Pattern Of Withdrawal Research Articles

청소년의 사회적 위축 발달 궤적: 친구관계와 교사관계의 동시 및 지연효과

청소년의 사회적 위축 발달 궤적: 친구관계와 교사관계의 동시 및 지연효과

Peran Pemerintah dalam Pengelolaan Zakat Menurut Abu Ubaid Al Qasim (Studi Kasus Kota Pontianak)

The management of zakat at this time has not implemented the pattern and system of withdrawal, management and distribution as a whole as stated in the Regional Regulation of Pontianak City No. 25 of 2002 concerning Guidelines for the Management of Pontianak City Zakat. Abu Ubaid Al-Qasim Bin Salam gave new thoughts and perspectives on the government's role in zakat management, including the management of zakat - zakat other than zakat assets that can be taken forcibly if not fulfilled. Thus making the government as the sole executor and punisher. Regarding the distribution of excess use of zakat funds, it can be transferred to other areas, not just for business development that has been carried out as it is now. This research uses literature study research. The type of data used is secondary data, namely data obtained indirectly. The data needed in this study were taken from documents related to research. The data analysis technique used was descriptive analytic which was sourced from the discussion in the Kitab al-Amwal by Abu Ubaid al-Qasim and its relation to the role of the government, especially the Pontianak city government.

Patterns of withdrawal in patients with opioid use disorder (OUD) transitioning from untreated OUD or buprenorphine treatment to extended-release naltrexone

ABSTRACT Background Pharmacologic treatment is recommended for many individuals with opioid use disorder (OUD). For patients who select opioid antagonist treatment, effective management of opioid withdrawal symptoms during transition to antagonist treatment requires consideration of the patient experience. Objectives To compare patterns of opioid withdrawal between those withdrawing from untreated opioid use and those withdrawing from buprenorphine. Methods We performed a post hoc, cross-study comparison of the temporal pattern of opioid withdrawal during 1-week induction onto extended-release naltrexone by similar protocols enrolling two participant populations: participants with OUD entering a study with untreated opioid use (N = 378, NCT02537574) or on stable buprenorphine (BUP) treatment (N = 101, NCT02696434). Results The temporal pattern of withdrawal from induction day 1 through day 7 differed between the two participant populations for Clinical Opiate Withdrawal Score (COWS) and Subjective Opiate Withdrawal Score (SOWS): participants with untreated OUD prior to study entry were more likely to experience an earlier relative peak in opioid withdrawal followed by a gradual decline, whereas participants on stable BUP treatment prior to study entry were more likely to experience a relatively later, though still mild, peak opioid withdrawal. The peak COWS was reached at a mean (standard deviation) of 1.9 (1.5) days for participants with untreated OUD and 5.0 (1.5) days for participants on stable BUP. Daily peak cravings were generally higher for participants with untreated OUD than participants on stable BUP. Conclusion Awareness of population-specific variations in the patient experience of opioid withdrawal may help clinicians anticipate the expected course of withdrawal.

Is There a Characteristic Autonomic Response During Outbursts of Combative Behavior in Dementia Patients?

We sought to determine whether skin conductance level could warn of outbursts of combative behavior in dementia patients by using a wristband device. Two outbursts were captured and are reported here. Although no physiologic parameter measured by the wristband gave advance warning, there is a common pattern of parasympathetic withdrawal (increased heart rate) followed approximately 30 seconds later by sympathetic activation (increased skin conductance). In the literature, a similar pattern occurs in psychogenic non-epileptic seizures. We hypothesize that similar autonomic responses reflect similarities in pathophysiology and that physical activity may partially account for the time course of skin conductance.

Cardiac autonomic modulation during yoga postures and cycling: An “Acute State Effect”

Objectives: Health benefits of aerobic exercises and Yogaasana (Yoga Postures) in lifestyle diseases are well known. There are pointers that these health benefits may be mediated through cardiac autonomic modulation. “Acute State effects” of autonomic modulation during aerobic exercise is fairly established; however there is relative dearth of information about it during Yogasana (Yoga Postures). The purpose of present study is to explore “Acute State Effect” of cardiac autonomic modulations during Yogasana (postures) and mild aerobic exercise (cycling) using heart rate variability (HRV) a cardiac autonomic marker in Yoga naïve volunteers. Materials and Methods: Thirty consenting volunteers between eighteen to twenty five years, of both genders performed test protocol comprised of four blocks of modified yoga postures, one block of cycling each of five minute duration and a block of supine rest that served as baseline. High sampled ECG (1 KHz) was recorded during protocol for HRV analysis. Friedman test for multiple blocks comparison and Wilcoxon signed rank test for pair wise comparison was employed. P < 0.05 considered as significant. Results: Multiple block comparison of HRV indices (P < 0.0001) and for breathing rate (P < 0.0004) were highly significant. Compared to resting baseline a pattern of vagal withdrawal (decrease in HF nu) with increment in average heart rate was observed during modified yogasanas and cycling. Shavasana showed pattern of parasympathetic reactivation with decrement in average heart rate. Conclusion: The pattern of autonomic modulation in Yoga naïve performing modified yogasanas was similar to mild intensity cycling. Shavasana showed pattern of post exercise recovery.

The Frantic Seeking of Credit during Poker Machine Problem Gambling: A Public Health Perspective.

(1) Background: Financial harms associated with problem gambling are substantial and result in suicidal ideation, depression, anxiety and relationship damage, causing distress for problem gamblers and their families. This paper examines Electronic Gaming Machine gamblers’ frantic use of credit during episodes of gambling as a substantial public health burden. (2) Methods: This qualitative study comprised 29 participants purposefully selected who participated in either focus groups or in-depth interviews, which were analysed using thematic, textual analysis. (3) Results: Ready access to credit in the gambling venues enabled problem gamblers to engage in desperate credit transactions to continue to gamble. Many showed frantic, repeated patterns of e-credit withdrawal, which may be typical of gambling while “in the zone”, when it is highly likely that the gamblers are not able to make informed decisions about the use of credit. This pattern of the electronic withdrawal of cash may well be recognisable electronically by financial institutions in real-time, as part of a duty of care potentially owed by banks to their customers. It would provide an opportunity for the identification of people at financial risk due to gambling and systemic intervention to limit the financial harm at a time when financial decision-making is impaired. (4) Conclusions: Although this finding needs further confirmation, there are significant implications for harm minimisation and early intervention for affected PGs. It also raises the issue of the ‘duty of care’ owed to PG customers by financial institutions.

Haemodialysis withdrawal in Australia and New Zealand: a binational registry study.

Withdrawal from dialysis is an increasingly common cause of death in patients with end-stage kidney disease (ESKD). As most published reports of dialysis withdrawal have been outside the Oceania region, the aims of this study were to determine the frequency, temporal pattern and predictors of dialysis withdrawal in Australian and New Zealand patients receiving chronic haemodialysis. This study included all people with ESKD in Australia and New Zealand who commenced chronic haemodialysis between 1 January 1997 and 31 December 2016, using data from the Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry. Competing risk regression models were used to identify predictors of dialysis withdrawal mortality, using non-withdrawal cause of death as the competing risk event. Among 40447 people receiving chronic haemodialysis (median age 62 years, 61% male, 9% Indigenous), dialysis withdrawal mortality rates increased from 1.02 per 100 patient-years (11% of all deaths) during the period 1997-2000 to 2.20 per 100 patient-years (32% of all deaths) during 2013-16 (P < 0.001). Variables that were significantly associated with a higher likelihood of haemodialysis withdrawal were older age {≥70 years subdistribution hazard ratio [SHR] 1.77 [95% confidence interval (CI) 1.66-1.89]; reference 60-70 years}, female sex [SHR 1.14 (95% CI 1.09-1.21)], white race [Asian SHR 0.56 (95% CI 0.49-0.65), Aboriginal and Torres Strait Islander SHR 0.83 (95% CI 0.74-0.93), Pacific Islander SHR 0.47 (95% CI 0.39-0.68), reference white race], coronary artery disease [SHR 1.18 (95% CI 1.11-1.25)], cerebrovascular disease [SHR 1.15 (95% CI 1.08-1.23)], chronic lung disease [SHR 1.13 (95% CI 1.06-1.21)] and more recent era [2013-16 SHR 3.96 (95% CI 3.56-4.48); reference 1997-2000]. Death due to haemodialysis withdrawal has become increasingly common in Australia and New Zealand over time. Predictors of haemodialysis withdrawal include older age, female sex, white race and haemodialysis commencement in a more recent era.

Buprenorphine for managing opioid withdrawal.

Buprenorphine for managing opioid withdrawal.

Characterizing opioid withdrawal during double-blind buprenorphine detoxification.

Prescription opioid (PO) abuse has become an urgent public health issue in the United States. Detoxification is one important treatment option, yet relatively little is known about the time course and severity of opioid withdrawal during buprenorphine detoxification. This is a secondary analysis of data from a randomized, placebo-controlled, double-blind evaluation of 1, 2, and 4-week outpatient buprenorphine tapers among primary prescription opioid (PO) abusers. The aim is to characterize the time course and severity of buprenorphine withdrawal under rigorous, double-blind conditions, across multiple taper durations, and using multiple withdrawal-related measures (i.e., self-report and observer ratings, pupil diameter, ancillary medication utilization). Participants were PO-dependent adults undergoing buprenorphine detoxification and biochemically-verified to be continuously abstinent from opioids during their taper (N = 28). Participants randomly assigned to the 4-week taper regimen experienced a relatively mild and stable course of withdrawal, with few peaks in severity. In contrast, the 1- and 2-week taper groups experienced stark increases in withdrawal severity during the week following the last buprenorphine dose, followed by declines in withdrawal severity thereafter. The 4-week taper group also reported significantly fewer disruptions in sleep compared to the other experimental groups. When predictors of withdrawal were examined, baseline ratings of "Expected Withdrawal Severity" was the most robust predictor of withdrawal experienced during the taper. Data from this trial may inform clinicians about the expected time course, magnitude, and pattern of buprenorphine withdrawal and aid efforts to identify patients who may need additional clinical support during outpatient buprenorphine detoxification.

Exploration of Withdrawal of Life-Sustaining Therapy in Canadian Intensive Care Units.

The process of controlled donation after circulatory death (cDCD) is strongly connected with the process of withdrawal of life-sustaining therapy. In addition to impacting cDCD success, actions comprising withdrawal of life-sustaining therapy have implications for quality of palliative care. We examined pilot study data from Canadian intensive care units to explore current practices of life-sustaining therapy withdrawal in nondonor patients and described variability in standard practice. Secondary analysis of observational data collected for Determination of Death Practices in Intensive Care pilot study. Four Canadian adult intensive care units. Patients ≥18 years in whom a decision to withdraw life-sustaining therapy was made and substitute decision makers consented to study participation. Organ donors were excluded. None. Prospective observational data on interventions withdrawn, drugs administered, and timing of life-sustaining therapy withdrawal was available for 36 patients who participated in the pilot study. Of the patients, 42% died in ≤1 hour; median length of time to death varied between intensive care units (39-390 minutes). Withdrawal of life-sustaining therapy processes appeared to follow a general pattern of vasoactive drug withdrawal followed by withdrawal of mechanical ventilation and extubation in most sites but specific steps varied. Approaches to extubation and weaning of vasoactive drugs were not consistent. Protocols detailing the process of life-sustaining therapy withdrawal were available for 3 of 4 sites and also exhibited differences across sites. Standard practice of life-sustaining therapy withdrawal appears to differ between selected Canadian sites. Variability in withdrawal of life-sustaining therapy may have a potential impact both on rates of cDCD success and quality of palliative care.

Attention-deficit hyperactivity disorder and cardiac vagal control: a systematic review

Attention-deficit hyperactivity disorder (ADHD) is characterized by behavioural disinhibition, deficient emotional self-regulation, inattention, and hyperactivity. The constellation of deficits found in children with ADHD implicates autonomic dysregulation characterized by deficient control of the heart by parasympathetic influences. While it is generally assumed that autonomic regulation of the heart is impaired during ADHD, the information pertaining to this dysregulation is limited. A systematic review of three databases was conducted between January and March 2012 for peer reviewed publications examining the relationship between cardiac vagal control (CVC) and ADHD without comorbid psychopathology. 19 articles were reviewed with only 6 meeting inclusion criteria. Findings were not unanimous but suggested that children with unmedicated ADHD experienced lower levels of CVC than did healthy controls. It was difficult to evaluate whether children with ADHD exhibited a different pattern of withdrawal and application of CVC than did normal controls. Findings suggested CVC reactivity depended on the task employed but children with ADHD experienced dampened CVC reactivity during tasks that involved self-regulation and emotion regulation. Finally, medication acted to correct the autonomic imbalance experienced by children with ADHD but did not bring this imbalance into normal levels. Given that so few studies were identified, no firm conclusions can be made, and there is a clear need for additional research in this area. Recommendations for future research are discussed.

"La comunitŕ che rifiuta di accettare la Legge di Dio": dinamiche di radicalizzazione nelle relazioni tra gruppi di militanti islamici e le loro constituencies

In the study of radicalization and processes of political violence, the relationship between militant groups and their social and political environment is considered mainly with respect to interactions between the militants and their adversaries (police, governments). Drawing on an analysis of the Egyptian militant Islamist group al-Jamaa al-Islamiyya between 1986 and 1997, this paper argues that beyond this dyadic relationship, interactions between the militants and their constituencies [social environment] may contribute to processes of radicalization. In the case of al-Jamaa al-Islamiyya, two basic mechanisms could be identified that reinforced this process: Firstly, the militants’ agenda of transforming the Muslim community’s social and cultural order (fighting moral corruption in society) caused resentment and triggered a cycle of rejection and radicalization, culminating in attempts to impose norms of moral conduct by force, which, in turn, contributed to a further loss of support. Secondly, the weakening of support during the violent conflict with the police triggered a dynamic of social isolation and radicalization, either in a pattern of withdrawal and disengagement, with militants turning away from local arenas and engage in national (or international) terrorist campaigns; or in a violent struggle over controlling the community, in which the militants reacted to what they perceived as betrayal by trying to coerce and terrorize the population into compliance and into not collaborating with their enemy, thereby destroying all remnants of supportive relations with local communities.

Unexplained Chronic Fatigue and Interpersonal Problems: A Study in a Primary Care Population

Unexplained fatigue syndromes are multidimensional phenomena that involve a constellation of symptoms. This article explores whether typical interpersonal problems are associated with self-reported and clinically-rated fatigue symptoms in chronically fatigued patients. We hypothesize that the severity of fatigue symptoms will be associated with a pattern of withdrawal from social interaction. Interpersonal problems were assessed by means of a self-report questionnaire. Chronic fatigue was assessed with a self-report questionnaire (both self-rated and clinically-rated) in a primary care Chronic Fatigue Syndrome (CFS) group (N = 52) and compared with two other clinical populations (minor medical condition: N = 51; chronic organic disease: N = 52). Compared to patients with a minor medical condition, CFS patients are substantially more fatigued and more socially withdrawn. Compared to patients with a chronic organic disease, somewhat more fatigue-related disability was observed in CFS patients, but no distinct interpersonal problems came to the fore. CFS patients and physicians proved to differ in their opinion on the patient's motivation. In line with the hypothesis, self-rated and clinically-scored fatigue problems proved to be related to a pattern of withdrawal from social interaction. Differences between physicians' and patients in how symptoms are interpreted might be related to patients feeling misunderstood and result in social withdrawal.

Rats in acute withdrawal from ethanol exhibit left ventricular systolic dysfunction and cardiac sympathovagal balance shift

There is strong evidence that sympathovagal balance plays an important role in the progression of cardiac dysfunction in non-alcoholics. The purpose of this investigation was to determine whether a pattern of continuous ethanol intake and withdrawal modulates the cardiac sympathovagal balance and left ventricular (LV) systolic function in rats. Male Wistar rats were treated with a continuous ethanol liquid diet for 49 days, and then subjected to 1-day withdrawal and 21-day abstinence. Cardiac sympathovagal balance and LV systolic function were evaluated based on heart rate variability (HRV), Western blotting, and echocardiography. Longitudinal data obtained from the same rats showed that the 49-day continuous ethanol treatment induced LV systolic dysfunction, expressed by decreased fractional shortening and ejection fraction. At the 1-day withdrawal, LV systolic dysfunction was deteriorated, and the low-frequency power/high-frequency power (LF/HF) ratio in HRV was elevated because of the depressed HF and the increased LF. Western blot analysis showed an increased expression of myocardial tyrosine hydroxylase and a decreased expression of myocardial acetylcholine. All anomalies were recovered to baseline values with 21-day abstinence. We concluded that acute withdrawal from a 49-day continuous ethanol regimen is sufficient to promote the shift of cardiac sympathovagal balance toward sympathetic predominance and reduced vagal tone, contributing to the further deterioration of LV systolic function in rats. Those providing medical care for alcoholics should be aware of this enhanced susceptibility to LV systolic dysfunction with abrupt termination of a continuous ethanol regimen.

Social Skills Differences among Attention-Deficit/Hyperactivity Disorder Types in a Chat Room Assessment Task

This study assessed social skills in 116 children aged 7-12 with ADHD-Combined Type (ADHD-C; n=33), ADHD-Inattentive Type (ADHD-I; n=45), and comparison children (n=38), with consideration of the role sluggish cognitive tempo (SCT) symptoms play in distinguishing profiles. Social skills were assessed using a novel computerized chat room task, in which participants were encouraged to join a conversation and type messages to interact with four computer-simulated peers. Every participant received the identical stimulus from the simulated peers, but was free to respond to it in his or her own unique way. Relative to comparison children, children with ADHD-C made off-topic and hostile responses; children with ADHD-I made off-topic responses, few responses and showed poor memory for the conversation. ADHD subtype differences remained after statistical control of IQ, reading achievement, typing skill, and comorbid disruptive behavior disorders. SCT symptoms, most prevalent among children with ADHD-I, predicted a distinct pattern of social withdrawal and lower hostility. Parent and teacher ratings and in-vivo observations of social skills correlate with this new measure.

Rebound-withdrawal headache (medication overuse headache)

Rebound-withdrawal headache (medication overuse headache) is a problem that affects 1% of the population or perhaps more. Work from many countries has shown this to be a worldwide problem. It appears that the rebound-withdrawal headache often occurs on the background of pre-existing migraine or tension headache and may assume the phenotype of chronic migraine or chronic tension-type headache. The key feature of this entity is that the patient initially uses a symptomatic treatment for headache with good result. Use of this medication may increase over time, but as the use increases to more than 10 to 15 days per month, headache frequency may also increase, reaching a point where metabolic processing of the medication and removal from the system triggers another headache. The patient then finds that as use of the medication increases, the frequency and intensity of the headaches also increases, and the overall headache worsens. Once this pattern is established, therapy requires removal of the medication in order for the rebounding process to be terminated. Preventative antimigraine medications will not work in the presence of the rebound phenomenon. Once the rebound-withdrawal headache is established, it is difficult to treat. After withdrawal of the medication, there is often a high relapse rate of using the medication again with redevelopment of the rebound-withdrawal headache. Even in patients who do not relapse to drug use, headache usually remains a major problem. Recognition and treatment of rebound headache are key factors in management of these patients. Perhaps more important in regard to this entity is recognizing its existence and preventing patients from entering a pattern of rebound withdrawal, which can be achieved by early attention to their use of analgesic narcotic or migraine-abortive medications. Overall, it is likely that this will continue to be an increasing worldwide problem in managing patients with headache.

Emily Dickinson and Schizotypy

Emily Dickinson probably suffered from schizotypal personality disorder. Not to be confused with schizophrenia, schizotypy suggests a pattern of social withdrawal, especially face-to-face interaction, and behaviors considered eccentric to cultural norms, such as unusual dress. Schizotypy also carries implications for her work. Chief among its characteristics is an unusual use of language. Dickinson's peculiar rhetoric is consistent with patterns particular to schizotypy. While such a diagnosis does not explain her genius and only bluntly acts to reinforce modern scholarship, it does act to coalesce many disparate parts of Dickinson's life and work into a conceptual whole.

Precipitated opioid withdrawal across acute physical dependence induction methods

The phenomenon of acute opioid physical dependence (APD) is an established and well-characterized experimental model for studying the clinical phenomenon of physical dependence to opioids in humans. In this paradigm, an opioid withdrawal syndrome is elicited in non-opioid-dependent humans by the parenteral administration of naloxone (NX) following a single large dose of opioid agonist. Although induced by various opioids and NX administration schedules, lacking is a direct comparison of different induction protocols with respect to withdrawal severity. Using a crossover design, we compared withdrawal severity in four healthy male subjects pretreated with morphine (MS; 18 mg/70 kg im), MS (10 mg/70 kg iv) and hydromorphone (HM; 2 mg/70 kg) followed 2 or 6 h later with NX (10 mg/70 kg iv). Dependent measures included both physiological and subjective indicators of withdrawal. All opioid pretreatments reliably induced APD and repeated-measures analysis of variance (ANOVA) showed that both pattern and severity of precipitated withdrawal were similar across conditions. Thus, despite altering the pretreatment opioid and route of administration, all three APD protocols produced similar and reliable withdrawal symptoms in humans.

Assessment of the ultrastructural and proliferative properties of human embryonic stem cell-derived cardiomyocytes.

Assessment of early ultrastructural development and cell-cycle regulation in human cardiac tissue is significantly hampered by the lack of a suitable in vitro model. Here we describe the possible utilization of human embryonic stem cell (ES) lines for investigation of these processes. With the use of the embryoid body (EB) differentiation system, human ES cell-derived cardiomyocytes at different developmental stages were isolated and their histomorphometric, ultrastructural, and proliferative properties were characterized. Histomorphometric analysis revealed an increase in cell length, area, and length-to-width ratio in late-stage EBs (>35 days) compared with early (10-21 days) and intermediate (21-35 days) stages. This was coupled with a progressive ultrastructural development from an irregular myofibrillar distribution to an organized sarcomeric pattern. Cardiomyocyte proliferation, assessed by double labeling with cardiac-specific antibodies and either [3H]thymidine incorporation or Ki-67 immunolabeling, demonstrated a gradual withdrawal from cell cycle. Hence, the percentage of positively stained nuclei in early-stage cardiomyocytes ([3H]thymidine: 60 +/- 10%, Ki-67: 54 +/- 23%) decreased to 36 +/- 7% and 9 +/- 16% in intermediate-stage EBs and to <1% in late-stage cardiomyocytes. In conclusion, a reproducible temporal pattern of early cardiomyocyte proliferation, cell-cycle withdrawal, and ultrastructural maturation was noted in this model. Establishment of this unique in vitro surrogate system may allow to examine the molecular mechanisms underlying these processes and to assess interventions aiming to modify these properties. Moreover, the detailed characterization of the ES cell-derived cardiomyocyte may be crucial for the development of future cell replacement strategies aiming to regenerate functional myocardium.

Opioid antagonists under sedation or anaesthesia for opioid withdrawal.

Withdrawal (detoxification) is necessary prior to drug-free treatment. It may also represent the end point of long-term treatment such as methadone maintenance. The availability of managed withdrawal is essential to an effective treatment system. To assess the effectiveness of interventions involving the administration of opioid antagonists to induce opioid withdrawal with concomitant heavy sedation or anaesthesia. Multiple electronic databases (including MEDLINE, EMBASE, PsycLIT, Australian Medical Index, Cochrane Clinical Trials Register, and CINAHL) were systematically searched. Reference lists of retrieved studies, reviews and conference abstracts were handsearched. Randomised or quasi-randomised controlled trials that compared the administration of opioid antagonists under sedation or anaesthesia with another form of treatment. One reviewer assessed studied for inclusion and undertook data extraction. Inclusion decisions and the overall process were confirmed by consultation between all three reviewers. As yet, no studies have been published comparing treatment regimes involving the administration of opioid antagonists under sedation or anaesthesia with other approaches to detoxification. Treatment regimes for the studies considered for this review varied in the opioid antagonist used, the dose and mode of administration, the anaesthetic agent, duration of anaesthesia and adjunct medications employed. More detailed monitoring of withdrawal is required before any conclusions can be drawn as to what comprises a typical pattern of withdrawal and what factors might influence the pattern. There is only very limited information on referral to ongoing treatment, and relapse to opioid use. Together with the lack of adequate comparisons, this makes it impossible to draw any conclusions about the long-term effectiveness, or the cost-effectiveness, of withdrawal induced by opioid antagonists under sedation or anaesthesia. Considerably more research evidence will be needed before any conclusions can be drawn regarding the effectiveness of managing withdrawal by administration of opioid antagonists under sedation or anaesthesia. The risk of vomiting during sedation and respiratory depression point to the approach being limited to facilities equipped for intubation and assisted ventilation, and with the capacity to respond to adverse events that might occur. The approach must be regarded as experimental with both risks and benefits remaining uncertain.