Comprehensive Addictive Behaviors and Disorders, Volume 3 : Interventions for Addiction

"Interventions for Addiction examines a wide range of responses to addictive behaviors, including psychosocial treatments, pharmacological treatments, provision of health care to addicted individuals, prevention, and public policy issues. Its focus is on the practical application of information covered in the two previous volumes of the series, Comprehensive Addictive Behaviors and Disorders. Readers will find information on treatments beyond commonly used methods, including Internet-based and faith-based therapies, and criminal justice interventions. The volume features extensive coverage of pharmacotherapies for each of the major drugs of abuse-including disulfiram, buprenorphine, naltrexone, and others-as well as for behavioral addictions. In considering public policy, the book examines legislative efforts, price controls, and limits on advertising, as well as World Health Organization (WHO) efforts. Interventions for Addiction is one of three volumes comprising the 2,500-page series, Comprehensive Addictive Behaviors and Disorders. This series provides the most complete collection of current knowledge on addictive behaviors and disorders to date. In short, it is the definitive reference work on addictions."--publisher website

Implications of comorbidity for clinical practice

In the past, people with comorbidity have often received inadequate care. The ethical principle of equal access to quality services has important implications for agencies, when combined with knowledge about comorbidity and its management, and about diffusion of innovations across organizations. Comorbidity is common, and often has profound impacts on individuals and families. Tobacco smoking in particular is endemic and affects morbidity, mortality, and functioning. This implies that screening for co-occurring problems should be routine, and that a boutique comorbidity service is impractical. Large numbers mean that universal screening and intervention must be capable of large-scale implementation. Since multiple, closely linked problems are often present, treatments should address these multiple issues, and closely interrelated problems will require well-integrated treatment. Involvement of a single health agency is typically needed. Numbers and severity of problems can blind practitioners and patients to strengths and unaffected areas; these should be assessed and fostered. Better policies and practices for co-occurring disorders will require organizational change. Co-occurring disorders must become core business for organizations and practitioners, so that effective comorbidity practice is rewarded, required skills are present or taught, cues to use the practices are provided, and a culture supporting their application is established.

Export readiness index : construction and analysis

The internationalisation process of firms has attracted much research interest since the 1970s. It is noted, however, that a significant research gap exists in studies with a primary focus on the pre-internationalisation behaviour of firms. This paper proposes the incorporation of a pre-internationalisation phase into the traditional Uppsala model of firm internationalisation to address the issue of export readiness. Through extensive literature review, the concepts fundamental to the ability of an Uppsala type firm to begin internationalisation through an export entry mode are identified: exposure to stimuli factors, attitudinal commitment of decision makers towards exporting, the firm’s resource capabilities, as well as the moderating effect of lateral rigidity. The concept of export readiness is operationalised in this study through the construction of an export readiness index (ERI) using exploratory and confirmatory factor analysis. The index is then applied to some representative cases and tested using logistic regression to establish its validity as a diagnostic tool. The proposed ERI presents not only a more practical approach towards analysing firms’ export readiness but has also major public policy implications as a possible tool for government export promotion agencies.

Delirium in the ICU : a review

AIM The aim of this paper was to review the current discourse in relation to intensive care unit (ICU) delirium. In particular, it will discuss the predisposing and contributory factors associated with delirium's development as well as effects of delirium on patients, staff and family members. BACKGROUND Critically ill patients are at greater risk of developing delirium and, with an ageing population and increased patient acuity permitted by medical advances, delirium is a growing problem in the ICU. However, there is a universal consensus that the definition of ICU delirium needs improvement to aid its recognition and to ensure both hypoalert-hypoactive and hyperalert-hyperactive variants are easily and readily identified. RELEVANCE TO CLINICAL PRACTICE The effects of ICU delirium have cost implications to the National Health Service in terms of prolonged ventilation and length of hospital stay. The causes of delirium can be readily classified as either predisposing or precipitating factors, which are organic in nature and commonly reversible. However, contributory factors also exist to exacerbate delirium and having an awareness of all these factors promises to aid prevention and expedite treatment. This will avoid or limit the host of adverse physiological and psychological consequences that delirium can provoke and directly enhance both patient and staff safety. CONCLUSIONS Routine screening of all patients in the ICU for the presence of delirium is crucial to its successful management. Nurses are on the front line to detect, manage and even prevent delirium.

Advancing practice in critical care : a model of knowledge integration

Aim The aim of this paper was to discuss the potential development of a conceptual model of knowledge integration pertinent to critical care nursing practice. A review of the literature identified that reflective practice appeared to be at the forefront of professional development. Background It could be argued that advancing practice in critical care has been superseded by the advanced practice agenda. Some would suggest that advancing practice is focused on the core attributes of an individual’s practice, which then leads onto advanced practice status. However, advancing practice is more of a process than identifiable skills and as such is often negated when viewing the development of practitioners to the advanced practice level. For example, practice development initiatives can be seen as advancing practice for the masses, which ensures that practitioners are following the same level and practice of care. The question here is, are they developing individually? Relevance to clinical practice What this paper presents is that reflection may not be best suited to advancing practice if the individual practitioner does not have a sound knowledge base both theoretically and experientially. The knowledge integration model presented in this study uses multiple learning strategies that are focused in practice to develop practice, e.g. the use of work-based learning and clinical supervision. To demonstrate the models application, an exemplar of an issue from practice shows its relevance from a practical perspective. Conclusions In conclusion, further knowledge acquisition and its relationship with previously held theory and experience will enable individual practitioners to advance their own practice as well as being a resource for others.

The consultative process used in outreach : a narrative account

Aim The aim of this paper was to provide a narrative account of the communication skills used in an effective outreach consultation utilizing Neighbour’s consultative model. Other consultation models were considered; however, because of their overly comprehensive approach or emphasis on behaviour modification, these were deemed inappropriate. Background The nursing profession has endured significant changes of late and as a result is developing more autonomous roles in both the community and the acute health care settings. In the past, the term consultancy was used within the medical context; nowadays, there are advance nurse practitioners for whom consultancy is an integral part of their role. Although every nursing interaction is in essence a consultation, the fact that nurses are taking up on new advanced roles highlights the necessity for nurses to develop their consultation skills even further. Therefore, it makes sense to explore what aspects of that consultancy role needs special consideration in order to ensure that positive outcomes are achieved. Conclusions This paper has used a narrative account to uncover those salient skills needed to enhance the therapeutic relationship with a patient requiring the services of outreach. Furthermore, the application of a recognized consultation model was used to elucidate the underpinning knowledge of systematic history taking and assessment as well as demonstrating the communication skills and strategies needed to increase the patient’s participation and empowerment throughout the consultation. Relevance to clinical practice Effective communication skills encompassed in a consultative model are integral to the success in safeguarding the well-being of patients requiring advanced levels of care. Prejudging or pre-empting information being conveyed can be detrimental to patient safety and may prolong or complicate treatment plans.

A dedicated retrieval and transfer service : the QUARTS project

Background The transfer and/or retrieval of a critically patient is inherently dangerous not only for the patient but for staff as well. The quality and experience of unplanned transfers can influence patient mortality and morbidity. However, international evidence suggests that dedicated transfer/retrieval teams can improve mortality and morbidity outcomes. Aims The initial aim of this paper is to describe an in-house competency-based training programme, which encompasses the STaR approach to develop members of our existing nursing team to be part of the dedicated transfer/retrieval service. The paper also presents audit data findings which examined the source of referrals, number of patients actually transferred and clinical status of those being transferred. Results Audit data illustrate that the most frequent source of referrals comes from Accident and Emergency and the Surgical Directorate with the most common presenting condition being cardio-respiratory failure or arrest. Audit data reveal that the number of patients actually transferred or retrieved is relatively small (33%) compared with the overall number of requests for assistance. However, 36% of those patients transferred had a level 2 or level 3 acuity status that necessitated the admission to a critical care area. Conclusions A number of studies have concluded that the ill-experienced and ill-equipped transfer team can place patients’ at serious risk of harm. Whether planned or unplanned, dedicated critical care transfer/retrieval teams have been shown to reduce patient mortality and morbidity.

Sedation breaks : are they good for the critically ill patient? A review.

Background:  Tradition has led us to believe that a heavily sedated patient is a comfortable, settled, compliant patient for whom sedation will improve outcome. The current move witnessed in clinical practice today of limiting sedation has led health care in recent years to question the benefit and necessity of routine, continuous sedation for all patients requiring mechanical ventilation. However, as a result there has been a rise in the amount of agitation being reported as being experienced by patients with the daily withdrawal of sedation. Aims:  The purpose of this paper is to review current arguments for and against perserving with agitation versus re-sedating, when it presents during the daily sedation breaks. Findings:  Of the literature reviewed, the question to re-sedate the mechanically ventilated agitated patient during sedation breaks remains an issue of contention. Although there is evidence focusing on the psychological effects of long-term sedation and sedation breaks specifically, the complex nature of critical illness in some cases means that individualized care is of paramount importance and in-depth assessment is crucial when deciding to re-sedate in the face of undetermined agitation. Agitation has been closely linked with several incidents that can be detrimental to patient safety, such as removal of lines and unplanned self-extubation. Conclusion:  The recommendations of this review are that nurses should re-commence sedation if the patient becomes agitated following a sedation break. Aims:  The purpose of this paper is to review current arguments for and against perserving with agitation versus re-sedating, when it presents during the daily sedation breaks. Findings:  Of the literature reviewed, the question to re-sedate the mechanically ventilated agitated patient during sedation breaks remains an issue of contention. Although there is evidence focusing on the psychological effects of long-term sedation and sedation breaks specifically, the complex nature of critical illness in some cases means that individualized care is of paramount importance and in-depth assessment is crucial when deciding to re-sedate in the face of undetermined agitation. Agitation has been closely linked with several incidents that can be detrimental to patient safety, such as removal of lines and unplanned self-extubation. Conclusion:  The recommendations of this review are that nurses should re-commence sedation if the patient becomes agitated following a sedation break.

Noise levels in a general intensive care unit : a descriptive study.

The aim of this small-scale study was to measure, analyse and compare levels of acoustic noise, in a nine-bedded general intensive care unit (ICU). Measurements were undertaken using the Norsonic 116 sound level meter recording noise levels in the internationally agreed ‘A’ weighted scale. Noise level data were obtained and recorded at 5 min over 3 consecutive days. Results of noise level analysis indicated that mean noise levels within this clinical area was 56·42 dB(A), with acute spikes reaching 80 dB(A). The quietest noise level attained was that of 50 dB(A) during sporadic intervals throughout the 24-h period. Parametric testing using analysis of variance found a positive relationship (p ≤ 0·001) between the nursing shifts and the day of the week. However, Scheffe multiple range testing showed significant differences between the morning shift, and the afternoon and night shifts combined (p ≤ 0·05). There was no statistical difference between the afternoon and night shifts (p ≥ 0·05). While the results of this study may seem self-evident in many respects, what it has highlighted is that the problem of excessive noise exposure within the ICU continues to go unabated. More concerning is that the prolonged effects of excessive noise exposure on patients and staff alike can have deleterious effect on the health and well-being of these individuals.

Does counting still count? Revisiting the security of counting based user authentication protocols against statistical attacks

At NDSS 2012, Yan et al. analyzed the security of several challenge-response type user authentication protocols against passive observers, and proposed a generic counting based statistical attack to recover the secret of some counting based protocols given a number of observed authentication sessions. Roughly speaking, the attack is based on the fact that secret (pass) objects appear in challenges with a different probability from non-secret (decoy) objects when the responses are taken into account. Although they mentioned that a protocol susceptible to this attack should minimize this difference, they did not give details as to how this can be achieved barring a few suggestions. In this paper, we attempt to fill this gap by generalizing the attack with a much more comprehensive theoretical analysis. Our treatment is more quantitative which enables us to describe a method to theoretically estimate a lower bound on the number of sessions a protocol can be safely used against the attack. Our results include 1) two proposed fixes to make counting protocols practically safe against the attack at the cost of usability, 2) the observation that the attack can be used on non-counting based protocols too as long as challenge generation is contrived, 3) and two main design principles for user authentication protocols which can be considered as extensions of the principles from Yan et al. This detailed theoretical treatment can be used as a guideline during the design of counting based protocols to determine their susceptibility to this attack. The Foxtail protocol, one of the protocols analyzed by Yan et al., is used as a representative to illustrate our theoretical and experimental results.

Raman and infrared spectroscopic characterization of the phosphate mineral Lithiophilite—LiMnPO4

The metal lithium is very important in industry, including lithium batteries. An important source of lithium besides continental brines is granitic pegmatites as in Australia. Lithiophilite is a lithium and manganese phosphate with chemical formula LiMnPO4 and forms a solid solution with triphylite, its Fe analog, and belongs to the triphylite group that includes karenwebberite, natrophilite, and sicklerite. The mineral lithiophilite was characterized by chemical analysis and spectroscopic techniques. The chemical is: Li1.01(Mn0.60, Fe0.41, Mg0.01, Ca0.01)(PO4)0.99 and corresponds to an intermediate member of the triphylite-lithiophilite series, with predominance of the lithiophilite member. The mineral lithiophilite is readily characterized by Raman and infrared spectroscopy.

An object-oriented design of a World Model for autonomous city vehicles

This paper presents an object-oriented world model for the road traffic environment of autonomous (driver-less) city vehicles. The developed World Model is a software component of the autonomous vehicle's control system, which represents the vehicle's view of its road environment. Regardless whether the information is a priori known, obtained through on-board sensors, or through communication, the World Model stores and updates information in real-time, notifies the decision making subsystem about relevant events, and provides access to its stored information. The design is based on software design patterns, and its application programming interface provides both asynchronous and synchronous access to its information. Experimental results of both a 3D simulation and real-world experiments show that the approach is applicable and real-time capable.

Hydrolysis of triasulfuron, metsulfuron-methyl and chlorsulfuron in alkaline soil and aqueous solutions

The hydrolysis of triasulfuron, metsulfuron-methyl and chlorsulfuron in aqueous buffer solutions and in soil suspensions at pH values ranging from 5.2 to 11.2 was investigated. Hydrolysis of all three compounds in both aqueous buffer and soil suspensions was highly pH-sensitive. The rate of hydrolysis was much faster in the acidic pH range (5.2-6.2) than under neutral and moderately alkaline conditions (8.2-9.4), but it increased rapidly as the pH exceeded 10.2. All three compounds degraded faster at pH 5.2 than at pH 11.2. Hydrolysis rates of all three compounds could be described well with pseudo-first-order kinetics. There were no significant differences (P =0.05) in the rate constants (k, day-1) of the three compounds in soil suspensions from those in buffer solutions within the pH ranges studied. A functional relationship based on the propensity of nonionic and anionic species of the herbicides to hydrolyse was used to describe the dependence of the 'rate constant' on pH. The hydrolysis involving attack by neutral water was at least 100-fold faster when the sulfonylurea herbicides were undissociated (acidic conditions) than when they were present as the anion at near neutral pH. In aqueous buffer solution at pH > 11, a prominent degradation pathway involved O-demethylation of metsulfuron-methyl to yield a highly polar degradate, and hydrolytic opening of the triazine ring. It is concluded that these herbicides are not likely to degrade substantially through hydrolysis in most agricultural (C) 2000 Society of Chemical Industry.

Reinforced insulation properties of epoxy resin/SiO2 nanocomposites by atmospheric pressure plasma modification

Nanocomposite dielectrics hold a promising future for the next generation of insulation materials because of their excellent physical, chemical, and dielectric properties. In the presented study, we investigate the use of plasma processing technology to further enhance the dielectric performance of epoxy resin/SiO2 nanocomposite materials. The SiO2 nanoparticles are treated with atmospheric-pressure non-equilibrium plasma prior to being added into the epoxy resin host. Fourier transform infrared spectroscopy (FTIR) results reveal the effects of the plasma process on the surface functional groups of the treated nanoparticles. Scanning electron microscopy (SEM) results show that the plasma treatment appreciably improves the dispersion uniformity of nanoparticles in the host polymer. With respect to insulation performance, the epoxy/plasma-treated SiO2 specimen shows a 29% longer endurance time than the epoxy/untreated SiO2 nanocomposite under electrical aging. The Weibull plots of the dielectric breakdown field intensity suggest that the breakdown strength of the nanocomposite with the plasma pre-treatment on the nanoparticles is improved by 23.3%.

Defining the spatiotemporal surveillance space for alien species’ invasions using approximate Bayesian computation

The spatiotemporal dynamics of an alien species invasion across a real landscape are typically complex. While surveillance is an essential part of a management response, planning surveillance in space and time present a difficult challenge due to this complexity. We show here a method for determining the highest probability sites for occupancy across a landscape at an arbitrary point in the future, based on occupancy data from a single slice in time. We apply to the method to the invasion of Giant Hogweed, a serious weed in the Czech republic and throughout Europe.