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The US is experiencing an unprecedented opioid crisis, with a record 81,000 opioid-involved overdose deaths in the past year. Addressing the opioid crisis will require a substantial scale-up of access to effective treatment for opioid use disorder. Currently, only 18% of individuals with opioid use disorder receive evidence-based treatment in a given year. While health systems and public health departments are working to implement innovative strategies for engaging people with opioid use disorder into treatment, these efforts are hindered by widespread shortages of addiction treatment providers. Using a case study from the largest municipal hospital system in the US, the authors describe the effects of a workforce shortage on health system responses to the opioid crisis. Solving this national problem will require a multi-pronged approach, including federal programs focused on growing and diversifying the pipeline of addiction providers, medical education initiatives spanning pre-medical through residency training, and enhanced training and mentorship to increase the capacity of allied clinicians to treat opioid use disorder. Workforce development should be combined with structural reforms for integrating addiction treatment into mainstream medical care, and with new treatment models, including telehealth, that can lower patient barriers to accessing treatment.

This research unravels the formation mechanism of a hybrid conversion treatment including the well-established Zr conversion coating with a silane-based organic additive and Cu-based inorganic additive. The deposition mechanism of this coating was investigated on the thermal oxide film of Advanced High Strength Stainless Steels (AHSSS). This coating has been characterized using advanced surface analytical techniques such as XPS, FEG-AES, GDOES, and ToF-SIMS. The results showed that the simultaneous presence of these two additives results in the formation of a donor-acceptor complex between amine groups and Cu ions. The final coating contains Cu oxide together with a Cu-aminosilane complex, Zr oxide deposited mainly around Cu oxide and the aminosilane layer on the outer surface.

Evidence maps are emerging data visualization of a systematic review. There are no published evidence maps summarizing opioid use disorder (OUD) interventions.Our aim was to publish an interactive summary of all peer-reviewed interventional and observational trials assessing the treatment of OUD and common clinical outcomes.PubMed, Embase, PsycInfo, Cochrane Central Register of Clinical Trials, and Web of Science were queried using multiple OUD-related MESH terms, without date limitations, for English-language publications. Inclusions were human subjects, treatment of OUD, OUD patient or community-level outcomes, and systematic reviews of OUD interventions. Exclusions were laboratory studies, reviews, and case reports. Two reviewers independently scanned abstracts for inclusion before coding eligible full-text articles by pre-specified filters: research design, study population, study setting, intervention, outcomes, sample size, study duration, geographical region, and funding sources.The OUD Evidence Map (https://med.nyu.edu/research/lee-lab/research/opioid-use-disorder-treatment-evidence-map) identified and assessed 12,933 relevant abstracts through 2020. We excluded 9455 abstracts and full text reviewed 2839 manuscripts; 888 were excluded, 1591 were included in the final evidence map. The most studied OUD interventions were methadone (n = 754 studies), buprenorphine (n = 499), and naltrexone (n = 134). The most common outcomes were heroin/opioid use (n = 708), treatment retention (n = 557), and non-opioid drug use (n = 368). Clear gaps included a wider array of opioid agonists for treatment, digital behavioral interventions, studies of OUD treatments in criminal justice settings, and overdose as a clinical outcome.This OUD Evidence Map highlights the importance of pharmacologic interventions for OUD and reductions in opioid use. Future iterations will update results annually and scan policy-level interventions.

Purpose:Cigarette smoking is the leading modifiable risk factor for several genitourinary malignancies. Although smoking cessation after genitourinary cancer diagnosis is a critical component of su...

Childhood abuse and homelessness are independently associated with substance use. Though childhood abuse and homelessness are strongly correlated, research on the joint effect of exposure to both traumatic life events on substance use is limited.

BACKGROUND: This study evaluated clinical outcomes of a low barrier tele-buprenorphine bridge program for NYC residents with opioid use disorder (OUD) at 1 year during the coronavirus disease 2019 (COVID-19) pandemic. METHODS AND MATERIALS: This retrospective analysis of the NYC Health+Hospitals (NYC H+H) Virtual Buprenorphine Clinic registry assessed baseline demographic and clinical characteristics, rates of referrals to community treatment, and induction-related adverse events among city residents with OUD, from March 2020 to the end of March 2021. RESULTS: The program enrolled 199 patients, of whom 62.3% were provided same-day visits (n=124). Patients were enrolled in the program for a median of 14 days (range 0-130 days). Referrals sources included hospital and clinic staff (n=83, 47.7%), word of mouth (n=30, 17.2%), and correctional health or reentry services (n=30, 17.2%). Induction-related adverse events were mostly limited to precipitated withdrawal symptoms (n=21, 5%). Roughly half of patients were referred to community treatment (n=109, 54.8%) and of those 51.4% (n=56/109) completed at least one visit in community treatment. DISCUSSION: Our experience indicates that a low threshold tele-buprenorphine bridge program in place of a safe and feasible approach to facilitating entry in community treatment for underserved people who use opioids in a large metropolitan area.

New York City Health + Hospitals is the largest safety-net health care delivery system in the United States. Before the coronavirus disease 2019 (COVID-19) pandemic, NYC Health + Hospitals served more than one million patients annually, including the most vulnerable New Yorkers, while billing fewer than five hundred telehealth visits monthly. Once the pandemic struck, we established a strategy to allow us to continue to serve our existing patients while treating the surge of new patients. Starting in March 2020, we were able to transform the system using virtual care platforms through which we conducted almost eighty-three thousand billable televisits in one month, as well as more than thirty thousand behavioral health encounters via telephone and video. Telehealth also enabled us to support patient-family communication, postdischarge follow-up, and palliative care for patients with COVID-19. Expanded Medicaid coverage and insurance reimbursement for telehealth played a pivotal role in this transformation. As we move to a new blend of virtual and in-person care, it is vital that the major regulatory and insurance changes undergirding our COVID-19 telehealth response be sustained to protect access for our most vulnerable patients.

Criminal justice involved individuals have a high rate of opioid overdose death following release. In March 2020, New York City jails released over 1000 inmates due to concern of COVID-19 outbreaks in county jails. The closure of addiction treatment clinics further complicated efforts to expand access to medications for opioid use disorder among criminal justice involved adults. The New York City Health + Hospitals Virtual Buprenorphine Clinic established in March 2020 offered low-threshold telemedicine-based opioid treatment with buprenorphine-naloxone, specifically for criminal justice involved adults post-release. We describe a case report of the novel role of tele-conferencing for the provision of buprenorphine-naloxone for jail-released adults with opioid use disorder experiencing homelessness during the COVID-19 pandemic. The patient is a 49-year-old male with severe opioid use disorder released from New York City jail as part of its early release program. He then started using diverted buprenorphine-naloxone, and 1 month later a harm-reduction specialist at his temporary housing at a hotel referred him to an affiliated buprenorphine provider and then eventually to the New York City Health + Hospitals Virtual Buprenorphine Clinic, where he was continued on buprenorphine-naloxone, and was followed biweekly thereafter until being referred to an office-based opioid treatment program. For this patient, telemedicine-based opioid treatment offered a safe and feasible approach to accessing medication for opioid use disorder during the COVID-19 pandemic and following incarceration.

This research investigates the deposition mechanism of a hybrid Zr-aminosilane conversion coating as a replacement for the conventional pretreatment systems on a zinc substrate. The traditional Zr-based conversion treatment has been optimized by the addition of both Cu as an accelerator and aminosilane as an adhesion promotor. The deposition mechanism was unraveled using complementary surface analytical techniques such as XPS, FEG-AES, EDX, GDOES, and ToF-SIMS. The results showed the addition of aminosilane has resulted in the incorporation of N into the Zr oxide layer. This suggests that the influence of aminosilane is not only on the top surface, as an adhesion promoter, but also on the chemistry of the deposited layer. Additionally, the properties of this pretreatment on zinc is compared to Advanced High Strength Stainless Steel (AHSSS) as another automotive material. This was done in order to compare the behavior of active and passive substrates in the same conversion treatment. This comparison shows thatzinc as an active material can show higher interaction with the conversion treatment which results in a ticker film formation.

INTRODUCTION AND OBJECTIVE:Heat-Not-Burn (HNB) devices are FDA approved as alternatives to combustible cigarettes as they either heat a nicotine-free liquid which then passes through tobacco, or di...

Highlights • We estimated prevalence of e-cigarette dual use among smokers with substance use disorders. • Dual e-cigarette users were more likely to have tried to quit in the past year. • Overall, participants preferred to use e-cigarettes in comparison to nicotine patches/gum. • E-cigarettes seem appealing to patients with substance use disorders. • E-cigarette use may be effective for harm reduction among patients in addiction treatment., Background We explored characteristics and beliefs associated with e-cigarette use patterns among cigarette smokers requiring inpatient detoxification for opioid and/or alcohol use disorder(s). Methods Adult cigarette smokers (≥18 years), admitted to inpatient detoxification for alcohol and/or opioid use disorder(s) in a safety-net tertiary referral center in New York City were surveyed in 2015 (n = 158). Descriptive statistics (proportions) were used to assess for demographic, clinical diagnosis, cigarette smoking patterns (exclusive and dual use of e-cigarettes). Chi-square, t-test statistics, and logistic regression models were used. Results Among our sample of combustible cigarette users, 13.9% (n = 22) reported dual use with electronic cigarettes. Dual use did not differ by demographic or clinical variables. Compared to exclusive smokers, dual users were more likely to have tried to quit in the past year (Adjusted Odds ratio = 8.59; CI: 2.58, 28.35; p

Rapid changes in security threat landscapes cause uncertainty for IT operations and security professionals and may force changes to organizations’ security strategy. Decision support data that help reduce ambiguity or even predict future developments in this regard can thus be of economic value. Based on over 200 security predictions published in 2015, we use a topic modeling approach to identify 17 underlying predicted threat developments. To verify the extent to which these predicted threat topics were realized in 2016, we solicited opinions from respondents with varying experience of IT and information security. In addition, we reviewed secondary sources to corroborate the survey results. Based on the presented findings, we conclude that the security predictions for 2016 did foresee notable developments in that year. The identified latent predictions were related to hacking political campaigns, large-scale data breaches of personal data and health records, increasing threats from various types of malware, specifically ransomware, and large-scale DDoS attacks. The findings of this research are relevant to IT executives and security professionals, who can apply this approach to improve the effectiveness of organizations’ technology and cyber security strategy.

Background The growth in e-cigarette use may be driven by the perception that they are a safer, healthier alternative to conventional cigarettes. However, their long-term health implications are not well known and use is discouraged by most cancer societies. It is currently unclear how cancer survivors perceive the risks associated with e-cigarette and how this may influence use in this population. Methods A cross-sectional analysis was conducted using the Health Information National Trends Survey (HINTS) (Years 2017–2019). Our primary study outcome was the perception of harm associated with e-cigarettes compared to traditional cigarettes among adults with and without a self-reported history of cancer. We used logistic regression analyses assessing the association of a cancer history with the perception that e-cigarettes are as much or more harmful than cigarettes. Results A total of 11,846 respondents (weighted population estimate 243,728,483) were included. Of these, 26.6% reported a history of cancer. The proportion of cancer survivors who perceived e-cigarettes to be as much or more harmful than conventional cigarettes was similar to non-cancer respondents (70.6% vs 68.3%, P = 0.35). There was no difference in perception of harm among cancer and non-cancer respondents, adjusted for sociodemographic factors (OR 0.82, 95% CI 0.6–1.1). Past (OR 9.06, 95% Cl 5.06–16.20) and never e-cigarette use (OR 23.40, 95% Cl 13.56–40.38) as well as having a history of cardiopulmonary disease (OR 1.28, 95% Cl 1.05–1.56) was associated with higher odds of perceiving e-cigarettes to be as much or more harmful. Conclusion Cancer survivors commonly perceive e-cigarettes to be as much or more harmful than traditional cigarettes though these findings are similar to perceptions among adults without a history of cancer. There is a strong association with avoidance of e-cigarette products among those who perceive them to be harmful.

OBJECTIVES: The purpose of this study was to assess the feasibility and clinical impact of telemedicine-based opioid treatment with buprenorphine-naloxone following the Coronavirus disease 2019 pandemic. METHODS: Participants included in this retrospective analysis consisted of adult New York City residents with opioid use disorder eligible for enrollment in the NYC Health+Hospitals Virtual Buprenorphine Clinic between March and May 2020 (n = 78). Follow-up data were comprised of rates of retention in treatment at 2 months, referrals to community treatment, and induction-related events. RESULTS: During the initial 9 weeks of clinic operations, the clinic inducted 78 patients on to buprenorphine-naloxone and completed 252 visits. Patient referrals included non-NYC Health + Hospitals (n = 22, 28.2%) and NYC Health + Hospitals healthcare providers (n = 17, 21.8%), homeless shelter staff (n = 13, 16.7%), and the NYC Health + Hospitals jail reentry program in Rikers Island (n = 11, 14.1%). At 8 weeks, 42 patients remained in care (53.8%), 21 were referred to a community treatment program (26.9%), and 15 were lost to follow-up (19.2%). No patients were terminated from care due to disruptive behavior or suspicions of diversion or misuse of Buprenorphine. Adverse clinical outcomes were uncommon and included persistent withdrawal symptoms (n = 8, 4.3%) and one nonfatal opioid overdose (0.5%). CONCLUSIONS: Telemedicine-based opioid treatment and unobserved home induction on buprenorphine-naloxone offers a safe and feasible approach to expand the reach of opioid use disorder treatment, primary care, and behavioral health for a highly vulnerable urban population during an unprecedented natural disaster.

BACKGROUND: Smoking remains a major public health burden among persons with opioid and/or alcohol use disorder. METHODS: A 49-item semi-structured survey was conducted among urban, inpatient detoxification program patients eliciting demographic and clinical characteristics, smoking profile, technology use patterns, and preferences for adopting technology-based smoking cessation interventions. Multivariate logistic regression models further evaluated the association between participant demographic and clinical characteristics and technology preferences. RESULTS: Participants were mostly male (91%), and admitted for detoxification for alcohol (47%), heroin (31%), or both alcohol and heroin (22%). Past 30-day smoking was reported by 78% of the sample. Mobile phone ownership was common (89%); with an average past-year turnover of 3 mobile phones and 3 phone numbers. Computer ownership was low (28%) and one third reported daily internet use (34%). Telephone (41%) and text message-based interventions (40%) were the most popular platforms to facilitate smoking cessation. CONCLUSIONS: Despite concurrent AUD-OUD, most respondents had attempted to quit smoking in the last year and preferred telephone- and text message-based interventions to facilitate smoking cessation. High turnover of mobile phones, phone numbers, and limited access to computers pose barriers to dissemination of technology-based smoking cessation interventions in this vulnerable population.

Tobacco-use among cancer survivors leads to preventable morbidity, mortality, and increased healthcare costs. We sought to explore the prevalence of smoking and e-cigarette use among survivors of tobacco and non-tobacco related cancers.A cross-sectional analysis was conducted using the 2015-2018 National Health Interview Survey. Our primary outcome was the prevalence of current cigarette smoking or e-cigarette use among adults with self-reported history of tobacco related or non-tobacco related cancer. Logistic regression analysis was to assess the association of reported cancer type with cigarette smoking or e-cigarette use. Secondary outcomes included yearly trends and dual use.A total of 12,984 respondents reported a history of cancer, representing a weighted estimate of 5,060,059 individuals with a history of tobacco-related malignancy and 17,583,788 with a history of a tobacco and non-tobacco related cancer, respectively. Survivors of tobacco-related cancers had a significantly higher prevalence of current cigarette use (18.2 % vs 9.7 %, P 0.0001), e-cigarette use (2.7 % vs 1.6 %, P 0.0001) and similar rates of dual use. The prevalence of cigarette smoking among all survivors increased as time increased from the year of diagnosis up to 2 years post-diagnosis (P = 0.047). Odds of reporting current cigarette smoking use was higher for survivors of tobacco-related cancers, adjusted for sociodemographic factors (OR1.69, 95 % CI 1.44-1.99).Survivors of tobacco-related cancers have a higher prevalence of current cigarette smoking and e-cigarette use compared to survivors of non-tobacco related cancers. There was a sequential increase in the prevalence of cigarette use during each subsequent year from the time of a new cancer diagnosis, underscoring the need for long term tobacco cessation support among newly diagnosed adults with cancer.

New York City Health + Hospitals is the largest safety-net health care delivery system in the United States. Before the coronavirus disease 2019 (COVID-19) pandemic, NYC Health + Hospitals served more than one million patients annually, including the most vulnerable New Yorkers, while billing fewer than five hundred telehealth visits monthly. Once the pandemic struck, we established a strategy to allow us to continue to serve our existing patients while treating the surge of new patients. Starting in March 2020, we were able to transform the system using virtual care platforms through which we conducted almost eighty-three thousand billable televisits in one month, as well as more than thirty thousand behavioral health encounters via telephone and video. Telehealth also enabled us to support patient-family communication, postdischarge follow-up, and palliative care for patients with COVID-19. Expanded Medicaid coverage and insurance reimbursement for telehealth played a pivotal role in this transformation. As we move to a new blend of virtual and in-person care, it is vital that the major regulatory and insurance changes undergirding our COVID-19 telehealth response be sustained to protect access for our most vulnerable patients.

In this research, a novel governing mechanism has been proposed for the formation of conversion coating on the thermal oxide film of Advanced High Strength Stainless Steels (AHSSS). These new lightweight and engineered materials are being designed to impart emission reduction and solid performance. This coating has been characterized using advanced surface analysis such as HAADF-STEM, GDOES, and ToF-SIMS. The results showed that the conversion components can be found not only on the surface but also at the oxide/metal interface. This deposition in the depth happens preferentially in the Si-poor regions and with the penetration of the conversion components into depth. It was indicated that fluoride ions play an important role to facilitate this penetration by dissolving the less stable components in the oxide film. Dissolution of the Fe in the Fe-Cr solid solution structure results in the formation of a mixed chemical structure containing Cr and P. This novel mechanism brings a new insight into the field of conversion coating when a thick oxide film is present on the top surface.

Data is rapidly becoming one of the most important assets in global markets, and criminals are spotting opportunities to exploit new potential income sources. In response to this, organizations are dedicating increasing resources to information security programs. However, faced with unrelenting breach reports and rising costs, decision makers inevitably wonder which type of security investment is economically viable. In this article, the authors present an empirically tested model describing the underlying key constructs for assessing information security value in an organization. Based on identified latent variables previously put forward in the literature, the authors use a partial least squares structural equation modeling approach to verify the model's soundness. They identify five crucial variables for value-focused information security investment. The relationships among these latent variables are then investigated and contributions of the structural model assessed. The key findings are finally presented to highlight opportunities for security practitioners to apply the proposed model.

Context Use of electronic cigarettes (e-cigarettes) has rapidly increased despite unclear longitudinal health effects. Once thought to be a safer alternative to tobacco smoke, it is possible that e-cigarettes expose the user to similar carcinogenic byproducts during the vaping process. These toxicants are metabolized and excreted in the urine, and may have oncogenic implications for bladder urothelium. Objective To characterize and summarize known urinary carcinogenic biomarkers in e-cigarette users as they relate to the risk of developing bladder cancer. Evidence acquisition A systematic literature search was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, and included PubMed, Embase, Web of Science, and Cochrane Central Register of Controlled Trials (CENTRAL). Relevant articles published in peer-reviewed journals, through January 2019, that reported on urinary biomarkers in e-cigarettes users were included. Parent compounds and urinary biomarkers were classified according to the International Agency for Research on Cancer Monographs on the Evaluation of Carcinogenic Risks to Humans and cross referenced using the Collaborative on Health and the Environment, Toxicant and Disease Database to determine a link to bladder cancer, grouped by strength of evidence. Evidence synthesis Our initial search identified 1385 articles, 22 of which met final inclusion criteria and were included for analysis. In summation, these studies described 40 different parent compounds and four metals found in the urine of e-cigarette users. Since each parent compound can be metabolized several different ways, 63 unique toxicant or carcinogenic metabolite biomarkers were identified. Compared with nonuser controls, e-cigarette users had higher concentrations of urinary biomarkers of several carcinogenic compounds linked to bladder cancer. The majority of studies were limited by heterogeneous reporting and a dearth of control individuals who had never smoked. Conclusions Biomarkers of carcinogens, several with a strong link to bladder cancer, are present in the urine of e-cigarette users. Long-term implications of urothelial exposure to these toxicants are unknown but concerning, given the similarities to tobacco smoke and its established relationship with bladder cancer. Further study on the urological safety of e-cigarettes is necessary. Patient summary Our review shows that several carcinogens that have a known link to bladder cancer are present in the urine of electronic cigarette (e-cigarette) users. Further study on the urological safety of e-cigarettes is necessary.

This article describes how with information security steadily moving up on board room agendas, security programs are found to be under increasing scrutiny by practitioners. This level of attention by senior business leaders is new to many security professionals as their field has been of limited interest to non-executive directors so far. Currently, they have to regularly report on efficiency and value of their security capabilities whilst being measured against business priorities. Based on the Grounded Theory approach, the authors analysed the data gathered in a series of interviews with senior professionals in order to identify key factors in the context of information security investment decisions. The authors present detailed findings in context of a simplified framework that security practitioners can utilise for critical review or improvements of investment decisions in their own environments. Extensive details for each category as extracted through a qualitative data analysis are provided along with a category network analysis that highlights strong relationships within the framework.

Project Extension for Community Healthcare Outcomes (Project ECHO) offers an innovative and low-cost approach to enhancing the management of complex conditions among primary care providers. The NYC Health + Hospitals Buprenorphine ECHO (H + H ECHO) program offers primary care providers (PCPs) training and support in managing opioid use disorder (OUD). This exploratory study assessed the feasibility of a 16-session video conferencing platform led by Addiction Medicine experts in improving addiction knowledge, perceived self-efficacy, and buprenorphine prescribing among PCPs located in 17 publicly-funded ambulatory care clinics. A pre- and post-training survey assessed changes in knowledge and self-efficacy. Buprenorphine prescribing patterns were also captured pre-post training. Training sessions consisted of a review of the agenda by the H + H ECHO hub team, 15–30 min didactic lectures led by specialists, followed by a patient case presentation. Participants attended an average of 9 lectures (range, 1–15 sessions) and 53% of trainees attended at least 10 of the 16 sessions. Perceived self-efficacy improved post-H + H ECHO (73.2%) versus pre-training survey results (58.1%). There were minimal increases in knowledge post-training (58.4%) versus pre-training (51.4%). Only three additional providers reported prescribing Buprenorphine post-training (n = 10) versus pre-training (n = 7). Suggestions for improving H + H ECHO included trainings addressing stigma, administrative support, improved referrals to office-based opioid treatment (OBOT), integration of non-physician staff (i.e., case management, social work), and combining multimodal learning strategies (i.e., podcasts, web-based modules) with videoconferencing. This study demonstrates the feasibility of H + H ECHO among PCPs in publicly-funded clinics and improvements in self-efficacy. Studies are needed to identify alternative strategies to improve knowledge and prescribing of buprenorphine post-H + H ECHO.

BACKGROUND: Extended-release naltrexone (XR-NTX, Vivitrol®) and daily oral naltrexone tablets (O-NTX) are FDA-approved mu opioid receptor antagonist medications for alcohol dependence treatment. Despite the efficacy of O-NTX, non-adherence and poor treatment retention have limited its adoption into primary care. XR-NTX is a once-a-month injectable formulation that offers a potentially more effective treatment option in reducing alcohol consumption and heavy drinking episodes among persons with alcohol use disorders. METHODS: This pragmatic, open-label, randomized controlled trial examines the effectiveness of XR-NTX vs. ONTX in producing a Good Clinical Outcome, defined as abstinence or moderate drinking (< 2 drinks/day, men; < 1 drink/day, women; and < 2 heavy drinking occasions/month) during the final 20 of 24 weeks of primary care-based Medical Management treatment for alcohol dependence. Secondary aims will estimate the cost effectiveness of XR-NTX vs. O-NTX, in conjunction with primary-care based Medical Management for both groups, and patient-level characteristics associated with effectiveness in both arms. Alcohol dependent persons are recruited from the community into treatment in a New York City public hospital primary care setting (Bellevue Hospital Center) for 24 weeks of either XR-NTX (n = 117) or O-NTX (n = 120). RESULTS: We describe the rationale, specific aims, design, and recruitment results to date. Alternative design considerations and secondary aims and outcomes are reported. CONCLUSIONS: XR-NTX treatment in a primary care setting is potentially more efficacious, feasible, and cost-effective than oral naltrexone when treating community-dwelling persons with alcohol use disorders. This study will estimate XR-NTX’s treatment and cost effectiveness relative to oral naltrexone.

Background Research demonstrates strong associations between adverse childhood experiences (ACEs) and non-medical prescription opioid use (NMPO), but pathways are not understood, hindering prevention and treatment responses. Methods We assessed hypothesized mediators of the association between ACEs and NMPO in a nationally-representative U.S. sample. National Longitudinal Study of Adolescent to Adult Health data (N = 12,288) yielded an ordinal exposure comprising nine ACEs (neglect; emotional, physical, sexual abuse; parental incarceration and binge drinking; witnessed, threatened with, experienced violence) and a binary lifetime NMPO outcome. Nine potential mediators measured in adolescence and/or adulthood included depression, anxiety, suicidality, delinquency, impulsivity, and risk-taking. We estimated adjusted odds ratios (AOR) and 95% confidence intervals (CI) for sex-stratified associations of: ACEs and mediators; mediators and NMPO; and ACEs and NMPO adjusting for mediators individually and simultaneously. Results All associations of ACEs and mediators were statistically significant and similar by sex. All mediators had statistically significant associations with NMPO (except one depression measurement for each sex). Delinquency was strongly associated with ACEs and NMPO and was the strongest individual mediator. Every ACE increase was associated with increased NMPO odds of 32% for males and 27% for females. Adjusting for all mediators, odds of NMPO were attenuated partially for males [AOR = 1.18 (95% CI:1.07, 1.31)] and somewhat more for females [AOR = 1.11 (95% CI:1.00, 1.25)]. Conclusions Internalizing and externalizing factors partially explained the pathway from ACEs to NMPO. Substance abuse may be more difficult to treat with co-occurring psychopathologies and maladaptive behaviors, highlighting the need to address trauma early in life.

Research on technological aspects of information security risk is a well-established area and familiar territory for most information security professionals. The same cannot be said about the economic value of information security investments in organisations. While there is an emerging research base investigating suitable approaches measuring the value of investments in information security, it remains difficult for practitioners to identify key approaches in current research. To address this issue, we conducted a systematic literature review on approaches used to evaluate investments in information security. Following a defined review protocol, we searched several databases for relevant primary studies and extracted key details from the identified studies to answer our research questions. The contributions of this work include: a comparison framework and a catalogue of existing approaches and trends that would help researchers and practitioners navigate existing work; categorisation and mapping of approaches according to their key elements and components; and a summary of key challenges and benefits of existing work, which should help focus future research efforts.

Purpose – This study aims to examine the influence of one or more information security breaches on an organisation’s stock market value as a way to benchmark the wider economic impact of such events. Design/methodology/approach – An event studies-based approach was used where a measure of the event’s economic impact can be constructed using security prices observed over a relatively short period of time. Findings – Based on the results, it is argued that, although no strong conclusions could be made given the current data constraints, there was enough evidence to show that such correlation exists, especially for recurring security breaches. Research limitations/implications – One of the main limitations of this study was the quantity and quality of published data on security breaches, as organisations tend not to share this information. Practical implications – One of the challenges in information security management is assessing the wider economic impact of security breaches. Subsequently, this helps drive investment decisions on security programmes that are usually seen as cost rather than moneymaking initiatives. Originality/value – This study envisaged that as more breach event data become more widely available because of compliance and regulatory changes, this approach has the potential to emerge as an important tool for information security managers to help support investment decisions.

Information security is a main concern for many organisations with no signs of decreasing urgency in the coming years. To address this a structured approach is required, with the ISO 27000 series being one of the most popular practices for managing Information Security. In this work, we used a combination of qualitative research methods to conduct a SWOT analysis on the ISMS. The findings from the SWOT were then validated using a survey instrument. Finally, the results were validated and analysed using statistical methods. Our findings show that there was a generally positive view on the 'Strengths' and 'Opportunities' compared to that of 'Weaknesses' and 'Threats'. We identified statistically significant differences in the perception of 'Strengths' and 'Opportunities' across groups but also found that there is no significant variance in the perception of 'Threats'. The SWOT produced will help practitioners and researchers tailor ways to enhance ISMS using existing techniques such as TOWS matrix.

BACKGROUND Smoking remains a major public health burden among persons with opioid and/or alcohol use disorder yet preferences for technology assisted smoking cessation strategies remain largely unknown among this population. OBJECTIVE Assess smoking patterns and preferences for adopting technology-based interventions targeting smoking among individuals with opioid and/or alcohol use disorder. METHODS A 48-item semi-structured survey was conducted among inpatient detoxification program patients eliciting demographic and clinical characteristics, smoking profile, technology use patterns, and preferences for adopting technology-based smoking cessation interventions. Multivariate logistic regression models further evaluated the association between participant demographic and clinical characteristics and technology preferences. RESULTS Participants were mostly male (91%), unemployed or dependent on public assistance (68%), and admitted for detoxification for alcohol (47%), heroin (31%), or both alcohol and heroin (22%). Past 30-day smoking was reported by 78% of the sample, and 60% reported at least one quit attempt in the past year. Mobile phone ownership was common (89%); with an average past-year turnover of 4 mobile phones and 3 phone numbers. Computer ownership was low (28%) and one third reported daily internet use (34%). Telephone (41%) and text message-based interventions (40%) were the most popular technology-based intervention to facilitate smoking cessation. CONCLUSIONS Despite concurrent AUD-OUD, most had attempted to quit smoking in the last year and preferred telephone- and text message-based interventions to facilitate smoking cessation. However, high turnover of mobile phones, phone numbers, and limited access to computers pose barriers to dissemination of technology-based smoking cessation interventions in this vulnerable population. CLINICALTRIAL K23DA042140-01A1

OBJECTIVE With nearly 11 million people in the United States arrested in 2015, the need to identify antecedent risk factors driving criminal justice involvement (CJI) and possible mitigating factors is crucial. This study examines the relation between childhood trauma and CJI in adolescence and adulthood and assesses how this relation is moderated by mentoring during young adulthood. METHODS The analysis included 3 waves of data-adolescents, young adults, and adults-collected from 1995 to 2008 from 12,288 adolescents who participated in the National Longitudinal Study of Adolescent to Adult Health, a nationally representative study of adolescents in grades 7 to 12. Logistic regression was used to examine how having a close mentor in adolescence moderated the relation between criminal justice involvement and 9 childhood traumatic events: (1) neglect, (2) emotional abuse, (3) physical abuse, (4) sexual abuse, (5) parental incarceration, (6) parental binge drinking, (7) witnessed violence, (8) threatened with violence, and (9) experienced violence. RESULTS Cumulative exposure to childhood trauma was associated with CJI in adolescence (adjusted odds ratios [AORs] ranging from 2.24 to 25.98) and adulthood (AOR range, 1.82-6.69), and parental incarceration was consistently one of the, if not the, most strongly associated with each form of CJI; the strength of these associations was weakened for those who reported a close mentor compared to those who did not. CONCLUSIONS This study advances the literature regarding trauma and CJI, highlighting the role of social support and mentorship as protective factors for youth who experience childhood trauma. Interventions aimed at protecting vulnerable children from the harms of trauma should be the next priority.

BACKGROUND: Substance abuse is increasingly prevalent among young adults, but data on cardiovascular outcomes remain limited. OBJECTIVES: The objectives of this study were to assess the prevalence of cocaine and marijuana use in adults with their first myocardial infarction (MI) at ≤50 years and to determine its association with long-term outcomes. METHODS: The study retrospectively analyzed records of patients presenting with a type 1 MI at ≤50 years at 2 academic hospitals from 2000 to 2016. Substance abuse was determined by review of records for either patient-reported substance abuse during the week before MI or substance detection on toxicology screen. Vital status was identified by the Social Security Administration’s Death Master File. Cause of death was adjudicated using electronic health records and death certificates. Cox modeling was performed for survival free from all-cause and cardiovascular death. RESULTS: A total of 2,097 patients had type 1 MI (mean age 44.0 ± 5.1 years, 19.3% female, 73% white), with median follow-up of 11.2 years (interquartile range: 7.3 to 14.2 years). Use of cocaine and/or marijuana was present in 224 (10.7%) patients; cocaine in 99 (4.7%) patients, and marijuana in 125 (6.0%). Individuals with substance use had significantly lower rates of diabetes (14.7% vs. 20.4%; p=0.05) and hyperlipidemia (45.7% vs. 60.8%; p

Figure 1 is showing the gravimetric measurement system Topas GMS 141. The system is used to measure the condensate and oil concentration (oil carryover) in the full blow by stream of combustion engines. The quantity of the fluid blow by fraction is measured by the determination of the mass of a filter paper. The oil emission is determined in a steady state condition of the engine.

In recent years, ‘Cyber Security’ has emerged as a widely-used term with increased adoption by practitioners and politicians alike. However, as with many fashionable jargon, there seems to be very little understanding of what the term really entails. Although this is may not be an issue when the term is used in an informal context, it can potentially cause considerable problems in context of organizational strategy, business objectives, or international agreements. In this work, we study the existing literature to identify the main definitions provided for the term ‘Cyber Security’ by authoritative sources. We then conduct various lexical and semantic analysis techniques in an attempt to better understand the scope and context of these definitions, along with their relevance. Finally, based on the analysis conducted, we propose a new improved definition that we then demonstrate to be a more representative definition using the same lexical and semantic analysis techniques.

Context Palliative care (PC) consultations result in improved patient understanding of prognosis and better quality of life, yet the content and processes of prognosis communication during PC consultations remain unknown. Objectives To describe prognosis communication during PC consultation with seriously ill hospitalized patients. Methods We audio recorded 71 sequential inpatient PC consultations (initial visit) with seriously ill patients and their families who were referred for "goals of care" clarification or help with "end-of-life decision making." Conversations were coded using reliable methods and we then linked conversation codes to clinical record and clinician interview data. Results Ninety-three percent of consultations contained prognosis communication. Participants communicated prognoses regarding quality of life more frequently than survival; focused prognosis estimates on the unique patient more frequently than on a general population; and framed prognosis using pessimistic cues more frequently than optimistic ones. Prognoses were more commonly spoken by PC clinicians than by patients/families. The following two factors demonstrated an association with the rate of prognostic communication and with the pessimistic framing of that information: whether the patient, family, or both participated in the conversation, and shorter expected survival (as estimated by the attending physician). Conclusion Prognoses are routinely communicated in PC consultations with hospitalized patients and their families. The rate and characteristics of prognosis communication differ based on the length of time the patient is expected to live.

Ein groser Teil der im Bauwesen vorkommenden Rahmen zeigt einen symmetrischen Aufbau sowohl in den Systemmasen als auch in den Tragheitsmomenten und Tragerhohen. Derartige Tragwerke weisen besondere Eigenschaften auf, die in diesem Abschnitt naher betrachtet werden sollen.

Fachwerke sind Tragsysteme, bei denen alle Tragelemente (Fachwerkstabe) nur auf Zug oder auf Druck beansprucht werden. Damit dies gewahrleistet ist, mussen drei Voraussetzungen erfullt sein: 1. Die auseren Krafte werden nur uber die Knoten ins Tragwerk eingeleitet. 2. Die Stabachsen mussen gerade sein. 3. Die Stabe sind in den Knoten gelenkig zusammenzuschliesen.

Das Cross-Verfahren dient der Ermittlung von Knoten- oder Stutzenmomenten von Durchlauftragern und Rahmentragwerken. Es handelt sich hierbei um ein Iterationsverfahren, bei dem die Auflosung eines Gleichungssystems vermieden wird. Hierbei denkt man sich die Knoten zunachst undrehbar und unverschieblich festgehalten. Durch schrittweises Ausgleichen der Momente wird ein Gleichgewicht an samtlichen Knoten erreicht. Fur die Berechnung der Knotenmomente empfiehlt es sich, samtliche Grosen in einer Tabelle zusammenzustellen.

Rahmentragwerke entstehen durch starre Verbindungen von biegesteifen Staben. Sie gehoren in der Mehrzahl zu den statisch unbestimmten Tragwerken und werden in Rahmen mit gelenkiger Lagerung; Rahmen mit eingespannten Stielen; zweistielige, dreistielige oder mehrstielige Rahmen (Mehrfeldrahmen); einstockige, zweistockige oder mehrstockige Rahmen (Stockwerkrahmen); Rechteckrahmen, Dreieckrahmen sowie symmetrische und unsymmetrische Rahmen unterteilt.