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Owen L Woodman,1 Jacinta M Ortega,1 Joanne L Hart,1 Thomas Klein,2 Simon Potocnik11School of Health and Biomedical Sciences, RMIT University, Bundoora, VIC, Australia; 2Department of Cardiometabolic Diseases Research, Boehringer Ingelheim Pharma, Biberach, GermanyCorrespondence: Owen L WoodmanBaker Heart & Diabetes Institute, PO Box 6492, Melbourne 3004, AustraliaTel +61 38 532 1917Email owen.woodman@baker.edu.auPurpose: The aim of this study was to investigate the effects of the type-4 dipeptidyl peptidase (DPP-4) inhibitors linagliptin and vildagliptin as well as the sulfonylurea glimepiride on endothelium-dependent relaxation of aortae from female db/db mice with established hyperglycemia to determine whether these treatments were able to attenuate diabetes-induced endothelial dysfunction.Materials and methods: The mice were treated with glimepiride (2 mg/kg po per day, weeks 1–6, n=12), glimepiride plus vildagliptin (glimepiride 2 mg/kg po per day, weeks 1–6; vildagliptin 3 mg/kg po per day, weeks 4–6, n=11), glimepiride plus linagliptin (glimepiride 2 mg/kg po per day, weeks 1–6; linagliptin 3 mg/kg po per day, weeks 4–6, n=11) or linagliptin (3 mg/kg po per day, weeks 1–6, n=12). Endothelium-dependent relaxation using acetylcholine was assessed in the absence and presence of pharmacological tools (TRAM-34 1 μM; apamin 1 μM; N-nitro-L-arginine [L-NNA] 100 μM; 1H-[1,2,4]oxadiazolo [4,3-a]quinoxalin-1-one [ODQ] 10 μM) to distinguish relaxation mediated by nitric oxide (NO).Results: Linagliptin was associated with a significant improvement in endothelium-dependent relaxation (ACh Rmax; db/db 41±1%, linagliptin 73±6%, p

Background and Purpose: To investigate whether diabetes affects either or both nitric oxide (NO)-mediated and endothelium-derived hyperpolarizing factor (EDHF)-type relaxation in endothelium-dependent relaxation of mesenteric arteries from streptozotocin-induced diabetic rats.Experimental Approach: Wire myography was employed to examine endothelial function of mesenteric arteries. Superoxide levels were measured by L-012 and lucigenin-enhanced chemiluminescence. Western blotting was used to quantify protein expression levels.Key Results: Superoxide levels were significantly increased in diabetic mesenteric arteries compared with normal arteries. Diabetes significantly reduced the sensitivity to the endothelium-dependent relaxant, acetylcholine (ACh) in mesenteric arteries. When the contribution of NO to relaxation was abolished by N-nitro-L-arginine (L-NNA) + a soluble guanylate cyclase inhibitor (ODQ), the sensitivity to ACh was significantly decreased in the diabetic arteries compared with normal arteries, indicating an impaired EDHF-type relaxation despite increased expression of intermediate- and small-conductance calcium-activated potassium channels. Conversely, when the contribution of EDHF was inhibited with TRAM-34 + apamin + iberiotoxin, maximum relaxations to ACh were significantly decreased in diabetic compared with normal arteries, suggesting that the contribution of NO was also impaired by diabetes. Basal levels of NO release, indicated by contraction to L-NNA, were also significantly decreased in diabetic arteries. Western blot analysis demonstrated that diabetic arteries had an increased expression of Nox2, decreased pSer⁴⁷³ Akt and a reduced proportion of endothelial NO synthase (eNOS) expressed as a dimer, indicating uncoupling.Conclusion and Implications: The contribution of both NO and EDHF-type relaxations was impaired in diabetes and was caused by increased oxidative stress, decreased pSer⁴⁷³ Akt and/or eNOS uncoupling. [ABSTRACT FROM AUTHOR]

Objective: The technique of embolization of pulmonary arteriovenous malformations (PAVMs) with the Amplatzer vascular plug (AVP) has been reported, but no large series has evaluated the effectiveness of this relatively new embolic device. The purpose of this study is to assess the role of AVPs in the treatment of PAVMs.Materials and Methods: Sixty-nine consecutive patients underwent embolization of pulmonary arteriovenous malformations between September 2006 and December 2008. Clinical, procedural, and physiological data were reviewed retrospectively.Results: Of 161 PAVMs, 120 (75%) were successfully embolized with Amplatzer vascular plugs alone. Complete and rapid occlusion of feeding vessels was easily achieved at the site of arteriovenous communication without complication. Particularly small or tortuous feeding arteries supplying 27 complex and 14 simple PAVMs were occluded with coils. There have been no documented instances of recanalization on follow-up.Conclusion: Amplatzer vascular plugs allow the rapid and safe distal occlusion of the majority of PAVMs. [ABSTRACT FROM AUTHOR]

Contrary to notions that faculty women are overly sensitive and over-dramatize their work-life challenges, quantitative and qualitative data from a large public research university provide contrasting work-life experiences for female and male faculty. Significant gender differences, emphasized by rich description from faculty, are reported in teaching, service, and research responsibilities that contribute to increased levels of stress for women. Specific strategies for creating more equitable and less stressful work environments are highlighted. [ABSTRACT FROM AUTHOR]

Understanding the etiology of violent juvenile offending is critical for prevention and intervention efforts. The risk factors examined included marital status of parents, marital conflict, substance use, age of first substance use, learning difficulties, and school failure. The protective factors assessed included parenting styles, academic achievement, attitudes unfavorable toward violence, having a mentor, positive relationships with peers, and being involved in extracurricular activities. One hundred and twenty-four participants between the ages 14 and 18 years were assessed. A discriminant functions analysis revealed that multiple risk and protective factors were significant in predicting group membership. The nondelinquent group had significantly more protective factors than the other two groups. Significant gender differences were also found. [ABSTRACT FROM AUTHOR]

Rationale: Current critical care practice does not integrate social determinants of health (SDOH) in systematic or standardized ways. Routine assessment of SDOH in the intensive care unit (ICU) may improve clinical decision making, patient- and family-centered outcomes, and clinician well-being. Objective: Given that the appropriateness and feasibility of SDOH assessment in the ICU is unknown, we aimed to understand how ICU clinicians think about and use SDOH. Methods: We conducted semistructured interviews with clinicians focused on barriers to and facilitators of assessing SDOH during critical illness and perceptions of screening for SDOH in the ICU. We used chart-stimulated recall to assist clinicians in reflecting on how SDOH applied to and was used in patients' care. After deidentifying interviews, we analyzed transcripts guided by a thematic analysis approach using a combination of inductive and deductive coding, the latter framed within the Centers for Disease Control and Prevention SDOH Healthy People framework. Results: We completed interviews with 30 clinicians in a variety of professional roles. The majority of clinicians self-identified as men ( n  = 17; 56.7%) of White race ( n  = 25; 83.3%). Clinicians contextualize their use of SDOH within three frames of reference: 1 ) their own identity and experiences; 2 ) their relationships and communication with patients and caregivers; and 3 ) immediate structures of care around ICU patients, including clinician advocacy, care transitions, and readmission. Clinicians identified that discussing SDOH could allow them to recognize bias faced by their patients, elucidate drivers of critical illness, and navigate communication with patients' caregivers. Clinicians worried about ICU-specific factors impeding the discussion of SDOH, including time constraints and acuity, high stakes and emotions, and negative anticipatory emotions. Conclusions: Clinicians gather SDOH during critical illness both to understand their patients' stories and to provide individualized care, which may lead to better clinician satisfaction and patient- and family-centered care outcomes. Educational and operational efforts to increase SDOH assessment and use in critical care should also gather and integrate the perspectives of patients and caregivers regarding the collection and use of SDOH in the ICU.

Introduction: Previous investigations have reported that individuals living in greener neighborhoods have better cardiovascular health. It is unclear whether the effects reported at large geographic scales persist when examined at an intra-neighborhood level. The effects of greenness have not been thoroughly examined using high-resolution metrics of greenness exposure, and how they vary with spatial scales of assessment or participant characteristics., Methods: We conducted a cross-sectional assessment of associations between blood pressure and multiple high-resolution measures of residential area greenness in spatially concentrated HEAL Study cohort of the Green Heart Project. We employed generalized linear models, accounting for individual-level covariates, to examine associations between different high-resolution measures of greenness and blood pressure among 667 participants in a 4 sq. mile contiguous neighborhood area in Louisville, KY., Results: In adjusted models, we observed significant inverse associations between residential greenness, measured by leaf area index (LAI), and systolic blood pressure (SBP) within 150-250 m and 500 m of homes, but not for Normalized Difference Vegetation Index (NDVI) or grass cover. Weaker associations were also found with diastolic blood pressure (DBP). Significant positive associations were observed between LAI and SBP among participants who reported being female, White, without obesity, non-exercisers, non-smokers, younger age, of lower income, and who had high nearby roadway traffic. We found few significant associations between grass cover and SBP, but an inverse association in those with obesity, but positive associations for those without obesity., Conclusions: We found that leaf surface area of trees around participants home is strongly associated with lower blood pressure, with little association with grass cover. These effects varied with participant characteristics and spatial scales. More research is needed to test causative links between greenspace types and cardiovascular health and to develop population-, typology-, and place-based evidence to inform greening interventions., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier B.V.)

Cardiovascular disease (CVD) remains the leading cause of mortality in the U.S. accounting for 1 in 4 deaths each year. Environmental factors, such as neighborhood safety, may increase the risk of CVD. Therefore, the current study assessed perceived neighborhood safety and its association with CVD risk factors (i.e. dyslipidemia, hypertension, type II diabetes) among 663 adults (mean age: 49.97 years, 61.24% female, 78.28% White). Participants completed self-report measures as part of a larger study of environmental influences on cardiac health. Results indicated that individuals reporting low perceived neighborhood safety had greater odds of having at least one CVD risk factor (OR = 2.76, 95% CI: 1.46, 5.22) compared to those with high perceived safety. There was a significant interaction between gender and the presence of at least one CVD risk factor in relation to perceived neighborhood safety. Low perceived neighborhood safety was associated with greater odds of having at least one CVD risk factor among males (OR = 5.48, 95% C.I: 1.82, 16.52) but not females. These findings suggest that low perceived safety is associated with CVD risk factors, especially among males. Future work should seek to better understand the interaction by gender in the relationship between perceived safety and CVD risk factors.

Objectives: To quantify the frequency and patterns of clinicians' use of choice frames when discussing preference-sensitive care with surrogate decision-makers in the ICU., Design: Secondary sequential content analysis., Setting: One hundred one audio-recorded and transcribed conferences between surrogates and clinicians of incapacitated, critically ill adults from a prospective, multicenter cohort study., Subjects: Surrogate decision-makers and clinicians., Interventions: None., Measurements and Main Results: Four coders identified preference-sensitive decision episodes addressed in the meetings, including topics such as mechanical ventilation, renal replacement, and overall goals of care. Prior critical care literature provided specific topics identified as preference-sensitive specific to the critical care context. Coders then examined each decision episode for the types of choice frames used by clinicians. The choice frames were selected a priori based on decision science literature. In total, there were 202 decision episodes across the 101 transcripts, with 20.3% of the decision episodes discussing mechanical ventilation, 19.3% overall goals of care, 14.4% renal replacement therapy, 14.4% post-discharge care (i.e., discharge location such as a skilled nursing facility), and the remaining 32.1% other topics. Clinicians used default framing, in which an option is presented that will be carried out if another option is not actively chosen, more frequently than any other choice frame (127 or 62.9% of decision episodes). Clinicians presented a polar interrogative, or a "yes or no question" to accept or reject a specific care choice, in 43 (21.3%) decision episodes. Clinicians more frequently presented options emphasizing both potential losses and gains rather than either in isolation., Conclusions: Clinicians frequently use default framing and polar questions when discussing preference-sensitive choices with surrogate decision-makers, which are known to be powerful nudges. Future work should focus on designing interventions promoting the informed use of these and the other most common choice frames used by practicing clinicians., Competing Interests: Dr. Hart’s institution received funding from the National Institutes of Health (NIH); she received funding from the University of Pennsylvania, the U.S. Federal Government—Veterans Administration Medical Center, and St. Luke’s Bethlehem. Drs. Hart, Steingrub, and White received support for article research from the NIH. Dr. Summer received funding from the University of Pennsylvania, Penn Medicine, Project HOME, and Boston Healthcare for the Homeless. Dr. Ogunduyile disclosed government work. Dr. Lo received funding from Takeda Pharmaceuticals, Wolters Kluwer, Blue Cross Blue Shield, and Ropes and Gray; he disclosed that he is a member of the External Advisory Committee for Vivli. The remaining authors have disclosed that they do not have any potential conflicts of interest., (Copyright © 2024 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.)

Objective: The current study examined group differences in college students' views on e-cigarettes in terms of safety, popularity, health risks, social acceptability, efficacy as a cessation aid, and promoting combustible cigarette use. Participants : 337 undergraduates ( M age = 20.84, SD  = 3.79; 72.1% female; 68.5% White) divided into three groups: Never Users ( n  = 178), Ever Users ( n  = 108), and Current Users ( n  = 51). Methods: Participants completed questionnaires for course credit. Results: Compared to Ever and Never Users, Current Users believed e-cigarettes were safer, healthier, a useful tool to quit smoking, did not lead to combustible cigarette smoking, and that nicotine was less dangerous. Current Users also were less likely to endorse boosting social image as a motive for use. Conclusions: Public health campaigns could benefit from targeting current users' positive beliefs about e-cigarettes to reduce the prevalence of e-cigarette use among college students.

Despite declines in adolescent nicotine vaping during the COVID-19 pandemic, vaping continues to be a public health issue for many adolescents. Most studies on teen reasons for vaping and on barriers and facilitators of vaping were conducted prior to the pandemic. Because teen culture changes so rapidly, and because the pandemic had wide-reaching effects on teens and mental health, it is critical to have a current understanding what helps adolescents to quit vaping (facilitators), as well as what prevents them from quitting (barriers) in order to design effective and engaging interventions. The objective of this qualitative study was to examine reasons for vaping, and barriers and facilitators to quitting vaping among high school age (14-18 years old) students. Students (n = 28; 60.7 % female; 50 % White, 10.7 % Black or African American, 25 % Asian or Asian American, 3.6 % other non-Hispanic; 7.2 % Hispanic; 21.4 % former vapers, 78.6 % current vapers) were recruited online from four regions in the US and participated in one of five online focus groups. We conducted a content analysis of the focus groups using a team-based coding approach. The most frequently cited reasons for vaping were mood, peer influence, and boredom. Results also showed that the stigma of seeking treatment acted as a barrier to quitting vaping, while self-reflection acted as a facilitator. In addition, two factors, peer influence and health effects, served as both barriers and facilitators, depending on the context. Program developers can use this information to design engaging vaping cessation programs intended for adolescents., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Understanding the association between initial experimentation with a tobacco product and subsequent patterns of tobacco use among youth is important to informing prevention activities for youth in the US. We conducted an online survey from August to October 2017 among youth aged 13-18 years. The current analysis focused on respondents reporting initial experimentation with any tobacco product (n = 2,022). Using multinomial logistic regression, we examined the association between first tobacco product tried (cigarettes; cigars including cigarillos, little cigars, and bidis; electronic nicotine delivery systems (ENDS); smokeless and chewing tobacco; or hookah) with subsequent patterns of tobacco use while adjusting for covariates. Of the youth who experimented, 56.8% were non-current tobacco users. Of current tobacco users (n = 934), 13% were exclusive ENDS users, 5.3% exclusive combustible mono-users, 13.4% ENDS plus combustible poly-users, 3.3% combustible product only poly-users, and 8.2% other tobacco poly-users. The most common type of first tobacco product tried was ENDS (44.7%), followed by cigarettes (35.0%) and cigars (8.6%). Those who experimented with combustible tobacco products were less likely to be exclusive ENDS users [Relative Risk Ratio (RRR) = 0.46; 95% CI = 0.28, 0.73 for cigarettes; RRR = 0.32; 95% CI = 0.13, 0.81 for cigars; and RRR = 0.33; 95% CI = 0.14, 0.79 for hookah] when compared to non-current tobacco users (reference group). Tobacco product choices for initial experimentation appear to play a role in subsequent tobacco use patterns among youth. Understanding the reasons behind initial product choice may inform our understanding regarding the reasons for subsequent current tobacco product use, thus informing youth prevention efforts., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 El-Shahawy et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

The spin-orbit-assisted Mott insulator α-RuCl 3 is proximate to the coveted quantum spin liquid (QSL) predicted by the Kitaev model. In the search for the pure Kitaev QSL, reducing the dimensionality of this frustrated magnet by exfoliation has been proposed as a way to enhance magnetic fluctuations and Kitaev interactions. Here, we perform angle-dependent tunneling magnetoresistance (TMR) measurements on ultrathin α-RuCl 3 crystals with various layer numbers to probe their magnetic, electronic, and crystal structures. We observe a giant change in resistance, as large as ∼2500%, when the magnetic field rotates either within or out of the α-RuCl 3 plane, a manifestation of the strongly anisotropic spin interactions in this material. In combination with scanning transmission electron microscopy, this tunneling anisotropic magnetoresistance (TAMR) reveals that few-layer α-RuCl 3 crystals remain in the high-temperature monoclinic phase at low temperatures. It also shows the presence of a zigzag antiferromagnetic order below the critical temperature T N ≃ 14 K, which is twice the one typically observed in bulk samples with rhombohedral stacking. Our work offers valuable insights into the relation between the stacking order and magnetic properties of this material, which helps lay the groundwork for creating and electrically probing exotic magnetic phases such as QSLs via van der Waals engineering.

Background: Care management programs for chronic lung disease attempt to reduce hospitalizations, yet have not reliably achieved this goal. A key limitation of many programs is that they target patients with characteristics associated with hospitalization risk, but do not specifically modify the mechanisms that lead to hospitalization., Research Question: What are the common mechanisms underlying known patient-level risk characteristics leading to hospitalizations for acute exacerbations of chronic lung disease?, Study Design and Methods: We conducted a qualitative study of patients admitted to the University of Pennsylvania Health System with acute exacerbations of chronic lung disease between January and September 2019. We interviewed patients, their family caregivers, and their inpatient and outpatient clinicians about experiences leading up to the hospitalization. We analyzed the interview transcripts using triangulation and abductive analytic methods., Results: We conducted 69 interviews focused on the admission of 22 patients with a median age of 66 years (interquartile range, 60-70 years), of whom 16 patients (73%) were female and 14 patients (64%) were Black. We interviewed 22 patients, 14 caregivers, 19 inpatient clinicians, and 14 outpatient clinicians. We triangulated the available interview data for each patient admission and identified the underlying mechanisms of how several known patient characteristics associated with risk actually led to hospitalization. These mechanisms included limited capacity for home management of acute symptom changes, barriers to accessing care, chronic functional limitations, and comorbid behavioral health disorders. Importantly, many of the clinical, social, and behavioral mechanisms underlying hospitalizations were present for months or years before the symptoms that prompted inpatient care., Interpretation: Care management programs should be built to target specific clinical, social, and behavioral mechanisms that directly lead to hospitalization. Upstream interventions that reduce hospitalization risk are possible given that many contributory mechanisms are present for months or years before the onset of acute exacerbations.

We study the coupled charge density wave (CDW) and insulator-to-metal transitions in the 2D quantum material 1T-TaS 2 . By applying in situ cryogenic 4D scanning transmission electron microscopy with in situ electrical resistance measurements, we directly visualize the CDW transition and establish that the transition is mediated by basal dislocations (stacking solitons). We find that dislocations can both nucleate and pin the transition and locally alter the transition temperature T c by nearly ~75 K. This finding was enabled by the application of unsupervised machine learning to cluster five-dimensional, terabyte scale datasets, which demonstrate a one-to-one correlation between resistance-a global property-and local CDW domain-dislocation dynamics, thereby linking the material microstructure to device properties. This work represents a major step toward defect-engineering of quantum materials, which will become increasingly important as we aim to utilize such materials in real devices., Competing Interests: Competing interests statement:The authors declare no competing interest.

Introduction: Both electronic cigarette (e-cigarette) and social media use among youth are public health concerns. While the health impacts of extensive social media use and frequent use of e-cigarettes have been discussed independently in the literature, little is known about the relationship between the two. This study aims to examine the potential association between extensive social media use and the frequency of current, e-cigarette use among United States (US) youth., Methods: Data from the 2022 National Youth Tobacco Survey (NYTS) were analyzed. The sample included 23,655 middle and high school students aged 9-18 years. Frequency of current e-cigarette use was categorized based on past-30 day use (i.e., never/former, 1-9 days, 10-29 days, or 30 days). Social media use was dichotomized into less than 4 hours daily and 4+ hours daily (i.e., extensive use). Multivariable multinomial logistic regression estimated the relationship between social media use and e-cigarette use frequency., Results: Over one-third (35.8 %) of youth used social media extensively and 8.6 % reported current use of e-cigarettes. Extensive social media use was associated with daily e-cigarette use (OR: 1.94, 95 % CI: 1.48-2.56) but not with other use categories. Older age, female sex, lower grades, current other tobacco use, and family tobacco use were also associated with daily e-cigarette use., Conclusions: Extensive social media use is associated with daily e-cigarette use among US youth. Public health interventions should consider the influence of social media on tobacco use behaviors and tailor prevention strategies to address this potential modifiable risk factor., Competing Interests: None., (© 2024 The Authors.)

In situ Electron Energy Loss Spectroscopy (EELS) combined with Transmission Electron Microscopy (TEM) has traditionally been pivotal for understanding how material processing choices affect local structure and composition. However, the ability to monitor and respond to ultrafast transient changes, now achievable with EELS and TEM, necessitates innovative analytical frameworks. Here, we introduce a machine learning (ML) framework tailored for the real-time assessment and characterization of in operando EELS Spectrum Images (EELS-SI). We focus on 2D MXenes as the sample material system, specifically targeting the understanding and control of their atomic-scale structural transformations that critically influence their electronic and optical properties. This approach requires fewer labeled training data points than typical deep learning classification methods. By integrating computationally generated structures of MXenes and experimental datasets into a unified latent space using Variational Autoencoders (VAE) in a unique training method, our framework accurately predicts structural evolutions at latencies pertinent to closed-loop processing within the TEM. This study presents a critical advancement in enabling automated, on-the-fly synthesis and characterization, significantly enhancing capabilities for materials discovery and the precision engineering of functional materials at the atomic scale., (© 2024. The Author(s).)

Background and Aims: Disposable electronic cigarette (e-cigarette) use is becoming more popular among US youth, given the shifting landscape in product marketing, availability and regulation. This study aimed to estimate the prevalence of and test factors associated with the most used e-cigarette product (disposable versus other) among US youth aged 9-18 years who currently use e-cigarettes., Design, Setting and Participants: This was an observational study using cross-sectional data from the US-based 2021 and 2022 National Youth Tobacco Surveys (n = 48 704). We restricted our analytical sample to youth who currently use e-cigarettes (n = 4137). The sample ranged from 9 to 18 years old and was 53.0% female., Measurements: We dichotomized e-cigarette device type to disposable versus all other types (e.g. refillable pods/cartridges). We conducted logistic regression to estimate whether age, sex, race/ethnicity, sexual orientation, frequency of e-cigarette use, nicotine vaping, flavored e-cigarette use and current combustible/non-combustible tobacco use were associated with disposable e-cigarette use, compared with other e-cigarette use., Findings: Among youth who currently use e-cigarettes, 54.5% used disposable e-cigarettes. Older age (17-18 years), relative to younger age (9-14 years) [odds ratio (OR) = 1.43, 95% confidence interval (CI) = 1.07-1.91], non-Hispanic Black (versus non-Hispanic White) race/ethnicity (OR = 1.47, 95% CI = 1.01-2.15), any nicotine (versus non-nicotine) vaping (OR = 2.51, 95% CI = 1.96-3.23) and flavored (versus non-flavored) e-cigarette use (OR = 1.93, 95% CI = 1.46-2.56) were associated with increased odds of mainly using disposable e-cigarettes, compared with using other e-cigarette products, whereas current combustible tobacco use (versus non-current) (OR = 0.65, 95% CI = 0.53-0.80) and current non-combustible tobacco use (versus non-current) (OR = 0.58, 95% CI = 0.43-0.78) were associated with lower odds., Conclusion: Disposable e-cigarettes appear to be the most used type of e-cigarette product among US youth. Older age, non-Hispanic Black race/ethnicity, nicotine vaping and flavored e-cigarette use are associated with mainly using disposable e-cigarettes, relative to other e-cigarette products., (© 2024 Society for the Study of Addiction.)

Topological materials confined in 1D can transform computing technologies, such as 1D topological semimetals for nanoscale interconnects and 1D topological superconductors for fault-tolerant quantum computing. As such, understanding crystallization of 1D-confined topological materials is critical. Here, we demonstrate 1D template-assisted nanowire synthesis where we observe diameter-dependent phase selectivity for tungsten phosphides. A phase bifurcation occurs to produce tungsten monophosphide and tungsten diphosphide at the cross-over nanowire diameter regime of 35-70 nm. Four-dimensional scanning transmission electron microscopy is used to identify the two phases and to map crystallographic orientations of grains at a few nm resolution. The 1D-confined phase selectivity is attributed to the minimization of the total surface energy, which depends on the nanowire diameter and chemical potentials of precursors. Theoretical calculations are carried out to construct the diameter-dependent phase diagram, which agrees with experimental observations. Our findings suggest a crystallization route to stabilize topological materials confined in 1D., (© 2024. The Author(s).)

Introduction: Cannabis use is increasing due to several factors including the adoption of laws legalizing its use across the United States (US). We examined changes in current cannabis use among US youth and adults and by key sociodemographic groups., Methods: Using data from the 2013-2022 National Survey on Drug Use and Health (n=543,195), we estimated the prevalence of (2013-2019, 2020, 2021-2022) and trends in (2013-2019, 2021-2022) current (i.e., past 30-day) cannabis use among US youth (aged 12-17) and adults (aged 18+) overall and by age, gender, race and ethnicity, educational attainment, and total annual family income. We also examined sociodemographic factors associated with use from 2013 to 2019, in 2020, and from 2021 to 2022., Results: Cannabis use increased from 7.59 % to 11.48 % in 2013-2019, was 11.54 % in 2020, and increased again from 13.13 % to 15.11 % in 2021-2022. Among youth, cannabis use remained constant from 2013 to 2019 and 2021-2022. In 2022, use was highest among aged 18-34, male, non-Hispanic multiracial, and generally lower SES adults. From 2021-2022, cannabis use increased among several groups such as adults who were aged 35-49 (14.25-17.23 %), female (11.21-13.00 %), and Hispanic (10.42-13.50 %). Adults who were aged 18-25, male, non-Hispanic multiracial, some college educated, and of lower annual family income had consistently higher odds of current cannabis use from 2013 to 2019, in 2020, and from 2021 to 2022., Conclusions: Cannabis use is increasing overall and among certain sociodemographic groups. Our findings inform prevention and harm reduction efforts aimed at mitigating the prevalence of cannabis use in the US., Competing Interests: No conflict declared., (© 2024 The Author(s).)

To inform policy and messaging, this study examined characteristics of adolescents' and young adults' (AYAs') exposure to and engagement with nicotine and tobacco product (NTP) social media (SM) content. In this cross-sectional survey study, AYAs aged 13-26 ( N =1,163) reported current NTP use, SM use frequency, and exposure to and engagement with SM content promoting and opposing NTP use (i.e. frequency, source[s], format[s], platform[s]). Participants who used NTPs (vs. did not use) were more likely to report having seen NTP content (p-values<.001). Prevalent sources were companies/brands (46.6%) and influencers (44.4%); prevalent formats were video (65.4%) and image (50.7%). Exposure to content promoting NTP use was prevalent on several popular platforms (e.g. TikTok, Instagram, Snapchat); exposure to content opposing NTP use was most prevalent on YouTube (75.8%). Among those reporting content engagement (i.e. liking, commenting on, or sharing NTP content; 34.6%), 57.2% engaged with influencer content. Participants reported engaging with content promoting and opposing NTP use on popular platforms (e.g. TikTok, Instagram, YouTube). Participants with (versus without) current NTP use were significantly more likely to use most SM platforms and to report NTP content exposure and engagement (p-values<.05). Results suggest that NTP education messaging and enforcement of platforms' content restrictions are needed.

Background: Social determinants of health (SDOHs) mediate outcomes of critical illness. Increasingly, professional organizations recommend screening for social risks. Yet, how clinicians should identify and then incorporate SDOHs into acute care practice is poorly defined., Research Question: How do medical ICU clinicians currently operationalize SDOHs within patient care, given that SDOHs are known to mediate outcomes of critical illness?, Study Design and Methods: Using ethnographic methods, we observed clinical work rounds in three urban ICUs within a single academic health system to capture use of SDOHs during clinical care. Adults admitted to the medical ICU with respiratory failure were enrolled prospectively sequentially. Observers wrote field notes and narrative excerpts from rounding observations. We also reviewed electronic medical record documentation for up to 90 days after ICU admission. We then qualitatively coded and triangulated data using a constructivist grounded theory approach and the Centers for Disease Control and Prevention Healthy People SDOHs framework., Results: Sixty-six patients were enrolled and > 200 h of observation of clinical work rounds were included in the analysis. ICU clinicians infrequently integrated social structures of patients' lives into their discussions. Social structures were invoked most frequently when related to: (1) causes of acute respiratory failure, (2) decisions regarding life-sustaining therapies, and (3) transitions of care. Data about common SDOHs were not collected in any systematic way (eg, food and housing insecurity), and some SDOHs were discussed rarely or never (eg, access to education, discrimination, and incarceration)., Interpretation: We found that clinicians do not incorporate many areas of known SDOHs into ICU rounds. Improvements in integration of SDOHs should leverage the multidisciplinary team, identifying who is best suited to collect information on SDOHs during different time points in critical illness. Next steps include clinician-focused, patient-focused, and caregiver-focused assessments of feasibility and acceptability of an ICU-based SDOHs assessment.

A growing proportion of individuals adopt family caregiving roles. Family caregivers are the primary providers of long-term care in the United States yet limited federal policy supports exist, despite the known negative impacts of caregiving. There is also limited information about the prevalence of youth/young adult caregivers and the impacts of caregiving at formative ages in the United States. Our objective is to estimate the prevalence of youth caregivers and examine the association of caregiving with educational investments. We use the American Time Use Survey (2013-2019) to identify and describe youth caregivers (aged 15-18) and young adult caregivers (aged 19-22) and compare them with non-caregiving peers. We estimate that there are approximately 1,623,000 youth caregivers and 1,986,000 young adult caregivers, corresponding to 9.2% and 12.7% of these age groups, respectively. However, there is a wide range in the estimated prevalence per year, from approximately 364,000 to 2.8 million youth caregivers and from 353,000 to 2.2 million young adult caregivers, depending on caregiver definition. Unlike adult caregivers, we find that young men and women were nearly equally likely to provide care. We also find that non-White individuals are disproportionately represented as youth caregivers. Compared with non-caregiving peers, both youth and young adult caregivers are less likely to be enrolled in school and, among those enrolled in school, spend significantly less time on educational activities. Considering the association of caregiving among youth/young adults and education, policies supporting youth and young adult caregivers are critical., (Copyright © 2024 The Authors.)

Objectives: Nudging, a behavioral economics concept, subtly influences decision-making without coercion or limiting choice. Despite its frequent use, the specific application of nudging techniques by clinicians in shared decision-making (SDM) is understudied. Our aim was to analyze clinicians' use of nudging in a curated dataset of family care conferences in the PICU., Design: Between 2019 and 2020, we retrospectively studied and coded 70 previously recorded care conference transcripts that involved physicians and families from 2015 to 2019. We focused on decision-making discussions examining instances of nudging, namely salience, framing, options, default, endowment, commission, omission, recommend, expert opinion, certainty, and social norms. Nudging instances were categorized by decision type, including tracheostomy, goals of care, or procedures., Setting: Single-center quaternary pediatric facility with general and cardiac ICUs., Patients: None., Interventions: None., Measurements: We assessed the pattern and frequency of nudges in each transcript., Main Results: Sixty-three of the 70 transcripts contained SDM episodes. These episodes represented a total of 11 decision categories based on the subject matter of nudging instances, with 308 decision episodes across all transcripts (median [interquartile range] 5 [4-6] per conference). Tracheostomy was the most frequently discussed decision. A total of 1096 nudging instances were identified across the conferences, with 8 (6-10) nudge types per conference. The most frequent nudging strategy used was gain frame (203/1096 [18.5%]), followed by loss frame (150/1096 [13.7%])., Conclusions: Nudging is routinely employed by clinicians to guide decision-making, primarily through gain or loss framing. This retrospective analysis aids in understanding nudging in care conferences: it offers insight into potential risks and benefits of these techniques; it highlights ways in which their application has been used by caregivers; and it may be a resource for future trainee curriculum development., Competing Interests: Dr. October is currently a federal employee at the National Institutes for Health (NIH) and received support for article research from the NIH. Dr. Miller-Smith received funding from AAP Grand Rounds and Pediatrics in Review. The remaining authors have disclosed that they do not have any potential conflicts of interest., (Copyright © 2024 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies.)

Accumulating evidence suggests that living in areas of high surrounding greenness or even brief exposures to areas of high greenery is conducive to cardiovascular health, which may be related to the environmental, social, psychological, and physiological benefits of greenspaces. Recent data from multiple cross-sectional, longitudinal, and cohort studies suggest that living in areas of high surrounding greenness is associated with a lower risk of all-cause and cardiovascular mortality. High levels of neighborhood greenery have been linked also to a decrease in the burden of cardiovascular disease risk factors as reflected by lower rates of hypertension, dyslipidemia, and diabetes. Those who live in greener environments report better mental health and more frequent social interactions, which can benefit cardiovascular health as well. In this narrative review, we discuss evidence linking greenspaces to cardiovascular health as well as the potential mechanisms underlying the beneficial effects of greenspaces, including the impact of vegetation on air, noise and light pollution, ambient temperature, physical activity, mental health, and biodiversity. We review literature on the beneficial effects of acute and chronic exposure to nature on cardiovascular disease risk factors, inflammation and immune function, and we highlight the potential cardiovascular effects of biogenic volatile organic compounds that are emitted by trees and shrubs. We identify current knowledge gaps in this area and underscore the need for additional population studies to understand more clearly and precisely the link between greenness and health. Such understanding is urgently needed to fully redeem the promise of greenspaces in preventing adverse environmental exposures, mitigating the effects of climate change, and creating healthier living environments., Competing Interests: Disclosures None.

Introduction: Racial discrimination has been identified as a risk factor for cardiometabolic diseases, the leading cause of morbidity and mortality among racial/ethnic minority groups; however, there is no synthesis of current knowledge on the association between discrimination and cardiometabolic diseases. The objective of this systematic review was to summarize evidence linking racial/ethnic discrimination and cardiometabolic diseases., Methods: The review was conducted based on studies identified via electronic searches of 5 databases (PubMed, Google Scholar, WorldWideScience.org, ResearchGate and Microsoft Academic) using terms related to discrimination and cardiometabolic disease., Results: Of the 123 eligible studies included in the review, 87 were cross-sectional, 25 longitudinal, 8 quasi-experimental, 2 randomized controlled trials and 1 case-control. Cardiometabolic disease outcomes discussed were hypertension (n = 46), cardiovascular disease (n = 40), obesity (n = 12), diabetes (n = 11), metabolic syndrome (n = 9), and chronic kidney disease (n = 5). Although a variety of discrimination measures was employed across the studies, the Everyday Discrimination Scale was used most often (32.5%). African Americans/Blacks were the most frequently studied racial/ethnic group (53.1%), and American Indians the least (0.02%). Significant associations between racial/ethnic discrimination and cardiometabolic disease were found in 73.2% of the studies., Discussion: Racial/ethnic discrimination is positively associated with increased risk of cardiometabolic disease and higher levels of cardiometabolic biomarkers. Identifying racial/ethnic discrimination as a potential key contributor to the health inequities associated with cardiometabolic diseases is important for addressing the significant burden borne by racial/ethnic minorities., (© 2023. W. Montague Cobb-NMA Health Institute.)

Introduction: Cannabis vaping has become increasingly popular among adolescents in recent years. However, research examining mental health determinants of cannabis vaping is scant. This study investigated the relationship between psychological distress and cannabis vaping among a nationally representative sample of U.S. adolescents., Methods: Data are from the cross-sectional 2022 National Youth Tobacco Survey, restricted to adolescents ages 11-18 (n=22,202). Psychological distress was categorized as normal, mild, moderate, and severe according to the Patient Health Questionnaire for Depression and Anxiety-4. Cannabis vaping was defined as any use in the past 30 days. To estimate the association between psychological distress and cannabis vaping, logistic regression was performed adjusted for age, biological sex, race/ethnicity, sexual orientation, school grades, family smoking/vaping, nicotine vaping, other tobacco use, and blunt use. Analyses were conducted in 2023., Results: Nearly 8% of adolescents vaped cannabis in the past 30 days, and 25.6% reported moderate or severe psychological distress. Mild, moderate, and severe psychological distress were associated with cannabis vaping in the unadjusted model. In the adjusted model, the odds of cannabis vaping were higher among adolescents who had severe psychological distress (OR: 1.46, 95% CI: 1.09-1.96), compared to adolescents with no distress. Older age, poor grades, family smoking/vaping, nicotine vaping, other tobacco use, and blunt use were also associated with cannabis vaping., Conclusions: Severe psychological distress was associated with past 30-day cannabis vaping among U.S. adolescents. Adolescents experiencing psychological distress need to be screened for cannabis vaping to help prevent and reduce use and promote mental health., (Copyright © 2023 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.)

This study examined whether biological sex moderates the relationship between experiences of workplace culture and urinary levels of catecholamines and their metabolites. We conducted a series of regression analyses (predictors: 3-methoxytyramine (3MT), 5-hydroxyindolacetic (5HIAA), and dopamine (DA); outcomes: employee engagement and workplace culture) in a sample of 218 participants. Compared to men, women rated workplace culture less positively ( r = -0.210; p < 0.01) and had stronger positive associations with 3MT ( r = 0.328; p < 0.001), DA ( r = 0.376; p < 0.001), and 5HIAA ( r = 0.168; p < 0.01). There was a significant moderation effect between 3MT and sex on employee engagement (b = -1.76 (SE = 0.84); p < 0.01), and 3MT had a positive significant association for men with engagement ( p < 0.05); however, there was no significant association for women. Findings suggest that for women, less positive experiences with workplace culture could elevate 3MT, stimulating sympathetic nervous tone and potentially amplifying risks for negative health outcomes. Conversely, men who reported higher employee engagement had higher levels of 3MT, suggesting possible health risks associated with high levels of engagement, rather than lack of engagement. Overall, study findings suggested differential health risks based on biological sex, potentially impacting health risk policy development.

Background:  College students who identify as a sexual minority (i.e., lesbian, gay, bisexual, or other sexual orientation) are at higher risk for e-cigarette use than their heterosexual or "straight" peers. However, little is known about factors, such as e-cigarette outcome expectancies, that might influence these differences in prevalence rates. Therefore, the current study examined differences between heterosexual and sexual minority college student e-cigarette users in terms of days of past-month e-cigarette use, e-cigarette dependence, and e-cigarette outcome expectancies. A secondary aim of the study was to examine whether outcome expectancies served as an explanatory mechanism in the association between sexual minority status and e-cigarette use frequency and dependence. Methods:  Participants were heterosexual ( n  = 90; M age = 19.65, SD  = 2.70; 76.7% female; 77.8% White) and sexual minority ( n  = 44; M age = 20.02, SD  = 2.18; 68.2% female; 90.9% White) college student e-cigarette users who completed self-report measures. Results:  Students who identified as a sexual minority reported greater e-cigarette dependence, more frequent past 30-day use, and greater negative consequences and positive reinforcement e-cigarette outcome expectancies. Follow-up mediation analyses indicated a significant indirect effect of sexual minority status on both days of past-month e-cigarette use and e-cigarette dependence through expectancies for negative consequences and positive reinforcement. Conclusions:  These findings suggest that positive reinforcement and negative consequences outcome expectancies may be contributing to the disparities in e-cigarette use among college students who identify as a sexual minority and could be useful targets for cessation interventions for this population.

Introduction: In the US, health services research most often relies on Rural-Urban Commuting Area (RUCA) classification codes to measure rurality. This measure is known to misrepresent rurality and does not rely on individual experiences of rurality associated with healthcare inequities. We aimed to determine a patient-centered RUCA-based definition of rurality., Methods: In this cross-sectional study, we conducted an online survey asking US residents, 'Do you live in a rural area?' and the rationale for their answer. We evaluated the concordance between their self-identified rurality and their ZIP code-derived RUCA designation of rurality by calculating Cohen's kappa (&kappa;) statistic and percent agreement., Results: Of the 774 participants, 456 (58.9%) and 318 (41.1%) individuals had conventional urban and rural RUCA classifications, respectively. There was only moderate agreement between perceived rurality and rural RUCA classification (&kappa;=0.48; 95% confidence interval (CI)=0.42-0.54). Among people living within RUCA 2-3 defined urban areas (n=51), percent agreement was only 19.6%. Discordance was driven by their perception of the population density, proximity to the nearest neighbor, proximity to a metropolitan area, and the number of homes in their area. Based on our results, we reclassified RUCA 2-3 designations as rural, resulting in an increase in overall concordance (&kappa;=0.56; 95%CI=0.50-0.62)., Discussion: Patient-centered rural-urban classification is required to effectively evaluate the impact of rurality on health disparities. This study presents a more patient-centric RUCA-based classification of rurality that can be easily operationalized in future research in situations in which self-reported rural status is missing or challenging to obtain., Conclusion: Reclassification of RUCA 2-3 as rural represents a more patient-centric definition of rurality.

Background : E-cigarette outcome expectancies (i.e., beliefs about the expected consequences of e-cigarette use) are a key factor in motivating use. Emotion regulation difficulties have demonstrated significant associations with outcome expectancies; however, there has yet to be an examination of associations between specific emotion regulation difficulties and specific e-cigarette outcome expectancies, which could serve as targets for intervention efforts. Therefore, the current study sought to examine the unique predictive ability of specific emotion regulation difficulties in terms of e-cigarette outcome expectancies. Methods : Participants were 116 college student e-cigarette users ( M age = 19.72, SD  = 1.88; 71.6% female) who completed self-report questionnaires for course credit. Results : Greater difficulties engaging in goal-directed behavior when experiencing negative emotions and fewer difficulties accessing effective emotion regulation strategies were associated with positive reinforcement outcome expectancies. Greater emotion regulation difficulties in general were also associated with negative reinforcement outcome expectancies, though there were no significant individual predictors. Conclusion : These results suggest that greater emotion regulation difficulties are associated with mood-related e-cigarette outcome expectancies, and targeting emotion regulation difficulties, particularly difficulty engaging in goal-directed behavior when upset, may be useful to incorporate into intervention efforts.

The charge density wave material 1T-TaS 2 exhibits a pulse-induced insulator-to-metal transition, which shows promise for next-generation electronics such as memristive memory and neuromorphic hardware. However, the rational design of TaS 2 devices is hindered by a poor understanding of the switching mechanism, the pulse-induced phase, and the influence of material defects. Here, we operate a 2-terminal TaS 2 device within a scanning transmission electron microscope at cryogenic temperature, and directly visualize the changing charge density wave structure with nanoscale spatial resolution and down to 300 μs temporal resolution. We show that the pulse-induced transition is driven by Joule heating, and that the pulse-induced state corresponds to the nearly commensurate and incommensurate charge density wave phases, depending on the applied voltage amplitude. With our in operando cryogenic electron microscopy experiments, we directly correlate the charge density wave structure with the device resistance, and show that dislocations significantly impact device performance. This work resolves fundamental questions of resistive switching in TaS 2 devices, critical for engineering reliable and scalable TaS 2 electronics., (© 2023. The Author(s).)

Purpose of Review: The goals of this study were to identify smartphone apps targeting youth tobacco use prevention and/or cessation discussed in the academic literature and/or available in the Apple App Store and to review and rate the credibility of the apps. We took a multiphase approach in a non-systematic review that involved conducting parallel literature and App Store searches, screening the returned literature and apps for inclusion, characterizing the studies and apps, and evaluating app quality using a standardized rating scale., Recent Findings: The negative consequences of youth tobacco use initiation are profound and far-reaching. Half of the youth who use nicotine want to quit, but quit rates are low. The integration of smartphone apps shows promise in complementing and enhancing evidence-based youth tobacco prevention and treatment methods., Summary: Consistent with prior reviews, we identified a disconnect between apps that are readily accessible and those that have an evidence base, and many popular apps received low quality scores. Findings suggest a need for better integration between evidence-based and popular, available apps targeting youth tobacco use., Competing Interests: Conflict of Interest The authors declare no competing interests.

Importance: Pregnant adolescents sometimes use cigarettes; however, little is known about e-cigarette use among pregnant adolescents, a population with increased health vulnerability., Objective: To examine yearly trends, sociodemographic and pregnancy-related determinants, and the association with small-for-gestational-age (SGA) birth of e-cigarette and/or cigarette use during late pregnancy among adolescents., Design, Setting, and Participants: This cohort study used existing data from the 2016-2021 Pregnancy Risk Assessment Monitoring System on 10 428 US adolescents aged 10 to 19 years who had a singleton birth with complete data on e-cigarette or cigarette use and SGA birth., Exposure: Adolescents reported e-cigarette and cigarette use during the last 3 months of pregnancy., Main Outcomes and Measures: SGA birth (birth weight below the 10th percentile for the same sex and gestational duration) was determined from birth certificates. Multivariable logistic regression was used to compare the odds of SGA birth across pregnant adolescents who exclusively used e-cigarettes, exclusively used cigarettes, used e-cigarettes and cigarettes, or did not use either., Results: Of the 10 428 pregnant adolescents, 72.7% were aged 18 or 19 years; 58.9% self-identified as White and 23.3% as Black; and 69.8% were non-Hispanic. The weighted prevalence of exclusive e-cigarette use during late pregnancy increased from 0.8% in 2016 to 4.1% in 2021, while the prevalence of exclusive cigarette use decreased from 9.2% in 2017 to 3.2% in 2021. The prevalence of dual use fluctuated, ranging from 0.6% to 1.6%. White pregnant adolescents were more likely than those who self-identified as another race and ethnicity to use e-cigarettes (2.7% vs 1.0% for American Indian or Alaska Native adolescents, 0.8% for Asian or other race adolescents, 0.6% for Black adolescents, and 0.7% for multiracial adolescents). Compared with those who did not use either product, adolescents who exclusively used e-cigarettes (16.8% vs 12.9%; confounder-adjusted odds ratio [AOR], 1.68 [95% CI, 0.89-3.18]) or who used cigarettes and e-cigarettes (17.6% vs 12.9%; AOR, 1.68 [95% CI, 0.79-3.53]) had no statistically significant difference in risk of SGA birth. However, adolescents who exclusively used cigarettes had a more than 2-fold higher risk of SGA birth (24.6% vs 12.9%; AOR, 2.51 [95% CI, 1.79-3.52])., Conclusions and Relevance: This cohort study suggests that pregnant adolescents increasingly used e-cigarettes, with the highest use among White adolescents. Results from this analysis found that, unlike cigarette use, e-cigarette use during late pregnancy was not statistically significantly associated with an increased risk of SGA birth among adolescents. Due to the uncertainty of this nonsignificant association, future research could benefit from a larger sample size.

Importance: Patients' expectations for future health guide their decisions and enable them to prepare, adapt, and cope. However, little is known about how inaccurate expectations may affect patients' illness outcomes., Objective: To assess the association between patients' expectation inaccuracies and health-related quality of life., Design, Setting, and Participants: This cohort study of patients with severe chronic obstructive pulmonary disease (COPD) was conducted from 2017 to 2021, which included a 24-month follow-up period. Eligible participants received outpatient primary care at pulmonary clinics of a single large US health system. Data were analyzed between 2021 and 2023., Exposure: Expectation accuracy, measured by comparing patients' self-reported expectations of their symptom burden with their actual physical and emotional symptoms 3, 12, and 24 months in the future., Main Outcome and Measure: Health-related quality of life, measured by the St George's Respiratory Questionnaire-COPD at 3, 12, and 24 months., Results: A total of 207 participants were included (median age, 65.5 years [range, 42.0-86.0 years]; 120 women [58.0%]; 118 Black [57.0%], 79 White [38.2%]). The consent rate among approached patients was 80.0%. Most patients reported no or only limited discussions of future health and symptom burdens with their clinicians. Across physical and emotional symptoms and all 3 time points, patients' expectations were more optimistic than their experiences. There were no consistent patterns of measured demographic or behavioral characteristics associated with expectation accuracy. Regression models revealed that overoptimistic expectations of future burdens of dyspnea (linear regression estimate, 4.68; 95% CI, 2.68 to 6.68) and negative emotions (linear regression estimate, -3.04; 95% CI, -4.78 to 1.29) were associated with lower health-related quality of life at 3 months after adjustment for baseline health-related quality of life, forced expiratory volume over 1 second, and interval clinical events (P < .001 for both). Similar patterns were observed at 12 months (dyspnea: linear regression estimate, 2.41; 95% CI, 0.45 to 4.37) and 24 months (negative emotions: linear regression estimate, -2.39; 95% CI, -4.67 to 0.12; dyspnea: linear regression estimate, 3.21; 95% CI, 0.82 to 5.60), although there was no statistically significant association between expectation of negative emotions and quality of life at 12 months., Conclusions and Relevance: In this cohort study of patients with COPD, we found that patients are overoptimistic in their expectations about future negative symptom burdens, and such inaccuracies were independently associated with worse well-being over time. Developing and implementing strategies to improve patients' symptom expectations may improve patient-centered outcomes.

Objectives: To evaluate the association of race with proportion of time in deep sedation among mechanically ventilated adults., Design: Retrospective cohort study from October 2017 to December 2019., Setting: Five hospitals within a single health system., Patients: Adult patients who identified race as Black or White who were mechanically ventilated for greater than or equal to 24 hours in one of 12 medical, surgical, cardiovascular, cardiothoracic, or mixed ICUs., Interventions: None., Measurements and Main Results: The exposure was White compared with Black race. The primary outcome was the proportion of time in deep sedation during the first 48 hours of mechanical ventilation, defined as Richmond Agitation-Sedation Scale values of -3 to -5. For the primary analysis, we performed mixed-effects linear regression models including ICU as a random effect, and adjusting for age, sex, English as preferred language, body mass index, Elixhauser comorbidity index, Laboratory-based Acute Physiology Score, Version 2, ICU admission source, admission for a major surgical procedure, and the presence of septic shock. Of the 3337 included patients, 1242 (37%) identified as Black, 1367 (41%) were female, and 1002 (30%) were admitted to a medical ICU. Black patients spent 48% of the first 48 hours of mechanical ventilation in deep sedation, compared with 43% among White patients in unadjusted analysis. After risk adjustment, Black race was significantly associated with more time in early deep sedation (mean difference, 5%; 95% CI, 2-7%; p < 0.01)., Conclusions: There are disparities in sedation during the first 48 hours of mechanical ventilation between Black and White patients across a diverse set of ICUs. Future work is needed to determine the clinical significance of these findings, given the known poorer outcomes for patients who experience early deep sedation., Competing Interests: Dr. Ramadurai is supported by National Heart, Lung, and Blood Institute (NHLBI) T32HL098054. Dr. Kohn is supported by NHLBI K23HL146894. The remaining authors have disclosed that they do not have any potential conflicts of interest., (Copyright © 2023 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the Society of Critical Care Medicine.)

Background: Tobacco use is undertreated in the medical setting. One driver may be inadequate tobacco use disorder treatment (TUDT) training for clinicians in specialties treating tobacco-dependent patients., Objective: We sought to evaluate the current state of TUDT training for diverse professionals and how these skills are assessed in credentialing exams., Methods: We performed a focused review of current educational practices, evidence-based strategies, and accreditation exam contents focused on TUDT., Results: Among medical students, participants in reviewed studies reported anywhere from 45 minutes to 3 hours of TUDT training throughout their 4-year programs, most often in the form of didactic sessions. Similarly, little TUDT training was reported at the post-graduate (residency, fellowship, continuing medical education) levels, and reported training was typically delivered as time-based (expected hours of instruction) rather than competency-based (demonstration of mastery) learning. Multiple studies evaluated effective TUDT curricula at varied stages of training. More effective curricula incorporated longitudinal sessions and active learning, such as standardized patient encounters or proctored patient visits. Knowledge of TUDT is minimally evaluated on certification exams. For example, the American Board of Internal Medicine blueprint lists TUDT as <2% of one subtopic on both the internal medicine and pulmonary exams., Conclusion: TUDT training for most clinicians is minimal, does not assess competency, and is minimally evaluated on certification exams. Effective, evidence-based TUDT training incorporating active learning should be integrated into medical education at all levels, with attention paid to inclusion on subsequent certifying exams., (Copyright © 2023 by the American Thoracic Society.)