three direct paths to PTSD symptoms: avoidant coping, anxiety/arousal, and dissociation, all measured during or immediately after disclosure of sexual abuse. Additionally, age and gender predicted avoidant coping, while life stress and age at abuse onset predicted symptoms of anxiety/arousal. Taken together, these pathways accounted for approximately 57% of the variance in PTSD symptoms. Conclusions Symptoms measured at the time of disclosure constitute direct, independent pathways by which sexually abused children are likely to develop later PTSD symptoms. These findings speak to the importance of assessing children during the disclosure of abuse in order to identify those at greatest risk for later PTSD symptoms. PMID:15994713

  5. 7 CFR 760.113 - Refunds; joint and several liability.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 7 Agriculture 7 2010-01-01 2010-01-01 false Refunds; joint and several liability. 760.113 Section... Agricultural Disaster Assistance Programs § 760.113 Refunds; joint and several liability. (a) In the event that... provided that interest will in all cases run from the date of the original disbursement. (b) All persons...

  6. Cumulative Environmental Risk in Substance Abusing Women: Early Intervention, Parenting Stress, Child Abuse Potential and Child Development.

    ERIC Educational Resources Information Center

    Kelley, Susan J.

    2003-01-01

    A study of 161 substance-abusing mothers assessed 10 maternal risk factors: maternal depression; domestic violence; nondomestic violence; family size; incarceration; no significant other at home; negative life events; psychiatric problems; homelessness; and drug use severity. Parenting stress and child abuse potential was higher for women with…

  7. Long-term correlates of childhood abuse among adults with severe mental illness: adult victimization, substance abuse, and HIV sexual risk behavior.

    PubMed

    Meade, Christina S; Kershaw, Trace S; Hansen, Nathan B; Sikkema, Kathleen J

    2009-04-01

    The prevalence of childhood sexual and physical abuse among persons with severe mental illness (SMI) is disproportionately high. Adults with SMI also engage in high rates of HIV risk behaviors. This study examined the association between childhood abuse and adult victimization, substance abuse, and lifetime HIV sexual risk in a sample of 152 adults with SMI receiving community mental health services. Structured interviews assessed psychiatric, psychosocial, and behavioral risk factors. Seventy percent reported childhood physical and/or sexual abuse, and 32% reported both types of abuse. Participants with childhood abuse were more likely to report adult victimization and greater HIV risk. A structural equation model found that childhood abuse was directly and indirectly associated with HIV risk through drug abuse and adult vicitimization. Integrated treatment approaches that address interpersonal violence and substance abuse may be necessary for HIV risk reduction in this population.

  8. Torts Liability for Strike Action and Third Party Rights.

    ERIC Educational Resources Information Center

    Raday, Frances

    1979-01-01

    Studies the nature of the torts liability incurred in strikes and the extent of existing immunities bestowed on strikers and their organizers, and explores the principles that should govern liability and immunity. Available from Israel Law Review Association, c/o Faculty of Law, Hebrew University of Jerusalem, Mount Scopus, P.O.B. 24100, Jerusalem…

  9. Legal Liabilities of Administrators.

    ERIC Educational Resources Information Center

    Underwood, Julie

    This chapter of "Principles of School Business Management" discusses the implications of several court cases for legal issues affecting the role of the school business official. The issues addressed include civil rights, negligence, contracts, criminal liability, tuition and fees, and student records. The chapter opens with a brief overview of…

  10. Increasing Liability Premiums in Obstetrics – Analysis, Effects and Options

    PubMed Central

    Soergel, P.; Schöffski, O.; Hillemanns, P.; Hille-Betz, U.; Kundu, S.

    2015-01-01

    Whenever people act, mistakes are made. In Germany, it is thought that a total of 40 000 cases of malpractice occur per year. In recent years, costs for liability insurance have risen significantly in almost all spheres of medicine as a whole. Liability in the health care sector is founded on the contractual relationship between doctor and patient. Most recently, case law developed over many years has been codified with the Patientsʼ Rights Act. In obstetrics, the focus of liability law is on brain damage caused by hypoxia or ischemia as a result of management errors during birth. The costs per claim are made up of various components together with different shares of damage costs (increased needs, in particular therapy costs and nursing fees, acquisition damage, treatment costs, compensation). In obstetrics in particular, recent focus has been on massively increased liability payments, also accompanied by higher liability premiums. This causes considerable financial burdens on hospitals as well as on midwives and attending physicians. The premiums are so high, especially for midwives and attending physicians, that professional practice becomes uneconomical in some cases. In recent years, these circumstances have also been intensely debated in the public sphere and in politics. However, the focus here is on the occupation of midwife. In 2014, in the GKV-FQWG (Statutory Health Insurance – Quality and Further Development Act), a subsidy towards the occupational liability premium was defined for midwives who only attended a few deliveries. However, to date, a complete solution to the problem has not been found. A birth will never be a fully controllable risk, but in rare cases will always end with injury to the child. The goal must be to minimise this risk, through good education and continuous training, as well as constant critical analysis of oneʼs own activities. Furthermore, it seems sensible, especially in non-clinical Obstetrics, to look at the current

  11. Is there a place for extended assessments in addressing child sexual abuse allegations? How sensitivity and specificity impact professional perspectives.

    PubMed

    Williams, Javonda; Nelson-Gardell, Debra; Coulborn Faller, Kathleen; Tishelman, Amy; Cordisco-Steele, Linda

    2014-01-01

    Using data from a survey of perceptions of 932 child welfare professionals about the utility of extended assessments, the researchers constructed a scale to measure respondents' views about sensitivity (ensuring sexually abused children are correctly identified) and specificity (ensuring nonabused children are correctly identified) in child sexual abuse evaluations. On average, respondents scored high (valuing sensitivity) on the sensitivity versus specificity scale. Next, the researchers undertook bivariate analyses to identify independent variables significantly associated with the sensitivity versus specificity scale. Then those variables were entered into a multiple regression. Four independent variables were significantly related to higher sensitivity scores: encountering cases requiring extended assessments, valuing extended assessments among scarce resources, less concern about proving cases in court, and viewing the goal of extended assessments as understanding needs of child and family (adjusted R2 = .34).

  12. Depressive symptoms and suicidality in physically abused children.

    PubMed

    Finzi, R; Ram, A; Shnit, D; Har-Even, D; Tyano, S; Weizman, A

    2001-01-01

    Depressive symptoms and suicidality were assessed in 114 children 6-12 years old, of whom 41 had been physically abused, 38 neglected, and 35 neither abused nor neglected. The physically abused children manifested significantly higher levels of depressive symptomatology and suicidality than did the other two groups. Implications for research and clinical practice are discussed.

  13. Immunotherapy for the treatment of drug abuse.

    PubMed

    Kosten, Thomas; Owens, S Michael

    2005-10-01

    Antibody therapy (as either active or passive immunization) is designed primarily to prevent drugs of abuse from entering the central nervous system (CNS). Antidrug antibodies reduce rush, euphoria, and drug distribution to the brain at doses that exceed the apparent binding capacity of the antibody. This is accomplished through a pharmacokinetic antagonism, which reduces the amount of drug in the brain, the rate of clearance across the blood-brain barrier, and the volume of drug distribution. Because the antibodies remain primarily in the circulatory system, they have no apparent central nervous system side effects. Active immunization with drug-protein conjugate vaccines has been tested for cocaine, heroin, methamphetamine, and nicotine in animal, with 1 cocaine and 3 nicotine vaccines in Phase 2 human trials. Passive immunization with high affinity monoclonal antibodies has been tested for cocaine, methamphetamine, nicotine, and phencyclidine (PCP) in preclinical animal models. Antibodies have 2 immediate clinical applications in drug abuse treatment: to treat drug overdose and to reduce relapse to drug use in addicted patients. The specificity of the therapies, the lack of addiction liability, minimal side effects, and long-lasting protection against drug use offer major therapeutic benefit over conventional small molecule agonists and antagonists. Immunotherapies can also be combined with other antiaddiction medications and enhance behavioral therapies. Current immunotherapies already show efficacy, but improved antigen design and antibody engineering promise highly specific and rapidly developed treatments for both existing and future addictions.

  14. Malpractice liability and defensive medicine: a national survey of neurosurgeons.

    PubMed

    Nahed, Brian V; Babu, Maya A; Smith, Timothy R; Heary, Robert F

    2012-01-01

    Concern over rising healthcare expenditures has led to increased scrutiny of medical practices. As medical liability and malpractice risk rise to crisis levels, the medical-legal environment has contributed to the practice of defensive medicine as practitioners attempt to mitigate liability risk. High-risk specialties, such as neurosurgery, are particularly affected and neurosurgeons have altered their practices to lessen medical-legal risk. We present the first national survey of American neurosurgeons' perceptions of malpractice liability and defensive medicine practices. A validated, 51-question online-survey was sent to 3344 practicing U.S. neurosurgeon members of the American Association of Neurological Surgeons, which represents 76% of neurosurgeons in academic and private practices. A total of 1028 surveys were completed (31% response rate) by neurosurgeons representing diverse sub-specialty practices. Respondents engaged in defensive medicine practices by ordering additional imaging studies (72%), laboratory tests (67%), referring patients to consultants (66%), or prescribing medications (40%). Malpractice premiums were considered a "major or extreme" burden by 64% of respondents which resulted in 45% of respondents eliminating high-risk procedures from their practice due to liability concerns. Concerns and perceptions about medical liability lead practitioners to practice defensive medicine. As a result, diagnostic testing, consultations and imaging studies are ordered to satisfy a perceived legal risk, resulting in higher healthcare expenditures. To minimize malpractice risk, some neurosurgeons have eliminated high-risk procedures. Left unchecked, concerns over medical liability will further defensive medicine practices, limit patient access to care, and increase the cost of healthcare delivery in the United States.

  15. Malpractice Liability and Defensive Medicine: A National Survey of Neurosurgeons

    PubMed Central

    Smith, Timothy R.; Heary, Robert F.

    2012-01-01

    Background Concern over rising healthcare expenditures has led to increased scrutiny of medical practices. As medical liability and malpractice risk rise to crisis levels, the medical-legal environment has contributed to the practice of defensive medicine as practitioners attempt to mitigate liability risk. High-risk specialties, such as neurosurgery, are particularly affected and neurosurgeons have altered their practices to lessen medical-legal risk. We present the first national survey of American neurosurgeons’ perceptions of malpractice liability and defensive medicine practices. Methods A validated, 51-question online-survey was sent to 3344 practicing U.S. neurosurgeon members of the American Association of Neurological Surgeons, which represents 76% of neurosurgeons in academic and private practices. Results A total of 1028 surveys were completed (31% response rate) by neurosurgeons representing diverse sub-specialty practices. Respondents engaged in defensive medicine practices by ordering additional imaging studies (72%), laboratory tests (67%), referring patients to consultants (66%), or prescribing medications (40%). Malpractice premiums were considered a “major or extreme” burden by 64% of respondents which resulted in 45% of respondents eliminating high-risk procedures from their practice due to liability concerns. Conclusions Concerns and perceptions about medical liability lead practitioners to practice defensive medicine. As a result, diagnostic testing, consultations and imaging studies are ordered to satisfy a perceived legal risk, resulting in higher healthcare expenditures. To minimize malpractice risk, some neurosurgeons have eliminated high-risk procedures. Left unchecked, concerns over medical liability will further defensive medicine practices, limit patient access to care, and increase the cost of healthcare delivery in the United States. PMID:22761745

  16. 7 CFR 1216.85 - Personal liability.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... AGREEMENTS AND ORDERS; MISCELLANEOUS COMMODITIES), DEPARTMENT OF AGRICULTURE PEANUT PROMOTION, RESEARCH, AND INFORMATION ORDER Peanut Promotion, Research, and Information Order Miscellaneous § 1216.85 Personal liability...

  17. 7 CFR 1216.85 - Personal liability.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... AGREEMENTS AND ORDERS; MISCELLANEOUS COMMODITIES), DEPARTMENT OF AGRICULTURE PEANUT PROMOTION, RESEARCH, AND INFORMATION ORDER Peanut Promotion, Research, and Information Order Miscellaneous § 1216.85 Personal liability...

  18. 7 CFR 1280.229 - Personal liability.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... AGREEMENTS AND ORDERS; MISCELLANEOUS COMMODITIES), DEPARTMENT OF AGRICULTURE LAMB PROMOTION, RESEARCH, AND INFORMATION ORDER Lamb Promotion, Research, and Information Order Miscellaneous § 1280.229 Personal liability...

  19. 20 CFR 416.2140 - Liability for erroneous Medicaid eligibility determinations.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false Liability for erroneous Medicaid eligibility... SECURITY INCOME FOR THE AGED, BLIND, AND DISABLED Medicaid Eligibility Determinations § 416.2140 Liability for erroneous Medicaid eligibility determinations. If the State suffers any financial loss, directly...

  20. Sexual abuse of street children brought to an observation home.

    PubMed

    Pagare, Deepti; Meena, G S; Jiloha, R C; Singh, M M

    2005-02-01

    This study was conducted to assess the magnitude and pattern of sexual abuse among male inmates of an observation home in Delhi. A total of 189 boys aged 6 to 18 years were assessed for sexual abuse using Finkelhors scale and Child Maltreatment History Self-Report followed by clinical examination using American Medical Associations guidelines. Majority of boys were runaways and 38.1 percent had suffered sexual abuse. On clinical examination, 61.1 percent showed physical signs and 40.2 percent showed behavioral signs of sexual abuse. Forcible sex was reported by 44.4 percent of victims and 25 percent had signs suggestive of sexually transmitted diseases. Strangers were the most common perpetrators of sexual abuse.

  1. 29 CFR 790.4 - Liability of employer; effect of contract, custom, or practice.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ..., this section relieves the employer from certain liabilities or punishments to which he might otherwise... by such employee is relieved from liability or punishment therefor if, and only if, such activities... an employer of liability or punishment only with respect to activities of the kind described, which...

  2. 29 CFR 790.4 - Liability of employer; effect of contract, custom, or practice.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ..., this section relieves the employer from certain liabilities or punishments to which he might otherwise... by such employee is relieved from liability or punishment therefor if, and only if, such activities... an employer of liability or punishment only with respect to activities of the kind described, which...

  3. 29 CFR 790.4 - Liability of employer; effect of contract, custom, or practice.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ..., this section relieves the employer from certain liabilities or punishments to which he might otherwise... by such employee is relieved from liability or punishment therefor if, and only if, such activities... an employer of liability or punishment only with respect to activities of the kind described, which...

  4. 29 CFR 790.4 - Liability of employer; effect of contract, custom, or practice.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ..., this section relieves the employer from certain liabilities or punishments to which he might otherwise... by such employee is relieved from liability or punishment therefor if, and only if, such activities... an employer of liability or punishment only with respect to activities of the kind described, which...

  5. Affective responsiveness, betrayal, and childhood abuse.

    PubMed

    Reichmann-Decker, Aimee; DePrince, Anne P; McIntosh, Daniel N

    2009-01-01

    Several trauma-specific and emotion theories suggest that alterations in children's typical affective responses may serve an attachment function in the context of abuse by a caregiver or close other. For example, inhibiting negative emotional responses or expressions might help the child preserve a relationship with an abusive caregiver. Past research in this area has relied on self-report methods to discover links between affective responsiveness and caregiver abuse. Extending this literature, the current study used facial electromyography to assess affective responsiveness with 2 measures: mimicry of emotional facial expressions and affective modulation of startle. We predicted that women who reported childhood abuse by close others would show alterations in affective responsiveness relative to their peers. We tested 100 undergraduate women who reported histories of (a) childhood sexual or physical abuse by someone close, such as a parent (high-betrayal); (b) childhood abuse by someone not close (low-betrayal); or (c) no abuse in childhood (no-abuse). Especially when viewing women's emotional expressions, the high-betrayal group showed more mimicry of happy and less mimicry of angry faces relative to women who reported no- or low-betrayal abuse, who showed the opposite pattern. Furthermore, women who reported high-betrayal abuse showed less affective modulation of startle during pictures depicting men threatening women than did the other two groups. Findings suggest that, as predicted by betrayal trauma theory, women who have experienced high-betrayal abuse show alterations in automatic emotional processes consistent with caregiving-maintenance goals in an abusive environment.

  6. 15 CFR 996.4 - Liability.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... AND ATMOSPHERIC ADMINISTRATION, DEPARTMENT OF COMMERCE QUALITY ASSURANCE AND CERTIFICATION REQUIREMENTS FOR NOAA HYDROGRAPHIC PRODUCTS AND SERVICES QUALITY ASSURANCE AND CERTIFICATION REQUIREMENTS FOR NOAA HYDROGRAPHIC PRODUCTS AND SERVICES General § 996.4 Liability. The Government of the United States...

  7. Abuse of elderly people by their carers.

    PubMed Central

    Homer, A C; Gilleard, C

    1990-01-01

    OBJECTIVE--To assess the prevalence of abuse of elderly people by their carers and the characteristics of abusers and the abused. DESIGN--Information on abuse and risk factors was collected over six months from carers and patients. Risk factors were identified in the abused group and compared with those in a non-abused control group. SETTING--Carers were interviewed at home; patients were examined in the wards of Putney and Barnes geriatric hospitals, London. SUBJECTS--All patients referred from any source for respite care to the geriatric services over a six month period and their carers. MAIN OUTCOME MEASURES--Amount of physical and verbal abuse or neglect. Quantification of risk factors and correlation with the presence or absence of abuse. RESULTS--45% Of carers openly admitted to some form of abuse. Few patients admitted abuse. The most significant risk factor for physical abuse was alcohol consumption by the carer (p less than 0.001). Other significant risk factors were a poor pre-morbid relationship and previous abuse over many years. Abuse was often reciprocated and was associated with social dysfunction in many patients. Service delivery, respite care, and level of mental and physical disability were not significantly associated with abuse. CONCLUSION--The high level of abuse found in elderly patients in respite care was particularly associated with alcohol abuse and long term relationships of poor quality, which are difficult to change. Even with increased provision of services, care in the community may not be the best solution for these people. PMID:2271883

  8. Strategies for Limiting Engineers' Potential Liability for Indoor Air Quality Problems.

    PubMed

    von Oppenfeld, Rolf R; Freeze, Mark E; Sabo, Sean M

    1998-10-01

    Engineers face indoor air quality (IAQ) issues at the design phase of building construction as well as during the investigation and mitigation of potential indoor air pollution problems during building operation. IAQ issues that can be identified are "building-related illnesses" that may include problems of volatile organic compounds (VOCs). IAQ issues that cannot be identified are termed "sick building syndrome." Frequently, microorganism-caused illnesses are difficult to confirm. Engineers who provide professional services that directly or indirectly impact IAQ face significant potential liability to clients and third parties when performing these duties. Potential theories supporting liability claims for IAQ problems against engineers include breach of contract and various common law tort theories such as negligence and negligent misrepresentation. Furthermore, an increasing number of federal, state, and local regulations affect IAQ issues and can directly increase the potential liability of engineers. A duty to disclose potential or actual air quality concerns to third parties may apply for engineers in given circumstances. Such a duty may arise from judicial precedent, the Model Guide for Professional Conduct for Engineers, or the Code of Ethics for Engineers. Practical strategies engineers can use to protect themselves from liability include regular training and continuing education in relevant regulatory, scientific, and case law developments; detailed documentation and recordkeeping practices; adequate insurance coverage; contractual indemnity clauses; contractual provisions limiting liability to the scope of work performed; and contractual provisions limiting the extent of liability for engineers' negligence. Furthermore, through the proper use of building materials and construction techniques, an engineer or other design professional can effectively limit the potential for IAQ liability.

  9. Genetic Liability to Disability Pension in Women and Men: A Prospective Population-Based Twin Study

    PubMed Central

    Narusyte, Jurgita; Ropponen, Annina; Silventoinen, Karri; Alexanderson, Kristina; Kaprio, Jaakko; Samuelsson, Åsa; Svedberg, Pia

    2011-01-01

    Background Previous studies of risk factors for disability pension (DP) have mainly focused on psychosocial, or environmental, factors, while the relative importance of genetic effects has been less studied. Sex differences in biological mechanisms have not been investigated at all. Methods The study sample included 46,454 Swedish twins, consisting of 23,227 complete twin pairs, born 1928–1958, who were followed during 1993–2008. Data on DP, including diagnoses, were obtained from the National Social Insurance Agency. Within-pair similarity in liability to DP was assessed by calculating intraclass correlations. Genetic and environmental influences on liability to DP were estimated by applying discrete-time frailty modeling. Results During follow-up, 7,669 individuals were granted DP (18.8% women and 14.1% men). Intraclass correlations were generally higher in MZ pairs than DZ pairs, while DZ same-sexed pairs were more similar than opposite-sexed pairs. The best-fitting model indicated that genetic factors contributed 49% (95% CI: 39–59) to the variance in DP due to mental diagnoses, 35% (95% CI: 29–41) due to musculoskeletal diagnoses, and 27% (95% CI: 20–33) due to all other diagnoses. In both sexes, genetic effects common to all ages explained one-third, whereas age-specific factors almost two-thirds, of the total variance in liability to DP irrespective of diagnosis. Sex differences in liability to DP were indicated, in that partly different sets of genes were found to operate in women and men, even though the magnitude of genetic variance explained was equal for both sexes. Conclusions The findings of the study suggest that genetic effects are important for liability to DP due to different diagnoses. Moreover, genetic contributions to liability to DP tend to differ between women and men, even though the overall relative contribution of genetic influences does not differ by sex. Hence, the pathways leading to DP might differ between women and men. PMID

  10. Improving the Clinical Pharmacologic Assessment of Abuse Potential: Part 1: Regulatory Context and Risk Management.

    PubMed

    Sellers, Edward M

    2018-02-01

    This article brings to the attention of drug developers the Food and Drug Administration's (FDA's) recent final Guidance to Industry on Assessment of Abuse Potential and provides practical suggestions about compliance with the Guidance. The Guidance areas are reviewed, analyzed, and placed in the context of current scientific knowledge and best practices to mitigate regulatory risk. The Guidance provides substantial new detail on what needs to be done at all stages of drug development for central nervous system-active drugs. However, because many psychopharmacologic agents have unique preclinical and clinical features, the plan for each agent needs to be not only carefully prepared but also reviewed and approved by the FDA. Examples are provided where assumptions about interpretation of the Guidance can delay development. If the expertise and experience needed for assessing abuse potential during drug development do not exist within a company, external preclinical and clinical expert should be involved. Consultation with the FDA is encouraged and important because the specific requirements for each drug will vary.

  11. Psychological Characteristics of Adolescent Males Who Have Been Sexually Abused.

    ERIC Educational Resources Information Center

    Boisso, Cynthia V.; And Others

    While female victims of sexual abuse have received increased attention, male victims continue to be overlooked. Recognition of effects of sexual abuse has been an important step in increasing identification of and treatment for victims of abuse. To assess the characteristics of male victims, sexually abused male (N=13) and female (N=16)…

  12. 7 CFR 1207.365 - Personal liability.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... AGREEMENTS AND ORDERS; MISCELLANEOUS COMMODITIES), DEPARTMENT OF AGRICULTURE POTATO RESEARCH AND PROMOTION PLAN Potato Research and Promotion Plan Miscellaneous § 1207.365 Personal liability. No member of the...

  13. 7 CFR 1207.365 - Personal liability.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... AGREEMENTS AND ORDERS; MISCELLANEOUS COMMODITIES), DEPARTMENT OF AGRICULTURE POTATO RESEARCH AND PROMOTION PLAN Potato Research and Promotion Plan Miscellaneous § 1207.365 Personal liability. No member of the...

  14. 7 CFR 1207.365 - Personal liability.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... AGREEMENTS AND ORDERS; MISCELLANEOUS COMMODITIES), DEPARTMENT OF AGRICULTURE POTATO RESEARCH AND PROMOTION PLAN Potato Research and Promotion Plan Miscellaneous § 1207.365 Personal liability. No member of the...

  15. 7 CFR 1207.365 - Personal liability.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... AGREEMENTS AND ORDERS; MISCELLANEOUS COMMODITIES), DEPARTMENT OF AGRICULTURE POTATO RESEARCH AND PROMOTION PLAN Potato Research and Promotion Plan Miscellaneous § 1207.365 Personal liability. No member of the...

  16. 7 CFR 1207.365 - Personal liability.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... AGREEMENTS AND ORDERS; MISCELLANEOUS COMMODITIES), DEPARTMENT OF AGRICULTURE POTATO RESEARCH AND PROMOTION PLAN Potato Research and Promotion Plan Miscellaneous § 1207.365 Personal liability. No member of the...

  17. Predictors of Substance Abuse Assessment and Treatment Completion for Parents Involved with Child Welfare: One State's Experience in Matching across Systems.

    PubMed

    Traube, Dorian E; He, Amy S; Zhu, Limei; Scalise, Christine; Richardson, Tyrone

    2015-01-01

    To date, few studies have examined the effect of interagency collaboration on substance abuse assessment ity of Southern California and treatment completion for parents who are involved in child welfare. The purpose of this paper is to: (1) describe a statewide, interagency collaborative program aimed at providing targeted substance abuse assessment and treatment to parents engaged in the child welfare system; (2) document the specialized assessment and treatment outcomes for parents engaged through this collaborative program; and (3) determine factors related to successful treatment completion for parents involved in the child welfare system. This is a retrospective study of an open cohort of 13,829 individuals admitted to the New Jersey Child Protection Substance Abuse Initiative (CPSAI) program from October 1, 2009, through September 30, 2010. Data were drawn from two unique administrative data sources. Multivariate Cox regression models were used to explore factors related to successfil treatment completion for parents involved in the child welfare system. Trend analysis for the total sample in the CPSAI program revealed that, of the 10,909 individuals who received a CPSAI assessment, 59% were referred to treatment. Of those referred to treatment, 40% enrolled in a treatment program. Once enrolled in a treatment program, 55% completed or were in the process of completing substance abuse treatment. These findings suggest that when adequate screening and treatment is available through a streamlined process, many of the ethnic and gender disparities present among other populations of individuals seeking treatment are minimized. Utilizing inherent child welfare case factors appears to be an important motivating element that aids parents during the assessment and treatment process.

  18. Abused women: dispelling myths and encouraging intervention.

    PubMed

    King, M C; Ryan, J

    1989-05-01

    Our society abounds with myths and misperceptions in relation to the battering of women. These myths impede the identification of women who are experiencing violence and abuse, and inhibit appropriate intervention. Abuse is not too private a matter to assess for, nor does abuse affect only poor black or Hispanic women. No woman deserves to be beaten. Women do not like or seek out abuse. Abused women are courageous, competent women; what abused women have in common is that they are threatened and controlled by a male partner and live under the constant fear of violence and abuse. Raising one's consciousness about the victimization and oppression of women in our society, and uncovering the myths which leave practitioners powerless and ineffective agents of change for women are important tasks for health care providers. By focusing attention on this enormous health problem, clinicians can provide a leadership role in using health care responses that actually empower women to take control of their own lives.

  19. Risky Business - Questions To Ask Your Liability Insurance Agent and Attorney.

    ERIC Educational Resources Information Center

    Strickland, James

    2000-01-01

    Discusses the unique vulnerabilities of the child care industry related to liability insurance. Presents questions for beginning liability- and coverage-related dialogue between the caregiver or center director and the attorney and insurance agent. (KB)

  20. 12 CFR 205.6 - Liability of consumer for unauthorized transfers.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... transfers. 205.6 Section 205.6 Banks and Banking FEDERAL RESERVE SYSTEM BOARD OF GOVERNORS OF THE FEDERAL RESERVE SYSTEM ELECTRONIC FUND TRANSFERS (REGULATION E) § 205.6 Liability of consumer for unauthorized transfers. (a) Conditions for liability. A consumer may be held liable, within the limitations described in...

  1. 12 CFR 205.6 - Liability of consumer for unauthorized transfers.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... transfers. 205.6 Section 205.6 Banks and Banking FEDERAL RESERVE SYSTEM BOARD OF GOVERNORS OF THE FEDERAL RESERVE SYSTEM ELECTRONIC FUND TRANSFERS (REGULATION E) § 205.6 Liability of consumer for unauthorized transfers. (a) Conditions for liability. A consumer may be held liable, within the limitations described in...

  2. 32 CFR 536.123 - Limitation of liability for maritime claims.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 32 National Defense 3 2010-07-01 2010-07-01 true Limitation of liability for maritime claims. 536... AND ACCOUNTS CLAIMS AGAINST THE UNITED STATES Maritime Claims § 536.123 Limitation of liability for maritime claims. For admiralty claims arising within the United States under the provisions of the...

  3. HIV liability & disability services providers: an introduction to tort principles.

    PubMed

    Harvey, D C; Decker, C L

    1991-08-01

    Mental health and developmental disability services providers are concerned that liability issues regarding worker and client exposure to HIV have not been adequately addressed. By developing policy specifically in the areas of education, infection control practices, and confidentiality, providers may minimize findings of liability and protect patient rights.

  4. 26 CFR 20.2206-1 - Liability of life insurance beneficiaries.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 26 Internal Revenue 14 2010-04-01 2010-04-01 false Liability of life insurance beneficiaries. 20.2206-1 Section 20.2206-1 Internal Revenue INTERNAL REVENUE SERVICE, DEPARTMENT OF THE TREASURY... § 20.2206-1 Liability of life insurance beneficiaries. With respect to the right of the district...

  5. 26 CFR 20.2206-1 - Liability of life insurance beneficiaries.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 26 Internal Revenue 14 2011-04-01 2010-04-01 true Liability of life insurance beneficiaries. 20.2206-1 Section 20.2206-1 Internal Revenue INTERNAL REVENUE SERVICE, DEPARTMENT OF THE TREASURY... § 20.2206-1 Liability of life insurance beneficiaries. With respect to the right of the district...

  6. 26 CFR 20.2206-1 - Liability of life insurance beneficiaries.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 26 Internal Revenue 14 2014-04-01 2013-04-01 true Liability of life insurance beneficiaries. 20.2206-1 Section 20.2206-1 Internal Revenue INTERNAL REVENUE SERVICE, DEPARTMENT OF THE TREASURY... § 20.2206-1 Liability of life insurance beneficiaries. With respect to the right of the district...

  7. 26 CFR 20.2206-1 - Liability of life insurance beneficiaries.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 26 Internal Revenue 14 2013-04-01 2013-04-01 false Liability of life insurance beneficiaries. 20.2206-1 Section 20.2206-1 Internal Revenue INTERNAL REVENUE SERVICE, DEPARTMENT OF THE TREASURY... § 20.2206-1 Liability of life insurance beneficiaries. With respect to the right of the district...

  8. 26 CFR 20.2206-1 - Liability of life insurance beneficiaries.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 26 Internal Revenue 14 2012-04-01 2012-04-01 false Liability of life insurance beneficiaries. 20.2206-1 Section 20.2206-1 Internal Revenue INTERNAL REVENUE SERVICE, DEPARTMENT OF THE TREASURY... § 20.2206-1 Liability of life insurance beneficiaries. With respect to the right of the district...

  9. Civil Liability of Schools, Teachers and Pupils for Careless Behaviour.

    ERIC Educational Resources Information Center

    Wenham, David

    1999-01-01

    Identifies elements that (British) courts consider in school or teacher negligence cases. Reviews significant case law establishing liability of schools and teachers for harm sustained by pupils and children's personal liability for careless acts leading to personal harm. Discusses implications of a recent child negligence case. (Contains 14…

  10. 12 CFR 205.6 - Liability of consumer for unauthorized transfers.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... transfers. 205.6 Section 205.6 Banks and Banking FEDERAL RESERVE SYSTEM BOARD OF GOVERNORS OF THE FEDERAL RESERVE SYSTEM ELECTRONIC FUND TRANSFERS (REGULATION E) § 205.6 Liability of consumer for unauthorized transfers. (a) Conditions for liability. A consumer may be held liable, within the limitations described in...

  11. 12 CFR 205.6 - Liability of consumer for unauthorized transfers.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... transfers. 205.6 Section 205.6 Banks and Banking FEDERAL RESERVE SYSTEM BOARD OF GOVERNORS OF THE FEDERAL RESERVE SYSTEM ELECTRONIC FUND TRANSFERS (REGULATION E) § 205.6 Liability of consumer for unauthorized transfers. (a) Conditions for liability. A consumer may be held liable, within the limitations described in...

  12. 12 CFR 205.6 - Liability of consumer for unauthorized transfers.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... transfers. 205.6 Section 205.6 Banks and Banking FEDERAL RESERVE SYSTEM BOARD OF GOVERNORS OF THE FEDERAL RESERVE SYSTEM ELECTRONIC FUND TRANSFERS (REGULATION E) § 205.6 Liability of consumer for unauthorized transfers. (a) Conditions for liability. A consumer may be held liable, within the limitations described in...

  13. 26 CFR 1.357-2 - Liabilities in excess of basis.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... exchange as to which under section 357(b) (relating to assumption of liabilities for tax-avoidance purposes... 1.357-2 Internal Revenue INTERNAL REVENUE SERVICE, DEPARTMENT OF THE TREASURY (CONTINUED) INCOME TAX (CONTINUED) INCOME TAXES Effects on Shareholders and Security Holders § 1.357-2 Liabilities in excess of...

  14. The Substance Abuse Counseling Needs of Women in the Criminal Justice System: A Needs Assessment Approach

    ERIC Educational Resources Information Center

    Laux, John M.; Dupuy, Paula J.; Moe, Jeffry L.; Cox, Jane A.; Lambert, Eric; Ventura, Lois A.; Williamson, Celia; Benjamin, Barbaranne J.

    2008-01-01

    The authors assessed the substance abuse counseling needs of women in the criminal justice system using interviews (n = 304) and surveys (n = 1,170). On the basis of the results, the authors call for gender-specific treatment as well as family-oriented support for women who are mothers.

  15. First responder and physician liability during an emergency.

    PubMed

    Eddy, Amanda

    2013-01-01

    First responders, especially emergency medical technicians and paramedics, along with physicians, will be expected to render care during a mass casualty event. It is highly likely that these medical first responders and physicians will be rendering care in suboptimal conditions due to the mass casualty event. Furthermore, these individuals are expected to shift their focus from individually based care to community- or population-based care when assisting disaster response. As a result, patients may feel they have not received adequate care and may seek to hold the medical first responder or physician liable, even if they did everything they could given the emergency circumstances. Therefore, it is important to protect medical first responders and physicians rendering care during a mass casualty event so that their efforts are not unnecessarily impeded by concerns about civil liability. In this article, the author looks at the standard of care for medical first responders and physicians and describes the current framework of laws limiting liability for these persons during an emergency. The author concludes that the standard of care and current laws fail to offer adequate liability protection for medical first responders and physicians, especially those in the private sector, and recommends that states adopt clear laws offering liability protection for all medical first responders and physicians who render assistance during a mass casualty event.

  16. Maternity care and liability: least promising policy strategies for improvement.

    PubMed

    Sakala, Carol; Yang, Y Tony; Corry, Maureen P

    2013-01-01

    The present liability system is not serving well childbearing women and newborns, maternity care clinicians, or those who pay for maternity care. Examination of evidence about the impact of this system on maternity care led us to identify seven aims for a high-functioning liability system in this clinical context. Herein, we identify policy strategies that are unlikely to meet the proposed criteria and contribute to needed improvements. A companion paper considers more promising strategies. We considered whether 25 strategies that have been used or proposed for improvement have met or could meet the seven aims. We used a best available evidence approach and drew on more recent empirical legal studies and health services research about maternity care and liability, when available, and considered other studies when unavailable. Fifteen strategies seem to have little potential to improve liability matters in maternity care. Despite support for capping non-economic damages, a series of studies has found a modest impact at best on maternity care. Maternity-specific studies also do not lend support to tort reforms collectively and several other specific tort reforms. Some tort alternative and liability insurance reform strategies have narrow aims and are not policy priorities. Caps on non-economic damages and other tort reforms have narrow aims and have been marginally effective at best in the context of maternity care. Several other possible reforms similarly are not promising. Continued focus on these strategies is unlikely to result in the high-performing liability system that maternity care stakeholders need. Copyright © 2013 Jacobs Institute of Women's Health. Published by Elsevier Inc. All rights reserved.

  17. Use, indications and distribution in different countries of the stimulant and hallucinogenic amphetamine derivatives under consideration by WHO.

    PubMed

    Keup, W

    1986-06-01

    Information is presented on legal manufacture, distribution, medical uses and in various countries of the stimulants and hallucinogens under consideration by the World Health Organization (WHO). Data are reported from the Substance Abuse Warning System (SAWS) in the F.R.G. and other surveillance systems regarding illicit manufacture, trafficking and abuse of these compounds internationally. In addition, it is pointed out that assessment of the liability of these compounds for abuse must consider not only the substance itself but also its potential metabolic products. These data, collectively, indicate that the substances currently of most concern with respect to abuse are fenetylline and norpseudoephedrine.

  18. Federal government provision of third-party liability insurance to space vehicle users

    NASA Technical Reports Server (NTRS)

    1985-01-01

    Support decisions concerning the provision by the Federal Government of third-party liability insurance for commercial space activities were studied. The practices associated with third-party liability insurance in the marine, aviation, and electric utility industries in addition to those industries associated with space missions were reviewed. Theoretical considerations of rate setting are discussed and a methodology to determine the period of time over which the insurers of each industry intend to set aside reserves to recover from a maximum liability loss should one occur is introduced. The data were analyzed to determine the setaside period in each industry, and to suggest reasonable standards from the insurer's point of view. Criteria for Federal provision of insurance are discussed, an interpretation of the Price-Anderson Act, determinants of the availability of commercial insurance, potential insurer liability, and measures of reasonableness for premium rates from the user's point of view are presented. Options available to the government regarding third part liability protection are presented.

  19. Substance Abuse and the American Woman.

    ERIC Educational Resources Information Center

    Columbia Univ., New York, NY. National Center on Addiction and Substance Abuse.

    The first comprehensive assessment of substance abuse and women, this report arose from an analysis of more than 1,700 scientific and technical articles, surveys, government reports and books. Results show that American women are closing the gap with men in that they are increasingly likely to abuse substances at the same rate as men. Findings…

  20. Understanding the neurobiology, assessment, and treatment of substances of abuse and dependence: a guide for the critical care nurse.

    PubMed

    Genung, Vanessa

    2012-03-01

    What do I as a critical care nurse do? Nurses, by virtue of being trained in health promotion, and also because they interact with patients, families, and communities, have firsthand opportunities to play an active role in practicing primary prevention. To avoid the first occurrence of substance abuse, assess community need, assess facility needs, and identify potential risk. Identify the magnitude of the problem. Intervene early with the youth and at-risk populations. Refer patients and their families to mental health specialists. Provide education to patients, families, communities. To reduce occurrences of substance abuse, practicing secondary prevention requires prompt action in the earliest moments of recognizing a problem and directing patients to early intervention and rehabilitation. Screening your patients, providing brief education, and prompt referral constitutes early intervention. To retard the progress of the disease, practice tertiary prevention by providing education, counseling, and support to the afflicted in achieving and maintaining sobriety through medication compliance and rehabilitative group and counseling work. The goal of intervention in the lives of substance abusers is to stop drug use, avoid relapse, and sustain recovery. After years of research, NIDA has identified 13 fundamental principles to effective drug abuse treatment. 1. Addiction is a complex but treatable disease that affects brain function and behavior. 2. No single treatment is appropriate for everyone. 3. Treatment needs to be readily available. 4. Effective treatment attends to multiple needs of the individual, not just his or her drug abuse. 5. Remaining in treatment for an adequate period of time is critical. 6. Counseling--individual and/or group--and other behavioral therapies are the most commonly used forms of drug abuse treatment. 7. Medications are an important element of treatment for many patients, especially when combined with counseling and other behavioral

  1. Partner, workplace, and stranger abuse during pregnancy in Germany.

    PubMed

    Stöckl, Heidi; Hertlein, Linda; Friese, Klaus; Stöckl, Doris

    2010-11-01

    To investigate the prevalence, perpetrators, sociodemographic correlates, and health impacts of psychological, physical, and sexual abuse during pregnancy among women attending a maternity ward in Germany. A written questionnaire was given to pregnant women in a maternity ward of a university hospital in Munich. Abuse during pregnancy was assessed using the Abuse Assessment Screen. Of 552 women, 401 completed the questionnaire for a response rate of 72.6%. The prevalence of psychological, physical, or sexual abuse during pregnancy by any perpetrator was 6.7% (n = 27); the main perpetrators were women's partners and work colleagues. After controlling for the effect of age, psychological, physical, or sexual abuse during pregnancy was significantly associated with a history of abuse, low education level of the woman and the father of her child, short relationship duration, unintended pregnancy, financial problems caused by the pregnancy, having more than 3 children, and insufficient social support. Women who reported abuse during pregnancy were significantly more likely to smoke and to have adverse maternal health outcomes. Psychological, physical, or sexual abuse during pregnancy was experienced by 1 in 15 women who attended a maternity ward in Munich and adversely affected maternal health outcomes. Copyright © 2010 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

  2. Volatile Solvents as Drugs of Abuse: Focus on the Cortico-Mesolimbic Circuitry

    PubMed Central

    Beckley, Jacob T; Woodward, John J

    2013-01-01

    Volatile solvents such as those found in fuels, paints, and thinners are found throughout the world and are used in a variety of industrial applications. However, these compounds are also often intentionally inhaled at high concentrations to produce intoxication. While solvent use has been recognized as a potential drug problem for many years, research on the sites and mechanisms of action of these compounds lags behind that of other drugs of abuse. In this review, we first discuss the epidemiology of voluntary solvent use throughout the world and then consider what is known about their basic pharmacology and how this may explain their use as drugs of abuse. We next present data from preclinical and clinical studies indicating that these substances induce common addiction sequelae such as dependence, withdrawal, and cognitive impairments. We describe how toluene, the most commonly studied psychoactive volatile solvent, alters synaptic transmission in key brain circuits such as the mesolimbic dopamine system and medial prefrontal cortex (mPFC) that are thought to underlie addiction pathology. Finally, we make the case that activity in mPFC circuits is a critical regulator of the mesolimbic dopamine system's ability to respond to volatile solvents like toluene. Overall, this review provides evidence that volatile solvents have high abuse liability because of their selective effects on critical nodes of the addiction neurocircuitry, and underscores the need for more research into how these compounds induce adaptations in neural circuits that underlie addiction pathology. PMID:23954847

  3. 24 CFR 965.215 - Lead-based paint liability insurance coverage.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 24 Housing and Urban Development 4 2014-04-01 2014-04-01 false Lead-based paint liability... Insurance Coverage § 965.215 Lead-based paint liability insurance coverage. (a) General. The purpose of this... with lead-based paint activities that the PHA undertakes, in accordance with the PHA's ACC with HUD...

  4. 24 CFR 965.215 - Lead-based paint liability insurance coverage.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 24 Housing and Urban Development 4 2013-04-01 2013-04-01 false Lead-based paint liability... Insurance Coverage § 965.215 Lead-based paint liability insurance coverage. (a) General. The purpose of this... with lead-based paint activities that the PHA undertakes, in accordance with the PHA's ACC with HUD...

  5. 24 CFR 965.215 - Lead-based paint liability insurance coverage.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 24 Housing and Urban Development 4 2011-04-01 2011-04-01 false Lead-based paint liability... Insurance Coverage § 965.215 Lead-based paint liability insurance coverage. (a) General. The purpose of this... with lead-based paint activities that the PHA undertakes, in accordance with the PHA's ACC with HUD...

  6. 24 CFR 965.215 - Lead-based paint liability insurance coverage.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 24 Housing and Urban Development 4 2012-04-01 2012-04-01 false Lead-based paint liability... Insurance Coverage § 965.215 Lead-based paint liability insurance coverage. (a) General. The purpose of this... with lead-based paint activities that the PHA undertakes, in accordance with the PHA's ACC with HUD...

  7. 24 CFR 965.215 - Lead-based paint liability insurance coverage.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 24 Housing and Urban Development 4 2010-04-01 2010-04-01 false Lead-based paint liability... Insurance Coverage § 965.215 Lead-based paint liability insurance coverage. (a) General. The purpose of this... with lead-based paint activities that the PHA undertakes, in accordance with the PHA's ACC with HUD...

  8. The Economic Costs of Substance Abuse Treatment: Updated Estimates and Cost Bands for Program Assessment and Reimbursement

    PubMed Central

    French, Michael T.; Popovici, Ioana; Tapsell, Lauren

    2008-01-01

    Federal, State, and local government agencies require current and accurate cost information for publicly funded substance abuse treatment programs to guide program assessments and reimbursement decisions. The Center for Substance Abuse Treatment (CSAT) published a list of modality-specific cost bands for this purpose in 2002. However, the upper and lower values in these ranges are so wide that they offer little practical guidance for funding agencies. Thus, the dual purpose of this investigation was to assemble the most current and comprehensive set of economic cost estimates from the readily-available literature and then use these estimates to develop updated modality-specific cost bands for more reasonable reimbursement policies. Although cost estimates were scant for some modalities, the recommended cost bands are based on the best available economic research, and we believe these new ranges will be more useful and pertinent for all stakeholders of publicly-funded substance abuse treatment. PMID:18294803

  9. Development of short-form measures to assess four types of elder mistreatment: Findings from an evidence-based study of APS elder abuse substantiation decisions.

    PubMed

    Beach, Scott R; Liu, Pi-Ju; DeLiema, Marguerite; Iris, Madelyn; Howe, Melissa J K; Conrad, Kendon J

    2017-01-01

    Improving the standardization and efficiency of adult protective services (APS) investigations is a top priority in APS practice. Using data from the Elder Abuse Decision Support System (EADSS), we developed short-form measures of four types of elder abuse: financial, emotional/psychological, physical, and neglect. The EADSS data set contains 948 elder abuse cases (age 60+) with yes/no abuse substantiation decisions for each abuse type following a 30-day investigation. Item sensitivity/specificity analyses were conducted on long-form items with the substantiation decision for each abuse type as the criterion. Validity was further tested using receiver-operator characteristic (ROC) curve analysis, correlation with long forms and internal consistency. The four resulting short-form measures, containing 36 of the 82 original items, have validity similar to the original long forms. These short forms can be used to standardize and increase efficiency of APS investigations, and may also offer researchers new options for brief elder abuse assessments.

  10. Development of short-form measures to assess four types of elder mistreatment: Findings from an evidence-based study of APS elder abuse substantiation decisions

    PubMed Central

    Beach, Scott R.; Liu, Pi-Ju; DeLiema, Marguerite; Iris, Madelyn; Howe, Melissa J.K.; Conrad, Kendon J.

    2018-01-01

    Improving the standardization and efficiency of adult protective services (APS) investigations is a top priority in APS practice. Using data from the Elder Abuse Decision Support System (EADSS), we developed short-form measures of four types of elder abuse: financial, emotional/psychological, physical, and neglect. The EADSS data set contains 948 elder abuse cases (age 60+) with yes/no abuse substantiation decisions for each abuse type following a 30-day investigation. Item sensitivity/specificity analyses were conducted on long-form items with the substantiation decision for each abuse type as the criterion. Validity was further tested using receiver–operator characteristic (ROC) curve analysis, correlation with long forms and internal consistency. The four resulting short-form measures, containing 36 of the 82 original items, have validity similar to the original long forms. These short forms can be used to standardize and increase efficiency of APS investigations, and may also offer researchers new options for brief elder abuse assessments. PMID:28590799

  11. 12 CFR 303.15 - Certain limited liability companies deemed incorporated under State law.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 12 Banks and Banking 4 2010-01-01 2010-01-01 false Certain limited liability companies deemed... liability companies deemed incorporated under State law. (a) For purposes of the definition of “State bank... liability company (LLC) under the law of any State is deemed to be “incorporated” under the law of the State...

  12. Decreased dopamine activity predicts relapse in methamphetamine abusers.

    PubMed

    Wang, G J; Smith, L; Volkow, N D; Telang, F; Logan, J; Tomasi, D; Wong, C T; Hoffman, W; Jayne, M; Alia-Klein, N; Thanos, P; Fowler, J S

    2012-09-01

    Studies in methamphetamine (METH) abusers showed that the decreases in brain dopamine (DA) function might recover with protracted detoxification. However, the extent to which striatal DA function in METH predicts recovery has not been evaluated. Here we assessed whether striatal DA activity in METH abusers is associated with clinical outcomes. Brain DA D2 receptor (D2R) availability was measured with positron emission tomography and [(11)C]raclopride in 16 METH abusers, both after placebo and after challenge with 60 mg oral methylphenidate (MPH) (to measure DA release) to assess whether it predicted clinical outcomes. For this purpose, METH abusers were tested within 6 months of last METH use and then followed up for 9 months of abstinence. In parallel, 15 healthy controls were tested. METH abusers had lower D2R availability in caudate than in controls. Both METH abusers and controls showed decreased striatal D2R availability after MPH and these decreases were smaller in METH than in controls in left putamen. The six METH abusers who relapsed during the follow-up period had lower D2R availability in dorsal striatum than in controls, and had no D2R changes after MPH challenge. The 10 METH abusers who completed detoxification did not differ from controls neither in striatal D2R availability nor in MPH-induced striatal DA changes. These results provide preliminary evidence that low striatal DA function in METH abusers is associated with a greater likelihood of relapse during treatment. Detection of the extent of DA dysfunction may be helpful in predicting therapeutic outcomes.

  13. 7 CFR 927.75 - Liability.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 7 Agriculture 8 2010-01-01 2010-01-01 false Liability. 927.75 Section 927.75 Agriculture Regulations of the Department of Agriculture (Continued) AGRICULTURAL MARKETING SERVICE (Marketing Agreements..., shall be held personally responsible, either individually or jointly with others, in any way whatsoever...

  14. University Liability for Sports Injuries.

    ERIC Educational Resources Information Center

    Rieder, Robert W.; Woodruff, William B., Jr.

    1993-01-01

    Analyzes sports injury claims against colleges and universities in recent years to help administrators better understand and minimize liability risks for certain curricular and cocurricular activities. Reviews court cases in areas of duty of care and negligence and proximate cause, and discusses defenses. (Author/NB)

  15. Non-Abused Preschool Children's Perception of an Anogenital Examination

    ERIC Educational Resources Information Center

    Gulla, Kari; Fenheim, Gred Eva; Myhre, Arne K.; Lydersen, Stian

    2007-01-01

    Objective: An anogenital examination is usually part of the standard medical assessment in children evaluated for suspected sexual abuse, and the emotional impact on the child has been studied. The primary aim of this study was to assess non-abused preschool children's responses to an anogenital examination. Method: One hundred and fifty-eight…

  16. 31 CFR 240.18 - Lack of authority to shift liability.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 31 Money and Finance:Treasury 2 2012-07-01 2012-07-01 false Lack of authority to shift liability. 240.18 Section 240.18 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued... depositor(s) under authority of state law. (b) A financial institution's liability under this part is not...

  17. Assessment of family history of substance abuse for preventive interventions with patients experiencing chronic pain: A quality improvement project.

    PubMed

    Pestka, Elizabeth; Nash, Virginia; Evans, Michele; Cronin, Joan; Bee, Susan; King, Susan; Osborn, Kristine; Gehin, Jessica; Weis, Karen; Loukianova, Larissa

    2016-04-01

    This quality improvement project demonstrates that RN Care Managers, in a chronic pain programme, can assess for a family history of substance abuse in 5-10 min. Information informs treatment based on specific high risk criteria. Benefits include heightened awareness of the genetic and environmental risks associated with a family history of substance abuse, an opportunity to participate in motivational interventions to prevent or minimize consequences of substance use disorders, and likely substantial overall health-care cost savings. © 2015 John Wiley & Sons Australia, Ltd.

  18. Methodological Issues and Practical Problems in Conducting Research on Abused Children.

    ERIC Educational Resources Information Center

    Kinard, E. Milling

    In order to inform policy and programs, research on child abuse must be not only methodologically rigorous, but also practically feasible. However, practical problems make child abuse research difficult to conduct. Definitions of abuse must be explicit and different types of abuse must be assessed separately. Study samples should be as…

  19. Correlates of Male and Female Juvenile Offender Abuse Experiences

    ERIC Educational Resources Information Center

    Dembo, Richard; Schmeidler, James; Childs, Kristina

    2007-01-01

    This paper reports the results of developing and evaluating a classification of 315 arrested youth processed at the Hillsborough County Juvenile Assessment Center from September 1, 1994 to January 31, 1998. Youth were characterized as physically or sexually abused if they reported abuse or if they had been referred to juvenile court for abuse.…

  20. Interviewing Children Versus Tossing Coins: Accurately Assessing the Diagnosticity of Children’s Disclosures of Abuse

    PubMed Central

    LYON, THOMAS D.; AHERN, ELIZABETH C.; SCURICH, NICHOLAS

    2014-01-01

    We describe a Bayesian approach to evaluating children’s abuse disclosures and review research demonstrating that children’s disclosure of genital touch can be highly probative of sexual abuse, with the probative value depending on disclosure spontaneity and children’s age. We discuss how some commentators understate the probative value of children’s disclosures by: confusing the probability of abuse given disclosure with the probability of disclosure given abuse, assuming that children formally questioned about sexual abuse have a low prior probability of sexual abuse, misstating the probative value of abuse disclosure, and confusing the distinction between disclosure and nondisclosure with the distinction between true and false disclosures. We review interviewing methods that increase the probative value of disclosures, including interview instructions, narrative practice, noncontingent reinforcement, and questions about perpetrator/caregiver statements and children’s reactions to the alleged abuse. PMID:22339423

  1. Perceptions of Childhood Sexual Abuse Survivors: Development and Initial Validation of a New Scale to Measure Stereotypes of Adult Survivors of Childhood Sexual Abuse

    ERIC Educational Resources Information Center

    Zafar, Sadia; Ross, Erin C.

    2013-01-01

    The Childhood Sexual Abuse Stereotypes Scale was developed to assess stereotypes of adult survivors of childhood sexual abuse. Scale items were derived from two studies that elicited cultural and personal beliefs about, and emotions experienced towards adult childhood sexual abuse survivors among university undergraduates. Two scales, Emotions and…

  2. Abuse-resistant drug delivery.

    PubMed

    DuPont, Robert L; Bensinger, Peter B

    2006-08-01

    In attempting to reduce the nonmedical use of controlled substances, a reasonable step is to educate the physicians prescribing controlled substances, including the prescription stimulants used to treat ADHD, as well as patients and family members, about the risks of nonmedical use and the dangers of giving or selling these medicines to persons for whom they were not prescribed. Patients who find benefits in the use of such medicines have a significant interest in protecting their continued access to them. Such access is potentially threatened by concerns about widespread nonmedical use. Physicians can help protect the appropriate medical use of prescription stimulants by considering the abuse potential of various medicines used to treat patients with ADHD, especially when these patients also have a history of nonmedical substance use. In addition, we suggest that today there is an opportunity to add a new and perhaps more hopeful paradigm: the wider use of drug delivery systems that make products less attractive to drug abusers. This new drug abuse prevention paradigm holds great promise for efforts to reduce the nonmedical use of prescription controlled substances, including the prescription stimulants used to treat ADHD. To achieve the full potential of this new paradigm to reduce prescription drug abuse, it will be necessary to develop standards to assess the relative abuse resistance of various drug formulations and delivery systems, as well as meaningful incentives to foster the development of these abuse-resistant delivery systems for controlled substances.

  3. 26 CFR 1.704-2 - Allocations attributable to nonrecourse liabilities.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... gain is determined with reference to the property's book basis. See also paragraph (i)(4) of this... under this section are made with reference to the property's book value. See section 704(c) and § 1.704... liability. (i) In general. (ii) Allocating liabilities. (3) Partnership minimum gain if there is a book/tax...

  4. 26 CFR 1.456-4 - Cessation of liability or existence.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 26 Internal Revenue 6 2010-04-01 2010-04-01 false Cessation of liability or existence. 1.456-4... of liability or existence. (a) If a taxpayer has elected to apply the provisions of section 456 to a trade or business in connection with which prepaid dues income is received, and if the taxpayer's...

  5. Psychiatric disorders, spouse abuse and child abuse.

    PubMed

    Bland, R C; Orn, H

    1986-01-01

    The results of 2000 standardized psychiatric diagnostic interviews of randomly selected adult household residents of Edmonton showed that having had any psychiatric diagnosis increased the risk for being involved in spouse and child abuse, particularly for those with alcohol abuse/dependence plus anti-social personality or depression. Altogether 56% of spouse abusers and 69% of child abusers had a lifetime psychiatric diagnosis.

  6. Elder abuse.

    PubMed

    Kurrle, Susan

    2004-10-01

    Elder abuse is a common and yet often unrecognised problem in our community. With up to 5% of the community dwelling older population being victims of abuse, the general practitioner has a pivotal role in identifying this abuse. This article provides an outline of the definition of elder abuse, describes the types of abuse seen and the reasons for occurrence of abuse. It summarises the role of the GP in the identification and management of abuse and provides guidance on intervention strategies. Case studies are used to illustrate the issues discussed. Elder abuse is defined as any pattern of behaviour which causes physical, psychological, financial or social harm to an older person. The role of the GP in identifying abuse is critical. The vast majority of older people visit their GP at least once a year, and the GP often has a long standing relationship with their patient and the patient's family. They are therefore ideally placed to identify elder abuse.

  7. Schoolyard Ponds: Safety and Liability.

    ERIC Educational Resources Information Center

    Danks, Sharon Gamson

    2001-01-01

    Engaging, attractive schoolyard ponds provide habitat for wildlife and hold great educational promise. Reviews water safety and liability issues including mud, stagnant pond water that serves as mosquito breeding grounds, and drowning. Offers ideas for creatively addressing those issues through site planning, shallow water depth, signage and…

  8. Cognitive and Emotional Differences between Abusive and Non-Abusive Fathers

    ERIC Educational Resources Information Center

    Francis, Karen J.; Wolfe, David A.

    2008-01-01

    Objective: Abusive fathers perpetrate a substantial portion of child physical abuse. Despite this, little is known about how they differ from non-abusive fathers. This study compared a broad range of cognitive and affective factors between physically abusive and non-abusive fathers. Methods: Abusive (n = 24) and non-abusive (n = 25) fathers…

  9. Protein biomarkers of alcohol abuse

    PubMed Central

    Torrente, Mariana P; Freeman, Willard M; Vrana, Kent E

    2012-01-01

    Alcohol abuse can lead to a number of health and social issues. Our current inability to accurately assess long-term drinking behaviors is an important obstacle to its diagnosis and treatment. Biomarkers for chronic alcohol consumption have made a number of important advances but have yet to become highly accurate and as accepted as objective tests for other diseases. Thus, there is a crucial need for the development of more sensitive and specific markers of alcohol abuse. Recent advancements in proteomic technologies have greatly increased the potential for alcohol abuse biomarker discovery. Here, the authors review established and novel protein biomarkers for long-term alcohol consumption and the proteomic technologies that have been used in their study. PMID:22967079

  10. Legal liability and workplace violence.

    PubMed

    Brakel, S J

    1998-01-01

    Workplace violence is a growing social problem. Some of this growth may be perceptual, reflecting our new awareness of what constitutes violence in the workplace. Furthermore, much of what falls under its current rubric does not correspond to the classic image of worker-on-worker or worker-on-employer mayhem. Nevertheless, the total number of incidents is alarmingly large; the problem is real. It is natural to consider law (i.e., legal liability) as a potential solution. Aiming the liability threat at the employer may be the most effective and efficient strategy. There are ample theories to choose from: negligence (tort) law, agency law, contract, civil rights, and regulatory law. Judges and juries appear eager to hold employers accountable for violent incidents in the workplace, sometimes in the face of other, more logical constructions of the facts or theory. One's best hope is that the fear this strikes in the hearts of employers will make for maximum preventive results.

  11. Data Supporting the Environmental Liability Reported on the FY 2000 Financial Statements

    DTIC Science & Technology

    2001-08-10

    consolidated financial statements . This audit supports our audit of the FY 2000 DoD Agency-Wide Financial Statements, specifically the line item for environmental liabilities. The Army, the Navy, and the General Accounting Office also issued audit reports related to the reliability, completeness, and supportability of environmental liabilities for FY 2000. Environmental liabilities included estimated amounts for future cleanup of contamination resulting from waste disposal methods, leaks, spills, and other past activity which have created a public health or

  12. Practical Approaches for Identifying and Managing Abused and Neglected Children.

    ERIC Educational Resources Information Center

    Radford, Nola T.

    1998-01-01

    Discusses the exceptional challenges that abused and neglected children may pose for early-intervention providers, particularly speech-language pathologists. It focuses on practical strategies regarding reporting child abuse, effectively assessing the children who have been abused, and managing the bizarre behavior they may exhibit. (Author/CR)

  13. Aging and Alcohol Abuse: Increasing Counselor Awareness

    ERIC Educational Resources Information Center

    Williams, June M.; Ballard, Mary B.; Alessi, Hunter

    2005-01-01

    Alcohol abuse in older adulthood is a rapidly growing but often hidden problem. The authors provide an overview of the issues related to older adult alcohol abuse through a discussion of physiological, psychological, and social risk factors; an examination of appropriate assessment procedures; and an overview of factors related to treatment.

  14. Bankruptcy, product liability, and hazardous waste

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Sterrett, S.B. Jr.

    Bankruptcy does not serve the goals underlying product liability and hazardous waste laws, which are to discourage accidents and to compensate accident victims. The author contends that changes in the existing priority scheme could improve the situation by encouraging corporation to improve their compliance with product liability and hazardous waste laws. He discusses the efficiency rationale of existing laws, then describes the theoretical rationales for the bankruptcy and secured credit systems. His Superpriority Proposal creates two beneficial effects by subordinating voluntary creditors to involuntary creditors: (1) it reduces the extent to which corporate debtors can externalize actual product costs basedmore » on their probability of insolvency, and (2) it provides incentives for voluntary creditors to monitor for debtor misconduct and corporate debtors to reassure and persuade creditors.« less

  15. Decreased dopamine activity predicts relapse in methamphetamine abusers

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Wang G. J.; Wang, G.-J.; Smith, L.

    2011-01-20

    Studies in methamphetamine (METH) abusers showed that the decreases in brain dopamine (DA) function might recover with protracted detoxification. However, the extent to which striatal DA function in METH predicts recovery has not been evaluated. Here we assessed whether striatal DA activity in METH abusers is associated with clinical outcomes. Brain DA D2 receptor (D2R) availability was measured with positron emission tomography and [{sup 11}C]raclopride in 16 METH abusers, both after placebo and after challenge with 60 mg oral methylphenidate (MPH) (to measure DA release) to assess whether it predicted clinical outcomes. For this purpose, METH abusers were tested withinmore » 6 months of last METH use and then followed up for 9 months of abstinence. In parallel, 15 healthy controls were tested. METH abusers had lower D2R availability in caudate than in controls. Both METH abusers and controls showed decreased striatal D2R availability after MPH and these decreases were smaller in METH than in controls in left putamen. The six METH abusers who relapsed during the follow-up period had lower D2R availability in dorsal striatum than in controls, and had no D2R changes after MPH challenge. The 10 METH abusers who completed detoxification did not differ from controls neither in striatal D2R availability nor in MPH-induced striatal DA changes. These results provide preliminary evidence that low striatal DA function in METH abusers is associated with a greater likelihood of relapse during treatment. Detection of the extent of DA dysfunction may be helpful in predicting therapeutic outcomes.« less

  16. Professional dental and oral surgery liability in Italy: a comparative analysis of the insurance products offered to health workers.

    PubMed

    Di Lorenzo, Pierpaolo; Paternoster, Mariano; Nugnes, Mariarosaria; Pantaleo, Giuseppe; Graziano, Vincenzo; Niola, Massimo

    2016-01-01

    In Italy there has been an increase in claims for damages for alleged medical malpractice. A study was therefore conducted that aimed at assessing the content of the coverage of insurance policy contracts offered to oral health professionals by the insurance market. The sample analysed composed of 11 insurance policy contracts for professional dental liability offered from 2010 to 2015 by leading insurance companies operating in the Italian market. The insurance products analysed are structured on the "claims made" clause. No policy contract examined covers the damage due to the failure to acquire consent for dental treatment and, in most cases, damage due to unsatisfactory outcomes of treatment of an aesthetic nature and the failure to respect regulatory obligations on privacy. On entering into a professional liability insurance policy contract, the dentist should pay particular attention to the period covered by the guarantee, the risks both covered and excluded, as well as the extent of the limit of liability and any possible fixed/percentage excess. When choosing a professional liability contract, a dentist should examine the risks in relation to the professional activity carried out before signing.

  17. Professional dental and oral surgery liability in Italy: a comparative analysis of the insurance products offered to health workers

    PubMed Central

    Paternoster, Mariano; Nugnes, Mariarosaria; Pantaleo, Giuseppe; Graziano, Vincenzo; Niola, Massimo

    2016-01-01

    Abstract Introduction In Italy there has been an increase in claims for damages for alleged medical malpractice. A study was therefore conducted that aimed at assessing the content of the coverage of insurance policy contracts offered to oral health professionals by the insurance market. Material and methods The sample analysed composed of 11 insurance policy contracts for professional dental liability offered from 2010 to 2015 by leading insurance companies operating in the Italian market. Results The insurance products analysed are structured on the “claims made” clause. No policy contract examined covers the damage due to the failure to acquire consent for dental treatment and, in most cases, damage due to unsatisfactory outcomes of treatment of an aesthetic nature and the failure to respect regulatory obligations on privacy. Discussion On entering into a professional liability insurance policy contract, the dentist should pay particular attention to the period covered by the guarantee, the risks both covered and excluded, as well as the extent of the limit of liability and any possible fixed/percentage excess. Conclusions When choosing a professional liability contract, a dentist should examine the risks in relation to the professional activity carried out before signing. PMID:28352805

  18. [Legal aspects of the health care institution liability for nosocomial infections].

    PubMed

    Garus-Pakowska, Anna; Szatko, Franciszek; Pakowski, Maciej

    2009-01-01

    In this paper, the basic concepts concerning the liability of health care institution for nosocomial infections are presented. The principles of ex contracto and ex delicto liabilities, as well as the concept of so-called anonymous guilt are discussed. The range of duties for both the health care institution and the employed medical personnel is indicated, the duties and the consequences of their non-fulfillment are systematized, and the obligatory jurisdiction concerning the functioning of prima facie evidence is considered. The author aimed at explaining the principles governing the civil liability of health care institutions and their employees.

  19. Neurological malpractice and nonmalpractice liability.

    PubMed

    Johnston, James C

    2010-05-01

    This article provides an overview of the current neurological malpractice trends, and outlines management strategies for several common recurring claims involving headache, stroke, and epilepsy. Selected nonmalpractice liability issues are reviewed, focusing on the unique risks engendered by the forensic expert. Copyright 2010 Elsevier Inc. All rights reserved.

  20. Suicide attempts among men with histories of child sexual abuse: examining abuse severity, mental health, and masculine norms.

    PubMed

    Easton, Scott D; Renner, Lynette M; O'Leary, Patrick

    2013-06-01

    Men who were sexually abused during childhood are at risk for a variety of long-term mental health problems, including suicidality. However, little is known about which factors are related to recent suicide attempts for this vulnerable, under-researched population. The purpose of this study was to examine the relationship between abuse severity, mental health, masculine norms and recent suicide attempts among men with histories of child sexual abuse (CSA). We analyzed survey data gathered from a purposive sample of 487 men who were sexually abused during childhood. The age of the sample ranged from 19 to 84 years (μ = 50.4 years). Recent suicide attempts served as the dependent variable in the study. Self-reported measures of sexual abuse severity, child physical abuse, mental health, masculine norms, and demographic information (age, race) represented the independent variables. The results from logistic regression modeling found that five variables - duration of the sexual abuse, use of force during the sexual abuse, high conformity to masculine norms, level of depressive symptoms, and suicidal ideation - increased the odds of a suicide attempt in the past 12 months. To improve mental health services for men with histories of CSA, mental health practitioners should incorporate sexual abuse severity, current mental health, and adherence to masculine norms into assessment and treatment planning. Copyright © 2013 Elsevier Ltd. All rights reserved.

  1. Policy statement—Professional liability insurance and medicolegal education for pediatric residents and fellows.

    PubMed

    Gonzalez, Jose Luis

    2011-09-01

    The American Academy of Pediatrics believes that pediatric residents and fellows should be fully informed of the scope and limitations of their professional liability insurance coverage while in training. The academy states that residents and fellows should be educated by their training institutions on matters relating to medical liability and the importance of maintaining adequate and continuous professional liability insurance coverage throughout their careers in medicine.

  2. Child Eyewitness Testimony in Sexual Abuse Investigations.

    ERIC Educational Resources Information Center

    Mapes, Bruce E.

    Intended to help in the forensic investigation of child abuse allegations, this book explores several issues related to children's allegations of sexual abuse and subsequent testimony. Chapter 1 presents an overview of: the informational needs of child welfare agencies and the courts; the scope of the forensic assessment; and the standards and…

  3. Child abuse and mental disorders in Canada

    PubMed Central

    Afifi, Tracie O.; MacMillan, Harriet L.; Boyle, Michael; Taillieu, Tamara; Cheung, Kristene; Sareen, Jitender

    2014-01-01

    Background: Nationally representative Canadian data on the prevalence of child abuse and its relation with mental disorders are lacking. We used contemporary, nationally representative data to examine the prevalence of 3 types of child abuse (physical abuse, sexual abuse and exposure to intimate partner violence) and their association with 14 mental conditions, including suicidal ideation and suicide attempts. Methods: We obtained data from the 2012 Canadian Community Health Survey: Mental Health, collected from the 10 provinces. Respondents aged 18 years and older were asked about child abuse and were selected for the study sample (n = 23 395). The survey had a multistage stratified cluster design (household response rate 79.8%). Results: The prevalence of any child abuse was 32% (individual types ranged from 8% to 26%). All types of child abuse were associated with all mental conditions, including suicidal ideation and suicide attempts, after adjustment for sociodemographic variables (adjusted odds ratios ranged from 1.4 to 7.9). We found a dose–response relation, with increasing number of abuse types experienced corresponding with greater odds of mental conditions. Associations between child abuse and attention deficit disorder, suicidal ideation and suicide attempts showed stronger effects for women than men. Interpretation: We found robust associations between child abuse and mental conditions. Health care providers, especially those assessing patients with mental health problems, need to be aware of the relation between specific types of child abuse and certain mental conditions. Success in preventing child abuse could lead to reductions in the prevalence of mental disorders, suicidal ideation and suicide attempts. PMID:24756625

  4. 42 CFR 422.132 - Protection against liability and loss of benefits.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM MEDICARE ADVANTAGE PROGRAM Benefits and Beneficiary Protections § 422.132 Protection against liability and loss of benefits. Enrollees of MA organizations are... 42 Public Health 3 2010-10-01 2010-10-01 false Protection against liability and loss of benefits...

  5. The Relationship of Exposure to Childhood Sexual Abuse to Other Forms of Abuse, Neglect, and Household Dysfunction during Childhood.

    ERIC Educational Resources Information Center

    Dong, Maxia; Anda, Robert F.; Dube, Shanta R.; Giles, Wayne H.; Felitti, Vincent J.

    2003-01-01

    This retrospective cohort study assessed the relationship of childhood sexual abuse (CSA) to other categories of adverse childhood experiences (ACEs), such as childhood abuse, neglect, and parental separation/divorce. Adults reporting CSA experienced a 1.6- to 3.4-fold greater likelihood of experience each category of ACE. The ACE score was also…

  6. Reading between the Lines: Implicit Assessment of the Association of Parental Attributions and Empathy with Abuse Risk

    ERIC Educational Resources Information Center

    Rodriguez, Christina M.; Cook, Anne E.; Jedrziewski, Chezlie T.

    2012-01-01

    Objective: Researchers in the child maltreatment field have traditionally relied on explicit self-reports to study factors that may exacerbate physical child abuse risk. The current investigation evaluated an implicit analog task utilizing eye tracking technology to assess both parental attributions of child misbehavior and empathy. Method: Based…

  7. Vehicle Safety. Managing Liability Series.

    ERIC Educational Resources Information Center

    Newby, Deborah, Ed.

    This monograph discusses the safety of vehicles owned, leased, maintained, and operated by colleges and universities. First, the risks by colleges and universities is discussed. First, the risks associated with college vehicles are outlined, including the liability that comes with staff/faculty and student drivers and such special concerns as…

  8. 48 CFR 1852.228-81 - Insurance-Partial Immunity From Tort Liability.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 48 Federal Acquisition Regulations System 6 2014-10-01 2014-10-01 false Insurance-Partial Immunity... Provisions and Clauses 1852.228-81 Insurance—Partial Immunity From Tort Liability. As prescribed in 1828.311-270(c), insert the following clause: Insurance—Partial Immunity From Tort Liability (SEP 2000) (a...

  9. 48 CFR 1852.228-81 - Insurance-Partial Immunity From Tort Liability.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 48 Federal Acquisition Regulations System 6 2010-10-01 2010-10-01 true Insurance-Partial Immunity... Provisions and Clauses 1852.228-81 Insurance—Partial Immunity From Tort Liability. As prescribed in 1828.311-270(c), insert the following clause: Insurance—Partial Immunity From Tort Liability (SEP 2000) (a...

  10. 48 CFR 1852.228-81 - Insurance-Partial Immunity From Tort Liability.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 48 Federal Acquisition Regulations System 6 2012-10-01 2012-10-01 false Insurance-Partial Immunity... Provisions and Clauses 1852.228-81 Insurance—Partial Immunity From Tort Liability. As prescribed in 1828.311-270(c), insert the following clause: Insurance—Partial Immunity From Tort Liability (SEP 2000) (a...

  11. 48 CFR 1852.228-82 - Insurance-Total Immunity From Tort Liability.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 48 Federal Acquisition Regulations System 6 2012-10-01 2012-10-01 false Insurance-Total Immunity... Provisions and Clauses 1852.228-82 Insurance—Total Immunity From Tort Liability. As prescribed in 1828.311-270(d), insert the following clause: Insurance—Total Immunity From Tort Liability (SEP 2000) (a) The...

  12. 48 CFR 1852.228-81 - Insurance-Partial Immunity From Tort Liability.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 48 Federal Acquisition Regulations System 6 2013-10-01 2013-10-01 false Insurance-Partial Immunity... Provisions and Clauses 1852.228-81 Insurance—Partial Immunity From Tort Liability. As prescribed in 1828.311-270(c), insert the following clause: Insurance—Partial Immunity From Tort Liability (SEP 2000) (a...

  13. 48 CFR 1852.228-82 - Insurance-Total Immunity From Tort Liability.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 48 Federal Acquisition Regulations System 6 2010-10-01 2010-10-01 true Insurance-Total Immunity... Provisions and Clauses 1852.228-82 Insurance—Total Immunity From Tort Liability. As prescribed in 1828.311-270(d), insert the following clause: Insurance—Total Immunity From Tort Liability (SEP 2000) (a) The...

  14. 48 CFR 1852.228-82 - Insurance-Total Immunity From Tort Liability.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 48 Federal Acquisition Regulations System 6 2011-10-01 2011-10-01 false Insurance-Total Immunity... Provisions and Clauses 1852.228-82 Insurance—Total Immunity From Tort Liability. As prescribed in 1828.311-270(d), insert the following clause: Insurance—Total Immunity From Tort Liability (SEP 2000) (a) The...

  15. 48 CFR 1852.228-82 - Insurance-Total Immunity From Tort Liability.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 48 Federal Acquisition Regulations System 6 2014-10-01 2014-10-01 false Insurance-Total Immunity... Provisions and Clauses 1852.228-82 Insurance—Total Immunity From Tort Liability. As prescribed in 1828.311-270(d), insert the following clause: Insurance—Total Immunity From Tort Liability (SEP 2000) (a) The...

  16. 48 CFR 1852.228-81 - Insurance-Partial Immunity From Tort Liability.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 48 Federal Acquisition Regulations System 6 2011-10-01 2011-10-01 false Insurance-Partial Immunity... Provisions and Clauses 1852.228-81 Insurance—Partial Immunity From Tort Liability. As prescribed in 1828.311-270(c), insert the following clause: Insurance—Partial Immunity From Tort Liability (SEP 2000) (a...

  17. 48 CFR 1852.228-82 - Insurance-Total Immunity From Tort Liability.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 48 Federal Acquisition Regulations System 6 2013-10-01 2013-10-01 false Insurance-Total Immunity... Provisions and Clauses 1852.228-82 Insurance—Total Immunity From Tort Liability. As prescribed in 1828.311-270(d), insert the following clause: Insurance—Total Immunity From Tort Liability (SEP 2000) (a) The...

  18. 18 CFR 367.2420 - Account 242, Miscellaneous current and accrued liabilities.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ..., FEDERAL POWER ACT AND NATURAL GAS ACT Balance Sheet Chart of Accounts Current and Accrued Liabilities... 18 Conservation of Power and Water Resources 1 2010-04-01 2010-04-01 false Account 242, Miscellaneous current and accrued liabilities. 367.2420 Section 367.2420 Conservation of Power and Water...

  19. Recognizing Emotion in Faces: Developmental Effects of Child Abuse and Neglect.

    ERIC Educational Resources Information Center

    Pollak, Seth D.; Cicchetti, Dante; Hornung, Katherine; Reed, Alex

    2000-01-01

    Two experiments assessed recognition of emotion among physically abused and neglected preschoolers. Results showed that neglected children had more difficulty discriminating emotional expressions that control or abused children. Abused children displayed response bias for angry facial expressions. Control children viewed discrete emotions as…

  20. Telecommunications, health care, and legal liability

    NASA Astrophysics Data System (ADS)

    Levy, Chris

    1990-06-01

    Regulation of health care telecommunications is fragmented in Canada. Further neither the legislative nor the administrative nor the judicial processes have managed to respond successfully to the impact of telecommunications technology. The result is a legal environment that is necessarily speculative for both telecommunications service providers and health care personnel and facilities. Critical issues include ensuring confidentiality for sensitive patient records and health information liability of telecommunications service providers for inaccurate transmission liability of health care providers for use or non-use of telecommunications services. Limitation of legal liability for both telecommunications and health care service providers is likely to be most effective when based on contract but the creation of the necessary contracts is potentially unduly cumbersome both legally and practically. 1. CONSTITUTIONAL ASPECTS Telecommunications systems that are empowered to operate or connect cross provincial or international boundaries are subject to federal regulation bu the scheme is incomplete in respect of a system set up as a provincial agency. Health care on the other hand is very much a matter of provincial rather than federal authority as a matter of strict law but the fiscal strength of the federal government enables it to provide money to the provinces for financing health care and to4 use this as a device for securing compliance with certain federal standards. Nevertheless the political willingness of the federal health authorities to impose standards on the provinces

  1. Buss-Durkee Assessment and Validation with Violent versus Nonviolent Chronic Alcohol Abusers.

    ERIC Educational Resources Information Center

    Renson, Gisele J.; And Others

    1978-01-01

    Chronic alcohol abusers who had been violent while intoxicated and nonviolent alcohol abusers were administered the Buss-Durkee Inventory. Violence was documented. Violent drinkers scored significantly higher than control subjects on the inventory total hostility score and on subscales measuring assault, irritability, verbal hostility, indirect…

  2. The advent of clinical standards for professional liability.

    PubMed

    Holzer, J F

    1990-02-01

    The development of clinically based written standards to reduce the frequency and severity of medical malpractice loss appears to be gaining in popularity among provider specialty groups and professional liability underwriters. To date, such standards have addressed problems in specialties such as obstetrics and anesthesia where dollar losses associated with malpractice claims have been high. Guidelines can be developed and used by providers on a purely voluntary basis or mandated on an involuntary basis by third parties such as malpractice insurance companies or legislators. Because the advent of risk-control standards is a relatively new phenomenon, formal scientific studies on the long-term benefits of such guidelines have not yet been published. However, it appears that sharp reductions of malpractice losses in specialties such as anesthesia have coincided with the implementation of formal written standards specifically designed for liability control. This has led some liability insurance carriers to decrease premiums associated with specialists following such standards. Many providers are understandably concerned about the potential use of written standards by plaintiff attorneys in medical malpractice suits. Although it is possible that such policies and guidelines could be admitted into evidence to show that a provider breached the legal duty or standard of care owed to a patient, it is uncertain whether these risk-control standards could ultimately pass the evidentiary rules of relevancy or materiality in a given lawsuit. It is clear, however, that the consensus-based process of creating clinical standards and guidelines specifically for controlling professional liability losses is itself a powerful and emerging standard for health care risk management programs.

  3. Child Abuse

    MedlinePlus

    ... puts a child at risk of harm. Child abuse can be physical, sexual or emotional. Neglect, or not providing for a child's needs, is also a form of abuse. Most abused children suffer greater emotional than physical damage. An abused child may become ...

  4. Do abuse deterrent opioid formulations work?

    PubMed

    Dart, Richard C; Iwanicki, Janetta L; Dasgupta, Nabarun; Cicero, Theodore J; Schnoll, Sidney H

    We performed a systematic review to answer the question, "Does the introduction of an opioid analgesic with abuse deterrent properties result in reduced overall abuse of the drug in the community?" We included opioid analgesics with abuse deterrent properties (hydrocodone, morphine, oxycodone) with results restricted to the metasearch term "delayed onset," English language, use in humans, and publication years 2009-2016. All articles that contained data evaluating misuse, abuse, overdose, addiction, and death were included. The results were categorized using the Bradford-Hill criteria. We included 44 reports: hydrocodone (n = 7), morphine (n = 5), or oxycodone (n = 32) with Food and Drug Administration-approved Categories 1, 2, or 3 abuse deterrent labeling. The data currently available support the Hill criteria of strength (effect size), consistency (reproducibility), temporality, plausibility, and coherence. There was insufficient or no information available for the criteria of biological gradient, experiment, and analogy. We also assessed confounding factors and bias, which indicated that both were present and substantial in magnitude. Our analysis found that only oxycodone extended release (ER) had information available to evaluate abuse deterrence in the community. In Australia, Canada, and the United States, reformulation of oxycodone ER was followed by marked reduction in measures of abuse. The precise extent of reduced abuse cannot be calculated because of heterogeneous data sets, but the reported reductions ranged from 10 to 90 percent depending on the measure and the duration of follow-up.

  5. 26 CFR 1.404(g)-1 - Deduction of employer liability payments.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ...(g)-1 Section 1.404(g)-1 Internal Revenue INTERNAL REVENUE SERVICE, DEPARTMENT OF THE TREASURY.... § 1.404(g)-1 Deduction of employer liability payments. (a) General rule. Employer liability payments... deductible under section 404(g) and this section only if the payment satisfies the conditions of section 162...

  6. 26 CFR 1.404(g)-1 - Deduction of employer liability payments.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ...(g)-1 Section 1.404(g)-1 Internal Revenue INTERNAL REVENUE SERVICE, DEPARTMENT OF THE TREASURY.... § 1.404(g)-1 Deduction of employer liability payments. (a) General rule. Employer liability payments... deductible under section 404(g) and this section only if the payment satisfies the conditions of section 162...

  7. 26 CFR 1.404(g)-1 - Deduction of employer liability payments.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ...(g)-1 Section 1.404(g)-1 Internal Revenue INTERNAL REVENUE SERVICE, DEPARTMENT OF THE TREASURY.... § 1.404(g)-1 Deduction of employer liability payments. (a) General rule. Employer liability payments... deductible under section 404(g) and this section only if the payment satisfies the conditions of section 162...

  8. 48 CFR 252.247-7016 - Contractor liability for loss or damage.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... loss or damage. 252.247-7016 Section 252.247-7016 Federal Acquisition Regulations System DEFENSE... CLAUSES Text of Provisions And Clauses 252.247-7016 Contractor liability for loss or damage. As prescribed in 247.270-3(k), use the following clause: Contractor Liability for Loss or Damage (DEC 1991) (a...

  9. Effects of dram shop liability and enhanced overservice law enforcement initiatives on excessive alcohol consumption and related harms: Two community guide systematic reviews.

    PubMed

    Rammohan, Veda; Hahn, Robert A; Elder, Randy; Brewer, Robert; Fielding, Jonathan; Naimi, Timothy S; Toomey, Traci L; Chattopadhyay, Sajal K; Zometa, Carlos

    2011-09-01

    Dram shop liability holds the owner or server(s) at a bar, restaurant, or other location where a patron, adult or underage, consumed his or her last alcoholic beverage responsible for harms subsequently inflicted by the patron on others. Liability in a state can be established by case law or statute. Overservice laws prohibit the sale of alcoholic beverages to intoxicated patrons drinking in on-premises retail alcohol outlets (i.e., premises where the alcohol is consumed where purchased); enhanced enforcement of these laws is intended to ensure compliance by premises personnel. Both of these interventions are ultimately designed to promote responsible beverage service by reducing sales to intoxicated patrons, underage youth, or both. This review assesses the effectiveness of dram shop liability and the enhanced enforcement of overservice laws for preventing excessive alcohol consumption and related harms. Studies assessing alcohol-related harms in states adopting dram shop laws were evaluated, as were studies assessing alcohol-related harms in regions with enhanced overservice enforcement. Methods previously developed for systematic reviews for the Guide to Community Preventive Services were used. Eleven studies assessed the association of state dram shop liability with various outcomes, including all-cause motor vehicle crash deaths, alcohol-related motor vehicle crash deaths (the most common outcome assessed in the studies reviewed), alcohol consumption, and other alcohol-related harms. There was a median reduction of 6.4% (range of values 3.7% to 11.3% reduction) in alcohol-related motor vehicle fatalities associated with the presence of dram shop liability in jurisdictions where premises are licensed. Other alcohol-related outcomes also showed a reduction. Only two studies assessed the effects of enhanced enforcement initiatives on alcohol-related outcomes; findings were inconsistent, some indicating benefit and others none. According to Community Guide rules

  10. 7 CFR 1212.85 - Personal liability.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... Agriculture Regulations of the Department of Agriculture (Continued) AGRICULTURAL MARKETING SERVICE (MARKETING... RESEARCH, PROMOTION, CONSUMER EDUCATION AND INDUSTRY INFORMATION ORDER Honey Packers and Importers Research, Promotion, Consumer Education, and Industry Information Order Miscellaneous § 1212.85 Personal liability. No...

  11. The role of abuse-deterrent formulations in countering opioid misuse and abuse.

    PubMed

    Nguyen, V; Raffa, R B; Taylor, R; Pergolizzi, J V

    2015-12-01

    Pain is a prevalent, and due to the ageing population, increasing medical problem. Opioids are frequently prescribed to meet the unmet medical need. Unfortunately, with the increase in the legitimate use of opioids, there has been a corresponding increase in abuse. A practical way to retain the pain relief afforded by opioids while decreasing opportunities for abuse is to make it more difficult to extract the opioid from the product or to make it less desirable to do so by designing an abuse-deterrent formulation (ADF). We provide a brief overview of the strategies and early evidence related to opioid ADFs. Published and unpublished literature, websites, and other sources were searched for current opioid formulation options, including immediate-release and extended-release products. Each was summarized, reviewed and assessed. The strategies that have been used to design the current opioid ADFs involve one or more of four approaches: a physical barrier; incorporation of an opioid receptor antagonist (e.g. naloxone) that self-limits opioid action when taken in excess amount; inclusion of a noxious agent that is released during inappropriate use; or a pro-drug. Legitimate use of opioid analgesics carries with it certain risks, including the risk of abuse. The new ADFs utilize four major strategies and provide innovative additions to the armamentarium. They likely will become an important part of a comprehensive approach to limiting, although not eliminating, opioid misuse and abuse. © 2015 John Wiley & Sons Ltd.

  12. Research on Child Abuse in the US Armed Forces

    DTIC Science & Technology

    2001-01-01

    Child maltreatment in the United States has provoked considerable interest in recent years. Child abuse and neglect are prevalent in all parts of...American society. Although children of military personnel experience maltreatment, little research has been completed which compares child abuse rates in...the military with those for civilian populations. Studies that have assessed child abuse in the armed forces have been based on official reports

  13. [Addictive potential in man: methodological aspects].

    PubMed

    Warot, D; Marra, D

    1995-01-01

    Different methods have been developed in clinical abuse liability testing in man. Tolerance, psychic and/or physical dependence must be investigated through clinical studies during drug development of a new substance. Adequate methodology is needed using double-blind, time-blind evaluations, comparisons of different dose levels and duration of treatment for a given drug, abrupt and gradual interruption of treatment, appropriate period of observation after treatment cessation ... The optimal scale to evaluate properly the symptoms occurring after drug discontinuation is still under investigation. These studies will or should permit the differentiation of rebound, withdrawal and recurrence. Methods developed to study reinforcing effects in post-addicts and healthy subjects are self-administration and choice procedures. In addition, the more traditional approach has been through assessing self-reported effects in which standardized questionnaires are used (Addiction Research Center Inventory or A.R.C.I.; Single Dose Questionnaire or S.D.Q.). A third focus of measurement has been discrimination studies performed in individuals with histories of drug abuse as well as healthy subjects. Abuse-liability testing of a new compound needs a multidimensional assessment to optimize the predictivity in defining the relative risk.

  14. Substance abuse associated with elder abuse in the United States.

    PubMed

    Jogerst, Gerald J; Daly, Jeanette M; Galloway, Lara J; Zheng, Shimin; Xu, Yinghui

    2012-01-01

    Substance abuse by either victim or perpetrator has long been associated with violence and abuse. Sparse research is available regarding elder abuse and its association with substance abuse. The objective of this study was to evaluate the association of state-reported domestic elder abuse with regional levels of substance abuse. Census demographic and elder abuse data were sorted into substate regions to align with the substance use treatment-planning regions for 2269 US counties. From the 2269 US counties there were 229 substate regions in which there were 213,444 investigations of abuse. For the other Ns (reports and substantiations) there were fewer counties and regions. See first sentence of data analyses and first sentence of results. Elder abuse report rates ranged from .03 to .41% (80 regions), investigation rates .001 to .34% (229 regions), and substantiation rates 0 to .22% (184 regions). Elder abuse investigations and substantiations were associated with various forms of substance abuse. Higher investigation rates were significantly associated with a higher rate of any illicit drug use in the past month, a lower median household income, lower proportion of the population graduated high school, and higher population of Hispanics. Higher substantiation rates were significantly associated with higher rate of illicit drug use in the past month and higher population of Hispanics. It may be worthwhile for administrators of violence programs to pay particular attention to substance abuse among their clients and in their community's environment, especially if older persons are involved. Measures of documented elder abuse at the county level are minimal. To be able to associate substance abuse with elder abuse is a significant finding, realizing that the substance abuse can be by the victim or the perpetrator of elder abuse.

  15. Assessing the effects of Families for Safe Dates, a family-based teen dating abuse prevention program.

    PubMed

    Foshee, Vangie A; McNaughton Reyes, Heath Luz; Ennett, Susan T; Cance, Jessica D; Bauman, Karl E; Bowling, J Michael

    2012-10-01

    To examine the effects of a family-based teen dating abuse prevention program, Families for Safe Dates, primarily on outcomes related to testing the conceptual underpinnings of the program including (1) factors motivating and facilitating caregiver engagement in teen dating abuse prevention activities, and 2) risk factors for teen dating abuse, and secondarily on dating abuse behaviors. Families were recruited nationwide using listed telephone numbers. Caregivers and teens completed baseline and 3-month follow-up telephone interviews (n = 324). Families randomly allocated to treatment condition received the Families for Safe Dates program including six mailed activity booklets followed-up by health educator telephone calls. There were significant (<.05) treatment effects in hypothesized directions on most of the factors motivating and facilitating caregiver engagement in teen dating abuse prevention activities including caregiver perceived severity of dating abuse, response efficacy for preventing dating abuse, self-efficacy for talking about dating abuse, knowledge of dating abuse, acceptance of dating abuse, communication skills with the teen, and belief in the importance of involvement in their male (but not female) teen's dating. The latter effect was the only one moderated by sex of the teen. The targeted risk factor affected by the program was teen acceptance of dating abuse. Treatment was also significantly associated with less physical dating abuse victimization. Modifications to the program are warranted, but overall, the findings are very favorable for the first family-based teen dating abuse prevention program to be evaluated. Copyright © 2012 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

  16. Receptive language and educational attainment for sexually abused females.

    PubMed

    Noll, Jennie G; Shenk, Chad E; Yeh, Michele T; Ji, Juye; Putnam, Frank W; Trickett, Penelope K

    2010-09-01

    The objective of this study was to test whether the experience of childhood sexual abuse is associated with long-term receptive language acquisition and educational attainment deficits for females. Females with substantiated familial childhood sexual abuse (n=84) and a nonabused comparison group (n=102) were followed prospectively for 18 years. Receptive language ability was assessed at 6 time points across distinct stages of development, including childhood, adolescence, and young adulthood. Rates of high school graduation and total educational attainment were assessed during young adulthood. Hierarchical linear modeling revealed that receptive language did not differ between the groups at the initial assessment point in childhood; however, a significant group by time interaction was observed across development with abused females (1) acquiring receptive language at a significantly slower rate throughout development and (2) achieving a lower overall maximum level of proficiency. Significant differences in receptive language scores emerged as early as midadolescence. In addition, abused females reported significantly lower rates of high school graduation and lower overall educational attainment when compared with their nonabused peers. Exposure to childhood sexual abuse may be a significant risk factor for cognitive performance and achievement deficits for victims. These findings have particular public health relevance given the high prevalence of sexual abuse and that poor cognitive functioning and low levels of educational attainment can contribute to continued adversity throughout the life course. Early intervention may assist victims in improving cognitive functioning, altering deleterious trajectories, and promoting greater life successes.

  17. 7 CFR 1220.253 - Personal liability.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... AGREEMENTS AND ORDERS; MISCELLANEOUS COMMODITIES), DEPARTMENT OF AGRICULTURE SOYBEAN PROMOTION, RESEARCH, AND CONSUMER INFORMATION Soybean Promotion and Research Order Miscellaneous § 1220.253 Personal liability. No... Soybean Boards, acting pursuant to authority provided in this subpart, shall be held personally...

  18. Screening for childhood physical and sexual abuse among outpatient substance abusers.

    PubMed

    Simpson, T L; Westerberg, V S; Little, L M; Trujillo, M

    1994-01-01

    Research demonstrates that substance-abusing individuals report substantially higher rates of childhood sexual and physical abuse than the general population. This study sought to test a method of identifying substance-abusing clients with histories of childhood sexual and/or physical abuse and to explore the differences between those reporting childhood abuse and those not. Files of substance abusing clients from two distinct time periods were examined for reports of childhood abuse. At Time 1 (n = 399) clients were not systematically asked about experiences of childhood abuse, and at Time 2 (n = 305) clients were routinely asked about this issue. Results indicate that significantly more male and female clients disclosed childhood abuse at Time 2. Additionally, male clients reporting childhood abuse appeared more distressed than those not reporting abuse; female clients reporting childhood abuse did not appear more distressed than their counterparts.

  19. Evidence for the hERG Liability of Antihistamines, Antipsychotics, and Anti-Infective Agents: A Systematic Literature Review From the ARITMO Project.

    PubMed

    Hazell, Lorna; Raschi, Emanuel; De Ponti, Fabrizio; Thomas, Simon H L; Salvo, Francesco; Ahlberg Helgee, Ernst; Boyer, Scott; Sturkenboom, Miriam; Shakir, Saad

    2017-05-01

    A systematic review was performed to categorize the hERG (human ether-a-go-go-related gene) liability of antihistamines, antipsychotics, and anti-infectives and to compare it with current clinical risk of torsade de pointes (TdP). Eligible studies were hERG assays reporting half-minimal inhibitory concentrations (IC50). A "hERG safety margin" was calculated from the IC50 divided by the peak human plasma concentration (free C max ). A margin below 30 defined hERG liability. Each drug was assigned an "uncertainty score" based on volume, consistency, precision, and internal and external validity of evidence. The hERG liability was compared to existing knowledge on TdP risk (www.credibledrugs.org). Of 1828 studies, 82 were eligible, allowing calculation of safety margins for 61 drugs. Thirty-one drugs (51%) had evidence of hERG liability including 6 with no previous mention of TdP risk (eg, desloratadine, lopinavir). Conversely, 16 drugs (26%) had no evidence of hERG liability including 6 with known, or at least conditional or possible, TdP risk (eg, chlorpromazine, sulpiride). The main sources of uncertainty were the validity of the experimental conditions used (antihistamines and antipsychotics) and nonuse of reference compounds (anti-infectives). In summary, hERG liability was categorized for 3 widely used drug classes, incorporating a qualitative assessment of the strength of available evidence. Some concordance with TdP risk was observed, although several drugs had hERG liability without evidence of clinical risk and vice versa. This may be due to gaps in clinical evidence, limitations of hERG/C max data, or other patient/drug-specific factors that contribute to real-life TdP risk. © 2016, The American College of Clinical Pharmacology.

  20. 12 CFR 1008.309 - Absence of liability for good-faith administration.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 12 Banks and Banking 8 2013-01-01 2013-01-01 false Absence of liability for good-faith... for Administration of the NMLSR § 1008.309 Absence of liability for good-faith administration. The... action or proceeding for monetary damages by reason of the good-faith action or omission of any officer...