Effects of high-dose heroin versus morphine in intravenous drug users: a randomised double-blind crossover study

The purpose of this study is to evaluate the effects of high doses of injected opiates as prescribed maintenance in intravenous drugs users. This was accomplished via a randomised double-blind study with crossover at an outpatient clinic in Bern, Switzerland. The subjects were 39 patients with a long history of intravenous opioid use and persistent abuse despite treatment; they were randomly allocated to two groups. Group A was started on controlled injection of graduated doses of morphine up to a satisfying individual dose and was then switched as a double blind to heroin at a randomly determined day between week three and four. Subsequently this group was given heroin for the remaining two to three weeks of the study. Group B was started on heroin and was then switched to morphine in the same manner. Equipotent solutions of 3% morphine and 2% heroin were administered. The main outcome measures were clinical observations, structural interviews and self report of subjective experiences to assess the effects of the drugs. In 16 cases, the study had to be discontinued owing to severe morphine-induced histamine reactions. Thirteen participants in Group B presented these adverse reactions on the day of the switch-over. Full data were thus only obtainable for 17 participants. Average daily doses were 491 mg for heroin and 597 mg for morphine. The findings indicate that heroin significantly produced a lower grade of itching, flushing, urticaria and pain/nausea. A negative correlation between dose and euphoria was observed for both heroin and morphine. The authors concluded that as heroin produces fewer side effects it is the preferred high-dose maintenance prescription to morphine. The perceived euphoric effects are limited in both substances.

Pharmacokinetics and excretion of gamma-hydroxybutyrate (GHB) in healthy subjects

In Europe and the United States, the recreational use of gamma-hydroxy butyric acid (GHB) at dance clubs and "rave" parties has increased substantially. In addition, GHB is used to assist in the commission of sexual assaults. The aim of this controlled clinical study was to acquire pharmacokinetic profiles, detection times, and excretion rates in human subjects. Eight GHB-naïve volunteers were administered a single 25-mg/kg body weight oral dose of GHB, and plasma, urine, and oral fluid specimens were analyzed by using gas chromatography-mass spectrometry (GC-MS). Liquid-liquid extraction was performed after acid conversion of GHB to gamma-butyrolactone. Limits of quantitation of 0.1 (oral fluid), 0.2 (urine), and 0.5 microg/mL (plasma) could be achieved in the selected ion monitoring mode. GHB plasma peaks of 39.4 +/- 25.2 microg/mL (mean +/- SEM) occurred 20-45 min after administration. The terminal plasma elimination half-life was 30.4 +/- 2.45 min, the distribution volume 52.7 +/- 15.0 L, and the total clearance 1228 +/- 233 microL/min. In oral fluid, GHB could be detected up to 360 min, with peak concentrations of 203 +/- 92.4 microg/mL in the 10-min samples. In urine, 200 +/- 71.8 and 230 +/- 86.3 microg/mL, were the highest GHB levels measured at 30 and 60 min, respectively. Only 1.2 +/- 0.2% of the dose was excreted, resulting in a detection window of 720 min. Common side-effects were confusion, sleepiness, and dizziness; euphoria and change of vital functions were not observed. GHB is extensively metabolized and rapidly eliminated in urine and oral fluid. Consequently, samples should be collected as soon as possible after ingestion.

Gamma-hydroxybutyrate enhances mood and prosocial behavior without affecting plasma oxytocin and testosterone.

Gamma-hydroxybutyrate (GHB) is a GHB-/GABAB-receptor agonist. Reports from GHB abusers indicate euphoric, prosocial, and empathogenic effects of the drug. We measured the effects of GHB on mood, prosocial behavior, social and non-social cognition and assessed potential underlying neuroendocrine mechanisms. GHB (20mg/kg) was tested in 16 healthy males, using a randomized, placebo-controlled, cross-over design. Subjective effects on mood were assessed by visual-analogue-scales and the GHB-Specific-Questionnaire. Prosocial behavior was examined by the Charity Donation Task, the Social Value Orientation test, and the Reciprocity Task. Reaction time, memory, empathy, and theory-of-mind were also tested. Blood plasma levels of GHB, oxytocin, testosterone, progesterone, dehydroepiandrosterone (DHEA), cortisol, aldosterone, and adrenocorticotropic-hormone (ACTH) were determined. GHB showed stimulating and sedating effects, and elicited euphoria, disinhibition, and enhanced vitality. In participants with low prosociality, the drug increased donations and prosocial money distributions. In contrast, social cognitive abilities such as emotion recognition, empathy, and theory-of-mind, and basal cognitive functions were not affected. GHB increased plasma progesterone, while oxytocin and testosterone, cortisol, aldosterone, DHEA, and ACTH levels remained unaffected. GHB has mood-enhancing and prosocial effects without affecting social hormones such as oxytocin and testosterone. These data suggest a potential involvement of GHB-/GABAB-receptors and progesterone in mood and prosocial behavior.

Contribuições do direito norte-americano ao sistema de proteção do investidor no mercado de capitais brasileiro

O atual arcabouço normativo de proteção do investidor no mercado de capitais brasileiro teve suas linhas mestras cravadas pela reforma bancária introduzida pelas Leis 4.595, de 31 de dezembro de 1964, e 4.728, de 14 de julho de 1965, pela criação de um regulador especializado em mercado de capitais pela Lei 6.385, de 07 de dezembro de 1976, e pela reforma da legislação das sociedades anônimas introduzida pela Lei 6.404, de 15 de dezembro de 1976. Desde 1976, o arcabouço normativo de proteção do investidor no mercado de capitais brasileiro vem sendo desenvolvido a partir dessas linhas mestras iniciais, incorporando as lições aprendidas com as turbulências e euforias vividas pela economia nacional. Esse arcabouço normativo que aí está desde 1976 foi inspirado por contribuições do direito federal norte-americano, as quais foram conscientemente captadas no Brasil pelo legislador e pela comunidade jurídica nacional. Difundiram-se internacionalmente dos EUA para o Brasil os preceitos da proteção do investidor no mercado de capitais calcados na existência de um órgão regulador do mercado de capitais, na divulgação de informações relevantes para decisões de investimento (disclosure), na regulação funcional dos agentes do mercado de capitais e na vedação de fraudes com valores mobiliários.

Noticias sobre el virus del papiloma humano y su vacuna en la prensa valenciana (2006-2011)

La introducción de la vacuna contra el virus del papiloma humano (VPH) dirigida a mujeres adolescentes ha tenido en España un desarrollo no exento de cierta controversia. Asociada inicialmente al mensaje de «vacuna contra el cáncer de útero» que ofrecía una nueva posibilidad de lucha contra esa enfermedad, obtuvo una réplica que moderaba la euforia con un mensaje dirigido a probar evidencias. Mientras se administraba la segunda dosis de vacuna (febrero de 2009) ocurrió un suceso inesperado en Valencia relacionado con la aparición de acontecimientos adversos tras la administración de la vacuna en dos adolescentes, que tuvo un explosivo tratamiento mediático. Este estudio analiza el alcance y el contenido de las noticias aparecidas en dos periódicos regionales valencianos de gran tirada durante el sexenio 2006-2011 que mencionan al VPH, su vacuna y el cáncer de útero. Se discute la influencia que los mensajes emitidos hayan podido tener en la aceptabilidad de la vacuna.

Towards a Dynamic Asia-Europe Meeting (ASEM)? EU Centre Singapore Working Paper No. 14, May 2013

The Asia-Europe Meeting (ASEM) launched in 1996 is into its 17th year, and has expanded from a membership of  26 to 51. ASEM membership is made up of 10 ASEAN countries, the ASEAN Secretariat, China, Japan, South Korea,  Mongolia,  Bangladesh,  India,  Pakistan, Australia, New  Zealand  and  Russia  on the Asian side,  and the  27  EU  member states,  the  European  Commission,  Norway  and  Switzerland  on  the  European side.  Yet,  with such  impressive and diverse membership accounting for around 60% of the world’s population, 50% of global GDP,  and up to 60% of world trade, it remains relatively unknown in the public domain. There is also a palpable sense  that not all is well as interest in ASEM (particularly among the leaders) may wane without adequate follow‐up  actions, concrete deliverables and improved visibility.    The  challenges faced by ASEM were discussed in a recent Symposium in Yangzhou organised by the Chinese  government and co‐sponsored by Laos, India, Poland and the Asia‐Europe Foundation (ASEF).    Into its 17th year, ASEM remains essentially a forum for dialogue. After an initial euphoria following the launch   of the inaugural summit in Bangkok in 1996, symbolising Asia’s and Europe’s commitment to step up engagement  with each other, ASEM has since been plagued by the perennial questions of its lack of effectiveness, efficacy and  visibility, and doubts about sustained interest by its political leaders in light of the lack of concrete deliverables.   This paper drawn in part from an earlier article on The Asia‐Europe Meeting (ASEM) in the Palgrave Handbook on  EU‐Asia Relations (2013), and from the discussions at the above ASEM Symposium, will begin with an examination  of the on‐going debates with regards to the challenges faced by ASEM and the various suggestions to address  some  of these  challenges.  The  paper will  conclude with some  observations  on the real  issues  behind these  debates and a prognosis on the future development of ASEM.   

Disappearing government bond spreads in the eurozone - Back to normal? CEPS Working Document No. 396, May 2014

Since the announcement of the Outright Monetary Transactions (OMT) programme by Mario Draghi, President of the ECB, in 2012, the government bond spreads began a strong decline. This paper finds that most of this decline is due to the positive market sentiments that the OMT programme has triggered and is not related to underlying fundamentals, such as the debt-to-GDP ratios or the external debt position that have continued to increase in most countries. The authors even argue that the market’s euphoria may have gone too far in taking into account the same market fundamentals. They conclude with some thoughts about the future governance of the OMT programme.

Being stoned: A review of self-reported cannabis effects

Although there has been considerable research into the adverse effects of cannabis, less attention has been directed toward subjective effects that may be associated with ongoing cannabis use. Examination of self-reported cannabis effects is an important issue in understanding the widespread use of cannabis. While reviews have identified euphoria as a primary factor in maintaining cannabis use, relaxation is the effect reported most commonly in naturalistic studies of cannabis users, irrespective of the method used. Self-reported effects in 12 naturalistic and 18 laboratory studies were compared. Regardless of methodology there was considerable variation in the effects experienced. Variation has been reported in terms of opposite effects being experienced by different individuals, variation of effects by individuals within a single occasion and between occasions of use. Factors that might explain this variation are outlined. Limitations of the available literature and suggested directions for future research are discussed.

What is the Future of Strategic Management?

The history of planning and creating strategies has a past of over half a century. Throughout this lifetime period we have witnessed both the evolution of theory and practice. The MBA study books in the last-third of the 20th century have with predilection exhibited this very process as a complex of monetary centered budget planning, forecast-based planning, strategic planning and strategic management. There might be a controversy existing about the naming, characteristics and timing of these different sections but there is an accordance that the changes that we have taken place in the last decade as a whole without a doubt can be derived from these very changes in the business environment or in some outstanding cases (like 9/11) they can be acknowledged as the ability of corporate foreseeing and the ability to adapt to the vision of the future. The main purposes of the research is to provide a summarized picture about the changing process of this procedure during last decades as far as the planning and creating strategies are concerned and also their milestones and periods. Try to explore and systemize the very aspects of these changes. The happenings of the first decade of the new millennium are outstandingly interesting if we consider their real effect on the theory and practice of strategic management. Let us remember the euphoria around the year 2000, the predictions of „new technologies”, „new economy”, „new organization” and „new leadership”. We have implied before on the destruction of the twin towers of the World Trade Center which meant a new era, a new quality of international terrorism and its consequences (Afghanistan, Iraq). But the „product” of this decade is the strategic aim that companies focus on, which is the social responsibility regarding the unavoidance of the effects of climate change on the long run. During the research the big question has risen concerning how did the science of strategic management do as far as the predictions of the global monetary and economic crisis are concerned? And also its solutions this very science has to offer in order to handle and get over the crisis. Does it conclude from the answers given to the questions that a change in paradigms are necessary, a new quality is needed or may be we have come to a new crossroad of the development process that will take over strategic management? (...)

Comparative reproductive biology of two Florida pawpaws Asimina reticulata Chapman and Asimina tetramera Small

I investigated the phenology and breeding systems of two Florida endemic pawpaws, Asimina reticulata, widespread in peninsular Florida, and A. tetramera, a federally endangered species limited to two counties on the Atlantic Coastal Ridge. The purpose of this study was to determine if differences contribute to the rarity of Asimina tetramera compared with A. reticulata. The study was conducted in sand pine scrub sites with the largest populations of A. tetramera in the two counties. Flowering seasons differ for the two species. Both species are hermaphroditic and strongly protogynous. Pollination experiments show that neither species is autogamous and the primary breeding mechanism is outcrossing, although low levels of geitonogamous pollination occur in mature scrub habitats. High levels of inbreeding depression were noted in both species at both sites but inbreeding depression was relaxed the first year post-fire. Fruit set in mature habitats may be pollinator limited. ^ I studied insects associated with the flowers in sand pine scrub habitat in southeastern Florida from 1994–1996. The most commonly represented orders were Coleoptera (25 spp.), Lepidoptera. (3 spp.) and Hymenoptera. (3 spp.). All Coleoptera. were flower visitors; one species, Euphoria sepulchralis (Fabricius)(Scarabeaidae), visited flowers of the two Asimina species at both sites. Eurytides marcellus (Cramer) (Lepidoptera: Papilionidae) eggs and larvae were observed on both species of Asimina during each year of the study. ^ Resource management techniques were applied to a mature sand pine scrub community in Jonathan Dickinson State Park in southeastern Florida for the management of Asimina tetramera. Manipulations conducted in 1996 included combinations of fire and mechanical treatments. I measured effects of these treatments on flowering and fruit set on A. tetramera and found cutting and burning was most effective in increasing flowering, followed by burning. Mechanical cutting and mulching had no significant effect. ^

A phenomenology of crack abuse

The aim of this dissertation is to identify, describe, and explain the common experiences defining the crack abuser's life-world. Its method is phenomenological. Using basic cybernetic premises, a neurophysiologically oriented phenomenological framework concerning the constitution of thoughts, memories, and perceptions is first written. The framework is designed to hypothetically represent the neuropathology of crack abuse within a perspective that prescinds and describes the constitution, flow, and interdependence of experience. After the framework is written, the dissertation outlines the neuro-psychopharmacology of crack abuse and delimits crack abusers as a specific group within the more general population of cocaine users. It then represents the neuropathology of crack abuse within its phenomenological framework and uses the first-person accounts of forty-two crack dependents to actualize a phenomenological sketch of the crack abuser's life-world. The ethnographies afford the possibility of writing a “thick” description of the crack abuser's daily life—one that communicates the substance, order, and subjective and cultural dimensions of the dependent's defining experiences. ^ The dissertation's goals are successfully realized. The framework written and the ethnographies recorded and transcribed, the dissertation is able to identify, describe, and to a certain extent explain some of the common experiences defining the crack abusers life-world. The dissertation concludes that the crack abuser's life-world is organized around three primary and four secondary experiences. His primary experiences include: (1) an almost complete, yet fleeting, satisfaction of the ego's innate insufficiency and sublime, erotic-like stimulation of its core, (2) a fundamental inclination and expansion of the uniquely oriented euphoria-dysphoria dynamic that vivifies and orients the flow of consciousness, and (3) a change in the ego's innate structure. His secondary experiences include: (a) a characteristic aiming of projects, actions, and conduct toward the procurement and consumption of crack, (b) a denigration in the hold of legitimations and institutionalizations on the thematic field, (c) a strict alignment and a contraction in the scope of logical types pointing to the salient experiences within the stock of knowledge, and (d) for some crack abusers, ontological insecurity, despair, and exhaustion. ^

La antropología de Pedro Laín Entralgo, y su aplicación a la enfermería

Introduction. Current times are distinguished, among other things, by the instability of the events, facts and ideas that follow one another vertiginously. The circumstances that surround our society are extremely changing, as well as the way of understanding things and assessing recent developments. The material world dominates over human life. Productive tasks take first place. Appearances are unstable and the ephemeral confirms its power in the 21st century’s mentality. We are immersed in the aesthetics of seduction and image. And in human life, the expansion of needs in all walks of life has become part of the structure of human beings’ existence in the current world. The consumerist fever, the euphoria for new things have made the sense of life virtually insubstantial. All this hardly fits into the nature of healthcare professions. In our case, nursing science has scarce support in our society for continuing the research about the meaning of being a nurse that the reality of the profession requires...