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Biomedical subjects

J A Cunningham

Publications and source records attributed to J A Cunningham.

At least 19 recordsLinked to original sources
PubMed2001

Enhanced in situ bioremediation of BTEX-contaminated groundwater by combined injection of nitrate and sulfate.

Enhancement of in situ anaerobic biodegradation of BTEX compounds was demonstrated at a petroleum-contaminated aquifer in Seal Beach, CA. Specifically, combined injection of nitrate and sulfate into the contaminated aquifer was used to accelerate BTEX removal as compared to remediation by natural attenuation. An array of multi-level sampling wells was used to monitor the evolution of the in situ spatial distributions of the electron acceptors and the BTEX compounds. Nitrate was utilized preferentially over sulfate and was completely consumed within a horizontal distance of 4-6 m from the injection well; sulfate reduction occurred in the region outside the denitrifying zone. By combining injection of both nitrate and sulfate, the total electron acceptor capacity was enhanced without violating practical considerations that limit the amount of nitrate or sulfate that can be added individually. Degradation of total xylene appears linked to sulfate utilization, indicating another advantage of combined injection versus injection of nitrate alone. Benzene degradation also appears to have been stimulated by the nitrate and sulfate injection close to the injection well but only toward the end of the 15-month demonstration. The results are consistent with the hypothesis that benzene can be biodegraded anaerobically after other preferentially degraded hydrocarbons have been removed.

Benzene↗
PubMed2001

Using self-help materials to motivate change at assessment for alcohol treatment.

The utility of a brief self-help booklet provided at assessment for alcohol treatment was evaluated using a quasi-experimental design (booklet provided to all clients for one month at a time, interspersed by one month of no booklets, for a 6-month period). While the booklet did not result in any significant reduction in client attrition, clients who received the booklet at their assessment were drinking less by the 6-month follow-up than those who did not receive the booklet. Limitations of this study, including the quasi-experimental design and the impact of the low baseline attrition rates, are discussed.

Adult↗
PubMed2001

Alcoholism: beliefs and attitudes among Canadian alcoholism treatment practitioners.

OBJECTIVES: To explore differences in views concerning adjunctive medications and theoretical orientation among Canadian practitioners from different professional backgrounds who treat alcoholism. METHODS: A survey of clinicians from different disciplines was conducted by mail. The response rate was 56%: 95 drug and alcohol counsellors, 46 social workers, 81 nonpsychiatrist addiction physicians, and 74 addiction psychiatrists. The number of items in the questionnaire was reduced using principal component analysis. Group differences were explored using analysis of variance with Bonferroni correction and Scheffé's posthoc comparisons. RESULTS: Physicians and nonphysicians differed in their views on the utility of medications in treating alcohol problems, the disease concept of alcohol problems, and the classification of alcohol abuse or dependence as psychiatric conditions. No group differences emerged on views regarding cognitive-behavioural treatment, pharmacological-only interventions, combined treatment, and recovery without treatment. Psychopathology in the alcoholic was significantly more likely to be considered as secondary to the use of alcohol by nonpsychiatrist physicians. Nonphysician practitioners viewed alcoholic behaviour as self-medication. CONCLUSIONS: Groups differed on questionnaire items concerning medication use and the disease concept of alcoholism. Agreement on several areas may facilitate bridging the gap across disciplines. The implications of these results are discussed.

Alcohol Deterrents↗
PubMed2001

Impact of normative feedback on problem drinkers: a small-area population study.

OBJECTIVE: As many as one in four adults in North America experiences some problems due to alcohol consumption. Although most of these problem drinkers do not have concerns that are severe enough to merit formal treatment, such drinking has large economic costs and can place the drinker at risk for long-term negative health and social consequences. The present study evaluated a minimal intervention that used normative feedback about population drinking to motivate changes in alcohol use. METHOD: An intervention pamphlet was mailed to over 6,000 households in Toronto, randomized by block from a region containing almost 10,000 households. In the month after the mailing, a general population survey was conducted in the region to assess alcohol use. RESULTS: Respondents from households receiving normative feedback (n = 472) reported significantly lower alcohol use than controls (n = 225), but this effect occurred only among respondents who met an objective criterion for problem drinking and who perceived some risk associated with their drinking. CONCLUSIONS: Viewed from a public health perspective, normative feedback interventions have the potential for a significant payoff because they can be provided at low cost and to problem drinkers who might ordinarily never access any treatment services.

Adult↗
PubMed2001

Help-seeking timeline followback for problem drinkers: preliminary comparison with agency records of treatment contacts.

OBJECTIVE: A pilot study assessed the utility of the Timeline Followback (TLFB) method to collect information on help seeking. METHOD: Using the TLFB method, 34 clients (26 men) who had attended at least one session of an outpatient alcohol treatment program reported on treatment contacts, including any supplemental services (e.g., psychiatric care). TLFB reports of help seeking at that agency were compared with agency records of treatment contacts. RESULTS: Clients reported on their help-seeking behavior for a period of approximately 8 months after they had completed an initial assessment for the outpatient treatment. With regard to the number of outpatient sessions they attended, intraclass correlations and equivalence testing showed that the TLFB data were comparable to the agency records of treatment contacts. Analysis of week-to-week correspondence of the presence or absence of help-seeking episodes showed good agreement between TLFB and the agency records for most participants, although there was substantial variation. Degree of correspondence was not associated with the length of the recall period or individual differences (e.g., drinking pattern). Older participants, however, tended to have lower week-to-week concordance than did younger participants. CONCLUSIONS: These data provide preliminary support for the utility of a help-seeking TLFB instrument to assess addiction- and mental health-related contacts. This instrument may be especially useful in research in which collecting temporal patterns of help seeking is of interest (e.g., in studies examining factors influencing the delay in help seeking after relapse).

Adult↗
PubMed2000

Remissions from drug dependence: is treatment a prerequisite?

The present study investigated the prevalence of untreated drug remissions in a representative sample of respondents who had a lifetime diagnosis of one of five types of illicit drug dependence in the past (cannabis, cocaine/crack, hallucinogens, amphetamines, or heroin) but no diagnosis of drug abuse or dependence in the last year. It was concluded that, among recovered individuals with previous clinically significant drug concerns (as measured using DSM-IV criteria), a substantial proportion had accessed addictions treatment services prior to remission.

Humans↗
PubMed2000

Appropriate use of psychotropic drugs in nursing homes.

The Omnibus Budget Reconciliation Act (OBRA) of 1987 limited the use of psychotropic medications in residents of long-term care facilities. Updates of OBRA guidelines have liberalized some dosing restrictions, but documentation of necessity and periodic trials of medication withdrawal are still emphasized. Antidepressant drugs are typically underutilized in nursing homes. Tricyclic antidepressants have many side effects and thus are not preferred medications in elderly patients. Anxiety and insomnia are common problems in the institutionalized elderly. If behavioral measures are not successful, antidepressant medications with shorter half-lives may avoid drug accumulation, which can lead to excessive sedation, cognitive impairment and an increased risk for falls. In the elderly, antipsychotic medications can cause serious side effects, such as extrapyramidal symptoms and tardive dyskinesia. Newer antipsychotic drugs are less often associated with these side effects, but they should be used only for specific diagnoses and when behavioral and environmental measures are unsuccessful.

Aged↗
PubMed2000

Hyperlipidemia.

Coronary heart disease (CHD) is prevalent and often related to an unhealthy diet and hyperlipidemia. The diagnosis of hyperlipidemia should be carefully made, using more than one measurement in the manner described. An assessment of risks allows one to decide whom to treat. Patients with CHD should be treated aggressively but it is less clear how aggressive to be with patients without CHD. Diet and exercise recommendations are appropriate for almost all patients. For those for whom the benefit is greater than the potential risks, statins are first-line drug therapy and they appear to have beneficial effects aside from their lipid-lowering properties.

Adult↗
PubMed2000

Enhanced anaerobic bioremediation of groundwater contaminated by fuel hydrocarbons at Seal Beach, California.

Enhanced anaerobic biodegradation of groundwater contaminated by fuel hydrocarbons has been evaluated at a field experiment conducted at the Naval Weapons Station, Seal Beach, California. This experiment included the establishment of three different remediation zones in situ: one zone was augmented with sulfate, one was augmented with sulfate and nitrate, and the third was unaugmented. This enables a comparison of hydrocarbon biodegradation under sulfate-reducing, sequential denitrifying/sulfate-reducing, and methanogenic conditions, respectively. In general, the results from the field experiment are: (1) Certain fuel hydrocarbons were removed preferentially over others, but the order of preference is dependent upon the geochemical conditions; and (2) In the zones that were augmented with sulfate and/or nitrate, the added electron acceptors were consumed quickly, indicating that enhancement via electron acceptor injection accelerates the biodegradation process. More specifically, in the sulfate-reducing zone, sulfate was utilized with an apparent first-order rate coefficient of approximately 0.1 day(-1). In the combined denitrifying/sulfate-reducing zone, nitrate was utilized preferentially over sulfate, with an apparent first-order rate coefficient of 0.1-0.6 day(-1). However, the data suggest that slow sulfate utilization does occur in the presence of nitrate, i.e., the two processes are not strictly sequential. With regard to the aromatic BTEX hydrocarbons, toluene was preferentially removed under intrinsic conditions; biodegradation of benzene was slow if it occurred at all; augmentation with sulfate preferentially stimulated biodegradation of o-xylene; and ethylbenzene appeared recalcitrant under sulfate-reducing conditions but readily degradable under denitrifying conditions.

Bacteria, Anaerobic↗
PubMed2000

Providing personalized assessment feedback for problem drinking on the Internet: a pilot project.

OBJECTIVE: This project developed an Internet program that conducts a brief assessment of an individual's drinking habits and then provides normative feedback comparing the user's drinking to that of others of the same gender and age group. The Internet program, "Try Our Free Drinking Evaluation," was based at the Addiction Research Foundation Internet web site (now at http://notes.camh.net/efeed.nsf/ newform). METHOD: A voluntary survey linked to the participant's feedback summary collected respondents' impressions of the program. RESULTS: During the trial period, the site received approximately 500 hits per month. While the feedback was generally well received, the weekly summary format was less credible to those individuals who drink less than once per week or whose consumption varies a great deal over time. CONCLUSIONS: Given these pilot results indicating that there is an audience for Internet-based interventions, the next step is to evaluate whether receiving such personalized feedback materials on the Internet leads to any change in drinking behavior by participants

Adolescent↗
PubMed2000

Disseminated bacille Calmette-Guérin infection in an infant with a novel deletion in the interferon-gamma receptor gene.

Six weeks after receiving BCG vaccination, a Canadian aboriginal infant presented with suspected sepsis, lymphadenopathy and hepatosplenomegaly. Lymph node biopsy revealed macrophages filled with acid-fast bacilli. Mycobacterium bovis was cultured from tissue specimens and there was evidence of concomitant cytomegalovirus disease. The infant died of disseminated BCG infection. A novel deletion at nucleotide 165 in the interferon-gamma receptor (IFN-gammaR1) was identified. The incidence of this mutation in the aboriginal population and the impact on the heterozygous state are unknown.

BCG Vaccine↗
PubMed1999

Resolving alcohol-related problems with and without treatment: the effects of different problem criteria.

OBJECTIVE: Prior research indicates that the majority of people who resolve an alcohol problem do so without treatment. Further, a substantial proportion return to moderate drinking. One of the concerns with these findings, however, is that the definition of prior alcohol problems may reflect a less severe problem criterion. Thus, it could be argued that the majority of people "recover" from alcohol problems without treatment because a substantial proportion of these individuals did not actually have a severe alcohol problem. METHOD: This article systematically replicates earlier findings regarding the predominance of alcohol recoveries without treatment, using data from the 1994 Canadian Alcohol and Drug Survey. Further, variations in estimates of the proportion of resolutions from alcohol problems both with and without treatment, and to abstinence and moderate drinking, were assessed when different definitions of prior alcohol problems were employed. RESULTS: Of 9,892 adult lifetime drinkers, 2,177 had experienced at least one problem related to their alcohol consumption and, of these, 885 (57.2% male) had experienced no problems in the last year. Estimates of the prevalence of nontreatment recoveries ranged from 87.5% to 53.7% depending on the stringency of the definition of prior alcohol problems employed. CONCLUSIONS: Although a significant proportion of individuals recover from alcohol problems without treatment, such recoveries appear less common among individuals with more severe alcohol problems.

Adolescent↗
PubMed1999

What is the price of perfection? The hidden costs of using detailed assessment instruments to measure alcohol consumption.

OBJECTIVE: This article describes results from a study investigating the effects of using long assessment instruments on attrition rates in mailed-out surveys. METHOD: Participants were randomly assigned to receive one of two versions of a mailed-out survey; one version incorporated a detailed assessment of drinking using the Timeline Follow back method (TLFB; n = 46) and the other employed a brief graduated frequency measure of alcohol consumption (n = 49). RESULTS: 29% fewer respondents who received the TLFB returned any of their survey materials as compared to those respondents who received just the graduated frequency measure (22% vs 51%). CONCLUSIONS: In some situations, e.g., mailed-out surveys, employing detailed survey instruments may not be justified as the increased respondent burden may result in increased attrition rates.

Alcohol Drinking↗
PubMed1998

Structure determination of echovirus 1.

The atomic structure of echovirus 1 (a member of the enterovirus genus of the picornavirus family) has been determined using cryo-crystallography and refined to 3.55 A resolution. Echovirus 1 crystallizes in space group P22121 with a = 352.45, b = 472.15 and c = 483.20 A. The crystals contain one full virus particle in the asymmetric unit allowing for 60-fold noncrystallographic symmetry averaging. The diffraction pattern shows strong pseudo-B-centering with reflections with h + l = 2n + 1 being systematically weak or absent below about 6 A resolution. The size of the unit cell and presence of pseudo-B-centering placed strong constraints on the allowed packing of the icosahedral particle in the crystal lattice. These constraints greatly facilitated the determination of the orientation and position of the virus by reducing the dimensionality of the search, but interactions between the crystallographic and noncrystallographic symmetries rendered the choice of space group ambiguous until very late in the structure determination. This structure determination provides a striking example of the power of packing analysis in molecular replacement and illustrates how subtle interactions between crystallographic and noncrystallographic symmetries can be resolved.

Crystallization↗
PubMed1998

Problem drinkers: evaluation of a stepped-care approach.

The present study evaluated a stepped-care model for the treatment of problem drinkers; those not severely dependent on alcohol. The initial treatment consisted of a motivationally based, four-session outpatient treatment. Based on previous research, treatment nonresponders were defined as having consumed more than 12 drinks per week between the assessment and third session. Six-month follow-up interviews were conducted on three groups of problem drinkers: (1) those who responded to the initial intervention (n = 67); (2) those who did not respond to the initial treatment (n = 36); and (3) those who did not respond to the initial treatment and received a supplemental intervention (n = 33). The last two groups were used to evaluate whether providing treatment nonresponders with an additional "step" would improve treatment outcomes. The primary dependent measures were posttreatment percent days abstinent and posttreatment drinks per drinking day. Results suggested that (1) within treatment drinking can help identify treatment nonresponse in stepped-care models; (2) the supplemental intervention did not influence posttreatment drinking; (3) treatment responders and nonresponders sought additional help at the same rate. The present study is the first study on stepped-care for alcohol treatment and provides a methodology for evaluating stepped interventions. Recommendations for future research in this area include more attention to assessing the needs of treatment nonresponders and help seeking behavior of both responders and nonresponders after an initial intervention.

Adult↗
PubMed1998

DNA adducts of 2,3-epoxy-4-hydroxynonanal: detection of 7-(1', 2'-dihydroxyheptyl)-3H-imidazo[2,1-i]purine and 1,N6-ethenoadenine by gas chromatography/negative ion chemical ionization/mass spectrometry.

2,3-Epoxy-4-hydroxynonanal (EH) is a bifunctional aldehyde formed by epoxidation of trans-4-hydroxy-2-nonenal, a peroxidation product of omega-6 polyunsaturated fatty acids. EH is mutagenic and tumorigenic and capable of modifying DNA bases forming etheno adducts in vitro. Recent studies showed that etheno adducts are present in tissue DNA of humans and untreated rodents, suggesting a potential endogenous role of EH in their formation. A sensitive assay is needed so we can determine whether EH is involved in etheno adduct formation in vivo and study the biological significance of the etheno adducts in DNA. In this study, we developed a gas chromatography/negative ion chemical ionization/mass spectrometry assay for the analysis of 1, N6-ethenoadenine (epsilonAde) and 7-(1', 2'-dihydroxyheptyl)-3H-imidazo[2,1-i]purine (DHH-epsilonAde) in DNA; both are products from the reaction of adenine with EH. The assay entails the following sequence of steps: (1) addition of [15N5]epsilonAde and [15N5]DHH-epsilonAde to DNA as internal standards, (2) acid hydrolysis of DNA, (3) adduct enrichment by C18 solid phase extraction (SPE), (4) derivatization by pentafluorobenzylation (PFB), (5) separation of PFB-epsilonAde and PFB-DHH-epsilonAde on a Si SPE column, (6) acetonide (ACT) formation of PFB-DHH-epsilonAde, and (7) GC/MS analysis with selective ion monitoring (SIM). The limit of detection by on-column injection for PFB-epsilonAde monitoring of the (M - PFB)- ion at m/z 158 was 30 amol and for ACT-PFB-DHH-epsilonAde monitoring of the (M - PFB)- ion at m/z 328 was 0.4 fmol; the detection limits for the entire assay were 6.3 fmol for epsilonAde and 36 fmol for DHH-epsilonAde. In calf thymus DNA modified with EH at 37 degreesC for 50 h, both epsilonAde and DHH-epsilonAde were detected at high levels by this method, 4.5 +/- 0.7 and 90.8 +/- 8.7 adducts/10(3) adenine, respectively. These levels were also verified by HPLC fluorescence analysis, indicating that EH extensively reacts with adenine in DNA, forming etheno adducts. The high sensitivity of the assay suggests that it may be used in the analysis of ethenoadenine adducts in vivo.

Adenine↗
PubMed1998

A social marketing model for disseminating research-based treatments to addictions treatment providers.

AIMS: Researchers must develop effective strategies for disseminating research-based treatments. This study evaluates the application of a dissemination model based on principles of social marketing and diffusion theory. DESIGN: A case study describes how the model was implemented. A qualitative design was employed to examine rates of adoption and adaptation of an early intervention program by a targeted system of addictions agencies. SETTING: The interventions were developed at the Addiction Research Foundation in Toronto and disseminated to Assessment and Referral (A/R) Centres in Ontario, Canada. PARTICIPANTS: Study participants included the managers and a designated therapist for 33 participating A/R centres. MEASUREMENTS: Managers were asked mainly open-ended questions concerning whether their agency had made a formal decision to adopt the intervention and whether therapists in their agency were using the early intervention program. "Adoption" was operationalized as offering the complete four-session intervention to at least one client. FINDINGS: At 12 months after the completion of training workshops, 68% of 34 agencies in the target system had adopted the program while 85% of the agencies were using some components of the intervention with clients. CONCLUSIONS: The dissemination model appeared to be effective although its application proved to be time-consuming and labour-intensive. The "market analysis", systems focus and field-test components of the model appeared to contribute to its success.

Delivery of Health Care↗