Effect of Temperature and H Flux on the NH3 Synthesis via Electrochemical Hydrogen Permeation.

Ammonia is an indispensable commodity and a potential carbon free energy carrier. The use of H permeable electrodes to synthesize ammonia from N2 , water and electricity, provides a promising alternative to the fossil fuel based Haber-Bosch process. Here, H permeable Ni electrodes are investigated in the operating temperature range 25-120 °C, and varying the rate of electrochemical atomic hydrogen permeation. At 120 °C, a steady reaction is achieved for over 12 h with 10 times higher cumulative NH3 production and almost 40-fold increase in faradaic efficiency compared to room temperature experiments. NH3 is formed with a cell potential of 1.4 V, corresponding to a minimum electrical energy investment of 6.6 kWh kg-1 NH 3 ${{_{{\rm NH}{_{3}}}}}$ . The stable operation is attributed to a balanced control over the population of N, NHx and H species at the catalyst surface. These findings extend the understanding on the mechanisms involved in the nitrogen reduction reaction and may facilitate the development of an efficient green ammonia synthesis process.

The RL13 Temperance Factor Represses Replication of the Highly Cell Culture-Adapted Towne Strain of Human Cytomegalovirus.

Human cytomegalovirus (CMV) has evolved to replicate while causing minimal damage, maintain life-long latency, reactivate sub-clinically, and, in spite of robust host immunity, produce and shed infectious virus in order to transmit to new hosts. The CMV temperance factor RL13 may contribute to this strategy of coexistence with the host by actively restricting viral replication and spread. Viruses with an intact RL13 gene grow slowly in cell culture, release little extracellular virus, and form small foci. By contrast, viruses carrying disruptive mutations in the RL13 gene form larger foci and release higher amounts of cell-free infectious virions. Such mutations invariably arise during cell culture passage of clinical isolates and are consistently found in highly adapted strains. The potential existence in such strains of other mutations with roles in mitigating RL13's restrictive effects, however, has not been explored. To this end, a mutation that frame shifts the RL13 gene in the highly cell culture-adapted laboratory strain Towne was repaired, and a C-terminal FLAG epitope was added. Compared to the frame-shifted parental virus, viruses encoding wild-type or FLAG-tagged wild-type RL13 produced small foci and replicated poorly. Within six to ten cell culture passages, mutations emerged in RL13 that restored replication and focus size to those of the RL13-frame-shifted parental virus, implying that none of the numerous adaptive mutations acquired by strain Towne during more than 125 cell culture passages mitigate the temperance activity of RL13. Whilst RL13-FLAG expressed by passage zero stocks was localized exclusively within the virion assembly compartment, RL13-FLAG with a E208K substitution that emerged in one lineage was mostly dispersed into the cytoplasm, suggesting that localization to the virion assembly compartment is likely required for RL13 to exert its growth-restricting activities. Changes in localization also provided a convenient way to assess the emergence of RL13 mutations during serial passage, highlighting the usefulness of RL13-FLAG Towne variants for elucidating the mechanisms underlying RL13's temperance functions.

Active Cigarette Smoking Is Associated With Increased Age-Related Decline on Measures of Visuospatial Learning and Memory and Executive Function in Alcohol Use Disorder.

AIMS: The goal of this study was to determine if active cigarette smoking in Veterans with alcohol use disorder (AUD) was associated with greater age-related neurocognitive decline. METHODS: Veterans with AUD, in residential treatment (n = 125; 47 ± 14 years of age, min = 24, max = 76, 29 ± 26 days of abstinence), completed measures of executive functions, learning and memory, processing speed and working memory. Actively smoking AUD (AsAUD, n = 47) were active daily cigarette smokers; former smoking AUD (FsAUD, n = 45) were predominately daily smokers prior to study but did not smoke at the time of study; non-smoking AUD (NsAUD, n = 33) never used cigarettes or smoked 'only a few times' during lifetime. RESULTS: AsAUD demonstrated greater age-related decline on measures of visuospatial learning and memory, and response inhibition/cognitive flexibility, primarily relative to NsAUD; there were no age-related differences between FsAUD and NsAUD on any measure. There were few significant mean differences between groups across the 15 neurocognitive measures. In AsAUD, higher scores on indices of smoking severity were associated with poorer performance on measures of auditory-verbal learning and memory, response inhibition, set-shifting and working memory. In FsAUD, longer smoking cessation duration was related to lower PTSD, anxiety and depressive symptomatology. CONCLUSIONS: Active smoking was associated with accelerated age-related decline on cognitive functions implicated in response to common evidence-based AUD interventions. Results suggest that smoking history contributes to the considerable heterogeneity observed in neurocognitive function in early AUD recovery, and reinforce the clinical movement to offer smoking cessation resources concurrent with treatment for AUD.

New temperance movements across the cinemas of Canada.

This essay presents three film examples from across the cinemas of Canada which grapple with the politics of sobriety amidst unique cultural contexts: Werewolf (Ashley McKenzie, 2016) broaches the topic of opioid addiction on Cape Breton Island; Love in the Time of Civil War (Rodrigue Jean, 2014) of drug addiction on the streets of Montreal; and The Honour of All (Phil Lucas, 1992), the history of alcoholism on Esk'etemec First Nation in British Columbia. The narratives, aesthetics and modes of production of each film are analysed with an eye towards how they advance a new temperance sensibility that is non-prohibitionist, non-universalist and non-moralist. The three films are positioned within a canon of Canadian films about alcohol and substance misuse, as well as within a broader set of new temperance initiatives found in Canadian society at large. By selecting one film each from an English-Canadian, Acadian-Québécois and First Nations milieu, this paper proposes that their diffuse affinity for surviving addiction offers a means of organizing Canadian cultural studies for reasons other than national belonging, and conceives of temperance as an autonomous movement distinct from state-based public health solutions.

Psychometric Properties of the Multidimensional Temperance Scale in Adolescents.

Recent research has shown the relevance of measuring the virtue of temperance. The present study tested a multidimensional and second-order structure scale to assess temperance using a sub-scale of the Values in Action Inventory of Strengths for Youth (VIA-Youth). Scale properties were tested using data from a sample of 860 adolescents aged from 12 to 18 years old (M = 14.28 years, SD = 1.65). The sample was randomly split into two subsamples for model cross-validation. Using the first sample, we assessed scale dimensionality, measurement invariance, and discriminant and concurrent validity. A second sample was used for model cross-validation. Confirmatory factorial analysis confirmed the fit of one second-order factor temperance virtue model, with the dimensions of forgiveness, modesty, prudence, and self-control. The results indicate scale measurement equivalence across gender and stage of adolescence (early vs. middle). Latent means difference tests showed significant differences in forgiveness, modesty, and self-regulation by gender, and modesty according to adolescence stage. Moreover, the scale showed discriminant and concurrent validity. These findings indicate that this scale is helpful for assessing temperance in adolescents and suggest the value of temperance as a multidimensional and second-order construct.

Effects of Combined Varenicline With Nicotine Patch and of Extended Treatment Duration on Smoking Cessation: A Randomized Clinical Trial.

Importance: Smoking cessation medications are routinely used in health care. Research suggests that combining varenicline with the nicotine patch, extending the duration of varenicline treatment, or both, may increase cessation effectiveness. Objective: To compare combinations of varenicline plus the nicotine or placebo patch vs combinations used for either 12 weeks (standard duration) or 24 weeks (extended duration). Design, Settings, and Participants: Double-blind, 2 × 2 factorial randomized clinical trial conducted from November 11, 2017, to July 9, 2020, at 1 research clinic in Madison, Wisconsin, and at 1 clinic in Milwaukee, Wisconsin. Of the 5836 adults asked to participate in the study, 1251 who smoked 5 cigarettes/d or more were randomized. Interventions: All participants received cessation counseling and were randomized to 1 of 4 medication groups: varenicline monotherapy for 12 weeks (n = 315), varenicline plus nicotine patch for 12 weeks (n = 314), varenicline monotherapy for 24 weeks (n = 311), or varenicline plus nicotine patch for 24 weeks (n = 311). Main Outcomes and Measures: The primary outcome was carbon monoxide-confirmed self-reported 7-day point prevalence abstinence at 52 weeks. Results: Among 1251 patients who were randomized (mean [SD] age, 49.1 [11.9] years; 675 [54.0%] women), 751 (60.0%) completed treatment and 881 (70.4%) provided final follow-up. For the primary outcome, there was no significant interaction between the 2 treatment factors of medication type and medication duration (odds ratio [OR], 1.03 [95% CI, 0.91 to 1.17]; P = .66). For patients randomized to 24-week vs 12-week treatment duration, the primary outcome occurred in 24.8% (154/622) vs 24.3% (153/629), respectively (risk difference, -0.4% [95% CI, -5.2% to 4.3%]; OR, 1.01 [95% CI, 0.89 to 1.15]). For patients randomized to varenicline combination therapy vs varenicline monotherapy, the primary outcome occurred in 24.3% (152/625) vs 24.8% (155/626), respectively (risk difference, 0.4% [95% CI, -4.3% to 5.2%]; OR, 0.99 [95% CI, 0.87 to 1.12]). Nausea occurrence ranged from 24.0% to 30.9% and insomnia occurrence ranged from 24.4% to 30.5% across the 4 groups. Conclusions and Relevance: Among adults smoking 5 cigarettes/d or more, there were no significant differences in 7-day point prevalence abstinence at 52 weeks among those treated with combined varenicline plus nicotine patch therapy vs varenicline monotherapy, or among those treated for 24 weeks vs 12 weeks. These findings do not support the use of combined therapy or of extended treatment duration. Trial Registration: ClinicalTrials.gov Identifier: NCT03176784.

Integrative data analysis of self-efficacy in 4 clinical trials for alcohol use disorder.

BACKGROUND: Self-efficacy has been proposed as a key predictor of alcohol treatment outcomes and a potential mechanism of success in achieving abstinence or drinking reductions following alcohol treatment. Integrative data analysis, where data from multiple studies are combined for analyses, can be used to synthesize analyses across multiple alcohol treatment trials by creating a commensurate measure and controlling for differential item functioning (DIF) to determine whether alcohol treatments improve self-efficacy. METHOD: The current study used moderated nonlinear factor analysis (MNLFA) to examine the effect of treatment on self-efficacy across four different treatment studies (N = 3720; 72.5% male, 68.4% non-Hispanic white). Self-efficacy was measured using the Alcohol Abstinence Self-Efficacy Scale (AASE) in the COMBINE Study (n = 1383) and Project MATCH (n = 1726), and the Drug Taking Confidence Questionnaire (DTCQ) in two studies of Telephone Continuing Care (TEL Study 1: n = 303; TEL Study 2: n = 212). DIF was examined across time, study, treatment condition, marital status, age, and sex. RESULTS: We identified 12 items from the AASE and DTCQ to create a commensurate measure of self-efficacy using MNLFA. All active treatments, including cognitive-behavioral treatment, a combined behavioral intervention, medication management, motivation enhancement treatment, telephone continuing care, twelve-step facilitation, and relapse prevention, were associated with significant increases in self-efficacy from baseline to posttreatment that were maintained for up to a year. Importantly, treatment as usual in community settings, which consisted of weekly group therapy that included addiction counseling and twelve-step recovery support, was not associated with significant increases in self-efficacy. CONCLUSIONS: Alcohol self-efficacy increases following treatment and numerous evidence-based treatments are associated with significant increases in self-efficacy, which are maintained over time. Community treatment that focuses solely on addiction counseling and twelve-step support may not promote increases in self-efficacy.

Alcohol dependence severity determines the course of treatment-seeking patients.

BACKGROUND: While accumulating evidence suggests a relation between the severity of alcohol dependence and the risk of its recurrence, the impact of dependence severity on the course of the disorder has not been carefully evaluated. The present study examined the impact of several severity indices of alcohol dependence on the drinking course after inpatient treatment. METHODS: This prospective study was conducted over a 12-month period following alcohol treatment at a specialized hospital. A total of 712 consecutively admitted alcohol-dependent patients were targeted for enrollment at the time of their hospitalization, with 637 patients registered and followed. The characteristics and severity of the subjects were assessed using multiple methods at admission, with their course after discharge followed continuously using mailed questionnaires that queried them regarding their drinking behavior. RESULTS: Greater severity of dependence, assessed using the number of ICD-10 diagnostic criteria met, was associated with a lower rate of abstinence during the study period (p = 0.035). The rate of abstinence also decreased significantly as the baseline blood gamma-glutamyl transferase value and Alcohol Dependence Scale (ADS) score increased (p = 0.031 and p = 0.0002, respectively). In multivariate Cox proportional hazards analyses, the group with the most severe ADS scores had a significantly greater risk of relapse to drinking than the group with the least severe scores (HR = 2.67, p = 0.001). Dependence severity also associated with the drinking pattern; participants in both the controlled drinking group and the abstinence group had lower ADS scores at admission and a later age at first drinking (p = 0.001 and p < 0.001, respectively) than those with poorer drinking outcomes. CONCLUSIONS: The present study showed that more severe alcohol dependence predicts a poorer course after alcohol treatment, as reflected by findings on multiple measures. These results suggest that assessing the dependence severity at the outset of treatment could be useful both in predicting treatment outcome and targeting interventions to alcohol-dependent individuals who need additional support in their recovery.

Temperance, Feminism, and Phrenology in Lydia Fowler's Nora: The Lost and Redeemed.

In both the U.S. and Britain, Dr. Lydia Fowler was a leader in women's political and health reform organizations and temperance associations. Her publications, which targeted a popular audience of women and children, included self-help medical lectures and guides, a book of poetry, and the temperance novel Nora: The Lost and Redeemed (1853). Nora represents the broader political fight surrounding temperance, but also the medical arguments about alcohol abuse itself. Fowler's phrenological writings, including Nora, served as a bridge between the nineteenth-century construction of "intemperance" as a moral failing and the disease model of "alcoholism" that came to dominate medicine in the early twentieth century. With Nora, Fowler employs the power and reach of Victorian fiction to dramatize the dangers of alcohol and the hopeful remedies of feminist-driven reform.

Assessment of Changes in Alcohol and Marijuana Abstinence, Co-Use, and Use Disorders Among US Young Adults From 2002 to 2018.

Importance: Recent information on the trends in past-year alcohol abstinence and marijuana abstinence, co-use of alcohol and marijuana, alcohol use disorder, and marijuana use disorder among US young adults is limited. Objectives: To assess national changes over time in past-year alcohol and marijuana abstinence, co-use, alcohol use disorder, and marijuana use disorder among US young adults as a function of college status (2002-2018) and identify the covariates associated with abstinence, co-use, and marijuana use disorder in more recent cohorts (2015-2018). Design, Setting, and Participants: This study examined cross-sectional survey data collected in US households annually between 2002 and 2018 as part of the National Survey on Drug Use and Health. The survey used an independent, multistage area probability sample for all states to produce nationally representative estimates. The sample included 182 722 US young adults aged 18 to 22 years. The weighted screening and weighted full interview response rates were consistently above 80% and 70%, respectively. Main Outcomes and Measures: Measures included past-year abstinence, alcohol use, marijuana use, co-use, alcohol use disorder, marijuana use disorder, prescription drug use, prescription drug misuse, prescription drug use disorder, and other drug use disorders based on Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria. Results: The weighted sample comprised 51.1% males. Between 2002 and 2018, there was an annual increase in past-year alcohol abstinence among young adults (college students: 0.54%; 95% CI, 0.44%-0.64%; non-college students: 0.33%; 95% CI, 0.24%-0.43%). There was an annual increase in marijuana use from 2002 to 2018 (college: 0.46%; 95% CI, 0.37%-0.55%; non-college: 0.49%; 95% CI, 0.40%-0.59%) without an increase in marijuana use disorder for all young adults. Past-year alcohol use disorder decreased annually (college: 0.66%; 95% CI, 0.60%-0.74%; non-college: 0.61%; 95% CI, 0.55%-0.69%), while co-use of alcohol and marijuana increased annually between 2002 and 2018 among all young adults (college: 0.60%; 95% CI, 0.51%-0.68%; non-college: 0.56%; 95% CI, 0.48%-0.63%). Young adults who reported co-use of alcohol and marijuana or met criteria for alcohol use disorder and/or marijuana use disorder accounted for 82.9% of young adults with prescription drug use disorder and 85.1% of those with illicit drug use disorder. More than three-fourths of those with both alcohol use disorder and marijuana use disorder reported past-year prescription drug use (78.2%) and illicit drug use (77.7%); 62.2% reported prescription drug misuse. Conclusions and Relevance: The findings of this study suggest that US colleges and communities should create and maintain supportive resources for young adults as the substance use landscape changes, specifically as alcohol abstinence, marijuana use, and co-use increase. Interventions for polysubstance use, alcohol use disorder, and marijuana use disorder may provide valuable opportunities for clinicians to screen for prescription drug misuse.

Effect of Sustained Smoking Cessation Counseling and Provision of Medication vs Shorter-term Counseling and Medication Advice on Smoking Abstinence in Patients Recently Diagnosed With Cancer: A Randomized Clinical Trial.

Importance: Persistent smoking may cause adverse outcomes among patients with cancer. Many cancer centers have not fully implemented evidence-based tobacco treatment into routine care. Objective: To determine the effectiveness of sustained telephone counseling and medication (intensive treatment) compared with shorter-term telephone counseling and medication advice (standard treatment) to assist patients recently diagnosed with cancer to quit smoking. Design, Setting, and Participants: This unblinded randomized clinical trial was conducted at Massachusetts General Hospital/Dana-Farber/Harvard Cancer Center and Memorial Sloan Kettering Cancer Center. Adults who had smoked 1 cigarette or more within 30 days, spoke English or Spanish, and had recently diagnosed breast, gastrointestinal, genitourinary, gynecological, head and neck, lung, lymphoma, or melanoma cancers were eligible. Enrollment occurred between November 2013 and July 2017; assessments were completed by the end of February 2018. Interventions: Participants randomized to the intensive treatment (n = 153) and the standard treatment (n = 150) received 4 weekly telephone counseling sessions and medication advice. The intensive treatment group also received 4 biweekly and 3 monthly telephone counseling sessions and choice of Food and Drug Administration-approved cessation medication (nicotine replacement therapy, bupropion, or varenicline). Main Outcome and Measures: The primary outcome was biochemically confirmed 7-day point prevalence tobacco abstinence at 6-month follow-up. Secondary outcomes were treatment utilization rates. Results: Among 303 patients who were randomized (mean age, 58.3 years; 170 women [56.1%]), 221 (78.1%) completed the trial. Six-month biochemically confirmed quit rates were 34.5% (n = 51 in the intensive treatment group) vs 21.5% (n = 29 in the standard treatment group) (difference, 13.0% [95% CI, 3.0%-23.3%]; odds ratio, 1.92 [95% CI, 1.13-3.27]; P < .02). The median number of counseling sessions completed was 8 (interquartile range, 4-11) in the intensive treatment group. A total of 97 intensive treatment participants (77.0%) vs 68 standard treatment participants (59.1%) reported cessation medication use (difference, 17.9% [95% CI, 6.3%-29.5%]; odds ratio, 2.31 [95% CI, 1.32-4.04]; P = .003). The most common adverse events in the intensive treatment and standard treatment groups, respectively, were nausea (n = 13 and n = 6), rash (n = 4 and n = 1), hiccups (n = 4 and n = 1), mouth irritation (n = 4 and n = 0), difficulty sleeping (n = 3 and n = 2), and vivid dreams (n = 3 and n = 2). Conclusions and Relevance: Among smokers recently diagnosed with cancer in 2 National Cancer Institute-designated Comprehensive Cancer Centers, sustained counseling and provision of free cessation medication compared with 4-week counseling and medication advice resulted in higher 6-month biochemically confirmed quit rates. However, the generalizability of the study findings is uncertain and requires further research. Trial Registration: ClinicalTrials.gov Identifier: NCT01871506.

Implementation of two alcohol reduction interventions among persons with hazardous alcohol use who are living with HIV in Thai Nguyen, Vietnam: a micro-costing analysis.

BACKGROUND: Hazardous alcohol use is detrimental to persons with HIV (PWH), impacting medication adherence and liver function, yet globally resources to target alcohol use behavior in this population are limited. Few studies have identified the costs of integrating alcohol reduction interventions into HIV care. OBJECTIVE: To estimate the costs of implementing and delivering two evidence-based behavioral counseling interventions targeting hazardous alcohol use among persons with HIV and to estimate the costs of scale-up in ART clinics in Thai Nguyen, Vietnam. METHODS: We undertook a micro-costing approach to determine the costs of delivering two adapted evidence-based interventions to reduce alcohol use: an intensive combined cognitive behavioral therapy and motivational enhancement therapy-informed intervention (CoI) and an abbreviated brief alcohol intervention (BI). A total of 294 participants with hazardous alcohol use were identified through a brief screening tool and received the CoI (n = 147) and the BI (n = 147) over 3 months. We estimated costs using time and motion studies, budget analysis, staff interviews, and participant questionnaires. Data were collected from 2016 to 2018 in VND and converted to USD. RESULTS: The total cost of implementation and administration of the intervention to 147 participants receiving the CoI was $13,900 ($95 per participant) and to 147 participants receiving the BI was $5700 ($39 per participant). Implementation and startup costs including training accounted for 27% of costs for the CoI and 28% for the BI. Counselor costs accounted for a large proportion of both the CoI (41%) and the BI (30%). CONCLUSIONS: Implementing and delivering alcohol reduction interventions to people with HIV in Vietnam with appropriate fidelity is costly. These costs may be reduced, particularly counselor labor costs, by using an evidence-based brief intervention format. Future research should explore the budgetary impact of brief and combined interventions to reduce hazardous alcohol use, particularly among vulnerable populations.

Development and validation of Temperance Scale in Pakistan.

The purpose of the present research was to construct and validate a measure of temperance-one's capability of moderation or voluntary self-restraint. This research comprised two studies. In Study I, an item pool of 83 items was generated, 75 items were finalized by a committee of experts, and then these items were administered on a purposive sample of university students (n = 250). Exploratory factor analysis (EFA) revealed a four-factor solution with 24 items and the factors were named as Self-regulation (α = .72), Prudence (α = .71), Humility (α = .79), and Forgiveness (α = .73). Study II of the present research confirmed the factorial structure of the Temperance Scale in an independent sample of university students (n = 268). The Temperance Scale, Academic Procrastination Scale, and Empathy Quotient Short Form were administered to the participants. Confirmatory factor analysis of the Temperance Scale demonstrated a good model fit to the data with the same four factors as established during the EFA. The Temperance Scale was positively correlated with empathy and it had a nonsignificant relationship with academic procrastination. The results support that the newly developed scale has promising validity.

Relations Between Acute Effects of Alcohol on Response Inhibition, Impaired Control over Alcohol Use, and Alcohol-Related Problems.

BACKGROUND: Alcohol consistently impairs response inhibition in the laboratory, and alcohol impairment of response inhibition may lead to excess consumption or increases in intoxicated risk behavior, both of which contribute to risk for alcohol-related problems. To our knowledge, no prior studies have examined relations between alcohol impairment of response inhibition and either impaired control over alcohol (i.e., inability to adhere to predetermined drinking limits) or real-world alcohol-related problems. The current study addressed this gap in the literature. METHODS: Young adult social drinkers (N = 215, 76% male) participated in a between-subjects, placebo-controlled alcohol challenge study and completed self-reports approximately 2 weeks later. Multilevel models were used to examine the hypothesis that alcohol impairment of response inhibition would indirectly lead to alcohol-related problems through impaired control over alcohol use. RESULTS: Greater alcohol-induced impairment of response inhibition and impaired control over alcohol use were both significant predictors of alcohol-related problems. However, greater alcohol-induced response inhibition was not a significant predictor of impaired control over alcohol use. CONCLUSIONS: To our knowledge, this is the first study demonstrating relationships between alcohol impairment of response inhibition and real-world alcohol-related problems and the first to address relationships between alcohol impairment of response inhibition and impaired control over alcohol use. These results suggest that impaired control over alcohol use may result from deficits in the trait ability to control behavior rather than deficits in alcohol-induced response inhibition. Regardless, results suggest that alcohol impairment of response inhibition and impaired control over alcohol are both worthwhile intervention targets.

Lifecourse Drinking Patterns, Hypertension, and Heart Problems Among U.S. Adults.

INTRODUCTION: Understanding the role of alcohol in hypertension and heart problems requires a lifecourse perspective accounting for drinking patterns before onset of health problems that distinguishes between lifetime abstinence and former drinking, prior versus current drinking, and overall alcohol consumption in conjunction with heavy episodic drinking. Using prospective data among U.S. adults aged 21-55 years, this study accounts for these lifecourse factors to investigate the effect of alcohol on hypertension and heart problems. METHODS: Data from the U.S. National Longitudinal Survey of Youth, aged 14-21 years in 1979 and followed through 2012 (n=8,289), were analyzed in 2017-18 to estimate hypertension and heart problems onset from lifecourse drinking patterns. Discrete-time survival models stratified by sex and race/ethnicity, controlling for demographics and time-varying factors of employment, smoking, and obesity. RESULTS: Elevated risks for hypertension were found for women drinking >14 drinks/week regardless of any heavy drinking (AOR=1.57, p=0.023) and for men engaged in risky drinking (15-28 drinks/week) together with monthly heavy drinking (AOR=1.64, p=0.016). Having a history of weekly heavy drinking elevated the risk for women but not for men. No significant relationship was evident for alcohol and heart problems onset. CONCLUSIONS: This study confirms previous findings of increased hypertension risk from higher volume and heavier drinking patterns among women and men but did not find any support for increased heart problems risk, which may be due to the younger age profile of the sample. Further research that incorporates lifecourse drinking patterns is needed to better understand the alcohol-health relationship.

The development and validation of a human screening model of tobacco abstinence.

INTRODUCTION: Given the low efficacy of smoking cessation methods, an experimental medicine model indicating smoking abstinence would be of great benefit to the development of new treatments. Hence the sensitivity of cognitive tasks and ambulatory craving measures to smoking abstinence were investigated. METHODS: Cognitive tasks and ambulatory ratings of craving were assessed for sensitivity to acute abstinence (experiment 1), and nicotine replacement therapy administration (NRT) (experiment 2). RESULTS: In experiment 1 go/no-go performance was improved (Mean Difference [MD] -0.99, 95% CI: -1.90 to -0.08) and craving was lower (Regression Coefficient [RC] -33.39, 95% CI: -39.96 to -26.82) in satiated compared with abstinent smokers. There was no clear evidence that N-back (MD 0.64, 95% CI: -0.42 to 2.51), delay discounting (MD 0.01, 95% CI: 0.001 to 0.005) or dot probe performance (MD 0.61, 95% CI: -0.87 to 1.54) were sensitive to acute abstinence. In experiment 2 go/no-go performance was improved (MD 1.12, 95% CI: 0.16-2.08) and craving was lower (RC -18.59, 95% CI: -24.63 to -12.55) smokers abstinent overnight receiving NRT compared with placebo. There was no clear evidence that N-back (MD -0.25, 95% CI: -1.45 to 0.94), delay discounting (MD 0.01, 95% CI: -0.002 to 0.004) or dot probe performance (MD -0.49, 95% CI: -1.61 to -0.64) were sensitive to NRT. CONCLUSIONS: Findings from two experiments converge to suggest that abstinence in smokers reliably increases ambulatory craving assessments and, to a lesser extent, decreases go/no-go task performance. These findings can be utilized in the development of an experimental medicine model to test novel treatments for smoking cessation.

Decision making of individuals with heroin addiction receiving opioid maintenance treatment compared to early abstinent users.

BACKGROUND AND AIMS: Individuals with heroin addiction are prone to dysfunctional decision-making. They frequently choose the short-term rewarding option of drug intake despite experiencing long-term negative consequences. Opioid maintenance treatment (OMT) is the most common treatment of heroin addiction. METHODS: In this study, 38 individuals in an early stage of abstinence from heroin addiction (ESA-HA individuals) at the end of inpatient detoxification treatment and 41 individuals in long-term OMT were examined. Decision-making was assessed by (I) a modified version of the Iowa Gambling Task (IGT) with drug-related stimuli focusing on decision-making under ambiguity and (II) the Game of Dice Task (GDT) assessing decision-making under objective risk. RESULTS: OMT-individuals showed significantly better performance in the IGT than the ESA-HA-individuals. They also showed significantly less craving under exposure of drug-related pictures. In the GDT, OMT-individuals showed significantly less risky decision-making than ESA-HA-individuals. CONCLUSION: The results suggest that patients receiving OMT show better functional decision-making and lower craving reactions. It could be assumed that the effectiveness of OMT in preventing relapse is linked to better decision-making and lower craving among these patients.

Temperance, Moral Friendship, and Smoking Cessation.

The predominant approach of public health experts to cigarette smoking might be described as behaviorist, for it aims to eliminate this behavior without attending to human agency and intention. The requirement that physicians address smoking cessation at every patient visit also constitutes physicians as "managers" who focus narrowly on technical means to achieve predetermined ends. In this paper, I contrast such an approach with the Aristotelian tradition, according to which physician and patient ought to develop the virtue of temperance that would allow the patient to quit smoking. Although this model could potentially mitigate medicine's behaviorist-managerial tendencies, I follow Aristotle to argue that it requires a moral friendship in which participants share a conception of the human good and pursue that good together. Due to the intractable moral pluralism that characterizes contemporary life, physicians and patients are unlikely to achieve this sort of friendship, making Aristotelian medicine impracticable at present.