Unintentional use of fentanyl attributed to surreptitious cannabis adulteration.

OBJECTIVE: This case addresses the issue of surreptitious adulteration of cannabis. Many with opioid and substance use disorders use cannabis while receiving office-based opioid treatment (OBOT), making it valuable to understand the rationale for its use. Further study of the effects that cannabis use has on OBOT success or failure is necessary. CASE SUMMARY: A 50-year-old man receiving OBOT continually tested positive in urine drug screenings (UDSs) for fentanyl, while abstaining from all opiates, but he endorsed smoking cannabis 2-3 times weekly as a self-reported headache reliever and a sleep aid. After changing the source from which he bought cannabis, his UDS became negative for fentanyl. He was maintained on a stable dose of buprenorphine with a consistent UDS after this intervention and was able to make many positive lifestyle changes as a result (i.e., maintaining a relationship with his girlfriend, continuing attendance at support groups, and pursuing employment opportunities). PRACTICE IMPLICATIONS: The consequences of cannabis use on OBOT success are highly variable and dependent on many factors. Although the concern regarding adulteration of cannabis exists, there is no systematic monitoring or reliable data on its frequency or the magnitude of its effect, which generates a demand for further research and exploration. Depending on state-specific regulations, patients may be able to obtain cannabis from reliable, regulated (nonadulterated) sources. However, providers must thoroughly consider the barriers to patients obtaining medicinal or legalized cannabis.

Evaluating the Impact of the Synar Program: Tobacco Access and Use among Youth in Mississippi, the South, and the U.S.

(1) Background: This study examines the impact of Synar policy adoption on youth commercial access to tobacco products in Mississippi, the South, and the remaining U.S. The principal focus on youth commercial access is complemented by analyses of Synar's impact on minors' non-commercial access to tobacco and tobacco use patterns. Mississippi has been especially aggressive in implementing Synar, as evidenced by its unusually low retailer violation rates (RVRs). Synar, a mandatory, enforceable regulation meant to limit youth's retail access to tobacco, was implemented nationwide in 1997. This study is governed by a combination of conceptual insights from a diffusion of health innovation perspective and structuration theory. (2) Methods: Repeated cross-sectional data from 1995 to 2011 from the CDC Youth Risk Behavior Survey are analyzed using a pre/post-implementation, quasi-experimental analytic strategy. Tobacco access and use in the pre-Synar era (1995-1997) are compared with two post-Synar periods (1999-2005 and 2007-2011), thereby highlighting diffusion effects related to this policy innovation within Mississippi, the South, and the remaining U.S. (3) Results: Analyses of temporal trends reveal that Mississippi and other study regions effectively restricted commercial access to tobacco. Positive outcomes associated with Synar adoption were observed several years after initial implementation, thus supporting a diffusion of innovation perspective. However, results also reveal that Mississippi youth were more inclined than their counterparts elsewhere to gain access to tobacco through non-commercial means after Synar implementation, and that declines in tobacco use among Mississippi youth were less robust than those observed elsewhere. Such variegated effects are in line with expectations linked to structuration theory. (4) Conclusions: Synar policy implementation has been generally effective at deterring youth access to tobacco and, in many cases, has yielded declines in tobacco use. However, there is no evidence that especially aggressive retailer compliance checks in Mississippi have yielded distinctive benefits for youth in this state.

Managing Acute Salicylate Toxicity in the Emergency Department.

Salicylates are among the oldest and most widely used medication to date and are utilized for a variety of purposes including the management of fever, inflammation, pain, and cardiovascular prophylaxis. Reports from U.S. Poison Control Centers indicate that over 40,000 Americans are exposed to salicylate-containing substances annually, and although generally deemed safe, fatal intoxications can occur from a single ingestion. Although some ingestions are intentional, many are not, and are a result of the prevalence of salicylates in a wide array of prescription and over-the-counter substances. Because of the wide range of symptoms associated with toxic overdose, as well as the high rate of mortality and complications associated with these cases, the emergency nurse practitioner should have a systematic approach to diagnosing and treating these patients. This case narrative describes the clinical case of a 22-year-old man who presented to the emergency department after ingesting an unknown amount of a salicylate-containing medication. It demonstrates the difficulty associated with appropriately distinguishing between toxic ingestions, hallmark indicators that can assist in appropriate diagnoses, and key interventions that must be initiated in a timely manner to mitigate negative outcomes. This case also serves as the basis for a review of current practice guidelines, and provides the clinician with tools to ensure evidence-based interventions are not delayed, thus increasing the chance of recovery for this patient population.

Interrelationships between apoptosis and fertility in bull sperm.

Male fertility, the ability of sperm to fertilize and activate the egg and support early embryogenesis, is vital for mammalian reproduction. Despite producing adequate numbers of sperm with normal motility and morphology, some males suffer from low fertility whose molecular mechanisms are not known. The objective was to determine apoptosis in sperm from high and low fertility bulls and its relationship with male fertility. DNA damage, phosphatidylserine (PS) translocation, and expression of pro- and anti-apoptotic proteins (BAX and BCL-2) in the sperm were determined using TUNEL, Annexin V, and immunoblotting approaches, respectively. Amounts of apoptotic spermatozoa were 2.86 (± 1.31) and 3.00 (± 0.96) in high and low fertility bulls, respectively (P=0.548), and were not correlated with fertility. There was a negative correlation between early necrotic spermatozoa and viable spermatozoa (r = -0.99, P<0.0001). Fertility scores were correlated with live spermatozoa detected by eosin-nigrosin test and necrotic spermatozoa determined via flow cytometry (r = -0.49, P<0.006 and r = -0.266, P<0.0113, respectively). BAX level was higher in low fertile group than high fertile group; however, this difference was not statistically significant due to the variations of bull samples (Bull 1-3 vs. Bull 4-5) in low fertile group (P<0.283). BCL-2 was not detectable in any of the sperm samples. The results shed light onto molecular and cellular underpinnings of male fertility.

Salivary hormonal values from high-speed resistive exercise workouts.

Our study purpose examined salivary hormonal responses to high-speed resistive exercise. Healthy subjects (n = 45) performed 2 elbow flexor workouts on a novel (inertial kinetic exercise; Oconomowoc, WI, USA) strength training device. Our methods included saliva sample collection at both preexercise and immediately postexercise; workouts entailed two 60-second sets separated by a 90-second rest period. The samples were analyzed in duplicate for their testosterone and cortisol concentrations ([T], [C]). Average and maximum elbow flexor torque were measured from each exercise bout; they were later analyzed with a 2(gender) × 2(workout) analysis of variance (ANOVA) with repeated measures for workout. The [T] and [C] each underwent a 2(gender) × 2(time) ANOVA with repeated measures for time. A within-subject design was used to limit error variance. Average and maximum torque each had gender (men > women; p < 0.05) effects. The [T] elicited a 2-way interaction (p < 0.05), as men incurred a significant 14% increase over time, but women's values were unchanged. Yet multivariate regression revealed that 3 predictor variables (body mass and average and maximum torques) did not account for a significant amount of variance associated with the rise in male [T]. Changes in [C] were not significant. In conclusion, changes in [T] concur with the results from other studies that showed significant elevations in male [T], despite the brevity of current workouts and the rather modest volume of muscle mass engaged. Practical applications imply that salivary assays may be a viable alternative to blood draws from athletes, yet coaches and others who may administer this treatment should know that our results may have produced greater pre-post hormonal changes if postexercise sample collection had occurred at a later time point.

Net energy expenditure of gravity-independent high-speed resistive exercise done by women.

INTRODUCTION: Elevated metabolism is common to spaceflight while exercise in microgravity exacerbates energy costs. Thus in-flight exercise countermeasures must be devised that minimize energy costs as they are performed on hardware operable in microgravity. METHODS: Female subjects (N = 28), subdivided into athletic and sedentary groups, each performed two workouts on a resistive exercise device (Impulse Training Systems; Newnan, GA). Comprised exclusively of either tonic or phasic repetitions, each exercise bout entailed two 1 -min sets interspersed by a 90-s rest from which the work volume was determined. Oxygen consumption was measured before, during, and after workouts until gas uptake returned to pre-exercise levels. Net oxygen consumption was converted to net energy expenditures via indirect calorimetry. Mean net energy expenditure and work volume values were each compared with 2 (athletes, sedentaries) x 2 (tonic, phasic) ANOVAs, with repeated measures for workout. In addition, multivariate regression employed three predictor (body mass, body fat percentage, work volume) variables to account for the net energy expenditure variance. RESULTS: Workouts yielded a metabolic cost of approximately 14 kcal, yet the data produced no significant intergroup or workout differences. However, work volume analysis yielded a significant (tonic > phasic) effect. The multivariate analysis explained small yet significant amounts of net energy expenditure variance. DISCUSSION: Current results: 1) are partly attributable to higher series elastic element activity seen with Impulse repetitions; and 2) offer new information with respect to in-flight exercise protocols for female astronauts.

Front squat data reproducibility collected with a triple-axis accelerometer.

The purpose of our study was to assess data reproducibility from 2 consecutive front squat workouts, spaced 1 week apart, performed by American college football players (n = 18) as they prepared for their competitive season. For each workout, our methods entailed the performance of 3-6 front squat repetitions per set at 55, 65, and 75% of subject's 1 repetition maximum (1RM) load. In addition, a fourth set was done at a heavier load, with a resistance equal to 80 and 83% of their 1RM values, for the first and second workouts, respectively. A triple-axis accelerometer was affixed to a barbell to quantify exercise performance. Per load, the accelerometer measures peak values for the following indices: force, velocity, and power. To assess data reproducibility, inter-workout comparisons were made for 12 performance indices with 4 statistical test-retest measures: intraclass correlation coefficients, coefficients of variation (CVs), and the SEM expressed in both absolute and relative terms. Current results show that the majority of performance indices exceeded intraclass correlation (0.75-0.80) and CV (10-15%) values previously deemed as acceptable levels of data reproducibility. The 2 indices with the greatest variability were power and velocity values obtained at 55% of the 1RM load; thus, it was concluded that higher movement rates at the lightest load were the most difficult aspect of front squat performance to repeat successfully over time. Our practical applications imply lighter loads, with inherently higher rates of barbell movement, yield lower data reproducibility values.

Anthropometry as a predictor of vertical jump heights derived from an instrumented platform.

The current study purpose examined the vertical height-anthropometry relationship with jump data obtained from an instrumented platform. Our methods required college-aged (n = 177) subjects to make 3 visits to our laboratory to measure the following anthropometric variables: height, body mass, upper arm length (UAL), lower arm length, upper leg length, and lower leg length. Per jump, maximum height was measured in 3 ways: from the subjects' takeoff, hang times, and as they landed on the platform. Standard multivariate regression assessed how well anthropometry predicted the criterion variance per gender (men, women, pooled) and jump height method (takeoff, hang time, landing) combination. Z-scores indicated that small amounts of the total data were outliers. The results showed that the majority of outliers were from jump heights calculated as women landed on the platform. With the genders pooled, anthropometry predicted a significant (p < 0.05) amount of variance from jump heights calculated from both takeoff and hang time. The anthropometry-vertical jump relationship was not significant from heights calculated as subjects landed on the platform, likely due to the female outliers. Yet anthropometric data of men did predict a significant amount of variance from heights calculated when they landed on the platform; univariate correlations of men's data revealed that UAL was the best predictor. It was concluded that the large sample of men's data led to greater data heterogeneity and a higher univariate correlation. Because of our sample size and data heterogeneity, practical applications suggest that coaches may find our results best predict performance for a variety of college-aged athletes and vertical jump enthusiasts.

Anthropometry as a predictor of bench press performance done at different loads.

The purpose of our study was to examine the ability of anthropometric variables (body mass, total arm length, biacromial width) to predict bench press performance at both maximal and submaximal loads. Our methods required 36 men to visit our laboratory and submit to anthropometric measurements, followed by lifting as much weight as possible in good form one time (1 repetition maximum, 1RM) in the exercise. They made 3 more visits in which they performed 4 sets of bench presses to volitional failure at 1 of 3 (40, 55, or 75% 1RM) submaximal loads. An accelerometer (Myotest Inc., Royal Oak MI) measured peak force, velocity, and power after each submaximal load set. With stepwise multivariate regression, our 3 anthropometric variables attempted to explain significant amounts of variance for 13 bench press performance indices. For criterion measures that reached significance, separate Pearson product moment correlation coefficients further assessed if the strength of association each anthropometric variable had with the criterion was also significant. Our analyses showed that anthropometry explained significant amounts (p < 0.05) of variance for 8 criterion measures. It was concluded that body mass had strong univariate correlations with 1RM and force-related measures, total arm length was moderately associated with 1RM and criterion variables at the lightest load, whereas biacromial width had an inverse relationship with the peak number of repetitions performed per set at the 2 lighter loads. Practical applications suggest results may help coaches and practitioners identify anthropometric features that may best predict various measures of bench press prowess in athletes.

Roles of hCG in Advancing Follicular Growth to Ovulation after Concurrent Injections of PGF(2α) and GnRH in Postpubertal Holstein Heifers Bearing a CL.

A study was conducted to test the hypothesis that injecting Gonadotropin-releasing hormone (GnRH) concurrently with Prostaglandin F2 alpha (PGF(2α)) followed by an injection of human Chorionic Gonadotropin (hCG), would advance follicular growth to ovulation in Holstein heifers bearing a corpus luteum (CL). After manual examination of the CL, group 1 (PGF; n = 12) received an injection of PGF(2α) (25 mg, im). Group 2 (PGF + GnRH; n = 13) received an injection of GnRH (100 µg, im) immediately after an injection of PGF(2α). Group 3 (PGF + GnRH + hCG; n = 12) received concurrent injections of PGF(2α) and GnRH followed with hCG (1500 IU, im) two days later. Follicular size and day of ovulation were monitored by daily ultrasonographic examination from days 1 to 10. Blood was collected on days-7, 0 (PGF(2α) administration), 2, and 7. Progesterone was not different (P > .05) on days-7, 0, and 2 between the experimental groups. However, it was higher (P < .005) in the PGF + GnRH + hCG group on day 7 compared to PGF + GnRH heifers, but not significantly higher than the PGF. Additionally, heifers in the PGF + GnRH + hCG group ovulated earlier (P < .05) than heifers in the PGF + GnRH and the PGF group. This data indicates that hCG advances follicular growth to ovulation in spite of high levels of progesterone when injected 48 h after concurrent treatments of GnRH and PGF(2α) on heifers bearing a CL.

Diffusion tensor imaging correlates with cytopathology in a rat model of neonatal hydrocephalus.

BACKGROUND: Diffusion tensor imaging (DTI) is a non-invasive MRI technique that has been used to quantify CNS abnormalities in various pathologic conditions. This study was designed to quantify the anisotropic diffusion properties in the brain of neonatal rats with hydrocephalus (HCP) and to investigate association between DTI measurements and cytopathology. METHODS: DTI data were acquired between postnatal day 7 (P7) and P12 in 12 rats with HCP induced at P2 and in 15 age-matched controls. Animals were euthanized at P11 or P22/P23 and brains were processed with immunohistochemistry for glial fibrillary acidic protein (GFAP), ionized calcium-binding adaptor molecule (Iba-1), and luxol fast blue (LFB) to assess astrocytosis, microglial reactivity and degree of myelination, respectively. RESULTS: Hydrocephalic rats were consistently found to have an abnormally low (at corrected p-level of <0.05) fractional anisotropy (FA) value and an abnormally high mean diffusivity (MD) value in the cerebral cortex (CX), the corpus callosum (CC), and the internal capsule (IC). Immunohistochemical analysis demonstrated trends of increasing astrocyte and microglial reactivity in HCP rats at P11 that reached statistical significance at P22/P23. A trend toward reduced myelination in the HCP rats was also found at P22/P23. Correlation analysis at P11 for the CC demonstrated statistically significant correlations (or trends) between the DTI measurement (the decreased FA and increased MD values) and the GFAP or Iba-1 rankings. The immunohistochemical rankings in the IC at P22/P23 were also significantly correlated or demonstrated a trend with both FA and MD values. CONCLUSIONS: This study demonstrates the feasibility of employing DTI on the brain in experimental hydrocephalus in neonatal rats and reveals impairments in multiple regions of interest in both grey and white matter. A strong correlation was found between the immunohistochemical results and the changes in anisotropic diffusion properties.

Prediction of resultant testosterone concentrations from flywheel-based resistive exercise.

INTRODUCTION: Numerous variables impact resultant testosterone concentrations (TC) that foretell the efficacy of workouts. Identifying variables may aid the development of in-flight exercise prescription. METHODS: To identify variables that predict the variance in TC from flywheel ergometer exercise, 17 subjects did 3 workouts in a randomized order. Comprised of 10-repetition leg press sets, workouts entailed either: 1) 3 sets of both concentric and eccentric muscle actions (CE3), and concentric-only actions done for 2) three (CO3), or 3) six (CO6) sets. Venous plasma TC were collected before and at 1 and 30 min postexercise. The last two collection points served as criterion measures. Body mass, delta blood lactate levels, peak angular velocity, average power, and total work from workouts were used to predict the variance in TC. RESULTS: Predictor variables accounted for significant levels of variance at both 1 and 30 min post-exercise for both the CE3 and the concentric-only (CO3 and CO6 bouts combined) workouts using multivariate regression. Inclusion of eccentric variables (only collected from the CE3 bout; r2 = 0.90) predicted nearly twice the variance than the concentric-only (r2 = 0.54) workouts. CONCLUSIONS: Body mass and average power indices were the best predictors of the variance in post-workout TC. Since a flywheel-based device is used to abate in-flight muscle atrophy and strength losses, exercise prescriptions may wish to monitor these indices as they impacted post-workout TC to the greatest extent. Future research should assess why eccentric variables increased the amount of explained variance from flywheel ergometer workouts.