Mortality Risk of Low BMI in Life Insurance Applicants.

OBJECTIVES: -This study seeks to quantify the mortality effect of low levels of body mass index (BMI) on life insurance applicants who, based on their laboratory profile and other information, appear to be suitable for life insurance coverage. BACKGROUND: -It has been demonstrated that low BMI is associated with higher mortality risk than normal or near-normal BMI. METHODS: -Data were collected from over 4.7 million life insurance applicants with available BMI tested between 1995 and 2021, and vital status was assessed via the Social Security Death Master File. Cox models treating BMI as continuous and as a categorical variable were constructed, controlling for age, and split by sex after excluding those with laboratory or biometric test results, which were far enough outside the normal range to imply elevated mortality. RESULTS: -Models treating BMI as a continuous variable and allowing an interaction term for age showed that low BMI was strongly associated with mortality at ages 50 and above in both sexes. In the categorical models, only the lowest category of BMI (below the 1st percentile) in men aged 40-60, the lowest 2 categories (below the 5th percentile) in women aged 40-60, and the lowest 3 categories (below the 10th percentile) in those aged 60-80 years, were significantly associated with elevated mortality. No elevated mortality was detected in those under age 40 with low BMI. CONCLUSION: -Based on this study, low BMI is associated with elevated mortality in otherwise healthy applicants, but this association is dependent on age.

Prevalence of Antibodies to COVID-19 Due to Infection or Vaccination in US Adults.

OBJECTIVE: -Determine the seroprevalence of SARS-CoV-2 infection and vaccination in a population applying for life insurance. SETTING: -This is a cross-sectional study of 2584 US life insurance applicants, to determine the seroprevalence of antibodies to COVID-19. This convenience sample was selected on two consecutive days April 25-26, 2022. RESULTS: -For COVID-19, 97.3% are seropositive, and 63.9% have antibodies to nucleocapsid protein, a marker of prior infection. An additional, 33.7% have been vaccinated with no serologic evidence of infection. METHODOLOGY: -Serum and urine samples from a nationwide group of insurance applicants for routine risk assessment were collected. The examination of applicants typically occurs, in their homes, their place of employment, or a clinic. The paramedic exam occurs 7-14 days after the insurance application. Before the exam, an office assistant calls the applicant and inquires if they have been in contact with a person with SARS-CoV-2, been ill within the last 2 weeks, felt sick, or recently had a fever. If the applicant answers yes, the exam is rescheduled. Before sample collection, the applicant reads and signs a consent form to release medical information and testing. Next, the examiner records the applicant's blood pressure, height, and weight. Then, a blood and a urine sample are collected and sent with the consent form to our laboratory via Federal Express. On April 25-26, 2022, we tested 2584 convenience samples from adult insurance applicants for the presence of antibodies to nucleocapsid and spike proteins from SARS-CoV-2. As a standard practice, we reported the client-specified test profile results to our life insurance carriers. In contrast, the COVID-19 test results were only available to the authors. Patient and Public Involvement.-There was no patient involvement in study design, reporting of results, or journal publication selection. There was patient consent to publish de-identified study results. No public involvement occurred in the creation or completion of the study. The authors thank the participants in this study for approving the use of their blood samples to further society's understanding of the SARS-CoV-19 pandemic. Ethics Review.-Western Institutional Review Board reviewed the study design and determined it to be exempt under the Common Rule and applicable guidance. Therefore, it is exempt under 45 CFR § 46.104(d)(4) from using de-identified study samples for epidemiologic investigation, WIRB Work Order #1-1324846-1. In addition, all test subjects had signed a consent allowing research of their blood and urine samples with the removal of personally identifiable information. RESULTS: -The combined seroprevalence for antibodies to nucleocapsid, a marker of prior infection, and antibodies to spike protein, an indicator of either previous infection or vaccination, was 97.3%. Higher infection rates occur in younger vs older age groups, with a non-statistical difference for vaccinated and acquired natural immunity. For the age group 16-84, the total estimated seroprevalence of COVID-19 in the US is 249 million cases. CONCLUSIONS: -The US population has widespread immune resistance to current variants of COVID-19 due to prior infection or vaccination. The infectivity of new variants and silent disease, independent of previous infection or vaccination, are the driving force behind the sporadic increase in clinical SARS-CoV-2 cases.

Correlates and Predictors of NT-proBNP in Life Insurance Applicants.

OBJECTIVES: -To document the various laboratory and demographic/historical correlates of NT-proBNP levels in applicants for life insurance, and to explore the accuracy of a prediction model based on those variables. METHOD: -NT-proBNP blood test results were obtained from 1.34 million insurance applicants between the age of 50 and 85 years, beginning in 2003. Exploratory data analysis was carried out to document correlations with other laboratory variables, sex, age, and the presence of relevant diseases. Further, predictive models were used to quantify the proportion of the variance of NT-proBNP, which can be explained by a combination of these other, easier to determine variables. RESULTS: -NT-proBNP shows the expected, negative correlation with estimated glomerular filtration rate (eGFR) is markedly higher in those with a history of heart disease and is somewhat higher in those with a history of hypertension. A strong, unexpected, negative correlation between NT-proBNP and albumin was discovered. Of the variables evaluated, a multivariate adaptive regression spline (MARS) model automated selection procedure selected 7 variables (age, sex, albumin, eGFR, BMI, systolic blood pressure, cholesterol, and history of heart disease). Variable importance evaluation determined that age, albumin and eGFR were the 3 most important continuous variables in the prediction of NT-proBNP levels. An ordinary least squares (OLS) model using these same variables achieved a R-squared of 24.7%. CONCLUSION: -Expected ranges of NT-proBNP may vary substantially depending on the value of other variables in the prediction equation. Albumin is significantly negatively correlated with NT-proBNP levels. The reasons for this are unclear.

Prevalence of Antibodies to COVID-19 Due to Infection or Vaccination in US Adults.

OBJECTIVE: -Determine the seroprevalence of SARS-CoV-2 infection and vaccination in a population applying for life insurance. SETTING: -This is a cross-sectional study of 2584 US life insurance applicants, to determine the seroprevalence of antibodies to COVID-19. This convenience sample was selected on two consecutive days April 25-26, 2022. RESULTS: -For COVID-19, 97.3% are seropositive, and 63.9% have antibodies to nucleocapsid protein, a marker of prior infection. An additional, 33.7% have been vaccinated with no serologic evidence of infection. METHODOLOGY: -Serum and urine samples from a nationwide group of insurance applicants for routine risk assessment were collected. The examination of applicants typically occurs, in their homes, their place of employment, or a clinic. The paramedic exam occurs 7-14 days after the insurance application. Before the exam, an office assistant calls the applicant and inquires if they have been in contact with a person with SARS-CoV-2, been ill within the last 2 weeks, felt sick, or recently had a fever. If the applicant answers yes, the exam is rescheduled. Before sample collection, the applicant reads and signs a consent form to release medical information and testing. Next, the examiner records the applicant's blood pressure, height, and weight. Then, a blood and a urine sample are collected and sent with the consent form to our laboratory via Federal Express. On April 25-26, 2022, we tested 2584 convenience samples from adult insurance applicants for the presence of antibodies to nucleocapsid and spike proteins from SARS-CoV-2. As a standard practice, we reported the client-specified test profile results to our life insurance carriers. In contrast, the COVID-19 test results were only available to the authors. Patient and Public Involvement.-There was no patient involvement in study design, reporting of results, or journal publication selection. There was patient consent to publish de-identified study results. No public involvement occurred in the creation or completion of the study. The authors thank the participants in this study for approving the use of their blood samples to further society's understanding of the SARS-CoV-19 pandemic. Ethics Review.-Western Institutional Review Board reviewed the study design and determined it to be exempt under the Common Rule and applicable guidance. Therefore, it is exempt under 45 CFR § 46.104(d)(4) from using de-identified study samples for epidemiologic investigation, WIRB Work Order #1-1324846-1. In addition, all test subjects had signed a consent allowing research of their blood and urine samples with the removal of personally identifiable information. RESULTS: -The combined seroprevalence for antibodies to nucleocapsid, a marker of prior infection, and antibodies to spike protein, an indicator of either previous infection or vaccination, was 97.3%. Higher infection rates occur in younger vs older age groups, with a non-statistical difference for vaccinated and acquired natural immunity. For the age group 16-84, the total estimated seroprevalence of COVID-19 in the US is 249 million cases. CONCLUSIONS: -The US population has widespread immune resistance to current variants of COVID-19 due to prior infection or vaccination. The infectivity of new variants and silent disease, independent of previous infection or vaccination, are the driving force behind the sporadic increase in clinical SARS-CoV-2 cases.

Treatment of anger problems in previously deployed post-911 veterans: A randomized controlled trial.

BACKGROUND: Problems with anger and aggression affect many veterans who have deployed to a warzone, resulting in serious impairment in multiple aspects of functioning. Controlled studies are needed to improve treatment options for these veterans. This randomized controlled trial compared an individually delivered cognitive behavioral therapy adapted from Novaco's Anger Control Therapy to a manualized supportive therapy to control for common therapeutic factors. METHODS: Ninety-two post-911 veterans deployed during Operation Enduring Freedom (OEF), Operation Iraqi Freedom (OIF), or Operation New Dawn (OND) with moderate to severe anger problems were randomized to receive the cognitive behavioral intervention (CBI) or the supportive intervention (SI). Anger, aggression, multiple areas of functioning and quality of life were assessed at multiple time points inclu\ding 3- and 6-month follow-up. RESULTS: Hierarchical linear modeling (HLM) analyses showed significant treatment effects favoring CBI for anger severity, social and interpersonal functioning, and quality of life. The presence of a PTSD diagnosis did not affect outcomes. CONCLUSIONS: CBI is an effective treatment for OEF/OIF/OND veterans with anger problems following deployment, regardless of PTSD diagnosis.

Diffusiophoresis of charged colloidal particles in the limit of very high salinity.

Diffusiophoresis is the migration of a colloidal particle through a viscous fluid, caused by a gradient in concentration of some molecular solute; a long-range physical interaction between the particle and solute molecules is required. In the case of a charged particle and an ionic solute (e.g., table salt, NaCl), previous studies have predicted and experimentally verified the speed for very low salt concentrations at which the salt solution behaves ideally. The current study presents a study of diffusiophoresis at much higher salt concentrations (approaching the solubility limit). At such large salt concentrations, electrostatic interactions are almost completely screened, thus eliminating the long-range interaction required for diffusiophoresis; moreover, the high volume fraction occupied by ions makes the solution highly nonideal. Diffusiophoretic speeds were found to be measurable, albeit much smaller than for the same gradient at low salt concentrations.

Association of Liver Function Tests with Mortality in an Insurance Applicant Population.

OBJECTIVES: -Determine the relationship between liver function test (LFT) results (GGT, alkaline phosphatase, AST, ALT and albumin) and all-cause mortality in life insurance applicants. METHOD: -By use of the Social Security Master Death File, mortality was examined in 15,272,955 insurance applicants for whom blood samples were submitted to the Clinical Reference Laboratory. There were 268,593 deaths observed in this study population, after an average follow-up time of 10.9 years. Results were stratified by sex and by age less/greater than 60, creating 4 groups. Liver function test values were grouped using percentiles of their distribution within these age/ sex groups - so as to update the results generated in prior publications. Additional models were fit using different exclusions and percentile groups within single year age groups. Also, LFTs were treated as continuous variables and included in Cox models with age and smoking status. RESULTS: -Using the risk of the middle 50% of the population by distribution as a reference, relative mortality observed for GGT and alkaline phosphatase was linear with a steep slope from very low to high values. AST showed a J-shaped association with mortality. ALT showed a low-magnitude inverse correlation with mortality. Albumin demonstrated a higher-magnitude inverse correlation with mortality, especially at values below the median. The overall risk associated with LFTs was durable over at least 10 years of follow-up. CONCLUSION: -Liver function tests show a strong and durable correlation to mortality in a large group of insurance applicants. The durability over time suggests that even older values of LFTs found in medical records could be of use in mortality risk prediction.

One-Stop Shopping for Recovery: An Investigation of Participant Characteristics and Benefits Derived From U.S. Recovery Community Centers.

BACKGROUND: Recovery community centers (RCCs) are the "new kid on the block" in providing addiction recovery services, adding a third tier to the 2 existing tiers of formal treatment and mutual-help organizations (MHOs). RCCs are intended to be recovery hubs facilitating "one-stop shopping" in the accrual of recovery capital (e.g., recovery coaching; employment/educational linkages). Despite their growth, little is known about who uses RCCs, what they use, and how use relates to improvements in functioning and quality of life. Greater knowledge would inform the field about RCC's potential clinical and public health utility. METHODS: Online survey conducted with participants (N = 336) attending RCCs (k = 31) in the northeastern United States. Substance use history, services used, and derived benefits (e.g., quality of life) were assessed. Systematic regression modeling tested a priori theorized relationships among variables. RESULTS: RCC members (n = 336) were on average 41.1 ± 12.4 years of age, 50% female, predominantly White (78.6%), with high school or lower education (48.8%), and limited income (45.2% <$10,000 past-year household income). Most had either a primary opioid (32.7%) or alcohol (26.8%) problem. Just under half (48.5%) reported a lifetime psychiatric diagnosis. Participants had been attending RCCs for 2.6 ± 3.4 years, with many attending <1 year (35.4%). Most commonly used aspects were the socially oriented mutual-help/peer groups and volunteering, but technological assistance and employment assistance were also common. Conceptual model testing found RCCs associated with increased recovery capital, but not social support; both of these theorized proximal outcomes, however, were related to improvements in psychological distress, self-esteem, and quality of life. CONCLUSIONS: RCCs are utilized by an array of individuals with few resources and primary opioid or alcohol histories. Whereas strong social supportive elements were common and highly rated, RCCs appear to play a more unique role not provided either by formal treatment or by MHOs in facilitating the acquisition of recovery capital and thereby enhancing functioning and quality of life.

Psychometric Validation of the Brief Alcohol Social Density Assessment in an Adult Community Sample.

BACKGROUND: Individuals' social networks exert a strong influence on alcohol use, but valid assessment of network drinking behavior is typically lengthy and high in participant burden. The aim of this study was to validate the Brief Alcohol Social Density Assessment (BASDA), an efficient measure of perceived alcohol use within a person's social network, in a sample of adult drinkers from the general community. Specifically, the convergent, criterion-related, incremental validity and internal validity were investigated by examining the BASDA in relation to other established measures of drinking motives, weekly drinking level, and severity of involvement. METHODS: Participants were 903 (56% female) adults who reported drinking in the last year and who completed the BASDA, the Drinking Motives Questionnaire, the Daily Drinking Questionnaire, and the Alcohol Use Disorders Identification Test (AUDIT). RESULTS: Significant positive correlations were found between the BASDA and drinking motives, drinking quantity, and the AUDIT (rs = 0.21 to 0.51, ps < 0.001), providing support for convergent validity. There was a significantly higher BASDA score for those scoring at or above an AUDIT cutoff for hazardous drinking (p < 0.001), providing support for criterion-related validity. Finally, beyond motives and covariates, the BASDA was significantly associated with total AUDIT score (ΔR2  = 0.09, p < 0.001), indicating its additive contribution and providing support for incremental validity. Confirmatory factor analysis revealed excellent fit, and all items significantly loaded onto a single factor (p < 0.0001), providing evidence of internal validity. The resulting alcohol social density latent variable was significantly and robustly associated with drinks per week and AUDIT total score. CONCLUSIONS: These findings provide further support for the BASDA as a valid and efficient measure of social network alcohol density for understanding social influences on alcohol misuse.

Regional environmental assessment of dairy farms.

A comprehensive, yet in depth, assessment is needed of the environmental impacts of dairy farms at regional and national scales to better track improvements made by the industry. With Pennsylvania as an example, a method using process-level simulation and cradle-to-farm gate life cycle assessment was developed and used to assess important environmental footprints of dairy farms within a state. Representative dairy farms of various sizes and management practices throughout 7 regions of the state were simulated with the Integrated Farm System Model. Environmental footprints varied widely among farms, with this variation influenced primarily by soil characteristics and climate and secondarily by farm management. Therefore, prescriptive mitigation strategies for individual farms are more effective than uniform enforcement of specific strategies across the state. Footprints for the whole state were determined by totaling values among farms and regions based on the amounts of milk produced by each. Pennsylvania dairy farms were determined to emit 4,555 with an uncertainty of ±415 Gg of CO2 equivalent of greenhouse gas with an intensity of 0.99 ± 0.09 kg of CO2 equivalent/kg of fat- and protein-corrected milk (FPCM) produced. Fossil energy consumption was 12,324 ± 1,946 TJ or 2.69 ± 0.42 MJ/kg of FPCM. Blue (nonprecipitation) water consumption was 64.1 ± 13.5 Tg with an intensity of 14.0 ± 3.0 kg/kg of FPCM. A total of all forms of reactive N loss was 43.2 ± 5.0 Gg with an intensity of 9.4 ± 1.1 g/kg of FPCM. These metrics were equivalent to 1.6% of the greenhouse gas emissions, 0.4% of fossil energy use, and 0.8% of fresh water consumption reported for the state. Thus, greenhouse gas emissions, fossil energy use, and blue water use associated with dairy farm production are relatively small compared with total estimates for the state. Perhaps the greatest environmental concern is that of ammonia emission, where dairy farms accounted for about half the estimated emissions of the state. This method can be applied to assessments of the dairy industry at larger regional and national scales.

Activity Level as a Mortality Predictor in a Population Sample after Typical Underwriting Exclusions and Laboratory Scoring.

Objectives.- To quantify the effect of physical activity on the mortality rates of healthy individuals in a population sample, after controlling for other sources of mortality risk. Background.- The widespread availability of activity monitors has spurred life insurance companies to consider incorporating such data into their underwriting practices. Studies have shown that sedentary lifestyles are associated with poor health outcomes and higher risks of death. The aim of this paper is to investigate how well certain measures of activity predict mortality when controlled for other known predictors of mortality including a multivariate laboratory based risk score. Methods.- Data were obtained from the National Health and Nutrition Examination Survey (NHANES) for the years 1999 through 2014. Laboratory and biometric data were scored for mortality risk using a previously developed proprietary algorithm (CRL SmartScore). Data on activity were obtained from the NHANES questionnaires pertaining to activity. In a second analysis, data were obtained from pedometers worn for 1 week by NHANES participants (years 2003-2004, and 2005-2006 only). Before analysis, cases were selected based on commonly used life insurance underwriting criteria to remove from consideration those who have major health issues, which would ordinarily preclude an offer of life insurance. Results.-In fully-adjusted Cox model which included survey-based MET*hours per day as a 3-level categorical variable, the moderate and minimal levels of activity were associated with hazard ratios of 1.15 (95% CI: 1.04-1.28) and 1.38 (95% CI: 1.23-1.56), respectively, when compared to the highest level of activity. When treated as a continuous variable, the fully adjusted model the HR for MET*hours per day was 0.91 (95% CI: 0.87-0.95). In fully adjusted models using pedometer data, the percentage of wear time spent sedentary was associated with mortality (HR: 1.19, 95% CI: 1.09-1.31), while average counts per minute were negatively associated with mortality (HR: 0.82, CI: 0.75-0.90). Conclusions.-It is clear from these results that high proportions of sedentary time are associated with increased mortality, whether the sedentary time is quantified via questionnaire or pedometer. Because both laboratory scores and activity levels remain significant in Cox models where both are included, these factors are largely independent, indicating that they are measuring distinct influences on the risk of mortality.

Association of Carcinoembryonic Antigen with Mortality in an Insurance Applicant Population.

Objectives.- To quantify the mortality risks associated with elevated levels of carcinoembryonic antigen (CEA). Background.- Carcinoembryonic antigen is cell surface glycoprotein and has been associated with the presence of high grade or metastatic cancers of the colon as well as other malignant and non-malignant disease. Prior publications have demonstrated the utility of CEA levels in the determination of mortality risk in life insurance applicants. The aim of this paper is to further characterize this risk with a larger set of data containing additional person-years of follow-up, more outcomes, and additional variables potentially associated with occult malignancy. Methods.- By use of the Social Security Death Index, mortality was examined in 321,574 insurance applicants age 50 years and older, who submitted blood samples to Clinical Reference Laboratories for testing including CEA. Results were stratified by age group and by CEA level (<5 ng/mL, 5 to 9.9 ng/mL, 10+ ng/mL), though other thresholds were tested. Mortality comparisons were carried out using Cox models and tabular methods with the 2015 smoker-distinct Valuation Basic Tables as a comparator. Results.- Relative mortality is increased at CEA levels above 4.0 ng/mL in both smokers and non-smokers. This association is persistent in Cox models when albumin, BMI and cholesterol are included as covariates. The strongest association with mortality risk occurred in the first 3-4 durations. The 3-year cumulative mortality ratio when using the 2015 VBT as baseline was 6.51 when comparing the group with CEA levels of 10+ ng/mL, compared to those with levels below 5.0 ng/mL. Conclusion.- This study shows that CEA is strongly associated with the risk of early excess mortality in life insurance applicants, and this risk appears not to be mitigated by consideration of other markers thought to be associated with occult malignancy.

A Pilot Randomized Controlled Trial of a Technology-Based Substance Use Intervention for Youth Exiting Foster Care.

Youth exiting foster care represent a unique, at-risk population in that they receive supportive health services while under the umbrella of the foster care system, but access to care can drop precipitously upon release from foster custody. Traditional means of substance use treatment may not meet the needs of this vulnerable population. Mobile interventions, however, have demonstrated high acceptability and efficacy across a range of mental and physical health issues. The specific advantages to mobile interventions dovetail well with the barriers faced by youth exiting foster care. This study describes the feasibility, acceptability, and initial efficacy of iHeLP, a computer- and mobile phone-based intervention based in Motivational Interviewing for reducing substance use among youth exiting foster care (n = 33). Participants were randomly assigned to either iHeLP or a contact control, each of which lasted six months. Feasibility was evaluated through eligibility and enrollment rates at baseline, and retention and intervention reach rates 3, 6, 9, and 12 months later. Acceptability was measured through a 5-item satisfaction measure and exit interviews. The two groups were then compared on a monthly measure of substance use. Study enrollment, retention, response rate, engagement, and satisfaction were all very good. Participants receiving iHeLP reported higher percent days abstinent than the control group, with effect sizes ranging from 0.32 to 0.62. Technology-based interventions such as iHeLP may be attractive to this population and support efforts towards reductions in substance use.

NT-proBNP Predicts All-Cause Mortality in a Population of Insurance Applicants, Follow-up Analysis and Further Observations.

OBJECTIVE: - Further refine the independent value of NT-proBNP, accounting for the impact of other test results, in predicting all-cause mortality for individual life insurance applicants with and without heart disease. METHOD: - Using the Social Security Death Master File and multivariate analysis, relative mortality was determined for 245,322 life insurance applicants ages 50 to 89 tested for NT-proBNP (almost all based on age and policy amount) along with other laboratory tests and measurement of blood pressure and BMI. RESULTS: - NT-proBNP values ≤75 pg/mL included the majority of applicants denying heart disease and had the lowest risk, while values >500 pg/mL for females and >300 pg/mL for males had very high relative risk. Those admitting to heart disease had a higher mortality risk for each band of NT-proBNP relative to those denying heart disease but had a similar and equally predictive risk curve. CONCLUSION: - NT-proBNP is a strong independent predictor of all-cause mortality in the absence or presence of known heart disease but the range of values associated with increased risk varies by sex.

Developing a Tailored Texting Preventive Intervention: A Card Sort Methodology.

PURPOSE: Intervention content written by adults for youth can result in miscommunication due to generational and cultural differences. Inviting at-risk youth to participate in the creation of intervention material can augment acceptability for their peers. METHODS: To improve intervention messaging, the present study examines the utility of a card sort technique when creating cellular phone text messages to be used in a preventive substance use intervention. During focus groups with 24 youth who are exiting the foster care system - a population with distinct cultural attributes - participants were asked to rate stage of change-specific health messages rooted in Motivational Interviewing and the Transtheoretical Model. RESULTS: Participants unanimously favored content that encouraged autonomy and choice. Statements that invited a "look to the future" were also rated favorably. Messages that referenced the past were not rated well, as were suggestions for professional assistance. Finally, encouragement to receive social support for change was met with ambivalence. While some participants regarded support as helpful, many others felt a severe lack of support in their lives, possibly prompting further substance use. CONCLUSIONS: Youth exiting foster care constitute a unique population whose voice is paramount in the development of interventions. The content present in traditional approaches to substance use prevention (e.g., increasing social support) may not apply to this group of vulnerable youth. The card sort technique has strong potential to evoke youth-specific intervention content that is more readily understood and accepted by target audiences.

Self-Generated Electrokinetic Fluid Flows during Pseudomorphic Mineral Replacement Reactions.

Pseudomorphic mineral replacement reactions involve one mineral phase replacing another, while preserving the original mineral's size and texture. Macroscopically, these transformations are driven by system-wide equilibration through dissolution and precipitation reactions. It is unclear, however, how replacement occurs on the molecular scale and what role dissolved ion transport plays. Here, we develop a new quantitative framework to explain the pseudomorphic replacement of KBr crystal in a saturated KCl solution through a combination of microscopic, spectroscopic, and modeling techniques. Our observations reveal that pseudomorphic mineral replacement (pMRR) is transport-controlled for this system and that convective fluid flows, caused by diffusioosmosis, play a key role in the ion transport process across the reaction-induced pores in the product phase. Our findings have important implications for understanding mineral transformations in natural environments and suggest that replacement could be exploited in commercial and laboratory applications.

Interpersonal psychotherapy (IPT) for major depression following perinatal loss: a pilot randomized controlled trial.

This randomized controlled pilot trial examined the feasibility, acceptability, and preliminary efficacy of an adapted interpersonal psychotherapy (IPT) for major depressive disorder (MDD) following perinatal loss (miscarriage, stillbirth, or early neonatal death). Fifty women who experienced a perinatal loss within the past 18 months, whose current depressive episode onset occurred during or after the loss, were randomized to the group IPT adapted for perinatal loss (the Group IPT for Major Depression Following Perinatal Loss manual developed for this study is available at no cost by contacting either of the first two authors) or to the group Coping with Depression (CWD), a cognitive behavioral treatment which did not focus on perinatal loss nor social support. Assessments occurred at baseline, treatment weeks 4 and 8, post-treatment, and 3 and 6 months after the end of treatment. IPT was feasible and acceptable in this population. Although some participants were initially hesitant to discuss their losses in a group (as occurred in IPT but not CWD), end of treatment satisfaction scores were significantly (p = 0.001) higher in IPT than in CWD. Confidence intervals around between-groups effect sizes favored IPT for reductions in depressive symptoms during treatment as well as for improvement in mode-specific targets (social support, grief symptoms) and recovery from a post-traumatic stress disorder over follow-up. This group IPT treatment adapted for MDD after perinatal loss is feasible, acceptable, and possibly efficacious.

Test-Retest Reliability and descriptive analyses of the Modified Important People and Activities (MIPA) Interview.

BACKGROUND: The Important People and Activities (IPA) instrument assesses network characteristics and social support for drinking and abstinence. The IPA has garnered widespread use in the alcohol treatment field. We modified the IPA to assess HIV status, drug of choice, and IV drug use among social network members. Further, we queried frequency of unprotected sex, between the participant and network members. AIM: Since this measure was modified, and the test-retest reliability of the IPA has only rarely been examined, we conducted a small substudy (n=26) to examine 1-week test-retest reliability of this measure. METHODS: Participants were individuals in a day treatment program with an SUD and/or AUD diagnosis. RESULTS: Drug of choice for the participants represented roughly equal thirds of heroin, cocaine, and alcohol. The sample was 62% female and 39% Latino/a. At pretest 198 persons were named on the MIPA (M=7.6 network members per subject). It was determined that 152 of the people were overlapping between the test and retest. CONCLUSIONS: Percent agreement, ICCs, and kappas for the items ranged from acceptable to excellent across the two time periods. Classification of network members as positive, negative, or neutral influences on sobriety also demonstrated good to excellent kappas.

Testing a Dynamic Automated Substance Use Intervention Model for Youths Exiting Foster Care.

With an ever increasing gap between need and availability for substance use services, more scalable and efficient interventions are needed. For youth in the foster care system, this gap is dramatic and expands as they leave care. Effective prevention services are strongly needed for this group of vulnerable young people. We propose a novel technology-driven intervention for preventing problematic substance use among youth receiving foster care services. This intervention approach would extend the work in brief computerized interventions by adding a text message-based booster, dynamically tailored to each individual's readiness to change. It also combats many barriers to service receipt. Dynamically tailored interventions delivered through technologies commonly used by adolescents and young adults have the strong potential to reduce the burden of problematic substance use.

2014 CRL Build Study of Life Insurance Applicants.

Objective .- Determine the impact of build on insurance applicant mortality accounting for smoking, laboratory test values and blood pressure. Method .- The study consisted of 2,051,370 applicants tested at Clinical Reference Laboratory between 1993 and 2007 with build and cotinine measurements available whose body mass index (BMI) was between 15 and 47. Vital status was determined as of September, 2011 by the Social Security Death Master File. Excluded from the primary study were applicants with HbA1c values ≥6.5%, systolic BP ≥141 mmHg, albumin values ≤3.3 g/dL or total cholesterol values ≤130 mg/dL. Relative mortality was determined by Cox regression analysis for bands of BMI split by age, sex and smoking status (urine cotinine positive). Results .- A majority of applicants had BMI >24 (overweight or obese by WHO criteria). After the exclusions noted above, relative mortality does not increase by >34% unless BMI is <20 (<18 for female non-smokers age 18 to 59) or BMI is >34. BMI values in the range of 22 to 24 and 25 to 29, overall, had similar and the lowest relative risks. For most nonsmokers, risk was lowest in the lower of these two BMI bands but for smokers (and non-smoking males age 60 to 89) risk was lowest in the higher BMI band. Additional analysis showed limited reduction in relative risk by accounting for all laboratory test values as well as continuing the exclusions. Eliminating the exclusions resulted in only a modest increase in relative risk because the mortality rate of the reference band increased as well. Conclusion .- After excluding elevated HbA1c and blood pressure (associated with high BMI) and low albumin and cholesterol (associated with low BMI) which are usually evaluated separately, mortality varies by a limited degree for BMI 20 to 34. Accounting for the mortality impact of other test values, in addition to the exclusions noted, reduced mortality associated with high BMI to a limited extent, but had little impact on mortality associated with low BMI.