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Pharmacological Treatment of Neonatal Opiate Withdrawal: Between the Devil and the Deep Blue Sea
Anthony Liu,Tracey Bj rkman,Caroline Stewart,Ralph Nanan
International Journal of Pediatrics , 2011, DOI: 10.1155/2011/935631
Abstract: Illicit drug use with opiates in pregnancy is a major global health issue with neonatal withdrawal being a common complication. Morphine is the main pharmacological agent administered for the treatment of neonatal withdrawal. In the past, morphine has been considered by and large inert in terms of its long-term effects on the central nervous system. However, recent animal and clinical studies have demonstrated that opiates exhibit significant effects on the growing brain. This includes direct dose-dependent effects on reduction in brain size and weight, protein, DNA, RNA, and neurotransmitters—possibly as a direct consequence of a number of opiate-mediated systems that influence neural cell differentiation, proliferation, and apoptosis. At this stage, we are stuck between the devil and the deep blue sea. There are no real alternatives to pharmacological treatment with opiates and other drugs for neonatal opiate withdrawal and opiate addiction in pregnant women. However, pending further rigorous studies examining the potential harmful effects of opiate exposure in utero and the perinatal period, prolonged use of these agents in the neonatal period should be used judiciously, with caution, and avoided where possible.
Pharmacological Treatment of Neonatal Opiate Withdrawal: Between the Devil and the Deep Blue Sea
Anthony Liu,Tracey Bj？rkman,Caroline Stewart,Ralph Nanan
International Journal of Pediatrics , 2011, DOI: 10.1155/2011/935631
Abstract: Illicit drug use with opiates in pregnancy is a major global health issue with neonatal withdrawal being a common complication. Morphine is the main pharmacological agent administered for the treatment of neonatal withdrawal. In the past, morphine has been considered by and large inert in terms of its long-term effects on the central nervous system. However, recent animal and clinical studies have demonstrated that opiates exhibit significant effects on the growing brain. This includes direct dose-dependent effects on reduction in brain size and weight, protein, DNA, RNA, and neurotransmitters—possibly as a direct consequence of a number of opiate-mediated systems that influence neural cell differentiation, proliferation, and apoptosis. At this stage, we are stuck between the devil and the deep blue sea. There are no real alternatives to pharmacological treatment with opiates and other drugs for neonatal opiate withdrawal and opiate addiction in pregnant women. However, pending further rigorous studies examining the potential harmful effects of opiate exposure in utero and the perinatal period, prolonged use of these agents in the neonatal period should be used judiciously, with caution, and avoided where possible. 1. Introduction Illicit drug use in pregnancy and the associated adverse effects for both mother and child are important public health issues in most developed countries. Recent Australian data has shown that the prevalence of newborns with neonatal withdrawal has surged more than 30-fold over the past two decades, causing a major strain on the health system [1]. Opiates and to a lesser extent barbiturates are the main pharmacological agents administered for the treatment of neonatal withdrawal. In the past, these agents have been considered by and large inert in terms of their long-term effects on the central nervous system [2–5]. However, a growing body of evidence from animal studies and recent clinical studies in children suggests a more cautious approach towards uncritical use of these drugs for neonatal withdrawal. 2. Current Approaches to Opiate Treatment of Neonatal Withdrawal Undoubtedly, neonatal withdrawal is a potentially fatal condition, which requires early recognition and appropriate pharmacological treatment [6]. It is accepted that neonatal withdrawal requires treatment due to its associated morbidity, increased incidence of seizures [7–11], difficulties with weight gain [12–15], increase in infant mortality and sudden infant death syndrome (SIDS) [11, 16–21], and evidence of infant suffering [22]. With these potentially
Neonatal seizures and disruption to neurotransmitter systems
Kate Goasdoue,S. Tracey Bj？rkman,Stephanie M. Miller
- , 2017, DOI: 10.4103/1673-5374.200803
Abstract: Seizure disorders and epilepsies are well documented to be associated with long-term neurological and cognitive deficits in the adult and pediatric patients, but what about seizures in the newborn? The neonatal brain is highly susceptible to seizures, with hypoxic-ischemic encephalopathy (HIE) the most common aetiology of seizures in the first 24 hours of life. Numerous neonatal rodent models have shown deficits in cognitive and behavioural tests after recurrent neonatal seizures, suggestive of persistent alterations at the cellular level. Debate exists however as to whether neonatal seizures are ‘responsible’ for neurological deficits, or whether seizures are simply a symptom of underlying neurological injury
Mid-Gestational Enlargement of Fetal Thalami in Women Exposed to Methadone during Pregnancy
Meredith Schulson,Anthony Liu,Tracey Bj？rkman,Ann Quinton,Kristy P. Mann,Michael Peek,Ralph Nanan
Frontiers in Surgery , 2014, DOI: 10.3389/fsurg.2014.00028
Abstract: Methadone maintenance therapy is the standard of care in many countries for opioid-dependent women who become pregnant. Despite recent evidence showing significant neurodevelopmental changes in children and adults exposed to both licit and illicit substances in utero, data on the effects of opioids in particular remains scarce. The purpose of this study was to examine the effects of opiate use, in particular methadone, on various fetal cortical and biometric growth parameters in utero using ultrasound measurements done at 18–22 weeks gestation. Head circumference (HC), bi-parietal diameter, lateral ventricle diameter, transcerebellar diameter, thalamic diameter, cisterna magna diameter, and femur length were compared between fetuses born to methadone-maintained mothers and non-substance using controls. A significantly larger thalamic diameter (0.05 cm, p = 0.01) was observed in the opiate-exposed group. Thalamic diameter/HC ratio was also significantly raised (0.03 mm, p = 0.01). We hypothesize here that the increase in thalamic diameter in opiate-exposed fetuses could potentially be explained by regional differences in opioid and serotonin receptor densities, an alteration in monoamine neurotransmitter systems, and an enhancement of the normal growth increase that occurs in the thalamus during mid-gestation.
Reformas de saúde em perspectiva comparada: uma quest？o sem fim .... ou uma busca improvável
Bj？rkman,James Warner;
Ciência & Saúde Coletiva , 2009, DOI: 10.1590/S1413-81232009000300012
Abstract: given the problematic nature of attempts to reform national delivery systems for health care, the paper reviews the context and logic of reforms in the health sector. after a background on approaches to building capacity within three generations of public sector reforms, it examines the reforms applied to financing, organizing and delivering health services and suggests strategies for reform that take capacity into account.
English as a lingua franca in higher education: Implications for EAP
Beyza Bj？rkman
Ibérica , 2011,
Abstract: The last decade has brought a number of changes for higher education in continental Europe and elsewhere, a major one being the increasing use of English as a lingua franca (ELF) as the medium of instruction. With this change, EAP is faced with a new group of learners who will need to use it predominantly in ELF settings to communicate with speakers from other first language backgrounds. This overview paper first discusses the changes that have taken place in the field of EAP in terms of student body, followed by an outline of the main findings of research carried out on ELF. These changes and the results of recent ELF research have important implications for EAP instruction and testing. It is argued here that EAP needs to be modified accordingly to cater for the needs of this group. These revolve around the two major issues: norms and standards for spoken English and target use. If the aim of EAP instruction and testing is to prepare speakers for academic settings where English is the lingua franca, the findings of ELF research need to be taken into consideration and then integrated into EAP curriculum design and testing, rethinking norms and target use. The norms and standards used by EAP instruction must be based on this realistic English, and educational resources should be deployed more realistically, including the usage of ELF, thereby validating the pluralism of English. This paper argues that any practice that excludes this perspective would be reducing EAP qualitatively and quantitatively.
A van der Waals density functional for solids
Torbj？rn Bj？rkman
Physics , 2012, DOI: 10.1103/PhysRevB.86.165109
Abstract: The recent non-local correlation functional of Vydrov and van Voorhis[J. Chem. Phys. 133, 244103 (2010)] is investigated and two new versions of the functional are suggested as being appropriate for describing van der Waals interactions in solids. A refitting of the original functional is demonstrated to result in very accurate interlayer binding energies for weakly bonded layered solids. A VV10 functional based on the generalized gradient approximation by Armiento and Mattsson[Phys. Rev. B 72, 085108 (2005)], while performing slightly worse for interlayer binding is highly successful in describing the equilibrium geometries of both weakly bonded and close packed solids.
Testing several recent van der Waals density functionals for layered structures
Torbj？rn Bj？rkman
Physics , 2014, DOI: 10.1063/1.4893329
Abstract: Six recently developed exchanged functionals for pairing with different two versions of van der Waals density functionals (vdW-DF) are tested for weakly bonded solids. The test, using 26 layered weakly bonded compounds, benchmarks the lattice constants against experimental data and the interlayer binding energies against reference data from the random-phase approximation (RPA). The investigated functionals tend to give interlayer binding energies higher than the RPA benchmark, and the overall performance for lattice constants is good. The exchange functionals optB86b and cx13 paired with the original vdW-DF and the B86R functional paired with vdW-DF2 are found to give particularly good results for equilibrium geometries.
Book review: Gautam Bhan, In the Public’s Interest. Evictions, Citizenship and Inequality in Contemporary Delhi
Lisa Bj？rkman
- , 2018, DOI: 10.1177/2321023018762832
Abstract: Gautam Bhan, In the Public’s Interest. Evictions, Citizenship and Inequality in Contemporary Delhi. New Delhi: Orient Blackswan, 2016. 304 pages. ？825
Food Conditioning Affects Expression of Insect Resistance in Diploid Willows (Salix spp.)  [PDF]
Christer Bj？rkman, Karin Eklund, Anna Lehrman, Johan A. Stenberg
American Journal of Plant Sciences (AJPS) , 2013, DOI: 10.4236/ajps.2013.41008
Abstract: The high energy quota and versatility of use make willows (Salix spp.) attractive as bioenergy crops. Insect defoliation constitutes a threat to the profitability of willow growers. Hitherto, the breeding for resistance against the main insect pests has been hampered by the fact that all known resistant willow clones are polyploids, and existing molecular breeding tools work most effectively for diploids. Here, we firstly report diploid willows highly resistant to the main insect defoliator, the leaf beetle (Phratora vulgatissima), offering new opportunities for breeding resistance. Leaf beetles exposed to three resistant clones (two S. purpurea one S. eriocephala) laid three to 27 times fewer eggs than females on a susceptible S. viminalis clone. Secondly, we show that beetles laid significantly more eggs on resistant clones if they were fed the susceptible clone prior to the oviposition monitoring test compared to when they prefed on resistant clones. Nevertheless, the differences observed between resistant and susceptible clones were pronounced in all cases. The food conditioning effect means that small differences in resistance among clones may be undetected.
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