Science.gov

Sample records for 747-100b sud 747-200b

  1. 75 FR 38007 - Airworthiness Directives; The Boeing Company Model 747-100, 747-100B, 747-100B SUD, 747-200B, 747...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-07-01

    ... foam insulation, a material of which the fire retardant properties deteriorate with age. We are issuing... wrapped with BMS 8-39 polyurethane foam insulation, a material of which the fire retardant properties... on the duct assemblies of the ECS, which could propagate a small fire and lead to a larger fire...

  2. 76 FR 34625 - Airworthiness Directives; The Boeing Company Model 747-100, 747-100B, 747-100B SUD, 747-200B, 747...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-06-14

    ... AD 2010-23-13 Amendment 39-16502 (75 FR 68688, November 9, 2009), for Model 757 airplanes, and are... Procedures (44 FR 11034, February 26, 1979), (3) Will not affect intrastate aviation in Alaska, and (4) Will... the products listed above. This proposed AD would require modification of the fluid drain path in...

  3. 75 FR 3150 - Airworthiness Directives; The Boeing Company Model 747-100, 747-100B, 747-100B SUD, 747-200B, 747...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-01-20

    ... as of February 24, 2010. On January 29, 2007 (72 FR 1427, January 12, 2007), the Director of the... 39 to include an AD that supersedes AD 2007-01-15, amendment 39-14887 (72 FR 1427, January 12, 2007... on September 18, 2009 (74 FR 47897). That NPRM proposed to continue to require repetitive...

  4. 76 FR 19278 - Airworthiness Directives; The Boeing Company Model 747-100, 747-100B, 747-100B SUD, 747-200B, 747...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-04-07

    ...-15-10, Amendment 39-15139 (72 FR 41438, July 30, 2007), for all Boeing Model 747 airplanes. A correction of that AD was published in the Federal Register on September 21, 2007 (72 FR 53923), which...'' under the DOT Regulatory Policies and Procedures (44 FR 11034, February 26, 1979), (3) Will not...

  5. 75 FR 61337 - Airworthiness Directives; The Boeing Company Model 747-100, 747-100B, 747-100B SUD, 747-200B, 747...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-10-05

    ... inspections to find cracking of the web, strap, inner chords, and inner chord angle of the forward edge frame... inner chord of the forward edge frame of the number 5 main entry door cutouts, between stringers 16 and... flight. DATES: This AD becomes effective November 9, 2010. The Director of the Federal Register...

  6. 75 FR 9760 - Airworthiness Directives; The Boeing Company Model 747-100, 747-100B, 747-100B SUD, 747-200B, 747...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-03-04

    ... cracks in the wing and horizontal stabilizer side-of-body joints and the fuselage skin circumferential... from Boeing analysis indicating that the wing and horizontal stabilizer side-of-body joints, and the... FR 42807). That NPRM proposed to require one-time detailed and high frequency eddy...

  7. 75 FR 78591 - Airworthiness Directives; The Boeing Company Model 747-100, 747-100B, 747-100B SUD, 747-200B, 747...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-12-16

    ... the left and right override/jettison pumps of the center wing tanks. This AD also requires replacing... uncommanded operation of the override/jettison pumps of the center wing tanks, and failure to manually shut... inside the center wing tank. This condition, in combination with flammable fuel vapors, could result in...

  8. 75 FR 60661 - Airworthiness Directives; The Boeing Company Model 747-100, 747-100B, 747-100B SUD, 747-200B, 747...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-10-01

    ... right override/jettison pumps of the center wing tanks. The original NPRM would also have required.../ jettison pumps of the center wing tanks, and failure to manually shut off the override/jettison pumps at the correct time, either of which could lead to an ignition source inside the center wing tank....

  9. 75 FR 3658 - Airworthiness Directives; The Boeing Company Model 747-100, 747-100B, 747-100B SUD, 747-200B, 747...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-01-22

    ... through due to inadvertent electrical current from a short circuit in the audio select panel. We are proposing this AD to prevent inadvertent electrical current, which can cause the low-pressure flex-hoses of... inadvertent electrical current from a short circuit in the audio select panel on a Model 757 airplane....

  10. 75 FR 47208 - Airworthiness Directives; The Boeing Company Model 747-100, 747-100B, 747-100B SUD, 747-200B, 747...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-08-05

    ...-pressure flex- hoses of the crew oxygen system that burned through due to inadvertent electrical current... electrical current, which can cause the low-pressure flex-hoses of the crew oxygen system to melt or burn... that burned through due to inadvertent electrical current from a short circuit in the audio...

  11. 75 FR 70868 - Airworthiness Directives; The Boeing Company Model 747-100, 747-100B, 747-100B SUD, 747-200B, 747...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-11-19

    ... connection will overheat with electrical current passing through it. An overheated connector can degrade the... electrical terminal at the left and right flightdeck window 1, and corrective actions if necessary. This... equipped with different electrical connections, which would terminate the repetitive inspections for...

  12. 75 FR 20792 - Airworthiness Directives; The Boeing Company Model 747-100, 747-100B, 747-100B SUD, 747-200B, 747...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-04-21

    ... Engineer, Airframe Branch, ANM-120S, FAA, Seattle Aircraft Certification Office (ACO), 1601 Lind Avenue, SW... that section, Congress charges the FAA with promoting safe flight of civil aircraft in air commerce by... rule'' under the DOT Regulatory Policies and Procedures (44 FR 11034, February 26, 1979), and 3....

  13. 75 FR 18446 - Airworthiness Directives; The Boeing Company Model 747-100, 747-100B, 747-100B SUD, 747-200B, 747...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-04-12

    ... installation, air distribution system Humidifier duct installation Heat exchanger installation, air... proposed AD, contact Boeing Commercial Airplanes, Attention: Data & Services Management, P. O. Box 3707, MC... CONTACT: Sue McCormick, Aerospace Engineer, Cabin Safety and Environmental Systems Branch, ANM-150S,...

  14. 75 FR 52907 - Airworthiness Directives; The Boeing Company Model 747-100, 747-100B, 747-100B SUD, 747-200B, 747...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-08-30

    ..., which can develop into fatigue cracks in the skin and cause sudden decompression of the airplane. DATES..., environmental, and energy aspects of this proposed AD. We will consider all comments received by the closing... airplanes. That original NPRM was published in the Federal Register on January 31, 2008 (73 FR 5768)....

  15. 75 FR 27424 - Airworthiness Directives; The Boeing Company Model 747-100, 747-100B, 747-100B SUD, 747-200B, 747...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-05-17

    ... joint that is modified. This AD results from a structural review of affected skin lap joints for... listed in the AD as of June 21, 2010. On July 13, 1994 (59 FR 30277, June 13, 1994), the Director of the... 39 to include an AD that supersedes AD 94-12-04, Amendment 39- 8932 (59 FR 30277, June 13, 1994)....

  16. 76 FR 13067 - Airworthiness Directives; The Boeing Company Model 747-100, 747-100B, 747-100B SUD, 747-200B, 747...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-03-10

    ..., amendment 39-15210 (72 FR 53939, September 21, 2007). That AD applies to the specified products. The NPRM was published in the Federal Register on July 8, 2010 (75 FR 39185). That NPRM proposed to continue to... Policies and Procedures (44 FR 11034, February 26, 1979), (3) Will not affect intrastate aviation in...

  17. 75 FR 39818 - Airworthiness Directives; The Boeing Company Model 747-100, 747-100B, 747-100B SUD, 747-200B, 747...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-07-13

    ... was published in the Federal Register on April 21, 2010 (75 FR 20792). That NPRM proposed to require... ``significant rule'' under DOT Regulatory Policies and Procedures (44 FR 11034, February 26, 1979), and (3) Will... in a rapid loss of cabin pressure. DATES: This AD is effective August 17, 2010. The Director of...

  18. 75 FR 39185 - Airworthiness Directives; The Boeing Company Model 747-100, 747-100B, 747-100B SUD, 747-200B, 747...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-07-08

    ... holidays. For service information identified in this proposed AD, contact Boeing Commercial Airplanes... on the Internet at http://www.regulations.gov ; or in person at the Docket Management Facility... for the Docket Office (telephone 800-647-5527) is in the ADDRESSES section. Comments will be...

  19. 75 FR 37997 - Airworthiness Directives; The Boeing Company Model 747-100, 747-100B, 747-100B SUD, 747-200B, 747...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-07-01

    ... Federal Register on October 13, 2009 (74 FR 52431). That NPRM proposed to require replacing the power... requirements of AD 97-26-07, Amendment 39-10250 (62 FR 65352, December 12, 1997). JAL states that AD 97-26-07... 39-15512 (73 FR 25990, May 8, 2008), already requires incorporation of AWLs 28-AWL-24 through 28-...

  20. 75 FR 3147 - Airworthiness Directives; The Boeing Company Model 747-100B SUD, -200B, -300, -400, and -400D...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-01-20

    ... 26, 2003, as of August 30, 2005 (70 FR 43020, July 26, 2005). ADDRESSES: For service information..., amendment 39-14197 (70 FR 43020, July 26, 2005). The existing AD applies to certain Model 747-100B SUD... 14, 2009 (74 FR 33928). That NPRM proposed to require repetitive inspections for cracking in...

  1. 75 FR 38404 - Airworthiness Directives; The Boeing Company Model 747-100B, 747-200B, 747-200F, 747-300, 747-400...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-07-02

    ... 2010-01-10, Amendment 39-16168 (75 FR 3150, January 20, 2010), applicable to certain Model 747-100, 747... Executive Order 12866, (2) Is not a ``significant rule'' under DOT Regulatory Policies and Procedures (44 FR... upper link load path and consequent fracture of the diagonal brace, which could result in in-...

  2. 76 FR 38074 - Airworthiness Directives; The Boeing Company Model 747-100, 747-100B, 747-200B, 747-200C, 747...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-06-29

    ... for other airplanes. This proposed AD results from reports of multiple adjacent cracks on an airplane..., environmental, and energy aspects of this proposed AD. We will consider all comments received by the closing... post a report summarizing each substantive verbal contact we receive about this proposed AD....

  3. 75 FR 22514 - Airworthiness Directives; The Boeing Company Model 747-200B Series Airplanes

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-04-29

    ... Executive Order 12866, (2) Is not a ``significant rule'' under DOT Regulatory Policies and Procedures (44 FR... Model 747-200B Series Airplanes AGENCY: Federal Aviation Administration (FAA), DOT. ACTION: Final rule...-200B series airplanes. This AD requires repetitive inspections for cracking of the fuselage skin...

  4. 75 FR 35356 - Airworthiness Directives; The Boeing Company Model 747-100, 747-200B, and 747-200F Series Airplanes

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-06-22

    ... 3, 1990, we issued AD 90-15-06, Amendment 39-6653 (55 FR 28600, July 12, 1990), for certain Boeing...-8937 (59 FR 30285, June 13, 1994), for certain Boeing Model 747-100, 747-200B, and 747-200F series... and Procedures (44 FR 11034, February 26, 1979); and 3. Will not have a significant economic...

  5. 78 FR 28767 - Airworthiness Directives; The Boeing Company Airplanes

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-05-16

    ...We propose to adopt a new airworthiness directive (AD) for certain The Boeing Company Model 747-100, 747-100B, 747-100B SUD, 747- 200B, 747-200C, 747-200F, 747-300, 747-400, 747-400D, 747-400F, 747SR, and 747SP series airplanes. This proposed AD was prompted by a report of a disbonded doubler and a skin crack in section 41 of the fuselage, and multiple reports of cracked or missing fastener......

  6. 77 FR 70362 - Airworthiness Directives; The Boeing Company Airplanes

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-11-26

    ..., Amendment 39-16157 (75 FR 1533, January 12, 2010)), AD 2010-01-01 requires accomplishing the main entry door... new airworthiness directive (AD) for all The Boeing Company Model 747-100, 747-100B, 747-100B SUD, 747.... This AD was prompted by reports of cracks in the main entry door number 1 upper main sill outer...

  7. 75 FR 10669 - Airworthiness Directives; The Boeing Company Model 747-100, 747-200B, 747-300, and 747SR Series...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-03-09

    ...) This AD results from a report of water contamination in the electrical and electronic units in the main... closeout panel and moisture curtains for the main equipment center. This AD results from a report of water contamination in the electrical and electronic units in the main equipment center. We are issuing this AD...

  8. 75 FR 61977 - Airworthiness Directives; The Boeing Company Model 747-100, 747-200B, and 747-200F Series Airplanes

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-10-07

    ..., Amendment 39- 6653 (55 FR 28600, July 12, 1990), and AD 94-12-09, Amendment 39-8937 (59 FR 30285, June 13... NPRM was published in the Federal Register on June 22, 2010 (75 FR 35356). That NPRM proposed to... Policies and Procedures (44 FR 11034, February 26, 1979); and (3) Will not have a significant...

  9. 76 FR 24349 - Airworthiness Directives; The Boeing Company Model 747-200B, -300, -400, -400D, and -400F Series...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-05-02

    ... General Electric CF6-80C2 Series Engines AGENCY: Federal Aviation Administration (FAA), DOT. ACTION: Final... airplanes; certificated in any category; equipped with Pratt and Whitney 4000 or General Electric CF6-80C2..., 2010 (75 FR 69612). That NPRM proposed to require an inspection to determine the part number of the...

  10. 75 FR 69612 - Airworthiness Directives; The Boeing Company Model 747-200B, -300, -400, -400D, and -400F Series...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-11-15

    ... General Electric CF6-80C2 Series Engines AGENCY: Federal Aviation Administration (FAA), DOT. ACTION... General Electric CF6-80C2 series engines, as identified in Boeing Alert Service Bulletin 747-54A2232... under the authority described in ``Subtitle VII, Part A, Subpart III, Section 44701:...

  11. Una visita en Sud America

    NASA Astrophysics Data System (ADS)

    1982-09-01

    Oisfrute de una estadfa en el Hotel La Silla, el mejor hotel de Sud America con su tan unica atmosfera extraterrestre! Los espera su calificado personal de experimentados hoteleros, jefes de cocina, etc., ansiosos todos de satisfacer sus deseos hasta el mas mfnimo detalle. Naturalmente nuestro espacioso restaurant de tres estrellas ofrece un completo surtido de exquisitas comidas y deliciosos tragos (conocedores usualmente eligen "Oelicia Orion" 0 "Centauro Especial"). EI servicio cempleto durante 24 horas incluye nuestra ya mundialmente famosa "Cena de medianoche para los miradores de estrellas", por eso - no olvide: No pierda la oportunidad de una estadfa en EL HOTEL LA SILLA - una experiencia maravillosa!

  12. Validity of global physical and emotional SUDS.

    PubMed

    Tanner, Barry A

    2012-03-01

    Despite the wide-spread use of Subjective Units of Discomfort Scales, or SUDS, to measure anxiety to specific stimuli, little information has been published on the validity of such scales and even less on their use as global measures of emotional and physical discomfort. Data was examined for 182 consecutive admissions to a psychology clinic to determine the relationship of self-rating of emotional and physical discomfort to one another and of the emotional self-rating to the clinician rating of general functioning (GAF). As expected, patients' ratings of their emotional discomfort were significantly higher than ratings of their physical discomfort (t = 9.077, p < .001). Emotional SUDS were significantly and negatively related to clinicians' GAF ratings (r = - 0.439, p < .001), indicating that the two ratings measured related global constructs. Data for the 53 patients who also completed the MMPI-2 was drawn from the larger sample to determine the nature of the relationship between SUDS and two measures of general emotional distress, with patients' SUDS significantly related to both the A scale (r = 0.351, p < .05) and the neurotic index (r = 0.366, p < .01). Finally, there was a significant decrease in the emotional SUDS (t = 4.686, p < .001) but not the physical SUDS (t = 0.788, p = .434) after 3 months of psychotherapy. The data supports SUDS as global measures of both physical and emotional discomfort. PMID:22038278

  13. Evaluation of MUREX SUDS Toxo test.

    PubMed Central

    Moyer, N P; Hudson, J D; Hausler, W J

    1987-01-01

    The SUDS Toxo test (MUREX Corp., Norcross, Ga.) was compared with the indirect hemagglutination test (IHA) and the indirect fluorescent-antibody test (IFA) by examining 404 serum specimens, including 64 (15.8%) specimens with IFA titers of greater than or equal to 1:2. When SUDS was compared with IHA, sensitivity (96.4%), specificity (97.9%), and negative predictive value (99.4%) indicated that there were similar reactivities between the two tests. When an IFA titer of greater than or equal to 1:16 was considered significant and IHA and SUDS were compared with IFA, IHA was slightly less sensitive but had a higher positive predictive value than did SUDS; however, there was no statistical difference between the tests. When SUDS was compared with IFA, in which a titer of greater than or equal to 1:16 was considered significant, the high negative predictive value (100%), excellent sensitivity (100%) and specificity (98.3%), and ease of performance made SUDS an attractive alternative to IHA for screening single serum specimens for toxoplasmosis. PMID:3320079

  14. 77 FR 47267 - Airworthiness Directives; The Boeing Company Airplanes

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-08-08

    ... as of November 28, 2007 (72 FR 65655, November 23, 2007). ADDRESSES: For service information... AD 2007-23-18, Amendment 39-15266 (72 FR 65655, November 23, 2007). The SNPRM published in the Federal Register on February 2, 2012 (77 FR 5195). The SNPRM applied to all Boeing Model 747-100B SUD,...

  15. Smart SUDS: recognising the multiple-benefit potential of sustainable surface water management systems.

    PubMed

    Jose, Roshni; Wade, Rebecca; Jefferies, Chris

    2015-01-01

    How can we make sustainable urban drainage systems (SUDS) smart? SUDS help us to manage surface water runoff from urban environments but they are capable of delivering much more. This paper looks beyond the water quantity and quality improvement functions of SUDS and investigates the multiple benefits that can be gained by implementing smart SUDS solutions. This work provides a new perspective, using methodologies not normally associated with SUDS research, to determine multiple benefits. The outputs of the work can potentially assist decision-makers, designer and planners in recognising the potential for multiple benefits that can be delivered by SUDS. The ecosystem services (ES) associated with a large redevelopment in Dundee, Scotland, UK, are identified and a public perception study together with public participatory geographical information system (PPGIS) methods was used to confirm the goods and benefits of the SUDS. The paper presents findings on the public perception of SUDS as they provide cultural benefits such as recreation, aesthetics and biodiversity. The results show that greenspace is important when choosing a location, and willingness to pay for greenspace is high in this area. This paper concludes that SUDS provide multi-functional benefits in relation to the ES, thereby justifying the cachet of being termed Smart SUDS. PMID:25633948

  16. Program to convert SUDS2ASC files to a single binary SEGY file

    USGS Publications Warehouse

    Goldman, Mark

    2000-01-01

    This program, SUDS2SEGY, converts and combines ASCII files created using SUDS2ASC Version 2.60, to a single SEGY file. SUDS2ASC has been used previously to create an ASCII file of three-component seismic data for an individual recording station. However, many seismic processing packages have difficulty reading in ASCII data. In addition, it may be cumbersome to process a separate file for each recording station, particularly if traces from different recording stations contain a different number of data samples and/or a different start time. This new program - SUDS2SEGY - combines these recording station files into a single SEGY file. In addition, SUDS2SEGY normalizes the trace times so that each trace starts at a given time and consists of a fixed number of samples. This normalization allows seismic data from many different stations to be read in as a single "data gather". SUDS2SEGY also produces a report summarizing the offset and maximum absolute amplitude for each component in a station file. These data are output separately to an ASCII file and can be subsequently input to a plotting package.

  17. Comorbidity of ADHD and Substance Use Disorder (SUD): A Neuroimaging Perspective

    ERIC Educational Resources Information Center

    Frodl, Thomas

    2010-01-01

    Introduction: ADHD has a high comorbidity with substance use disorders (SUD). Both diseases have profound social, psychological, and economic consequences and are therefore highly relevant for health systems. The high comorbidity indicates some shared underlying neurobiological substrates. Knowing these substrates may increase the understanding of…

  18. Integrated and Holistic Treatment Approach to PTSD and SUD: A Synergy

    ERIC Educational Resources Information Center

    Weis, Melanie

    2010-01-01

    Individuals living with posttraumatic stress disorder (PTSD) and addiction experience a complex and dynamic interaction of symptoms from both diagnoses. However, heretofore, each diagnosis has been approached as if it were a separate treatment consideration. Therefore, an individual may be treated for either a substance use disorder (SUD) or PTSD,…

  19. The relationship between Clinical Trial Network protocol involvement and quality of substance use disorder (SUD) treatment

    PubMed Central

    Abraham, Amanda J.; Knudsen, Hannah K.; Roman, Paul M.

    2013-01-01

    The National Institute on Drug Abuse’s Clinical Trials Network (CTN) is a practice-based research network that partners academic researchers with community based substance use disorder (SUD) treatment programs designed primarily to conduct effectiveness trials of promising interventions. A secondary goal of the CTN is to widely disseminate results of these trials and thus improve the quality of SUD treatment in the US. Drawing on data from 156 CTN programs, this study examines the association between involvement in CTN protocols and overall treatment quality measured by a comprehensive index of 35 treatment services. Negative binomial regression models show that treatment programs that participated in a greater number of CTN protocols had significantly higher levels of treatment quality, an association that held after controlling for key organizational characteristics. These findings contribute to the growing body of research on the role of practice-based research networks in promoting health care quality. PMID:24080073

  20. Assessment of undiscovered oil and gas resources of the Sud Province, north-central Africa

    USGS Publications Warehouse

    Brownfield, M.E.; Klett, T.R.; Schenk, C.J.; Charpentier, R.R.; Cook, T.A.; Pollastro, R.M.; Tennyson, M.E.

    2011-01-01

    The Sud Province located in north-central Africa recently was assessed for undiscovered, technically recoverable oil, natural gas, and natural gas liquids resources as part of the U.S. Geological Survey's (USGS) World Oil and Gas Assessment. Using a geology-based assessment methodology, the USGS estimated mean volumes of 7.31 billion barrels of oil, 13.42 trillion cubic feet of natural gas, and 353 million barrels of natural gas liquids.

  1. Multifunctional benefits of SuDS: techno-economic evaluation of decentralised solutions for urban water management

    NASA Astrophysics Data System (ADS)

    Mijic, Ana; Ossa-Moreno, Juan; Smith, Karl M.

    2016-04-01

    The increased frequency of extreme weather events associated with climate change poses a significant threat to the integrity and function of critical urban infrastructure - rail, road, telecommunications, power and water supply/sewerage networks. A key threat within the United Kingdom (UK) is the increased risk of pluvial flooding; the conventional approach of channeling runoff to an outfall has proven to be unsustainable during severe storm events. Green infrastructure, in the form of Sustainable Urban Drainage Systems (SuDS), has been proposed as a means of minimising the risk of pluvial flooding. However, despite their technical performance, SuDS uptake in the UK has not reached its full capacity yet, mostly due to reasons that go beyong the engineering realm. This work investigated the strategic role of SuDS retrofit in managing environmental risks to urban infrastructure in London at a catchment level, through an economic appraisal of multifunctional benefits. It was found that by including the multifunctional benefits of SuDS, the economic feasibility of the project improves considerably. The case study has also shown a mechanism towards achieving wider-scale SuDS retrofit, whereby the investments are split amongst multiple stakeholder groups by highlighting the additional benefits each group derives. Groups include water utilities and their users, local government and critical infrastructure owners. Finally, limitations to the existing cost-benefit methdology in the UK were identified, and recommendations made regarding incentives and governmental regulations to enhance the uptake of SuDS in London. The proposed methodology provides compelling and robust, cost-benefit based evidence of SUDS' effectiveness within the flood risk management planning framework, but also with regard to the additional benefits of Nature Based Solutions in urban environments.

  2. The management of urban surface water flood risks: SUDS performance in flood reduction from extreme events.

    PubMed

    Viavattene, C; Ellis, J B

    2013-01-01

    The need to improve the urban drainage network to meet recent urban growth and the redevelopment of old industrial and commercial areas provides an opportunity for managing urban surface water infrastructure in a more sustainable way. The use of sustainable urban drainage systems (SUDS) can reduce urban surface water flooding as well as the pollution impact of urban discharges on receiving waters. However, these techniques are not yet well known by many stakeholders involved in the decision-making process, or at least the evidence of their performance effectiveness may be doubted compared with more traditional engineering solutions often promoted by existing 1D/2D drainage models. The use of geographic information systems (GIS) in facilitating the inter-related risk analysis of sewer surface water overflows and urban flooding as well as in better communication with stakeholders is demonstrated in this paper. An innovative coupled 1D/2D urban sewer/overland flow model has been developed and tested in conjunction with a SUDS selection and location tool (SUDSLOC) to enable a robust management approach to surface water flood risks and to improve the resilience of the urban drainage infrastructure. The paper demonstrates the numerical and modelling basis of the integrated 1D/2D and SUDSLOC approach and the working assumptions and flexibility of the application together with some limitations and uncertainties. The role of the SUDSLOC modelling component in quantifying flow, and surcharge reduction benefits arising from the strategic selection and location of differing SUDS controls are also demonstrated for an extreme storm event scenario.

  3. Rainfall-Runoff Simulations to Assess the Potential of SuDS for Mitigating Flooding in Highly Urbanized Catchments.

    PubMed

    Jato-Espino, Daniel; Charlesworth, Susanne M; Bayon, Joseba R; Warwick, Frank

    2016-01-01

    Sustainable Urban Drainage Systems (SuDS) constitute an alternative to conventional drainage when managing stormwater in cities, reducing the impact of urbanization by decreasing the amount of runoff generated by a rainfall event. This paper shows the potential benefits of installing different types of SuDS in preventing flooding in comparison with the common urban drainage strategies consisting of sewer networks of manholes and pipes. The impact of these systems on urban water was studied using Geographic Information Systems (GIS), which are useful tools when both delineating catchments and parameterizing the elements that define a stormwater drainage system. Taking these GIS-based data as inputs, a series of rainfall-runoff simulations were run in a real catchment located in the city of Donostia (Northern Spain) using stormwater computer models, in order to compare the flow rates and depths produced by a design storm before and after installing SuDS. The proposed methodology overcomes the lack of precision found in former GIS-based stormwater approaches when dealing with the modeling of highly urbanized catchments, while the results demonstrated the usefulness of these systems in reducing the volume of water generated after a rainfall event and their ability to prevent localized flooding and surcharges along the sewer network. PMID:26805864

  4. Rainfall-Runoff Simulations to Assess the Potential of SuDS for Mitigating Flooding in Highly Urbanized Catchments.

    PubMed

    Jato-Espino, Daniel; Charlesworth, Susanne M; Bayon, Joseba R; Warwick, Frank

    2016-01-21

    Sustainable Urban Drainage Systems (SuDS) constitute an alternative to conventional drainage when managing stormwater in cities, reducing the impact of urbanization by decreasing the amount of runoff generated by a rainfall event. This paper shows the potential benefits of installing different types of SuDS in preventing flooding in comparison with the common urban drainage strategies consisting of sewer networks of manholes and pipes. The impact of these systems on urban water was studied using Geographic Information Systems (GIS), which are useful tools when both delineating catchments and parameterizing the elements that define a stormwater drainage system. Taking these GIS-based data as inputs, a series of rainfall-runoff simulations were run in a real catchment located in the city of Donostia (Northern Spain) using stormwater computer models, in order to compare the flow rates and depths produced by a design storm before and after installing SuDS. The proposed methodology overcomes the lack of precision found in former GIS-based stormwater approaches when dealing with the modeling of highly urbanized catchments, while the results demonstrated the usefulness of these systems in reducing the volume of water generated after a rainfall event and their ability to prevent localized flooding and surcharges along the sewer network.

  5. Rainfall–Runoff Simulations to Assess the Potential of SuDS for Mitigating Flooding in Highly Urbanized Catchments

    PubMed Central

    Jato-Espino, Daniel; Charlesworth, Susanne M.; Bayon, Joseba R.; Warwick, Frank

    2016-01-01

    Sustainable Urban Drainage Systems (SuDS) constitute an alternative to conventional drainage when managing stormwater in cities, reducing the impact of urbanization by decreasing the amount of runoff generated by a rainfall event. This paper shows the potential benefits of installing different types of SuDS in preventing flooding in comparison with the common urban drainage strategies consisting of sewer networks of manholes and pipes. The impact of these systems on urban water was studied using Geographic Information Systems (GIS), which are useful tools when both delineating catchments and parameterizing the elements that define a stormwater drainage system. Taking these GIS-based data as inputs, a series of rainfall–runoff simulations were run in a real catchment located in the city of Donostia (Northern Spain) using stormwater computer models, in order to compare the flow rates and depths produced by a design storm before and after installing SuDS. The proposed methodology overcomes the lack of precision found in former GIS-based stormwater approaches when dealing with the modeling of highly urbanized catchments, while the results demonstrated the usefulness of these systems in reducing the volume of water generated after a rainfall event and their ability to prevent localized flooding and surcharges along the sewer network. PMID:26805864

  6. sud1+ targets cyclin-dependent kinase-phosphorylated Cdc18 and Rum1 proteins for degradation and stops unwanted diploidization in fission yeast

    PubMed Central

    Jallepalli, Prasad V.; Tien, Deborah; Kelly, Thomas J.

    1998-01-01

    In the fission yeast Schizosaccharomyces pombe, S phase is limited to a single round per cell cycle through cyclin-dependent kinase phosphorylation of critical replication factors, including the Cdc18 replication initiator protein. Because defects in Cdc18 phosphorylation lead to a hyperstable and hyperactive form of Cdc18 that promotes high levels of overreplication in vivo, we wished to identify the components of the Cdc18 proteolysis pathway in fission yeast. In this paper we describe one such component, encoded by the sud1+ gene. sud1+ shares homology with the budding yeast CDC4 gene and is required to prevent spontaneous re-replication in fission yeast. Cells lacking sud1+ accumulate high levels of Cdc18 and the CDK inhibitor Rum1, because they cannot degrade these two key cell cycle regulators. Through genetic analysis we show that hyperaccumulation of Rum1 contributes to re-replication in Δsud1 cells, but is not the cause of the defect in Cdc18 proteolysis. Rather, Sud1 itself is associated with the ubiquitin pathway in fission yeast and binds to Cdc18 in vivo. Most importantly, Sud1-Cdc18 binding requires prior phosphorylation of the Cdc18 polypeptide at CDK consensus sites. These results provide a biochemical mechanism for the phosphorylation-dependent degradation of Cdc18 and other cell cycle regulators, including Rum1. Evolutionary conservation of the Sud1/CDC4 pathway suggests that phosphorylation-coupled proteolysis may be a general feature of nearly all eukaryotic cell cycles. PMID:9653157

  7. Influence of biofilms on heavy metal immobilization in sustainable urban drainage systems (SuDS).

    PubMed

    Feder, Marnie; Phoenix, Vernon; Haig, Sarah; Sloan, William; Dorea, Caetano; Haynes, Heather

    2015-01-01

    This paper physically and numerically models the influence of biofilms on heavy metal removal in a gravel filter. Experimental flow columns were constructed to determine the removal of Cu, Pb and Zn by gabbro and dolomite gravel lithologies with and without natural biofilm from sustainable urban drainage systems (SuDS). Breakthrough experiments showed that, whilst abiotic gravel filters removed up to 51% of metals, those with biofilms enhanced heavy metal removal by up to a further 29%, with Cu removal illustrating the greatest response to biofilm growth. An advection-diffusion equation successfully modelled metal tracer transport within biofilm columns. This model yielded a permanent loss term (k) for metal tracers of between 0.01 and 1.05, correlating well with measured data from breakthrough experiments. Additional 16S rRNA clone library analysis of the biofilm indicated strong sensitivity of bacterial community composition to the lithology of the filter medium, with gabbro filters displaying Proteobacteria dominance (54%) and dolomite columns showing Cyanobacteria dominance (47%).

  8. Influence of biofilms on heavy metal immobilization in sustainable urban drainage systems (SuDS).

    PubMed

    Feder, Marnie; Phoenix, Vernon; Haig, Sarah; Sloan, William; Dorea, Caetano; Haynes, Heather

    2015-01-01

    This paper physically and numerically models the influence of biofilms on heavy metal removal in a gravel filter. Experimental flow columns were constructed to determine the removal of Cu, Pb and Zn by gabbro and dolomite gravel lithologies with and without natural biofilm from sustainable urban drainage systems (SuDS). Breakthrough experiments showed that, whilst abiotic gravel filters removed up to 51% of metals, those with biofilms enhanced heavy metal removal by up to a further 29%, with Cu removal illustrating the greatest response to biofilm growth. An advection-diffusion equation successfully modelled metal tracer transport within biofilm columns. This model yielded a permanent loss term (k) for metal tracers of between 0.01 and 1.05, correlating well with measured data from breakthrough experiments. Additional 16S rRNA clone library analysis of the biofilm indicated strong sensitivity of bacterial community composition to the lithology of the filter medium, with gabbro filters displaying Proteobacteria dominance (54%) and dolomite columns showing Cyanobacteria dominance (47%). PMID:25982923

  9. Making Space for Water: A review of SUstainable Drainage systems (SUDs) in a rural/urban area of Newcastle upon Tyne, UK.

    NASA Astrophysics Data System (ADS)

    Quinn, Paul; Tellier, Sebastien; Wilkinson, Mark

    2010-05-01

    Expansion of the city of Newcastle included a new development of over 3000 houses and an associated commercial area on agricultural land. The development firmly signed up to the notion that the new estate should adhere to full SUDs design and implementation. In essence there should be no loss of floodplain capacity, the total runoff from the new housing should not increase flood risk downstream and benefits to ecology, recreation and amenity should be fully maximised. Credit must be given to Newcastle City Council, the Environment Agency, the local water company and the developers themselves as a full set of large scale SUDs now exist and they are clearly an asset to the city. However, such a large scale landscape engineering endeavour has not been without direct and indirect problems. This paper reviews some of the experiences, problems and lessons learnt from SUDs implementation, the function of SUDs during flood events and the perception of SUDs by the public. During the life of the project several older estates close to the new development suffered from two major flood events; including foul water inundation, the drowning out of sewer overflows and intense flash flooding. These floods at first gave rise to the public perception that the new development had caused the flooding. During a research project entitled 'making space for water', the instrumentation of the river in the area and the SUDs took place. The hydrological data this produced has given rise to a mixture of positive and negative aspects of SUDs implementation. The cause of one flood was due to the drowning out of key sewer overflows by locally generated by urban flood flow arising from an upstream estate. The second flood was caused by a 48 hour storm event giving rise to high runoff from the rural area again drowning out key sewer overflows. The SUDs were found to perform well during storm events and do not increase runoff from the new estates. The main fundamental complaint is that despite such

  10. Un cas de leishmaniose féline disséminée dans le sud de la France

    PubMed Central

    Pocholle, E.; Reyes-Gomez, E.; Giacomo, A.; Delaunay, P.; Hasseine, L.; Marty, P.

    2012-01-01

    Cet article rapporte un cas de leishmaniose féline disséminée chez un chat (Felis catus) de 14 ans, séropositif pour le FIV et vivant dans les Alpes-Maritimes (sud de la France). Le chat présente des papules érythémateuses ulcérées sur la face et l’encolure, et une lésion proliférative ulcérée sur l’oreille gauche. C’est l’examen histopathologique des lésions cutanées qui permet le diagnostic d’une leishmaniose disséminée, associée à un carcinome épidermoïde de l’oreille. 100 mg d’allopurinol administrés une fois par jour per os pendant quatre mois ont permis la rémission totale des lésions cutanées. Des prélèvements post mortem ont révélé la persistance du parasite dans l’organisme après six mois de traitement. Cet article discute de la sensibilité du chat à la leishmaniose et de son rôle potentiel de réservoir. PMID:22314243

  11. Maximizing Effectiveness Trials in PTSD and SUD Through Secondary Analysis: Benefits and Limitations Using the National Institute on Drug Abuse Clinical Trials Network “Women and Trauma” Study as a Case Example

    PubMed Central

    Hien, Denise A.; Campbell, Aimee N.C.; Ruglass, Lesia M.; Saavedra, Lissette; Mathews, Abigail G.; Kiriakos, Grace; Morgan-Lopez, Antonio

    2015-01-01

    Recent federal legislation and a renewed focus on integrative care models underscore the need for economical, effective, and science-based behavioral health care treatment. As such, maximizing the impact and reach of treatment research is of great concern. Behavioral health issues, including the frequent co-occurrence of substance use disorders (SUD) and posttraumatic stress disorder (PTSD), are often complex, with a myriad of factors contributing to the success of interventions. Although treatment guides for comorbid SUD/PTSD exist, most patients continue to suffer symptoms following the prescribed treatment course. Further, the study of efficacious treatments has been hampered by methodological challenges (e.g., overreliance on “superiority” designs (i.e., designs structured to test whether or not one treatment statistically surpasses another in terms of effect sizes) and short term interventions). Secondary analyses of randomized controlled clinical trials offer potential benefits to enhance understanding of findings and increase the personalization of treatment. This paper offers a description of the limits of randomized controlled trials as related to SUD/PTSD populations, highlights the benefits and potential pitfalls of secondary analytic techniques, and uses a case example of one of the largest effectiveness trials of behavioral treatment for co-occurring SUD/PTSD conducted within the National Drug Abuse Treatment Clinical Trials Network (NIDA CTN) and producing 19 publications. The paper concludes with implications of this secondary analytic approach to improve addiction researchers’ ability to identify best practices for community-based treatment of these disorders. Innovative methods are needed to maximize the benefits of clinical studies and better support SUD/PTSD treatment options for both specialty and non-specialty healthcare settings. Moving forward, planning for and description of secondary analyses in randomized trials should be given equal

  12. Maximizing Effectiveness Trials in PTSD and SUD Through Secondary Analysis: Benefits and Limitations Using the National Institute on Drug Abuse Clinical Trials Network "Women and Trauma" Study as a Case Example.

    PubMed

    Hien, Denise A; Campbell, Aimee N C; Ruglass, Lesia M; Saavedra, Lissette; Mathews, Abigail G; Kiriakos, Grace; Morgan-Lopez, Antonio

    2015-09-01

    Recent federal legislation and a renewed focus on integrative care models underscore the need for economical, effective, and science-based behavioral health care treatment. As such, maximizing the impact and reach of treatment research is of great concern. Behavioral health issues, including the frequent co-occurrence of substance use disorders (SUD) and posttraumatic stress disorder (PTSD), are often complex, with a myriad of factors contributing to the success of interventions. Although treatment guides for comorbid SUD/PTSD exist, most patients continue to suffer symptoms following the prescribed treatment course. Further, the study of efficacious treatments has been hampered by methodological challenges (e.g., overreliance on "superiority" designs (i.e., designs structured to test whether or not one treatment statistically surpasses another in terms of effect sizes) and short term interventions). Secondary analyses of randomized controlled clinical trials offer potential benefits to enhance understanding of findings and increase the personalization of treatment. This paper offers a description of the limits of randomized controlled trials as related to SUD/PTSD populations, highlights the benefits and potential pitfalls of secondary analytic techniques, and uses a case example of one of the largest effectiveness trials of behavioral treatment for co-occurring SUD/PTSD conducted within the National Drug Abuse Treatment Clinical Trials Network (NIDA CTN) and producing 19 publications. The paper concludes with implications of this secondary analytic approach to improve addiction researchers' ability to identify best practices for community-based treatment of these disorders. Innovative methods are needed to maximize the benefits of clinical studies and better support SUD/PTSD treatment options for both specialty and non-specialty healthcare settings. Moving forward, planning for and description of secondary analyses in randomized trials should be given equal

  13. Laboratory based experiments to assess the use of green and food based compost to improve water quality in a Sustainable Drainage (SUDS) device such as a swale.

    PubMed

    Charlesworth, S M; Nnadi, E; Oyelola, O; Bennett, J; Warwick, F; Jackson, R; Lawson, D

    2012-05-01

    Many tonnes of compost are generated per year due to door step composting of both garden and kitchen waste. Whilst there are commercial outlets for the finer grade of compost (<10mm) in plant nurseries, there is little demand for the coarser material (>25 mm). This paper reports part of a WRAP-sponsored (Waste Resources Action Programme) study which investigated the potential for green (GC) and mixed green and food (MC) composts to be incorporated into Sustainable Drainage (SUDS) devices such as swales, and replace the topsoil (TS) onto which turf is laid or grass seed distributed. However, it is not known whether compost can replace TS in terms of pollutant remediation, both the trapping of polluted particulates and in dealing with hydrocarbons such as oil, but also from a biofilm development and activity perspective. Using laboratory based experiments utilising leaching columns and an investigation of microbiological development in the composts studied, it was found that many of the differences in performance between MC and GC were insignificant, whilst both composts performed better in terms of pollutant retention than TS. Mixed compost in particular could be used in devices where there may be oil spillages, such as the lorry park of a Motorway Service Area due to its efficiency in degrading oil. Samples of GC and MC were found to contain many of the bacteria and fungi necessary for an active and efficient biofilm which would be an argument in their favour for replacement of TS and incorporation in swales.

  14. Design of the axial beam line for the injection of high intensity beams into the Laboratorio Nazionale del Sud superconducting cyclotron

    NASA Astrophysics Data System (ADS)

    Gammino, S.; Ciavola, G.

    1996-03-01

    At Laboratorio Nazionale del Sud the superconducting electron cyclotron resonance source SERSE will be used as injector for the K-800 Superconducting Cyclotron which in the future will provide the intense light ion beams to be used as primary beams for the radioactive beam project EXCYT. The goal is to inject and accelerate a few pμA of fully stripped carbon and oxygen into the cyclotron with an emittance as close as possible to the typical acceptance of the cyclotron, which should be in the order of 50π mm mrad. The study of the beam line has been carried out by taking into account both the phase space growth due to space charge and the aberrations inside the magnets. The design has been based on the results of different codes (TRANSPORT, GIOSP, PARMILA). A few details on the diagnostics will also be given. The assembly of the beam line is scheduled for the summer of 1996, just before the transfer of the source SERSE from Grenoble to Catania.

  15. Les conjonctivites néonatales dans le canton de Glidji au Sud du Togo: une étude transversale à propos de 159 nouveau-nés

    PubMed Central

    Kokou, Vonor; Nidain, Maneh; Kassoula, Nononsaa Batomguela; Kwassi, Fiaty- Amenouvor; Meba, Banla; Patrice, Balo Komi

    2016-01-01

    Introduction Le but de l’étude était décrire les aspects épidémiologiques des conjonctivites néonatales dans le canton de Glidji au Sud du Togo. Methodes Nous avons mené une étude transversale dans les 4 Unités Sanitaires Périphériques du canton de Glidji du 19 Mars au 13 Mai 2009 soit 8 semaines. Tous les nouveau-nés ont été inclus et la conjonctivite néonatale était définie par la présence chez un nouveau-né d'au moins deux des signes suivants: hyperhémie conjonctivale, œdème palpébral, chémosis, sécrétions purulentes, larmoiement. Les paramètres étudiés étaient l’âge, le sexe, les facteurs de risque, les antécédents, la présence ou non de conjonctivite, les germes en causes et l’évolution sous traitement. Resultats Sur la période, 159 nouveau-nés ont été examinés. L’âge moyen était de 10,9 jours avec des extrêmes de 0 à 28 jours. Il y avait 80 garçons pour 79 filles soit un sex-ratio de 1,01. Sur les 159 nouveau-nés, 7 cas de conjonctivite ont été diagnostiqués soit une prévalence de 4,4%. Les facteurs de risque identifiés étaient l'accouchement par voie basse et la présence d'IST chez la mère pendant la grossesse. Sur les 7 cas de conjonctivite, l'examen cytobactériologique a permis d'isoler le staphylococcus aureus dans 2 cas. L’évolution des cas de conjonctivite sous traitement était favorable avec régression des signes dès le 3è jour. Conclusion Les conjonctivites néonatales avaient une prévalence de 4,4% dans le canton de Glidji au sud du Togo et le staphylocoque doré était le germe en cause. Leur prévention passe par un bon suivi lors de la consultation prénatale et l'instillation de collyre antibiotique à la naissance PMID:27642383

  16. Expeditions INDIEN-SUD-1 &2 : Variations of the Antarctic Circumpolar Current (ACC) and of the Austral ocean in the Kerguelen sector during the Deglaciation and the last Climatic Cycles

    NASA Astrophysics Data System (ADS)

    Mazaud, Alain; Michel, Elisabeth; Crosta, Xavier; Eynaud, Frederique; Paterne, Martine; Bout-Roumazeilles, Viviane; Jaccard, Samuel

    2015-04-01

    IndienSud-1 and 2 expeditions aboard the RV Marion-Dufresne were conducted in 2011 and 2012 in the Kerguelen sector of the South Indian Ocean. Objectives are to document past ocean circulation changes, in particular the variations of the Antarctic Circumpolar Current (ACC), as well as oceanic temperature variability and frontal movement, during the last climatic cycles, with a focus on the last deglaciation. Sedimentary archives collected with the Casq and Calypso coring systems of the RV Marion-Dufresne allow producing high-resolution, well-dated sedimentary records. Comparaisons with exisiting records from other ocean-continental-glaciological archives allow examining the mechanisms involved, with a close attention paid to the temporal phasing between ocean and atmosphere proxy records, at both regional- and hemispheric scales. Past Changes in the intensity of the ACC are investigated using environmental magnetism methods, which trace amount and size of sedimentary magnetic grains. Oxygen isotopes and foraminifera faunal assemblages trace hydrological and temperature changes, while vertical mixing is documented by δ13C. A precise age scale will be derived from 14C ages determinations, augmented by regional correlations (magnetic susceptibility) to well-dated cores in the same area, thanks to a tephrochronological study of the marine cores and peat cores from the Kerguelen archipelago. Results document a stronger ACC current during glacial intervals than during interglacials over at least the last 600 kyrs. This pattern is opposite to observations of flow of the NADW branch (WBUC) south of Greenland in the North Atlantic Ocean. It suggests an inter-hemispheric antiphasing between ACC and NADW at Milankovitch timescales, with a strong circulation in the deep North Atlantic when the ACC is weak, and vice versa (thus with an ACC correlated with the GNAIW intensity). During the last deglaciation, temperature and vertical mixing increased prior to changes in the ACC

  17. CHIMERA Multidetector at Laboratori Nazionali del Sud

    SciTech Connect

    Aiello, S.; Anzalone, A.; Baldo, M.; Barna, R.; Campisi, M.g.; Cardella, G.; Cavallaro, Sl., Amico, V.D.; De Filippo, E.; DePasquale, D.; Femino, S.; Geraci, E.; Giustolisi, F.; Guazzoni, P.; Iacono-Manno, C.M.; Italiano, A.; Lanzalone, G.; Lanzano, G.; LoNigro, S.; Lombardo, U.; Manfredi, G.; Pagano, A.; Papa, M.; Pirrone, S.; Politi, G.; Porto, F.; Sambataro, S.; Sperduto, M.L.; Sutera, C.M.; Zetta, L.

    2000-12-31

    The installation of CHIMERA multidetector, designed in order to study central collisions in heavy ion reactions at intermediate energy, is going on at LNS and the first experiment with the forward part (688 telescopes) is running since May 1999. The aim of this contribution is to present the status of the project.

  18. Predicted airframe noise levels

    NASA Technical Reports Server (NTRS)

    Raney, J. P.

    1980-01-01

    Calculated values of airframe noise levels corresponding to FAA noise certification conditions for six aircraft are presented. The aircraft are: DC-9-30; Boeing 727-200; A300-B2 Airbus; Lockheed L-1011; DC-10-10; and Boeing 747-200B. The prediction methodology employed is described and discussed.

  19. 76 FR 9984 - Airworthiness Directives; B/E Aerospace, Continuous Flow Passenger Oxygen Mask Assembly, Part...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-02-23

    ... CONTACT: David Fairback, Aerospace Engineer, Wichita Aircraft Certification Office, FAA, 1801 Airport Road..., amendment 39-15308 (72 FR 71210, December 17, 2007), for certain Boeing Model 747-200B, 747-300, and 747-400...-08, amendment 39-15460 (73 FR 19982, April 14, 2008), for certain Boeing Model 757-200,...

  20. Assessment and Diagnosis of the Substance Use Disorders (SUDs).

    ERIC Educational Resources Information Center

    Evans, William N.

    1998-01-01

    A brief history of Substance Use Disorders in the Diagnostic and Statistical Manual of Mental Disorders is presented, and the symptoms of substance dependence are presented. Substance dependence is distinguished from substance abuse. Assessment instruments, including laboratory tests and interviews for diagnosing substance use disorders, are…

  1. Traceurs sédimentaires des variations du niveau marin et de la mousson sud-est asiatique depuis 450 ka en mer de Chine du Sud

    NASA Astrophysics Data System (ADS)

    Boulay, Sébastien; Colin, Christophe; Trentesaux, Alain

    2008-06-01

    In order to reconstruct the past variations of the Southeast Asian monsoon intensity and estimate the sedimentary system reactivity to climatic changes in Southeast Asia over the last 450 kyr, mineralogical and sedimentological analyses have been performed on the terrigenous fraction of the South China Sea sediment. End-member modelling coupled with grain size data discriminates three end-members that determine the nature and intensity of the main sediment transport vectors. Low sea-level stands are characterized by sediment reworking that allows transportation of a coarse end-member (20-40 μm) to the deep-basin. By contrast, the other end-members (4-6 μm; 9-13 μm) are controlled by the shoreline position (sea level) and/or by changes of the rivers capacity transport (monsoon). Finally, aeolian input to the northern margin of the South China Sea can be considered negligible compared to the massive fluvial input and the reworking of the sediments.

  2. SU-D-18A-04: Quantifying the Ability of Tumor Tracking to Spare Normal Tissue

    SciTech Connect

    Burger, A; Buzurovic, I; Hurwitz, M; Williams, C; Lewis, J; Mishra, P; Seco, J

    2014-06-01

    Purpose: Tumor tracking allows for smaller tissue volumes to be treated, potentially reducing normal tissue damage. However, tumor tracking is a more complex treatment and has little benefit in some scenarios. Here we quantify the benefit of tumor tracking for a range of patients by estimating the dose of radiation to organs at risk and the normal tissue complication probability (NTCP) for both standard and tracking treatment plans. This comparison is performed using both patient 4DCT data and extended Cardiac-Torso (XCAT) digital phantoms. Methods: We use 4DCT data for 10 patients. Additionally, we generate digital phantoms with motion derived from measured patient long tumor trajectories to compare standard and tracking treatment plans. The standard treatment is based on the average intensity projection (AIP) of 4DCT images taken over a breath cycle. The tracking treatment is based on doses calculated on images representing the anatomy at each time point. It is assumed that there are no errors in tracking the target. The NTCP values are calculated based on RTOG guidelines. Results: The mean reduction in the mean dose delivered was 5.5% to the lungs (from 7.3 Gy to 6.9 Gy) and 4.0% to the heart (from 12.5 Gy to 12.0 Gy). The mean reduction in the max dose delivered was 13% to the spinal cord (from 27.6 Gy to 24.0 Gy), 2.5% to the carina (from 31.7 Gy to 30.9 Gy), and 15% to the esophagus (from 69.6 Gy to 58.9 Gy). The mean reduction in the probability of 2nd degree radiation pneumonitis (RP) was 8.7% (3.1% to 2.8%) and the mean reduction in the effective volume was 6.8% (10.8% to 10.2%). Conclusions: Tumor tracking has the potential to reduce irradiation of organs at risk, and consequentially reduce the normal tissue complication probability. The benefits vary based on the clinical scenario. This study is supported by Varian Medical Systems, Inc.

  3. SU-D-210-03: Limited-View Multi-Source Quantitative Photoacoustic Tomography

    SciTech Connect

    Feng, J; Gao, H

    2015-06-15

    Purpose: This work is to investigate a novel limited-view multi-source acquisition scheme for the direct and simultaneous reconstruction of optical coefficients in quantitative photoacoustic tomography (QPAT), which has potentially improved signal-to-noise ratio and reduced data acquisition time. Methods: Conventional QPAT is often considered in two steps: first to reconstruct the initial acoustic pressure from the full-view ultrasonic data after each optical illumination, and then to quantitatively reconstruct optical coefficients (e.g., absorption and scattering coefficients) from the initial acoustic pressure, using multi-source or multi-wavelength scheme.Based on a novel limited-view multi-source scheme here, We have to consider the direct reconstruction of optical coefficients from the ultrasonic data, since the initial acoustic pressure can no longer be reconstructed as an intermediate variable due to the incomplete acoustic data in the proposed limited-view scheme. In this work, based on a coupled photo-acoustic forward model combining diffusion approximation and wave equation, we develop a limited-memory Quasi-Newton method (LBFGS) for image reconstruction that utilizes the adjoint forward problem for fast computation of gradients. Furthermore, the tensor framelet sparsity is utilized to improve the image reconstruction which is solved by Alternative Direction Method of Multipliers (ADMM). Results: The simulation was performed on a modified Shepp-Logan phantom to validate the feasibility of the proposed limited-view scheme and its corresponding image reconstruction algorithms. Conclusion: A limited-view multi-source QPAT scheme is proposed, i.e., the partial-view acoustic data acquisition accompanying each optical illumination, and then the simultaneous rotations of both optical sources and ultrasonic detectors for next optical illumination. Moreover, LBFGS and ADMM algorithms are developed for the direct reconstruction of optical coefficients from the acoustic data. Jing Feng and Hao Gao were partially supported by the NSFC (#11405105), the 973 Program (#2015CB856000) and the Shanghai Pujiang Talent Program (#14PJ1404500)

  4. Impact of Relapse Predictors on Psychosocial Functioning of SUD Youth One Year after Treatment

    ERIC Educational Resources Information Center

    Anderson, Kristen G.; Ramo, Danielle E.; Schulte, Marya T.; Cummins, Kevin; Brown, Sandra A.

    2008-01-01

    This investigation examined how personal, environmental and substance use factors predicted psychosocial functioning for youth with alcohol and drug problems. Four hundred twenty-four adolescents (M = 15.9, SD = 1.3) completed comprehensive assessments, including personal characteristics (e.g., Axis I diagnosis, motivation, self-esteem),…

  5. SU-D-213-01: Transparent Photon Detector For The Online Monitoring Of IMRT Beams

    SciTech Connect

    Delorme, R; Arnoud, Y; Fabbro, R; Boyer, B; Rossetto, O; Gallin-Martel, L; Gallin-Martel, M; Pelissier, A; Fonteille, I

    2015-06-15

    Purpose: An innovative Transparent Detector for Radiotherapy (TraDeRa) has been developed. The detector aims at real-time monitoring of modulated beam ahead of the patient during delivery sessions, with a field cover up to 40×40 cm {sup 2}. Methods: TraDeRa consists in a pixelated matrix of ionization chambers with a patented electrodes design. An in-house designed specific integrated circuit allows to extract the signal and provides a real-time map of beam intensity and shape, at the linac pulse-scale. The measurements under irradiation are made with a 6 MV clinical X-Ray beam. Dose calculations are performed with the Monte Carlo code PENELOPE, modeling the full accelerator head and the TraDeRa detector. Results: A 2 % attenuation of the beam was measured in the presence of TraDeRa and the PENELOPE dosimetric study showed no significant modification of the photon beam properties. TraDeRa detects error leaf position as small as 1 mm compared to a reference field, for both static and modulated fields. In addition, measurements are accurate over a large dynamic range from low intensity signals, as inter-leaves leaks, to very high intensities as obtained on the medical line of the European Synchrotron Radiation Facility. The detector is fully operational for conventional and high dose rate beams as FFF modes (up to 2400 MU/min). Conclusion: The current version of TraDeRa shows promising results for IMRT quality assurance (QA), allowing pulse-scale monitoring of the beam and high sensitivity for errors detection. The attenuation is small enough not to hinder the irradiation while keeping the beam upstream of the patient under constant control. A final prototype under development will include 1600 independent electrodes, half of them with a high resolution centered on the beam axis. This compact detector provides an independent set of measurements for a better QA. Funding support : This work was supported by the LABEX PRIMES (ANR-11-LABX-0063) of Universite de Lyon, within the program “Investissements d’Avenir” (ANR-11-IDEX-0007) operated by the French National Research Agency (ANR) and within the project “INSPIRA” operated by the OSEO institution.

  6. SU-D-9A-03: STAMP: Simulator for Texture Analysis in MRI/PET

    SciTech Connect

    Laberge, S; Vallieres, M; Levesque, I R.; El Naqa, I

    2014-06-01

    Purpose: To develop a convenient simulation platform to facilitate PET/MR image analysis with the prospect of gaining a better understanding of the influence of acquisition parameters on PET/MRI textural features. The simulation platform is demonstrated by showing textural variations of a representative case study using different image acquisition parameters. Methods: The simulation platform is composed of MRI simulators JEMRIS and SIMRI to achieve simulations of customized MRI sequences on sample tumor models. The PET simulator GATE is used to get 2D and 3D Monte Carlo acquisitions of voxelized PET sources using a phantom geometry and a customized scanner architecture. The platform incorporates a series of graphical user interfaces written in Matlab. Two GUIs are used to facilitate communication with the simulation executables installed on a computer cluster. A third GUI is used to collect and display the clinical and simulated images, as well as fused PET/MRI images, and perform computation of textural features.To illustrate the capabilities of this platform, one FDG-PET and T1-weighted (T1w) digitized tumor models were generated from clinical images of a soft-tissue sarcoma patient. Numerically simulated MR images were produced using 3 different echo times (TE) and 5 different repetition times (TR). PET 2D images were simulated using an OSEM algorithm with 1 to 32 iterations and a post-reconstruction Gaussian filter of 0, 2, 4 or 6 mm width. Results: STAMP was successfully used to produce numerically simulated FDG-PET and MRI images, and to calculate their corresponding textures. Three typical textures (GLCM-Contrast, GLSZM-ZSV and NGTDM-Coarseness) were found to vary by a range of 45% on average compared to reference scanning conditions in the case of FDG-PET, and by a range of 40% in the case of T1w MRI. Conclusion: We have successfully developed a Matlab-based simulation platform to facilitate PET/MRI texture image analysis for outcome prediction.

  7. SU-D-210-04: Using Radiotherapy Biomaterials to Brand and Track Deadly Cancer Cells

    SciTech Connect

    Altundal, Y; Sajo, E; Ngwa, W

    2015-06-15

    Purpose: Metastasis accounts for over 90% of all cancer associated suffering and death and arguably presents the most formidable challenges in cancer management. The detection of metastatic or rare circulating tumor cells (CTCs) in blood or lymph nodes remains a formidable technological challenge. In this study, we investigated the time needed to label each cancer cell in-situ (right at the source tumor) with sufficient number of GNPs that will allow enhanced non-invasive detection via photoacoustic imaging in the lymph nodes. Such in-situ labeling can be achieved via sustained release of the GNPs from Radiotherapy (RT) biomaterials (e.g. fiducials, spacers) coated/loaded with the GNP. Methods: The minimum concentration (1000 GNPs/cell for 50nm GNPs) to detect GNPs with photoacoustic imaging method was experimentally measured by Mallidi et al. and fixed at the tumor sub-volume periphery. In this work, the GNPs were assumed to diffuse from a point source, placed in the middle of a 2–3cm tumor, with an initial concentration of 7–30 mg/g. The time required to label the cells with GNPs was calculated by solving the three dimensional diffusion-reaction equation analytically. The diffusion coefficient of 10nm GNPs was experimentally determined previously. Stokes-Einstein equation was used to calculate the diffusion coefficients for other sizes (2–50nm) of GNPs. The cellular uptake rate constants for several sizes of GNPs were experimentally measured by Jin et al. Results: The time required to label the cells was found 0.635–15.91 days for 2–50nm GNPs with an initial concentration of 7 mg/g GNPs in a 2 cm tumor; 1.379–34.633 days for 2–50nm GNPs with an initial concentration of 30 mg/g GNPs in a 3cm tumor. Conclusion: Our results highlight new potential for labeling CTCs with GNPs released from smart RT biomaterials (i.e. fiducials or spacers loaded with the GNP) towards enhanced non-invasive imaging/detection via photoacoustic imaging.

  8. SU-D-304-07: Application of Proton Boron Fusion Reaction to Radiation Therapy

    SciTech Connect

    Jung, J; Yoon, D; Shin, H; Kim, M; Suh, T

    2015-06-15

    Purpose: we present the introduction of a therapy method using the proton boron fusion reaction. The purpose of this study is to verify the theoretical validity of proton boron fusion therapy using Monte Carlo simulations. Methods: After boron is accumulated in the tumor region, the emitted from outside the body proton can react with the boron in the tumor region. An increase of the proton’s maximum dose level is caused by the boron and only the tumor cell is damaged more critically. In addition, a prompt gamma ray is emitted from the proton boron reaction point. Here we show that the effectiveness of the proton boron fusion therapy (PBFT) was verified using Monte Carlo simulations. Results: We found that a dramatic increase by more than half of the proton’s maximum dose level was induced by the boron in the tumor region. This increase occurred only when the proton’s maximum dose point was located within the boron uptake region (BUR). In addition, the 719 keV prompt gamma ray peak produced by the proton boron fusion reaction was positively detected. Conclusion: This therapy method features the advantages such as the application of Bragg-peak to the therapy, the accurate targeting of tumor, improved therapy effects, and the monitoring of the therapy region during treatment.

  9. SU-D-213-06: Dosimetry of Modulated Electron Radiation Therapy Using Fricke Gel Dosimeter

    SciTech Connect

    Gawad, M Abdel; Elgohary, M; Hassaan, M; Emam, M; Desouky, O; Eldib, A; Ma, C

    2015-06-15

    Purpose: Modulated electron radiation therapy (MERT) has been proposed as an effective modality for treatment of superficial targets. MERT utilizes multiple beams of different energies which are intensity modulated to deliver optimized dose distribution. Energy independent dosimeters are thus needed for quantitative evaluations of MERT dose distributions and measurements of absolute doses delivered to patients. Thus in the current work we study the feasibility of Fricke gel dosimeters in MERT dosimetry. Methods: Batches of radiation sensitive Fricke gel is fabricated and poured into polymethyl methacrylate cuvettes. The samples were irradiated in solid water phantom and a thick layer of bolus was used as a buildup. A spectrophotometer system was used for measuring the color changes (the absorbance) before and after irradiation and then we calculate net absorbance. We constructed calibration curves to relate the measured absorbance in terms of absorbed dose for all available electron energies. Dosimetric measurements were performed for mixed electron beam delivery and we also performed measurement for segmented field delivery with the dosimeter placed at the junction of two adjacent electron beams of different energies. Dose measured by our gel dosimetry is compared to that calculation from our precise treatment planning system. We also initiated a Monte Carlo study to evaluate the water equivalence of our dosimeters. MCBEAM and MCSIM codes were used for treatment head simulation and phantom dose calculation. PDDs and profiles were calculated for electron beams incident on a phantom designed with 1cm slab of Fricke gel. Results: The calibration curves showed no observed energy dependence with all studied electron beam energies. Good agreement was obtained between dose calculated and that obtained by gel dosimetry. Monte Carlo results illustrated the tissue equivalency of our Gel dosimeters. Conclusion: Fricke Gel dosimeters represent a good option for the dosimetric quality assurance prior to MERT application.

  10. SU-D-18A-05: Assessing Elekta MLC Tracking Performance

    SciTech Connect

    Glitzner, M; Crijns, S; Lagendijk, J; Raaymakers, B

    2014-06-01

    Purpose: To investigate the technical feasibility of using Elekta MLCs in tracked radiotherapy, specifically to show the capability of an Agility MLC to follow model tumor trajectories using object tracking. The system performance of the MLC is to be assessed via dosimetric experiments and temporal response measures. Methods: The system observer in the tracking cascade consisted of a camera serving for this proof of concept; Images of a moving object were acquired continuously and decorrelated for the position information, which was fed forward to the RT computer controlling the MLC via an interface provided by Elekta. The 1D motion (in the direction of the leaves) was induced by a CIRS motion controller. Additionally, the aperture position was observed by means of the light field of the linac. Calculating the phase between aperture and object yielded the mean aperture lag for the current setup. The object was restricted to sinusoidal motion with a period of 10s. For dosimetry, GafChromic radiosensitive film was irradiated with a total dose of 1000MU using an aperture size of 40mm and a motion range of 30mm. Results: Object tracking can substantially reconstruct the geometric dose response of a static target. In the dynamic case, dose is smeared out into the legs of the static distribution, leading to a reduced plateau and increased FWHM of 5mm, compared to the static width of 38mm. The time-lag between object and aperture was determined to be approximately 300ms for the current set-up. Conclusion: We demonstrated a tracking experiment performed on a clinical Elekta linear accelator for the first time. Observed profile variations show the dosimetric impact of tracked delivery. The determined lag is a valuable descriptor for a future tracking cascade employing predictor filters. The performed experiments are generic and possible predecessors for future applications with MR-Linac or ultrasound probes. Conflict of interest: this project is partly funded by Elekta.

  11. SU-D-304-02: Magnetically Focused Proton Irradiation of Small Field Targets

    SciTech Connect

    McAuley, GA; Slater, JM; Slater, JD; Wroe, AJ

    2015-06-15

    Purpose: To investigate the use of magnetic focusing for small field proton irradiations. It is hypothesized that magnetic focusing will provide significant dose distribution benefits over standard collimated beams for fields less than 10 mm diameter. Methods: Magnets consisting of 24 segments of radiation hard samarium-cobalt adhered into hollow cylinders were designed and manufactured. Two focusing magnets were placed on a positioning track on our Gantry 1 treatment table. Proton beams with energies of 127 and 157 MeV, 15 and 30 mm modulation, and 8 mm initial diameters were delivered to a water tank using single-stage scattering. Depth dose distributions were measured using a PTW PR60020 diode detector and transverse profiles were measured with Gafchromic EBT3 film. Monte Carlo simulations were also performed - both for comparison with experimental data and to further explore the potential of magnetic focusing in silica. For example, beam spot areas (based on the 90% dose contour) were matched at Bragg depth between simulated 100 MeV collimated beams and simulated beams focused by two 400 T/m gradient magnets. Results: Preliminary experimental results show 23% higher peak to entrance dose ratios and flatter spread out Bragg peak plateaus for 8 mm focused beams compared with uncollimated beams. Monte Carlo simulations showed 21% larger peak to entrance ratios and a ∼9 fold more efficient dose to target delivery compared to spot-sized matched collimated beams. Our latest results will be presented. Conclusion: Our results suggest that rare earth focusing magnet assemblies could reduce skin dose and beam number while delivering dose to nominally spherical radiosurgery targets over a much shorter time compared to unfocused beams. Immediate clinical applications include those associated with proton radiosurgery and functional radiosurgery of the brain and spine, however expanded treatment sites can be also envisaged.

  12. 78 FR 52568 - TUV SUD America, Inc.: Modification of Scope of Recognition

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-08-23

    ...)), Secretary of Labor's Order No. 1-2012 (77 FR 3912, Jan. 25, 2012), and 29 CFR 1910.7. Signed at Washington... public that it is deleting the test standards (1) UL 551 Transformer-type Arc-welding Machine, (2)...

  13. SU-D-16A-06: Modeling Biological Effects of Residual Uncertainties For Stereotactic Radiosurgery

    SciTech Connect

    Ma, L; Larson, D; McDermott, M; Sneed, P; Sahgal, A

    2014-06-01

    Purpose: Residual uncertainties on the order of 1-2 mm are frequently observed when delivering stereotactic radiosurgery via on-line imaging guidance with a relocatable frame. In this study, a predictive model was developed to evalute potentiral late radiation effects associated with such uncertainties. Methods: A mathematical model was first developed to correlate the peripherial isodose volume with the internal and/or setup margins for a radiosurgical target. Such a model was then integrated with a previoulsy published logistic regression normal tissue complication model for determining the symptomatic radiation necrosis rate at various target sizes and prescription dose levels. The model was tested on a cohort of 15 brain tumor and tumor resection cavity patient cases and model predicted results were compared with the clinical results reported in the literature. Results: A normalized target diameter (D{sub 0}) in term of D{sub 0} = 6V/S, where V is the volume of a radiosurgical target and S is the surface of the target, was found to correlate excellently with the peripheral isodose volume for a radiosurgical delivery (logarithmic regression R{sup 2} > 0.99). The peripheral isodose volumes were found increase rapidly with increasing uncertainties levels. In general, a 1-mm residual uncertainties as calculated to result in approximately 0.5%, 1%, and 3% increases in the symptomatic radiation necrosis rate for D{sub 0} = 1 cm, 2 cm, and 3 cm based on the prescription guideline of RTOG 9005, i.e., 21 Gy to a lesion of 1 cm in diameter, 18 Gy to a lesion 2 cm in diameter, and 15 Gy to a lesion 3 cm in diameter respectively. Conclusion: The results of study suggest more stringent criteria on residual uncertainties are needed when treating a large target such as D{sub 0}≤ 3 cm with stereotactic radiosurgery. Dr. Ma and Dr. Sahgal are currently serving on the board of international society of stereotactic radiosurgery (ISRS)

  14. Dismantling of the 904 Cell at the HAO/Sud Facility - 13466

    SciTech Connect

    Vaudey, C.E.; Crosnier, S.; Renouf, M.; Gaspard, N.; Pinot, L.

    2013-07-01

    La Hague facility, in France, is the spent fuel recycling plant wherein a part of the fuel coming from some of the French, German, Belgian, Swiss, Dutch and Japanese nuclear reactors is reprocessed before being recycled in order to separate certain radioactive elements. The facility has been successively handled by the CEA (1962-1978), Cogema (1978-2006), and AREVA NC (since 2006). La Hague facility is composed of 3 production units: The UP2-400 production unit started to be operated in 1966 for the reprocessing of UNGG metal fuel. In 1976, following the dropout of the graphite-gas technology by EDF, an HAO workshop to reprocess the fuel from the light water reactors is affiliated and then stopped in 2003. - UP2-400 is partially stopped in 2002 and then definitely the 1 January 2004 and is being dismantled - UP2-800, with the same capacity than UP3, started to be operated in 1994 and is still in operation. And UP3 - UP3 was implemented in 1990 with an annual reprocessing capacity of 800 tons of fuel and is still in operation The combined licensed capacity of UP2-800 and UP3 is 1,700 tons of used fuel. (authors)

  15. Highlighting the Impacts of North-South Research Collaboration among Canadian and Southern Higher Education Partners (Principaux impacts des collaborations de recherche Nord-Sud entre les partenaires des etablissements d'enseignement superieur du Canada et du Sud)

    ERIC Educational Resources Information Center

    Association of Universities and Colleges of Canada, 2006

    2006-01-01

    The Association of Universities and Colleges of Canada (AUCC) felt it was timely to create an academic forum in which university researchers have the opportunity to engage with their peers and relevant stakeholders and document the impacts of their North-South research collaboration in a peer-reviewed publication. The Association achieved this by…

  16. SU-D-18C-01: A Novel 4D-MRI Technology Based On K-Space Retrospective Sorting

    SciTech Connect

    Liu, Y; Yin, F; Cai, J

    2014-06-01

    Purpose: Current 4D-MRI techniques lack sufficient temporal/spatial resolution and consistent tumor contrast. To overcome these limitations, this study presents the development and initial evaluation of an entirely new framework of 4D-MRI based on k-space retrospective sorting. Methods: An important challenge of the proposed technique is to determine the number of repeated scans(NR) required to obtain sufficient k-space data for 4D-MRI. To do that, simulations using 29 cancer patients' respiratory profiles were performed to derive the relationship between data acquisition completeness(Cp) and NR, also relationship between NR(Cp=95%) and the following factors: total slice(NS), respiratory phase bin length(Lb), frame rate(fr), resolution(R) and image acquisition starting-phase(P0). To evaluate our technique, a computer simulation study on a 4D digital human phantom (XCAT) were conducted with regular breathing (fr=0.5Hz; R=256×256). A 2D echo planer imaging(EPI) MRI sequence were assumed to acquire raw k-space data, with respiratory signal and acquisition time for each k-space data line recorded simultaneously. K-space data was re-sorted based on respiratory phases. To evaluate 4D-MRI image quality, tumor trajectories were measured and compared with the input signal. Mean relative amplitude difference(D) and cross-correlation coefficient(CC) are calculated. Finally, phase-sharing sliding window technique was applied to investigate the feasibility of generating ultra-fast 4D-MRI. Result: Cp increased with NR(Cp=100*[1-exp(-0.19*NR)], when NS=30, Lb=100%/6). NR(Cp=95%) was inversely-proportional to Lb (r=0.97), but independent of other factors. 4D-MRI on XCAT demonstrated highly accurate motion information (D=0.67%, CC=0.996) with much less artifacts than those on image-based sorting 4D-MRI. Ultra-fast 4D-MRI with an apparent temporal resolution of 10 frames/second was reconstructed using the phase-sharing sliding window technique. Conclusions: A novel 4D-MRI technology based on k-space sorting has been successfully developed and evaluated on the digital phantom. Framework established can be applied to a variety of MR sequences, showing great promises to develop the optimal 4D-MRI technique for many radiation therapy applications. NIH (1R21CA165384-01A1)

  17. SU-D-303-03: Impact of Uncertainty in T1 Measurements On Quantification of Dynamic Contrast Enhanced MRI

    SciTech Connect

    Aryal, M; Cao, Y

    2015-06-15

    Purpose: Quantification of dynamic contrast enhanced (DCE) MRI requires native longitudinal relaxation time (T1) measurement. This study aimed to assess uncertainty in T1 measurements using two different methods. Methods and Materials: Brain MRI scans were performed on a 3T scanner in 9 patients who had low grade/benign tumors and partial brain radiotherapy without chemotherapy at pre-RT, week-3 during RT (wk-3), end-RT, and 1, 6 and 18 months after RT. T1-weighted images were acquired using gradient echo sequences with 1) 2 different flip angles (50 and 150), and 2) 5 variable TRs (100–2000ms). After creating quantitative T1 maps, average T1 was calculated in regions of interest (ROI), which were distant from tumors and received a total of accumulated radiation doses < 5 Gy at wk-3. ROIs included left and right normal Putamen and Thalamus (gray matter: GM), and frontal and parietal white matter (WM). Since there were no significant or even a trend of T1 changes from pre-RT to wk-3 in these ROIs, a relative repeatability coefficient (RC) of T1 as a measure of uncertainty was estimated in each ROI using the data pre-RT and at wk-3. The individual T1 changes at later time points were evaluated compared to the estimated RCs. Results: The 2-flip angle method produced small RCs in GM (9.7–11.7%) but large RCs in WM (12.2–13.6%) compared to the saturation-recovery (SR) method (11.0–17.7% for GM and 7.5–11.2% for WM). More than 81% of individual T1 changes were within T1 uncertainty ranges defined by RCs. Conclusion: Our study suggests that the impact of T1 uncertainty on physiological parameters derived from DCE MRI is not negligible. A short scan with 2 flip angles is able to achieve repeatability of T1 estimates similar to a long scan with 5 different TRs, and is desirable to be integrated in the DCE protocol. Present study was supported by National Institute of Health (NIH) under grant numbers; UO1 CA183848 and RO1 NS064973.

  18. An environmental tracers approach to characterize groundwater recharge within a carbonate coastal aquifer (Corse-du-Sud, France)

    NASA Astrophysics Data System (ADS)

    Garel, Emilie; Huneau, Frederic; Khoumeri, Beatrice; Travi, Yves

    2013-04-01

    Bonifacio is a coastal city, highly touristic, located in the southest part of Corsica Island. One million people visit the city in July and August, whereas 3000 inhabitants live throughout the year. Bonifacio lies on a small limestone plateau with a potential aquifer poorly understood. Actually there is a strong need to characterize the hydrogeological behavior for the reason that the economic development of the region is highly dependent of the groundwater supply potential. The Miocene sedimentary basin of Bonifacio has an area of 25 km2 with a depth up to 250 m in the center. It is based and surrounded by a Hercynian granitic substratum. The basin is open to the Mediterranean Sea on its south and east sides. The formation is calcareous-sandstone and is divided in 3 sedimentary units. The upper unit is highly calcareous and sandstone with a pseudo-karstic morphology, the intermediary unit is more silty-sandstone than the last but less than the unit from below. To establish a conceptual model of the groundwater flows of the Bonifacio aquifer, a hydrochemical (major ions, δ18O, δ2H, 3H) and hydrodynamic investigation was carried out on 12 wells, 1 spring and 1 river since May 2011. Vertical recharge is dominant in the centre of the aquifer where unsaturated zone is thicker, while on the aquifer boundaries with the granitic area, lateral flow was significant. Environmental tracers approach had clearly showed the important role of the boundaries conditions for the groundwater flow behavior of the aquifer of Bonifacio and the necessity of an investigation larger than the aquifer itself due to its limited spatial extension.

  19. SU-D-204-01: Dual-Energy Calibration for Breast Density Measurement Using Spectral Mammography

    SciTech Connect

    Ding, H; Cho, H; Kumar, N; Sennung, D; Molloi, S

    2015-06-15

    Purpose: To investigate the feasibility of minimizing the systematic errors in dual-energy breast density quantification induced by the use of tissue-equivalent plastic phantoms as the calibration basis materials. Methods: Dual-energy calibration using tissue-equivalent plastic phantoms was performed on a spectral mammography system based on scanning multi-slit Si strip photon-counting detectors. The plastic phantom calibration used plastic water and adipose-equivalent phantoms as the basis materials, which have different x-ray attenuation properties compared to water and lipid in actual breast tissue. Two methods were used to convert the dual-energy decomposition measurements in plastic phantom thicknesses into true water and lipid basis. The first method was based entirely on the theoretical x-ray attenuation coefficients of the investigated materials in the mammographic energy range. The conversion matrix was determined from least-squares fitting of the target material using the reported attenuation coefficients of water and lipid. The second method was developed based on experimental calibrations, which measured the low-and high-energy signals of pure water and lipid of known thicknesses. A non-linear rational function was used to correlate the decomposed thicknesses to the known values, so that the conversion coefficients can be determined. Both methods were validated using independent measurements of water and lipid mixture phantoms. The correlation of the dual-energy decomposition measurements and the known values were studied with linear regression analysis. Results: There was an excellent linear correlation between the converted water thicknesses and the known values. The slopes of the linear fits were determined to be 0.63 and 1.03 for the simulation and experimental results, respectively. The non-linear fitting in the experimental approach reduced the root-mean-square (RMS) errors from approximately 3.4 mm to 1.5 mm. Conclusion: The results suggested that conversion of the dual-energy measurements into water and lipid thicknesses minimized the systematic errors in tissue decomposition studies.

  20. SU-D-207-04: GPU-Based 4D Cone-Beam CT Reconstruction Using Adaptive Meshing Method

    SciTech Connect

    Zhong, Z; Gu, X; Iyengar, P; Mao, W; Wang, J; Guo, X

    2015-06-15

    Purpose: Due to the limited number of projections at each phase, the image quality of a four-dimensional cone-beam CT (4D-CBCT) is often degraded, which decreases the accuracy of subsequent motion modeling. One of the promising methods is the simultaneous motion estimation and image reconstruction (SMEIR) approach. The objective of this work is to enhance the computational speed of the SMEIR algorithm using adaptive feature-based tetrahedral meshing and GPU-based parallelization. Methods: The first step is to generate the tetrahedral mesh based on the features of a reference phase 4D-CBCT, so that the deformation can be well captured and accurately diffused from the mesh vertices to voxels of the image volume. After the mesh generation, the updated motion model and other phases of 4D-CBCT can be obtained by matching the 4D-CBCT projection images at each phase with the corresponding forward projections of the deformed reference phase of 4D-CBCT. The entire process of this 4D-CBCT reconstruction method is implemented on GPU, resulting in significantly increasing the computational efficiency due to its tremendous parallel computing ability. Results: A 4D XCAT digital phantom was used to test the proposed mesh-based image reconstruction algorithm. The image Result shows both bone structures and inside of the lung are well-preserved and the tumor position can be well captured. Compared to the previous voxel-based CPU implementation of SMEIR, the proposed method is about 157 times faster for reconstructing a 10 -phase 4D-CBCT with dimension 256×256×150. Conclusion: The GPU-based parallel 4D CBCT reconstruction method uses the feature-based mesh for estimating motion model and demonstrates equivalent image Result with previous voxel-based SMEIR approach, with significantly improved computational speed.

  1. SU-D-207-01: Markerless Respiratory Motion Tracking with Contrast Enhanced Thoracic Cone Beam CT Projections

    SciTech Connect

    Chao, M; Yuan, Y; Rosenzweig, K; Lo, Y; Brousmiche, S

    2015-06-15

    Purpose: To develop a novel technique to enhance the image contrast of clinical cone beam CT projections and extract respiratory signals based on anatomical motion using the modified Amsterdam Shroud (AS) method to benefit image guided radiation therapy. Methods: Thoracic cone beam CT projections acquired prior to treatment were preprocessed to increase their contrast for better respiratory signal extraction. Air intensity on raw images was firstly estimated and then applied to correct the projections to generate new attenuation images that were subsequently improved with deeper anatomy feature enhancement through taking logarithm operation, derivative along superior-inferior direction, respectively. All pixels on individual post-processed two dimensional images were horizontally summed to one column and all projections were combined side by side to create an AS image from which patient’s respiratory signal was extracted. The impact of gantry rotation on the breathing signal rendering was also investigated. Ten projection image sets from five lung cancer patients acquired with the Varian Onboard Imager on 21iX Clinac (Varian Medical Systems, Palo Alto, CA) were employed to assess the proposed technique. Results: Application of the air correction on raw projections showed that more than an order of magnitude of contrast enhancement was achievable. The typical contrast on the raw projections is around 0.02 while that on attenuation images could greater than 0.5. Clear and stable breathing signal can be reliably extracted from the new images while the uncorrected projection sets failed to yield clear signals most of the time. Conclusion: Anatomy feature plays a key role in yielding breathing signal from the projection images using the AS technique. The air correction process facilitated the contrast enhancement significantly and attenuation images thus obtained provides a practical solution to obtaining markerless breathing motion tracking.

  2. SU-D-201-06: Random Walk Algorithm Seed Localization Parameters in Lung Positron Emission Tomography (PET) Images

    SciTech Connect

    Soufi, M; Asl, A Kamali; Geramifar, P

    2015-06-15

    Purpose: The objective of this study was to find the best seed localization parameters in random walk algorithm application to lung tumor delineation in Positron Emission Tomography (PET) images. Methods: PET images suffer from statistical noise and therefore tumor delineation in these images is a challenging task. Random walk algorithm, a graph based image segmentation technique, has reliable image noise robustness. Also its fast computation and fast editing characteristics make it powerful for clinical purposes. We implemented the random walk algorithm using MATLAB codes. The validation and verification of the algorithm have been done by 4D-NCAT phantom with spherical lung lesions in different diameters from 20 to 90 mm (with incremental steps of 10 mm) and different tumor to background ratios of 4:1 and 8:1. STIR (Software for Tomographic Image Reconstruction) has been applied to reconstruct the phantom PET images with different pixel sizes of 2×2×2 and 4×4×4 mm{sup 3}. For seed localization, we selected pixels with different maximum Standardized Uptake Value (SUVmax) percentages, at least (70%, 80%, 90% and 100%) SUVmax for foreground seeds and up to (20% to 55%, 5% increment) SUVmax for background seeds. Also, for investigation of algorithm performance on clinical data, 19 patients with lung tumor were studied. The resulted contours from algorithm have been compared with nuclear medicine expert manual contouring as ground truth. Results: Phantom and clinical lesion segmentation have shown that the best segmentation results obtained by selecting the pixels with at least 70% SUVmax as foreground seeds and pixels up to 30% SUVmax as background seeds respectively. The mean Dice Similarity Coefficient of 94% ± 5% (83% ± 6%) and mean Hausdorff Distance of 1 (2) pixels have been obtained for phantom (clinical) study. Conclusion: The accurate results of random walk algorithm in PET image segmentation assure its application for radiation treatment planning and diagnosis.

  3. SU-D-201-01: Attenuation of PET/CT Gantries with 511 KeV Photons

    SciTech Connect

    Busse, N

    2015-06-15

    Purpose: PET shielding requires the use of large amounts of lead because of the penetrating nature of 511 keV photons. While the uptake rooms generally require the thickest lead, the scan room often requires substantial shielding. Attenuation by the PET/CT gantry is normally assumed to be zero, but may be significant in directions perpendicular to the scanner axis. Methods: A 5 mL tube was filled with between 14.7 and 20.5 mCi of F-18 and inserted into a phantom (70 cm NEMA PET Scatter Phantom). Exposure rates were recorded at several distances and 15° intervals with a pressurized ionization chamber (Ludlum 9DP) both with the phantom outside the gantry and centered in the CT and PET acquisition positions. These measurements were repeated with three scanners: Siemens Biograph TruePoint 6, GE Optima 560, and Philips Gemini 64. Measurements were decay corrected and normalized to exposure rates outside the gantry to calculate percent transmission. Results: Between 45° to 135° (measured from the patient bed at 0°), average transmission was about 20% for GE, 35% for Philips, and 30% for Siemens. The CT gantry was roughly twice as attenuating as the PET gantry at 90° for all three manufacturers, with about 10% transmission through the CT gantry and 20% through the PET gantry. Conclusion: The Philips system is a split-gantry and therefore has a narrower angle of substantial attenuation. For the GE and Siemens systems, which are single-gantry design, transmission was relatively constant once the angle was sufficient to block line-of-sight from the phantom. While the patient may spend a greater fraction of time at the PET position of the scanner, transmission characteristics of the two components are similar enough to be treated collectively. For shielding angles between 45° and 135°, a reasonably conservative assumption would be to assume gantry transmission of 50%.

  4. SU-D-18C-06: Initial Experience with Implementing MRI Safety Guidelines for Patients with Pacemakers - Medical Physicist Perspective

    SciTech Connect

    James, J; Place, V; Panda, A; Edmonson, H; Felmlee, J; Pooley, R

    2014-06-01

    Purpose: Several institutions have developed MRI guidelines for patients with MR-unsafe or MR-conditional pacemakers. Here we highlight the role of a medical physicist in implementing these guidelines for non-pacemaker dependent patients. Guidelines: Implementing these guidelines requires involvement from several medical specialties and a strong collaboration with the site MRI supervisor to develop a structured workflow. A medical physicist is required to be present during the scan to supervise the MR scanning and to maintain a safety checklist that ensures: 1) uninterrupted patient communication with the technologist, 2) continuous patient physiologic monitoring (e.g. blood pressure and electrocardiography) by a trained nurse, 3) redundant patient vitals monitoring (e.g. pulse oximetry) due to the possibility of in vivo electrocardiography reading fluctuations during image acquisition. A radiologist is strongly recommended to be available to review the images before patients are discharged from the scanner. Pacemaker MRI should be restricted to 1.5T field strength. The MRI sequences should be optimized by the physicist with regards to: a) SAR: limited to <1.5 W/Kg for MR-unsafe pacemakers in normal operating mode, b) RF exposure time: <30 min, c) Coils: use T/R coils but not restricted to such, d) Artifacts: further optimization of sequences whenever image quality is compromised due to the pacemaker. In particular, cardiac, breast and left-shoulder MRIs are most susceptible to these artifacts. Possible strategies to lower the SAR include: a) BW reduction, 2) echo-train-length reduction, 3) increase TR, 4) decrease number of averages, 5) decrease flip angle, 6) reduce slices and/or a combination of all the options. Conclusion: A medical physicist in collaboration with the MR supervisor plays an important role in the supervision/implementation of safe MR scanning of pacemaker patients. Developing and establishing a workflow has enabled our institution to scan over 30 patients with pacemakers without complications, including 3 cardiac MR exams.

  5. SU-D-201-03: Imaging Cellular Pharmacokinetics of 18F-FDG in Inflammatory/Stem Cells

    SciTech Connect

    Zaman, R; Tuerkcan, S; Mahmoudi, M; Toshinobu, T; Kosuge, H; Yang, P; Chin, F; McConnell, M; Xing, L

    2015-06-15

    Purpose: Atherosclerosis is a progressive inflammatory condition that underlies coronary artery disease (CAD)—the leading cause of death in the USA. Thus, understating the metabolism of inflammatory cells can be a valuable tool for investigating CAD. To the best of our knowledge, we are the first to successfully investigate the pharmacokinetics of [18F]fluoro-deoxyglucose (18F-FDG) uptake in a single macrophages and compared with induced pluripotent stem cells (iPSCs) and mesenchymal stem cells (MSCs) with a novel imaging technique, radioluminescence microscopy, initially developed for cancer imaging. Methods: Live cells were cultured sparsely on Matrigel in a glass-bottom dish and starved for 1 hour before incubation with 250 microCi of 18F-FDG for 45 minutes. Excess radiotracer was removed using DMEM medium without glucose. Before imaging, DMEM (1 mL) was added to the cell culture and a 100 microm-thin CdWO4 scintillator plate was placed on top of the cells. Light produced following beta decay was imaged with a highly sensitive inverted microscope (LV200, Olympus) fitted with a 40x/1.3 high-NA oil objective, and an EM-CCD camera. The images were collected over 18,000 frames with 4×4 binning (1200 MHz EM Gain, 300ms exposure). Custom-written software was developed in MATLAB for image processing (Figure 1). For statistical analysis 10 different region-of-interests (ROIs) were selected for each cell type. Results: Figures 2A–2B show bright-field/fusion images for all three different cell types. The relationship between cell-to-cell comparisons was found to be linear for macrophages unlike iPSCs and MSCs, which were best fitted with moving or rolling average (Figure 2C). The average observed decay of 18F-FDG in a single cell of MSCs per second (0.067) was 20% and 36% higher compared to iPSCs (0.054) and macrophages (0.043), respectively (Figure 2D). Conclusion: MSCs was found to be 2–3x more sensitive to glucose molecule despite constant parameters for each cell type examined.

  6. SU-D-19A-07: Dosimetric Comparison of HDR Plesiotherapy and Electron Beam Therapy for Superficial Lesions

    SciTech Connect

    Mitchell, A; Jacob, D; Andreou, K; Raben, A; Chen, H; Koprowski, C; Mourtada, F

    2014-06-01

    Purpose: Large superficial (skin, soft tissue sarcoma) lesions located on curved areas are hard to treat with electrons. The Freiburg Flap (Nucletron, Netherlands) is a flexible mesh style surface which can be easily shaped to fit curved surfaces for reproducible HDR fraction delivery. To understand the fundamental dosimetric differences, a dosimetric comparison was made between HDR plesiotherapy (Freiburg applicator for lesions over 4cm) and external electron beam radiotherapy over cases with varying target curvature (both stylized and clinical cases). Methods: Four stylized cases with variable complexity were created using artificial DICOM axial CT slices and RT structures (a square and three curved structures on a 4.5cm radius cylinder). They were planned using Oncentra v4.3 and exported to Pinnacle v9.6 for electrons planning. The HDR source dwell positions were optimized for the best coverage of the targets using graphical optimization. Electron treatment plans were created in Pinnacle using the same CT and RT structures of three HDR cases with surface lesions previously treated with the Freiburg flap. The En face electron plans used 6-12 MeV electrons and 0.5–1 cm bolus was added to increase surface dose. The electron plans were prescribed to an isodose line to conform to the target. Results: For all lesions, the average target dose coverage was similar (D90ave of 100% for HDR vs 101% for electrons). For lesions with high curvature, the HDR coverage was better (D90 102% vs D90 97% for electron). For all cases, adjacent structures high dose region was lower for HDR than electrons (D1cc 100% for HDR vs D1cc 111% for electrons). Conclusion: HDR plesiotherapy offers excellent target conformity for superficial targets similar to electrons. However, for lesions with complex curved surfaces, HDR has the advantage to achieve better dose distributions using graphical optimization to spare adjacent normal tissue while maximizing target coverage.

  7. SU-D-304-03: Small Field Proton Dosimetry Using MicroDiamond and Gafchromic Film

    SciTech Connect

    Andersen, A; Das, I; Coutinho, L

    2015-06-15

    Purpose: Certain dosimetric characteristics continue to make proton beam therapy an appealing modality for cancer treatment. The proton Bragg peak allows for conformal radiation dose delivery to the target while reducing dose to normal tissue and organs. As field sizes become very small the benefit of the Bragg peak is diminished due to loss of transverse equilibrium along the central beam axis. Furthermore, aperture scattering contributes additional dose along the central axis. These factors warrant the need for accurate small field dosimetry. In this study small field dosimetry was performed using two different methods. Methods: Small field dosimetry measurements were performed using a PTW microdiamond detector and Gafchromic EBT2 film for aperture sizes ranging from 0.5cm to 10cm and a proton range in water of 10cm to 27cm. The measurements were analyzed and then compared to each other and to reference dosimetry data acquired with a Markus chamber. Results: A decrease in normalized output is observed at small field sizes and at larger ranges in water using both measurement methods. Also, a large variation is observed between the output measurements by microdiamond and film at very small field sizes. At the smallest aperture, normalized output ranged from 0.16 to 0.72 and the percent difference between both measurement methods ranged from 36% to 70% depending on proton range. At field sizes above 5cm the film and microdiamond agree within 3%. Conclusion: Although both measurement methods exhibit a general decrease in output factor at small field sizes, dosimetric measurements for small fields using these two methods can vary significantly. Dosimetry under standard conditions is not sufficient to correctly model the dose distributions and outputs factors for small field sizes, additional small field measurements should be performed.

  8. Palladium, platinum, rhodium, ruthenium, and iridium in chromitites from the Massif du Sud and Tiebaghi massif, New Caledonia.

    USGS Publications Warehouse

    Page, N.J.; Cassard, D.; Haffty, J.

    1982-01-01

    The massive and disseminated podiform chromitites from 43 mines and other occurrences in the area contain up to (in ppb) Pd 9, Pt 45, Rh 31, Ir 410 and Ru 1300. The possble origins of the chromitites are discussed. -K.A.R.

  9. Destination Raval Sud: A Visual Ethnography on Pedagogy, Aesthetics, and the Spatial Experience of Growing Up Urban

    ERIC Educational Resources Information Center

    Trafi-Prats, Laura

    2009-01-01

    This article focuses on issues of childhood identity and urban environment. It discusses how a performance art pedagogy inspired by nomadic and relational aesthetics can provide a framework to promote creative learning experiences that address migratory conditions and forms of public alienation lived by young people today. As Lefebvre (1991)…

  10. Rupture politique et enseignement de l'histoire en Afrique du Sud: Les manuels de l'enseignement primaire

    NASA Astrophysics Data System (ADS)

    Carpentier, Claude

    2000-07-01

    In all parts of the world, the teaching of history, because of its important ideological dimension, tends to be influenced by social and political changes. The recent upheavals in South Africa have confronted the nation with so many new tasks that it is difficult to decide which of them should have priority. These tasks include the establishing of a new educational curriculum which, paradoxically, no longer includes the subject of history as such. Instead, history is subsumed under the human and social sciences. This article analyses the content of history text books from the primary level upwards and from the 1980s to the most recent publications. On this basis it attempts to assess the extent and limits of the changes within a political setting marked by a tension between the historic struggle for equality and justice and the constraints imposed by the functioning of a liberal economy within the context of the globalization of modern capitalism. The considerable changes in the content of these books seem to be based on two different theoretical models: the multicultural model embodied in the idea of the "rainbow nation"; and the notion of the universality of humanity, transcending the diversity of cultures and confirmed by the findings of archaeology. While these two models can be a basis on which to refute racial inequality, they are not used to combat other forms of inequality, in particular social inequality.

  11. SU-D-18A-07: Towards 6-Degree-Of-Freedom Real-Time Motion Management in Cancer Radiotherapy

    SciTech Connect

    Huang, C.Y.; Keall, P; Nasehi Tehrani, J; Booth, J

    2014-06-01

    Purpose: Lung tumor motion has been identified as a major issue that deteriorates treatment efficacy for radiotherapy, especially for SBRT. As tighter PTV margins are applied due to translational compensation, tumor rotation will become the dominant factor limiting tumor targeting accuracy. This is the world-first study quantifies lung tumor rotation by utilizing kV images with fiducial markers and a step towards 6-degree-of-freedom real-time cancer radiotherapy. Methods: Three or four gold coils were implanted as tumor surrogates in 3 lung cancer patients. 50 fractions of 8- minute, 10 Hz 4D CBCT projections were acquired for the patients immediately prior or after radiotherapy. The fiducial marker positions are segmented, reconstructed and used to determine tumour rotation by the iterative closest point algorithm. Different data acceptance and filtering methods were applied to accept data or smooth the marker trajectory. Results: The average rotation angles around the left/ right (LR), superior/inferior (SI), anterior/posterior (AP) rotations were found to be 0.8±4.2, -0.8±4.5 and 1.7±3.1 degrees respectively. For 28% of the treatment time, the lung tumors rotated more than 5° around the SI axis. Respiration-induced rotational motion was detected in 2 of the 3 lung patients. This can be explained by the patient developed atelectasis during the treatment period. Interestingly, no heart beating component of rotation was observed in the power spectrum. Different rotational types were observed within the patient cohort with large variations in the magnitude of the rotation between patients. Conclusions: For the first time, continuous tumor rotation has been measured for lung patients with gold fiducial markers. Tumors were found to undergo rotations of more than 5° for almost a third of the total treatment time. The study also demonstrated the feasibility of using continuously kV images for real-time lung tumour motion adaptive radiotherapy which can potentially reduce treatment margins and side effects. The authors acknowledge the financial support of an NHMRC Australia Fellowship.

  12. SU-D-12A-07: Optimization of a Moving Blocker System for Cone-Beam Computed Tomography Scatter Correction

    SciTech Connect

    Ouyang, L; Yan, H; Jia, X; Jiang, S; Wang, J; Zhang, H

    2014-06-01

    Purpose: A moving blocker based strategy has shown promising results for scatter correction in cone-beam computed tomography (CBCT). Different parameters of the system design affect its performance in scatter estimation and image reconstruction accuracy. The goal of this work is to optimize the geometric design of the moving block system. Methods: In the moving blocker system, a blocker consisting of lead strips is inserted between the x-ray source and imaging object and moving back and forth along rotation axis during CBCT acquisition. CT image of an anthropomorphic pelvic phantom was used in the simulation study. Scatter signal was simulated by Monte Carlo calculation with various combinations of the lead strip width and the gap between neighboring lead strips, ranging from 4 mm to 80 mm (projected at the detector plane). Scatter signal in the unblocked region was estimated by cubic B-spline interpolation from the blocked region. Scatter estimation accuracy was quantified as relative root mean squared error by comparing the interpolated scatter to the Monte Carlo simulated scatter. CBCT was reconstructed by total variation minimization from the unblocked region, under various combinations of the lead strip width and gap. Reconstruction accuracy in each condition is quantified by CT number error as comparing to a CBCT reconstructed from unblocked full projection data. Results: Scatter estimation error varied from 0.5% to 2.6% as the lead strip width and the gap varied from 4mm to 80mm. CT number error in the reconstructed CBCT images varied from 12 to 44. Highest reconstruction accuracy is achieved when the blocker lead strip width is 8 mm and the gap is 48 mm. Conclusions: Accurate scatter estimation can be achieved in large range of combinations of lead strip width and gap. However, image reconstruction accuracy is greatly affected by the geometry design of the blocker.

  13. SU-D-19A-03: Monte Carlo Investigation of the Mobetron to Perform Modulated Electron Beam Therapy

    SciTech Connect

    Emam, I; Eldib, A; Hosini, M; AlSaeed, E; Ma, C

    2014-06-01

    Purpose: Modulated electron radiotherapy (MERT) has been proposed as a mean of delivering conformal dose to shallow tumors while sparing distal structures and surrounding tissues. In intraoperative radiotherapy (IORT) utilizing Mobetron, an applicator is placed as closely as possible to the suspected cancerous tissues to be treated. In this study we investigate the characteristics of Mobetron electron beams collimated by an in-house prospective electron multileaf collimator (eMLC) and its feasibility for MERT. Methods: IntraOp Mobetron™ dedicated to perform radiotherapy during surgery was used in the study. It provides several energies (6, 9 and 12 MeV). Dosimetry measurements were performed to obtain percentage depth dose curves (PDD) and profiles for a 10-cm diameter applicator using the PTW MP3/XS 3D-scanning system and the semiflex ion chamber. MCBEAM/MCSIM Monte Carlo codes were used for the treatment head simulation and phantom dose calculation. The design of an electron beam collimation by an eMLC attached to the Mobetron head was also investigated using Monte Carlo simulations. Isodose distributions resulting from eMLC collimated beams were compared to that collimated using cutouts. The design for our Mobetron eMLC is based on our previous experiences with eMLCs designed for clinical linear accelerators. For Mobetron the eMLC is attached to the end of a spacer-mounted rectangular applicator at 50 cm SSD. Steel will be used as the leaf material because other materials would be toxic and will not be suitable for intraoperative applications. Results: Good agreement (within 2%) was achieved between measured and calculated PDD curves and profiles for all available energies. Dose distributiosn provided by the eMLC showed reasonable agreement (∼3%/1mm) with those obtained by conventional cutouts. Conclusion: Monte Carlo simulations are capable of modeling Mobetron electron beams with a reliable accuracy. An eMLC attached to the Mobteron treatment head will allow better treatment options with those machines.

  14. SU-D-19A-02: Electron and Photon Absorbed Fractions for Tumors of Varying Sizes and Compositions

    SciTech Connect

    Olguin, E; Bolch, W

    2014-06-01

    Purpose: To calculate absorbed fractions for mono-energetic photons and electrons in tumors of varying compositions using Monte Carlo simulations in MCNPX. Although tumor dosimetry has been previously investigated, these studies are very limited as they only consider absorbed fractions for soft-tissue tumors. Methods: The tumors were modeled as spheres with radii ranging from 0.10 cm to 6.0 cm and with compositions varying from 100% soft tissue to 100% bone. The energies of both the photons and electrons were varied from 10 keV to 10 MeV and were homogenously distributed throughout the tumor volume. Furthermore, this investigation addresses the issue of spherical versus elliptical tumors. Both prolate and oblate spheroid tumors of different compositions were modeled, and absorbed fractions were calculated for various electron and photon energies. Results: The data clearly shows an absorbed fraction dependence on tumor composition. For example, a soft-tissue model for a 3 MeV electron emitted in a 1 cm diameter bone tumor would have an 83% error, and this same assumption for a 500 keV photon would yield a 74% error. Ultimately, empirical fits were created for each of the five material compositions in order to facilitate the absorbed fraction calculation, requiring only the tumor size and particle energy. Furthermore, the data shows that absorbed fractions for moderate spheroids can be well approximated by spherical tumors of equal mass to within 8%, but in the extreme cases where the spheroid resembles more of a disk, the errors can be as high as 30%. Conclusion: This comprehensive data set is most valuable for nuclear medicine dosimetry because it incorporates particle type, particle energy, tumor size, and tumor composition. Although mono-energetic particles were modeled, absorbed fractions and S-values may be calculated for any radionuclide via linear interpolation, as long as the particle energies or spectra are known.

  15. SU-D-19A-04: Parameter Characterization of Electron Beam Monte Carlo Phase Space of TrueBeam Linacs

    SciTech Connect

    Rodrigues, A; Yin, F; Wu, Q; Sawkey, D

    2014-06-01

    Purpose: For TrueBeam Monte Carlo simulations, Varian does not distribute linac head geometry and material compositions, instead providing a phase space file (PSF) for the users. The PSF has a finite number of particle histories and can have very large file size, yet still contains inherent statistical noises. The purpose of this study is to characterize the electron beam PSF with parameters. Methods: The PSF is a snapshot of all particles' information at a given plane above jaws including type, energy, position, and directions. This study utilized a preliminary TrueBeam PSF, of which validation against measurement is presented in another study. To characterize the PSF, distributions of energy, position, and direction of all particles are analyzed as piece-wise parameterized functions of radius and polar angle. Subsequently, a pseudo PSF was generated based on this characterization. Validation was assessed by directly comparing the true and pseudo PSFs, and by using both PSFs in the down-stream MC simulations (BEAMnrc/DOSXYZnrc) and comparing dose distributions for 3 applicators at 15 MeV. Statistical uncertainty of 4% was limited by the number of histories in the original PSF. Percent depth dose (PDD) and orthogonal (PRF) profiles at various depths were evaluated. Results: Preliminary results showed that this PSF parameterization was accurate, with no visible differences between original and pseudo PSFs except at the edge (6 cm off axis), which did not impact dose distributions in phantom. PDD differences were within 1 mm for R{sub 7} {sub 0}, R{sub 5} {sub 0}, R{sub 3} {sub 0}, and R{sub 1} {sub 0}, and PRF field size and penumbras were within 2 mm. Conclusion: A PSF can be successfully characterized by distributions for energy, position, and direction as parameterized functions of radius and polar angles; this facilitates generating sufficient particles at any statistical precision. Analyses for all other electron energies are under way and results will be included in the presentation.

  16. SU-D-12A-02: DeTECT, a Method to Enhance Soft Tissue Contrast From Mega Voltage CT

    SciTech Connect

    Sheng, K; Gou, S; Qi, S

    2014-06-01

    Purpose: MVCT images have been used on TomoTherapy system to align patients based on bony anatomies but its usefulness for soft tissue registration, delineation and adaptive radiation therapy is severely limited due to minimal photoelectric interaction and prominent presence of noise resulting from low detector quantum efficiency of megavoltage x-rays. We aim to utilize a non-local means denoising method and texture analysis to recover the soft tissue information for MVCT. Methods: A block matching 3D (BM3D) algorithm was adapted to reduce the noise while keeping the texture information of the MVCT images. BM3D is an imaging denoising algorithm developed from non-local means methods. BM3D additionally creates 3D groups by stacking 2D patches by the order of similarity. 3D denoising operation is then performed. The resultant 3D group is inversely transformed back to 2D images. In this study, BM3D was applied to MVCT images of a CT quality phantom, a head and neck and a prostate patient. Following denoising, imaging texture was enhanced to create the denoised and texture enhanced CT (DeTECT). Results: The original MVCT images show prevalent noise and poor soft tissue contrast. By applying BM3D denoising and texture enhancement, all MVCT images show remarkable improvements. For the phantom, the contrast to noise ratio for the low contrast plug was improved from 2.2 to 13.1 without compromising line pair conspicuity. For the head and neck patient, the lymph nodes and vein in the carotid space inconspicuous in the original MVCT image becomes highly visible in DeTECT. For the prostate patient, the boundary between the bladder and the prostate in the original MVCT is successfully recovered. Both results are visually validated by kVCT images of the corresponding patients. Conclusion: DeTECT showed the promise to drastically improve the soft tissue contrast of MVCT for image guided radiotherapy and adaptive radiotherapy.

  17. Prevalence of glucose-6-phosphate dehydrogenase (G6PD) deficiency in the Ouest and Sud-Est departments of Haiti.

    PubMed

    von Fricken, Michael E; Weppelmann, Thomas A; Eaton, Will T; Alam, Meer T; Carter, Tamar E; Schick, Laura; Masse, Roseline; Romain, Jean R; Okech, Bernard A

    2014-07-01

    Malaria remains a significant public health issue in Haiti, with chloroquine (CQ) used almost exclusively for the treatment of uncomplicated infections. Recently, single dose primaquine (PQ) was added to the Haitian national malaria treatment policy, despite a lack of information on the prevalence of glucose-6-phosphate dehydrogenase (G6PD) deficiency within the population. G6PD deficient individuals who take PQ are at risk of developing drug induced hemolysis (DIH). In this first study to examine G6PD deficiency rates in Haiti, 22.8% (range 14.9%-24.7%) of participants were found to be G6PD deficient (class I, II, or III) with 2.0% (16/800) of participants having severe deficiency (class I and II). Differences in deficiency were observed by gender, with males having a much higher prevalence of severe deficiency (4.3% vs. 0.4%) compared to females. Male participants were 1.6 times more likely to be classified as deficient and 10.6 times more likely to be classified as severely deficient compared to females, as expected. Finally, 10.6% (85/800) of the participants were considered to be at risk for DIH. Males also had much higher rates than females (19.3% vs. 4.6%) with 4.9 times greater likelihood (p value 0.000) of having an activity level that could lead to DIH. These findings provide useful information to policymakers and clinicians who are responsible for the implementation of PQ to control and manage malaria in Haiti.

  18. SU-D-213-02: Characterization of the Effect of a New Commercial Transmission Detector On Radiotherapy Beams

    SciTech Connect

    Cheung, J; Morin, O

    2015-06-15

    Purpose: To evaluate the influence of a new commercial transmission detector on radiotherapy beams of various energies. Methods: A transmission detector designed for online treatment monitoring was characterized on a TrueBeam STx linear accelerator with 6MV, 6FFF, 10MV, and 10FFF beams. Measurements of beam characteristics including percentage depth doses (PDDs), inplane and crossplane off-axis profiles at different depths, transmission factors, and skin dose were acquired at field sizes of 3×3cm, 5×5m, 10×10cm, and 20×20cm at 100cm and 80cm source-to-surface distance (SSD). All measurements were taken with and without the transmission detector in the path of the beam. A CC04 chamber was used for all profile and transmission factor measurements. Skin dose was assessed at 100cm, 90cm, and 80cm SSD and using a variety of detectors (Roos and Markus parallel-plate chambers, and OSLD). Results: The PDDs showed small differences between the unperturbed and perturbed beams for both 100cm and 80cm SSD (≤4mm dmax difference and <1.2% average profile difference). The differences were larger for the flattened beams and at larger field sizes. The off-axis profiles showed similar trends. The penumbras looked similar with and without the transmission detector. Comparisons in the central 80% of the profile showed a maximum average (maximum) profile difference between all field sizes of 0.756% (1.535%) and 0.739% (3.682%) for 100cm and 80cm SSD, respectively. The average measured skin dose at 100cm (80cm) SSD for 10×10cm field size was <4% (<35%) dose increase for all energies. For 20×20cm field size, this value increased to <10% (≤45%). Conclusion: The transmission detector has minimal effect on the clinically relevant radiotherapy beams for IMRT and VMAT (field sizes 10×10cm and less). For larger field sizes, some perturbations are observable which would need to be assessed for clinical impact. The authors of this publication has research support from IBA Dosimetry.

  19. SU-D-213-07: Initial Characterization of a Gel Patch Dosimeter for in Vivo Dosimetry

    SciTech Connect

    Matrosic, C; Culberson, W; Rosen, B; Madsen, E; Frank, G; Bednarz, B

    2015-06-15

    Purpose: In vivo dosimetry, despite being the most direct method for monitoring the dose delivered during radiation therapy and being recommended by several national and international organizations (AAPM, ICRU, NACP), is underutilized in the clinic due to issues associated with dose sensitivity, feasibility, and cost. Given the increasing complexity of radiation therapy modern treatments, there is a compelling need for a robust, affordable in vivo dosimetry option. In this work we present the initial characterization of a novel gel patch in vivo dosimeter. Methods: DEFGEL (6%T) was used to make 1-cm thick small cylindrical patch dosimeters. The optical density of each dosimeter was read before and after irradiation by an in-house laser densitometer. The dosimeters were irradiated using a Varian Clinac EX linac. Three separate batches of gel patches were used to create dose response curves and evaluate repeatability. The development time of the dosimeter was also evaluated. Results: The dose response of the dosimeter was found to be linear from a range of approximately 1-Gy to 20-Gy, which is a larger window of linearity compared to other in vivo dosimeters. At doses below 1-Gy, the cumulative uncertainties were on the order of the measured data. When compared, the three batches demonstrated repeatability from 1-Gy to approximately 13-Gy, with some variation at higher doses. For doses of >8-Gy, the dosimeter reached full optical density after 4-hours, whereas low doses developed within an hour. Conclusion: Initial results indicate that the gel patch dosimeter is a reliable and simple way to measure a large range of doses, including high doses such as those delivered during hypofractionated treatments (e.g. SBRT or MR-guided radiotherapy). The simple fabrication method for the dosimeter and the use of a laser densitometer would allow for the dosimeter to used and read in-house, cheaply and easily.

  20. SU-D-303-01: Spatial Distribution of Bone Metastases In Metastatic Castrate-Resistant Prostate Cancer

    SciTech Connect

    Perk, T; Bradshaw, T; Harmon, S; Perlman, S; Liu, G; Jeraj, R

    2015-06-15

    Purpose: Identification of metastatic bone lesions is critical in prostate cancer, where treatments may be more effective in patients with fewer lesions. This study aims characterize the distribution and spread of bone lesions and create a probability map of metastatic spread in bone. Methods: Fifty-five metastatic castrate-resistant prostate cancer patients received up to 3 whole-body [F-18]NaF PET/CT scans. Lesions were identified by physician on PET/CT and contoured using a threshold of SUV>15. An atlas-based segmentation method was used to create CT regions, which determined skeletal location of lesions. Patients were divided into 3 groups with low (N<40), medium (40100) numbers of lesions. A combination of articulated and deformable registrations was used to register the skeletal segments and lesions of each patient to a single skeleton. All the lesion data was then combined to make a probability map. Results: A total of 4038 metastatic lesions (mean 74, range 2–304) were identified. Skeletal regions with highest occurrence of lesions included ribs, thoracic spine, and pelvis with 21%, 19%, and 15% of the total number lesions and 8%, 18%, and 31 % of the total lesion volume, respectively. Interestingly, patients with fewer lesions were found to have a lower proportion of lesions in the ribs (9% in low vs. 27% in high number of lesions). Additionally, the probability map showed specific areas in the spine and pelvis where over 75% of patients had metastases, and other areas in the skeleton with a less than 2% of metastases. Conclusion: We identified skeletal regions with higher incidence of metastases and specific sub-regions in the skeleton that had high or low probability of occurrence of metastases. Additionally, we found that metastatic lesions in the ribs and skull occur more commonly in advanced disease. These results may have future applications in computer-aided diagnosis. Funding from the Prostate Cancer Foundation.

  1. Enfants autochtones et apprentissage: la corporalité comme langage en Amérique du Sud tropicale

    NASA Astrophysics Data System (ADS)

    da Silva, Aracy Lopes

    1999-05-01

    In this article on the cultural context of children's learning processes among the indigenous peoples of tropical South America, the author aims to show how in these cultures the human body offers a language and a mechanism central to the process of production, elaboraton and transmission of knowledge, skills and emotions. She works from the assumption that the construction of a child's identity is a process which takes place in the body, creating a synthesis of social, cosmological, psychological, emotional and cognitive meanings. In constructing an ethnography of the Akwe~-Xavante and Akwe~-Xerente peoples of central Brazil, the author refers to recent anthropological debates on the cosmology and outlook of the indigenous peoples of this region, as well as to the literature of the new discipline known as "anthropology of the child".

  2. SU-D-9A-06: 3D Localization of Neurovascular Bundles Through MR-TRUS Registration in Prostate Radiotherapy

    SciTech Connect

    Yang, X; Rossi, P; Ogunleye, T; Jani, A; Curran, W; Liu, T

    2014-06-01

    Purpose: Erectile dysfunction (ED) is the most common complication of prostate-cancer radiotherapy (RT) and the major mechanism is radiation-induced neurovascular bundle (NVB) damage. However, the localization of the NVB remains challenging. This study's purpose is to accurately localize 3D NVB by integrating MR and transrectal ultrasound (TRUS) images through MR-TRUS fusion. Methods: T1 and T2-weighted MR prostate images were acquired using a Philips 1.5T MR scanner and a pelvic phase-array coil. The 3D TRUS images were captured with a clinical scanner and a 7.5 MHz biplane probe. The TRUS probe was attached to a stepper; the B-mode images were captured from the prostate base to apex at a 1-mm step and the Doppler images were acquired in a 5-mm step. The registration method modeled the prostate tissue as an elastic material, and jointly estimated the boundary condition (surface deformation) and the volumetric deformations under elastic constraint. This technique was validated with a clinical study of 7 patients undergoing RT treatment for prostate cancer. The accuracy of our approach was assessed through the locations of landmarks, as well as previous ultrasound Doppler images of patients. Results: MR-TRUS registration was successfully performed for all patients. The mean displacement of the landmarks between the post-registration MR and TRUS images was 1.37±0.42 mm, which demonstrated the precision of the registration based on the biomechanical model; and the NVB volume Dice Overlap Coefficient was 92.1±3.2%, which demonstrated the accuracy of the NVB localization. Conclusion: We have developed a novel approach to improve 3D NVB localization through MR-TRUS fusion for prostate RT, demonstrated its clinical feasibility, and validated its accuracy with ultrasound Doppler data. This technique could be a useful tool as we try to spare the NVB in prostate RT, monitor NBV response to RT, and potentially improve post-RT potency outcomes.

  3. SU-D-12A-04: Investigation of a 2D Antiscatter Grid for Flat Panel Detectors

    SciTech Connect

    Altunbas, C; Kavanagh, B; Miften, M; Zhong, Y; Shaw, C

    2014-06-01

    Purpose: To improve CT number accuracy and contrast sensitivity, a novel 2D antiscatter grid (ASG) for flat panel detector (FPD) based CBCT imaging was evaluated. Experiments were performed to characterize the scatter rejection and contrast sensitivity performance of ASG. The reduction in primary transmission for various ASG geometries was also evaluated by a computational model. Methods: The 2D ASG design was based on multi-hole collimators used in Nuclear Medicine. It consisted of abutted hexagon shaped apertures with 2.5 mm pitch and 32 mm height, and separated by 0.25 mm thick lead septa. Scatter-to-primary ratio (SPR), contrast-to-noise ratio (CNR), and mean primary transmission were measured using a benchtop FPD/x-ray source system. Acrylic slabs of varying thicknesses were imaged with a contrast-detail phantom to measure CNR and SPR under different scatter conditions. Primary transmission was also measured by averaging pixel values in flood field images without the phantom. We additionally explored variation of primary transmission with pitch and septum thickness using a computational model of our ASG. Results: Our 2D ASG reduced the SPR from 3.3 to 0.12, and improved CNR by 50% in 20 cm thick slab phantom projections acquired at 120 kVp. While the measured primary transmission was 72.8%, our simulations show that primary transmission can be increased to 86% by reducing the septum thickness to 0.1 mm. Primary transmission further increases to 93% if septum thickness of 0.1 mm is used in conjunction with an increased pitch of 4 mm. Conclusion: The 2D ASG appears to be a promising scatter rejection device, offering both superior scatter rejection and improved contrast sensitivity. Though its lead footprint reduced primary transmission, our work shows that optimization of aperture pitch and septum thickness can significantly improve the primary transmission.

  4. Dermatomyosite du sujet âgé: étude de 4 observations dans le sud tunisien

    PubMed Central

    Frikha, Faten; Snoussi, Mouna; Salah, Raida Ben; Saidi, Noura; Kaddour, Neila; Bahloul, Zouhir

    2012-01-01

    La dermatomyosite (DM) touche essentiellement l’adolescent et l’adulte jeune, elle est très rare chez le sujet âgé, le plus souvent associée à des complications iatrogènes et à une pathologie cancéreuse. Nous avons étudié les caractéristiques de la DM du sujet âgé à travers une étude rétrospective dans laquelle nous avons comparé 4 patients âgés de plus de 65 ans au début de la myosite avec 40 sujets jeunes. PMID:23308331

  5. SU-D-12A-05: Iterative Reconstruction Techniques to Enable Intrinsic Respiratory Gated CT in Mice

    SciTech Connect

    Sun, T; Sun, N; Tan, S; Liu, Y; Mistry, N

    2014-06-01

    Purpose: Longitudinal studies of lung function in mice need the ability to image different phases of ventilation in free-breathing mice using retrospective gating. However, retrospective gating often produces under-sampled and uneven angular samples, resulting in severe reconstruction artifacts when using traditional FDK based reconstruction algorithms. We wanted to demonstrate the utility of iterative reconstruction method to enable intrinsic respiratory gating in small-animal CT. Methods: Free-breathing mice were imaged using a Siemens Inveon PET/micro-CT system. Evenly distributed projection images were acquired at 360 angles. Retrospective respiratory gating was performed using an intrinsic marker based on the average intensity in a region covering the diaphragm. Projections were classified into 4 and 6 phases (finer temporal resolution) resulting in 138 and 67 projections respectively. Reconstruction was carried out using 3 Methods: conventional FDK, iterative penalized least-square (PWLS) with total variation (TV), and PWLS with edge-preserving penalty. The performance of the methods was compared using contrast-to-noise (CNR) in a region of interest (ROI). Line profile through a specific region was plotted to evaluate the preserving of edges. Results: In both the cases with 4 and 6 phases, inadequate and non-uniform angular sampling results in artifacts using conventional FDK. However, such artifacts are minimized using both the iterative methods. Using both 4 and 6 phases, the iterative techniques outperformed FDK in terms of CNR and maintaining sharp edges. This is further evidenced especially with increased artifacts using FDK for 6 phases. Conclusion: This work indicates fewer artifacts and better image details can be achieved with iterative reconstruction methods in non-uniform under-sampled reconstruction. Using iterative methods can enable free-breathing intrinsic respiratory gating in small-animal CT. Further studies are needed to compare the computational complexity for large datasets.

  6. SU-D-17A-07: Development and Evaluation of a Prototype Ultrasonography Respiratory Monitoring System for 4DCT Reconstruction

    SciTech Connect

    Yan, P; Cheng, S; Chao, C; Jain, A

    2014-06-01

    Purpose: Respiratory motion artifacts are commonly seen in the abdominal and thoracic CT images. A Real-time Position Management (RPM) system is integrated with CT simulator using abdominal surface as a surrogate for tracking the patient respiratory motion. The respiratory-correlated four-dimensional computed tomography (4DCT) is then reconstructed by GE advantage software. However, there are still artifacts due to inaccurate respiratory motion detecting and sorting methods. We developed an Ultrasonography Respiration Monitoring (URM) system which can directly monitor diaphragm motion to detect respiratory cycles. We also developed a new 4DCT sorting and motion estimation method to reduce the respiratory motion artifacts. The new 4DCT system was compared with RPM and the GE 4DCT system. Methods: Imaging from a GE CT scanner was simultaneously correlated with both the RPM and URM to detect respiratory motion. A radiation detector, Blackcat GM-10, recorded the X-ray on/off and synchronized with URM. The diaphragm images were acquired with Ultrasonix RP system. The respiratory wave was derived from diaphragm images and synchronized with CT scanner. A more precise peaks and valleys detection tool was developed and compared with RPM. The motion is estimated for the slices which are not in the predefined respiratory phases by using block matching and optical flow method. The CT slices were then sorted into different phases and reconstructed, compared with the images reconstructed from GE Advantage software using respiratory wave produced from RPM system. Results: The 4DCT images were reconstructed for eight patients. The discontinuity at the diaphragm level due to an inaccurate identification of phases by the RPM was significantly improved by URM system. Conclusion: Our URM 4DCT system was evaluated and compared with RPM and GE 4DCT system. The new system is user friendly and able to reduce motion artifacts. It also has the potential to monitor organ motion during therapy.

  7. SU-D-9A-07: Imaging Dose and Cancer Risk in Image-Guided Radiotherapy of Cancers

    SciTech Connect

    Zhou, L; Bai, S; Zhang, Y; Ming, X; Zhang, Y; Deng, J

    2014-06-01

    Purpose: To systematically evaluate the imaging doses and cancer risks associated with various imaging procedures involving ionizing radiation during image-guided radiotherapy of an increasingly large number of cancer patients. Methods: 141 patients (52 brain cases, 47 thoracic cases, 42 abdominal cases, aged 3 to 91 years old) treated between October 2009 and March 2010 were included in this IRB-approved retrospective study. During the whole radiotherapy course, each patient underwent at least one type of imaging procedures, i.e., kV portal, MV portal and kVCBCT, besides CT simulations. Based on Monte Carlo modeling and particle transport in human anatomy of various dimensions, the correlations between the radiation doses to the various organs-at-risk (OARs) at the head, the thoracic and the abdominal regions and one's weight, circumference, scan mAs and kVp have been obtained and used to estimate the radiation dose from a specific imaging procedure. The radiation-induced excess relative risk (ERR) was then estimated with BEIR VII formulism based on one's gender, age and radiation dose. 1+ ERR was reported in this study as relative cancer risk. Results: For the whole cohort of 141 patients, the mean imaging doses from various imaging procedures were 8.3 cGy to the brain, 10.5 cGy to the lungs and 19.2 cGy to the red bone marrow, respectively. Accordingly, the cancer risks were 1.140, 1.369 and 2.671, respectively. In comparison, MV portal deposited largest doses to the lungs while kVCBCT delivered the highest doses to the red bone marrow. Conclusion: The compiled imaging doses to a patient during his/her treatment course were patient-specific and site-dependent, varying from 1.2 to 263.5 cGy on average, which were clinically significant and should be included in the treatment planning and overall decision-making. Our results indicated the necessity of personalized imaging to maximize its clinical benefits while reducing the associated cancer risks. Sichuan University Scholarship.

  8. Impact of Adolescent Alcohol and Drug Use on Neuropsychological Functioning in Young Adulthood: 10-Year Outcomes

    ERIC Educational Resources Information Center

    Hanson, Karen L.; Medina, Krista Lisdahl; Padula, Claudia B.; Tapert, Susan F.; Brown, Sandra A.

    2011-01-01

    Because of ongoing neuromaturation, youth with chronic alcohol/substance use disorders (AUD/SUD) are at risk for cognitive decrements during young adulthood. We prospectively examined cognition over 10 years based on AUD/SUD history. Youth (N = 51) with no AUD/SUD history (n = 14), persisting AUD/SUD (n = 18), or remitted AUD/SUD (n = 19) were…

  9. 76 FR 64944 - Notice of Agreements Filed

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-10-19

    ...: Hamburg-Sud (``HSDG''); Alianca Navegacao e Logistica Ltda. e CIA (``Alianca''); Compania Sud Americana de...-010. Title: Maritime Credit Agreement. Parties: Alianca Navegacao e Logistica Ltda. & Cia.;...

  10. The relationship between parental mental illness and/or substance use disorder on adolescent substance use disorder: Results from a nationally representative survey.

    PubMed

    Ali, Mir M; Dean, David; Hedden, Sarra L

    2016-08-01

    This study examines the relationship between parental comorbid mental illness and substance use disorder (SUD) and adolescent SUD. Nationally representative parent-child data pooled over six years from the National Survey on Drug Use and Health (NSDUH) was utilized in this study. Multivariable regression analysis was conducted to determine whether adolescents living with parents who have mental health disorders and/or substance use disorder are themselves more likely to have SUD while controlling for potential confounding variables. The results show that comorbid AMI-SUD in mothers is significantly associated with adolescent SUD after controlling for potential confounders. However, comorbid AMI-SUD in fathers is not associated with adolescent SUD when other controls are included in the model. The association of parental comorbid AMI-SUD with adolescent SUD indicates that parental behavioral health treatment may be a preventive measure to protect their children and may function as an important deterrent to adolescent SUD.

  11. The relationship between parental mental illness and/or substance use disorder on adolescent substance use disorder: Results from a nationally representative survey.

    PubMed

    Ali, Mir M; Dean, David; Hedden, Sarra L

    2016-08-01

    This study examines the relationship between parental comorbid mental illness and substance use disorder (SUD) and adolescent SUD. Nationally representative parent-child data pooled over six years from the National Survey on Drug Use and Health (NSDUH) was utilized in this study. Multivariable regression analysis was conducted to determine whether adolescents living with parents who have mental health disorders and/or substance use disorder are themselves more likely to have SUD while controlling for potential confounding variables. The results show that comorbid AMI-SUD in mothers is significantly associated with adolescent SUD after controlling for potential confounders. However, comorbid AMI-SUD in fathers is not associated with adolescent SUD when other controls are included in the model. The association of parental comorbid AMI-SUD with adolescent SUD indicates that parental behavioral health treatment may be a preventive measure to protect their children and may function as an important deterrent to adolescent SUD. PMID:27070095

  12. SU-D-18A-02: Towards Real-Time On-Board Volumetric Image Reconstruction for Intrafraction Target Verification in Radiation Therapy

    SciTech Connect

    Xu, X; Iliopoulos, A; Zhang, Y; Pitsianis, N; Sun, X; Yin, F; Ren, L

    2014-06-01

    Purpose: To expedite on-board volumetric image reconstruction from limited-angle kV—MV projections for intrafraction verification. Methods: A limited-angle intrafraction verification (LIVE) system has recently been developed for real-time volumetric verification of moving targets, using limited-angle kV—MV projections. Currently, it is challenged by the intensive computational load of the prior-knowledge-based reconstruction method. To accelerate LIVE, we restructure the software pipeline to make it adaptable to model and algorithm parameter changes, while enabling efficient utilization of rapidly advancing, modern computer architectures. In particular, an innovative two-level parallelization scheme has been designed: At the macroscopic level, data and operations are adaptively partitioned, taking into account algorithmic parameters and the processing capacity or constraints of underlying hardware. The control and data flows of the pipeline are scheduled in such a way as to maximize operation concurrency and minimize total processing time. At the microscopic level, the partitioned functions act as independent modules, operating on data partitions in parallel. Each module is pre-parallelized and optimized for multi-core processors (CPUs) and graphics processing units (GPUs). Results: We present results from a parallel prototype, where most of the controls and module parallelization are carried out via Matlab and its Parallel Computing Toolbox. The reconstruction is 5 times faster on a data-set of twice the size, compared to recently reported results, without compromising on algorithmic optimization control. Conclusion: The prototype implementation and its results have served to assess the efficacy of our system concept. While a production implementation will yield much higher processing rates by approaching full-capacity utilization of CPUs and GPUs, some mutual constraints between algorithmic flow and architecture specifics remain. Based on a careful analysis of the prototype performance, it will be feasible to resolve such issues through appropriate algorithmic modifications or special-purpose hardware, thus enabling target verification in seconds with the LIVE system. This work was partially supported by a research grant from Varian Medical Systems.

  13. SU-D-16A-01: A Novel Method to Estimate Normal Tissue Dose for Radiotherapy Patients to Support Epidemiologic Studies of Second Cancer Risk

    SciTech Connect

    Lee, C; Jung, J; Pelletier, C; Kim, J; Lee, C

    2014-06-01

    Purpose: Patient cohort of second cancer study often involves radiotherapy patients with no radiological images available: We developed methods to construct a realistic surrogate anatomy by using computational human phantoms. We tested this phantom images both in a commercial treatment planning system (Eclipse) and a custom Monte Carlo (MC) transport code. Methods: We used a reference adult male phantom defined by International Commission on Radiological Protection (ICRP). The hybrid phantom which was originally developed in Non-Uniform Rational B-Spline (NURBS) and polygon mesh format was converted into more common medical imaging format. Electron density was calculated from the material composition of the organs and tissues and then converted into DICOM format. The DICOM images were imported into the Eclipse system for treatment planning, and then the resulting DICOM-RT files were imported into the MC code for MC-based dose calculation. Normal tissue doses were calculation in Eclipse and MC code for an illustrative prostate treatment case and compared to each other. Results: DICOM images were generated from the adult male reference phantom. Densities and volumes of selected organs between the original phantom and ones represented within Eclipse showed good agreements, less than 0.6%. Mean dose from Eclipse and MC code match less than 7%, whereas maximum and minimum doses were different up to 45%. Conclusion: The methods established in this study will be useful for the reconstruction of organ dose to support epidemiological studies of second cancer in cancer survivors treated by radiotherapy. We also work on implementing body size-dependent computational phantoms to better represent patient's anatomy when the height and weight of patients are available.

  14. SU-D-19A-06: The Effect of Beam Parameters On Very High-Energy Electron Radiotherapy: A Planning Study

    SciTech Connect

    Palma, B; Bazalova, M; Qu, B; Loo, B; Maxim, P; Hardemark, B; Hynning, E

    2014-06-01

    Purpose: We evaluated the effect of very high-energy electron (VHEE) beam parameters on the planning of a lung cancer case by means of Monte Carlo simulations. Methods: We simulated VHEE radiotherapy plans using the EGSnrc/BEAMnrc-DOSXYZnrc code. We selected a lung cancer case that was treated with 6MV photon VMAT to be planned with VHEE. We studied the effect of beam energy (80 MeV, 100 MeV, and 120 MeV), number of equidistant beams (16 or 32), and beamlets sizes (3 mm, 5 mm or 7 mm) on PTV coverage, sparing of organs at risk (OARs) and dose conformity. Inverse-planning optimization was performed in a research version of RayStation (RaySearch Laboratories AB) using identical objective functions and constraints for all VHEE plans. Results: Similar PTV coverage and dose conformity was achieved by all the VHEE plans. The 100 MeV and 120 MeV VHEE plans were equivalent amongst them and were superior to the 80 MeV plan in terms of OARs sparing. The effect of using 16 or 32 equidistant beams was a mean difference in average dose of 2.4% (0%–7.7%) between the two plans. The use of 3 mm beamlet size systematically reduced the dose to all the OARs. Based on these results we selected the 100MeV-16beams-3mm-beamlet-size plan to compare it against VMAT. The selected VHEE plan was more conformal than VMAT and improved OAR sparing (heart and trachea received 125% and 177% lower dose, respectively) especially in the low-dose region. Conclusion: We determined the VHEE beam parameters that maximized the OAR dose sparing and dose conformity of the actually delivered VMAT plan of a lung cancer case. The selected parameters could be used for the planning of other treatment sites with similar size, shape, and location. For larger targets, a larger beamlet size might be used without significantly increasing the dose. B Palma: None. M Bazalova: None. B Hardemark: Employee, RaySearch Americas. E Hynning: Employee, RaySearch Americas. B Qu: None. B Loo Jr.: Research support, RaySearch, Varian. P Maxim: Research support, RaySearch, Varian.

  15. Paléomagnétisme des régions volcaniques plio-quaternaires de la Georgie (Caucase du Sud): une étude pilote.

    NASA Astrophysics Data System (ADS)

    Goguitchaichvili, Avto; Calvo, Manuel; Sologashvili, Djemal; Alva, Luis; Urrutia, Jaime

    2000-12-01

    A preliminary palaeomagnetic and rock magnetic study was carried out on 248 Plio-Quaternary lava flows and three interbedded lacustrine sedimentary layers from Georgia (Caucasus). Most samples are characterised by a single palaeomagnetic component, carried by magnetite, as confirmed by susceptibility-temperature curves. Normal, reversed and in a few cases intermediate polarities were recognised. A palaeomagnetic mean direction of D = 6.0°, I = 57.8°, k = 30, α95 = 3.8° was obtained. Considering the three sampled volcanic provinces separately, differences with the expected palaeodeclination are non-significative (Kazbeki and Khzami) or small (Djavakheti). A mean palaeointensity value of 41.5 ± 11.3 μT, corresponding to a mean VDM of 7.8 ± 3.7·10 22 A·m 2 is obtained.

  16. SU-D-201-02: Prediction of Delivered Dose Based On a Joint Histogram of CT and FDG PET Images

    SciTech Connect

    Park, M; Choi, Y; Cho, A; Hwang, S; Cha, J; Lee, N; Yun, M

    2015-06-15

    Purpose: To investigate whether pre-treatment images can be used in predicting microsphere distribution in tumors. When intra-arterial radioembolization using Y90 microspheres was performed, the microspheres were often delivered non-uniformly within the tumor, which could lead to an inefficient therapy. Therefore, it is important to estimate the distribution of microspheres. Methods: Early arterial phase CT and FDG PET images were acquired for patients with primary liver cancer prior to radioembolization (RE) using Y90 microspheres. Tumor volume was delineated on CT images and fused with FDG PET images. From each voxel (3.9×3.9×3.3 mm3) in the tumor, the Hounsfield unit (HU) from the CT and SUV values from the FDG PET were harvested. We binned both HU and SUV into 11 bins and then calculated a normalized joint-histogram in an 11×11 array.Patients also underwent a post-treatment Y90 PET imaging. Radiation dose for the tumor was estimated using convolution of the Y90 distribution with a dose-point kernel. We also calculated a fraction of the tumor volume that received a radiation dose great than 100Gy. Results: Averaged over 40 patients, 55% of tumor volume received a dose greater than 100Gy (range : 1.1 – 100%). The width of the joint histogram was narrower for patients with a high dose. For patients with a low dose, the width was wider and a larger fraction of tumor volume had low HU. Conclusion: We have shown the pattern of joint histogram of the HU and SUV depends on delivered dose. The patterns can predict the efficacy of uniform intra-arterial delivery of Y90 microspheres.

  17. SU-D-18C-04: The Feasibility of Quantifying MRI Contrast Agent in Pulsatile Flowing Blood Using DCE-MRI

    SciTech Connect

    N, Gwilliam M; J, Collins D; O, Leach M; R, Orton M

    2014-06-01

    Purpose: To assess the feasibility of accurately quantifying the concentration of MRI contrast agent (CA) in pulsatile flowing blood by measuring its T{sub 1}, as is common for the purposes of obtaining a patientspecific arterial input function (AIF). Dynamic contrast enhanced (DCE) - MRI and pharmacokinetic (PK) modelling is widely used to produce measures of vascular function but accurate measurement of the AIF undermines their accuracy. A proposed solution is to measure the T{sub 1} of blood in a large vessel using the Fram double flip angle method during the passage of a bolus of CA. This work expands on previous work by assessing pulsatile flow and the changes in T{sub 1} seen with a CA bolus. Methods: A phantom was developed which used a physiological pump to pass fluid of a known T{sub 1} (812ms) through the centre of a head coil of a clinical 1.5T MRI scanner. Measurements were made using high temporal resolution sequences suitable for DCE-MRI and were used to validate a virtual phantom that simulated the expected errors due to pulsatile flow and bolus of CA concentration changes typically found in patients. Results: : Measured and virtual results showed similar trends, although there were differences that may be attributed to the virtual phantom not accurately simulating the spin history of the fluid before entering the imaging volume. The relationship between T{sub 1} measurement and flow speed was non-linear. T{sub 1} measurement is compromised by new spins flowing into the imaging volume, not being subject to enough excitations to have reached steady-state. The virtual phantom demonstrated a range of recorded T{sub 1} for various simulated T{sub 1} / flow rates. Conclusion: T{sub 1} measurement of flowing blood using standard DCE-MRI sequences is very challenging. Measurement error is non-linear with relation to instantaneous flow speed. Optimising sequence parameters and lowering baseline T{sub 1} of blood should be considered.

  18. SU-D-17A-02: Four-Dimensional CBCT Using Conventional CBCT Dataset and Iterative Subtraction Algorithm of a Lung Patient

    SciTech Connect

    Hu, E; Lasio, G; Yi, B

    2014-06-01

    Purpose: The Iterative Subtraction Algorithm (ISA) method generates retrospectively a pre-selected motion phase cone-beam CT image from the full motion cone-beam CT acquired at standard rotation speed. This work evaluates ISA method with real lung patient data. Methods: The goal of the ISA algorithm is to extract motion and no- motion components form the full reconstruction CBCT. The workflow consists of subtracting from the full CBCT all of the undesired motion phases and obtain a motion de-blurred single-phase CBCT image, followed by iteration of this subtraction process. ISA is realized as follows: 1) The projections are sorted to various phases, and from all phases, a full reconstruction is performed to generate an image CTM. 2) Generate forward projections of CTM at the desired phase projection angles, the subtraction of projection and the forward projection will reconstruct a CTSub1, which diminishes the desired phase component. 3) By adding back the CTSub1 to CTm, no motion CBCT, CTS1, can be computed. 4) CTS1 still contains residual motion component. 5) This residual motion component can be further reduced by iteration.The ISA 4DCBCT technique was implemented using Varian Trilogy accelerator OBI system. To evaluate the method, a lung patient CBCT dataset was used. The reconstruction algorithm is FDK. Results: The single phase CBCT reconstruction generated via ISA successfully isolates the desired motion phase from the full motion CBCT, effectively reducing motion blur. It also shows improved image quality, with reduced streak artifacts with respect to the reconstructions from unprocessed phase-sorted projections only. Conclusion: A CBCT motion de-blurring algorithm, ISA, has been developed and evaluated with lung patient data. The algorithm allows improved visualization of a single phase motion extracted from a standard CBCT dataset. This study has been supported by National Institute of Health through R01CA133539.

  19. SU-D-17A-03: 5D Respiratory Motion Model Based Iterative Reconstruction Method for 4D Cone-Beam CT

    SciTech Connect

    Gao, Y; Thomas, D; Low, D; Gao, H

    2014-06-01

    Purpose: The purpose of this work is to develop a new iterative reconstruction method for 4D cone-beam CT (CBCT) based on a published time-independent 5D respiratory motion model. The proposed method will offer a single high-resolution image at a user-selected breathing phase and the 5D motion model parameters, which could be used to generate the breathing pattern during the CT acquisition. Methods: 5D respiratory motion model was proposed for accurately modeling the motion of lung and lung tumor tissues. 4D images are then parameterized by a reference image, measured breathing amplitude, breathing rate, two time-independent vector fields that describe the 5D model parameters, and a scalar field that describes the change in HU as a function of breathing amplitude. In contrast with the traditional method of reconstructing multiple temporal image phases to reduce respiratory artifact, 5D model based method simplify the problem into the reconstruction of a single reference image and the 5D motion model parameters. The reconstruction formulation of the reference image and scalar and vector fields is a nonlinear least-square optimization problem that consists of solving the reference image and fields alternately, in which the reference image is regularized with the total variation sparsity transform and the vector fields are solved through linearizations regularized by the H1 norm. 2D lung simulations were performed in this proof-of-concept study. Results: The breathing amplitude, its rate, and the corresponding scalar and vector fields were generated from a patient case. Compared with filtered backprojection method and sparsity regularized iterative method for the phase-by-phase reconstruction, the proposed 5D motion model based method yielded improved image quality. Conclusion: Based on 5D respiratory motion model, we have developed a new iterative reconstruction method for 4D CBCT that has the potential for improving image quality while providing needed on-table motion information.

  20. SU-D-304-04: Pre-Clinical Feasibility Study for Intensity Modulated Grid Proton Therapy (IMgPT) Using a Newly Developed Delivery System

    SciTech Connect

    Tsiamas, P; Moskvin, V; Shin, J; Axente, M; Pirlepesov, F; Krasin, M; Merchant, T; Farr, J

    2015-06-15

    Purpose: The purpose of the current study was to characterize and evaluate intensity-modulated proton grid therapy (IMgPT) using a clinical proton beam. Methods: A TOPAS MC model of a new developmental mode (pre-clinical) of the Hitachi proton therapy system (PROBEAT) was used for simulation and characterization of proton grid therapy. TOPAS simulations of different energy ranges, depths and spot separation distances were performed. LET spectra for various energies and depths were produced with FLUKA MC code for evaluation potential interplay between planning parameters and their effect on the characterization of areas (valley) between spots. IMgPT planning aspects (spot spacing, skin dose, peak-to-valley ratios, beam selection, etc.) were evaluated for different phantom and patient cases. Raysearch software (v4.51) was used to perform the evaluation. Results: Calculated beam peak-to-valley ratios scenarios showed strong energy and depth dependence with ratios to be larger for higher energies and shallower depths. Peak-to-valley ratios for R90 range and for spot spacing of 1cm varied from 30% (E = 221.3 MeV, depth 30.6 cm) to 80% (E = 70.3 MeV, depth 4 cm). LET spectra calculations showed spectral hardening with depth, which might potential increase, spot separation distance and improve peak-to-valley ratios. IMgPT optimization, using constant spot spacing, showed skin dose reduction between peak regions of dose due to the irradiation of less skin. Single beam for bulky shallower tumors might be a potential candidate for proton grid therapy. Conclusions: Proton grid therapy using a clinical beam is a promising technique that reduces skin dose between peak regions of dose and may be suitable for the treatment of shallow tumors. IMgPT may be considered for use when bystander effects in off peak regions would be appropriate.

  1. SU-D-19A-01: Can Farmer-Type Ionization Chambers Be Used to Improve the Accuracy of Low-Energy Electron Beam Reference Dosimetry?

    SciTech Connect

    Muir, B R; McEwen, M R

    2014-06-01

    Purpose: To investigate the use of cylindrical Farmer-type ionization chambers to improve the accuracy of low-energy electron beam calibration. Historically, these chamber types have not been used in beams with incident energies less than 10 MeV (R{sub 5} {sub 0} < 4.3 cm) because early investigations suggested large (up to 5 %) fluence perturbation factors in these beams, implying that a significant component of uncertainty would be introduced if used for calibration. More recently, the assumptions used to determine perturbation corrections for cylindrical chambers have been questioned. Methods: Measurements are made with cylindrical chambers in Elekta Precise 4, 8 and 18 MeV electron beams. Several chamber types are investigated that employ graphite walls and aluminum electrodes with very similar specifications (NE2571, NE2505/3, FC65-G). Depth-ionization scans are measured in water in the 8 and 18 MeV beams. To reduce uncertainty from chamber positioning, measurements in the 4 MeV beam are made at the reference depth in Virtual Water™. The variability of perturbation factors is quantified by comparing normalized response of various chambers. Results: Normalized ion chamber response varies by less than 0.7 % for similar chambers at average electron energies corresponding to that at the reference depth from 4 or 6 MeV beams. Similarly, normalized measurements made with similar chambers at the reference depth in the 4 MeV beam vary by less than 0.4 %. Absorbed dose calibration coefficients derived from these results are stable within 0.1 % on average over a period of 6 years. Conclusion: These results indicate that the uncertainty associated with differences in fluence perturbations for cylindrical chambers with similar specifications is only 0.2 %. The excellent long-term stability of these chambers in both photon and electron beams suggests that these chambers might offer the best performance for all reference dosimetry applications.

  2. Direct gene transfer study and transgenic plant regeneration after electroporation into mesophyll protoplasts of Pelargonium x hortorum, 'Panaché Sud'.

    PubMed

    Hassanein, Anber; Hamama, Latifa; Loridon, Karine; Dorion, Noëlle

    2009-10-01

    Direct genetic transformation of mesophyll protoplasts was studied in Pelargonium x hortorum. Calcein and green-fluorescent protein (GFP) gene were used to set up the process. Electroporation (three electric pulses from a 33-microF capacitor in a 250-V cm(-1) electric field) was more efficient than PEG 6000 for membrane permeation, protoplast survival and cell division. Transient expression of GFP was detected in 33-36% of electroporated protoplasts after 2 days and further in colonies. A protoplast suspension conductivity of >1,500 microS cm(-1) allowed high colony formation and plant regeneration. Stable transformation was obtained using the plasmid FAJ3000 containing uidA and nptII genes. When selection (50 mg l(-1) kanamycin) was achieved 6 weeks after electroporation, regenerated shoots were able to grow and root on 100 mg l(-1) kanamycin. The maximum transformation efficiency was 4.5%, based on the number of colonies producing kanamycin-resistant rooted plants or 0.7% based on the number of cultured protoplasts. Polymerase chain reaction (PCR) analysis on in vitro micropropagated plants showed that 18 clones out of 20 contained the nptII gene, while the uidA gene was absent. These results were confirmed after PCR analyses of five glasshouse-acclimatized clones.

  3. SU-D-17A-01: Geometric and Dosimetric Evaluation of a 4D-CBCT Reconstruction Technique Using Prior Knowledge

    SciTech Connect

    Zhang, Y; Yin, F; Ren, L

    2014-06-01

    Purpose: To evaluate a 4D-CBCT reconstruction technique both geometrically and dosimetrically Methods: A prior-knowledge guided 4DC-BCT reconstruction method named the motion-modeling and free-form deformation (MM-FD) has been developed. MM-FD views each phase of the 4D-CBCT as a deformation of a prior CT volume. The deformation field is first solved by principal component analysis based motion modeling, followed by constrained free-form deformation.The 4D digital extended-cardiac- torso (XCAT) phantom was used for comprehensive evaluation. Based on a simulated 4D planning CT of a lung patient, 8 different scenarios were simulated to cover the typical on-board anatomical and respiratory variations: (1) synchronized and (2) unsynchronized motion amplitude change for body and tumor; tumor (3) shrinkage and (4) expansion; tumor average position shift in (5) superior-inferior (SI) direction, (6) anterior-posterior (AP) direction and (7) SI, AP and lateral directions altogether; and (8) tumor phase shift relative to the respiratory cycle of the body. Orthogonal-view 30° projections were simulated based on the eight patient scenarios to reconstruct on-board 4D-CBCTs. For geometric evaluation, the volume-percentage-difference (VPD) was calculated to assess the volumetric differences between the reconstructed and the ground-truth tumor.For dosimetric evaluation, a gated treatment plan was designed for the prior 4D-CT. The dose distributions were calculated on the reconstructed 4D-CBCTs and the ground-truth images for comparison. The MM-FD technique was compared with MM-only and FD-only techniques. Results: The average (±s.d.) VPD values of reconstructed tumors for MM-only, FDonly and MM-FD methods were 59.16%(± 26.66%), 75.98%(± 27.21%) and 5.22%(± 2.12%), respectively. The average min/max/mean dose (normalized to prescription) of the reconstructed tumors by MM-only, FD-only, MM-FD methods and ground-truth tumors were 78.0%/122.2%/108.2%, 13%/117.7%/86%, 58.1%/120.8%/103.6% and 57.6%/118.6%/101.8%,respectively. Conclusion: The MM-FD method provides superior reconstruction accuracy both geometrically and dosimetrically, which can potentially be used for 4D target localization, dose tracking and adaptive radiation therapy. This research is supported by grant from Varian Medical Systems.

  4. SU-D-207-05: Real-Time Intrafractional Motion Tracking During VMAT Delivery Using a Conventional Elekta CBCT System

    SciTech Connect

    Park, Yang-Kyun; Sharp, Gregory C.; Gierga, David P.; Winey, Brian A.; Ye, Sung-Joon

    2015-06-15

    Purpose: Real-time kV projection streaming capability has become recently available for Elekta XVI version 5.0. This study aims to investigate the feasibility and accuracy of real-time fiducial marker tracking during CBCT acquisition with or without simultaneous VMAT delivery using a conventional Elekta linear accelerator. Methods: A client computer was connected to an on-board kV imaging system computer, and receives and processes projection images immediately after image acquisition. In-house marker tracking software based on FFT normalized cross-correlation was developed and installed in the client computer. Three gold fiducial markers with 3 mm length were implanted in a pelvis-shaped phantom with 36 cm width. The phantom was placed on a programmable motion platform oscillating in anterior-posterior and superior-inferior directions simultaneously. The marker motion was tracked in real-time for (1) a kV-only CBCT scan with treatment beam off and (2) a kV CBCT scan during a 6-MV VMAT delivery. The exposure parameters per projection were 120 kVp and 1.6 mAs. Tracking accuracy was assessed by comparing superior-inferior positions between the programmed and tracked trajectories. Results: The projection images were successfully transferred to the client computer at a frequency of about 5 Hz. In the kV-only scan, highly accurate marker tracking was achieved over the entire range of cone-beam projection angles (detection rate / tracking error were 100.0% / 0.6±0.5 mm). In the kV-VMAT scan, MV-scatter degraded image quality, particularly for lateral projections passing through the thickest part of the phantom (kV source angle ranging 70°-110° and 250°-290°), resulting in a reduced detection rate (90.5%). If the lateral projections are excluded, tracking performance was comparable to the kV-only case (detection rate / tracking error were 100.0% / 0.8±0.5 mm). Conclusion: Our phantom study demonstrated a promising Result for real-time motion tracking using a conventional Elekta linear accelerator. MV-scatter suppression is needed to improve tracking accuracy during MV delivery. This research is funded by Motion Management Research Grant from Elekta.

  5. SU-D-204-07: Comparison of AAPM TG150 Draft Image Receptor Tests with Vendor Automated QC Tests for Five Mobile DR Units

    SciTech Connect

    Li, G; Nishino, T; Greene, T; Willis, C

    2015-06-15

    Purpose: To determine the consistency of digital detector (DR) tests recommended by AAPM TG150 and tests provided by commercially available DirectView Total Quality Tool (TQT). Methods: The DR tests recommended by the TG150 Detector Subgroup[1] were performed on 4 new Carestream DRX-Revolution and one Carestream DRX1C retrofit of a GE AMX-4 that had been in service for three years. After detector calibration, flat-field images plus images of two bar patterns oriented parallel and perpendicular to the A-C axis, were acquired at conditions recommended by TG150. Raw images were harvested and then analyzed using a MATLAB software previously validated[2,3,4]. Data were analyzed using ROIs of two different dimensions: 1) 128 x 128 ROIs matching the detector electronics; and 2) 256 x 256 ROIs, each including 4 adjacent smaller ROIs. TG150 metrics from 128 x 128 ROIs were compared to TQT metrics, which are also obtained from 128 x 128 ROIs[5]. Results: The results show that both TG150 and TQT measurements were consistent among these detectors. Differences between TG150 and TQT values appear systematic. Compared with 128 x 128 ROIs, noise and SNR non-uniformity were lower with 256 x 256 ROIs, although signal non-uniformity was similar, indicating detectors were appropriately calibrated for gain and offset. MTF of the retrofit unit remained essentially the same between 2012 and 2015, but was inferior to the new units. The older generator focal spot is smaller (0.75mm vs. 1.2mm), and the SID for acquisition is 182cm as well, so focal spot dimensions cannot explain the difference. The difference in MTF may be secondary to differences in generator X-ray spectrum or by unannounced changes in detector architecture. Further investigation is needed. Conclusion: The study shows that both TG150 and TQT tests are consistent. The numerical value of some metrics are dependent on ROI size.

  6. SU-D-207-07: Implementation of Full/half Bowtie Filter Model in a Commercial Treatment Planning System for Kilovoltage X-Ray Imaging Dose Estimation

    SciTech Connect

    Kim, S; Alaei, P

    2015-06-15

    Purpose: To implement full/half bowtie filter models in a commercial treatment planning system (TPS) to calculate kilovoltage (kV) x-ray imaging dose of Varian On-Board Imager (OBI) cone beam CT (CBCT) system. Methods: Full/half bowtie filters of Varian OBI were created as compensator models in Pinnacle TPS (version 9.6) using Matlab software (version 2011a). The profiles of both bowtie filters were acquired from the manufacturer, imported into the Matlab system and hard coded in binary file format. A Pinnacle script was written to import each bowtie filter data into a Pinnacle treatment plan as a compensator. A kV x-ray beam model without including the compensator model was commissioned per each bowtie filter setting based on percent depth dose and lateral profile data acquired from Monte Carlo simulations. To validate the bowtie filter models, a rectangular water phantom was generated in the planning system and an anterior/posterior beam with each bowtie filter was created. Using the Pinnacle script, each bowtie filter compensator was added to the treatment plan. Lateral profile at the depth of 3cm and percent depth dose were measured using an ion chamber and compared with the data extracted from the treatment plans. Results: The kV x-ray beams for both full and half bowtie filter have been modeled in a commercial TPS. The difference of lateral and depth dose profiles between dose calculations and ion chamber measurements were within 6%. Conclusion: Both full/half bowtie filter models provide reasonable results in kV x-ray dose calculations in the water phantom. This study demonstrates the possibility of using a model-based treatment planning system to calculate the kV imaging dose for both full and half bowtie filter modes. Further study is to be performed to evaluate the models in clinical situations.

  7. SU-D-213-04: Accounting for Volume Averaging and Material Composition Effects in An Ionization Chamber Array for Patient Specific QA

    SciTech Connect

    Fugal, M; McDonald, D; Jacqmin, D; Koch, N; Ellis, A; Peng, J; Ashenafi, M; Vanek, K

    2015-06-15

    Purpose: This study explores novel methods to address two significant challenges affecting measurement of patient-specific quality assurance (QA) with IBA’s Matrixx Evolution™ ionization chamber array. First, dose calculation algorithms often struggle to accurately determine dose to the chamber array due to CT artifact and algorithm limitations. Second, finite chamber size and volume averaging effects cause additional deviation from the calculated dose. Methods: QA measurements were taken with the Matrixx positioned on the treatment table in a solid-water Multi-Cube™ phantom. To reduce the effect of CT artifact, the Matrixx CT image set was masked with appropriate materials and densities. Individual ionization chambers were masked as air, while the high-z electronic backplane and remaining solid-water material were masked as aluminum and water, respectively. Dose calculation was done using Varian’s Acuros XB™ (V11) algorithm, which is capable of predicting dose more accurately in non-biologic materials due to its consideration of each material’s atomic properties. Finally, the exported TPS dose was processed using an in-house algorithm (MATLAB) to assign the volume averaged TPS dose to each element of a corresponding 2-D matrix. This matrix was used for comparison with the measured dose. Square fields at regularly-spaced gantry angles, as well as selected patient plans were analyzed. Results: Analyzed plans showed improved agreement, with the average gamma passing rate increasing from 94 to 98%. Correction factors necessary for chamber angular dependence were reduced by 67% compared to factors measured previously, indicating that previously measured factors corrected for dose calculation errors in addition to true chamber angular dependence. Conclusion: By comparing volume averaged dose, calculated with a capable dose engine, on a phantom masked with correct materials and densities, QA results obtained with the Matrixx Evolution™ can be significantly improved. In addition, necessary correction factors are reduced, allowing for more reliable and meaningful patient-specific QA measurements.

  8. SU-D-18C-05: Variable Bolus Arterial Spin Labeling MRI for Accurate Cerebral Blood Flow and Arterial Transit Time Mapping

    SciTech Connect

    Johnston, M; Jung, Y

    2014-06-01

    Purpose: Arterial spin labeling (ASL) is an MRI perfusion imaging method from which quantitative cerebral blood flow (CBF) maps can be calculated. Acquisition with variable post-labeling delays (PLD) and variable TRs allows for arterial transit time (ATT) mapping and leads to more accurate CBF quantification with a scan time saving of 48%. In addition, T1 and M0 maps can be obtained without a separate scan. In order to accurately estimate ATT and T1 of brain tissue from the ASL data, variable labeling durations were invented, entitled variable-bolus ASL. Methods: All images were collected on a healthy subject with a 3T Siemens Skyra scanner. Variable-bolus Psuedo-continuous ASL (PCASL) images were collected with 7 TI times ranging 100-4300ms in increments of 700ms with TR ranging 1000-5200ms. All boluses were 1600ms when the TI allowed, otherwise the bolus duration was 100ms shorter than the TI. All TI times were interleaved to reduce sensitivity to motion. Voxel-wise T1 and M0 maps were estimated using a linear least squares fitting routine from the average singal from each TI time. Then pairwise subtraction of each label/control pair and averaging for each TI time was performed. CBF and ATT maps were created using the standard model by Buxton et al. with a nonlinear fitting routine using the T1 tissue map. Results: CBF maps insensitive to ATT were produced along with ATT maps. Both maps show patterns and averages consistent with literature. The T1 map also shows typical T1 contrast. Conclusion: It has been demonstrated that variablebolus ASL produces CBF maps free from the errors due to ATT and tissue T1 variations and provides M0, T1, and ATT maps which have potential utility. This is accomplished with a single scan in a feasible scan time (under 6 minutes) with low sensivity to motion.

  9. SU-D-210-07: The Dependence On Acoustic Velocity of Medium On the Needle Template and Electronic Grid Alignment in Ultrasound QA for Prostate Brachytherapy

    SciTech Connect

    Kapoor, P; Kapoor, R; Curran, B

    2015-06-15

    Purpose: To analyze the impact on acoustic velocity (AV) of two different media (water and milk) using the needle template/electronic grid alignment test. Water, easily available, makes a good material to test the alignment of the template and grid although water’s AV (1498 m/s at 25°C) is significantly different from tissue (1540 m/s). Milk, with an AV much closer (1548 m/s) to prostate tissue, may be a good substitute for water in ultrasound quality assurance testing. Methods: Tests were performed using a Hitachi ultrasound unit with a mechanical arrangement designed to position needles parallel to the transducer. In this work, two materials – distilled water and homogenized whole milk (AVs of 1498 and 1548 m/s at 25°C) were used in a phantom to test ultrasound needle/grid alignment. The images were obtained with both materials and analyzed for their placement accuracy. Results: The needle template/electronic grid alignment tests showed displacement errors between measured and calculated values. The measurements showed displacements of 2.3mm (water) and 0.4mm (milk), and 1.6mm (water) and 0.3mm (milk) at depths of 7cm and 5cm respectively from true needle positions. The calculated results showed a displacement of 2.36 mm (water); 0.435mm (milk), and 1.66mm (water) and 0.31mm (milk) at a depth of 7cm and 5cm respectively. The displacements in the X and Y directions were also calculated. At depths of 7cm and 5cm, the (ΔX,ΔY) displacements in water were (0.829mm, 2.21mm) and (0.273mm, 1.634mm) and for milk were (0.15mm, 0.44mm) and (0.05mm, 0.302mm) respectively. Conclusion: The measured and calculated values were in good agreement for all tests. They show that milk provides superior results when performing needle template and electronic grid alignment tests for ultrasound units used in prostate brachytherapy.

  10. SU-D-9A-01: Listmode-Driven Optimal Gating (OG) Respiratory Motion Management: Potential Impact On Quantitative PET Imaging

    SciTech Connect

    Lee, K; Hristov, D

    2014-06-01

    Purpose: To evaluate the potential impact of listmode-driven amplitude based optimal gating (OG) respiratory motion management technique on quantitative PET imaging. Methods: During the PET acquisitions, an optical camera tracked and recorded the motion of a tool placed on top of patients' torso. PET event data were utilized to detect and derive a motion signal that is directly coupled with a specific internal organ. A radioactivity-trace was generated from listmode data by accumulating all prompt counts in temporal bins matching the sampling rate of the external tracking device. Decay correction for 18F was performed. The image reconstructions using OG respiratory motion management technique that uses 35% of total radioactivity counts within limited motion amplitudes were performed with external motion and radioactivity traces separately with ordered subset expectation maximization (OSEM) with 2 iterations and 21 subsets. Standard uptake values (SUVs) in a tumor region were calculated to measure the effect of using radioactivity trace for motion compensation. Motion-blurred 3D static PET image was also reconstructed with all counts and the SUVs derived from OG images were compared with SUVs from 3D images. Results: A 5.7 % increase of the maximum SUV in the lesion was found for optimal gating image reconstruction with radioactivity trace when compared to a static 3D image. The mean and maximum SUVs on the image that was reconstructed with radioactivity trace were found comparable (0.4 % and 4.5 % increase, respectively) to the values derived from the image that was reconstructed with external trace. Conclusion: The image reconstructed using radioactivity trace showed that the blurring due to the motion was reduced with impact on derived SUVs. The resolution and contrast of the images reconstructed with radioactivity trace were comparable to the resolution and contrast of the images reconstructed with external respiratory traces. Research supported by Siemens.

  11. SU-D-16A-04: Accuracy of Treatment Plan TCP and NTCP Values as Determined Via Treatment Course Delivery Simulations

    SciTech Connect

    Siebers, J; Xu, H; Gordon, J

    2014-06-01

    Purpose: To to determine if tumor control probability (TCP) and normal tissue control probability (NTCP) values computed on the treatment planning image are representative of TCP/NTCP distributions resulting from probable positioning variations encountered during external-beam radiotherapy. Methods: We compare TCP/NTCP as typically computed on the planning PTV/OARs with distributions of those parameters computed for CTV/OARs via treatment delivery simulations which include the effect of patient organ deformations for a group of 19 prostate IMRT pseudocases. Planning objectives specified 78 Gy to PTV1=prostate CTV+5 mm margin, 66 Gy to PTV2=seminal vesicles+8 mm margin, and multiple bladder/rectum OAR objectives to achieve typical clinical OAR sparing. TCP were computed using the Poisson Model while NTCPs used the Lyman-Kutcher-Bruman model. For each patient, 1000 30-fraction virtual treatment courses were simulated with each fractional pseudo- time-oftreatment anatomy sampled from a principle component analysis patient deformation model. Dose for each virtual treatment-course was determined via deformable summation of dose from the individual fractions. CTVTCP/ OAR-NTCP values were computed for each treatment course, statistically analyzed, and compared with the planning PTV-TCP/OARNTCP values. Results: Mean TCP from the simulations differed by <1% from planned TCP for 18/19 patients; 1/19 differed by 1.7%. Mean bladder NTCP differed from the planned NTCP by >5% for 12/19 patients and >10% for 4/19 patients. Similarly, mean rectum NTCP differed by >5% for 12/19 patients, >10% for 4/19 patients. Both mean bladder and mean rectum NTCP differed by >5% for 10/19 patients and by >10% for 2/19 patients. For several patients, planned NTCP was less than the minimum or more than the maximum from the treatment course simulations. Conclusion: Treatment course simulations yield TCP values that are similar to planned values, while OAR NTCPs differ significantly, indicating the need for probabilistic methods or PRVs for OAR risk assessment. Presenting author receives support from Philips Medical Systems.

  12. SU-D-304-05: Validation of Low-Dose-Tail Modeling for Proton Pencil Beam Spot Scanning Using a Quality Assurance Test Pattern

    SciTech Connect

    Lin, L; Huang, S; Kang, M; Solberg, T; McDonough, J; Ainsley, C

    2015-06-15

    Purpose: The purpose of this manuscript is to demonstrate the utility of a comprehensive test pattern in validating calculation models of the low-dose tails of proton pencil beam scanning (PBS) spots. Such a pattern has been used previously for quality assurance purposes to assess spot shape and location, and for determining monitor units. Methods: In this study, a scintillation detector was used to measure the test pattern in air at isocenter for two proton beam energies (115 and 225 MeV) of two IBA universal nozzles (UN). Planar measurements were compared with calculated dose distribution based on the weighted superposition of spot profiles previously measured using a pair-magnification method. Results: Including the halo component below 1% of the central dose is shown to improve the gamma-map comparison between calculation and measurement from 94.9% to 98.4% using 2 mm/2% criteria for the 115 MeV proton beam of UN #1. In contrast, including the halo component below 1% of the central dose does not improve the gamma agreement for the 115 MeV proton beam of UN #2, due to the cutoff of the halo component at off-axis locations. When location-dependent spot profiles are used for calculation instead of spot profiles at central axis, the gamma agreement is improved from 98.0% to 99.5% using 2 mm/2% criteria. The cutoff of the halo component is smaller at higher energies, and is not observable for the 225 MeV proton beam for UN #2. Conclusion: In conclusion, the use of a comprehensive test pattern can facilitate the validation of the halo component of proton PBS spots at off axis locations. The cutoff of the halo component should be taken into consideration for large fields or PBS systems that intend to trim spot profiles using apertures. This work was supported by the US Army Medical Research and Materiel Command under Contract Agreement No. DAMD17-W81XWH-07-2-0121 and W81XWH-09-2-0174.

  13. SU-D-12A-01: An Inter-Projection Interpolation (IPI) Approach for the Synchronized Moving Grid (SMOG) to Reduce Dose in Cone Beam CT

    SciTech Connect

    Zhang, H; Kong, V; Jin, J; Ren, L

    2014-06-01

    Purpose: Synchronized moving grid is a promising technique to reduce scatter and ghost artifacts in cone beam computed tomography (CBCT). However, it requires 2 projections in the same gantry angle to obtain full information due to signal blockage by the grid. We proposed an inter-projection interpolation (IPI) method to estimate blocked signals, which may reduce the scan time and the dose. This study aims to provide a framework to achieve a balance between speed, dose and image quality. Methods: The IPI method is based on the hypothesis that an abrupt signal in a projection can be well predicted by the information in the two immediate neighboring projections if the gantry angle step is small. The study was performed on a Catphan and a head phantom. The SMOG was simulated by erasing the information (filling with “0”) of the areas in each projection corresponding to the grid. An IPI algorithm was applied on each projection to recover the erased information. FDK algorithm was used to reconstruct CBCT images for the IPI-processed projections, and compared with the original image in term of signal to noise ratio (SNR) measured in the whole reconstruction image range. The effect of gantry angle step was investigated by comparing the CBCT images from projection sets of various gantry intervals, with IPI-predicted projections to fill the missing projection in the interval. Results: The IPI procession time was 1.79s±0.53s for each projection. SNR after IPI was 29.0db and 28.1db for the Catphan and head phantom, respectively, comparing to 15.3db and 22.7db for an inpainting based interpolation technique. SNR was 28.3, 28.3, 21.8, 19.3 and 17.3 db for gantry angle intervals of 1, 1.5, 2, 2.5 and 3 degrees, respectively. Conclusion: IPI is feasible to estimate the missing information, and achieve an reasonable CBCT image quality with reduced dose and scan time. This study is supported by NIH/NCI grant 1R01CA166948-01.

  14. SU-D-207-06: Clinical Validations of Shading Correction for Cone-Beam CT Using Planning CT as a Prior

    SciTech Connect

    Tsui, T; Zhu, L; Wei, J

    2015-06-15

    Purpose: Current cone-beam CT (CBCT) images contain severe shading artifacts mainly due to scatter, hindering their quantitative use in current radiation therapy. We have previously proposed an effective shading correction method for CBCT using planning CT (pCT) as prior knowledge. In this work, we investigate the method robustness via statistical analyses on studies of a large patient group and compare the performance with that of a state-of-the-art method implemented on the current commercial radiation therapy machine -- the Varian Truebeam system. Methods: Since radiotherapy patients routinely undergo multiple-detector CT (MDCT) scans in the planning procedure, we use the high-quality pCT as “free” prior knowledge for CBCT image improvement. The CBCT image with no correction is first spatially registered with the pCT. Primary CBCT projections are estimated via forward projections of the registered image. The low frequency errors in the projections, which stem from mainly scatter, are estimated by filtering the difference between original line integral and the estimated scatter projections. The corrected CBCT image is then reconstructed from the scatter corrected projections. The proposed method is evaluated on 40 cancer patients. Results: On all patient images, we compare errors on CT number, spatial non-uniformity (SNU) and image contrast, using pCT as the ground truth. T-tests show that our algorithm improves over the Varian method on CBCT accuracies of CT number and SNU with 90% confident. The average CT number error is reduced from 54.8 HU on the Varian method to 40.9 HU, and the SNU error is reduced from 7.7% to 3.8%. There is no obvious improvement on image contrast. Conclusion: Large-group patient studies show that the proposed pCT-based algorithm outperforms the Varian method of the Truebeam system on CBCT shading correction, by providing CBCT images with higher CT number accuracy and greater image uniformity.

  15. SU-D-16A-02: A Novel Methodology for Accurate, Semi-Automated Delineation of Oral Mucosa for Radiation Therapy Dose-Response Studies

    SciTech Connect

    Dean, J; Welsh, L; Gulliford, S; Harrington, K; Nutting, C

    2014-06-01

    Purpose: The significant morbidity caused by radiation-induced acute oral mucositis means that studies aiming to elucidate dose-response relationships in this tissue are a high priority. However, there is currently no standardized method for delineating the mucosal structures within the oral cavity. This report describes the development of a methodology to delineate the oral mucosa accurately on CT scans in a semi-automated manner. Methods: An oral mucosa atlas for automated segmentation was constructed using the RayStation Atlas-Based Segmentation (ABS) module. A radiation oncologist manually delineated the full surface of the oral mucosa on a planning CT scan of a patient receiving radiotherapy (RT) to the head and neck region. A 3mm fixed annulus was added to incorporate the mucosal wall thickness. This structure was saved as an atlas template. ABS followed by model-based segmentation was performed on four further patients sequentially, adding each patient to the atlas. Manual editing of the automatically segmented structure was performed. A dose comparison between these contours and previously used oral cavity volume contours was performed. Results: The new approach was successful in delineating the mucosa, as assessed by an experienced radiation oncologist, when applied to a new series of patients receiving head and neck RT. Reductions in the mean doses obtained when using the new delineation approach, compared with the previously used technique, were demonstrated for all patients (median: 36.0%, range: 25.6% – 39.6%) and were of a magnitude that might be expected to be clinically significant. Differences in the maximum dose that might reasonably be expected to be clinically significant were observed for two patients. Conclusion: The method developed provides a means of obtaining the dose distribution delivered to the oral mucosa more accurately than has previously been achieved. This will enable the acquisition of high quality dosimetric data for use in dose-response studies. We would like to thank the Engineering and Physical Sciences Research Council for funding. We acknowledge support from the NIHR RM/ICR Biomedical Research Centre. RayStatation was used under an evaluation agreement with RaySearch Laboratories AB.

  16. Les unités gneissiques et la zone de cisaillement crustal du Sud-Togo (Gneissic units and crustal shear zone of South Togo)

    NASA Astrophysics Data System (ADS)

    Castaing, C.; Aregba, A.; Assih-Edeou, P.; Chevremont, P.; Godonou, K. S.; Sylvain, J. P.

    This publication is the result of recent geological mapping in Togo. An important crustal shear-zone in the South Togo is reviewed and the overall structural evolution of the area is examined in the light of current ideas on the chain. The geological evolution of the area occurred in three tectono-metamorphic stages in which the foliation developed and was folded under upper amphibolite facies conditions, with anatexis and the emplacement of granites, followed by transcurrent shearing under retrograde metamorphic conditions. The shear-zones, recognised in southeastern Togo, are the southward continuation of the great submeridian shear zones of the Hoggar and the Adrar des Iforas. They take the form of kilometres wide, blasto to ultramylonitic zones in which a mylonitic foliation indicates dextral ductile deformation under greenschist facies conditions. The ductile deformation evolves towards late cataclasis in the center of the shear zones. The geological evolution of the South Togo accords with the geotectonic framework of the internal Pan-African zones of the central Hoggar and Nigeria, where a polycyclic tectono-metamorphic history, with important granitization and late shearing appears to be the general case.

  17. SU-D-16A-03: A Radiation Pneumonitis Dose-Response Model Incorporating Non- Local Radiation-Induced Bystander Effect

    SciTech Connect

    Gordon, J; Snyder, K; Zhong, H; Chetty, I

    2014-06-01

    Purpose: Dose-response models that can reliably predict radiation pneumonitis (RP) to guide radiation therapy (RT) for lung cancer presently do not exist. A model is proposed that incorporates non-local radiationinduced bystander effect (RIBE). Methods: A single sigmoid response function, derived from published data for whole lung irradiation, relates RP probability to cumulative lung damage, regardless of fractionation scheme. Lung damage is assumed to be caused by direct local radiation damage, quantified via the linear-quadratic (LQ) model, and RIBE. Based on published data, RIBE is assumed to be activated when per-fraction dose rises above ∼0.6 Gy, but is constant with dose above that threshold. Integral RIBE damage is assumed proportional to lung volume irradiated above ∼0.6 Gy per fraction. Key model parameters include LQ α and β, and two RIBE parameters: the single-fraction probability δ of damage, and a proportionality parameter κ that relates the potential for RIBE damage to irradiated lung volume. All parameters are tentatively fitted from published data, the RIBE parameters from published RP rates for conventionally fractionated RT (CFRT) and stereotactic body RT (SBRT). Results: The model predicts dose-response curves that are consistent with clinical experience. It provides a tentative explanation for why V20 (33 fractions), V13 (20 fractions) and V5 (<10 fractions) are observed to be correlated with RP. It also provides a plausible explanation for the success of SBRT — RIBE damage increases with the number of fractions, so penalizes CFRT relative to SBRT. Conclusion: The proposed model is relatively simple, extrapolates from published data, plausibly explains several clinical observations, and produces dose-response curves that are consistent with clinical experience. While capable of elaboration, its ability to explain doseresponse experience with different fractionation schemes using a small number of assumptions and parameters is an advantage.

  18. SU-D-201-04: Study On the Impact of Tumor Shape and Size On Drug Delivery to Pancreatic Tumors

    SciTech Connect

    Soltani, M; Bazmara, H; Sefidgar, M; Subramaniam, R; Rahmim, A

    2015-06-15

    Purpose: Drug delivery to solid tumors can be expressed physically using transport phenomena such as convection and diffusion for the drug of interest within extracellular matrices. We aimed to carefully model these phenomena, and to investigate the effect of tumor shape and size on drug delivery to solid tumors in the pancreas. Methods: In this study, multiple tumor geometries as obtained from clinical PET/CT images were considered. An advanced numerical method was used to simultaneously solve fluid flow and solute transport equations. Data from n=45 pancreatic cancer patients with non-resectable locoregional disease were analyzed, and geometrical information from the tumors including size, shape, and aspect ratios were classified. To investigate effect of tumor shape, tumors with similar size but different shapes were selected and analyzed. Moreover, to investigate effect of tumor size, tumors with similar shapes but different sizes, ranging from 1 to 77 cm{sup 3}, were selected and analyzed. A hypothetical tumor similar to one of the analyzed tumors, but scaled to reduce its size below 0.2 cm{sup 3}, was also analyzed. Results: The results showed relatively similar average drug concentration profiles in tumors with different sizes. Generally, smaller tumors had higher absolute drug concentration. In the hypothetical tumor, with volume less than 0.2 cm{sup 3}, the average drug concentration was 20% higher in comparison to its counterparts. For the various real tumor geometries, however, the maximum difference between average drug concentrations was 10% for the smallest and largest tumors. Moreover, the results demonstrated that for pancreatic tumors the shape is not significant. The negligible difference of drug concentration in different tumor shapes was due to the minimum effect of convection in pancreatic tumors. Conclusion: In tumors with different sizes, smaller tumors have higher drug delivery; however, the impact of tumor shape in the case of pancreatic tumors is not significant.

  19. SU-D-210-06: Feasibility for Monitoring the Head of the Pancreas Motion Through a Surrogate Using Ultrasound During Radiation Therapy Delivery

    SciTech Connect

    Omari, E; Noid, G; Ehlers, C; Erickson, B; Quiroz, F; Li, X; Cooper, D; Lachaine, M

    2015-06-15

    Purpose: Substantial target motion during the delivery of radiation therapy (RT) for pancreatic cancer is well recognized as a major limiting factor on RT effectiveness. The aim of this work is to monitor intra-fractional motion of the pancreas using ultrasound during RT delivery. Methods: Transabdominal Ultrasound B-mode images were collected from 5 volunteers using a research version of the Clarity Autoscan System (Elekta). The autoscan transducer with center frequency of 5 MHz was utilized for the scans. Imaging parameters were adjusted to acquire images at the desired depth with good contrast and a wide sweep angle. Since well-defined boundaries of the pancreas can be difficult to find on ultrasound B-mode images, the portal vein was selected as a surrogate for motion estimation of the head of the pancreas. The selection was due to its anatomical location posterior to the neck of the pancreas and close proximity to the pancreas head. The portal vein was contoured on the ultrasound images acquired during simulation using the Clarity Research AFC Workstation software. Volunteers were set up in a similar manner to the simulation for their monitoring session and the ultrasound transducer was mounted on an arm fixed to the couch. A video segment of the portal vein motion was captured. Results: The portal vein was visualized and segmented. Successful monitoring sessions of the portal vein were observed. In addition, our results showed that the ultrasound transducer itself reduces breathing related motion. This is analogous to the use of a compression plate to suppress respiration motion during thorax or abdominal irradiation. Conclusion: We demonstrate the feasibility of tracking the pancreas through the localization of the portal vein using abdominal ultrasound. This will allow for real-time tracking of the intra-fractional motion to justify PTV-margin and to account for unusual motions, thus, improving normal tissue sparing. This research was funding in part by Elekta Inc.

  20. SU-D-213-03: Towards An Optimized 3D Scintillation Dosimetry Tool for Quality Assurance of Dynamic Radiotherapy Techniques

    SciTech Connect

    Rilling, M; Goulet, M; Thibault, S; Archambault, L

    2015-06-15

    Purpose: The purpose of this work is to simulate a multi-focus plenoptic camera used as the measuring device in a real-time three-dimensional scintillation dosimeter. Simulating and optimizing this realistic optical system will bridge the technological gap between concept validation and a clinically viable tool that can provide highly efficient, accurate and precise measurements for dynamic radiotherapy techniques. Methods: The experimental prototype, previously developed for proof of concept purposes, uses an off-the-shelf multi-focus plenoptic camera. With an array of interleaved microlenses of different focal lengths, this camera records spatial and angular information of light emitted by a plastic scintillator volume. The three distinct microlens focal lengths were determined experimentally for use as baseline parameters by measuring image-to-object magnification for different distances in object space. A simulated plenoptic system was implemented using the non-sequential ray tracing software Zemax: this tool allows complete simulation of multiple optical paths by modeling interactions at interfaces such as scatter, diffraction, reflection and refraction. The active sensor was modeled based on the camera manufacturer specifications by a 2048×2048, 5 µm-pixel pitch sensor. Planar light sources, simulating the plastic scintillator volume, were employed for ray tracing simulations. Results: The microlens focal lengths were determined to be 384, 327 and 290 µm. A realistic multi-focus plenoptic system, with independently defined and optimizable specifications, was fully simulated. A f/2.9 and 54 mm-focal length Double Gauss objective was modeled as the system’s main lens. A three-focal length hexagonal microlens array of 250-µm thickness was designed, acting as an image-relay system between the main lens and sensor. Conclusion: Simulation of a fully modeled multi-focus plenoptic camera enables the decoupled optimization of the main lens and microlens specifications. This work leads the way to improving the 3D dosimeter’s achievable resolution, efficiency and build for providing a quality assurance tool fully meeting clinical needs. M.R. is financially supported by a Master’s Canada Graduate Scholarship from the NSERC. This research is also supported by the NSERC Industrial Research Chair in Optical Design.

  1. SU-D-213-05: Design, Evaluation and First Applications of a Off-Site State-Of-The-Art 3D Dosimetry System

    SciTech Connect

    Malcolm, J; Mein, S; McNiven, A; Letourneau, D; Oldham, M

    2015-06-15

    Purpose: To design, construct and commission a prototype in-house three dimensional (3D) dose verification system for stereotatic body radiotherapy (SBRT) verification at an off-site partner institution. To investigate the potential of this system to achieve sufficient performance (1mm resolution, 3% noise, within 3% of true dose reading) for SBRT verification. Methods: The system was designed utilizing a parallel ray geometry instigated by precision telecentric lenses and an LED 630nm light source. Using a radiochromic dosimeter, a 3D dosimetric comparison with our gold-standard system and treatment planning software (Eclipse) was done for a four-field box treatment, under gamma passing criteria of 3%/3mm/10% dose threshold. Post off-site installation, deviations in the system’s dose readout performance was assessed by rescanning the four-field box irradiated dosimeter and using line-profiles to compare on-site and off-site mean and noise levels in four distinct dose regions. As a final step, an end-to-end test of the system was completed at the off-site location, including CT-simulation, irradiation of the dosimeter and a 3D dosimetric comparison of the planned (Pinnacle{sup 3}) to delivered dose for a spinal SBRT treatment(12 Gy per fraction). Results: The noise level in the high and medium dose regions of the four field box treatment was relatively 5% pre and post installation. This reflects the reduction in positional uncertainty through the new design. This At 1mm dose voxels, the gamma pass rates(3%,3mm) for our in-house gold standard system and the off-site system were comparable at 95.8% and 93.2% respectively. Conclusion: This work will describe the end-to-end process and results of designing, installing, and commissioning a state-of-the-art 3D dosimetry system created for verification of advanced radiation treatments including spinal radiosurgery.

  2. SU-D-9A-04: Brain PET/CT Imaging On a Scanner with a Large Axial Field-Of-View

    SciTech Connect

    Park, M; Gerbaudo, V; Hamberg, L; Seaver, K; Kijewski, M

    2014-06-01

    Purpose: Large axial field-of-view (FOV) PET/CT scanners are valued for high sensitivity. Brain PET image quality may depend on the head position within the FOV. We investigated the precision of activity estimation for brain PET imaging when the brain was positioned at the end (END) and in the middle (CEN) of the FOV. The additional CT dose for the CEN position was recorded. Methods: An image quality (Jaszczak) phantom and a striatal phantom were filled with F-18 and positioned in END and CEN locations. For each phantom and each location, we acquired a ∼1-hr listmode PET, rebinned the data into 10 frames with equal number of coincidence events, and reconstructed each frame using an iterative algorithm. For the striatal phantom, END and CEN were compared by drawing on each image three regions of interest (ROI) in axially separated uniform areas. The standard deviation of the activity estimation within each ROI was averaged over the 10 images. The coefficient of variation (CV) for activity estimation was calculated at each position. Image quality was assessed by inspecting the resolution bar pattern in the Jaszczak phantom at two different head positions. Results: The CV was the lowest for ROIs near the center of the FOV. For slices near the end, not only was the CV highest, but also the resolution pattern was degraded. CTDIvol summarized in the dose report indicated that the CT dose was ∼ 10% higher for CEN as compared to END position. Conclusion: Positioning the brain in the middle of the FOV in a large FOV PET/CT scanner allows more precise measurement of tracer uptake and better image quality at the cost of increased CT dose. For the end location longer scan times may minimize image quality degradation without any additional CT dose.

  3. SU-D-201-05: Phantom Study to Determine Optimal PET Reconstruction Parameters for PET/MR Imaging of Y-90 Microspheres Following Radioembolization

    SciTech Connect

    Maughan, N; Conti, M; Parikh, P; Faul, D; Laforest, R

    2015-06-15

    Purpose: Imaging Y-90 microspheres with PET/MRI following hepatic radioembolization has the potential for predicting treatment outcome and, in turn, improving patient care. The positron decay branching ratio, however, is very small (32 ppm), yielding images with poor statistics even when therapy doses are used. Our purpose is to find PET reconstruction parameters that maximize the PET recovery coefficients and minimize noise. Methods: An initial 7.5 GBq of Y-90 chloride solution was used to fill an ACR phantom for measurements with a PET/MRI scanner (Siemens Biograph mMR). Four hot cylinders and a warm background activity volume of the phantom were filled with a 10:1 ratio. Phantom attenuation maps were derived from scaled CT images of the phantom and included the MR phased array coil. The phantom was imaged at six time points between 7.5–1.0 GBq total activity over a period of eight days. PET images were reconstructed via OP-OSEM with 21 subsets and varying iteration number (1–5), post-reconstruction filter size (5–10 mm), and either absolute or relative scatter correction. Recovery coefficients, SNR, and noise were measured as well as total activity in the phantom. Results: For the 120 different reconstructions, recovery coefficients ranged from 0.1–0.6 and improved with increasing iteration number and reduced post-reconstruction filter size. SNR, however, improved substantially with lower iteration numbers and larger post-reconstruction filters. From the phantom data, we found that performing 2 iterations, 21 subsets, and applying a 5 mm Gaussian post-reconstruction filter provided optimal recovery coefficients at a moderate noise level for a wide range of activity levels. Conclusion: The choice of reconstruction parameters for Y-90 PET images greatly influences both the accuracy of measurements and image quality. We have found reconstruction parameters that provide optimal recovery coefficients with minimized noise. Future work will include the effects of the body matrix coil and off-center measurements.

  4. SU-D-304-06: Measurement of LET in Patient-Specific Proton Therapy Treatment Fields Using Optically Stimulated Luminescence Detectors

    SciTech Connect

    Granville, DA; Sahoo, N; Sawakuchi, GO

    2015-06-15

    Purpose: To investigate the use of optically stimulated luminescence (OSL) detectors (OSLDs) for measurements of dose-averaged linear energy transfer (LET) in patient-specific proton therapy treatment fields. Methods: We used Al{sub 2}O{sub 3}:C OSLDs made from the same material as commercially available nanoDot OSLDs from Landauer, Inc. We calibrated two parameters of the OSL signal as functions of LET in therapeutic proton beams: the ratio of the ultraviolet and blue emission intensities (UV/blue ratio) and the OSL curve shape. These calibration curves were created by irradiating OSLDs in passively scattered beams of known LET (0.96 to 3.91 keV/µm). The LET values were determined using a validated Monte Carlo model of the beamline. We then irradiated new OSLDs with the prescription dose (16 to 74 cGy absorbed dose to water) at the center of the spread-out Bragg peak (SOBP) of four patient-specific treatment fields. From readouts of these OSLDs, we determined both the UV/blue ratio and OSL curve shape parameters. Combining these parameters with the calibration curves, we were able to measure LET using the OSLDs. The measurements were compared to the theoretical LET values obtained from Monte Carlo simulations of the patient-specific treatments fields. Results: Using the UV/blue ratio parameter, we were able to measure LET within 3.8%, 6.2%, 5.6% and 8.6% of the Monte Carlo value for each of the patient fields. Similarly, using the OSL curve shape parameter, LET measurements agreed within 0.5%, 11.0%, 2.5% and 7.6% for each of the four fields. Conclusion: We have demonstrated a method to verify LET in patient-specific proton therapy treatment fields using OSLDs. The possibility of enhancing biological effectiveness of proton therapy treatment plans by including LET in the optimization has been previously shown. The LET verification method we have demonstrated will be useful in the quality assurance of such LET optimized treatment plans. DA Granville received financial support from the Natural Sciences and Engineering Research Council of Canada.

  5. SU-D-18C-02: Feasibility of Using a Short ASL Scan for Calibrating Cerebral Blood Flow Obtained From DSC-MRI

    SciTech Connect

    Wang, P; Chang, T; Huang, K; Yeh, C; Chien, C; Wai, Y; Lee, T; Liu, H

    2014-06-01

    Purpose: This study aimed to evaluate the feasibility of using a short arterial spin labeling (ASL) scan for calibrating the dynamic susceptibility contrast- (DSC-) MRI in a group of patients with internal carotid artery stenosis. Methods: Six patients with unilateral ICA stenosis enrolled in the study on a 3T clinical MRI scanner. The ASL-cerebral blood flow (-CBF) maps were calculated by averaging different number of dynamic points (N=1-45) acquired by using a Q2TIPS sequence. For DSC perfusion analysis, arterial input function was selected to derive the relative cerebral blood flow (rCBF) map and the delay (Tmax) map. Patient-specific CF was calculated from the mean ASL- and DSC-CBF obtained from three different masks: (1)Tmax< 3s, (2)combined gray matter mask with mask 1, (3)mask 2 with large vessels removed. One CF value was created for each number of averages by using each of the three masks for calibrating the DSC-CBF map. The CF value of the largest number of averages (NL=45) was used to determine the acceptable range(< 10%, <15%, and <20%) of CF values corresponding to the minimally acceptable number of average (NS) for each patient. Results: Comparing DSC CBF maps corrected by CF values of NL (CBFL) in ACA, MCA and PCA territories, all masks resulted in smaller CBF on the ipsilateral side than the contralateral side of the MCA territory(p<.05). The values obtained from mask 1 were significantly different than the mask 3(p<.05). Using mask 3, the medium values of Ns were 4(<10%), 2(<15%) and 2(<20%), with the worst case scenario (maximum Ns) of 25, 4, and 4, respectively. Conclusion: This study found that reliable calibration of DSC-CBF can be achieved from a short pulsed ASL scan. We suggested use a mask based on the Tmax threshold, the inclusion of gray matter only and the exclusion of large vessels for performing the calibration.

  6. [Imported dengue: study of 44 cases observed from 1994 to 1997 in 9 university hospital centers. Infectio-Sud-France group].

    PubMed

    Badiaga, S; Delmont, J; Brouqui, P; Janbon, F; Durant, J; Bosseray, A; Malvy, D; Bonnet, E; Sotto, A; Dydymski, S; Peyramond, D

    1999-05-01

    Imported dengue is increasingly observed in non endemic countries. We report a retrospective study of 44 cases of dengue fever diagnosed in nine french university hospitals between 1994 and 1997. The patients were aged between 13 and 67 years. Most of them were tourists and had been traveling for a few weeks, in French West Indies and French Guyana (18), South-East Asia (10), India (7) or Polynesia (4). Only, two contracted the disease in Africa. The onset of symptoms preceded the return or followed it within 7 days. The most frequent clinical presentation was a febrile and painful syndrome. Cutaneous manifestations (rash or macular exanthem) were observed in 59% of cases, digestive symptoms in 50%, pharyngitis and/or cough in 25%, microadenopathy in 20%, moderate mucous haemorrhagic manifestations in 16% and neuropsychiatric manifestations in 14%. The common biological abnormalities were thrombocytopenia (84%), leukopenia (59%), and elevated transminases (57%). The diagnosis, orientated by negativity of malaria smears, the knowledge of an epidemic in the visited country, or occurrence of similar cases in the entourage, were argued by serological results: presence of anti-DEN IgM in 25 cases, serological conversion (anti- DEN IgG) in 7 cases or very high seropositivity (anti-DEN IgG > 1/1280) in 12 cases. No virus isolation was obtained.

  7. Enfants Autochtones et Apprentissage: la Corporalite comme Langage en Amerique du Sud Tropicale. (Indigenous Children and Learning: the Body's Language in Tropical South America.)

    ERIC Educational Resources Information Center

    da Silva, Aracy Lopes

    1999-01-01

    Shows how, among the cultures of the indigenous peoples of tropical South America, the human body offers a language and mechanism central to the process of production, elaboration, and transmission, of knowledge, skills, and emotions. Discusses recent anthropological debates and describes a new discipline known as "anthropology of the child."…

  8. SU-D-204-06: Dose and Image Quality Evaluation of a Low-Dose Slot-Scanning X-Ray System for Pediatric Orthopedic Studies

    SciTech Connect

    Liu, Z; Hoerner, M; Lamoureux, R; Rill, L; Arreola, M

    2015-06-15

    Purpose: Children in early teens with scoliosis require repeated radiographic exams over a number of years. The EOS (EOS imaging S.A., Paris, France) is a novel low-dose slot-scanning digital radiographic system designed to produce full-spine images of a free-standing patient. The radiation dose and image quality characteristics of the EOS were evaluated relative to those of a Computed Radiography (CR) system for scoliosis imaging. Methods: For dose evaluation, a full-torso anthropomorphic phantom was scanned five times using the default standard clinical protocols for both the EOS and a CR system, which include both posteroanterior and lateral full-spine views. Optically stimulated luminescent dosimeters (OSLDs), also known as nanoDots™ (Landauer, Inc., Glenwood, IL), were placed on the phantom’s surface to measure entrance skin dose. To assess image quality, MTF curves were generated from sampling the noise levels within the high-contrast regions of a line-pair phantom. Vertical and horizontal distortions were measured for the square line-pair phantom with the EOS system to evaluate the effects of geometric magnification and misalignment with the indicated imaging plane. Results: The entrance skin dose was measured to be 0.4 to 1.1 mGy for the EOS, and 0.7 to 3.6 mGy for the CR study. MTF comparison shows that CR greatly outperforms the EOS, despite both systems having a limiting resolution at 1.8 line-pairs per mm. Vertical distortion was unaffected by phantom positioning, because of the EOS slot-scanning geometry. Horizontal distortion increased linearly with miscentering distance. Conclusion: The EOS system resulted in approximately 70% lower radiation dose than CR for full-spine images. Image quality was found to be inferior to CR. Further investigation is required to see if EOS system is an acceptable modality for performing clinically diagnostic scoliosis examinations.

  9. Contribution à l'analyse des inter-relations entre activités humaines et variabilité climatique : cas du Sud forestier ivoirien

    NASA Astrophysics Data System (ADS)

    Yao, Télésphore Brou; Servat, Eric; Paturel, Jean-Emmanuel

    1998-12-01

    The South Ivorian Forest has suffered a large rainfall deficit for 25 years. At the same time, it has been noticed that the movement of the coffee and cocoa production seems concomitant with that of the isohyets during recent decades. The variations in albedo and rainfall gradient seem to be linked to the significant changes to the forest cover. These could affect precipitation locally.

  10. SU-D-18A-01: Tumor Motion Tracking with a Regional Deformable Registration Model for Four Dimensional Radiation Treatment of Lung Cancer

    SciTech Connect

    Chao, M; Lo, Y; Yuan, Y; Sheu, R; Rosenzweig, K

    2014-06-01

    Purpose: To develop a tumor motion model from four-dimensional computed tomography (4DCT) of thoracic patients and demonstrate its impact on 4D radiation therapy simulation. Methods: A regional deformable image registration algorithm was introduced to extract tumor motion out of patient's breathing cycle. The gross target volume (GTV) was manually delineated on a selected phase of 4DCT and a subregion with 10mm margin supplemented to the GTV was created on the Eclipse treatment planning system (Varian Medical Systems, Palo Alto, CA). Together with 4DCT the structures were exported into an inhouse research platform. A free form B-Spline deformable registration was carried out to map the subregion to other respiratory phases. The displacement vector fields were employed to propagate GTV contours with which the center of mass (CoM) of the GTV was computed for each breathing phase of 4DCT. The resultant GTV motion and its volumetric shape are utilized to facilitate 4D treatment planning. Five lung cancer patients undergoing stereotactic body radiation therapy were enrolled and their 4DCT sets were included in the study. Results: Application of the algorithm to five thoracic patients indicates that clinically satisfactory outcomes were achievable with a spatial accuracy better than 2mm for GTV contour propagation between adjacent phases, and 3mm between opposite phases. The GTV CoM was found to be in the range of 2.0mm through 2.5cm, depending upon the tumor location. Compared to the traditional whole image based registration, the computation of the regional model was found to be an order of magnitude more efficient. Conclusion: A regional deformable registration model was implemented to extract tumor motion. It will have widespread application in 4D radiation treatment planning in the future to maximally utilize the available spatial-tempo information.

  11. SU-D-210-05: The Accuracy of Raw and B-Mode Image Data for Ultrasound Speckle Tracking in Radiation Therapy

    SciTech Connect

    O’Shea, T; Bamber, J; Harris, E

    2015-06-15

    Purpose: For ultrasound speckle tracking there is some evidence that the envelope-detected signal (the main step in B-mode image formation) may be more accurate than raw ultrasound data for tracking larger inter-frame tissue motion. This study investigates the accuracy of raw radio-frequency (RF) versus non-logarithmic compressed envelope-detected (B-mode) data for ultrasound speckle tracking in the context of image-guided radiation therapy. Methods: Transperineal ultrasound RF data was acquired (with a 7.5 MHz linear transducer operating at a 12 Hz frame rate) from a speckle phantom moving with realistic intra-fraction prostate motion derived from a commercial tracking system. A normalised cross-correlation template matching algorithm was used to track speckle motion at the focus using (i) the RF signal and (ii) the B-mode signal. A range of imaging rates (0.5 to 12 Hz) were simulated by decimating the imaging sequences, therefore simulating larger to smaller inter-frame displacements. Motion estimation accuracy was quantified by comparison with known phantom motion. Results: The differences between RF and B-mode motion estimation accuracy (2D mean and 95% errors relative to ground truth displacements) were less than 0.01 mm for stable and persistent motion types and 0.2 mm for transient motion for imaging rates of 0.5 to 12 Hz. The mean correlation for all motion types and imaging rates was 0.851 and 0.845 for RF and B-mode data, respectively. Data type is expected to have most impact on axial (Superior-Inferior) motion estimation. Axial differences were <0.004 mm for stable and persistent motion and <0.3 mm for transient motion (axial mean errors were lowest for B-mode in all cases). Conclusions: Using the RF or B-mode signal for speckle motion estimation is comparable for translational prostate motion. B-mode image formation may involve other signal-processing steps which also influence motion estimation accuracy. A similar study for respiratory-induced motion would also be prudent. This work is support by Cancer Research UK Programme Grant C33589/A19727.

  12. SU-D-207-03: Development of 4D-CBCT Imaging System with Dual Source KV X-Ray Tubes

    SciTech Connect

    Nakamura, M; Ishihara, Y; Matsuo, Y; Ueki, N; Iizuka, Y; Mizowaki, T; Hiraoka, M

    2015-06-15

    Purpose: The purposes of this work are to develop 4D-CBCT imaging system with orthogonal dual source kV X-ray tubes, and to determine the imaging doses from 4D-CBCT scans. Methods: Dual source kV X-ray tubes were used for the 4D-CBCT imaging. The maximum CBCT field of view was 200 mm in diameter and 150 mm in length, and the imaging parameters were 110 kV, 160 mA and 5 ms. The rotational angle was 105°, the rotational speed of the gantry was 1.5°/s, the gantry rotation time was 70 s, and the image acquisition interval was 0.3°. The observed amplitude of infrared marker motion during respiration was used to sort each image into eight respiratory phase bins. The EGSnrc/BEAMnrc and EGSnrc/DOSXYZnrc packages were used to simulate kV X-ray dose distributions of 4D-CBCT imaging. The kV X-ray dose distributions were calculated for 9 lung cancer patients based on the planning CT images with dose calculation grid size of 2.5 x 2.5 x 2.5 mm. The dose covering a 2-cc volume of skin (D2cc), defined as the inner 5 mm of the skin surface with the exception of bone structure, was assessed. Results: A moving object was well identified on 4D-CBCT images in a phantom study. Given a gantry rotational angle of 105° and the configuration of kV X-ray imaging subsystems, both kV X-ray fields overlapped at a part of skin surface. The D2cc for the 4D-CBCT scans was in the range 73.8–105.4 mGy. Linear correlation coefficient between the 1000 minus averaged SSD during CBCT scanning and D2cc was −0.65 (with a slope of −0.17) for the 4D-CBCT scans. Conclusion: We have developed 4D-CBCT imaging system with dual source kV X-ray tubes. The total imaging dose with 4D-CBCT scans was up to 105.4 mGy.

  13. SU-D-17A-04: The Impact of Audiovisual Biofeedback On Image Quality During 4D Functional and Anatomic Imaging: Results of a Prospective Clinical Trial

    SciTech Connect

    Keall, P; Pollock, S; Yang, J; Diehn, M; Berger, J; Graves, E; Loo, B; Yamamoto, T

    2014-06-01

    Purpose: The ability of audiovisual (AV) biofeedback to improve breathing regularity has not previously been investigated for functional imaging studies. The purpose of this study was to investigate the impact of AV biofeedback on 4D-PET and 4D-CT image quality in a prospective clinical trial. We hypothesized that motion blurring in 4D-PET images and the number of artifacts in 4D-CT images are reduced using AV biofeedback. Methods: AV biofeedback is a real-time, interactive and personalized system designed to help a patient self-regulate his/her breathing using a patient-specific representative waveform and musical guides. In an IRB-approved prospective clinical trial, 4D-PET and 4D-CT images of 10 lung cancer patients were acquired with AV biofeedback (AV) and free breathing (FB). The 4D-PET images in 6 respiratory bins were analyzed for motion blurring by: (1) decrease of GTVPET and (2) increase of SUVmax in 4-DPET compared to 3D-PET. The 4D-CT images were analyzed for artifacts by: (1) comparing normalized cross correlation-based scores (NCCS); and (2) quantifying a visual assessment score (VAS). A two-tailed paired t-test was used to test the hypotheses. Results: The impact of AV biofeedback on 4D-PET and 4D-CT images varied widely between patients, suggesting inconsistent patient comprehension and capability. Overall, the 4D-PET decrease of GTVPET was 2.0±3.0cm3 with AV and 2.3±3.9cm{sup 3} for FB (p=0.61). The 4D-PET increase of SUVmax was 1.6±1.0 with AV and 1.1±0.8 with FB (p=0.002). The 4D-CT NCCS were 0.65±0.27 with AV and 0.60±0.32 for FB (p=0.32). The 4D-CT VAS was 0.0±2.7 (p=ns). Conclusion: A 10-patient study demonstrated a statistically significant reduction of motion blurring of AV over FB for 1/2 functional 4D-PET imaging metrics. No difference between AV and FB was found for 2 anatomic 4D-CT imaging metrics. Future studies will focus on optimizing the human-computer interface and including patient training sessions for improved comprehension and capability. Supported by NIH/NCI R01 CA 093626, Stanford BioX Interdisciplinary Initiatives Program, NHMRC Australia Fellowship, and Kwanjeong Educational Foundation. GE Healthcare provided the Respiratory Gating Toolbox for 4D-PET image reconstruction. Stanford University owns US patent #E7955270 which is unlicensed to any commercial entity.

  14. The GAIN Short Screener (GSS) as a Predictor of Future Arrest or Incarceration Among Youth Presenting to Substance Use Disorder (SUD) Treatment

    PubMed Central

    Garner, Bryan R.; Belur, Vinetha K.; Dennis, Michael L.

    2013-01-01

    The National Institutes of Health (NIH) data harmonization project on existing measures (www.phenx.org) has recommended the Global Appraisal of Individual Needs (GAIN)—Short Screener (GSS) as one of the most reliable, valid, efficient, and inexpensive general behavioral health screeners to quickly identify people with internalizing and externalizing mental health disorders, substance use disorders, and crime/violence problems. The present study examined how well the four GSS screeners and their sum predict future arrest or incarceration among individuals entering treatment for a substance use disorder. Using a cross-validation design, a diverse sample of 6,815 youth with substance use disorders was split into a development sample and a validation sample. Overall, results found the GSS’s crime and violence screener (CVScr) and the substance disorder screener (SDScr) to be the two best predictors of arrest/incarceration within the 12 months following treatment intake. Additionally, we found that these screeners could be used to categorize individuals into three groups (low risk, moderate risk, high risk) and this simplified classification had good predictive validity (Area Under the Curve = 0.601). In sum, the GSS’s predictive validity was similar to other instruments that have been developed to predict risk for recidivism; however, the GSS takes only a fraction of the time to collect (ie, approximately 2–3 minutes for just these two screeners). PMID:24348045

  15. Temperament and character dimensions in male patients with substance use disorders: Differences relating to psychiatric comorbidity.

    PubMed

    Marquez-Arrico, Julia E; López-Vera, Silvia; Prat, Gemma; Adan, Ana

    2016-03-30

    Previous research has not considered the influence of the Comorbid Mental Disorder (CMD) among Substance Use Disorders (SUD) patients. We explored the possible differences in personality dimensions among SUD patients taking into account their CMD (Schizophrenia, SZ; Bipolar Disorder, BD; Major Depressive Disorder, MDD); and elucidated clinical factors related to personality dimensions according to the CMD. The Temperament and Character Inventory Revised was used to assess a sample of 102 SUD male patients, considered in three groups according to their CMD: SUD+SZ (N=37), SUD+BD (N=30) and SUD+MDD (N=35). SUD+BD patients had the highest levels of Novelty Seeking and Persistence, SUD+SZ patients showed the highest levels of Harm Avoidance, and SUD+MDD patients reported a lower level of Self-transcendence. Novelty Seeking was positively associated with severity of addiction for SUD+BD; Harm Avoidance was positively associated with psychiatric symptoms for SUD+SZ; and the age of SUD onset was positively linked to Cooperativeness for SUD+BD and to Self-transcendence for SUD+MDD. The different personality characteristics associated to the type of CMD among SUD patients are related to several clinical variables. Interventions in these patients should be tailored according the personality traits that could influence treatment outcomes and patients' prognoses.

  16. Why clinicians do not implement integrated treatment for comorbid substance use disorder and posttraumatic stress disorder: a qualitative study

    PubMed Central

    Gielen, Nele; Krumeich, Anja; Havermans, Remco C.; Smeets, Feikje; Jansen, Anita

    2014-01-01

    Background Healthcare providers working in addiction facilities do not often implement integrated treatment of comorbid substance use disorder (SUD) and posttraumatic stress disorder (PTSD) while there is empirical evidence to do so. Objective This study aims to get insight into the views of clinicians with regard to the diagnosis and treatment of PTSD in SUD patients. Method A qualitative research method was chosen. Fourteen treatment staff members of different wards of an addiction care facility were interviewed by an independent interviewer. Results Despite acknowledging adverse consequences of trauma exposure on SUD, severe underdiagnosis of PTSD was mentioned and treatment of PTSD during SUD treatment was not supported. Obstacles related to the underestimation of PTSD among SUD patients and to the perceptions of SUD clinicians concerning the treatment of comorbid SUD/PTSD were reported. Conclusions It is concluded that SUD facilities should train their clinicians to enable them to provide for integrated treatment of SUD/PTSD. PMID:24511368

  17. Risk Factors for Borderline Personality Disorder in Treatment Seeking Patients with a Substance Use Disorder: An International Multicenter Study.

    PubMed

    Wapp, Manuela; van de Glind, Geurt; van Emmerik-van Oortmerssen, Katelijne; Dom, Geert; Verspreet, Sofie; Carpentier, Pieter Jan; Ramos-Quiroga, Josep Antoni; Skutle, Arvid; Bu, Eli-Torlid; Franck, Johan; Konstenius, Maija; Kaye, Sharlene; Demetrovics, Zsolt; Barta, Csaba; Fatséas, Melina; Auriacombe, Marc; Johnson, Brian; Faraone, Stephen V; Levin, Frances R; Allsop, Steve; Carruthers, Susan; Schoevers, Robert A; Koeter, Maarten W J; van den Brink, Wim; Moggi, Franz

    2015-01-01

    Borderline personality disorder (BPD) and substance use disorders (SUDs) often co-occur, partly because they share risk factors. In this international multicenter study, risk factors for BPD were examined for SUD patients. In total, 1,205 patients were comprehensively examined by standardized interviews and questionnaires on psychiatric diagnosis and risk factors, and it was found that 1,033 (85.7%) had SUDs without BPD (SUD) and 172 (14.3%) had SUD with BPD (SUD + BPD). SUD + BPD patients were significantly younger, more often females and more often diagnosed with comorbid adult attention deficit/hyperactivity disorder. SUD + BPD patients did not differ from SUD patients on most risk factors typical for SUD such as maternal use of drugs during pregnancy or parents having any SUD. However, SUD + BPD patients did have a higher risk of having experienced emotional and physical abuse, neglect, or family violence in childhood compared to SUD patients, suggesting that child abuse and family violence are BPD-specific risk factors in patients with SUDs. PMID:25832736

  18. Risk Factors for Borderline Personality Disorder in Treatment Seeking Patients with a Substance Use Disorder: An International Multicenter Study

    PubMed Central

    Wapp, Manuela; van de Glind, Geurt; van Emmerik-van Oortmerssen, Katelijne; Dom, Geert; Verspreet, Sofie; Carpentier, Pieter Jan; Ramos-Quiroga, Josep Antoni; Skutle, Arvid; Bu, Eli-Torlid; Franck, Johan; Konstenius, Maija; Kaye, Sharlene; Demetrovics, Zsolt; Barta, Csaba; Fatséas, Melina; Auriacombe, Marc; Johnson, Brian; Faraone, Stephen V.; Levin, Frances R.; Allsop, Steve; Carruthers, Susan; Schoevers, Robert A.; Koeter, Maarten W.J.; van den Brink, Wim; Moggi, Franz

    2016-01-01

    Borderline personality disorder (BPD) and substance use disorders (SUDs) often co-occur, partly because they share risk factors. In this international multicenter study, risk factors for BPD were examined for SUD patients. In total, 1,205 patients were comprehensively examined by standardized interviews and questionnaires on psychiatric diagnosis and risk factors, and it was found that 1,033 (85.7%) had SUDs without BPD (SUD) and 172 (14.3%) had SUD with BPD (SUD + BPD). SUD + BPD patients were significantly younger, more often females and more often diagnosed with comorbid adult attention deficit/hyperactivity disorder. SUD + BPD patients did not differ from SUD patients on most risk factors typical for SUD such as maternal use of drugs during pregnancy or parents having any SUD. However, SUD + BPD patients did have a higher risk of having experienced emotional and physical abuse, neglect, or family violence in childhood compared to SUD patients, suggesting that child abuse and family violence are BPD-specific risk factors in patients with SUDs. PMID:25832736

  19. Risk Factors for Borderline Personality Disorder in Treatment Seeking Patients with a Substance Use Disorder: An International Multicenter Study.

    PubMed

    Wapp, Manuela; van de Glind, Geurt; van Emmerik-van Oortmerssen, Katelijne; Dom, Geert; Verspreet, Sofie; Carpentier, Pieter Jan; Ramos-Quiroga, Josep Antoni; Skutle, Arvid; Bu, Eli-Torlid; Franck, Johan; Konstenius, Maija; Kaye, Sharlene; Demetrovics, Zsolt; Barta, Csaba; Fatséas, Melina; Auriacombe, Marc; Johnson, Brian; Faraone, Stephen V; Levin, Frances R; Allsop, Steve; Carruthers, Susan; Schoevers, Robert A; Koeter, Maarten W J; van den Brink, Wim; Moggi, Franz

    2015-01-01

    Borderline personality disorder (BPD) and substance use disorders (SUDs) often co-occur, partly because they share risk factors. In this international multicenter study, risk factors for BPD were examined for SUD patients. In total, 1,205 patients were comprehensively examined by standardized interviews and questionnaires on psychiatric diagnosis and risk factors, and it was found that 1,033 (85.7%) had SUDs without BPD (SUD) and 172 (14.3%) had SUD with BPD (SUD + BPD). SUD + BPD patients were significantly younger, more often females and more often diagnosed with comorbid adult attention deficit/hyperactivity disorder. SUD + BPD patients did not differ from SUD patients on most risk factors typical for SUD such as maternal use of drugs during pregnancy or parents having any SUD. However, SUD + BPD patients did have a higher risk of having experienced emotional and physical abuse, neglect, or family violence in childhood compared to SUD patients, suggesting that child abuse and family violence are BPD-specific risk factors in patients with SUDs.

  20. State Parity Laws and Access to Treatment for Substance Use Disorder in the United States: Implications for Federal Parity Legislation

    PubMed Central

    Wen, Hefei; Cummings, Janet R.; Hockenberry, Jason M.; Gaydos, Laura M.; Druss, Benjamin G.

    2014-01-01

    Context The passage of the 2008 Mental Health Parity and Addiction Equity Act (MHPAEA) and the 2010 Affordable Care Act (ACA) incorporated parity for substance use disorder (SUD) into federal legislation. Yet prior research provides us with scant evidence as to whether federal parity legislation will hold the potential for improving access to SUD treatment. Objective This study examined the effect of state-level SUD parity laws on state-aggregate SUD treatment rates from 2000 to 2008, to shed light on the impact of the recent federal-level SUD parity legislation. Design A quasi-experimental study design using a two-way (state and year) fixed-effect method Setting and Participants All known specialty SUD treatment facilities in the United States Interventions State-level SUD parity laws between 2000 and 2008 Main Outcome Measures State-aggregate SUD treatment rates in: (1) all specialty SUD treatment facilities, and (2) specialty SUD treatment facilities accepting private insurance Results The implementation of any SUD parity law increased the treatment rate by 9 percent (p<0.01) in all specialty SUD treatment facilities and by 15 percent (p<0.05) in facilities accepting private insurance. Full parity and parity-if-offered (i.e., parity only if SUD coverage is offered) increased SUD treatment rate by 13 percent (p<0.05) and 8 percent (p<0.05) in all facilities, and by 21 percent (p<0.05) and 10 percent (p<0.05) in those accepting private insurance. Conclusions We found a positive effect of the implementation of state SUD parity legislation on access to specialty SUD treatment. Furthermore, the positive association was more pronounced in states with more comprehensive parity laws. Our findings suggest that federal parity legislation holds the potential to improve access to SUD treatment. PMID:24154931

  1. Parental Psychopathology and Paternal Child Neglect in Late Childhood

    ERIC Educational Resources Information Center

    Stewart, Chris; Mezzich, Ada C.; Day, Bang-Shiuh

    2006-01-01

    We aimed at determining the association of both severity of paternal and maternal substance use disorder (SUD) and psychiatric disorders with paternal child neglect severity during late childhood. The sample comprised 146 intact SUD (n=71) and non SUD (n=75) families with a 10-12 year old female or male biological offspring. The average age of…

  2. Do Executive Function Deficits Predict Later Substance Use Disorders among Adolescents and Young Adults?

    ERIC Educational Resources Information Center

    Wilens, Timothy E.; Martelon, MaryKate; Fried, Ronna; Petty, Carter; Bateman, Clancey; Biederman, Joseph

    2011-01-01

    Objective: There is increasing interest regarding the risk and overlap of executive function deficits (EFDs) in stable cigarette smoking and substance use disorders (SUD). Therefore, we examined whether earlier EFD was a risk factor for subsequent cigarette smoking and SUD and further explored the relationship between EFD and SUD. Method: We…

  3. Childhood Attention-Deficit/Hyperactivity Disorder and Future Substance Use Disorders: Comparative Meta-Analyses

    ERIC Educational Resources Information Center

    Charach, Alice; Yeung, Emanuela; Climans, Troy; Lillie, Erin

    2011-01-01

    Objective: In recent years cohort studies have examined childhood attention-deficit/hyperactivity disorder (ADHD) as a risk factor for substance use disorders (SUDs) in adolescence and young adulthood. The long-term risk is estimated for development of alcohol, cannabis, combined alcohol and psychoactive SUDs, combined SUDs (nonalcohol), and…

  4. Attitudes toward Substance Abuse Clients: An Empirical Study of Clinical Psychology Trainees.

    PubMed

    Mundon, Chandra R; Anderson, Melissa L; Najavits, Lisa M

    2015-01-01

    Despite the high prevalence of substance use disorder (SUD) and its frequent comorbidity with mental illness, individuals with SUD are less likely to receive effective SUD treatment from mental health practitioners than SUD counselors. Limited competence and interest in treating this clinical population are likely influenced by a lack of formal training in SUD treatment. Using a factorial survey-vignette design that included three clinical vignettes and a supplementary survey instrument, we investigated whether clinical psychology doctoral students differ in their level of negative emotional reactions toward clients with SUD versus major depressive disorder (MDD); whether they differ in their attributions for SUD versus MDD; and how their negative emotional reactions and attributions impact their interest in pursuing SUD clinical work. Participants were 155 clinical psychology graduate-level doctoral students (72% female). Participants endorsed more negative emotional reactions toward clients with SUD than toward clients with MDD. They were also more likely to identify poor willpower as the cause for SUD than for MDD. More than a third reported interest in working with SUD populations. Highest levels of interest were associated with prior professional and personal experience with SUD, four to six years of clinical experience, and postmodern theoretical orientation.

  5. Suicide Attempts within 12 Months of Treatment for Substance Use Disorders

    ERIC Educational Resources Information Center

    Britton, Peter C.; Conner, Kenneth R.

    2010-01-01

    There are limited prospective data on suicide attempts (SA) during the months following treatment for substance use disorders (SUD), a period of high risk. In an analysis of the Drug Abuse Treatment Outcomes Study, a longitudinal naturalistic multisite study of treated SUDs, variables associated with SA in the 12 months following SUD treatment…

  6. Amygdala Activation and Emotional Processing in Adolescents at Risk for Substance Use Disorders

    ERIC Educational Resources Information Center

    Lindsay, Dawn L.; Pajtek, Stefan; Tarter, Ralph E.; Long, Elizabeth C.; Clark, Duncan B.

    2014-01-01

    Studies are needed that examine neurobiological characteristics in high-risk individuals prior to substance use disorder (SUD) development. In this pilot study, 4 adolescent subjects at high risk for SUD (having at least 1 parent with an SUD) were compared with 4 adolescent reference subjects on a cortico-limbic reactivity paradigm, where they…

  7. Does Smoking Intervention Influence Adolescent Substance Use Disorder Treatment Outcomes?

    ERIC Educational Resources Information Center

    Myers, Mark G.; Prochaska, Judith J.

    2008-01-01

    Although tobacco use is reported by the majority of substance use disordered (SUD) youth, little work has examined tobacco focused interventions with this population. The present study is an initial investigation of the effect of a tobacco use intervention on adolescent SUD treatment outcomes. Participants were adolescents in SUD treatment taking…

  8. Attitudes toward Substance Abuse Clients: An Empirical Study of Clinical Psychology Trainees

    PubMed Central

    Mundon, Chandra R.; Anderson, Melissa L.; Najavits, Lisa M.

    2015-01-01

    Despite the high prevalence of substance use disorder (SUD) and its frequent comorbidity with mental illness, individuals with SUD are less likely to receive effective SUD treatment from mental health practitioners than SUD counselors. Limited competence and interest in treating this clinical population is likely influenced by a lack of formal training in SUD treatment. Using a factorial survey-vignette design that included three clinical vignettes and a supplementary survey instrument, we investigated whether clinical psychology doctoral students differ in their level of negative emotional reactions toward clients with SUD versus major depressive disorder (MDD); whether they differ in their attributions for SUD versus MDD; and how their negative emotional reactions and attributions impact their interest in pursuing SUD clinical work. Participants were 155 clinical psychology graduate-level doctoral students (72% female). Participants endorsed more negative emotional reactions toward clients with SUD than toward clients with MDD. They were also more likely to identify poor willpower as the cause for SUD than for MDD. More than a third reported interest in working with SUD populations. Highest levels of interest were associated with prior professional and personal experience with SUD, four to six years of clinical experience, and postmodern theoretical orientation. PMID:26375324

  9. Does ADHD Predict Substance-Use Disorders? A 10-Year Follow-up Study of Young Adults with ADHD

    ERIC Educational Resources Information Center

    Wilens, Timothy E.; Martelon, MaryKate; Joshi, Gagan; Bateman, Clancey; Fried, Ronna; Petty, Carter; Biederman, Joseph

    2011-01-01

    Objective: High rates of substance-use disorders (SUD) have been found in samples of adolescents and adults with attention-deficit/hyperactivity disorder (ADHD). Predictors of SUD in children with ADHD who are at risk for the development of SUDs remain understudied. The main aims of this study were to identify clinically meaningful characteristics…

  10. Aggression, impulsivity, and psychopathic traits in combined antisocial personality disorder and substance use disorder.

    PubMed

    Alcorn, Joseph L; Gowin, Joshua L; Green, Charles E; Swann, Alan C; Moeller, F Gerard; Lane, Scott D

    2013-01-01

    Aggression, impulsivity, and psychopathic traits are prominent in both antisocial personality disorder (ASPD) and substance use disorders (SUD), but have rarely been examined collectively. The authors' results show that all three variables were elevated in adults with comorbid ASPD/SUD, relative to SUD-only and control subjects.

  11. The Treatment of Co-Occurring PTSD and Substance Use Disorders Using Trauma-Focused Exposure Therapy

    ERIC Educational Resources Information Center

    Baschnagel, Joseph S.; Coffey, Scott F.; Rash, Carla J.

    2006-01-01

    Co-morbidity between posttraumatic stress disorder (PTSD) and substance use disorders (SUD) is high and there is a need for empirically validated treatments designed to address PTSD among SUD patients. One effective PTSD treatment that may be useful in treating PTSD-SUD is exposure therapy. This paper reviews the relationship between comorbid PTSD…

  12. Testing the Drug Substitution Switching-Addictions Hypothesis

    PubMed Central

    Blanco, Carlos; Okuda, Mayumi; Wang, Shuai; Liu, Shang-Min; Olfson, Mark

    2016-01-01

    IMPORTANCE Adults who remit from a substance use disorder (SUD) are often thought to be at increased risk for developing another SUD. A greater understanding of the prevalence and risk factors for drug substitution would inform clinical monitoring and management. OBJECTIVE To determine whether remission from an SUD increases the risk of onset of a new SUD after a 3-year follow-up compared with lack of remission from an SUD and whether sociodemographic characteristics and psychiatric disorders, including personality disorders, independently predict a new-onset SUD. DESIGN, SETTING, AND PARTICIPANTS A prospective cohort study where data were drawn from a nationally representative sample of 34 653 adults from the National Epidemiologic Survey on Alcohol and Related Conditions. Participants were interviewed twice, 3 years apart (wave 1, 2001–2002; wave 2, 2004–2005). MAIN OUTCOMES AND MEASURES We compared new-onset SUDs among individuals with at least 1 current SUD at wave 1 who did not remit from any SUDs at wave 2 (n = 3275) and among individuals with at least 1 current SUD at wave 1 who remitted at wave 2 (n = 2741). RESULTS Approximately one-fifth (n = 2741) of the total sample had developed a new-onset SUD at the wave 2 assessment. Individuals who remitted from 1 SUD during this period were significantly less likely than those who did not remit to develop a new SUD (13.1% vs 27.2%, P < .001). Results were robust to sample specification. An exception was that remission from a drug use disorder increased the odds of a new SUD (odds ratio [OR] = 1.46; 95% CI, 1.11–1.92). However, after adjusting for the number of SUDs at baseline, remission from drug use disorders decreased the odds of a new-onset SUD (OR = 0.66; 95% CI, 0.46–0.95) whereas the number of baseline SUDs increased those odds (OR=1.68; 95% CI, 1.43–1.98). Being male, younger in age, never married, having an earlier age at substance use onset, and psychiatric comorbidity significantly increased

  13. Conscious knowledge influences decision-making differently in substance abusers with and without co-morbid antisocial personality disorder.

    PubMed

    Mellentin, Angelina I; Skøt, Lotte; Teasdale, Thomas W; Habekost, Thomas

    2013-08-01

    Decision-making impairment, as measured by the Iowa Gambling Task (IGT), is a consistent finding among individuals with substance use disorder (SUD). We studied how this impairment is influenced by co-morbid antisocial personality disorder (ASPD) and conscious knowledge of the task. Three groups were investigated: SUD individuals without co-morbid ASPD (n = 30), SUD individuals with co-morbid ASPD (n = 16), and healthy controls (n = 17). Both SUD and SUD+ASPD participants had poor overall IGT performance. A block-by-block analysis revealed that SUD participants exhibited slow but steady improvement across the IGT, whereas SUD+ASPD participants exhibited initial normal improvement, but dropped off during the last 40 trials. Conscious knowledge of the task was significantly correlated to performance for controls and SUD participants, but not for SUD+ASPD participants. Our findings suggest that decision-making proceeds differently in SUD and SUD+ASPD individuals due to differences in acquisition and application of conscious knowledge.

  14. Concurrent Treatment of Substance Use and PTSD.

    PubMed

    Flanagan, Julianne C; Korte, Kristina J; Killeen, Therese K; Back, Sudie E

    2016-08-01

    Substance use disorders (SUD) and posttraumatic stress disorder (PTSD) are chronic, debilitating conditions that frequently co-occur. Individuals with co-occurring SUD and PTSD suffer a more complicated course of treatment and less favorable treatment outcomes compared to individuals with either disorder alone. The development of effective psychosocial and pharmacological interventions for co-occurring SUD and PTSD is an active and critically important area of investigation. Several integrated psychosocial treatments for co-occurring SUD and PTSD have demonstrated promising outcomes. While recent studies examining medications to treat co-occurring SUD and PTSD have yielded encouraging findings, there remain substantial gaps in the evidence base regarding the treatment of co-occurring SUD and PTSD. This review will summarize the findings from clinical trials targeting a reduction in SUD and PTSD symptoms simultaneously. These results may improve our knowledge base and subsequently enhance our ability to develop effective interventions for this complex comorbid condition. PMID:27278509

  15. Psychosocial Functioning of Adults who Experienced Substance Use Disorders as Adolescents

    PubMed Central

    Rohde, Paul; Lewinsohn, Peter M.; Seeley, John R.; Klein, Daniel N.; Andrews, Judy A.; Small, Jason W.

    2008-01-01

    We examined whether substance use disorder (SUD) before age 19 was associated with functioning at age 30 in 773 individuals assessed twice during adolescence, and at ages 24 and 30. Eight of 14 adult measures were associated with adolescent SUD: education, unemployment, income, risky sexual behavior, suicide attempt, coping, stressful life events, and global adjustment. Controlling for adolescent comorbidity and functioning and adult SUD, education and unemployment remained associated, and three variables emerged as significant: being a parent (significant only for participants without adult SUD), and being currently married and decreased life satisfaction (significant only for participants with adult SUD). Adolescent SUD is associated with numerous functioning difficulties at age 30, some of which appear to be related to recurrent SUD, comorbid adolescent disorders, or functioning problems already evident in adolescence. PMID:17563135

  16. Low Earth Orbit Raider (LER) winged air launch vehicle concept

    NASA Technical Reports Server (NTRS)

    Feaux, Karl; Jordan, William; Killough, Graham; Miller, Robert; Plunk, Vonn

    1989-01-01

    The need to launch small payloads into low earth orbit has increased dramatically during the past several years. The Low Earth orbit Raider (LER) is an answer to this need. The LER is an air-launched, winged vehicle designed to carry a 1500 pound payload into a 250 nautical mile orbit. The LER is launched from the back of a 747-100B at 35,000 feet and a Mach number of 0.8. Three staged solid propellant motors offer safe ground and flight handling, reliable operation, and decreased fabrication cost. The wing provides lift for 747 separation and during the first stage burn. Also, aerodynamic controls are provided to simplify first stage maneuvers. The air-launch concept offers many advantages to the consumer compared to conventional methods. Launching at 35,000 feet lowers atmospheric drag and other loads on the vehicle considerably. Since the 747 is a mobile launch pad, flexibility in orbit selection and launch time is unparalleled. Even polar orbits are accessible with a decreased payload. Most importantly, the LER launch service can come to the customer, satellites and experiments need not be transported to ground based launch facilities. The LER is designed to offer increased consumer freedom at a lower cost over existing launch systems. Simplistic design emphasizing reliability at low cost allows for the light payloads of the LER.

  17. La faille de Conquista: Caractérisation structurale et cinématique d'un cisaillement ductile dextre à composante normale dans le domaine sud de l'Arc ibéro-armoricain

    NASA Astrophysics Data System (ADS)

    Aranguren, Aitor; Cuevas, Julia; Tubía, José María; Carracedo, Manuel; Larrea, Francisco J.

    1997-10-01

    The Conquista Fault is a high-temperature, ductile shear-zone developed along the northern contact of the Los Pedroches batholith in the southern part of the Central Iberian Zone (Variscan Belt, Spain). Structural and kinematic criteria show that the Conquista fault is a dextral oblique shear with a component of eastward extension. The motion of the Conquista fault is consistent with that of a transfer shear-zone subordinate to the eastward-directed late extensional evolution of the Central Iberian Zone.

  18. Interprétation hydrogéologique de l'aquifère des bassins sud-rifains (Maroc) : apport de la sismique réflexionHydrogeological interpretation of the southern Rifean basins aquifer (Morocco): seismic reflexion contribution

    NASA Astrophysics Data System (ADS)

    Zouhri, Lahcen; Gorini, Christian; Lamouroux, Christian; Vachard, Daniel; Dakki, Mohammed

    2003-03-01

    The aquifer of the Rharb Basin is constituted by heterogeneous material. The seismic reflexion interpretation carried out in this area, highlighted a permeable device compartmentalized in raised and subsided blocks. Depressions identified in the northern and southernmost zones are characterized by Plio-Quaternary fillings that are favourable to the hydrogeological exploitation. Two mechanisms contribute to structure the Plio-Quaternary aquifer: the Hercynian reactivation in the southernmost part, and the gravitational mechanism of the Pre-Rifean nappe. The groundwater flow and the aquifer thickening are controlled by this reactivation.

  19. SU-D-304-01: Development of An Applicator for Treating Shallow and Moving Tumors with Respiratory-Gated Spot-Scanning Proton Therapy Using Real-Time Image Guidance

    SciTech Connect

    Matsuura, T; Fujii, Y; Takao, S; Yamada, T; Matsuzaki, Y; Miyamoto, N; Shimizu, S; Shirato, H; Takayanagi, T; Fujitaka, S; Umegaki, K

    2015-06-15

    Purpose: To develop a method for treating shallow and moving tumors (e.g., lung tumors) with respiratory-gated spot-scanning proton therapy using real-time image guidance (RTPT). Methods: An applicator was developed which can be installed by hand on the treatment nozzle. The mechanical design was considered such that the Bragg peaks are placed at the patient surface while a sufficient field of view (FOV) of fluoroscopic X-rays was maintained during the proton beam delivery. To reduce the treatment time maintaining the robustness of the dose distribution with respect to motion, a mini-ridge filter (MRF) was sandwiched between two energy absorbers. The measurements were performed to obtain a data for beam modeling and to verify the spot position-invariance of a pencil beam dose distribution. For three lung cancer patients, treatment plans were made with and without the MRF and the effects of the MRF were evaluated. Next, the effect of respiratory motion on the dose distribution was investigated. Results: To scan the proton beam over a 14 x 14 cm area while maintaining the φ16 cm of fluoroscopic FOV, the lower face of the applicator was set 22 cm upstream of the isocenter. With an additional range variance of 2.2 mm and peak-to-peak distance of 4 mm of the MRF, the pencil beam dose distribution was unchanged with the displacement of the spot position. The quality of the treatment plans was not worsened by the MRF. With the MRF, the number of energy layers was reduced to less than half and the treatment time by 26–37%. The simulation study showed that the interplay effect was successfully suppressed by respiratory-gating both with and without MRF. Conclusions: The spot-scanning proton beam was successfully delivered to shallow and moving tumors within a sufficiently short time by installing the developed applicator at the RTPT nozzle.

  20. SU-D-204-05: Quantitative Comparison of a High Resolution Micro-Angiographic Fluoroscopic (MAF) Detector with a Standard Flat Panel Detector (FPD) Using the New Metric of Generalized Measured Relative Object Detectability (GM-ROD)

    SciTech Connect

    Russ, M; Ionita, C; Bednarek, D; Rudin, S

    2015-06-15

    Purpose: In endovascular image-guided neuro-interventions, visualization of fine detail is paramount. For example, the ability of the interventionist to visualize the stent struts depends heavily on the x-ray imaging detector performance. Methods: A study to examine the relative performance of the high resolution MAF-CMOS (pixel size 75µm, Nyquist frequency 6.6 cycles/mm) and a standard Flat Panel Detector (pixel size 194µm, Nyquist frequency 2.5 cycles/mm) detectors in imaging a neuro stent was done using the Generalized Measured Relative Object Detectability (GM-ROD) metric. Low quantum noise images of a deployed stent were obtained by averaging 95 frames obtained by both detectors without changing other exposure or geometric parameters. The square of the Fourier transform of each image is taken and divided by the generalized normalized noise power spectrum to give an effective measured task-specific signal-to-noise ratio. This expression is then integrated from 0 to each of the detector’s Nyquist frequencies, and the GM-ROD value is determined by taking a ratio of the integrals for the MAF-CMOS to that of the FPD. The lower bound of integration can be varied to emphasize high frequencies in the detector comparisons. Results: The MAF-CMOS detector exhibits vastly superior performance over the FPD when integrating over all frequencies, yielding a GM-ROD value of 63.1. The lower bound of integration was stepped up in increments of 0.5 cycles/mm for higher frequency comparisons. As the lower bound increased, the GM-ROD value was augmented, reflecting the superior performance of the MAF-CMOS in the high frequency regime. Conclusion: GM-ROD is a versatile metric that can provide quantitative detector and task dependent comparisons that can be used as a basis for detector selection. Supported by NIH Grant: 2R01EB002873 and an equipment grant from Toshiba Medical Systems Corporation.

  1. SU-D-201-07: Exploring the Utility of 4D FDG-PET/CT Scans in Design of Radiation Therapy Planning Compared with 3D PET/CT: A Prospective Study

    SciTech Connect

    Ma, C; Yin, Y

    2015-06-15

    Purpose: A method using four-dimensional(4D) PET/CT in design of radiation treatment planning was proposed and the target volume and radiation dose distribution changes relative to standard three-dimensional (3D) PET/CT were examined. Methods: A target deformable registration method was used by which the whole patient’s respiration process was considered and the effect of respiration motion was minimized when designing radiotherapy planning. The gross tumor volume of a non-small-cell lung cancer was contoured on the 4D FDG-PET/CT and 3D PET/CT scans by use of two different techniques: manual contouring by an experienced radiation oncologist using a predetermined protocol; another technique using a constant threshold of standardized uptake value (SUV) greater than 2.5. The target volume and radiotherapy dose distribution between VOL3D and VOL4D were analyzed. Results: For all phases, the average automatic and manually GTV volume was 18.61 cm3 (range, 16.39–22.03 cm3) and 31.29 cm3 (range, 30.11–35.55 cm3), respectively. The automatic and manually volume of merged IGTV were 27.82 cm3 and 49.37 cm3, respectively. For the manual contour, compared to 3D plan the mean dose for the left, right, and total lung of 4D plan have an average decrease 21.55%, 15.17% and 15.86%, respectively. The maximum dose of spinal cord has an average decrease 2.35%. For the automatic contour, the mean dose for the left, right, and total lung have an average decrease 23.48%, 16.84% and 17.44%, respectively. The maximum dose of spinal cord has an average decrease 1.68%. Conclusion: In comparison to 3D PET/CT, 4D PET/CT may better define the extent of moving tumors and reduce the contouring tumor volume thereby optimize radiation treatment planning for lung tumors.

  2. SU-D-19A-05: The Dosimetric Impact of Using Xoft Axxent® Electronic Brachytherapy Source TG-43 Dosimetry Parameters for Treatment with the Xoft 30 Mm Diameter Vaginal Applicator

    SciTech Connect

    Simiele, S; Micka, J; Culberson, W; DeWerd, L

    2014-06-01

    Purpose: A full TG-43 dosimetric characterization has not been performed for the Xoft Axxent ® electronic brachytherapy source (Xoft, a subsidiary of iCAD, San Jose, CA) within the Xoft 30 mm diameter vaginal applicator. Currently, dose calculations are performed using the bare-source TG-43 parameters and do not account for the presence of the applicator. This work focuses on determining the difference between the bare-source and sourcein- applicator TG-43 parameters. Both the radial dose function (RDF) and polar anisotropy function (PAF) were computationally determined for the source-in-applicator and bare-source models to determine the impact of using the bare-source dosimetry data. Methods: MCNP5 was used to model the source and the Xoft 30 mm diameter vaginal applicator. All simulations were performed using 0.84p and 0.03e cross section libraries. All models were developed based on specifications provided by Xoft. The applicator is made of a proprietary polymer material and simulations were performed using the most conservative chemical composition. An F6 collision-kerma tally was used to determine the RDF and PAF values in water at various dwell positions. The RDF values were normalized to 2.0 cm from the source to accommodate the applicator radius. Source-in-applicator results were compared with bare-source results from this work as well as published baresource results. Results: For a 0 mm source pullback distance, the updated bare-source model and source-in-applicator RDF values differ by 2% at 3 cm and 4% at 5 cm. The largest PAF disagreements were observed at the distal end of the source and applicator with up to 17% disagreement at 2 cm and 8% at 8 cm. The bare-source model had RDF values within 2.6% of the published TG-43 data and PAF results within 7.2% at 2 cm. Conclusion: Results indicate that notable differences exist between the bare-source and source-in-applicator TG-43 simulated parameters. Xoft Inc. provided partial funding for this work.

  3. Changements climatiques et variations du champ magnetique terrestre dans le sud de la Patagonie (Argentine) depuis 51 200 ans reconstitues a partir des proprietes magnetiques des sediments du lac Laguna Potrok Aike

    NASA Astrophysics Data System (ADS)

    Lise-Pronovost, Agathe

    Rock magnetism is influenced by climate and by the Earth's magnetic field. The goal of this thesis is to use the rock magnetic properties of the long sedimentary sequence from the lake Laguna Potrok Aike (106 m, 51200 cal BP) to derive paleomagnetic and paleoclimatic records in a key area of the Southern Hemisphere that is poorly documented. Laguna Potrok Aike (52°S, 70°W) is located in southeastern Patagonia (Argentina) in the path of the strong Southern Hemisphere westerly winds and in the source area of the dust deposited in Antarctica during Glacial periods. The lake geographical location is therefore ideal to reconstruct past changes in aeolian activity and climate changes in Patagonia. It is also a key location to reconstruct past changes of the geomagnetic field because the Southern Hemisphere is significantly under-documented relative to the Northern Hemisphere. In addition, the proximity of the South Atlantic Anomaly (SAA) as well as the Southern Hemisphere high flux lobes could allow identifying differences in the paleomagnetic field evolution in southern South America relative to the much more documented Northern Hemisphere. For his strong potential to provide high-resolution climatic, aeolian and paleomagnetic records beyond the last climatic transition, the maar lake Laguna Potrok Aike was drilled in the framework of the International scientific Continental Drilling Program (ICDP) for the Potrok Aike maar lake Sediment Archive Drilling prOject (PASADO). In this thesis, high-resolution rock-magnetic and physical properties are used in order to reconstruct paleoclimate and paleomagnetic records from the southernmost part of South America. In the first chapter, the full-vector paleomagnetic record (inclination, declination and relative paleointensity) derived from the sediments of Laguna Potrok Aike. A grain size influence on the relative paleointensity record (NRM/ARM) was corrected using the median destructive field of the natural remanent magnetisation (MDFNRM). Full-vector comparison of the new paleomagnetic record with other records from southern South America, elsewhere in the Southern Hemisphere, as well as dipole field models and compilations reveal similar millennial-scale variability. The Laschamp geomagnetic excursion and possibly the Mono Lake as well as the Hilina Pali excursions are recorded and suggest the global nature of these events. Nevertheless comparison with the Lake Baikal and Biwa records located on the opposite side of the globe in Siberia and Japan respectively reveals a different behaviour at ca. 46000 cal BP in Laguna Potrok Aike and in southern South America, hinting at a non-dipolar origin. In the second chapter, rock-magnetic proxies of dust and wind intensity since 51200 cal BP are constructed. The combined use of rock magnetism and grain size data allowed identifying the median destructive field of the isothermal remanent magnetisation (MDFIRM) as best reflecting silt-sized magnetite typically transported by wind in suspension over short distances. The MDF IRM displays similar variability than other wind intensity proxies derived from marine and lacustrine sediments, peat bug and speleothem records from Patagonia since the last climatic transition and from the Southern Hemisphere since 51200 cal BP. In addition, estimation of the flux of magnetite to the lake, investigation of the grain size influence on magnetic susceptibility and comparison with distal Patagonian dust records from the Southern Ocean and Antarctica indicate that the magnetic susceptibility signal from Laguna Potrok Aike is a dust record at the multi-millennial scale. In the third chapter, rock-magnetic proxies of runoff events associated with extreme precipitation and permafrost melt since 51200 cal BP are presented. The runoff events are identified by the presence of high coercivity magnetic mineral (such as hematite and goethite) which its pedogenic origin is inferred from geological, limnological, stratigraphic and climatic evidence. The runoff events are generally associated with mass movement deposits during time of enhanced lake productivity in Laguna Potrok Aike and are also coeval within the limit of the chronology to warm atmospheric conditions recorded in Antarctica. In addition, we show that the authigenic formation of iron sulfide such as greigite is strictly associated to reworked sands and tephra layers providing the required suboxic conditions and dissolved sulfate. As a whole, rock magnetism of the sediment from Laguna Potrok Aike provides a high quality full-vector paleomagnetic record as well as rock-magnetic proxies of past climate changes in southeastern Patagonia that are also associated with climate changes in Antarctica. Keywords: [Paleomagnetism, sediment magnetism, paleoclimatology, Laguna Potrok Aike, Patagonia, Southern Hemisphere, millennial- to centennial-scale variability, last Glacial period, Holocene, wind intensity].

  4. SU-D-9A-02: Relative Effects of Threshold Choice and Spatial Resolution Modeling On SUV and Volume Quantification in F18-FDG PET Imaging of Anal Cancer Patients

    SciTech Connect

    Zhao, F; Bowsher, J; Palta, M; Czito, B; Willett, C; Yin, F

    2014-06-01

    Purpose: PET imaging with F18-FDG is utilized for treatment planning, treatment assessment, and prognosis. A region of interest (ROI) encompassing the tumor may be determined on the PET image, often by a threshold T on the PET standard uptake values (SUVs). Several studies have shown prognostic value for relevant ROI properties including maximum SUV value (SUVmax), metabolic tumor volume (MTV), and total glycolytic activity (TGA). The choice of threshold T may affect mean SUV value (SUVmean), MTV, and TGA. Recently spatial resolution modeling (SRM) has been introduced on many PET systems. SRM may also affect these ROI properties. The purpose of this work is to investigate the relative influence of SRM and threshold choice T on SUVmean, MTV, TGA, and SUVmax. Methods: For 9 anal cancer patients, 18F-FDG PET scans were performed prior to treatment. PET images were reconstructed by 2 iterations of Ordered Subsets Expectation Maximization (OSEM), with and without SRM. ROI contours were generated by 5 different SUV threshold values T: 2.5, 3.0, 30%, 40%, and 50% of SUVmax. Paired-samples t tests were used to compare SUVmean, MTV, and TGA (a) for SRM on versus off and (b) between each pair of threshold values T. SUVmax was also compared for SRM on versus off. Results: For almost all (57/60) comparisons of 2 different threshold values, SUVmean, MTV, and TGA showed statistically significant variation. For comparison of SRM on versus off, there were no statistically significant changes in SUVmax and TGA, but there were statistically significant changes in MTV for T=2.5 and T=3.0 and in SUVmean for all T. Conclusion: The near-universal statistical significance of threshold choice T suggests that, regarding harmonization across sites, threshold choice may be a greater concern than choice of SRM. However, broader study is warranted, e.g. other iterations of OSEM should be considered.

  5. (Collaboration with the Institut de Physique Nucleaire, Universite de Paris Sud, on use of skull melting techniques to grow ZrO/sub 2/ crystals doped with divalent ions, Orsay, France, March 2--6, 1989): Foreign trip report

    SciTech Connect

    Finch, C.B.

    1989-07-21

    The traveler collaborated with Michel Genet and others at the Institut de Physique Nucleaire to grow CaO-stabilized ZrO/sub 2/ single crystals by the skull technique. This effort was the initial state of a program to produce rare-earth-doped ZrO/sub 2/ single-crystal specimens to be used in spectroscopic studies at both IPN and ORNL. Because of a re-direction in the research priorities at the IPN and the accompanying dearth of funding for this project, this assignment was terminated with the mutual consent of the two institutions.

  6. Investigation hydrogéologique dans le delta du Mékong, autour de la ville de Ho-Chi-Minh (Sud-Vietnam), par tomographie électrique

    NASA Astrophysics Data System (ADS)

    Pham, Van Ngoc; Boyer, Danièle; Le Mouël, Jean-Louis; Kim Thoa Nguyen, Thi

    In the Mekong Delta (South Vietnam), the agglomeration of Ho-Chi-Minh (HCM) City, with more than 5 million inhabitants, is confronted with a dramatic shortage of fresh water supply because of the pollution of several aquifers at different depths. The electric tomography, obtained by concurrent inversion of two complementary geoelectrical methods, the Vertical Electrical Sounding (VES) and the Magneto-Telluric Sounding (MTS), turned out to be very efficient to provide a complete electrical image of the underground from the surface until about 800 m depth. This methodology constitutes a very cheap guide for the evaluation of the quality of the groundwater resources in the vast alluvial plain of the Mekong Delta. To cite this article: V.N. Pham et al., C. R. Geoscience 334 (2002) 733-740.

  7. SU-D-18A-06: Variation of Controlled Breath Hold From CT Simulation to Treatment and Its Dosimetric Impact for Left-Sided Breast Radiotherapy with a Real-Time Optical Tracking System

    SciTech Connect

    Mittauer, K; Deraniyagala, R; Li, J; Lu, B; Liu, C; Lightsey, J; Yan, G

    2014-06-01

    Purpose: Different breath-hold (BH) maneuvers (abdominal breathing vs. chest breathing) during CT simulation and treatment can lead to chest wall positional variation. The purpose of this study is to quantify the variation of active breathing control (ABC)-assisted BH and estimate its dosimetric impact for left-sided whole-breast radiotherapy with a real-time optical tracking system (OTS). Methods: Seven breast cancer patients were included. An in-house OTS tracked an infrared (IR) marker affixed over the xiphoid process of the patient at CT simulation and throughout the treatment course to measure BH variations. Correlation between the IR marker and the breast was studied for dosimetric purposes. The positional variations of 860 BHs were retrospectively incorporated into treatment plans to assess their dosimetric impact on breast and cardiac organs (heart and left anterior descending artery [LAD]). Results: The mean intrafraction variations were 2.8 mm, 2.7 mm, and 1.6 mm in the anteroposterior (AP), craniocaudal (CC), and mediolateral (ML) directions, respectively. Mean stability in any direction was within 1.5 mm. A general trend of BH undershoot at treatment relative to CT simulation was observed with an average of 4.4 mm, 3.6 mm, and 0.1 mm in the AP, CC, and ML directions, respectively. Undershoot up to 12.6 mm was observed for individual patients. The difference between the planned and delivered dose to breast targets was negligible. The average planned/delivered mean heart doses, mean LAD doses, and max LAD doses were 1.4/2.1, 7.4/15.7, and 18.6/31.0 Gy, respectively. Conclusion: Systematic undershoot was observed in ABC-assisted BHs from CT simulation to treatment. Its dosimetric impact on breast coverage was minimized with image guidance, but the benefits of cardiac organ sparing were degraded. A real-time tracking system can be used in junction with the ABC device to improve BH reproducibility.

  8. La vulnerabilite de l'universite face aux politiques gouvernementales et la cooperation internationale nord-sud (The Vulnerability of the University in the Face of Governmental Politics and North-South International Cooperation).

    ERIC Educational Resources Information Center

    Barot, Elisabeth

    1991-01-01

    Cooperation between universities in northern and southern hemispheres in the current economic and geopolitical climate is discussed. The relationship between Canadian universities and the government is chronicled, and mechanisms of international cooperation are analyzed. Certain ethical principles are proposed as a framework for Canadian…

  9. Rupture politique et enseignement de l'histoire en Afrique du Sud: Les manuels de l'enseignement primaire. (Political rupture and the teaching of history in South Africa: Handbooks of primary-level teaching.)

    ERIC Educational Resources Information Center

    Carpentier, Claude

    2000-01-01

    Analyzes the content of South African history text books from the primary level upwards and from the 1980s to the most recent publications. The considerable changes in the content of these books seem to be based on two different theoretical models: the multicultural model and the notion of the universality of humanity. (Contains 40 references.)…

  10. Adaptation linguistique et culturelle: L'experience des refugies d'Asie du sud-est au Quebec (Linguistic and Cultural Adaptation: The Experience of Southeast Asian Refugees in Quebec).

    ERIC Educational Resources Information Center

    Chan, Kwok B.; Dorais, Louis-Jacques

    A collection of papers, in English and French, on the adjustment processes and problems of Southeast Asian refugees in Quebec includes: "Prelude to Resettlement: A Clinical View on the Transit Camp Experience of Vietnamese Refugees" (David Loveridge, Kwok B. Chan); "Une communaute culturelle en situation de diglossie: Les Vietnamiens du Quebec"…

  11. The Complicated Relationship Between Attention Deficit/Hyperactivity Disorder and Substance Use Disorders

    PubMed Central

    Zulauf, Courtney A.; Sprich, Susan E.; Safren, Steven A.

    2015-01-01

    Adolescents and young adults with substance use disorders (SUD) and attention deficit/hyperactivity disorder (ADHD) are increasingly presenting in clinical practice. The overlap and role of treatment for these co-occurring disorders remains unclear. A review of the literature was conducted to highlight and update recent evidence on the overlap of ADHD and SUD, the role of ADHD medication on later SUD, and the treatment of ADHD and SUD in adolescents and young adults. Recent work continues to highlight the high risk for comorbid ADHD in patients with SUD; and conversely, the high risk for SUD developing in ADHD across the lifespan, particularly in the context of comorbid conduct disorder. Although the data remains discordant, it appears that ADHD pharmacotherapy does not increase the risk for SUD. Medication treatment alone does not appear to be particularly effective in treating SUD in currently active substance abusing individuals with ADHD. Structured therapies may be effective in treating adolescents and young adults with ADHD and SUD. Further controlled trials evaluating the sequence and effect of structured psychotherapies and/or ADHD pharmacotherapy on SUD relapse in these groups are warranted. PMID:24526271

  12. Organizing Publicly Funded Substance Use Disorder Treatment in the United States: Moving Toward a Service System Approach.

    PubMed

    Padwa, Howard; Urada, Darren; Gauthier, Patrick; Rieckmann, Traci; Hurley, Brian; Crèvecouer-MacPhail, Desirée; Rawson, Richard A

    2016-10-01

    Historically, publicly funded substance use disorder (SUD) treatment services in the United States have been disorganized and inefficient. By reconfiguring and linking services to create systems of care-services, structures, and processes that are purposively interconnected to treat SUD systematically-health systems can transform discrete service components into cohesive service systems that comprehensively and efficiently treat SUDs. In this article we: (1) articulate the potential benefits of organizing publicly funded SUD services into systems of care; (2) review basic principles underlying theories of SUD system organization; (3) describe the mix and configuration of services needed to create comprehensive, integrated systems of publicly funded SUD care; (4) elucidate how patients can flow through systems of SUD services in a clinically sound and cost-efficient manner, and; (5) propose eight steps that can be taken to create systems of care by identifying and leveraging the strengths, assets, and capacities of SUD service providers already operating within their health care systems. In July 2015, the Centers for Medicare and Medicaid Services (CMS) announced opportunities for states to redesign their Medicaid-funded SUD service systems. This paper provides considerations for SUD system design and development. PMID:27568505

  13. The complicated relationship between attention deficit/hyperactivity disorder and substance use disorders.

    PubMed

    Zulauf, Courtney A; Sprich, Susan E; Safren, Steven A; Wilens, Timothy E

    2014-03-01

    Adolescents and young adults with substance use disorders (SUD) and attention deficit/hyperactivity disorder (ADHD) are increasingly presenting in clinical practice. The overlap and role of treatment for these co-occurring disorders remains unclear. A review of the literature was conducted to highlight and update recent evidence on the overlap of ADHD and SUD, the role of ADHD medication on later SUD, and the treatment of ADHD and SUD in adolescents and young adults. Recent work continues to highlight the high risk for comorbid ADHD in patients with SUD; and conversely, the high risk for SUD developing in ADHD across the lifespan, particularly in the context of comorbid conduct disorder. Although the data remains discordant, it appears that ADHD pharmacotherapy does not increase the risk for SUD. Medication treatment alone does not appear to be particularly effective in treating SUD in currently active substance abusing individuals with ADHD. Structured therapies may be effective in treating adolescents and young adults with ADHD and SUD. Further controlled trials evaluating the sequence and effect of structured psychotherapies and/or ADHD pharmacotherapy on SUD relapse in these groups are warranted. PMID:24526271

  14. Familial influence of substance use disorder on emotional disorder across three generations.

    PubMed

    Leventhal, Adam M; Pettit, Jeremy W; Lewinsohn, Peter M

    2011-02-28

    The concomitant influence of grandparental (Generation 1; G1) and parental (G2) substance use disorder (SUD) on grandchild (G3) emotional disorder (EmD) across three generations is unclear. The present study addressed this in a sample of 284 families participating in the Oregon Adolescent Depression Project. Structured clinical interviews were used to collect psychiatric history data on a community cohort of G2 individuals and their G1 parents. G2 parents rated EmD symptoms in their G3 children (M age=5 years, SD=2.4). Results indicated that G1 SUD was associated with increased risk of G3 EmD symptom elevations, above and beyond the influence of comorbid G1 EmD. G2 SUD was associated with a similar independent increase in risk for G3 EmD symptoms. Also, G1 SUD conferred risk for G2 SUD. Mediational tests indicated that the influence of G1 SUD on G3 EmD was transmitted via its influence on G2 SUD. G1 and G2 SUD did not interact in predicting G3 EmD; rather results suggested an additive influence. There was no evidence that the influence of G1 SUD on G3 EmD was transmitted via G2 EmD. These findings shed light on the multigenerational processes through which SUD influences EmD.

  15. The Impact of Substance Use Disorders on Families and Children: From Theory to Practice

    PubMed Central

    Lander, Laura; Howsare, Janie; Byrne, Marilyn

    2013-01-01

    The effects of a substance use disorder (SUD) are felt by the whole family. The family context holds information about how SUDs develop, are maintained, and what can positively or negatively influence the treatment of the disorder. Family systems theory and attachment theory are theoretical models that provide a framework for understanding how SUDs affect the family. In addition, understanding the current developmental stage a family is in helps inform assessment of impairment and determination of appropriate interventions. SUDs negatively affect emotional and behavioral patterns from the inception of the family, resulting in poor outcomes for the children and adults with SUDs. Social workers can help address SUDs in multiple ways, which are summarized in this article. PMID:23731414

  16. Parental substance use impairment, parenting and substance use disorder risk.

    PubMed

    Arria, Amelia M; Mericle, Amy A; Meyers, Kathleen; Winters, Ken C

    2012-07-01

    Using data from a nationally representative sample, this study investigated substance use disorder (SUD) among respondents with ages 15-54 years as a function of their parents' substance-related impairment and parents' treatment history. In addition, associations among maternal and paternal substance-related impairment, specific parenting behaviors, and risk for SUD in the proband were examined. As expected, parental substance-related impairment was associated with SUD. Paternal treatment history was associated with a decreased risk for SUD in the proband but did not appear to be associated with positive parenting practices. Results of post hoc analyses suggested that parenting behaviors might operate differently to influence SUD risk in children where parents are affected by substance use problems compared with nonaffected families. Future research is warranted to better understand the complex relationships among parental substance use, treatment, parenting behaviors, and SUD risk in offspring. Opportunities might exist within treatment settings to improve parenting skills.

  17. TRICARE; Mental Health and Substance Use Disorder Treatment. Final rule.

    PubMed

    2016-09-01

    This final rule modifies the TRICARE regulation to reduce administrative barriers to access to mental health benefit coverage and to improve access to substance use disorder (SUD) treatment for TRICARE beneficiaries, consistent with earlier Department of Defense and Institute of Medicine recommendations, current standards of practice in mental health and addiction medicine, and governing laws. This rule seeks to eliminate unnecessary quantitative and non-quantitative treatment limitations on SUD and mental health benefit coverage and align beneficiary cost-sharing for mental health and SUD benefits with those applicable to medical/surgical benefits, expand covered mental health and SUD treatment under TRICARE to include coverage of intensive outpatient programs and treatment of opioid use disorder and to streamline the requirements for mental health and SUD institutional providers to become TRICARE authorized providers, and to develop TRICARE reimbursement methodologies for newly recognized mental health and SUD intensive outpatient programs and opioid treatment programs.

  18. TRICARE; Mental Health and Substance Use Disorder Treatment. Final rule.

    PubMed

    2016-09-01

    This final rule modifies the TRICARE regulation to reduce administrative barriers to access to mental health benefit coverage and to improve access to substance use disorder (SUD) treatment for TRICARE beneficiaries, consistent with earlier Department of Defense and Institute of Medicine recommendations, current standards of practice in mental health and addiction medicine, and governing laws. This rule seeks to eliminate unnecessary quantitative and non-quantitative treatment limitations on SUD and mental health benefit coverage and align beneficiary cost-sharing for mental health and SUD benefits with those applicable to medical/surgical benefits, expand covered mental health and SUD treatment under TRICARE to include coverage of intensive outpatient programs and treatment of opioid use disorder and to streamline the requirements for mental health and SUD institutional providers to become TRICARE authorized providers, and to develop TRICARE reimbursement methodologies for newly recognized mental health and SUD intensive outpatient programs and opioid treatment programs. PMID:27592499

  19. Delinquency, depression, and substance use disorder among child welfare-involved adolescent females

    PubMed Central

    Lalayants, Marina

    2014-01-01

    Although adolescents with delinquency are known to have higher-than-average rates of depression or substance use disorder (SUD), research on the topic is inconsistent. It remains unclear weather depression or SUD leads to delinquency, whether delinquency leads to depression or SUD, or whether there is bi-directionality. Utilizing the National Survey of Child and Adolescent Well-Being (Wave I: 2008–2009; Wave II: 18 months later: N = 5872), we used logistic regression to predict depression from delinquency (and vice versa), and SUD from delinquency (and vice versa). After inclusion of control variables, we found that females with minor theft in Wave I were more than 4 times as likely (adjusted odds ratio [aOR] = 4.34; 95% CI: 1.10–17.16) as females without minor theft to be depressed in Wave II, and those with public disorder in Wave I were almost 3 times as likely (aOR = 2.74; 95% CI: 1.03–7.30) as those without public disorder to have SUD in Wave II. Overall delinquency also predicted depression or SUD, and SUD predicted delinquency. Practitioners could address risk for depression or SUD among child welfare-involved adolescent females by focusing on overall delinquency or on specific types of delinquency (minor theft for depression and public disorder for SUD) and by offering interventions (e.g., cognitive-behavioral psychotherapy) that have been shown to be effective in preventing depression or SUD. In addition, with respect to our finding that SUD predicts delinquency among adolescent females, practitioners can help prevent delinquency by offering interventions (e.g., intensive outpatient treatments) that have well documented effectiveness in addressing SUD. PMID:24060474

  20. HEDIS initiation and engagement quality measures of substance use disorder care: impact of setting and health care specialty.

    PubMed

    Harris, Alex H S; Bowe, Thomas; Finney, John W; Humphreys, Keith

    2009-08-01

    Many health care systems track the HEDIS measures of initiation and engagement in substance use disorder (SUD) care. However, the impact of setting of care (inpatient vs. outpatient) and health care specialty (SUD, psychiatric, other) on the likelihood of patients meeting the initiation and engagement criteria are unknown. If the vast majority of initiation and engagement occurs within SUD specialty clinics, then these quality measures could be used to discriminate among and incentivize SUD clinic managers. However, if these criteria are satisfied in different settings and specialties, then they should be considered characteristics of the entire facility, rather than just specialty SUD units. Using a Markov model, the probabilities of advancing to treatment initiation and engagement given initial setting and specialty of care were estimated for 320,238 SUD-diagnosed Veterans Health Affairs (VA) patients. Patients in SUD specialty units progressed more often (diagnosis to initiation, initiation to engagement) than patients in other specialties. Progression through the criteria differed for inpatients vs. outpatients. Approximately 25% of initiation and over 40% of engagement occurred outside of SUD specialty care. VA patients who have contact with SUD specialty treatment have higher rates of advancing to initiation, and from initiation to engagement, compared to SUD-diagnosed patients in psychiatric or other medical locations. Even so, a substantial portion of initiation and engagement occurs outside of SUD specialty units. Therefore, these quality measures should be considered measures of facility performance rather than measures of the quality of SUD specialty care. The usual combining of inpatient and outpatient performance on these measures into overall facility scores clouds measurement and interpretation.

  1. Pharmacotherapy for substance abuse disorders in adolescence.

    PubMed

    Kaplan, Gabriel; Ivanov, Iliyan

    2011-02-01

    The public health effects of adolescent substance abuse disorders (SUD) reaches further than the immediate intoxicating effects. Medications play a limited role in the treatment of youth beyond addressing short-term symptoms but may improve longer-term outcomes for some patients. Given the potential devastating consequences of SUD, clinicians should become familiar with all available treatment options. This article reviews the pharmacotherapy for adolescent SUD to inform clinicians considering the use of this modality for selected groups of patients.

  2. Personality traits and vulnerability or resilience to substance use disorders.

    PubMed

    Belcher, Annabelle M; Volkow, Nora D; Moeller, F Gerard; Ferré, Sergi

    2014-04-01

    Clear evidence supports a genetic basis for substance use disorders (SUD). Yet, the search to identify individual gene contributions to SUD has been unsuccessful. Here, we argue for the study of endophenotypes within the frame of individual differences, and identify three high-order personality traits that are tied to specific brain systems and genes, and that offer a tractable approach to studying SUD. These personality traits, and the genes that moderate them, interact dynamically with the environment and with the drugs themselves to determine ultimately an individual's vulnerability or resilience to developing SUD.

  3. The Role of Pharmacotherapy in the Treatment of Adolescent Substance Use Disorders.

    PubMed

    Hammond, Christopher J

    2016-10-01

    Adolescent substance use disorders (SUDs) are a significant public health issue due to the associated morbidity, mortality, and societal cost. While effective for some adolescents, psychosocial interventions generally produce small-to-moderate reductions in substance use. Most youth relapse within 12 months of treatment. One approach to improve outcomes is through adjunctive pharmacotherapy. Medication assisted treatments have been shown to improve adult SUD treatment outcomes, and preliminary studies in adolescents suggest that combining medication with psychosocial interventions may also enhance SUD outcomes for youth. This article presents a comprehensive review and grading of the evidence from studies conducted in adolescents with SUDs. PMID:27613346

  4. Personality in male patients with substance use disorder and/or severe mental illness.

    PubMed

    Fernández-Mondragón, Susana; Adan, Ana

    2015-08-30

    Dual diagnosis (DD) is the coexistence of a substance use disorder (SUD) and severe mental illness (SMI). The aim of this study is to determine for the first time if a specific personality pattern exists for DD patients compared to those who only have SUD or SMI. The sample was composed of 102 male, 34 patients in each group (DD, SUD and SMI). DD and SMI groups included 20 schizophrenic and 14 depressed patients respectively. Cloninger's TCI-R was administered together with a structured interview of sociodemographic and clinical characteristics. All the temperament dimensions and Self-directedness provided differences among groups. The DD and SUD showed significant higher scores in Novelty Seeking regarding SMI, whereas for Harm Avoidance the SUD subjects scored lower with respect to the DD and SMI group. Persistence was significant lower for the DD and SMI groups compared to the SUD patients. The DD obtained low significant scores in Reward Dependence in relation to the SUD and Self-directedness in relation to the SUD and SMI. Our data highlight the presence of a different personality profiles among DD, SUD and SMI disorders. Taking into account the patients' personality can benefit the clinical course and minimize the DD impact.

  5. Personality Traits and Vulnerability or Resilience to Substance Use Disorders

    PubMed Central

    Belcher, Annabelle M.; Volkow, Nora D.; Moeller, F. Gerard; Ferré, Sergi

    2014-01-01

    Clear evidence supports a genetic basis for Substance Use Disorders (SUD). Yet the search to identify individual gene contributions to SUD has been quite unsuccessful. Here we argue for the study of endophenotypes within the frame of individual differences, and identify three high-order personality traits that are tied to specific brain systems and genes, and that offer a tractable approach to studying SUD. These personality traits, and the genes that moderate them, interact dynamically with the environment and with the drugs themselves to ultimately determine an individual’s vulnerability or resilience to developing SUD. PMID:24612993

  6. Parental Warmth and Risks of Substance Use in Children with Attention-Deficit/Hyperactivity Disorder: Findings from a 10–12 Year Longitudinal Investigation

    PubMed Central

    Tandon, Mini; Tillman, Rebecca; Spitznagel, Edward; Luby, Joan

    2013-01-01

    Objective The study examined factors in the risk trajectory for Substance Use Disorder (SUD) over a 10–12 year period in children with ADHD. Method N=145 children between the ages of 7 and 16 with ADHD and healthy controls were assessed every 2 years for 10–12 years as part of a larger, longitudinal investigation. Onset of substance use disorder was examined using Cox proportional hazards modeling, and included child and parent psychopathology, and parental warmth as well as other key factors. Results Low paternal warmth and maternal SUD were predictors of SUD in n=59 ADHD participants after adjusting for gender, child ODD, paternal SUD, maternal/paternal ADHD, maternal/paternal major depressive disorder (MDD), maternal/paternal anxiety, and low maternal warmth in the Cox model. Conclusions Longitudinal study findings suggest that in addition to the established risk of ADHD and maternal SUD in development of child SUD, low paternal warmth is also associated with onset of SUD. This was evident after controlling for pertinent parent and child psychopathology. These findings suggest that paternal warmth warrants further investigation as a key target for novel interventions to prevent SUD in children with ADHD. More focused investigations examining paternal parenting factors in addition to parent and child psychopathology in the risk trajectory from ADHD to SUD are now warranted. PMID:24955084

  7. Social Workers and Delivery of Evidence-Based Psychosocial Treatments for Substance Use Disorders

    PubMed Central

    WELLS, ELIZABETH A.; KRISTMAN-VALENTE, ALLISON N.; PEAVY, K. MICHELLE; JACKSON, T. RON

    2013-01-01

    Social workers encounter individuals with substance use disorders (SUDs) in a variety of settings. With changes in health care policy and a movement toward integration of health and behavioral health services, social workers will play an increased role vis-a-vis SUD. As direct service providers, administrators, care managers and policy makers, they will select, deliver, or advocate for delivery of evidence-based SUD treatment practices. This paper provides an overview of effective psychosocial SUD treatment approaches. In addition to describing the treatments, the article discusses empirical support, populations for whom the treatments are known to be efficacious, and implementation issues. PMID:23731420

  8. Substance use disorders and comorbid Axis I and II psychiatric disorders among young psychiatric patients: findings from a large electronic health records database.

    PubMed

    Wu, Li-Tzy; Gersing, Ken; Burchett, Bruce; Woody, George E; Blazer, Dan G

    2011-11-01

    This study examined the prevalence of substance use disorders (SUDs) among psychiatric patients aged 2-17 years in an electronic health records database (N=11,457) and determined patterns of comorbid diagnoses among patients with a SUD to inform emerging comparative effectiveness research (CER) efforts. DSM-IV diagnoses of all inpatients and outpatients at a large university-based hospital and its associated psychiatric clinics were systematically captured between 2000 and 2010: SUD, anxiety (AD), mood (MD), conduct (CD), attention deficit/hyperactivity (ADHD), personality (PD), adjustment, eating, impulse-control, psychotic, learning, mental retardation, and relational disorders. The prevalence of SUD in the 2-12-year age group (n=6210) was 1.6% and increased to 25% in the 13-17-year age group (n=5247). Cannabis diagnosis was the most prevalent SUD, accounting for more than 80% of all SUD cases. Among patients with a SUD (n=1423), children aged 2-12 years (95%) and females (75-100%) showed high rates of comorbidities; blacks were more likely than whites to be diagnosed with CD, impulse-control, and psychotic diagnoses, while whites had elevated odds of having AD, ADHD, MD, PD, relational, and eating diagnoses. Patients with a SUD used more inpatient treatment than patients without a SUD (43% vs. 21%); children, females, and blacks had elevated odds of inpatient psychiatric treatment. Collectively, results add clinical evidence on treatment needs and diagnostic patterns for understudied diagnoses.

  9. Validation of the treatment identification strategy of the HEDIS addiction quality measures: concordance with medical record review

    PubMed Central

    2011-01-01

    Background Strategies to accurately identify the occurrence of specific health care events in administrative data is central to many quality improvement and research efforts. Many health care quality measures have treatment identification strategies based on diagnosis and procedure codes - an approach that is inexpensive and feasible but usually of unknown validity. In this study, we examined if the diagnosis/procedure code combinations used in the 2006 HEDIS Initiation and Engagement quality measures to identify instances of addiction treatment have high concordance with documentation of addiction treatment in clinical progress notes. Methods Four type of records were randomly sampled from VHA electronic medical data: (a) Outpatient records from a substance use disorder (SUD) specialty clinic with a HEDIS-qualified substance use disorder (SUD) diagnosis/CPT code combination (n = 700), (b) Outpatient records from a non-SUD setting with a HEDIS-qualified SUD diagnosis/CPT code combination (n = 592), (c) Specialty SUD Inpatient/residential records that included a SUD diagnosis (n = 700), and (d) Non-SUD specialty Inpatient/residential records that included a SUD diagnosis (n = 700). Clinical progress notes for the sampled records were extracted and two raters classified each as documenting or not documenting addiction treatment. Rates of concordance between the HEDIS addiction treatment identification strategy and the raters' judgments were calculated for each record type. Results Within SUD outpatient clinics and SUD inpatient specialty units, 92% and 98% of sampled records had chart evidence of addiction treatment. Of outpatient encounters with a qualifying diagnosis/procedure code combination outside of SUD clinics, 63% had chart evidence of addiction treatment. Within non-SUD specialty inpatient units, only 46% of sampled records had chart evidence of addiction treatment. Conclusions For records generated in SUD specialty settings, the HEDIS strategy of

  10. The Effects of PTSD on Treatment Adherence, Drug Relapse, and Criminal Recidivism in a Sample of Incarcerated Men and Women

    ERIC Educational Resources Information Center

    Kubiak, Sheryl Pimlott

    2004-01-01

    Objective/Method: Given the relationship between post-traumatic stress disorder (PTSD) and substance use disorders (SUD), and the prevalence of SUD among offenders, the inattention to trauma before, during, and after incarceration is troubling. This exploratory study compared those with and without co-occurring PTSD among men (n = 139) and women…

  11. In-depth study of personality disorders in first-admission patients with substance use disorders

    PubMed Central

    2012-01-01

    Background Assessment of comorbid personality disorders (PDs) in patients with substance use disorders (SUDs) is challenging due to symptom overlap, additional mental and physical disorders, and limitations of the assessment methods. Our in-depth study applied methods to overcome these difficulties. Method A complete catchment area sample of 61 consecutively admitted patients with SUDs, with no previous history of specialized treatment (addiction clinics, psychiatry) were studied, addressing PDs and associated clinical and demographic variables. The thorough assessments included the Psychiatric Research Interview for Substance and Mental Disorders and the Structured Clinical Interview for DSM-IV Axis II Personality Disorders. Results Forty-six percent of the SUD patients had at least one PD (16% antisocial [males only]; 13% borderline; and 8% paranoid, avoidant, and obsessive-compulsive, respectively). Cluster C disorders were as prevalent as Cluster B disorders. SUD patients with PDs were younger at the onset of their first SUD and at admission; used more illicit drugs; had more anxiety disorders, particularly social phobia; had more severe depressive symptoms; were more distressed; and less often attended work or school. Conclusion The psychiatric comorbidity and symptom load of SUD patients with PDs differed from those of SUD patients without PDs, suggesting different treatment needs, and stressing the value of the assessment of PDs in SUD patients. PMID:23107025

  12. Evaluation of a Substance Use Disorder Curriculum for Internal Medicine Residents

    ERIC Educational Resources Information Center

    Stein, Melissa R.; Arnsten, Julia H.; Parish, Sharon J.; Kunins, Hillary V.

    2011-01-01

    Teaching about diagnosis, treatment, and sequelae of substance use disorders (SUDs) is insufficient in most Internal Medicine residency programs. To address this, the authors developed, implemented, and evaluated a novel and comprehensive SUD curriculum for first year residents (interns) in Internal Medicine, which anchors the ensuing 3-year…

  13. Mapping the Clinical Complexities of Adolescents with Substance Use Disorders: A Typological Study

    ERIC Educational Resources Information Center

    Meyers, Kathleen; McDermott, Paul A.; Webb, Alicia; Hagan, Teresa Ann

    2006-01-01

    Because of the vast improvements in adolescent substance use assessment, it is widely recognized that adolescent substance use disorders (SUD) encompasses diverse drugs, patterns and etiologies and are characterized by extensive heterogeneity in other life domains. The next step in advancing adolescent SUD assessment is to classify adolescents…

  14. Clinical Characteristics and Staff Training Needs of Two Substance Use Disorder Treatment Programs Specialized for Persons with Disabilities

    ERIC Educational Resources Information Center

    Moore, Dennis; Lorber, Cathy

    2004-01-01

    The clinical aspects and staff training needs for two substance use disorder (SUD) treatment programs that serve persons with co-existing disabilities are described. The article addresses SUD prevalence among persons with disabilities and the corresponding specialized treatment needs and accommodations that may be necessary. The philosophical…

  15. Video-Based Cognitive Behavioral Therapy Module as a Supplemental Treatment in a V.A. Residential Substance Use Disorder Therapeutic Community

    ERIC Educational Resources Information Center

    Scheer, David

    2012-01-01

    Substance use disorders (SUDs) are one of the most prevalent psychiatric disorders among adults in the United States. For men, SUDs have the highest lifetime prevalence (33-35.4%) of any psychiatric disorder, and, for women, the lifetime prevalence is 17.9-20% (Conway et al., 2006; Kessler et al., 1994). There are many effective treatments for SUD…

  16. Reduced Functional Connectivity within the Mesocorticolimbic System in Substance Use Disorders: An fMRI Study of Puerto Rican Young Adults

    PubMed Central

    Posner, Jonathan; Amira, Leora; Algaze, Antonio; Canino, Glorisa; Duarte, Cristiane S.

    2016-01-01

    Studies of the mesocorticolimbic reward system (MCLS) and its relationship with impulsivity and substance use disorders (SUD) have largely focused on individuals from non-minority backgrounds. This represents a significant gap in the literature particularly for minority populations who are disproportionately affected by the consequences of SUD. Using resting-state functional MRI (fMRI), we examined the coherence of neural activity, or functional connectivity, within the brain’s MCLS in 28 young adult Puerto Ricans (ages 25–27) who were part of a population-based cohort study. Half of the sample lived in San Juan, Puerto Rico; the other half lived in the South Bronx, New York. At each of the two sites, half of the sample had a history of a SUD. Relative to those without SUD, individuals with SUD had decreased connectivity between the nucleus accumbens (NAcc) and several regions within the MCLS. This finding was true irrespective of study site (i.e., San Juan or South Bronx). Reduced connectivity within the MCLS was also associated with higher self-reported levels of impulsivity. Path analysis suggested a potential mechanism linking impulsivity, the MCLS, and SUD: impulsivity, potentially by chronically promoting reward seeking behaviors, may contribute to decreased MCLS connectivity, which in turn, may confer vulnerability for SUD. Expanding upon prior studies suggesting that alterations within the MCLS underlie SUD, our findings suggest that such alterations are also related to impulsivity and are present in a high-risk young minority population. PMID:27252633

  17. Does Temperament Moderate Treatment Response in Adolescent Substance Use Disorders?

    ERIC Educational Resources Information Center

    Burleson, Joseph A.; Kaminer, Yifrah

    2008-01-01

    To assess whether temperament moderates response to treatment for substance use disorders (SUD), n = 88 consecutively referred adolescents with SUD were randomized to cognitive-behavioral (CBT) or psychoeducational (PET) therapies. Principal components analyses reduced the 10-attribute Dimensions of Temperament Revised (DOTS-R) to three factors…

  18. Study design, interventions, and baseline characteristics for the Substance use and TRauma Intervention for VEterans (STRIVE) trial.

    PubMed

    Kehle-Forbes, Shannon M; Drapkin, Michelle L; Foa, Edna B; Koffel, Erin; Lynch, Kevin G; Polusny, Melissa A; Van Horn, Deborah H A; Yusko, David A; Charlesworth, Molly; Blasco, Molly; Oslin, David W

    2016-09-01

    While comorbidity between posttraumatic stress disorder (PTSD) and substance use disorders (SUD) is common among veterans, there is debate regarding how to best treat individuals suffering from both conditions. Despite data supporting the effectiveness of integrated treatments that simultaneously address both disorders, due to concerns that an early focus on trauma may increase dropout and reduce the likelihood of achieving SUD-related goals, providers continue to prefer a sequential approach, where the addiction is treated first and PTSD treatment is instituted following sustained abstinence or reduced use. This project is designed to directly examine these provider concerns by evaluating the benefits and harms of an integrated versus a sequential approach to treating comorbid PTSD and SUD. This paper reviews the study's methodology, treatment approaches, and baseline participant characteristics. In this randomized clinical trial, one hundred eighty-three veterans with co-occurring PTSD and SUD have been randomized to one of two psychotherapies that include the same treatment components for SUD and PTSD (Motivational Enhancement Therapy and Prolonged Exposure respectively), but differ by whether the components are delivered sequentially or are integrated such that PTSD and SUD symptoms are addressed concurrently. We hypothesize that veterans assigned to integrated treatment will show greater improvement in PTSD and SUD symptoms than veterans assigned to sequential treatment. If this hypothesis is supported, the findings have the potential to change clinicians' beliefs and challenge long-standing practice patterns that require participation in SUD treatment prior to initiating trauma-focused therapies for PTSD. PMID:27444425

  19. Alcohol Medical Scholars Program--A Mentorship Program for Improving Medical Education regarding Substance Use Disorders

    ERIC Educational Resources Information Center

    Neufeld, Karin J.; Schuckit, Marc A.; Hernandez-Avila, Carlos A.

    2011-01-01

    The Alcohol Medical Scholars Program (AMSP) is designed to improve medical education related to substance use disorders (SUDs) through mentorship of junior, full-time academic faculty from medical schools across the United States. Scholarship focuses on literature review and synthesis, lecture development and delivery, increasing SUD education in…

  20. The International ADHD in Substance Use Disorders Prevalence (IASP) study: background, methods and study population.

    PubMed

    van de Glind, Geurt; Van Emmerik-van Oortmerssen, Katelijne; Carpentier, Pieter Jan; Levin, Frances R; Koeter, Maarten W J; Barta, Csaba; Kaye, Sharlene; Skutle, Arvid; Franck, Johan; Konstenius, Maija; Bu, Eli-Torild; Moggi, Franz; Dom, Geert; Demetrovics, Zolt; Fatséas, Mélina; Schillinger, Arild; Kapitány-Fövény, Máté; Verspreet, Sofie; Seitz, Andrea; Johnson, Brian; Faraone, Stephen V; Ramos-Quiroga, J Antoni; Allsop, Steve; Carruthers, Susan; Schoevers, Robert A; van den Brink, Wim

    2013-09-01

    Attention deficit/hyperactivity disorder (ADHD) is an increasingly recognized comorbid condition in subjects with substance use disorders (SUDs). This paper describes the methods and study population of the International ADHD in Substance Use Disorders Prevalence (IASP) study. Objectives of the IASP are to determine the prevalence of ADHD in adult treatment seeking patients with SUD in different countries and SUD populations, determine the reliability and validity of the Adult ADHD Self-report Scale V 1.1 (ASRS) as ADHD screening instrument in SUD populations, investigate the comorbidity profile of SUD patients with and without ADHD, compare risk factors and protective factors in SUD patients with and without a comorbid diagnosis of ADHD, and increase our knowledge about the relationship between ADHD and the onset and course of SUD. In this cross-sectional, multi-centre two stage study, subjects were screened for ADHD with the ASRS, diagnosed with the Conner's Adult ADHD Diagnostic Interview for DSM-IV (CAADID), and evaluated for SUD, major depression, bipolar disorder, anti social personality disorder and borderline personality disorder. Three thousand five hundred and fifty-eight subjects from 10 countries were included. Of these 40.9% screened positive for ADHD. This is the largest international study on this population evaluating ADHD and comorbid disorders. PMID:24022983

  1. Predictors of treatment response in adolescents with comorbid substance use disorder and attention-deficit/hyperactivity disorder.

    PubMed

    Tamm, Leanne; Trello-Rishel, Kathlene; Riggs, Paula; Nakonezny, Paul A; Acosta, Michelle; Bailey, Genie; Winhusen, Theresa

    2013-02-01

    Attention-Deficit/Hyperactivity Disorder (ADHD) frequently co-occurs with substance use disorder (SUD) and is associated with poor substance-use treatment outcomes. A trial evaluating osmotic-release oral system methylphenidate (OROS-MPH) for adolescents with ADHD and SUD, concurrently receiving behavioral therapy, revealed inconsistent medication effects on ADHD or SUD. Clinical care for this population would be advanced by knowledge of treatment outcome predictors. Data from the randomized placebo-controlled trial (n = 299) were analyzed. Significant treatment predictors included: 1) Substance use severity, associated with poorer ADHD and SUD outcomes, 2) ADHD severity, associated with better ADHD and SUD outcomes, 3) comorbid conduct disorder, associated with poorer ADHD outcomes, and 4) court-mandated status, associated with better SUD outcomes but poorer treatment completion. An interaction effect showed that OROS-MPH improved SUD outcomes in adolescents with comorbid conduct disorder compared to placebo. While severe SUD may require more intensive psychosocial treatment, OROS-MPH may improve substance treatment outcomes in adolescents with co-morbid attention and conduct problems. PMID:22889694

  2. Working with Children of Parents with Substance Use Disorders: Evaluation of a Course Module

    ERIC Educational Resources Information Center

    Wiechelt, Shelly A.; Okundaye, Joshua N.

    2012-01-01

    Social workers are in a position to identify the effects of substance use disorders (SUDs) on children and families and provide appropriate interventions in broad practice contexts. Unfortunately, many social workers are not trained to consider parental SUDs and their effects on children in the assessment process. A course module for training…

  3. Craving among Polysubstance-Using Adolescents

    ERIC Educational Resources Information Center

    Florsheim, Paul; Shiozaki, Teisha; Hiraoka, Regina; Tiffany, Stephen; Heavin, Sarah; Hall, Spencer; Teske, Noelle; Clegg, Carl

    2008-01-01

    The phenomenon of drug craving among adolescents with substance use disorders has been largely overlooked by addiction researchers. This study was designed to: (1) assess craving among adolescents with polysubstance use disorders (SUDs); and (2) examine the association between personality traits and craving among adolescents with SUDs. Craving was…

  4. Randomized, Controlled Trial of Atomoxetine for Attention-Deficit/Hyperactivity Disorder in Adolescents with Substance Use Disorder

    ERIC Educational Resources Information Center

    Thurstone, Christian; Riggs, Paula D.; Salomonsen-Sautel, Stacy; Mikulich-Gilbertson, Susan K.

    2010-01-01

    Objective: To evaluate the effect of atomoxetine hydrochloride versus placebo on attention-deficit/hyperactivity disorder (ADHD) and substance use disorder (SUD) in adolescents receiving motivational interviewing/cognitive behavioral therapy (MI/CBT) for SUD. Method: This single-site, randomized, controlled trial was conducted between December…

  5. A One-Session Human Immunodeficiency Virus Risk-Reduction Intervention in Adolescents with Psychiatric and Substance Use Disorders

    ERIC Educational Resources Information Center

    Thurstone, Christian; Riggs, Paula D.; Klein, Constance; Mikulich-Gilbertson, Susan K.

    2007-01-01

    Objective: To explore change in human immunodeficiency virus (HIV) risk among teens in outpatient treatment for substance use disorders (SUDs). Method: From December 2002 to August 2004, 50 adolescents (13-19 years) with major depressive disorder, conduct disorder, and one or more non-nicotine SUD completed the Teen Health Survey (THS) at the…

  6. Risk of Substance Use Disorders in Adolescents with Bipolar Disorder

    ERIC Educational Resources Information Center

    Wilens, Timothy E.; Biederman, Joseph; Kwon, Anne; Ditterline, Jeffrey; Forkner, Peter; Moore, Hadley; Swezey, Allison; Snyder, Lindsey; Henin, Aude; Wozniak, Janet; Faraone, Stephen V.

    2004-01-01

    Objective: Previous work in adults and youths has suggested that juvenile onset bipolar disorder (BPD) is associated with an elevated risk of substance use disorders (SUD). Considering the public health importance of this issue, the authors now report on a controlled study of adolescents with and without BPD to evaluate the risk of SUD. Method:…

  7. Posttraumatic Stress Disorder and Substance Use Disorders in College Students

    ERIC Educational Resources Information Center

    Borsari, Brian; Read, Jennifer P.; Campbell, James F.

    2008-01-01

    Research indicates that many college students report posttraumatic stress disorder (PTSD) or substance use disorder (SUD), yet there has been scant attention paid to the co-occurrence of these disorders in college students. This review examines the co-occurrence of PTSD and SUD in college students. Recommendations for counseling centers are…

  8. Evidence for Substance Abuse Services and Policy Research: A Systematic Review of National Databases

    ERIC Educational Resources Information Center

    Coffey, Rosanna M.; Levit, Katharine R.; Kassed, Cheryl A.; McLellan, A. Thomas; Chalk, Mady; Brady, Thomas M.; Vandivort-Warren, Rita

    2009-01-01

    We reviewed 39 national government- and nongovernment-sponsored data sets related to substance addiction policy. These data sets describe patients with substance use disorders (SUDs), treatment providers and the services they offer, and/or expenditures on treatment. Findings indicate the availability of reliable data on the prevalence of SUD and…

  9. Pharmacological and clinical dilemmas of prescribing in co-morbid adult attention-deficit/hyperactivity disorder and addiction

    PubMed Central

    Pérez de los Cobos, José; Siñol, Núria; Pérez, Víctor; Trujols, Joan

    2014-01-01

    The present article reviews whether available efficacy and safety data support the pharmacological treatment of adult attention-deficit/hyperactivity disorder (ADHD) in patients with concurrent substance use disorders (SUD). Arguments for and against treating adult ADHD with active SUD are discussed. Findings from 19 large open studies and controlled clinical trials show that the use of atomoxetine or extended-release methylphenidate formulations, together with psychological therapy, yield promising though inconclusive results about short term efficacy of these drugs in the treatment of adult ADHD in patients with SUD and no other severe mental disorders. However, the efficacy of these drugs is scant or lacking for treating concurrent SUD. No serious safety issues have been associated with these drugs in patients with co-morbid SUD-ADHD, given their low risk of abuse and favourable side effect and drug–drug interaction profile. The decision to treat adult ADHD in the context of active SUD depends on various factors, some directly related to SUD-ADHD co-morbidity (e.g. degree of diagnostic uncertainty for ADHD) and other factors related to the clinical expertise of the medical staff and availability of adequate resources (e.g. the means to monitor compliance with pharmacological treatment). Our recommendation is that clinical decisions be individualized and based on a careful analysis of the advantages and disadvantages of pharmacological treatment for ADHD on a case-by-case basis in the context of active SUD. PMID:23216449

  10. Exposure Therapy for Substance Abusers with PTSD: Translating Research to Practice

    ERIC Educational Resources Information Center

    Coffey, Scott F.; Schumacher, Julie A.; Brimo, Marcella L.; Brady, Kathleen T.

    2005-01-01

    Epidemiological research indicates that there is substantial comorbidity between posttraumatic stress disorder (PTSD) and substance use disorder (SUD). Moreover, there is growing evidence that having a comorbid PTSD diagnosis is associated with greater substance use problem severity and poorer outcomes from SUD treatment. In an attempt to improve…

  11. Integrating Treatment of Posttraumatic Stress Disorder and Substance Use Disorder

    ERIC Educational Resources Information Center

    Ford, Julian D.; Russo, Eileen M.; Mallon, Sharon D.

    2007-01-01

    Historically, administrators and clinicians have been hesitant to address posttraumatic stress disorder (PTSD) in the treatment of substance use disorders (SUDs). However, research shows that SUD treatment recruitment and outcomes may be adversely affected if co-occurring PTSD is left untreated. The authors provide guidelines for screening and…

  12. Women in addictions treatment: comparing VA and community samples.

    PubMed

    Davis, Tania M; Carpenter, Kelly M; Malte, Carol A; Carney, Molly; Chambers, Sharon; Saxon, Andrew J

    2002-07-01

    Despite increasing awareness of gender issues in substance use treatment, women with substance use disorders (SUD) and gender-specific treatment remain understudied. This study examines differences, including identification of comorbid issues and patients' perceived treatment needs, between women in different SUD treatment settings: an intensive VA outpatient program (VA; N = 76) and a private residential/outpatient program (Residence XII; N = 308). In both settings the Addiction Severity Index (ASI) was administered at intake; ASI data were collected from retrospective chart review. Results support previous findings that women entering SUD treatment endorse high rates of psychiatric and medical comorbidity, and past abuse. Women in VA SUD treatment experienced more impairment on indices of medical, psychiatric, and employment issues whereas the private agency sample had higher alcohol and family/social composite scores. The differences between and similarities among the two treatment groups have implications for design of women-specific SUD treatment programs.

  13. Neurobehavior disinhibition, parental substance use disorder, neighborhood quality and development of cannabis use disorder in boys☆

    PubMed Central

    Ridenour, Ty A.; Tarter, Ralph E.; Reynolds, Maureen; Mezzich, Ada; Kirisci, Levent; Vanyukov, Michael

    2009-01-01

    This prospective investigation examined the contribution of neighborhood context and neurobehavior disinhibition to the association between substance use disorder (SUD) in parents and cannabis use disorder in their sons. It was hypothesized that both neighborhood context and son’s neurobehavior disinhibition mediate this association. Two hundred and sixteen boys were tracked from ages 10–12 to age 22. The extent to which neighborhood context and neurobehavior disinhibition mediate the association between parental SUD and son’s cannabis use disorder was evaluated using structural equation modeling. The best fitting model positioned neighborhood context and neurobehavior disinhibition as mediators of the association between parental SUD and cannabis use disorder in sons. Neurobehavior disinhibition also was a mediator of the association between neighborhood context and son’s cannabis use. The implications of this pattern of association between parental SUD, neighborhood context and individual risk for SUD for improving prevention are discussed. PMID:19268495

  14. A Primer on the Genetics of Comorbid Eating Disorders and Substance Use Disorders.

    PubMed

    Munn-Chernoff, Melissa A; Baker, Jessica H

    2016-03-01

    Eating disorders (EDs) and substance use disorders (SUDs) frequently co-occur; however, the reasons for this are unclear. We review the current literature on genetic risk for EDs and SUDs, as well as preliminary findings exploring whether these classes of disorders have overlapping genetic risk. Overall, genetic factors contribute to individual differences in liability to multiple EDs and SUDs. Although initial family studies concluded that no shared familial (which includes genetic) risk between EDs and SUDs exists, twin studies suggest a moderate proportion of shared variance is attributable to overlapping genetic factors, particularly for those EDs characterized by binge eating and/or inappropriate compensatory behaviours. No adoption or molecular genetic studies have examined shared genetic risk between these classes of disorders. Research investigating binge eating and inappropriate compensatory behaviours using emerging statistical genetic methods, as well as examining gene-environment interplay, will provide important clues into the aetiology of comorbid EDs and SUDs. PMID:26663753

  15. Association among parental substance use disorder, p300 amplitude, and neurobehavioral disinhibition in preteen boys at high risk for substance use disorder.

    PubMed

    Habeych, Miguel E; Sclabassi, Robert J; Charles, Prophete J; Kirisci, Levent; Tarter, Ralph E

    2005-06-01

    The P300 amplitude of the event-related potential as a mediator of the association between parental substance use disorder (SUD) and child's neurobehavioral disinhibition was assessed. The P300 amplitude was recorded using an oddball task in sons of fathers having either lifetime SUD (n = 105) or no psychiatric disorder (n = 160). Neurobehavioral disinhibition was assessed using measures of affect regulation, behavior control, and executive cognitive function. Parental SUD and child's P300 amplitude accounted for, respectively, 16.6% and 16.8% of neurobehavioral disinhibition variance. Controlling for parental and child psychopathology, an association between parental SUD and child's P300 amplitude was not observed. It was concluded that the P300 amplitude does not mediate the association between parental SUD and child's neurobehavioral disinhibition. PMID:16011382

  16. A Primer on the Genetics of Comorbid Eating Disorders and Substance Use Disorders.

    PubMed

    Munn-Chernoff, Melissa A; Baker, Jessica H

    2016-03-01

    Eating disorders (EDs) and substance use disorders (SUDs) frequently co-occur; however, the reasons for this are unclear. We review the current literature on genetic risk for EDs and SUDs, as well as preliminary findings exploring whether these classes of disorders have overlapping genetic risk. Overall, genetic factors contribute to individual differences in liability to multiple EDs and SUDs. Although initial family studies concluded that no shared familial (which includes genetic) risk between EDs and SUDs exists, twin studies suggest a moderate proportion of shared variance is attributable to overlapping genetic factors, particularly for those EDs characterized by binge eating and/or inappropriate compensatory behaviours. No adoption or molecular genetic studies have examined shared genetic risk between these classes of disorders. Research investigating binge eating and inappropriate compensatory behaviours using emerging statistical genetic methods, as well as examining gene-environment interplay, will provide important clues into the aetiology of comorbid EDs and SUDs.

  17. Comparison of treatment outcomes in severe personality disorder patients with or without substance use disorders: a 36-month prospective pragmatic follow-up study

    PubMed Central

    Lana, Fernando; Sánchez-Gil, Carmen; Adroher, Núria D; Pérez, Víctor; Feixas, Guillem; Martí-Bonany, Josep; Torrens, Marta

    2016-01-01

    Background Concurrent personality disorder (PD) and substance use disorder (SUD) are common in clinical practice. However, SUD is the main criterion for study exclusion in most psychotherapeutic studies of PD. As a result, data on treatment outcomes in patients with concurrent PD/SUD are scarce. Methods The study sample consisted of 51 patients diagnosed with severe PD and admitted for psychotherapeutic treatment as a part of routine mental health care. All patients were diagnosed with PD according to the Structured Clinical Interview for PD. Patients were further assessed (DSM-IV diagnostic criteria) to check for the presence of concurrent SUD, with 28 patients diagnosed with both disorders (PD-SUD). These 28 cases were then compared to the 23 patients without SUD (PD-nSUD) in terms of psychiatric hospitalizations and psychiatric emergency room (ER) visits before and during the 6-month therapeutic intervention and every 6 months thereafter for a total of 36 months. Results The baseline clinical characteristics correspond to a sample of PD patients (78% met DSM-IV criteria for borderline PD) with poor general functioning and a high prevalence of suicide attempts and self-harm behaviors. Altogether, the five outcome variables – the proportion and the number of psychiatric inpatient admissions, the number of days hospitalized, and the proportion and the number of psychiatric ER visits – improved significantly during the treatment period, and this improvement was maintained throughout the follow-up period. Although PD-SUD patients had more psychiatric hospitalizations and ER visits than PD-nSUD patients during follow-up, the differences between these two groups remained stable over the study period indicating that the treatment was equally effective in both groups. Conclusion Specialized psychotherapy for severe PD can be effectively applied in patients with concurrent PD-SUD under usual practice conditions. These findings suggest that exclusion of patients with

  18. Comorbidity of PTSD, Major Depression, and Substance Use Disorder among Adolescent Victims of the Spring 2011 Tornadoes in Alabama and Joplin, Missouri

    PubMed Central

    Adams, Zachary W.; Danielson, Carla Kmett; Sumner, Jennifer A.; McCauley, Jenna L.; Cohen, Joseph R.; Ruggiero, Kenneth J.

    2015-01-01

    Objective The purpose of this study was two-fold: (1) to estimate the prevalence of comorbid posttraumatic stress disorder (PTSD), major depressive episode (MDE), and substance use disorder (SUD), and (2) to identify risk factors for patterns of comorbidity among adolescents affected by disasters. Method A population-based sample of 2,000 adolescents (51% female; 71% Caucasian, 26% African-American) aged 12–17 years (M=14.5, SD=1.7) and their parents was recruited from communities affected by the Spring 2011 tornadoes in Alabama and Joplin, Missouri. Participants completed structured telephone interviews assessing demographic characteristics, impact of disaster, prior trauma history, DSM-IV symptoms of PTSD and MDE, and SUD symptoms. Prevalence estimates were calculated for PTSD+MDE, PTSD+SUD, MDE+SUD, and PTSD+MDE+SUD. Hierarchical logistic regression was used to identify risk factors for each comorbidity profile. Results Overall prevalence since the tornado was 3.7% for PTSD+MDE, 1.1% for PTSD+SUD, 1.0% for MDE+SUD, and 0.7% for PTSD+MDE+SUD. Girls were significantly more likely than boys to meet criteria for PTSD+MDE and MDE+SUD (ps < .05). Female gender, exposure to prior traumatic events, and persistent loss of services were significant risk factors for patterns of comorbidity. Parental injury was associated with elevated risk for PTSD+MDE. Adolescents should be evaluated for comorbid problems, including SUD, following disasters so that appropriate referrals to evidence-based treatments can be made. Conclusions Results suggest that screening procedures to identify adolescents at risk for comorbid disorders should assess demographic characteristics (gender), impact of the disaster on the family, and adolescents’ prior history of stressful events. PMID:26168094

  19. Dopamine and serotonin genetic risk scores predicting substance and nicotine use in attention deficit/hyperactivity disorder.

    PubMed

    Groenman, Annabeth P; Greven, Corina U; van Donkelaar, Marjolein M J; Schellekens, Arnt; van Hulzen, Kimm J E; Rommelse, Nanda; Hartman, Catharina A; Hoekstra, Pieter J; Luman, Marjolein; Franke, Barbara; Faraone, Stephen V; Oosterlaan, Jaap; Buitelaar, Jan K

    2016-07-01

    Individuals with attention deficit/hyperactivity disorder (ADHD) are at increased risk of developing substance use disorders (SUDs) and nicotine dependence. The co-occurrence of ADHD and SUDs/nicotine dependence may in part be mediated by shared genetic liability. Several neurobiological pathways have been implicated in both ADHD and SUDs, including dopamine and serotonin pathways. We hypothesized that variations in dopamine and serotonin neurotransmission genes were involved in the genetic liability to develop SUDs/nicotine dependence in ADHD. The current study included participants with ADHD (n = 280) who were originally part of the Dutch International Multicenter ADHD Genetics study. Participants were aged 5-15 years and attending outpatient clinics at enrollment in the study. Diagnoses of ADHD, SUDs, nicotine dependence, age of first nicotine and substance use, and alcohol use severity were based on semi-structured interviews and questionnaires. Genetic risk scores were created for both serotonergic and dopaminergic risk genes previously shown to be associated with ADHD and SUDs and/or nicotine dependence. The serotonin genetic risk score significantly predicted alcohol use severity. No significant serotonin × dopamine risk score or effect of stimulant medication was found. The current study adds to the literature by providing insight into genetic underpinnings of the co-morbidity of ADHD and SUDs. While the focus of the literature so far has been mostly on dopamine, our study suggests that serotonin may also play a role in the relationship between these disorders. PMID:25752199

  20. Cortico-striatal circuits: Novel therapeutic targets for substance use disorders.

    PubMed

    Kravitz, Alexxai V; Tomasi, Dardo; LeBlanc, Kimberly H; Baler, Ruben; Volkow, Nora D; Bonci, Antonello; Ferré, Sergi

    2015-12-01

    It is widely believed that substance use disorder (SUD) results from both pre-alterations (vulnerability) and/or post-alterations (drug effects) on cortico-striatal circuits. These circuits are essential for cognitive control, motivation, reward dependent learning, and emotional processing. As such, dysfunctions in cortico-striatal circuits are thought to relate to the core features of SUD, which include compulsive drug use, loss of the ability to control drug intake, and the emergence of negative emotional states (Koob and Volkow, 2010. Neuropsychopharmacology 35(1), 217-238). While the brain circuits underlying SUD have been studied in human patients largely through imaging studies, experiments in animals have allowed researchers to examine the specific cell-types within these circuits to reveal their role in behavior relevant to SUD. Here, we will review imaging studies on cortico-striatal systems that are altered in SUD, and describe animal experiments that relate SUD to specific neural projections and cell types within this circuitry. We will end with a discussion of novel clinical approaches such as deep brain stimulation (DBS), repeated transcranial magnetic stimulation (rTMS), and pharmacological targeting of G protein-coupled receptor (GPCR) heteromers that may provide promising avenues for modulating these circuits to combat SUD in humans. PMID:25863130

  1. Substance use disorder patient privacy and comprehensive care in integrated health care settings.

    PubMed

    Schaper, Elizabeth; Padwa, Howard; Urada, Darren; Shoptaw, Steven

    2016-02-01

    The Affordable Care Act (ACA) expands health insurance coverage for substance use disorder (SUD) treatment, underscoring the value of improving SUD service integration in primarily physical health care settings. It is not yet known to what degree specialized privacy regulations-Code of Federal Regulations Title 42, Part 2 (42 CFR Part 2), in particular-will affect access to or the utilization and delivery of SUD treatment in primary care. In addition to exploring the emerging benefits and barriers that specialized confidentiality regulations pose to treatment in early adopting integrated health care settings, this article introduces and explicates 42 CFR Part 2 to support provider and administrator implementation of SUD privacy regulations in integrated settings. The authors also argue that, although intended to protect patients with SUD, special SUD information protection may inadvertently reinforce stigma against patients by purporting the belief that SUD is different from other health problems and must be kept private. In turn, this stigma may inhibit the delivery of comprehensive integrated care. PMID:26845493

  2. Quality of Life in Patients with Substance Use Disorders Admitted to Detoxification Compared with Those Admitted to Hospitals for Medical Disorders: Follow-Up Results

    PubMed Central

    Vederhus, John-Kåre; Pripp, Are Hugo; Clausen, Thomas

    2016-01-01

    Quality of life (QoL) in patients admitted to a general hospital was compared with those admitted to a detoxification unit for the treatment of substance use disorder (SUD). This study combines data from two separate data collections: a cross-sectional study in a general hospital unit (somatic sample, N = 519) and a follow-up study in a detoxification unit (SUD sample, N = 140). A total of 659 patients recruited during 2008–2013 were included in this study. All patients completed a generic QoL questionnaire at inclusion, and the SUD sample also completed it at the six-month follow-up. SUD patients experienced comparably low physical QoL and had significantly lower psychological, social, and existential QoL domain scores when compared with the somatic sample. Mental distress and having a SUD were the major factors explaining variations in QoL, with both influencing QoL negatively. In the SUD sample, QoL improved moderately at the six-month follow-up with less improvement for the domain relationship to a partner. To facilitate the recovery of SUD patients, clinicians must view their patients’ situation holistically and invest efforts into the different life domains affected by poor QoL. PMID:27226719

  3. Suicidality, Aggression and Other Treatment Considerations Among Pregnant, Substance Dependent Women with Posttraumatic Stress Disorder

    PubMed Central

    Eggleston, A. Meade; Calhoun, Patrick S.; Svikis, Dace S.; Tuten, Michelle; Chisolm, Margaret S.; Jones, Hendree E.

    2010-01-01

    Posttraumatic stress disorder (PTSD) and other Axis I comorbidity among women with substance use disorders (SUD) appear similarly prevalent and are associated with comparable negative clinical profiles and treatment outcomes. The relative contribution of comorbid PTSD versus other Axis I psychiatric disorders to clinical characteristics is largely unexamined, however, despite theory and empirical data indicating that PTSD and substance use disorders may have a unique relationship that confers specific risk for clinical severity and poor treatment outcome. In a sample of pregnant, opioid and/or cocaine dependent women entering substance abuse treatment, women with PTSD (SUD-PTSD; n=23) were compared to those with other Axis I comorbidity (SUD-PSY; n=45) and those without Axis I comorbidity (SUD-Only; n=37). Data were collected via face-to-face interviews and urinalysis drug assays. While the study groups had similar substance use severity, the SUD-PTSD group was more likely to report suicidality, aggression and psychosocial impairment than both the SUD-PSY and SUD-Only groups. Findings indicate treatment considerations for substance dependent women with PTSD are broader and more severe than those with other Axis I conditions or substance dependence alone. PMID:19683611

  4. Prevalence of post-traumatic stress disorder among patients with substance use disorder: it is higher than clinicians think it is

    PubMed Central

    Gielen, Nele; Havermans, Remco C.; Tekelenburg, Mignon; Jansen, Anita

    2012-01-01

    Objectives This study had three objectives. Firstly, the prevalence of post-traumatic stress disorder (PTSD) and trauma exposure was compared between individuals with and without substance use disorder (SUD). Secondly, we compared self-rating of PTSD and clinical judgement. Thirdly, an analysis of the characteristics of SUD/PTSD patients was performed. Methods The sample consisted of 423 patients with SUD and 206 healthy controls. All individuals were screened on PTSD using the self-rating inventory for PTSD. Results Significantly higher numbers of PTSD and trauma exposure were found in the SUD group (resp. 36.6 and 97.4%). PTSD went frequently unnoticed when relying on clinical judgement alone. Patients with SUD/PTSD were significantly more often unemployed and had a lower educational level. Axis I comorbidity and especially depressive disorders were more common in the SUD/PTSD group. Conclusion It is concluded that patients with SUD/PTSD are a substantial and vulnerable subgroup in addiction treatment facilities and that a systematic screening for PTSD is required. PMID:22893849

  5. Difficulties In Emotional Regulation and Substance Use Disorders: A Controlled Family Study of Bipolar Adolescents

    PubMed Central

    Wilens, Timothy E.; Martelon, MaryKate; Anderson, Jesse P.; Shelley-Abrahamson, Rachel; Biederman, Joseph

    2013-01-01

    Background Self-regulatory mechanisms appear etiologically operant in the context of both substance use disorders (SUD) and bipolar disorder (BD), however, little is known about the role of deficits in emotional self-regulation (DESR) as it relates to SUD in context to mood dysregulation. To this end, we examined to what extent DESR was associated with SUD in a high-risk sample of adolescents with and without BD. Methods 203 families were assessed with a structured psychiatric interview. Using the Child Behavior Checklist (CBCL), a subject was considered to have DESR when he or she had an average elevation of 1 standard deviation (SD) above the norm on 3 clinical scale T scores (Attention, Aggression, and Anxiety/Depression; scores: 60×3 ≥180). Results Among probands and siblings with CBCL data (N=303), subjects with DESR were more likely to have any SUD, alcohol use disorder, drug use disorder, and cigarette smoking compared to subjects with scores<180 (all p values <0.001), even when correcting for BD. We found no significant differences in the risk of any SUD and cigarette smoking between those with 1 SD and 2 SD above the mean (all p values >0.05). Subjects with cigarette smoking and SUD had more DESR compared to those without these disorders. Conclusions Adolescents with DESR are more likely to smoke cigarettes and have SUD. More work is needed to explore DESR in longitudinal samples. PMID:23422834

  6. Sex differences in substance use disorders: focus on side effects.

    PubMed

    Agabio, Roberta; Campesi, Ilaria; Pisanu, Claudia; Gessa, Gian Luigi; Franconi, Flavia

    2016-09-01

    Although sex differences in several aspects of substance use disorders (SUDs) have been identified, less is known about the importance of possible sex differences in side effects induced by substances of abuse or by medications used to treat SUDs. In the SUD field, the perception of certain subjective effects are actively sought, while all other manifestations might operationally be considered side effects. This article was aimed at reviewing sex differences in side effects induced by alcohol, nicotine, heroin, marijuana and cocaine and by medications approved for alcohol, nicotine and heroin use disorders. A large body of evidence suggests that women are at higher risk of alcohol-induced injury, liver disease, cardiomyopathy, myopathy, brain damages and mortality. The risk of tobacco-induced coronary heart disease, lung disease and health problems is higher for women than for men. Women also experience greater exposure to side effects induced by heroin, marijuana and cocaine. In addition, women appear to be more vulnerable to the side effects induced by medications used to treat SUDs. Patients with SUDs should be advised that the risk of developing health problems may be higher for women than for men after consumption of the same amount of substances of abuse. Doses of medications for SUD women should be adjusted at least according to body weight. The sex differences observed also indicate an urgent need to recruit adequate numbers of female subjects in pre-clinical and clinical studies to improve our knowledge about SUDs in women. PMID:27001402

  7. Substance abuse in women.

    PubMed

    Greenfield, Shelly F; Back, Sudie E; Lawson, Katie; Brady, Kathleen T

    2010-06-01

    Gender differences in substance use disorders (SUDs) and treatment outcomes for women with SUDs have been a focus of research in the last 15 years. This article reviews gender differences in the epidemiology of SUDs, highlighting the convergence of male/female prevalence ratios of SUDs in the last 20 years. The telescoping course of SUDs, recent research on the role of neuroactive gonadal steroid hormones in craving and relapse, and sex differences in stress reactivity and relapse to substance abuse are described. The role of co-occurring mood and anxiety, eating, and posttraumatic stress disorders is considered in the epidemiology, natural history, and treatment of women with SUDs. Women's use of alcohol, stimulants, opioids, cannabis, and nicotine are examined in terms of recent epidemiology, biologic and psychosocial effects, and treatment. Although women may be less likely to enter substance abuse treatment than men over the course of the lifetime, once they enter treatment, gender itself is not a predictor of treatment retention, completion, or outcome. Research on gender-specific treatments for women with SUDs and behavioral couples treatment has yielded promising results for substance abuse treatment outcomes in women.

  8. Improving drug abuse treatment delivery through adoption of harmonized electronic health record systems.

    PubMed

    Ghitza, Udi E; Sparenborg, Steven; Tai, Betty

    2011-07-01

    A great divide currently exists between mainstream health care and specialty substance use disorders (SUD) treatment, concerning the coordination of care and sharing of medical information. Improving the coordination of SUD treatment with other disciplines of medicine will benefit SUD patients. The development and use of harmonized electronic health record systems (EHR) containing standardized person-level information will enable improved coordination of healthcare services. We attempt here to illuminate the urgent public health need to develop and implement at the national level harmonized EHR including data fields containing standardized vocabulary/terminologies relevant to SUD treatment. The many advantages and barriers to harmonized EHR implementation in SUD treatment service groups, and pathways to their successful implementation, are also discussed. As the US Federal Government incentivizes Medicare and Medicaid Service providers nationwide for "meaningful use" of health information technology (HIT) systems, relevant stakeholders may face relatively large and time-consuming processes to conform their local practices to meet the federal government's "meaningful use" criteria unless they proactively implement data standards and elements consistent with those criteria. Incorporating consensus-based common data elements and standards relevant to SUD screening, diagnosis, and treatment into the federal government's "meaningful use" criteria is an essential first step to develop necessary infrastructure for effective coordination of HIT systems among SUD treatment and other healthcare service providers to promote collaborative-care implementation of cost-effective, evidence-based treatments and to support program evaluations.

  9. Sex differences in substance use disorders: focus on side effects.

    PubMed

    Agabio, Roberta; Campesi, Ilaria; Pisanu, Claudia; Gessa, Gian Luigi; Franconi, Flavia

    2016-09-01

    Although sex differences in several aspects of substance use disorders (SUDs) have been identified, less is known about the importance of possible sex differences in side effects induced by substances of abuse or by medications used to treat SUDs. In the SUD field, the perception of certain subjective effects are actively sought, while all other manifestations might operationally be considered side effects. This article was aimed at reviewing sex differences in side effects induced by alcohol, nicotine, heroin, marijuana and cocaine and by medications approved for alcohol, nicotine and heroin use disorders. A large body of evidence suggests that women are at higher risk of alcohol-induced injury, liver disease, cardiomyopathy, myopathy, brain damages and mortality. The risk of tobacco-induced coronary heart disease, lung disease and health problems is higher for women than for men. Women also experience greater exposure to side effects induced by heroin, marijuana and cocaine. In addition, women appear to be more vulnerable to the side effects induced by medications used to treat SUDs. Patients with SUDs should be advised that the risk of developing health problems may be higher for women than for men after consumption of the same amount of substances of abuse. Doses of medications for SUD women should be adjusted at least according to body weight. The sex differences observed also indicate an urgent need to recruit adequate numbers of female subjects in pre-clinical and clinical studies to improve our knowledge about SUDs in women.

  10. Heterogeneity of mental health service utilization and high mental health service use among women eight years after initiating substance use disorder treatment

    PubMed Central

    Evans, Elizabeth; Padwa, Howard; Li, Libo; Lin, Veronique; Hser, Yih-Ing

    2015-01-01

    Objective To determine mental health service utilization patterns among women treated for substance use disorders (SUD) and identify factors associated with patterns of high mental health service use. Methods Data were provided by 4,447 women treated for SUD in California during 2000–2002 for whom mental health services utilization records were acquired. A latent class model was fitted to women’s high use of services (≥6 services/year over 8 years). Multinomial logistic regression was used to identify predisposing, enabling, and need factors associated with utilization patterns. Results In 8 years after initiating SUD treatment, 50% of women utilized mental health services. High use probability was consistently low for most women (76.9%); for others, however, it decreased immediately following SUD treatment and then increased over time (9.3%), increased immediately following SUD treatment and then decreased (8.7%), or remained consistently high (5.1%). Consistently high services use was negatively associated with marriage (OR 0.60, p<0.05) and employment (OR 0.53, p<0.05) and positively associated with older age (OR 1.04, p<0.001), homelessness (OR 1.68, p<0.05), public assistance (OR 1.76, p<0.01), outpatient SUD treatment (OR 3.69, p<0.01), longer SUD treatment retention (OR 1.00, p<0.01), treatment desire (ORs 1.46, p<0.001), and co-occurring disorder diagnosis (ORs 2.89–44.93, p<0.001). Up to 29% of women with co-occurring mental health disorders at SUD treatment entry did not receive any mental health treatment in the subsequent 8 years. Conclusions Mental health services utilization patterns among women treated for SUD are hetereogeneous and dynamic. Understanding factors related to women’s utilization patterns may aid efforts to optimize care and ensure appropriate use of mental health services. PMID:26321439

  11. Independent predictors for lifetime and recent substance use disorders in patients with rapid-cycling bipolar disorder: focus on anxiety disorders.

    PubMed

    Gao, Keming; Chan, Philip K; Verduin, Marcia L; Kemp, David E; Tolliver, Bryan K; Ganocy, Stephen J; Bilali, Sarah; Brady, Kathleen T; Findling, Robert L; Calabrese, Joseph R

    2010-01-01

    We set out to study independent predictor(s) for lifetime and recent substance use disorders (SUDs) in patients with rapid-cycling bipolar disorder (RCBD). Extensive Clinical Interview and Mini-International Neuropsychiatric Interview were used to ascertain DSM-IV Axis I diagnoses of RCBD, anxiety disorders, and SUDs. Data from patients enrolling into four similar clinical trials were used. Where appropriate, univariate analyses with t-test or chi-square were applied. Stepwise logistic regression was used to examine the relationship among predictor variables and lifetime and recent SUDs. Univariate analysis showed that patients with co-occurring anxiety disorders (n = 261) had significantly increased rates of lifetime (odds ratio [OR]= 2.1) and recent (OR = 1.9) alcohol dependence as well as lifetime (OR = 3.4) and recent (OR = 2.5) marijuana dependence compared to those without co-occurring anxiety disorder (n = 303). In logistic regression analyses, generalized anxiety disorder (GAD) was associated with increased risk for lifetime SUDs (OR = 2.34), alcohol dependence (OR = 1.73), and marijuana dependence (OR = 3.36) and recent marijuana dependence (OR = 3.28). A history of physical abuse was associated with increased risk for lifetime SUDs (OR = 1.71) and recent marijuana dependence (OR = 3.47). Earlier onset of first mania/hypomania was associated with increased risk for lifetime SUDs (5% per year), and recent marijuana dependence (12% per year) and later treatment with a mood stabilizer were also associated with increased risk for recent SUDs (8% per year). Positive associations between GAD, later treatment with a mood stabilizer, and early childhood trauma and history of SUDs suggest that adequate treatment of comorbid anxiety, early treatment with a mood stabilizer, and prevention of childhood trauma may reduce the risk for the development of SUDs in patients with bipolar disorder.

  12. Comorbid personality disorders and substance use disorders of mentally ill homicide offenders: a structured clinical study on dual and triple diagnoses.

    PubMed

    Putkonen, Anu; Kotilainen, Irma; Joyal, Christian C; Tiihonen, Jari

    2004-01-01

    Comorbid substance use disorders (SUDs) increase the risk of homicide by persons with major mental disorders (MMDs). However, there are no published data from clinical interviews or lifetime objective documents on the prevalence of lifetime personality disorder (PD) or SUD among a comprehensive sample of mentally ill homicide offenders. Therefore, a nationally representative sample of men with MMD (n = 90) who had committed or attempted homicide was assessed using the research version of the Structured Clinical Interview for DSM-IV Axis I and Axis II Disorders. Lifetime documents, records, and questionnaires from persons who knew the subjects since childhood were used. Seventy-eight percent of the mentally ill homicide offenders were diagnosed with schizophrenia, 17 percent with schizoaffective disorder, and 5 percent with other psychosis. A lifetime SUD was detected in 74 percent and alcohol use disorder in 72 percent. PD accounted for 51 percent, in 47 percent as antisocial personality disorder (APD). All subjects diagnosed with PD had SUD. Only 25 percent of the subjects had neither SUD nor PD. Among persons with dual diagnoses (MMD and SUD), about two-thirds had PD or APD. These results indicated that there were two-thirds major diagnostic categories of psychotic homicide offenders: about one-half had triple diagnosis (APD + SUD + MMD), one-quarter had "pure" dual diagnosis (SUD + MMD), and one-quarter had "pure" MMD. The fourth possible category, "APD + MMD but no SUD," was not found. The prevention of severe violence by persons with MMD necessitates effective treatments for those with dual diagnosis who also have a history of APD. PMID:15176762

  13. Treatment outcomes for substance use disorder among women of reproductive age in Massachusetts: A population-based approach

    PubMed Central

    Bernstein, Judith; Derrington, Taletha M.; Belanoff, Candice; Cabral, Howard J.; Babakhanlou-Chase, Hermik; Diop, Hafsatou; Evans, Stephen R.; Jacobs, Hilary; Kotelchuck, Milton

    2014-01-01

    Introduction Longitudinal patterns of treatment utilization and relapse among women of reproductive age with substance use disorder (SUD) are not well known. In this statewide report spanning seven years we describe SUD prevalence, SUD treatment utilization, and differences in subsequent emergency department (ED) use and post-treatment relapse rates by type of treatment: none, ‘acute only’ (detoxification/stabilization), or ‘ongoing’ services. Methods We linked a statewide dataset of hospital discharge, observation stay and ED records with SUD treatment admission records from hospitals and freestanding facilities, and birth/fetal death certificates, in Massachusetts, 2002–2008. We aggregated episodes into individual woman records, identified evidence of SUD and treatment, and tested post-treatment outcomes. Results Nearly 150,000 (8.5%) of 1.7 million Massachusetts women aged 15–49 were identified as SUD-positive. Nearly half of SUD-positive women (71,533 or 48.3%) had evidence of hospital or facility-based SUD treatment; among these, 12% received acute care/detoxification only while 88% obtained ‘ongoing’ treatment. Treatment varied by substance type; women with dual diagnosis and those with opiate use were least likely to receive ‘ongoing’ treatment. Treated women were older and less likely to have a psychiatric history or chronic illness. Women who received ‘acute only’ services were more likely to relapse (12.4% vs. 9.6%) and had a 10% higher rate of ED visits post-treatment than women receiving ‘ongoing’ treatment. Conclusions Many Massachusetts women of reproductive age need but do not receive adequate SUD treatment. ‘Ongoing’ services beyond detoxification/stabilization may reduce the likelihood of post-treatment relapse and/or reliance on the ED for subsequent medical care. PMID:25496707

  14. Mindfulness-Action Based Cognitive Behavioral Therapy for concurrent Binge Eating Disorder and Substance Use Disorders.

    PubMed

    Courbasson, Christine M; Nishikawa, Yasunori; Shapira, Leah B

    2011-01-01

    Individuals with Binge Eating Disorder (BED) often evidence comorbid Substance Use Disorders (SUD), resulting in poor outcome. This study is the first to examine treatment outcome for this concurrent disordered population. In this pilot study, 38 individuals diagnosed with BED and SUD participated in a 16-week group Mindfulness-Action Based Cognitive Behavioral Therapy (MACBT). Participants significantly improved on measures of objective binge eating episodes; disordered eating attitudes; alcohol and drug addiction severity; and depression. Taken together, MACBT appears to hold promise in treating individuals with co-existing BED-SUD.

  15. Combat posttraumatic stress disorder, substance use disorders, and traumatic brain injury.

    PubMed

    Brady, Kathleen T; Tuerk, Peter; Back, Sudie E; Saladin, Michael E; Waldrop, Angela E; Myrick, Hugh

    2009-12-01

    Among both civilian and veteran populations, substance use disorders (SUDs) and anxiety disorders frequently co-occur. One of the most common comorbid anxiety disorder is posttraumatic stress disorder (PTSD), a condition which may develop after exposure to traumatic events, such as military combat. In comparison with the general population, rates of both SUDs and PTSD are elevated among veterans. Recent data show that soldiers returning from Iraq and Afghanistan demonstrate high rates of co-occurring SUDs, PTSD, and traumatic brain injury. Careful assessment of these conditions is critical and may be complicated by symptom overlap. More research targeting integrated interventions for these conditions is needed to establish optimal treatments.

  16. BARRIERS TO DRUG ABUSE TREATMENT FOR LATINO MIGRANTS: TREATMENT PROVIDERS’ PERSPECTIVES1

    PubMed Central

    Pagano, Anna

    2014-01-01

    This paper disseminates findings from a pilot study undertaken to learn more about treatment providers’ perceptions of treatment access barriers faced by Latino migrants with substance use disorders (SUDs) in Northern California. Semi-structured interviews were conducted with treatment providers (n=11) at 7 residential treatment programs with Spanish-language services. Interviewees identified and described three primary types of treatment barriers: language, legal, and gender-based. In response to these barriers, Latino migrants with SUDs have opened their own residential recovery houses called anexos (annexes). Collaborative efforts by community clinics and public health agencies are needed to facilitate Latino migrants’ access to SUD treatment. PMID:25176120

  17. Amygdala Activation and Emotional Processing in Adolescents at Risk for Substance Use Disorders.

    PubMed

    Thatcher, Dawn L; Pajtek, Stefan; Tarter, Ralph; Long, Elizabeth C; Clark, Duncan B

    2014-05-01

    Studies are needed that examine neurobiological characteristics in high risk individuals prior to substance use disorder (SUD) development. In this pilot study, 4 adolescent subjects at high risk (having at least 1 parent with a SUD) for SUD were compared with 4 adolescent reference subjects on a corticolimbic reactivity paradigm, where they were presented with affect-laden faces or geometric shapes. FMRI was used to measure cortical activation in response to these stimuli. High risk subjects, compared to low risk, exhibited greater left amygdala activation (t=3.60, df=6, p=0.01), suggesting they may exhibit hyper-responsivity of the amygdala in response to emotional stimuli.

  18. Sediment transport mechanisms through the sustainable vegetated flow networks

    NASA Astrophysics Data System (ADS)

    Allen, Deonie; Haynes, Heather; Arthur, Scott

    2016-04-01

    Understanding the pollution treatment efficiency of a sustainable urban drainage (SuDS) asset or network requires the influx, transport, detention and discharge of the pollutant within the system. To date event specific monitoring of sediment (primarily total suspended solids) concentrations in the inflow and discharge from SuDS have been monitored. Long term analysis of where the sediment is transported to and the residency time of this pollutant within the SuDS asset or network have not been unraveled due to the difficulty in monitoring specific sediment particulate movement. Using REO tracing methodology, sediment particulate movement has become possible. In tracing sediment movement from an urban surface the internal residency and transportation of this sediment has illustrated SuDS asset differences in multi-event detention. Of key importance is the finding that sediment remains within the SuDS asset for extended periods of time, but that the location sediment detention changes. Thus, over multiple rainfall-runoff events sediment is seen to move through the SuDS assets and network proving the assumption that detained sediment is permanent and stationary to be inaccurate. Furthermore, mass balance analysis of SuDS sediment indicates that there is notable re-suspension and ongoing release of sediment from the SuDS over time and cumulative rainfall-runoff events. Continued monitoring of sediment deposition and concentration in suspension illustrates that sediment detention within SuDS decreases over time/multiple events, without stabilizing within a 12 month period. Repeated experiments show a consistent pattern of detention and release for the three SuDS networks monitored in Scotland. Through consideration of both rainfall and flow factors the drivers of sediment transport within the monitored SuDS have been identified. Within the limitation of this field study the key drivers to SuDS sediment detention efficiency (or transport of sediment through the system

  19. A Preliminary Examination of Negative Affect, Emotion Dysregulation, and Risky Behaviors among Military Veterans in Residential Substance Abuse Treatment

    PubMed Central

    Weiss, Nicole H.; Williams, Daniel C.; Connolly, Kevin M.

    2016-01-01

    Substance use disorder (SUD) is highly prevalent among military populations and associated with a wide range of negative outcomes. The goal of the present study was to explicate the relations among negative affect, emotion dysregulation, and urges to engage in risky behaviors among military veterans in residential SUD treatment. Emotion dysregulation (overall and three dimensions: access to emotion regulation strategies, impulse control, and emotional awareness) mediated the relation between negative affect and urges to engage in risky behaviors. Findings highlight the potential utility of treatments targeting emotion dysregulation in reducing risky behaviors among military veterans with SUD. PMID:27088056

  20. Constructive thinking skills and impulsivity dimensions in conduct and substance use disorders: differences and relationships in an adolescents' sample.

    PubMed

    Urben, Sébastien; Suter, Maya; Pihet, Sandrine; Straccia, Claudio; Stéphan, Philippe

    2015-06-01

    Impact of conduct disorder (CD) and substance use disorder (SUD) on constructive thinking skills and impulsivity was explored. 71 offending adolescents were assessed for CD and SUD. Furthermore, the constructive thinking inventory, the immediate and delayed memory tasks and the UPPS impulsive behaviour scale were administered. Results showed that youths with CD, independently from SUD, presented higher personality impulsivity (urgency) and altered constructive thinking skills (categorical thinking and personal superstitious thinking). Furthermore, trait-impulsivity explained variation in constructive thinking skills. The implications of these results were discussed. PMID:25231102

  1. Néotectonique affectant les dépôts marins tyrrhéniens du littoral sud-est tunisien : implications pour les variations du niveau marinNeotectonics in the Tyrrhenian marine deposits of the southeastern Tunisian coast: implications for sea level changes

    NASA Astrophysics Data System (ADS)

    Bouaziz, Samir; Jedoui, Younes; Barrier, Éric; Angelier, Jacques

    2003-01-01

    Pleistocene marine deposits of so-called Tyrrhenian age in southeastern Tunisia include two lithostratigraphic units of Last Interglacial (marine isotopic substage 5e). The lower unit culminates at about +3 m above the sea level; the upper unit with Strombus bubonius culminates at +5 m. Brittle deformations affected the upper unit. The analysis of fault-slip data sets reveals a post-Tyrrhenian N020°E trending compression, consistent with joint patterns. This event induced limited vertical movements, showing that at the northeastern edge of the Saharan Platform, the coastal area of the southern Tunisia remained relatively stable since at least the Last Interglacial.

  2. Datation par la méthode U/Th d'un travertin quaternaire du Sud-Est marocain : implications paléoclimatiques pendant le Pléistocène moyen et supérieurU/Th dating of a Quaternary travertine from southern Morocco: palaeoclimatic consequences during Middle and Upper Pleistocene

    NASA Astrophysics Data System (ADS)

    Boudad, Larbi; Kabiri, Lahcen; Farkh, Samer; Falguères, Christophe; Rousseau, Louis; Beauchamp, Jacques; Nicot, Élisabeth; Cairanne, Guillaume

    2003-05-01

    A large travertine outcrop south of Errachidia, southern Morocco, was studied and U/Th dated. The carbonate fraction was provided by groundwaters then, as now, from the eastern High Atlas percolating through the regional Infra-Cenomanian aquifer. There were two main periods of accumulation at ca 262 kyr BP and 20-11.5 kyr BP separated by a long discontinuity with some limited weathering and erosion and correlated in part with a period of erosion at 30-20 kyr BP further to the west. The two travertine-deposition periods suggest increased rainfall and/or cooler thermal conditions in the eastern High Atlas source regions. Massive travertine accumulation ceased at the end of the Upper Pleistocene. To cite this article: L. Boudad et al., C. R. Geoscience 335 (2003).To cite this article: L. Boudad et al., C. R. Geoscience 335 (2003).

  3. Biodiversité et spéciation dans le Sud-Est du Brésil et le bassin du fleuve Parana: exemple de quelques espèces appartenant à un complexe du genre Sorocea A. St.-Hil. (Moraceae)

    NASA Astrophysics Data System (ADS)

    Romaniuc-Neto, Sergio

    1998-11-01

    In the genus Sorocea A. St.-Hil. (Moraceae) the species group of the coastal Atlantic from Brazil presents similar morphological taxa with taxonomical difficulties. Using a combined approach, linking morphology, ecology and biogeography and the concept of the Functional Biological Unit (FBU) it was possible to define and to specify the taxonomic ranks of nine FBUS, five considered as valid species of which one is new to science, four are subspecies and one is not described. All of these species, most of which are endemic to a restricted area, appear to be the result of a relatively recent and intense speciation caused by a phenomena of vicariance related to a rich and complex palaeohistory of the region (palaeoclimates; variations in the course of rivers, and in particular the Parana and Atlantic Mountains refugia).

  4. Phénomènes karstiques fossiles et actuels au sein des formations métamorphiques silico-alumineuses de la nappe pan-africaine de Yaoundé (Sud-Cameroun)Fossil and present-time karstic phenomena in silico-aluminous metamorphic formations of the Pan-African nappe of Yaoundé (South-Cameroon)

    NASA Astrophysics Data System (ADS)

    Vicat, Jean-Paul; Mvondo, Hubert; Willems, Luc; Pouclet, André

    Numerous karstic features have been recognised in the non-carbonaceous micaschists and gneisses of the Yaoundé Pan-African nappe, south of Cameroon. It is shown that their formation was controlled by the structural features of the rocks. The wells and the pipes in the bedrock outcrops point out a current karstification process, resulting from the plagioclase dissolution by the acid rain waters. Hill wall alveoli and caves, of pre-Miocene age, are exhumed features that were done by dissolution in the aquiferous underground. To cite this article: J.-P. Vicat et al., C. R. Geoscience 334 (2002) 545-550.

  5. Séquence de chevauchements et de sédimentation syntectonique dans un bassin transporté (piggy-back) : le bassin oligo-aquitanien de Mula Pliego (Zone interne bétique, Sud-Est de l'Espagne)

    NASA Astrophysics Data System (ADS)

    Martín-Martín, Manuel; Martín-Algarra, Agustín.

    The Oligo-Aquitanian deposits of the Mula-Pliego basin consist of a marine carbonate platform assemblage (bottom), transitioning into a turbidite wedge (top). This evolution was controlled by tectonics in a piggy-back basin by means of three main mechanisms: first, a flexural tectonic event created the basin; later on, blind-fault-propagation folds deformed it progressively from south to north; finally a tectonic event destroyed the basin. To cite this article: M. Martı´n-Martı´n, A. Martı´n-Algarra, C. R. Geoscience 334 (2002) 363-370.

  6. Le « flysch post-obductionde Népoui, un bassin transporté? Conséquences sur l'âge et les modalités de l'obduction tertiaire en Nouvelle-Calédonie (Pacifique sud-ouest)

    NASA Astrophysics Data System (ADS)

    Cluzel, Dominique

    1998-09-01

    The sedimentological and tectonic features of the Bartonian Népoui flysch do not correspond to its postulated post-obduction character and only the Miocene conglomerate clearly derives from the erosion of the ultramafic ophiolitic nappe. According to new micropaleontologic data, the Nepoui flysch is older than some parts of the autochthonous terranes and therefore unlikely to post-date the obduction. Derivation from predominantly mafic material, intercalation of neritic carbonate rocks and prominent tectonic deformation similar to that of the underlying mafic allochthon fit better with a piggy-back basin transported by the Poya Nappe during obduction. Consequently, the obduction could be younger than the previously postulated pre-Upper Bartonian age.

  7. The Mean Machine.

    ERIC Educational Resources Information Center

    McShane, Joan Braunagel

    1988-01-01

    Discusses a research project of testing detergents that resulted from students' classroom observations of and questions about water pollution and suds. Outlines procedures and responsibilities necessary for conducting the experiment. A sample student data sheet is included. (RT)

  8. A Review of Genome-Wide Association Studies of Stimulant and Opioid Use Disorders.

    PubMed

    Jensen, Kevin P

    2016-05-01

    Substance use disorders (SUD) are a major contributor to disability and disease burden worldwide. Risk for developing SUDs is influenced by variation in the genome. Identifying the genetic variants that influence SUD risk may help us to understand the biological mechanisms for the disorders and improve treatments. Genome-wide association studies (GWAS) have been successful in identifying many regions of the genome associated with common human disorders. Here, findings from recent GWAS of SUDs that involve illicit substances will be reviewed. Several GWAS have been reported, including studies on opioid and stimulant use disorder (cocaine and methamphetamine). Several of these GWAS report associations that are biologically interesting and statistically robust. Replication of the associations in independent samples and functional studies to understand the basis for the statistical associations will be important next steps. PMID:27606319

  9. Human pharmacology for addiction medicine: From evidence to clinical recommendations.

    PubMed

    Quednow, Boris B; Herdener, Marcus

    2016-01-01

    Substance use disorders (SUD) are complex and often chronic diseases with negative health outcomes and social consequences. Pharmacological treatment options for SUD can be separated in medications for (i) intoxication, (ii) withdrawal, and (iii) reduction of use together with relapse prevention. This chapter will focus on approved or clinically established pharmacological strategies suited to manage symptoms of withdrawal, and to reduce substance use or to promote abstinence. Hereby SUD involving alcohol, nicotine, stimulants, and opioids are primarily discussed as these substances are considered most harmful for both the individual and the society. Moreover, the pharmacotherapy of SUD related to the use of cannabis, benzodiazepines, and gamma-hydroxybutyrate is also briefly reviewed. Since most approved pharmacological treatment options show only moderate effect sizes especially in the long term, the development of new treatment strategies including new drugs, new combinations of available compounds, and biomarkers for response prediction is still warranted. PMID:26822361

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  11. Growing with the wind

    PubMed Central

    Katz, Maximiliano J; Acevedo, Julieta M; Wappner, Pablo

    2014-01-01

    In this Extra View we comment on our recent work on Sudestada1 (Sud1), a Drosophila 2-oxoglutarate (2OG)-dependent dioxygenase that belongs to the Ribosomal Oxygenase (ROX) subfamily. Sud1 is required for normal growth in Drosophila, and is conserved in yeast and mammals. We reported that Sud1 hydroxylates the ribosomal protein S23 (RPS23), and that its loss of function restricts growth and provokes activation of the unfolded protein response, apoptosis and autophagy. In this Extra View we speculate on the role that RPS23 hydroxylation might play in stop codon recognition and on the possible link between Sud1 loss-of-function and activation of the Unfolded Protein Response, Stress Granules formation and growth impairment. PMID:25482726

  12. Mindfulness meditation for substance use disorders: a systematic review.

    PubMed

    Zgierska, Aleksandra; Rabago, David; Chawla, Neharika; Kushner, Kenneth; Koehler, Robert; Marlatt, Alan

    2009-01-01

    Relapse is common in substance use disorders (SUDs), even among treated individuals. The goal of this article was to systematically review the existing evidence on mindfulness meditation-based interventions (MM) for SUDs. The comprehensive search for and review of literature found over 2000 abstracts and resulted in 25 eligible manuscripts (22 published, 3 unpublished: 8 randomized controlled trials, 7 controlled nonrandomized, 6 noncontrolled prospective, and 2 qualitative studies, and 1 case report). When appropriate, methodological quality, absolute risk reduction, number needed to treat, and effect size were assessed. Overall, although preliminary evidence suggests MM efficacy and safety, conclusive data for MM as a treatment of SUDs are lacking. Significant methodological limitations exist in most studies. Further, it is unclear which persons with SUDs might benefit most from MM. Future trials must be of sufficient sample size to answer a specific clinical question and should target both assessment of effect size and mechanisms of action.

  13. Measurement of Mental Health in Substance Use Disorder Outpatients

    PubMed Central

    Alterman, Arthur I.; Cacciola, John S.; Dugosh, Karen L.; Ivey, Megan A.; Coviello, Donna M.

    2010-01-01

    Few studies have examined mental health (MH) attributes of substance use disorder (SUD) patients. The present study examines the internal consistency, concurrent validity, and comparative level of MH attributes (i.e., optimism, life attitudes, spirituality/religiousness, social support, positive mood, hope, and vitality) in SUD patients compared to the instrument development group. The internal consistency of optimism, spirituality/religiousness, positive mood, hope, and vitality were similar in both groups. Some subscales of the social support and life attitude measures had lower internal consistency than was found for the original samples, although internal consistency of more global constructs were comparable. SUD patients had higher positive mood, spirituality/religiousness, and hope scores, while social support, life attitudes, and optimism scores were lower than in the original sample. Correlations between MH attributes and recent life problems of SUD patients generally supported the concurrent validity of the MH measures. PMID:20708901

  14. The Relationship Between Emotion Dysregulation and Deliberate Self-Harm Among Inpatients with Substance Use Disorders

    PubMed Central

    Tull, Matthew T.

    2010-01-01

    Despite the emphasis on the role of emotion dysregulation in deliberate self-harm (DSH), no studies have examined this association among patients with substance use disorders (SUD). This study examined if emotion dysregulation is heightened among SUD inpatients with (vs. without) DSH, and if the association between DSH and emotion dysregulation remains significant when controlling for their shared association with risk factors for both, including borderline personality disorder (BPD), posttraumatic stress disorder (PTSD), childhood abuse, and substance use severity. Findings indicate heightened emotion dysregulation among SUD patients with (vs. without) DSH, and provide evidence of a unique association between emotion dysregulation and DSH when controlling for BPD, PTSD, childhood abuse, and substance use severity. Findings also highlight the particular relevance of three dimensions of emotion dysregulation to DSH among SUD patients: limited access to effective emotion regulation strategies, difficulties engaging in goal-directed behaviors when distressed, and emotional nonacceptance. PMID:21132101

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  16. Gender differences in the relationship between discrimination and substance use disorder among Latinos.

    PubMed

    Ornelas, India J; Hong, Seunghye

    2012-10-01

    Using data from the National Latino and Asian American Study collected in 2002-2003 (N = 2,554), we assessed the adjusted odds of lifetime substance use disorder (SUD) associated with report of both unfair treatment and racial/ethnic discrimination. Among men, SUD was increased for those reporting low, moderate, and high levels of unfair treatment compared to those reporting no unfair treatment and patterns were similar for racial/ethnic discrimination. Among women, only those reporting high levels of unfair treatment were at increased risk of lifetime SUD and no associations were observed between racial/ethnic discrimination and lifetime SUD. Future research should examine the role that discrimination plays in the development of substance misuse among Latinos.

  17. Attention-Deficit/Hyperactivity Disorder and Risk of Substance Use Disorder: Developmental Considerations, Potential Pathways, and Opportunities for Research

    PubMed Central

    Molina, Brooke S.G.; Pelham, William E.

    2014-01-01

    Many opportunities to explain ADHD-related risk of substance use/disorder (SUD) remain available for study. We detail these opportunities by considering characteristics of children with ADHD and factors affecting their outcomes side-by-side with overlapping variables in the developmental literature on SUD etiology. Although serious conduct problems are a known contributor to ADHD-related risk of SUD, few studies have considered their emergence developmentally and in relation to other candidate mediators and moderators that could also explain risk and be intervention targets. Common ADHD-related impairments, such as school difficulties, are in need of research. Heterogeneous social impairments have the potential for predisposing, and buffering, influences. Research on neurocognitive domains should move beyond standard executive function batteries to measure deficits in the interface between cognitive control, reward, and motivation. Ultimately, maximizing prediction will depend, as it has in the SUD literature, on simultaneous consideration of multiple risk factors. PMID:24437435

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  19. Posttraumatic Stress Disorder and Co-Occurring Substance Use Disorders: Advances in Assessment and Treatment

    PubMed Central

    McCauley, Jenna L; Killeen, Therese; Gros, Daniel F.; Brady, Kathleen T.; Back, Sudie E.

    2013-01-01

    Posttraumatic stress disorder (PTSD) and substance use disorders (SUDs) are prevalent and frequently co-occur. Comorbid PTSD/SUD is associated with a more complex and costly clinical course when compared with either disorder alone, including increased chronic physical health problems, poorer social functioning, higher rates of suicide attempts, more legal problems, increased risk of violence, worse treatment adherence, and less improvement during treatment. In response, psychosocial treatment options have increased substantially over the past decade and integrated approaches – treatments that address symptoms of both PTSD and SUD concurrently –are fast becoming the preferred model for treatment. This paper reviews the prevalence, etiology and assessment practices as well as advances in the behavioral and pharmacologic treatment of comorbid PTSD and SUDs. PMID:24179316

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  1. Advancing Performance Measures for Use of Medications in Substance Abuse Treatment

    PubMed Central

    Garnick, Deborah W.; Horgan, Constance M.; McCorry, Frank; Gmyrek, Amanda; Chalk, Mady; Gastfriend, David; Rinaldo, Suzanne Gelber; Albright, Joann; Capoccia, Victor; Harris, Alex; Harwood, Henrick J.; Greenberg, Pamela; Mark, Tami; Un, Huong; Oros, Marla; Stringer, Mark; Thatcher, James

    2010-01-01

    Performance measures have the potential to drive high quality health care. However, technical and policy challenges exist in developing and implementing measures to assess substance use disorder (SUD) pharmacotherapy. Of critical importance in advancing performance measures for use of SUD pharmacotherapy is recognition that different measurement approaches may be needed in the public and private sectors, and will be determined by the availability of different data collection and monitoring systems. In 2009, the Washington Circle convened a panel of nationally recognized insurers, purchasers, providers, policy makers, and researchers to address this topic. The charge of the panel was to identify opportunities and challenges in advancing use of SUD pharmacotherapy performance measures across a range of systems. This paper summarizes those findings by identifying a number of critical themes related to advancing SUD pharmacotherapy performance measures, highlighting examples from the field, and recommending actions for policy makers. PMID:20934836

  2. Mindfulness Meditation for Substance Use Disorders: A Systematic Review

    PubMed Central

    Zgierska, Aleksandra; Rabago, David; Chawla, Neharika; Kushner, Kenneth; Koehler, Robert; Marlatt, Allan

    2009-01-01

    Relapse is common in substance use disorders (SUDs), even among treated individuals. The goal of this article was to systematically review the existing evidence on mindfulness meditation-based interventions (MM) for SUDs. The comprehensive search for and review of literature found over 2,000 abstracts and resulted in 25 eligible manuscripts (22 published, 3 unpublished: 8 RCTs, 7 controlled non-randomized, 6 non-controlled prospective, 2 qualitative studies, 1 case report). When appropriate, methodological quality, absolute risk reduction, number needed to treat, and effect size (ES) were assessed. Overall, although preliminary evidence suggests MM efficacy and safety, conclusive data for MM as a treatment of SUDs are lacking. Significant methodological limitations exist in most studies. Further, it is unclear which persons with SUDs might benefit most from MM. Future trials must be of sufficient sample size to answer a specific clinical question and should target both assessment of effect size and mechanisms of action. PMID:19904664

  3. Risk for behavior problems in children of parents with substance use disorders.

    PubMed

    Bountress, Kaitlin; Chassin, Laurie

    2015-05-01

    Using a high-risk community sample (N = 567), the current study examined risk for externalizing and internalizing problems in the children of parents with recovered and current substance use disorders (SUDs). This study also tested whether parenting mediated the relations between these variables. Results suggest that children of parents with current diagnoses were at elevated risk for externalizing and internalizing problems, but children of parents with recovered diagnoses were only at risk for externalizing problems. Perceived parental consistency of support mediated the relations between parent current SUD and child externalizing and internalizing problems. Disruption of the home environment may in part explain why children of parents with SUDs are at risk for externalizing and internalizing problems. However, even after parent SUD has remitted, children remain at risk for externalizing problems, suggesting multiple mechanisms by which parents confer risk for psychopathology.

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  5. Assessment of risk for substance use disorder consequent to consumption of illegal drugs: psychometric validation of the neurobehavior disinhibition trait.

    PubMed

    Mezzich, Ada C; Tarter, Ralph E; Feske, Ulrike; Kirisci, Levent; McNamee, Rebecca L; Day, Bang-Shiuh

    2007-12-01

    Previous research has shown that the trait neurobehavior disinhibition (ND), which consists of affect, behavior, and cognitive indicators of self-regulation, is a significant predictor of substance use disorder (SUD) between childhood and young adulthood. The authors evaluated the psychometric properties of the ND trait in 278 boys evaluated at ages 10-12 and 16 years. ND score significantly predicted SUD and outcomes that commonly manifest in tandem with SUD by age 19, such as violence, arrests, committing crime while intoxicated, and concussion injury. In addition to predictive validity, the ND trait was found to have good construct, discriminative, and concurrent validity, as well as good test-retest and internal reliability. The ND trait may be useful for detecting youths at high risk for developing SUD and related outcomes.

  6. Reusing single-use devices in hospitals: a case study

    NASA Astrophysics Data System (ADS)

    Srivastava, Rajesh

    2004-02-01

    Traditionally, Single Use Devices (SUDs) have been used and discarded, as the name suggests. These SUDs include operating room devices used in areas such as arthroscopy and laparoscopy, devices such as catheters in cardiovascular surgery and in endoscopy, and other general products. However, many of these devices can be remanufactured. Hospitals face challenges in reducing costs. They are increasingly turning to reusing these SUDs. The use of SUDs by a local hospital is examined with the focus on the savings achieved through the program, as well as problems encountered in the process of implementing the program. Various aspects of the remanufacture and use of such devices, including the economics, quality, and customer perception are examined, as well as medical users attitudes. The success of the current program, and its viability in the future are also examined.

  7. Questioning the Specificity of ASRS-v1.1 to Accurately Detect ADHD in Substance Abusing Populations

    ERIC Educational Resources Information Center

    Chiasson, Jean-Pierre; Stavro, Katherine; Rizkallah, Elie; Lapierre, Luc; Dussault, Maxime; Legault, Louis; Potvin, Stephane

    2012-01-01

    Objective: To assess the specificity of the Adult ADHD Self-Report Scale (ASRS-v1.1) in detecting ADHD among individuals with substance use disorders (SUDs). Method: A chart review of 183 SUD patients was conducted. Patients were screened for ADHD with the ASRS-v1.1 and were later assessed by a psychiatrist specialized in ADHD. Results: Among SUD…

  8. Methylphenidate in Adults with Attention Deficit Hyperactivity Disorder and Substance Use Disorders.

    PubMed

    Simon, Nicolas; Rolland, Benjamin; Karila, Laurent

    2015-01-01

    Attention-Deficit/Hyperactivity Disorder (ADHD) is a neurodevelopment disorder occurring during childhood. However, ADHD persists into adulthood in 45.7% of cases. The global prevalence of adult ADHD is estimated to 5.3%, with no difference between Europe and North America. ADHD is often comorbid with substance use disorder (SUD), with Odds Ratio ranges from 1.5 to 7.9, depending on the substance and the dependence level. Conversely, the prevalence of ADHD among patients with SUD is 10.8%, versus 3.8% for patients without SUD. Methylphenidate (MPH) alleviates ADHD symptoms and, as such, is currently considered as a first choice medication. MPH blocks the dopamine and norepinephrine transporters leading to an increase in extracellular dopamine. It should be noted that its subjective effects are highly dependent on the pharmacokinetic and especially on the rate of input, which highlights the importance of choosing a sustained-release formulation. Meanwhile, prescribing MPH to patients with comorbid SUD has always been challenging for clinicians. The aim of this review is to address the benefits and pitfalls of using MPH in adults with ADHD comorbid SUD, depending on each of the following types of SUD: amphetamine, cocaine, nicotine, alcohol, cannabis and opiates. Overall, due to the prevalence of ADHD in SUD and to the benefits of MPH observed in this population, and considering the mild or low side effects observed, the response to MPH treatment should be evaluated individually in adults with comorbid ADHD and SUD. The choice of the formulation should favor sustained- release MPH over immediate release MPH. Cardiovascular parameters also have to be monitored during long-term use.

  9. Is there heterogeneity among syndromes of substance use disorder for illicit drugs?

    PubMed Central

    Beseler, Cheryl; Jacobson, Kristen C.; Kremen, William S.; Lyons, Michael J.; Glatt, Stephen J.; Faraone, Stephen V.; Gillespie, Nathan A.; Tsuang, Ming T.

    2014-01-01

    The use of DSM criteria to evaluate liability to substance use disorders (SUDs) and to identify SUD phenotypes may not provide the sensitivity required to identify genes associated with vulnerability to SUDs. The purpose of this study is to evaluate a number of basic aspects of substance use that may be more proximal than full SUDs to risk genes, some of which may thus have greater potential utility as phenotypes in subsequent molecular genetic analyses. In this paper we present results from the first stage of our planned analyses, focusing on how individual symptoms of abuse and dependence may be used to create alternate phenotypes for SUDs. Specifically, we used factor analysis and biometrical modeling on each symptom of illicit substance abuse and dependence within different types of substances, and compared and contrasted factor patterns and heritabilities across the different substances. These analyses were carried out using a population-based sample of 3372 male–male twin pairs from the Vietnam Era Twin Registry who participated in the Harvard Twin Study of Substance Abuse. We obtained extensive data from these participants on substance use and SUDs via telephone interview in 1992, including data on the illicit substances: opiates, cocaine, cannabis, sedatives, stimulants, and psychedelics. The results indicate that: A) although a one-factor model assuming a single underlying liability for abuse and dependence symptoms and behaviors can be rejected for most substances, there is no uniform support for a two-factor model differentiating between abuse versus dependence; B) patterns of symptoms or behaviors reported by substance users vary across substances; C) not all symptoms or behaviors contribute equally to the presentation of an SUD; and D) the heritability of symptoms or behaviors of substance users varies both within and between substances. These results represent important first steps in facilitating the search for SUD-risk genes in subsequent high

  10. A “refugee paradox” for substance use disorders?

    PubMed Central

    Vaughn, Michael G.

    2014-01-01

    Background Few, if any, studies have systematically examined the link between nativity and substance use disorders (SUD) among refugees using national samples. As such, it remains uncertain if the “immigrant paradox” for substance use can be extended to include refugees in the United States. Methods Employing data from the National Epidemiologic Survey on Alcohol and Related Conditions, we examine the lifetime prevalence of SUDs among refugees (n = 428) in contrast with non-refugee immigrants (n = 4,955) and native-born Americans (n = 29,267). We also examine the impact of gender and refugee duration on the relationship between nativity, refugee status, and SUDs. Results Refugees were between 3–6 times less likely than native-born Americans meet criteria for all SUDs examined, and significantly less likely than non-refugee immigrants to meet criteria for alcohol (AOR = 0.44, 95% CI = 0.41–0.47), cocaine (AOR = 0.54, 95% CI = 0.50–0.59), hallucinogen (AOR = 0.66, 95% CI = 0.58–0.74), and opioid/heroin (AOR = 0.62, 95% CI = 0.58–0.66) use disorders. The refugee-SUD link was significantly moderated by gender. Duration as a refugee was associated with increased risk for alcohol use disorder and decreased risk of cannabis and illicit drug use disorders. Conclusions Study findings provide evidence in support of a “refugee paradox” for SUDs among adults in the United States. Refugees are substantially less likely than native-born Americans to meet criteria for all SUDs examined and, albeit with weaker effects, significantly less likely than non-refugee immigrants to meet criteria for a variety of SUDs. PMID:24999058

  11. Satisfaction With Methadone Among Heroin-Dependent Patients With Current Substance Use Disorders During Methadone Maintenance Treatment.

    PubMed

    Perez de Los Cobos, Jose; Trujols, Joan; Siñol, Núria; Duran-Sindreu, Santiago; Batlle, Francesca

    2016-04-01

    Methadone maintenance treatment (MMT) has long been used to treat heroin-dependent patients. However, satisfaction with methadone in this patient population is unknown. The aim of this cross-sectional case-control study was to evaluate satisfaction with methadone in heroin-dependent patients with current substance use disorders (SUDs). Cases included 152 methadone-maintained patients with current SUD, requiring inpatient detoxification treatment, and controls included 33 methadone-maintained patients in sustained full remission for SUD. Satisfaction with methadone as a medication to treat heroin addiction was measured by using the Scale to Assess Satisfaction with Medications for Addiction Treatment-methadone for heroin addiction (SASMAT-METHER). The SASMAT-METHER subscales assess the following domains: personal functioning and well-being, antiaddictive effect on heroin, and antiaddictive effect on other substances. Compared with patients with remitted SUD, patients with current SUD scored lower on all SASMAT-METHER assessments. In such patients, overall SASMAT-METHER scores were independently and negatively associated with downward desired adjustment of methadone dose and days of heroin use during last month; although various sets of factors were independently associated with each of the SASMAT-METHER subscales, the only determinant of dissatisfaction on all subscales was the desire for downward adjustment of methadone dose. In summary, MMT patients with current SUD are less satisfied with methadone than MMT patients with remitted SUD. In patients with current SUD, downward desired adjustment of methadone dose and days of heroin use during last month are independently associated with overall dissatisfaction with methadone. PMID:26825608

  12. The “Younger-Sibling-at-Risk Design”: a Pilot Study of Adolescents with ADHD and an Older Sibling with Substance Use Disorder

    PubMed Central

    Donovan, Stephen J.; Levin, Frances R.

    2011-01-01

    Introduction This article introduces a “younger at-risk sibling” design to study progression from other psychopathologies to their substance use disorder (SUD) complications. The design selects not-yet-SUD adolescents with high-risk-for-SUD psychopathology only if an older sibling has SUD. This “proof of concept” pilot study examines the design’s feasibility if the younger sibling has attention deficit hyperactivity disorder (ADHD). Method Subjects were recruited from families at substance abuse treatment centers that had a non-SUD younger child with ADHD, from families at behavior disorder clinics that had a younger child with ADHD and SUD older child, and through general advertisements. Subjects were seen weekly for at least 3 months and monthly thereafter for 3 months. All were treated with open-label lisdexamfetamine dimesylate 30–70 mg per day. Outcomes explored were recruitment, compliance, diversion, ADHD improvement, and substance use interest. Results 25 families were screened, 13 evaluated, and 8 began medication. ADHD Rating Scale-IV scores obtained by parent adolescent consensus improved as expected with a stimulant. Rating forms could quantify substance use interest in subjects with some drug culture exposure but encountered a floor effect in those without. The design’s complexity and implicit commentary on family dynamics complicated recruitment but may have facilitated retention. Conclusion Sibling pairs in which the older sibling has substance use and the younger sibling has ADHD exist. Such younger siblings can be recruited into a treatment study. The design may shed light on the pathogenesis and prevention of SUD complications from ADHD and theoretically other SUD comorbidities. PMID:21517711

  13. Substance Abuse and Trauma.

    PubMed

    Simmons, Shannon; Suárez, Liza

    2016-10-01

    There is a strong, bidirectional link between substance abuse and traumatic experiences. Teens with cooccurring substance use disorders (SUDs) and posttraumatic stress disorder (PTSD) have significant functional and psychosocial impairment. Common neurobiological foundations point to the reinforcing cycle of trauma symptoms, substance withdrawal, and substance use. Treatment of teens with these issues should include a systemic and integrated approach to both the SUD and the PTSD. PMID:27613348

  14. Pathological Gambling: Biological and Clinical Considerations

    PubMed Central

    Topf, Jocelyn L.; Yip, Sarah W.; Potenza, Marc N.

    2009-01-01

    Pathological gambling (PG) is categorized as an impulse control disorder (ICD). Phenomenological, neurobiological and pharmacological data suggest similarities in the pathophysiologies of substance use disorders (SUDs) and PG. Both behavioral and pharmacological approaches, including those that have been empirically validated for SUDs, have shown promise in the treatment of PG. Findings from biological studies of PG are reviewed, and treatment approaches based on controlled studies are summarized. PMID:20161094

  15. Enhancing response inhibition by incentive: Comparison of adolescents with and without substance use disorder

    PubMed Central

    Chung, Tammy; Geier, Charles; Luna, Beatriz; Pajtek, Stefan; Terwilliger, Robert; Thatcher, Dawn; Clark, Duncan

    2010-01-01

    Effective response inhibition is a key component of recovery from addiction. Some research suggests that response inhibition can be enhanced through reward contingencies. We examined the effect of monetary incentive on response inhibition among adolescents with and without substance use disorder (SUD) using a fast event-related fMRI antisaccade reward task. The fMRI task permits investigation of how reward (monetary incentive) might modulate inhibitory control during three task phases: cue presentation (reward or neutral trial), response preparation, and response execution. Adolescents with lifetime SUD (n=12; 100% marijuana use disorder) were gender and age-matched to healthy controls (n=12). Monetary incentive facilitated inhibitory control for SUD adolescents; for healthy controls, the difference in error rate for neutral and reward trials was not significant. There were no significant differences in behavioral performance between groups across reward and neutral trials, however, group differences in regional brain activation were identified. During the response preparation phase of reward trials, SUD adolescents, compared to controls, showed increased activation of prefrontal and oculomotor control (e.g., frontal eye field) areas, brain regions that have been associated with effective response inhibition. Results indicate differences in brain activation between SUD and control youth when preparing to inhibit a prepotent response in the context of reward, and support a possible role for incentives in enhancing response inhibition among youth with SUD. PMID:21115229

  16. The Blackfeet Indian culture camp: Auditioning an alternative indigenous treatment for substance use disorders.

    PubMed

    Gone, Joseph P; Calf Looking, Patrick E

    2015-05-01

    American Indian and Alaska Native (AIAN) communities experience alarming health disparities, including high rates of substance use disorders (SUDs). Psychological services for AIANs, including SUDs treatment, are primarily funded by the federal Indian Health Service and typically administered by tribal governments. Tribal administration of SUDs treatment programs has routinely involved either inclusion of traditional cultural practices into program activities or adaptation of conventional treatment approaches to distinctive community sensibilities. In this article, we investigate a third possibility: the collaborative, community-based development of an alternative indigenous intervention that was implemented as a form of SUDs treatment in its own right and on its own terms. Specifically, in July of 2012, we undertook a trial implementation of a seasonal cultural immersion camp based on traditional Pikuni Blackfeet Indian cultural practices for 4 male clients from the reservation's federally funded SUDs treatment program. Given a variety of logistical and methodological constraints, the pilot offering of the culture camp primarily served as a demonstration of "proof of concept" for this alternative indigenous intervention. In presenting and reflecting on this effort, we consider many challenges associated with alternative indigenous treatment models, especially those associated with formal outcome evaluation. Indeed, we suggest that the motivation for developing local indigenous alternatives for AIAN SUDs treatment may work at cross-purposes to the rigorous assessment of therapeutic efficacy for such interventions. Nevertheless, we conclude that these efforts afford ample opportunities for expanding the existing knowledge base concerning the delivery of community-based psychological services for AIANs. PMID:25961644

  17. Neuroimaging Risk Markers for Substance Abuse: Recent Findings on Inhibitory Control and Reward System Functioning

    PubMed Central

    Cope, Lora M.; Martz, Meghan E.; Hardee, Jillian E.

    2015-01-01

    Rates of alcohol and other drug use rise sharply throughout adolescence and peak in the early 20s. Likewise, prevalence of first-time substance use disorder (SUD) and past-year SUD both peak between ages 18–23. SUD is associated with a host of negative outcomes and is a serious health concern. Understanding the mechanisms that precede the onset and escalation of substance use is crucial in order to develop more effective prevention and intervention strategies for children and adolescents at risk for SUD. In this review, we discuss recent findings from functional neuroimaging studies in children, adolescents, and emerging adults that focus on uncovering the neural underpinnings of SUD risk. The focus is on inhibitory control and reward circuitry due to their involvement in risk-taking behaviors, which are heightened in adolescence and may facilitate substance use. We discuss convergences in the literature and highlight findings suggesting that the association between SUD risk and neurofunctioning may be moderated by age, gender, and history of substance use. Recommendations for future directions are also discussed. PMID:26236575

  18. A geographic information system screening tool to tackle diffuse pollution through the use of sustainable drainage systems.

    PubMed

    Todorovic, Zorica; Breton, Neil P

    2014-01-01

    Sustainable drainage systems (SUDS) offer many benefits that traditional solutions do not. Traditional approaches are unable to offer a solution to problems of flood management and water quality. Holistic consideration of the wide range of benefits from SUDS can result in advantages such as improved flood resilience and water quality enhancement through consideration of diffuse pollution sources. Using a geographical information system (GIS) approach, diffuse pollutant sources and opportunities for SUDS are easily identified. Consideration of potential SUDS locations results in source, site and regional controls, leading to improved water quality (to meet Water Framework Directive targets). The paper will discuss two different applications of the tool, the first of which is where the pollutant of interest is known. In this case the outputs of the tool highlight and isolate the areas contributing the pollutants and suggest the adequate SUDS measures to meet the required criteria. The second application is where the tool identifies likely pollutants at a receiving location, and SUDS measures are proposed to reduce pollution with assessed efficiencies.

  19. Decisional impairments in cocaine addiction, reward bias, and cortical oscillation “unbalance”

    PubMed Central

    Balconi, Michela; Finocchiaro, Roberta

    2015-01-01

    A vast amount of research has suggested that subjects with substance use disorder (SUD) might have difficulty making advantageous decisions that opt in favor of a longer-term, larger reward than an immediate, smaller reward. The current research explored the impact of reward bias and cortical frontal asymmetry (left lateralization effect) in SUD in response to a decisional task (Iowa Gambling Task). Fifty SUD participants and 40 controls (CG) were tested using the Iowa Gambling Task. Electrophysiology (electroencephalography) recording was performed during task execution. We measured left and right dorsolateral prefrontal cortex power activity. Behavioral responses (gain/loss options); frequency band modulation (asymmetry index) for delta, theta, alpha, and beta band; and cortical source localization (standardized low-resolution brain electromagnetic tomography) were considered. The SUD group opted in favor of the immediate reward option (loss) more frequently than the long-term option (gain) when compared to the CG. Secondly, SUD showed increased left-hemisphere activation in response to losing (with immediate reward) choices in comparison with the CG. The left hemispheric unbalance effect and the “reward bias” were adduced to explain the decisional impairment in SUD. PMID:25848274

  20. Effective Clinical Supervision in Substance Use Disorder Treatment Programs and Counselor Job Performance

    PubMed Central

    2013-01-01

    When mental health counselors have limited and/or inadequate training in substance use disorders (SUDs), effective clinical supervision (ECS) may advance their professional development. The purpose of the current study was to investigate whether ECS is related to the job performance of SUD counselors. Data were obtained in person via paper-and-pencil surveys from 392 matched SUD counselor-clinical supervisor dyads working in 27 SUD treatment organizations across the United States. ECS was rated by counselors and measured with five multi-item scales (i.e., sponsoring counselors’ careers, providing challenging assignments, role modeling, accepting/confirming counselors’ competence, overall supervisor task proficiency). Clinical supervisors rated counselors’ job performance, which was measured with two multi-item scales (i.e., task performance, performance within supervisory relationship). Using mixed-effects models, we found that most aspects of ECS are related to SUD counselor job performance. Thus, ECS may indeed enhance counselors’ task performance and performance within the supervisory relationship, and, as a consequence, offset limited formal SUD training. PMID:25061265

  1. Genetic variants in KCNE1, KCNQ1, and NOS1AP in sudden unexplained death during daily activities in Chinese Han population.

    PubMed

    Huang, Jinglu; Wang, Xiaoguang; Hao, Bo; Chen, Yijiu; Liu, Hong; Quan, Li; Tang, Dawei; Sheng, Lihui; Li, Ming; Huang, Erwen; Liu, Chao; Luo, Bin

    2015-03-01

    Fifty-six sudden unexplained death (SUD) cases were collected from Chinese Han population, which occurred during daily activities and were autopsy negative in comprehensive postmortem autopsy. The coding exons of potassium channel genes KCNE1, KCNQ1, and nitric oxide synthase gene NOS1AP were sequenced. A synonymous mutation, KCNE1 F54F T>C was identified in 2 SUD cases, which was absent in the control subjects. Neither genotype nor allele frequencies of KCNE1 and KCNQ1 exhibited a significant difference between the SUD and control group. In contrast, the allele frequency (p = 2.7 × 10(-10)) and genotype frequency (p = 5.9 × 10(-7)) of rs3751284, and the genotype frequency (p = 2.9 × 10(-2)) of rs348624 in NOS1AP of SUD were significantly different from that of controls (p < 0.05). Our study suggested that rs3751284 and rs348624 might be susceptibility loci for SUD during daily activities. Larger sample sizes and further molecular studies are needed to confirm or exclude an effect of the NOS1AP SNPs on SUD risk.

  2. Does DSM-5 nomenclature for inhalant use disorder improve upon DSM-IV?

    PubMed

    Ridenour, Ty A; Halliburton, Amanda E; Bray, Bethany C

    2015-03-01

    Among drug classes, substance use disorder (SUD) consequent to using inhalants (SUD-I) has perhaps the smallest evidence base. This study compared DSM-IV versus DSM-5 nomenclatures, testing whether 4 traditional categories of inhalants (aerosols, gases, nitrites, solvents) are manifestations of a single pathology, obtaining item parameters of SUD-I criteria, and presenting evidence that SUD can result from using nitrites. An urban, Midwestern, community sample of 162 inhalant users was recruited. Participants were 2/3 male, nearly 85% White, and had a mean age of 20.3 years (SD = 2.4 years), spanning the ages of greatest incidence of SUD and slightly older than the primary ages of inhalants use initiation. Analyses consisted of bivariate associations, principle components analysis, and item response theory analysis. Validity was demonstrated for SUD-I consequent to each inhalant type as well as for aggregating all inhalant types into a single drug class. Results supported DSM-5 nomenclature over DSM-IV in multiple ways except that occurrence of diagnostic orphans was not statistically smaller using DSM-5. (PsycINFO Database Record

  3. Mediating and Moderating Role of Depression, Conduct Disorder or Attention-Deficit/Hyperactivity Disorder in Developing Adolescent Substance Use Disorders: A Population-Based Study

    PubMed Central

    Yoshimasu, Kouichi; Barbaresi, William J.; Colligan, Robert C.; Voigt, Robert G.; Weaver, Amy L.; Katusic, Slavica K.

    2016-01-01

    Objective To evaluate the mediating/moderating effects of common internalizing /externalizing disorders on the association between ADHD and adolescent substance use disorders (SUD) in a population-based birth cohort. Methods Among 5718 children in the birth cohort, 343 ADHD incident cases and 712 matched controls were identified. Psychiatric diagnoses prior to age 19 were classified into DSM-IV categories. The association between ADHD and SUD was summarized (hazard ratios (HR), 95% CI). The effect of depression, CD/ODD, anxiety was evaluated separately. Results Assessment of the joint effects of ADHD and each psychiatric disorder did not support a moderating effect of these disorders on SUD on additive scale. However, the association between ADHD and SUD was partially explained by a mediating role of these psychiatric disorders. Conclusion For clinicians our results emphasize that depression (or CD/ODD) confers greater risk for SUD than ADHD alone. Early detection/treatment of SUD among adolescents with depression (or CD/ODD) is crucial regardless of ADHD. PMID:27294778

  4. Inpatient Hospitalization in Addiction Treatment for Patients with a History of Suicide Attempt: A Case of Support for Treatment Performance Measures†

    PubMed Central

    Glass, Joseph E.; Ilgen, Mark A.; Winters, Jamie J.; Murray, Regan L.; Perron, Brian E.; Chermack, Stephen T.

    2010-01-01

    This study attempts to validate substance use disorder (SUD) treatment performance measures (PM) in a naturalistic treatment setting. Despite its significance in healthcare systems and in SUD populations, suicidality is one patient characteristic that remains unexplored in the context of SUD PMs. The current study focused on the extent to which the care processes encouraged by SUD PMs were associated with improved outcomes in patients with a prior suicide attempt as compared to those without. We abstracted Addiction Severity Index and health services data from the VA medical record for 381 veterans who initiated outpatient SUD treatment and completed baseline intake measures at a Midwestern VA hospital. Cox proportional hazard regressions examined how baseline characteristics, prior suicide attempts, and PM status predicted the time until hospitalization for psychiatric or substance use problems. Prior suicide attempts significantly interacted with treatment engagement, and hospitalization risk was significantly higher among individuals with a prior suicide attempt who did not meet PMs. This study provides initial observational evidence that past suicide attempts may be a factor that should be considered when defining performance standards that influence the processes of SUD treatment. Future research on PMs should take into account the differences on indicators of high risk and poor treatment outcomes. PMID:21053754

  5. Hypothesizing Dopaminergic Genetic Antecedents in Schizophrenia and Substance Seeking Behavior

    PubMed Central

    Blum, Kenneth; Oscar-Berman, Marlene; Badgaiyan, Rajendra; Palomo, Tomas; Gold, Mark S.

    2014-01-01

    The dopamine system has been implicated in both substance use disorder (SUD) and schizophrenia. A recent meta- analysis suggests that A1 allele of the DRD2 gene imposes genetic risk for SUD, especially alcoholism and has been implicated in Reward Deficiency Syndrome (RDS). We hypothesize that dopamine D2 receptor (DRD2) gene Taq1 A2 allele is associated with a subtype of non- SUD schizophrenics and as such may act as a putative protective agent against the development of addiction to alcohol or other drugs of abuse. Schizophrenics with SUD may be carriers of the DRD2 Taq1 A1 allele, and/or other RDS reward polymorphisms and have hypodopaminergic reward function. One plausible mechanism for alcohol seeking in schizophrenics with SUD, based on previous research, may be a deficiency of gamma type endorphins that has been linked to schizophrenic type psychosis.. We also propose that alcohol seeking behavior in schizophrenics, may serve as a physiological self-healing process linked to the increased function of the gamma endorphins, thereby reducing abnormal dopaminergic activity at the nucleus accumbens (NAc). These hypotheses warrant further investigation and cautious interpretation. We, therefore, encourage research involving neuroimaging, genome wide association studies (GWAS), and epigenetic investigation into the relationship between neurogenetics and systems biology to unravel the role of dopamine in psychiatric illness and SUD. PMID:24636783

  6. Hypothesizing dopaminergic genetic antecedents in schizophrenia and substance seeking behavior.

    PubMed

    Blum, Kenneth; Oscar-Berman, Marlene; Badgaiyan, Rajendra D; Palomo, Tomas; Gold, Mark S

    2014-05-01

    The dopamine system has been implicated in both substance use disorder (SUD) and schizophrenia. A recent meta-analysis suggests that A1 allele of the DRD2 gene imposes genetic risk for SUD, especially alcoholism and has been implicated in Reward Deficiency Syndrome (RDS). We hypothesize that dopamine D2 receptor (DRD2) gene Taq1 A2 allele is associated with a subtype of non-SUD schizophrenics and as such may act as a putative protective agent against the development of addiction to alcohol or other drugs of abuse. Schizophrenics with SUD may be carriers of the DRD2 Taq1 A1 allele, and/or other RDS reward polymorphisms and have hypodopaminergic reward function. One plausible mechanism for alcohol seeking in schizophrenics with SUD, based on previous research, may be a deficiency of gamma type endorphins that has been linked to schizophrenic type psychosis. We also propose that alcohol seeking behavior in schizophrenics, may serve as a physiological self-healing process linked to the increased function of the gamma endorphins, thereby reducing abnormal dopaminergic activity at the nucleus accumbens (NAc). These hypotheses warrant further investigation and cautious interpretation. We, therefore, encourage research involving neuroimaging, genome wide association studies (GWAS), and epigenetic investigation into the relationship between neurogenetics and systems biology to unravel the role of dopamine in psychiatric illness and SUD. PMID:24636783

  7. Inhibitory control deficits in childhood and risk for substance use disorders: a review.

    PubMed

    Ivanov, Iliyan; Schulz, Kurt P; London, Edythe D; Newcorn, Jeffrey H

    2008-01-01

    Identification of neurobiological factors that confer risk for the development of addiction may substantially advance development of new prevention and treatment strategies to combat substance use disorders. This review focuses on the relationship between impulsivity - a behavior that is common to the clinical picture of both substance use disorders (SUD) and childhood disruptive behavior disorders - and neurobiological risk for SUD. It further examines various behaviors within the over-arching domain of impulsivity, ultimately focusing on the more narrowly defined and measurable construct of inhibitory control, and concluding that underlying deficits in inhibitory control may be central to many of the behaviors associated with high risk for SUD. Targeted cross-sectional study of the neural basis of inhibitory dyscontrol in subjects at high risk for SUD, who have not yet begun to abuse drugs, has the potential to generate important hypotheses regarding the neurobiological underpinnings of SUD risk. Hypotheses developed using this approach can be more definitively evaluated in longitudinal studies with these same populations, extending through the period of maximal risk for SUD in adolescence and early adulthood.

  8. Social Relationships, Social Assimilation, and Substance-Use Disorders among Adult Latinos in the U.S

    PubMed Central

    Canino, Glorisa; Vega, William A.; Sribney, William M.; Warner, Lynn A.; Alegría, Margarita

    2009-01-01

    Based on social control perspectives and results from prior studies we test hypotheses about the extent to which characteristics of family and social networks are associated with substance use disorders (SUD), and whether these associations vary by sex. In this study SUD is alcohol or illicit drug abuse or dependence as defined by criteria of the Diagnostic and Statistical Manual of the American Psychiatric Association. With nationally representative data of adult Latinos from the National Latino and Asian American Survey (NLAAS), we found that respondents’ language use with family, rather than language proficiency, appears to be a more efficient proxy for social assimilation to represent differential levels of risk of SUD. SUD was positively associated with problematic family relations for men but not women, and SUD was positively associated with more frequent interactions with friends for women but not men. The results suggest that the salient features of social assimilation associated with SUD include the context of language use and transformations in family and social network relationships that differ in important ways between Latino men and women. PMID:20011228

  9. p53 down-regulates SARS coronavirus replication and is targeted by the SARS-unique domain and PLpro via E3 ubiquitin ligase RCHY1.

    PubMed

    Ma-Lauer, Yue; Carbajo-Lozoya, Javier; Hein, Marco Y; Müller, Marcel A; Deng, Wen; Lei, Jian; Meyer, Benjamin; Kusov, Yuri; von Brunn, Brigitte; Bairad, Dev Raj; Hünten, Sabine; Drosten, Christian; Hermeking, Heiko; Leonhardt, Heinrich; Mann, Matthias; Hilgenfeld, Rolf; von Brunn, Albrecht

    2016-08-30

    Highly pathogenic severe acute respiratory syndrome coronavirus (SARS-CoV) has developed strategies to inhibit host immune recognition. We identify cellular E3 ubiquitin ligase ring-finger and CHY zinc-finger domain-containing 1 (RCHY1) as an interacting partner of the viral SARS-unique domain (SUD) and papain-like protease (PL(pro)), and, as a consequence, the involvement of cellular p53 as antagonist of coronaviral replication. Residues 95-144 of RCHY1 and 389-652 of SUD (SUD-NM) subdomains are crucial for interaction. Association with SUD increases the stability of RCHY1 and augments RCHY1-mediated ubiquitination as well as degradation of p53. The calcium/calmodulin-dependent protein kinase II delta (CAMK2D), which normally influences RCHY1 stability by phosphorylation, also binds to SUD. In vivo phosphorylation shows that SUD does not regulate phosphorylation of RCHY1 via CAMK2D. Similarly to SUD, the PL(pro)s from SARS-CoV, MERS-CoV, and HCoV-NL63 physically interact with and stabilize RCHY1, and thus trigger degradation of endogenous p53. The SARS-CoV papain-like protease is encoded next to SUD within nonstructural protein 3. A SUD-PL(pro) fusion interacts with RCHY1 more intensively and causes stronger p53 degradation than SARS-CoV PL(pro) alone. We show that p53 inhibits replication of infectious SARS-CoV as well as of replicons and human coronavirus NL63. Hence, human coronaviruses antagonize the viral inhibitor p53 via stabilizing RCHY1 and promoting RCHY1-mediated p53 degradation. SUD functions as an enhancer to strengthen interaction between RCHY1 and nonstructural protein 3, leading to a further increase in in p53 degradation. The significance of these findings is that down-regulation of p53 as a major player in antiviral innate immunity provides a long-sought explanation for delayed activities of respective genes. PMID:27519799

  10. p53 down-regulates SARS coronavirus replication and is targeted by the SARS-unique domain and PLpro via E3 ubiquitin ligase RCHY1.

    PubMed

    Ma-Lauer, Yue; Carbajo-Lozoya, Javier; Hein, Marco Y; Müller, Marcel A; Deng, Wen; Lei, Jian; Meyer, Benjamin; Kusov, Yuri; von Brunn, Brigitte; Bairad, Dev Raj; Hünten, Sabine; Drosten, Christian; Hermeking, Heiko; Leonhardt, Heinrich; Mann, Matthias; Hilgenfeld, Rolf; von Brunn, Albrecht

    2016-08-30

    Highly pathogenic severe acute respiratory syndrome coronavirus (SARS-CoV) has developed strategies to inhibit host immune recognition. We identify cellular E3 ubiquitin ligase ring-finger and CHY zinc-finger domain-containing 1 (RCHY1) as an interacting partner of the viral SARS-unique domain (SUD) and papain-like protease (PL(pro)), and, as a consequence, the involvement of cellular p53 as antagonist of coronaviral replication. Residues 95-144 of RCHY1 and 389-652 of SUD (SUD-NM) subdomains are crucial for interaction. Association with SUD increases the stability of RCHY1 and augments RCHY1-mediated ubiquitination as well as degradation of p53. The calcium/calmodulin-dependent protein kinase II delta (CAMK2D), which normally influences RCHY1 stability by phosphorylation, also binds to SUD. In vivo phosphorylation shows that SUD does not regulate phosphorylation of RCHY1 via CAMK2D. Similarly to SUD, the PL(pro)s from SARS-CoV, MERS-CoV, and HCoV-NL63 physically interact with and stabilize RCHY1, and thus trigger degradation of endogenous p53. The SARS-CoV papain-like protease is encoded next to SUD within nonstructural protein 3. A SUD-PL(pro) fusion interacts with RCHY1 more intensively and causes stronger p53 degradation than SARS-CoV PL(pro) alone. We show that p53 inhibits replication of infectious SARS-CoV as well as of replicons and human coronavirus NL63. Hence, human coronaviruses antagonize the viral inhibitor p53 via stabilizing RCHY1 and promoting RCHY1-mediated p53 degradation. SUD functions as an enhancer to strengthen interaction between RCHY1 and nonstructural protein 3, leading to a further increase in in p53 degradation. The significance of these findings is that down-regulation of p53 as a major player in antiviral innate immunity provides a long-sought explanation for delayed activities of respective genes.

  11. Glutamatergic and HPA-axis pathway genes in bipolar disorder comorbid with alcohol- and substance use disorders.

    PubMed

    Dalvie, Shareefa; Fabbri, Chiara; Ramesar, Raj; Serretti, Alessandro; Stein, Dan J

    2016-02-01

    Glutamatergic neurotransmission has been shown to be dysregulated in bipolar disorder (BD), alcohol use disorder (AUD) and substance use disorder (SUD). Similarly, disruption in the hypothalamic-pituitary-adrenal (HPA)-axis has also been observed in these conditions. BD is often comorbid with AUD and SUD. The effects of the glutamatergic and HPA systems have not been extensively examined in individuals with BD-AUD and BD-SUD comorbidity. The aim of this investigation was to determine whether variants in the glutamatergic pathway and HPA-axis are associated with BD-AUD and BD-SUD comorbidity. The research cohort consisted of 498 individuals with BD type I from the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD). A subset of the cohort had comorbid current AUD and current SUD. A total of 1935 SNPs from both the glutamatergic and HPA pathways were selected from the STEP-BD genome-wide dataset. To identify population stratification, IBS clustering was performed using the program Plink 1.07. Single SNP association and gene-based association testing were conducted using logistic regression. A pathway analysis of glutamatergic and HPA genes was performed, after imputation using IMPUTE2. No single SNP was associated with BD-AUD or BD-SUD comorbidity after correction for multiple testing. However, from the gene-based analysis, the gene PRKCI was significantly associated with BD-AUD. The pathway analysis provided overall negative findings, although several genes including GRIN2B showed high percentage of associated SNPs for BD-AUD. Even though the glutamatergic and HPA pathways may not be involved in BD-AUD and BD-SUD comorbidity, PRKCI deserves further investigation in BD-AUD.

  12. Personality Disorders and the Persistence of Substance Use Disorders: A Reanalysis of Published NESARC Findings

    PubMed Central

    Vergés, Alvaro; Jackson, Kristina M.; Bucholz, Kathleen K.; Trull, Timothy J.; Lane, Sean P.; Sher, Kenneth J.

    2014-01-01

    The purpose of this study was to examine whether published findings regarding the association of personality disorders (PDs) with the persistence of substance use disorders (SUDs) are attributable to an artifact due to time of assessment of the PD. Two previous studies analyzed data from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) and found that Antisocial PD, Schizotypal PD, and Borderline PD are unique predictors of SUDs. However, a design limitation in NESARC (assessment of PDs at different waves) can potentially compromise these findings. To assess the influence of time of assessment of PDs and to identify associations that might be robust to time of assessment, we compared the association of PDs with two estimates of SUD persistence that were based on different populations at risk: 1) among those who were diagnosed with SUD at baseline, the proportion who continued to meet full criteria at follow-up (“prediction”), and 2) among those who were diagnosed with SUD at follow-up, the proportion who met full criteria at baseline (“postdiction”). Differences between prediction and postdiction revealed a robust pattern of higher odds ratios for postdiction among PDs assessed at baseline, and lower odds ratios for postdiction among PDs assessed at follow-up. All published significant associations between PDs and persistence of SUDs became non-significant in the postdiction analyses, with the exception of Obsessive-Compulsive PD predicting Nicotine Dependence persistence. The present results raise serious doubts about the validity of published findings on PDs and SUD persistence from the NESARC. Design limitations in NESARC preclude a direct comparison among PDs measured at different waves. PMID:25314264

  13. Psychiatric Consultation and Substance Use Disorders

    PubMed Central

    Specker, Sheila; Meller, William H.; Thurber, Steven

    2009-01-01

    Background A substantial number of patients in general hospitals will evince substance abuse problems but a majority is unlikely to be adequately identified in the referral-consultation process. This failure may preclude patients from receiving effective interventions for substance use disorders. Objectives 1. To evaluate all referred patients for possible substance use disorders. 2. To ascertain the degree of convergence between patients referred for chemical problems and the corresponding DSM diagnosis. 3. To compare demographic data for substance abusing patients and referrals not so classified. 4. To evaluate conditions concomitant with substance use disorders. Method Consecutive one-year referrals (524) to consultation-liaison psychiatric services were scrutinized for chemically-related problems by psychiatric consultants. Results Of the referrals, 176 met criteria for substance use disorders (SUD) (57% alcohol; 25% other drugs; 18% both alcohol and other drugs). Persons diagnosed with SUD tended to be younger, male, non-Caucasian, unmarried, and unemployed. They were more likely to be depressed, have liver and other gastrointestinal problems, and to have experienced traumatic events; they also tended to have current financial difficulties. Most were referred for SUD evaluation by personnel in general medicine and family practice. Following psychiatric consultation, SUD designated patients were referred mainly to substance abuse treatment programs. The only variable related to recommended inpatient versus outpatient services for individuals with SUD was the Global Assessment of Functioning Axis (GAF) with persons having lower estimated functioning more likely to be referred for inpatient interventions. Conclusions These data are similar to the results of past studies in this area. Unlike previous investigations in the domain of consultative-liaison psychiatry, financial stressors and specific consultant recommendations were included in data gathering. Although

  14. Impact of Adolescent Alcohol and Drug Use on Neuropsychological Functioning in Young Adulthood: 10-Year Outcomes

    PubMed Central

    Hanson, Karen L.; Medina, Krista Lisdahl; Padula, Claudia B.; Tapert, Susan F.; Brown, Sandra A.

    2011-01-01

    Background Alcohol and other substance use disorders (AUD/SUD) are common among youth and often continue into adulthood; therefore, the neurocognitive effects of substance use are of great concern. Because neuromaturation continues into young adulthood, youth with AUD/SUD may be at risk for lasting cognitive decrements. This study prospectively examines neuropsychological functioning over 10 years as a function of AUD/SUD history and outcomes. Methods The 51 participants consisted of 18 youth with persisting AUD/SUD, 19 youth with remitted AUD/SUD, and 14 community youth with no AUD/SUD history followed over 10 years (ages 16 to 27 on average) with neuropsychological testing and substance use interviews on 8 occasions. Neuropsychological performance from baseline to 10-year follow-up was compared between the three groups. Results Despite scoring higher than controls at intake, both AUD/SUD groups showed a relative decline in visuospatial construction at 10-year follow-up (p=.001). Regressions showed that alcohol use (β=−.33, p < .01) and drug withdrawal symptoms (β=−.31, p<.05) over follow-up were predictive of year 10 visuospatial function. Alcohol use also predicted verbal learning and memory (β=−.28, p<.05), while stimulant use predicted visual learning and memory function (β=−.33, p=.01). More recent substance use was associated with poorer executive function (β=.28, p<.05). Discussion These findings confirm prior studies suggesting that heavy, chronic alcohol and other substance use persisting from adolescence to young adulthood may produce cognitive disadvantages, primarily in visuospatial and memory abilities. Youth who chronically consume heavy quantities of alcohol and/or experience drug withdrawal symptoms may be particularly at risk for cognitive deterioration by young adulthood. PMID:21532924

  15. Adolescent Substance Use in the Multimodal Treatment Study of Attention-Deficit/Hyperactivity Disorder (ADHD) (MTA) as a Function of Childhood ADHD, Random Assignment to Childhood Treatments, and Subsequent Medication

    PubMed Central

    Molina, Brooke S.G.; Hinshaw, Stephen P.; Arnold, L. Eugene; Swanson, James M.; Pelham, William E.; Hechtman, Lily; Hoza, Betsy; Epstein, Jeffery N.; Wigal, Timothy; Abikoff, Howard B.; Greenhill, Laurence L.; Jensen, Peter S.; Wells, Karen C.; Vitiello, Benedetto; Gibbons, Robert D.; Howard, Andrea; Houck, Patricia R.; Hur, Kwan; Lu, Bo; Marcus, Sue

    2013-01-01

    Objectives To determine long-term effects on substance use and substance use disorder (SUD), up to 8 years after childhood enrollment, of the randomly assigned 14-month treatments in the multisite Multimodal Treatment Study of Children with Attention-Deficit/Hyperactivity Disorder (MTA; n=436); to test whether (a) medication at follow-up, (b) cumulative psychostimulant treatment over time, or (c) both relate to substance use/SUD; to compare substance use/SUD in the ADHD sample to the non-ADHD childhood classmate comparison group (n=261). Method Mixed-effects regression models with planned contrasts were used for all tests except the important cumulative stimulant treatment question, for which propensity score matching analysis was used. Results The originally randomized treatment groups did not differ significantly on substance use/SUD by the 8 year follow-up or earlier (M age = 17 years). Neither medication at follow-up (mostly stimulants) nor cumulative stimulant treatment was associated with adolescent substance use/SUD. Substance use at all time points, including use of two or more substances and SUD, were each greater in the ADHD than non-ADHD samples, regardless of sex. Conclusions Medication for ADHD did not protect from, nor contribute to, visible risk of substance use or SUD by adolescence, whether analyzed as randomized treatment assignment in childhood, as medication at follow-up, or as cumulative stimulant treatment over an 8 year follow-up from childhood. These results suggest the need to identify alternative or adjunctive adolescent-focused approaches to substance abuse prevention and treatment for boys and girls with ADHD, especially given their increased risk for use and abuse of multiple substances that is not improved with stimulant medication. Clinical trial registration information—Multimodal Treatment Study of Children with Attention Deficit and Hyperactivity Disorder (MTA); http://clinical trials.gov/; NCT00000388. PMID:23452682

  16. Nuclear Magnetic Resonance Structure Shows that the Severe Acute Respiratory Syndrome Coronavirus-Unique Domain Contains a Macrodomain Fold▿

    PubMed Central

    Chatterjee, Amarnath; Johnson, Margaret A.; Serrano, Pedro; Pedrini, Bill; Joseph, Jeremiah S.; Neuman, Benjamin W.; Saikatendu, Kumar; Buchmeier, Michael J.; Kuhn, Peter; Wüthrich, Kurt

    2009-01-01

    The nuclear magnetic resonance (NMR) structure of a central segment of the previously annotated severe acute respiratory syndrome (SARS)-unique domain (SUD-M, for “middle of the SARS-unique domain”) in SARS coronavirus (SARS-CoV) nonstructural protein 3 (nsp3) has been determined. SUD-M(513-651) exhibits a macrodomain fold containing the nsp3 residues 528 to 648, and there is a flexibly extended N-terminal tail with the residues 513 to 527 and a C-terminal flexible tail of residues 649 to 651. As a follow-up to this initial result, we also solved the structure of a construct representing only the globular domain of residues 527 to 651 [SUD-M(527-651)]. NMR chemical shift perturbation experiments showed that SUD-M(527-651) binds single-stranded poly(A) and identified the contact area with this RNA on the protein surface, and electrophoretic mobility shift assays then confirmed that SUD-M has higher affinity for purine bases than for pyrimidine bases. In a further search for clues to the function, we found that SUD-M(527-651) has the closest three-dimensional structure homology with another domain of nsp3, the ADP-ribose-1"-phosphatase nsp3b, although the two proteins share only 5% sequence identity in the homologous sequence regions. SUD-M(527-651) also shows three-dimensional structure homology with several helicases and nucleoside triphosphate-binding proteins, but it does not contain the motifs of catalytic residues found in these structural homologues. The combined results from NMR screening of potential substrates and the structure-based homology studies now form a basis for more focused investigations on the role of the SARS-unique domain in viral infection. PMID:19052085

  17. Addiction history associates with the propensity to form habits

    PubMed Central

    McKim, Theresa H.; Bauer, Daniel J.; Boettiger, Charlotte A.

    2016-01-01

    Learned habitual responses to environmental stimuli allow efficient interaction with the environment, freeing cognitive resources for more demanding tasks. However, when the outcome of such actions is no longer a desired goal, established stimulus-response (S-R) associations, or habits, must be overcome. Among people with substance use disorders (SUDs), difficulty in overcoming habitual responses to stimuli associated with their addiction in favor of new, goal-directed behaviors, contributes to relapse. Animal models of habit learning demonstrate that chronic self-administration of drugs of abuse promotes habitual responding beyond the domain of compulsive drug seeking. However, whether a similar propensity toward domain-general habitual responding occurs in humans with SUDs has remained unclear. To address this question, we used a visuomotor S-R learning and re-learning task, the Hidden Association Between Images Task (HABIT), which employs abstract visual stimuli and manual responses. This task allows us to measure new S-R association learning, well-learned S-R association execution, and includes a response contingency change manipulation to quantify the degree to which responding is habit-based, rather than goal-directed. We find that people with SUDs learn new S-R associations as well as healthy control subjects do. Moreover, people with an SUD history slightly outperform controls in S-R execution. In contrast, people with SUDs are specifically impaired in overcoming well-learned S-R associations; those with SUDs make a significantly greater proportion of perseverative errors during well-learned S-R replacement, indicating the more habitual nature of their responses. Thus, with equivalent training and practice, people with SUDs appear to show enhanced domain-general habit formation. PMID:26967944

  18. Impaired Aerobic Endurance and Muscular Strength in Substance Use Disorder Patients

    PubMed Central

    Flemmen, Grete; Wang, Eivind

    2015-01-01

    Abstract Although substance use disorder (SUD) patients are documented to have an inactive lifestyle, which is associated with cardiovascular disease, other lifestyle-related diseases and premature death, evidence regarding their aerobic endurance and muscular strength is limited. Therefore, the authors aimed to evaluate directly assessed maximal oxygen consumption, walking efficiency, as well as maximal strength in a group of SUD patients. A total of 44 SUD patients in residential treatment, 31 men (31 ± 8 years) and 13 women (34 ± 10 years), were included and completed the physical testing. The patients were compared with an age- and sex-matched reference group. Male and female SUD patients exhibited a maximal oxygen consumption of 44.6 ± 6.2 and 33.8 ± 6.6 mL· min−1 kg−1, respectively. This was significantly lower than the reference group, 15% (P = 0.03) for men and 25% (P = 0.001) for women. In addition, the SUD patients had a 13% significantly reduced walking efficiency (P = 0.02), compared with healthy controls. The impairments in aerobic endurance were accompanied by significant reductions in maximal strength of 30% (P = 0.001) and 33% (P = 0.01) for men and women, respectively. In combination, these results imply that SUD patients have impaired endurance and muscular strength compared with what is typically observed in the population, and consequently suffer a higher risk of developing cardiovascular and other lifestyle-related diseases and early death. Effective physical exercise should be advocated as an essential part of the clinical practice of SUD treatment to improve the patient's health and consequently reduce the costs because of the high use of emergency departments, hospital, and medical care. PMID:26554792

  19. Race/Ethnicity and Geographic Access to Medicaid Substance Use Disorder Treatment Facilities in the United States

    PubMed Central

    Cummings, Janet R.; Wen, Hefei; Ko, Michelle; Druss, Benjamin G.

    2014-01-01

    Background Although substance use disorders (SUD) are prevalent and associated with adverse consequences, treatment rates remain extremely low. Unlike physical and mental health problems, treatment for SUD is predominantly provided in a separate specialty sector and more heavily financed by public sources. The Medicaid expansion under the Affordable Care Act (ACA) has the potential to increase access to treatment for SUD, but only if an infrastructure exists to serve new enrollees. Objective This study examines the availability of outpatient SUD treatment facilities that accept Medicaid across U.S. counties, and whether counties with a higher percentage of racial/ethnic minorities are more likely to have gaps in this infrastructure. Design We used data from the 2009 National Survey of Substance Abuse Treatment Services and the 2011-2012 Area Resource file to examine sociodemographic factors associated with county-level access to SUD treatment facilities that serve Medicaid enrollees. We estimated a probit model with state indicators to adjust for state-level heterogeneity in demographics, politics, and policies. Independent variables assessed county racial/ethnic composition (i.e., percentage Black and percentage Hispanic), percentage living in poverty, percentage living in a rural area, percentage insured with Medicaid, percentage uninsured, and total population. Participants U.S. Counties in all 50 states. Main Outcome Measure Dichotomous indicator for counties with at least one outpatient SUD treatment facility that accepts Medicaid. Results About sixty percent of U.S. counties have at least one outpatient SUD facility that accepts Medicaid, although this rate is lower in many Southern and Midwestern states. Counties with a higher percentage of Black (Marginal Effect [M.E.]=−3.1; 95% CI= −5.2,−0.9%), rural (M.E.=−9.2%; 95% CI=−11.1%,−7.4%), and/or uninsured (M.E.= −9.5%, 95% CI=−13.0%,−5.9%) residents are less likely to have one of these

  20. p53 down-regulates SARS coronavirus replication and is targeted by the SARS-unique domain and PLpro via E3 ubiquitin ligase RCHY1

    PubMed Central

    Ma-Lauer, Yue; Carbajo-Lozoya, Javier; Müller, Marcel A.; Deng, Wen; Lei, Jian; Meyer, Benjamin; Kusov, Yuri; von Brunn, Brigitte; Bairad, Dev Raj; Hünten, Sabine; Drosten, Christian; Hermeking, Heiko; Leonhardt, Heinrich; Mann, Matthias; Hilgenfeld, Rolf; von Brunn, Albrecht

    2016-01-01

    Highly pathogenic severe acute respiratory syndrome coronavirus (SARS-CoV) has developed strategies to inhibit host immune recognition. We identify cellular E3 ubiquitin ligase ring-finger and CHY zinc-finger domain-containing 1 (RCHY1) as an interacting partner of the viral SARS-unique domain (SUD) and papain-like protease (PLpro), and, as a consequence, the involvement of cellular p53 as antagonist of coronaviral replication. Residues 95–144 of RCHY1 and 389–652 of SUD (SUD-NM) subdomains are crucial for interaction. Association with SUD increases the stability of RCHY1 and augments RCHY1-mediated ubiquitination as well as degradation of p53. The calcium/calmodulin-dependent protein kinase II delta (CAMK2D), which normally influences RCHY1 stability by phosphorylation, also binds to SUD. In vivo phosphorylation shows that SUD does not regulate phosphorylation of RCHY1 via CAMK2D. Similarly to SUD, the PLpros from SARS-CoV, MERS-CoV, and HCoV-NL63 physically interact with and stabilize RCHY1, and thus trigger degradation of endogenous p53. The SARS-CoV papain-like protease is encoded next to SUD within nonstructural protein 3. A SUD–PLpro fusion interacts with RCHY1 more intensively and causes stronger p53 degradation than SARS-CoV PLpro alone. We show that p53 inhibits replication of infectious SARS-CoV as well as of replicons and human coronavirus NL63. Hence, human coronaviruses antagonize the viral inhibitor p53 via stabilizing RCHY1 and promoting RCHY1-mediated p53 degradation. SUD functions as an enhancer to strengthen interaction between RCHY1 and nonstructural protein 3, leading to a further increase in in p53 degradation. The significance of these findings is that down-regulation of p53 as a major player in antiviral innate immunity provides a long-sought explanation for delayed activities of respective genes. PMID:27519799

  1. Alcohol and Opioid Use Disorder in Older Adults: Neglected and Treatable Illnesses.

    PubMed

    Le Roux, Christoffel; Tang, Yilang; Drexler, Karen

    2016-09-01

    The purpose of this article is to provide an overview of alcohol use disorder (AUD) and opioid use disorder (OUD) in older adults for general psychiatrists. The rapid growth of the geriatric population in the USA has wide-ranging implications as the baby boomer generation ages. Various types of substance use disorders (SUDs) are common in older adults, and they often take a greater toll on affected older adults than on younger adults. Due to multiple reasons, SUDs in older adults are often under-reported, under-detected, and under-treated. Older adults often use substances, which leads to various clinical problems. Space limitations prevents a comprehensive review; therefore, we primarily focus on alcohol use disorder and the problem of opioid use disorder, with more emphasis given to the latter, because the opioid use epidemic in the USA has gained much attention. We reviewed the literature on the topics, integrated across geriatric psychiatry, addiction psychiatry, research, and national trends. We discuss unique vulnerabilities of older adults to SUDs with regard to management of SUDs in older adults, medication-assisted treatment (MAT), and psychosocial treatments. We encourage general psychiatrists to raise their awareness of SUDs in older adults and to provide brief intervention or referral for further assessment. PMID:27488204

  2. Facial emotion recognition in alcohol and substance use disorders: A meta-analysis.

    PubMed

    Castellano, Filippo; Bartoli, Francesco; Crocamo, Cristina; Gamba, Giulia; Tremolada, Martina; Santambrogio, Jacopo; Clerici, Massimo; Carrà, Giuseppe

    2015-12-01

    People with alcohol and substance use disorders (AUDs/SUDs) show worse facial emotion recognition (FER) than controls, though magnitude and potential moderators remain unknown. The aim of this meta-analysis was to estimate the association between AUDs, SUDs and FER impairment. Electronic databases were searched through April 2015. Pooled analyses were based on standardized mean differences between index and control groups with 95% confidence intervals, weighting each study with random effects inverse variance models. Risk of publication bias and role of potential moderators, including task type, were explored. Nineteen of 70 studies assessed for eligibility met the inclusion criteria, comprising 1352 individuals, of whom 714 (53%) had AUDs or SUDs. The association between substance related disorders and FER performance showed an effect size of -0.67 (-0.95, -0.39), and -0.65 (-0.93, -0.37) for AUDs and SUDs, respectively. There was no publication bias and subgroup and sensitivity analyses based on potential moderators confirmed core results. Future longitudinal research should confirm these findings, clarifying the role of specific clinical issues of AUDs and SUDs.

  3. Impact of Substance Use Disorder on Presentation and Short-Term Course of Schizophrenia

    PubMed Central

    Chakraborty, Rudraprosad; Chatterjee, Arunima; Chaudhury, Suprakash

    2014-01-01

    The aim of the present study was to compare a cohort of schizophrenia patients with substance use disorder (SUD) with a similar cohort of schizophrenia patients without SUD with regard to sociodemographic variables, clinical variables, psychopathology, anxiety symptoms, depressive symptoms, treatment outcome, and side effect profile of drugs. A total of 143 consecutive inpatients with ICD-10 DCR diagnosis of schizophrenia were included after obtaining informed consent. Patients were evaluated by a semistructured data sheet and Maudsley Addiction Profile. They were then rated by Positive and Negative Symptoms Scale, Calgary Depression Scale, Hamilton Anxiety Rating Scale, and Brief Psychiatric Rating Scale at presentation, three weeks, and six weeks. At three weeks and six weeks, they were also evaluated by UKU Side Effect Rating Scale. Substance abuse was detected in 63.6% schizophrenia patients. Nicotine was the commonest substance followed by cannabis and alcohol. Substance users had longer untreated illness and more depressive symptoms at presentation and six-week follow-up. Dual diagnosis patients had difficulty in abstraction at three and six weeks but not at presentation. Schizophrenia patients with SUD had more depressive symptoms. SUD appeared to mask abstraction difficulties at presentation. Schizophrenia patients with SUD should be carefully assessed for presence of depression. PMID:24839596

  4. The impact of mental and substance-use disorders on employment transitions.

    PubMed

    Baldwin, Marjorie L; Marcus, Steven C

    2014-03-01

    The cyclic nature of serious mental illness (SMI) and substance-use disorders (SUD) suggests that persons with these conditions may experience high rates of transitions among employment states (full-time, part-time, and no employment). This study uses longitudinal data from two waves of the National Epidemiologic Survey of Alcoholism and Related Conditions to examine employment transitions for persons with SMI/SUD relative to a no-disorder control group. Conditional on employment status in Wave I, we estimate conditional odds ratios and marginal effects of each diagnosis on the probabilities of part-time or full-time employment in Wave II, holding constant other characteristics that influence employment decisions. The results show transitions across employment states are common for all groups but more frequent for persons with SMI/SUD than the controls. Persons with SMI are less likely, and persons with SUDs more likely, to transition out of no employment than the controls. Part-time employment is a relatively transitory state, particularly for persons with SMI/SUD, but full-time employment brings a measure of job stability to all groups. After controlling for differences in observable characteristics, the marginal effects of SMI and alcohol disorders on employment transitions are largely significant, but the effects of drug disorders are not.

  5. The impact of intolerance of emotional distress and uncertainty on veterans with co-occurring PTSD and substance use disorders.

    PubMed

    Banducci, Anne N; Bujarski, Sarah J; Bonn-Miller, Marcel O; Patel, Amee; Connolly, Kevin M

    2016-06-01

    The risk of developing a substance use disorder (SUD) is significantly higher among veterans with posttraumatic stress disorder (PTSD). Veterans with this co-occurrence have poorer outcomes than singly diagnosed veterans, which may be related to two risk factors: intolerance uncertainty (IU) and low tolerance of emotional distress (TED). We hypothesized low TED and high IU would independently and interactively relate to heightened PTSD symptomatology and trauma-cue elicited SUD cravings. A sample of 70 veterans (M age=50; 95% men; 65% Black) with co-occurring PTSD-SUD was recruited. The Posttraumatic Stress Disorder Checklist (PCL), Craving Questionnaire, Distress Tolerance Scale, and Intolerance of Uncertainty Scale were administered. In general, low TED and high IU were significantly correlated with the PCL total and subscale scores. When examined within regression models, low TED was associated with elevated PCL scores and trauma-cue elicited SUD cravings; IU was not. However, there was a significant interaction between IU and TED; veterans with elevated IU and low TED had higher PCL Total, Hyperarousal, and Intrusions scores. This highlights the importance of assessing TED and IU among veterans with co-occurring PTSD-SUD, as these risk factors may not only be prognostic indicators of outcomes, but also treatment targets. PMID:27004450

  6. Alcohol and Opioid Use Disorder in Older Adults: Neglected and Treatable Illnesses.

    PubMed

    Le Roux, Christoffel; Tang, Yilang; Drexler, Karen

    2016-09-01

    The purpose of this article is to provide an overview of alcohol use disorder (AUD) and opioid use disorder (OUD) in older adults for general psychiatrists. The rapid growth of the geriatric population in the USA has wide-ranging implications as the baby boomer generation ages. Various types of substance use disorders (SUDs) are common in older adults, and they often take a greater toll on affected older adults than on younger adults. Due to multiple reasons, SUDs in older adults are often under-reported, under-detected, and under-treated. Older adults often use substances, which leads to various clinical problems. Space limitations prevents a comprehensive review; therefore, we primarily focus on alcohol use disorder and the problem of opioid use disorder, with more emphasis given to the latter, because the opioid use epidemic in the USA has gained much attention. We reviewed the literature on the topics, integrated across geriatric psychiatry, addiction psychiatry, research, and national trends. We discuss unique vulnerabilities of older adults to SUDs with regard to management of SUDs in older adults, medication-assisted treatment (MAT), and psychosocial treatments. We encourage general psychiatrists to raise their awareness of SUDs in older adults and to provide brief intervention or referral for further assessment.

  7. Psychopathology in Substance Use Disorder Patients with and without Substance-Induced Psychosis

    PubMed Central

    Zhornitsky, Simon; Tikàsz, Andràs; Rizkallah, Élie; Chiasson, Jean-Pierre; Potvin, Stéphane

    2015-01-01

    Background. Substance-induced psychotic disorder (SIPD) is a diagnosis constructed to distinguish substance-induced psychotic states from primary psychotic disorders. A number of studies have compared SIPD persons with primary psychotic patients, but there is little data on what differentiates substance use disorder (SUD) individuals with and without SIPD. Here, we compared psychopathology, sociodemographic variables, and substance use characteristics between SUD patients with and without SIPD. Methods. A retrospective chart review was conducted on newly admitted patients at a rehabilitation centre between 2007 and 2012. Results. Of the 379 patients included in the study, 5% were diagnosed with SIPD (n = 19) and 95% were diagnosed with SUDs without SIPD (n = 360). More SIPD patients reported using cannabis and psychostimulants, and fewer SIPD patients reported using alcohol than SUDs patients without SIPD. SIPD patients scored higher on the “schizophrenia nuclear symptoms” dimension of the SCL-90R psychoticism scale and exhibited more ClusterB personality traits than SUD patients without SIPD. Discussion. These data are consistent with previous studies suggesting that psychopathology, substance type, and sociodemographic variables play important role in the development of SIPD. More importantly, the results highlight the need for paying greater attention to the types of self-reported psychotic symptoms during the assessment of psychotomimetic effects associated with psychoactive substances. PMID:26417473

  8. The Affordable Care Act, Substance Use Disorders, and Low-Income Clients: Implications for Social Work.

    PubMed

    McCabe, Heather A; Wahler, Elizabeth A

    2016-07-01

    Social workers are leaders in the substance abuse services field and may often work in substance use disorder (SUD) education, prevention, assessment, treatment, or resource coordination and case management roles. As the Patient Protection and Affordable Care Act (ACA) (2010) drives changes in the fields of health and behavioral health, social workers have an opportunity to lead structural changes at the micro and macro levels that will have a positive impact on low-income clients with SUDs. In this article, authors examine the current state of SUDs and health care access, the impact of the ACA on the field, and implications for social work practice and education. Social workers should seek specialized education and credentialing in SUD services, know how to help clients apply for health care coverage, and advocate for integrated substance abuse treatment and health care programs and an expansion of Medicaid in their local communities. Social workers are well positioned to be a voice for clients to ensure that the current structural changes result in a better, integrated system of care that is able to respond to the needs of low-income clients with SUDs. PMID:27501640

  9. Exploring Attachment Patterns in Patients With Comorbid Borderline Personality and Substance Use Disorders.

    PubMed

    Schindler, Andreas; Sack, Peter-Michael

    2015-11-01

    Studies exploring attachment patterns in samples of patients with borderline personality disorder (BPD) report a combination of preoccupied and fearful-avoidant patterns. This has been interpreted as reflecting the approach-avoidance dilemma of BPD. Comorbid substance use disorders (SUD) have not been considered in these studies, despite the high proportions of SUD among BPD patients and despite the more avoidant attachment in SUD samples. This cross-sectional, naturalistic study explores attachment patterns in a sample of comorbid (BPD and SUD) patients, comparing them to two samples of patients with either SUD or BPD only. Within-group comparisons replicated findings of both preoccupied and fearful-avoidant attachment in BPD and comorbid groups. But between-group comparisons showed that comorbid patients were significantly less preoccupied (p = 0.018) and more dismissing-avoidant (p = 0.030). Although both groups were similar in several psychiatric measures, attachment patterns of the comorbid group were more similar to substance abusers than to borderline patients. PMID:26488917

  10. The Affordable Care Act, Substance Use Disorders, and Low-Income Clients: Implications for Social Work.

    PubMed

    McCabe, Heather A; Wahler, Elizabeth A

    2016-07-01

    Social workers are leaders in the substance abuse services field and may often work in substance use disorder (SUD) education, prevention, assessment, treatment, or resource coordination and case management roles. As the Patient Protection and Affordable Care Act (ACA) (2010) drives changes in the fields of health and behavioral health, social workers have an opportunity to lead structural changes at the micro and macro levels that will have a positive impact on low-income clients with SUDs. In this article, authors examine the current state of SUDs and health care access, the impact of the ACA on the field, and implications for social work practice and education. Social workers should seek specialized education and credentialing in SUD services, know how to help clients apply for health care coverage, and advocate for integrated substance abuse treatment and health care programs and an expansion of Medicaid in their local communities. Social workers are well positioned to be a voice for clients to ensure that the current structural changes result in a better, integrated system of care that is able to respond to the needs of low-income clients with SUDs.

  11. Psychological treatments for concurrent posttraumatic stress disorder and substance use disorder: a systematic review.

    PubMed

    van Dam, Debora; Vedel, Ellen; Ehring, Thomas; Emmelkamp, Paul M G

    2012-04-01

    This article gives an overview of research into psychological treatments for concurrent posttraumatic stress disorder (PTSD) and substance used disorder (SUD), with a special focus on the effectiveness of treatments addressing both disorders compared to treatments addressing one of the disorders alone. In addition, a distinction is made between trauma-focused versus non-trauma-focused therapies for concurrent PTSD and SUD. The databases Embase, Psychinfo, Medline and Web of science were searched for relevant articles. In total, seventeen studies were identified evaluating ten treatments protocols (six trauma-focused and four non-trauma-focused treatment approaches). In general, the studies showed pre-post reductions for PTSD and/or SUD symptoms. Although most treatments for concurrent PTSD and SUD did not prove to be superior to regular SUD treatments, there are some promising preliminary results suggesting that some patients might benefit from trauma-focused interventions. However, the lack of methodologically sound treatment trials makes it difficult to draw firm conclusions. Methodological limitations are discussed, along with recommendations for future research.

  12. Similarities and Differences between Pathological Gambling and Substance Use Disorders: A Focus on Impulsivity and Compulsivity

    PubMed Central

    Leeman, Robert F.; Potenza, Marc N.

    2011-01-01

    Rationale Pathological gambling (PG) has recently been considered as a “behavioral” or non-substance addiction. A comparison of characteristics of PG and substance use disorders (SUDs) has clinical ramifications and could help advance future research on these conditions. Specific relationships with impulsivity and compulsivity may be central to understanding PG and SUDs. Objectives To compare and contrast research findings in PG and SUDs pertaining to neurocogntive tasks, brain function and neurochemistry, with a focus on impulsivity and compulsivity. Results Multiple similarities were found between PG and SUDs, including poor performance on neurocognitive tasks, specifically with respect to impulsive choice and response tendencies and compulsive features (e.g., response perseveration and action with diminished relationship to goals or reward). Findings suggest dysfunction involving similar brain regions, including the ventromedial prefrontal cortex (PFC) and striatum and similar neurotransmitter systems, including dopaminergic and serotonergic. Unique features exist which may in part reflect influences of acute or chronic exposures to specific substances. Conclusions Both similarities and differences exist between PG and SUDs. Understanding these similarities more precisely may facilitate treatment development across addictions, whereas understanding differences may provide insight into treatment development for specific disorders. Individual differences in features of impulsivity and compulsivity may represent important endophenotypic targets for prevention and treatment strategies. PMID:22057662

  13. Genetic and Environmental Risk Factors for Illicit Substance Use and Use Disorders: Joint Analysis of Self and Co-twin Ratings

    PubMed Central

    Reichborn-Kjennerud, Ted; Neale, Michael C.; Kendler, Kenneth S.

    2014-01-01

    The specificity of genetic and environmental risk factors for illicit substance use and substance use disorders (SUD) was investigated by utilizing self and co-twin reports in 1,791 male twins. There was a high rate of comorbidity between both use of, and SUD from, different classes of illicit substances. For substance use, the model that included one common genetic, one shared environmental, and one individual-specific (i.e., unique) environmental factor, along with substance-specific effects that were attributed entirely to genetic factors fit the data best. For illicit SUD, one common genetic and one common unique environmental risk factor, and substance specific shared environmental and unique environmental risk factors were identified. Risk factors for illicit substance use and SUD are mainly non-specific to substance class. Co-twin rating of illicit substance use and SUD was a reliable source of information, and by taking account of random and systematic measurement error, environmental exposures unique to the individual were of lesser importance than found in earlier studies. PMID:24196977

  14. Psychopathology in Substance Use Disorder Patients with and without Substance-Induced Psychosis.

    PubMed

    Zhornitsky, Simon; Tikàsz, Andràs; Rizkallah, Élie; Chiasson, Jean-Pierre; Potvin, Stéphane

    2015-01-01

    Background. Substance-induced psychotic disorder (SIPD) is a diagnosis constructed to distinguish substance-induced psychotic states from primary psychotic disorders. A number of studies have compared SIPD persons with primary psychotic patients, but there is little data on what differentiates substance use disorder (SUD) individuals with and without SIPD. Here, we compared psychopathology, sociodemographic variables, and substance use characteristics between SUD patients with and without SIPD. Methods. A retrospective chart review was conducted on newly admitted patients at a rehabilitation centre between 2007 and 2012. Results. Of the 379 patients included in the study, 5% were diagnosed with SIPD (n = 19) and 95% were diagnosed with SUDs without SIPD (n = 360). More SIPD patients reported using cannabis and psychostimulants, and fewer SIPD patients reported using alcohol than SUDs patients without SIPD. SIPD patients scored higher on the "schizophrenia nuclear symptoms" dimension of the SCL-90R psychoticism scale and exhibited more ClusterB personality traits than SUD patients without SIPD. Discussion. These data are consistent with previous studies suggesting that psychopathology, substance type, and sociodemographic variables play important role in the development of SIPD. More importantly, the results highlight the need for paying greater attention to the types of self-reported psychotic symptoms during the assessment of psychotomimetic effects associated with psychoactive substances. PMID:26417473

  15. Health Care Experiences when Pain Substance Use Disorder Coexist: “Just Because I’m an Addict Doesn’t Mean I Don’t Have Pain

    PubMed Central

    St Marie, Barbara

    2015-01-01

    Objective To report the healthcare experiences of 34 individuals with coexisting substance use disorder (SUD) and chronic pain. Design Narrative inquiry qualitative study of 90-minute interviews. Setting: Midwest metropolitan methadone clinic. Subjects All individuals had SUD, were treated for SUD with methadone. They all self- identified as having pain greater than 6 months. Methods This qualitative design allowed exploration of how participants made sense of events related to living with SUD and chronic pain. Narrative inquiry gives a consistent story from the participants’ perspective and researchers can perform additional analysis using the storyline. Thematic analysis occurred of their healthcare experiences. Results Results revealed that participants (a) spoke about how they used deception to obtain opioids when their addiction was out of control, (b) were disturbed by health care providers having little understanding or ability to help them with their painful condition, (c) felt they wanted to abuse opiates again when receiving poor treatment by the health care team, (d) related what went well in their health care to help them maintain their sobriety, and (e) recommended improvements on health care interventions that included effective treatment of pain. Conclusions Coexisting chronic pain and SUD create unique health care needs by mutually activating and potentiating the other. There are very few comparable studies exploring the experiences of individuals when pain and substance use disorder coexist. The health care team can better develop treatment plans and test interventions sensitive to their unique needs when they understand the experiences of this population. PMID:25041442

  16. Family composition and symptom severity among Veterans with comorbid PTSD and substance use disorders.

    PubMed

    Jobe-Shields, Lisa; Flanagan, Julianne C; Killeen, Therese; Back, Sudie E

    2015-11-01

    Posttraumatic stress disorder (PTSD) and substance use disorders (SUD) frequently co-occur and affect a substantial proportion of military Veterans. Although the impact of parental PTSD and SUD on child development is well-documented, little is known about the influence of family composition on PTSD/SUD symptom severity. The present study investigated children in the home as an independent risk factor for symptom severity in a sample of treatment-seeking Veterans (N = 94; 92% male) with comorbid PTSD/SUD. Twenty-seven percent of the sample had minor children (age 18 or younger) living in the home. Veterans with children in the home evidenced significantly higher PTSD symptomatology as measured by the Clinical Administered PTSD Scale (CAPS; M = 82.65 vs. M = 72.17; t = -2.18; p < .05), and reported using marijuana more frequently than Veterans without children in the home (34% vs. 13% of past 60 days; t = -2.35, p < .05). In a multivariate model, having children in the home accounted for unique variance (ΔR(2) = .07) in PTSD severity after accounting for a range of covariates; however, having children in the home did not account for unique variance in substance use. Directions for future research as well as potential clinical implications for parents seeking treatment for PTSD/SUD are discussed.

  17. Substance use disorders and Cluster B personality disorders: physiological, cognitive, and environmental correlates in a college sample.

    PubMed

    Taylor, Jeanette

    2005-01-01

    Substance use disorders (SUDs) and Cluster B personality disorders (PDs) are both marked by impulsivity and poor behavioral control and may result in part from shared neurobiological or executive cognitive functioning deficits. To examine the potential utility of such models in explaining variance in SUDs and PDs at the lower end of symptom expression and impairment, 123 (73 female) volunteer college students were administered 2 measures of executive cognitive functioning; a task assessing autonomic reactivity to aversive noise blasts; a life events and a peer substance use measure; and structured clinical interviews to assess symptoms of substance abuse/dependence and antisocial, borderline, histrionic, and narcissistic PDs. As expected, symptoms of SUDs and PDs were significantly positively correlated. Antisocial PD, alcohol and cannabis use disorder symptoms were significantly positively related to proportion of friends who use alcohol and drugs regularly and drug use among romantic partners. Number of negative life events was positively related to PD symptoms and to alcohol use disorder symptoms. Executive cognitive functioning was not related to SUD and PD symptoms in the expected direction. Findings suggest that, among higher functioning young adults, environmental factors may be particularly relevant to our understanding of SUDs and certain PDs.

  18. The Relationship Between Eating Disorder Symptoms and Treatment Rejection among Young Adult Men in Residential Substance Use Treatment.

    PubMed

    Elmquist, JoAnna; Shorey, Ryan C; Anderson, Scott E; Temple, Jeff R; Stuart, Gregory L

    2016-01-01

    Research has demonstrated that individuals with substance use disorders (SUDs) and comorbid mental health problems evidence heightened negative consequences, including poorer treatment outcomes, a higher risk for relapse, and mortality compared to individuals with a single disorder. In this study, we focus on the comorbidity between SUDs and eating disorder (ED) symptomatology, as EDs are similarly associated with high rates of relapse, morbidity, and mortality. Of particular importance is research examining treatment rejection among individuals in treatment for SUDs with cooccurring ED symptomatology. This study seeks to add to the literature by examining treatment rejection among young adult men in residential treatment for SUDs (N = 68) with cooccurring ED symptomatology. Results from hierarchical regression analyses indicated that ED symptoms were significantly associated with treatment rejection after controlling for alcohol and drug use and problems and depression symptoms. Although this is a preliminary study, the results add to a growing body of research examining the comorbidity between SUDs and ED symptomatology. Future research examining this relationship is needed to further elucidate the treatment patterns among individuals with comorbid ED symptoms and substance use diagnoses. PMID:27257382

  19. The Relationship Between Eating Disorder Symptoms and Treatment Rejection among Young Adult Men in Residential Substance Use Treatment

    PubMed Central

    Elmquist, JoAnna; Shorey, Ryan C.; Anderson, Scott E.; Temple, Jeff R.; Stuart, Gregory L.

    2016-01-01

    Research has demonstrated that individuals with substance use disorders (SUDs) and comorbid mental health problems evidence heightened negative consequences, including poorer treatment outcomes, a higher risk for relapse, and mortality compared to individuals with a single disorder. In this study, we focus on the comorbidity between SUDs and eating disorder (ED) symptomatology, as EDs are similarly associated with high rates of relapse, morbidity, and mortality. Of particular importance is research examining treatment rejection among individuals in treatment for SUDs with cooccurring ED symptomatology. This study seeks to add to the literature by examining treatment rejection among young adult men in residential treatment for SUDs (N = 68) with cooccurring ED symptomatology. Results from hierarchical regression analyses indicated that ED symptoms were significantly associated with treatment rejection after controlling for alcohol and drug use and problems and depression symptoms. Although this is a preliminary study, the results add to a growing body of research examining the comorbidity between SUDs and ED symptomatology. Future research examining this relationship is needed to further elucidate the treatment patterns among individuals with comorbid ED symptoms and substance use diagnoses. PMID:27257382

  20. ADHD, stimulant treatment in childhood and subsequent substance abuse in adulthood - a naturalistic long-term follow-up study.

    PubMed

    Dalsgaard, Søren; Mortensen, Preben Bo; Frydenberg, Morten; Thomsen, Per Hove

    2014-01-01

    The purpose of the study was to estimate the risk of substance use disorder (SUD) and alcohol abuse in adulthood among children and adolescents with attention-deficit hyperactivity disorder (ADHD) compared to the background population. Furthermore, to examine whether the age at initiation and duration of stimulant treatment in childhood predicts SUD and alcohol abuse in adulthood. 208 youths with ADHD (183 boys; 25 girls) were followed prospectively. Diagnoses of SUD and alcohol abuse were obtained from The Danish Psychiatric Central Register. The relative risk (RR) of SUD and alcohol abuse for cases with ADHD, compared to the background population was 7.7 (4.3-13.9) and 5.2 (2.9-9.4), respectively. Female gender, conduct disorder in childhood and older age at initiation of stimulant treatment increased the risk of later SUD and alcohol abuse. Our results warrant increased focus on the possibly increased risk of substance abuse in females with ADHD compared to males with ADHD.

  1. Animal Models and the Development of Vaccines to Treat Substance Use Disorders.

    PubMed

    Ohia-Nwoko, O; Kosten, T A; Haile, C N

    2016-01-01

    The development of pharmacotherapies for substance use disorders (SUDs) is a high priority in addiction research. At present, there are no approved pharmacotherapies for cocaine and methamphetamine use disorders, while treatments for nicotine and opioid use are moderately effective. Indeed, many of these treatments can cause adverse drug side effects and have poor medication compliance, which often results in increased drug relapse rates. An alternative to these traditional pharmacological interventions is immunotherapy or vaccines that can target substances associated with SUDs. In this chapter, we discuss the current knowledge on the efficacy of preclinical vaccines, particularly immunogens that target methamphetamine, cocaine, nicotine, or opioids to attenuate drug-induced behaviors in animal models of SUDs. We also review vaccines (and antibodies) against cocaine, nicotine, and methamphetamine that have been assessed in human clinical trials. While preclinical studies indicate that several vaccines show promise, these findings have not necessarily translated to the clinical population. Thus, continued effort to design more effective vaccine immunogens using SUD animal models is necessary in order to support the use of immunotherapy as a viable option for individuals with SUDs. PMID:27055616

  2. The Relationship Between Eating Disorder Symptoms and Treatment Rejection among Young Adult Men in Residential Substance Use Treatment

    PubMed Central

    Elmquist, JoAnna; Shorey, Ryan C.; Anderson, Scott E.; Temple, Jeff R.; Stuart, Gregory L.

    2016-01-01

    Research has demonstrated that individuals with substance use disorders (SUDs) and comorbid mental health problems evidence heightened negative consequences, including poorer treatment outcomes, a higher risk for relapse, and mortality compared to individuals with a single disorder. In this study, we focus on the comorbidity between SUDs and eating disorder (ED) symptomatology, as EDs are similarly associated with high rates of relapse, morbidity, and mortality. Of particular importance is research examining treatment rejection among individuals in treatment for SUDs with cooccurring ED symptomatology. This study seeks to add to the literature by examining treatment rejection among young adult men in residential treatment for SUDs (N = 68) with cooccurring ED symptomatology. Results from hierarchical regression analyses indicated that ED symptoms were significantly associated with treatment rejection after controlling for alcohol and drug use and problems and depression symptoms. Although this is a preliminary study, the results add to a growing body of research examining the comorbidity between SUDs and ED symptomatology. Future research examining this relationship is needed to further elucidate the treatment patterns among individuals with comorbid ED symptoms and substance use diagnoses. PMID:27257382

  3. Does depression and substance abuse co-morbidity affect socioeconomic status? Evidence from a prospective study of urban African Americans.

    PubMed

    Dagher, Rada K; Green, Kerry M

    2015-01-30

    Studies have established a graded association between mental health and socioeconomic status (SES). However, scarce research has examined the impact of substance use disorders (SUD) and depression comorbidity on SES. We use data from the Woodlawn Study, a longitudinal cohort study, which recruited a cohort of first graders from Chicago starting 1966-1967 (N=1242). Analyses focus on those interviewed in young adulthood and followed up through midlife. Regression analyses adjusting for childhood confounders showed that young adults with depression and SUD comorbidity had higher likelihood of having any periods of unemployment, higher likelihood of being unemployed for 3 or more months, and lower household income in midlife than those with neither disorder. Moreover, young adults with SUD without depression had higher odds of having any periods of unemployment and higher odds of being unemployed for 3 or more months than those with neither disorder. Findings point to the possibility of social selection where depression and SUD comorbidity contributes to a downward drift in SES. Clinical interventions that integrate the treatment of SUD and depression may be more effective at reducing socioeconomic disparities among minority populations.

  4. Blunted feedback processing during risky decision making in adolescents with a parental history of substance use disorders.

    PubMed

    Euser, Anja S; Greaves-Lord, Kirstin; Crowley, Michael J; Evans, Brittany E; Huizink, Anja C; Franken, Ingmar H A

    2013-11-01

    Risky decision making, a hallmark phenotype of substance use disorders (SUD), is thought to be associated with deficient feedback processing. Whether these aberrations are present prior to SUD onset or reflect merely a consequence of chronic substance use on the brain remains unclear. The present study investigated whether blunted feedback processing during risky decision making reflects a biological predisposition to SUD. We assessed event-related potentials elicited by positive and negative feedback during performance of a modified version of the Balloon Analogue Risk Task (BART) among high-risk adolescents with a parental history of SUD (HR; n = 61) and normal-risk controls (NR; n = 91). HR males made significantly more risky and faster decisions during the BART than did NR controls. Moreover, HR adolescents showed significantly reduced P300 amplitudes in response to both positive and negative feedback as compared to NR controls. These differences were not secondary to prolonged substance use exposure. Results are discussed in terms of feedback-specific processes. Reduced P300 amplitudes in the BART may reflect poor processing of feedback at the level of overall salience, which may keep people from effectively predicting the probability of future gains and losses. Though conclusions are tentative, blunted feedback processing during risky decision making may represent a promising endophenotypic vulnerability marker for SUD. PMID:24229553

  5. Implementation of Electronic Health Records and Entrepreneurial Strategic Orientation in Substance Use Disorder Treatment Organizations

    PubMed Central

    Fields, Dail; Riesenmy, Kelly; Blum, Terry C.; Roman, Paul M.

    2015-01-01

    Objective: This research studied the relationships of the components of entrepreneurial strategic orientation (ESO) with implementation of electronic health records (EHRs) within organizations that treat patients with substance use disorders (SUDs). Method: A national sample of 317 SUD treatment providers were studied in a period after the Health Information Technology for Economic and Clinical Health (HITECH) Act was enacted (2009) and meaningful use EHR requirements were established (2010), but before implementation of the Affordable Care Act. The study sample was selected using stratified random sampling and was part of a longitudinal study of treatment providers across the United States. Results: After we controlled for potentially confounding variables, four components of ESO had a significant relationship with EHR implementation. Levels of slack resources in an organization moderated the relationship of ESO with meaningful use of EHRs, increasing the strength of the relationship for some components but reducing the strength of others. Conclusions: From a policy and practice perspective, the results suggest that training and education to develop higher levels of ESO within SUD treatment organizations are likely to increase their level of meaningful use of EHRs, which in turn may enhance the integration of SUD treatment with primary medical providers, better preparing SUD treatment providers for the environmental changes of the Affordable Care Act. PMID:26562603

  6. Improving Access to Long-Acting Contraceptive Methods and Reducing Unplanned Pregnancy Among Women with Substance Use Disorders.

    PubMed

    Black, Kirsten I; Day, Carolyn A

    2016-01-01

    Much has been written about the consequences of substance use in pregnancy, but there has been far less focus on the prevention of unintended pregnancies in women with substance use disorders (SUDs). We examine the literature on pregnancy incidence for women with SUDs, the clinical and economic benefits of increasing access to long-acting reversible contraceptive (LARC) methods in this population, and the current hurdles to increased access and uptake. High rates of unintended pregnancies and poor physical and psychosocial outcomes among women with SUDs underscore the need for increased access to, and uptake of, LARC methods among these women. A small number of studies that focused on improving access to contraception, especially LARC, via integrated contraception services predominantly provided in drug treatment programs were identified. However, a number of barriers remain, highlighting that much more research is needed in this area. PMID:27199563

  7. Mindfulness training and stress reactivity in substance abuse: results from a randomized, controlled stage I pilot study.

    PubMed

    Brewer, Judson A; Sinha, Rajita; Chen, Justin A; Michalsen, Ravenna N; Babuscio, Theresa A; Nich, Charla; Grier, Aleesha; Bergquist, Keri L; Reis, Deidre L; Potenza, Marc N; Carroll, Kathleen M; Rounsaville, Bruce J

    2009-01-01

    Stress is important in substance use disorders (SUDs). Mindfulness training (MT) has shown promise for stress-related maladies. No studies have compared MT to empirically validated treatments for SUDs. The goals of this study were to assess MT compared to cognitive behavioral therapy (CBT) in substance use and treatment acceptability, and specificity of MT compared to CBT in targeting stress reactivity. Thirty-six individuals with alcohol and/or cocaine use disorders were randomly assigned to receive group MT or CBT in an outpatient setting. Drug use was assessed weekly. After treatment, responses to personalized stress provocation were measured. Fourteen individuals completed treatment. There were no differences in treatment satisfaction or drug use between groups. The laboratory paradigm suggested reduced psychological and physiological indices of stress during provocation in MT compared to CBT. This pilot study provides evidence of the feasibility of MT in treating SUDs and suggests that MT may be efficacious in targeting stress. PMID:19904666

  8. An impact assessment methodology for urban surface runoff quality following best practice treatment.

    PubMed

    Ellis, J Bryan; Revitt, D Michael; Lundy, Lian

    2012-02-01

    The paper develops an easy to apply desk-based semi-quantitative approach for the assessment of residual receiving water quality risks associated with urban surface runoff following its conveyance through best practice sustainable drainage systems (SUDS). The innovative procedure utilises an integrated geographical information system (GIS)-based pollution index approach based on surface area impermeability, runoff concentrations/loadings and individual SUDS treatment performance potential to evaluate the level of risk mitigation achievable by SUDS drainage infrastructure. The residual impact is assessed through comparison of the determined pollution index with regulatory receiving water quality standards and objectives. The methodology provides an original theoretically based procedure which complements the current acute risk assessment approaches being widely applied within pluvial flood risk management.

  9. Personality risk profile for conduct disorder and substance use disorders in youth.

    PubMed

    Anderson, Kristen G; Tapert, Susan F; Moadab, Ida; Crowley, Thomas J; Brown, Sandra A

    2007-10-01

    The five factor model of personality is a useful metric to describe personality profiles associated with maladaptive functioning. Using the NEO-Five Factor Inventory (NEO-FFI), we examined a conceptually based profile of high neuroticism, low agreeableness and low conscientiousness among 243 youth (aged 13-18 years) with varying degrees of conduct disorder (CD) and substance use disorders (SUD). Comparisons of the NEO-FFI personality dimensions between CD/SUD youth and adolescent siblings (N=173), and relations between the personality dimensions and behavioral indicators of conduct disorder and substance involvement were examined. Youth with CD and SUD had greater neuroticism, lower agreeableness, and lower conscientiousness than siblings of a similar age. The NEO-FFI scales predicted aggression and substance involvement for both probands and siblings in this cross-sectional investigation. These findings support the role for personality in models of the etiology and persistence of conduct disorder and substance use disorders. PMID:17408870

  10. Psychotic-like symptoms as a risk factor of violent recidivism in detained male adolescents.

    PubMed

    Colins, Olivier F; Vermeiren, Robert R; Noom, Marc; Broekaert, Eric

    2013-06-01

    The aim of this study was to prospectively examine whether psychotic-like symptoms (PLSs) are positively associated with violent recidivism and whether this relation is stronger when PLSs co-occur with substance use disorders (SUDs). Participants were 224 detained male adolescents from all youth detention centers in Flanders. The Diagnostic Interview Schedule for Children was used to assess PLSs and the number of SUDs. Two to 4 years later, information on official recidivism was obtained. Although hallucinations were unrelated to violent recidivism, paranoid delusions (PDs) and threat/control override delusions (TCODs) were negatively related to violent recidivism. The relation between PLSs and violent recidivism did not become stronger in the presence of SUDs. Detained youths with PLSs do not have a higher risk for violent recidivism than detained youths without PLSs. In contrast, by identifying detained youths with PDs or TCODs, clinicians are likely to identify youths with a low risk for future violent crimes.

  11. Mindfulness training and stress reactivity in substance abuse: results from a randomized, controlled stage I pilot study.

    PubMed

    Brewer, Judson A; Sinha, Rajita; Chen, Justin A; Michalsen, Ravenna N; Babuscio, Theresa A; Nich, Charla; Grier, Aleesha; Bergquist, Keri L; Reis, Deidre L; Potenza, Marc N; Carroll, Kathleen M; Rounsaville, Bruce J

    2009-01-01

    Stress is important in substance use disorders (SUDs). Mindfulness training (MT) has shown promise for stress-related maladies. No studies have compared MT to empirically validated treatments for SUDs. The goals of this study were to assess MT compared to cognitive behavioral therapy (CBT) in substance use and treatment acceptability, and specificity of MT compared to CBT in targeting stress reactivity. Thirty-six individuals with alcohol and/or cocaine use disorders were randomly assigned to receive group MT or CBT in an outpatient setting. Drug use was assessed weekly. After treatment, responses to personalized stress provocation were measured. Fourteen individuals completed treatment. There were no differences in treatment satisfaction or drug use between groups. The laboratory paradigm suggested reduced psychological and physiological indices of stress during provocation in MT compared to CBT. This pilot study provides evidence of the feasibility of MT in treating SUDs and suggests that MT may be efficacious in targeting stress.

  12. Identifying and Intervening with Substance-Using Women Exposed to Intimate Partner Violence: Phenomenology, Comorbidities, and Integrated Approaches Within Primary Care and Other Agency Settings

    PubMed Central

    Gilbert, Louisa; El-Bassel, Nabila; Resnick, Heidi S.; Noursi, Samia

    2015-01-01

    Abstract Substance use and/or disorders (SUDs) have been identified as a significant correlate of intimate partner violence (IPV) exposure and present complex issues that intersect with the topography of IPV, attendant mental health, and physical co-morbidities and may pose barriers to primary care- and other agency-based screening and intervention efforts. Despite substantial research indicating significantly higher rates of all types and severity of IPV victimization among women with SUDs and bidirectional associations between partner or self-use of drugs or alcohol and IPV victimization, effective screening, brief interventions, coordinated systems of care, and treatment approaches to address these co-occurring problems remain very limited. We integrated select research examining the intersection of IPV victimization and SUDs and several comorbidities that have significant public health impact and provided recommendations for scaling up targeted interventions to redress these co-occurring problems among women in primary, emergency, and other care settings. PMID:25554915

  13. Barriers to Quitting Smoking Among Substance Dependent Patients Predict Smoking Cessation Treatment Outcome.

    PubMed

    Martin, Rosemarie A; Cassidy, Rachel N; Murphy, Cara M; Rohsenow, Damaris J

    2016-05-01

    For smokers with substance use disorders (SUD), perceived barriers to quitting smoking include concerns unique to effects on sobriety as well as usual concerns. We expanded our Barriers to Quitting Smoking in Substance Abuse Treatment (BQS-SAT) scale, added importance ratings, validated it, and then used the importance scores to predict smoking treatment response in smokers with substance use disorders (SUD) undergoing smoking treatment in residential treatment programs in two studies (n=184 and 340). Both components (general barriers, weight concerns) were replicated with excellent internal consistency reliability. Construct validity was supported by significant correlations with pretreatment nicotine dependence, smoking variables, smoking self-efficacy, and expected effects of smoking. General barriers significantly predicted 1-month smoking abstinence, frequency and heaviness, and 3-month smoking frequency; weight concerns predicted 1-month smoking frequency. Implications involve addressing barriers with corrective information in smoking treatment for smokers with SUD.

  14. Theater-Based Community Engagement Project for Veterans Recovering From Substance Use Disorders.

    PubMed

    Wasmuth, Sally; Pritchard, Kevin

    2016-01-01

    In this study, we examine the feasibility and acceptability of a 6-wk, interdisciplinary, occupation-based theater project for facilitating community engagement and substance use disorder (SUD) recovery in veterans. All data were collected at baseline, postintervention, and 6-wk and 6-mo follow-up intervals. Of the invited veterans, 24% consented to participate (n = 14), and 50% were retained (n = 7). Average attendance was 91%. Considerable improvements in social and occupational participation were noted at postintervention and at 6-wk follow-up but were not retained at 6 mo. No important change in self-efficacy was noted. Of the participants, 86% remained abstinent for 6 wk following the intervention. Theater provides a feasible and acceptable resource for potentially facilitating SUD recovery. Larger controlled effectiveness studies of theater are needed to examine whether robust and notable recovery outcomes in people with SUDs can be linked to participation in theater. PMID:27294989

  15. Sixteen-year predictors of substance use disorder diagnoses for patients with mental health disorders.

    PubMed

    Irmiter, Cheryl; Barry, Kristen L; Cohen, Kenneth; Blow, Fredrick C

    2009-01-01

    Individuals with substance use disorders (SUDs). including co-occurring disorders, are among the highest-risk populations for medical and psychiatric rehospitalizations, and are often underdiagnosed at initial hospitalization. This study examined predictors for these individuals at baseline hospitalization and subsequent rehospitalizations. Three groups were compared from a sample of individuals admitted to inpatient psychiatry (1982 to 1987) with at least one rehospitalization within a 16-year period. Multivariate logistical regressions were used to determine associations with predictor variables. The data showed that individuals' diagnosed with a SUD after baseline hospitalization were more likely to have more medical hospitalizations and to be diagnosed with schizophrenia compared to those who were diagnosed with a SUD, including co-occurring disorders, at baseline. The results of this study indicate the importance of substance use screening to enhance service resources and treatment outcomes for medically and psychiatrically complex populations. PMID:19197780

  16. Improving Access to Long-Acting Contraceptive Methods and Reducing Unplanned Pregnancy Among Women with Substance Use Disorders

    PubMed Central

    Black, Kirsten I.; Day, Carolyn A.

    2016-01-01

    Much has been written about the consequences of substance use in pregnancy, but there has been far less focus on the prevention of unintended pregnancies in women with substance use disorders (SUDs). We examine the literature on pregnancy incidence for women with SUDs, the clinical and economic benefits of increasing access to long-acting reversible contraceptive (LARC) methods in this population, and the current hurdles to increased access and uptake. High rates of unintended pregnancies and poor physical and psychosocial outcomes among women with SUDs underscore the need for increased access to, and uptake of, LARC methods among these women. A small number of studies that focused on improving access to contraception, especially LARC, via integrated contraception services predominantly provided in drug treatment programs were identified. However, a number of barriers remain, highlighting that much more research is needed in this area. PMID:27199563

  17. A pilot study of seeking safety therapy with OEF/OIF veterans.

    PubMed

    Norman, Sonya B; Wilkins, Kendall C; Tapert, Susan F; Lang, Ariel J; Najavits, Lisa M

    2010-03-01

    PTSD and substance use disorder (SUD) are highly prevalent among veterans returning from Iraq and Afghanistan (Operation Enduring Freedom/Operation Iraqi Freedom; OEF/OIF). Seeking Safety (SS) is a cognitive-behavioral psychotherapy for co-occurring PTSD/SUD. This pilot study with fourteen male OEF/OIF veterans suggests that SS may help to reduce alcohol use, PTSD, and depression in some participants at clinically significant levels, even when providing less than half of the full model. We emphasize several SS features as especially helpful: the case management component to help engage clients in further mental health and SUD care, offering PTSD as an entry point, and emphasis on community resources. Issues particular to veterans include reintegration to civilian life and supporting their connection with other veterans.

  18. Cue-induced Behavioral and Neural Changes among Excessive Internet Gamers and Possible Application of Cue Exposure Therapy to Internet Gaming Disorder.

    PubMed

    Zhang, Yongjun; Ndasauka, Yamikani; Hou, Juan; Chen, Jiawen; Yang, Li Zhuang; Wang, Ying; Han, Long; Bu, Junjie; Zhang, Peng; Zhou, Yifeng; Zhang, Xiaochu

    2016-01-01

    Internet gaming disorder (IGD) may lead to many negative consequences in everyday life, yet there is currently no effective treatment for IGD. Cue-reactivity paradigm is commonly used to evaluate craving for substance, food, and gambling; cue exposure therapy (CET) is applied to treating substance use disorders (SUDs) and some other psychological disorders such as pathological gambling (PG). However, no study has explored CET's application to the treatment of IGD except two articles having implied that cues' exposure may have therapeutic effect on IGD. This paper reviews studies on cue-induced behavioral and neural changes in excessive Internet gamers, indicating that behavioral and neural mechanisms of IGD mostly overlap with those of SUD. The CET's effects in the treatment of SUDs and PG are also reviewed. We finally propose an optimized CET paradigm, which future studies should consider and investigate as a probable treatment of IGD. PMID:27242589

  19. Essential Ingredients for Successful Redesign of Addiction Treatment

    PubMed Central

    Gustafson, David H.

    2013-01-01

    Summary Since the passage of healthcare reform, there have been many discussions about how the mental health and substance use disorder (MH/SUD) system will need to change. Of the many components involved in a system redesign, the identification of essential ingredients is crucial to its success. In an effort to determine what essential ingredients the new MH/SUD system requires to optimally meet the needs of its customers, we convened a group of 16 multi-industrial experts who analyzed data collected from a string of 7 focus groups and 15 interviews with people dealing with or working in the SUD field. This paper summarizes the 11 essential ingredients our group identified. PMID:25243237

  20. How should we revise diagnostic criteria for substance use disorders in the DSM-V?

    PubMed

    Martin, Christopher S; Chung, Tammy; Langenbucher, James W

    2008-08-01

    This article reviews literature on the validity and performance characteristics of the Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV; American Psychiatric Association, 1994) diagnostic criteria for substance use disorders (SUDs) and recommends changes in these criteria that should be considered for the next edition of the DSM (DSM-V). Substantial data indicate that DSM-IV substance abuse and substance dependence are not distinct categories and that SUD criteria are best modeled as reflecting a unidimensional continuum of substance-problem severity. The conceptually and empirically problematic substance abuse diagnosis should be abandoned in the DSM-V, with substance dependence defined by a single set of criteria. Data also indicate that various individual SUD criteria should be revised, dropped, or considered for inclusion in the DSM-V. The DSM-V should provide a framework that allows the integration of categorical and dimensional approaches to diagnosis. Important areas for further research are noted.

  1. Cue-induced Behavioral and Neural Changes among Excessive Internet Gamers and Possible Application of Cue Exposure Therapy to Internet Gaming Disorder

    PubMed Central

    Zhang, Yongjun; Ndasauka, Yamikani; Hou, Juan; Chen, Jiawen; Yang, Li zhuang; Wang, Ying; Han, Long; Bu, Junjie; Zhang, Peng; Zhou, Yifeng; Zhang, Xiaochu

    2016-01-01

    Internet gaming disorder (IGD) may lead to many negative consequences in everyday life, yet there is currently no effective treatment for IGD. Cue-reactivity paradigm is commonly used to evaluate craving for substance, food, and gambling; cue exposure therapy (CET) is applied to treating substance use disorders (SUDs) and some other psychological disorders such as pathological gambling (PG). However, no study has explored CET’s application to the treatment of IGD except two articles having implied that cues’ exposure may have therapeutic effect on IGD. This paper reviews studies on cue-induced behavioral and neural changes in excessive Internet gamers, indicating that behavioral and neural mechanisms of IGD mostly overlap with those of SUD. The CET’s effects in the treatment of SUDs and PG are also reviewed. We finally propose an optimized CET paradigm, which future studies should consider and investigate as a probable treatment of IGD. PMID:27242589

  2. Emotional exposure in the treatment of substance use disorders: conceptual model, evidence, and future directions.

    PubMed

    Otto, Michael W; Powers, Mark B; Fischmann, Diana

    2005-09-01

    In this article, we review research on the nature and treatment of panic disorder, and apply these findings to a discussion of the role of internal cue exposure in the treatment of substance use disorders (SUDs). Two features of panic treatment were used as a model for interventions for SUDs: exposure to internal (interoceptive) cues rather than reliance on external (environmental) exposure alone, and use of cue exposure to try to inoculate individuals against future maladaptive patterns. Specifically, we emphasized the role of exposure to internal, largely emotional cues, as a way to enhance resilience to cues for relapse in individuals with SUDs. Hypothesized moderators and mediators of this treatment approach were discussed, as were similarities between this research agenda and an increasing focus on the role of emotional acceptance/tolerance in cognitive-behavioral treatments.

  3. Personality and substance use disorders: a prospective study.

    PubMed

    Sher, K J; Bartholow, B D; Wood, M D

    2000-10-01

    The personality systems of Cloninger (as measured by the Tridimensional Personality Questionnaire [TPQ]) and Eysenck (as measured by the Eysenck Personality Questionnaire [EPQ]) both have been linked to substance use and abuse. The current study examined the predictive utility of both systems for substance use disorder (SUD) diagnoses, both cross-sectionally and prospectively. Participants (N = 489 at baseline) completed the EPQ and TPQ and were assessed via structured diagnostic interview at baseline and 6 years later (N = 457 at follow-up). Both the EPQ and TPQ scales demonstrated bivariate cross-sectional and prospective associations with SUDs. Within each system, those dimensions marking a broad impulsive sensation-seeking or behavioral disinhibition trait were the best predictors prospectively, although the 2 systems were differentially sensitive to specific diagnoses. These relations remained significant even with autoregressivity, other concurrent SUD diagnoses, and multiple personality dimensions statistically controlled.

  4. Rape, sex partnership, and substance use consequences in women veterans.

    PubMed

    Booth, Brenda M; Mengeling, Michelle; Torner, James; Sadler, Anne G

    2011-06-01

    The association of rape history and sexual partnership with alcohol and drug use consequences in women veterans is unknown. Midwestern women veterans (N = 1,004) completed a retrospective telephone interview assessing demographics, rape history, substance abuse and dependence, depression, and posttraumatic stress disorder (PTSD). One third met lifetime criteria for substance use disorder (SUD), half reported lifetime completed rape, a third childhood rape, one quarter in-military rape, 11% sex with women. Lifetime SUD was higher for women with rape history (64% vs. 44%). Women with women as sex partners had significantly higher rates of all measures of rape, and also lifetime substance use disorder. Postmilitary rape, sex partnership, and current depression were significantly associated with lifetime SUD in multivariate models (odds ratio = 2.3, 3.6, 2.1, respectively). Many women veterans have a high need for comprehensive mental health services.

  5. Distal and proximal factors associated with aggression towards partners and non-partners among patients in substance abuse treatment.

    PubMed

    Epstein-Ngo, Quyen M; Walton, Maureen A; Sanborn, Michelle; Kraus, Shane; Blow, Fred; Cunningham, Rebecca; Chermack, Stephen T

    2014-10-01

    Studies of violence in substance use disorder (SUD) treatment settings typically focus on partner aggression (PA) although non-partner aggression (NPA) is also a common problem. This study examines potentially distinct paths of distal and proximal risk factors related to aggression towards non-partners (NPA) and partners (PA) among a SUD treatment sample. The sample included 176 adults reporting past-year violence. Bivariate analyses indicated several distal and proximal factors were associated with NPA and PA. According to multivariate, multiple mediation analyses youth aggression history was a factor for both NPA and PA. Alcohol and cocaine use and psychological distress were associated with NPA; marijuana use was associated with PA. There also was evidence of indirect effects of distal factors on NPA and PA. The results suggest that there may be substantially different dynamics associated with NPA and PA, and have implications for developing screening, assessment and treatment protocols targeting violence among individuals in SUD treatment.

  6. Reprocessing single-use devices--the equipment connection.

    PubMed

    Dunn, Debra

    2002-06-01

    This is the second in a series of three articles about reprocessing medical devices labeled as "single use" by the manufacturer. The goal of reprocessing single-use devices (SUDs) is to save money and decrease environmental pollution. Reprocessing can be performed on SUDs that have been used on other patients or opened but not used. In this article, the procedures for reprocessing (e.g., cleaning, inspecting, sterilizing, tracking, testing, validating) and establishing a reuse program are discussed. The first article of the series, published in the May 2002 issue of the Journal, discussed the ethical component of reusing SUDs. The third article, to be published in the July 2002 issue, will discuss the roles of the involved regulatory agencies and organizations guiding the process. PMID:12085405

  7. Co-occurring disorders: policy and practice in Germany.

    PubMed

    Hintz, Thomas; Mann, Karl

    2006-01-01

    The occurrence of substance use disorders (SUD) with other mental disorders-what is often referred to as co-occurring disorders (COD)-is a common phenomenon, but for a long time, little attention has been paid to this problem in Germany. During the last 25 years, however, COD awareness has increased due to a shift toward community-based services. Scientific research has also demonstrated the significance and clinical relevance of COD. High prevalence rates and evidence of poor clinical outcomes were found in German studies. Many practitioners as well as policymakers acknowledge that changes in systems of care are necessary to meet the requirements of COD patients. The traditional German system is currently divided into addiction services and mental health services (predominantly in inpatient settings), often resulting in ineffective sequential treatment for COD patients. Research demonstrates that integrative treatment models are more appropriate, and the division of services should be reorganized to help COD patients appropriately. Efforts have already been made to restructure healthcare systems toward a more flexible approach with improved networking between in- and outpatient services. A further issue is the general attitude toward SUD patients. Many practitioners continue to hold negative opinions (eg, "SUD patients are only weak-minded") or feel insecure when confronted with SUD. This results in SUD problems being frequently ignored or depreciated. Educational programs have been intensive over recent years to address this problem (eg, Fachkunde Sucht, an advanced training program on SUD). In general, treatment conditions for COD patients are improving, but further efforts are necessary. Guidelines and treatment strategies for COD patients have been recently published in Germany.

  8. Cardiac Channel Molecular Autopsy: Insights From 173 Consecutive Cases of Autopsy-Negative Sudden Unexplained Death Referred for Postmortem Genetic Testing

    PubMed Central

    Tester, David J.; Medeiros-Domingo, Argelia; Will, Melissa L.; Haglund, Carla M.; Ackerman, Michael J.

    2012-01-01

    Objective To perform long QT syndrome and catecholaminergic polymorphic ventricular tachycardia cardiac channel postmortem genetic testing (molecular autopsy) for a large cohort of cases of autopsy-negative sudden unexplained death (SUD). Methods From September 1, 1998, through October 31, 2010, 173 cases of SUD (106 males; mean ± SD age, 18.4±12.9 years; age range, 1-69 years; 89% white) were referred by medical examiners or coroners for a cardiac channel molecular autopsy. Using polymerase chain reaction, denaturing high-performance liquid chromatography, and DNA sequencing, a comprehensive mutational analysis of the long QT syndrome susceptibility genes (KCNQ1, KCNH2, SCN5A, KCNE1, and KCNE2) and a targeted analysis of the catecholaminergic polymorphic ventricular tachycardia type 1–associated gene (RYR2) were conducted. Results Overall, 45 putative pathogenic mutations absent in 400 to 700 controls were identified in 45 autopsy-negative SUD cases (26.0%). Females had a higher yield (26/67 [38.8%]) than males (19/106 [17.9%]; P<.005). Among SUD cases with exercise-induced death, the yield trended higher among the 1- to 10-year-olds (8/12 [66.7%]) compared with the 11- to 20-year-olds (4/27 [14.8%]; P=.002). In contrast, for those who died during a period of sleep, the 11- to 20-year-olds had a higher yield (9/25 [36.0%]) than the 1- to 10-year-olds (1/24 [4.2%]; P=.01). Conclusion Cardiac channel molecular autopsy should be considered in the evaluation of autopsy-negative SUD. Several interesting genotype-phenotype observations may provide insight into the expected yields of postmortem genetic testing for SUD and assist in selecting cases with the greatest potential for mutation discovery and directing genetic testing efforts. PMID:22677073

  9. Survey of Eating Disorder Symptoms among Women in Treatment for Substance Abuse

    PubMed Central

    Cohen, Lisa R.; Greenfield, Shelly F.; Gordon, Susan; Killeen, Therese; Jiang, Huiping; Zhang, Yulei; Hien, Denise

    2010-01-01

    A strong association between substance use disorders (SUD) and eating disorders (ED) in women has been established. Yet, little is known about the rates and impact of ED symptoms in women presenting to addiction treatment. The current investigation assessed the prevalence of ED symptoms and their effect on treatment outcomes in a sample of substance abusing women with co-occurring posttraumatic stress disorder (PTSD) enrolled in outpatient substance use programs. Participants were 122 women who participated in a multi-site clinical trial comparing two behavioral treatments for co-occurring SUD and PTSD. The Eating Disorder Examination-self report (EDE-Q), and measures of PTSD and SUD symptoms were administered at baseline, during treatment and at four follow-up points. Two subgroups emerged; those reporting binge eating in the 28 days prior to baseline (Binge group; n = 35) and those who reported no binge eating episodes (No Binge group; n = 87). Women in the Binge group endorsed significantly higher ED, PTSD and depression symptoms at baseline than those in the No Binge group. Though all participants showed significant reductions in PTSD symptoms and improvements in abstinence rates during the study period, the improvements for the Binge group were significantly lower. These findings suggest that a sub-group of women with co-occurring PTSD and SUDs who endorsed binge ED symptoms responded differently to SUD/PTSD group treatment. Identification of eating disorder symptoms among treatment-seeking women with SUDs may be an important element in tailoring interventions and enhancing treatment outcomes. PMID:20525031

  10. The Course of Substance Use Disorders in Patients with Borderline Personality Disorder and Axis II Comparison Subjects: A 10-Year Follow-up Study

    PubMed Central

    Zanarini, Mary C.; Frankenburg, Frances R.; Weingeroff, Jolie L.; Reich, D. Bradford; Fitzmaurice, Garrett M.; Weiss, Roger D.

    2011-01-01

    Aim The purpose of this study is to detail the course of substance use disorders (SUDs) over 10 years of prospective follow-up among patients with borderline personality disorder (BPD) and axis II comparison subjects. Design This study uses data from the McLean Study of Adult Development (MSAD), a multifaceted study of the longitudinal course of BPD using reliable repeated measures administered every two years over a decade of prospective follow-up. Setting All subjects were initially inpatients at McLean Hospital in Belmont Massachusetts. Participants A total of 290 patients with BPD and 72 axis II comparison subjects were assessed at baseline and five waves of follow-up. Measurements The Structured Clinical Interview for DSM-III-R Axis I Disorders (SCID-I), the Revised Diagnostic Interview for Borderlines (DIB-R), and the Diagnostic Interview for DSM-III-R Personality Disorders (DIPD-R) were administered six times. Generalized estimating equations were used to assess longitudinal prevalence of SUDs. Kaplan–Meier analyses were used to assess time-to-remission, recurrence, and new onsets of SUDs. Results The prevalence of SUDs among borderline patients and axis II comparison subjects declined significantly over time, while remaining significantly more common among those with BPD. Over 90% of borderline patients meeting criteria for a SUD at baseline experienced a remission by 10-year follow-up. Recurrences and new onsets of SUDs were less common (35-40% and 21-23%). Conclusions Remissions of alcohol and drug abuse/dependence among borderline patients are both common and relatively stable. Results also suggest that new onsets of these disorders are less common than might be expected. PMID:21083831

  11. Racial/Ethnic Differences in Treatment for Substance Use Disorders among U.S. Adolescents

    PubMed Central

    Cummings, Janet R.; Wen, Hefei; Druss, Benjamin G.

    2011-01-01

    Objective This study examined differences in treatment rates for substance use disorders (SUD) among White, Black, Hispanic, Asian, Native American/Alaskan Native, and Native Hawaiian/Pacific Islander adolescents. Method Eight years of cross-sectional data (2001–2008) were pooled from the National Survey on Drug Use and Health to derive a nationally representative sample of 144,197 adolescents (age 12–17); 12,634 adolescents were identified with SUD in the previous year. Weighted probit regressions were estimated with year fixed effects to examine whether racial/ethnic minorities had lower rates of treatment in: (1) any setting, (2) medical settings (i.e. hospital, rehabilitation facility, mental health clinic, and/or doctor’s office), and (3) self-help programs. Initial models controlled for demographics and health status. Additional models further adjusted for family income and health insurance status. Results Among adolescents with SUD, unadjusted treatment rates ranged from 8.4% among Blacks to 23.5% among Native Hawaiian/Pacific Islanders. After adjusting for demographics and health status, Blacks (RD= −3.9%, 95% CI= −6.4%,−1.3%) and Hispanics (RD= −2.3%, 95% CI= −4.1%,−0.4%) were significantly less likely to receive SUD treatment than Whites (adjusted treatment rate 10.7%). These differences were exacerbated after adjusting for family income and insurance status. Lower treatment rates for Black and Hispanic adolescents persisted when examining SUD treatment rates in medical settings and self-help programs. Treatment rates for other racial/ethnic groups did not generally differ from Whites. Conclusion Results highlight exceptionally low treatment rates for SUD among all adolescents, with Blacks and Hispanics experiencing the lowest treatment rates across all racial/ethnic groups. PMID:22115147

  12. Next-generation sequencing of 34 genes in sudden unexplained death victims in forensics and in patients with channelopathic cardiac diseases.

    PubMed

    Hertz, C L; Christiansen, S L; Ferrero-Miliani, L; Fordyce, S L; Dahl, M; Holst, A G; Ottesen, G L; Frank-Hansen, R; Bundgaard, H; Morling, N

    2015-07-01

    Sudden cardiac death (SCD) is responsible for a large proportion of sudden deaths in young individuals. In forensic medicine, many cases remain unexplained after routine postmortem autopsy and conventional investigations. These cases are called sudden unexplained deaths (SUD). Genetic testing has been suggested useful in forensic medicine, although in general with a significantly lower success rate compared to the clinical setting. The purpose of the study was to estimate the frequency of pathogenic variants in the genes most frequently associated with SCD in SUD cases and compare the frequency to that in patients with inherited cardiac channelopathies. Fifteen forensic SUD cases and 29 patients with channelopathies were investigated. DNA from 34 of the genes most frequently associated with SCD were captured using NimbleGen SeqCap EZ library build and were sequenced with next-generation sequencing (NGS) on an Illumina MiSeq. Likely pathogenic variants were identified in three out of 15 (20%) forensic SUD cases compared to 12 out of 29 (41%) patients with channelopathies. The difference was not statistically significant (p = 0.1). Additionally, two larger deletions of entire exons were identified in two of the patients (7%). The frequency of likely pathogenic variants was >2-fold higher in the clinical setting as compared to SUD cases. However, the demonstration of likely pathogenic variants in three out of 15 forensic SUD cases indicates that NGS investigations will contribute to the clinical investigations. Hence, this has the potential to increase the diagnostic rate significantly in the forensic as well as in the clinical setting.

  13. New Onsets of Substance Use Disorders in Borderline Personality Disorder Over Seven Years of Follow-ups: Findings from the Collaborative Longitudinal Personality Disorders Study

    PubMed Central

    Walter, Marc; Gunderson, John G.; Zanarini, Mary C.; Sanislow, Charles A.; Grilo, Carlos M.; McGlashan, Thomas H.; Morey, Leslie C.; Yen, Shirley; Stout, Robert L.; Skodol, Andrew E.

    2008-01-01

    Aims The purpose of the study was to examine whether patients with borderline personality disorder (BPD) have a higher rate of new onsets of substance use disorders (SUD) than do patients with other personality disorders (OPD). Design This study uses data from the Collaborative Longitudinal Personality Disorder Study (CLPS), a prospective naturalistic study with reliable repeated measures over 7 years of follow-up. Setting Multiple clinical sites in four northeastern US cities. Participants 175 patients with BPD and 396 patients with OPD (mean age 32.5 years), were assessed at baseline and at 6, 12, 24, 36, 48, 60, 72, and 84 months. Measurements The Structured Clinical Interview for DSM-IV Axis I Disorders and the Diagnostic Interview for DSM-IV Personality Disorders were used at baseline, the Follow-Along Version of the DIPD-IV and the Longitudinal Interval Follow-Up Evaluation at the follow-up evaluations. Kaplan-Meier analyses were calculated to generate the time to new onsets. Findings BPD patients showed a shorter time to new onsets of SUD. Thirteen percent of BPD patients developed a new alcohol use disorder, and 11% developed a new drug use disorder, as compared to rates of 6% and 4% respectively for OPD. Non-remitted BPD and remitted BPD patients did not differ significantly in rates of new onsets of SUD. Conclusions BPD patients have a high vulnerability for new onsets of SUDs even when their psychopathology improves. These findings indicate some shared etiological factors between BPD and SUD and underscore the clinical significance of treating SUD when it co-occurs in BPD patients. PMID:19133893

  14. Can persons with a history of multiple addiction treatment episodes benefit from technology delivered behavior therapy? A moderating role of treatment history at baseline.

    PubMed

    Kim, Sunny Jung; Marsch, Lisa A; Acosta, Michelle C; Guarino, Honoria; Aponte-Melendez, Yesenia

    2016-03-01

    A growing line of research has shown positive treatment outcomes from technology-based therapy for substance use disorders (SUDs). However, little is known about the effectiveness of technology-based SUD interventions for persons who already had numerous prior SUD treatments. We conducted a secondary analysis on a 12-month trial with patients (N=160) entering methadone maintenance treatment (MMT). Patients were randomly assigned to either standard MMT treatment or a model in which half of standard counseling sessions were replaced with a computer-based intervention, called Therapeutic Education System (standard+TES). Four treatment history factors at baseline, the number of lifetime SUD treatment episodes, detoxification episodes, and inpatient/outpatient treatment episodes were categorized into three levels based on their tertile points, and analyzed as moderators. Dependent variables were urine toxicology results for opioid and cocaine abstinence for 52-weeks. The standard+TES condition produced significantly better opioid abstinence than standard treatment for participants with 1) a moderate or high frequency of lifetime SUD treatment episodes, and 2) those with all three levels (low, moderate and high) of detoxification and inpatient/outpatient treatment episodes, ps<.01. The standard+TES condition enhanced cocaine abstinence compared to standard treatment among people with 1) a moderate or high frequency of lifetime SUD treatment episodes, 2) a high level of detoxification episodes, and 3) a moderate or high level of inpatient treatment history, ps<.01. We found that including technology-based behavioral therapy as part of treatment can be more effective than MMT alone, even among patients with a history of multiple addiction treatment episodes.

  15. Some Observations from Behavioral Economics for Consideration in Promoting Money Management among Those with Substance Use Disorders

    PubMed Central

    Chivers, Laura L.; Higgins, Stephen T.

    2016-01-01

    Background Behavioral economics research has revealed systematic biases in decision making that merit consideration in efforts to promote money management skills among those with substance use disorders (SUDs). Objectives The objective of this article was to briefly review the literature on five of those biases (i.e., hyperbolic delay discounting, defaults and preference for the status quo, loss aversion, mental accounting, and failure to account for opportunity cost) that may have particular relevance to the topic of money management. Methods Selected studies are reviewed to illustrate these biases and how they may relate to efforts to promote money management skills among those with substance use disorders. Studies were identified by searching PubMed using the terms “behavioral economics” and “substance use disorders”, reviewing bibliographies of published articles, and discussions with colleagues. Results Only one of these biases (i.e., hyperbolic delay discounting) has been investigated extensively among those with SUDs. Indeed, it has been found to be sufficiently prevalent among those with SUDs to be considered as a potential risk factor for those disorders and certainly merits careful consideration in efforts to improve money management skills in that population. There has been relatively little empirical research reported regarding the other biases among those with SUDs, although they appear to be sufficiently fundamental to human behavior and relevant to the topic of money management (e.g., loss aversion) to also merit consideration. There is precedent of effective leveraging of behavioral economics principles in treatment development for SUDs (e.g., contingency management), including at least one intervention that explicitly focuses on money management (i.e., advisor–teller money management therapy). Conclusions and Scientific Significance The consideration of the systematic biases in human decision making that have been revealed in behavioral

  16. Childhood ADHD and Risk for Substance Dependence in Adulthood: A Longitudinal, Population-Based Study

    PubMed Central

    Levy, Sharon; Katusic, Slavica K.; Colligan, Robert C.; Weaver, Amy L.; Killian, Jill M.; Voigt, Robert G.; Barbaresi, William J.

    2014-01-01

    Background Adolescents with attention-deficit/hyperactivity disorder (ADHD) are known to be at significantly greater risk for the development of substance use disorders (SUD) compared to peers. Impulsivity, which could lead to higher levels of drug use, is a known symptom of ADHD and likely accounts, in part, for this relationship. Other factors, such as a biologically increased susceptibility to substance dependence (addiction), may also play a role. Objective This report further examines the relationships between childhood ADHD, adolescent- onset SUD, and substance abuse and substance dependence in adulthood. Method Individuals with childhood ADHD and non-ADHD controls from the same population-based birth cohort were invited to participate in a prospective outcome study. Participants completed a structured neuropsychiatric interview with modules for SUD and a psychosocial questionnaire. Information on adolescent SUD was obtained retrospectively, in a previous study, from medical and school records. Associations were summarized using odds ratios (OR) and 95% CIs estimated from logistic regression models adjusted for age and gender. Results A total of 232 ADHD cases and 335 non-ADHD controls participated (mean age, 27.0 and 28.6 years, respectively). ADHD cases were more likely than controls to have a SUD diagnosed in adolescence and were more likely to have alcohol (adjusted OR 14.38, 95% CI 1.49–138.88) and drug (adjusted OR 3.48, 95% CI 1.38–8.79) dependence in adulthood. The subgroup of participating ADHD cases who did not have SUD during adolescence were no more likely than controls to develop new onset alcohol dependence as adults, although they were significantly more likely to develop new onset drug dependence. Conclusions Our study found preliminary evidence that adults with childhood ADHD are more susceptible than peers to developing drug dependence, a disorder associated with neurological changes in the brain. The relationship between ADHD and

  17. Trends in use of opioids for chronic non-cancer pain among individuals with mental health and substance use disorders: the TROUP study

    PubMed Central

    Edlund, Mark J.; Martin, Bradley C.; Devries, Andrea; Fan, Ming-Yu; Braden, Jennifer Brennan; Sullivan, Mark D.

    2010-01-01

    Objectives Use of prescription opioids for chronic pain is increasing, as is abuse of these medications, though the nature of the link between these trends is unclear. These increases may be most marked in patients with mental health (MH) and substance use disorders (SUDs). We analyzed trends between 2000 and 2005 in opioid prescribing among individuals with non-cancer pain conditions (NCPC), with and without MH and SUDs. Methods Secondary data analysis of longitudinal administrative data from two dissimilar populations: a national, commercially-insured population, and Arkansas Medicaid enrollees. We examined these opioid outcomes: (1) Rates of any prescription opioid use in the past year, (2) rates of chronic use of prescription opioids (greater than 90 days in the past year), (3) mean days supply of opioids, (4) mean daily opioid dose in morphine equivalents, and (5) percentage of total opioid dose that was Schedule II opioids. Results In 2000, among individuals with NCPC, chronic opioid use was more common among those with a MH or SUD than those without in commercially insured (8% versus 3%, p<0.001) and Arkansas Medicaid (20% versus 13%, p<0.001). Between 2000 and 2005, in commercially insured, rates of chronic opioid use increased by 34.9% among individuals with an MH or SUD, and 27.8% among individuals without these disorders. In Arkansas Medicaid chronic opioid use increased 55.4% among individuals with an MH or SUD, and 39.8% among those without. Discussion Chronic use of prescription opioids for NCPC is much higher and growing faster in patients with MH and SUDs than those without these diagnoses. Clinicians should monitor use of prescription opioids in these vulnerable groups to determine whether opioids are substituting for or interfering with appropriate mental health and substance abuse treatment. PMID:20026946

  18. HIV/Sexually Transmitted Infection Risk Behaviors in Delinquent Youth With Psychiatric Disorders: A Longitudinal Study

    PubMed Central

    Elkington, Katherine S.; Teplin, Linda A.; Mericle, Amy A.; Welty, Leah J.; Romero, Erin G.; Abram, Karen M.

    2009-01-01

    Objectives To examine the prevalence and persistence of 20 HIV/sexually transmitted infection (STI) sexual and drug use risk behaviors and to predict their occurrence in 4 mutually exclusive diagnostic groups of delinquent youth: (1) major mental disorders (MMD); (2) substance use disorders (SUD); (3) comorbid MMD and SUD (MMD+SUD); and (4) neither disorder. Methods At the baseline interview, HIV/STI risk behaviors were assessed in 800 juvenile detainees, aged 10 to 18 years; youth were reinterviewed approximately 3 years later. The final sample (n = 689) includes 298 females and 391 males. Results The prevalence and persistence of HIV/STI risk behaviors was high in all diagnostic groups. Youth with SUD at baseline were over 10 times more likely to be sexually active and to have vaginal sex at follow-up than youth with MMD+SUD (AOR=10.86, 95% CI=1.43–82.32; AOR=11.63, 95% CI=1.49–90.89, respectively) and four times more likely to be sexually active and to have vaginal sex than youth with neither disorder (AOR=4.20, 95% CI=1.06–16.62; AOR=4.73, 95% CI=1.21–18.50, respectively). Youth with MMD at baseline were less likely to have engaged in unprotected vaginal and oral sex at follow-up compared with youth with neither disorder (AOR=0.11, 95% CI=0.02–0.50; AOR=0.07, 95% CI=0.01–0.34, respectively), and with youth with SUD (AOR=0.10, 95% CI=0.02–0.50; OR=0.10, 95% CI=0.02–0.47, respectively). Youth with MMD+SUD were less likely (AOR=0.28, 95% CI=0.09–0.92) to engage in unprotected oral sex compared with those with neither disorder. Conclusions Irrespective of diagnostic group, delinquent youth are at great risk for HIV/STIs as they age into adulthood. SUD increases risk. Because detained youth are released after approximately 2 weeks, their risk behaviors become a community health problem. Pediatricians and child psychiatrists must collaborate with corrections professionals to develop HIV/STI interventions and ensure that programs started in detention

  19. Posttraumatic Stress Disorder and Substance Use Disorders in College Students

    PubMed Central

    Borsari, Brian; Read, Jennifer P.; Campbell, James F.

    2009-01-01

    Research indicates that many college students report post-traumatic stress disorder (PTSD) or substance use disorder (SUD), yet there has been scant attention paid to the co-occurrence of these disorders in college students. This review examines the co-occurrence of PTSD and SUD in college students. Recommendations for counseling centers are provided regarding the assessment of this population, an overview of treatment issues, and three areas of clinical importance when working with this population: risk behaviors, interpersonal violence, and social isolation. Future directions for research are also suggested. PMID:19834572

  20. PREFACE: International Conference on Many Particle Spectroscopy of Atoms, Molecules, Clusters and Surfaces

    NASA Astrophysics Data System (ADS)

    Dowek, Danielle; Bennani, Azzedine; Lablanquie, Pascal; Maquet, Alfred

    2008-12-01

    The 2008 edition of the International Conference on Many Particle Spectroscopy of Atoms, Molecules, Clusters and Surfaces was held in Paris from 30 June to 2 July 2008. This biennial conference alternates with the International Symposium on (e,2e), Double Photoionization and Related Topics which is a satellite of the International Conference on Photonic, Electronic and Atomic Collisions (ICPEAC) conference. Over 110 participants from 20 countries gathered to examine the latest developments in the field of radiation interactions with matter. These include electron-electron correlation effects in excitation and in single and multiple ionization of atoms, molecules, clusters and surfaces with various projectiles: electrons, photons and ions. The present proceedings gathers the contributions of invited speakers and is intended to provide a detailed state-of-the-art account of the various facets of the field. Special thanks are due to Université Paris Sud XI, CNRS, and the laboratories LCAM, LIXAM and LCPMR which provided financial support for the organization of the conference. We are also grateful to the contribution of the companies Varian and RoentDek Handels GmbH. Guest Editors: Danielle Dowek and Azzedine Bennani LCAM, Université Paris Sud XI, France Pascal Lablanquie and Alfred Maquet LCPMR, Université Pierre et Marie Curie, Paris, France INTERNATIONAL SCIENTIFIC COMMITTEE Lorenzo Avaldi, (Italy) Alexei Grum Grzhimailo, (Russia) Klaus Bartschat, (USA) Nikolai Kabachnik, (Russia) Jamal Berakdar, (Germany) Birgit Lohmann, (Australia) Nora Berrah, (USA) Don H Madison, (USA) Michael Brunger, (Australia) Francis Penent, (France) Albert Crowe, (UK) Bernard Piraux, (Belgium) Claude Dal Cappello, (France) Roberto Rivarola, (Argentina) JingKang Deng, (China) Emma Sokkel, (Ireland) Alexander Dorn, (Germany) Giovanni Stefani, (Italy) Reinhardt Dorner, (Germany) Noboru Watanabe, (Japan) François Frémont, (France) LOCAL ORGANIZING COMMITTEE Azzedine BENNANI (Chair

  1. for Residents: A Literature Review and Case Study

    ERIC Educational Resources Information Center

    Wamsley, Maria A.; Julian, Katherine A.; O'Sullivan, Patricia; Satterfield, Jason M.; Satre, Derek D.; McCance-Katz, Elinore; Batki, Steven L.

    2013-01-01

    Objectives: Resident physicians report insufficient experience caring for patients with substance use disorders (SUDs). Resident training in Screening, Brief Intervention, and Referral to Treatment (SBIRT) has been recommended. We describe the development of a standardized patient (SP) assessment to measure SBIRT skills, resident perceptions of…

  2. Onset of Alcohol or Substance Use Disorders Following Treatment for Adolescent Depression

    ERIC Educational Resources Information Center

    Curry, John; Silva, Susan; Rohde, Paul; Ginsburg, Golda; Kennard, Betsy; Kratochvil, Christopher; Simons, Anne; Kirchner, Jerry; May, Diane; Mayes, Taryn; Feeny, Norah; Albano, Anne Marie; Lavanier, Sarah; Reinecke, Mark; Jacobs, Rachel; Becker-Weidman, Emily; Weller, Elizabeth; Emslie, Graham; Walkup, John; Kastelic, Elizabeth; Burns, Barbara; Wells, Karen; March, John

    2012-01-01

    Objective: This study tested whether positive response to short-term treatment for adolescent major depressive disorder (MDD) would have the secondary benefit of preventing subsequent alcohol use disorders (AUD) or substance use disorders (SUD). Method: For 5 years, we followed 192 adolescents (56.2% female; 20.8% minority) who had participated in…

  3. Measurement error and outcome distributions: Methodological issues in regression analyses of behavioral coding data.

    PubMed

    Holsclaw, Tracy; Hallgren, Kevin A; Steyvers, Mark; Smyth, Padhraic; Atkins, David C

    2015-12-01

    Behavioral coding is increasingly used for studying mechanisms of change in psychosocial treatments for substance use disorders (SUDs). However, behavioral coding data typically include features that can be problematic in regression analyses, including measurement error in independent variables, non normal distributions of count outcome variables, and conflation of predictor and outcome variables with third variables, such as session length. Methodological research in econometrics has shown that these issues can lead to biased parameter estimates, inaccurate standard errors, and increased Type I and Type II error rates, yet these statistical issues are not widely known within SUD treatment research, or more generally, within psychotherapy coding research. Using minimally technical language intended for a broad audience of SUD treatment researchers, the present paper illustrates the nature in which these data issues are problematic. We draw on real-world data and simulation-based examples to illustrate how these data features can bias estimation of parameters and interpretation of models. A weighted negative binomial regression is introduced as an alternative to ordinary linear regression that appropriately addresses the data characteristics common to SUD treatment behavioral coding data. We conclude by demonstrating how to use and interpret these models with data from a study of motivational interviewing. SPSS and R syntax for weighted negative binomial regression models is included in online supplemental materials.

  4. Sudden unexplained death syndrome--a new manifestation in melioidosis?

    PubMed Central

    Yap, E. H.; Chan, Y. C.; Goh, K. T.; Chao, T. C.; Heng, B. H.; Thong, T. W.; Tan, H. C.; Thong, K. T.; Jacob, E.; Singh, M.

    1991-01-01

    The indirect haemagglutination (IHA) test using sensitized turkey erythrocytes and the indirect immunofluorescence assay (IgM-IFA) was confirmed to be sensitive in the detection of a recent or current Pseudomonas pseudomallei infection in 19 culture-confirmed Singapore melioidosis patients. All were found to have antibody titres from 4 to 32768 in the IHA test and 10 to 320 in the IgM-IFA test. When these tests were employed on sera from 16 immigrant Thai construction workers who died of sudden unexplained death syndrome (SUDS) and 73 healthy Thai fellow workers, 93.8% and 68.8% of SUDS cases had IHA titre of greater than or equal to 4 and IgM-IFA titre of greater than or equal to 10 respectively, in contrast to 39.7% and 12.3% found among healthy Thai workers. These data indicate that at the time of death, most of the SUDS patients had an active infection with P. pseudomallei, possibly resulting from reactivation of a latent infection. The aetiological role of P. pseudomallei as the major cause of SUDS is discussed. PMID:1721589

  5. 78 FR 75345 - Notice of Agreements Filed

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-12-11

    ...@fmc.gov . Agreement No.; 011314-002. Title: CSAV/Trans Global Cooperative Working Agreement. Parties: Compania Sud Americana de Vapores S.A. and Trans Global Shipping NV. Filing Party: Walter H. Lion Esq.; Mc... party Swordfish Shipping Inc. to Trans Global Shipping NV and changes the agreement's termination...

  6. Racial/Ethnic Differences in Treatment for Substance Use Disorders among U.S. Adolescents

    ERIC Educational Resources Information Center

    Cummings, Janet R.; Wen, Hefei; Druss, Benjamin G.

    2011-01-01

    Objective: This study examined differences in treatment rates for substance use disorders (SUD) among adolescents of white, black, Hispanic, Asian, Native American/Alaska Native, and Native Hawaiian/Pacific Islander race/ethnicity. Method: Eight years of cross-sectional data (2001-2008) were pooled from the National Survey on Drug Use and Health…

  7. Normative Feedback and Adolescent Readiness to Change: A Small Randomized Trial

    ERIC Educational Resources Information Center

    Smith, Douglas C.; Davis, Jordan P.; Ureche, Daniel J.; Tabb, Karen M.

    2015-01-01

    For adolescents with substance use problems, it is unknown whether the provision of normative feedback is a necessary active ingredient in motivational interviewing (MI). This study investigated the impact of normative feedback on adolescents' readiness to change and perceptions of MI quality. Adolescents referred for substance use disorder (SUD)…

  8. Substance Use Disorder and ADHD: Is ADHD a Particularly "Specific" Risk Factor?

    ERIC Educational Resources Information Center

    Kousha, Maryam; Shahrivar, Zahra; Alaghband-rad, Javad

    2012-01-01

    Objective: To assess the pattern of substance use disorder (SUD) in adolescents with and without history of attention-deficit/hyperactivity disorder (ADHD) using an Iranian sample in the context of a cultural background and drug availability is differing from Western countries. Method: In this case-control study, the participants were interviewed…

  9. Trajectories of Substance Use Disorders in Youth: Identifying and Predicting Group Memberships

    ERIC Educational Resources Information Center

    Lee, Chih-Yuan S.; Winters, Ken C.; Wall, Melanie M.

    2010-01-01

    This study used latent class regression to identify latent trajectory classes based on individuals' diagnostic course of substance use disorders (SUDs) from late adolescence to early adulthood as well as to examine whether several psychosocial risk factors predicted the trajectory class membership. The study sample consisted of 310 individuals…

  10. Exploring Clinical Psychology Doctoral Students' Attitudes towards Adults with Substance Use Disorders

    ERIC Educational Resources Information Center

    Mundon, Chandra R.

    2013-01-01

    This study sought to determine whether clinical psychology doctoral students hold uniquely stigmatizing views of adults with substance use disorders (SUDs) compared to adults with other clinical disorders. Through the use of clinical vignettes and attitudinal measures, three hypotheses investigated clinical psychology doctoral students'…

  11. Exploring Massachusetts Health Care Reform Impact on Fee-for-Service-Funded Substance Use Disorder Treatment Providers.

    PubMed

    Fields, Dail; Pruett, Jana; Roman, Paul M

    2015-01-01

    The Affordable Care Act (ACA) is forecast to increase the demand for and utilization of substance use disorder (SUD) treatment. Massachusetts implemented health reforms similar to the ACA in 2006-2007 that included expanding coverage for SUD treatment. This study explored the impact of Massachusetts health reforms from 2007 to 2010 on SUD treatment providers in Massachusetts, who relied on fee-for-service billings for more than 50% of their revenue. The changes across treatment facilities located in Massachusetts were compared to changes in other similar fee-for-service-funded SUD treatment providers in Northeast states bordering Massachusetts and in all other states across the US. From 2007-2010, the percentage changes for Massachusetts based providers were significantly different from the changes among providers located in the rest of the US for admissions, outpatient census, average weeks of outpatient treatment, residential/in-patient census, detoxification census, length of average inpatient and outpatient stays, and provision of medication-assisted treatment. Contrary to previous studies of publicly funded treatment providers, the results of this exploratory study of providers dependent on fee-for-service revenues were consistent with some predictions for the overall effects of the ACA. PMID:26514378

  12. The Experiences of Advanced Practice Nurses Caring for Patients with Substance Use Disorder and Chronic Pain.

    PubMed

    St Marie, Barbara

    2016-10-01

    Management of chronic pain is a challenge shared by healthcare providers in various clinical settings. The epidemic of opioid misuse has escalated this challenge. A gap exists in understanding barriers and facilitators to practices of advanced practice registered nurses (APRNs) caring for patients with chronic pain and substance use disorder (SUD). The purpose of this study was to examine the APRNs' experiences while caring for patients with coexisting SUD and chronic pain to help envision better ways to manage pain and direct educational initiatives. Qualitative narrative method. Telephone interviews. Twenty APRNs caring for patients with coexisting SUD and chronic pain were recruited nationwide through the American Society for Pain Management Nursing list serve. Semistructured interviews with thematic analysis. Participants identified 1) a shift of patients from other healthcare providers into the APRNs' practices; 2) barriers to accessing nonmedical modalities for managing pain, including insurance coverage, geographic location, and the patient's desire for only medication management; 3) the role of the APRN in caring for this population contained subthemes of educating and guiding patients through a process of change, applying risk strategies to keep patients safe, and educating colleagues on implementing risk management strategies while prescribing opioids. The APRNs identified barriers to providing care for patients with coexisting SUD and chronic pain. They also described the role of APRNs in providing focused education regarding risk management strategies for assessment, prescribing opioids to manage pain, and minimizing risk. PMID:27567096

  13. Managing Chronic Pain in Adults with or in Recovery from Substance Use Disorders. Treatment Improvement Protocol (TIP) Series 54

    ERIC Educational Resources Information Center

    Substance Abuse and Mental Health Services Administration, 2012

    2012-01-01

    Chronic noncancer pain (CNCP) is common in the general population as well as in people who have a substance use disorder (SUD) (Exhibit 1-1). Chronic pain is not harmless; it has physiological, social, and psychological dimensions that can seriously harm health, functioning, and well-being. As a multidimensional condition with both objective and…

  14. German-French Case Study: Using Multi-Online Tools to Collaborate across Borders

    ERIC Educational Resources Information Center

    Brautlacht, Regina; Ducrocq, Csilla

    2013-01-01

    This paper examines how students learn to collaborate in English by participating in an intercultural project that focuses on teaching students to work together on a digital writing project using various online tools, and documents their reflections working in an intercultural context. Students from Université Paris Sud Orsay and Bonn…

  15. Concordance between Measures of Anxiety and Physiological Arousal Following Treatment of Panic Disorder in Adolescence

    ERIC Educational Resources Information Center

    Bacow, Terri Landon; May, Jill Ehrenreich; Choate-Summers, Molly; Pincus, Donna B.; Mattis, Sara G.

    2010-01-01

    This study examined the concordance (or synchrony/desynchrony) between adolescents' self-reports of anxiety and physiological measures of arousal (heart rate) both prior to and after treatment for panic disorder. Results indicated a decline in reported subjective units of distress (SUDS) for the treatment group only at the post-treatment…

  16. Substance use disorders and HIV in Vietnam since Doi Moi (Renovation): an overview.

    PubMed

    Giang, Le Minh; Ngoc, Lung Bich; Hoang, Vu Huy; Mulvey, Kevin; Rawson, Richard A

    2013-12-01

    Drawing from published and gray literature, this manuscript focuses on the following topics: (1) changing patterns of substance use and abuse in Vietnam since the early 1990s; (2) the roles of substance use in the HIV epidemic; (3) the responses of the Vietnamese government and other entities (both domestic and international) to substance use disorders (SUDs) and HIV; and (4) the current research capacity in Vietnam and ways in which furthering research in Vietnam could enrich our knowledge of the linkages between SUDs and HIV and of effective measures to reduce their public health consequences. A growing number of studies during the past two decades show dynamic and still evolving twin epidemics of SUDs and HIV in Vietnam, including a shift from consumption of opium to heroin and amphetamine-type stimulants, the concurrent use of drugs, and the increasing embrace by the government of internationally recognized effective responses (including harm reduction and methadone substitution therapy). And yet, remaining issues, such as the rapid ascendance of amphetamine-type stimulant use among the country's most vulnerable populations, the lack of effective integration of SUD and HIV services for HIV-infected drug users, and the reliance on international resources for maintaining quality services, among others, are posing challenges for building sustainable Vietnamese responses. Therefore, building local research and training capacity is a crucial foundation to meet these challenges.

  17. Evidence for a Multi-Dimensional Latent Structural Model of Externalizing Disorders

    ERIC Educational Resources Information Center

    Witkiewitz, Katie; King, Kevin; McMahon, Robert J.; Wu, Johnny; Luk, Jeremy; Bierman, Karen L.; Coie, John D.; Dodge, Kenneth A.; Greenberg, Mark T.; Lochman, John E.; Pinderhughes, Ellen E.

    2013-01-01

    Strong associations between conduct disorder (CD), antisocial personality disorder (ASPD) and substance use disorders (SUD) seem to reflect a general vulnerability to externalizing behaviors. Recent studies have characterized this vulnerability on a continuous scale, rather than as distinct categories, suggesting that the revision of the…

  18. Discriminability of personality profiles in isolated and Co-morbid marijuana and nicotine users.

    PubMed

    Ketcherside, Ariel; Jeon-Slaughter, Haekyung; Baine, Jessica L; Filbey, Francesca M

    2016-04-30

    Specific personality traits have been linked with substance use disorders (SUDs), genetic mechanisms, and brain systems. Thus, determining the specificity of personality traits to types of SUD can advance the field towards defining SUD endophenotypes as well as understanding the brain systems involved for the development of novel treatments. Disentangling these factors is particularly important in highly co morbid SUDs, such as marijuana and nicotine use, so treatment can occur effectively for both. This study evaluated personality traits that distinguish isolated and co-morbid use of marijuana and nicotine. To that end, we collected the NEO Five Factor Inventory in participants who used marijuana-only (n=59), nicotine-only (n=27), both marijuana and nicotine (n=28), and in non-using controls (n=28). We used factor analyses to identify personality profiles, which are linear combinations of the five NEO Factors. We then conducted Receiver Operating Characteristics (ROC) curve analysis to test accuracy of the personality factors in discriminating isolated and co-morbid marijuana and nicotine users from each other. ROC curve analysis distinguished the four groups based on their NEO personality patterns. Results showed that NEO Factor 2 (openness, extraversion, agreeableness) discriminated marijuana and marijuana+nicotine users from controls and nicotine-only users with high predictability. Additional ANOVA results showed that the openness dimension discriminated marijuana users from nicotine users. These findings suggest that personality dimensions distinguish marijuana users from nicotine users and should be considered in prevention strategies.

  19. An Overview of Principles of Effective Treatment of Substance Use Disorders and their Potential Application to Pregnant Cigarette Smokers

    PubMed Central

    Heil, Sarah H.; Scott, Teresa Linares; Higgins, Stephen T.

    2009-01-01

    Cigarette smoking remains a leading preventable cause of poor pregnancy outcomes and infant morbidity and mortality. Despite three decades of research encompassing more than 60 trials and 20,000 pregnant women, cessation rates produced by existing interventions are often low (< 20%), especially among socioeconomically disadvantaged women. This has led to a call for the development and testing of novel interventions. One strategy for identifying novel interventions for pregnant smokers is to examine efficacious interventions for other types of substance use disorders (SUDs). Pregnant smokers share many sociodemographic similarities with other sub-populations of individuals with SUDs, suggesting that interventions efficacious with the latter may also benefit the former. The National Institute on Drug Abuse’s guide, “Principles of Drug Addiction Treatment: A Research-based Guide”, presents empirically validated principles of effective treatments for other SUDs. The present report enumerates these principles, briefly describes some of the empirical evidence supporting them, and explores their potential application to the treatment of smoking during pregnancy. Overall, the results of this exercise suggest much promise for enhancing treatment outcomes for pregnant smokers by borrowing from and extending what has been learned with other populations with SUDs. PMID:19540679

  20. The role of perceived need and health insurance in substance use treatment: implications for the Affordable Care Act.

    PubMed

    Ali, Mir M; Teich, Judith L; Mutter, Ryan

    2015-07-01

    The expansions in insurance coverage under the Patient Protection & Affordable Care Act (ACA) that took full effect in 2014 have been projected to increase the number of users of behavioral health services. By analyzing data from the 2008-2012 National Survey on Drug Use and Health, this paper examines whether health insurance expansion may result in an increase in substance use disorder (SUD) treatment utilization. The study sample includes 18,600 adults with SUD but no diagnosable mental health condition. The analysis finds that over 80% of that population receives no treatment and 97% do not perceive a need for treatment. When they do receive treatment, they are more likely to receive mental health treatment. Using multinomial logistic regression, the study finds that having Medicaid or private insurance is associated with higher likelihood of receiving SUD treatment, but only when individuals perceive a need for it, compared to being uninsured and not perceiving a need for treatment (the reference category). These results indicate that increased service utilization is associated with perceiving a need for substance abuse treatment, implying that outreach initiatives to raise awareness about SUD and the effective role of substance use treatment are needed to enhance the impact of the structural changes to the substance abuse treatment system resulting from the ACA.

  1. Perceptions of behavioral health care among veterans with substance use disorders: results from a national evaluation of mental health services in the Veterans Health Administration.

    PubMed

    Blonigen, Daniel M; Bui, Leena; Harris, Alex H S; Hepner, Kimberly A; Kivlahan, Daniel R

    2014-08-01

    Understanding patients' perceptions of care is essential for health care systems. We examined predictors of perceptions of behavioral health care (satisfaction with care, helpfulness of care, and perceived improvement) among veterans with substance use disorders (SUD; n = 1,581) who participated in a phone survey as part of a national evaluation of mental health services in the U.S. Veterans Health Administration. In multivariate analyses, SUD specialty care utilization and higher mental health functioning were associated positively with all perceptions of care, and comorbid schizophrenia, bipolar, and PTSD were associated positively with multiple perceptions of care. Perceived helpfulness of care was associated with receipt of SUD specialty care in the prior 12 months (adjusted OR = 1.77, p<.001). Controlling for patient characteristics, satisfaction with care exhibited strong associations with perceptions of staff as supportive and empathic, whereas perceived improvement was strongly linked to the perception that staff helped patients develop goals beyond symptom management. Survey responses that account for variation in SUD patients' perceptions of care could inform and guide quality improvement efforts with this population.

  2. ADHD, Substance Use Disorders, and Psychostimulant Treatment: Current Literature and Treatment Guidelines

    ERIC Educational Resources Information Center

    Kollins, Scott H.

    2008-01-01

    Objective: This review explores the relationship between ADHD and substance use disorder (SUD), factors that determine the abuse potential of psychostimulants, and strategies for identifying and treating at-risk ADHD patients. Method: This study uses a Medline review of literature. Results: Psychostimulants, such as methylphenidate and…

  3. Discriminability of personality profiles in isolated and Co-morbid marijuana and nicotine users.

    PubMed

    Ketcherside, Ariel; Jeon-Slaughter, Haekyung; Baine, Jessica L; Filbey, Francesca M

    2016-04-30

    Specific personality traits have been linked with substance use disorders (SUDs), genetic mechanisms, and brain systems. Thus, determining the specificity of personality traits to types of SUD can advance the field towards defining SUD endophenotypes as well as understanding the brain systems involved for the development of novel treatments. Disentangling these factors is particularly important in highly co morbid SUDs, such as marijuana and nicotine use, so treatment can occur effectively for both. This study evaluated personality traits that distinguish isolated and co-morbid use of marijuana and nicotine. To that end, we collected the NEO Five Factor Inventory in participants who used marijuana-only (n=59), nicotine-only (n=27), both marijuana and nicotine (n=28), and in non-using controls (n=28). We used factor analyses to identify personality profiles, which are linear combinations of the five NEO Factors. We then conducted Receiver Operating Characteristics (ROC) curve analysis to test accuracy of the personality factors in discriminating isolated and co-morbid marijuana and nicotine users from each other. ROC curve analysis distinguished the four groups based on their NEO personality patterns. Results showed that NEO Factor 2 (openness, extraversion, agreeableness) discriminated marijuana and marijuana+nicotine users from controls and nicotine-only users with high predictability. Additional ANOVA results showed that the openness dimension discriminated marijuana users from nicotine users. These findings suggest that personality dimensions distinguish marijuana users from nicotine users and should be considered in prevention strategies. PMID:27086256

  4. Characteristics of Youth Presenting to a Canadian Youth Concurrent Disorders Program: Clinical Complexity, Trauma, Adaptive Functioning and Treatment Priorities

    PubMed Central

    Catchpole, Rosalind E. H.; Brownlie, E. B.

    2016-01-01

    Objective: This study describes clinical characteristics of youth presenting for service at a Canadian youth concurrent mental health and substance use disorders (SUD) program. Method: Participants were 100 adolescents and emerging adults (aged 14–25) who attended a Canadian concurrent mental health and substance use disorders outpatient program. SUDs were assigned using the Structured Clinical Interview for DSM-IV. Self-reported mental health symptoms, trauma exposure and adaptive functioning were also assessed. Results: Eighty-three percent of participants scored over the clinical cut-off on at least one mental health scale and 33% reported at least one suicide attempt. Sixty-six percent met criteria for a current SUD; 96% met lifetime criteria. Exposure to adverse events was nearly universal (94%). Almost half of female (46%) and almost a third of male (31%) participants endorsed symptoms consistent with posttraumatic stress disorder (PTSD). Youth reported impairment and need for support in multiple domains of functioning, including school, peer, family and mental health. Substance use was least likely to be identified as a treatment priority. Conclusions: High rates of adverse events and PTSD highlight the need for trauma-informed care when providing services to this vulnerable population. Functional impairment in domains related to developmental transitions and tasks underscores the need for a developmental lens and integrated treatment that goes beyond mental health and SUD symptoms and addresses developmentally relevant domains during this transitional age. PMID:27274746

  5. Disparities in Treatment for Substance Use Disorders and Co-Occurring Disorders for Ethnic/Racial Minority Youth

    ERIC Educational Resources Information Center

    Alegria, Margarita; Carson, Nicholas J.; Goncalves, Marta; Keefe, Kristen

    2011-01-01

    Objective: To review the literature on racial and ethnic disparities in behavioral health services and present recent data, focusing on services for substance use disorders (SUD) and comorbid mental health disorders for children and adolescents. Method: A literature review was conducted of behavioral health services for minority youth. Articles…

  6. Distinct facets of impulsivity exhibit differential associations with substance use disorder treatment processes: a cross-sectional and prospective investigation among military veterans.

    PubMed

    Heinz, Adrienne J; Bui, Leena; Thomas, Katherine M; Blonigen, Daniel M

    2015-08-01

    Impulsivity, a multi-faceted construct characterized by rash, unplanned actions and a disregard for long-term consequences, is associated with poor substance use disorder (SUD) treatment outcomes. Little is known though about the influence of impulsivity on treatment process variables critical for initiating and maintaining behavioral change. This knowledge gap is important as different aspects of impulsivity may be susceptible to diverse cognitive, behavioral and pharmacological influences. The present study examined two distinct facets of impulsivity (lack of planning and immoderation--a proxy of urgency) as predictors of processes that impact SUD treatment success (active coping, avoidant coping, self-efficacy, and interpersonal problems). Participants were 200 Veterans who completed impulsivity and treatment process assessments upon entering an SUD treatment program and treatment process assessments at treatment discharge. Results from multivariate models revealed that lack of planning was associated with lower active coping and higher avoidant coping and interpersonal problems at intake, though not with lower self-efficacy to abstain from substances. Immoderation was associated with higher avoidant coping and lower self-efficacy to abstain from substances at intake, but not with lower active coping or higher interpersonal problems. Higher immoderation, but not lack of planning, predicted lower self-efficacy to abstain from substances at treatment discharge. These findings suggest that different facets of impulsivity confer risk for different SUD treatment process indicators and that clinicians should consider the behavioral expression of patients' impulse control problems in treatment planning and delivery.

  7. Characteristics of students participating in collegiate recovery programs: a national survey.

    PubMed

    Laudet, Alexandre B; Harris, Kitty; Kimball, Thomas; Winters, Ken C; Moberg, D Paul

    2015-04-01

    Relapse rates are high among individuals with substance use disorders (SUD), and for young people pursuing a college education, the high rates of substance use on campus can jeopardize recovery. Collegiate Recovery Programs (CRPs) are an innovative campus-based model of recovery support that is gaining popularity but remains under-investigated. This study reports on the first nationwide survey of CRP-enrolled students (N = 486 from 29 different CRPs). Using an online survey, we collected information on background, SUD and recovery history, and current functioning. Most students (43% females, mean age =26) had used multiple substances, had high levels of SUD severity, high rates of treatment and 12-step participation. Fully 40% smoke. Many reported criminal justice involvement and periods of homelessness. Notably, many reported being in recovery from, and currently engaging in multiple behavioral addictions-e.g., eating disorders, and sex and love addiction. Findings highlight the high rates of co-occurring addictions in this under-examined population and underline the need for treatment, recovery support programs and college health services to provide integrated support for mental health and behavioral addictions to SUD--affected young people. PMID:25481690

  8. Molecular autopsy of sudden unexplained death in the young.

    PubMed

    Ackerman, M J; Tester, D J; Driscoll, D J

    2001-06-01

    Sudden unexplained death (SUD) claims over 4,000 persons between the age of 1 and 22 each year in the United States. Nearly half of all pediatric SUD cases have a normal structural autopsy evaluation and are dismissed without a diagnosis. With the discovery of the genetic basis for potentially fatal arrhythmias associated with the inherited long QT syndrome (LQTS), postmortem molecular diagnosis of this disorder is possible. The authors describe the results of a molecular autopsy performed on a 17-year-old boy found dead in bed. A novel clinical test involving an epinephrine challenge in the decedent's mother implicated a potential defect in the phase 3 potassium current encoded by the gene KVLQT1. Exon-specific amplification by polymerase chain reaction and direct DNA sequencing of KVLQT1 revealed a 5-base pair deletion in the genetic material recovered from the decedent's paraffin-embedded heart tissue. The ability to perform molecular autopsies on archived necropsy material undoubtedly will transform the forensic evaluation of SUD. The combination of catecholamine provocation testing in survivors and a postmortem LQTS gene analysis may unmask families with "concealed" LQTS and establish the cause and manner of death in SUDS.

  9. Management of chronic pain with chronic opioid therapy in patients with substance use disorders.

    PubMed

    Chang, Yu-Ping; Compton, Peggy

    2013-12-16

    Substance use disorders (SUDs), whether active or in remission, are often encountered in patients with chronic nonmalignant pain. Clinicians are challenged when managing chronic pain while facing substance abuse issues during the course of chronic opioid therapy (COT). Further, the interrelated behavioral symptomatology of addiction and chronic pain suggests that if one disorder is untreated, effective treatment of the other in not possible. Incomplete understanding of the overlapping presentations of the two disorders, coupled with insufficient management of both conditions, leads to undertreated pain and premature discharge of SUD patients from pain treatment. In order to achieve pain relief and optimal functionality, both conditions need to be carefully managed. This paper reviews the prevalence of SUDs in chronic pain patents; the overlapping presentation of the two disorders; risk factors and stratification for addiction; identification of addiction in the chronic pain population; and suggestions for treating patients with COT, with an emphasis on relapse prevention. With appropriate assessment and treatment, COT for chronic pain patients with a history of SUD can be successful, leading to improved functionality and quality of life.

  10. Psychological interventions for post-traumatic stress disorder and comorbid substance use disorder: A systematic review and meta-analysis.

    PubMed

    Roberts, Neil P; Roberts, Pamela A; Jones, Neil; Bisson, Jonathan I

    2015-06-01

    Co-morbid post-traumatic stress disorder (PTSD) and substance use disorder (SUD) are common, difficult to treat, and associated with poor prognosis. This review aimed to determine the efficacy of individual and group psychological interventions aimed at treating comorbid PTSD and SUD, based on evidence from randomised controlled trials. Our pre-specified primary outcomes were PTSD severity, drug/alcohol use, and treatment completion. We undertook a comprehensive search strategy. Included studies were rated for methodological quality. Available evidence was judged through GRADE. Fourteen studies were included. We found that individual trauma-focused cognitive-behavioural intervention, delivered alongside SUD intervention, was more effective than treatment as usual (TAU)/minimal intervention for PTSD severity post-treatment, and at subsequent follow-up. There was no evidence of an effect for level of drug/alcohol use post-treatment but there was an effect at 5-7 months. Fewer participants completed trauma-focused intervention than TAU. We found little evidence to support the use of individual or group-based non-trauma-focused interventions. All findings were judged as being of low/very low quality. We concluded that there is evidence that individual trauma-focused psychological intervention delivered alongside SUD intervention can reduce PTSD severity, and drug/alcohol use. There is very little evidence to support use of non-trauma-focused individual or group-based interventions.

  11. Examining intensity and types of interagency collaboration between child welfare and drug and alcohol service providers.

    PubMed

    He, Amy S

    2015-08-01

    The co-occurrence of child maltreatment and caregiver substance use disorders (SUDs) is a pervasive problem, with an estimated two thirds of child welfare (CW) systems cases involving SUDs. Interagency collaboration between CW and drug and alcohol service (DAS) providers shows promise in improving connections to and delivery of SUD services for CW-involved families. However, interagency collaboration between CW and DAS providers continues to be difficult to achieve and little is known about organizational characteristics and contexts that influence collaboration between these two entities. Using data from the second cohort of families from the National Survey of Child and Adolescent Well-Being, this study examined national trends in interagency collaboration between CW and DAS providers and organizational factors that influence the nature and intensity of interagency collaboration. Results indicated that collaboration intensity was greater for CW agencies that reported increased caseloads and those located in more populated counties. However, collaboration intensity decreased for CW agencies located in counties with higher child poverty. Study findings have implications for policy leaders and directors of CW agencies throughout the United States, especially because collaborating with DAS providers may increase CW agencies' organizational capacity and relieve job stress related to high caseloads. Development of strategies that spur engagement in more intense and multiple types of collaboration between CW agencies and DAS providers has the potential to relieve service burden on CW staffs and expedite service delivery to CW-involved families dealing with SUDs. PMID:26188423

  12. Measurement error and outcome distributions: Methodological issues in regression analyses of behavioral coding data.

    PubMed

    Holsclaw, Tracy; Hallgren, Kevin A; Steyvers, Mark; Smyth, Padhraic; Atkins, David C

    2015-12-01

    Behavioral coding is increasingly used for studying mechanisms of change in psychosocial treatments for substance use disorders (SUDs). However, behavioral coding data typically include features that can be problematic in regression analyses, including measurement error in independent variables, non normal distributions of count outcome variables, and conflation of predictor and outcome variables with third variables, such as session length. Methodological research in econometrics has shown that these issues can lead to biased parameter estimates, inaccurate standard errors, and increased Type I and Type II error rates, yet these statistical issues are not widely known within SUD treatment research, or more generally, within psychotherapy coding research. Using minimally technical language intended for a broad audience of SUD treatment researchers, the present paper illustrates the nature in which these data issues are problematic. We draw on real-world data and simulation-based examples to illustrate how these data features can bias estimation of parameters and interpretation of models. A weighted negative binomial regression is introduced as an alternative to ordinary linear regression that appropriately addresses the data characteristics common to SUD treatment behavioral coding data. We conclude by demonstrating how to use and interpret these models with data from a study of motivational interviewing. SPSS and R syntax for weighted negative binomial regression models is included in online supplemental materials. PMID:26098126

  13. Psychometric and discriminative properties of the Teen Addiction Severity Index (Brazilian Portuguese version).

    PubMed

    Sartes, Laisa Marcorela A; De Micheli, Denise; Souza-Formigoni, Maria Lucia O

    2009-11-01

    In this study we evaluated the internal consistency of the Brazilian Portuguese version of Teen Addiction Severity Index (T-ASI) and validated its "substance use" area. Evaluating 100 psychoactive substance abusers/dependent adolescents (SUD) and 108 adolescents without such diagnosis (NON-SUD), we found good correlations between the classification by the Composite International Diagnostic Interview (CIDI, used as "gold standard") and the severity (r = 0.73) and composite (r = 0.72) scores of the T-ASI. The area under the ROC curve was 0.88, showing a satisfactory correct classification rate. The internal consistency, evaluated by Cronbach's alpha coefficients, was considered good regarding the substance use (0.89), legal (0.81), and psychiatric (0.80) areas of the T-ASI. The Brazilian Portuguese version of T-ASI presented good internal consistency and a valid substance use area. A comparison between the groups regarding the answers to each question in all the areas was conducted in order to identify which questions in the T-ASI discriminate SUD from NON-SUD adolescents, to have a basis for the proposal of a shorter version of the instrument.

  14. The GSO Data Centre

    NASA Astrophysics Data System (ADS)

    Paletou, F.; Glorian, J.-M.; Génot, V.; Rouillard, A.; Petit, P.; Palacios, A.; Caux, E.; Wakelam, V.

    2015-12-01

    Hereafter we describe the activities of the Grand Sud-Ouest Data Centre operated for INSU (CNRS) by the OMP--IRAP and the Université Paul Sabatier in Toulouse, in a collaboration with the OASU--LAB in Bordeaux and OREME--LUPM in Montpellier.

  15. Longitudinal Examination of Medical Staff Utilization in Substance Use Disorder Treatment Organizations.

    PubMed

    Fields, Dail; Roman, Paul

    2015-12-01

    This study examined changes in utilization of medical staff within organizations specializing in treatment of patients with substance use disorder (SUD) at two points in time (2007 and 2010). Utilization was calculated as the number of hours paid weekly for psychiatrists, physicians, nurses, and other medical staff working as employees or on contract. Study data come from a longitudinal national sample of 274 substance use disorder treatment centers. Average utilization of medical staff by these SUD treatment organizations increased by 26% from 2007 to 2010. The results showed that growing SUD treatment centers that obtained more referrals from health care providers, used case managers to coordinate comprehensive approaches to patient care, provided medication assisted treatment (MAT), and that were connected more closely with hospitals made increased use of medical staff over the 2007-2010 period. In 2010, these organizations seem to have been moving in directions consistent with trends forecasted for the SUD treatment environment after implementation of the Affordable Care Act. PMID:26219681

  16. Substance Abuse and Dependency Risk: The Role of Peer Perceptions, Marijuana Involvement, and Attitudes toward Substance Use among College Students

    ERIC Educational Resources Information Center

    Lewis, Todd F.; Mobley, A. Keith

    2010-01-01

    Many college students are using substances at levels consistent with Substance Abuse or Dependence, yet little explanation for this phenomenon exits. The aim of this study was to explore a risk factor profile that best separates those with low and high potential for having a Substance Use Disorder (SUD). A discriminant function analysis revealed…

  17. Characteristics of students participating in Collegiate Recovery Programs: A national survey

    PubMed Central

    Laudet, Alexandre B.; Harris, Kitty; Kimball, Thomas; Winters, Ken C.; Moberg, D. Paul

    2014-01-01

    Relapse rates are high among individuals with substance use disorders (SUD), and for young people pursuing a college education, the high rates of substance use on campus can jeopardize recovery. Collegiate Recovery Programs (CRPs) are an innovative campus-based model of recovery support that is gaining popularity but remains under-investigated. This study reports on the first nationwide survey of CRP-enrolled students (N = 486 from 29 different CRPs). Using an online survey, we collected information on background, SUD and recovery history, and current functioning. Most students (43% females, mean age = 26) had used multiple substances, had high levels of SUD severity, high rates of treatment and 12-step participation. Fully 40% smoke. Many reported criminal justice involvement and periods of homelessness. Notably, many reported being in recovery from, and currently engaging in multiple behavioral addictions-e.g., eating disorders, and sex and love addiction. Findings highlight the high rates of co-occurring addictions in this under-examined population and underline the need for treatment, recovery support programs and college health services to provide integrated support for mental health and behavioral addictions to SUD-affected young people. PMID:25481690

  18. Developmental epidemiology of drug use and abuse in adolescence and young adulthood: Evidence of generalized risk

    PubMed Central

    Palmer, R.H.C.; Young, S.E.; Hopfer, C.J.; Corley, R.P.; Stallings, M.C.; Crowley, T.J.; Hewitt, J.K.

    2009-01-01

    Past studies highlight a narrowing gender gap and the existence of a shared etiology across substances of abuse; however, few have tested developmental models using longitudinal data. We present data on developmental trends of alcohol, tobacco, and marijuana use, abuse and dependence assessed during adolescence and young adulthood in a community-based Colorado twin sample of 1733 respondents through self-report questionnaires and structured psychiatric interviews. Additionally, we report on the rates of multiple substance use and disorders at each developmental stage, and the likelihood of a substance use disorder (SUD; i.e., abuse or dependence) diagnosis in young adulthood based on adolescent drug involvement. Most notably, we evaluate whether the pattern of multiple substance use and disorders and likelihood ratios across substances support a model of generalized risk. Lastly, we evaluate whether the ranked magnitudes of substance-specific risk match the addiction liability ranking. Substance use and SUDs are developmental phenomena, which increase from adolescence to young adulthood with fewand inconsistent gender differences. Adolescents and young adults are not specialized users, but rather tend to use or abuse multiple substances increasingly with age. Risk analyses indicated that progression toward a SUD for any substance was increased with prior involvement with any of the three substances during adolescence. Despite the high prevalence of alcohol use, tobacco posed the greatest substance-specific risk for developing subsequent problems. Our data also confirm either a generalized risk or correlated risk factors for early onset substance use and subsequent development of SUDs. PMID:19250776

  19. Psychometric and discriminative properties of the Teen Addiction Severity Index (Brazilian Portuguese version).

    PubMed

    Sartes, Laisa Marcorela A; De Micheli, Denise; Souza-Formigoni, Maria Lucia O

    2009-11-01

    In this study we evaluated the internal consistency of the Brazilian Portuguese version of Teen Addiction Severity Index (T-ASI) and validated its "substance use" area. Evaluating 100 psychoactive substance abusers/dependent adolescents (SUD) and 108 adolescents without such diagnosis (NON-SUD), we found good correlations between the classification by the Composite International Diagnostic Interview (CIDI, used as "gold standard") and the severity (r = 0.73) and composite (r = 0.72) scores of the T-ASI. The area under the ROC curve was 0.88, showing a satisfactory correct classification rate. The internal consistency, evaluated by Cronbach's alpha coefficients, was considered good regarding the substance use (0.89), legal (0.81), and psychiatric (0.80) areas of the T-ASI. The Brazilian Portuguese version of T-ASI presented good internal consistency and a valid substance use area. A comparison between the groups regarding the answers to each question in all the areas was conducted in order to identify which questions in the T-ASI discriminate SUD from NON-SUD adolescents, to have a basis for the proposal of a shorter version of the instrument. PMID:19377864

  20. Co-morbidity of substance use disorder and psychopathology in women who use methamphetamine during pregnancy in the US and New Zealand

    PubMed Central

    Wouldes, Trecia A.; LaGasse, Linda L.; Derauf, Chris; Newman, Elana; Shah, Rizwan; Smith, Lynne M.; Arria, Amelia M.; Huestis, Marilyn A.; DellaGrotta, Sheri; Wilcox, Tara; Neal, Charles R.; Lester, Barry M.

    2012-01-01

    BACKGROUND Methamphetamine (MA) abuse is a worldwide problem. Little is known about the co-morbidity of substance use disorders (SUD) and other psychiatric disorders of mothers who use MA prenatally. The Infant Development, Environment and Lifestyle (IDEAL) Study is a prospective, investigation of prenatal MA use and child outcome in the United States (US) and New Zealand (NZ). This study examined prenatal MA use and the co-morbidity of SUD and psychiatric disorders at 1-month postpartum. METHOD Mothers who used MA (US = 127, NZ = 97) were compared to a matched comparison group (US = 193, NZ = 110). The Substance Abuse Subtle Screening Inventory-3 was used to measure the probability of a SUD. The Brief Symptom Inventory was used to measure the likelihood of a positive diagnosis of a psychiatric disorder. RESULTS In US and NZ, the MA groups had lower SES, increased single parenting, delayed prenatal care, increased polydrug use. In the US only, MA mothers had lower income than the comparison group. MA users were 10 times more likely to have a SUD and twice as likely to meet Brief Symptom Inventory criteria for a diagnosable psychiatric disorder. In NZ, but not the US, MA users were five times more likely have co-morbidity of both. This disparity may be due to higher quantities of prenatal alcohol use associated with increased psychiatric symptoms. CONCLUSION These findings suggest that addressing both substance abuse and psychiatric disorders in mothers who use MA may be required to effectively treat maternal MA use. PMID:22789630

  1. Ibogaine and addiction in the animal model, a systematic review and meta-analysis.

    PubMed

    Belgers, M; Leenaars, M; Homberg, J R; Ritskes-Hoitinga, M; Schellekens, A F A; Hooijmans, C R

    2016-01-01

    Ibogaine is a naturally occurring substance which has been increasingly used in the lay-scene to reduce craving and relapse in patients with substance use disorders (SUDs). Although human clinical trials on the safety and efficacy of ibogaine are lacking, animal studies do support the efficacy of ibogaine. In this systematic review and meta-analysis (MA), we summarise these animal findings, addressing three questions: (1) does ibogaine reduce addictive behaviour in animal models of SUDs?; (2) what are the toxic effects of ibogaine on motor functioning, cerebellum and heart rhythm?; (3) what are neuropharmacological working mechanisms of ibogaine treatment in animal models of SUDs? MA of 27 studies showed that ibogaine reduced drug self-administration, particularly during the first 24 h after administration. Ibogaine had no effect on drug-induced conditioned place preference. Ibogaine administration resulted in motor impairment in the first 24 h after supplementation, and cerebral cell loss even weeks after administration. Data on ibogaines effect on cardiac rhythm, as well as on its neuropharmacological working mechanisms are limited. Our results warrant further studies into the clinical efficacy of ibogaine in SUD patients in reducing craving and substance use, but close monitoring of the patients is recommended because of the possible toxic effects. In addition, more work is needed to unravel the neuropharmacological working mechanisms of ibogaine and to investigate its effects on heart rhythm. PMID:27244235

  2. A Randomized Controlled Trial of Pemoline for Attention-Deficit-hyperactivity Disorder in Substance-Abusing Adolescents

    ERIC Educational Resources Information Center

    Riggs, Paula D.; Hall, Shannon K.; Mikulich-Gilbertson, Susan K.; Lohman, Michelle; Kayser, Ashley

    2004-01-01

    Objective: In adolescents with substance use disorder (SUD), comorbid attention-deficit/hyperactivity disorder (ADHD) is associated with greater severity of substance abuse, conduct problems, and worse treatment outcomes. Although many controlled trials have established the efficacy of psychostimulants, including pemoline, for ADHD in children and…

  3. Psychotropic Medications and Substances of Abuse Interactions in Youth

    ERIC Educational Resources Information Center

    Kaminer, Yifrah; Goldberg, Pablo; Connor, Daniel F.

    2010-01-01

    The majority of youth with substance use disorders (SUDs) manifest one or more co-occurring psychiatric disorders. Consequently, many of these youths are being prescribed with psychotropic medications. As prescribing rates continue to increase for early-onset psychiatric disorders, potential risk for substance of abuse-psychiatric medication…

  4. A Collaborative Approach to Teaching Medical Students How to Screen, Intervene, and Treat Substance Use Disorders

    ERIC Educational Resources Information Center

    Neufeld, Karin J.; Alvanzo, Anika; King, Van L.; Feldman, Leonard; Hsu, Jeffrey H.; Rastegar, Darius A.; Colbert, Jorie M.; MacKinnon, Dean F.

    2012-01-01

    Few medical schools require a stand-alone course to develop knowledge and skills relevant to substance use disorders (SUDs). The authors successfully initiated a new course for second-year medical students that used screening, brief intervention, and referral to treatment (SBIRT) as the course foundation. The 15-hour course (39 faculty teaching…

  5. The factor structure of psychiatric comorbidity among Iraq/Afghanistan-era veterans and its relationship to violence, incarceration, suicide attempts, and suicidality.

    PubMed

    Kimbrel, Nathan A; Calhoun, Patrick S; Elbogen, Eric B; Brancu, Mira; Beckham, Jean C

    2014-12-15

    The present research examined how incarceration, suicide attempts, suicidality, and difficulty controlling violence relate to the underlying factor structure of psychiatric comorbidity among a large sample of Iraq/Afghanistan-era veterans (N=1897). Diagnostic interviews established psychiatric diagnoses; self-report measures assessed history of incarceration, difficulty controlling violence, suicide attempts, and suicidality. A 3-factor measurement model characterized by latent factors for externalizing-substance-use disorders (SUD), distress, and fear provided excellent fit to the data. Alcohol-use disorder, drug-use disorder, and nicotine dependence were indicators on the externalizing-SUD factor. Posttraumatic stress disorder and depression were indicators on the distress factor. Panic disorder, social phobia, specific phobia, and obsessive-compulsive disorder were indicators on the fear factor. Incarceration was exclusively predicted by the externalizing-SUD factor. Difficulty controlling violence, suicidality, and suicide attempts were exclusively predicted by the distress factor. Contrary to hypotheses, the path from the externalizing/SUD factor to difficulty controlling violence was not significant. Taken together, these findings suggest that the distress factor of psychiatric comorbidity is a significant risk factor for suicidality, suicide attempts, and difficulty controlling violence and could help to explain the frequent co-occurrence of these critical outcomes among returning Iraq/Afghanistan veterans.

  6. Decision Making Impairment: A Shared Vulnerability in Obesity, Gambling Disorder and Substance Use Disorders?

    PubMed Central

    Mallorquí-Bagué, Nuria; Fagundo, Ana B.; Jimenez-Murcia, Susana; de la Torre, Rafael; Baños, Rosa M.; Botella, Cristina; Casanueva, Felipe F.; Crujeiras, Ana B.; Fernández-García, Jose C.; Fernández-Real, Jose M.; Frühbeck, Gema; Granero, Roser; Rodríguez, Amaia; Tolosa-Sola, Iris; Ortega, Francisco J.; Tinahones, Francisco J.; Alvarez-Moya, Eva; Ochoa, Cristian; Menchón, Jose M.

    2016-01-01

    Introduction Addictions are associated with decision making impairments. The present study explores decision making in Substance use disorder (SUD), Gambling disorder (GD) and Obesity (OB) when assessed by Iowa Gambling Task (IGT) and compares them with healthy controls (HC). Methods For the aims of this study, 591 participants (194 HC, 178 GD, 113 OB, 106 SUD) were assessed according to DSM criteria, completed a sociodemographic interview and conducted the IGT. Results SUD, GD and OB present impaired decision making when compared to the HC in the overall task and task learning, however no differences are found for the overall performance in the IGT among the clinical groups. Results also reveal some specific learning across the task patterns within the clinical groups: OB maintains negative scores until the third set where learning starts but with a less extend to HC, SUD presents an early learning followed by a progressive although slow improvement and GD presents more random choices with no learning. Conclusions Decision making impairments are present in the studied clinical samples and they display individual differences in the task learning. Results can help understanding the underlying mechanisms of OB and addiction behaviors as well as improve current clinical treatments. PMID:27690367

  7. Adolescent Substance Use in the Multimodal Treatment Study of Attention-Deficit/Hyperactivity Disorder (ADHD) (MTA) as a Function of Childhood ADHD, Random Assignment to Childhood Treatments, and Subsequent Medication

    ERIC Educational Resources Information Center

    Molina, Brooke S. G.; Hinshaw, Stephen P.; Arnold, L. Eugene; Swanson, James M.; Pelham, William E.; Hechtman, Lily; Hoza, Betsy; Epstein, Jeffery N.; Wigal, Timothy; Abikoff, Howard B.; Greenhill, Laurence L.; Jensen, Peter S.; Wells, Karen C.; Vitiello, Benedetto; Gibbons, Robert D.; Howard, Andrea; Houck, Patricia R.; Hur, Kwan; Lu, Bo; Marcus, Sue

    2013-01-01

    Objective: To determine long-term effects on substance use and substance use disorder (SUD), up to 8 years after childhood enrollment, of the randomly assigned 14-month treatments in the multisite Multimodal Treatment Study of Children with Attention-Deficit/Hyperactivity Disorder (MTA; n = 436); to test whether medication at follow-up, cumulative…

  8. Rapid Cognitive Screening of Patients with Substance Use Disorders

    PubMed Central

    Copersino, Marc L.; Fals-Stewart, William; Fitzmaurice, Garrett; Schretlen, David J.; Sokoloff, Jody; Weiss, Roger D.

    2011-01-01

    To date, there has not been a time-efficient and resource-conscious way to identify cognitive impairment in patients with substance use disorders (SUD). The present study assesses the validity, accuracy, and clinical utility of a brief (10 min) screening instrument, the Montreal Cognitive Assessment (MoCA), in identifying cognitive impairment among SUD patients. The Neuropsychological Assessment Battery-Screening Module (NAB-SM), a 45-minute battery with known sensitivity to the mild-to-moderate deficits observed in SUD patients, was used as the reference criterion for determining agreement, rates of correct and incorrect decision classifications, and criterion-related validity for the MoCA. Classification accuracy of the MoCA, based on receiver-operating characteristic (ROC) analysis, was strong, with an area under the ROC curve = 0.86 [95% CI: 0.75-0.97]. The MoCA also showed acceptable sensitivity (83.3%) and specificity (72.9%) for the identification of cognitive impairment. Using a cut-off of 25 on the MoCA, the overall agreement was 75.0%; chance-corrected agreement (kappa) was 41.9%. These findings indicate that the MoCA provides a time-efficient and resource-conscious way to identify SUD patients with neuropsychological impairment, thus addressing a critical need in the addiction treatment research community. PMID:19803633

  9. Intraspecific variability of the essential oil of Calamintha nepeta subsp. nepeta from Southern Italy (Apulia).

    PubMed

    Negro, C; Notarnicola, S; De Bellis, L; Miceli, A

    2013-03-01

    The essential oil of 46 spontaneous plants of Calamintha nepeta (L.) Savi subsp. nepeta growing wild in Sud, Italy (Salento, Apulia), were investigated by GC/MS. Fifty-seven components were identified in the oil representing over the 98% of the total oil composition. Four chemotypes were identified: piperitone oxide, piperitenone oxide, piperitone-menthone and pulegone.

  10. Predictors of Decision-Making on the Iowa Gambling Task: Independent Effects of Lifetime History of Substance Use Disorders and Performance on the Trail Making Test

    ERIC Educational Resources Information Center

    Barry, D.; Petry, N. M.

    2008-01-01

    Poor decision-making and executive function deficits are frequently observed in individuals with substance use disorders (SUDs), and executive deficits may contribute to poor decision-making in this population. This study examined the influence of lifetime history of an alcohol, cocaine, heroin, or polysubstance use disorder on decision-making as…

  11. Fate of hydrocarbon pollutants in source and non-source control sustainable drainage systems.

    PubMed

    Roinas, Georgios; Mant, Cath; Williams, John B

    2014-01-01

    Sustainable drainage (SuDs) is an established method for managing runoff from developments, and source control is part of accepted design philosophy. However, there are limited studies into the contribution source control makes to pollutant removal, especially for roads. This study examines organic pollutants, total petroleum hydrocarbons (TPH) and polycyclic aromatic hydrocarbons (PAHs), in paired source and non-source control full-scale SuDs systems. Sites were selected to cover local roads, trunk roads and housing developments, with a range of SuDs, including porous asphalt, swales, detention basins and ponds. Soil and water samples were taken bi-monthly over 12 months to assess pollutant loads. Results show first flush patterns in storm events for solids, but not for TPH. The patterns of removal for specific PAHs were also different, reflecting varying physico-chemical properties. The potential of trunk roads for pollution was illustrated by peak runoff for TPH of > 17,000 μg/l. Overall there was no significant difference between pollutant loads from source and non-source control systems, but the dynamic nature of runoff means that longer-term data are required. The outcomes of this project will increase understanding of organic pollutants behaviour in SuDs. This will provide design guidance about the most appropriate systems for treating these pollutants.

  12. Interactions between Disordered Sleep, Post-Traumatic Stress Disorder, and Substance Use Disorders

    PubMed Central

    Vandrey, Ryan; Babson, Kimberly A.; Herrmann, Evan S.; Bonn-Miller, Marcel O.

    2014-01-01

    Disordered sleep is associated with a number of adverse health consequences and is an integral component of many psychiatric disorders. Rates of substance use disorders (SUDs) are markedly higher among individuals with posttraumatic stress disorder (PTSD), and this relationship may be partly mediated by disturbed sleep. Sleep disturbances (e.g. insomnia, daytime sleepiness, vivid nightmares) are hallmark features of PTSD and there is evidence that individuals with PTSD engage in substance use as a means of coping with these symptoms. However, prolonged substance use can lead to more severe sleep disturbances due to the development of tolerance and withdrawal. Behavioral or pharmacological treatment of disordered sleep is associated with improved daytime symptoms and psychosocial functioning among individuals who have developed PTSD. Initial research also suggests that improving sleep could be similarly beneficial in reducing coping oriented substance use and preventing relapse among those seeking treatment for SUDs. Together, these findings suggest that ameliorating sleep disturbance among at-risk individuals would be a viable target for the prevention and treatment of PTSD and associated SUDs, but prospective research is needed to examine this hypothesis. Enhanced understanding of the interrelation between sleep, PTSD, and SUDs may yield novel prevention and intervention approaches for these costly, prevalent and frequently co-occurring disorders. PMID:24892898

  13. Characteristics of students participating in collegiate recovery programs: a national survey.

    PubMed

    Laudet, Alexandre B; Harris, Kitty; Kimball, Thomas; Winters, Ken C; Moberg, D Paul

    2015-04-01

    Relapse rates are high among individuals with substance use disorders (SUD), and for young people pursuing a college education, the high rates of substance use on campus can jeopardize recovery. Collegiate Recovery Programs (CRPs) are an innovative campus-based model of recovery support that is gaining popularity but remains under-investigated. This study reports on the first nationwide survey of CRP-enrolled students (N = 486 from 29 different CRPs). Using an online survey, we collected information on background, SUD and recovery history, and current functioning. Most students (43% females, mean age =26) had used multiple substances, had high levels of SUD severity, high rates of treatment and 12-step participation. Fully 40% smoke. Many reported criminal justice involvement and periods of homelessness. Notably, many reported being in recovery from, and currently engaging in multiple behavioral addictions-e.g., eating disorders, and sex and love addiction. Findings highlight the high rates of co-occurring addictions in this under-examined population and underline the need for treatment, recovery support programs and college health services to provide integrated support for mental health and behavioral addictions to SUD--affected young people.

  14. Noninvasive brain stimulation to suppress craving in substance use disorders: Review of human evidence and methodological considerations for future work.

    PubMed

    Hone-Blanchet, Antoine; Ciraulo, Domenic A; Pascual-Leone, Alvaro; Fecteau, Shirley

    2015-12-01

    Substance use disorders (SUDs) can be viewed as a pathology of neuroadaptation. The pharmacological overstimulation of neural mechanisms of reward, motivated learning and memory leads to drug-seeking behavior. A critical characteristic of SUDs is the appearance of craving, the motivated desire and urge to use, which is a main focus of current pharmacological and behavioral therapies. Recent proof-of-concept studies have tested the effects of noninvasive brain stimulation on craving. Although its mechanisms of action are not fully understood, this approach shows interesting potential in tuning down craving and possibly consumption of diverse substances. This article reviews available results on the use of repetitive transcranial magnetic stimulation (rTMS) and transcranial electrical stimulation (tES) in SUDs, specifically tobacco, alcohol and psychostimulant use disorders. We discuss several important factors that need to be addressed in future works to improve clinical assessment and effects of noninvasive brain stimulation in SUDs. Factors discussed include brain stimulation devices and parameters, study designs, brain states and subjects' characteristics.

  15. Using Standardized Patients to Evaluate Screening, Brief Intervention, and Referral to Treatment (SBIRT) Knowledge and Skill Acquisition for Internal Medicine Residents

    ERIC Educational Resources Information Center

    Satterfield, Jason M.; O'Sullivan, Patricia; Satre, Derek D.; Tsoh, Janice Y.; Batki, Steven L.; Julian, Kathy; McCance-Katz, Elinore F.; Wamsley, Maria

    2012-01-01

    Comprehensive clinical competency curricula for hazardous drinking and substance use disorders (SUDs) exists for medical students, residents, and practicing health care providers. Evaluations of these curricula typically focus on learner attitudes and knowledge, although changes in clinical skills are of greater interest and utility. The authors…

  16. Fate of hydrocarbon pollutants in source and non-source control sustainable drainage systems.

    PubMed

    Roinas, Georgios; Mant, Cath; Williams, John B

    2014-01-01

    Sustainable drainage (SuDs) is an established method for managing runoff from developments, and source control is part of accepted design philosophy. However, there are limited studies into the contribution source control makes to pollutant removal, especially for roads. This study examines organic pollutants, total petroleum hydrocarbons (TPH) and polycyclic aromatic hydrocarbons (PAHs), in paired source and non-source control full-scale SuDs systems. Sites were selected to cover local roads, trunk roads and housing developments, with a range of SuDs, including porous asphalt, swales, detention basins and ponds. Soil and water samples were taken bi-monthly over 12 months to assess pollutant loads. Results show first flush patterns in storm events for solids, but not for TPH. The patterns of removal for specific PAHs were also different, reflecting varying physico-chemical properties. The potential of trunk roads for pollution was illustrated by peak runoff for TPH of > 17,000 μg/l. Overall there was no significant difference between pollutant loads from source and non-source control systems, but the dynamic nature of runoff means that longer-term data are required. The outcomes of this project will increase understanding of organic pollutants behaviour in SuDs. This will provide design guidance about the most appropriate systems for treating these pollutants. PMID:24569267

  17. Dependency, impulsivity, and self-harm: traits hypothesized to underlie the association between cluster B personality and substance use disorders.

    PubMed

    Casillas, Alex; Clark, Lee Anna

    2002-10-01

    Cluster B personality disorders (PDs) (i.e., antisocial, borderline, histrionic, and narcissistic) typically show a high degree of comorbidity with substance use disorders (SUDs). Previous research suggests that the broad-based personality domains of Disinhibition and Negative Temperament/Neuroticism may be common factors to both types of disorders. Using a two-phase process (i.e., screening and follow-up), this study examined three lower-order personality traits (i.e., dependency, impulsivity, and self-harm) that fall within the Disinhibition and Neuroticism domains. The study evaluated the hypotheses that these traits (a) are related both to cluster B PDs and to SUDs; and (b) underlie the association between the two types of disorders. Results indicate that impulsivity and self-harm play a significant role in cluster B PDs and SUDs, as well as in their association with each other. However, dependency was not associated with either type of disorder. These results indicate that sets of individual traits can be of significant utility in understanding the comorbidity between PDs and SUDs.

  18. The Need and Opportunity to Expand Substance Use Disorder Treatment in School-Based Settings

    ERIC Educational Resources Information Center

    Dennis, Michael L.; Clark, H. Westley; Huang, Larke N.

    2014-01-01

    In this paper, we explore the unmet need for substance use disorder (SUD) treatment among youth, its consequences, and the opportunity to address this gap due to the expansion of behavioral health services to school-based settings under the Parity and Affordable Care Acts. We discuss the importance of using evidence-based approaches to assessment…

  19. Intraspecific variability of the essential oil of Calamintha nepeta subsp. nepeta from Southern Italy (Apulia).

    PubMed

    Negro, C; Notarnicola, S; De Bellis, L; Miceli, A

    2013-03-01

    The essential oil of 46 spontaneous plants of Calamintha nepeta (L.) Savi subsp. nepeta growing wild in Sud, Italy (Salento, Apulia), were investigated by GC/MS. Fifty-seven components were identified in the oil representing over the 98% of the total oil composition. Four chemotypes were identified: piperitone oxide, piperitenone oxide, piperitone-menthone and pulegone. PMID:22646908

  20. 49 CFR Appendix B to Part 178 - Alternative Leakproofness Test Methods

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... the results of the test. The exterior surface of all seams and welds must be coated with a solution of soap suds or a water and oil mixture. The test must be conducted for a period of time sufficient to... packaging must be coated with a soap solution over the entire side seam and a distance of not less...

  1. 49 CFR Appendix B to Part 178 - Alternative Leakproofness Test Methods

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... the results of the test. The exterior surface of all seams and welds must be coated with a solution of soap suds or a water and oil mixture. The test must be conducted for a period of time sufficient to... packaging must be coated with a soap solution over the entire side seam and a distance of not less...

  2. 49 CFR Appendix B to Part 178 - Alternative Leakproofness Test Methods

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... the results of the test. The exterior surface of all seams and welds must be coated with a solution of soap suds or a water and oil mixture. The test must be conducted for a period of time sufficient to... packaging must be coated with a soap solution over the entire side seam and a distance of not less...

  3. 49 CFR Appendix B to Part 178 - Alternative Leakproofness Test Methods

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... the results of the test. The exterior surface of all seams and welds must be coated with a solution of soap suds or a water and oil mixture. The test must be conducted for a period of time sufficient to... packaging must be coated with a soap solution over the entire side seam and a distance of not less...

  4. New directions in management strategy evaluation through cross-fertilization between fisheries science and terrestrial conservation

    PubMed Central

    Milner-Gulland, E. J.; Arroyo, Beatriz; Bellard, Celine; Blanchard, Julia; Bunnefeld, Nils; Delibes-Mateos, Miguel; Edwards, Charles; Nuno, Ana; Palazy, Lucille; Reljic, Slaven; Riera, Pere; Skrbinsek, Tomaz

    2010-01-01

    On 1 and 2 June 2010, an international meeting was held at the University of Paris Sud XI, France, organized within the framework of the EU FP7 consortium project HUNT, to bring together fisheries and conservation scientists to discuss a unified framework for the future of management strategies for harvested species. PMID:20659924

  5. Randomized Controlled Trial of Osmotic-Release Methylphenidate with Cognitive-Behavioral Therapy in Adolescents with Attention-Deficit/Hyperactivity Disorder and Substance Use Disorders

    ERIC Educational Resources Information Center

    Riggs, Paula D.; Winhusen, Theresa; Davies, Robert D.; Leimberger, Jeffrey D.; Mikulich-Gilbertson, Susan; Klein, Constance; Macdonald, Marilyn; Lohman, Michelle; Bailey, Genie L.; Haynes, Louise; Jaffee, William B.; Haminton, Nancy; Hodgkins, Candace; Whitmore, Elizabeth; Trello-Rishel, Kathlene; Tamm, Leanne; Acosta, Michelle C.; Royer-Malvestuto, Charlotte; Subramaniam, Geetha; Fishman, Marc; Holmes, Beverly W.; Kaye, Mary Elyse; Vargo, Mark A.; Woody, George E.; Nunes, Edward V.; Liu, David

    2011-01-01

    Objective: To evaluate the efficacy and safety of osmotic-release methylphenidate (OROS-MPH) compared with placebo for attention-deficit/hyperactivity disorder (ADHD), and the impact on substance treatment outcomes in adolescents concurrently receiving cognitive-behavioral therapy (CBT) for substance use disorders (SUD). Method: This was a…

  6. Using the Autism-Spectrum Quotient to Discriminate Autism Spectrum Disorder from ADHD in Adult Patients with and without Comorbid Substance Use Disorder

    ERIC Educational Resources Information Center

    Sizoo, Bram B.; van den Brink, Wim; Gorissen-van Eenige, Marielle; Koeter, Maarten W.; van Wijngaarden-Cremers, Patricia J. M.; van der Gaag, Rutger Jan

    2009-01-01

    It is unknown whether the Autism-spectrum quotient (AQ) can discriminate between Autism Spectrum Disorder (ASD) and Attention Deficit and Hyperactivity Disorder (ADHD) with or without comorbid Substance Use Disorder (SUD). ANOVA's were used to analyse the mean AQ (sub)scores of 129 adults with ASD or ADHD. We applied receiver operating…

  7. Relationships between substance initiation sequence and further substance use: A French nationwide retrospective study.

    PubMed

    Attaiaa, Lalla-Asma; Beck, Francois; Richard, Jean-Baptiste; Marimoutou, Catherine; Mayet, Aurélie

    2016-06-01

    The Gateway theory (GT) proposes that tobacco or alcohol use lead to cannabis use, which can itself be followed by other illicit drugs (OID) onset. Aim of this study was to evaluate if the order of initiation sequence could influence further substance use. Data from a 2010 population-based survey were used (22,774 subjects aged 15-64). Using reported ages at initiations, 7 sequences were identified: initiation of tobacco only (T), cannabis or OID only, tobacco followed by cannabis (T-C), cannabis followed by tobacco (C-T), alternative 2-substance sequences, gateway sequence (T-C-OID) and 3-substance alternative sequences. Logistics regressions were performed to study the impact of sequence on further use (tobacco, alcohol, cannabis and OID), and substance use disorders (SUD) (tobacco, alcohol and cannabis). The most observed sequences were T (45.5%), T-C (20.5%), C-T (5.1%) and T-C-OID (3.5%). Further use and SUD likelihoods, whatever the substance considered, increased with the number of substances previously initiated. However, for a same number of substances initiated, current use and SUD likelihoods did not significantly vary according to sequence. Polysubstance initiation appears as a better predictor of further use and SUD than the initiation sequence, questioning the GT and being more in line with a common liability to substance use. PMID:26826476

  8. Mapping hazard from urban non-point pollution: a screening model to support sustainable urban drainage planning.

    PubMed

    Mitchell, Gordon

    2005-01-01

    Non-point sources of pollution are difficult to identify and control, and are one of the main reasons that urban rivers fail to reach the water quality objectives set for them. Whilst sustainable drainage systems (SuDS) are available to help combat this diffuse pollution, they are mostly installed in areas of new urban development. However, SuDS must also be installed in existing built areas if diffuse loadings are to be reduced. Advice on where best to locate SuDS within existing built areas is limited, hence a semi-distributed stochastic GIS-model was developed to map small-area basin-wide loadings of 18 key stormwater pollutants. Load maps are combined with information on surface water quality objectives to permit mapping of diffuse pollution hazard to beneficial uses of receiving waters. The model thus aids SuDS planning and strategic management of urban diffuse pollution. The identification of diffuse emission 'hot spots' within a water quality objectives framework is consistent with the 'combined' (risk assessment) approach to pollution control advocated by the EU Water Framework Directive. PMID:15572076

  9. A Practical Clinical Trial of Coordinated Care Management to Treat Substance Use Disorders among Public Assistance Beneficiaries

    ERIC Educational Resources Information Center

    Morgenstern, Jon; Hogue, Aaron; Dauber, Sarah; Dasaro, Christopher; McKay, James R.

    2009-01-01

    This study tested whether coordinated care management (CCM), a continuity of care intervention for substance use disorders (SUD), improved rates of abstinence when compared with usual welfare management for substance-using single adults and adults with dependent children applying for public assistance. The study was designed as a practical…

  10. Brief Report: Autism Spectrum Disorder and Substance Use Disorder: A Review and Case Study

    ERIC Educational Resources Information Center

    Rengit, Ashy C.; McKowen, James W.; O'Brien, Julie; Howe, Yamini J.; McDougle, Christopher J.

    2016-01-01

    There is limited literature available on the comorbidity between autism spectrum disorder (ASD) and substance use disorder (SUD). This paper reviews existing literature and exemplifies the challenges of treating this population with a case report of an adult male with ASD and DSM-5 alcohol use disorder. This review and case study seeks to…

  11. PTSD and Comorbid Disorders in a Representative Sample of Adolescents: The Risk Associated with Multiple Exposures to Potentially Traumatic Events

    ERIC Educational Resources Information Center

    Macdonald, Alexandra; Danielson, Carla Kmett; Resnick, Heidi S.; Saunders, Benjamin E.; Kilpatrick, Dean G.

    2010-01-01

    Objective: This study compared the impact of multiple exposures to potentially traumatic events (PTEs), including sexual victimization, physical victimization, and witnessed violence, on posttraumatic stress disorder (PTSD) and comorbid conditions (i.e., major depressive episode [MDE], and substance use [SUD]). Methods: Participants were a…

  12. Residential family treatment for parents with substance use disorders who are involved with child welfare: two perspectives on program design, collaboration, and sustainability.

    PubMed

    Hammond, Gretchen Clark; McGlone, Amanda

    2013-01-01

    This article discusses the service design, implementation, and evaluation findings of two residential family treatment programs: Wayside House (MN) and OnTrack (OR). Both programs specialize in family-centered services for adults with substance use disorders (SUD) who are involved with child welfare. Information on program design, services offered, and key collaborations are detailed. Implications for program sustainability are provided.

  13. A Pilot Study of the DBT Coach: An Interactive Mobile Phone Application for Individuals with Borderline Personality Disorder and Substance Use Disorder

    ERIC Educational Resources Information Center

    Rizvi, Shireen L.; Dimeff, Linda A.; Skutch, Julie; Carroll, David; Linehan, Marsha M.

    2011-01-01

    Dialectical behavior therapy (DBT) has received strong empirical support and is practiced widely as a treatment for borderline personality disorder (BPD) and BPD with comorbid substance use disorders (BPD-SUD). Therapeutic success in DBT requires that individuals generalize newly acquired skills to their natural environment. However, there have…

  14. Health Disparities in Drug- and Alcohol-Use Disorders: A 12-Year Longitudinal Study of Youths After Detention

    PubMed Central

    Welty, Leah J.; Harrison, Anna J.; Abram, Karen M.; Olson, Nichole D.; Aaby, David A.; McCoy, Kathleen P.; Washburn, Jason J.

    2016-01-01

    Objectives. To examine sex and racial/ethnic differences in the prevalence of 9 substance-use disorders (SUDs)—alcohol, marijuana, cocaine, hallucinogen or PCP, opiate, amphetamine, inhalant, sedative, and unspecified drug— in youths during the 12 years after detention. Methods. We used data from the Northwestern Juvenile Project, a prospective longitudinal study of 1829 youths randomly sampled from detention in Chicago, Illinois, starting in 1995 and reinterviewed up to 9 times in the community or correctional facilities through 2011. Independent interviewers assessed SUDs with Diagnostic Interview Schedule for Children 2.3 (baseline) and Diagnostic Interview Schedule version IV (follow-ups). Results. By median age 28 years, 91.3% of males and 78.5% of females had ever had an SUD. At most follow-ups, males had greater odds of alcohol- and marijuana-use disorders. Drug-use disorders were most prevalent among non-Hispanic Whites, followed by Hispanics, then African Americans (e.g., compared with African Americans, non-Hispanic Whites had 32.1 times the odds of cocaine-use disorder [95% confidence interval = 13.8, 74.7]). Conclusions. After detention, SUDs differed markedly by sex, race/ethnicity, and substance abused, and, contrary to stereotypes, did not disproportionately affect African Americans. Services to treat substance abuse—during incarceration and after release—would reach many people in need, and address health disparities in a highly vulnerable population. PMID:26985602

  15. 77 FR 61615 - Agency Information Collection Activities: Submission for OMB Review; Comment Request

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-10-10

    .../SUD Services--Beginning in 2014, block grant dollars should be used to pay for (1) people who are... that state dollars are being used for people and/or services not otherwise covered. States (or the... monitor the implementation of the Act in their states. States should begin to identify whether people...

  16. Substance use disorders and HIV in Vietnam since Doi Moi (Renovation): an overview.

    PubMed

    Giang, Le Minh; Ngoc, Lung Bich; Hoang, Vu Huy; Mulvey, Kevin; Rawson, Richard A

    2013-12-01

    Drawing from published and gray literature, this manuscript focuses on the following topics: (1) changing patterns of substance use and abuse in Vietnam since the early 1990s; (2) the roles of substance use in the HIV epidemic; (3) the responses of the Vietnamese government and other entities (both domestic and international) to substance use disorders (SUDs) and HIV; and (4) the current research capacity in Vietnam and ways in which furthering research in Vietnam could enrich our knowledge of the linkages between SUDs and HIV and of effective measures to reduce their public health consequences. A growing number of studies during the past two decades show dynamic and still evolving twin epidemics of SUDs and HIV in Vietnam, including a shift from consumption of opium to heroin and amphetamine-type stimulants, the concurrent use of drugs, and the increasing embrace by the government of internationally recognized effective responses (including harm reduction and methadone substitution therapy). And yet, remaining issues, such as the rapid ascendance of amphetamine-type stimulant use among the country's most vulnerable populations, the lack of effective integration of SUD and HIV services for HIV-infected drug users, and the reliance on international resources for maintaining quality services, among others, are posing challenges for building sustainable Vietnamese responses. Therefore, building local research and training capacity is a crucial foundation to meet these challenges. PMID:25278736

  17. Sudestada1, a Drosophila ribosomal prolyl-hydroxylase required for mRNA translation, cell homeostasis, and organ growth

    PubMed Central

    Katz, Maximiliano J.; Acevedo, Julieta M.; Loenarz, Christoph; Galagovsky, Diego; Liu-Yi, Phebee; Pérez-Pepe, Marcelo; Thalhammer, Armin; Sekirnik, Rok; Ge, Wei; Melani, Mariana; Thomas, María G.; Simonetta, Sergio; Boccaccio, Graciela L.; Schofield, Christopher J.; Cockman, Matthew E.; Ratcliffe, Peter J.; Wappner, Pablo

    2014-01-01

    Genome sequences predict the presence of many 2-oxoglutarate (2OG)-dependent oxygenases of unknown biochemical and biological functions in Drosophila. Ribosomal protein hydroxylation is emerging as an important 2OG oxygenase catalyzed pathway, but its biological functions are unclear. We report investigations on the function of Sudestada1 (Sud1), a Drosophila ribosomal oxygenase. As with its human and yeast homologs, OGFOD1 and Tpa1p, respectively, we identified Sud1 to catalyze prolyl-hydroxylation of the small ribosomal subunit protein RPS23. Like OGFOD1, Sud1 catalyzes a single prolyl-hydroxylation of RPS23 in contrast to yeast Tpa1p, where Pro-64 dihydroxylation is observed. RNAi-mediated Sud1 knockdown hinders normal growth in different Drosophila tissues. Growth impairment originates from both reduction of cell size and diminution of the number of cells and correlates with impaired translation efficiency and activation of the unfolded protein response in the endoplasmic reticulum. This is accompanied by phosphorylation of eIF2α and concomitant formation of stress granules, as well as promotion of autophagy and apoptosis. These observations, together with those on enzyme homologs described in the companion articles, reveal conserved biochemical and biological roles for a widely distributed ribosomal oxygenase. PMID:24550463

  18. More Than Just a Break from Treatment: How Substance Use Disorder Patients Experience the Stable Environment in Horse-Assisted Therapy

    PubMed Central

    Kern-Godal, Ann; Brenna, Ida Halvorsen; Arnevik, Espen Ajo; Ravndal, Edle

    2016-01-01

    Inclusion of horse-assisted therapy (HAT) in substance use disorder (SUD) treatment is rarely reported. Our previous studies show improved treatment retention and the importance of the patient–horse relationship. This qualitative study used thematic analysis, within a social constructionist framework, to explore how eight patients experienced contextual aspects of HAT’s contribution to their SUD treatment. Participants described HAT as a “break from usual treatment”. However, four interrelated aspects of this experience, namely “change of focus”, “activity”, “identity”, and “motivation,” suggest HAT is more than just a break from usual SUD treatment. The stable environment is portrayed as a context where participants could construct a positive self: one which is useful, responsible, and accepted; more fundamentally, a different self from the “patient/self” receiving treatment for a problem. The implications extend well beyond animal-assisted or other adjunct therapies. Their relevance to broader SUD policy and treatment practices warrants further study. PMID:27746677

  19. Neural activation during risky decision-making in youth at high risk for substance use disorders.

    PubMed

    Hulvershorn, Leslie A; Hummer, Tom A; Fukunaga, Rena; Leibenluft, Ellen; Finn, Peter; Cyders, Melissa A; Anand, Amit; Overhage, Lauren; Dir, Allyson; Brown, Joshua

    2015-08-30

    Risky decision-making, particularly in the context of reward-seeking behavior, is strongly associated with the presence of substance use disorders (SUDs). However, there has been little research on the neural substrates underlying reward-related decision-making in drug-naïve youth who are at elevated risk for SUDs. Participants comprised 23 high-risk (HR) youth with a well-established SUD risk phenotype and 27 low-risk healthy comparison (HC) youth, aged 10-14. Participants completed the balloon analog risk task (BART), a task designed to examine risky decision-making, during functional magnetic resonance imaging. The HR group had faster reaction times, but otherwise showed no behavioral differences from the HC group. HR youth experienced greater activation when processing outcome, as the chances of balloon explosion increased, relative to HC youth, in ventromedial prefrontal cortex (vmPFC). As explosion probability increased, group-by-condition interactions in the ventral striatum/anterior cingulate and the anterior insula showed increasing activation in HR youth, specifically on trials when explosions occurred. Thus, atypical activation increased with increasing risk of negative outcome (i.e., balloon explosion) in a cortico-striatal network in the HR group. These findings identify candidate neurobiological markers of addiction risk in youth at high familial and phenotypic risk for SUDs.

  20. Distinct Facets of Impulsivity Exhibit Differential Associations with Substance Use Disorder Treatment Processes: A Cross-Sectional and Prospective Investigation Among Military Veterans

    PubMed Central

    Heinz, Adrienne J.; Bui, Leena; Thomas, Katherine M.; Blonigen, Daniel M.

    2015-01-01

    Impulsivity, a multi-faceted construct characterized by rash, unplanned actions and a disregard for long-term consequences, is associated with poor substance use disorder (SUD) treatment outcomes. Little is known though about the influence of impulsivity on treatment process variables critical for initiating and maintaining behavioral change. This knowledge gap is important as different aspects of impulsivity may be susceptible to diverse cognitive, behavioral and pharmacological influences. The present study examined two distinct facets of impulsivity (lack of planning and immoderation - a proxy of urgency) as predictors of processes that impact SUD treatment success (active coping, avoidant coping, self-efficacy, and interpersonal problems). Participants were 200 Veterans who completed impulsivity and treatment process assessments upon entering a SUD treatment program and treatment process assessments at treatment discharge. Results from multivariate models revealed that lack of planning was associated with lower active coping and higher avoidant coping and interpersonal problems at intake, though not with lower self-efficacy to abstain from substances. Immoderation was associated with higher avoidant coping and lower self-efficacy to abstain from substances at intake, but not with lower active coping or higher interpersonal problems. Higher immoderation, but not lack of planning, predicted lower self-efficacy to abstain from substances at treatment discharge. These findings suggest that different facets of impulsivity confer risk for different SUD treatment process indicators and that clinicians should consider the behavioral expression of patients’ impulse control problems in treatment planning and delivery. PMID:25770869

  1. Neural Activation During Risky Decision-Making in Youth at High Risk for Substance Use Disorders

    PubMed Central

    Hulvershorn, Leslie A.; Hummer, Tom A.; Fukunaga, Rena; Leibenluft, Ellen; Finn, Peter; Cyders, Melissa A.; Anand, Amit; Overhage, Lauren; Dir, Allyson; Brown, Joshua

    2015-01-01

    Risky decision-making, particularly in the context of reward-seeking behavior, is strongly associated with the presence of substance use disorders (SUDs). However, there has been little research on the neural substrates underlying reward-related decision-making in drug-naïve youth who are at elevated risk for SUDs. Participants comprised 23 high-risk (HR) youth with a well-established SUD risk phenotype and 27 low-risk healthy comparison (HC) youth, aged 10–14. Participants completed the balloon analog risk task (BART), a task designed to examine risky decision-making, during functional magnetic resonance imaging. The HR group had faster reaction times, but otherwise showed no behavioral differences from the HC group. HR youth experienced greater activation when processing outcome, as the chances of balloon explosion increased, relative to HC youth, in ventromedial prefrontal cortex (vmPFC). As explosion probability increased, group-by-condition interactions in the ventral striatum/anterior cingulate and the anterior insula showed increasing activation in HR youth, specifically on trials when explosions occurred. Thus, atypical activation increased with increasing risk of negative outcome (i.e., balloon explosion) in a cortico-striatal network in the HR group. These findings identify candidate neurobiological markers of addiction risk in youth at high familial and phenotypic risk for SUDs. PMID:26071624

  2. Integrative Interventions for Men with Concurrent Substance Misuse and Trauma: Roles for Mindfulness and Masculinities

    ERIC Educational Resources Information Center

    Foster, Durwin B.; Kelly, Mary Theresa

    2012-01-01

    Men experience higher lifetime trauma rates than women, and they use and misuse substances at rates far exceeding women. Men are also reported to experience significantly higher lifetime rates of comorbid posttraumatic stress disorder (PTSD) and substance use disorder (SUD) than women. Although there is agreement in the clinical field of trauma…

  3. Modeling risk for child abuse and harsh parenting in families with depressed and substance-abusing parents.

    PubMed

    Kelley, Michelle L; Lawrence, Hannah R; Milletich, Robert J; Hollis, Brittany F; Henson, James M

    2015-05-01

    Children with substance abusing parents are at considerable risk for child maltreatment. The current study applied an actor-partner interdependence model to examine how father only (n=52) and dual couple (n=33) substance use disorder, as well as their depressive symptomology influenced parents' own (actor effects) and the partner's (partner effects) overreactivity in disciplinary interactions with their children, as well as their risk for child maltreatment. Parents completed the Center for Epidemiologic Studies Depression Scale (CES-D; Radloff, 1977), the overreactivity subscale from the Parenting Scale (Arnold, O'Leary, Wolff, & Acker, 1993), and the Brief Child Abuse Potential Inventory (Ondersma, Chaffin, Mullins, & LeBreton, 2005). Results of multigroup structural equation models revealed that a parent's own report of depressive symptoms predicted their risk for child maltreatment in both father SUD and dual SUD couples. Similarly, a parent's report of their own depressive symptoms predicted their overreactivity in disciplinary encounters both in father SUD and dual SUD couples. In all models, partners' depressive symptoms did not predict their partner's risk for child maltreatment or overreactivity. Findings underscore the importance of a parent's own level of depressive symptoms in their risk for child maltreatment and for engaging in overreactivity during disciplinary episodes.

  4. Examining intensity and types of interagency collaboration between child welfare and drug and alcohol service providers.

    PubMed

    He, Amy S

    2015-08-01

    The co-occurrence of child maltreatment and caregiver substance use disorders (SUDs) is a pervasive problem, with an estimated two thirds of child welfare (CW) systems cases involving SUDs. Interagency collaboration between CW and drug and alcohol service (DAS) providers shows promise in improving connections to and delivery of SUD services for CW-involved families. However, interagency collaboration between CW and DAS providers continues to be difficult to achieve and little is known about organizational characteristics and contexts that influence collaboration between these two entities. Using data from the second cohort of families from the National Survey of Child and Adolescent Well-Being, this study examined national trends in interagency collaboration between CW and DAS providers and organizational factors that influence the nature and intensity of interagency collaboration. Results indicated that collaboration intensity was greater for CW agencies that reported increased caseloads and those located in more populated counties. However, collaboration intensity decreased for CW agencies located in counties with higher child poverty. Study findings have implications for policy leaders and directors of CW agencies throughout the United States, especially because collaborating with DAS providers may increase CW agencies' organizational capacity and relieve job stress related to high caseloads. Development of strategies that spur engagement in more intense and multiple types of collaboration between CW agencies and DAS providers has the potential to relieve service burden on CW staffs and expedite service delivery to CW-involved families dealing with SUDs.

  5. Residential family treatment for parents with substance use disorders who are involved with child welfare: two perspectives on program design, collaboration, and sustainability.

    PubMed

    Hammond, Gretchen Clark; McGlone, Amanda

    2013-01-01

    This article discusses the service design, implementation, and evaluation findings of two residential family treatment programs: Wayside House (MN) and OnTrack (OR). Both programs specialize in family-centered services for adults with substance use disorders (SUD) who are involved with child welfare. Information on program design, services offered, and key collaborations are detailed. Implications for program sustainability are provided. PMID:26030984

  6. Substance Use and Treatment of Substance Use Disorders in a Community Sample of Transgender Adults

    PubMed Central

    Keuroghlian, Alex S.; Reisner, Sari L.; White, Jaclyn M.; Weiss, Roger D.

    2015-01-01

    Background Transgender people have elevated substance use prevalence compared with the U.S. general population, however no studies have comprehensively examined the relationship of psychosocial risk factors to substance use and substance use disorder (SUD) treatment among both male-to-female (MTF) and female-to-male (FTM) transgender adults. Methods Secondary data analysis of a 2013 community-based survey of transgender adults in Massachusetts (N=452) was conducted. Adjusted multivariable logistic regression models were fit to examine the relationship of four risk factor domains with SUD treatment history and recent substance use: (1) demographics; (2) gender-related characteristics; (3) mental health; (4) socio-structural factors. Adjusted Odds Ratios (aOR) and 95% Confidence Intervals (95% CI) were estimated. Results Ten percent of the sample reported lifetime SUD treatment. Factors associated with significant increase in odds of lifetime SUD treatment alongside recent substance use (all p<0.05) were: (1) older age (aOR=1.02; 95% CI=1.01–1.04), higher educational attainment (aOR=3.59; 95% CI=2.35–5.50), low income (aOR=0.58; 95% CI=0.39–0.86); (2) MTF identity (aOR=3.03; 95% CI=1.95–4.67), gender-affirming medical care (aOR=1.99; 95% CI=1.32–3.00); (3) intimate partner violence (aOR=1.68; 95% CI=1.13–2.49), posttraumatic stress disorder (aOR = 2.56; 95% CI=1.69–3.88), depression (aOR=2.30; 95% CI=1.58–3.35), mental health treatment (aOR=1.65; 95% CI=1.11–2.45); (4) discrimination (aOR=1.90; 95% CI=1.22–2.95), unstable housing (aOR=1.80; 95% CI=1.21–2.67), and sex work (aOR=2.48; 95% CI=1.24–4.95). Conclusions Substance use and SUD treatment among transgender adults are associated with demographic, gender-related, mental health, and socio-structural risk factors. Studies are warranted that identify SUD treatment barriers, and integrate SUD treatment with psychosocial and structural interventions for a diverse spectrum of transgender adults

  7. A clinical approach to the assessment and management of co-morbid eating disorders and substance use disorders

    PubMed Central

    2013-01-01

    Introduction Research has shown that eating disorder (ED) patients who abuse substances demonstrate worse ED symptomatology and poorer outcomes than those with EDs alone, including increased general medical complications and psychopathology, longer recovery times, poorer functional outcomes and higher relapse rates. This article provides a broad overview of the prevalence, aetiology, assessment and management of co-morbid EDs and substance use disorders (SUDs). Review The co-occurrence of EDs and SUDs is high. The functional relationship between EDs and SUDs vary within and across ED subtypes, depends on the class of substance, and needs to be carefully assessed for each patient. Substances such as caffeine, tobacco, insulin, thyroid medications, stimulants or over the counter medications (laxatives, diuretics) may be used to aid weight loss and/or provide energy, and alcohol or psychoactive substances could be used for emotional regulation or as part of a pattern of impulsive behaviour. A key message conveyed in the current literature is the importance of screening and assessment for co-morbid SUDs and EDs in patients presenting with either disorder. There is a paucity of treatment studies on the management of co-occurring EDs and SUDs. Overall, the literature indicates that the ED and SUD should be addressed simultaneously using a multi-disciplinary approach. The need for medical stabilization, hospitalization or inpatient treatment needs to be assessed based on general medical and psychiatric considerations. Common features across therapeutic interventions include psycho-education about the aetiological commonalities, risks and sequelae of concurrent ED behaviours and substance abuse, dietary education and planning, cognitive challenging of eating disordered attitudes and beliefs, building of skills and coping mechanisms, addressing obstacles to improvement and the prevention of relapse. Emphasis should be placed on building a collaborative therapeutic

  8. Cultural adaptation, psychometric properties, and outcomes of the Native American Spirituality Scale.

    PubMed

    Greenfield, Brenna L; Hallgren, Kevin A; Venner, Kamilla L; Hagler, Kylee J; Simmons, Jeremiah D; Sheche, Judith N; Homer, Everett; Lupee, Donna

    2015-05-01

    Spirituality is central to many Native Americans (NAs) and has been associated with recovery from substance use disorders (SUDs). However, no published questionnaire uniquely taps tribal-specific spiritual beliefs and practices. This hinders efforts to integrate traditional NA spirituality into SUD treatment and track spiritual outcomes. As part of a randomized controlled trial examining SUD treatment for NAs, we adapted the Daily Spiritual Experience Scale (DSES) in collaboration with members of a Southwest tribe to create the Native American Spirituality Scale (NASS) and measured changes in the NASS over the course of treatment. The 83 participants (70% male) were from a single Southwest tribe and seeking SUD treatment. They completed the NASS at baseline, 4, 8, and 12 months. Exploratory factor analysis of the NASS was conducted and its temporal invariance, construct validity, and longitudinal changes in the factor and item scores were examined. The NASS yielded a 2-factor structure that was largely invariant across time. Factor 1 reflected behavioral practices, while Factor 2 reflected more global beliefs. Both factors significantly increased across 12 months, albeit at different assessment points. At baseline, Factor 1 was negatively related to substance use and positively associated with measures of tribal identification while Factor 2 was unrelated to these measures. Given the importance of tribal spirituality to many NAs, the development of this psychometrically sound measure is a key precursor and complement to the incorporation of tribal spirituality into treatment, as well as research on mechanisms of change for SUD treatment among NAs and assessment of NA spirituality in relation to other aspects of health.

  9. Autism Spectrum Disorder and Co-occurring Substance Use Disorder – A Systematic Review

    PubMed Central

    Arnevik, Espen Ajo; Helverschou, Sissel Berge

    2016-01-01

    OBJECTIVE Patients with co-occurring autism spectrum disorders (ASD) and substance use disorder (SUD) require special attention from clinical services. Screening for this co-occurrence is not generally an integral part of routine clinical assessments, and failure to identify and understand this group of patients may contribute to a worsening of their symptoms and/or an increase in drug abuse. Thus, there is a need to review the evidence base on patients with co-occurring ASD and SUD in order to enhance clinical practice and future research. METHODS We reviewed all identified papers on patients with co-occurring ASD and SUD. The focus of the review was on epidemiology, patient characteristics, function of drug use, and the effect of current interventions. RESULTS A total of 18 papers were included in the analysis. Eleven papers were based on epidemiological studies, although only one study reported the prevalence of ASD in an SUD population. Two papers explored the role of personality, three papers studied subgroups of individuals serving prison for violent or sexual crimes, and one paper explored the function of drugs in the ASD patient group. There were no studies testing specific treatment interventions. CONCLUSIONS In most of the treatment settings studied, there were relatively few patients with co-occurring ASD and SUD, but due to differences in study samples it was difficult to establish a general prevalence rate. The one consistent finding was the lack of focused treatment studies. There is clearly a need for research on interventions that take account of the special needs of this patient group. PMID:27559296

  10. Brain activity classifies adolescents with and without a familial history of substance use disorders

    PubMed Central

    Qiao, Jianping; Wang, Zhishun; Geronazzo-Alman, Lupo; Amsel, Lawrence; Duarte, Cristiane; Lee, Seonjoo; Musa, George; Long, Jun; He, Xiaofu; Doan, Thao; Hirsch, Joy; Hoven, Christina W.

    2015-01-01

    We aimed to uncover differences in brain circuits of adolescents with parental positive or negative histories of substance use disorders (SUD), when performing a task that elicits emotional conflict, testing whether the brain circuits could serve as endophenotype markers to distinguish these adolescents. We acquired functional magnetic resonance imaging data from 11 adolescents with a positive familial history of SUD (FH+ group) and seven adolescents with a negative familial history of SUD (FH− group) when performing an emotional stroop task. We extracted brain features from the conflict-related contrast images in group level analyses and granger causality indices (GCIs) that measure the causal interactions among regions. Support vector machine (SVM) was applied to classify the FH+ and FH− adolescents. Adolescents with FH+ showed greater activity and weaker connectivity related to emotional conflict, decision making and reward system including anterior cingulate cortex (ACC), prefrontal cortex (PFC), and ventral tegmental area (VTA). High classification accuracies were achieved with leave-one-out cross validation (89.75% for the maximum conflict, 96.71% when combining maximum conflict and general conflict contrast, 97.28% when combining activity of the two contrasts and GCIs). Individual contributions of the brain features to the classification were further investigated, indicating that activation in PFC, ACC, VTA and effective connectivity from PFC to ACC play the most important roles. We concluded that fundamental differences of neural substrates underlying cognitive behaviors of adolescents with parental positive or negative histories of SUD provide new insight into potential neurobiological mechanisms contributing to the elevated risk of FH+ individuals for developing SUD. PMID:25954186

  11. Exercise-based treatments for substance use disorders: evidence, theory, and practicality

    PubMed Central

    Linke, Sarah E.; Ussher, Michael

    2016-01-01

    Background Epidemiological studies reveal that individuals who report risky substance use are generally less likely to meet physical activity guidelines (with the exception of certain population segments, such as adolescents and athletes). A growing body of evidence suggests that individuals with substance use disorders (SUDs) are interested in exercising and that they may derive benefits from regular exercise, in terms of both general health/fitness and SUD recovery. Objectives The aims of this paper were to: (i) summarize the research examining the effects of exercise-based treatments for SUDs; (ii) discuss the theoretical mechanisms and practical reasons for investigating this topic; (iii) identify the outstanding relevant research questions that warrant further inquiry; and (iv) describe potential implications for practice. Methods The following databases were searched for peer-reviewed original and review papers on the topic of substance use and exercise: PubMed Central, MEDLINE, EMBASE, PsycINFO, and CINAHL Plus. Reference lists of these publications were subsequently searched for any missed but relevant manuscripts. Identified papers were reviewed and summarized by both authors. Results The limited research conducted suggests that exercise may be an effective adjunctive treatment for SUDs. In contrast to the scarce intervention trials to date, a relative abundance of literature on the theoretical and practical reasons supporting the investigation of this topic has been published. Conclusions Definitive conclusions are difficult to draw due to diverse study protocols and low adherence to exercise programs, among other problems. Despite the currently limited and inconsistent evidence, numerous theoretical and practical reasons support exercise-based treatments for SUDs, including psychological, behavioral, neurobiological, nearly universal safety profile, and overall positive health effects. PMID:25397661

  12. Parental Substance Abuse As an Early Traumatic Event. Preliminary Findings on Neuropsychological and Personality Functioning in Young Drug Addicts Exposed to Drugs Early.

    PubMed

    Parolin, Micol; Simonelli, Alessandra; Mapelli, Daniela; Sacco, Marianna; Cristofalo, Patrizia

    2016-01-01

    Parental substance use is a major risk factor for child development, heightening the risk of drug problems in adolescence and young adulthood, and exposing offspring to several types of traumatic events. First, prenatal drug exposure can be considered a form of trauma itself, with subtle but long-lasting sequelae at the neuro-behavioral level. Second, parents' addiction often entails a childrearing environment characterized by poor parenting skills, disadvantaged contexts and adverse childhood experiences (ACEs), leading to dysfunctional outcomes. Young adults born from/raised by parents with drug problems and diagnosed with a Substance Used Disorder (SUD) themselves might display a particularly severe condition in terms of cognitive deficits and impaired personality function. This preliminary study aims to investigate the role of early exposure to drugs as a traumatic event, capable of affecting the psychological status of young drug addicts. In particular, it intends to examine the neuropsychological functioning and personality profile of young adults with severe SUDs who were exposed to drugs early in their family context. The research involved three groups, each consisting of 15 young adults (aged 18-24): a group of inpatients diagnosed with SUDs and exposed to drugs early, a comparison group of non-exposed inpatients and a group of non-exposed youth without SUDs. A neuropsychological battery (Esame Neuropsicologico Breve-2), an assessment procedure for personality disorders (Shedler-Westen Assessment Procedure-200) and the Symptom CheckList-90-Revised were administered. According to present preliminary results, young drug addicts exposed to drugs during their developmental age were characterized by elevated rates of neuropsychological impairments, especially at the expense of attentive and executive functions (EF); personality disorders were also common but did not differentiate them from non-exposed youth with SUDs. Alternative multi-focused prevention and

  13. Deficit of circulating stem – progenitor cells in opiate addiction: a pilot study

    PubMed Central

    Reece, Albert S; Davidson, Peter

    2007-01-01

    A substantial literature describes the capacity of all addictive drugs to slow cell growth and potentiate apoptosis. Flow cytometry was used as a means to compare two lineages of circulating progenitor cells in addicted patients. Buprenorphine treated opiate addicts were compared with medical patients. Peripheral venous blood CD34+ CD45+ double positive cells were counted as haemopoietic stem cells (HSC's), and CD34+ KDR+ (VEGFR2+) cells were taken as endothelial progenitor cells (EPC's). 10 opiate dependent patients with substance use disorder (SUD) and 11 non-addicted (N-SUD) were studied. The ages were (mean + S.D.) 36.2 + 8.6 and 56.4 + 18.6 respectively (P <0.01). HSC's were not different in the SUD (2.38 + 1.09 Vs. 3.40 + 4.56 cells/mcl). EPC's were however significantly lower in the SUD (0.09 + 0.14 Vs. 0.26 + 0.20 cells/mcl; No. > 0.15, OR = 0.09, 95% C.I. 0.01–0.97), a finding of some interest given the substantially older age of the N-SUD group. These laboratory data are thus consistent with clinical data suggesting accelerated ageing in addicted humans and implicate the important stem cell pool in both addiction toxicology and ageing. They carry important policy implications for understanding the fundamental toxicology of addiction, and suggest that the toxicity both of addiction itself and of indefinite agonist maintenance therapies may have been seriously underestimated. PMID:17615060

  14. Cultural Adaptation, Psychometric Properties, and Outcomes of the Native American Spirituality Scale

    PubMed Central

    Greenfield, Brenna L.; Hallgren, Kevin A.; Venner, Kamilla L.; Hagler, Kylee J.; Simmons, Jeremiah D.; Sheche, Judith N.; Homer, Everett; Lupee, Donna

    2015-01-01

    Spirituality is central to many Native Americans (NAs) and has been associated with recovery from substance use disorders (SUDs). However, no published questionnaire uniquely taps tribal-specific spiritual beliefs and practices. This hinders efforts to integrate traditional NA spirituality into SUD treatment and track spiritual outcomes. As part of a randomized controlled trial examining SUD treatment for NAs, we adapted the Daily Spiritual Experience Scale (DSES) in collaboration with members of a Southwest tribe to create the Native American Spirituality Scale (NASS) and measured changes in the NASS over the course of treatment. The 83 participants (70% male) were from a single Southwest tribe and seeking SUD treatment. They completed the NASS at baseline, four-, eight-, and 12-months. Exploratory factor analysis of the NASS was conducted and its temporal invariance, construct validity, and longitudinal changes in the factor and item scores were examined. The NASS yielded a two-factor structure that was largely invariant across time. Factor 1 reflected behavioral practices, while Factor 2 reflected more global beliefs. Both factors significantly increased across 12 months, albeit at different assessment points. At baseline, Factor 1 was negatively related to substance use and positively associated with measures of tribal identification while Factor 2 was unrelated to these measures. Given the importance of tribal spirituality to many NAs, the development of this psychometrically sound measure is a key precursor and complement to the incorporation of tribal spirituality into treatment, as well as research on mechanisms of change for SUD treatment among NAs and assessment of NA spirituality in relation to other aspects of health. PMID:25961648

  15. Contribution of the patient–horse relationship to substance use disorder treatment: Patients’ experiences

    PubMed Central

    Brenna, Ida H.; Kogstad, Norunn; Arnevik, Espen A.; Ravndal, Edle

    2016-01-01

    Background A good therapeutic relationship is a strong predictor of successful treatment in addiction and other psychological illness. Recent studies of horse-assisted therapy (HAT) have drawn attention to the importance of the client's relationship to the horse in psychotherapy. Few have reported on the patient's own perspective and none have reported specifically on the human–horse relationship in substance use disorder (SUD) treatment and its implications for health and well-being. Aim This article explores SUD patients’ own experience of their relationship with the horse and their perceptions of its contribution to their therapy. Methods As part of a large mixed-method study of HAT in SUD treatment, we used semi-structured interviews of eight patients to gather information about their experiences of HAT. From the data obtained, the relationship with the horse was found to be a significant part of participants’ HAT experience. It is therefore the subject of the current phenomenological study, in which thematic analysis was used to investigate how the participants constructed the reality of their relationship with the horse(s) and their perceptions of the consequences of that reality in SUD treatment. Results Participants’ own descriptions suggest that the horses were facilitators of a positive self-construct and provided important emotional support during treatment. Analysis found relationship with the horse, emotional effect, and mastery to be important and interrelated themes. The findings were interpreted within an attachment theory context. Conclusion The results appear to be consistent with key addiction treatment theories and with findings in HAT theoretical and empirical studies. They add to our understanding of the impact of HAT on SUD treatment. However, further research is needed into both the construct validity of the patient–horse therapeutic relationship and the possible variance within and between different populations. PMID:27291162

  16. The Use of Virtual Reality in Craving Assessment and Cue-Exposure Therapy in Substance Use Disorders

    PubMed Central

    Hone-Blanchet, Antoine; Wensing, Tobias; Fecteau, Shirley

    2014-01-01

    Craving is recognized as an important diagnosis criterion for substance use disorders (SUDs) and a predictive factor of relapse. Various methods to study craving exist; however, suppressing craving to successfully promote abstinence remains an unmet clinical need in SUDs. One reason is that social and environmental contexts recalling drug and alcohol consumption in the everyday life of patients suffering from SUDs often initiate craving and provoke relapse. Current behavioral therapies for SUDs use the cue-exposure approach to suppress salience of social and environmental contexts that may induce craving. They facilitate learning and cognitive reinforcement of new behavior and entrain craving suppression in the presence of cues related to drug and alcohol consumption. Unfortunately, craving often overweighs behavioral training especially in real social and environmental contexts with peer pressure encouraging the use of substance, such as parties and bars. In this perspective, virtual reality (VR) is gaining interest in the development of cue-reactivity paradigms and practices new skills in treatment. VR enhances ecological validity of traditional craving-induction measurement. In this review, we discuss results from (1) studies using VR and alternative virtual agents in the induction of craving and (2) studies combining cue-exposure therapy with VR in the promotion of abstinence from drugs and alcohol use. They used virtual environments, displaying alcohol and drugs to SUD patients. Moreover, some environments included avatars. Hence, some studies have focused on the social interactions that are associated with drug-seeking behaviors and peer pressure. Findings indicate that VR can successfully increase craving. Studies combining cue–exposure therapy with virtual environment, however, reported mitigated success so far. PMID:25368571

  17. Risk of Criminal Victimisation in Outpatients with Common Mental Health Disorders

    PubMed Central

    Meijwaard, Sabine C.; Kikkert, Martijn; de Mooij, Liselotte D.; Lommerse, Nick M.; Peen, Jaap; Schoevers, Robert A.; Van, Rien; de Wildt, Wencke; Bockting, Claudi L. H.; Dekker, Jack J. M.

    2015-01-01

    Background Crime victimisation is a serious problem in psychiatric patients. However, research has focused on patients with severe mental illness and few studies exist that address victimisation in other outpatient groups, such as patients with depression. Due to large differences in methodology of the studies that address crime victimisation, a comparison of prevalence between psychiatric diagnostic groups is hard to make. Objectives of this study were to determine and compare one-year prevalence of violent and non-violent criminal victimisation among outpatients from different diagnostic psychiatric groups and to examine prevalence differences with the general population. Method Criminal victimisation prevalence was measured in 300 outpatients living in Amsterdam, The Netherlands. Face-to-face interviews were conducted with outpatients with depressive disorder (n = 102), substance use disorder (SUD, n = 106) and severe mental illness (SMI, n = 92) using a National Crime Victimisation Survey, and compared with a matched general population sample (n = 10865). Results Of all outpatients, 61% reported experiencing some kind of victimisation over the past year; 33% reported violent victimisation (3.5 times more than the general population) and 36% reported property crimes (1.2 times more than the general population). Outpatients with depression (67%) and SUD (76%) were victimised more often than SMI outpatients (39%). Younger age and hostile behaviour were associated with violent victimisation, while being male and living alone were associated with non-violent victimisation. Moreover, SUD was associated with both violent and non-violent victimisation. Conclusion Outpatients with depression, SUD, and SMI are at increased risk of victimisation compared to the general population. Furthermore, our results indicate that victimisation of violent and non-violent crimes is more common in outpatients with depression and SUD than in outpatients with SMI living independently in

  18. Integrated Cognitive Behavioral Therapy Versus Cognitive Processing Therapy for Adults With Depression, Substance Use Disorder, and Trauma.

    PubMed

    Haller, Moira; Norman, Sonya B; Cummins, Kevin; Trim, Ryan S; Xu, Xiaomin; Cui, Ruifeng; Allard, Carolyn B; Brown, Sandra A; Tate, Susan R

    2016-03-01

    The comorbidity of substance use disorder (SUD), depression, and PTSD is common among veterans. Prior research has shown that among veterans with SUD and depression, those with PTSD did not maintain cognitive-behavioral treatment gains as well as those without PTSD. Thus, the current study was designed to evaluate whether adding trauma-focused treatment following an initial group-based integrated cognitive behavioral treatment (ICBT) for SUD and depression improved treatment outcomes. Participants were 123 veterans (89% male) recruited from the VA San Diego Healthcare System. All participants received ICBT in twice weekly, group-delivered sessions for 12 weeks (Phase 1). Participants were then randomized to receive 12 sessions of individual follow-up sessions (Phase 2) utilizing either ICBT or cognitive processing therapy that was modified to integrate SUD treatment (CPT-M). Results indicated that PTSD and depression symptoms slightly improved at the end of Phase 1 group ICBT and further improved through Phase 2 individual treatment (except for participants without PTSD who received CPT-M), with treatment gains maintained one year later. Substance use significantly improved at the end of Phase 1 group ICBT and these improvements were maintained through Phase 2 and the one year follow-up. Participants in the trauma-focused Phase 2 treatment (CPT-M) exhibited similar levels of symptom reduction and maintenance of treatment gains as those in the non-trauma-focused Phase 2 treatment (ICBT). However, there was a slight advantage for Phase 2 CPT-M over Phase 2 ICBT with respect to heavy drinking outcomes for individuals with PTSD. Overall, the combination of group ICBT followed by either CPT-M or ICBT individual therapy appears to be effective for veterans with depression, SUD, and trauma history.

  19. Immunohistochemical Analysis of Brainstem Lesions in the Autopsy Cases with Severe Motor and Intellectual Disabilities Showing Sudden Unexplained Death

    PubMed Central

    Hayashi, Masaharu; Sakuma, Hiroshi

    2016-01-01

    It is known that patients with severe motor and intellectual disabilities (SMID) showed sudden unexplained death (SUD), in which autopsy failed to identify causes of death. Although the involvement of brainstem dysfunction is speculated, the detailed neuropathological analysis still remains to be performed. In order to clarify pathogenesis, we investigated the brainstem functions in autopsy cases of SMID showing SUD. We immunohistochemically examined expressions of tyrosine hydroxylase, tryptophan hydroxylase, substance P, methionine-enkephalin, and c-fos in the serial sections of the midbrain, pons, and medulla oblongata in eight SUD cases and seven controls, having neither unexplained death nor pathological changes in the brain. Expressions of tyrosine hydroxylase and tryptophan hydroxylase were reduced in two of eight cases, and those of substance P and/or methionine-enkephalin were augmented in the pons and medulla oblongata in seven of eight cases, including the aforementioned two cases, when compared with those in controls. The hypoglossal nucleus and/or the dorsal vagal nucleus demonstrated increased neuronal immunoreactivity for c-fos in seven of eight cases, although there was no neuronal loss or gliosis in both the nuclei. Controls rarely showed immunoreactivity for c-fos in the medulla oblongata. These data suggest the possible involvement of brainstem dysfunction in SUD in patients with SMID, and consecutive neurophysiological evaluation of brainstem functions, such as all-night polysomnography and blink reflex, may be useful for the prevention of SUD, because some parameters in the neurophysiological examination are known to be related to the brainstem catecholamine neurons and the spinal tract nucleus of trigeminal nerve. PMID:27445960

  20. Examining the relationships between posttraumatic stress disorder symptoms, positive smoking outcome expectancies, and cigarette smoking in people with substance use disorders: a multiple mediator model.

    PubMed

    Hruska, Bryce; Bernier, Jennifer; Kenner, Frank; Kenne, Deric R; Boros, Alec P; Richardson, Christopher J; Delahanty, Douglas L

    2014-01-01

    Cigarette smoking is highly prevalent in people with substance use disorders (SUDs) and is associated with significant physical health problems. Posttraumatic stress disorder (PTSD) is also highly associated with both SUDs and cigarette smoking and may serve as a barrier to smoking cessation efforts. In addition, people with PTSD are more likely to hold positive smoking outcome expectancies (i.e., beliefs that smoking cigarettes results in positive outcomes); these beliefs may contribute to cigarette smoking in people with SUDs experiencing PTSD symptoms. The present study examined the relationship between PTSD symptoms and typical daily cigarette smoking/cigarette dependence symptoms in a sample of 227 trauma-exposed current smokers with SUDs (59.9% male, 89.4% Caucasian) seeking detoxification treatment services. Additionally, the indirect effects of multiple types of positive smoking outcome expectancies on these relationships were examined. Participants completed questionnaires assessing PTSD symptoms, positive smoking outcome expectancies, cigarette consumption, and cigarette dependence symptoms. Results indicated that PTSD symptoms were not directly related to cigarette consumption or cigarette dependence symptoms. However, negative affect reduction outcome expectancies were shown to have a significant indirect effect between PTSD symptoms and cigarette consumption, while negative affect reduction, boredom reduction, and taste-sensorimotor manipulation outcome expectancies were all found to have significant indirect effects between PTSD symptoms and cigarette dependence symptoms. The indirect effect involving negative affect reduction outcome expectancies was statistically larger than that of taste sensorimotor manipulation outcome expectancies, while negative affect reduction and boredom reduction outcome expectancies were comparable in magnitude. These results suggest that expectancies that smoking can manage negative affective experiences are related to

  1. Parental Substance Abuse As an Early Traumatic Event. Preliminary Findings on Neuropsychological and Personality Functioning in Young Drug Addicts Exposed to Drugs Early

    PubMed Central

    Parolin, Micol; Simonelli, Alessandra; Mapelli, Daniela; Sacco, Marianna; Cristofalo, Patrizia

    2016-01-01

    Parental substance use is a major risk factor for child development, heightening the risk of drug problems in adolescence and young adulthood, and exposing offspring to several types of traumatic events. First, prenatal drug exposure can be considered a form of trauma itself, with subtle but long-lasting sequelae at the neuro-behavioral level. Second, parents' addiction often entails a childrearing environment characterized by poor parenting skills, disadvantaged contexts and adverse childhood experiences (ACEs), leading to dysfunctional outcomes. Young adults born from/raised by parents with drug problems and diagnosed with a Substance Used Disorder (SUD) themselves might display a particularly severe condition in terms of cognitive deficits and impaired personality function. This preliminary study aims to investigate the role of early exposure to drugs as a traumatic event, capable of affecting the psychological status of young drug addicts. In particular, it intends to examine the neuropsychological functioning and personality profile of young adults with severe SUDs who were exposed to drugs early in their family context. The research involved three groups, each consisting of 15 young adults (aged 18–24): a group of inpatients diagnosed with SUDs and exposed to drugs early, a comparison group of non-exposed inpatients and a group of non-exposed youth without SUDs. A neuropsychological battery (Esame Neuropsicologico Breve-2), an assessment procedure for personality disorders (Shedler-Westen Assessment Procedure-200) and the Symptom CheckList-90-Revised were administered. According to present preliminary results, young drug addicts exposed to drugs during their developmental age were characterized by elevated rates of neuropsychological impairments, especially at the expense of attentive and executive functions (EF); personality disorders were also common but did not differentiate them from non-exposed youth with SUDs. Alternative multi-focused prevention and

  2. Examining the relationships between posttraumatic stress disorder symptoms, positive smoking outcome expectancies, and cigarette smoking in people with substance use disorders: a multiple mediator model.

    PubMed

    Hruska, Bryce; Bernier, Jennifer; Kenner, Frank; Kenne, Deric R; Boros, Alec P; Richardson, Christopher J; Delahanty, Douglas L

    2014-01-01

    Cigarette smoking is highly prevalent in people with substance use disorders (SUDs) and is associated with significant physical health problems. Posttraumatic stress disorder (PTSD) is also highly associated with both SUDs and cigarette smoking and may serve as a barrier to smoking cessation efforts. In addition, people with PTSD are more likely to hold positive smoking outcome expectancies (i.e., beliefs that smoking cigarettes results in positive outcomes); these beliefs may contribute to cigarette smoking in people with SUDs experiencing PTSD symptoms. The present study examined the relationship between PTSD symptoms and typical daily cigarette smoking/cigarette dependence symptoms in a sample of 227 trauma-exposed current smokers with SUDs (59.9% male, 89.4% Caucasian) seeking detoxification treatment services. Additionally, the indirect effects of multiple types of positive smoking outcome expectancies on these relationships were examined. Participants completed questionnaires assessing PTSD symptoms, positive smoking outcome expectancies, cigarette consumption, and cigarette dependence symptoms. Results indicated that PTSD symptoms were not directly related to cigarette consumption or cigarette dependence symptoms. However, negative affect reduction outcome expectancies were shown to have a significant indirect effect between PTSD symptoms and cigarette consumption, while negative affect reduction, boredom reduction, and taste-sensorimotor manipulation outcome expectancies were all found to have significant indirect effects between PTSD symptoms and cigarette dependence symptoms. The indirect effect involving negative affect reduction outcome expectancies was statistically larger than that of taste sensorimotor manipulation outcome expectancies, while negative affect reduction and boredom reduction outcome expectancies were comparable in magnitude. These results suggest that expectancies that smoking can manage negative affective experiences are related to

  3. Sudden Unexpected Deaths and Vaccinations during the First Two Years of Life in Italy: A Case Series Study

    PubMed Central

    Traversa, Giuseppe; Spila-Alegiani, Stefania; Bianchi, Clara; Ciofi degli Atti, Marta; Frova, Luisa; Massari, Marco; Raschetti, Roberto; Salmaso, Stefania; Scalia Tomba, Gianpaolo

    2011-01-01

    Background The signal of an association between vaccination in the second year of life with a hexavalent vaccine and sudden unexpected deaths (SUD) in the two days following vaccination was reported in Germany in 2003. A study to establish whether the immunisation with hexavalent vaccines increased the short term risk of SUD in infants was conducted in Italy. Methodology/Principal Findings The reference population comprises around 3 million infants vaccinated in Italy in the study period 1999–2004 (1.5 million received hexavalent vaccines). Events of SUD in infants aged 1–23 months were identified through the death certificates. Vaccination history was retrieved from immunisation registries. Association between immunisation and death was assessed adopting a case series design focusing on the risk periods 0–1, 0–7, and 0–14 days after immunisation. Among the 604 infants who died of SUD, 244 (40%) had received at least one vaccination. Four deaths occurred within two days from vaccination with the hexavalent vaccines (RR = 1.5; 95% CI 0.6 to 4.2). The RRs for the risk periods 0–7 and 0–14 were 2.0 (95% CI 1.2 to 3.5) and 1.5 (95% CI 0.9 to 2.4). The increased risk was limited to the first dose (RR = 2.2; 95% CI 1.1 to 4.4), whereas no increase was observed for the second and third doses combined. Conclusions The RRs of SUD for any vaccines and any risk periods, even when greater than 1, were almost an order of magnitude lower than the estimates in Germany. The limited increase in RRs found in Italy appears confined to the first dose and may be partly explained by a residual uncontrolled confounding effect of age. PMID:21298113

  4. Validation of the Full and Short-Form Self-Help Involvement Scale Against the Rasch Measurement Model

    PubMed Central

    Conrad, Karen M.; Conrad, Kendon J.; Passetti, Lora L.; Funk, Rodney R.; Dennis, Michael L.

    2015-01-01

    Background Substance use disorders (SUDs) are one of the nation’s most costly problems in terms of dollars, disability, and death. Self-help programs are among the varied recovery support options available to address SUD, and evaluation of these programs depends on good measurement. There exists an unmet need for a psychometrically sound, brief, efficient measure of self-help involvement for individuals with SUD that is valid across different substances and age-groups. Methods Using data from 2,101 persons presenting for SUD treatment, the full 21-item Global Appraisal of Individual Needs Self-Help Involvement Scale (SHIS) and a newly developed 11-item short-form version were validated against the Rasch measurement model and each other. Differential item functioning (DIF) was assessed by primary substance and age. Results Both versions met Rasch psychometric criteria. The full scale had minor misfit with no DIF for alcohol, marijuana, or opioids but a few instances of DIF for amphetamine and cocaine users as well as for age, in that youth tended to endorse several easier items more frequently than did adults. The 11-item short form had neither misfit nor DIF by substance and only minor DIF by age was highly correlated with the full version and was relatively more efficient. Criterion-related validity was supported for both. Conclusions Both the long and short versions of SHIS are psychometrically sound measures of a more comprehensive conceptualization of self-help involvement for SUDs that can be used as part of an in-depth assessment or as a short measure that lessens respondent burden. PMID:26275980

  5. Immunohistochemical Analysis of Brainstem Lesions in the Autopsy Cases with Severe Motor and Intellectual Disabilities Showing Sudden Unexplained Death.

    PubMed

    Hayashi, Masaharu; Sakuma, Hiroshi

    2016-01-01

    It is known that patients with severe motor and intellectual disabilities (SMID) showed sudden unexplained death (SUD), in which autopsy failed to identify causes of death. Although the involvement of brainstem dysfunction is speculated, the detailed neuropathological analysis still remains to be performed. In order to clarify pathogenesis, we investigated the brainstem functions in autopsy cases of SMID showing SUD. We immunohistochemically examined expressions of tyrosine hydroxylase, tryptophan hydroxylase, substance P, methionine-enkephalin, and c-fos in the serial sections of the midbrain, pons, and medulla oblongata in eight SUD cases and seven controls, having neither unexplained death nor pathological changes in the brain. Expressions of tyrosine hydroxylase and tryptophan hydroxylase were reduced in two of eight cases, and those of substance P and/or methionine-enkephalin were augmented in the pons and medulla oblongata in seven of eight cases, including the aforementioned two cases, when compared with those in controls. The hypoglossal nucleus and/or the dorsal vagal nucleus demonstrated increased neuronal immunoreactivity for c-fos in seven of eight cases, although there was no neuronal loss or gliosis in both the nuclei. Controls rarely showed immunoreactivity for c-fos in the medulla oblongata. These data suggest the possible involvement of brainstem dysfunction in SUD in patients with SMID, and consecutive neurophysiological evaluation of brainstem functions, such as all-night polysomnography and blink reflex, may be useful for the prevention of SUD, because some parameters in the neurophysiological examination are known to be related to the brainstem catecholamine neurons and the spinal tract nucleus of trigeminal nerve. PMID:27445960

  6. Cigarette smoking during substance use disorder treatment: Secondary outcomes from a National Drug Abuse Treatment Clinical Trials Network study

    PubMed Central

    McClure, Erin A.; Campbell, Aimee N. C.; Pavlicova, Martina; Hu, Meichen; Winhusen, Theresa; Vandrey, Ryan G.; Ruglass, Lesia M.; Covey, Lirio S.; Stitzer, Maxine L.; Kyle, Tiffany L.; Nunes, Edward V.

    2015-01-01

    Introduction The majority of patients enrolled in treatment for substance use disorders (SUDs) also use tobacco. Many will continue to use tobacco even during abstinence from other drugs and alcohol, often leading to smoking-related illnesses. Despite this, little research has been conducted to assess the influence of being a smoker on SUD treatment outcomes and changes in smoking during a treatment episode. Methods In this secondary analysis, cigarette smoking was evaluated in participants completing outpatient SUD treatment as part of a multi-site study conducted by the National Drug Abuse Treatment Clinical Trials Network. Analyses included the assessment of changes in smoking and nicotine dependence via the Fagerström Test for Nicotine Dependence during the 12-week study among all smokers (Aim #1), specifically among those in the experimental treatment group (Aim #2), and the moderating effect of being a smoker on treatment outcomes (Aim #3). Results Participants generally did not reduce or quit smoking throughout the course of the study. Among a sub-set of participants with higher baseline nicotine dependence scores randomized to the control arm, scores at the end of treatment were lower compared to the experimental arm, though measures of smoking quantity did not appear to decrease. Further, being a smoker was associated with poorer treatment outcomes compared to non-smokers enrolled in the trial. Conclusions This study provides evidence that patients enrolled in community-based SUD treatment continue to smoke, even when abstaining from drugs and alcohol. These results add to the growing literature encouraging the implementation of targeted, evidence-based interventions to promote abstinence from tobacco among SUD treatment patients. PMID:25595301

  7. Psychiatric comorbidity in treatment-seeking substance use disorder patients with and without attention deficit hyperactivity disorder: results of the IASP study

    PubMed Central

    van Emmerik-van Oortmerssen, Katelijne; van de Glind, Geurt; Koeter, Maarten W. J.; Allsop, Steve; Auriacombe, Marc; Barta, Csaba; Bu, Eli Torild H.; Burren, Yuliya; Carpentier, Pieter-Jan; Carruthers, Susan; Casas, Miguel; Demetrovics, Zsolt; Dom, Geert; Faraone, Stephen V.; Fatseas, Melina; Franck, Johan; Johnson, Brian; Kapitány-Fövény, Máté; Kaye, Sharlene; Konstenius, Maija; Levin, Frances R.; Moggi, Franz; Møller, Merete; Ramos-Quiroga, J. Antoni; Schillinger, Arild; Skutle, Arvid; Verspreet, Sofie; van den Brink, Wim; Schoevers, Robert A.

    2014-01-01

    Aims To determine comorbidity patterns in treatment-seeking substance use disorder (SUD) patients with and without adult attention deficit hyperactivity disorder (ADHD), with an emphasis on subgroups defined by ADHD subtype, taking into account differences related to gender and primary substance of abuse. Design Data were obtained from the cross-sectional International ADHD in Substance use disorder Prevalence (IASP) study. Setting Forty-seven centres of SUD treatment in 10 countries. Participants A total of 1205 treatment-seeking SUD patients. Measurements Structured diagnostic assessments were used for all disorders: presence of ADHD was assessed with the Conners’ Adult ADHD Diagnostic Interview for DSM-IV (CAADID), the presence of antisocial personality disorder (ASPD), major depression (MD) and (hypo)manic episode (HME) was assessed with the Mini International Neuropsychiatric Interview-Plus (MINI Plus), and the presence of borderline personality disorder (BPD) was assessed with the Structured Clinical Interview for DSM-IV Axis II (SCID II). Findings The prevalence of DSM-IV adult ADHD in this SUD sample was 13.9%. ASPD [odds ratio (OR) = 2.8, 95% confidence interval (CI) = 1.8–4.2], BPD (OR = 7.0, 95% CI = 3.1–15.6 for alcohol; OR = 3.4, 95% CI = 1.8–6.4 for drugs), MD in patients with alcohol as primary substance of abuse (OR = 4.1, 95% CI = 2.1–7.8) and HME (OR = 4.3, 95% CI = 2.1–8.7) were all more prevalent in ADHD+ compared with ADHD− patients (P < 0.001). These results also indicate increased levels of BPD and MD for alcohol compared with drugs as primary substance of abuse. Comorbidity patterns differed between ADHD subtypes with increased MD in the inattentive and combined subtype (P < 0.01), increased HME and ASPD in the hyperactive/impulsive (P < 0.01) and combined subtypes (P < 0.001) and increased BPD in all subtypes (P < 0.001) compared with SUD patients without ADHD. Seventy-five per cent of ADHD patients had at least one additional

  8. Obsessive-compulsive disorder, impulse control disorders and drug addiction: common features and potential treatments.

    PubMed

    Fontenelle, Leonardo F; Oostermeijer, Sanne; Harrison, Ben J; Pantelis, Christos; Yücel, Murat

    2011-05-01

    The basic concepts underlying compulsive, impulsive and addictive behaviours overlap, which may help explain why laymen use these expressions interchangeably. Although there has been a large research effort to better characterize and disentangle these behaviours, clinicians and scientists are still unable to clearly differentiate them. Accordingly, obsessive-compulsive disorder (OCD), impulse control disorders (ICD) and substance-related disorders (SUD) overlap on different levels, including phenomenology, co-morbidity, neurocircuitry, neurocognition, neurochemistry and family history. In this review we summarize these issues with particular emphasis on the role of the opioid system in the pathophysiology and treatment of OCD, ICD and SUD. We postulate that with progression and chronicity of OCD, the proportion of the OCD-related behaviours (e.g. checking, washing, ordering and hoarding, among others) that are driven by impulsive 'rash' processes increase as involvement of more ventral striatal circuits becomes prominent. In contrast, as SUD and ICD progress, the proportion of the SUD- and ICD-related behaviours that are driven by compulsive 'habitual' processes increase as involvement of more dorsal striatal circuits become prominent. We are not arguing that, with time, ICD becomes OCD or vice versa. Instead, we are proposing that these disorders may acquire qualities of the other with time. In other words, while patients with ICD/SUD may develop 'compulsive impulsions', patients with OCD may exhibit 'impulsive compulsions'. There are many potential implications of our model. Theoretically, OCD patients exhibiting impulsive or addictive features could be managed with drugs that address the quality of the underlying drives and the involvement of neural systems. For example, agents for the reduction or prevention of relapse of addiction (e.g. heavy drinking), which modulate the cortico-mesolimbic dopamine system through the opioid (e.g. buprenorphine and naltrexone

  9. The Classification of Substance Use Disorders: Historical, Contextual, and Conceptual Considerations.

    PubMed

    Robinson, Sean M; Adinoff, Bryon

    2016-01-01

    This article provides an overview of the history of substance use and misuse and chronicles the long shared history humans have had with psychoactive substances, including alcohol. The practical and personal functions of substances and the prevailing views of society towards substance users are described for selected historical periods and within certain cultural contexts. This article portrays how the changing historical and cultural milieu influences the prevailing medical, moral, and legal conceptualizations of substance use as reflected both in popular opinion and the consensus of the scientific community and represented by the American Psychiatric Association's (APA) Diagnostic and Statistical Manual of Mental Disorders (DSM). Finally, this article discusses the efforts to classify substance use disorders (SUDs) and associated psychopathology in the APA compendium. Controversies both lingering and resolved in the field are discussed, and implications for the future of SUD diagnoses are identified. PMID:27548233

  10. New risk indicator approach for Operators, Workers, Bystanders and Residents for a sustainable use of plant protection products.

    PubMed

    Sacchettini, Gabriele; Calliera, Maura; Marchis, Alexandru; Glass, Richard; Ellis, Clare Butler; Machera, Kyriaki; Gerritsen-Ebben, Rianda; Spanoghe, Pieter; Capri, Ettore

    2015-11-01

    In 2009, the European Union adopted the Directive on Sustainable Use of pesticides (SUD, Directive 2009/128/EC) establishing a framework for achieving a sustainable use of Plant Protection Products (PPPs) through reducing the risks and impacts of PPP use on human health and the environment, promoting integrated pest management and stimulating effective non-chemical alternatives. The core idea of the SUD is that it is necessary to monitor the use of PPPs through the implementation of an appropriate set of risk indicators to monitor progress and trends in risk reduction within the Member States. To contribute to this direction, following a comprehensive analysis of the risk (including procedures of risk assessment and risk management) and involving stakeholders in the decision process, specific toolboxes of practical indirect risk indicators of exposure of Operators, Workers, Bystanders and Residents were developed and are now available to be used by Member States (MSs) based on their specific context.

  11. Vaccines in the Treatment of Substance Abuse.

    PubMed

    Shorter, Daryl; Kosten, Thomas R

    2011-12-01

    Reconceptualizing drugs as toxins allowed an important shift in the approach to the treatment of substance abuse, because it ushered in consideration of immunological methods of pharmacotherapy. This paradigm shift represented a dramatic departure from previously considered approaches to pharmacotherapy for substance use disorders (SUDs), which had up until that time focused predominantly on either agonist and/or antagonist medications meant to block drug effects or to decrease reward, reinforcement, or craving. Use of immunological theory in SUD treatment also meant that 1) a potentially addicting medication would not be administered as part of therapy and 2) side effects could be limited, because the individual's immune system would be responsible for delivering treatment.

  12. Personality psychopathology, drug use and psychological symptoms in adolescents with substance use disorders and community controls

    PubMed Central

    Forns, Maria; Goti, Javier; Castro-Fornieles, Josefina

    2015-01-01

    Substance use is a risk behavior that tends to increase during adolescence, a time when part of the personality is still in development. Traditionally, personality psychopathology has been measured in terms of categories, although dimensional models have demonstrated better consistency. This study aimed to analyze differences in personality profiles between adolescents with substance use disorders (SUD n = 74) and matched community controls (MCC n = 74) using the Personality Psychopathology Five (PSY-5) dimensional model. Additionally, we compared age at first drug use, level of drug use and internalizing and externalizing symptoms between the groups. In this study, the PSY-5 model has proved to be useful for differentiating specific personality disturbances in adolescents with SUD and community adolescents. The Disconstraint scale was particularly useful for discriminating adolescents with substance use problems and the Delinquent Attitudes facet offered the best differentiation. PMID:26082873

  13. Zero liquid carryover whole-body shower vortex liquid/gas separator

    NASA Technical Reports Server (NTRS)

    1975-01-01

    The development and evaluation of a liquid/gas vortex type separator design eliminating liquid and semi-liquid (suds) carryover into air recirculating system were described. Consideration was given to a number of soaps other than the "Miranol JEM" which was the low sudsing soap used in previous test runs of the space shower. Analysis of test parameters and prototype testing resulted in a revised separator configuration and a better understanding of the suds generating mechanism in the wastewater collection system. The final design of the new separator provides for a wider choice of soaps without leading to the problem of "carryover". Furthermore, no changes in separator-to-shower interfaces were required. The new separator was retrofitted on the "space shower" and satisfactorily demonstrated in one-g testing.

  14. Comparative analysis of the outflow water quality of two sustainable linear drainage systems.

    PubMed

    Andrés-Valeri, V C; Castro-Fresno, D; Sañudo-Fontaneda, L A; Rodriguez-Hernandez, J

    2014-01-01

    Three different drainage systems were built in a roadside car park located on the outskirts of Oviedo (Spain): two sustainable urban drainage systems (SUDS), a swale and a filter drain; and one conventional drainage system, a concrete ditch, which is representative of the most frequently used roadside drainage system in Spain. The concentrations of pollutants were analyzed in the outflow of all three systems in order to compare their capacity to improve water quality. Physicochemical water quality parameters such as dissolved oxygen, total suspended solids, pH, electrical conductivity, turbidity and total petroleum hydrocarbons were monitored and analyzed for 25 months. Results are presented in detail showing significantly smaller amounts of outflow pollutants in SUDS than in conventional drainage systems, especially in the filter drain which provided the best performance.

  15. Non-response of cortisol during stressful exposure therapy in patients with obsessive-compulsive disorder--preliminary results.

    PubMed

    Kellner, Michael; Wiedemann, Klaus; Yassouridis, Alexander; Muhtz, Christoph

    2012-09-30

    Exposure with response prevention (ERP) is an established treatment for patients with obsessive-compulsive disorder (OCD) and also an interesting model to characterize neuroendocrine response to psychological stress. However, so far few studies have assessed hypothalamic-pituitary-adrenocortical (HPA) function during ERP and results are inconsistent. In 15 patients with OCD we repeatedly measured salivary cortisol and subjective units of distress (SUD) on two consecutive afternoons. The first day served as a comparison condition; on the second day the very first session of ERP took place. While SUD were significantly increased during ERP versus the comparison day, salivary cortisol was statistically indistinguishable between ERP and comparison conditions before, during and after ERP. Thus, despite considerable psychological stress no increase of cortisol was observed. This response pattern to ERP in OCD patients needs further research.

  16. Examining the temporal relationship between psychological climate, work attitude, and staff turnover

    PubMed Central

    Garner, Bryan R.; Hunter, Brooke D.

    2012-01-01

    Relative to the broader industrial-organizational (I-O) psychology field, research on the turnover of substance use disorder (SUD) treatment staff is in its infancy. Despite its long and rich history, recent reviews of the turnover literature within I-O psychology have noted there remains considerable room for improvement. In particular, recommendations have been made for research that considers time in the turnover process and explores more distal causes of staff turnover. Addressing these gaps, this paper examined the temporal relationship between latent measures of psychological climate, work attitude, and staff turnover. Using data from 95 SUD treatment staff clustered within 29 treatment organizations, multilevel discrete-time survival analyses revealed that a latent measure of work attitude (e.g., job satisfaction, pay satisfaction, turnover intentions) fully mediated the temporal relationship between latent measures of psychological climate (e.g., supervisor support, coworker support, role conflict) and subsequent staff turnover. PMID:22658290

  17. The Classification of Substance Use Disorders: Historical, Contextual, and Conceptual Considerations.

    PubMed

    Robinson, Sean M; Adinoff, Bryon

    2016-08-18

    This article provides an overview of the history of substance use and misuse and chronicles the long shared history humans have had with psychoactive substances, including alcohol. The practical and personal functions of substances and the prevailing views of society towards substance users are described for selected historical periods and within certain cultural contexts. This article portrays how the changing historical and cultural milieu influences the prevailing medical, moral, and legal conceptualizations of substance use as reflected both in popular opinion and the consensus of the scientific community and represented by the American Psychiatric Association's (APA) Diagnostic and Statistical Manual of Mental Disorders (DSM). Finally, this article discusses the efforts to classify substance use disorders (SUDs) and associated psychopathology in the APA compendium. Controversies both lingering and resolved in the field are discussed, and implications for the future of SUD diagnoses are identified.

  18. An Exploratory Investigation of Marital Functioning and Order of Spousal Onset in Couples Concordant for Psychopathology

    PubMed Central

    Van Orden, Kimberly A.; Braithwaite, Scott; Anestis, Mike; Timmons, Katherine Merrill; Fincham, Frank; Joiner, Thomas E.; Lewinsohn, Peter M.

    2012-01-01

    Individuals with a psychiatric disorder are significantly more likely to have a spouse with a clinical diagnosis—marital concordance. We used a community sample of 304 couples concordant for either Major Depressive Disorder (MDD) or Substance Use Disorders (SUDs) to examine the relationship between marital functioning and gendered patterns of mental health diagnosis onset. For SUD concordance, couples in which wives onset before husbands—in spite of typical later onset for males—reported lower levels of marital satisfaction compared to couples in which the husband onset first. For MDD concordance, couples in which husbands onset with depression before wives—in spite of typical later onset for males—reported lower levels of marital satisfaction. These results suggest that for couples concordant for mental diagnoses, it is most problematic for marital functioning for one partner to have an atypically early onset. Implications for treatment targets in marital therapy are discussed. PMID:22765342

  19. Prenatal Substance Use: Exploring Assumptions of Maternal Unfitness

    PubMed Central

    Terplan, Mishka; Kennedy-Hendricks, Alene; Chisolm, Margaret S

    2015-01-01

    In spite of the growing knowledge and understanding of addiction as a chronic relapsing medical condition, individuals with substance use disorders (SUD) continue to experience stigmatization. Pregnant women who use substances suffer additional stigma as their use has the potential to cause fetal harm, calling into question their maternal fitness and often leading to punitive responses. Punishing pregnant women denies the integral interconnectedness of the maternal-fetal dyad. Linking substance use with maternal unfitness is not supported by the balance of the scientific evidence regarding the actual harms associated with substance use during pregnancy. Such linkage adversely impacts maternal, child, and family health by deterring pregnant women from seeking both obstetrical care and SUD treatment. Pregnant women who use substances deserve compassion and care, not pariah-status and punishment. PMID:26448685

  20. EEG Biofeedback as a Treatment for Substance Use Disorders: Review, Rating of Efficacy, and Recommendations for Further Research

    PubMed Central

    Cannon, Rex L.; Trudeau, David L.

    2008-01-01

    Electroencephalographic (EEG) biofeedback has been employed in substance use disorder (SUD) over the last three decades. The SUD is a complex series of disorders with frequent comorbidities and EEG abnormalities of several types. EEG biofeedback has been employed in conjunction with other therapies and may be useful in enhancing certain outcomes of therapy. Based on published clinical studies and employing efficacy criteria adapted by the Association for Applied Psychophysiology and Biofeedback and the International Society for Neurofeedback and Research, alpha theta training—either alone for alcoholism or in combination with beta training for stimulant and mixed substance abuse and combined with residential treatment programs, is probably efficacious. Considerations of further research design taking these factors into account are discussed and descriptions of contemporary research are given. PMID:18214670