Detoxification Treatment Research Articles

Family Function Impacts Relapse Tendency in Substance Use Disorder: Mediated Through Self-Esteem and Resilience.

BackgroundSubstance abuse has been a public health concern, and even after detoxification treatment, the relapse rate is still high. Family function is closely related to substance dependence. However, studies on psychological mechanisms between them are rare.ObjectivesWe aimed to explore the mediating role of self-esteem and resilience in the pathway that family function impacts the relapse tendency among patients with substance use disorder (SUD).MethodsA total of 282 SUD patients were recruited, and standard questionnaires were administered for each patient. The relapse tendency, family function, self-esteem and resilience were assessed by the family care index questionnaire, the Connor-Davidson resilience scale, the Rosenberg self-esteem scale and the relapse tendency questionnaire. Bootstrap method was conducted for mediation analysis to test the effects of how family function affects relapse tendency mediated through self-esteem and resilience.ResultsThe average score of relapse tendency of the patients was 28.47 (SD = 11.89). Intermediary analysis found that self-esteem played an intermediary role in the relationship between family function and relapse tendency. Resilience plays an intermediary role in the relationship between family function and relapse tendency. Further, the path analysis showed that family function not only had a direct association with relapse tendency, but also indirectly related to relapse tendency through self-esteem and resilience.ConclusionsSelf-esteem and resilience are the key factors in the relationship between family function and relapse tendency of SUD patients.

Concentrically Encapsulated Dual-Enzyme Capsules for Synergistic Metabolic Disorder Redressing and Cytotoxic Intermediates Scavenging.

Enzyme therapy has important implications for the treatment of metabolic disorders and biological detoxification. It remains challenging to prepare enzymatic nanoreactors with high therapeutic efficiency and low emission of cytotoxic reaction intermediates. Here, we propose a novel strategy for the preparation of enzymes-loaded polypeptide microcapsules (EPM) with concentrically encapsulated enzymes to achieve higher cascade reaction rates and minimal emission of cytotoxic intermediates. Mesoporous silica spheres (MSS) are used as a highly porous matrix to efficiently load a therapeutic enzyme (glucose oxidase, GOx), and a layer-by-layer (LbL) assembly strategy is employed to assemble the scavenging enzyme (catalase) and polyelectrolyte multilayers on the MSS surface. After removal of the MSS, a concentrically encapsulated EPM is obtained with the therapeutic enzyme encapsulated inside the capsule, and the scavenging enzyme immobilized in the polypeptide multilayer shell. Performance of the concentrically encapsulated GOx-catalase capsules is investigated for synergistic glucose metabolism disturbance correction and cytotoxic intermediate H2O2 clearance. The results show that the EPM can simultaneously achieve 99% H2O2 clearance and doubled glucose consumption rate. This strategy can be extended to the preparation of other dual- or multi-enzyme therapeutic nanoreactors, showing great promise in the treatment of metabolic disorders.

A new protein-coupled antigen of α-conotoxin MI displays high immunogenicity and can produce antiserum with high detoxification activity

α-conotoxin (α-CTX) MI is a small peptide toxin with 14 amino acids and two disulfide bonds. It potently inhibits muscle-type nicotinic acetylcholine receptors (nAChRs), and poses a threat as a toxin to tropical fishermen. However, there are currently no effective drugs for the treatment of MI envenomation due to the toxin's low immunogenicity. In this report, we generated neutralizing antiserum and F(ab')2 to MI by synthesizing a new MI antigen through the coupling of alkynyl-modified MI and azide-modified bovine serum albumin (BSA), followed by immunization into mouse and horse. The new MI-BSA antigen generated high titers of mouse and horse antiserum (1:204,800 and 1:51,200, respectively), and both the antiserum as well as the horse F(ab')2 displayed highly potent neutralization and detoxification efficacy. 12.5 μL of mouse or horse antiserum preincubated with MI could completely neutralize a lethal dose of the MI (0.4 μg, 1.7 × LD50), while 6.25 μL (mouse) or 10.41 μL (horse) of the antiserum could exert complete detoxification of mice injected with 1.7 × LD50 of MI. Moreover, the mouse and horse antiserum exhibited medium cross-reactivity for highly toxic α-CTX GI. These results demonstrate that the integrity of MI's antigen epitope and carrier effect of BSA can improve MI's immunogenicity, and provides an effective detoxification treatment for highly toxic α-conotoxins as well as an effective method for the preparation of antiserum of small peptide toxins.

Patient-centered placement matching of alcohol-dependent patients based on a standardized intake assessment: process evaluation within an exploratory randomized controlled trial

BackgroundIn the implementation of placement matching guidelines, feasibility has been concerned in previous research. Objectives of this process evaluation were to investigate whether the patient-centered matching guidelines (PCPM) are consistently applied in referral decision-making from an inpatient qualified withdrawal program to a level of care in aftercare, which factors affect whether patients actually receive matched aftercare according to PCPM, and whether its use is feasible and accepted by clinic staff.MethodsThe study was conducted as process evaluation within an exploratory randomized controlled trial in four German psychiatric clinics offering a 7-to-21 day qualified withdrawal program for patients suffering from alcohol dependence, and with measurements taken during detoxification treatment and six months after the initial assessment. PCPM were used with patients in the intervention group by feeding back to them a recommendation for a level of care in aftercare that had been calculated from Measurements in the Addictions for Triage and Evaluation (MATE) and discussed with the staff on the treatment unit. As measurements, The MATE, the Client Socio-Demographic and Service Receipt Inventory—European Version, a documentation form, the Control Preference Scale, and the Motivation for Treatment Scale were administered. A workshop for the staff at the participating trial sites was conducted after data collection was finished.ResultsAmong 250 patients participating in the study, 165 were interviewed at follow-up, and 125 had received aftercare. Although consistency in the application of PCPM was moderate to substantial within the qualified withdrawal program (Cohen’s kappa ≥ .41), it was fair from discharge to follow-up. In multifactorial multinomial regression, the number of foregoing substance abuse treatments predicted whether patients received more likely undermatched (Odds Ratio=1.27; p=.018) or overmatched (Odds Ratio=0.78; p=.054) treatment. While the implementation process during the study was evaluated critically by the staff, they stated a potential of quality assurance, more transparency and patient-centeredness in the use of PCPM.ConclusionsWhile the use of PCPM has the potential to enhance the quality of referral decision making within treatment, it may not be sufficient to determine referral decisions for aftercare.Trial RegistrationGerman Clinical Trials Register DRKS00005035. Registered 03/06/2013.

Sulphated dehydroepiandrosterone serum levels are reduced in women with alcohol use disorder and correlate negatively with craving: A sex-separated cross-sectional and longitudinal study.

Previous studies have established a role of sex hormones in alcohol use disorder (AUD).Only few clinical investigations with low numbers of patients with AUD have focused on the sulphated form of dehydroepiandrosterone (DHEA-S), despite its function as a neuromodulating sex steroid on receptors in the central nervous system (γ-aminobutyric acid type A, N-methyl-D-aspartate, sigma-1 receptors). DHEA-S serum levels were compared between 200 inpatients with AUD (44% women) admitted for withdrawal treatment and 240 healthy controls (45% women) and analysed longitudinally in patients from early abstinence (baseline) to a median of 5 days later. We also correlated DHEA-S levels with craving, liver enzyme activities, and prospective alcohol-related readmissions during a 24-month follow-up. DHEA-S concentrations were lower in female patients than in female healthy controls during baseline (70%) and decreased from baseline to follow-up in the female and male patients groups (down to: women, 92%; men, 76%). Baseline DHEA-S concentrations correlated with the total and obsessive subscales of the Obsessive-Compulsive Drinking Scale and with maximum visual analogue scale craving scores in female patients (Rho ≤ -0.240) and gamma-glutamyl transferase activity in female (Rho = -0.292) and male (Rho = -0.391) patients. DHEA-S did not significantly predict outcome. We found interactions with smoking behaviour and age. This is the first study based on large cohorts of inpatients with AUD undergoing a qualified detoxification treatment to provide sex-separated evidence for associations of DHEA-S serum concentrations with AUD and related phenotypes. The results stimulate further investigations whether DHEA-S directly influences alcohol craving building a basis to develop sex-sensitive prevention and treatment strategies.

The importance of appropriate detoxification treatment in patients with Wernicke-Korsakoff

The importance of appropriate detoxification treatment in patients with Wernicke-Korsakoff

Development of Wet Treatment Process for Volume Reduction, Detoxification and Recycling of Low-grade Aluminum Dross

For the purpose of volume reduction and detoxification of the low-grade aluminum dross (abbreviated as L-dross) with low content of metallic Al, the leaching behavior of two kinds of L-dross was investigated using 2 mol/dm3 H2SO4 and 2 mol/dm3 NaOH with or without heating operation. Ettringite with an anion removal ability was synthesized from the L-dross leachate generated after the volume reduction and detoxification treatment. A series of wet treatment process composed of L-dross leaching and ettringite synthesis was tried to develop in this study.

Rosmarinic acid production in cell suspension cultures of Ehretia asperula Zollinger & Moritz

Plant cell cultures provide an alternative means for producing secondary compounds in food, cosmetic and pharmaceutical industries. Ehretia asperula Zollinger & Moritzi is used as a traditional medicine for the treatment of liver detoxification, ulcers, tumors, inflammation and enhancing the body's resistance in Vietnam. The study was carried out to select suitable callus line for cell suspension cultures of E. asperula Zollinger & Moritzi and investigate the effects of inoculum size, rotation speed and naphthalene acetic acid (NAA) on the proliferation of cell suspension cultures. In addition, the influence of light intensity on the growth and rosmarinic acid (RA) biosynthesis of cell suspension was also surveyed. After 4 weeks of culture, the white to pale yellow friable callus expanded significantly with a fresh weight (FW) of 0.788 g and a high RA content of 2.062 mg/g FW. An appropriate medium for cell proliferation was the liquid B5 medium, which contained 30 g/l glucose, 0.1 mg/l benzyl adenine (BA) and 0.4 mg/l NAA. The results also demonstrated that a 1:20 ratio (w/v) inoculum size, darkness and rotation speed of 90 rpm were the optimal conditions for the proliferation and RA accumulation to 188.217 mg/l in 4 weeks of culture. These findings showed that E. asperula Zollinger & Moritzi cell suspension cultures could be a potential alternative approach for RA production in vitro.

High levels of benzodiazepines after treatment of moderate alcohol withdrawal syndrome: the problem of incomplete detoxification.

Some alcohol-dependence relapses occur soon after a concluded detoxification treatment. A popular agent used in that treatment is diazepam, which effectively relieves withdrawal symptoms due to its long half-life and affinity to the same receptors. It is hypothesized here that these attributes, after nominally completed detoxification, result in, respectively, persisting benzodiazepine (BZD) influence and a distorted (optimistic) clinical presentation. This could contribute to later reemergence of withdrawal symptoms caused by delayed final elimination of BZDs, as the evidence puts into doubt the concept of a gentle self-taper of a long-acting drug. Serum-BZD concentration levels were measured with a radioimmunoassay at the end of routine treatment of moderately- intense alcohol withdrawal syndrome. These data were cross-referenced with individual diazepam administration schedules, including the maximal daily dose and the day of its administration, and the day of overall diazepam cessation. Most patients revealed clinically relevant serum-BZD levels. These correlated with the doses but also with the day of maximal- dose administration and the day of diazepam withdrawal. The confrontation with actual abstinence comes after detoxification. Delayed elimination of diazepam may be a contributing factor in the re-emergence of symptoms and early post-detox relapses. The optimization of the procedure has been discussed in terms of concentration evolution and known treatment schedules. Maximal initial dosage compression and further decisive counteracting the tendencies of diazepam towards accumulation increase the patient's chance of going through the low-concentration crisis under medical assistance.

Biomedical waste management in Panchakarma practice: Present scenario and scope

Ayurveda is a traditional medical system of India. In Ayurveda, Panchakarma (fivefold detoxification treatment) procedures are designed for internal purification and cleansing. As per the Indian government’s initiative (launched in September 2014), Ayurveda is part of wellness industry. There is a constant rise in the number of Ayurveda clinics, hospitals, wellness centers, and spas in India. The various Panchakarma procedures performed in these hospitals, clinics, wellness centers, and spas generate biomedical wastes (BMW). Metropolitan areas in India bring about 62 million tonnes of wastes annually, and this figure is predicted to rise to 165 million tonnes by 2030. Forty-three million tonnes of the municipal solid waste are collected every year, of which 31 million are disposed of in landfills and only 11.9 million are treated. Pharmaceutical wastes are one among them. Reports from the Indian medicinal plant industries indicate that presently more than 9000 plant industries are registered in India, which produces a huge amount of waste each year. This has created a need in the proper management of waste generated. Here is the description and discussion of categorization, classification, and treatment options for waste generated during Panchakarma procedures in Ayurveda hospitals. Effective and proper management of the BMW is necessary to maintain personal as well as environmental health. The current available techniques for the treatment of waste generated during Panchakarma procedure are sewage drainage, incineration, and landfill. Nothing turns around to be waste until it is being not used further with intelligence. The natural cycles of life taught us the same through science: utilizing of three Rs of ideal waste management. While further advancement can include the use of phytoremediation, composting, vermicomposting, biofiltration, bioaugmentation and use of solar energy in waste management.

Anisodamine affects the pigmentation, mineral density, craniofacial area, and eye development in zebrafish embryos.

Anisodamine is one of the major components of the tropine alkaloid family and is widely used in the treatment of pain, motion sickness, pupil dilatation, and detoxification of organophosphorus poisoning. As a muscarinic receptor antagonist, the low toxicity and moderate drug effect of anisodamine often result in high doses for clinical use, making it important to fully investigate its toxicity. In this study, zebrafish embryos were exposed to 1.3-, 2.6-, and 5.2-mM anisodamine for 7 days to study the toxic effects of drug exposure on pigmentation, mineral density, craniofacial area, and eye development. The results showed that exposure to anisodamine at 1.3 mM resulted in cranial malformations and abnormal pigmentation in zebrafish embryos; 2.6- and 5.2-mM anisodamine resulted in significant eye development defects and reduced bone density in zebrafish embryos. The associated toxicities were correlated with functional development of neural crest cells through gene expression (col1a2, ddb1, dicer1, mab21l1, mab21l2, sox10, tyrp1b, and mitfa) in the dose of 5.2-mM exposed group. In conclusion, this study provides new evidence of the developmental toxicity of high doses of anisodamine in aqueous solutions to organisms and provides a warning for the safe use of this drug.

New Access Routes to Undertreated Populations; How Do Problem Substance Users Recruited from an Unemployment Office Differ from Detoxification Treatment Inpatients?

Background: Only a minority of subjects with substance use disorders (SUDs) are in addiction-specific treatment (treatment gap). Co-operation between an unemployment office and a psychiatric hospital was established for the assessment and counseling of long-term unemployed clients with SUD. We aim at validating whether such a treatment gap exists in that group, and whether clients from an unemployment office differed from a matched group of inpatient detoxification patients with regard to socio-economic characteristics, substance use and treatment history, and the prevalence of mental disorders Methods: Unemployment office clients (n = 166) with an SUD were assessed using a standardized sociodemographic and clinical interview. They were compared with 83 inpatients from a local detoxification ward, matched for age, sex, and primary addictive disorder (matching ratio 2:1). Results: Most (75.9%) subjects were males, with an average age of 36.7 years. The SUDs mostly related to alcohol (63.9%) and cannabis (27.7%). Although most unemployment office clients had a long SUD history, only half of them had ever been in addiction-specific treatment during their lifetime, and only one in four during the last year. There were no statistically significant differences between the groups regarding age at onset of problematic substance use, the proportion of migrants, and prevalence of comorbid mental disorders. The unemployment office sample showed lower levels of education (p < 0.001), job experience (p = 0.009), and current employment rates (p < 0.001). Conversely, inpatients showed lower rates of imprisonment (p < 0.001), more inpatient detoxification episodes (p < 0.03); and longer abstinence periods (p < 0.005). Conclusions: There was a lifetime and recent treatment gap in the group of long-term unemployed subjects with alcohol and cannabis dependence. The markedly lower educational attainment, chronic employment problems and higher degree of legal conflicts in the client group, as compared with patients in detoxification treatment, might require specific access and treatment options. The co-operation between the psychiatric unit and the unemployment office facilitated access to that group.

Demographic and Clinical Correlates of Treatment Completion among Older Adults with Heroin and Prescription Opioid Use Disorders

ABSTRACT In this study using 2015–2018 Treatment Episode Data Set-Discharge (TEDS-D) cases age 55+ for heroin (N = 101,524) or prescription opioids (PO; N = 25,510) as the primary substance, we examined treatment completion rates and correlates. We fit separate logistic regression models for heroin and PO cases with treatment completion status (completed vs. discontinued due to dropout/termination/other reasons) for each treatment setting (detoxification, residential rehabilitation, and outpatient) as the dependent variable. Results show that detoxification cases had the highest completion rates and outpatient cases had the lowest (14.8% for heroin and 24.0% for PO cases). A consistently significant correlate of treatment completion was legal system referral for heroin cases and having a bachelor’s degree for PO cases. Medication-assisted therapy was associated with higher odds of completing residential treatment for both types of opioids but lower odds of completing detoxification and outpatient treatment. Treatment duration >30 days tended to have higher odds of completion. PO cases age 65+ had higher odds of completing residential treatment than cases age 55–64. Racial/ethnic minorities tended to have lower odds of outpatient treatment completion. Study findings underscore the importance of helping older adults complete treatment, especially those who are racial/ethnic minorities and receiving outpatient treatment.

Identification of best detoxification strategies for sustainable valorization of waste from Jatropha-based biodiesel industry: Compounding the benefits of plant-based vehicular fuel

Bioenergy generated from plants is one of the best potential energy supplies. Recently, the non-edible Jatropha curcas has been considered one of the world’s most sustainable biofuel crops. Protein rich defatted Jatropha curcas kernel meal (DJKM) is toxic which contains phorbol esters (PEs, 1307 μ g g −1 ) as a major toxic component, therefore it was detoxified through physical, chemical and solid-state fermentation treatments. Water soaking and moist heat treatment (autoclaving) had no significant effect on the PEs removal compared to control. Exposure of DJKM to electron beam radiation (2.5, 5, 10, 15 and 20 kGy) had a significant effect on PEs degradation and most efficient was at 25 kGy dose. Solvent extraction with either 90% methanol or 80% ethanol in combination with moist heat treatment was the most efficient method compared to other concentrations of methanol or ethanol. Solvent extraction of kernel meal through 0.2 or 0.3 M NaOH in 90% methanol and 0.1, 0.2 or 0.3 M NaOH in 80% ethanol, followed by moist heat treatment led to the removal of PEs completely. The PEs content in DJKM through highly alkaline methanol plus moist heat treatment (AM3.0) and ferric chloride & hydrogen peroxide plus moist heat treatments significantly ( p < 0.05) decreased to 13.0 and 53.6 μ g g −1 , respectively. Non-alkaline solvent extraction of DJKM using either 90% methanol (M90H) or 80% ethanol (E80H) in addition to heating while magnetic stirring reduced PEs content significantly ( p < 0.05) compared to control exhibiting 99.77 and 99.32% removal, respectively. The DJKM was free of PEs when it was treated via solid-state fermentation through Aspergillus niger fungus. Conclusively, chemical detoxification treatments are cumbersome, un-economical, and their incorporation in the diet may affect animal performance, whereas, the fermentation approach is cost economical, environmentally sustainable and offers greater efficiency. • Defatted Jatropha kernel meal is protein rich ingredient. • Toxic principle (phorbol esters) in the Jatropha meal needs to be eliminated. • Physical treatments did not degrade phorbol esters completely. • Solvent extraction using alkaline methanol or ethanol removed phorbol esters. • Solid-state fermentation completely detoxified Jatropha meal.

Severity of opioid dependence and its relation with psychosocial factors of users.

Objectives: To determine the relationship between severe opioid dependence and psychosocial factors of users Study Design: Descriptive Cross Sectional study. Setting: Department of Psychiatry Nishtar Hospital Multan. Period: Nov 2018 to May 2020. Material &amp; Methods: 196 participants were enrolled through non probability purposive sampling technique. Pearson chi square test was applied to identify significant relationship between severe opioid dependence and psychosocial factors. Result: Mean age of study cases was 30.86 ± 1.66. The frequency of severe opioid dependence was noted in 159 (81.1%) of study participants. Statistical significant relation of severe opioid dependence was noted with age, literacy status, literacy level, marital status, monthly income, route of opioid use, frequency of opioid use per day, previous detoxification treatment and encounters with law enforcement agencies Conclusion: The severity of opioid dependence was high in patients admitted for treatment of opioid use. Severe opioid dependence was related with certain psychosocial factors such as user’s age, literacy status, literacy level, marital status, monthly income, route of opiod use, frequency of opioid use, previous detoxification treatment for opioid use and encounters with law enforcement agencies. This suggests that optimal treatment of severe opioid dependence should include interventions based on individual’s psychosocial needs.

Possible repair mechanisms of renin-angiotensin system inhibitors, matrix metalloproteinase-9 inhibitors and protein hormones on methamphetamine-induced neurotoxicity.

Methamphetamine is a highly addictivecentral stimulant with extensive and strong neurotoxicity. The neurotoxicity of methamphetamine is closely related to the imbalance of dopamine levels and the destruction of the blood-brain barrier. An increase in dopamine may induce adverse effects such as behavioral sensitization and excessive locomotion. Damage to the blood-brain barrier can cause toxic or harmful substances to leak to the central nervous system, leading to neurotoxicity. The renin-angiotensin system is essential for the regulation of dopamine levels in the brain. Matrix metalloproteinase-9 causes reward effects and behavioral sensitization by inducing dopamine release. Prolactin has been shown to be involved in the regulation of tight junction proteins and the integrity of the blood-brain barrier. At present, the treatment of methamphetamine detoxification is still based on psychotherapy, and there is no specific medicine. With the rapid increase in global seizures of methamphetamine, the treatment of its toxicity has attracted more and more attention. This review intends to summarize the therapeutic mechanisms of renin-angiotensin inhibitors, matrix metalloproteinase-9 inhibitors and protein hormones (prolactin) on methamphetamine neurotoxicity. The repair effects of these three on methamphetamine may be related to the maintenance of brain dopamine balance and the integrity of the blood-brain barrier. This review is expected to provide the new therapeutic strategy of methamphetamine toxicity.

Tulburările digestive induse de acumularea arseniului în organismul uman

Exposure to arsenic is common, but unconscious, inducing major imbalances especially in the digestive tract, lungs, skin. Contamination is achieved by exposure to arsenic in the air, soil, groundwater, food. It is noted the use of arsenic in pesticides, herbicides, paints, wood preservatives, drinking water, various foods with a wide range of consumption (seafood, rice – including rice milk, rice bran, rice cereals, rice syrup rice, rice crackers). The diagnosis of arsenic poisoning is an important step in establishing the diet and detoxification treatment, focusing on the cause, not the symptoms. We present the case of a 45-year-old patient with symptoms manifested in the digestive tract for 4 years: abdominal bloating, cramps, vomiting, weekly episodes of acute diarrhea. During these period the patient received multiple treatments depending on the symptoms, without a significant improvement, without performing specific investigations of arsenic poisoning. The personalized diet and treatment plan, used in the case of this patient, for a period of 4 months was distinguished by a total solution of the manifestations presented in the anamnesis stage.

Скарлатина на фоне токсикодермии у ребенка: клинический случай и краткий обзор

В статье представлен случай скарлатины на фоне токсикодермии у девочки 12 лет. Клиническая картина, скорее всего, возникла из-за сочетания этиологических факторов, таких как бактериальная инфекция и аллергическая реакция на экзотоксины. Течение болезни осложнялось поражениями слизистой носа, зева и кожи. Парентеральное введение глюкокортикоидов, антибактериальной терапии, антигистаминных препаратов привело к регрессированию клинических симптомов и предотвратило развитие осложнений. Иногда трудно дифференцировать этиологию токсикодермии в сочетании со скарлатиной. Врачи должны обследовать всех пациентов с аллергодерматозами на наличие бета-гемолитических стрептококков и антител.

Factors Associated With Leaving Against Medical Advice From Inpatient Substance Use Detoxification Treatment

Objective: The objective of this study was to identify factors associated with leaving against medical advice (AMA) from inpatient substance use detoxification treatment. Methods: A retrospective study of 832 adult patients discharged AMA from an inpatient substance use detoxification unit. Variables from the following factors were included: demographics, substance type, medical history, psychiatric history, tobacco use, detoxification protocol, legal history, and reason for discharge AMA. The outcome variable was days until discharge AMA. Results: For demographics, only increased age was significantly associated with increased days before leaving AMA (B=0.002, SE=0.001, P&lt; 0.01). For detoxification protocol, lorazepam was significantly associated with increased days before leaving AMA (B=0.06, SE=0.03, P&lt; 0.05). For reasons for discharge AMA, only personal obligation was significantly associated with increased days before leaving AMA (B=0.05, SE=0.02, P&lt; 0.01). Medical history, substance type, psychiatric history, tobacco use, and legal history were each not significantly associated with days before leaving AMA. Conclusions: This study identified factors associated with leaving AMA from substance use detoxification units. Clinicians may find it useful to spend more time counseling younger patients to encourage engagement in the entire spectrum of care, including detoxification completion. Patients who cited personal obligations as a reason for leaving AMA stayed more days than those who did not cite personal obligations as a reason for leaving AMA. Clinicians may thus find it useful to assess the urgency of the patient’s personal obligations before initiating detoxification, highlight ways addiction impacts each patient’s personal obligations, and identify available supports in the community to promote treatment completion.

Bismuth ferrite Fenton‐like pretreatment improves lactic acid production from corn stover without detoxification by Bacillus coagulans

AbstractAgricultural stover is attractive as a raw material for lactic acid (LA) and polylactic acid (PLA) production because it does not compete with other food sources. The demand for PLA is extremely high. Pretreatment is an important step for LA production from agricultural stover. It improves the degradability of cellulose but always generates fermentation inhibitors. In this study, corn stover was pretreated with ammonia combined with a bismuth ferrite Fenton‐like process and then used for LA production through simultaneous enzymic saccharification and fermentation without detoxification treatment. The LA titer and yield were 92.35 ± 2.25 g L−1 and 0.62 g/g in fed batch fermentation under nonsterile conditions. Traces of formic acid were detected at the beginning of all experiments and disappeared during fermentation. Specific surface area and scanning electron microscopy observations of lignocellulose showed that there were many pore holes in pretreated corn stover fiber, which obviously improved the enzymatic hydrolysis efficiency. These results indicated that the bismuth ferrite Fenton‐like process is an economical and efficient pretreatment method that can improve the degradability of fiber, reduce inhibitors, and then achieve high LA production without detoxification and sterilization. © 2021 Society of Chemical Industry and John Wiley &amp; Sons, Ltd