Buying 'legal' recreational drugs does not mean that you are not breaking the law.

BACKGROUND: Recreational drug use in the UK is common; sources of recreational drugs are changing, with increasing purchase of legal highs from the Internet. Previous studies have shown that there is not consistency of active ingredient(s) in legal highs purchased from the Internet. AIM: The aim of this study was to determine the impact of the 16 April 2010 change to the Misuse of Drugs Act (1971) on the content of 'legal highs' purchased over the Internet and supplied within the UK. METHODS: Legal highs were purchased from a number of different Internet suppliers and the active ingredients determined by analysis undertaken within a Home Office approved and licensed laboratory set in a UK academic institution. The active ingredient(s) detected on screening were then compared to the UK legislation in force at the time of purchase to determine whether each individual 'legal' high was in fact legal or not. RESULTS: All 18 products purchased prior to the change in the UK legislation contained active ingredients that were legal under the Misuse of Drugs Act (1971) in force at that time. Six products were purchased and analysed after the changes to the UK Misuse of Drugs Act (1971) on the 16 April 2010. Five of the products contained information, either on the Internet site or the packaging, stating that the product contained legal substances; the final product did not specify the active ingredient and so purchasers would be unable to determine if this was truly a legal product. Five of the six products contained an active ingredient that is a Class B drug under the Misuse of Drugs Act (1971); the other product contained an unlicensed medicine not controlled under the Misuse of Drugs Act (1971). CONCLUSION: We have shown in this study that some drugs sold as 'legal' highs contain drugs that are controlled under the Misuse of Drugs Act (1971). Under current UK legislation, individuals purchasing legal highs that contained controlled drugs would be subject to the same penalties as if they had knowingly purchased a controlled drug. Dissemination of information on the harm associated with the use of legal highs should also inform individuals that they may be purchasing controlled substances and the potential legal consequences of this.

Purchasing 'legal highs' on the Internet--is there consistency in what you get?

BACKGROUND: The supply of recreational drugs has changed and users increasingly buy 'legal highs' over the Internet. Use of these is common and there is a potential for significant toxicity associated with their use. AIM: To determine the content of legal highs available for purchase in the UK and whether the content of these remains consistent. METHODS: Twenty-six legal highs were purchased monthly from five different Internet sites over 6 months. These were analysed to determine the drugs in the products and whether there were any changes in their content over this time period. RESULTS: All products were supplied initially, but there was a decline in supply of products month by month. The following drug classes were detected: piperazines, cathinones, caffeine/ephedrine or products in which no psychoactive drugs were detected. Of the products supplied on more than one occasion, 15 (75%) contained the same compounds on each occasion. In three products there was a change in the piperazine detected, with 1-benzylpiperazine being substituted for 1-methyl-4-benzylpiperazine or vice versa. In two other products there was a cathinone [4-fluorophenylpiperazine (pFPP) or 3-fluromethcathinone (3FMC)] detected in products purchased in Month 1 that was not present in the products purchased in subsequent months. CONCLUSION: Whilst there was no variation in the composition of most legal highs supplied over 6 month, there was significant variation in the piperazine or cathinone content of one quarter of the products. This variation could be of clinical significance as the cathinone and piperazine products can be associated with significant toxicity.

Shoulder function following autologous latissimus dorsi breast reconstruction. A prospective three year observational study comparing quilting and non-quilting donor site techniques.

Latissimus dorsi harvest and axillary surgery can affect shoulder function. The effect of autologous latissimus dorsi flap (ALD) breast reconstruction and donor site quilting have been inadequately studied. A cohort of ALD flap breast reconstruction patients were assessed pre-operatively and at eight post-operative time-points (up to 3 years after reconstruction) using the self-administered Disabilities of the Arm, Shoulder and Hand (DASH) outcome measure, for which validated normative data is available. Patients with incidental shoulder conditions and bilateral reconstructions were excluded. This was a prospective, observational study with blinded data interpretation: 58 patients, 22 of whom had donor site quilting, were assessed. Groups were compatible demographically, in breast care management and in pre-operative DASH score (quilted 6.5, non-quilted 6.4; P=0.98). Scores were significantly increased at initial post-operative clinic review (mean 49, SD19; P<0.001), 6 week (29, SD20; P<0.001), and 3 month (19, SD19; P<0.01), thereafter remaining at a plateau value of approximately 15 (P>0.05). Seroma incidence was reduced in the quilted group (5% vs 70%). A strong, significant correlation was found between 3 month DASH score and long term function (r=0.66, P<0.0003); patients with DASH >20 fare significantly worse in the longterm (mean 20 point increase, SD5.0, P<0.001). Higher post-operative DASH scores correlated significantly with pre-operative DASH (r=0.58) and BMI (r=0.36). Adjuvant therapy had no effect on shoulder function. Axillary dissection had a weak correlation with a higher DASH score, but only at the 3-month post-operative time-point (r=0.32, P=0.03). ALD flap breast reconstruction generally results in a functionally insignificant increase (6.5 points) in longterm DASH score, although a small subset of patients do develop longterm impairment, and quilting does not appear to inhibit shoulder function.

Physical analysis of the complex rye (Secale cereale L.) Alt4 aluminium (aluminum) tolerance locus using a whole-genome BAC library of rye cv. Blanco.

Rye is a diploid crop species with many outstanding qualities, and is important as a source of new traits for wheat and triticale improvement. Rye is highly tolerant of aluminum (Al) toxicity, and possesses a complex structure at the Alt4 Al tolerance locus not found at the corresponding locus in wheat. Here we describe a BAC library of rye cv. Blanco, representing a valuable resource for rye molecular genetic studies, and assess the library's suitability for investigating Al tolerance genes. The library provides 6 x genome coverage of the 8.1 Gb rye genome, has an average insert size of 131 kb, and contains only ~2% of empty or organelle-derived clones. Genetic analysis attributed the Al tolerance of Blanco to the Alt4 locus on the short arm of chromosome 7R, and revealed the presence of multiple allelic variants (haplotypes) of the Alt4 locus in the BAC library. BAC clones containing ALMT1 gene clusters from several Alt4 haplotypes were identified, and will provide useful starting points for exploring the basis for the structural variability and functional specialization of ALMT1 genes at this locus.

What evidence is there that the UK should tackle the potential emerging threat of methamphetamine toxicity rather than established recreational drugs such as MDMA ('ecstasy')?

BACKGROUND: There is increasing interest in whether methamphetamine is an emerging recreational drug in the UK. AIM: To determine what evidence is there that methamphetamine use is an emerging drug in the UK compared to established recreational drugs such as MDMA. DESIGN AND METHODS: We undertook a retrospective study collating data on the number of enquiries to both our poisons centre and the UK National Poisons Information Service (NPIS) relating to all recreational drugs, methamphetamine and MDMA; presentations to our Emergency Department (ED) with acute methamphetamine toxicity and the frequency of positive urine tests for methamphetamine and MDMA in workplace drug screening programmes. RESULTS: There was a small increase in the number of methamphetamine-related calls to our poisons centre, but it remained uncommon (0.1% of all recreational drugs cases in 2000 to 1.23% in 2006) compared to MDMA (17.3-42.7% of all recreational drugs cases). The number of 2005/6 enquiries to the UK NPIS for methamphetamine was 12, compared to 455 MDMA enquiries (0.014 and 0.52% of all enquiries, respectively). There were five presentations to our ED relating to methamphetamine over a 15-month period compared to 171 for MDMA. Of the 254 440 urine samples screened for the presence of drugs in the workplace (2000-06), three were positive for methamphetamine and 147 for MDMA. CONCLUSION: There is no evidence of increasing use of methamphetamine or that acute methamphetamine poisoning is a significant clinical problem compared to established recreational drugs such as MDMA. In our opinion, healthcare, educational and law enforcement resources should be proportionally directed towards tackling drugs that pose an immediate and continuing healthcare risk to the population rather than emerging recreational drugs.

Disposal of syringes, needles, and lancets used by diabetic patients in North East Essex.

To investigate community disposal of contaminated sharps by insulin-treated diabetes mellitus patients, we surveyed 144 patients. Twenty-three (16.0%) were non-contactable, leaving a study sample of 121, of whom 102 (84.3%) responded. Among the respondents 93.1% used lancets and 97.1% needles; 70.6% used lancets once or twice a day and 65.7% used needles twice a day. The majority said they had received no information on safe disposal of sharps. Of those recalling advice, most received it from diabetes nurse specialists. The majority of needle users used needle clippers and/or sharps bins for disposal. Most of the lancet users resorted to drinks cans/bottles or domestic waste. There were statistically significant differences in practices between patients receiving and not receiving advice on sharps disposal (odds ratio [OR] 6.36 [95% CI 2.04-23.28] p = 0.0007 for needle disposal and OR 15.41 [95% CI 3.57-90.12] p = 0.00001 for lancet disposal). There were also statistically significant differences among needle users using and not using needle clippers and/or sharps bins according to the interval since diagnosis and the frequency of needle use per day. This study identifies a need for a standardised approach to sharps disposal supported by an effective method of disseminating information, and a need for advice on auditing its impact.

The relationship of psychological variables and disease progression among long-term HIV-infected men.

This study investigated the contribution of psychological factors to disease progression among long-term HIV-1 infected gay men. Participants completed self-report measures including coping strategies, life events, social support, personality and psychological morbidity and were followed clinically for up to 30 months. Cox proportional hazards survival analyses were carried out to CD4<200 x 106/1 and AIDS-related complex (ARC) or AIDS diagnosis controlling for viral load, antiretroviral drug use and CD4 count. Only acceptance coping was a significant predictor of time to ARC or AIDS diagnosis: the risk of ARC or AIDS was almost 5 times greater for those scoring within the lowest tertile compared with those scoring in the highest tertile (HR=4.7, 95% CI 1.8-12.3).

Politics and the success of school-based health centers.

School-based health centers (SBHCs) provide access to health services by bringing providers to children (and sometimes parents) and furnishing low cost services in an atmosphere of trust. While the number of SBHCs has continued to grow and some clinics have continued to expand their services, others have barely survived and some have even closed. This study investigated factors, particularly political forces, that affected the success of SBHCs. Using a national survey of clinic directors, this study assessed clinic success in terms both of longevity and service delivery. Findings indicate the factors most consistently and significantly associated with success include not only measures of "need" (school size and percent African-American enrollment or population) but of "politics" (citizen political ideology and Southern conservatism). Thus, politics matters more than previous studies suggested.

Residential and home-based postacute rehabilitation of individuals with traumatic brain injury: a case control study.

OBJECTIVES: To compare the outcomes of severely brain-injured individuals treated in a postacute residential rehabilitation program with a matched sample of individuals receiving limited services in their homes or on an outpatient basis. DESIGN: Controlled study using a matched design in a before-and-after trial and a 1-year follow-up trial. SETTING: A postacute community-based residential rehabilitation program or in the homes of patients. PATIENTS AND OTHER PARTICIPANTS: The treatment group included all persons admitted consecutively for rehabilitation to the postacute residential program over a 3-year period (n = 23). All subjects had severe traumatic brain injury. The comparison group was selected from the roster of a support group on the basis of a systematic matching procedure. Matching variables included gender, age, length of coma, time since injury, and level of disability. Subjects of the two groups were matched on an individual basis. MAIN OUTCOME MEASURES: A functional assessment instrument (modified Health andActivity Limitations Survey [HALS]) and the Community Integration Questionnaire (CIQ). RESULTS: Individuals with traumatic brain injury who received residential-based postacute rehabilitation displayed a statistically significant increase in functional abilities when compared with a traditional (home-based) service group. More specifically, treatment subjects showed significantly greater improvement in motor skills and cognitive abilities. Treatment subjects also showed greater improvement in community integration, although this may have been accounted for by initial group differences. CONCLUSIONS: Postacute rehabilitation appears to be effective in improving function for individuals with severe brain injury. Residential-based services appear to produce greater functional improvement, whereas home-based services are more effective at maintaining community integration.

Performance of administrators, professionals, and paraprofessionals during community-based brain injury rehabilitation training.

OBJECTIVE: Two related studies that evaluated the impact of a continuing education program about community-based rehabilitation on the performance of administrators, professionals, and paraprofessionals are presented. One study contained a second part that examined whether differences between pre-course test performance and post-course test performance might be accounted for by practice effects. DESIGN: Factorial mixed model designs. SETTING: University classroom. PARTICIPANTS: Three hundred and eight professionals, administrators, and paraprofessionals from a variety of community-based rehabilitation programs. INTERVENTION: The 4-day graduate-level course focused on three content areas: brain and behavior relationships, behavioral and cognitive intervention strategies, and a rehabilitation philosophy that emphasizes individual client rights. MAIN OUTCOME MEASURE: An examination completed before and immediately after taking the course. RESULTS: Professionals and administrators perform better than paraprofessionals when tested at the beginning and end of the training. However, the absolute differences among these groups were not substantial. In addition, the rate of learning course content was the same for administrators, paraprofessionals, and professionals. CONCLUSIONS: The results support the usefulness of training for all levels of staff and suggest that all levels of staff benefit in an equal fashion.

The politics of school-based programs which address sexual orientation.

This study examined both the content of school district programs related to sexual orientation, and the social and political determinants of these school programs. Data were collected from districts within all 126 U.S. communities with legal protection against discrimination on the basis of sexual orientation, and from a random sample of 129 U.S. jurisdictions without such legislation. Results showed that most school districts are not offering recommended program elements related to sexual orientation issues. Districts within localities with gay rights protection are doing more than those without. Although compositional factors account for some of the differences in educational efforts, a politically engaged constituency also made a major difference in school district efforts. To the extent that gays and lesbians served in local public office and mobilized to influence school elections, they were able to affect school programs and policies.

The unquiet future of intergenerational politics.

Empirical studies of political opinion and behavior about national issues affecting the aging have not revealed the intergenerational conflicts often predicted in recent decades. Using public opinion studies of attitudes about the aging at the community level in Florida, this study does identify significant cleavages in attitude and belief between generations, suggesting intergenerational political conflict may be likely in the future. The research implies the most important source of this conflict may be the community level and the "image" of the aging that is developing among younger community residents.

The politics of school-based clinics: a community-level analysis.

School-based primary health care, supported as an effective means for addressing the health needs of youth, also tends to be perceived as controversial partly due to opposition by national and state level organizations. This investigation used case studies of four selected school-based clinic (SBC) sites, and of one community in which an SBC was disputed, to investigate the existence of organized opposition, how proponents contended with opposition, and effects of organized opposition on SBC approval and implementation. Four sites experienced opposition affiliated with larger conservative organizations. Opponents' strategies and proponents counterstrategies were identified. Effects ranged from limiting SBC services to preventing an SBC's establishment. Proponents, consisting largely of medical and school administrative professionals, overcame opposition through strategies to increase public awareness about youth health issues and to demonstrate public support in the face of expressed opposition. Implications for planning and implementing potentially controversial programs are offered.

Bilateral internal mammary artery grafts in reoperative and primary coronary bypass surgery.

Bilateral internal mammary artery grafting is recognized as a preferred method of myocardial revascularization. However, its efficacy in coronary bypass reoperation has not been clearly established. From January 1982 through June 1989, 88 patients underwent coronary bypass reoperation with bilateral internal mammary artery grafts. Results were compared with those for a subset of 88 patients receiving primary revascularization with bilateral internal mammary artery grafts who were computer matched for sex, age, left ventricular function, anginal classification, and left main coronary artery disease. In each group, 62.5% (55 patients) had unstable angina, 43.2% (38 patients) had reduced ejection fraction, and 21.6% (19 patients) in the reoperation group and 20.5% (18 patients) in the reference group had left main coronary artery disease. Hospital mortality for the reoperation group was 6.8% (6 patients) and for the reference group, 3.4% (3 patients). No significant difference was found in the incidence of reoperation for bleeding, sternal infection, or stroke in the two groups. The incidence of respiratory insufficiency in the reoperation group was 13.6% (12 patients) and in the reference group, 3.4% (3 patients) (p less than 0.015). Recurrent angina occurred in 13.7% (10 patients) of patients in the reoperation group and 13.3% (10 patients) in the reference group. The long-term survival at 5 years for the reoperation group was 85.3% +/- 5.6% (+/- standard error of the mean) and for the reference group, 91.6% +/- 3.1%. No significant difference was found in the equality of survival distribution for the two groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Accumulation of photosynthesis gene transcripts in response to sodium chloride by salt-tolerant alfalfa cells.

A cell line from diploid alfalfa (Medicago sativa L.), HG2-N1, which is stably tolerant to 1% (0.171 M) NaCl in the medium and noticeably more green than the parent line (HG2), was investigated to determine if increased chlorophyll accumulation was related to chloroplast development toward greater photosynthetic activity and increases in chloroplast-gene expression in this cell line. The ctDNA (chloroplast-DNA) copy number in HG2-N1 was found to be increased by 50% from that of the salt-sensitive parent HG2 line. RNA accumulation, as detected by hybridization to a nuclear actin gene, appeared comparable in HG2 and HG2-N1. In contrast, mRNA levels of the plastid-encoded psbA gene were increased in the salt-tolerant HG2-N1 grown on normal medium. The mRNA levels of HG2-N1 were further increased in response to added NaCl in the medium. The mRNA levels from other chloroplast genes necessary for photosynthesis (psbD, psaB, atpB, rbcL), as well as from several nuclear genes (pCab4, pCab1, rbcS) encoding polypeptides participating in photosynthesis, also increased in the salt-tolerant HG2-N1 when it was grown in the presence of NaCl whereas actin-mRNA and chloroplast-rRNA levels remained comparable under growth conditions ± NaCl. Several independently isolated salt-tolerant cell lines showed a similar response to salt, as monitored by accumulation of rbcL mRNA, indicating that transcript accumulation for photosynthesis genes is correlated with the salt response in these salt-tolerant alfalfa cell lines.

Seventeen-year experience with bilateral internal mammary artery grafts.

The internal mammary artery (IMA) is being recognized as the conduit of choice for myocardial revascularization. From January 1972 through June 1988, 1,087 patients received bilateral IMA and supplemental vein grafts. There were 917 men (84.4%) and 170 women (15.6%) with a mean age of 62.4 years (range, 29 to 84 years). Three hundred ninety-four patients (36.2%) had unstable angina, and 194 (17.8%) had left main coronary artery stenosis greater than 50%. In all, 3,741 coronary grafts were performed, with a mean of 3.4 per patient. Hospital mortality was 2.7% (29 patients). Hospital complications included reoperation for bleeding, 19 patients (1.7%); sternal infection, 16 patients (1.5%); respiratory failure, 35 patients (3.2%); perioperative myocardial infarction, 22 patients (2.0%); and stroke, 20 patients (1.8%). Post-operative arteriography in 53 patients (mean postoperative time, 53.0 months) showed that 92.1% (58/63) of the left IMA and 84.9% (45/53) of the right IMA grafts were patent. Follow-up was completed on 1,058 hospital survivors. There were 82 late deaths (7.8%). The actuarial survival for patients discharged from the hospital was 80.0 +/- 3.2% (plus or minus standard error of the mean) at 10 years and 60.0% +/- 5.0% at 15 years. At follow-up, 866 patients (90.3%) were asymptomatic and in New York Heart Association class I and 68 (7.1%) were in class II. This longitudinal analysis demonstrates that bilateral IMA grafting has a low operative risk and provides excellent long-term functional improvement and survival.

Is there a gray peril? Retirement politics in Florida.

Using data from Florida, the most significant destination for Sunbelt retirees, three hypotheses concerning the political impact of retirement migration on the Sunbelt were tested. Surveys of local government officials and socioeconomic data about local government regarding 103 municipalities and 62 counties suggested that aging persons, although politically active, are seldom involved in organized advocacy or political opposition to local policies that are largely beneficial to other interests.

Seeing gray: school bond issues and the aging in Florida.

Conventional wisdom and previous studies strongly suggest that aging citizens oppose local school bond issues because the issues represent increased taxes without direct benefit to the aging. This article tests this assumption through an aggregate level analysis of voting in all Florida school bond referenda since 1969 (n = 56). Among the independent variables in the regression equations were three associated with the aging: percentage 65+, growth rate of population 65+, and an indicator of the degree of political organization among the aging in the election districts. Results showed that one or more characteristics of the aging population were significantly (statistically) and positively related to the percentage of "yes" votes, particularly for the years 1976-1988 and for summer referenda when more resident retirees are politically active. The study indicates that the presence of an organized, relatively affluent, and educated aging population can lead to increased support for local educational referenda.

Sodium cholate extraction of rat liver nuclear xenobiotic-metabolizing enzymes.

DNA is the purported target of several carcinogenic and mutagenic agents. Nuclear enzymes which could generate or detoxify reactive metabolites are of major concern. Several such enzymes have been identified within nuclei, but obtaining samples with enriched content or activity is difficult, time-consuming, and uses harsh isolation techniques. Extraction of rat liver nuclear suspensions with cholate-containing buffer results in solubilization of 25-30% of the protein. Linear extraction was obtained for total protein and cytochromes P-450 and b5, NADPH-cytochrome P-450 reductase, NADH-cytochrome b5 reductase, DT-diaphorase, and microsomal-like epoxide hydrolase with specific activities comparable to values reported for isolated nuclear membrane, while the yield was five to ten times greater. Detergent extracts of rat liver nuclei were employed to study the comparative response of microsomal and nuclear enzymes to chemical treatment. While the responses to acute inductive (phenobarbital and 3-methylcholanthrene) and toxic (carbon tetrachloride and dibromochloropropane) treatments were qualitatively similar, an initiation-promotion protocol (diethylnitrosamine with phenobarbital promotion) resulted in divergent responses between the enzymes in the two subcellular fractions. Detergent extracts of nuclei offer an efficient means of recovering xenobiotic-metabolizing enzymes from rat liver nuclei, and have been utilized to demonstrate a differential response of nuclear enzymes during preneoplastic development.