First semester college experiences: Associations with substance use and mental health.

Introduction: Substance use (SU) and mental health (MH) concerns often occur as students transition from high school to college and may be associated with first semester experiences. Methods: Incoming first-year college students at a U.S., predominantly white, midwestern university were recruited for an intervention study. Participants reported on substance use, mental health, and college experiences at the end of their first semester of college (n = 781; 62.9 % female, mean age = 18.06 [SD = 0.24]; 77.2 % non-Hispanic white; 84.6 % heterosexual). Data for these current analyses were cross-sectional. Results: Identifying as Black, Indigenous, or another Person of Color, as a sexual minority, or as female was associated with more challenging first semester experiences. Social experiences that represent more social engagement were associated with greater substance use. College experiences reflecting an easier transition were associated with fewer mental health concerns. Alcohol use moderated the relation between academic challenges and mental health with stronger associations found at greater levels of alcohol use. Conclusions: First semester experiences were related to student mental health and substance use, suggesting the importance of early, targeted support for students to adjust to campus life.

Trends in coping reasons for marijuana use among U.S. adolescents from 2016 to 2022.

OBJECTIVE: This study examines historical trends in coping reasons for marijuana use among adolescents (1976-2022) and explores sociodemographic variations in recent years (2016-2022). METHOD: Data from U.S. national samples of 12th grade adolescents in the Monitoring the Future (MTF) study were used to examine long-term trends (1976-2022, N = 43,237) and recent differences by sociodemographic characteristics (2016-2022, N = 3,816). Measures included marijuana use, coping reasons for use, and sociodemographic characteristics. RESULTS: The most prevalent coping reason across time was "relax," endorsed by 52.9% of past 12-month users. Coping reasons mostly exhibited significant increases over time. Sociodemographic factors were associated with coping reasons. Females had higher odds of using marijuana to escape problems and get through the day (vs. males). Black respondents were more likely to use marijuana to get through the day, and Hispanic respondents were more likely to use to relax (vs. White respondents). Those with lower (vs. higher) parental education were more likely to use due to anger/frustration and to escape problems. Adolescents who used marijuana frequently (vs. less often) had higher odds of endorsing all coping reasons. There was no robust evidence of interactions between sociodemographic characteristics and year. CONCLUSIONS: Results indicate a consistent increase in coping reasons for adolescent marijuana use over time, with variations based on sociodemographic characteristics. The findings highlight the importance of understanding subpopulations of adolescents who have higher risk of coping-related marijuana use.

A Survey of Feeding Practices During High-Flow Nasal Cannula Oxygen Therapy.

BACKGROUND: High-flow nasal cannula (HFNC) oxygen therapy is used to deliver warm and humidified gases to patients in respiratory failure. A purported advantage of HFNC oxygen therapy is that it can allow for oral feeding while on the device, although few data support this practice. The purpose of this study was to identify practices and opinions with regard to feeding practices during HFNC oxygen therapy. METHODS: A survey related to the practice and opinions of feeding practices during HFNC oxygen therapy was developed and sent to respiratory therapists, speech-language pathologists, physicians, advanced practice providers, and registered dietitians. RESULTS: Respondents included 307 professionals from 14 different countries. Most respondents worked in an academic/teaching hospital (n = 174 [56.7%]) with patients ages ≥ 18 years (n = 282 [91.9%]). Most respondents stated that their institution did not have a specific feeding protocol for HFNC oxygen therapy (n = 246 [80.4%]) and felt that patients could have an oral diet during HFNC oxygen therapy if not in imminent danger of being intubated (n = 264 [86.3%]). Fewer than half of the respondents felt that patients should have a bedside/clinical swallow examination before eating and/or drinking during HFNC oxygen therapy (n = 143 [46.7%]). By profession, most physicians/advanced practice providers (n = 67 [59.3%]), respiratory therapists (n = 37 [62.7%]) and half of the registered dietitians (n = 16 [50%]) felt that bedside/clinical swallow examinations were unnecessary before eating and/or drinking with HFNC, but speech-language pathologists were in favor (n = 77 [75.5%]). CONCLUSIONS: Most facilities did not have a protocol to guide feeding practices when HFNC oxygen therapy is used. Most clinicians felt that an oral diet is safe for stable patients not in danger of being intubated. In general, speech-language pathologists felt that patients on HFNC oxygen therapy should undergo a bedside/clinical swallow examination before eating and/or drinking.

Age- and Sex-Varying Associations Between Depressive Symptoms and Substance Use from Modal Ages 35 to 55 in a National Sample of U.S. Adults.

It is important to examine normative age-related change in substance use risk factors across the lifespan, with research focusing on middle adulthood particularly needed. The current study examined time-varying associations between depressive symptoms and alcohol, cigarette, and marijuana use from modal ages 35 to 55 in a national sample of US adults, overall and by sex. Data were obtained from 11,147 individuals in the longitudinal Monitoring the Future study. Participants were in 12th grade (modal age 18) in 1976-1982 and (for the data reported in this study) were surveyed again at modal ages 35 (in 1993-1999), 40, 45, 50, and 55 (in 2013-2019). Weighted time-varying effect modeling was used to examine age-related change in associations among depressive symptoms, any and heavy use of cigarettes, alcohol, and marijuana. Across midlife, greater depressive symptoms were associated with decreased odds of any alcohol use during the 40 s and 50 s, but with increased odds of binge drinking from ages 35-40, and-at most ages-any and pack + cigarette use and any and frequent marijuana use. The association between depressive symptoms and substance use was generally similar for men and women. Results highlight the increased risk for binge drinking, smoking, and marijuana with higher levels of depressive symptoms and underscore the importance of screening and interventions for depressive symptoms and substance use in midlife.

High-intensity drinking and hours spent drinking.

BACKGROUND: High-intensity drinking (HID) is associated with negative consequences, but it remains unclear whether a time qualifier (i.e., time spent drinking) is needed to identify individuals at highest risk. To improve the measurement and conceptualization of HID, we examined the utility of adding a time qualifier to define what constitutes an occasion of HID using repeated daily surveys in a sample of young adults. METHODS: Participants were selected from a nationally representative sample of 12th-grade students in the United States who participated in the Monitoring the Future (MTF) study in Spring 2018. In 2019 and 2020, young adults (at modal ages 19-20) responded to annual and daily (14 consecutive days per year) online surveys about their alcohol use. RESULTS: When we compared moderate drinking days (less than 4/5 drinks for women/men), binge drinking days (4-7/5-9 drinks), and HID days (8+/10+ drinks), HID days had the longest duration of drinking (5.2 h), highest peak estimated blood alcohol concentration (eBAC, 0.30%), and greatest drinking pace (2.58 drinks/h). HID was associated with a greater number of negative consequences than either moderate or binge drinking; adjusting for time spent drinking did not impact this interpretation. HID was reported on 10.9% of days; when defined as 8/10+ drinks in 4 h or 2 h, HID was reported on 4.8% and 1.0% of days, respectively. Nearly all differences in eBAC and negative consequences persisted across drinking intensity despite the introduction of time constraints. CONCLUSIONS: HID days were characterized by both a longer time spent drinking and a more rapid pace of drinking. Adding a time qualifier to the definition of HID would restrict variability by only describing the minority of days and does not improve the distinctions among levels of risk.

Prevalence of low computed tomography-measured skeletal muscle index and handgrip strength in a general medical population.

BACKGROUND: Sarcopenia is defined as the loss of muscle mass and function and has been associated with worsened outcomes, including disability and mortality. The aim of this study was to describe the prevalence of sarcopenia in patients who had an abdominal computed tomography (CT) scan completed within 7 days of hospital admission. METHODS: A retrospective study was conducted. Adult patients admitted to either the general medical or surgical floor were included. Muscle function was assessed using handgrip strength (HGS, kg), completed within the first 48 hours of admission. Skeletal muscle index (SMI, kg/m2 ) at the third lumber region was calculated among patients who had an abdominal CT scan completed within 7 days of admission. Sarcopenia was identified by the combination of low SMI and HGS. The primary outcome was the percentage of patients diagnosed with sarcopenia. RESULTS: A total of 1318 patients were admitted; 11% (n = 141) had an abdominal CT scan completed within 7 days of admission. Only race and prevalence of malnutrition were different between patients who did and did not have a CT completed. The overall prevalence of sarcopenia was 13% (n = 18/141). Additionally, 39% of the sample was at risk for sarcopenia, with either low SMI (n = 13/141) or low HGS (n = 42/141). CONCLUSIONS: Overall prevalence of sarcopenia was low, but more than one-third of patients had either low SMI or low HGS. Minimal differences were observed between patients who did and did not have an abdominal CT scan completed upon admission.

Relationship between blood glucose variability and muscle composition in ICU patients receiving nutrition support: A pilot study.

BACKGROUND AND AIMS: Many critically ill patients experience increased blood glucose variability (BGV). The objective of the current pilot study was to assess the relationship between muscle composition (defined as average Hounsfield units (HU)) among ICU patients with an abdominal CT scan within seven days of intubation, and BGV (defined as coefficient of variation (CV)) calculated from blood glucose levels measured each morning while intubated. METHODS: The first serum blood glucose measurement obtained each day during intubation was recorded, blood glucose CV ((mean/SD)∗100) was calculated. Cross-sectional muscle area (CSA; cm2) at the third lumbar region was identified using the -29 to +150 HU range; muscle composition was calculated as the average HU. BGV predictors were determined using linear regression. RESULTS: Eighty-two patients were included (53% female), with a median age of 64 (25th, 75 percentile (IQR): 51, 70) years. The median CV was 29% (IQR: 20, 37); 40% of subjects required insulin. The median CSA was 100.4 cm2 (IQR: 84.0, 120.8) and muscle composition was 20.4 HU (IQR: 12.2, 29.4). Patients received only 36% of estimated calorie requirements. Insulin administration, history of diabetes, and muscle composition were significant BGV predictors. CONCLUSION: Among these adult intubated ICU patients, higher muscle composition was associated with lower BGV. Future research is needed to corroborate these findings, determine other factors associated with poor muscle quality, and identify methods to describe muscle composition for all ICU patients.

The Influence of Timing in Critical Care Nutrition.

Proper timing of critical care nutrition has long been a matter of controversy. Critical illness waxes and wanes in stages, creating a dynamic flux in energy needs that we have only begun to examine. Furthermore, response to nutrition support likely differs greatly at the level of the individual patient in regard to genetic status, disease stage, comorbidities, and more. We review the observational and randomized literature concerning timing in nutrition support, discuss mechanisms of harm in feeding critically ill patients, and highlight the role of precision nutrition for moving the literature beyond the realm of blunt population averages into one that accounts for the patient-specific complexities of critical illness and host genetics.

Clinician's Guide to Understanding Effect Size, Alpha Level, Power, and Sample Size.

Effect size, α level, power, and sample size are misunderstood concepts that play a major role in the design and interpretation of studies. Effect size represents the magnitude of a change in an outcome or the strength of a relationship. Often, the effect size may be more important than just relying on the α level when interpreting results from a study because it informs a researcher of the actual magnitude of the difference or relationship. Confidence intervals can also assist in making this assessment. Power represents the probability of rejecting the null hypothesis when it is false. Effect size, power, and α level are all important in the calculation of sample size needed to conduct a study. Calculating the sample size a priori and including the required number of participants is essential. Studies with small sample sizes, relative to the needed number provided from a power analysis, may lead to false negative results. Studies with grossly large sample sizes may yield statistically significant findings with small effect sizes that may not be clinically relevant. It is beneficial when all four components are clearly presented in analytic studies. Failure to include these elements may limit the ability of other researchers to replicate the study's findings and lead to difficulty when interpreting the study's results.

How people experience and respond to their distress predicts problem drinking more than does the amount of distress.

Although broad dispositional negative affect predicts problematic alcohol use, emerging evidence suggests that individual differences in how people experience and respond to negative affect may play an important role in risk. In a sample of 358 college students assessed twice across their first year of college, the current study investigated the predictive roles of trait negative affect, affective lability (the tendency to experience rapid and intense shifts in mood), negative urgency (the tendency to act rashly when highly emotional), and problem drinking via self-report measures completed online. Data were analyzed using structural equation modeling (SEM). Individual differences in how negative affect is experienced and responded to, represented by affective lability and negative urgency, predicted problem drinking above and beyond trait negative affect, and trait negative affect had no incremental predictive power. Additionally, affective lability predicted increases in negative urgency, but the opposite was not true. A focus on characteristic ways in which individuals experience and respond to negative affect, rather than negative affect itself, may improve risk assessment and clarify the etiology of problem drinking. Continued work toward the development of comprehensive affect-based risk models for problem drinking is needed.

Affect-Based Problem Drinking Risk: The Reciprocal Relationship between Affective Lability and Problem Drinking.

AIMS: Negative affect has been implicated in risk for the development of problematic drinking behavior. Furthermore, there is evidence for reciprocal relationships between negative affect and problem drinking, such that engagement in problem drinking also predicts increases in negative affect. However, affective models of risk often fail to consider affective lability-the experience of rapidly changing mood. Although affective lability appears to increase risk for problem drinking, it is unknown if this relationship persists above and beyond other affect-related constructs (e.g. depression, anxiety) and if it is reciprocal in nature. Accordingly, we used a longitudinal survey design to examine (a) if affective lability predicts problem drinking above and beyond depression and anxiety and (b) if affective lability and problem drinking demonstrate a reciprocal relationship. METHODS: First-year college students (n = 358) participated in a three wave longitudinal study. We constructed a structural equation model (SEM) of a random intercept cross-lagged panel model to test our hypotheses. RESULTS: Consistent with our hypotheses, affective lability predicted increases in problem drinking while anxiety and depression did not. Problem drinking and affective lability demonstrated a reciprocal relationship in which increases in one predicted increases in the other at subsequent time points. This relationship was present beyond the predictive effects of anxiety or depression. CONCLUSIONS: Affective lability appears to be an important affect-based predictor of problem drinking, and there may be a reciprocal, risk-enhancing relationship between affective lability and problem drinking.Components of negative affect, such as depression or anxiety, have been shown to predict risk for problem drinking, and vice versa. A less considered construct, affective lability, predicted problem drinking while anxiety and depression did not add any predictive power. Problem drinking and affective lability also appeared to demonstrate a reciprocal relationship.

Prevalence and risk factors for delirium in critically ill patients with COVID-19 (COVID-D): a multicentre cohort study.

BACKGROUND: To date, 750 000 patients with COVID-19 worldwide have required mechanical ventilation and thus are at high risk of acute brain dysfunction (coma and delirium). We aimed to investigate the prevalence of delirium and coma, and risk factors for delirium in critically ill patients with COVID-19, to aid the development of strategies to mitigate delirium and associated sequelae. METHODS: This multicentre cohort study included 69 adult intensive care units (ICUs), across 14 countries. We included all patients (aged ≥18 years) admitted to participating ICUs with severe acute respiratory syndrome coronavirus 2 infection before April 28, 2020. Patients who were moribund or had life-support measures withdrawn within 24 h of ICU admission, prisoners, patients with pre-existing mental illness, neurodegenerative disorders, congenital or acquired brain damage, hepatic coma, drug overdose, suicide attempt, or those who were blind or deaf were excluded. We collected de-identified data from electronic health records on patient demographics, delirium and coma assessments, and management strategies for a 21-day period. Additional data on ventilator support, ICU length of stay, and vital status was collected for a 28-day period. The primary outcome was to determine the prevalence of delirium and coma and to investigate any associated risk factors associated with development of delirium the next day. We also investigated predictors of number of days alive without delirium or coma. These outcomes were investigated using multivariable regression. FINDINGS: Between Jan 20 and April 28, 2020, 4530 patients with COVID-19 were admitted to 69 ICUs, of whom 2088 patients were included in the study cohort. The median age of patients was 64 years (IQR 54 to 71) with a median Simplified Acute Physiology Score (SAPS) II of 40·0 (30·0 to 53·0). 1397 (66·9%) of 2088 patients were invasively mechanically ventilated on the day of ICU admission and 1827 (87·5%) were invasively mechanical ventilated at some point during hospitalisation. Infusion with sedatives while on mechanical ventilation was common: 1337 (64·0%) of 2088 patients were given benzodiazepines for a median of 7·0 days (4·0 to 12·0) and 1481 (70·9%) were given propofol for a median of 7·0 days (4·0 to 11·0). Median Richmond Agitation-Sedation Scale score while on invasive mechanical ventilation was -4 (-5 to -3). 1704 (81·6%) of 2088 patients were comatose for a median of 10·0 days (6·0 to 15·0) and 1147 (54·9%) were delirious for a median of 3·0 days (2·0 to 6·0). Mechanical ventilation, use of restraints, and benzodiazepine, opioid, and vasopressor infusions, and antipsychotics were each associated with a higher risk of delirium the next day (all p≤0·04), whereas family visitation (in person or virtual) was associated with a lower risk of delirium (p<0·0001). During the 21-day study period, patients were alive without delirium or coma for a median of 5·0 days (0·0 to 14·0). At baseline, older age, higher SAPS II scores, male sex, smoking or alcohol abuse, use of vasopressors on day 1, and invasive mechanical ventilation on day 1 were independently associated with fewer days alive and free of delirium and coma (all p<0·01). 601 (28·8%) of 2088 patients died within 28 days of admission, with most of those deaths occurring in the ICU. INTERPRETATION: Acute brain dysfunction was highly prevalent and prolonged in critically ill patients with COVID-19. Benzodiazepine use and lack of family visitation were identified as modifiable risk factors for delirium, and thus these data present an opportunity to reduce acute brain dysfunction in patients with COVID-19. FUNDING: None. TRANSLATIONS: For the French and Spanish translations of the abstract see Supplementary Materials section.

Prioritizing nutrition during recovery from critical illness.

PURPOSE OF REVIEW: Patients admitted to the intensive care unit (ICU) often experience a significant decline in nutritional status due to a combination of the physiologic response to critical illness and insufficient calorie intake. The majority of research related to nutrition interventions for this population focuses on nutrition support during the acute phase. Minimal attention is given to the nutritional status of ICU patients during the recovery phase. This review will describe calorie intake when ICU care ends, provide an overview of barriers that limit intake, and possible interventions to improve nutritional status. RECENT FINDINGS: Current evidence suggests patients are consuming < 60% of calorie requirements after extubation and ICU discharge. This inadequate calorie intake may exacerbate weight loss and muscle and fat wasting. Physiologic, physical, and cognitive manifestations of critical illness can lead to multiple issues that cause poor intake. Possible interventions to improve calorie intake include a patient-centered approach that utilizes oral nutrition supplements and enteral nutrition. SUMMARY: Consuming adequate caloric intake in the recovery phase of critical illness is essential for rehabilitation. A systematic, patient centered approach that includes close monitoring of calorie and protein and timely interventions may be the best method to improve overall intake.

Impact of MnSOD and GPx1 Genotype at Different Levels of Enteral Nutrition Exposure on Oxidative Stress and Mortality: A Post hoc Analysis From the FeDOx Trial.

BACKGROUND: Converting nutrition support to energy results in mitochondrial free radical production, possibly increasing oxidative stress. Highly prevalent single nucleotide variants (SNV) exist for the genes encoding antioxidant enzymes responsible for the detoxification of reactive oxygen species. Our objective was to explore the interaction between nutrition support and genetic SNV's for two anti-oxidant proteins (rs4880 SNV for manganese superoxide dismutase and rs1050450 SNV for glutathione peroxidase 1) on oxidative stress and secondarily on intensive care unit (ICU) mortality. METHODS: We performed a post-hoc analysis on 34 mechanically ventilated sepsis patients from a randomized control feeding trial. Participants were dichotomized into those who carried both the rs4880 and the rs1050450 at-risk alleles (Risk Group) versus all others (Nonrisk Group). We explored the interaction between genotype and percent time spent in the upper median of energy exposure on oxidative stress and ICU mortality. RESULTS: Adjusting for confounders, the slope of log F2-isoprostane levels across percentage of days spent in the upper median of daily kilocalories per kilogram (kcal/kg) was 0.01 higher in the Risk Group compared to the Non-Risk Group (p=0.01). Every 1 percent increase in days spent in the upper median of daily kcal/kg was associated with an adjusted 10.3 percent increased odds of ICU mortality amongst participants in the Risk Group (odds ratio [OR]=1.103, p=0.06) but was highly insignificant in the Nonrisk group (OR=0.991, P=0.79). CONCLUSION: Nutrition support may lead to increased oxidative stress and worse clinical outcomes in a large percent of ICU patients with an at-risk genotype.

Real-Time Energy Exposure Is Associated With Increased Oxidative Stress Among Feeding-Tolerant Critically Ill Patients: Results From the FEDOX Trial.

BACKGROUND: Prospective randomized controlled trials (PRCTs) that found harm in patients receiving higher levels of energy exposure have been largely ignored, in part because of the lack of a known mechanism of harm. OBJECTIVE: The current 7-day pilot study is a PRCT and post hoc analysis designed to explore the relationship between energy exposure and oxidative stress (as plasma total F2-isoprostanes) in mechanically ventilated intensive care unit patients with systemic inflammatory response syndrome. METHODS: Thirty-five participants were randomized to receive either 100% or 40% of their estimated energy needs. Our intent-to-treat model found no differences in F2-isoprostanes between groups. A post hoc analysis revealed that on days when participants were in the highest tertile of daily kcal/kg, the real-time energy flow rate within 2 hours of the blood draw was predictive of increased oxidative stress. On these days, participants in the second or third vs the first tertile of real-time energy flow rate experienced a 41.8% (P = .006) or 26.5% (P = .001) increase in F2-isoprostane levels, respectively. This was confirmed through a within-group subanalysis restricted to participants with measurements on both sides of the median of real-time energy flow rate that found a 28.2% F2-isoprostane increase on days in the upper vs lower median of flow rate (P = .002). CONCLUSION: The benefits of feeding may be more nuanced than previously suspected. Our findings imply a potential mechanism of harm in meeting the current recommendations for nutrition support in the critically ill that warrants further investigation.

Higher Caloric Exposure in Critically Ill Patients Transiently Accelerates Thyroid Hormone Activation.

INTRODUCTION: The inflammatory response of critical illness is accompanied by nonthyroidal illness syndrome (NTIS). Feeding has been shown to attenuate this process, but this has not been explored prospectively over time in critically ill patients. OBJECTIVE: To explore the impact of calorie exposure on NTIS over time in critically ill patients. METHODS: Mechanically ventilated patients with systemic inflammatory response syndrome (SIRS) were randomized to receive either 100% or 40% of their estimated caloric needs (ECN). Thyroid hormones were measured daily for 7 days or until intensive care unit discharge or death. Mixed level regression modeling was used to explore the effect of randomization group on plasma triiodothyronine (T3), reverse triiodothyronine (rT3), thyroxine (T4), and thyroid stimulating hormone (TSH), as well as the T3/rT3 ratio. RESULTS: Thirty-five participants (n=19 in 100% ECN; n=16 in 40% ECN) were recruited. Adjusting for group differences in baseline T3/rT3 ratio, the parameters defining the fitted curves (intercept, linear effect of study day, and quadratic effect of study day) differed by randomization group (P = 0.001, P = 0.01, and P = 0.02 respectively). Plots of the fitted curves revealed that participants in the 100% ECN group had a 54% higher T3/rT3 ratio on postintervention day 1 compared with the 40% ECN group, a difference which attenuated over time. This was driven by a 23% higher plasma T3 and 10% lower plasma rT3 levels on postintervention 1. CONCLUSIONS: Higher caloric exposure in NTIS patients transiently attenuates the drop of the plasma T3/rT3 ratio, an effect that is minimized and finally lost over the following 3 days of continued higher caloric exposure.

Relationship Between Respiratory Muscle Strength, Handgrip Strength, and Muscle Mass in Hospitalized Patients.

BACKGROUND: Minimal information is available to validate measurement of respiratory muscle strength (RMS) in the clinical setting. The purpose of this study was to determine the correlation between maximal inspiratory pressure (MIP), maximal expiratory pressure (MEP), and sniff nasal inspiratory pressure (SNIP) with handgrip strength (HGS) and cross sectional muscle area obtained via diagnostic abdominal computed tomography (CT). MATERIALS AND METHODS: Measures of MIP, MEP, SNIP, and HGS were obtained from individuals that participated in a previously published study; individuals who had an abdominal CT completed with (±)7 days of obtaining RMS measures were included. Both RMS and HGS were measured within 48-72 hours of admission; for RMS, the highest absolute (cm H2 O) and percent predicted values were recorded, and the average of 3 HGS measurements (kg) was documented. Cross-sectional muscle area (cm2 ) at the third lumbar region was recorded. Spearman's correlation coefficient was used to assess the relationship between variables. RESULTS: A total of 35 participants were included. HGS was correlated to absolute MIP (rs = 0.62, rs = 0.61), MEP (rs = 0.74, rs = 0.73), and SNIP (rs = 0.58, rs = 0.54) for males and females, respectively. Crosss-sectional muscle area was correlated with absolute MIP (rs = 0.66), MEP (rs = 0.58), and SNIP (rs = 0.783) for men and absolute SNIP (rs = 0.56) among women. CONCLUSION: Measures of RMS represent a promising assessment of muscle mass and function among hospitalized patients.

Impulsigenic personality: Is urgency an example of the jangle fallacy?

Negative and positive urgency (the disposition to act rashly when in a highly negative or positive mood, respectively) have been identified as strong correlates of problem drinking and other addictive behaviors and potent predictors of subsequent drinking onset and increase (Peterson & Smith, 2017; Smith & Cyders, 2016). An unaddressed, important question about the validity of the urgency traits is whether they represent functionally distinct constructs or simply the interaction between lack of planning (the disposition to act rashly) and negative or positive affectivity (the disposition to experience negative or positive mood). If urgency is better represented by interactions between lack of planning and affect, there is no need for urgency risk models or separate urgency measures (Smith & Cyders, 2016). In a longitudinal adolescent sample, we tested whether (a) negative urgency differed from the interaction between lack of planning and negative affect, (b) positive urgency differed from the interaction between lack of planning and positive affect, and (c) each urgency trait predicted the subsequent onset of, and increases in, drinking behavior separately from the corresponding interaction. We found that (a) the corresponding interaction accounted for only 1-3% of the variance in negative or positive urgency, and (b) negative (or positive) urgency prospectively predicted drinking behavior but the corresponding interaction did not. These findings suggest that the urgency traits are distinct from interactions between affect and lack of planning. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Differences in Respiratory Muscle Strength Measures in Well-Nourished and Malnourished Hospitalized Patients.

BACKGROUND: Objective indicators of nutritional status are essential for accurate identification of malnutrition. Previous research has indicated an association between measures of respiratory muscle strength (RMS) and nutritional status. Measurement of RMS-including maximal inspiratory pressure (MIP), maximal expiratory pressure (MEP), and sniff nasal inspiratory pressure (SNIP)-may provide evidence to support the assessment of nutritional status in hospitalized patients. OBJECTIVE: The purpose of this study was to determine whether there was a difference in MIP, MEP, and SNIP between well-nourished and malnourished hospitalized patients. DESIGN: A cross-sectional study was conducted. PARTICIPANTS/SETTING: Patients were screened for eligibility criteria on admission by means of electronic medical records in general medical or surgical units at a tertiary care hospital in Chicago, IL, from January 2016 to January 2017. A total of 140 patients were included for analysis. MAIN OUTCOMES MEASURED: The primary outcome was detection of differences in measures of RMS between malnourished and well-nourished hospitalized patients. Nutritional status was assessed using subjective global assessment and Academy of Nutrition and Dietetics/American Society for Parenteral and Enteral Nutrition (Academy/ASPEN) criteria recommended to identify malnutrition. The MIP, MEP, and SNIP measures were obtained and reported as absolute values (expressed in centimeters of water) and percent of predicted values. STATISTICAL ANALYSIS: Independent t tests or Mann-Whitney U tests were used to determine differences in RMS measures between patients assessed as well nourished and those assessed as malnourished, depending on normality. RESULTS: Compared with well-nourished patients, malnourished patients identified by subjective global assessment criteria had significantly lower absolute SNIP (73.7±28.7 vs 59.5±27.1 cm H2O, P=0.004) and percent of predicted SNIP (78.6%±26.3% vs 64.8%± 30.0% predicted, P=0.006). Similarly, compared with well-nourished patients when Academy/ASPEN guidelines were used, malnourished individuals had significantly lower absolute SNIP (76.5±28.6 vs 58.3±26.3 cm H2O, P<0.001), percent of predicted SNIP (81.4%±26.4% vs 63.5%±28.7% predicted, P<0.001), absolute MIP (83.5±34.6 vs 71.1±33.6 cm H2O, P=0.05), and absolute MEP (108.7±36.6 vs 94.2±39.9 cm H2O, P=0.04). CONCLUSION: Differences in RMS between well-nourished and malnourished patients were observed when SNIP measures were used. However, there were no differences in MIP and MEP measures. Further research is needed to build on the findings from this study.