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Myroides odoratimimus is a Gram-negative opportunistic pathogen known to rarely cause a wide range of opportunistic infections in humans. We report a novel case of M. odoratimimus bacteremia in a paraplegic patient with an extensive medical history likely due to a tunneled dialysis catheter infection that was successfully treated with levofloxacin.

Background: Social interactions are essential to social connectedness among older adults. While many scales have been developed to measure various aspects of social connectedness, most are narrow in scope, which may not be optimally encompassing, practical, or relevant for use with older adults across clinical and community settings. Efforts are needed to create more sensitive scales that can identify "upstream risk," which may facilitate timey referral and/or intervention., Objective: The purposes of this study were to: (1) develop and validate a brief scale to measure threats to social connectedness among older adults in the context of their social interactions; and (2) offer practical scoring and implementation recommendations for utilization in research and practice contexts., Methods: A sequential process was used to develop the initial instrument used in this study, which was then methodologically reduced to create a brief 13-item scale. Relevant, existing scales and measures were identified and compiled, which were then critically assessed by a combination of research and practice experts to optimize the pool of relevant items that assess threats to social connectedness while reducing potential redundancies. Then, a national sample of 4,082 older adults ages 60 years and older completed a web-based questionnaire containing the initial 36 items about social connection. Several data analysis methods were applied to assess the underlying dimensionality of the data and construct measures of different factors related to risk, including item response theory (IRT) modeling, clustering techniques, and structural equation modeling (SEM)., Results: IRT modeling reduced the initial 36 items to create the 13-item Upstream Social Interaction Risk Scale (U-SIRS-13) with strong model fit. The dimensionality assessment using different clustering algorithms supported a 2-factor solution to classify risk. The SEM predicting highest risk items fit exceptionally well (RMSEA = 0.048; CFI = 0.954). For the 13-item scale, theta scores generated from IRT were strongly correlated with the summed count of items binarily identifying risk ( r  = 0.896, p  < 0.001), thus supporting the use of practical scoring techniques for research and practice (Cronbach's alpha = 0.80)., Conclusion: The U-SIRS-13 is a multidimensional scale with strong face, content, and construct validity. Findings support its practical utility to identify threats to social connectedness among older adults posed by limited physical opportunities for social interactions and lacking emotional fulfillment from social interactions., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Smith and Barrett.)

Introduction: Age-related cognitive decline has been linked to distinct patterns of cellular dysfunction in the prelimbic cortex (PL) and the CA3 subregion of the hippocampus. Because higher cognitive functions require both structures, selectively targeting a neurobiological change in one region, at the expense of the other, is not likely to restore normal behavior in older animals. One change with age that both the PL and CA3 share, however, is a reduced ability to utilize glucose, which can produce aberrant neural activity patterns., Methods: The current study used a ketogenic diet (KD) intervention, which reduces the brain's reliance on glucose, and has been shown to improve cognition, as a metabolic treatment for restoring neural ensemble dynamics in aged rats. Expression of the immediate-early genes Arc and Homer 1a were used to quantify the neural ensembles that were active in the home cage prior to behavior, during a working memory/biconditional association task, and a continuous spatial alternation task., Results: Aged rats on the control diet had increased activity in CA3 and less ensemble overlap in PL between different task conditions than did the young animals. In the PL, the KD was associated with increased activation of neurons in the superficial cortical layers, establishing a clear link between dietary macronutrient content and frontal cortical activity. The KD did not lead to any significant changes in CA3 activity., Discussion: These observations suggest that the availability of ketone bodies may permit the engagement of compensatory mechanisms in the frontal cortices that produce better cognitive outcomes., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The author(s) declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision., (Copyright © 2023 Hernandez, Barrett, Lubke, Maurer and Burke.)

Sexual violence remains a prevalent issue on college campuses. Sexual coercion, a form of sexual violence, is frequently employed within casual sexual encounters (i.e., hookups). The present study investigated hypersexuality and sexual narcissism as unique predictors of sexual coercion and examined whether there were gender differences in these associations. Participants (N = 793, ages 18-25) were undergraduate students at a large southeastern university who have: (1) engaged in sexual activity within the past six months and (2) had at least one prior hookup experience. Respondents completed surveys online assessing levels of sexual narcissism, hypersexuality, and sexual coercion perpetration in hookups. Participants primarily identified as female (71.7%), White (84.2%), and heterosexual (86.6%), with an average of 9.77 sexual engagements per month. Bivariate correlations and independent samples t-tests were conducted to examine associations between and gender differences across study variables, respectively. We assessed the factor structure of study variables using confirmatory factor analysis and tested hypotheses using structural equation modeling. Compared to women, men scored higher on sexual exploitation and all hypersexuality subscales. After establishing good-fitting measurement models, we found that both sexual narcissism and hypersexuality predicted increased sexual coercion perpetration and that gender did not moderate these associations. Study findings demonstrated that sexual narcissism and hypersexuality are risk factors for sexual coercion perpetration in hookups across gender. Although associations were consistent across gender, men may report higher levels of sexual coercion perpetration risk factors. Future researchers could focus on gender differences in the etiology of sexual coercion risk factors., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Objectives: One important function of military audiology is to conduct evaluations of service members (SMs) with hearing loss to ensure they are fit for deployment in dangerous operational environments. The objective of this study was to establish evidence-based auditory fitness-for-duty criteria based on speech-in-noise performance on the 80- and 160-word clinical versions of the Modified Rhyme Test (MRT 80 and MRT 160 )., Design: Approximately 2400 SMs with various levels of hearing loss were recruited to complete the MRT 80 in conjunction with their annual hearing conservation evaluations. These SMs were also asked to perform one or more operationally-relevant listening tasks based on audio recordings made in highly realistic military training environments. The scores on these tests were compared to determine how well a proposed cutoff criterion for the MRT 80 was able to identify individuals who are hard of hearing with an exceptionally high risk of abnormally poor performance on operationally-relevant hearing tasks., Results: The results show that a cutoff criterion that combines the percent correct score on two lists of the MRT 80 (i.e. MRT 160 ) with information about the better-ear threshold at 2 kHz is generally able to separate listeners with hearing loss into those who are likely to perform relatively well on operational listening tests and those who are likely to perform poorly on these tasks. This is consistent with current military acquisition standards, which identify the MRT as the preferred test for evaluating speech intelligibility for radios, headsets, and other communication equipment. It is also consistent with prior studies conducted in high-fidelity military simulations which have shown a significant correlation between MRT performance and operational outcomes., Conclusions: The proposed selection criteria, along with the new hearing profile standards that were recently adopted by the US Army, appear to provide an effective evidence-based methodology for identifying those SMs with hearing loss who are most at risk for poor performance on hearing-critical military tasks., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

The objective of this study was to evaluate the impact of wearing various types of personal protective equipment on speech recognition in a real-world, noisy listening environment. Groups of four young, normal-hearing adults participated in a live version of the Modified Rhyme Test in a noisy public cafeteria with and without the use of a non-medical disposable facial mask or combat earplugs in two different modes. Speech recognition, response time, and subjective difficulty were measured per individual. In addition, the signal-to-noise ratio was estimated during the interval when the talker spoke the target word. Results showed that the listeners' speech recognition performance declined not only when the listener wore earplugs, but also when the talker wore earplugs. The measured signal-to-noise ratio significantly decreased when the talker wore earplugs, suggesting that occlusion may have caused the talkers to reduce their voice levels. Results also showed a decline in speech recognition performance when the talker wore a facial mask. Listeners rated all conditions in which talkers and listeners wore personal protective equipment as more difficult than the baseline condition. These data suggest that speech recognition in real-world listening environments can be impaired by personal protective equipment worn by both talkers and listeners.

This study examined the speech-related advantages of binaural listening for individuals conversing in a noisy restaurant. Young, normal-hearing adults were tested in groups of four during monaural and binaural listening conditions. Monosyllabic word stimuli were presented in a closed-set format. Speech intelligibility, response time (RT), and self-reported difficulty were measured. Results showed a speech intelligibility advantage of 17%, a 0.26 s decrease in RT, and a reduction in reported difficulty in binaural compared to monaural listening. These data suggest the binaural advantage obtained in real-world settings compares favorably with that observed in the laboratory, indicating that speech testing in laboratories approximates real-world performance.

The objective of this study was to obtain a normative database of speech intelligibility data for young normal-hearing listeners communicating in public spaces. A total of 174 listeners participated in an interactive speech intelligibility task that required four-person groups to conduct a live version of the Modified Rhyme Test in noisy public spaces. The public spaces tested included a college library, a college cafeteria, a casual dining restaurant during lunch hour, and a crowded bar during happy hour. At the start of each trial, one of the participants was randomly selected as the talker, and a tablet computer was used to prompt them to say a word aloud from the Modified Rhyme Test. Then, the other three participants were required to select this word from one of six rhyming alternatives displayed on three other tablet computers. The tablet computers were also used to record the SPL at each listener location during and after the interval where the target talker was speaking. These SPL measurements were used to estimate the signal-to-noise ratio (SNR) in each trial of the experiment. As expected, the results show that speech intelligibility decreases, response time increases, and perceived difficulty increases as the background noise level increases. There was also a systematic decrease in SNR with increasing background noise, with SNR decreasing 0.44 dB for every 1 dB increase in ambient noise level above 60 dB. Overall, the results of this study have demonstrated how low-cost tablet computer-based data collection systems can be used to collect live-talker speech intelligibility data in real-world environments. We believe these techniques could be adapted for use in future studies focused on obtaining ecologically valid assessments of the effects of age, hearing impairment, amplification, and other factors on speech intelligibility performance in real-world environments.

Prefrontal cortical and medial temporal lobe connectivity is critical for higher cognitive functions that decline in older adults. Likewise, these cortical areas are among the first to show anatomical, functional, and biochemical alterations in advanced age. The prelimbic subregion of the prefrontal cortex and the perirhinal cortex of the medial temporal lobe are densely reciprocally connected and well-characterized as undergoing age-related neurobiological changes that correlate with behavioral impairment. Despite this fact, it remains to be determined how changes within these brain regions manifest as alterations in their functional connectivity. In our previous work, we observed an increased probability of age-related dysfunction for perirhinal cortical neurons that projected to the prefrontal cortex in old rats compared to neurons that were not identified as projection neurons. The current study was designed to investigate the extent to which aged prelimbic cortical neurons also had altered patterns of Arc expression during behavior, and if this was more evident in those cells that had long-range projections to the perirhinal cortex. The expression patterns of the immediate-early gene Arc were quantified in behaviorally characterized rats that also received the retrograde tracer cholera toxin B (CTB) in the perirhinal cortex to identify projection neurons to this region. As in our previous work, the current study found that CTB+ cells were more active than those that did not have the tracer. Moreover, there were age-related reductions in prelimbic cortical neuron Arc expression that correlated with a reduced ability of aged rats to multitask. Unlike the perirhinal cortex, however, the age-related reduction in Arc expression was equally likely in CTB+ and CTB- negative cells. Thus, the selective vulnerability of neurons with long-range projections to dysfunction in old age may be a unique feature of the perirhinal cortex. Together, these observations identify a mechanism involving prelimbic-perirhinal cortical circuit disruption in cognitive aging., (Copyright © 2020 Hernandez, Truckenbrod, Barrett, Lubke, Clark and Burke.)

Traditional hearing conservation programs are based on the premise that noise dose, as measured by the time-weighted average noise level, is the primary risk factor associated with occupational hearing loss and that permanent threshold shifts are the most relevant outcome measures for determining when a noise-related hearing loss has occurred. However, recent studies in animal models have suggested that significant neurological damage to the hearing system can occur from noise exposures even when they are not severe enough to result in permanent threshold shifts. This has led to a number of studies attempting to relate subjective measures of noise exposure to subjective measures of hearing difficulty and suprathreshold measures of hearing performance (e.g., speech-in-noise tests). In this study, 3,330 U.S. service members volunteered to complete a survey on noise exposure, subjective hearing complaints, and tinnitus in conjunction with their annual hearing tests. Two questions were also included about the frequency and duration of temporary hearing losses that may have been experienced by the service member. The results show that subjective reports of temporary threshold shifts were substantially more predictive of tinnitus and other hearing complaints than more traditional questions based on the frequency of noise exposure.

Interaural correlation change detection was measured in untrained normal-hearing listeners. Narrowband (10-Hz) noises were varied by center frequency (CF; 500 or 4000 Hz) and diotic level roving (absent or present). For the 500-Hz CF, 96% of listeners could achieve threshold (79.4% correct at the easiest testing level) if roving was absent, but only 36% of listeners could if level roving was present. No one could achieve threshold at the 4000-Hz CF, unlike trained listeners in the literature. The results raise questions about how individual differences affect learning and generalization of monaural and binaural cues related to interaural correlation detection.

Dermatoses of the breast during lactation can be difficult to diagnose because of their overlapping clinical appearances. It is important to properly diagnose and treat nipple dermatitis since it can be a significant source of pain when nursing. Poorly controlled nipple pain in nursing mothers is one of the primary reasons for breastfeeding to be discontinued earlier than is recommended. Therefore, it is relevant for practicing dermatologists to be aware of certain facts in a patient's history, specific physical exam findings, and the most appropriate laboratory tests used to diagnose these conditions. In addition, the therapeutic approach should be effective and safe for the mother and infant. This review article provides dermatologists with a detailed discussion on the clinical features and management of various breast dermatoses seen in lactation, including atopic dermatitis, irritant contact dermatitis, allergic contact dermatitis, psoriasis, bacterial infections, yeast infections and herpes simplex virus infections., (© 2013 Wiley Periodicals, Inc.)

Objective: To elucidate the diagnostic criteria of Raynaud phenomenon of the nipple that will aid in recognizing and treating Raynaud phenomenon in breast feeding mothers with chronic deep nipple pain during lactation., Design: Retrospective review of a patient database composed of 22 cases of breastfeeding mothers who fit the diagnostic criteria for Raynaud phenomenon of the nipple., Setting: Menlo Dermatology Medical Group in Menlo Park, California, an academic-affiliated, private dermatologic referral center., Patients: All patients diagnosed as having Raynaud phenomenon of the nipple evaluated from January 1, 2004,through December 31, 2010., Main Outcome Measures: The rate of failed treatment for Candida mastitis, the rate of improvement of symptoms with nifedipine use, and the overall rate of improvement of symptoms with appropriate therapy involving treatment of Raynaud phenomenon., Results: Among the 22 patients with Raynaud phenomenon of the nipple, previous treatment for Candida mastitis with oral or topical antifungals was ineffective in 20(91%). Of the 12 patients who tolerated a trial of nifedipine,10 (83%) reported decreased or resolved nipple pain. All patients experienced marked improvement of symptoms with appropriate therapy involving treatment of Raynaud phenomenon., Conclusions: Most patients were treated with antifungals before presentation without resolution of nipple pain. Nifedipine appears to be an effective medication for the treatment of Raynaud phenomenon of the nipple. With appropriate management of Raynaud phenomenon,breastfeeding mothers demonstrated improvement of nipple pain. Raynaud phenomenon of the nipple should be considered in the differential diagnosis of nipple pain during lactation.

Due to decreases in the availability and quality of traditional water resources, harvested rainwater is increasingly used for potable and non-potable purposes. In this study, we examined the effect of conventional roofing materials (i.e., asphalt fiberglass shingle, Galvalume(®) metal, and concrete tile) and alternative roofing materials (i.e., cool and green) on the quality of harvested rainwater. Results from pilot-scale and full-scale roofs demonstrated that rainwater harvested from any of these roofing materials would require treatment if the consumer wanted to meet United States Environmental Protection Agency primary and secondary drinking water standards or non-potable water reuse guidelines; at a minimum, first-flush diversion, filtration, and disinfection are recommended. Metal roofs are commonly recommended for rainwater harvesting applications, and this study showed that rainwater harvested from metal roofs tends to have lower concentrations of fecal indicator bacteria as compared to other roofing materials. However, concrete tile and cool roofs produced harvested rainwater quality similar to that from the metal roofs, indicating that these roofing materials also are suitable for rainwater harvesting applications. Although the shingle and green roofs produced water quality comparable in many respects to that from the other roofing materials, their dissolved organic carbon concentrations were very high (approximately one order of magnitude higher than what is typical for a finished drinking water in the United States), which might lead to high concentrations of disinfection byproducts after chlorination. Furthermore the concentrations of some metals (e.g., arsenic) in rainwater harvested from the green roof suggest that the quality of commercial growing media should be carefully examined if the harvested rainwater is being considered for domestic use. Hence, roofing material is an important consideration when designing a rainwater catchment., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

This paper investigated the highway stormwater quality at two Texas cities-Austin and College Station. Two highways with high average daily traffic were monitored using passive stormwater samplers for collecting first-flush runoff during a 16-month period. Detailed traffic and weather data were collected at College Station sites, but only weather data were obtained at Austin sites. A stepwise regression analysis on College Station data identifies the antecedent dry period (ADP) as the most significant predictor of pollutant concentration. Specifically, the College Station data show an unexpected result that pollutant event mean concentrations significantly decrease with increasing ADP for all analyzed pollutants. However, the runoff concentrations observed in Austin were not significantly correlated with ADP. The result from College Station data provides a different insight to the pollutant buildup and removal process on highways. Conceptual highway pollutant buildup and removal models are proposed for generating further discussion and research interest.

The objective of this research was to modify an extended detention basin to provide batch treatment of stormwater runoff. An automated valve/controller was developed and placed on the outlet of a detention basin in Austin, Texas, which allowed the water quality volume to be retained in the basin for a preset length of time. The influent and effluent of the modified basin were monitored for total suspended solids (TSS), nutrients, chemical oxygen demand (COD), and total and dissolved metals. Statistically significant removal of total metals, COD, total nitrogen, total phosphorus, and TSS was observed, with a discharge event mean TSS concentration of 7 mg/L and a TSS removal efficiency of 91%. The modified basin has substantially better pollutant removal than conventional extended detention basins and is comparable with that of Austin sand filters, which are a common structural stormwater treatment system in the Austin area. The valve also can be used to isolate hazardous material spills.

This project has two main objectives; the first is to documents the effect of a porous friction course overlay on the quality of highway stormwater runoff, and the second is to assess pollutant removal of a vegetated area along the side of a road from both conventional and porous pavements. The quantity and quality of stormwater runoff from a four-lane divided highway in the Austin, Texas, area was monitored before and after the installation of a porous friction course (PFC). Observed concentrations of suspended solids and pollutants associated with particulate material were much lower in the runoff from the PFC compared with runoff from the conventional asphalt surface. The vegetated highway shoulder reduced the concentrations of many stormwater constituents from the conventional asphalt surface; however, the concentrations of these constituents in runoff produced by the PFC were so low that the vegetated area produced no further reduction in concentration.

Objective: We conducted a survey to compare condom use and its associated factors between foreign Asian and local clients of female sex workers in Singapore., Study: A survey was conducted between 2001 and 2002 on a random sample of 810 clients (677 foreign Asian workers and 133 locals) recruited from the streets and outside the brothels in Singapore., Results: Foreign clients were more likely than locals to be inconsistent condom users with sex workers. Clients from China reported the highest percentage of inconsistent condom use (29.2%) and sexually transmitted infections (16.7%) compared with 8.3% (P < 0.003) and 2.3% (P < 0.005), respectively, among locals. On multivariate analysis, inconsistent condom use among foreign clients increased significantly with the number of freelance sex workers. The reverse trend was found for local clients., Conclusion: There is a need to design separate condom-promotion programs for foreign Asian and local clients of sex workers in Singapore.

This paper describes a method for comparing the pollutant removal of a number of structural stormwater treatment devices, commonly referred to as best management practices (BMPs). Historically, the pollutant removal ability of a BMP has been expressed as a percent reduction in concentration or load. Unfortunately, the calculated percent reduction in pollutant concentration is strongly affected by the influent concentration, with the calculated reduction generally being much lower when the event mean concentrations (EMCs) in the untreated runoff from the test watershed are low. The objective of the proposed methodology is to eliminate this problem by predicting BMP performance for an arbitrary influent concentration, so that BMPs evaluated in different watersheds can be compared as if the influent quality at all sites were the same. This method allows BMPs to be compared based on the quality of effluent produced and the mass reduction. The proposed method uses linear regression as the primary tool to compute the expected effluent concentration from a BMP, given a specific influent concentration of interest and was developed using data collected in the California Department of Transportation BMP Retrofit Pilot Program. This technique reveals that for media filters, the concentration of sediment and other particle-associated pollutants in treated runoff is generally unrelated to influent quality and is relatively constant. Wet basins with large permanent pool volumes also have effluent concentrations that are constant for most constituents and unrelated to influent concentrations. In these situations, the "percent reduction" in a pollutant EMC is not an inherent characteristic of the BMP, but a function of the influent EMC, because the quality of effluent produced is constant. Predicting the effluent quality of several types of conventional BMPs based on a common influent concentration allows an objective comparison of their performance and the selection of a BMP that addresses specific constituents of concern.

Background/objectives: Female sex workers and their male clients have been identified as risk groups for the transmission of STDs and HIV. Behavioural interventions targeting clients need to address inconsistent condom use among them. The aim of the study is to assess the sociodemographic, behavioural, and psychological factors associated with inconsistent condom use among clients of sex workers., Methods: 229 male patients attending the STD clinic in Singapore who reported paying for sex in the previous 6 months were interviewed. Response rate was 91%., Results: Overall, 45% used condoms inconsistently; these clients were more likely to have poor STD knowledge, visit sex workers five or more times in the past 6 months, have lower self efficacy, less favourable social norms for condom use, and more likely to forget condom use when intoxicated (alcohol impaired decision making)., Conclusions: Behavioural interventions for clients need to improve STD/HIV transmission knowledge and focus on improving client's self efficacy in using condoms.

A study was conducted in 31 Karen tribal villages in Northern Thailand in 1999-2000 to address the question of why some villages have a relatively high prevalence of illicit drug use compared with others? Data were gathered from village leaders, residents, and through observations by field workers and the researchers, and included demographic, economic, and infrastructure development, and social and acculturation measures. Overall, few village-level variables were related significantly to drug use in the villages; those that were included: 1) better access to elementary education reported by "high drug" villages (81%) in comparison with "low drug" villages (29%) and 2) high drug villages reported having more alcoholic residents than low drug villages. The findings provide some support for the hypothesis that illicit drug use is positively associated with socioeconomic development, acculturation, and socialization into mainstream attitudes, values, and behaviors.

This is an evaluation study of a community-based intervention model used in a project designed to reduce the demand for and use of opium, heroin, and other drugs among 85 tribal villages located in Northern Thailand. The Integrated Drug Abuse Prevention (IDAP) Project was conducted from 1995 to 1997 and used a community-based approach which included innovative methods such as multimedia awareness raising campaigns, networking between villages and local government agencies, and village-based drug detoxification and treatment to assist villages in solving their drug problems. The intervention model was successfully implemented in most villages and demonstrated very good results in improving awareness, decreasing the number of active drug users living in the villages, and preventing new cases of addiction. However, a follow-up study at 6 months after project termination indicated problems with sustainability of demand reduction activities and outcomes. These problems were attributed in part to a lack of empowerment among village leaders to continue activities without assistance from project staff. Also, village leaders expressed problems in resisting drug dealers who returned to the area, which suggested that support from law enforcement is critical to the viability of drug demand reduction programs.

This study investigated possible explanations for increases in marijuana use among eighth grade students in Texas from 1992 to 1996. The variables examined were availability of marijuana, perceived dangerousness of marijuana use, use of alcohol and cigarettes, parental attitudes toward marijuana use, and a number of other variables related to family, peers, and school. Although many of these variables were strongly related to marijuana use during the past year, only measures relating to availability of marijuana showed increases in prevalence similar to those of marijuana use across three time periods investigated. Another finding of interest was the dramatic increase (from 4% in 1992 to 24% in 1996) in marijuana use among African American students.

Since 1959 Wat Thamkrabok, a Buddhist monastery in Thailand, has been conducting a drug addiction rehabilitation program which claims a 70% success rate. The program is known for its use of unconventional methods, such as inducing vomiting to relieve "cravings" for drugs, herbal saunas, strict discipline, an emphasis on Buddhism, and a sacred vow to never again use drugs. This is a descriptive study based on observations and interviews (mostly with foreigners) made at the monastery. While it was not possible to evaluate claims of success, there were several interesting aspects of the program which emerged. Vomiting was reported to be effective in reducing "craving," and participants seemed to have a positive regard for the program, but there were some serious concerns raised about health risks and the coercive nature of the program.

A survey of 481 homeless persons in Cook County, Illinois, was conducted to assess the prevalence of alcohol and illicit drug use in this population, and potential treatment needs. Respondents were sampled at random in emergency and transitional shelters, soup kitchens, drop-in centers, and single room occupancy (SRO) hotels. Approximately 30% were characterized as having alcohol-related treatment needs. A slightly smaller proportion (26.7%) were estimated to have treatment needs associated with drug use behavior, and 13.5% were found to have both alcohol and drug-related, or dual, treatment needs. Those with alcohol user treatment needs were mostly male, age 35 and older, White, and living in SRO hotels. In contrast, persons with drug user treatment needs found in shelter settings. Implications for the treatment of homeless persons with substance misuse problems are discussed.

Objective: To examine the prevalence of self-reported alcohol use among women of childbearing age and their ability to recall information about pregnancy risk contained in warning labels on alcoholic beverage containers and warning signs posted in places where liquor is sold., Design: A telephone survey was conducted with adults using a dual-frame procedure. Specifically, approximately one third of the total sample were contacted by random-digit dialing, and the remainder were obtained from listed residential telephone numbers. Also, poststratification weighting was done using estimates of age, ethnic, and sex groups to approximate the 1990 adult population of Illinois., Setting: A total of 4987 adults with known residence (excluding those without residences and/or telephones and those living in institutions or group quarters) in Illinois participated in a survey during the spring and summer of 1990., Participants: A total of 1515 women of childbearing age (18 through 45 years old) participated in the survey. A random subsample of approximately half were asked questions regarding warning labels and signs; the other half were omitted from the investigation, which yielded the final sample of 748., Main Outcome Measures: The two main outcome measures were self-reported alcohol use and ability to recall information about pregnancy risk contained in warning labels and signs., Results: Pregnant women were significantly less likely than nonpregnant women to report using alcohol in the past 30 days. Approximately one fourth of all women were able to recall information about pregnancy risk contained in warning labels and signs., Conclusions: Alcohol warning labels and signs seem to be reaching a minority of women; this was uniform across several sociodemographic subpopulations, with few exceptions.

In 1988 Congress passed the Alcohol Beverage Labeling Act, requiring that two specific health warning labels appear on all alcoholic beverage containers sold in the United States after November 1989. The following year, a random sample of 481 homeless persons interviewed in shelters, soup kitchens, drop-in centers, and single room occupancy (SRO) hotels in Cook County, Illinois were asked about their awareness and knowledge of these messages. As a group traditionally considered at high risk for alcohol abuse, the degree to which the newly-mandated warning messages have been communicated to homeless persons has important implications for the success of this public health measure. Findings revealed that age and level of alcohol consumption were each associated with label awareness and content familiarity, suggesting that alcohol beverage warning labels may be reaching homeless persons.

The role of drug availability and psychological proneness in opioid addiction was examined using longitudinal data from the Drug Abuse Reporting Program (DARP). The sample included 424 addicts who were followed up and interviewed approximately 12 years after admission to treatment in the DARP, and for whom admission, during-treatment, and 6-year follow-up data were also available. Drug availability and proneness were both found to be important for drug use at any given time--from initial stages of addiction as well as in Year 12 of the follow-up--but proneness was rated as relatively more important for opioid use in the later stages of the addiction career. Proneness measures contributed more to the prediction of long-term drug use outcomes.

Follow-up interviews on a sample of 298 ex-heroin addicts 12 years after they entered treatment were used to examine alcohol use and substitution of alcohol for heroin. Almost one-fourth of the sample were classified as heavy drinkers in Year 12, and half had previously used alcohol in a substitution pattern. Classifications into one of three substitution groups (none, low and high) and multivariate analysis of variance were carried out to identify background and baseline factors related to substitution and long-term behavioral outcomes 12 years after entering treatment. Substitution was found to be related to higher levels of alcohol problems and treatment before addiction, parental alcohol problems, to vulnerability to peer influence in starting drug use and to feelings of rejection by peers during adolescence. In terms of 12-year outcomes, substitution was related to more use of nonopioid drugs, more heavy drinking and alcohol-related problems and more psychological dysfunction symptoms (such as depression). These results showed a strong relationship between substitution and preaddiction as well as postaddiction alcohol abuse. However, to delineate the effects of substitution apart from the effects of previous alcohol abuse, additional analyses were computed in which substitution was examined after controlling for previous alcohol abuse. The results confirmed the validity of substitution as a powerful construct in identifying behavioral differences before and after addition.

Florida is one of several states that have sought to protect newborns by requiring that mothers known to have used alcohol or illicit drugs during pregnancy be reported to health authorities. To estimate the prevalence of substance abuse by pregnant women, we collected urine samples from all pregnant women who enrolled for prenatal care at any of the five public health clinics in Pinellas County, Florida (n = 380), or at any of 12 private obstetrical offices in the county (n = 335); each center was studied for a one-month period during the first half of 1989. Toxicologic screening for alcohol, opiates, cocaine and its metabolites, and cannabinoids was performed blindly with the use of an enzyme-multiplied immunoassay technique; all positive results were confirmed. Among the 715 pregnant women we screened, the overall prevalence of a positive result on the toxicologic tests of urine was 14.8 percent; there was little difference in prevalence between the women seen at the public clinics (16.3 percent) and those seen at the private offices (13.1 percent). The frequency of a positive result was also similar among white women (15.4 percent) and black women (14.1 percent). Black women more frequently had evidence of cocaine use (7.5 percent vs. 1.8 percent for white women), whereas white women more frequently had evidence of the use of cannabinoids (14.4 percent vs. 6.0 percent for black women). During the six-month period in which we collected the urine samples, 133 women in Pinellas County were reported to health authorities after delivery for substance abuse during pregnancy. Despite the similar rates of substance abuse among black and white women in our study, black women were reported at approximately 10 times the rate for white women (P less than 0.0001), and poor women were more likely than others to be reported. We conclude that the use of illicit drugs is common among pregnant women regardless of race and socio-economic status. If legally mandated reporting is to be free of racial or economic bias, it must be based on objective medical criteria.

Reduction of problem behaviors (drug and alcohol use, school problems, and legal involvement) by Mexican-American youth (N = 326) during their first 3 months in drug abuse intervention programs was related negatively to peer drug use during the program and was related positively to the amount of family support available during the program, participation in program activities, and a background of religious involvement. These findings support previous research that has shown the importance of peer influences and commitment to conventional structures of family and religion in relation to adolescent problem behaviors. These findings suggest that two goals that adolescent drug abuse programs should stress are working heavily on developing positive peer relations and family support while they encourage disassociation from deviant friends.