Effectiveness of the caregiver support intervention on child psychosocial wellbeing among Syrian refugees in Lebanon: Mediation and secondary analysis of a Randomized Controlled Trial

BACKGROUND

War and violence have a serious negative impact on the wellbeing and mental health of many children. Caregivers play an important role in mitigating or exacerbating this impact.

OBJECTIVE

This study evaluates the impact of the nine session Caregiver Support Intervention on improving children's wellbeing and examines putative mediators of changes in children's psychosocial wellbeing.

PARTICIPANTS AND SETTING

240 female caregivers were randomly allocated (1:1) to the CSI or a waitlist control comparison condition. The study was implemented in Lebanon, in an area characterized by high levels of poverty and a high number of the Syrian refugees.

METHODS

A parallel group Randomized Controlled Trial reporting on caregiver-reported child-level wellbeing. We used a combination of the Kid- and Kiddy-KINDL (parent version) for index children ages three to 12. Putative mediators of the CSI on children's psychosocial wellbeing included harsh parenting, caregiver psychological distress, caregiver wellbeing. Measurements were conducted at baseline, post-intervention and 3-months follow-up.

RESULTS

We demonstrated a statistically significant change in caregiver reported children's psychosocial wellbeing at post-intervention (Mdiff =4.39, 95 % CI = 1.12, 7.65, p < 0.01, d = 0.28) but not at follow-up (Mdiff = -0.97, 95 % CI = -4.27, 2.32, p > 0.05). The proportion of the total effect of the CSI intervention on child psychosocial wellbeing mediated by caregiver distress, caregiver wellbeing and harsh parenting was 77 %.

CONCLUSION

The CSI holds potential for down-stream short-term effect on improving children's psychosocial wellbeing, beyond the previously reported positive caregiver outcomes. This effect was not sustained three months post intervention. The study confirms caregiver wellbeing and parenting support as dual pathways mediating child psychosocial wellbeing. Prospective trial registration: ISRCTN22321773.

Peer sexual harassment, affect, and substance use: Daily level associations among adolescents

INTRODUCTION

Peer sexual harassment is associated with adolescent substance use at the global level; however, it is unknown whether substance use occurs proximal in time to the sexual harassment experience. This study used daily reports to examine the proximal relations between sexual harassment victimization and affect and substance use. Based on theories of self-medication, we hypothesized that negative affect and substance use (cigarettes, electronic cigarettes, alcohol, and marijuana) would be higher than typical on days when sexual harassment occurred relative to nonvictimization days.

METHOD

A community sample of 13-16-year-old adolescents (N = 204, 55.4% female) from a metropolitan area in the northeastern United States completed 56 days of online reports assessing experiences with peer sexual harassment, substance use (cigarettes, electronic cigarettes, alcohol, and marijuana), and positive and negative affect.

RESULTS

Multilevel modeling revealed that experiencing sexual harassment on a given day was associated with higher than typical negative affect on that day, relative to nonvictimization days. The likelihood of cigarette and alcohol use (but not electronic cigarettes, marijuana, or positive affect) was greater on days when sexual harassment occurred.

CONCLUSION

Sexual harassment victimization is proximally associated with negative affect and alcohol and cigarette use, suggesting that adolescents may be using substances to cope with sexual harassment victimization. The co-occurrence of sexual harassment with negative affect and substance use points to the need for prevention efforts that conjointly address sexual harassment victimization, coping, and substance use.

Association of multiple tracheal intubation attempts with clinical outcomes in extremely preterm infants: a retrospective single-center cohort study

OBJECTIVE

We examined the association between the number of tracheal intubation (TI) attempts and clinical outcomes in extremely preterm infants.

METHOD

This is a single-center retrospective cohort study examining infants born at ≤28 weeks gestation intubated within the first four postnatal days. We analyzed infant, provider, and practice characteristics and clinical outcomes by exposure groups (1 vs. 2 vs. ≥3 TI attempts). Primary outcomes were death prior to NICU discharge or severe intraventricular hemorrhage (IVH).

RESULT

Ninety-nine infants were included. 46.5% required one TI attempt, 29.3% required two, and 24.2% required three or more. Increasing attempts was significantly associated with death (p = 0.004), adverse tracheal intubation-associated events (TIAEs; p = 0.004), and the training level of the first attempt provider (p = 0.002). No association was found with severe IVH or complications of prematurity.

CONCLUSIONS

Increasing attempts was associated with death and adverse TIAEs. Careful selection of providers could decrease adverse TIAEs and improve outcomes.

Alcohol Mixed With Energy Drinks and Sexually Related Causes of Conflict in the Barroom

The popularity of alcohol mixed with energy drinks (AmED) among young adults has spurred studies that focus on its links to aggression and risk-taking behaviors, including risky sex and sexual victimization. However, no studies to date have looked at the relationship between AmED and causes of interpersonal conflict in bars at the event level. The present study evaluated whether AmED use at the time of the bar conflict was associated with greater odds that a bar conflict would be precipitated by sexually related causes. Online survey data, including a description of a recent bar conflict, were collected from a community sample of 175 young adult (97 female) AmED users age 18 to 30 in western New York state. Qualitative findings included the natural categorization of sexually related causes of conflict, consisting of unwanted sexual advances and jealousy, and the prominence of sexual competition in these conflicts. Proportion of AmED use (out of the total quantity of alcoholic drinks) predicted the odds that the bar conflict would have a sexually related cause, above and beyond control variables. How AmED use might be associated with sexual competition and conflict in the bar is discussed.

0462 Identifying and Characterizing Insomnia Symptom Groups Across the Deployment Cycle in Current Army Soldiers

Introduction

Most research conducted on insomnia and its development in military personnel focuses on cross-sectional data, precluding examination of the course of sleep changes over time. The present study characterized Army Soldiers based on insomnia symptom status trajectory from pre to post-deployment and explored baseline factors predictive of these trajectories in a sample of 7,245 soldiers across 3 Brigade Combat Teams.

Methods

Data were analyzed from the Army Study to Assess Risk and Resilience in Service members (STARRS)-All-Army Study (AAS) Pre Post Deployment Study, using surveys that captured 1-2 months pre-deployment, during deployment, and 6-months post-deployment. Insomnia symptom status was defined at each timepoint as insomnia symptoms that interfered with one or more domains of functioning at least some of the time in the past month. Theoretically-derived variables linked to sleep disturbance were selected as predictors of insomnia symptom trajectory and evaluated using a general linear selection model.

Results

Four trajectories characterized the majority of the sample: ‘good sleepers’ (no insomnia symptoms across time; 44.4%), ‘non-remitting new onset insomnia’ (no pre-deployment insomnia, developed insomnia symptoms during deployment that remained at 6 months; 22.8%), ‘deployment-only insomnia symptoms’ (no pre-deployment insomnia, developed insomnia during deployment but recovered by follow-up; 12.8%), and ‘chronic insomnia’ (insomnia both pre- and post-deployment; 7.4%). Several pre-deployment factors predicted insomnia trajectory, the strongest of which were past six-month attention deficit disorder symptoms, number of lifetime exposures to potentially traumatic events, and past month depression symptoms.

Conclusion

Insomnia is one of the most common reasons that military personnel seek behavioral health treatment and is associated with poorer military readiness. Better characterization and identification of insomnia symptoms over time can improve intervention during post-deployment transitions, particularly for those with new onset insomnia that does not remit.

Support

Cooperative agreement U01MH087981 (Department of the Army; U.S. Department of Health and Human Services, National Institutes of Health, National Institute of Mental Health); U.S. Department of Veterans Affairs, Clinical Science Research and Development-IK2CX001874-PI:Katherine E. Miller, IK2CX001501-PI:Elaine M. Boland; Rehabilitation Research and Development-1IK2RX001836-PI:Elizabeth A. Klingaman. The views expressed here are those of the authors and do not represent the Department of Veterans Affairs.

Proximal Associations among Bullying, Mood, and Substance Use: A Daily Report Study

Adolescent involvement in bullying as a victim or perpetrator has been associated with negative health outcomes, including emotional distress and substance use. Whether negative affect and substance use are acute responses to bullying involvement or whether they develop over time is unknown. Such knowledge is needed to understand the conditions under which bullying contributes to adverse outcomes, as well as to inform the development of appropriate interventions. This study examined the daily-level associations among bullying, negative affect, and substance use (i.e., alcohol, cigarettes, electronic-cigarettes, marijuana) among a community sample of adolescents (N = 204) ages 13 - 16 years (55% female, 81% European American, 13% African-American) who had reported bully victimization or perpetration in the past six months. Participants completed a brief on-line survey every day for 56 consecutive days, reporting on their experiences with bully victimization, bully perpetration, mood, and substance use for that day. Consistent with hypotheses, being bullied on a given day was associated with reporting greater than average levels of sadness (b = 0.279, 95% CI = [0.172, 0.387]), anger (b = 0.354, 95% CI = [0.242, 0.466]), and cigarette use (OR = 1.453, 95% CI = [1.006, 2.099]) on that day; however, it was not associated with alcohol, electronic-cigarette, or marijuana use. Perpetration was not associated with same day negative affect or substance use. Results of the current study suggest that negative affect and cigarette use may be acute responses to bully victimization. Bully perpetration does not appear to be proximally linked to mood or substance use after accounting for victimization.

The association between caffeinated alcoholic beverages and the perpetration of intimate partner violence

Background: Problematic alcohol use is a recognized risk factor for intimate partner violence (IPV) perpetration.Objective: The use of caffeinated alcoholic beverages (CAB) appears to be associated with high-risk drinking behavior but the relationship between CAB use and IPV has yet to be explored.Methods: Sixty male and 40 female married or dating participants responded to an online survey including measures of past-year alcohol use and partner violence.Results: Logistic regression analyses revealed that CAB users were significantly more likely to perpetrate physical assault and partner injury after controlling for age, sex, ethnicity, income, and heavy alcohol use. The relationship between CAB use and perpetration of sexual coercion was better accounted for by heavy alcohol use.Conclusion: Results from the current study suggest that there exists an independent link between CAB use and partner violence perpetration.

Caffeinated Alcoholic Beverages and Intimate Partner Violence Victimization

Background: Caffeinated alcoholic beverage (CAB) use is associated with general victimization beyond the use of alcohol alone. Materials and Methods: No prior research has evaluated the association between CAB use and intimate partner violence (IPV) victimization. This study evaluated the CAB-IPV victimization relationship using the responses of 100 (40 female) respondents to an online survey. Results: Results of logistic regression analyses indicated that CAB use was associated with IPV physical and sexual victimization after adjusting for demographics and heavy alcohol use. Exploratory analyses detected little evidence of sex differences in the strength of the relationship between CAB use and IPV victimization. Conclusions: The current results provide initial evidence that CAB use may place males and females at greater risk of IPV victimization.

Alcohol mixed energy drink use as a risk factor for experiencing and perpetrating bar aggression

Despite the recent, widespread trend of consuming alcohol mixed with energy drinks (AmEDs) in commercial bar settings, few studies have examined whether this practice exacerbates the risk of experiencing aggression in bars and licensed establishments. Past studies have been limited to between-subjects comparison analyses that are at risk for bias due to selection effects. The present analysis examines whether a sample of individuals who regularly use AmEDs are at elevated risk for experiencing or perpetrating physical aggression in bars when drinking AmEDs versus when they are drinking noncaffeinated alcohol (NCA) use alone. This within-subject analysis controls for any individual differences that may be related to both AmED use and the tendency to engage in aggressive behavior. An online survey was completed by 175 young adults (78 male) who were frequent bar patrons, used AmEDs regularly, and had experienced at least one recent bar conflict incident. Although NCA use was more common than was AmED use, AmED-involved bar aggression was more frequently reported than was aggression that coincided with NCA use only. Additionally, victimization and perpetration of aggression in bar environments were both more common when AmEDs were used than when only NCA was used. Frequency of going to bars was predictive of rates of experiencing bar aggression only when drinking NCA but not when drinking AmEDs. Results suggest that AmED use introduces a unique risk factor into the bar environment that must be considered in future research and in subsequent interventions meant to reduce the incidence of bar aggression. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Caffeinated energy drink use by U.S. adolescents aged 13-17: A national profile

The present study examined the national prevalence and distribution of adolescent use of caffeinated energy drinks, assessing variations in sociodemographic characteristics, personality traits, lifestyles, and patterns of alcohol and caffeine use. A cross-sectional survey was conducted in May 2014, using a nationally representative sample of 1,032 U.S. early (aged 13-15; n = 602) and middle adolescents (aged 16-17; n = 430). Nearly two thirds of teens reported ever using energy drinks; 41% had done so recently, that is, in the past 3 months. Middle adolescents reported higher prevalences of both lifetime and recent use of energy drinks than early adolescents. Common situational contexts for use (e.g., compensating for lack of sleep or playing sports) differed by both gender and age cohort. In hierarchical logistic regression analyses, gender and geographic region significantly predicted both lifetime and recent use for early adolescents only, whereas age and race were significant predictors only for middle adolescents. For both age cohorts, odds of both lifetime and recent use increased with sensation-seeking score, lifetime alcohol use, and recent caffeinated soft drink use. Among early adolescents, grade point average predicted lifetime use only, whereas coffee and caffeine pill use predicted recent use only. Among middle adolescents, impulsivity and past sports participation predicted lifetime but not recent use. Our findings show that adolescent energy drink use is widespread and varies as a function of demographic, psychosocial, lifestyle, and substance use characteristics. Future research is needed to assess whether differences between early and middle adolescent use patterns are primarily developmental or cohort effects. (PsycINFO Database Record

Intoxication-Related Alcohol Mixed with Energy Drink Expectancies Scale: Initial Development and Validation

BACKGROUND

Young adult use of alcohol mixed with energy drinks (AmEDs) has been linked with elevated risks of a constellation of problem behaviors. These risks may be conditioned by expectancies regarding the effects of caffeine in conjunction with alcohol consumption. The aim of this study was to describe the construction and psychometric evaluation of the Intoxication-Related AmED Expectancies Scale (AmED_EXPI), 15 self-report items measuring beliefs about how the experience of AmED intoxication differs from the experience of noncaffeinated alcohol (NCA) intoxication.

METHODS

Scale development and testing were conducted using data from a U.S. national sample of 3,105 adolescents and emerging adults aged 13 to 25. Exploratory and confirmatory factor analyses were conducted to evaluate the factor structure and establish factor invariance across gender, age, and prior experience with AmED use. Cross-sectional and longitudinal analyses examining correlates of AmED use were used to assess construct and predictive validity.

RESULTS

In confirmatory factor analyses, fit indices for the hypothesized 4-factor structure (i.e., Intoxication Management [IM], Alertness [AL], Sociability [SO], and Jitters [JT]) revealed a moderately good fit to the data. Together, these factors accounted for 75.3% of total variance. The factor structure was stable across male/female, teen/young adult, and AmED experience/no experience subgroups. The resultant unit-weighted subscales showed strong internal consistency and satisfactory convergent validity. Baseline scores on the IM, SO, and JT subscales predicted changes in AmED use over a subsequent 3-month period.

CONCLUSIONS

The AmED_EXPI appears to be a reliable and valid tool for measuring expectancies about the effects of caffeine during alcohol intoxication.

Modeling molecular mechanisms in the axon

Axons are living systems that display highly dynamic changes in stiffness, viscosity, and internal stress. However, the mechanistic origin of these phenomenological properties remains elusive. Here we establish a computational mechanics model that interprets cellular-level characteristics as emergent properties from molecular-level events. We create an axon model of discrete microtubules, which are connected to neighboring microtubules via discrete crosslinking mechanisms that obey a set of simple rules. We explore two types of mechanisms: passive and active crosslinking. Our passive and active simulations suggest that the stiffness and viscosity of the axon increase linearly with the crosslink density, and that both are highly sensitive to the crosslink detachment and reattachment times. Our model explains how active crosslinking with dynein motors generates internal stresses and actively drives axon elongation. We anticipate that our model will allow us to probe a wide variety of molecular phenomena-both in isolation and in interaction-to explore emergent cellular-level features under physiological and pathological conditions.

Alcohol Mixed with Energy Drink Use as an Event-Level Predictor of Physical and Verbal Aggression in Bar Conflicts

BACKGROUND

Young adult use of alcohol mixed with caffeinated energy drinks (AmEDs) has been globally linked with increased odds of interpersonal aggression, compared with the use of alcohol alone. However, no prior research has linked these behaviors at the event level in bar drinking situations. The present study assessed whether AmED use is associated with the perpetration of verbal and physical aggression in bar conflicts at the event level.

METHODS

In Fall 2014, a community sample of 175 young adult AmED users (55% female) completed a web survey describing a recent conflict experienced while drinking in a bar. Use of both AmED and non-AmED alcoholic drinks in the incident were assessed, allowing calculation of our main predictor variable, the proportion of AmEDs consumed (AmED/total drinks consumed). To measure perpetration of aggression, participants reported on the occurrence of 6 verbal and 6 physical acts during the bar conflict incident.

RESULTS

Linear regression analyses showed that the proportion of AmEDs consumed predicted scores for perpetration of both verbal aggression (β = 0.16, p < 0.05) and physical aggression (β = 0.19, p < 0.01) after controlling for gender, age, sensation-seeking and aggressive personality traits, aggressive alcohol expectancies, aggressogenic physical and social bar environments, and total number of drinks.

CONCLUSIONS

Results of this study suggest that in alcohol-related bar conflicts, higher levels of young adult AmED use are associated with higher levels of aggression perpetration than alcohol use alone and that the elevated risk is not attributable to individual differences between AmED users and nonusers or to contextual differences in bar drinking settings. While future research is needed to identify motivations, dosages, and sequencing issues associated with AmED use, these beverages should be considered a potential risk factor in the escalation of aggressive bar conflicts.

Implications of sleep and energy drink use for health disparities

The popularity of energy drinks has increased rapidly in the past decade. One of the main reasons people use energy drinks is to counteract effects of insufficient sleep or sleepiness. Risks associated with energy drink use, including those related to sleep loss, may be disproportionately borne by racial minorities and those of lower socioeconomic status. In this review, a brief introduction to the issue of health disparities is provided, population-level disparities and inequalities in sleep are described, and the social-ecological model of sleep and health is presented. Social and demographic patterns of energy drink use are then presented, followed by discussion of the potential ways in which energy drink use may contribute to health disparities, including the following: 1) effects of excessive caffeine in energy drinks, 2) effects of energy drinks as sugar-sweetened beverages, 3) association between energy drinks and risk-taking behaviors when mixed with alcohol, 4) association between energy drink use and short sleep duration, and 5) role of energy drinks in cardiometabolic disease. The review concludes with a research agenda of critical unanswered questions.

Organic molecules in the Sheepbed Mudstone, Gale Crater, Mars

The Sample Analysis at Mars (SAM) instrument on board the Mars Science Laboratory Curiosity rover is designed to conduct inorganic and organic chemical analyses of the atmosphere and the surface regolith and rocks to help evaluate the past and present habitability potential of Mars at Gale Crater. Central to this task is the development of an inventory of any organic molecules present to elucidate processes associated with their origin, diagenesis, concentration, and long-term preservation. This will guide the future search for biosignatures. Here we report the definitive identification of chlorobenzene (150-300 parts per billion by weight (ppbw)) and C₂ to C₄ dichloroalkanes (up to 70 ppbw) with the SAM gas chromatograph mass spectrometer (GCMS) and detection of chlorobenzene in the direct evolved gas analysis (EGA) mode, in multiple portions of the fines from the Cumberland drill hole in the Sheepbed mudstone at Yellowknife Bay. When combined with GCMS and EGA data from multiple scooped and drilled samples, blank runs, and supporting laboratory analog studies, the elevated levels of chlorobenzene and the dichloroalkanes cannot be solely explained by instrument background sources known to be present in SAM. We conclude that these chlorinated hydrocarbons are the reaction products of Martian chlorine and organic carbon derived from Martian sources (e.g., igneous, hydrothermal, atmospheric, or biological) or exogenous sources such as meteorites, comets, or interplanetary dust particles.

KEY POINTS

First in situ evidence of nonterrestrial organics in Martian surface sediments Chlorinated hydrocarbons identified in the Sheepbed mudstone by SAM Organics preserved in sample exposed to ionizing radiation and oxidative condition.

Organic molecules in the Sheepbed Mudstone, Gale Crater, Mars

The Sample Analysis at Mars (SAM) instrument on board the Mars Science Laboratory Curiosity rover is designed to conduct inorganic and organic chemical analyses of the atmosphere and the surface regolith and rocks to help evaluate the past and present habitability potential of Mars at Gale Crater. Central to this task is the development of an inventory of any organic molecules present to elucidate processes associated with their origin, diagenesis, concentration, and long-term preservation. This will guide the future search for biosignatures. Here we report the definitive identification of chlorobenzene (150-300 parts per billion by weight (ppbw)) and C₂ to C₄ dichloroalkanes (up to 70 ppbw) with the SAM gas chromatograph mass spectrometer (GCMS) and detection of chlorobenzene in the direct evolved gas analysis (EGA) mode, in multiple portions of the fines from the Cumberland drill hole in the Sheepbed mudstone at Yellowknife Bay. When combined with GCMS and EGA data from multiple scooped and drilled samples, blank runs, and supporting laboratory analog studies, the elevated levels of chlorobenzene and the dichloroalkanes cannot be solely explained by instrument background sources known to be present in SAM. We conclude that these chlorinated hydrocarbons are the reaction products of Martian chlorine and organic carbon derived from Martian sources (e.g., igneous, hydrothermal, atmospheric, or biological) or exogenous sources such as meteorites, comets, or interplanetary dust particles.

KEY POINTS

First in situ evidence of nonterrestrial organics in Martian surface sediments Chlorinated hydrocarbons identified in the Sheepbed mudstone by SAM Organics preserved in sample exposed to ionizing radiation and oxidative condition.

Volatile and organic compositions of sedimentary rocks in Yellowknife Bay, Gale crater, Mars

H2O, CO2, SO2, O2, H2, H2S, HCl, chlorinated hydrocarbons, NO, and other trace gases were evolved during pyrolysis of two mudstone samples acquired by the Curiosity rover at Yellowknife Bay within Gale crater, Mars. H2O/OH-bearing phases included 2:1 phyllosilicate(s), bassanite, akaganeite, and amorphous materials. Thermal decomposition of carbonates and combustion of organic materials are candidate sources for the CO2. Concurrent evolution of O2 and chlorinated hydrocarbons suggests the presence of oxychlorine phase(s). Sulfides are likely sources for sulfur-bearing species. Higher abundances of chlorinated hydrocarbons in the mudstone compared with Rocknest windblown materials previously analyzed by Curiosity suggest that indigenous martian or meteoritic organic carbon sources may be preserved in the mudstone; however, the carbon source for the chlorinated hydrocarbons is not definitively of martian origin.

Commentary: correlates of concurrent energy drink and alcohol use among socially active adults

BACKGROUND

Despite the popularity of caffeinated energy drinks mixed with alcohol, the links between these beverages and patterns of problem drinking are not yet well understood. The aim of this short commentary is to review a current study investigating the environmental contexts within which AmED use occurs, and to examine its implications.

MATERIALS AND METHODS

The strengths of Wells and colleagues? study are reviewed. The researchers used a field-based survey to survey 1,476 adult patrons at a range of New York City nightlife scenes.

RESULTS

The importance of the study lies in its exploration of the urban nightlife venues within which energy drinks and alcohol are used concurrently by socially active adults. Previous research has largely been confined to investigations of either the physiological effects of alcohol/caffeine coadministration or the demographic, psychosocial, and problem-behavioral correlates of AmED use. The present study?s context-oriented approach offers a third avenue of inquiry.

CONCLUSIONS

The findings are relevant in light of the growing consensus that regular AmED use should be a source of concern to advocates of public health. Future researchers will need to assess the relative importance of physiological, demographic, and contextual factors influencing relationships between AmED use and other health-risk behaviors, and their implications for public policy.

Alcohol Mixed with Energy Drink Use and Sexual Risk-Taking: Casual, Intoxicated, and Unprotected Sex

OBJECTIVE

This study examined the confluence of several behaviors common to U.S. young adults: caffeinated energy drink use, alcohol use, and sexual risk-taking. The author examined relationships between the use of energy drinks mixed with alcohol (AmEDs) and three sexual risk behaviors: casual sex (i.e., intercourse with a nonexclusive and/or nonromantic partner), intoxicated sex (i.e., intercourse while under the influence of alcohol and/or illicit drugs), and unprotected sex (i.e., intercourse without use of a condom).

METHOD

Logistic regression analyses were employed to analyze data from a cross-sectional survey of 648 sexually active undergraduate students at a large public university.

RESULTS

After controlling for risk-taking norms and frequency of noncaffeinated alcohol use, AmED use was associated with elevated odds of casual sex and intoxicated sex but not unprotected sex.

CONCLUSIONS

Although further studies are needed to test for event-level relationships, AmED use should be considered a possible risk factor for potentially health-compromising sexual behaviors.

Potential mechanisms for hypoalgesia induced by anti-nerve growth factor immunoglobulin are identified using autoimmune nerve growth factor deprivation

Nerve growth factor (NGF) antagonism has long been proposed as a chronic pain treatment. In 2010, the FDA suspended clinical trials using tanezumab, a humanized monoclonal anti-NGF antibody, to treat osteoarthritis due to worsening joint damage in 16 patients. Increased physical activity in the absence of acute pain which normally prevents self-harm was purported as a potential cause. Such an adverse effect is consistent with an extension of tanezumab's primary mechanism of action by decreasing pain sensitivity below baseline levels. In animal inflammatory pain models, NGF antagonism decreases intraepidermal nerve fiber (IENF) density and attenuates increases in expression of nociception-related proteins, such as calcitonin gene-related peptide (CGRP) and substance P (SP). Little is known of the effects of NGF antagonism in noninflamed animals and the hypoalgesia that ensues. In the current study, we immunized rats with NGF or cytochrome C (cytC) and examined (1) nocifensive behaviors with thermal latencies, mechanical thresholds, the hot plate test, and the tail flick test, (2) IENF density, and (3) expression of CGRP, SP, voltage-gated sodium channel 1.8 (Nav1.8), and glutaminase in subpopulations of dorsal root ganglion (DRG) neurons separated by size and isolectin B4 (IB4) labeling. Rats with high anti-NGF titers had delayed responses on the hot plate test but no other behavioral abnormalities. Delayed hot plate responses correlated with lower IENF density. CGRP and SP expression was decreased principally in medium (400-800 μm(2)) and small neurons (<400 μm(2)), respectively, regardless of IB4 labeling. Expression of Nav1.8 was only decreased in small and medium IB4 negative neurons. NGF immunization appears to result in a more profound antagonism of NGF than tanezumab therapy, but we hypothesize that decreases in IENF density and nociception-related protein expression are potential mechanisms for tanezumab-induced hypoalgesia.

'THEY LIGHT THE CHRISTMAS TREE IN OUR TOWN': Reflections on Identity, Gender, and Adolescent Sports

Sport occupies a prominent space in the public lives and private identities of US adolescents. Using the retrospective reflections of college students, this analysis explores two questions about sport-related identities during high school: Are 'athletes' and 'jocks' distinctly separate identities? Are these identities explicitly gendered? In four gender-segregated focus groups conducted in early 2005, 32 student-athletes from two upstate New York colleges discussed their high school experiences of sport, status, gender, and identity. Three primary themes developed with regard to differences between the 'jock' and 'athlete' archetypes: academic focus, teamwork, and cockiness/aggression. Examining the intersection of gender, high-status/high-profile sport, and identity in both popular cultural imagery and the personal experiences of the focus group discussants provided support for the thesis of a 'toxic jock' phenomenon.

Athletic participation and seatbelt omission among u.s. High school students

Although seatbelts save lives, adolescents may be disproportionately likely to omit their use. Using data from the 1997 Youth Risk Behavior Survey, a national survey of more than 16,000 U.S. public and private high school students, the authors employed a series of logistic regression analyses to examine cross-sectional associations between past year athletic participation and regular seatbelt omission. Controlling for the effects of gender, age, race, parental education, and school urbanicity, student athletes were significantly less likely than nonathletes to report seatbelt omission. Separate gender-specific analyses showed that this effect was significant for girls but only marginally significant for boys; in addition, the effect was strongest for adolescents who participated on three or more school or community sports teams. Possible explanations for the relationship between athletic participation and seatbelt omission, including Jessor's problem behavior syndrome, prosocial sport subcultures, and sensation seeking, are considered.

Mental Well-Being and Sport-Related Identities in College Students

Past research has linked physical activity and sports participation with improved mental and social well-being, including reduced risk of depression and suicidality. In this study we examined relationships among several dimensions of athletic involvement (team sport participation, individual sport participation, athlete identity, and jock identity), gender, and depression and suicidal behavior in a sample of 791 undergraduate students. Both participation in a team sport and athlete identity were associated with lower depression scores. Athlete identity was also associated with lower odds of a past-year suicide attempt, whereas jock identity was associated with elevated odds of a suicide attempt. The findings are discussed in light of the relationship between mental well-being and a larger constellation of health-risk behaviors linked to a "toxic jock" identity.

Sport-Related Identities and the "Toxic Jock"

Little attention has been paid to the multidimensional nature of athletic involvement, which includes identity formation as well as participation in sports activities. Five hundred eighty-one sport-involved undergraduate students completed a questionnaire assessing their sport-related identities, goal orientations, primary sport ratings, and conformity to masculine norms. F-tested mean comparisons and hierarchical linear regressions were used to explore the characteristics associated with two distinct sport-related identities ("athletes" and "jocks"). Jock identity was associated with an ego-oriented approach to sports (men only), whereas athlete identity was associated with a task-oriented approach (both genders). Jock identity was positively associated with conformity to masculine norms, particularly for men, whereas athlete identity was positively associated with some masculine norms (i.e., Winning) and negatively associated with others (i.e., Playboy). These findings help to identify the correlates of a "toxic Jock" identity that may signal elevated risk for health-compromising behavior.

Energy drinks, race, and problem behaviors among college students

PURPOSE

This study examined relationships between energy drink consumption and problem behaviors among adolescents and emerging adults. It was hypothesized that frequent consumption of energy drinks would be positively associated with substance abuse and other risky behaviors, and that these relationships would be moderated by race.

METHODS

Cross-sectional, self-report survey data were collected from 602 Western New York undergraduate students in the spring of 2006. Differences in problem behaviors by frequency of energy drink consumption were assessed with multivariate linear and logistic regressions, controlling for gender, race, age, parental education, and college grade point average. Follow-up regressions were conducted to test for a moderating effect of race.

RESULTS

Frequency of energy drink consumption was positively associated with marijuana use, sexual risk-taking, fighting, seatbelt omission, and taking risks on a dare for the sample as a whole, and associated with smoking, drinking, alcohol problems, and illicit prescription drug use for white students but not for black students.

CONCLUSIONS

These findings suggest that energy drink consumption is closely associated with a problem behavior syndrome, particularly among whites. Frequent consumption of energy drinks may serve as a useful screening indicator to identify students at risk for substance use and/or other health-compromising behavior.

Wired: energy drinks, jock identity, masculine norms, and risk taking

OBJECTIVE

The author examined gendered links among sport-related identity, endorsement of conventional masculine norms, risk taking, and energy-drink consumption.

PARTICIPANTS

The author surveyed 795 undergraduate students enrolled in introductory-level courses at a public university.

METHODS

The author conducted linear regression analyses of energy-drink consumption frequencies on sociodemographic characteristics, jock identity, masculine norms, and risk-taking behavior.

RESULTS

Of participants, 39% consumed an energy drink in the past month, with more frequent use by men (2.49 d/month) than by women (1.22 d/month). Strength of jock identity was positively associated with frequency of energy-drink consumption; this relationship was mediated by both masculine norms and risk-taking behavior.

CONCLUSIONS

Sport-related identity, masculinity, and risk taking are components of the emerging portrait of a toxic jock identity, which may signal an elevated risk for health-compromising behaviors. College undergraduates' frequent consumption of Red Bull and comparable energy drinks should be recognized as a potential predictor of toxic jock identity.

Evidence of relaxation and spontaneous transition to a high-confinement state in high-beta steady-state plasmas sustained by rotating magnetic fields

Evidence of relaxation has appeared, for the first time, in the extremely high-beta, steady-state field-reversed configuration plasma states driven by rotating magnetic fields (RMF) in the translation, confinement, and sustainment experiment. The plasma self-organizes into a near-force-free state in the vicinity of the magnetic axis, with significant improvement in confinement. Associated with this change in magnetic topology is the appearance of an axial RMF component; this would, in turn, generate a current drive in the poloidal direction, thus sustaining the magnetic helicity. A newly developed two-dimensional "equilibrium-lite" model is employed to analyze the magnetic properties of the final high-confinement state, and shows a large q and a significant magnetic shear in the core.

Athletic Involvement and Adolescent Delinquency

Athough conventional wisdom suggests that organized sport deters delinquency by building character, structuring adolescents' time, and providing incentives for socially approved behavior, the empirical evidence to date has been mixed. Based on a sample of approximately 600 Western New York adolescents, the present study examined how self-reported jock identity, school athlete status, and frequency of athletic activity differentially influenced a range of delinquent behaviors. Neither athlete status nor frequency of athletic activity predicted these behaviors; however, jock identity was associated with significantly more incidents of delinquency. This finding was robust across both gender and race. Follow-up analyses indicated that jock identity facilitated both minor and major delinquency, with major delinquency effects for white but not black adolescents.

Relation between intrinsic connections and isofrequency contours in the inferior colliculus of the big brown bat, Eptesicus fuscus

Information processing in the inferior colliculus depends on interactions between ascending pathways and intrinsic circuitry, both of which exist within a functional tonotopic organization. To determine how local projections of neurons in the inferior colliculus are related to tonotopy, we placed a small iontophoretic injection of biodextran amine at a physiologically characterized location in the inferior colliculus. We then used electrophysiological recording to place a grid of small deposits of Chicago Sky Blue throughout the same frequency range to specify an isofrequency contour. Using three-dimensional computer reconstructions, we analyzed patterns of transport relative to the physiologically determined isofrequency contour to quantify the extent of the intrinsic connection lamina in all three dimensions. We also performed a quantitative analysis of the numbers of cells in different regions relative to the biodextran amine injection. Biodextran amine-labeled fibers were mainly located dorsomedial to the injection site, confined within the isofrequency contour, but biodextran amine-labeled cells were mainly located ventrolateral to the injection site. When we counted numbers of labeled cells classified by morphological type, we found that both elongate and multipolar cells were labeled within the isofrequency contour. Because the dendrites of multipolar cells typically extend outside the isofrequency lamina, it is likely that they receive input from other isofrequency contours and relay it to more dorsomedial portions of their specific isofrequency contour, along with the frequency-specific projections of the elongate cells. Within a given isofrequency contour, there is a consistent organization in which intrinsic connections ascend from the ventrolateral portion to more dorsomedial points along the contour, forming a cascaded system of intrinsic feedforward connections that seem ideally suited to provide the delay lines necessary to produce several forms of selectivity for temporal patterns in inferior colliculus neurons.

Jocks, gender, binge drinking, and adolescent violence

Previous research has suggested a link between athletic involvement and elevated levels of adolescent violence outside the sport context. The present study expanded on this literature by positing differences in the sport-violence relationship across dimensions of athletic involvement (athletic participation vs. jock identity), type of violence (family vs. nonfamily), and gender as well as by examining the impact of binge drinking on the sport-violence relationship. Regression analyses using a sample of 608 Western New York adolescents indicated that (a) jock identity (but not athletic participation) was associated with more frequent violence, (b) jock identity predicted nonfamily violence (but not family violence), and (c) the link between jock identity and nonfamily violence was stronger for boys than for girls. Binge drinking predicted family violence among nonjocks only.

Observations of improved stability and confinement in a high-beta self-organized spherical-torus-like field-reversed configuration

An extremely high-beta (over 85%) self-organized field-reversed configuration (FRC) with a spherical-torus- (ST-)like core is produced in the translation, confinement, and sustainment experiment by highly super-Alfvénic translation of a spheromaklike plasmoid. Substantial flux conversion from toroidal into poloidal occurs during the capture process, resulting in the ST-like core. This plasma state exhibits a remarkable stabilizing property for the ubiquitous centrifugally driven interchange modes present in theta-pinch formed FRCs. This is explained, for the first time, by a simple model taking into account magnetic shear and centrifugal effects. The FRC-ST configuration has up to 4 times improvement in flux confinement times over the scaling of conventional theta-pinch formed FRCs and, thus, a significant improvement in the resistivity and transport.

Untangling the Links among Athletic Involvement, Gender, Race, and Adolescent Academic Outcomes

Although previous research has established that high school sports participation may be associated with positive academic outcomes, the parameters of the relationship remain unclear. Using a longitudinal sample of nearly 600 Western New York adolescents, this study examined gender- and race-specific differences in the impact of two dimensions of adolescent athletic involvement ("jock" identity and athlete status) on changes in school grades and school misconduct over a two-year interval. Female and black adolescents who identified themselves as "jocks" reported lower grades than those who did not, whereas female athletes reported higher grades than female nonathletes. Jocks also reported significantly more misconduct (including skipping school, cutting classes, having someone from home called to the school for disciplinary purposes, and being sent to the principal's office) than nonjocks. Gender moderated the relationship between athlete status and school misconduct; athletic participation had a less salutary effect on misconduct for girls than for boys.

Stabilization of interchange modes by rotating magnetic fields

Interchange modes have been a key limiting instability for many magnetic confinement fusion configurations. In previous studies intended to deal with these ubiquitous instabilities, complex, transport enhancing, minimum-B producing coils were added to the otherwise simple linear mirror plasma. Possible solutions for returning to a simple symmetric mirror configuration, such as ponderomotive fields, are weak and difficult to apply. A new method is demonstrated here for the first time, utilizing rotating magnetic fields that are simple to apply and highly effective. A simple and easily comprehensible theory has also been developed to explain the remarkable stabilizing properties. Although this work has been performed on field reversed configurations, it should have a wide application to other confinement schemes, and could become a cornerstone for high-beta plasma stability.

Gender/Racial Differences in Jock Identity, Dating, and Adolescent Sexual Risk

Despite recent declines in overall sexual activity, sexual risk-taking remains a substantial danger to US youth. Existing research points to athletic participation as a promising venue for reducing these risks. Linear regressions and multiple analyses of covariance were performed on a longitudinal sample of nearly 600 Western New York adolescents in order to examine gender- and race-specific relationships between "jock" identity and adolescent sexual risk-taking, including age of sexual onset, past-year and lifetime frequency of sexual intercourse, and number of sexual partners. After controlling for age, race, socioeconomic status, and family cohesion, male jocks reported more frequent dating than nonjocks but female jocks did not. For both genders, athletic activity was associated with lower levels of sexual risk-taking; however, jock identity was associated with higher levels of sexual risk-taking, particularly among African American adolescents. Future research should distinguish between subjective and objective dimensions of athletic involvement as factors in adolescent sexual risk.

Adolescent anabolic steroid use, gender, physical activity, and other problem behaviors*

To test the comparative value of strain theory and problem behavior theory as explanations of adolescent anabolic steroid use, this study examined gender-specific relationships among steroid use, physical activity, and other problem behaviors. Based on the United States Centers for Disease Control and Prevention's 1997 Youth Risk Behavior Survey, a nationally representative sample of over 16,000 U.S. public and private high school students, binge drinking, cocaine use, fighting, and sexual risk-taking were associated with higher odds of lifetime steroid use. In gender-specific analyses, steroid use was strongly associated with female fighting and smokeless tobacco use as well as male sexual risk. Neither athletic participation nor strength conditioning predicted odds of steroid use after controlling for problem behaviors, nor did steroid-using athletes report more frequent use than steroid-using nonathletes. The study's limitations and policy implications were noted. These data suggest that other problem behaviors such as substance use, fighting, and sexual risk are better predictors of adolescent steroid use than physical activity. Interventions to prevent steroid use should not be limited to male participants in organized sports programs, but should also target adolescents identified as at risk for other problem behaviors.

Increased extracellular glutamate evoked by 1-methyl-4-phenylpyridinium [MPP(+)] in the rat striatum is not essential for dopaminergic neurotoxicity and is not derived from released glutathione

A number of studies have implicated the interactions of the excitatory amino acid L-glutamate (Glu) with its ionotropic and metabotropic receptors as important components of the mechanism underlying the dopaminergic neurotoxicity of 1-methyl-4-phenylpyridinium [MPP(+)]. Furthermore, microdialysis experiments have demonstrated that perfusion of relatively high concentrations of MPP(+) into the rat striatum evoke a delayed, massive release of Glu. Interestingly, perfusion of MPP(+) also mediates a similar release of glutathione (GSH). Together, these observations raise the possibility that the rise of extracellular Glu mediated by MPP(+) may be the result of hydrolysis of released GSH by gamma-glutamyl transpeptidase (gamma-GT). In the present investigation it is demonstrated that perfusions of solutions of 0.7 and 1.3 mM MPP(+) dissolved in artificial cerebrospinal fluid into the rat striatum evoke neurotoxic damage to dopaminergic terminals, assessed by both a two-day test/challenge procedure and tyrosine hydroxylase immunoreactivity, but without the release of Glu. Perfusions of 2.5 mM MPP(+) cause more extensive dopaminergic neurotoxicity and a dose-dependent release of Glu. However, neither this release of Glu nor MPP(+)-induced dopaminergic neurotoxicity are blocked by the irreversible gamma-GT inhibitor acivicin. Together, these observations indicate that a rise of extracellular levels of Glu is not essential for the dopaminergic neurotoxicity of MPP(+). Furthermore, the rise of extracellular Glu caused by perfusion of 2.5 mM MPP(+) is not the result of the gamma-GT-mediated hydrolysis of released GSH. It is possible that the rise of extracellular levels of Glu, L-aspartate, L-glycine and L-taurine evoked by perfusions of 2.5 mM MPP(+) into the rat striatum may reflect, at least in part, the release of these amino acids from astrocytes.

HIGH SCHOOL ATHLETIC PARTICIPATION AND ADOLESCENT SUICIDE: A Nationwide US Study

Suicide is the third leading cause of death among US adolescents aged 15-24, with males incurring higher rates of completion than females. This study used hierarchical logistic regression analysis to test whether athletic participation was associated with lower rates of suicidal ideation and behavior among a nationally representative sample of over 16,000 US public and private high school students. Net of the effects of age, race/ethnicity, parental educational attainment, and urbanicity, high school athletic participation was significantly associated with reduced odds of considering suicide among both females and males, and reduced odds of planning a suicide attempt among females only. Though the results point to favorable health outcomes for athletes, athletic participation was also associated with higher rates of injury to male athletes who actually attempted suicide.

Flux conversion and evidence of relaxation in a high-beta plasma formed by high-speed injection into a mirror confinement structure

High-beta plasmoids can survive the violent dynamics of supersonic reflection off mirror structures, producing a stable high-beta field-reversed configuration (FRC). This shows both the robustness of FRCs and their tendency to assume a preferred plasma state, possibly conforming to a relaxation principle. The key observations are (1) approximate preservation of the magnetic helicity, (2) substantial conversion from toroidal to poloidal magnetic flux, (3) substantial toroidal flow, and (4) a high-beta quiescent final state. These results are from the Translation, Confinement, and Sustainment experiment where a disorganized plasmoid is injected at super-Alfvenic speed into a confinement chamber. After successive reflections from end mirrors, the plasmoid settled into a near-FRC state with high beta and low toroidal magnetic field. The flux conversion and helicity preservation are inferred by an interpretive model.

Jocks, gender, race, and adolescent problem drinking

Alcohol remains the drug of choice for many adolescents; however, the nature of the relationship between athletic involvement and alcohol misuse remains ambiguous. In this article, we used a longitudinal sample of over 600 Western New York adolescents and their families to explore the gender-specific and race-specific relationships between identification with the "jock" label and adolescent alcohol consumption, specifically problem drinking. Operationalization of problem drinking included frequency measures of heavy drinking, binge drinking, and social problems related to alcohol (e.g., trouble with family, friends, school officials over drinking). Self-identified adolescent "jocks" were more likely to engage in problem drinking than their non-jock counterparts, even after controlling for gender, age, race, socioeconomic status, physical maturity, social maturity, and frequency of athletic activity. Jock identity was strongly associated with higher binge drinking frequency in Black adolescent girls. This study underscores the need to distinguish between objective and subjective meanings of athletic involvement when assessing the relationship between sport and adolescent health-risk behavior.

Gender and racial/ethnic differences in predicting adolescent sexual risk: athletic participation versus exercise

Though often conflated, informal physical exercise and organized athletic participation have very different implications for adolescent sexual risk outcomes. The purpose of this research is to disaggregate strenuous exercise from sports, examine how each is associated with sexual risk, and explain the observed differences using the conceptual lens of cultural resource theory. Using a nationally representative sample of over 16,000 public and private high school students, we employ logistic regression to test hypotheses about the gender-specific and race-specific effects of strenuous exercise and athletic participation on adolescent sexual risk behavior. The results show that both forms of physical activity buffer sexual risk for girls. Strenuous exercise is associated with increased odds of sexual risk for boys. Sports and race interact to influence boys' sexual risk outcomes: Athletic participation is associated with lowered odds of sexual risk for white male adolescents, but heightened odds of sexual risk for black male adolescents.

Tobacco use among high school athletes and nonatieletes: results of the 1997 youth risk behavior survey

In the United States today, the use of tobacco has become an entrenched part of teenage culture. The present study used the 1997 Youth Risk Behavior Survey (YRBS), which collected data from a nationally representative sample of 16,262 students in public and private high schools, to compare the tobacco use patterns of athletes and nonathletes. The independent variable, athletic participation, differentiated between moderately involved (1 or 2 teams) and highly involved (3 or more teams) athletes. Frequency of cigarette and cigar smoking and smokeless tobacco use served as the operational measure of tobacco use. Age, race/ethnicity, parental education, and residence were controlled. Logistic regression was used to calculate odds ratios for female and male athletes and nonathletes for each of the tobacco use variables. It was found that both male and female athletes were less likely to have ever smoked regularly, the effect being stronger for more highly involved athletes of both genders. Cigar smoking was unrelated to athlete status. Both female and male athletes were more likely to have used smokeless tobacco, the effect being stronger for more highly involved athletes of both genders. The findings are discussed in terms of access to health information, performance considerations, social status factors, the salience of an athletic identity, and the influence of the athletic subculture on its members.

Challenges in pain management at the end of life

Effective pain management in the terminally ill patient requires an understanding of pain control strategies. Ongoing assessment of pain is crucial and can be accomplished using various forms and scales. It is also important to determine if the pain is nociceptive (somatic or visceral pain) or neuropathic (continuous dysesthesias or chronic lancinating or paroxysmal pain). Nociceptive pain can usually be controlled with nonsteroidal antiinflammatory drugs or corticosteroids, whereas neuropathic pain responds to tricyclic antidepressants or anticonvulsants. Relief of breakthrough pain requires the administration of an immediate-release analgesic medication. If a significant amount of medication for breakthrough pain is already being given, the baseline dose of sustained-release analgesic medication should be increased. If pain does not respond to one analgesic medication, physicians should use an equianalgesic dose chart when changing the medication or route of administration. Opioid rotation can be used if pain can no longer be controlled on a specific regimen. The impact of unresolved psychosocial or spiritual issues on pain management may need to be addressed.

Responses and afferent pathways of superficial and deeper c(1)-c(2) spinal cells to intrapericardial algogenic chemicals in rats

Electrical stimulation of vagal afferents or cardiopulmonary sympathetic afferent fibers excites C(1)--C(2) spinal neurons. The purposes of this study were to compare the responses of superficial (depth <0.35 mm) and deeper C(1)--C(2) spinal neurons to noxious chemical stimulation of cardiac afferents and determine the relative contribution of vagal and sympathetic afferent pathways for transmission of noxious cardiac afferent input to C(1)--C(2) neurons. Extracellular potentials of single C(1)--C(2) neurons were recorded in pentobarbital anesthetized and paralyzed male rats. A catheter was placed in the pericardial sac to administer a mixture of algogenic chemicals (0.2 ml) that contained adenosine (10(-3) M), bradykinin, histamine, serotonin, and prostaglandin E(2) (10(-5) M each). Intrapericardial chemicals changed the activity of 20/106 (19%) C(1)--C(2) spinal neurons in the superficial laminae, whereas 76/147 (52%) deeper neurons responded to cardiac noxious input (P < 0.01). Of 96 neurons responsive to cardiac inputs, 48 (50%) were excited (E), 41 (43%) were inhibited (I), and 7 were excited/inhibited (E-I) by intrapericardial chemicals. E or I neurons responsive to intrapericardial chemicals were subdivided into two groups: short-lasting (SL) and long-lasting (LL) response patterns. In superficial gray matter, excitatory responses to cardiac inputs were more likely to be LL-E than SL-E neurons. Mechanical stimulation of the somatic field from the head, neck, and shoulder areas excited 85 of 95 (89%) C(1)--C(2) spinal neurons that responded to intrapericardial chemicals; 31 neurons were classified as wide dynamic range, 49 were high threshold, 5 responded only to joint movement, and no neuron was classified as low threshold. For superficial neurons, 53% had small somatic fields and 21% had bilateral fields. In contrast, 31% of the deeper neurons had small somatic fields and 46% had bilateral fields. Ipsilateral cervical vagotomy interrupted cardiac noxious input to 8/30 (6 E, 2 I) neurons; sequential transection of the contralateral cervical vagus nerve (bilateral vagotomy) eliminated the responses to intrapericardial chemicals in 4/22 (3 E, 1 I) neurons. Spinal transection at C(6)--C(7) segments to interrupt effects of sympathetic afferent input abolished responses to cardiac input in 10/10 (7 E, 3 I) neurons that still responded after bilateral vagotomy. Results of this study support the concept that C(1)-C(2) superficial and deeper spinal neurons play a role in integrating cardiac noxious inputs that travel in both the cervical vagal and/or thoracic sympathetic afferent nerves.