State Policies, Racial Disparities, and Income Support: A Way to Address Infant Outcomes and the Persistent Black-White Gap?

Low birth weight and preterm births vary by state, and Black mothers typically face twice the risk that their white counterparts do. This gap reflects an accumulation of psychosocial and material exposures that include interpersonal racism, differential experience with area-level deprivation such as residential segregation, and other harmful exposures that the authors refer to as "institutional" or "structural" racism. The authors use logistic regression models and a dataset that includes all births from 1994 to 2017 as well as five state policies from this period-Aid to Families with Dependent Children/Temporary Aid for Needy Families, housing assistance, Medicaid, minimum wage, and the earned income tax credit (EITC)-to examine whether these state social policies, designed to provide a financial safety net, are associated with risk reduction of low birth weight and preterm birth to Black and white mothers, and whether variations in state generosity attenuate the racial inequalities in birth outcomes. The authors also examine whether the relationship between state policies and racial inequalities in birth outcomes is moderated by the education level of the mother. We find that the EITC reduces the risk of low birth weight and preterm birth for Black mothers. The impact is much less consistent for white mothers. For both Black and white mothers, the benefits to birth outcomes are larger for mothers with less education.

The role of work in gender identity, stress and health in low-income, middle-aged African-American men.

Although progress has been made in reducing disparities in life expectancy, addressing the persistence of health inequities by race remains a high priority for public health professionals. The purpose of this research was to refine a minority stress model (MSM) by identifying previously unrecognized factors contributing to stress and chronic disease health disparities among low-income middle-aged African-American men. Using a Community-Based Participatory Research approach, we conducted semi-structured individual health interviews with 42 low-income middle-aged African-American men in a mid-size New England city. The interviews focused on the participants' perceptions of the causes of health disparities. Four major themes emerged from the analysis: the positive aspects of work, both financial and symbolic; and the negative repercussions of not working, both financial and symbolic in terms of a sense of self-respect. On an instrumental level, working men can support their family, be physically active and find social support. Symbolically, work provides a positive sense of identity as a man; it offers both social- and self-respect; it provides discipline and a sense of gratitude. Conversely, the lack of work is a significant source of stress, stemming both from the inability to support one's family and from having nothing to do, which lead to depression, low self-esteem, suicidal ideation and anger. With no perceived viable routes to socially approved roles, many low-income men of color succumb to internalizing a negative identity. This research demonstrates a clear link between structural problems with the US economy and harms to sense of identity among low-income, middle-aged African-American men.

New Predictions for Λ_{b}→Λ_{c} Semileptonic Decays and Tests of Heavy Quark Symmetry.

The heavy quark effective theory makes model independent predictions for semileptonic Λ_{b}→Λ_{c} decays in terms of a small set of parameters. No subleading Isgur-Wise function occurs at order Λ_{QCD}/m_{c,b}, and only two subsubleading functions enter at order Λ_{QCD}^{2}/m_{c}^{2}. These features allow us to fit the form factors and decay rates calculated up to order Λ_{QCD}^{2}/m_{c}^{2} to LHCb data and lattice QCD calculations. We derive a significantly more precise standard model prediction for the ratio B(Λ_{b}→Λ_{c}τν[over ¯])/B(Λ_{b}→Λ_{c}µν[over ¯]) than prior results, and find the expansion in Λ_{QCD}/m_{c} well behaved, addressing a long-standing question. Our results allow more precise and reliable calculations of Λ_{b}→Λ_{c}ℓν[over ¯] rates, and are systematically improvable with better data on the µ (or e) modes.

Disentangling Mass and Mixing Hierarchies.

We present a fully perturbative mechanism that naturally generates mass hierarchies for the standard model (SM) fermions in a flavor-blind sector. The dynamics generating the mass hierarchies can therefore be independent from the source of flavor violation, and hence this dynamics may operate at a much lower scale. This mechanism works by dynamically enforcing simultaneous diagonalization--alignment--among a set of flavor-breaking spurions, as well as generating highly singular spectra for them. It also has general applications in model building beyond the SM, wherever alignment between exotic and SM sources of flavor violation is desired.

Towards More Precise Determinations of the Quark Mixing Phase ß.

We derive a new flavor symmetry relation for the determination of the weak phase ß=ϕ_{1} from time-dependent CP asymmetries and B→J/ψP decay rates. In this relation, the contributions to sin2ß proportional to V_{ub} are parametrically suppressed compared to the contributions in the B→J/ψK^{0} time-dependent CP asymmetry alone. This relation uses only SU(3) flavor symmetry, and does not require further diagrammatic assumptions. The current data either fluctuate at the 2σ level from expectations, or may hint at effects of unexpected magnitude from contributions proportional to V_{ub} or from isospin breaking.

Perceptions of wellness to monitor adaptive responses to training and competition in elite Australian football.

Perceptions of wellness are often used by athletes and coaches to assess adaptive responses to training. The purpose of this research was to describe how players were coping with the demands of elite level Australian football over a competitive season using subjective ratings of physical and psychological wellness and to assess the ecological validity of such a monitoring approach. Twenty-seven players completed ratings for 9 items (fatigue, general muscle, hamstring, quadriceps, pain/stiffness, power, sleep quality, stress, well-being). Players subjectively rated each item as they arrived at the training or competition venue on a 1-5 visual analog scale, with 1 representing the positive end of the continuum. A total of 2,583 questionnaires were analyzed from completions on 183 days throughout the season (92 ± 24 per player, 103 ± 20 per week; mean ± SD). Descriptive statistics and multilevel modelling were used to understand how player ratings of wellness varied over the season and during the week leading into game day and whether selected player characteristics moderated these relationships. Results indicated that subjective ratings of physical and psychological wellness were sensitive to weekly training manipulations (i.e., improve steadily throughout the week to a game day low, p < 0.001), to periods of unloading during the season (i.e., a week of no competition, p < 0.05) and to individual player characteristics (e.g., muscle strain after a game was poorer in players with high maximum speed, p < 0.01). It is concluded that self-reported player ratings of wellness provide a useful tool for coaches and practitioners to monitor player responses to the rigorous demands of training, competition, and life as a professional athlete.

Influence of physical fitness, age, experience, and weekly training load on match performance in elite Australian football.

Season long competition schedules in football create unique challenges for coaches in balancing the requirements of recovery, developing and maintaining physical fitness, and adjusting the training load before each match. The aim of this study was to investigate the influence of player characteristics (physical fitness, age, and playing experience) and weekly in-season training load on elite match performance across an Australian football season. Twenty-five players (age: 24.1 ± 3.0 years; height: 188.3 ± 7.3 cm; weight: 90.4 ± 8.3 kg) from one elite team participated in this study. Before the season, player's age, experience, height, and weight along with measures of aerobic (6-minute run) and anaerobic (6 × 40 m repeated sprints) physical fitness were recorded. Individual player training load during the season was measured using global positioning system technology for the main training session of the week. Player match performance was calculated weekly from 33 individual playing statistics. Multilevel modeling was used to investigate the relationship between weekly training load and match performance and to explore the influence of player characteristics on this relationship. Playing experience (p < 0.01) and aerobic fitness (p < 0.05) displayed positive relationships with performance, whereas player age (p < 0.01) showed a negative relationship. Most players coped well with weekly variations in training load; however, the relationship was moderated by the results of the preseason repeated sprint test (p < 0.05). The adverse effect on playing performance in selected players after a more intense training session suggests that recovery from the session may be delayed in players who exhibit a better anaerobic fitness profile.

Lung Cancer Surgery in the Early Phase After Acute COVID-19 Pneumonitis.

A 65-year-old woman was diagnosed with early-stage lung cancer in 2020 and scheduled for robotic assisted-left upper lobectomy. Unfortunately, the patient contracted symptomatic COVID-19, resulting in postponement of lung resection. She was admitted for surgery 6 weeks after the acute infection. A preoperative computed tomographic scan showed widespread interstitial pneumonitis. However, the operation went ahead given concerns over tumor progression, albeit with a lesser resection to preserve lung tissue because the patient was slightly hypoxic. Her postoperative recovery was uneventful, and she was discharged 5 days later. Final histology confirmed a fully resected stage T1c N0 M0 adenocarcinoma of the lung.

Synchronous Parathyroidectomy and Extended Thymectomy in Multiple Endocrine Neoplasia Type 1.

A 49-year-old man presented with symptoms of hypercalcemia that had been present for 3 months. An initial chest x-ray showed a large anterior mediastinal mass. Subsequent computed tomography also demonstrated a calcified lesion in the uncinate process of the pancreas, and a neck ultrasound showed parathyroid lesions. The combination of symptoms and tumors raised the possibility of multiple endocrine neoplasia type 1 as the diagnosis. The lesions were later biopsy-proven to be atypical carcinoid neuroendocrine tumors. The patient underwent simultaneous neck dissection for bilateral subtotal parathyroidectomy and midline sternotomy for thymectomy of the large mediastinal mass.

Eslicarbazepine acetate.

Eslicarbazepine acetate, a prodrug of eslicarbazepine (S-licarbazepine), is a novel, voltage-gated sodium channel antagonist under development for the adjunctive treatment of adult patients experiencing treatment-refractory partial-onset seizures. * In phase III trials, eslicarbazepine acetate 800 and 1200 mg once daily significantly reduced seizure frequency compared with placebo over 12 weeks of maintenance treatment in adults experiencing partial-onset seizures who were taking 1-3 concomitant antiepileptic drugs. * During long-term, open-label treatment for up to 1 year, eslicarbazepine acetate at a median dosage of 800 mg once daily produced sustained reductions from baseline in seizure frequency. * Long-term treatment with eslicarbazepine acetate significantly improved from baseline health-related quality of life as assessed by the Quality-of-Life in Epilepsy Inventory-31 instrument. Similarly, eslicarbazepine acetate significantly reduced depressive symptoms assessed by the Montgomery-Asberg Depression Rating Scale. * Eslicarbazepine acetate was generally well tolerated in clinical trials. The majority of treatment-emergent adverse events were of mild to moderate severity and most occurred early in treatment.

P2Y1 receptor modulation of the pre-Bötzinger complex inspiratory rhythm generating network in vitro.

ATP is released during hypoxia from the ventrolateral medulla (VLM) and activates purinergic P2 receptors (P2Rs) at unknown loci to offset the secondary hypoxic depression of breathing. In this study, we used rhythmically active medullary slices from neonatal rat to map, in relation to anatomical and molecular markers of the pre-Bötzinger complex (preBötC) (a proposed site of rhythm generation), the effects of ATP on respiratory rhythm and identify the P2R subtypes responsible for these actions. Unilateral microinjections of ATP in a three-dimensional grid within the VLM revealed a "hotspot" where ATP (0.1 mM) evoked a rapid 2.2 +/- 0.1-fold increase in inspiratory frequency followed by a brief reduction to 0.83 +/- 0.02 of baseline. The hotspot was identified as the preBötC based on histology, overlap of injection sites with NK1R immunolabeling, and potentiation or inhibition of respiratory frequency by SP ([Sar9-Met(O2)11]-substance P) or DAMGO ([D-Ala2,N-MePhe4,Gly-ol5]-enkephalin), respectively. The relative potency of P2R agonists [2MeSADP (2-methylthioadenosine 5'-diphosphate) approximately = 2MeSATP (2-methylthioadenosine 5'-triphosphate) approximately = ATPgammas (adenosine 5'-[gamma-thio]triphosphate tetralithium salt) approximately = ATP >> UTP approximately = alphabeta meATP (alpha,beta-methylene-adenosine 5'-triphosphate)] and attenuation of the ATP response by MRS2179 (2'-deoxy-N6-methyladenosine-3',5'-bisphosphate) (P2Y1 antagonist) indicate that the excitation is mediated by P2Y1Rs. The post-ATP inhibition, which was never observed in response to ATPgammas, is dependent on ATP hydrolysis. These data establish in neonatal rats that respiratory rhythm generating networks in the preBötC are exquisitely sensitive to P2Y1R activation, and suggest a role for P2Y1Rs in respiratory motor control, particularly in the P2R excitation of rhythm that occurs during hypoxia.

Amlodipine/Valsartan: fixed-dose combination in hypertension.

Amlodipine, a dihydropyridine calcium channel blocker, and valsartan, an angiotensin II receptor blocker, are established antihypertensive agents. Fixed-dose combinations of amlodipine/valsartan are available in several European countries and in the US. Individual dose titration with amlodipine and valsartan is generally recommended before changing to the fixed-dose combination. Amlodipine/valsartan, at approved dosage regimens, achieved significantly greater reductions in mean sitting diastolic and systolic blood pressure (BP) than amlodipine or valsartan monotherapy, or placebo in two randomized, double-blind, factorial trials in patients with mild to moderate hypertension. Approximately 80-90% of patients receiving approved dosages of amlodipine/valsartan achieved a response, defined as a mean sitting diastolic BP <90 mmHg or a >or= 10 mmHg reduction from baseline. Subgroup analyses of data from the two trials showed that the antihypertensive efficacy of amlodipine/valsartan in the elderly, Black patients and those with stage 2 hypertension was consistent with that observed in the overall study population. Marked reductions in BP were also observed in patients whose BP was previously uncontrolled on monotherapy (with various antihypertensives) who were switched (without washout) to amlodipine/valsartan in a phase IIIb-IV study. Amlodipine/valsartan was generally well tolerated in clinical trials. In particular, the incidence of peripheral oedema was significantly lower in patients receiving amlodipine/valsartan than in those treated with amlodipine monotherapy.

Nilotinib.

Nilotinib is an orally administered BCR-ABL tyrosine kinase inhibitor that has shown good clinical efficacy in imatinib-resistant or -intolerant, Philadelphia chromosome-positive, chronic myeloid leukaemia (CML) in a phase I/II trial. The phase I component of the trial established the dosage regimen used in the phase II part of the trial, which included several arms. Three of these arms, or phase II trials, evaluated nilotinib in each of the three phases of CML (chronic, accelerated or blast crisis).I n the phase II trial in patients with chronic-phase CML, major cytogenetic response (primary endpoint) was achieved in 48% of the 280 patients who received nilotinib and had a follow-up period of > or = 6 months. Major cytogenetic response rates did not differ between imatinib-resistant and -intolerant patients, and nilotinib was effective in patients with BCR-ABL mutations (except T315I). Haematologic response rate (primary endpoint) was 47% in the phase II trial with nilotinib in patients with accelerated-phase CML (n = 119). Complete haematologic response was achieved in 26% of patients and 21% had no evidence of leukaemia or returned to chronic-phase CML. Major cytogenetic response, an important secondary endpoint in the trial, occurred in 29% of patients. Data from the phase II trial in patients with CML in blast crisis (n = 135) also showed promising results, with 39% of patients achieving haematologic response with nilotinib. Adverse events reported with nilotinib have generally been of mild to moderate severity. Grade 3 or 4 neutropenia and thrombocytopenia were reported in 29% of patients each.

Mosapride in gastrointestinal disorders.

Mosapride was effective in improving overall symptoms in patients with gastrointestinal disorders, including chronic gastritis, gastro-oesophageal reflux disease and functional dyspepsia. Mosapride was more effective than teprenone in improving gastric stasis symptoms and gastric pain after 2 weeks of therapy (p < 0.001) in an open-label trial in 1042 patients with functional dyspepsia. Mosapride was as effective as famotidine and itopride, but more effective than tandospirone, in improving overall or individual symptoms of functional dyspepsia in randomized trials. However, in one randomized, double-blind trial in patients with mild to severe disease, the improvement in overall symptoms of functional dyspepsia did not differ significantly between mosapride or placebo treatment. Mosapride was well tolerated, with diarrhoea/loose stools, dry mouth, malaise and headache being reported in <5% of patients.

Rosuvastatin: a review of its effect on atherosclerosis.

The HMG-CoA reductase inhibitor (statin) rosuvastatin (Crestor) is widely available for use in the management of dyslipidemia, and was recently approved in the US to slow the progression of atherosclerosis as part of a strategy to lower low-density lipoprotein-cholesterol (LDL-C) and total cholesterol (TC) to target levels. Rosuvastatin has greater lipid-lowering efficacy than any of the other currently available statins, and significantly more patients receiving rosuvastatin than other statins achieve LDL-C goals. Rosuvastatin delayed the progression of carotid atherosclerosis in patients with subclinical carotid atherosclerosis, moderately elevated cholesterol levels, and a low risk of cardiovascular disease in a primary prevention trial (METEOR). The results of METEOR suggest a possible role for the earlier use of rosuvastatin in primary prevention, although more data are needed from trials examining the effects of the drug on cardiovascular endpoints. Significant regression of atherosclerosis was seen with rosuvastatin 40 mg/day in patients with established coronary heart disease (CHD) in the ASTEROID trial, supporting the use of intensive lipid lowering in secondary prevention patients (although it should be noted that it has not yet been established that atherosclerotic regression translates into improved cardiovascular outcomes). Rosuvastatin is generally well tolerated, with a similar tolerability profile to that of other currently available statins. Thus, rosuvastatin is an important lipid-lowering treatment option that has been shown to cause regression of atherosclerosis in secondary prevention patients, and has a potential future role in delaying atherosclerosis in primary prevention patients.

Quetiapine: a review of its use in the treatment of bipolar depression.

Quetiapine (Seroquel) is the only atypical antipsychotic approved in the US for use as monotherapy in both bipolar mania and depression, offering potential compliance advantages. Monotherapy with oral quetiapine 300 mg/day is effective in the treatment of patients with bipolar I or II depression. Rapid and sustained improvements in depressive and anxiety symptoms are seen with quetiapine, as well as improvements in health-related quality of life (HR-QOL). Quetiapine is generally well tolerated in bipolar depression and is not associated with an increased risk of treatment-emergent mania. Thus, despite the current lack of data from active comparator trials, quetiapine monotherapy should be considered a first-line option for the acute treatment of bipolar depression.

Delayed-release Multi Matrix System (MMX) mesalazine: in ulcerative colitis.

* Mesalazine appears to act locally on the mucosa of the colon and reduces the inflammation associated with ulcerative colitis. * Following oral administration, the majority (*78%) of a dose of delayed-release Multi Matrix System (MMX) mesalazine passes unabsorbed through the upper gastrointestinal tract to reach and traverse the entire length of the colon. * In a well designed phase III trial in patients with active, mild to moderate ulcerative colitis (n = 262), significantly (p < 0.01) more MMX mesalazine 2.4 (34%) or 4.8 g/day (29%) recipients than placebo recipients (13%) achieved clinical and endoscopic remission after 8 weeks of treatment.* In a second phase III trial (n = 341), clinical and endoscopic remission rates with MMX mesalazine 2.4 (40.5%) and 4.8 g/day (41.2%) were significantly (p < 0.01) greater than with placebo (22.1%) after 8 weeks, while the remission rate with non-MMX delayed-release mesalazine (Asacol) [32.6%] did not differ from placebo.* Overall, MMX mesalazine was generally well tolerated in controlled clinical trials, with a similar incidence of treatment-emergent adverse events in placebo (66%) and MMX mesalazine (56%) recipients in a pooled analysis; most adverse events were of mild or moderate severity. Two of 434 MMX mesalazine recipients experienced serious adverse events that were considered treatment related (pancreatitis caused by mesalazine sensitivity).

Imidapril: a review of its use in essential hypertension, Type 1 diabetic nephropathy and chronic heart failure.

Imidapril (Tanatril), through its active metabolite imidaprilat, acts as an ACE inhibitor to suppress the conversion of angiotensin I to angiotensin II and thereby reduce total peripheral resistance and systemic blood pressure (BP). In clinical trials, oral imidapril was an effective antihypertensive agent in the treatment of mild to moderate essential hypertension. Some evidence suggests that imidapril also improves exercise capacity in patients with chronic heart failure (CHF) and reduces urinary albumin excretion rate in patients with type 1 diabetes mellitus. Imidapril was well tolerated, with a lower incidence of dry cough than enalapril or benazepril, and is a first choice ACE inhibitor for the treatment of mild to moderate essential hypertension.

Drospirenone/ethinylestradiol 3mg/20microg (24/4 day regimen): a review of its use in contraception, premenstrual dysphoric disorder and moderate acne vulgaris.

Drospirenone 3mg with ethinylestradiol 20microg (Yaz) is a low-dose combined oral contraceptive (COC) administered in a regimen of 24 days of active tablets followed by a short hormone-free interval (4 days; 24/4 regimen). Drospirenone, unlike other synthetic progestogens used in COCs, is a 17alpha-spirolactone derivative and a 17alpha-spironolactone analogue with antimineralocorticoid and antiandrogenic properties. Drospirenone/ethinylestradiol 3mg/20microg (24/4) is approved in the US for the prevention of pregnancy in women, for the treatment of the symptoms of premenstrual dysphoric disorder (PMDD) and for the treatment of moderate acne vulgaris in women who wish to use an oral contraceptive for contraception.Drospirenone/ethinylestradiol 3mg/20microg (24/4) provided 99% contraceptive protection over 1 year of treatment in two large studies. The same treatment regimen over three treatment cycles also significantly improved the emotional and physical symptoms associated with PMDD, and improved moderate acne vulgaris over six treatment cycles in double-blind trials. It was generally well tolerated, with adverse events generally typical of those experienced with other COCs and which were most likely to occur in the first few cycles. Clinical trials indicate that drospirenone/ethinylestradiol 3mg/20microg (24/4) is a good long-term contraceptive option, and additionally offers relief of symptoms that characterise PMDD and has a favourable effect on moderate acne vulgaris.

A randomized trial of telemedicine-based collaborative care for depression.

BACKGROUND: Evidence-based practices designed for large urban clinics are not necessarily portable into smaller isolated clinics. Implementing practice-based collaborative care for depression in smaller primary care clinics presents unique challenges because it is often not feasible to employ on-site psychiatrists. OBJECTIVE: The purpose of the Telemedicine Enhanced Antidepressant Management (TEAM) study was to evaluate a telemedicine-based collaborative care model adapted for small clinics without on-site psychiatrists. DESIGN: Matched sites were randomized to the intervention or usual care. PARTICIPANTS: Small VA Community-based outpatient clinics with no on-site psychiatrists, but access to telepsychiatrists. In 2003-2004, 395 primary care patients with PHQ9 depression severity scores > or = 12 were enrolled, and followed for 12 months. Patients with serious mental illness and current substance dependence were excluded. MEASURES: Medication adherence, treatment response, remission, health status, health-related quality of life, and treatment satisfaction. RESULTS: The sample comprised mostly elderly, white, males with substantial physical and behavioral health comorbidity. At baseline, subjects had moderate depression severity (Hopkins Symptom Checklist, SCL-20 = 1.8), 3.7 prior depression episodes, and 67% had received prior depression treatment. Multivariate analyses indicated that intervention patients were more likely to be adherent at both 6 (odds ratio [OR] = 2.1, p = .04) and 12 months (OR = 2.7, p = .01). Intervention patients were more likely to respond by 6 months (OR = 2.0, p = .02), and remit by 12 months (OR = 2.4, p = .02). Intervention patients reported larger gains in mental health status and health-related quality of life, and reported higher satisfaction. CONCLUSIONS: Collaborative care can be successfully adapted for primary care clinics without on-site psychiatrists using telemedicine technologies.