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Objective: The addiction cycle has been proposed as a framework for understanding the progression of alcohol use disorder (AUD) in terms of psychological and biological domains, including reward drinking/incentive salience, relief drinking/negative emotionality, and loss of control/executive functioning impairment. To have utility in clinical practice, self-report measures of these domains that are applicable across sociodemographic groups and associated with clinical outcomes are needed. This study sought to validate domains from self-report measures and to test whether domains are measurement invariant across sociodemographic groups and associated with treatment outcomes. Method: Secondary analysis of individuals with AUD (n = 3,092) who participated in two alcohol clinical trials, Project Matching Alcohol Treatment to Client Heterogeneity (MATCH) and COMBINE. Factor analytic methods were used to derive addiction cycle domains at baseline. These domains were then examined as predictors of outcomes. Results: Fifteen self-report items were used as indicators of the addiction cycle domains, with sociodemographic differences in measurement by sex, age, race, education, and AUD symptoms. Relief/negative emotionality and reward/incentive salience were significantly associated with outcomes at 1 and 3 years following treatment, and executive functioning also predicted nonabstinent recovery at 3 years. Conclusions: The results support the utility of domains relevant to the addiction cycle in predicting AUD treatment outcomes and recovery among individuals who sought treatment for AUD. The addiction cycle domains were more strongly associated with outcomes than other measures clinicians might use to predict outcomes (e.g., AUD symptoms). Future research should continue to develop and refine the items and test whether the addiction cycle domains can inform treatment planning.

The worldwide outbreak of the novel coronavirus (COVID-19) and the likelihood of future pandemics has raised the attention to the effects of pandemics on the psychological well-being of individuals. Given their indispensable role in such situations, healthcare workers are at greater risk of mental health issues. This paper aimed to review the mediators of psychological well-being among healthcare workers responding to global pandemics. After registration on PROSPERO, a systematic review was performed in four databases. Following study selection (PRISMA guidelines), inclusion criteria and analysis methods were assessed. The quality of the included studies was assessed using the EPHPP criteria. Out of 1467 references, 39 studies were included in this review. In most studies, worse well-being outcomes, such as stress, depressive symptoms, anxiety, and burnout were related to demographic characteristics, direct contact with infected patients, and poor perceived support. In turn, self-efficacy, coping ability, altruism, and support from employers and organisations were found to be protective factors. Despite some limitations in the quality of the available evidence, this review highlights the prevalence of poor mental health outcomes in healthcare workers responding to global pandemics. Future interventions should target the identified mediators to promote psychological well-being among this population, particularly social and organisational support, which may improve workers’ mental health and reduce burnout and turnover.

Previous research on pandemics and emergencies has shown that such events often widen health inequalities in society and have a greater impact on socially disadvantaged groups No review has so far looked at the impact of inequality factors on mental health outcomes during the novel coronavirus outbreak (COVID-19) The aim of the current review was therefore to assess the impact of inequality factors on mental health outcomes during COVID-19 After registration on PROSPERO, a systematic review was conducted for papers published up to July 31, 2020, using the databases Google Scholar, PsycINFO, PubMed (MEDLINE), and Web of Science The following inequality factors were considered: education, income, employment, occupation, material and social deprivation, age, immigrant status, sexual orientation, functional health, cultural/racial background, sex, gender, and place of residence Out of 1,931 references, 117 studies (300,061 participants) were included Female sex, being of a younger age, financial insecurity, lack of access to clear messaging/information about the pandemic, proximity to large infection sites, having existing physical and/or psychological health conditions, and being subjected to abuse/stigma because of one's identity as a member of an ethnic or sexual marginalized group predicted mental health inequalities More research is required on how inequality affects mental health in less studied vulnerable populations, such as ethnic, sexual, and gender marginalized participants, as well as how inequality factors interact to affect mental health in the long term Recommendations for researchers, mental health practitioners, and public health authorities for mitigating adverse mental health outcomes in vulnerable populations are outlined (PsycInfo Database Record (c) 2021 APA, all rights reserved) Abstract (French) Des recherches anterieures sur les pandemies et les urgences ont montre que de tels evenements augmentent souvent les inegalites en matiere de sante dans la societe et ont une incidence plus grave sur les groupes socialement defavorises A ce jour, aucune etude n'a examine l'incidence des facteurs d'inegalite sur les resultats en matiere de sante mentale lors de l'epidemie du nouveau coronavirus (COVID-19) L'objectif de la presente etude etait donc d'evaluer l'incidence des facteurs d'inegalite sur les resultats en matiere de sante mentale pendant la COVID-19 Apres inscription sur PROSPERO, un examen systematique a ete effectue pour les articles publies jusqu'au 31 juillet 2020, en utilisant les bases de donnees Google Scholar, PsycINFO, PubMed (MEDLINE) et Web of Science Les facteurs d'inegalite suivants ont ete pris en consideration : education, revenu, emploi, profession, privation materielle et sociale, age, statut d'immigrant, orientation sexuelle, sante fonctionnelle, origine culturelle/raciale, sexe, genre et lieu de residence Sur 1 931 references, 117 etudes (300 061 participants) ont ete incluses Le sexe feminin, le jeune age, l'insecurite financiere, le manque d'acces a des messages/renseignements clairs sur la pandemie, la proximite d'importants sites d'infection, les conditions de sante physique et/ou psychologique existantes et le fait d'etre victime d'abus/stigmatisation en raison de son identite en tant que membre d'un groupe ethnique ou sexuel marginalise ont permis de predire les inegalites en matiere de sante mentale Des recherches supplementaires sont necessaires sur la maniere dont les inegalites affectent la sante mentale dans les populations vulnerables moins etudiees, telles que les participants marginalises sur le plan ethnique, sexuel et sexospecifique, ainsi que sur la maniere dont les facteurs d'inegalite interagissent pour affecter la sante mentale a long terme Des recommandations sont formulees a l'intention des chercheurs, des praticiens de la sante mentale et des autorites de sante publique pour attenuer les effets nefastes sur la sante mentale des populations vulnerables (PsycInfo Database Record (c) 2021 APA, all rights reserved) Impact Statement Public Significance Statement-The findings of this review suggest that several inequality factors, such as female sex, younger age, financial insecurity, having existing chronic health conditions, and being in an ethnic or sexual marginalized group predict worse mental health outcomes during the ongoing COVID-19 pandemic There is an urgent need for mental health services to support vulnerable populations at this time, to reduce mental health inequalities and improve long-term psychological functioning (PsycInfo Database Record (c) 2021 APA, all rights reserved)

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Meropenem-vaborbactam is a newly approved antibiotic for complex urinary tract infections and to treat carbapenem-resistant Enterobacteriaceae infections. Its advantage over meropenem is the betalactamase inhibitor which slows bacterial resistance. This medication has been studied in numerous countries and has relatively few side effects. There were slightly higher incidences of alanine aminotransferase (ALT), aspartate aminotransferase (AST), elevations, infusion site phlebitis, but less anemia, vaginal infections, and discontinuation when compared with pipercacilin-tazobactam. The combination drug's relevance for the geriatrician is that older adults are at higher risk for urinary tract infections (UTIs). Some drugs that had previously been prescribed are now less useful for treating UTIs. This leaves clinicians with drugs that have more side effects. This new drug has two significant drug interactions. Meropenem competes with probenecid in the kidney's tubular secretion. This increases the concentration of meropenem. Meropenem lessens valproic acid blood levels, putting patients at risk for seizures. It is not known to impact cytochrome p450 enzymes. It comes as a dry powder and should be diluted in 250 mL of normal saline and given over a three-hour infusion. Vaborbactam is not known to have drug interactions. Vaborbactam does not affect the cytochrome p450 enzymes. This antibiotic has been studied in patients as old as 92 years. Renal dose adjustment allows the medication to be administered safely at all stages of kidney disease. If a patient is on dialysis, it is to be given after dialysis. No dose adjustment is needed based on the Child-Pugh score (i.e., for hepatic function). Based on local resistance, it may be beneficial to add this medication to one's formulary.

A critical component to any modern cybersecurity endeavor is effective use of its human resources to secure networks, maintain services and mitigate adversarial events. Despite the importance of the human cyber- analyst and operator to cybersecurity, there has not been a corresponding rise in data-driven analytical approaches for understanding, evaluating, and improving the effectiveness of cybersecurity teams as a whole. Fortunately, cyber defense competitions are well-established and provide a critical window into what makes a cybersecurity team more or less effective. We examined data collected at the national finals and four regional events of the Collegiate Cyber Defense Competition and posited that experience, access to simulation-based training, and functional role composition by the teams would predict team performance on four scoring dimensions relevant to the application of information assurance skills and defensive cyber operations: (a) maintaining services, (b) help-desk customer support, (c) handling scenario injects, and (d) mitigating red team attacks. Bayesian analysis highlighted that experience was a strong predictor of service availability, scenario injects, and red team defense. Simulation training was also associated with good performance along these scoring dimensions. High-performing and experienced teams clustered with one another based on the functional role composition of team skills. These results are discussed within the context of stages of team development, the efficacy of challenge-based learning events, and reinforce previous analytical results from cyber competitions.

Background: Behavioral studies using pharmacological manipulations that increase neuronal activity of the central nucleus of the amygdala (CeA) have implicated the CeA in enhancement of memory modulation. To date, however, there has been a dearth of studies investigating the effect of a drug that decreases CeA activity on memory modulation—a drug that inhibits the neuronal activity of the CeA might be expected to impair memory modulation. To determine whether ethanol inhibits CeA activity and, if so, whether decreased CeA activity is associated with impairment of memory modulation, this study investigated the effect of ethanol on spontaneous single-unit activity of CeA neurons and retention in the passive-avoidance task. Methods: The effect of ethanol (0.35, 0.75, 1.5, 2.5 g/kg) was determined on spontaneously firing neurons in the CeA in urethane-anesthetized rats by use of standard in vivo single-unit electrophysiological recording techniques. Additionally, the effect of ethanol when administered immediately after training in a standard passive-avoidance task was determined on retention the following day. Results: Ethanol profoundly inhibited spontaneous CeA firing rates in urethane-anesthetized rats at all doses tested. Maximal inhibition was related to dose. Each dose of ethanol significantly inhibited CeA activity within 15 min of administration; within 35 min of administration, 0.75 g/kg of ethanol inhibited CeA activity by 65.2%, and the highest dose (2.5 g/kg) produced nearly complete suppression of CeA activity (81.3%). Although ethanol markedly inhibited CeA activity, these same doses of ethanol failed to impair retention in the passive-avoidance task: 0.35, 0.75, 1.5, and 2.5 g/kg of ethanol, administered immediately after training, failed to alter latency to step-through the following day. Conclusions: These results show that ethanol profoundly inhibits spontaneous CeA activity and suggest that inhibition of the CeA is not sufficient to impair retention in the passive-avoidance task.

The effect of systemically administered propranolol was determined on spontaneous activity of neurons in the central nucleus (CeA) of the amygdala, a brain site implicated in fear-related learning and memory. Extracellular recordings of single units in the CeA were obtained in vivo from rats administered saline or the centrally and peripherally acting β-adrenergic receptor blocker propranolol (4, 7, 10 mg/kg ip). The high dose (10 mg/kg) of propranolol markedly increased spontaneous activity of CeA neurons. In contrast, the low (4 mg/kg) and intermediate (7 mg/kg) doses of propranolol significantly decreased spontaneous CeA activity, with the suppressant effect of propranolol on CeA firing rates weakening as the dosage increased from 4 to 7 mg/kg. These results suggest that (1) spontaneous activity of CeA neurons is tonically influenced by competing excitatory and inhibitory modulatory circuits, and (2) propranolol's effect on the two modulatory circuits is dose dependent: the high dose increasing spontaneous CeA activity by preferentially blocking an inhibitory circuit, the low dose decreasing spontaneous CeA activity by preferentially blocking an excitatory circuit, and the intermediate dose weakly suppressing CeA activity by blocking both the excitatory and inhibitory modulatory circuits. Disinhibition of CeA activity by the high dose of propranolol may explain the enhancement of retention observed in the passive-avoidance task when this dose of the drug is administered systemically, and may have implications for the use of propranolol clinically in treating aversive-memory-related anxiety disorders such as posttraumatic stress syndrome.

Robot-assisted surgery is becoming more widespread, but despite adoption by most academic institutions, curricula for training residents in robotics have yet to be developed fully. Even after teaching surgeons have mastered robotic techniques, an inherent risk of avoidable injuries may persist as they seek to impart their knowledge of this relatively new surgical modality to trainees. Two cases of aortic injury during access for robot-assisted prostatectomy are described along with their successful robotic repair with root-cause analysis of the events. Robotic surgeons who are involved in training programs should be prepared to handle even major potential complications of robot-assisted surgery regardless of their own expertise or experience.

Dear Sir, I have lately had an opportunity of inspecting a singular human fœtus, at the full period of utero-gestation, and hope that a history of it will not be unacceptable to the learned Society, of which you are a member. Some deviations, which it exhibits, from the usual form and structure of the human body, have not (as far as my information extends) been yet recorded; and the consideration that they were all apparently compatible with life, gives additional interest to the subject; for if the difficulty of parturition had not proved almost im­mediately fatal, the complex structure of the animal would have formed no impediment to its existence. Instances of two entire human bodies united together, are by no means rare in the collections of anatomists. Sometimes their conjunction takes place back to back; sometimes the reverse; at other times side by side; or in such a position as to form a kind of cross: the two heads lying in one direction, and the opposite extremities in another, and intersecting it at right angles.

Although instances of human bodies nearly entire, united side by side, or back to back, or otherwise, are by no means rare in the collections of anatomists; and although such a conjunction is generally not connected with any peculiarity in the organs which compose them, and lead the physiologist to anticipate nothing curious in their internal configuration;—yet, where some parts are found double, and others single, the resources of nature become apparent in adjusting parts which have naturally no connexion. Such is the instance here described; and it appears peculiarly interesting, from the consideration, that the system of deviation was apparently compatible with life; for if the difficulty of the birth had not proved almost immediately fatal, the complexity of the structure would probably have formed no impediment to its existence. This curious production had two heads, placed side by side, united to one body, with two legs and two arms. The countenance of the one appeared to the author to be male, and of the other female; and the conformation of the organs of generation, which partook of both sexes, confirmed that persuasion.

Background: Public health initiatives seek to modify lifestyle behaviours associated with risk (e.g., diet, exercise, and smoking), but underpinning psychological and affective processes must also be considered to maximize success.\ud Objective: This study aimed to qualitatively assess how participants engaged with and utilized the best possible self (BPS)-intervention specifically as a type 2 diabetes (T2D) prevention tool.\ud Design and Methods: Fourteen participants engaged with a tailored BPS intervention. Reflexive thematic analysis analysed accounts of participant's experiences and feasibility of use.\ud Results: All participants submitted evidence of engagement with the intervention. The analysis considered two main themes: Holistic Health and Control. The analysis highlighted several nuanced ways in which individuals conceptualized their health, set goals, and received affective benefits, offering insights into how people personalized a simple intervention to meet their health needs.\ud Conclusions: To our knowledge, this is the first study to tailor the BPS intervention as a public health application for the prevention of T2D. The intervention enabled users to identify their best possible selves in a way that encouraged T2D preventive behaviours. We propose that our tailored BPS intervention could be a flexible and brief tool to assist public health efforts in encouraging change to aid T2D prevention.\ud Public Contribution: The format, language and application of the BPS intervention were adapted in response to a public consultation group that developed a version specifically for application in this study.