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The origins and expression of addiction are best understood within the context of developmental processes and dynamic systems organization and change. For some individuals, these dynamic processes lead to risk cumulative or cascade effects that embody adverse childhood experiences that exacerbate risk; predict early onset of drinking, smoking, or other substance use; and often lead to a substance use disorder (SUD) during the transitions to adolescence and emergent adulthood. In other cases, protective factors within or outside of the individual’s immediate family enable embodiment of normative stress regulatory systems and neural networks that support resilience and prevention of SUDs. A case study is provided to illustrate these processes and principles of the organization of addictive behavior. Finally, a model of risk to resilience captures the flow of development and the extent to which individual-experience relationships contribute to risk and resilience.

Background The effects of individualised perioperative lung-protective ventilation (based on the open-lung approach [OLA]) on postoperative complications is unknown. We aimed to investigate the effects of intraoperative and postoperative ventilatory management in patients scheduled for abdominal surgery, compared with standard protective ventilation. Methods We did this prospective, multicentre, randomised controlled trial in 21 teaching hospitals in Spain. We enrolled patients who were aged 18 years or older, were scheduled to have abdominal surgery with an expected time of longer than 2 h, had intermediate-to-high-risk of developing postoperative pulmonary complications, and who had a body-mass index less than 35 kg/m(2). Patients were randomly assigned (1: 1: 1: 1) online to receive one of four lung-protective ventilation strategies using low tidal volume plus positive end-expiratory pressure (PEEP): open-lung approach (OLA)-iCPAP (individualised intraoperative ventilation [individualised PEEP after a lung recruitment manoeuvre] plus individualised postoperative continuous positive airway pressure [CPAP]), OLA-CPAP (intraoperative individualised ventilation plus postoperative CPAP), STD-CPAP (standard intraoperative ventilation plus postoperative CPAP), or STD-O-2 (standard intraoperative ventilation plus standard postoperative oxygen therapy). Patients were masked to treatment allocation. Investigators were not masked in the operating and postoperative rooms; after 24 h, data were given to a second investigator who was masked to allocations. The primary outcome was a composite of pulmonary and systemic complications during the first 7 postoperative days. We did the primary analysis using the modified intention-to-treat population. This trial is registered with ClinicalTrials.gov, number NCT02158923. Findings Between Jan 2, 2015, and May 18, 2016, we enrolled 1012 eligible patients. Data were available for 967 patients, whom we included in the final analysis. Risk of pulmonary and systemic complications did not differ for patients in OLA-iCPAP (110 [46%] of 241, relative risk 0.89 [95% CI 0.74-1.07; p=0.25]), OLA-CPAP (111 [47%] of 238, 0.91 [0.76-1.09; p=0.35]), or STD-CPAP groups (118 [48%] of 244, 0.95 [0.80-1.14; p=0.65]) when compared with patients in the STD-O-2 group (125 [51%] of 244). Intraoperatively, PEEP was increased in 69 (14%) of patients in the standard perioperative ventilation groups because of hypoxaemia, and no patients from either of the OLA groups required rescue manoeuvres. Interpretation In patients who have major abdominal surgery, the different perioperative open lung approaches tested in this study did not reduce the risk of postoperative complications when compared with standard lung-protective mechanical ventilation.

First results on the longitudinal asymmetry and its effect on the pseudorapidity distributions in Pb-Pb collisions at root s(NN) = 2.76 TeV at the Large Hadron Collider are obtained with the ALICE detector. The longitudinal asymmetry arises because of an unequal number of participating nucleons from the two colliding nuclei, and is estimated for each event by measuring the energy in the forward neutron-Zero-Degree-Calorimeters (ZNs). The effect of the longitudinal asymmetry is measured on the pseudorapidity distributions of charged particles in the regions vertical bar eta vertical bar < 0.9, 2.8 < eta < 5.1 and -3.7 < eta < -1.7 by taking the ratio of the pseudorapidity distributions from events corresponding to different regions of asymmetry. The coefficients of a polynomial fit to the ratio characterise the effect of the asymmetry. A Monte Carlo simulation using a Glauber model for the colliding nuclei is tuned to reproduce the spectrum in the ZNs and provides a relation between the measurable longitudinal asymmetry and the shift in the rapidity (y(0)) of the participant zone formed by the unequal number of participating nucleons. The dependence of the coefficient of the linear term in the polynomial expansion, c(1), on the mean value of y(0) is investigated. (C) 2018 The Author(s). Published by Elsevier B.V.

Although diet, physical activity, and behavioral modifications are the cornerstones of weight management, weight loss achieved by lifestyle modifications alone is often limited and difficult to maintain. Pharmacotherapy for obesity can be considered if patients have a body mass index (BMI) of 30 kg/m

These 4 cases illustrate how weight loss drugs--including the 4 newest--can be integrated into a treatment plan that includes diet, exercise, and behavior modification.

Obesity is a major health crisis resulting in comorbidities such as hypertension, type 2 diabetes, and obstructive sleep apnea. The need for safe and efficacious drugs to help assist with weight loss and reduce cardiometabolic risk factors is great. With several FDA-approved drugs on the market, there is still a great need to develop long-term obesity treatments or noninvasive oral agents to help assist individuals with obesity when used in conjunction with lifestyle modifications.

Given the evidence that several cognitive and emotional functions are impaired in adult alcohol-dependent patients and the possibility that some of these deficits are transmitted to their children, the objective of the present study was to test the hypothesis that the perception of complex mental states would be reduced in young adults from families with a positive family history of alcohol dependence. It was also anticipated that social-perceptual deficits would confer unique predictive ability beyond that shared with other cognitive risk factors for alcohol dependence and/or substance use risk.Data from 301 youth ages 18-21 years, recruited from an ongoing community longitudinal study of alcoholic and matched control families, were analyzed. Family history of alcohol dependence as well as alcohol-dependence diagnosis in the youth was based on diagnostic criteria in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. A substance use risk factor measured early problem alcohol/other drug use. The perception of mental states was measured with the computerized version of the Reading the Mind in the Eyes Test (RMET).Children of alcohol-dependent parents did not show impairment in the mental states perception task, nor did social perception skills predict alcohol dependence in the youth. Correlational analysis performed between RMET and the substance use risk factor showed no significant association between the variables.The study results do not confirm the hypothesis that behaviorally measured social perception impairment is more prevalent in the children of alcohol-dependent parents. In addition, social-perceptual deficits were not a unique marker of either alcohol dependence or high risk for alcohol dependence in this young adult sample.

This study aimed to (a) characterize gender-specific risk of onset of alcohol, nicotine, and marijuana use developmentally; (b) investigate the effects of early-onset status and frequency of nicotine and marijuana use on alcohol outcomes, controlling for the effects of alcohol use; and (c) examine gender differences in the developmental trajectories of alcohol outcomes and the effects of nicotine and marijuana use on alcohol outcomes.This study conducted secondary analysis on a longitudinal study that recruited at-risk youth through fathers' drunk-driving records and door-to-door canvassing in the midwestern United States. The sample included 160 female-male sibling pairs who were assessed on substance use and Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, diagnosis from early childhood to young adulthood.Although males were at higher risk for being early-onset alcohol users, females tended to be at higher risk for initiating marijuana use at younger ages. When early onset and amount of alcohol use were controlled for, early onset of nicotine and marijuana use did not contribute to alcohol outcomes, but frequencies of nicotine and marijuana use did. We also found the associations of quantity/frequency of alcohol and marijuana use with drinking problems to be stronger among females than among males.Higher frequencies of nicotine and marijuana use may contribute to worse alcohol outcomes above and beyond the effect of alcohol use. Females tend to be at higher risk than males for initiating marijuana use and meeting an alcohol use disorder diagnosis at younger ages as well as being more vulnerable to a negative impact of alcohol and marijuana use.

Data suggest that the temporal sequence of carbohydrate ingestion during a meal has a significant impact on postprandial glucose (1–3), insulin, and glucagon-like peptide 1 (GLP-1) excursions (4) in type 2 diabetes, while the effects on ghrelin suppression and satiety have not been reported. The study design and methods have previously been described in detail (4). Briefly, using a crossover design, 16 subjects with overweight/obesity and metformin-treated type 2 diabetes were assigned to consume the same meal on 3 days in random order: Blood was sampled for glucose, insulin, active GLP-1, and total ghrelin measurements at baseline (just before meal ingestion) and at 30-min intervals up to 180 min. Participants rated their hunger and fullness levels using a visual analog …

Presents statistics on foreign language enrollments in two- and four-year colleges and universities and offers suggestions of ways to reverse the trend, particularly outreach to the high schools. (RM)

FEPs are rare, benign mucosal growths that may cause urinary tract obstruction in both adults and children. We present the case of a ten year old Hispanic male with recurring urinary tract infections and hydronephrosis diagnosed with fibroepithelial polyps (FEPs). Despite multiple radiographic procedures, we were unable to accurately preoperatively diagnose FEPs. Here we demonstrate the difficulties in preoperative diagnosis and suggest that perhaps a combination of US and MRI in the setting of persistent urinary tract infections and flank pain may be the best approach for early diagnosis and conservative management, including less invasive treatment protocols.

Background: Self-adhesive resin cements do not require the surface treatment of teeth and are said to release fluoride, which makes them suitable candidates for bonding of orthodontic brackets. The objectives of this study was to investigate the shear bond strength (SBS) of self-adhesive resin cements on etched on non-etched surfaces in vitro and to assess their fluoride release features. Materials and Methods: Four fluoride-releasing dual-cure self-adhesive resin cements were investigated. For SBS experiment, 135 freshly extracted human maxillary premolars were used and divided into nine groups of 15 teeth. In the control group, brackets were cemented by Transbond XT (3M Unitek, USA), in four groups self-adhesive resin cements were used without acid-etching and in four groups self-adhesive cements were applied on acid-etched surfaces and the brackets were then deboned in shear with a testing machine. Adhesive remnant index (ARI) scores were also calculated. For fluoride release investigation, 6 discs were prepared for each self-adhesive cement. Transbond XT and Fuji Ortho LC (GC, Japan) served as negative and positive control groups, respectively. The fluoride release of each disc into 5 ml of de-ionized water was measured at days 1, 2, 3, 7, 14, 28, and 56 using a fluoride ion-selective electrode connected to an ion analyzer. To prevent cumulative measurements, the storage solutions were changed daily. Results: The SBS of brackets cemented with Transbond XT were significantly higher compared to self-adhesives applied on non-etched surfaces (P

Weight gain secondary to medications is a potentially modifiable risk. Here's how to optimize drug choices for patients with several common conditions.

Alcohol Use Disorders (AUDs) are a major public health issue worldwide. Although drinking and problematic alcohol use usually begins during adolescence, developmental origins of the disorder can be traced back to infancy and early childhood. Identification of early risk factors is essential to understanding developmental origins. Using data from the Michigan Longitudinal Study, an ongoing, prospective, high-risk family study, this paper summarizes findings of family context and functioning of both children and parents. We draw attention to the development of the self, an understudied aspect of very young children being reared in alcoholic families that exacerbates exposure to high childhood adverse experiences. We also provide evidence demonstrating that young boys are embedded in a dynamic system of genes, epigenetic processes, brain organization, family dynamics, peers, community, and culture that strengthens risky developmental pathways if nothing is done to intervene during infancy and early childhood.

Obesity management requires a multidisciplinary approach, as there are many factors that contribute to the development of obesity, as well as the preservation of excess weight once it has been gained. Diet, exercise, and behavior modification are key components of treatment. In addition to lifestyle changes, weight gain secondary to medications is an important modifiable risk factor. Even after appropriate lifestyle modification, and medication adjustments (where possible) to avoid agents that can contribute to weight gain, many patients are still unable to achieve clinically meaningful weight loss. Pharmacotherapy for obesity management can fill an important role for these patients. This article will review medications that can lead to weight gain and potential alternatives, currently approved anti-obesity medications and best practices to individualize the selection process, and the use of testosterone in men with hypogonadism and obesity.

Background & Aims Endoscopic sleeve gastroplasty (ESG) is an incisionless, minimally invasive bariatric procedure that reduces the length and width of the gastric cavity to facilitate weight loss. We performed a prospective study to evaluate the effects of ESG on total body weight loss and obesity-related comorbidities. Methods We collected data from 91 consecutive patients (mean age, 43.86 ± 11.26 years; 68% female) undergoing ESG from August 2013 through March 2016. All patients had a body mass index (BMI) greater than 30 kg/m 2 and had failed noninvasive weight-loss measures or had a BMI greater than 40 kg/m 2 and were not considered as surgical candidates or refused surgery. All procedures were performed with a cap-based flexible endoscopic suturing system to facilitate a triangular pattern of sutures to imbricate the greater curvature of the stomach. Patients were evaluated after 6 months (n = 73), 12 months (n = 53), and 24 months (n = 12) for anthropometric features (BMI, weight, waist circumference, blood pressure) and underwent serologic (hemoglobin A1c), lipid panel, serum triglycerides, and liver function tests. The primary outcomes were total body weight loss at 6, 12, and 24 months. Secondary outcomes were the effects of ESG on metabolic factors (blood pressure, diabetes, hyperlipidemia, steatohepatitis) and safety. Results The patients' mean BMI before the procedure was 40.7 ± 7.0 kg/m 2 . Patients had lost 14.4% of their total body weight at 6 months (80% follow-up rate), 17.6% at 12 months (76% follow-up rate), and 20.9% at 24 months (66% follow-up rate) after ESG. At 12 months after ESG, patients had statistically significant reductions in levels of hemoglobin A1c ( P = .01), systolic blood pressure ( P = .02), waist circumference ( P P P = .02). However, there was no significant change in low-density lipoprotein after vs before ESG ( P = .79). There was one serious adverse event (1.1%) (perigastric leak) that occurred that was managed non-operatively. Conclusions ESG is a minimally invasive and effective endoscopic weight loss intervention. In addition to sustained total body weight loss up to 24 months, ESG reduced markers of hypertension, diabetes, and hypertriglyceridemia.

In this paper we explore the effect that a recent drought in Andhra Pradesh, India, has had on the school and work patterns of children aged 11 to 12 years. Previous empirical studies have investigated the effect of shocks on outcomes for children but few have allowed for heterogeneous treatment effects across children. Ignoring such heterogeneity might lead to biases in the estimated impact of the shocks. The aim of this paper is to address this lacuna. Using data from Young Lives, a longitudinal cohort study of children, we estimate the average impact of the drought on participation in schooling. We then expand our empirical model to allow for heterogeneous effects across children of different demographic categories – namely gender and birth order. Our analysis shows that ignoring child heterogeneity would underestimate the severity of the effect of the drought on children’s welfare and human capital accumulation. In particular, we find that the drought significantly reduced the time spent on schooling by most demographic groups. The exception is the group most likely to have been involved in agricultural work when there is no drought; the schooling participation of eldest sons appears to increase because of the drought. Furthermore, we trace the impact of the drought on child labour and cognitive development, while we rule out the possibility that the uncovered heterogeneous patterns might be driven by social norms or cultural biases in favour of eldest sons.