Treating Addictions: Harm Reduction in Clinical Care and Prevention

This paper examines the role of clinical practitioners and clinical researchers internationally in establishing the utility of harm-reduction approaches to substance use. It thus illustrates the potential for clinicians to play a pivotal role in health promoting structural interventions based on harm-reduction goals and public health models. Popular media images of drug use as uniformly damaging, and abstinence as the only acceptable goal of treatment, threaten to distort clinical care away from a basis in evidence, which shows that some ways of using drugs are far more harmful than others and that punitive approaches and insistence on total abstinence as the only goal of treatment often increases the harms of drug use rather than reducing drug use. Therefore the leadership and scientific authority of clinicians who understand the health impact of harm-reduction strategies is needed. Through a review of harm-reduction interventions in Canada, the United Kingdom, the United States, Australia, Switzerland, and the Netherlands, we identify three ways that clinicians have helped to achieve a paradigm shift from punitive approaches to harm-reduction principles in clinical care and in drug policy: (1) through clinical research to provide data establishing the effectiveness and feasibility of harm-reduction approaches, (2) by developing innovative clinical programmes that employ harm reduction, and thereby (3) changing the standard of care to include routine use of these evidence-based (but often misunderstood) approaches in their practices. We argue that through promotion of harm-reduction goals and methods, clinicians have unique opportunities to improve the health outcomes of vulnerable populations.     

Towards new sources of resistance to the currant-lettuce aphid (<Emphasis Type="Italic">Nasonovia ribisnigri</Emphasis>)

Domesticated lettuce varieties encompass much morphological variation across a range of crop type groups, with large collections of cultivars and landrace accessions maintained in genebanks. Additional variation not captured during domestication, present in ancestral wild relatives, represents a potentially rich source of alleles that can deliver to sustainable crop production. However, these large collections are difficult and costly to screen for many agronomically important traits. In this paper, we describe the generation of a diversity collection of 96 lettuce and wild species accessions that are amenable to routine phenotypic analysis and their genotypic characterization with a panel of 682 newly developed expressed sequence tag (EST)-linked KASP? single nucleotide polymorphism (SNP) markers that are anchored to the draft Lactuca sativa genome assembly. To exemplify the utility of these resources, we screened the collection for putative sources of resistance to currant-lettuce aphid (Nasonovia ribisnigri) and carried out association analyses to look for potential SNPs linked to resistance.     

Nitrogen input quality changes the biochemical composition of soil organic matter stabilized in the fine fraction: a long-term study

The chemical composition of soil organic matter (SOM) is a key determinant of its biological stability. Our objective in this study was to evaluate the effects of various sources of supplemental N on the chemical composition of SOM in the fine (<5 μm) mineral fraction. Treatments were fallow, maize/soybean in rotation, and continuous maize receiving no fertilizer (maize0N), synthetic fertilizer N (maize + N), or composted manure (maize + manure). The chemical structures in SOM associated with the fine fraction were determined using XANES spectroscopy at the C and N K-edges, which was assessed using multidimensional scaling. Analysis of amino sugar biomarkers were used to evaluate the fungal:bacterial contributions to the SOM. The addition of N to soils (i.e., maize + N, maize + manure, and maize/soybean treatments) resulted in the enrichment of proteinaceous compounds. Soils which did not receive supplemental N (i.e., fallow and maize0N treatments) were enriched in plant-derived compounds (e.g., aromatics, phenolics, carboxylic acids and aliphatic compounds), suggesting that decomposition of plant residues was constrained by N-limitation. Microbial populations assessed by amino sugar biomarker ratios showed that the highest contributions to SOM by bacteria occurred in the maize + manure treatment (high N input), and by fungi in the fallow treatment (low N input). The SOM in the maize + N and maize/soybean treatments was enriched in N-bonded aromatics; we attribute this enrichment to the abiotic reaction of inorganic N with organic C structures. The SOM in the maize + manure treatment was enriched in pyridinic-N, likely as a result of intense microbial processing and high SOM turnover. The presences of signals for ketone and pyrrole compounds in XANES spectra suggest their use as biomarkers for microbially transformed and stabilized SOM. The SOM in the maize + manure treatment was enriched in ketones which are likely microbial by-products of fatty acid catabolism. Pyrrole compounds, which may accumulate over the long term as by-products of protein transformations by an N-limited microbial community, were dominant in the fallow soil. A combination of molecular spectroscopy and biomarker analysis showed that the source of supplemental N to soil influences the stable C- and N-containing compounds of SOM in a long-term field study. Indeed, any increase in N availability allowed the microbial community to transform plant material into microbial by-products which occur as stable SOM compounds in the fine soil fraction.     

Frequent Seizures Are Associated with a Network of Gray Matter Atrophy in Temporal Lobe Epilepsy with or without Hippocampal Sclerosis

Objective

Patients with temporal lobe epilepsy (TLE) with hippocampal sclerosis (HS) have diffuse subtle gray matter (GM) atrophy detectable by MRI quantification analyses. However, it is not clear whether the etiology and seizure frequency are associated with this atrophy. We aimed to evaluate the occurrence of GM atrophy and the influence of seizure frequency in patients with TLE and either normal MRI (TLE-NL) or MRI signs of HS (TLE-HS).

Methods

We evaluated a group of 172 consecutive patients with unilateral TLE-HS or TLE-NL as defined by hippocampal volumetry and signal quantification (122 TLE-HS and 50 TLE-NL) plus a group of 82 healthy individuals. Voxel-based morphometry was performed with VBM8/SPM8 in 3T MRIs. Patients with up to three complex partial seizures and no generalized tonic-clonic seizures in the previous year were considered to have infrequent seizures. Those who did not fulfill these criteria were considered to have frequent seizures.

Results

Patients with TLE-HS had more pronounced GM atrophy, including the ipsilateral mesial temporal structures, temporal lobe, bilateral thalami and pre/post-central gyri. Patients with TLE-NL had more subtle GM atrophy, including the ipsilateral orbitofrontal cortex, bilateral thalami and pre/post-central gyri. Both TLE-HS and TLE-NL showed increased GM volume in the contralateral pons. TLE-HS patients with frequent seizures had more pronounced GM atrophy in extra-temporal regions than TLE-HS with infrequent seizures. Patients with TLE-NL and infrequent seizures had no detectable GM atrophy. In both TLE-HS and TLE-NL, the duration of epilepsy correlated with GM atrophy in extra-hippocampal regions.

Conclusion

Although a diffuse network GM atrophy occurs in both TLE-HS and TLE-NL, this is strikingly more evident in TLE-HS and in patients with frequent seizures. These findings suggest that neocortical atrophy in TLE is related to the ongoing seizures and epilepsy duration, while thalamic atrophy is more probably related to the original epileptogenic process.