Muscle in the caterpillar Manduca sexta responds to an immune challenge, but at a cost, suggesting a physiological trade-off.

Although skeletal muscle is a specialized tissue that provides the motor for movement, it also participates in other functions, including the immune response. However, little is known about the effects of this multitasking on muscle. We show that muscle loses some of its capacity while it is participating in the immune response. Caterpillars (Manduca sexta) were exposed to an immune challenge, predator stress or a combination of immune challenge and predator stress. The expression of immune genes (toll-1, domeless, cactus, tube and attacin) increased in body wall muscle after exposure to an immune challenge. Muscle also showed a reduction in the amount of the energy storage molecule glycogen. During an immune challenge, the force of the defensive strike, an important anti-predator behaviour in M. sexta, was reduced. Caterpillars were also less able to defend themselves against a common enemy, the wasp Cotesia congregata, suggesting that the effect on muscle is biologically significant. Our results support the concept of an integrated defence system in which life-threatening events activate organism-wide responses. We suggest that increased mortality from predation is a non-immunological cost of infection in M. sexta. Our study also suggests that one reason non-immunological costs of infection exist is because of the participation of diverse organs, such as muscle, in immunity.

Alcohol Use Severity among Hispanic Emerging Adults: Examining Intragroup Marginalization, Bicultural Self-Efficacy, and the Role of Gender within a Stress and Coping Framework.

Most research on cultural stressors and alcohol has focused on intercultural stressors. Continuing to exclude intracultural stressors (e.g., intragroup marginalization) from alcohol research will yield a biased understanding of the experiences of Hispanics living in a bicultural society. As we amass more studies on intracultural stressors, research will be needed to identify mutable sociocultural factors that may mitigate the association between intracultural stressors and alcohol. To address these limitations, we examined the association between intragroup marginalization and alcohol use severity and the extent to which gender and bicultural self-efficacy may moderate this association. A convenience sample of 200 Hispanic emerging adults ages 18-25 (men = 101, women = 99) from Arizona (n = 99) and Florida (n = 101) completed a cross-sectional survey. Data were analyzed using hierarchical multiple regression and moderation analyses. Higher intragroup marginalization was associated with higher alcohol use severity. Gender functioned as a moderator whereby intragroup marginalization was associated with higher alcohol use severity among men, but not women. Also, higher social groundedness functioned as a moderator that weakened the association between intragroup marginalization and alcohol use severity. Role repertoire did not function as a moderator. Our findings are significant because they enhance the reliability of the association between intragroup marginalization and alcohol use severity, and the moderating effect of gender in this respective association. This emerging line of research suggests that alcohol interventions targeting Hispanics may have a significant limitation by not accounting for intracultural stressors.

Socioeconomic inequalities and Black/White disparities in US cocaine-involved overdose mortality risk.

PURPOSE: This study examined whether socioeconomic inequalities account for Black/White disparities in: (a) the prevalence of potential risk factors for overdose among adults using cocaine; and (b) national mortality rates for cocaine-involved overdose. METHODS: Data from 2162 Non-Hispanic (NH) Black or White adults (26 +) who reported past-year cocaine use in the 2015-2019 National Survey of Drug Use and Health were analyzed to obtain predicted probabilities of potential overdose risk factors by race and sex, using marginal effects via regression analyses, adjusting for age and socioeconomic indicators. Next, National Center for Health Statistics data (for 47,184 NH Black or White adults [26 +] who died of cocaine-involved overdose between 2015 and 2019) were used to calculate cocaine-involved overdose mortality rates by race and sex across age and educational levels. RESULTS: Several potential overdose vulnerabilities were disproportionately observed among NH Black adults who reported past-year cocaine use: poor/fair overall health; cocaine use disorder; more days of cocaine use yearly; hypertension (for women); and arrests (for men). Adjusting for age and socioeconomic indicators attenuated or eliminated many of these racial differences, although predicted days of cocaine use per year (for men) and cocaine use disorder (for women) remained higher in NH Black than White adults. Cocaine-involved overdose mortality rates were highest in the lowest educational strata of both races; nonetheless, Black/White disparities were observed even at the highest level of education, especially for adults ages 50 + . CONCLUSION: Age and socioeconomic characteristics may account for some, yet not all, of Black/White disparities in vulnerability to cocaine-involved overdose.

Trends in substance use and prevention education involvement among U.S. adolescents receiving public assistance: new evidence.

PURPOSE: The present study aimed to examine the substance use prevention education involvement in different social settings among adolescents receiving public assistance-cash or food voucher-for low household income (heretofore, "PA program enrollees") and preventive effects of each prevention educational setting on current substance use. METHODS: Using data from a nationally-representative sample of PA program enrollees from the 2002-2017 National Survey on Drug Use and Health, we estimated the prevalence of substance use prevention education involvement in home, school, and neighborhood settings and the associations between involvement in each educational setting and current alcohol/illicit drug use. RESULTS: Compared to nonenrollees, PA program enrollees reported significantly lower rates of involvement in all prevention education settings, including parent-child conversations (54.6% vs. 60.1%) and neighborhood prevention resources (71.3% vs. 79.3%). All educational setting were associated with lower odds of current substance use, with the largest effects found for parent-child conversations (AOR = 0.821 [P < .001] for alcohol use; AOR = 0.817 [P < .001] for illicit drug use). CONCLUSIONS: To reduce the elevated risk of illicit drug use among PA program enrollees, special attention needs to be paid to promote parent-child conversation about substance use and increase access to prevention education in regular classes and preventive messages outside schools.

Cultural Stress Theory in the Context of Family Crisis Migration: Implications for Behavioral Health with Illustrations from the Adelante Boricua Study.

On September 20, 2017, Hurricane Maria made landfall in Puerto Rico as a Category 4 hurricane with sustained winds of 155 miles per hour and torrential rains that ravaged the United States territory. In the midst of the crisis, several hundred thousand Maria survivors boarded humanitarian flights and cruise ships, seeking refuge on the United States mainland. More than three years later, tens of thousands of post-Maria migrants remain on the mainland as long-term emigres. In this article, we lay the theoretical/conceptual groundwork for researchers and practitioners interested in understanding the experiences of post-Maria migrants. Specifically, we aim to assist readers in thinking deeply about: [1] why many Puerto Ricans relocated, [2] the experiences of post-Maria migrants en movimiento, and [3] how such experiences shape their lives, behavior, and well-being. In understanding the experiences of post-Maria migrants, several theories/constructs emerge as especially salient. These include "push and pull" models, cultural stress theory and its transnational variants, the concept of crisis migration, and models of cumulative risk. We provide a succinct overview of each of these theories/constructs and describe the broad perspectives that serve as a foundational or orienting paradigm for our work (i.e., the life course perspective, the strengths perspective, and an ecodevelopmental framework). Finally, we provide illustrations of how these theories/concepts apply to emerging data from the Adelante Boricua study, an ongoing research project with post-Maria migrant youth and their parents, supported by funding from the National Institute on Minority Health and Health Disparities.

Financial relationships between industry and principal investigators of US cooperative group randomized cancer clinical trials.

Financial conflicts of interest (FCOIs) could bias the potentially practice-changing oncologic randomized clinical trials (RCTs) of tomorrow. This investigation characterized the FCOIs of the principal investigators (PIs) of all currently accruing trials of the four (adult) cooperative groups of the National Clinical Trials Network. For our study, the PI list was first compiled, and each name was then searched in the CMS Open Payments database. For each transaction (general payments (GPs) or research funding (RF)), the amount/number/source of payments was recorded. Results showed that from 2014 to 2019, the 91 PIs collectively accepted nearly one-third of a billion dollars ($10 477 023 GPs and $320 096 233 RF). The mean and median GP was $6505 and $945, respectively, and $301 693 and $49 824 RF, respectively. Multivariable Gamma regression analysis revealed that higher GP sums were associated with RCTs involving any type of systemic therapy, and higher RF sums with medical oncologist PIs, trials with phase III components, and RCTs involving radiotherapy (P < .05 for all). Both higher-volume GPs and RF were predicted by PIs having accepted payment(s) from the manufacturer of the drug utilized in their RCT (P < .001 GP, P = .008 RF). Taken together, the main message of this investigation is that FCOIs may be particularly high in PIs of phase III systemic therapy trials, especially if the PI accepted payments from the manufacturer of the drug utilized in their trial. Such RCTs should be thoroughly scrutinized by medical journals, the FDA, and insurance companies for potential "industry bias" that could influence the integrity of their conclusions.

Substance Misuse Profiles of Women in Families Receiving Temporary Assistance for Needy Families (TANF) Benefits: Findings from a National Sample.

OBJECTIVE: Women in families receiving Temporary Assistance for Needy Families (TANF) cash assistance are twice as likely to have a substance use disorder (SUD) than their non-TANF counterparts in the past year. However, evidence is limited about substance misuse patterns and comorbid mental health problems among women in TANF families. METHOD: Data from the 2015-2018 National Survey on Drug Use and Health were used to examine the prevalence of substance misuse and use disorders among women age 18 or older in TANF families. We used latent class analysis to identify subgroups of distinctive substance misuse behaviors and tested the associations between SUD/serious psychological distress (SPD) and the group classification. RESULTS: Despite higher odds of having an SUD in all substance categories than their non-TANF counterparts, more than 84% of the women in TANF families were considered to have low substance misuse risks. Of the three identified at-risk groups, the polysubstance and the prescription pain reliever and alcohol misuse groups reported higher risks of having an SUD and SPD than the low-risk group. Individuals at risk of marijuana and alcohol misuse, represented by young, Black mothers, reported the lowest rates of treatment receipt despite having past-year SUD, SPD, or both. CONCLUSIONS: Although special attention needs to be paid to integrated care for those at risk of multiple substance misuse, additional efforts are required to increase substance abuse and mental health treatment among women at risk of marijuana and alcohol misuse.

Gender-based Disparities in Receipt of Care and Survival in Malignant Pleural Mesothelioma.

BACKGROUND: Despite accounting for a minority of malignant pleural mesothelioma (MPM) diagnoses, females may experience differential survival relative to males. It is unclear if there are gender-based differences in receipt of treatment or disease-related outcomes for patients with MPM. We therefore utilized the National Cancer Database (NCDB) to assess patterns-of-care and overall survival (OS) among patients with MPM by gender. MATERIALS AND METHODS: Patients with histologically confirmed MPM treated from 2004 to 2013 were identified from the NCDB. The association between female gender and OS was assessed using multivariable Cox proportional hazards models with propensity score matching. Patterns-of-care were assessed using multivariable logistic regression. The overall treatment effect was tested in subsets of patients by treatment strategy, histology, and clinical stage. RESULTS: A total of 18,799 patients were identified, of whom 14,728 (78%) were male and 4071 (22%) were female. Females were statistically more likely to present at a younger age, with fewer comorbidities, and with epithelioid histology. Despite these favorable prognostic features, women were less likely to receive surgery (P ≤ .001) or chemotherapy (P ≤ .001) compared with males. On multivariable analysis, female gender was associated with improved OS (hazard ratio, 0.83; 95% confidence interval, 0.80-0.86; P ≤ .001). Gender-based survival differences were seen across all stages, but only among patients with epithelioid (P ≤ .001) and not biphasic (P = .17) or sarcomatoid (P = 1.00) histology. CONCLUSIONS: Surgery and chemotherapy are disproportionately underutilized in female patients with MPM. Despite this concerning disparity, female gender is independently associated with improved survival relative to males. Further research to understand factors that lead to gender disparities in MPM is warranted.

A Low-Cost Paper Glucose Sensor with Molecularly Imprinted Polyaniline Electrode.

For the hundreds of millions of worldwide diabetic patients, glucose test strips are the most important and commonly used tool for monitoring blood glucose levels. Commercial test strips use glucose oxidases as recognition agents, which increases the cost and reduces the durability of test strips. To lower the cost of glucose sensors, we developed a paper-based electrical sensor with molecularly imprinted glucose recognition sites and demonstrated the determination of various glucose concentrations in bovine blood solutions. The sensing electrode is integrated with molecular recognition sites in the conductive polymer. A calibration graph as a function of glucose concentration in aqueous solution was acquired and matched with a correlation coefficient of 0.989. We also demonstrated the determination of the added glucose concentrations ranging from 2.2 to 11.1 mM in bovine blood samples with a linear correlation coefficient of 0.984. This non-enzymatic glucose sensor has the potential to reduce the health care cost of test strips as well as make glucose sensor test strips more accessible to underserved communities.

Trends and Correlates of Youth Violence-Prevention Program Participation, 2002-2016.

INTRODUCTION: Adolescent participation in violence-prevention programming is critical in addressing the nation's elevated rates of youth fighting and violence. However, little is known about the secular trends and correlates of violence-prevention program participation in the U.S. Using national data, the authors examined the year-by-year trends and correlates of participation among American adolescents over a 15-year span. METHODS: National trend data (2002-2016) were analyzed on non-Hispanic black/African American (n=35,216), Hispanic (n=45,780), and non-Hispanic white (n=153,087) youth aged 12-17years from the National Survey on Drug Use and Health in 2018. Consistent with the Centers for Disease Control and Prevention's trend analysis guidelines, the authors conducted logistic regression analyses with survey year specified as an independent variable and youth violence-prevention program participation specified as the dependent variable, while controlling for sociodemographic factors and other key correlates. RESULTS: Youth participation in violence-prevention programs decreased significantly from 16.7% in 2002 to 11.7% in 2016, a 29% relative decrease in participation. A significant declining trend in participation over time was found across all sociodemographic subgroups examined and among youth reporting the use of violence and no use of violence in the past year. Participation among black/African American youth was significantly greater than Hispanic youth who, in turn, had significantlyhigher participation rates than white youth. CONCLUSIONS: Youth participation in violence-prevention programming has decreased in recent years, with particularly large declines observed among younger adolescents (aged 12-14 years), youth in higher-income households, and youth reporting no past-year use of violence.

Trends and correlates of perceived access to heroin among young adults in the United States, 2002-2016.

BACKGROUND: We are at a unique moment in United States (US) history as heroin overdose rates are higher than at any time in recent memory. Based on prior research and the developmental risks faced by young adults (ages 18-25), we examine the trends and correlates of perceived access to heroin among this group over a 15-year period. METHODS: We analyzed national trend data from the National Survey on Drug Use and Health (2002-2016) on young adults' (N = 247,679; ages 18-25) perceived access to heroin. We conducted logistic regression analyses with survey year specified as an independent variable and heroin access specified as the dependent variable while controlling for sociodemographic factors. RESULTS: A majority of respondents reported that it would be difficult or impossible to obtain heroin, if desired. Young adult reports that it would be "probably impossible" to access heroin increased significantly from 31% in 2002 to 41% in 2016. The upward trend in the perceived lack of access was most robust among African Americans and Hispanics as well as those reporting no past-year substance use or drug/criminal justice system involvement. CONCLUSIONS: In the midst of a very serious opioid epidemic, the present study found that most young adults in the US consider that it would be "probably impossible" to obtain heroin. This trend was observed across young adulthood and across gender, racial/ethnic, and family income differences. However, we found that these trends are largely driven by those at relatively low risk of drug misuse and deviant behaviors generally.

Assessment of novel tobacco heating product THP1.0. Part 3: Comprehensive chemical characterisation of harmful and potentially harmful aerosol emissions.

For a tobacco heating product (THP), which heats rather than burns tobacco, the emissions of toxicants in the aerosol were compared with those in cigarette smoke under a machine-puffing regimen of puff volume 55 ml, puff duration 2 s and puff interval 30 s. The list of toxicants included those proposed by Health Canada, the World Health Organization Study Group on Tobacco Product Regulation (TobReg), the US Food and Drug Administration and possible thermal breakdown products. In comparison to the University of Kentucky 3R4F reference cigarette the toxicant levels in the THP1.0 emissions were significantly reduced across all chemical classes. For the nine toxicants proposed by TobReg for mandated reduction in cigarette emissions, the mean reductions in THP1.0 aerosol were 90.6-99.9% per consumable with an overall average reduction of 97.1%. For the abbreviated list of harmful and potentially harmful constituents of smoke specified by the US Food and Drug Administration Tobacco Products Scientific Advisory Committee for reporting in cigarette smoke (excluding nicotine), reductions in the aerosol of THP1.0 were 84.6-99.9% per consumable with an overall average reduction of 97.5%.

A Social Work Approach to Policy: Implications for Population Health.

The substantial disparities in health and poorer outcomes in the United States relative to peer nations suggest the need to refocus health policy. Through direct contact with the most vulnerable segments of the population, social workers have developed an approach to policy that recognizes the importance of the social environment, the value of social relationships, and the significance of value-driven policymaking. This approach could be used to reorient health, health care, and social policies. Accordingly, social workers can be allies to public health professionals in efforts to eliminate disparities and improve population health.

Assessing modified risk tobacco and nicotine products: Description of the scientific framework and assessment of a closed modular electronic cigarette.

Cigarette smoking causes many human diseases including cardiovascular disease, lung disease and cancer. Novel tobacco products with reduced yields of toxicants compared to cigarettes, such as tobacco-heating products, snus and electronic cigarettes, hold great potential for reducing the harms associated with tobacco use. In the UK several public health agencies have advocated a potential role for novel products in tobacco harm reduction. Public Health England has stated that "The current best estimate is that e-cigarettes are around 95% less harmful than smoking" and the Royal College of Physicians has urged public health to "Promote e-cigarettes widely as substitute for smoking". Health related claims on novel products such as 'reduced exposure' and 'reduced risk' should be substantiated using a weight of evidence approach based on a comprehensive scientific assessment. The US FDA, has provided draft guidance outlining a framework to assess novel products as Modified Risk Tobacco Products (MRTP). Based on this, we now propose a framework comprising pre-clinical, clinical, and population studies to assess the risk profile of novel tobacco products. Additionally, the utility of this framework is assessed through the pre-clinical and part of the clinical comparison of a commercial e-cigarette (Vype ePen) with a scientific reference cigarette (3R4F) and the results of these studies suggest that ePen has the potential to be a reduced risk product.

Medical High Dependency Series 2: Haemodynamics and Shock: Assessment, Interventions and Support.

Shock is a life-threatening state commonly encountered by the acute physician. As such those practicing and training in the specialty should strive to become true experts in this field by going beyond even the learning provided by generic life support courses when involved with identifying and managing the shocked state. This article explores the current evidence, where it exists and provides a framework for approaching such patients along with common pitfalls.

Comparing social group identifications and socioeconomic deprivation as predictors of psychological distress: Evidence from a Scottish primary care sample.

Social group identification and socioeconomic deprivation have both been linked to self-reported depressive symptoms in general population samples; however, no study to date has explored the strength of the joint predictive value of these factors within a mental health population. The current study explored the impact of social group identifications and socioeconomic deprivation, together with important clinical and demographic variables, on psychological distress in a Scottish mental health sample. Participants (N = 976) were recruited from referrals to a computerized cognitive behavioural therapy (cCBT) programme in Scotland, 'Beating the Blues' (BtB) over a 25-month period. Participants completed the Clinical Outcomes in Routine Evaluation Outcome Measure (CORE-OM) as a measure of psychological distress and three versions of the group identifications scale (GIS), one for each of three groups: family, community, and a social group of choice. Demographic information and clinical information were collected on commencing BtB. Higher numbers of group identifications were significantly associated with lower psychological distress. Additionally, increased socioeconomic deprivation was significantly associated with more severe psychological distress; however, interestingly, the association was not as strong as that of group identifications. Identifying with fewer social groups predicts more severe psychological symptom presentations, even more so than living in a greater state of socioeconomic deprivation.

Trends in Fighting and Violence Among Adolescents in the United States, 2002-2014.

OBJECTIVES: To examine trends in and correlates of fighting and violence among youths from the 3 largest racial/ethnic groups in the United States. METHODS: We derived race/ethnicity-specific prevalence estimates for fighting, group fighting, and attacks with intent to harm from the National Survey on Drug Use and Health, a population-based study of youths aged 12 to 17 years. RESULTS: The prevalence of youth fighting and violence decreased significantly in all racial/ethnic groups over the study period (2002-2014), dropping from a high of 33.6% in 2003 to a low of 23.7% in 2014, reflecting a 29% decrease in the relative proportion of young people involved in these behaviors. However, there was also a clear severity gradient in which year-by-year point estimates for fighting and violence were consistently highest among non-Hispanic African American youths, followed by Hispanic and then non-Hispanic White youths. CONCLUSIONS: Although fighting and violence are on the decline among young people in general and across racial/ethnic subgroups, there is a stable pattern of disparities in youth involvement in these behaviors.

Adverse Childhood Experiences Among Immigrants to the United States.

A growing number of studies have examined the "immigrant paradox" with respect to health behaviors in the United States. However, little research attention has been afforded to the study of adverse childhood experiences (ACE; neglect, physical and sexual abuse, and witnessing violence) among immigrants in the United States. The present study, using Waves I and II data from the National Epidemiologic Survey of Alcohol and Related Conditions (NESARC), aims to address these gaps by comparing forms of ACE of first- and second-generation immigrants with native-born American adults in the United States. We also examined the latent structure of ACE among immigrants and conducted analyses to assess the psychiatric correlates of identified latent classes. With the exception of neglect, the prevalence of ACE was markedly higher among native-born Americans and second-generation immigrants compared with first-generation immigrants. Four latent classes were identified-limited adverse experience ( n = 3,497), emotional and physical abuse ( n = 1,262), family violence ( n = 358), and global adversity ( n = 246). The latter three classes evinced greater likelihood of being diagnosed with a mood, anxiety, personality, and substance use disorder, and to report violent and non-violent antisocial behavior. Consistent with prior research examining the associations between the immigrant paradox and health outcomes, results suggest that first-generation immigrants to the United States are less likely to have experienced physical and sexual abuse and witness domestic violence. However, likely due to cultural circumstances, first-generation immigrants were more likely to report experiences that are deemed neglectful by Western standards.

Handgun carrying among White youth increasing in the United States: New evidence from the National Survey on Drug Use and Health 2002-2013.

The objective of the present study was to examine trends and correlates of handgun carrying among adolescents ages 12-17 in the United States. Data was derived from the National Survey on Drug Use and Health (NSDUH) involving non-Hispanic White, African American, and Hispanic respondents ages 12-17 (n=197,313) and spanning the years 2002-2013. Logistic regression was used to examine significance of trend year and correlates of previous 12-month handgun carrying. The overall self-reported prevalence of handgun carrying was 3.4%. The prevalence of handgun carrying during 2004-2005 was significantly higher for African-Americans (4.39%) compared to non-Hispanic Whites (3.03%). However, by 2012-2013, non-Hispanic Whites (4.08%) completely diverged and reported carrying handguns significantly more than both African-American (2.96%) and Hispanic (2.82%) youth. Male gender and a number of externalizing behaviors were significant correlates of handgun carrying; however, we also found evidence of differential correlates with regard to such factors as drug selling, parental affirmation, and income by race/ethnicity. To our knowledge, this is the largest study of handgun carrying among youth in the United States. Findings indicate that although at historically low levels handgun carrying is on the rise but only among non-Hispanic Whites. Differential correlates among racial/ethnic groups suggest prevention programming and policies may need modifications depending on group and geographic locale targeted.