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Wickens C, Hersom MJ, Easterly RG, Jennings E, Myers B, Shuffitt J, Stice B, Weir J. 0582 Creation, delivery, and assessment of the livestock education and certification for agricultural law enforcement extension program. J Anim Sci 2016. [DOI: 10.2527/jam2016-0582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Ashworth B, Myers B, Hippman K, Viggiani S, King C, Hutchinson K, DeRoche K, Richard M, Dilks L. C-39A Progressive Study of Age and Education Norms for the Montreal Cognitive Assessment. Arch Clin Neuropsychol 2016. [DOI: 10.1093/arclin/acw043.188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Hutchinson K, Richard M, Viggiani S, Dilks L, Myers B, King C, Hippman K, Ashworth B, DeRoche K. B-55An Examination of the World Health Organization Disability Assessment Schedule 2.0 with an Inpatient Rehabilitation Population. Arch Clin Neuropsychol 2016. [DOI: 10.1093/arclin/acw043.130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Viggiani S, DeRoche K, Richard M, Dilks L, Hutchinson K, King C, Hippman K, Myers B, Ashworth B. B-04Multi Effects of Cerebrovascular Accident on Reading and Visual Abilities: A Case Study. Arch Clin Neuropsychol 2016. [DOI: 10.1093/arclin/acw043.79] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Myers B, Ashworth B, Hutchinson K, Viggiani S, Chelsi K, Hippman K, Dilks L, Richard M, DeRoche K. B-06A Matched Case-Control Study of the Validity of the Montreal Cognitive Assessment for Individuals with Cerebral Vascular Accident or Orthopedic Difficulties. Arch Clin Neuropsychol 2016. [DOI: 10.1093/arclin/acw043.81] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Viggiani S, Myers B, Hutchinson K, DeRoche K, King C, Richard M, Hippman K, Ashworth B, Dilks L. C-04Profile of an Individual with a History of Thalidomide Exposure, Cerebral Vascular Accident, and Lifestyle Factor: A Case Study. Arch Clin Neuropsychol 2016. [DOI: 10.1093/arclin/acw043.153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Goodson ML, Packard AEB, Buesing DR, Maney M, Myers B, Fang Y, Basford JE, Hui DY, Ulrich-Lai YM, Herman JP, Ryan KK. Chronic stress and Rosiglitazone increase indices of vascular stiffness in male rats. Physiol Behav 2016; 172:16-23. [PMID: 27040922 DOI: 10.1016/j.physbeh.2016.03.031] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Revised: 03/14/2016] [Accepted: 03/26/2016] [Indexed: 11/20/2022]
Abstract
Prolonged and/or frequent exposure to psychological stress responses may lead to deterioration of organs and tissues, predisposing to disease. In agreement with this, chronic psychosocial stress is linked to greater cardiovascular risk, including increased incidence of atherosclerosis, myocardial ischemia, coronary heart disease, and death. Thus the association between stress and cardiovascular dysfunction represents an important node for therapeutic intervention in cardiovascular disease. Here we report that 2weeks of chronic variable stress (CVS) increased indices of vascular stiffness, including increased collagen deposition in the aortic adventitia and increased resting pulse pressure, in male rats. Thus CVS may represent a useful rodent model for stress-associated CVD, especially for aging populations for which widening pulse pressure is a well-known risk factor. Additionally, we report that the thiazolidinedione Rosiglitazone (RSG) blunts chronic stress-associated increases in circulating corticosterone. Despite this, RSG was not protective against adverse cardiovascular outcomes associated with chronic stress. Rather RSG itself is associated with increased pulse pressure, and this is exacerbated by chronic stress-highlighting that chronic stress may represent an additional contributor to RSG-associated cardiovascular risk.
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Myers B, Neal R, Myers O, Ruparelia M. Unplanned pregnancy on a direct oral anticoagulant (Rivaroxaban): A warning. Obstet Med 2016; 9:40-2. [PMID: 27512489 PMCID: PMC4950440 DOI: 10.1177/1753495x15621814] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Accepted: 11/18/2015] [Indexed: 01/10/2023] Open
Abstract
Direct oral anticoagulants (DOACs or NOACs -non-vitamin K oral anticoagulants), as the name suggests, are oral anticoagulants with a direct inhibitory action either against factor X or factor II (thrombin). Pregnant women were excluded from participating in all the large trials of the DOACs and they are considered contra-indicated in pregnancy and breast feeding. We present a case of inadvertent exposure to rivaroxaban in a woman who presented at 25 weeks' gestation. The management of her pregnancy and delivery is described, and the previous published case reports are reviewed with a discussion about the use of DOACs in woman of childbearing age.
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Sorsdahl K, Stein DJ, Corrigall J, Cuijpers P, Smits N, Naledi T, Myers B. The efficacy of a blended motivational interviewing and problem solving therapy intervention to reduce substance use among patients presenting for emergency services in South Africa: A randomized controlled trial. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2015; 10:46. [PMID: 26576946 PMCID: PMC4650345 DOI: 10.1186/s13011-015-0042-1] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Accepted: 11/08/2015] [Indexed: 12/13/2022]
Abstract
Background The treatment of substance use disorders is a public health priority, particularly in South Africa where the prevalence of these disorders is high. We tested two peer-counsellor delivered brief interventions (BIs) for risky substance use among adults presenting to emergency departments (EDs) in South Africa. Methods In this randomised controlled trial, we enrolled patients presenting to one of three 24-hour EDs who screened at risk for substance use according to the Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST). Eligible patients were randomly allocated to one of three conditions: Motivational Interviewing (MI), blended MI and Problem Solving Therapy (MI-PST) or a Psycho-educational Control Group (CG). The primary outcome was reduction in ASSIST scores at three months follow-up. Results Of the 2736 patients screened, 335 met inclusion criteria, were willing to participate in the intervention and were randomised to one of three conditions: 113 to MI, 112 to MI-PST and 110 to CG. ASSIST scores at three months were lower in the MI-PST group than they were in the MI and CG groups (adjusted mean difference of −1.72, 95 % CI −3.36 - -0.08). We recorded no significant difference in ASSIST scores between the CG and MI group (adjusted mean difference of −0.02, 95 % CI −2.01 - 1.96). Conclusion With the addition of minimal resources, BIs are feasible to conduct in EDs in a low resourced country. These preliminary findings report that MI-PST appears to be an effective BI for reducing substance use among at risk participants. Further research is required to replicate these findings with effort to limit attrition, to determine whether reductions in substance use are persistent at 6 and 12 month follow-up and whether parallel changes occur in other indications of treatment outcomes, such as injury rates and ED presentations. Trial registration This trial registered with the Pan African Clinical Trial Registry (PACTR201308000591418)
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Priori ES, Dmochowski L, Myers B, Shigematsu T, Wilbur JR. Studies on a human cell line (ESP-1) producing type C virus particles. BIBLIOTHECA HAEMATOLOGICA 2015; 39:720-31. [PMID: 4130401 DOI: 10.1159/000427901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Stein DJ, Koen N, Donald KA, Adnams CM, Koopowitz S, Lund C, Marais A, Myers B, Roos A, Sorsdahl K, Stern M, Tomlinson M, van der Westhuizen C, Vythilingum B, Myer L, Barnett W, Brittain K, Zar HJ. Investigating the psychosocial determinants of child health in Africa: The Drakenstein Child Health Study. J Neurosci Methods 2015; 252:27-35. [PMID: 25797842 DOI: 10.1016/j.jneumeth.2015.03.016] [Citation(s) in RCA: 99] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Revised: 03/11/2015] [Accepted: 03/12/2015] [Indexed: 01/06/2023]
Abstract
BACKGROUND Early life psychobiological and psychosocial factors play a key role in influencing child health outcomes. Longitudinal studies may help elucidate the relevant risk and resilience profiles, and the underlying mechanisms that impact on child health, but there is a paucity of birth cohort data from low and middle-income countries (LMIC). We describe the rationale for and present baseline findings from the psychosocial component of the Drakenstein Child Health Study (DCHS). METHODS We review the psychosocial measures used in the DCHS, a multidisciplinary birth cohort study in a peri-urban area in South Africa, and provide initial data on psychological distress, depression, substance use, and exposure to traumatic stressors and intimate partner violence (IPV). These and other measures will be assessed longitudinally in mothers in order to investigate associations with child neurodevelopmental and health outcomes. RESULTS Baseline psychosocial data is presented for mothers (n=634) and fathers (n=75) who have completed antenatal assessments to date. The sample of pregnant mothers is characterized by multiple psychosocial risk factors, including a high prevalence of psychological distress and depression, high levels of substance use, and high exposure to traumatic stressors and IPV. DISCUSSION These data are consistent with prior South African studies which have documented a high prevalence of a multitude of risk factors during pregnancy. Further longitudinal assessment of mothers and children may clarify the underlying psychobiological and psychosocial mechanisms which impact on child health, and so inform clinical and public health interventions appropriate to the South African and other LMIC contexts.
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Sorsdahl K, Stein DJ, Williams DR, Anthony J, Myers B. Childhood Punishment and Risk for Alcohol use Disorders: Data from South Africa. Int J Ment Health Addict 2014. [DOI: 10.1007/s11469-014-9516-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Egan T, Blackwell J, Forrest L, Gazda S, Requard III J, Haithcock B, Birchard K, Stewart P, Randell S, Venkataraman A, Beamer S, Reddy S, Myers B, Bachman M, Casey N, Niedfeldt D. Evaluation of Human Lungs from Uncontrolled Donation After Cardiac Death Donors (uDCDDs) with Ex-vivo Lung Perfusion (EVLP). J Heart Lung Transplant 2014. [DOI: 10.1016/j.healun.2014.01.157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Sethuraman K, Myers B, Comer A, Meador T, Hirshon J, Rosenthal R. The Correlation of Lactate and Carboxyhemoglobin Levels in Carbon Monoxide Poisonings. Ann Emerg Med 2013. [DOI: 10.1016/j.annemergmed.2013.07.175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Onya H, Tessera A, Myers B, Flisher A. Adolescent alcohol use in rural South African high schools. ACTA ACUST UNITED AC 2013; 15:352-7. [PMID: 23044890 DOI: 10.4314/ajpsy.v15i5.44] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2011] [Accepted: 08/23/2011] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To examine psychosocial correlates of lifetime alcohol use among adolescents in rural South African high schools. METHOD Questionnaires were administered to 1600 students from 20 randomly selected high schools in the Mankweng district within Limpopo province. Self-report data on alcohol use, demographic, environmental and psychosocial variables were collected. RESULTS About 22% of the students had ever used alcohol. Males were 2.4 times more likely to use alcohol than females. For students who attended religious services, the odds of ever having used alcohol were double those of students who did not attend religious services. The fitted logistic regression model shows that gender, age, ever having smoked a cigarette, ever damaged property, walking home alone at night, easy availability of alcohol, thinking alcohol use was wrong, attending religious services and number of friends who used alcohol are the best predictors of alcohol use among high school students in this setting. CONCLUSION The results underline the importance of addressing personal, family, peer and school conduct factors as part of alcohol education initiatives. Efforts to prevent alcohol use among rural high school students should focus on changing drinking behaviour and on reducing risk factors for problem drinking.
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Parry CDH, Plüddemann A, Myers B, Wechsberg WM, Flisher AJ. Methamphetamine use and sexual risk behaviour in Cape Town, South Africa: a review of data from 8 studies conducted between 2004 and 2007. ACTA ACUST UNITED AC 2012; 14:372-6. [PMID: 22183467 DOI: 10.4314/ajpsy.v14i5.4] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2010] [Accepted: 03/11/2011] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Community studies and studies of admissions to drug treatment centers indicate a dramatic increase in the prevalence of methamphetamine use in Cape Town since 2003. There has also been a substantial increase over this time period in the prevalence of HIV infection among women attending public antenatal clinics in the Western Cape province. This study aimed to review research conducted in Cape Town on the link between methamphetamine use and sexual risk behaviour. METHOD A review of published research conducted in Cape Town between 2004 and 2007 was undertaken using PubMed, EBSCOhost and Science Direct. RESULTS Eight studies were identified, both quantitative and qualitative, and focusing on diverse populations, such as learners in school, out of school youth, adults in the community, men who have sex with men and sex workers. The total sample across the studies was 8153. Across multiple studies methamphetamine was fairly consistently associated with early vaginal sex, condom use during sex, having casual sex and other HIV risk behaviours. For some sub-groups the direction of the relationship was in an unexpected direction. CONCLUSION The consistency of the findings across studies highlights the increased risk for contracting HIV among methamphetamine users, and reinforces the importance of interventions addressing both methamphetamine use and unsafe sexual behaviour among young people and other sectors of the population. The need for further research is also considered, particularly research that will explain some of the racial differences that were found.
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Ellis R, Traughber B, Ryder C, Zheng Y, Kaminsky D, Wojtylak P, Murray M, Myers B, Machtay M, Faulhaber P. Improved Care Delivery and Operational Work flow by Interdepartmental Coordination of PET/CT Exams and CT Simulations for IGRT. Int J Radiat Oncol Biol Phys 2012. [DOI: 10.1016/j.ijrobp.2012.07.2108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Myers B, Myers O, Moore J. Comparative efficacy and safety of intravenous ferric carboxymaltose (Ferinject) and iron(III) hydroxide dextran (Cosmofer) in pregnancy. Obstet Med 2012; 5:105-7. [PMID: 27582865 DOI: 10.1258/om.2012.110095] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/15/2012] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Iron-deficiency anaemia is common in pregnancy, with well-described maternal morbidities. When oral iron therapy has failed, intravenous (IV) preparations are considered. Ferric carboxymaltose (ferinject) is a new IV preparation which can be given quickly. There are no published data on Ferinject use in pregnancy. This study analyses historical data from women given Cosmofer, compared with those given Ferinject in pregnancy, to assess comparative efficacy and safety. METHODS Pregnant women treated with Cosmofer and Ferinject, were identified from pharmacy records. Records for all cases were reviewed and those which fulfilled inclusion criteria selected. The inclusion criteria included: symptomatic iron-deficient anaemia unresponsive to oral iron; age ≥18; second to third trimester; full blood count taken at least once at two, four and/or six weeks post-infusion. Data were collected on the pre-treatment Hb, ferritin, and same data collected at two, four and six weeks after the infusion. Side-effects or adverse reactions were noted for both the Cosmofer and Ferinject patients. RESULTS Results were obtained for 92 women (44 received Ferinject and 48 Cosmofer). Pre-infusion Hb and ferritin levels were comparable in the two groups. At two weeks, the mean Hb rise in the Ferinject group was 1.73 g/dL and 1.34 g/dL in the Cosmofer group. At four weeks, the total rise in Hb was 2.57 g/dL Ferinject, 2.34 g/dL Cosmofer. At six weeks the rise was 3.01 g/dL and 3.2 g/dL respectively. No serious adverse events were reported in either group. CONCLUSION Both preparations appear effective and safe, with low risk of serious adverse effects and side-effects.
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Herman JP, McKlveen JM, Solomon MB, Carvalho-Netto E, Myers B. Neural regulation of the stress response: glucocorticoid feedback mechanisms. Braz J Med Biol Res 2012; 45:292-8. [PMID: 22450375 PMCID: PMC3854162 DOI: 10.1590/s0100-879x2012007500041] [Citation(s) in RCA: 192] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2012] [Accepted: 03/09/2012] [Indexed: 11/22/2022] Open
Abstract
The mammalian stress response is an integrated physiological and psychological reaction to real or perceived adversity. Glucocorticoids are an important component of this response, acting to redistribute energy resources to both optimize survival in the face of challenge and to restore homeostasis after the immediate challenge has subsided. Release of glucocorticoids is mediated by the hypothalamo-pituitary-adrenal (HPA) axis, driven by a neural signal originating in the paraventricular nucleus (PVN). Stress levels of glucocorticoids bind to glucocorticoid receptors in multiple body compartments, including the brain, and consequently have wide-reaching actions. For this reason, glucocorticoids serve a vital function in negative feedback inhibition of their own secretion. Negative feedback inhibition is mediated by a diverse collection of mechanisms, including fast, non-genomic feedback at the level of the PVN, stress-shut-off at the level of the limbic system, and attenuation of ascending excitatory input through destabilization of mRNAs encoding neuropeptide drivers of the HPA axis. In addition, there is evidence that glucocorticoids participate in stress activation via feed-forward mechanisms at the level of the amygdala. Feedback deficits are associated with numerous disease states, underscoring the necessity for adequate control of glucocorticoid homeostasis. Thus, rather than having a single, defined feedback ‘switch’, control of the stress response requires a wide-reaching feedback ‘network’ that coordinates HPA activity to suit the overall needs of multiple body systems.
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Myers B, Louw J, Pasche S. Gender differences in barriers to alcohol and other drug treatment in Cape Town, South Africa. ACTA ACUST UNITED AC 2011; 14:146-53. [DOI: 10.4314/ajpsy.v14i2.7] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Myers B, van Heerden MS, Grimsrud A, Myer L, Williams DR, Stein DJ. Prevalence and correlates of atypical patterns of drug use progression: findings from the South African Stress and Health Study. AFRICAN JOURNAL OF PSYCHIATRY 2011; 14:38-44. [PMID: 21509404 PMCID: PMC3290124 DOI: 10.4314/ajpsy.v14i1.65467] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
OBJECTIVE Atypical sequences of drug use progression are thought to have important implications for the development of substance dependence. The extent to which this assumption holds for South African populations is unknown. This paper attempts to address this gap by examining the prevalence and correlates of atypical patterns of drug progression among South Africans. METHOD Data on substance use and other mental health disorders from a nationally representative sample of 4351 South Africans were analysed. Weighted cross tabulations were used to estimate prevalence and correlates of atypical patterns of drug use progression. RESULTS Overall, 12.2% of the sample reported atypical patterns of drug use progression. The most common violation was the use of extra-medical drugs prior to alcohol and tobacco. Gender was significantly associated with atypical patterns of drug use with the risk pattern varying by the type of drug. None of the anxiety or mood disorders were associated with atypical patterns of use. Atypical patterns of drug use were not associated with increased risk for a lifetime substance use disorder. CONCLUSION Atypical patterns of drug use initiation seem more prevalent in South Africa compared to other countries. The early use of extra-medical drugs is common, especially among young women. Drug availability and social environmental factors may influence patterns of drug use. The findings have important implications for prevention initiatives and future research.
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Casadio F, Xie S, Rukes SC, Myers B, Gray KA, Warta R, Fiedler I. Electron energy loss spectroscopy elucidates the elusive darkening of zinc potassium chromate in Georges Seurat’s A Sunday on La Grande Jatte—1884. Anal Bioanal Chem 2010; 399:2909-20. [DOI: 10.1007/s00216-010-4264-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2010] [Revised: 09/27/2010] [Accepted: 09/28/2010] [Indexed: 11/27/2022]
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Paul JH, Myers B. Fluorometric determination of DNA in aquatic microorganisms by use of hoechst 33258. Appl Environ Microbiol 2010; 43:1393-9. [PMID: 16346035 PMCID: PMC244245 DOI: 10.1128/aem.43.6.1393-1399.1982] [Citation(s) in RCA: 113] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A method for the determination of microbial DNA in aquatic environments by the use of Hoechst 33258 has been developed. With unsophisticated instrumentation and simple extraction procedures, it is possible to detect from 0.05 to 10 mug of DNA in bacterial cultures or natural water samples. The method is specific for DNA; DNase I treatment of extracts of natural microbial populations removed 95 to 100% of the observed fluorescence. DNA content ranged from 165 ng ml for relatively eutrophic Potomac River water to 27 ng ml for coastal Atlantic Ocean water and was correlated to an acridine orange direct count (r = 0.90).
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