Pain Predicts Dropout From Substance Use Treatment

OBJECTIVE

This project aimed to characterize the relationship between physical pain experienced at time of entry to residential treatment for substance use disorders (SUDs) and the frequency of treatment dropout. We hypothesized that both endorsement of recent pain and higher magnitude of endorsed pain intensity would be associated with higher dropout rates. We further hypothesized that these effects would be exacerbated among patients with opioid use disorder (OUD).

METHOD

Participants included 1,095 individuals in residential treatment for SUD. Data were collected within 24 hours of treatment entry. Analyses were conducted using logistic regression with dropout as the dependent variable. Dropout was operationally defined as leaving treatment against medical advice or being discharged from treatment because of use of substances. Pain (including endorsement and intensity) was the primary independent variable in all analyses. Analyses included demographic and affective covariates and included both main effects of OUD and interaction terms between OUD and pain.

RESULTS

Pain endorsement was associated with greater frequency of dropout (odds ratio [OR] = 1.49, p = .04). Higher levels of pain intensity predicted increased rates of dropout (OR = 1.13, p < .01). In contrast with our hypothesis, no interactions between OUD and pain were observed.

CONCLUSIONS

These results underscore the import of integrating pain monitoring and pain interventions as core components of treatment for SUD. Our findings are highly consistent with a growing literature recognizing the impact of pain across a constellation of important treatment outcomes and provide novel data strongly suggesting that pain predicts early cessation of treatment.

Associations between smoking and pain in early recovery in residential substance use treatment-seekers

INTRODUCTION

A growing literature indicates bidirectional associations between pain and tobacco use. Cigarette smokers are at increased risk for chronic pain, and observational and experimental studies indicate that pain increases motivation to smoke. Tobacco use disorder frequently co-occurs with other substance use disorders, which are also associated with chronic pain vulnerability. Despite evidence that pain significantly predicts smoking and relapse, associations between smoking history/trajectory and changes in pain over the course of treatment have not been characterized. The objective of the study was to determine the association between in-treatment smoking trajectory, pack-years (i.e., number of cigarette packs smoked per day multiplied by smoking duration), pain-related interference in daily activities, and pain intensity over the course of residential treatment.

METHODS

In this study, 280 adult smokers in a residential SUD treatment center in North Central Florida completed questionnaires assessing cigarette use, pain intensity, and pain interference at treatment entry and discharge (Mean = 80.3 days, SD = 25.6). Most participants were diagnosed with alcohol use disorder (66.1 %). Opioid (27.9 %) and cannabis use disorders (29.6 %) were also common. Participants were grouped by whether their smoking increased (n = 36), decreased (n = 46), or stayed the same (n = 133) from entry to discharge.

RESULTS

Analyses indicated a positive association between pack-years and pain intensity at both baseline (r = 0.185, p = 0.018) and discharge (r = 0.184, p = 0.019). Smoking trajectory was associated with pack-years, with those decreasing smoking having greater pack-years than those sustaining or increasing use [F(2,136) = 8.62, p < 0.01, η2p = 0.114]. Mixed general linear models indicated pain intensity [F(1,274) = 44.15, p < 0.0001, η2p = 0.138] and interference in day-to-day activities [F(1,276) = 31.79, p < 0.0001, η2p = 0.103] decreased significantly over time. However, there was no main effect of smoking trajectory on pain intensity [F(2,212) = 2.051, p = 0.131, η2p = 0.019] or of smoking trajectory by time interaction [F(2, 212) = 1.228, p = 0.295, η2p = 0.011].

CONCLUSIONS

Overall, findings provide evidence that smoking behavior influences pain within the context of residential substance use treatment. Given that pain is associated with urge to use substances and risk of return to use, more consistent and rigorous assessment of pain and proactive pain management is likely to enhance substance use treatment outcomes among people who smoke.

Urine and hair drug test results associated with daily consumption of codeine-predominant poppy seed food products

This study examined the urine and hair opiate profiles associated with the daily consumption of presumptive codeine-predominant poppy seed food products. Ten participants consumed one of five food products at breakfast for 10 consecutive days. Baseline urine and hair samples were collected on Day 1. The urine samples were collected 4, 8 and 12 h following poppy seed consumption on Days 1 and 10, and the first morning void urine samples were collected on Days 2-10. A second hair specimen was collected on Day 20 ± 2. Urine drug test results: Three of the food products were associated with opiate-negative urine drug test results at all time points at a 300 ng/mL cut-off. Two of the food products were associated with opiate-positive drug test results at all non-baseline time points at a 300 ng/mL cut-off. Of these, all samples (n = 60) were codeine-positive, and 27 (45%) were morphine-positive. Codeine concentrations exceeded morphine concentrations in every sample and always by multiples. Thirty-nine of the 60 samples (65%) were codeine-positive at a 2,000 ng/mL cut-off, while none of these samples were morphine-positive at this cut-off. None of the 60 samples reached an opiate threshold of 15,000 ng/mL, although one participant produced a maximum codeine concentration of 13,161 ng/mL (13,854 ng/mg creatinine). There was no clear trend toward increasing urinary opiate concentrations over the course of the study. Hair drug test results: The hair samples of two participants produced quantifiable codeine (41 pg/mg and 51 pg/mg), but no sample reached a common reporting threshold of 200 pg/mg for codeine or morphine.

A cold-atom Ramsey clock with a low volume physics package

We demonstrate a Ramsey-type microwave clock interrogating the 6.835 GHz ground-state transition in cold [Formula: see text]Rb atoms loaded from a grating magneto-optical trap (GMOT) enclosed in an additively manufactured loop-gap resonator microwave cavity. A short-term stability of [Formula: see text] is demonstrated, in reasonable agreement with predictions from the signal-to-noise ratio of the measured Ramsey fringes. The cavity-grating package has a volume of [Formula: see text]67 cm[Formula: see text], ensuring an inherently compact system while the use of a GMOT drastically simplifies the optical requirements for laser cooled atoms. This work is another step towards the realisation of highly compact portable cold-atom frequency standards.

Substance familiarity in middle childhood and adolescent substance use

BACKGROUND

Childhood familiarity with (knowledge of) substances is a potentially important, currently understudied adolescent substance use risk factor. We aimed to describe changes in childhood familiarity with substances and to test whether baseline familiarity predicts early adolescent substance use.

METHODS

Utilizing the Substance Use Module of the longitudinal cohort study, Adolescent Brain Cognitive Development (ABCD; US youth aged 9-10 years followed for 10 years) through Data Release 4 (n=7896; individuals who completed all six assessments in the first three years), we conducted longitudinal mixed models and survival analyses to describe changes in familiarity and to determine the adjusted odds of substance use by age 13 based on number of familiar substances at baseline.

RESULTS

The sample consisted of 3754 females and 4142 males, aged 9-10 at baseline, with majority White individuals (68.9%). Unconditional time models indicated age significantly predicted familiarity (B=0.08, p<0.001; R2=0.288) with ~3.59 familiar substances at 9 years increasing to ~7.43 substances at 13 years. Family history, home use, peer use, and neighborhood availability predicted familiarity, accounting for 1% of additional variance (R2=0.299; ∆R2=0.011). For each additional familiar substance at baseline, adjusted odds of future use increased 1.28 times (95% CI 1.22, 1.34).

CONCLUSIONS

This is the first study to characterize substance familiarity in this age range as a predictor of future substance use. Familiarity increases with age (age being the most predictive indicator). Familiarity at age 9-10 predicts early adolescent substance use. As such, childhood familiarity may represent an easily implemented screening tool for at-risk youth.

Co-occurring pain and addiction: prognostic implications for healthcare professionals in residential treatment for substance use disorder

Objectives: Chronic pain is both an important antecedent and consequence of substance use. Although evidence suggests healthcare professionals may be uniquely vulnerable to chronic pain, this vulnerability remains largely unexamined in the context of recovery from substance use disorders (SUDs). We characterized pain in a sample of treatment-seeking individuals, examined potential differences in pain trajectories between healthcare professionals and non-healthcare patients, and interrogated potential pain-related vulnerabilities in treatment outcomes between these groups. Methods: Patients with SUDs (n = 663; 251 women) completed questionnaires indexing pain intensity, craving, and abstinence self-efficacy (including self-efficacy in pain-related contexts). Assessments were conducted at treatment entry, 30 days, and discharge. Analyses included chi-square and longitudinal mixed models. Results: The proportion of healthcare and non-healthcare patients endorsing recent pain was equivalent (χ²=1.78, p=.18). Healthcare professionals reported lower pain intensity (p = 0.02) and higher abstinence self-efficacy (p < 0.001). Profession by pain interactions (ps <.040) revealed that among medical professionals, associations between pain and all three treatment outcomes of interest were more robust relative to the non-healthcare group. Conclusions: Results suggest that although healthcare professionals endorse similar rates of pain and lower average pain intensity, they may be uniquely vulnerable to pain-related disruptions in craving and abstinence self-efficacy.

WOMEN'S USE OF ALCOHOL: NEUROBIOBEHAVIORAL CONCOMITANTS AND CONSEQUENCES

In this narrative review, we draw from historical and contemporary literature to explore the impact of alcohol consumption on brain and behavior among women. We examine three domains: 1) the impact of alcohol use disorder (AUD) on neurobiobehavioral outcomes, 2) its impact on social cognition/emotion processing, and 3) alcohol's acute effects in older women. There is compelling evidence of alcohol-related compromise in neuropsychological function, neural activation, and brain structure. Investigations of social cognition and alcohol effects in older women represent emerging areas of study. Initial analyses suggest that women with AUD show significant deficits in emotion processing, a finding also observed in older women who have consumed a moderate dose of alcohol. Critically, despite the long-recognized need for programmatic interrogation of alcohol's effect in women, studies with sufficient numbers of women for meaningful analysis represent a small proportion of the literature, constraining interpretation and generalization.

Age as a potential modulator of alcohol-related deficits

Although their individual significance is well-documented, the interaction effects of age, sex, and alcohol use disorder (AUD) have undergone little systematic investigation. Here, we extend prior work interrogating sex and group (AUD vs. community comparison [CC]) by probing the main and interaction effects of age on emotion processes as well as two conventional neuropsychological tests. Main effects for age and group were anticipated; however, interaction effects comprise our primary focus. While sex differences in AUD prevalence are commonly reported, sex differences within AUD samples are inconsistently found. Therefore, we pose our inquiry regarding sex as exploratory. In this study, 54 CC (n = 30 women) and 55 AUD (n = 14 women) subjects completed a battery that included an emotional face discrimination task, the Trail-Making Test-B (TMT-B), and the Digit Symbol Substitution Test (DSST). The initial/full models included the main and interaction effects of age (as a continuous variable; 25-59 years of age), sex, and group (AUD, CC). In analysis of the emotional face discrimination task, performance on a non-affective face discrimination task was entered as a covariate. Analysis of emotion identification revealed group and age main (p = .02; d = .53 & .003; d = .50, respectively) and interaction effects (p = .05; d = .41). The latter suggested that age and emotion processing performance were positively correlated in the AUD group, but unrelated in the CC group. Notably, neither sex, main, nor interaction effects achieved significance. Using the full model, analysis of the TMT-B and DSST failed to show sex effects or reveal expected performance decrement in the AUD group. To clarify the latter, simple models including only group as well as correlations between age and performance by group for each task were conducted. These analyses demonstrated the expected AUD-related deficits and suggested differential relationships between age and neurocognitive performance as a function of both group and task. Outcomes across tasks emphasize the need to reframe aging effects, particularly in the context of AUD.

Blood Phosphatidylethanol (PEth) Concentrations following Intensive Use of an Alcohol-based Hand Sanitizer

Alcohol use disorders are prevalent in the USA and throughout the world. Monitoring for alcohol abstinence is useful in several clinical and forensic contexts. The direct alcohol biomarkers have the requisite sensitivity and specificity for abstinence monitoring. The relatively new direct biomarker phosphatidylethanol (PEth), measured in blood, is gaining increasing acceptance in monitoring abstinence from beverage alcohol consumption, but there remains little research addressing the potential for PEth formation consequent to incidental alcohol exposures. In the midst of the coronavirus disease 2019 pandemic, high-alcohol content hand sanitizer is a particularly important source of nonbeverage alcohol exposure. To assess the extent of alcohol absorption and subsequent formation of blood PEth related to intensive use of high alcohol content hand sanitizer, we recruited 15 participants to use a 70% ethyl alcohol-based hand sanitizer 24-100 times daily, for 12-13 consecutive days. Blood was analyzed for PEth 16:0/18:1 by liquid chromatography--tandem mass spectrometry. Our hypothesis that blood PEth concentrations would fail to reach a 20 ng/mL threshold was confirmed. This work adds to the nascent literature on the effects of incidental alcohol exposures on blood PEth formation.

Longitudinal associations between pain and substance use disorder treatment outcomes

INTRODUCTION

Pain is commonly reported among those in treatment for substance use disorders (SUD) and is associated with poorer SUD treatment outcomes. The current study examined the trajectory of pain over the course of SUD treatment and associations with substance use outcomes.

METHODS

This observational study included adults seeking treatment for alcohol, cannabis, or opioid use disorders (N = 811). Participants completed a battery of assessments at treatment admission, 30 days post admission, and at discharge, including measures of demographics, pain, quality of life, abstinence self-efficacy, and craving.

RESULTS

Analyses indicated linear reductions in pain intensity and interference over time. Significant interactive effects were observed for opioid use disorder (OUD) and time, such that participants with OUD had greater reductions in pain intensity and interference over time compared to those without OUD. Elevated pain intensity was associated with negative treatment outcomes, including reduced quality of life and abstinence self-efficacy, and greater craving and negative affect.

CONCLUSIONS

Reductions in pain occur over the course of SUD treatment, particularly for those with OUD. Greater pain was also associated with adverse SUD treatment outcomes. Results suggest that treatment and associated abstinence may be beneficial for those with co-occurring pain and SUD, highlighting an additional benefit of improving access to SUD treatment for patients and health care systems. Future research should replicate these findings among diverse samples and further characterize the trajectory of pain during and after SUD treatment.

External validation of a low fidelity dry-lab platform to enhance loupes surgical skills techniques for hypospadias repair

INTRODUCTION

Hypospadias repair is an index pediatric urology procedure that requires trainee familiarity with surgical loupes. A previous low-fidelity, 6-step curriculum was proposed that deconstructed the most important steps of loupe surgery. We expanded on this curriculum with an intermediate-fidelity silicone hypospadias model and designed an abbreviated version of the 6-step curriculum to precede the hypospadias repair simulation.

OBJECTIVE

To assess the validity of our prior, low-fidelity conceptual model using the metric of improved performance on the intermediate-fidelity silicone hypospadias model.

STUDY DESIGN

A silicone model was first prototyped with the design software Solidworks™, and then fabricated using a cast made of a mixture of silicone rubbers designed to function like skin and soft tissue (Mold Star 20T, Dragon skin FX-pro and Slacker). Casts were used to create the penile shaft model and the dorsal hooded foreskin model. The urethral plate was cast separately on a flat surface. The model was then assembled by hand. The model used for simulation included the penile shaft and urethral plate, while the dorsal-hooded foreskin was prepared to simulate the penile anatomy separately. Trainees were then divided into two groups. Group 1 practiced the low-fidelity curriculum (3 tasks) and then performed dissection of the urethral plate and suturing using the intermediate-fidelity hypospadias model. Group 2 practiced hypospadias repair prior to the low-fidelity curriculum. Both groups' models were scored by 3 blinded urologists. Trainees were then asked to complete a post simulation satisfaction survey. Data analysis was performed in IBM SPSS Statistics for Macintosh (Version 28.0 Armonk, NY: IBM Corp).

RESULTS

Twenty-two candidates across Wisconsin, USA, and Dublin, Ireland participated in the study. This included 7 s-year residents, 9 third-year residents, 2 fourth-year residents, and 3 fifth-year residents. Both Groups 1 and 2 had a similar distribution of trainees (p = 0.60). Group 1 outperformed group 2 in all tasks (p < 0.05, Table 1). Trainees reported that the platform was very useful (91%).

DISCUSSION

Our curriculum showed improvement in trainee ability and comfort to perform hypospadias repair. Advantages of such a simulated curriculum include improving current resident training in microsurgery, improving surgical ergonomics for trainees prior to real-time experience, and decreasing the learning curve for trainees pursuing pediatric urology.

CONCLUSION

An intermediate-fidelity hypospadias platform externally validates the conceptual model implemented in the low-fidelity loupes curriculum. This appears to lead to improvement in loupe surgical skills regardless of trainee level.

Tricuspid regurgitation worsening after transcatheter or surgical aortic valve replacement

Background

Tricuspid regurgitation (TR) often occurs concomitantly with severe aortic stenosis. Post-operative worsening of tricuspid regurgitation has been observed after surgical and transcatheter aortic valve replacement (SAVR, TAVR) [1,2].

Purpose

Pre-procedural severe tricuspid regurgitation has been shown to be a predictor of all-cause mortality in patients undergoing transcatheter aortic valve replacement (TAVR) [3,4]. However, little is known about the incidence of worsening tricuspid regurgitation after SAVR and TAVR and the impact on post-procedural outcomes. This study aims to evaluate, characterize and compare the incidence of worsening TR after TAVR and SAVR.

Methods

Retrospective single-center study of patients undergoing Transcatheter and Surgical Aortic Valve Replacement for severe aortic stenosis between 2014 and 2020. Incidence of tricuspid regurgitation was noted on echocardiogram at baseline and 1 year after TAVR or SAVR. This study enrolled 430 patients in the TAVR group and 237 patients in the SAVR group. The SAVR group only included patients who underwent isolated SAVR without any other valve intervention. Patients with severe TR at baseline were excluded from the study. Progression of TR severity was defined as deterioration by at least 1 grade of severity compared to baseline on echocardiography. Multivariable logistic regression analysis was performed to identify associations with worsening TR.

Results

Mean age of TAVR patients was higher than the SAVR patients (79±9 vs 68±12 years, p&lt;0.0001). TAVR patients also had a significantly higher EuroSCORE than the SAVR patients (8.0±7 vs 3.5±4, p&lt;0.0001). TAVR group was more likely to have atrial fibrillation than the SAVR group (34% vs 24%, p=0.006). Baseline right ventricular dysfunction and right ventricular enlargement were significantly higher in the TAVR group compared to the SAVR group [9% vs 4%, (p=0.009) and 10% vs 6%, (p=0.04), respectively]. Progression of TR severity occurred in 21.8% (94/430) of TAVR patients and 31.2% (74/237) of SAVR patients. Majority of these patients progressed from absent TR to mild TR [13.2% (57) in TAVR group vs 19.8% (47) in SAVR group (p=0.02)]. 6.3% (27) of patients in the TAVR group and 8.8% (21) of patients in the SAVR group had mild to moderate worsening of TR (p=0.22). 1.63% (7) in the TAVR group and 2.1% (5) in the SAVR group had progression from moderate to severe TR (p=0.65). On multivariable analysis, SAVR (Odds ratio, 2.46 [CI, 1.6–3.7]) and age (Odds ratio, 1.03 [CI, 1.03–1.05]) were associated with worsening TR severity.

Conclusions

In this retrospective observational study, SAVR and age were found to be associated with worsening tricuspid regurgitation. Majority of these patients progressed from absent TR to mild TR after SAVR. Further studies are necessary to determine long term outcomes of worsening tricuspid regurgitation after TAVR and SAVR.

Funding Acknowledgement

Type of funding sources: None.

4 year outcomes in a prospective evaluation of transcatheter mitral valve-in-valve, valve-in-ring and valve-in-mitral annular calcification: results from the MITRAL trial

Background

The MITRAL Trial (Mitral Implantation of TRAnscatheter vaLves) evaluates the safety and feasibility of balloon-expandable aortic transcatheter heart valves in patients with severe mitral valve disease with mitral annular calcification (MAC), failed surgical rings or failed bioprostheses.

Purpose

We sought to evaluate 4-year outcomes of patients enrolled in the MITRAL trial.

Methods

This is a prospective study that enrolled 91 high surgical risk patients at 13 sites in the U.S. 30 patients underwent Mitral Valve-in-Valve (MViV), 30 Valve-in-Ring (MViR) and 31 Valve-in-MAC (ViMAC). 4-year outcomes of these patients were evaluated in this analysis. Primary endpoints and key serious adverse events including deaths were adjudicated by an independent Clinical Events Committee. Cardiac computed tomography (CT) and echocardiographic images were evaluated by independent CT and Echocardiographic Core Laboratories.

Results

Mean age was 74.3±8.9 years. Most patients undergoing MViV and ViMAC were female (MVIV=63.3%, MViR=36.7% and ViMAC=71%). Mean STS score was 9.2±6.6% (MViV 10.2±6.5%, MViR 8.7±4.7%, ViMAC=8.6±8.2%). All-cause mortality at 4 years was higher for ViMAC and MViR: MViV=6.9% (cardiovascular 3.4%), MViR=48.1% (cardiovascular 18.5%), ViMAC=51.9% (cardiovascular 29.6%), p=0.002 (Figure 1). At 4 years, all survivors had ≤1+ mitral regurgitation and most had none or trace mitral regurgitation (MViV=87.5, MViR=33.3% and ViMAC=100%). Mean mitral valve gradients remained stable (MViV=5.9±2.2 mmHg, MViR= 6.6±5.1 mmHg, ViMAC=5.1±1.0 mmHg), Figure 2. Most survivors experienced significant improvement of symptoms and were in NYHA class I-II at 4-year follow-up (MViV=78.9%, MViR=66.7% and ViMAC=66.7%).

Conclusions

MViV is associated with excellent outcomes at 4 years. MViR and ViMAC were associated with higher mortality at 4 years. However, most survivors in all groups experienced sustained improvement of symptoms and stable THV performance at 4 years. Whether survival bias had an impact on THV performance and improved symptoms at follow-up is not known and deserves further evaluation.

Funding Acknowledgement

Type of funding sources: Private company. Main funding source(s): Unrestricted Research Grant from Edwards Lifesciences.

Barriers to fire spread in northern Australian tropical savannas, deriving fire edge metrics from long term high-frequency fire histories

The savannas of northern Australia are amongst the most fire-prone landscapes in the world. However, over the last fifteen years, increasing effort has been put into reducing fire extent and severity using prescribed burning strategies early in the dry season. This study seeks to improve the application of strategic fire management by providing a more detailed understanding of the landscape features that impede fire spread in Australia's tropical savannas using long-term satellite-derived fire histories. Spatial analysis of fire edges in Kakadu National Park based on fine-scale (30 m) Landsat imagery found that most fires stopped along linear edges, which were primarily associated with known features (roads, rivers and cliffs). Further analysis found linear features with the highest stopping ability covered only 13% of the park but divided the whole park into smaller containment regions. The stopping power of each feature type was found to vary according to their width and to change during the fire season, results that could help plan strategic fuel reduction burns. Similar results were seen with the lower-resolution continental-scale MODIS satellite-derived edge data. The MODIS dataset provided a means for applying fire edge analysis to support planning in areas of northern Australia that lack fine scale fire history mapping.

Blood Phosphatidylethanol Concentrations Following Regular Exposure to an Alcohol-Based Mouthwash

Direct biomarkers of ethanol are used to monitor individuals who are required to abstain from ethanol consumption. In recent years, blood phosphatidylethanol (PEth) has gained acceptance in clinical and forensic contexts as an abstinence marker. Its elimination half-life of several days provides a window of detection of days to weeks. However, there is no research addressing the extent of PEth formation related to extraneous ethanol exposures. To assess the degree of ethanol absorption and subsequent formation of blood PEth related a common extraneous exposure, regular use of an ethanol-containing mouthwash, we recruited 16 participants to gargle with an alcohol-based mouthwash (21.6% ethanol) 4 times daily, for 12 consecutive days. Blood was analyzed for PEth 16:0/18:1 by liquid chromatography-tandem mass spectrometry. Our hypothesis that blood PEth concentrations would not equal or exceed 20 ng/mL was confirmed. Although the data suggest that regular use of mouthwash is unlikely to result in suprathreshold PEth concentrations, this work highlights the importance of considering extraneous ethanol exposures in clinical decision-making and in future research.

Outcomes of ST-Elevation Myocardial Infarction due to spontaneous coronary artery dissection: a nationwide cohort sample

Background

Spontaneous coronary artery dissection (SCAD) is a common, non-atherosclerotic cause of myocardial infarction (MI). While conservative therapy is preferred in most cases, its role among those presenting as ST-elevation myocardial infarction (STEMI) remains undefined.

Purpose

We aimed to explore outcomes of SCAD causing STEMI, stratifying cases by involved coronary artery and revascularization status.

Methods

We used the Nationwide Readmission Database (2015–2018) to identify patients hospitalized with STEMI by using ICD-10-Clinical modification codes, and then stratified them into SCAD or no-SCAD groups. Each group was further subdivided by involved coronary artery (i.e., left main, left anterior descending, left circumflex, or right coronary artery), and if revascularization (i.e., percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG)) was performed. We excluded patients &gt;55 years old or with iatrogenic dissection. The age restriction allows us to compare a similarly aged group of patients. The primary outcome was in-hospital mortality. Cardiogenic shock, acute kidney injury, mechanical complications, length of stay, and 30-day readmission for all-cause, heart failure or MI were secondary outcomes.

Results

Of the 17,556 patients with STEMI identified, 338 (1.9%) had SCAD. Patients with SCAD were younger (median age (IQR) 46.0 (33–90) vs 49.0 (41–57); p&lt;0.001) and more likely to be female (67% vs 21.6%, p&lt;0.001). They were less likely to have PCI (55.3% vs. 80.7%; p&lt;0.001), more likely to undergo CABG (4.7% vs 1.3%; p&lt;0.001), with left main and left anterior descending coronary arteries more often affected (2.4% vs 1.1%, and 53.3% vs 48.6%; p for both =0.05, respectively). In-hospital mortality did not differ between groups (3.6% vs 3.3, p=0.81). Revascularization was associated with lower in-hospital mortality among no-SCAD patients (2.6% vs 7.0%, p&lt;0.001), but not among SCAD patients (4.0% vs 3.1%, p=0.76) even when stratified by involved coronary artery. Revascularization among SCAD patients was associated with lower 30-day readmission rates for MI (0.0% vs 2.8%, p=0.05). SCAD patients were less likely to have acute kidney injury (6.5% vs 11.2%, p=0.01), but had a longer length of stay (median (IQR) 3.0 (1.0–6.0) vs 2.0 (1.0–4.0), p&lt;0.001). Both groups had similar rates of cardiogenic shock (11.8% vs 10.6%, p=0.56), mechanical complications (0.6% vs 0.3%, p=0.22), and 30-day readmission rates for all-cause, and heart failure.

Conclusion

In-hospital mortality did not differ between patients with STEMI due to SCAD or no-SCAD. Although revascularization was not associated with lower in-hospital mortality among SCAD patients (regardless of involved coronary artery), their 30-day readmission rate for MI was lower suggesting further studies are warranted to explore patient subsets of SCAD that may benefit from revascularization.

Funding Acknowledgement

Type of funding sources: None.

Racially invariant stimuli may bias outcomes in assessment of emotion processing

OBJECTIVE

Difficulties identifying emotional facial expressions are commonly observed in alcohol use disorder (AUD). Critically, this work utilizes single-race stimulus sets, although study samples are not similarly constrained. This is particularly concerning given evidence among community samples showing the impact of racial incongruity, giving rise to interpretative caveats.

METHOD

Community controls (n = 55, 12 Black) and individuals with AUD (n = 46, 9 Black) completed a two-choice emotion judgment task. A similar nonaffective sex judgment task was employed as a covariate. Repeated measures mixed-model analyses were conducted with race, AUD status (AUD vs. control), and their interaction as fixed effects. Accuracy and reaction time (RT) were primary dependent measures. A post hoc analysis was conducted on efficiency (accuracy/RT).

RESULTS

In addition to lower accuracy by individuals with AUD (p = .02), Black participants were less accurate than White participants (p = .0001) overall. Significant interactions between race and AUD were also detected for accuracy (p = .002), RT (p = .05), and efficiency (p = .01), wherein Black participants with AUD identified emotional expressions most poorly. This latter finding suggests that AUD-associated differences may be biased under racial incongruity.

CONCLUSION

Taken together, these preliminary findings do not reflect a deficit among Black respondents. Instead, our results reflect the need for greater attention to stimulus diversity and sensitivity to respondent demographics in emotion-processing examinations. Given the purported role of emotion processing in alcohol-related problems and the increase in racial minority representation in the U.S., elucidating these differences remains critical. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Transforming fire management in northern Australia through successful implementation of savanna burning emissions reductions projects

Savannas are the most fire-prone of Earth's biomes and currently account for most global burned area and associated carbon emissions. In Australia, over recent decades substantial development of savanna burning emissions accounting methods has been undertaken to incentivise more conservative savanna fire management and reduce the extent and severity of late dry season wildfires. Since inception of Australia's formal regulated savanna burning market in 2012, today 25% of the 1.2M km² fire-prone northern savanna region is managed under such arrangements. Although savanna burning projects generate significant emissions reductions and associated financial benefits especially for Indigenous landowners, various biodiversity conservation considerations, including fine-scale management requirements for conservation of fire-vulnerable taxa, remain contentious. For the entire savanna burning region, here we compare outcomes achieved at 'with-project' vs 'non-project' sites over the period 2000-19, with respect to explicit ecologically defined fire regime metrics, and assembled fire history and spatial mapping coverages. We find that there has been little significant fire regime change at non-project sites, whereas, at with-project sites under all land uses, from 2013 there has been significant reduction in late season wildfire, increase in prescribed early season mitigation burning and patchiness metrics, and seasonally variable changes in extent of unburnt (>2, >5 years) habitat. Despite these achievements, it is acknowledged that savanna burning projects do not provide a fire management panacea for a variety of key regional conservation, production, and cultural management issues. Rather, savanna burning projects can provide an effective operational funded framework to assist with delivering various landscape-scale management objectives. With these caveats in mind, significant potential exists for implementing incentivised fire management approaches in other fire-prone international savanna settings.

The impact of emotional face stimuli on working memory performance among men and women with alcohol use disorder

BACKGROUND

Individuals with alcohol use disorder (AUD) often display compromise in emotional processing and non-affective neurocognitive functions. However, relatively little empirical work explores their intersection. In this study, we examined working memory performance when attending to and ignoring facial stimuli among adults with and without AUD. We anticipated poorer performance in the AUD group, particularly when task demands involved ignoring facial stimuli. Whether this relationship was moderated by facial emotion or participant sex were explored as empirical questions.

METHODS

Fifty-six controls (30 women) and 56 treatment-seekers with AUD (14 women) completed task conditions in which performance was advantaged by either attending to or ignoring facial stimuli, including happy, neutral, or fearful faces. Group, sex, and their interaction were independent factors in all models. Efficiency (accuracy/response time) was the primary outcome of interest.

RESULTS

An interaction between group and condition (F_1,107 = 6.03, p < .02) was detected. Individual comparisons suggested this interaction was driven by AUD-associated performance deficits when ignoring faces, whereas performance was equivalent between groups when faces were attended. Secondary analyses suggested little influence of specific facial emotions on these effects.

CONCLUSIONS

These data provide partial support for initial hypotheses, with the AUD group demonstrating poorer working memory performance conditioned on the inability to ignore irrelevant emotional face stimuli. The absence of group differences when scenes were to be ignored (faces remembered) suggests the AUD-associated inability to ignore irrelevance is influenced by specific stimulus qualities.

Brain Structure and Function in Recovery

Alcohol use disorder (AUD) commonly is associated with compromise in neurobiological and/or neurobehavioral processes. The severity of this compromise varies across individuals and outcomes, as does the degree to which recovery of function is achieved. This narrative review first summarizes neurobehavioral, neurophysiological, structural, and neurochemical aberrations/deficits that are frequently observed in people with AUD after detoxification. Subsequent sections review improvements across these domains during recovery, taking into account modulators of recovery to the extent permitted. Where appropriate, the discussion includes work integrating outcomes across domains, leveraging the strengths of diverse experimental methods. Interventions to ameliorate neurobiological or neurobehavioral deficits do not constitute a primary objective of this review. However, their consideration is a logical inclusion. Therefore, a limited introduction to existing methods is also presented.

A Fast Algorithm for Calculation of Thêo1

Thêo1 is a frequency stability statistic that is similar to the Allan variance but can provide stability estimates at longer averaging factors and with higher confidence. However, the calculation of Thêo1 is significantly slower than that of the Allan variance, particularly for large data sets, due to a worse computational complexity. A faster algorithm for calculating the "all- τ " version of Thêo1 is developed by identifying certain repeated sums and removing them with a recurrence relation. The new algorithm has a reduced computational complexity, which is equal to that of the Allan variance. Computation time is reduced by orders of magnitude for many data sets. The new, faster algorithm does introduce an error due to accumulated floating-point errors in very large data sets. The error can be compensated for by increasing the numerical precision used at critical steps. The new algorithm can also be used to increase the speed of ThêoBr and ThêoH that are more sophisticated statistics derived from Thêo1.

Exploring differences between self-report and electrophysiological indices of drowsy driving: A usability examination of a personal brain-computer interface device

INTRODUCTION

Impaired driving has resulted in numerous accidents, fatalities, and costly damage. One particularly concerning type of impairment is driver drowsiness. Despite advancements, modern vehicle safety systems remain ineffective at keeping drowsy drivers alert and aware of their state, even temporarily. Until recently the use of user-centric brain-computer interface (BCI) devices to capture electrophysiological data relating to driver drowsiness has been limited.

METHOD

In this study, 25 participants drove on a simulated roadway under drowsy conditions.

RESULTS

Neither subjective nor electrophysiological measures differed between individuals who showed overt signs of drowsiness (prolonged eye closure) during the drive. However, the directionality and effect size estimates provided by the BCI device suggested the practicality and feasibility of its future implementation in vehicle safety systems. Practical applications: This research highlights opportunities for future BCI device research for use to assess the state of drowsy drivers in a real-world context.

Recent declines in salmon body size impact ecosystems and fisheries

Declines in animal body sizes are widely reported and likely impact ecological interactions and ecosystem services. For harvested species subject to multiple stressors, limited understanding of the causes and consequences of size declines impedes prediction, prevention, and mitigation. We highlight widespread declines in Pacific salmon size based on 60 years of measurements from 12.5 million fish across Alaska, the last largely pristine North American salmon-producing region. Declines in salmon size, primarily resulting from shifting age structure, are associated with climate and competition at sea. Compared to salmon maturing before 1990, the reduced size of adult salmon after 2010 has potentially resulted in substantial losses to ecosystems and people; for Chinook salmon we estimated average per-fish reductions in egg production (-16%), nutrient transport (-28%), fisheries value (-21%), and meals for rural people (-26%). Downsizing of organisms is a global concern, and current trends may pose substantial risks for nature and people.

Erratum: Evolution of π^{0} Suppression in Au+Au Collisions from sqrt[s_{NN}]=39 to 200 GeV [Phys. Rev. Lett. 109, 152301 (2012)]

This corrects the article DOI: 10.1103/PhysRevLett.109.152301.

The roles of phosphatidylethanol, ethyl glucuronide, and ethyl sulfate in identifying alcohol consumption among participants in professionals health programs

Direct alcohol biomarkers, including urinary ethyl glucuronide (EtG), urinary ethyl sulfate (EtS), and blood phosphatidylethanol (PEth), are used to monitor alcohol abstinence in individuals who are mandated to abstain. In this consecutive case series study, we examined 1000 forensic reports of participants enrolled in a professionals health program who were contractually obligated to abstain from alcohol and who underwent recovery status evaluations. We identified 52 evaluations in which urinary EtG, EtS, and blood PEth were measured and which produced a positive result for at least one of these analytes. PEth, at a cutoff concentration of 20 ng/mL, revealed alcohol use more frequently than EtG or EtS at our laboratory's cutoff concentrations of 100 and 25 ng/mL, respectively. This was true, as well, at alternative EtG/EtS cutoff concentrations of 200/50, 300/75, and 400/100 ng/mL. PEth was more likely than EtG/EtS to be positive in participants previously diagnosed with alcohol use disorders (AUD), whereas EtG/EtS was more likely than PEth to be positive in participants without AUD. In this study, blood PEth was the most sensitive biomarker for evidencing alcohol use.

Impact of polysubstance use on social and non-affective cognitive performance among treatment-seeking individuals with alcohol use disorders

BACKGROUND

Individuals with alcohol use disorder (AUD) display deficits across a range of cognitive processes. Decrements in social cognition may be particularly important for interpersonal functioning and post-treatment adaptation. Although social cognitive deficits are associated with chronic use of numerous substances, the role of polysubstance use in AUD-associated deficits remains largely unaddressed.

METHODS

Community volunteers (n = 49; 22 men) and inpatient treatment-seekers with AUD were administered neurocognitive tasks indexing emotion processing and non-affective cognitive functioning. Tasks included an emotion discrimination task, a working memory task with affective stimuli, a general face processing (control) task, two measures of executive function, and two measures of visual spatial function. AUD subgroups included individuals with no recent (6-month) polysubstance use (AUD-Only; n = 22; 15 men), and those with at least weekly use (Poly-SU; n = 22; 18 men).

RESULTS

Poly-SU individuals evinced disadvantaged performance relative to other groups on the emotion discrimination task [ps ≤ 0.001], affective working memory task [ps ≤ 0.050], and two executive function measures [ps ≤ 0.051]. No differences were observed for visual spatial functioning [ps ≥ 0.498] or general face processing [ps ≥ 0.190]. No performance differences between AUD-Only and community volunteers were noted.

CONCLUSIONS

Results extend the emerging literature exploring emotion processing in AUD and add to the established literature regarding cognitive deficits in this population. The data suggest that among individuals with AUD, those with polysubstance use may be particularly vulnerable to deficits in decoding emotional face content. The current work highlights the need to incorporate more nuanced and careful considerations of polysubstance use in the design and analysis for future investigations of alcohol-associated deficits in emotion processing.

Effects of Age and Acute Moderate Alcohol Consumption on Electrophysiological Indices of Attention

OBJECTIVE

Despite increased attention to risks and benefits associated with moderate drinking lifestyles among aging adults, relatively few empirical studies focus on acute alcohol effects in older drinkers. Using electroencephalographic indices of early attention modulation (P1 and N1) and later stimulus processing (P3), we investigated whether acute alcohol consumption at socially relevant doses differentially influences neurocognitive performance in older, relative to younger, moderate drinkers.

METHOD

Younger (25-35 years; n = 97) and older (55-70 years; n = 87) healthy drinkers were randomly assigned to receive one of three alcohol doses (placebo, .04 g/dl, or .065 g/dl target breath alcohol concentrations). Repeated-measures analysis of variance examined the effects of age, alcohol dose concentration, and their potential interaction on P1/P3 amplitudes and N1 latency during completion of a directed attend/ignore task.

RESULTS

Age-specific effects on P1 amplitudes varied by instruction set, with alcohol-associated decreases in amplitude among older drinkers in response to task-relevant stimuli and increases to irrelevant stimuli, F(2, 141) = 2.70, p = .07, ηp2 = .04. In contrast, N1 analyses demonstrated alcohol-related latency reductions among older, relative to younger, adults, F(2, 83) = 3.42, p = .04. Although no Age × Alcohol interactions were detected for P3, main effects indicated dose-dependent amplitude reductions for relevant stimuli, F(2, 144) = 5.73, p < .01, ηp2 = .08.

CONCLUSIONS

Our results underscore the impact of acute moderate alcohol consumption on attentional functioning, highlighting age-dependent sensitivity in electrophysiological indices of early attentional processing. Given the import of attentional functioning to quality of life and increases in drinking among a rapidly expanding aging population, these findings have broad public health relevance.

Commentary on Ferguson, et al., "Impact of Non-pharmaceutical Interventions (NPIs) to Reduce COVID-19 Mortality and Healthcare Demand"

A recent manuscript (Ferguson et al. in Impact of non-pharmaceutical interventions (NPIs) to reduce COVID-19 mortality and healthcare demand, Imperial College COVID-19 Response Team, London, 2020. https://www.imperial.ac.uk/media/imperial-college/medicine/sph/ide/gida-fellowships/Imperial-College-COVID19-NPI-modelling-16-03-2020.pdf) from Imperial College modelers examining ways to mitigate and control the spread of COVID-19 has attracted much attention. In this paper, we will discuss a coarse taxonomy of models and explore the context and significance of the Imperial College and other models in contributing to the analysis of COVID-19.

Randomized trial to assess safety/feasibility of memantine administration during residential treatment for alcohol use disorder: a pilot study

The N-methyl-D-aspartate receptor (NMDAr) system is critically involved in the pathogenesis and neurobehavioral sequelae of alcohol use disorder (AUD), and constitutes a potential pharmacotherapeutic target. Memantine (Namenda) is an FDA-approved NMDAr antagonist with suggested utility in AUD, however its safety and tolerability during long-term administration among recently-detoxified patients remains uncharacterized. This pilot study assessed safety, feasibility, and several secondary measures of interest, during a 4-week period of residential AUD treatment. Participants (N = 18) met diagnostic criteria for AUD. A double-blind, placebo-controlled, escalating-dose design was utilized. Assessments of medication side-effects were conducted weekly. At intake, week 2, and study completion, participants completed a battery assessing affective symptomatology, craving, and neurocognitive function. Medication groups reported equivalent side effects and severity. Medication compliance was high, and did not differ by group. No memantine effects were observed in secondary outcome measures. Memantine maintains a profile of high tolerability and low side-effects during post-detoxification AUD treatment. These data suggest a more aggressive dosing/escalation schedule may be used safely in future trials designed to ascertain improvements in neurocognitive function, affect, and/or craving as primary measures.

Emotional Face Processing among Treatment-Seeking Individuals with Alcohol Use Disorders: Investigating Sex Differences and Relationships with Interpersonal Functioning

BACKGROUND

Individuals in treatment for alcohol use disorder (AUD) display deficits across a broad range of cognitive processes. Disruptions in affective processing are understudied, but may be particularly important for interpersonal functioning and post-treatment adaptation. In particular, the role of sex in AUD-associated emotion processing deficits remains largely unaddressed and was a focus of the current investigation.

METHODS

Fifty-six treatment seekers with AUD and 54 healthy community controls (N = 110) were administered an emotional face discrimination task. Non-affective tasks included a sex-discrimination task and two brief measures of executive functioning. Two measures of interpersonal function were included.

RESULTS

Emotion processing deficits were evident among women with AUD relative to other groups. This sex-contingent relationship was not observed in measures of executive function, sex-discrimination or interpersonal problems, although individuals with AUD performed more poorly on these measures.

CONCLUSIONS

Results were consistent with extant literatures examining cognitive, affective and interpersonal functioning among individuals with AUD, and provided novel evidence of vulnerability to alcohol-associated deficits in emotion processing among women. While similar sex-contingent effects were not apparent among other measures, results support modest interrelationships, specifically including the import of emotion processing to interpersonal functioning in AUD. These data offer guidance for further systematic investigation and highlight important considerations for future relapse-prevention and recovery-facilitation efforts.

Cold-atom clock based on a diffractive optic

Clocks based on cold atoms offer unbeatable accuracy and long-term stability, but their use in portable quantum technologies is hampered by a large physical footprint. Here, we use the compact optical layout of a grating magneto-optical trap (gMOT) for a precise frequency reference. The gMOT collects 10^{7 87}Rb atoms, which are subsequently cooled to 20 µK in optical molasses. We optically probe the microwave atomic ground-state splitting using lin⊥lin polarised coherent population trapping and a Raman-Ramsey sequence. With ballistic drop distances of only 0.5 mm, the measured short-term fractional frequency stability is 2×10^-11/τ.

Cognitive training as a component of treatment of alcohol use disorder: A review

OBJECTIVE

Cognitive training is an effective means of improving performance in a range of populations. Whether it may serve to facilitate cognitive recovery and longer-term outcomes in persons with alcohol use disorders (AUDs) is unclear. Here, we review historical and current literature and offer perspectives for model development and potential implementation.

METHOD

We considered a large literature regarding the nature of alcohol-related compromise, early efforts to clarify the nature of recovery and current models and methods underlying cognitive training paradigms. We then constructed a narrative review demonstrating evolving frameworks and empirical data informing the critical review of cognitive training methods as a means of mitigating compromise and facilitating functional outcomes.

RESULTS

Cognitive improvement with abstinence is generally noted, but training protocols may enhance performance and generalize benefit to untrained, but highly similar, tasks. Transfer of training to dissimilar tasks and functional outcomes is uncommonly reported. It is noteworthy that some work suggests that clinician ratings for participants are improved. Inconsistency in sample characteristics, training protocols, and outcome measures constrain general conclusions while suggesting opportunities for study and development.

CONCLUSIONS

Cognitive training protocols have shown benefit in a variety of populations but have been examined infrequently in persons with AUDs. This overview indicates significant opportunity for cognitive improvement and recovery and thus a strong potential role for training protocols. However, supportive data are not robustly obtained. We suggest that one step in bridging this gap is the implementation of a conceptual framework incorporating contextual, behavioral, and neurobiological variables. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Clarifying the neurobehavioral sequelae of moderate drinking lifestyles and acute alcohol effects with aging

Epidemiological estimates indicate not only an increase in the proportion of older adults, but also an increase in those who continue moderate alcohol consumption. Substantial literatures have attempted to characterize health benefits/risks of moderate drinking lifestyles. Not uncommonly, reports address outcomes in a single outcome, such as cardiovascular function or cognitive decline, rather than providing a broader overview of systems. In this narrative review, retaining focus on neurobiological considerations, we summarize key findings regarding moderate drinking and three health domains, cardiovascular health, Type 2 diabetes (T2D), and cognition. Interestingly, few investigators have studied bouts of low/moderate doses of alcohol consumption, a pattern consistent with moderate drinking lifestyles. Here, we address both moderate drinking as a lifestyle and as an acute event. Review of health-related correlates illustrates continuing inconsistencies. Although substantive reductions in risk for cardiovascular and T2D events are reported, robust conclusions remain elusive. Similarly, whereas moderate drinking is often associated with enhanced cognition and lower dementia risk, few benefits are noted in rates of decline or alterations in brain structure. The effect of sex/gender varies across health domains and by consumption levels. For example, women appear to differentially benefit from alcohol use in terms of T2D, but experience greater risk when considering aspects of cardiovascular function. Finally, we observe that socially relevant alcohol doses do not consistently impair performance in older adults. Rather, older drinkers demonstrate divergent, but not necessarily detrimental, patterns in neural activation and some behavioral measures relative to younger drinkers. Taken together, the epidemiological and laboratory studies reinforce the need for greater attention to key individual differences and for the conduct of systematic studies sensitive to age-related shifts in neurobiological systems.

'Entamoeba histolytica' identified by stool microscopy from children with acute diarrhoea in Peru is not E. histolytica

Entamoeba histolytica is a rare but feared pathogen owing to its related morbidity and mortality. Physicians in an ambulatory clinic in Cusco noted frequent reports of E. histolytica diagnosed by microscopy. Other non-pathogenic species of Entamoeba have an identical microscopic appearance. To determine whether the organisms were actually E. histolytica, faecal specimens from children aged six months to three years with diarrhoea were tested by a species-specific ELISA for E. histolytica antigen. Although 19/73 patients (26.0%) were presumptively diagnosed with amoebiasis based on microscopy, none were confirmed by ELISA. Most cases diagnosed as E. histolytic by microscopy in Peru are not infected by the pathogenic species and are probably colonised by non-pathogenic amoeba such as Entamoeba dispar.

6098The role of diastolic function in risk stratification of patients with moderate aortic stenosis

Background

Currently data on the risk stratification of patients with moderate aortic stenosis (AS) are very limited.

Method

Patients diagnosed with moderate AS in 2012 (aortic valve area [AVA]: >1 and ≤1.5cm2) were identified. Patients were stratifying by LV diastolic function (normal vs high filling pressure), left ventricular ejection fraction (LVEF ≥50 vs <50%) and stroke volume index (SVI ≥35 vs <35 ml/m2). High filling pressure was defined as average E/e' ≥14 or septal E/e' ≥11 when atrial fibrillation was present. The prognosis was compared to age- and sex-matched general population.

Results

898 patients were included (age 74 years, 58% male, AVA 1.25 cm2). During a median follow-up of 2.9 years, there were 346 deaths. In patients with moderate AS, mortality was higher than expected (P<0.001, Fig 1A). LV high filling pressure, LVEF<50% and SVI<35ml/m2 were present in 416 (55%), 140 (17%) and 81 (9%) patients, respectively. Those with normal filling pressure had similar prognosis when compared to controls (Fig 1C, P=0.35); whereas mortality rates remained higher than reference even when LVEF≥50% or SVI≥35ml/m2 (Fig 1E, 1G, P<0.001). Amongst all groups, mortality rates were the highest in patients with LVEF <50% or SVI <35 ml/m2 (Fig 1D, 1F, P<0.001); mortality ratios were 3.78 (95% CI 3.01–4.67) and 6.91 (95% CI 5.13–9.11), respectively. Noteworthy, high filling pressure allowed further risk stratification when LVEF or SVI was preserved (Fig 2, P<0.001).

Figures 1 & 2

Conclusions

Patients with moderate AS showed poor survival. A clinical trial examining role of aortic valve replacement would be beneficial not only in patients with reduced LVEF or SVI but also in those with high LV filling pressures.

P3634Cancer patients have a higher long-term risk of death and myocardial infarction after percutaneous coronary intervention - A matched cohort analysis of 3,560 patients

Background

Cancer patients have a higher risk of thromboembolic events but it is not well known if these patients also have a higher risk of death, myocardial infarction (MI) or repeat revascularization after percutaneous coronary intervention (PCI) is unknown.

Methods

Cancer patients who underwent first-time single vessel PCI from January 1, 2003, through December 31, 2013 were identified by cross-matching of institutional cancer and PCI registries. These cancer patients were matched 4:1 to non-cancer patients, likewise undergoing first-time single vessel PCI in the time period. The combined primary endpoint was death, MI and revascularization at 5 year follow-up. Secondary endpoints were death and MI combined and the individual components of the primary endpoint. Both time dependent and non-time-dependent analyses were conducted.

Results

A total of 712 cancer patients were identified and matched to 2,848 non-cancer patients (one third women in either group). Bare-metal stents were used in one third of patients in both groups. The combined primary study endpoint was significantly more frequently encountered in the cancer than in the non-cancer group in both time-dependent (Figure 1) and non-time dependent analyses (5-year event rate 48.6% vs. 31.2%, p<0.001). This was driven by a higher 5-year event rate of death (39.0% vs. 20.1%) and MI (14.8% vs 4.86%) in the cancer group. The 5-year rate of revascularization did not differ significantly between the two groups (10.5% vs 10.3%).

Figure 1. MI + revascularization-survival

Conclusion

Cancer patients have a two times higher rate of death and a three times higher rate of MI over the first 5 years after PCI. Future studies will need to define the etiology and factors accounting for this higher event rate in cancer patients, especially of these patients are predisposed to stent thrombosis and need longer term dual antiplatelet therapy.

Neurophysiological and Interpersonal Correlates of Emotional Face Processing in Alcohol Use Disorder

BACKGROUND

A growing literature suggests deficient emotional facial expression (EFE) processing among recently abstinent individuals with alcohol use disorders (AUDs). Further investigation is needed to clarify valence-related discrepancies and elucidate neural and psychosocial correlates. We examined neurobehavioral indices of EFE processing and interpersonal problems in treatment seekers with AUDs and healthy community controls (CCs).

METHODS

Thirty-four individuals with AUDs and 39 CCs completed an emotion judgment task (EJT), requiring discrimination between happy, angry, and sad EFEs. A second task requiring discrimination of male and female faces with neutral expressions served as the control task (i.e., sex judgment task, SJT). Neurophysiological (i.e., N170 and P3) and behavioral measures were analyzed using generalized linear mixed models (GLMM). Interpersonal problems were assessed with the Inventory of Interpersonal Problems-64 (IIP-64). The relationship of IIP-64 and EJT performance was investigated via within-group correlations.

RESULTS

Analysis of the SJT revealed no group differences in behavioral measures, N170 amplitude, or P3 latency. P3 amplitudes, however, were significantly lower in the AUD group. For the EJT, initial observations of group differences in P3 amplitude were accounted for by differences in the control task. Behavioral analyses indicated that the AUD group was significantly less accurate than the CC group. Hypothesis-driven analyses using GLMM-estimated group differences indicated that anger processing was affected to a greater degree than were other emotions. Significant EJT/IIP-64 correlations were observed for anger processing within the AUD group and were confined to IIP-64 subscales with relatively high ratings on the affiliation dimension.

CONCLUSIONS

Findings provide partial support for an emotion-specific processing deficit in persons with AUDs. Anger processing was more robustly affected than other emotions and was associated with interpersonal problems characterized by being overly needy, nonassertive, and overly accommodating. Results extend prior reports and reinforce the need for comprehensive study of emotion processing and its real-world implications.

Beam Energy and Centrality Dependence of Direct-Photon Emission from Ultrarelativistic Heavy-Ion Collisions

The PHENIX collaboration presents first measurements of low-momentum (0.4<p_{T}<3  GeV/c) direct-photon yields from Au+Au collisions at sqrt[s_{NN}]=39 and 62.4 GeV. For both beam energies the direct-photon yields are substantially enhanced with respect to expectations from prompt processes, similar to the yields observed in Au+Au collisions at sqrt[s_{NN}]=200. Analyzing the photon yield as a function of the experimental observable dN_{ch}/dη reveals that the low-momentum (>1  GeV/c) direct-photon yield dN_{γ}^{dir}/dη is a smooth function of dN_{ch}/dη and can be well described as proportional to (dN_{ch}/dη)^{α} with α≈1.25. This scaling behavior holds for a wide range of beam energies at the Relativistic Heavy Ion Collider and the Large Hadron Collider, for centrality selected samples, as well as for different A+A collision systems. At a given beam energy, the scaling also holds for high p_{T} (>5  GeV/c), but when results from different collision energies are compared, an additional sqrt[s_{NN}]-dependent multiplicative factor is needed to describe the integrated-direct-photon yield.

Characterizing chronic pain and alcohol use trajectory among treatment-seeking alcoholics

Accumulating evidence indicates pain may be an important risk factor for development of alcohol use disorder (AUD) and risk of relapse for people recovering from AUD. This study was conducted to characterize the prevalence and severity of significant recurrent pain and various chronic pain conditions in treatment-seeking alcoholics. In addition, we sought to examine associations between alcohol use trajectory and pain presence/severity. Four hundred fifty-one treatment-seeking alcoholics were recruited for this study. Participants completed a battery of assessments, including measures of demographics, affect, alcohol and other drug use, presence/absence of significant recurrent pain, recent pain severity, and chronic pain type. Analyses indicated significant recurrent pain was highly prevalent in the study sample (53.66%), and was significantly more common among women (62.57%) than men (47.35%; p = 0.001). Typical drinking prior to treatment did not differ by pain status, but participants with pain were more likely to report current opioid use. Individuals with pain reported greater depression and anxiety than those without (p < 0.0008), and pain tended to be more severe among women than men (p = 0.035). Both men and women with pain indicated that pain had affected their substance use. In addition, both later age of first treatment and longer transition time from alcohol dependence to treatment were associated with greater pain severity, especially among men. These data suggest chronic pain is highly prevalent among treatment-seeking alcoholics, especially women, and that delays to first treatment are associated with pain presence and intensity. These results highlight the importance of effective pain management for the subset of treatment seekers with pain.