Equitable Mindfulness: The practice of mindfulness for all.

The benefits of mindfulness are well-documented; however, these benefits may not be evenly distributed across communities. Equitable Mindfulness aims to make these benefits accessible to a wider and more inclusive audience. The aim of this study was to investigate the applicability of Equitable Mindfulness and systemic barriers that prevent mindfulness programs from being equitably accessed across communities. Twenty-one participants were recruited for qualitative in-depth interviews during a 2-day mindfulness conference. The constant comparison method was used to iteratively identify and categorize themes that emerged within and across interviews. Five dominant themes emerged from the data as follows: inherent equitability, accessibility, inclusiveness, awareness and knowledge-sharing, and acknowledgement of multiple perspectives. Having an applicable and meaningful term to use when describing mindfulness as an inclusive and equitable practice can facilitate the exploration of a new area of research. There is a need for future initiatives aimed at making mindfulness trainings and programs more equitable and accessible to all, regardless of socioeconomic status, race/ethnicity, or abilities/disabilities.

Descending Modulation of Laryngeal Vagal Sensory Processing in the Brainstem Orchestrated by the Submedius Thalamic Nucleus.

The nodose and jugular vagal ganglia supply sensory innervation to the airways and lungs. Jugular vagal airway sensory neurons wire into a brainstem circuit with ascending projections into the submedius thalamic nucleus (SubM) and ventrolateral orbital cortex (VLO), regions known to regulate the endogenous analgesia system. Here we investigate whether the SubM-VLO circuit exerts descending regulation over airway vagal reflexes in male and female rats using a range of neuroanatomical tracing, reflex physiology, and chemogenetic techniques. Anterograde and retrograde neuroanatomical tracing confirmed the connectivity of the SubM and VLO. Laryngeal stimulation in anesthetized rats reduced respiration, a reflex that was potently inhibited by activation of SubM. Conversely, inhibition of SubM potentiated laryngeal reflex responses, while prior lesions of VLO abolished the effects of SubM stimulation. In conscious rats, selective chemogenetic activation of SubM neurons specifically projecting to VLO significantly inhibited respiratory responses evoked by inhalation of the nociceptor stimulant capsaicin. Jugular vagal inputs to SubM via the medullary paratrigeminal nucleus were confirmed using anterograde transsynaptic conditional herpes viral tracing. Respiratory responses evoked by microinjections of capsaicin into the paratrigeminal nucleus were significantly attenuated by SubM stimulation, whereas those evoked via the nucleus of the solitary tract were unaltered. These data suggest that jugular vagal sensory pathways input to a nociceptive thalamocortical circuit capable of regulating jugular sensory processing in the medulla. This circuit organization suggests an intersection between vagal sensory pathways and the endogenous analgesia system, potentially important for understanding vagal sensory processing in health and mechanisms of hypersensitivity in disease.SIGNIFICANCE STATEMENT Jugular vagal sensory pathways are increasingly recognized for their important role in defensive respiratory responses evoked from the airways. Jugular ganglia neurons wire into a central circuit that is notable for overlapping with somatosensory processing networks in the brain rather than the viscerosensory circuits in receipt of inputs from the nodose vagal ganglia. Here we demonstrate a novel and functionally relevant example of intersection between vagal and somatosensory processing in the brain. The findings of the study offer new insights into interactions between vagal and spinal sensory processing, including the medullary targets of the endogenous analgesia system, and offer new insights into the central processes involved in airway defense in health and disease.

Evidence for multiple bulbar and higher brain circuits processing sensory inputs from the respiratory system in humans.

KEY POINTS: Unpleasant respiratory sensations contribute to morbidity in pulmonary disease. In rodents, these sensations are processed by nodose and jugular vagal sensory neurons, two distinct cell populations that differentially project to the airways and brainstem. Whether similar differences exist in bronchopulmonary sensory pathways in humans is unknown. We use functional magnetic resonance imaging during inhalation of capsaicin and ATP, showing that airway nodose pathways project centrally to the nucleus of the solitary tract, whereas jugular pathways input into the trigeminal brainstem nuclei. We also show differences between the efficacy of nodose and jugular stimuli to evoke cough and activity in motor control regions of the brain. Our data suggest that humans have two distinct vagal sensory neural systems governing airway sensations and this may have implications for the development of new antitussive therapies. ABSTRACT: In rodents, nodose vagal sensory neurons preferentially innervate the distal airways and terminate centrally in the nucleus of the solitary tract. By contrast, jugular vagal sensory neurons preferentially innervate the proximal airways and terminate in the paratrigeminal nucleus in the dorsolateral medulla. This differential organization suggests distinct roles for nodose and jugular pathways in respiratory sensory processing. However, it is unknown whether bronchopulmonary afferent pathways are similarly arranged in humans. We set out to investigate this using high resolution brainstem and whole brain functional magnetic resonance imaging in healthy human participants when they were inhaling stimuli known to differentially activate nodose and jugular pathways. Inhalation of capsaicin or ATP evoked respiratory sensations described as an urge-to-cough, although ATP was significantly less effective compared to capsaicin at evoking the motor act of coughing. The nodose and jugular neuron stimulant capsaicin increased blood oxygen level-dependent (BOLD) signals extending across the dorsomedial and dorsolateral medulla, encompassing regions containing both the nucleus of the solitary tract and the paratrigeminal nucleus. By contrast, at perceptually comparable stimulus intensities, the nodose-selective stimulant ATP resulted in BOLD signal intensity changes that were confined to the area of the nucleus of the solitary tract. During whole brain imaging, capsaicin demonstrated a wider distributed network of activity compared to ATP, with significantly increased activity in regions involved with motor control functions. These data suggest that functional and neuroanatomical differences in bronchopulmonary nodose and jugular sensory pathway organization are conserved in humans and also that this has implications for understanding the neurobiological mechanisms underpinning cough.

Regional brain stem activations during capsaicin inhalation using functional magnetic resonance imaging in humans.

Coughing is an airway protective behavior elicited by airway irritation. Animal studies show that airway sensory information is relayed via vagal sensory fibers to termination sites within dorsal caudal brain stem and thereafter relayed to more rostral sites. Using functional magnetic resonance imaging (fMRI) in humans, we previously reported that inhalation of the tussigenic stimulus capsaicin evokes a perception of airway irritation ("urge to cough") accompanied by activations in a widely distributed brain network including the primary sensorimotor, insular, prefrontal, and posterior parietal cortices. Here we refine our imaging approach to provide a directed survey of brain stem areas activated by airway irritation. In 15 healthy participants, inhalation of capsaicin at a maximal dose that elicits a strong urge to cough without behavioral coughing was associated with activation of medullary regions overlapping with the nucleus of the solitary tract, paratrigeminal nucleus, spinal trigeminal nucleus and tract, cardiorespiratory regulatory areas homologous to the ventrolateral medulla in animals, and the midline raphe. Interestingly, the magnitude of activation within two cardiorespiratory regulatory areas was positively correlated ( r2 = 0.47, 0.48) with participants' subjective ratings of their urge to cough. Capsaicin-related activations were also observed within the pons and midbrain. The current results add to knowledge of the representation and processing of information regarding airway irritation in the human brain, which is pertinent to the pursuit of novel cough therapies. NEW & NOTEWORTHY Functional brain imaging in humans was optimized for the brain stem. We provide the first detailed description of brain stem sites activated in response to airway irritation. The results are consistent with findings in animal studies and extend our foundational knowledge of brain processing of airway irritation in humans.

PA program characteristics and diversity in the profession.

OBJECTIVES: The primary objective of this study was to identify PA program characteristics that may be associated with higher or lower percentages of underrepresented minority students in PA programs. METHODS: Data from the Physician Assistant Education Association (PAEA) 2002-2003 and 2012-2013 annual surveys were analyzed. Bivariate correlation coefficients and multiple regression modeling were used to identify relationships between program characteristics and percentages of black and Hispanic students. RESULTS: The percentage of white matriculants in PA programs increased from 76.5% in 2002-2003 to 81.8% in 2012-2013; the percentage of black students decreased from 6.2% to 4.4%. Multiple linear regression revealed a modest negative relationship between master's degree and percentage of underrepresented minority students and a modest positive relationship between percentages of underrepresented minority employees and underrepresented minority students. CONCLUSIONS: Further research is needed to identify strategies to increase underrepresented minority participation in healthcare professions programs.

The Kölliker-Fuse nucleus: a review of animal studies and the implications for cranial nerve function in humans.

To review the scientific literature on the relationship between Kölliker-Fuse nucleus (KF) and cranial nerve function in animal models, with view to evaluating the potential role of KF maturation in explaining age-related normal physiologic parameters and developmental and acquired impairment of cranial nerve function in humans. Medical databases (Medline and PubMed). Studies investigating evidence of KF activity responsible for a specific cranial nerve function that were based on manipulation of KF activity or the use of neural markers were included. Twenty studies were identified that involved the trigeminal (6 studies), vagus (9), and hypoglossal nerves (5). These pertained specifically to a role of the KF in mediating the dive reflex, laryngeal adductor control, swallowing function and upper airway tone. The KF acts as a mediator of a number of important functions that relate primarily to laryngeal closure, upper airway tone and swallowing. These areas are characterized by a variety of disorders that may present to the otolaryngologist, and hence the importance of understanding the role played by the KF in maintaining normal function.

Ponto-medullary nuclei involved in the generation of sequential pharyngeal swallowing and concomitant protective laryngeal adduction in situ.

Both swallowing and respiration involve postinspiratory laryngeal adduction. Swallowing-related postinspiratory neurons are likely to be located in the nucleus of the solitary tract (NTS) and those involved in respiration are found in the Kölliker-Fuse nucleus (KF). The function of KF and NTS in the generation of swallowing and its coordination with respiration was investigated in perfused brainstem preparations of juvenile rats (n = 41). Orally injected water evoked sequential pharyngeal swallowing (s-PSW) seen as phasic, spindle-shaped bursting of vagal nerve activity (VNA) against tonic postinspiratory discharge. KF inhibition by microinjecting isoguvacine (GABAA receptor agonist) selectively attenuated tonic postinspiratory VNA (n = 10, P < 0.001) but had no effect on frequency or timing of s-PSW. KF disinhibition after bicuculline (GABAA receptor antagonist) microinjections caused an increase of the tonic VNA (n = 8, P < 0.01) resulting in obscured and delayed phasic s-PSW. Occurrence of spontaneous PSW significantly increased after KF inhibition (P < 0.0001) but not after KF disinhibition (P = 0.14). NTS isoguvacine microinjections attenuated the occurrence of all PSW (n = 5, P < 0.01). NTS bicuculline microinjections (n = 6) resulted in spontaneous activation of a disordered PSW pattern and long-lasting suppression of respiratory activity. Pharmacological manipulation of either KF or NTS also triggered profound changes in respiratory postinspiratory VNA. Our results indicate that the s-PSW comprises two functionally distinct components. While the primary s-PSW is generated within the NTS, a KF-mediated laryngeal adductor reflex safeguards the lower airways from aspiration. Synaptic interaction between KF and NTS is required for s-PSW coordination with respiration as well as for proper gating and timing of s-PSW.

Client perspectives on primary care integration in a rural-serving behavioral health center.

Purpose: Advancing behavioral health and primary care integration is a priority for helping clients overcome the complex health challenges impacting healthcare deserts like those in Arizona, United States of America (USA). This study aimed to explore the perspectives of people with a substance use disorder (SUD) on accessing integrated primary care (IPC) services in a rural-serving behavioral healthcare organization in Arizona. Design/methodology/approach: Clients from a behavioral health facility in Arizona (n = 10) diagnosed with SUDs who also accessed IPC participated in a 45-min semi-structured interview. Findings: The authors identified six overarching themes: (1) importance of IPC for clients being treated for SUDs, (2) client low level of awareness of IPC availability at the facility, (3) strategies to increase awareness of IPC availability at the behavioral health facility, (4) cultural practices providers should consider in care integration, (5) attitudes and perceptions about the experience of accessing IPC and (6) challenges to attending IPC appointments. The authors also identified subthemes for most of the main themes. Originality/value: This is the first study in rural Arizona to identify valuable insights into the experiences of people with SUDs accessing IPC, providing a foundation for future research in the region on care integration.

Mixed-methods analysis of satisfaction during a 12-session mindfulness-based intervention for women with a substance use disorder and trauma symptomatology.

Satisfaction with an intervention influences the uptake of behavior changes and the long-term efficacy of the intervention. Therefore, it is crucial to assess satisfaction by participant profile when creating and adapting behavior interventions for minoritized populations. Qualitative and quantitative data on participant trauma symptom severity and intervention satisfaction were collected through self-report surveys from 54 women. The sample was 59.3% Hispanic, with an average age of 33.21 (SD = 10.42), who were in residential treatment for substance use disorders (SUDs) and participated in a 12-session mindfulness-based intervention. Qualitative responses were coded using thematic analysis, and an integrative mixed-methods approach was used to compare qualitative theme frequency between high-trauma (N = 28) and low-trauma (N = 26) groups at session 2 and session 11. High- and low-trauma groups were determined by interquartile ranges (bottom 25% = low; top 75% = high). In session 2, the low-trauma group reported significantly higher satisfaction (M = 4.20, SD = 0.55) than the high-trauma group (M = 3.77, SD = 0.89); t(43) = 1.90, p = 0.03. In session 11, there was no significant difference between groups. The mixed-methods analysis revealed that "trouble focusing" appeared more frequently in the high-trauma group than in the low-trauma group during session 2, but the theme was not present in either group at session 11, suggesting that this might pose an initial barrier for individuals with high trauma but subsides as the intervention progresses. This speaks to the importance of retention strategies tailored for participants with SUDs and high trauma while they adjust to the intervention. Assessing initial challenges with satisfaction may help facilitators intervene to increase participant satisfaction.

The effect of the Russian invasion on mental, social, and behavioral health among Ukrainians living in the United States.

OBJECTIVE: The present research examines the disparities among Ukrainians residing in the United States, comparing Ukrainians who migrated before the February 2022 Russian invasion against those who arrived afterward. We compare these two cohorts vis-a-vis anxiety, depressive symptoms, optimism, posttraumatic stress, life satisfaction, family economic stress, cultural stress (discrimination, negative context of reception, and language stress), hazardous alcohol use, and domestic violence perpetration and victimization. METHOD: The present sample included 703 Ukrainians (53.63% women) residing in the United States. We conducted a series of multivariate analyses of variance using arrival cohort (pre- vs. postinvasion) and gender (male vs. female) as independent variables. RESULTS: Results indicated that postinvasion participants reported greater internalizing symptoms, cultural/economic stress, and hazardous alcohol use, whereas preinvasion arrivals reported greater levels of optimism and life satisfaction. No significant interactions between cohort and gender emerged for any of the outcomes. CONCLUSION: Our findings offer valuable insights into the mental health and well-being of displaced Ukrainians within the backdrop of ongoing conflicts. These findings have significant implications for support and intervention efforts not only for Ukrainians but also for other crisis migrant groups. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Cultural stress, personal identity development, and mental health among U.S. Hispanic college students.

The present study examines the extent to which culturally stressful experiences may predict impaired well-being, increased internalizing symptoms (depression and anxiety), and increased externalizing problems (social aggression, physical aggression, and rule breaking) among a sample of Hispanic college students in Miami across a 12-day period. The predictive effects of cultural stressors on these outcomes were examined both (a) directly and (b) indirectly through daily fluctuations in students' personal identity synthesis and confusion. Results indicated direct predictive effects of cultural stress on four forms of well-being (self-esteem, life satisfaction, psychological well-being, and eudaimonic well-being), on symptoms of depression and anxiety, and on physical aggression and rule breaking. The predictive effects of cultural stress on all four forms of well-being and on symptoms of depression and anxiety were partially mediated through daily fluctuations (instability) in students' sense of personal identity synthesis. Findings were consistent across genders and between U.S.- and foreign-born students. Results are discussed in terms of implications for intervention and for policy. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Investigating the association between discrimination, internalizing symptoms, and alcohol use among Latino/a immigrants in the United States.

Internalizing symptoms associated with anxiety and depression have been correlated with harmful alcohol use among Latino/as, but little attention has been paid to assessing the association between perceived discrimination and harmful alcohol use. The present study was designed to investigate the association between perceived discrimination, internalizing symptoms associated with anxiety and depression, and harmful alcohol use among Latino/a immigrants living in the United States (US). Our sample included 426 Latino/a immigrants. Their mean age was 40.05 years (SD = 6.50), 65.50% were women, 80.00% had a partner, 54.20% lived on less than $2,000 a month, and 41.50% reported having attained a college degree. Perceived discrimination was assessed using the Perceived Discrimination Scale, anxious symptoms were assessed using the GAD-7, depressive symptoms were assessed using the CES-D short form, and harmful alcohol use was assessed using AUDIT. We estimated a linear regression model using cross-sectional, self-reported data. The model was statistically significant, R 2 = 0.38, F (8, 425) = 32.09, p < 0.01. Discrimination was significantly associated with AUDIT scores, (ß = 0.21, p < 0.01) after accounting for covariates and for symptoms of anxiety and depression. Our results indicate that experiences of discrimination in the US are associated with increased harmful alcohol use even after controlling for other variables. These findings may be useful in designing coping interventions specifically for Latino/a immigrants to reduce the risk of alcohol use disorder. This study also has political and public health implications for acknowledging the detrimental health consequences of experiencing discrimination, providing support to the position that reducing racism and discrimination represent important public health priorities.

Investigation of vagal sensory neurons in mice using optical vagal stimulation and tracheal neuroanatomy.

In rats and guinea pigs, sensory innervation of the airways is derived largely from the vagus nerve, with the extrapulmonary airways innervated by Wnt1+ jugular neurons and the intrapulmonary airways and lungs by Phox2b+ nodose neurons; however, our knowledge of airway innervation in mice is limited. We used genetically targeted expression of enhanced yellow fluorescent protein-channelrhodopsin-2 (EYFP-ChR2) in Wnt1+ or Phox2b+ tissues to characterize jugular and nodose-mediated physiological responses and airway innervation in mice. With optical stimulation, Phox2b+ vagal fibers modulated cardiorespiratory function in a frequency-dependent manner while right Wnt1+ vagal fibers induced a small increase in respiratory rate. Mouse tracheae contained sparse Phox2b-EYFP fibers but dense networks of Wnt1-EYFP fibers. Retrograde tracing from the airways showed limited tracheal innervation by the jugular sensory neurons, distinct from other species. These differences in physiology and vagal sensory distribution have important implications when using mice for studying airway neurobiology.

Acute intermittent hypoxia induced neural plasticity in respiratory motor control.

Respiratory neural networks can adapt to rapid environmental change or be altered over the long term by various inputs. The mechanisms that underlie the plasticity necessary for adaptive changes in breathing remain unclear. Acute intermittent hypoxia (AIH)-induced respiratory long-term facilitation (LTF) is one of the most extensively studied types of respiratory plasticity. Acute intermittent hypoxia-induced LTF is present in several respiratory motor outputs, innervating both pump muscles (i.e. diaphragm) and valve muscles (i.e. tongue, pharynx and larynx). Long-term facilitation is present in various species, including humans, and the expression of LTF is influenced by gender, age and genetics. Serotonin plays a key role in initiating and modulating plasticity at the level of respiratory motor neurons. Recently, multiple intracellular pathways have been elucidated that are capable of giving rise to respiratory LTF. These mainly activate the metabolic receptors coupled to Gq ('Q' pathway) and Gs ('S' pathway) proteins. Herein, we discuss AIH-induced respiratory LTF in animals and humans, as well as recent advances in our understanding of the synaptic and intracellular pathways underlying this form of plasticity. We also discuss the potential to use intermittent hypoxia to induce functional recovery following cervical spinal injury.

Association between specific types of parent stressors and fast-food consumption among parents and children.

INTRODUCTION: Although stress has been associated with eating behaviors, such as overeating and eating less healthy foods, the relationships between specific types of parent stressors and fast-food consumption in parents and young children have not been well studied. We hypothesized that parent perceived stress, parenting stress, and household chaos would be positively associated with fast-food consumption for parents and their young children. METHODS: Parents of 2-5 year olds and with Body Mass Index >27 kg/m2 (N = 234, parent mean age: 34.3 (±5.7); child age: 44.9 (±13.8) months; 65.8 % from two parent households) completed surveys on parent perceived stress, parenting stress, household chaos, and their fast-food intake and that of their child. RESULTS: In separate regression models, controlling for covariates, parent perceived stress (ß = 0.21, p < 0.01; R2 = 0.10, p < 0.01), parenting stress (ß = 0.26, p < 0.01; R2 = 0.13, p < 0.01), and household chaos (ß = 0.25, p < 0.01; R2 = 0.12, p < 0.01) were each significantly associated with parent fast-food consumption, and separately with child fast-food consumption [Parent perceived stress (ß = 0.05, p = 0.02; R2 = 0.14, p < 0.01); parenting stress (ß = 0.14, p = 0.03; R2 = 0.14, p < 0.01); parent fast-food consumption (ß = 0.40, p < 0.01; R2 = 0.27, p < 0.01)]. However, combined final models showed parenting stress (p < 0.01) as the only significant predictor of parent fast-food consumption, which in turn was the only significant predictor of child fast-food consumption (p < 0.01). DISCUSSION: The findings support the inclusion of parenting stress interventions that target fast-food eating behaviors in parents, which may in turn, reduce fast-food intake in their young children.

What is well-being? A scoping review of the conceptual and operational definitions of occupational well-being.

Well-being is a multifaceted construct that is used across disciplines to portray a state of wellness, health, and happiness. While aspects of well-being seem universal, how it is depicted in the literature has substantial variation. The aim of this scoping review was to identify conceptual and operational definitions of well-being within the field of occupational health. Broad search terms were used related to well-being and scale/assessment. Inclusion criteria were (1) peer-reviewed articles, (2) published in English, (3) included a measure of well-being in the methods and results section of the article, and (4) empirical paper. The searches resulted in 4394 articles, 3733 articles were excluded by reading the abstract, 661 articles received a full review, and 273 articles were excluded after a full review, leaving 388 articles that met our inclusion criteria and were used to extract well-being assessment information. Many studies did not define well-being or link their conceptual definition to the operational assessment tool being used. There were 158 assessments of well-being represented across studies. Results highlight the lack of a consistent definitions of well-being and standardized measurements.

The temporal relationship between non-respiratory burst activity of expiratory laryngeal motoneurons and phrenic apnoea during stimulation of the superior laryngeal nerve in rat.

A striking effect of stimulating the superior laryngeal nerve (SLN) is its ability to inhibit central inspiratory activity (cause 'phrenic apnoea'), but the mechanism underlying this inhibition remains unclear. Here we demonstrate, by stimulating the SLN at varying frequencies, that the evoked non-respiratory burst activity recorded from expiratory laryngeal motoneurons (ELMs) has an intimate temporal relationship with phrenic apnoea. During 1­5 Hz SLN stimulation, occasional absences of phrenic nerve discharge (PND) occurred such that every absent PND was preceded by an ELM burst activity. During 10­20 Hz SLN stimulation, more bursts were evoked together with more absent PNDs, leading eventually to phrenic apnoea. Interestingly, subsequent microinjections of isoguvacine (10 mm, 20­40 nl) into ipsilateral Bötzinger complex (BötC) and contralateral nucleus tractus solitarii (NTS) significantly attenuated the apnoeic response but not the ELM burst activity. Our results suggest a bifurcating projection from NTS to both the caudal nucleus ambiguus and BötC, which mediates the closely related ELM burst and apnoeic response, respectively. We believe that such an intimate timing between laryngeal behaviour and breathing is crucial for the effective elaboration of the different airway protective behaviours elicited following SLN stimulation, including the laryngeal adductor reflex, swallowing and cough.

Neuronal mechanisms underlying the laryngeal adductor reflex.

OBJECTIVES: Electromyographic studies of the laryngeal adductor reflex, glottal closure occurring in response to laryngeal stimulation, have demonstrated an early ipsilateral response (R1) and a late bilateral response (R2). To better define the physiologic properties of these responses, we recorded responses from expiratory laryngeal motoneurons (ELMs) in rats during stimulation of the superior laryngeal nerve (SLN). METHODS: Single unit extracellular recordings were obtained from 5 ELMs, identified by their antidromic responses to recurrent laryngeal nerve stimulation and postinspiratory firing pattern, in 4 Sprague-Dawley rats. RESULTS: Unilateral stimulation of the SLN (at 20 Hz) stopped both phrenic nerve inspiratory activity and ELM postinspiratory activity. However, the ELMs displayed robust tonic firing, consisting of non-respiratory burst activity and single action potentials. The single action potentials were identified as short-latency ones (5 to 10 ms) activated by ipsilateral SLN stimulation, with an occurrence rate of 90%, and long-latency ones (20 to 50 ms) activated by bilateral SLN stimulation, with occurrence rates of 47% on the ipsilateral side and 58% on the contralateral side. CONCLUSIONS: The R1 response appears to be the result of the short-latency action potentials, orthodromically activated by ipsilateral stimulation of the SLN. The R2 response is likely to be a result of the long-latency action potentials that can be recorded from ELMs on both sides.

Social vulnerabilities for substance use: Stressors, socially toxic environments, and discrimination and racism.

Applying a social determinants of health framework, this review brings attention to evidence from social sciences and neuroscience on the role of selected social factors in individual and population-level vulnerability to substance use and substance use disorders (SUDs). The understanding that social vulnerability to substance use and SUDs is multifaceted and occurs across different levels of influence (individual, interpersonal, community, and societal) is underscored. We propose that socially based stressors play a critical role in creating vulnerability to substance use and SUDs, and as such, deserve greater empirical attention to further understand how they "get under the skin." Current knowledge from social sciences and neuroscience on the relationships among vulnerability to substance use resulting from stressors, exposure to socially toxic childhood environments, and racism and discrimination are summarized and discussed, as are implications for future research, practice, and policy. Specifically, we propose using a top-down approach to the examination of known, yet often unexplored, relationships between vulnerability to substance use and SUDs, related inequities, and potential differential effects across demographic groups. Finally, research gaps and promising areas of research, practice, and policy focused on ameliorating social vulnerabilities associated with substance use and SUDs across the lifespan are presented. This article is part of the special issue on 'Vulnerabilities to Substance Abuse'.

Behavioral and Regional Brain Responses to Inhalation of Capsaicin Modified by Painful Conditioning in Humans.

BACKGROUND: Cough is a defense mechanism that protects the airways and lungs in response to airway irritation. The sensory neurons involved in detecting airway irritants and the neural pathways mediating cough share similarities with those that encode pain from the body. Painful conditioning stimuli applied to one body site are known to reduce the perception of pain at another. However, whether the neural regulation of cough is influenced by painful stimuli is not known. RESEARCH QUESTION: What are the behavioral and neural outcomes of painful conditioning stimuli on urge-to-cough (UTC) and cough evoked by inhaled capsaicin? STUDY DESIGN AND METHODS: Sixteen healthy participants underwent psychophysical testing and functional MRI while completing a series of capsaicin inhalations to induce UTC and cough. The responses associated with capsaicin inhalation without pain were compared with those after the application of painful conditioning stimuli. RESULTS: Significant decreases were seen behaviorally of 18.7% ± 17.3% (P < .001) and 47.0% ± 30.8% (P < .001) in participants' UTC ratings and cough frequencies, respectively, during the application of pain. UTC ratings were reduced by 24.2% ± 36.5% (P < .005) and increased by 67% ± 40% (P < .001) for capsaicin and saline inhalation, respectively, during the scanning session. Painful conditioning stimuli were associated with widespread decreases in regional brain responses to capsaicin inhalation (P < .001). Several brain regions showed levels of reduced activation attributable to painful conditioning that correlated with related changes in behavioral responses during scanning (R2 = 0.53). INTERPRETATION: Pain-related decreases of cough and UTC are accompanied by widespread changes in brain activity during capsaicin inhalation, suggesting that pain can modify the central processing of inputs arising from the airways. A mechanistic understanding of how cough and pain processing interact within the brain may help develop more effective therapies to reduce unwanted coughing.