Abstract
This report describes the outcomes of a process undertaken to review and update the National Safety Council’s Alcohol, Drugs and Impairment Division’s recommendations for the toxicological ...investigation of suspected alcohol and drug-impaired driving cases and motor vehicle fatalities. The updates to the recommendations are made based on a survey of practices in laboratories in the USA and Canada performing testing in these cases, consideration of existing epidemiological crash and arrest data, current drug use patterns, and practical considerations of widely available technology platforms in laboratories performing this work. The final recommendations updates are derived from a consensus meeting of experts recruited from survey respondents and the membership of the National Safety Council’s Alcohol, Drug and Impairment Division. The principal changes in this round of recommendations include removal of butalbital, phenobarbital, and phencyclidine from Tier I (mandatory) to Tier II (optional) due to changes in prevalence. In addition, buprenorphine, fentanyl, tramadol, and their metabolites were moved from Tier II to Tier I due to increased prevalence and concerns about their potential for causing impairment. In addition, screening and confirmatory cutoffs for the oral fluid scope were further refined. Other additions were made to the list of Tier II compounds including fentanyl analogs (e.g., acetylfentanyl, butyrylfentanyl, furanylfentanyl, etc), mitragynine, novel opioids (e.g., MT-45, U-47700), atypical antipsychotics, and novel benzodiazepines (e.g., clonazolam, flubromazolam, etc).
Introduction
Lower blood levels of the omega-3 polyunsaturated fatty acid docosahexaenoic acid (DHA) are correlated with worse cognitive functions, particularly among
APOE
ε4 carriers. Whether DHA ...supplementation in
APOE
ε4 carriers with limited DHA consumption and dementia risk factors can delay or slow down disease progression when started before the onset of clinical dementia is not known.
Methods
PreventE4 is a double-blind, single site, randomized, placebo-controlled trial in cognitively unimpaired individuals with limited omega-3 consumption and dementia risk factors (n=368). Its objectives are to determine (1) whether carrying the
APOE
ε4 allele is associated with lower delivery of DHA to the brain; and (2) whether high dose DHA supplementation affects brain imaging biomarkers of AD and cognitive function.
Results
365 cognitively unimpaired individuals between 55 and 80 (mean age 66) were randomized to 2 grams of DHA per day or identically appearing placebo for a period of 2 years. Half the participants were asked to complete lumbar punctures at baseline and 6-month visits to obtain cerebrospinal fluid (CSF). The primary trial outcome measure is the change in CSF DHA to arachidonic acid ratio after 6 months of the intervention (n=181). Secondary trial outcomes include the change in functional and structural connectivity using resting state functional MRI at 24 months (n=365). Exploratory outcomes include the change in Repeatable Battery of the Assessment of Neuropsychological Status at 24 months (n=365).
Conclusions
Findings from PreventE4 will clarify the brain delivery of DHA in individuals carrying the
APOE
ε4 allele with implications for dementia prevention strategies. Trial was registered as NCT03613844.
Abstract Background Opioid abuse is common in the United States and is currently on the rise. Fentanyl transdermal patches (FTPs) have been on the market since 1991, and have recently become a ...popular source of opioids for abusers. There are currently two distinct FTP designs available on the market today; a gel reservoir system and a matrix construct. The gel reservoirs of FTPs contain massive amounts of fentanyl and are easily extractable for abuse. Ingesting the gel reservoir of an FTP is potentially lethal. Case Series In this case series, 4 patients ingested the gel reservoir of an FTP and experienced severe and recurrent respiratory depression necessitating continuous naloxone infusions. All patients responded adequately to initial prehospital doses of naloxone (0.8–2 mg intravenous) but developed recurrent respiratory depression within 2 h of presentation to the hospital. Conclusion The gel reservoir of an FTP contains massive amounts of fentanyl. Ingestion of the gel may cause severe and recurrent respiratory depression necessitating repeated naloxone boluses, continuous naloxone infusion, and a prolonged observation period.
Abstract Background: Drug abuse is a common problem in the United States. Drugs can be acquired in many ways, and can be knowingly or mistakenly misrepresented when sold. Propafenone is an uncommonly ...encountered class IC antidysrhythmic that is a look-alike for the opioid, oxycodone/acetaminophen 5/325. Objective: We report a case of propafenone overdose presenting with generalized tonic-clonic seizure and a widened QRS complex, occurring after the patient had reported ingesting “Percocet®” (Endo Pharmaceuticals, Chadds Ford, PA). Case Report: A 17-year-old boy presented to the emergency department (ED) after a witnessed seizure lasting 2 min. The patient reported having ingested 6 “Percocet®” tablets that he purchased from a classmate. He noted feeling weak and dizzy approximately 3 h after the ingestion, just before the seizure. On arrival in the ED, the patient was awake and alert with a QRS length of 168 ms. A sodium bicarbonate bolus and infusion shortened the QRS length to 90 ms. The patient was discharged the following day with no further complications. The pills were identified as propafenone hydrochloride (HCl) 225-mg tablets. The classmate surreptitiously sold the pills as “Percocet®” due to their similar “512” imprint. Conclusions: Pharmaceutical drugs are often sold on the street, and often misrepresented. Propafenone HCl 225-mg is an uncommonly encountered pharmaceutical, but is a look-alike for oxycodone/acetaminophen 5/325. An overdose due to propafenone ingestion may present with seizures and a widened QRS complex.
Morphological and structural investigation of textile artefacts recovered from Pompeii, Herculaneum and Scafati was successfully carried out by scanning electron microscopy (SEM), optical microscopy ...(OM) and wide angle X-ray scattering (WAXS). The majority of the samples were carbonized as a result of the eruption of the Vesuvius volcano in the yearad79 and therefore were blackish-brown coloured and very brittle. Only two textile fragments were recovered in a good state of preservation; the first was a cloth fragment characterized by a brown colour with green spots, the second was flock and peculiarly brown-green coloured. SEM, OM and WAXS studies allowed the identification of the nature, origin and molecular structure of the natural fibres and the determination of the kind of weaves used. In addition, cotton, broom, hemp, kapok and Graminae fibres, all obtained from seeds, stems and leaves, were recognized. Ovidae wool and Angora wool fibres coming from animal skin and byssus fibres coming from secretion of the Pinna mollusc were also found. Plain cloth and twill essential weaves were identified, together with derived weaves such as reps. The cassimere composite weave obtained without using a loom by intertwining parenchyma tissue of Graminae leaves was also recognized.
In this study, we present midrapidity measurements from the PHENIX experiment of large parity-violating single-spin asymmetries of high transverse momentum electrons and positrons from W±/Z decays, ...produced in longitudinally polarized p + p collisions at center of mass energies of √s = 500 and 510 GeV. These asymmetries allow direct access to the antiquark polarized parton distribution functions due to the parity-violating nature of the W-boson coupling to quarks and antiquarks. The results presented are based on data collected in 2011, 2012, and 2013 with an integrated luminosity of 240 pb–1, which exceeds previous PHENIX published results by a factor of more than 27. These high Q2 data probe the parton structure of the proton at W mass scale and provide an important addition to our understanding of the antiquark parton helicity distribution functions at an intermediate Bjorken x value of roughly MW/ √s = 0.16.
Back-to-back hadron pair yields in d+Au and p+p collisions at sqrt(s_NN)=200 GeV were measured with the PHENIX detector at the Relativistic Heavy Ion Collider. Rapidity separated hadron pairs were ...detected with the trigger hadron at pseudorapidity |eta|<0.35 and the associated hadron at forward rapidity (deuteron direction, 3.0
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