Workaholism is still a useful construct

Medical provision of orally-administered stimulants is a harm reduction technique that could reduce suffering and slow the spread of AIDS among cocaine misusers in Vancouver, B.C., Canada. However, experimentation with stimulant maintenance will be difficult to carry out until the public's exaggerated fears of cocaine and other stimulants, engendered by a prolonged “War on Drugs”, have subsided. This article explores the prospects for stimulant maintenance by (1) reviewing the actual dangers and benefits arising from use of cocaine and other stimulants, (2) describing small scale stimulant maintenance programs that already exist in various countries, and (3) drawing from Vancouver's experience with methadone maintenance to propose first steps towards stimulant maintenance. Although we focus our analysis on Vancouver, we believe it has wider applicability.     

The ‘social norms’ approach to alcohol misuse prevention: Testing transferability in a Scottish secondary school context

Abstract

This article describes the way in which “Anstie’s Limit” – a particular definition of moderate drinking first defined in Britain in the 1860s by the physician Francis Edmund Anstie (1833–1874) – became established as a useful measure of moderate alcohol consumption. Becoming fairly well-established in mainstream Anglophone medicine by 1900, it was also communicated to the public in Britain, North America and New Zealand through newspaper reports. However, the limit also travelled to less familiar places, including life assurance offices, where a number of different strategies for separating moderate from excessive drinkers emerged from the dialogue between medicine and life assurance. Whilst these ideas of moderation seem to have disappeared into the background for much of the twentieth century, re-emerging as the “J-shaped” curve, these early developments anticipate many of the questions surrounding uses of the “unit” to quantify moderate alcohol consumption in Britain today. The article will therefore conclude by exploring some of the lessons of this story for contemporary discussions of moderation, suggesting that we should pay more attention to whether these metrics work, where they work and why.     

Inferior alveolar and mental nerve injuries associated with open reduction and internal fixation of mandibular fractures: A Seven Year retrospective study

PurposeTo document adverse neurosensory changes in the inferior alveolar nerve (IAN) and mental nerve (MN) after surgical mandibular fracture treatment and to identify risk factors associated with these changes.Materials and methodsA retrospective study of patients surgically treated for mandibular fractures. The primary study variable was the postoperative change in IAN/MN neurosensory examination after fracture fixation. Risk factors were categorized as demographic, anatomic, experience of the operator, fracture displacement and number of miniplates placed at each fracture site. Appropriate statistics were computed.Results209 patients with 293 fractures were analysed. One hundred twenty fractures (41%) were located between the lingula and mental foramen, and 173 fractures (59%) were located distal to the mental foramen. Two hundred seventeen (41%) were displaced by 5 mm or more. In 38 fractures (13%), the IAN/MN neurosensory status worsened after treatment. In a multivariate model, fracture displacement, operator inexperience and two plate fixation were associated with a statistically significant risk (P ≤ 0.05) for postoperative deterioration of IAN/MN sensation.ConclusionFixation with two miniplates, fracture displacement of 5 mm or more and operator inexperience were associated with an increased risk for deterioration of the IAN/MN neurosensory status after treatment of mandibular fractures.     

Sufficient dimension reduction on the mean and rate functions of recurrent events

The counting process with a Cox‐type intensity function has been extensively applied to analyze recurrent event data, which assume that the underlying counting process is a time‐transformed Poisson process and that the covariates have multiplicative or additive effects on the mean and rate functions of the counting process. The existing statistical inference, however, often encounters difficulties due to high‐dimensional covariates, such as in gene expression and single nucleotide polymorphism data that have revolutionized our understanding of cancer recurrence and other diseases. In this paper, a technique of sufficient dimension reduction is applied to the mean and rate function for the number of occurrences of events over time. A two‐step procedure is proposed to estimate the model components: first, a nonparametric estimator is proposed for the baseline, and then the basis of the central subspace and its dimension are estimated through a modified slicing inverse regression. On the basis of the estimated structural dimension and on the basis of the central subspace, we can estimate the regression function by using the local linear regression. A simulation is performed to confirm and assess the theoretical findings, and an application is demonstrated on a set of chronic granulomatous disease data. Copyright © 2014 John Wiley & Sons, Ltd.     

Sequential vapour ablation of adjacent segments in canine lung

Introduction: Vapour ablation is used to create lung volume reduction for emphysema patients to improve lung function and quality of life. This study characterises effects of vapour ablation treatment in lung segments within a lobe that are adjacent to lung segments previously treated with vapour in a healthy canine model. Because emphysema is a progressive disease, subsequent treatments could offer continued benefit to the patient. Method: Six healthy canines were treated with vapour at 8.5?cal/g in one upper lobe segment. After a 4-week healing period, the adjacent segment was treated. After a second 4-week healing period, necropsy was performed and the tissue inspected. Clinical effects were monitored during each healing period. Results: Each treatment was well tolerated and no significant abnormalities were observed during the healing phases, including death, pneumothorax, or major decline in health status. Animal health, oxygenation changes, pathology, and airway changes were monitored during the study. Analysis of these end points showed no difference in changes after treatment 2 as compared to changes after treatment 1. Conclusion: In this model, there was no evidence of increased or different clinical observations after a second adjacent vapour ablation. It was not possible to differentiate between the clinical effects of treatment 1 and the clinical effects of treatment 2. These results support investigation of sequential adjacent segmental vapour treatments in humans.