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text:
The Choreographer's Lab is an eight-week session where artists of all abilities have the opportunity to create meaningful dance works in a supportive environment. Join us as we showcase the pieces created in the lab in live performances May 6th and 7th in the Fort Wayne Dance Collective's Elliott Studio Theater.
Please Email firstname.lastname@example.com for questions or to volunteer back stage

subset: commoncrawl


text:
1/2 michael ironside is the best thing about this
Meh. 2016, I see people finding the ghost of feminism in every movie.
There's enough about Visiting Hours for it to be an higher level than most slasher films. Its surprisingly feminist leanings make for a slightly unusual plot dynamic and having Michael Ironside's psychopath so visible right from the start, and even quite deeply characterised, makes it pleasingly disarming. It plods in places and it's about 20 minutes too long but Ironside's typical excellence will see you through.
Very average hospital slasher with a surprising feminist slant that just doesn't quite ring true. Lee Grant overacts badly and The Shat is wasted in a small supporting role but Michael Ironside is excellent.
A very underrated classic, does not get the praise it deserves
The quintessential feminist slasher film; the only one that truly strikes back at the misogynist tropes of the genre. It's doubly interesting that the villain should be given such a fascinating portrayal by Michael Ironside who's never been more interesting despite not having more than 20 lines of dialogue. The movie wants him to have one dimension, but Ironside's performance is too good for that. Thrilling.


text:
Monday, 23 September 2013
Hey I have Used One Squirrel !!!!!
The title of my post is directed at the lovely SQUIRREL as she knew I had bought stamps from the new L.O.T.V. range but hadn't got round to using them. I did keep promising her.
My 6 x 6 Card
Products Used
Stamp:- James - Santa Stop Here - ST463 - L.O.T.V.
DI - Brushed Corduroy
85 Crystal Glitter - Art Institute Glitter
Dp:- Bo Bunny - Item#6PB029
Dies:- Precious Snowflakes - Style:- 98729 - Memory Box
Sentiment Ticket - Crafty Ann's
Gems from my stash (I meant to put one on each of the snowflakes as well as the bow, I am off to rectify that Lol!!!)
Thank you for looking.
8 Challenges Entered
http://avenue613.blogspot.co.uk/ Ch#38 - Anything Goes
http://craftyhazelnutschristmaschallenge.blogspot.co.uk/ Ch#143 - Stamp, Stamp, Stamp
http://craftyhazelnutschristmaschallenge2.blogspot.co.uk/ - September Anything Goes
http://ilovepromarkers.blogspot.co.uk/ Ch#186 - Anything Goes
http://www.ladyanneschallenges.com/stamp-challenge.html Ch#11 - Anything Goes
http://ppp-makeitmonday.blogspot.co.uk/ MIM#159 - Anything Goes
http://sisteractcardchallenge.blogspot.co.uk/ Ch#25 - Anything Goes
http://sparklesforumchristmaschallenge.blogspot.co.uk/ Ch#32 - Non Traditional Colours
30 comments:
And it was well worth the wait hunny! Gorgeous James, and I love that you have combined Santa's reindeer in here too, all ready to pull the FatMan's sleigh that James is waiting for. Love the shaped edge too. Brilliant hun. Hugs, SxxReplyDelete
Your card is beautiful and I love your image so cute:):)
This is gorgeous Cathy, I like the adorable image the papers and the die cuts.ReplyDelete
Kevin xx
Absolutely adorable! Love this sweet image, the papers and layout are gorgeous and the ticket is fab, love itReplyDelete
Lindsay xx
Brilliant card Cathy.xxReplyDelete
Wow, this is a gorgeous card... I love the stamps and layers and the memory box dies...ReplyDelete
Saw this on MIM, my card is a Ghost card and free cut file
Hugs, Antonella :-)
This is wonderful Cathy. I love James Bear. Gorgeous backing paper and fabulous MB snowflakes.ReplyDelete
I hope you get your lift fixed today.
hugs Sue xx
Gorgeous card! I love the image and your embellishments are beautiful! Great job!ReplyDelete
Please join me for a chance to win FREE candy on my blog. Have a wonderful week! Hope to see you again next week. Hugs, Gloria
Beautiful card Cathy. Hugs Rita xxxReplyDelete
It's an adorable image and such a sweet design! Love those star pendants too!ReplyDelete
Gorgeous card Cathy, love the cute image.ReplyDelete
Hope you have had your lift fixed today.
Wendy xx
Such a beautiful little Christmas creation. Love the cute teddy.ReplyDelete
{Doing Life – my personal blog}
This is adorable Cathy. I love the sweet bear and fab design. I bought these too and haven't used them yet!!ReplyDelete
Lorraine x
rather taken with those snowflake dies don't they work so well on your gorgeous cardReplyDelete
Hugs Kate xx
Brilliant card Cathy, such a cute image. Hope the lift is repaired and you can get out and about again. Hugs xReplyDelete
Beautiful design! Your image is adorable and is very well colored! Great composition and fabulous execution! Thanks so much for dropping this off by our house here at 613 Avenue Create!ReplyDelete
Chana, Owner
Fab card ,love that cute image and little snowflake dieReplyDelete
Thanks for joining us at the I ♥ ProMarkers challenge. and good luck
Wonderful cute card.ReplyDelete
Aww this is really sweet Cathy… what a cute James image - he's adorable and you've coloured him beautifully!! I love the gorgeous paper and embellishments… the snowflakes are very pretty!!ReplyDelete
I hope you get your lift fixed very soon hun... and I hope you get some sunshine too - it's been glorious here this morning... blue skies... not too hot! :-))
Take Care
Hugs Sue xx
Really cute image, loving the backgroundReplyDelete
Wonderful card - love the colours - thanks for sharing for both CHNC challenges - hope to see you again soon. xReplyDelete
Gorgeous card and adorable image. I spotted this on MIM..lozReplyDelete
Wonderful creation Cathy. Love James the Bear.ReplyDelete
Such a cute card Cathy, gorgeous wee James, fabulous colouring and love the snowflake die cuts..ReplyDelete
Thanks for sharing with us at Make it Monday..
Luv CHRISSYxx
Love this Cathy!ReplyDelete
That muted colour combo is gorgeous and so is your snowflake die.
Chrissie xx
This is gorgeous sweetie I love this stamp, I brought it as well although I've still not inked the little cutie.ReplyDelete
Lotsa hugs Vicky xxx
ahhh this is sooo adorable. Totally love the image and how you have colored it. Love as well the great die cuts you have used.ReplyDelete
Thanks for joining us at 613 Avenue Create this week. Hope to see you again next week. DT Crafting Vicky
Great card - love all the details you've added.ReplyDelete
Thanks for joining us at Sparkles Christmas Challenge.
Helen x
This is so beautiful. I love the cute image and pretty design papers.ReplyDelete
!WOW! So beautiful is your entry thank you for sharing this in our challenge at Sparkles Christmas Challenge good luck and hope to see you again next time Dt Member Sandra H xxReplyDelete


text:
NEW YORK, October 17, 2016 /PRNewswire/ --
Last Friday, the US markets were in bullish territories with gains sending five out of nine sectors in the green and US indices following suit as the NASDAQ Composite ended the trading session at 5,214.16, up 0.02%; the Dow Jones Industrial Average edged 0.22% higher, to finish at 18,138.38; and the S&P 500 closed at 2,132.98, up 0.02%. Building on this news, Stock-Callers.com reviews the following Utilities stocks: NiSource Inc. (NYSE: NI), Eversource Energy (NYSE: ES), Pattern Energy Group Inc. (NASDAQ: PEGI), and Westar Energy Inc. (NYSE: WR). You can access of our complimentary research reports on these stocks now at:
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Eversource Energy
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Pattern Energy Group
San Francisco, California headquartered Pattern Energy Group Inc.'s stock advanced 1.11%, to close the day at $21.83. The stock recorded a trading volume of 584,273 shares. Pattern Energy Group Inc.'s shares have advanced 2.82% in the past one year. Shares of the Company, which operates as an independent power company that owns and operates power projects in the US, Canada, and Chile, are trading above its 200-day moving average by 7.68%. Additionally, the stock has an RSI of 40.92.
On September 27th, 2016, research firm UBS initiated a 'Neutral' rating on the Company's stock, issuing a target price of $24 per share. Register for free on Stock-Callers.com and download the PDF research report on PEGI at:
Westar Energy
On Friday, shares in Topeka, Kansas headquartered Westar Energy Inc. ended the session 0.49% higher at $57.22, with a total trading volume of 818,320 shares. Westar Energy's shares have advanced 3.23% in the last one month and 2.23% in the previous three months. Furthermore, the stock has surged 47.31% in the past one year. The stock is trading 3.90% and 12.94% above its 50-day and 200-day moving averages, respectively. Moreover, shares of the Company, which generates, transmits, and distributes electricity in Kansas, are trading at a PE ratio of 25.87 and have an RSI of 69.23. Get free access to your research report on WR at:
Stock Callers:
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Biologists say noise impacts should be part of wildlife conservation planning
Staff Report
FRISCO — Outside a few remote wilderness areas, human-caused noise pollution is so common that birds have started to "shout" in order to communicate with each other.
Biologists with the University of Exeter took a close look at how bluebirds alter their songs in response to increases in nearby background noise caused, in many cases, by human activities such as traffic.
The study found that the birds react in real time, producing songs that are louder and lower-pitched. The findings suggest that birds are able to perceive increases in noise and respond accordingly — just like humans do in raucous settings.
The study was aimed at helping improve environmental constraints to animal communication, and to explore how human activities affect wildlife, said Dr. Caitlin Kight, a behavioural ecologist based at the University of Exeter's Penryn Campus in Cornwall.
"Although many manmade noise regimes are often very different from those found in nature, there can be surprising similarities in certain features, including volume, pitch, or timing," Kight said. "Sounds caused by traffic, for example, may not be hugely different from those produced by waterfalls or heavy winds. Animals that evolved in habitats with those natural features may therefore already have, within their existing repertoires of behaviors, the flexibility to respond to noise pollution. This certainly seems to be the case with bluebirds," Kight said.
But that doesn't mean noise pollution doesn't have an impact on wildlife, said co-author Dr. John Swaddle, from The College of William and Mary.
"Unfortunately, the world is getting so noisy that even the most flexible of species will eventually reach a threshold beyond which they will have difficulty communicating," Swaddle said.
:When we build roads and airports near human neighbourhoods, we employ noise abatement protocols in an effort to mitigate against the negative impacts of noise pollution," Swaddle said. "It is time to apply similar caution to conservation, management, and landscaping plans that impact wildlife and their habitats."
Previous studies had shown that birds in noisier areas tend to sing differently than those in quieter surroundings, but the new study tried to determine whether birds can react in real time,
Dr, Kight recorded songs produced by 32 male bluebirds, and analyzed two from each male — those produced during the quietest and loudest period of ambient noise — to investigate whether males changes their songs between these two conditions.
She found that, as background noise increased, male bluebirds produced songs that were louder and lower-pitched. This suggests that the birds are able to both perceive and respond to increases in noise. This enabled them to produce songs that were more likely to be heard by potential mates or rivals.


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Fukushima: from fear to compassion
On March 11th 2011, a large M 9.0 earthquake hit off the coast of North Eastern Japan. The subsequent tsunami lead to one of the largest nuclear disasters since the advent of nuclear power production. Fast forward 3 years to March 11th 2014, and I am in the final stages of uprooting my life in Vancouver, BC to to move to Japan to start my Masters' degree in agricultural economics at Tokyo University of Agriculture. Besides the usual anxieties of starting over in a new city, let alone new country, was the fear that I had no idea what future health effects would result from this decision to live less than 300 km away from where the meltdown occurred. Here I was, reading reports of the environmental consequences of the radioactive waste along the coast of North America, an ocean away, and I was going to move CLOSER to where a nuclear plant was continuing to spew out contaminated waste water?
A week before Christmas, I boarded a bus to Shimizu, a small town in the prefecture of Shizuoka, to visit a small family owned mikan (Japanese tangerine) farm. I was SUPER excited because:
a) I love visiting farms, especially family farms
b) I love citrus and think it would be a DREAM to have too much citrus to deal with
c) I hadn't done any farm work in a couple of months and my body was aching for some physical labour.
Emi Do: Exploring ideas in small scale agriculture: feasibility, viability, relevance and resilience.
June 2017


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Baku. 27 May. REPORT.AZ/ Azerbaijan has never been as strong as today.
Report informs, Azerbaijani President Ilham Aliyev said at the official reception in the Buta palace on the occasion of Azerbaijan's Republic Day - May 28.
"We are owners of our destiny, we are an independent country, we are free people, we have taken our place in the world scape and will pursue ahead the path of the independence and development.
I would like to wish a success to all the people of Azerbaijan", the head of state said.


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Step 2: Define M&A Integration Strategy and Governance
Just as people can be challenged to perform better when they are confronted with more demanding expectations, they also are motivated to upgrade performance when they are given a clear sense of direction. The acquirer who steps forth promptly to structure integration goals for employees provides a crucial focus for organizational resources. Many of the conventional problems associated with mergers and acquisitions are a direct offshoot of people going off on tangents, operating in a fog, or essentially shifting into neutral for lack of well-defined targets.
Newly merged or acquired organizations need road maps with well-charted routes and specific destinations. But it is very common for employees to muddle around for months or a year before they finally figure out what is going on and where the new company is headed.
The extent the target company will be integrated should be clearly communiciated. Integration matters more in some types of mergers than others, and it matters more in some functions than others, depending on the rationale behind the deal. Before a merger is closed, the integration strategy, processes, and the responsibilities of the teams should be well defined.
Typically, the Integration Management Office (IMO) oversees the project and brings discipline and structure to the merger by setting up and managing the processes for charter creation, issue resolution, quality assurance, risk management, scope changes, status reporting, synergy program management, and project closeout.
The presentations and tools in this section cover the fundamentals of integration strategy, the duties of the integration teams, and the structure of an IMO. The documents can be customized to explain your integration approach to your teams.
Free Access
Moving through the transition with speed, focus, and urgency.
Three practices that position your new director group for merger success.
Roles of different teams, leaders, and task forces in a M&A integration are explained in this two-page document.
Partial or Restricted Access
Length: 1 minute 26 seconds
Length: 1 minute 44 seconds
Length: 2 minutes 54 seconds
Length: 2 minutes 4 seconds
2-page example on how the the M&A Steering Committee and Integration Team will work together to determine governance, their reporting relationship, the process for making decisions, resolving issues, etc.
An example of a RACI (Responsible, Accountable, Consulted, Informed) matrix that identifies roles and responsibilities for Steering Committee, IMO, Functional Teams, Synergy Owners, and Accounting.
Companies merge for at least one of three reasons.
Anticipate issues that could slow the realization of synergies.


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PlayersXpo 2017 Coming To Dublin This October
PlayersXpo is the gaming event that all the gamers have been waiting for. For the first time ever PlayersXpo 2017 will be rolling into the Convention Center in the heart of Dublin City and aims to be Ireland's ultimate gaming event. Dated on Saturday 28th and Sunday 29th of October and with more than 20,000 people it vows to be the biggest show of its kind the country has ever seen. It will bring together gamers, exhibitors, and talkers in a highly-anticipated two-day event. The industry-leading show will include some of the biggest names in gaming, YouTube, blogging, publishing, and game development, and showcase the best that next generation and retro gaming has to offer. PlayersXpo is an event organized and entirely owned by Independent News and Media (INM) Events, along with INM, one of the powers behind PlayersXpo is Creative Director Mick Finucane and Cogs & Marvel responsible for event management.
"We're delighted to be launching the very first PlayersXpo in Ireland giving families and fans alike a destination occasion for all things gaming. With a long heritage in the industry it's so important to us as fans first and foremost that the latest gaming consoles, from the biggest names with the best games, will be appearing at PlayersXpo this October," said the event's creative director, Mick Finucane.
PlayersXpo will provide a network of experiences for fans and content creators alike, with the latest in video games showcased from some of the most celebrated entertainment companies in the world, including Nintendo, Sony, and Microsoft. The event will boast 4,500 square meters of exhibition space, as well as a 2,000 seat auditorium. Attendees will be able to challenge YouTube celebrities and try plenty of unreleased console titles. Aside from the gaming entertainment, there will also be an educational talks & workshops that might help some concerned parents learn a little bit more about kiddo's favorite hobby while getting to experience some of those games & systems first hand.


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Download Valentine Hearts:Match3 Puzzle apk 1.0.5 free for Android smartphone
Posted by Absolutist Ltd in Puzzle | April 10, 2015 | 4 Comments
Apk file size: 17.0 MB
Valentine's Day is marked by sending gifts and love messages to the special ones. And the most popular gifts are flowers, chocolates and greeting cards – valentines. Express love to each other by presenting the game filled with hearts and flowers! Pretty colors, jolly music and sounds will brighten your Saint Valentine's Day!
- Romantic atmosphere
- Addicting puzzle concept
- Relaxing music
We are dealing with square colored tiles filled with differently sized bubble hearts. Clicking on the biggest hearts will make them pop and change the tile color, enlarging nearby objects. The objective of the game is to change the color of all tiles to white. But before you start playing, consider the most effective click-and-pop combination, because every move counts.
Earn bonuses for bursting three and more hearts in a row. As you go through the levels the board tiles form different maze-like play fields, so that's a great opportunity to develop non-linear thinking. This addicting and lovely puzzle game will deliver hours of fascinating gameplay.
Whats new
● New version 1.0.5 supports Android 5.0
● We have polished the game and fixed some small issues
Absolutist Ltd part of our Puzzle and have average installs from 5000 to 10000. Last Update April 10, 2015. Google play rating is 84.058. Current verison is 1.0.5. Actual size 17.0 MB.
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4 Comments
wing rusky
Sweet :-) Very sweet +pretty , a fun whimsical little game. Thanks!
Olga Diadina
Very nice game. Pleasant Experience
Gela White
Superb A great Valentin's gift.
Rita Well
Like it easy and fun - just what you need for valentine's day J


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Ron Butler is a Los Angeles based actor and voice artist with over a hundred film and television credits, which include playing everything from brooding doctors to screwball hipsters. A member of the Atlantic Theater Company, he won an Independent Filmmaker Project Award for his work in the HBO film Everyday People. He works regularly as a commercial and animation voice-over artist and has narrated a wide variety of audiobooks.
Read by Ron Butler
Winner of the 2016 Coretta Scott King/John Steptoe New Talent Author Award.
"The authenticity of Hoodoo's voice and this distinctive mashup of genres make Smith one to watch. Seekers of the scary and something different need look no further." - Kirkus Reviews
Released Tue Dec 06 00:00:00 UTC 2016
English, Unabridged
Washington and Hamilton
By Stephen F. Knott and Tony Williams
Read by Ron Butler
The Alliance That Forged America
This unlikely duo set the United States on the path to becoming a superpower.
"An elegant dual study resurrects Alexander Hamilton as one of George Washington's most valued advisers...Knott and Williams expertly show how Hamilton was often attacked because Washington was untouchable. " - Kirkus Reviews
Released Tue Oct 11 00:00:00 UTC 2016
English, Unabridged
Jazz Day: The Making of a Famous Photograph
Illustrated by Francis Vallejo
Read by J.D. Jackson , Jason Linere White , Ron Butler and Bahni Turpin
What happens when you invite as many jazz musicians as you can for a photo in 1950s Harlem?
"...alive with the presence and skill of the musicians...Beyond being a glorious tribute to these jazz greats...[this] is also a phenomenal debut for Vallejo, whose dynamic acrylic and pastel images bring readers into the heart of the action of a day like no other." - Publishers Weekly, Starred Review
Released Tue May 23 00:00:00 UTC 2017
English, Unabridged
Freedom Over Me: Eleven Slaves, Their Lives and Dreams Brought to Life
By Ashley Bryan
Illustrated by Ashley Bryan
Read by J.D. Jackson , Robin Eller , Ron Butler , Bahni Turpin and Susie Berneis
Fierce paintings and expansive poetry provide a unique glimpse into the lives of slaves.
"Bryan gives voices to the voiceless and presents the dreams of slaves who went to the grave without living them. Using historical slave documents from the 1820s to the 1860s, Bryan brings to life 11 slaves who once belonged to Cado Fairchilds...Bryan makes real and palpable what chattel slavery meant and how it affected those who were enslaved; every child who studies American slavery would benefit from experiencing this historically grounded web of narratives." - Kirkus Reviews, Starred Review
Released Tue Aug 22 00:00:00 UTC 2017
English, Unabridged
Schomburg: The Man Who Built a Library
Illustrated by Eric Velasquez
Read by Ron Butler
Where is our historian to give us our side? Arturo asked.
Available Tue Dec 12 00:00:00 UTC 2017
English, Unabridged
Schomburg: The Man Who Built a Library
Illustrated by Eric Velasquez
Read by Ron Butler
Where is our historian to give us our side? Arturo asked.
"All of the book's details paint Schomburg as an admirable, flawed, likable, passionate man whose lasting legacy, Harlem's Schomburg Center for Research in Black Culture, opens its doors to all who would learn more about the people its founder knew had been left out of the written record. A must-read for a deeper understanding of a well-connected genius who enriched the cultural road map for African-Americans and books about them." - Kirkus Reviews, Starred Review
Available Tue Dec 12 00:00:00 UTC 2017
English, Unabridged


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Art from Dana Naser (@dananaserart) / Dubai, United Arab Emirates
From Dana Naser:
Dana Naser is a Dubai – based artist, designer and photographer. Growing up, art was an important part of Dana's life. Throughout her life, she collected images, experiences and emotions expressing them through her art, relying on intense colours and incorporating various forms, patterns and textures, channeling this talent through her graphic design as well as her painting. For Dana, art is creation, transformation and a medium of expression. Her work concentrates on creating abstract surfaces through acrylics, but works in oil and has experimented with a variety of mixed media such as pastels, ink, wire, silk screen and many others.
"My paintings represent an ongoing quest to discover details around me and to reveal what cannot be expressed with words. I strive to tap into intuitive creative painting and share it by visual art and transfer it onto support medium such as a canvas. Every time I start a new painting, I take a moment to allow this creative energy to flow allowing me to "play"; experiment and allow the paint to take its different forms and to communicate something, creating an impression on the viewer – without natural imagery or symbols, but rather with pure visual form".
www.dananaser.com – @dananaserart – https://www.facebook.
Desirée O
Latest posts by Desirée O (see all)
- Bohemian Book Club: Acting Shakespeare is Outrageous!: Playing the Bard for Beginners - July 17, 2017
- Art Crime This Week (07.14.17) - July 14, 2017
- This Disney Make-up Art Is Like a Fairytale Come True - July 12, 2017


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Sacramento City College womens volleyball
Think about what career is best suited for you, and where you want to study. Request more information now.
Think about what career is best suited for you, and where you want to study. Request more information now.
Think about what career is best suited for you, and where you want to study. Request more information now.
Find info concerning Sacramento City College womens volleyball, and registering for elective lectures and seminars. Not all recruiting is done like NCAA Division I teams. It's practically impossible for college coaches to watch every player who has expressed interest in their program, so if you get the chance, make a memorable first impression by visiting the campus in person. Finally, check with your major department for assistance with prerequisites, tuition payment deadlines, and Sacramento City College Volleyball information. Please use the form above to request admissions info for Sacramento City College.
You don't have to quarterback the university football team to a state championship to earn an athletic scholarship. Most major sports that field a team in intercollegiate competition have sports scholarships available. From women's gymnastics to men's track and field, coaches are seeking players to build a team around. Further, that leadership role often is accompanied by a full-scholarship.
The best time to begin searching for scholarships is before your senior year, in order to meet deadlines. Schools confirm that it is important to file financial aid forms such as the CSS Profile early in the school year. There are many sports scholarships that focus on less tangible qualities, such as the ability to lead a team, motivate others, and learn new skills rapidly. Take stock of your athletic abilities as you mature through high school. Roger Williams University womens basketball may encourage student-athletes to apply via early decision. Students who are considering applying via early decision should be aware of the rules and obligations that this commitment entails. Beyond consideration for Sacramento City College womens volleyball, you may think about Shorter University class schedule 2017 for complementary electives to your primary course of study.
Head Coach
Kansas City, Kansas Public Schools
Support and follow all athletic trainers assigned to practices/contests and the recommendations from the trainers with regards to student safety, injury and..
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Mid-Michigan Area Public Schools
Football - Varsity - Offensive Coordinator. Assisting in the direction of the football program. 2017-2018 SCHOOL YEAR..
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TriFecta Athletics
We looking for Personal Trainers or Group instructors motivated to change others lives and build an empire! If this fits your credentials then please contact us.
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Rice University
High school and professional coaches. This position provides video services for home game production for volleyball, men's basketball, and women's basketball.
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University of Colorado
STUDENT ATHLETIC TRAINER PROGRAM. Years experience as a certified athletic trainer. Work in conjunction with staff athletic trainers in the prevention and care..
2 days ago


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Use of illicit stimulant drugs such as methamphetamine, cocaine, and ecstasy are a significant worldwide problem. However, little is known about the effect of these drugs on movement. The aim of the current study was to investigate hand function in adults with a history of illicit stimulant use. We hypothesized that prior use of illicit stimulant drugs is associated with abnormal manipulation of objects. The study involved 22 subjects with a history of illicit stimulant use (aged 29±8 yrs; time since last use: 1.8±4.0 yrs) and two control groups comprising 27 non-drug users (aged 25±8 yrs) and 17 cannabis users with no history of stimulant use (aged 22±5 yrs). Each subject completed screening tests (neuropsychological assessment, medical history questionnaire, lifetime drug history questionnaire, and urine drug screen) prior to gripping and lifting a light-weight object with the dominant right hand. Horizontal grip force, vertical lift force, acceleration, and first dorsal interosseus electromyographic (EMG) activity were recorded during three trials. In trial one, peak grip force was significantly greater in the stimulant group (12.8±3.9 N) than in the control groups (non-drug: 10.3±4.6 N; cannabis: 9.4±2.9 N, P<0.022). However, peak grip force did not differ between groups in trials two and three. The results suggest that individuals with a history of stimulant use overestimate the grip force required to manipulate a novel object but, are able to adapt grip force in subsequent lifts. The results suggest that movement dysfunction may be an unrecognized consequence of illicit stimulant use.
Citation: Pearson-Dennett V, Flavel SC, Wilcox RA, Thewlis D, Vogel AP, White JM, et al. (2014) Hand Function is Altered in Individuals with a History of Illicit Stimulant Use. PLoS ONE9(12): e115771. https://doi.org/10.1371/journal.pone.0115771
Editor: Kenji Hashimoto, Chiba University Center for Forensic Mental Health, Japan
Received: December 9, 2013; Accepted: December 2, 2014; Published: December 29, 2014
Copyright: © 2014 Pearson-Dennett et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Funding: This work was supported by the Ramaciotti Foundation (GT holds an Establishment Grant; ID2974/2010), National Health and Medical Research Council of Australia (GT holds a Career Development Award: ID 627003; APV holds an Early Career Research Fellowship: ID 1012302), Australian Government (VPD holds an Australian Postgraduate Award), and the University of South Australia (GT holds a Research SA Fellowship and Division of Health Sciences Research Grant, SCF held an Australian Postgraduate Award, and VPD holds a Top-up Scholarship. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Competing interests: The authors have declared that no competing interests exist.
Illicit use of stimulant drugs is a significant worldwide problem. The most commonly used illicit stimulant drugs are amphetamine, methamphetamine (termed 'amphetamines'), and ecstasy. 14–53 million people worldwide reported use of these drugs within the previous year [1]. The Oceania region, comprising people primarily from Australia and New Zealand, has the highest annual prevalence of illicit stimulant use in the world [1] with ∼10% of people aged 20–29 yrs reporting use of an illicit stimulant drug within the last 12 months [2].
Given the high prevalence of illicit drug use in the community, it is surprising that very little is known about the long-term effect of illicit drug use on movement. Long-lasting changes in movement are likely given that abnormalities in brain regions that control movement have been observed in humans with a history of illicit stimulant use [3], [4]. Furthermore, individuals with a history of stimulant use exhibit abnormally large tremor during finger movement [5] and poor performance on tests of hand dexterity (e.g. pegboard test) [6], [7].
The aim of the current study was to further explore hand function in individuals with a history of illicit stimulant use. We investigated hand function using a sensitive, objective, and well validated object grip and lift task. Lifting an object requires a grip force that is appropriate to overcome gravity and prevent slipping. This force is predetermined by an internal model based on the physical characteristics of the object, prior experience, sensory feedback, and the individual's safety margin to prevent slipping [8], [9]. Pathological (e.g. stroke) [10] and physiological states (e.g. fatiguing exercise) [11] have been shown to affect properties of the grip and lift task. We hypothesized that individuals with a history of illicit stimulant use would exhibit increased grip force (i.e. higher safety margin for error) and abnormal rate of force application during object manipulation. The hypothesis is based on several observations. First, methamphetamine and ecstasy are toxic to primarily dopaminergic and serotonergic neurons, respectively [12], [13] and these monoamine neurotransmitter systems are important for control of movement. Second, case studies of clinically diagnosed movement disorders have been observed in stimulant users [14]. Third, epidemiological data suggests that methamphetamine use is associated with increased risk of developing Parkinson's disease later in life (2.65 hazard ratio) [15] and increased grip force and decreased rate of grip force application have been observed in de novo Parkinson's disease patients [16]. The results of the current study will further our understanding of a potentially under recognized consequence of illicit stimulant use.
Materials and Methods
Ethics Statement
All experimental procedures were approved by the Human Research Ethics Committee at the University of South Australia. Experimental procedures were conducted according to The Code of Ethics of the World Medical Association (Declaration of Helsinki). Written informed consent was obtained prior to participation.
Subjects and screening
Hand function was assessed in 66 adults aged 18–48 yrs (see Table 1). Three groups of subjects were investigated: 22 subjects with a history of illicit stimulant use and two control groups comprising 27 non-drug users and 17 cannabis users (with no history of stimulant use). All subjects were recruited from the community and only right-hand dominant subjects were included in the study. The inclusion criteria for the stimulant group were use of amphetamine, methamphetamine, ecstasy, and/or cocaine on ≥7 occasions. Inclusion criteria for the cannabis control group were cannabis use on ≥7 occasions but no history of illicit stimulant use. Inclusion criteria for the non-drug control group was cannabis use on ≤2 occasions and no other history of illicit drug use (alcohol and tobacco use was permitted). The study was conducted in Adelaide, Australia.
Subjects underwent a series of screening tests prior to participation. Subjects were asked to complete a brief medical history questionnaire and provide a urine sample for routine drug screening (PSCupA-6MBAU, US Diagnostics Inc., Huntsville, Alabama, USA). Urine data is missing for one control subject due to mislabelling. All subjects were then asked to complete an in-house drug history questionnaire to document lifetime and recent use of alcohol, tobacco, and illicit drugs. The questionnaire listed 20 illicit drugs and requested information on other illicit drugs not listed. Items on the questionnaire included age of first use, age of regular use, duration of use, frequency of use (current and lifetime), number of times used in the last year, average dose (current and lifetime), frequency of high dose use, and time since last use defined for each drug. The number of drug overdoses and any treatment for drug dependency were also noted. The final screening test involved a neuropsychological assessment to ensure that all participants had normal memory and cognition. Four cognitive domains were assessed with the following tests: Logical Memory I and II [17], Verbal Trails [18], Verbal Fluency [18], [19], and Digit Span forwards and backwards [20]. Performance on each test was compared to published normative data matched for age and years of education. Symptoms of depression (over the past two weeks) were also assessed with a 21 item self-report rating scale (Beck Depression Inventory) [21].
Exclusion criteria included: a) history of neurological damage and/or neurological illness, b) non-neurological conditions that may affect movement (e.g. arthritis in the hand or carpel tunnel syndrome), c) current use of medications that may affect movement (e.g. antidepressants, benzodiazepines, beta blockers), d) frequent illicit opioid use (i.e. >5 times), and e) positive urine drug test for amphetamine, methamphetamine, MDMA (3,4-methylenedioxymethamphetamine or 'ecstasy'), cocaine, opioids, and/or benzodiazepines. Subjects who tested positive for cannabis were allowed to participate if use was greater than 12 hrs prior to the experiment. This exemption was due to the metabolite of the main active ingredient of cannabis (tetrahydrocannabinol) remaining in body fat for up to 90 days after last use. Subjects were also excluded if poor performance was observed on two or more of the cognitive domains tested. Poor performance was defined as greater than two standard deviations below the mean of published normative data for Digit Span [22], Verbal Fluency [23], and Logical Memory I and II [24] and performance greater than two standard deviations above the mean for Verbal Trails [25].
Experimental protocol
Subjects sat on a chair in front of a table and completed a modified version of the Edinburgh Handedness Inventory [26] to confirm right hand dominance. Subjects then performed three tasks with the right hand. The first task involved gripping and lifting a light-weight object (342 g; see Fig. 1). The test object consisted of two load cells (model MPL-100; Transducer Techniques, Temecula, CA, USA) mounted orthogonally for measurement of horizontal grip force and vertical lift force. The grip load cell was mounted between two polished brass disks, 35 mm apart. A dual axis accelerometer (±2 g, model ADXL311J, RS Components Pty Ltd, Smithfield, Australia) was also attached to the apparatus. Subjects were instructed to 'Lift the object off the table to the height indicated (∼10 cm). Hold the object there for 3 s and then replace it on the table'. The task (duration ∼6 s) was performed with the index finger and thumb (pinch grip) and the lifting movement occurred primarily through elbow flexion. The experimenter demonstrated the task prior to the subjects' first attempt and no practice was allowed. Subjects performed three trials, with trials commencing at ∼10 s intervals. Three trials is sufficient for adaptation of grip force to a novel object [27].
The index finger and thumb contacted the test object on two polished brass disks positioned 35 mm apart.
The second task involved three brief maximal voluntary contractions (MVCs; 2–3 s duration) to enable normalization of some parameters measured during the grip and lift task. MVCs were performed with a pinch grip and subjects were not required to lift the object off the table. MVCs were separated by ∼1 min to minimize fatigue. Subjects were given verbal encouragement and visual feedback of force production during MVCs.
The third task involved testing hand dexterity with the grooved pegboard test (for comparison to previous literature). Subjects were instructed to place key-shaped pegs into corresponding holes (model 32025, Lafayette Instrument Company, Lafayette IN, USA), in a set sequence and as fast as possible. Subjects performed three trials with 1 min rest between. The time to complete each trial was recorded.
Data recordings
During tasks one and two, electromyographic activity (EMG) was recorded with surface electrodes (Ag–AgCl, 10 mm in diameter) over the muscle belly (active) and tendon (reference) of the first dorsal interosseus muscle (FDI; inter-electrode distance: 3 cm). Data were sampled at 2000 Hz with a data acquisition system (CED 1902 Amplifier and Power 1401 Interface) and specialized software (Spike2; Cambridge Electronic Design, Cambridge, UK). Surface EMG was amplified (x300) and band-pass filtered (2nd order Butterworth filter, 20–1000 Hz). Force and acceleration signals were sampled at 400 Hz using the same data acquisition system. The signals were amplified (force: x1000; acceleration: x3) and low-pass filtered (2nd order Butterworth filter, 100 Hz).
Data Analysis
The grip and lift task (task one) was divided into two phases: lift (dynamic) phase and hold (stationary) phase. The lift phase was defined as the period between 0 s (lift onset) and 1.5 s and the hold phase was defined as the period between 1.5 s and 2.5 s. A total of 15 parameters were measured in the lift phase and three parameters were measured in the hold phase. The variety of parameters provided information about grip strategy, kinetics and kinematics of the lifting movement, and coupling between grip force and lift force. In the lift phase, grip and lift onset were determined by first applying a 20 Hz low-pass filter to the raw data followed by calculation of the rate of change in grip force (dGF/dt) and lift force (dLF/dt). Onset was defined as the time of the initial rise in the force derivative (above the noise level) that initiated the rise to the maximum derivative. This procedure was used because the change in lift force represents the first measurable mechanical event in lifting the object. Grip onset relative to lift onset (termed 'preload duration') and maximum rate of change in force (dGF/dtmax and dLF/dtmax) were also measured. The temporal relationship between grip force and lift force was assessed by cross-correlation of the rate of change in grip force (dGF/dt) and lift force (dLF/dt) [28]. dLF/dt was shifted in increments of 2.5 ms (sampling resolution) relative to dGF/dt until the maximum cross-correlation coefficient (ρ) was obtained (IBM SPSS Statistics 20, Armonk NY, USA). The time shift required to achieve the maximum cross-correlation coefficient represents the time difference between the change in lift force and the change in grip force, and is an index of whether the grip strategy was primarily anticipatory (i.e. grip force leads lift force, negative time shift) or reactive (i.e. grip force lags lift force, positive time shift). Other parameters that were measured in the lift phase include peak force and acceleration, time-to-peak force and acceleration, minimum lift force (degree of downward push before lifting the object), and root mean square (RMS) EMG, all of which were measured from raw traces. In the hold phase, mean grip force, grip force coefficient of variation (%), and RMS EMG were measured from raw traces. For brief MVCs, mean grip force and RMS EMG was measured over a 1 s period.
Statistical analysis
Group data are presented as means ± standard deviation in the text and mean ± standard error of the mean in figures. One-way ANOVA was used to compare subject characteristics, MVC force, alcohol and tobacco use between groups. Non-parametric data were transformed to ranks and one-way ANOVA on ranks were performed. Post hoc discrimination was made with a Bonferroni procedure. Independent Student's t-test was used for between-group comparison (stimulant versus cannabis) of cannabis use and the score on the agitation and irritability questions of the BDI–II. For task one and three, group data were analysed with two-way repeated measures ANOVA with gender as a covariate for comparison of group (control, stimulant, cannabis; between-subject factor) and trial (one, two, three; within-subject factor). Mauchly's test of sphericity was performed and the Greenhouse–Geisser method was used to correct for non-sphericity (IBM SPSS Statistics 20, Armonk NY, USA). Post hoc discrimination was made with a sequential Bonferroni procedure. Spearman Rank Order correlation was used to investigate the relationship between peak grip force and drug-use characteristics (trial one only) in the stimulant group. The relation between peak grip force and maximum rate of grip force application (dGF/dtmax) was investigated with linear regression analysis (SigmaPlot 11.0; Systat Software Inc, San Jose CA, USA). Statistical significance was set at P<0.05.
Subject characteristics
Table 1 shows the characteristics of each group. There was a significant main effect of group on age (F2,62 = 6.982, P = 0.002), symptoms of depression (F2,62 = 4.681, P = 0.013), and lifetime alcohol (F2,62 = 23.483, P<0.001) and tobacco use (F2,62 = 16.142, P<0.001). The age of subjects in the stimulant group (29±8 yrs) was higher than subjects in the non-drug control group (25±8 yrs; P = 0.032) and cannabis group (22±5 yrs; P = 0.002) but the groups were well matched for years of education. Subjects in the stimulant group (P = 0.014) reported more symptoms of depression (BDI–II score) than subjects in the non-drug control group but symptoms of depression did not differ between the drug using groups. The score on the agitation (0.55±0.60 vs 0.59±0.71) and irritability (0.64±0.66 vs 0.29±0.77) questions of the BDI–II also did not differ between the stimulant and cannabis groups. All subjects exhibited normal neuropsychological performance and performance on the neuropsychological tests did not significantly differ between groups. As expected, use of alcohol and tobacco differed between groups (P<0.001). Lifetime use of alcohol and tobacco was greatest in the stimulant group and least in the non-drug control group (P<0.001).
Table 2 shows history of illicit drug use in the stimulant and cannabis groups. In the stimulant group, ecstasy was the most commonly used stimulant but, use of methamphetamine was more frequent (i.e. number of occasions). Duration of abstinence from any stimulant drug ranged from 3 days to 15 yrs (mean: 1.9±4.0 yrs, median: 1.5 months) and the average duration of abstinence from ecstasy and amphetamines was 2.4±4.0 yrs (median: 8 months) and 5.6±7.8 yrs (median: 1.6 yrs), respectively. As expected, use of other classes of drugs (poly-drug use) was common. All subjects in the stimulant group reported prior use of cannabis and the average duration of abstinence from cannabis did not differ between the stimulant (mean: 73±102 days; median: 45 days) and cannabis (mean: 315±500 days; median: 30 days) groups. A large percentage of subjects in the stimulant group reported prior use of hallucinogens (primarily lysergic acid diethylamide or 'LSD') but use of hallucinogens was less common in the cannabis group. Illicit use of sedatives and opiates was minimal. Five subjects in total (three in the stimulant group) had a positive urine screen for cannabis, but none of the subjects reported cannabis use in the 12 hrs prior to testing.
Object grip and lift
Examples of raw data from one control subject and one stimulant subject are shown in Fig. 2A and B, respectively. Grip force and lift force increased in parallel before the object moved. After the object began to move (increase in acceleration), grip force and lift force continued to increase until reaching a peak. Grip force then decreased slightly and plateaued while the object was held stationary. The magnitude of the plateau in grip force was ∼2.5 times that of lift force, indicating a large safety margin to prevent slipping. Examples of the temporal characteristics of grip force and lift force are shown in Figs. 2C and D. Data in Fig. 2 suggest that the stimulant subject performed the task with a higher grip force and rate of grip force application than the control subject.
A and B) Raw traces of first dorsal interosseus EMG (top panel), grip force (2nd panel), lift force (3rd panel), and acceleration (bottom panel). The task was divided into two phases: lift (dynamic) phase and hold (stationary) phase. The lift phase ranged from 0 s (lift onset) to 1.5 s and the hold phase ranged from 1.5 to 2.5 s. C and D) Temporal characteristics of grip force and lift force. The derivative of grip force (i.e. dGF/dt, inset) was correlated with the derivative of lift force (dLF/dt) and the resultant cross-correlogram is shown. Vertical dashed lines in C and D represent the time shift required to achieve the maximal cross-correlation coefficient.
Fig. 3 shows group data for peak grip force during the lift phase. There was a significant main effect of trial on peak grip force (raw: F2,124 = 8.822, P = 0.001; normalised: F2,124 = 3.968, P = 0.021). Peak grip force decreased from trial one to trials two and three (P<0.025). Peak grip force did not significantly differ between groups but there was a significant group-by-trial interaction. The interaction reached statistical significance for raw peak grip force (F4,124 = 2.574, P = 0.049) but not normalised peak grip force (%MVC; F4,124 = 2.338, P = 0.059). In trial one, peak grip force was significantly greater in the stimulant group than in the two control groups (P<0.022) but, peak grip force did not differ between the two control groups. In the stimulant group, there was no significant correlation between peak grip force and a) lifetime stimulant use (number of occasions), b) duration of abstinence from stimulant use, c) lifetime alcohol use, d) lifetime tobacco use, and e) lifetime cannabis use.
Peak grip force (black symbols) and lift force (white symbols) are shown for trials one to three. A) Non-drug control group. B) Stimulant group. C) Cannabis group. * Significantly different from non-drug control group (P = 0.022) and cannabis group (P = 0.013).
Fig. 3 also shows group data for peak lift force. Peak lift force did not differ between trials or groups but, there was a significant main effect of group on minimum lift force (F2,62 = 4.347, P = 0.017). Minimum lift force was significantly larger in the stimulant group (−0.25±0.17 N) than in the non-drug control group (−0.21±0.18 N, P = 0.016) and cannabis group (−0.20±0.22 N, P = 0.025), but minimum lift force did not differ between the two control groups.
In the hold phase, mean grip and lift force did not differ between groups. Mean grip force also did not differ between trials but, a significant main effect of trial was observed for mean lift force (F2,124 = 11.371, P<0.001). Mean lift force tended to be lower in the stimulant group (3.34±0.06 N) and cannabis group (3.34±0.07 N) than in the non-drug control group (3.35±0.05 N) but post hoc analysis did not reach statistical significance (data not shown).
Fig. 4A–C shows group data for the maximum rate of change in force during the lift phase. There was a significant main effect of group but not trial on the maximum rate of change in grip force (dGF/dtmax: F2,62 = 3.516, P = 0.036) and lift force (dLF/dtmax: F2,62 = 3.892, P = 0.026). The maximum rate of change in grip force and lift force was significantly greater in the stimulant group than the non-drug control group (P = 0.016), but did not differ between the two control groups. A significant linear relation was observed between peak grip force and maximum rate of change in grip force for each group (assessed in trial one; P<0.001; Fig. 4D–F).
A–C) Group data (mean ± sem) for grip force (black symbols) and lift force (white symbols) in trials one to three for the A) non-drug control group, B) stimulant group, and C) cannabis group. D–F) Single-subject data showing the relationship between peak grip force and maximum rate of change in grip force in the D) non-drug control group, E) stimulant group, and F) cannabis group. Solid line shows result of linear regression analysis (P<0.001).
Fig. 5 shows group data for the temporal relation between grip and lift force (i.e. maximum cross-correlation coefficient). There was a significant main effect of trial on the maximum cross-correlation coefficient (F2,124 = 7.188, P<0.001). The maximum cross-correlation coefficient increased between trial one and trials two-three (P<0.025). However, the maximum cross-correlation coefficient did not differ between groups.
No other parameters differed between groups or trials.
Maximal voluntary pinch contraction
Force during the maximal voluntary pinch contraction differed between groups (F2,62 = 5.594, P = 0.006). Maximal force was significantly lower in the non-drug control group (53.3±15.4 N) than in the stimulant (64.7±20.3 N; P = 0.026) and cannabis (65.8±17.9 N; P = 0.015) groups. However, maximal force did not differ between the two drug groups.
Grooved pegboard
There was a significant main effect of trial on the grooved pegboard test (F2,124 = 14.511, P<0.001). Performance time decreased between trial one (64.7±11.2 s) and trials two (57.6±8.9 s; P = 0.017) and three (55.1±8.3 s; P = 0.025). However, performance did not differ between groups.
Object manipulation tasks were used to investigate hand function in adults with a history of illicit stimulant use. The results of our study show, for the first time, that individuals with a history of illicit stimulant use employ a different strategy to manipulate novel objects than non-stimulant users.
When lifting a novel object (i.e. trial one), individuals with a history of illicit stimulant use generate a significantly larger grip force than non-stimulant users. The grip force measured in individuals with a history of stimulant use was 25% and 37% larger than that measured in non-drug users and cannabis users, respectively. This suggests that individuals with a history of stimulant use overestimate the amount of grip force required to lift a novel object and consequently, manipulate new objects in a less efficient manner and with a higher safety margin for error. The higher rate of grip force application observed in stimulant users could also conceivably lead to inaccuracy of fine movements, but this was not evident during the grooved pegboard test.
Previous research suggests that estimation of grip force is determined largely prior to contact with a novel object. It is thought to involve an internal model that is based on the physical properties of the object, prior experience, sensory feedback, and the individual's safety margin to prevent slip [9], [8]. Our results suggest that this internal model may be altered in individuals with a history of illicit stimulant use.
The overestimation of grip force during manipulation of novel objects was observed in a population of stimulant users that had largely not used stimulant drugs for several months (mean: 1.9±4.0 yrs, median: 1.5 months). This suggests that overestimation of grip force may be a long-lasting consequence of illicit stimulant use. It is unclear if recovery occurs over time but the lack of a correlation between grip force and duration of abstinence is a worrying finding.
The overestimation of grip force required to lift a novel object in individuals with a history of illicit stimulant use was not related to strength of the muscles involved in the task. Maximal strength in the stimulant group was comparable to that of the cannabis group, yet cannabis users did not exhibit augmented grip force during manipulation of a novel object. It is unclear why a significant difference in maximal pinch grip was observed between the drug using and non-drug using groups. There does not appear to be an acute effect of amphetamine or cannabis use on maximal grip strength in healthy adults [29], [30] and there is no prior evidence for long lasting effects of these drugs on maximal grip force. Future studies will investigate this finding further.
Between group differences in the grip force used to lift a novel object was observed in trial one but not in trials two and three. This suggests that individuals with a history of illicit stimulant use are able to correct their mistake and perform the task in a similar manner to control subjects in subsequent trials. Thus, grip force adaptation and learning of this task appear to be preserved in individuals with a history of stimulant use. This may explain why performance on the grooved pegboard test, involving 25 consecutive peg placements, was unaltered in the stimulant group. Normal performance on the grooved pegboard test also suggests that movement speed, and possibly sensorimotor processing, are unaffected in individuals with a history of stimulant use.
The underling mechanism responsible for over-estimation of grip force during manipulation of novel objects in the stimulant group is difficult to identify. The effect is unlikely to be associated with cannabis use, neuropsychological factors, age, and peak lift force. Evidence that support this view is inclusion of a cannabis control group comprising individuals with a history of cannabis use but no history of illicit stimulant use. Over-estimation of grip force was not observed in the cannabis group and peak grip force was significantly larger in the stimulant group than in the cannabis group during trial one. Second, all subjects in the current study exhibited normal performance on tests of memory and cognition and, neuropsychological performance did not differ between groups. Furthermore, symptoms of depression (quantified with the BDI–II) did not differ between the stimulant and cannabis groups. Acute nervousness and anxiety were not measured in the current study but are unlikely to have differed between the stimulant and cannabis groups given that the response to the agitation and irritability questions on the BDI–II did not significantly differ between the drug using groups. Third, the age of subjects in the stimulant group (29±8 yrs) was higher than subjects in the non-drug control group (25±8 yrs) and cannabis group (22±5 yrs) but, peak grip force in the grip and lift task does not differ between healthy adults aged 18–30 yrs and 50–65 yrs [31]. However, one can only speculate about other contributing factors due to methodological limitations associated with all studies on illicit drug use in humans. The two most important limitations are poly-drug use (i.e. use of more than one psychoactive drug, e.g. Table 2) [2] and uncertainty surrounding the composition of ingested drugs.
Past use of illicit drugs is likely to have contributed to overestimation of grip force in the stimulant group. The word 'past' is important here because subjects were not under the influence of a drug at the time of testing. Stimulants, opiates, and benzodiazepines were not present in urine samples obtained from subjects in the stimulant group and only 3 of the 22 subjects tested positive for cannabis (consumed 1 day prior to the experiment). Identification of the exact drug responsible is difficult in humans. In the current study, the most commonly used illicit stimulant drugs were methamphetamine (192±316 occasions) and ecstasy (75±121 occasions) but use of cannabis (2,246±2,770 occasions) and hallucinogens (60±154 occasions, mainly LSD) was also common. Furthermore, subjects in the stimulant group consumed more alcohol than subjects in the control groups. Increased consumption of alcohol is not unexpected as high levels of alcohol and tobacco use are well documented in this population [32]. However, the average rate of alcohol consumption in the stimulant group was well below the level that would induce brain damage. The dose of licit and illicit drugs is also likely to be important but only four subjects reported experiencing a drug overdose.
Of the drugs consumed, illicit stimulants are most likely to affect hand function due to their mechanism of action. There are a number of lines of evidence to support this view. Amphetamine, methamphetamine, and cocaine damage dopaminergic nerve terminals and chronic use of amphetamines is associated with long-lasting dopaminergic dysfunction [12], [33]. Animal and human studies also document changes in brain regions that control movement. Methamphetamine administration is associated with altered substantia nigra morphology in vervet monkeys [34] and adult humans with a history of illicit stimulant use also exhibit changes in this brain region [4]. Overestimation of grip force also occurs in patients newly diagnosed with Parkinson's disease [16], a disease characterized by neurodegeneration of dopaminergic neurons in the substantia nigra [35]. History of illicit stimulant use is also associated with abnormal excitability in corticospinal projections to the hand of conscious humans [3] but the effect of illicit stimulant use on peripheral afferent input has not been investigated. These sorts of neurological changes may have functional consequences given that tremor during finger movement is abnormally large in individuals with a history of ecstasy use [5] and previous studies report impaired performance on the grooved pegboard test [36], [7], [6]. However, the latter finding was not replicated in the current study. Illicit stimulant drugs could act in isolation on hand function or they could interact with other licit and illicit drugs to alter performance.
In summary, our results suggest that individuals with a history of primarily methamphetamine and ecstasy use overestimate the grip force required to manipulate a novel object. The results provide additional evidence for an under recognized consequence of illicit stimulant use, movement dysfunction.
The authors would like to thank Drug and Alcohol Services South Australia for assistance with recruitment of volunteers.
Author Contributions
Conceived and designed the experiments: GT JMW. Performed the experiments: VPD GT SCF. Analyzed the data: GT VPD SCF RAW DT APV JMW. Wrote the paper: GT VPD. Interpretation of data: GT VPD SCF RAW DT APV JMW. Revision of manuscript: GT VPD SCF RAW DT APV JMW. Final approval of manuscript: GT VPD SCF RAW DT APV JMW.
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Do you remember the old Andre Agassi commercial for Canon Rebel camera?
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