Withdrawal Procedure Research Articles

Dye-based chromoendoscopy versus i-scan virtual chromoendoscopy in long-standing ulcerative colitis: Multicenter prospective RCT.

Background and study aims Long-standing ulcerative colitis (UC) is associated with an increased risk of developing colorectal neoplasia. Both dye-based chromoendoscopy (DCE) and virtual chromoendoscopy (VCE) increase detection of neoplastic lesions. In this prospective randomized controlled trial (RCT), we compared the neoplasia detection rate between DCE and i-scan VCE in patients with long-standing UC. Patient and methods In four European hospitals, 131 patients with long-standing UC (disease duration > 8 years) were randomized to either DCE with methylene blue 0.1% (n = 66) or i-scan VCE (n = 65). All procedures were performed by trained endoscopists. Biopsies were taken from all visible lesions and the surrounding mucosa. Results The mean number of neoplastic lesions detected per colonoscopy was not significantly different between DCE (0.27) and i-scan VCE (0.37) ( P = 0.41). Similarly, there was no significant difference in neoplasia detection rate between DCE (19.7%) and VCE (27.7%) (odds ratio0.64, 95% confidence interval 0.28-1.50, P = 0.31). However, the per lesion neoplasia detection rate was significantly higher with i-scan VCE compared to DCE (27.6% vs 15.3%, P = 0.036). Both withdrawal and total procedure time were on average 10.0 and 9.9 minutes shorter using i-scan VCE (both P < 0.001). Conclusions This multicenter, prospective RCT showed no significant difference in neoplasia detection between DCE and i-scan VCE in long-standing UC. However, use of i-scan VCE was associated with a lower false-positive rate and a significantly shorter procedure time compared with DCE. I-scan VCE, therefore, could be a valid replacement for DCE in UC surveillance colonoscopies.

Prevalence of “one and done” phenomenon in adenoma detection within a large community-based healthcare system

Adenoma detection rate (ADR) is a key quality metric in colonoscopy, reflecting the ability to detect adenomas. However, concerns remain regarding the robustness of ADR as a benchmark. In particular, the "one and done" phenomenon may exist in which physicians are less motivated to find additional adenomas after discovery of the first adenoma. To investigate this topic further, our goal was to understand the relationship between single and multiple adenoma detection. A retrospective cohort study was conducted by using data from 89,587 screening colonoscopies performed by 32 endoscopists within the Sutter Health-Palo Alto Medical Foundation between 2015 and 2020. ADR, single adenoma detection rate (ADR1), and multiple adenoma detection rate (ADR2+) were analyzed by using multivariate logistic regression and linear regression models. Endoscopists were then fit into 4 categories based on median ADR1 and ADR2+ (low ADR1, high ADR2+ ["all or none"], low ADR1, low ADR2+ ["none and done"], high ADR1, high ADR2+ ["all and done"], or high ADR1, low ADR2+ ["one and done"]). The overall ADR was 45.4%. ADR, ADR1, and ADR2+ were significantly associated with similar factors, including older age, male sex, higher body mass index, smoking status, high-risk colonoscopies, Medicare insured, use of mucosal assist devices, longer withdrawal times, adequate preparation, and procedures performed by high-volume, female endoscopists with a longer duration in practice. The median ADR1 and ADR2+ were 23.95% and 21.29%, respectively. ADR1 and ADR2+ were positively correlated (Pearson correlation coefficient [r], .701; P< .001). Only 4 of 32 endoscopists fit our "one and done" category. These findings suggest that ADR1 correlates with ADR2+. Despite concerns, the "one and done" phenomenon is not commonly seen in clinical practice. ADR remains a good surrogate marker for multiple adenoma detection.

A Discussion on the Requirements and Procedures for Preventive Product Withdrawal: Lessons from the Cimbuterol Residue Case

A Discussion on the Requirements and Procedures for Preventive Product Withdrawal: Lessons from the Cimbuterol Residue Case

Comparing withdrawal- and anxiety-like behaviors following oral and subcutaneous oxycodone administration in C57BL/6 mice.

Excessive prescribing and misuse of prescription opioids, such as oxycodone, significantly contributed to the current opioid crisis. Although oxycodone is typically consumed orally by humans, parenteral routes of administration have primarily been used in preclinical models of oxycodone dependence. To address this issue, more recent studies have used oral self-administration procedures to study oxycodone seeking and withdrawal in rodents. Behavioral differences, however, following oral oxycodone intake versus parenteral oxycodone administration remain unclear. Thus, the goal of the current studies was to compare anxiety- and withdrawal-like behaviors using established opioid dependence models of either home cage oral intake of oxycodone (0.5 mg/ml) or repeated subcutaneous (s.c.) injections of oxycodone (10 mg/kg) in male and female mice. Here, mice received 10 days of oral or s.c. oxycodone administration, and following 72 h of forced abstinence, anxiety- and withdrawal-like behaviors were measured using elevated zero maze, open field, and naloxone-induced precipitated withdrawal procedures. Global withdrawal scores were increased to a similar degree following oral and s.c. oxycodone use, while both routes of oxycodone administration had minimal effects on anxiety-like behaviors. When examining individual withdrawal-like behaviors, mice receiving s.c. oxycodone exhibited more paw tremors and jumps during naloxone-induced precipitated withdrawal compared with oral oxycodone mice. These results indicate that both models of oxycodone administration are sufficient to elevate global withdrawal scores, but, when compared with oral consumption, s.c. oxycodone injections yielded more pronounced effects on some withdrawal-like behaviors.

Realization Mechanism of Farmers’ Rights and Interests Protection in the Paid Withdrawal of Rural Homesteads in China—Empirical Analysis Based on Judicial Verdicts

In recent years, the paid withdrawal of rural homesteads has become a widely discussed topic within the academic community. However, from the perspective of protecting farmers’ rights and interests, literature exploring the impact of this policy’s implementation remains scarce. As the reform of the separation of the three rights of the homestead deepens, disputes related to paid withdrawal of homesteads have escalated rapidly. This study aims to highlight the importance of protecting farmers’ rights and interests, seeking to enhance their property rights and revitalize unused rural resources. Employing a case study methodology, this study systematically examines the issue of farmers’ rights and interests protection during homestead withdrawal. This analysis is based on the survey, collection, and evaluation of 324 judicial cases. The findings reveal the following: (1) Disputes involving paid withdrawal of homesteads encompass the entire withdrawal process, with the majority of conflicts arising during the withdrawal stage. (2) Prior to withdrawal, farmers express heightened concern regarding their political rights, particularly the right to be informed and to participate in withdrawal decisions. (3) During the withdrawal process, farmers prioritize resettlement and compensation rights. Additionally, novel issues such as the allocation of withdrawal compensation surface after farmers receive resettlement and compensation benefits. (4) After withdrawal, farmers anticipate more suitable “alternative” social rights and remedies. Based on these findings, this study presents policy recommendations for realizing farmers’ rights and interests in the context of paid withdrawal of rural homesteads. These suggestions include consistently respecting farmers’ autonomy and preserving their political rights throughout the withdrawal procedure. During the withdrawal stage, emphasis should be placed on the comprehensive value of resettlement compensation, encompassing both the residential and social security aspects of rural homesteads. Post-withdrawal, farmers’ social rights and the development rights of their homesteads ought to be fully guaranteed, ensuring a harmonious balance between farmers’ immediate and long-term interests. Furthermore, optimizing the dispute resolution mechanism stands as a pivotal aspect of safeguarding farmers’ rights and interests through legal recourse.

The Effects of Eating a Traditional High Fat/High Carbohydrate or a Ketogenic Diet on Sensitivity of Female Rats to Morphine.

Patients diagnosed with obesity are prescribed opioid medications at a higher rate than the general population; however, it is not known if eating a high fat diet might impact individual sensitivity to these medications. To explore the hypothesis that eating a high fat diet increases sensitivity of rats to the effects of morphine, 24 female Sprague-Dawley rats (n = 8/diet) ate either a standard (low fat) laboratory chow (17% kcal from fat), a high fat/low carbohydrate (ketogenic) chow (90.5% kcal from fat), or a traditional high fat/high carbohydrate chow (60% kcal from fat). Morphine-induced antinociception was assessed using a warm water tail withdrawal procedure, during which latency (in seconds) for rats to remove their tail from warm water baths was recorded following saline or morphine (0.32-56 mg/kg, i.p.) injections. Morphine was administered acutely and chronically (involving 18 days of twice-daily injections, increasing in 1/4 log dose increments every 3 days: 3.2-56 mg/kg, i.p., to induce dependence and assess tolerance). The adverse effects of morphine (i.e., tolerance, withdrawal, and changes in body temperature) were assessed throughout the study. Acute morphine induced comparable antinociception in rats eating different diets, and all rats developed tolerance following chronic morphine exposure. Observable withdrawal signs and body temperature were also comparable among rats eating different diets; however, withdrawal-induced weight loss was less severe for rats eating ketogenic chow. These results suggest that dietary manipulation might modulate the severity of withdrawal-related weight loss in ways that could be relevant for patients.

The Influence of Learning Orientation and Human Capital on Absorptive Capacity in SMEs Rattan Cirebon

The purpose of this research is to examine how human capital and learning orientation affect absorptive capacity. This study used a quantitative research design. The small and medium-sized businesses (SMEs) that deal with rattan in Cirebon City are the study's demographic. Thirty-six companies provided 146 individuals for the samples. In this study, non-probability sampling is employed in conjunction with data withdrawal procedures and questionnaires with a Likert scale for measuring purposes. Multiple regression analysis with SPSS 26 is the data analysis method employed. The findings demonstrated that learning orientation and human capital characteristics had a favorable and significant impact on absorptive ability.

Integration of Digital-based Banking Services on Customer Satisfaction (Study of Indonesian Islamic Banks)

The study’s population comprised 18,203 individuals who were registered customers of Bank Syariah Indonesia Labuhanbatu Selatan Regency as of December 2022. The authors decided to use a sample of 100 people because the sampling technique refers to the minimum sample size in PLS-SEM, which is 30-100 sample sizes. A purposive sampling technique was used for the sample withdrawal procedure in order to take into account customers who had saved for about six months. Techniques for gathering data include written data or primary data, interviews, and questionnaires (Google Form). The author used the SmartPLS 4.0 for the data analysis, to demonstrate any partial direct influence between the independent and dependent variables. The study’s findings are as follows: 1) variables related to Islamic banks’ digitalization partially affect banking innovation; 2) variables related to Islamic banks’ digitalization partially affect customer satisfaction; 3) variables related to banking innovation partially affect customer satisfaction; 4) variables related to banking services partially affect banking innovation; 5) variables related to banking service partially affect customer satisfaction; 6) variables related to trust partially affect banking innovation; and 7) variables related to trust partially have no positive and insignificant effect on customer satisfaction. Keywords: Islamic banking digitalization, banking services, trust, banking innovation, customer satisfaction

The effect of anesthetic blockade of greater occipital nerve during the withdrawal period of the medication overuse headache treatment.

<p>Discontinua&shy;tion of medication still remains a key element in the treatment of medication overuse headache (MOH), but there is no consensus on the withdrawal procedure. We aimed to share the promising results of anesthetic blockade of greater occipital nerve (GON), which can be an alternative to existing treatments during the early withdrawal period of MOH treatment.</p>. <p>This study was conducted using regular electronic medical records and headache diaries of patients diagnosed with MOH and treated with anesthetic GON blockade with 0.5% bupivacaine solution in a specia&shy;lized headache outpatient clinic. A total of 86 patients who developed MOH while being followed up for chronic migraine were included in the study.</p>. <p>The treatment schemes for MOH are based on expert consensus and withdrawal strategies are the most challenging part of treatment. In our study, numerical rating scale for headache intensity, overused medication consumption per month, headache frequency (day/month) and the duration of each attack (hour/day) decreased significantly in the first month compared to pre-treatment (p &lt; 0.01).&nbsp;</p>. <p>Conclusion &ndash; Our study suggests that GON blockade can be used as a good alternative therapy in the treatment of MOH.</p>.

테러방지법상 군(軍) 역할에 관한 법적 검토와 개정방향에 관한 제언

Today, terrorism becomes a threat in the form of megaterrorism triggering a transnational disaster that causes reckless and large damage. The Korean government dispatches troops as peace keeping force for various activities in the international society. For this reason, Korea comes to be a target of an international terrorist group. In particular, externally, since South Korea has a hostile relationship with North Korea which is equipped with an advanced ability of terrorism, it always faces the threat of terrorism. Therefore, it is more important to make preemptive prevention and responses in the comprehensive security dimension. In addition, internally, the country has frequence access of foreigners and an increased number of North Korean refugees due to its growing activities in the world; severe social discontent along with the increase in unemployment rate and the widening gap between the rich and the poor; such a structural setting as high population density suitable for new terrorism. In this circumstance, blended terrorism is likely to occur simultaneously. If these external or internal factors trigger complex megaterrorism in an urban area where important national facilities, multi-purpose facilities, or other social infrastructure are concentrated, and thereby a lot of human lives and assets are damaged, it is impossible to respond to such a disaster with limited police force. For this reason, it is inevitable to protect the security of the nation and the public and maintain public order with the use of military force. According to the counter-terrorism system of South Korea, in principle, military force is put in only if a terror is posed to military facilities. In this case, there is no controversy, because the system is well established under the leadership of the Ministry of National Defense and the Joint Chiefs of Staff. If the head of the countermeasure headquarters makes a request of support, exceptionally, it is possible to operate military force as well as military facilities. Even if the exceptional necessity to make up for insufficient police force is accepted, it is unavoidable to restrict military intervention in the private sector strictly in terms of constitutional order. Therefore, this study tries to suggest the establishment of new provisions pertinent to military presence and withdrawal procedures and the scope of work in the Act on Counter-Terrorism when counter-terrorism operation forces exceptionally intervene in a domestic situation, just as in Martial Law Act according to which military forces are allowed to intervene in such a situation as a state of national emergency in order to maintain public order. Essentially, the domestic counter-terrorism activity is use of public power for protecting social order and security. Therefore, in principle, it is required to prevent terrorism and take suppression activity with the use of police force. Exceptionally, if it is inevitable to put in the counter-terrorism operation forces under the Ministry of National Defense, it is necessary to establish new provisions suggested in this study, including ‘the limitations of the counter-terrorism of police force’, ‘the necessity of urgent support’, ‘the proposal by the director of National Counter Terrorism Committee’, ‘the approval by the President’, the control procedures of the National Assembly, such as notification to the National Assembly and the procedure of withdrawal request of the National Assembly, and the scope of work, in the Act on Counter-Terrorism.

Withdrawal of Application under section 12A of IBC &amp; implications: A Review Study

Application admitted under Insolvency and Bankruptcy Code, 2016 (IBC)1 vide section 7,9 or 10 of IBCcould be withdrawn under section 12A of IBC with the approval of ninety per cent voting share of the Committee of Creditors subject to the situations provided under the code. In terms of Regulation 30A of CIRP Regulations, an application for withdrawal under section 12A can be made to the Adjudicating Authority. The procedure for withdrawal of application prior to the constitution of the CoC and after the constitution of the CoC is provided in the code and its regulations. In the present paper the judicial pronouncements are reviewed to trace the several verdicts of Adjudicating Authorities and their observations. Key Words: IBC, COC, CIRP,AA, sec 12A,12C

The Effects of Chronic Naltrexone on Reinstatement of Opioid-Induced Drug-Seeking Behavior and Antinociception.

Opioid addiction is a chronic relapsing disorder in which drug-seeking behavior during abstinence can be provoked by exposure to a µ-opioid receptor (MOR) agonist or opioid-associated cues. Opioid self-administration behavior in laboratory subjects can be reinstated by priming with MOR agonists or agonist-related stimuli, providing a procedure suitable for relapse-related studies. The opioid antagonist naltrexone has been forwarded as a medication that can forestall relapse and, in an extended-release formulation, has demonstrated some treatment success. However, chronic naltrexone treatment has not been extensively investigated in nonhuman subjects and aspects of its pharmacology remain uncertain. For example, the relative effectiveness of naltrexone in reducing the priming strength of opioid agonists differing in efficacy is not well understood. Here, using intravenous self-administration and warm-water tail withdrawal procedures, we investigated changes in the direct reinforcing effects of oxycodone and in the priming strength and antinociceptive effects of opioid agonists in squirrel monkeys (n = 4) during chronic treatment with naltrexone (0.2 mg/kg/d). Results show that naltrexone produced: 1) a 10-fold rightward shift in the dose-response function for the reinforcing effects of oxycodone, and 2) in reinstatement and antinociception experiments, comparable rightward shifts in the dose-response functions for higher-efficacy MOR agonists (methadone, heroin, and oxycodone) but rightward and downward shifts in the dose-response functions for lower-efficacy MOR agonists (buprenorphine, nalbuphine, and butorphanol). These results suggest that, although chronic naltrexone should be effective in forestalling relapse following exposure to lower- and higher-efficacy agonists, the inability of lower-efficacy agonists to surmount naltrexone antagonism may complicate the prescription of opioids for pain. SIGNIFICANCE STATEMENT: Although naltrexone is commonly used in the treatment of opioid use disorder, its ability to reduce the priming strength of opioid agonists has not been extensively investigated. This study shows that chronic naltrexone treatment induces rightward shifts in the reinstatement and antinociceptive properties of higher efficacy opioid agonists, but rightward and downward shifts for lower efficacy opioid agonists, suggesting lower efficacy agonists may not be able to surmount naltrexone-induced antagonism of these two effects, and perhaps naltrexone offers greater protection against lower efficacy agonists.

Sampling Cerebrospinal Fluid and Blood from Lateral Tail Vein in Rats during EEG Recordings.

Because the composition of body fluids reflects many physiological and pathological dynamics, biological liquid samples are commonly obtained in many experimental contexts to measure molecules of interest, such as hormones, growth factors, proteins, or small non-coding RNAs. A specific example is the sampling of biological liquids in the research of biomarkers for epilepsy. In these studies, it is desirable to compare the levels of molecules in cerebrospinal fluid (CSF) and in plasma, by withdrawing CSF and plasma in parallel and considering the time distance of the sampling from and to seizures. The combined CSF and plasma sampling, coupled with video-EEG monitoring in epileptic animals, is a promising approach for the validation of putative diagnostic and prognostic biomarkers. Here, a procedure of combined CSF withdrawal from cisterna magna and blood sampling from the lateral tail vein in epileptic rats that are continuously video-EEG monitored is described. This procedure offers significant advantages over other commonly used techniques. It permits rapid sampling with minimal pain or invasiveness, and reduced time of anesthesia. Additionally, it can be used to obtain CSF and plasma samples in both tethered and telemetry EEG recorded rats, and it may be used repeatedly across multiple days of experiment. By minimizing the stress due to sampling by shortening isoflurane anesthesia, measures are expected to reflect more accurately the true levels of investigated molecules in biofluids. Depending on the availability of an appropriate analytical assay, this technique may be used to measure the levels of multiple, different molecules while performing EEG recording at the same time.

Preferences in medications for patients seeking treatment for opioid use disorder: A conjoint analysis

IntroductionThe opioid epidemic continues to be a public health crisis that has worsened during the COVID-19 pandemic. Medications for opioid use disorder (MOUD) are the most effective way to reduce complications from opioid use disorder (OUD), but uptake is limited by both structural and individual factors. To inform strategies addressing individual factors, we evaluated patients' preferences and trade-offs in treatment decisions using conjoint analysis. MethodWe developed a conjoint analysis survey evaluating patients' preferences for FDA-approved MOUDs. We recruited patients with OUD presenting to initiate treatment. This survey included five attributes: induction, location and route of administration, impact on mortality, side effects, and withdrawal symptoms with cessation. Participants performed 12 choice sets, each with two hypothetical profiles and a “none” option. We used Hierarchical Bayes to identify relative importance of each attribute and part-worth utility scores of levels, which we compared using chi-squared analysis. We used the STROBE checklist to guide our reporting of this cross-sectional observational study. ResultsFive-hundred and thirty participants completed the study. Location with route of administration was the most important attribute. Symptom relief during induction and withdrawal was a second priority. Mortality followed by side effects had lowest relative importance. Attribute levels with highest part-worth utilities showed patients preferred monthly pick-up from a pharmacy rather than daily supervised dosing; and oral medications more than injection/implants, despite the latter's infrequency. ConclusionWe measured treatment preferences among patients seeking to initiate OUD treatment to inform strategies to scale MOUD treatment uptake. Patients prioritize the route of administration in treatment preference—less frequent pick up, but also injections and implants were less preferred despite their convenience. Second, patients prioritize symptom relief during the induction and withdrawal procedures of medication. These transition periods influence the sustainability of treatment. Although health professionals prioritize mortality, it did not drive decision-making for patients. To our knowledge, this is the largest study on patients' preferences for MOUD among treatment-seeking people with OUD to date. Future analysis will evaluate patient preference heterogeneity to further target program planning, counseling, and decision aid development.

«В центре и на местах». Особенности кампании по изъятию церковных ценностей и организация раскола в Туркестанской епархии (1922–1923)

The article highlights the first period of the Soviet government's systematic struggle with the Russian Orthodox Church using the example of the Turkestan and Tashkent dioceses. It was an organized, tightly centralized campaign that began under the pretext of the need to withdraw all church valuables to help the hungry. The real goal of the campaign was to solve the financial problems of the Soviet state by defeating the Church (confiscation of valuables and organization of the Renovationist schism). In 1922, there were extremely few valuable items in the churches of the Turkestan ASSR, nevertheless, in the summer, with a delay of several months, the expropriation of church values was carried out here. The details of the withdrawal procedure are shown on the example of the churches of Alma-Ata, Tashkent and rural temples. The second goal of the withdrawal campaign – the elimination of the canonical system of church administration and its replacement with renovationist structures – in the Turkestan diocese was achieved by mid-1923. The specifics of achieving this goal were clarified by comparing the local church chronicle with the central plan of the campaign. Thanks to this, it became possible for the first time to explain the logic of the events that took place in the Tashkent in late 1922 – early 1923, and to explain the reasons for the sudden refusal of Archbishop Innokenty (Pustynsky) from the administration of the Turkestan diocese and his departure from Tashkent.

Unilateral withdrawal from a license agreement

Keywords: license agreement, unilateral withdrawal from an agreement, copyright,intellectual property&#x0D; The right to the unilateral withdrawal of a license agreement is formulated in Part 2 of Article 1110 ofthe Civil Code of Ukraine in a generalized form, leaving outside the legal regulation anumber of important issues that are significant for the effective application of this provision.In particular, what should be the duration of the delay in the term of beginning theuse of the object of intellectual property rights, whether the licensor should provide thelicensee with an additional term to start using this object, what is the nature of the violationof the terms of the license agreement that allows for a unilateral withdrawal from it,in what form such a withdrawal should be made and from what moment it can be consideredcommitted. These aspects remain almost unexplored which determines the relevanceof their scientific and practical analysis. The purpose of the article is to provide acomprehensive characterization of the right to unilateral withdrawal from a licenseagreement and the mechanism for its implementation on the example of copyright, takinginto account the provisions of the legislation of the EU Member States.Unilateral withdrawal from the license agreement is an extrajudicial procedurewhich is carried out by written notice of the interested party to the other party. Unlikethe laws of many EU member states, the Ukrainian legislation does not specify the durationof the delay in the use of the work by the licensee and does not establish the obligationto grant the licensee an additional term to start using the work, and therefore theparties may regulate these aspects at their own discretion. The absence in the licenseagreement of date or period within which the licensee must start using the work givesthe licensee the right to independently determine the moment of the work’s use and deprivesthe licensor of the opportunity to withdraw from the license agreement on thisbasis. It is substantiated that breach of contract may relate exclusively to the obligationsof a party under a license agreement but not to its rights since the law does not providefor the compulsory exercise of the right to use a work.Based on the experience of the EU Member States, it will be useful for Ukraine to providein Part 2 of Article 1110 of the Civil Code that the general prerequisite for the rightto unilateral withdrawal is the proper and timely performance by the party committingthe withdrawal of its obligations which determine the possibility of performance of theagreement by the other party. This will contribute to the stability of contractual relationsin this area and will prevent potential abuses, in particular, the exercise of the right tounilateral withdrawal from the license agreement in order to harm the interests of theother party. Also, in Part 2 of Article 1110 of the Civil Code, it is advisable to establishthat a unilateral withdrawal from a license agreement shall be made in writing and shallbe deemed to be made from the moment a party receives notice of the other party’s withdrawalfrom the agreement unless a later term is specified in the agreement or notice.This will properly clarify the unilateral withdrawal procedure and facilitate its more effectiveapplication in practice.

Standard procedures for blood withdrawal in conscious male rats induce stress and profoundly affect glucose tolerance and secretion of glucoregulatory hormones

ObjectiveA fundamental difference between physiological and pharmacological studies in rats and humans is that withdrawal of blood from conscious rats necessitates restraint which inevitably inflicts a higher level of stress. We investigated the impact of handling on acute glucose regulation and secretion of glucoregulatory hormones in rats. MethodsFasted male Sprague Dawley rats (375–400 g, n = 11) were given an oral glucose tolerance test (OGTT) by gavage (2 g/kg). Blood was sampled frequently until 90 min after challenge by handheld sampling (HS) or by automated sampling (AS). In the HS experiment, blood was withdrawn by restraint and sublingual vein puncture; two weeks later, samples were obtained by AS through an implanted catheter in a carotid artery, allowing sampling without disturbing the animals. ResultsOn the day of HS, post challenge glucose AUCs were ∼17% higher (P < 0.0001), despite gastric emptying (AUC) being reduced by ∼30% (P < 0.0001). Plasma insulin AUC was 3.5-fold lower (P < 0.001), and glucose-dependent insulinotropic peptide (GIP) AUC was reduced by ∼36% but glucagon-like peptide-1 concentrations were not affected. Glucagon concentrations were higher both before and after challenge (fold difference in AUCs = 3.3). Adrenocorticotropin (ACTH) and corticosterone AUCs were 2.4-fold and 3.6-fold higher (P < 0.001), respectively. Discussion and conclusionOur study highlights that sampling of blood from conscious rats by sublingual vein puncture inflicts stress which reduces glucose absorption and glucose tolerance and blunts secretion of insulin and GIP. As blood sampling in humans are less stressful, standard procedures of conducting OGTT's in rats by HS presumably introduce an interspecies difference that may have negative consequences for translatability of test results.

Evaluation Of Cash Withdrawal Procedures Based On PP No. 12 In North Sulawesi

Cash Disbursement Accounting Systems and Procedures will help expedite the management of company activities if all its components run according to proper procedures. The aim of the study is to find out that the accounting system for cash disbursements at the National Unity and Regional Politics Agency of North Sulawesi Province has been in accordance with PP No. 12 of 2019. The method used in this study is descriptive qualitative data, namely data presented in the form of a clear and detailed explanation in nature with data collection methods through interviews, observation, documentation. The results of the study show that the Regional Political and National Unity Agency of North Sulawesi Province in the Cash Disbursement Accounting System and procedure managed by the Accounting Section uses the Local Government Information System Application (SIPD) and the Financial Management Information System (FMIS) Application. In implementing this application there are obstacles experienced, while these obstacles are the internet network which is still not good and errors often occur due to viruses in the application which result in problems in inputting application data resulting in delays in issuing Payment Request Letters (SPP) which slows down the disbursement process funds, as well as a lack of human resources (HR) in using this application.

In-hospital withdrawal of benzodiazepines in long term users : a bad idea with good intentions

Benzodiazepines are among the most frequently prescribed medications in Switzerland, particularly in the elderly. Due to their unfavourable side effect profile, especially in the elderly population, this class of medication should not be prescribed for the treatment of insomnia or non-refractory anxiety disorders. A gradual withdrawal procedure, which is safe and effective according to the literature, should be offered to the patient taking such medication, with adequate monitoring of withdrawal symptoms. This procedure should, in principle, be performed in an outpatient setting but may be initiated in the hospital after discussion with the patient and the primary care physician.

The US withdrawal from Afghanistan and its impacts on the Pak-Afghan relationship

How to fix Afghanistan's challenges is one of the most talked-about issues of the 21st century. With its incredible nature and immense scale of being a safe haven for terrorists, the Afghanistan conundrum warrants all the thought it gets. The US hasty attack and abrupt withdrawal from Afghanistan affected the neighbouring states somehow and others. Pakistan is the most affected among these countries because of its chaotic past relationship. In the latest situation since the US retreat from Afghanistan, bordering countries have been trying to pull Afghanistan out of its misery. To achieve this goal, Pakistan had been trying to peacefully give passage to the US to leave and help the Taliban to assume control of Kabul. This is an uphill task because other regional and global powers have agendas to reshape Afghanistan’s future. On the other hand, for Afghanistan, common players, for instance, Pakistan, India, China, and Russia, have consistently been reconsidering their ways of meeting their national points of interest or terminations. This study investigates the Afghan harmony procedure and regional and global players waiting for the US withdrawal procedure and how it would affect Pakistan's future relationship with Afghanistan.