Withdrawal Programs Research Articles

Ecological restoration largely alleviates livestock grazing pressure in a montane grassland

Over the past few decades, grassland productivity in mountainous regions has been increasingly affected by livestock grazing and land use/cover changes. Human appropriation of net primary production (HANPP) is a valuable metric for assessing human impacts on grasslands. To date, knowledge of the patterns and drivers of HANPP in montane grasslands remains limited. In this study, we developed a 1 km × 1 km resolution HANPP dataset for the grasslands of the Qilian Mountains from 2000 to 2020 using two process-based models. We aimed to examine the spatial distribution characteristics and temporal trends of HANPP and explore the effects of climatic conditions, rural populations, cultivated areas, and livestock numbers on the interannual variability of HANPP. The results showed that HANPP decreased significantly with increasing elevation due to the corresponding decrease in population density. During the study period, HANPP showed a widespread decline, which was significant in 15.4% of the grassland area, mainly in alpine meadows. Climatic factors and human activities explained 60.8% and 39.2% of the temporal variability in HANPP, respectively. In particular, precipitation was negatively correlated with HANPP, whereas air temperature and number of livestock were positively correlated with HANPP based on correlation analysis. By providing a refined spatial assessment of human impacts on montane grasslands, this study suggests that ecological restoration projects, especially the Grain to Green and Grazing Withdrawal Programs, can reduce human pressures on grassland productivity by controlling population density and grazing intensity. Furthermore, the adoption of enclosed paddocks and supplemental feeding may mitigate montane grassland degradation near villages. This study elucidates the primary factors influencing the spatiotemporal patterns of HANPP in an area with typical montane grasslands, thereby supporting research-based decision making.

Client and stakeholder perceptions of a novel, nurse practitioner-led alcohol and other drug ambulatory withdrawal service.

Despite recommendations for ambulatory withdrawal programs appearing in many contemporary alcohol and other drug treatment guidelines, to date there have been few studies exploring such programs from client and service stakeholder perspectives. The aim of this study was to explore both individual and service stakeholder perceptions of a nurse practitioner-led ambulatory withdrawal service on the Gold Coast, Queensland, Australia. Data were obtained from three groups: clinicians with knowledge of the service (n = 6); relatives of clients who had used the service (n = 2); and clients who had used the service (n = 10) using a Qualitative Descriptive design. Saldaña's (Saldaña, The coding manual for qualitative researchers. 2013) structural coding framework was used to analyse and code data into themes, with the study reported in accordance with the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist (Tong et al. Int J Qual Health Care 2017;19:349-57). Participants noted advantages of the nurse practitioner-led ambulatory withdrawal service, including rapid availability of admission to the service and a person-centred approach. Compared with other ambulatory withdrawal options, clients valued the ability to remain in their own environment, however participants suggested greater follow-up after withdrawal, with the potential of a home visiting service for greater client engagement and treatment retention. Findings provide evidence to suggest that nurse practitioner-led ambulatory withdrawal services are an acceptable option for a proportion of clients who need rapid access to services when they wish to make changes to their alcohol and/or other drug use. Furthermore, they can provide person-centred care for comorbid physical and mental ill health occurring in addition to psychosocial issues associated with alcohol and/or other drug use.

“They make it too hard and too many hoops to jump”: system and organizational barriers to drug treatment during epidemic rates of opioid overdose

IntroductionThe United States is currently facing an opioid overdose crisis. Research suggests that multiple interventions are needed to reduce overdose deaths including increasing access and retention to medications to treat opioid use disorders (MOUD, i.e., methadone, buprenorphine, and naltrexone) and increasing the distribution and use of naloxone, a medication that can reverse the respiratory depression that occurs during opioid overdoses. However, barriers to MOUD initiation and retention persist and discontinuations of MOUD carry a heightened risk of overdose. Many times, MOUD is not sought as a first line of treatment by people with opioid use disorder (OUD), many of whom seek treatment from medically managed withdrawal (detox) programs. Among those who do initiate MOUD, retention is generally low. The present study examines the treatment experiences of people who use opioids in three states, Connecticut, Kentucky, and Wisconsin.MethodsWe conducted in-depth interviews with people who use opioids in a rural, urban, and suburban area of three states: Connecticut, Kentucky and Wisconsin. Data analysis was collaborative and key themes were identified through multiple readings, coding of transcripts and discussion with all research team members.ResultsResults reveal a number of systemic issues that reduce the likelihood that people initiate and are retained on MOUD including the ubiquity of detox as a first step in drug treatment, abstinence requirements and requiring patients to attend group treatment. MOUD-related stigma was a significant factor in the kinds of treatment participants chose and their experiences in treatment.ConclusionsInterventions to reduce MOUD stigma are needed to encourage MOUD as a first course of treatment. Eliminating abstinence-based rules for MOUD treatment may improve treatment retention and decrease overdose risk.

The Journey From Drug Addiction to Drug Withdrawal: A Christian Gospel Rehabilitation Program in Taiwan.

World Drug Report estimates the number of opioid users at 53 million and identifies opioids as responsible for two thirds of the 585,000 people who died as a result of drug use in 2017. The purpose of this study was to analyze the testimonies of 30 people regarding their journeys from drug addiction to drug withdrawal in Taiwan. This was a qualitative research design. The sample inclusion criteria were as follows: (a) being a drug abuser, (b) completed the Christian Gospel Drug Withdrawal Program or church-sponsored program, and (c) shared their related testimony on the Good TV television channel in Taiwan. The participants' stories were posted in Chinese, transcribed by the author, and translated from Chinese into English. Content analysis was used to identify the major themes. Of the 30 participants, 24 were male (80%) and six were female (20%). The major themes identified in their testimonies were: (a) Using illegal drugs related to peer recognition, lack of knowledge, and temptations; (b) drug addiction was an endless pain cycle; (c) turning points related to love, repentance, and hope; (d) drug withdrawal was related to avoiding temptation and overcoming the drug withdrawal syndrome through the Holy Spirit; and (e) outcomes were faith and new life. In this study, people who received the gospel drug withdrawal programs expressed that their lives had changed, they had withdrawn from drugs successfully, they had become volunteers to help others, and interactions with their family had improved. These programs may be applied in the mental health nursing profession.

Incorporation of peer support in a novel community-based mobile withdrawal management program

Despite the sweeping and deep-rooted impacts of problematic substance use throughout Canada, services remain under-resourced and overwhelmed. Innovative approaches are required if meaningful change is to occur. In this paper, we examine the incorporation of peer support into a novel, community-based outreach withdrawal program which engages with participants where they are situated. Peer support is an evidence-based intervention utilized in a wide range of health care arenas. It employs lived experience as a skillset to address health care needs to complement other components in the therapeutic journey. In the context of an outreach withdrawal service, peer support holds potential to deconstruct the power dynamic that acts as a barrier in conventional withdrawal programs. Peer support promotes the concept of interdisciplinary care, while actively dismantling stigma. More research is required to evaluate outcomes, client satisfaction, and cost-effectiveness with regards to peer support interventions in community-based outreach detoxification programming.

Barriers to accessing treatment for substance use after inpatient managed withdrawal (Detox): A qualitative study

IntroductionAccess to and uptake of evidence-based treatment for substance use disorder, specifically opioid use disorder (OUD), are limited despite the high death toll from drug overdose in the United States in recent years. Patient perceived barriers to evidence-based treatment after completion of short-term inpatient medically managed withdrawal programs (detox) have not been well studied. The purpose of the current study is to elicit patients' perspectives on challenges to transition to treatment, including medications for OUD (MOUD), after detox and potential solutions. MethodsWe conducted semi-structured interviews (N = 24) at a detox center (2018–2019) to explore patients' perspectives on obstacles to treatment. The study managed the data in NVivo and we used content analysis to identify themes. ResultsPatients' characteristics included the following: 54 % male; mean age 37 years; self-identified as White 67 %, Black 13 %, Latinx 8 %, Native Hawaiian/Pacific Islander 4 %, and other 8 %; heroin use in the past 3 months 67 %; and ever injecting drugs 71 %. Patients identified the following barriers: 1) lack of continuity of care; 2) limited number of detox and residential treatment program beds; 3) unstable housing; and 4) lack of options when choosing a treatment pathway. Solutions proposed by participants included: 1) increase low-barrier access to community MOUD; 2) add case managers at the detox center to establish continuity of care after discharge; 3) increase assistance with housing; and 4) encourage patient participation in treatment decisions. ConclusionsPatients identified lack of continuity of care, especially care coordination, as a major barrier to substance use treatment. Increasing treatment utilization, including MOUD, necessitates a multimodal approach to continuity of care, low-barrier access to MOUD, and support to address unstable housing. Patients want care that incorporates options and respect for.individualized preferences and needs.

Population-level impact of initiating pharmacotherapy and linking to care people with opioid use disorder at inpatient medically managed withdrawal programs: an effectiveness and cost-effectiveness analysis.

Medications for opioid use disorder (MOUD) are shown to reduce opioid use and the risk of overdose. People with opioid use disorder (OUD) who exit inpatient medically managed withdrawal programs (detox) without initiating MOUD and linking to outpatient care have high rates of overdose. While detox encounters provide a theoretical opportunity for MOUD initiation, this is not ubiquitous in the United States. We used simulation modeling to estimate the population-level health effects and cost-effectiveness of a policy encouraging MOUD initiation during inpatient detox encounters. We employed a dynamic population state-transition model to evaluate the effectiveness and cost-effectiveness of using detox programs as venues for initiating MOUD in Massachusetts, United States. We compared standard of care, where no detox patients initiate MOUD or link to outpatient MOUD providers, to strategies of offering MOUD to detox patients and linking those patients to outpatient MOUD. Budgetary impact to the Massachusetts health-care sector, incremental cost-effectiveness ratios (ICER) and total counts and percentage differences of fatal overdoses prevented. Initiating MOUD in detox with perfect linkage to outpatient MOUD would reduce fatal overdoses by 4.5% [95% confidence interval (CI) = 2.3-5.9], at an ICER of $56 000 per quality-adjusted life-year (QALY) gained, compared with the standard of care. With moderate linkage, fatal overdoses would be reduced by 2.3% (95% CI= 1.2-3.1) with an ICER of $78 500 per QALY gained, compared with standard of care. Budgetary increase to Massachusetts health-care spending ranged from 0.5-1%. A simulation model indicates that initiation of medications for opioid use disorder and linkage policies among detox patients in Massachusetts, USA could prevent fatal opioid overdoses in the opioid use disorder population and would be cost-effective from a health-care sector perspective.

Practices and issues of moulting programs for laying hen: A review

ABSTRACT 1. Moulting is a natural physiological process in birds when they shed their old feathers and replace them with new ones, and is followed by reproductive quiescence resulting in reduced egg production. Different birds undergo moulting at different points in their life. Some birds have seasonal moulting while some moult at the end of their breeding cycle. This review will mainly focus on moulting practices associated with commercial layer birds because, in all other bird types, this is not managed. 2. Commercial farms commonly analyse the cost-benefit ratio to decide the time and method to adopt for moulting. Commercial layer farms adopt different practices to force birds out of moult and restart the production cycle. Animal welfare groups consider this as stressful and against animal welfare, raising questions about the ethics of this practice. 3. Many studies have been conducted using complete or partial feed withdrawal and non-feed withdrawal programs to measure their effectiveness in maintaining animal welfare, economy, and post-moult performance in mind. 4. Animal welfare should not be compromised during moulting. The United States Egg Producers and other such groups from the United Kingdom and Europe have decided to sell eggs produced only through a non-feed withdrawal moulting programs.

Substance Use Withdrawal and Detox Strategies That Work.

Substance use disorders are considered chronic but treatable. The first step in recovery is going through withdrawal or detox from the substance used, which typically involves unpleasant physical and psychological symptoms. Some individuals are able and willing to enter inpatient facilities for withdrawal and detox. In some cases, outpatient withdrawal and detox programs are not available. Several barriers to treatment exist, including inability to pay, unavailability of programs, stigma, and co-occurring mental health disorders. During inpatient withdrawal and detox, patients are supported with medications. There is an underutilization of initiating medication that helps reduce substance use, such as naltrexone and suboxone, during inpatient withdrawal and detox. Many individuals opt or have no other choice but to go through withdrawal and detox on their own. Strategies include illicitly obtaining prescription medications for the symptoms and other measures, such as floating in the bathtub and exercise. Recovery from substance use can be facilitated by health care providers through use of harm reduction strategies, referrals to treatment, and prescribing medications when applicable. [Journal of Psychosocial Nursing and Mental Health Services, 59(9), 12-15.].

Antimicrobial Peptides in Farm Animals: An Updated Review on Its Diversity, Function, Modes of Action and Therapeutic Prospects.

Antimicrobial peptides (AMPs) are the arsenals of the innate host defense system, exhibiting evolutionarily conserved characteristics that are present in practically all forms of life. Recent years have witnessed the emergence of antibiotic-resistant bacteria compounded with a slow discovery rate for new antibiotics that have necessitated scientific efforts to search for alternatives to antibiotics. Research on the identification of AMPs has generated very encouraging evidence that they curb infectious pathologies and are also useful as novel biologics to function as immunotherapeutic agents. Being innate, they exhibit the least cytotoxicity to the host and exerts a wide spectrum of biological activity including low resistance among microbes and increased wound healing actions. Notably, in veterinary science, the constant practice of massive doses of antibiotics with inappropriate withdrawal programs led to a high risk of livestock-associated antimicrobial resistance. Therefore, the world faces tremendous pressure for designing and devising strategies to mitigate the use of antibiotics in animals and keep it safe for posterity. In this review, we illustrate the diversity of farm animal-specific AMPs, and their biochemical foundations, mode of action, and prospective application in clinics. Subsequently, we present the data for their systematic classification under the major and minor groups, antipathogenic action, and allied bioactivities in the host. Finally, we address the limitations of their clinical implementation and envision areas for further advancement.

Benzodiazepine and Z drug cessation in elderly patients: A qualitative study on the perception of healthcare providers and the place of advanced practice nurses.

Sedative-use disorder can occur in elderly individuals, but remains a taboo subject. France is the second top-consuming country of benzodiazepines (BZDs) and Z drugs in Europe, with 38% of women >80years old using these drugs. Despite the recommendations of the French National Authority for Health (HAS) to general practitioners, deprescription remains rare. The aim of this study was to understand the perception of healthcare providers towards BZD or Z drug withdrawal within a psychogeriatric unit and to provide insights from advanced practice nurses (APRNs) on this topic. Eight healthcare providers from different professions in a psychogeriatric unit were interviewed. The interviews were recorded and transcribed verbatim, and the data were analysed following the interpretive phenomenological approach. The COREQ statement was used as a guide in the reporting of the study. Four themes were identified in the interview transcripts: (i) problems specific to the elderly; (ii) problems specific to BZD or Z drug consumption; (iii) present care; and (iv) envisioned practice. While the healthcare providers interviewed appeared to have knowledge on the adverse effects of BZDs, it appears difficult to taper the use of BZDs outside crisis periods of behaviour disorders in elderly patients. Caregivers recommend an evolution of practices, such as introducing BDZ and Z drug withdrawal programs that could involve the emerging profession of APRNs in general practice in France. APRNs could be a valuable resource to screen for BZD-related disorders and to manage withdrawal strategies in complex cases.

Presidential Power and Withdrawing from Foreign Entanglements: Koreanization in the 1970s

AbstractIn the 1970s, the Nixon and Carter administrations attempted to withdraw American forces from South Korea. A policy of troop reductions continued throughout the decade, and although some U.S. troops were withdrawn from South Korea, tens of thousands remained at the end of the 1970s. Although the policy goals were largely symmetrical, the rate of withdrawal differed sharply, with Richard M. Nixon pulling out nearly 10 times as many troops as Jimmy Carter. This article argues that bureaucratic actors, including senior military officers, were responsible for the divergent results of the Korean withdrawal programs.

Initiating buprenorphine treatment for opioid use disorder during short‐term in‐patient ‘detoxification’: a randomized clinical trial

The effectiveness of linking people from short-term in-patient managed withdrawal programs ('detoxification') to long-term, primary care-based buprenorphine is unknown. We tested whether buprenorphine initiation during an opioid withdrawal program and linkage to office-based buprenorphine (LINK) after discharge would increase engagement with office-based buprenorphine and decrease illicit opioid use during the ensuing 6months compared with standard withdrawal management (WM). Single-site randomized controlled trial. Short-term in-patient detoxification program in Massachusetts, USA. People with opioid use disorder (n=115) who averaged 32.4years of age, 68.2% male, 79.1% white, using illicit opioids on 27.3 of the last 30days, were randomly assigned to WM (n=59) versus LINK (n=56). Intervention was buprenorphine induction, in-patient dose stabilization and post-discharge transition to maintenance buprenorphine at an affiliated primary care clinic (LINK). Comparator was 5-day buprenorphine managed withdrawal protocol (WM). Mean 30-day rate of use of illicit opioids (primary aim) and prescribed buprenorphine (secondary aim) at 1, 3 and 6months. Compared with WM, participants in the LINK condition had lower illicit opioid use rates at days 12 [b=-6.81, 95% confidence interval (CI)=-9.69; -3.92, P<0.001], 35 (b=-8.55, 95% CI-11.63; -5.47, P<0.001), 95 (b=-7.34, 95% CI=-10.59; -4.11, P<0.001) and 185 (b=-3.52, 95% CI=-7.07; 0.27, P=0.052). The LINK arm had higher prescription buprenorphine use rates (P<0.001) at all assessments. Among people with opioid use disorder, initiation of, and linkage to, office-based buprenorphine treatment post-discharge reduced illicit opioid use and increased days of buprenorphine treatment for up to 6months post-discharge compared with an in-patient detoxification protocol.

The Effect of Group Counseling Based on Quality of Life Therapy on Stress and Life Satisfaction in Family Caregivers of Individuals with Substance Use Problem: A Randomized Controlled Trial

Family caregivers of people with substance abuse are exposed to psychological problems that diminish their life quality and satisfaction. The purpose of this study was to diagnose the efficacy of quality-of-life intervention on stress and life satisfaction of family caregivers of individuals with substance use problem. This is a randomized controlled trial conducted on 80 family caregivers of individuals with substance use problem in the process of withdrawal who were referred to a psychiatric center in southeastern Iran (2018). The intervention group received seven sessions of quality-of-life group counseling every other day based on predetermined content. Twelve weeks post-intervention, data were collected from the control and intervention groups using the Depression Anxiety and Stress Scales (DASS-21) and the Satisfaction with Life Scale (SWLS). The results were analyzed through statistical tests. After group counseling based on quality of life, the mean stress score in the family caregivers of the intervention group (11.50 ± 4.36) was significantly lower than in those of the control group (14.67 ± 4.93) (p = 0.003). Also, in the posttest, the mean score of life satisfaction in the intervention group (24.75 ± 4.28) was significantly higher than that of the control group (19.57 ± 7.33) (p = 0.001). Group counseling based on quality of life exerted a significantly positive impact on reducing the severity of stress and improving life satisfaction among family caregivers of individuals with substance use problem. Therefore, it is highly recommended that healthcare service providers incorporate this counseling approach in substance use withdrawal programs so as to increase the well-being and mental health of family caregivers.

Physicians\u2019 beliefs and attitudes about Benzodiazepines: a cross-sectional study

BackgroundIn 2015, Portugal was the OECD country with the highest reported consumption of BZD. Physician’s perceptions and attitudes regarding BZD are main determinants of related prescription habits. This study aimed to characterize beliefs and attitudes of Portuguese physicians regarding the prescription, management challenges, benefits, risks and withdrawal effects of BZD.MethodsA cross-sectional, observational study with online data collection through anonymous self-administered questionnaire. Physicians registered with the Portuguese Medical Association were invited to participate through direct e-mail message. Physicians were asked to give their opinion (using a 5-points Likert scale) regarding the prescription of BZD, their benefits and risks in the management of insomnia and anxiety, the possible adverse effects of chronic use and alternative non-pharmacologic approaches. Descriptive statistics were used and groups were compared through logistic regression.ResultsA total of 329 physicians participated in the study (56% family physicians). Mean age was 44.10 ± 15.2 years, with 19.03 ± 14.9 years of clinical experience. Fifty eight percent of participants were female. Physicians reported BZD’s negative impact on cognitive function (89%), association with road traffic accidents (88%) and falls (79%). Also, 58% shared the belief that chronic use is justified if the patient feels better and without adverse events. Although 68% reported to feel capable of helping patients to reduce or stop BZD, 55% recognized difficulties in motivating them. Compared to other medical specialists (altogether), family physicians were significantly more aware about the adverse effects of BZD and considered that chronic use may not be justified. Conversely, more family physicians expressed concerns about their skills to motivate patients engaging in withdrawal programs and to support them during the process.ConclusionOur results show that physicians’ awareness about risks of BZD chronic use is adequate though their attitudes and self-perceived skills towards promoting BZD withdrawal can be improved. Interventions in primary care are needed to capacitate physicians to better motivate patients for BZD withdrawal.

Complete withdrawal is the most effective approach to reduce disability in patients with medication-overuse headache: A randomized controlled open-label trial

Medication-overuse headache leads to high disability and decreased quality of life, and the best approach for withdrawal has been debated. To compare change in disability and quality of life between two withdrawal programs. We randomized medication-overuse headache patients to program A (two months without acute analgesics or migraine medications) or program B (two months with acute medications restricted to two days/week) in a prospective, outpatient study. At 6 and 12 months, we measured disability and headache burden by the Headache Under-Response to Treatment index (HURT). We estimated quality of life by EUROHIS-QOL 8-item at 2-, 6-, and 12-month follow-up. Primary endpoint was disability change at 12 months. We included 72 medication-overuse headache patients with primary migraine and/or tension-type headache. Fifty nine completed withdrawal and 54 completed 12-month follow-up. At 12-month follow-up, 41 patients completed HURT and 38 completed EUROHIS-QOL 8-item. Disability reduction was 25% in program-A and 7% in program-B ( p = 0.027). Headache-burden reduction was 33% in program-A and 3% in program-B ( p = 0.005). Quality of life was increased by 8% in both programs without significant difference between the programs ( p = 0.30). At 2-month follow-up, quality of life increased significantly more in program-A than program-B ( p = 0.006). Both withdrawal programs reduced disability and increased quality of life. Withdrawal without acute medication was the most effective in reducing disability in medication-overuse headache patients. Clinicaltrials.gov (NCT02903329).

Expectations about alcohol, cocaine, and benzodiazepine abstinence following inpatient heroin withdrawal management.

Polysubstance use is associated with relapse and poor treatment outcomes among people dependent on heroin. Despite the high prevalence of polysubstance use among patients detoxifying from heroin, little is known about patients' expectations to abstain or use non-opiate substances. The current study examined factors associated with expectations about abstaining from alcohol, cocaine, and benzodiazepines (BZDs) following heroin withdrawal management. Between May and December of 2015, we surveyed 417 patients (71.9% male, 31.7 [±8.39] mean years old) initiating short-term inpatient heroin withdrawal management who reported alcohol, cocaine, or BZD use in the past 30 days. We used logistic regression to evaluate the adjusted associations of background characteristics with expectations about using each substance following discharge. Approximately half of respondents reported past month alcohol (52%), cocaine (47.0%), or BZD (47.0%) use, and 25.9% reported using all three substances. Approximately half of those reporting drinking, 6.6% reporting cocaine use, and 27% of reporting BZD use expected to abstain from using that substance following heroin withdrawal. Prior opioid withdrawal was associated with a lower likelihood of expecting to stop using alcohol and BZDs, and more days of BZD use was associated with a greater likelihood of expecting to abstain from BZDs following discharge. Persons with opioid use disorder often do not expect to stop using other substances following withdrawal management, with very few planning cocaine cessation. Inpatient heroin withdrawal programs need to address and educate patients about how polysubstance use complicates recovery from heroin use. (Am J Addict 2019;28:36-42).

Screening, quantification, and confirmation of synthetic cannabinoid metabolites in urine by UHPLC-QTOF-MS.

Synthetic cannabinoids are one of the most significant groups within the category new psychoactive substances (NPS) and in recent years new compounds have continuously been introduced to the market of recreational drugs. A sensitive and quantitative screening method in urine with metabolites of frequently seized compounds in Norway (AB‐FUBINACA, AB‐PINACA, AB‐CHMINACA, AM‐2201, AKB48, 5F‐AKB48, BB‐22, JWH‐018, JWH‐073, JWH‐081, JWH‐122, JWH‐203, JWH‐250, PB‐22, 5F‐PB‐22, RCS‐4, THJ‐2201, and UR‐144) using ultra‐high pressure liquid chromatography–quadrupole time of flight–mass spectrometry (UHPLC–QTOF–MS) has been developed. The samples were treated with ß‐glucuronidase prior to extraction and solid‐phase extraction was used. Liquid handling was automated using a robot. Chromatographic separation was achieved using a C18‐column and a gradient of water and acetonitrile, both with 0.1% formic acid. Each sample was initially screened for identification and quantification followed by a second injection for confirmation. The concentrations by which the compounds could be confirmed varied between 0.1 and 12 ng/mL. Overall the validation showed that the method fulfilled the set criteria and requirements for matrix effect, extraction recovery, linearity, precision, accuracy, specificity, and stability. One thousand urine samples from subjects in drug withdrawal programs were analyzed using the presented method. The metabolite AB‐FUBINACA M3, hydroxylated metabolite of 5F‐AKB48, hydroxylated metabolite of AKB48, AKB48 N‐pentanoic acid, 5F‐PB‐22 3‐carboxyindole, BB‐22 3‐carboxyindole, JWH‐018 N‐(5‐hydroxypentyl), JWH‐018 N‐pentanoic acid, and JWH‐073 N‐butanoic acid were quantified and confirmed in 2.3% of the samples. The method was proven to be sensitive, selective and robust for routine use for the investigated metabolites.

Measuring the impacts of anthropogenic activities on Inner Mongolian temperate grassland

AbstractMeasuring the impacts of anthropogenic activities on grassland ecosystems is of great significance to establish effective grassland management policies. Due to the uncertainty and complexity of the anthropogenic activities, the impacts are difficult to quantify, especially at large spatial and long temporal scales. We used the Zhou Guangsheng model to simulate climate‐driven potential net primary productivity (NPPP) and MOD17A3 NPP data to acquire actual NPP (NPPA) influenced by both anthropogenic activities and climate change over the temperate grassland of Inner Mongolian from 2000 to 2014. We then simulated human‐induced NPP (NPPH), calculated as the difference between actual and potential NPP (NPPH = NPPA − NPPP), to determine anthropogenic effects on the temperate grassland. By comparing the NPPH and its time‐series linear slope from 2000 to 2014, we further proposed six types of anthropogenic impacts. Along the temperate grassland climate gradient, vegetation changed from meadow steppe in the east to typical steppe in the middle and desert steppe in the west, and NPPA and NPPP decreased. NPPH had no obvious spatial pattern. We observed positive effect (NPPH &gt; 0) on only 4.2% of total grassland area. The area where the types of “positive effect (NPPH &gt; 0) decrease – negative effect (NPPH &lt; 0) increase” and “negative effect (NPPH &lt; 0) increase” were observed in time‐series trends accounted for 68.8% of total grassland area. The grazing withdrawal and ecological compensation programs implemented around 2004 did not lead to a decline in the number of livestock and NPPH. Governments need to improve livestock number controls and strengthen grazing regulations.

Experiences of substance abusers from methadone maintenance therapy.

Background: Substance abusers are not able to withdraw drugs eternally despite the abundance of different treatments; therefore, withdrawal programs are not quite successful and notwithstanding all the successes of methadone maintenance therapy, there are some defects found in the manner this treatment is applied. Thus, this study was conducted to explore the experience of drug abusers regarding methadone maintenance therapy. Methods: This is a qualitative study using content analysis methodology. The research community includes drug abusers admitted to the treatment centers of the western cities of Mazandaran Province, Iran in 2016. The sampling was purposive and the data were collected by face-to-face single interviews with 20 patients. The interviews were continued up to data saturation. Finally, the Lundman and Grenheim method was used to analyze the interviews and the four criteria of Guba and Lincoln were applied to check data integrity. Results: "Buying time," "methadone dependence," and "looking from a narrow view to the patient" were the main three categories that fit the results. Conclusion: Governmental free services for drug abusers; paying attention to different aspects of treatment such as mental, emotional, and social recovery; lifelong support of the family and society members; and balance in prescribing and following the treatment process prescribed by health care providers can enhance both the quality and safety of the treatment process. Psychological consultation alongside social services can facilitate the recovery process in methadone maintenance therapy.