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Sharon Cobb,1 Arash Javanbakht,2 Ebrahim Khalifeh Soltani,3 Mohsen Bazargan,4,5 Shervin Assari4 1School of Nursing, Charles R Drew University of Medicine and Science, Los Angeles, CA, USA; 2Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, MI, USA; 3Department of Political Science, Eastern Michigan University, Ypsilanti, MI, USA; 4Department of Family Medicine, Charles R Drew University of Medicine and Science, Los Angeles, CA, USA; 5Department of Family Medicine, UCLA, Los Angeles, CA, USACorrespondence: Shervin Assari Email assari@umich.eduBackground: Although health is a prerequisite for happiness, the salience of health for maintaining happiness may be diminished for Blacks when compared to Whites, a phenomenon which can be explained by the Black-White mental health paradox and minorities’ diminished returns.Aim: To understand if Black and White adult Americans differ in the effects of self-rated health (SRH) on happiness.Methods: This cross-sectional study used data from the General Social Survey (GSS; 1972– 2018), a nationally representative survey in the US. Our analytical sample included 42,201 Black and White adults. The independent variable was SRH. Happiness was the dependent variable. Sociodemographic factors were covariates. Race was the moderator. Logistic regression was used to analyze the data without and with interaction terms between race and SRH.Results: Overall, good SRH was positively associated with happiness, however, there was a significant interaction between race/ethnicity and good SRH on the outcome (i.e. happiness) . This finding suggested that the boosting effect of good SRH on happiness is weaker for Black than White people.Conclusion: In the United States, due to a weaker concordance between good health and happiness, Blacks who have poor SRH are more likely to report happiness. At the same time, Whites who are healthy report happiness, however, Blacks who are healthy do not necessarily report happiness. Disjointed link between health and happiness may be due to different racial, ethnic, and cultural perceptions of physical health and happiness as well as salience of physical health as a component of happiness. This may be an adaptive response of Blacks to sociopolitical as well as health-related adversities over centuries as a result of the combination of oppression, injustice, and poverty.Keywords: population groups, Blacks, Whites, race/ethnicity, self-rated health, happiness

ImportanceDespite the changing legal status of cannabis and the potential impact on health, few health systems routinely screen for cannabis use, and data on the epidemiology of cannabis use, and especially medical cannabis use among primary care patients, are limited.ObjectiveTo describe the prevalence of, factors associated with, and reasons for past-3 month cannabis use reported by primary care patients.Design, setting, and participantsThis cross-sectional study used electronic health record data from patients aged 18 years and older who had an annual wellness visit between January 2021 and May 2023 from a primary care clinic within a university-based health system in Los Angeles, California.ExposuresFactors of interest included age, race and ethnicity, sex, employment status, and neighborhood Area Deprivation Index (ADI).Main outcomes and measuresCannabis use was assessed using the Alcohol Substance Involvement Screening Test (ASSIST). Patients were also asked about reasons for use, symptoms for which they used cannabis, and mode of use.ResultsAmong the 175 734 patients screened, the median (range) age was 47 (18-102) years; 101 657 (58.0%) were female; 25 278 (15.7%) were Asian, 21 971 (13.7%) were Hispanic, and 51 063 (31.7%) were White. Cannabis use was reported by 29 898 (17.0%), with 10 360 (34.7%) having ASSIST scores indicative of moderate to high risk for cannabis use disorder (CUD). Prevalence of cannabis use was higher among male patients than female patients (14 939 [20.0%] vs 14 916 [14.7%]) and younger patients (18-29 years, 7592 [31.0%]; ≥60 years, 4200 [8.5%]), and lower among those who lived in the most disadvantaged neighborhoods (ADI decile 9-10, 189 [13.8%]; ADI decile 1-2, 12 431 [17.4%]). The most common modes of use included edibles (18 201 [61.6%]), smoking (15 256 [51.7%]), and vaporizing (8555 [29.0%]). While 4375 patients who reported using cannabis (15.6%) did so for medical reasons only, 21 986 patients (75.7%) reported using cannabis to manage symptoms including pain (9196 [31.7%]), stress (14 542 [50.2%]), and sleep (16 221 [56.0%]). The median (IQR) number of symptoms managed was 2 (1-4), which was higher among patients who were at moderate to high risk for CUD (4 [2-6] symptoms).Conclusions and relevanceIn this study, cannabis use and risk of CUD were common, and more than three-quarters of patients who reported any cannabis use reported doing so to manage a health-related symptom. These findings suggest that integration of information regarding cannabis use for symptom management could help provide a crucial point-of-care opportunity for clinicians to understand their patients' risk for CUD.

Post-traumatic stress disorder (PTSD) genetics are characterized by lower discoverability than most other psychiatric disorders. The contribution to biological understanding from previous genetic studies has thus been limited. We performed a multi-ancestry meta-analysis of genome-wide association studies across 1,222,882 individuals of European ancestry (137,136 cases) and 58,051 admixed individuals with African and Native American ancestry (13,624 cases). We identified 95 genome-wide significant loci (80 new). Convergent multi-omic approaches identified 43 potential causal genes, broadly classified as neurotransmitter and ion channel synaptic modulators (for example, GRIA1, GRM8 and CACNA1E), developmental, axon guidance and transcription factors (for example, FOXP2, EFNA5 and DCC), synaptic structure and function genes (for example, PCLO, NCAM1 and PDE4B) and endocrine or immune regulators (for example, ESR1, TRAF3 and TANK). Additional top genes influence stress, immune, fear and threat-related processes, previously hypothesized to underlie PTSD neurobiology. These findings strengthen our understanding of neurobiological systems relevant to PTSD pathophysiology, while also opening new areas for investigation.

IntroductionMethamphetamine use is highly prevalent among men who have sex with men (MSM), but knowledge of the long-term dynamics, and how they are affected by substance use treatment, is limited. This study aimed to describe trajectories of methamphetamine use among MSM, and to evaluate the impact of treatment for any kind of substance use on frequency of methamphetamine use.MethodsThis analysis used data from a cohort of MSM in Los Angeles, CA, who participated in semi-annual study visits from 2014 to 2022. The study characterized trajectories of methamphetamine use using a continuous time multistate Markov model with three states. States were defined using self-reported frequency of methamphetamine use in the past six months: frequent (daily), occasional (weekly or less), and never. The model estimated the association between receiving treatment for any kind of substance use and changes in state of frequency of methamphetamine use.ResultsThis analysis included 2348 study visits among 285 individuals who were followed-up for an average of 4.4 years. Among participants who were in the frequent use state, 65 % (n = 26) of those who were receiving any kind of substance use treatment at a study visit had reduced their methamphetamine use at their next visit, compared to 33 % (n = 95) of those who were not receiving treatment. Controlling for age, race/ethnicity, and HIV-status, those who reported receiving current treatment for substance use were more likely to transition from occasional to no use (HR: 1.63, 95 % CI: 1.10-2.42) and frequent to occasional use (HR: 4.25, 95 % CI: 2.11-8.59) in comparison to those who did not report receiving current treatment for substance use.ConclusionsFindings from this dynamic modeling study provide a new method for assessing longitudinal methamphetamine use outcomes and add important evidence outside of clinical trials that substance use treatment may reduce methamphetamine use.

Background: MicroRNAs expressions that are known as Posttranscriptional repressors of gene expression in animals and plants have an important role in diabetic consequences and pathogenesis. This research aimed to investigate the expression of miR-34a, miR-126, and miR-125a-5p levels for diagnosis of diabetes, and the effect of α-L-guluronic acidand β-D-mannuronic acid supplementation on expression patterns of these MicroRNAs in diabetic rats.Methods: Total MicroRNAs levels were measured by Quantitative reverse transcription polymerase chain reaction (qRT-PCR) method. Body weight, fasting insulin level, food intake and Vitamin D level in four groups were also assessed after 4 weeks.Results: The analyses illustrate marked declines in expression of miR-126 (p=0.009) and miR-125a-5p (p=0.019) levels in the control diabetic group when compared to the control healthy group. Expression levels of miR-126 (p=0.026) and miR-125a-5p (p=0.041) were upregulated considerably in diabetic rats after treatment with β-D-mannuronic acid and α-L-guluronic acid, respectively.Conclusion: These results suggest that use of miR-126 and 125a-5p is a sensible criterion for diagnosing diabetes. β-D-mannuronic acid is also considered a new therapeutic agent to correct disturbances in the MicroRNAs profile of diabetic rats.

BackgroundDespite its relevance for healthcare settings, social and behavioral risk screening is not systematically performed by clinicians or healthcare systems.ObjectiveTo address clinician concerns, such as social and behavioral risk screening disrupting the clinician-patient relationship and lack of resources to respond, we interviewed primary care patients at an academic medical center regarding their perceptions and preferences on social and behavioral risk screening.ParticipantsBetween September and December 2020, we recruited a convenience sample of 14 English-speaking primary care patients 18 years + from three clinics affiliated with an academic medical center.ApproachUsing a semi-structured interview guide, we asked about the importance of social and behavioral risk screening, whether or not and how to share social and behavioral risk factors, and how social and behavioral risk factors are addressed. We used a multi-step analytic process to identify the range and commonality of participants' responses thematically.Key resultsParticipants recognized that social and behavioral risk factor domains were relevant to primary care and important for treating the patient as a whole person. Participants preferred a conversation regarding social and behavioral risk factor with their primary care providers (PCPs), and suggested that, if surveys are used, they be followed with an open-ended, in-person discussion. Participants also suggested framing the discussion as something that is done routinely with all patients so that patients do not feel judged. Participants felt comfortable sharing social and behavioral risk factors when they trusted their PCPs, and felt that discussing social and behavioral risk factors with their PCPs built trust. Participants recognized that resources exist outside of the clinic, and suggested that PCPs distribute lists of relevant community resources to patients.ConclusionIn our study of primary care patients on perceptions and preferences about screening and addressing social and behavioral risk factors, we found that patients were willing to share social and behavioral risk factors with their PCP, preferred an in-person discussions with or without a survey, and wanted a list of community resources to address their needs.

Elizabeth R Duval, Arash Javanbakht, Israel LiberzonDepartment of Psychiatry, University of Michigan Health System, Ann Arbor, MI, USAAbstract: Anxiety and stress disorders are among the most prevalent neuropsychiatric disorders. In recent years, multiple studies have examined brain regions and networks involved in anxiety symptomatology in an effort to better understand the mechanisms involved and to develop more effective treatments. However, much remains unknown regarding the specific abnormalities and interactions between networks of regions underlying anxiety disorder presentations. We examined recent neuroimaging literature that aims to identify neural mechanisms underlying anxiety, searching for patterns of neural dysfunction that might be specific to different anxiety disorder categories. Across different anxiety and stress disorders, patterns of hyperactivation in emotion-generating regions and hypoactivation in prefrontal/regulatory regions are common in the literature. Interestingly, evidence of differential patterns is also emerging, such that within a spectrum of disorders ranging from more fear-based to more anxiety-based, greater involvement of emotion-generating regions is reported in panic disorder and specific phobia, and greater involvement of prefrontal regions is reported in generalized anxiety disorder and posttraumatic stress disorder. We summarize the pertinent literature and suggest areas for continued investigation.Keywords: fear, anxiety, neuroimaging

Abstract Background Gastric intestinal metaplasia (GIM) is a precancerous lesion that increases the risk of gastric cancer. Several preliminary studies have examined the prevalence of GIM. The present systematic review and meta-analysis were conducted aimed estimating the global prevalence of GIM. Methods The present systematic review and meta-analysis was conducted based on the PRISMA reporting guidelines in the range of 1988–2022. Articles related to the purpose of the study were obtained from Embase, PubMed, Scopus, Web of Science (WOS), MagIran, SID databases, and Google Scholar search engine using relevant and validated keywords in MeSH/Emtree. Inclusion criteria were observational articles, access to the full text of the article, and articles that reported prevalence. Heterogeneity among studies was examined using the I 2 index. The random effects model was used in this review due to the high heterogeneity between the results of the studies. Data were statistically analyzed using the Comprehensive Meta-Analysis (CMA) software. Results In the initial search, 4946 studies were found, of which 20 articles with a sample size of 57,263 met all the criteria for inclusion in the study. The global prevalence of GIM was 17.5% (95% confidence interval: 14.6–20.8%). The highest percentage of prevalence of GIM belonged to American continent with 18.6% (95% confidence interval: 13.8–24.6%) and patients with gastroesophageal reflux with 22.9% (95% confidence interval: 9.9–44.6%). Conclusion The results of this study showed that the prevalence of GIM in the world is high and needs further investigation. Therefore, it is recommended to be given more attention by experts, officials, and health policymakers.

Abstract Objective To assess the effectiveness of a modified Lichtenstein Repair combined with Herniorrhaphy in reducing postoperative chronic pain and enhancing recovery and quality of life in inguinal hernia patients. Methods This retrospective study, conducted at the Taleghani training center between January 2021 and February 2023, retrospectively examined 289 hernia surgeries, of which 130 employed a modified Lichtenstein technique. The investigation encompassed a detailed analysis of patient demographics, employed surgical techniques, operative methods with a focus on minimal dissection, and an evaluation of postoperative outcomes. Results In this study of 289 participants, primarily males aged 60–80 years, the modified technique group demonstrated a notably lower incidence of hernia recurrence (1.5%) compared to the Lichtenstein group (3.1%). Additionally, the modified technique was more effective in reducing postoperative pain, with a significantly lower mean Visual Analogue Scale (VAS) score of 0.15, compared to 0.31 in the Lichtenstein group. This suggests enhanced patient comfort and a potentially quicker recovery in the modified technique group. Conclusion The modified Lichtenstein hernioplasty technique, characterized by minimal tissue trauma and precise mesh placement, emerges as an effective approach in inguinal hernia repair. It offers significant benefits in reducing postoperative discomfort and chronic pain, thereby enhancing patient recovery and overall quality of life. This method aligns with current surgical trends towards patient-centric and minimally invasive procedures.

Purpose: Cannabis behaviors during the COVID-19 pandemic among sexual minority (SM) individuals in the United States remain understudied. This study assessed the prevalence and correlates of cannabis use and cannabis sharing, a potential risk for COVID-19 transmission, among SM and heterosexual-identified individuals in the United States during the COVID-19 pandemic. Methods: This cross-sectional study used data from an anonymous, US-based web survey on cannabis-related behaviors from August to September 2020. Included participants reported past-year nonmedical cannabis use. Associations between frequency of cannabis use and sharing behaviors by sexual orientation were evaluated using logistic regression analysis. Results: Overall, 1112 respondents reported past-year cannabis use; mean age 33 years (standard deviation = 9.4), 66% male identified (n = 723), and 31% SM identified adults (n = 340). Increased cannabis use during the pandemic was similar among SM (24.7%; n = 84) and heterosexual (24.9%; n = 187) respondents. Any sharing during the pandemic was 81% for SM adults (n = 237) and 73% for heterosexual adults (n = 486). In the fully adjusted models, the odds of daily/weekly cannabis use and the odds of any cannabis sharing among SM respondents were 0.56 (95% confidence interval [CI] = 0.42-0.74) and 1.60 (95% CI = 1.13-2.26), respectively, compared with heterosexual respondents. Conclusions: SM respondents were less likely to use cannabis with high frequency during the pandemic but more likely to share cannabis compared with heterosexual respondents. Sharing cannabis was high overall, which may increase COVID-19 risk. Public health messaging around sharing may be important during COVID-19 surges and respiratory pandemics especially as cannabis becomes more widely available in the United States.

ObjectiveWe describe the prevalence of COVID-19 vaccine uptake, substance use, and other factors associated with vaccine hesitancy among participants from nine North American cohort studies following a diverse group of individuals at risk for or living with HIV.MethodsBetween May 2021 and January 2022, participants completed a survey related to COVID-19 vaccination. Participants included those with and without substance use. Those responding as 'no' or 'undecided' to the question "Do you plan on getting the COVID-19 vaccine?" were categorized as vaccine hesitant. Differences between groups were evaluated using chi-square methods and multivariable log-binomial models were used to calculate prevalence ratios (PR) of COVID-19 vaccine hesitancy with separate models for each substance.ResultsAmong 1,696 participants, COVID-19 vaccination was deferred or declined by 16%. Vaccine hesitant participants were younger, with a greater proportion unstably housed (14.8% vs. 10.0%; p = 0.02), and not living with HIV (48.% vs. 36.6%; p

Purpose: We examined associations between vaccine confidence and COVID-19 vaccine uptake among gay, bisexual, and other men who have sex with men (GBMSM). Methods: Computer-assisted self-interviews were conducted among 249 GBMSM participating in mSTUDY from May to October 2021-a cohort of GBMSM with a history of substance use in Los Angeles. Data were collected using a vaccine confidence index. The association between vaccine confidence and COVID-19 vaccine uptake was assessed using multivariable log-binomial regression. Results: Two-thirds (64.7%) of GBMSM reported receiving at least one dose of COVID-19 vaccine. Vaccine confidence was positively associated with COVID-19 vaccine uptake. Participants expressed neutral attitudes on government trust and vaccine safety. Perceived health benefit and vaccine effectiveness were statistically significantly associated with vaccine uptake (adjusted prevalence ratio [APR] = 1.59, 95% confidence interval [CI]: 1.20-2.16; APR = 1.51, 95% CI: 1.07-2.15). Conclusions: Public health programs should prioritize public benefit and vaccine effectiveness messaging to advance vaccination among GBMSM who use substances.

Stimulant use is an important driver of HIV/STI transmission among men who have sex with men (MSM). Evaluating factors associated with increased stimulant use is critical to inform HIV prevention programming efforts. This study seeks to use machine learning variable selection techniques to determine characteristics associated with increased stimulant use and whether these factors differ by HIV status. Data from a longitudinal cohort of predominantly Black/Latinx MSM in Los Angeles, CA was used. Every 6 months from 8/2014-12/2020, participants underwent STI testing and completed surveys evaluating the following: demographics, substance use, sexual risk behaviors, and last partnership characteristics. Least absolute shrinkage and selection operator (lasso) was used to select variables and create predictive models for an interval increase in self-reported stimulant use across study visits. Mixed-effects logistic regression was then used to describe associations between selected variables and the same outcome. Models were also stratified based on HIV status to evaluate differences in predictors associated with increased stimulant use. Among 2095 study visits from 467 MSM, increased stimulant use was reported at 20.9% (n = 438) visits. Increased stimulant use was positively associated with unstable housing (adjusted [a]OR 1.81; 95% CI 1.27-2.57), STI diagnosis (1.59; 1.14-2.21), transactional sex (2.30; 1.60-3.30), and last partner stimulant use (2.21; 1.62-3.00). Among MSM living with HIV, increased stimulant use was associated with binge drinking, vaping/cigarette use (aOR 1.99; 95% CI 1.36-2.92), and regular use of poppers (2.28; 1.38-3.76). Among HIV-negative MSM, increased stimulant use was associated with participating in group sex while intoxicated (aOR 1.81; 95% CI 1.04-3.18), transactional sex (2.53; 1.40-2.55), and last partner injection drug use (1.96; 1.02-3.74). Our findings demonstrate that lasso can be a useful tool for variable selection and creation of predictive models. These results indicate that risk behaviors associated with increased stimulant use may differ based on HIV status and suggest that co-substance use and partnership contexts should be considered in the development of HIV prevention/treatment interventions.

Introduction: Varicella usually resolves without complications. However, there is a risk of necrotizing soft tissue infections such as necrotizing fasciitis (NF) that can complicate the management. Case series: Case 1 was a 5-year-old male who developed widespread vesicular lesions and fever, diagnosed as varicella. His condition worsened as he presented with abdominal distension and pain, leading to hospitalization for suspected toxic shock syndrome. Computed tomography (CT) of the chest and abdomen revealed features consistent with NF, prompting extensive debridement and subsequent vacuum-assisted closure (VAC) therapy. After several surgical revisions he underwent skin grafting and was eventually discharged home. Case 2 was a 4.5-year-old male with no significant medical history, who presented with generalized fever, neck pain, and rapidly spreading skin rashes. He subsequently developed severe acute idiopathic scrotal edema and extensive ecchymosis, requiring immediate hospitalization. Broad-spectrum antibiotics were started. He underwent emergent wide debridement of the ecchymotic areas. The pathology analysis confirmed necrotic tissue, and cultures were positive for bacteria and fungi. He underwent repeated debridement. The last debridement was followed by uncontrollable hemorrhage, and he passed away. Conclusion: While varicella is generally a mild disease, life-threatening complications such as necrotizing fasciitis can occur.

Background: Testicular ischemia/reperfusion injury, a significant result of testicular torsion, can lead to the risk of male infertility. Objective: The current study aimed to evaluate the effect of human amniotic membrane-derived mesenchymal stem cells (hAMSCs) secretome on testicular torsion/detorsion (T/D) in mice. Materials and Methods: All the experiments were performed in the Anatomy Department of Tehran University of Medical Sciences, Tehran, Iran, during the period of March 2023 to December 2023. 40 male NMRI mice (5–7 wk, 25–30 gr) were randomized into: 1) the sham group: mice received sham operations with no other interventions, 2) T/D group, 3) negative control group; torsion detorsion + intratesticular injection of Dulbecco’s Modified Eagle Medium/Nutrient Mixture F-12, and 4) the T/D group + hAMSCs secreted factors. Serum testosterone levels, hematoxylin and eosin staining, and sperm quality parameters were used to evaluate the therapeutic effects of hAMSCs secreted factors on the testicular structure and function. Tissue oxidative stress was measured by determining malondialdehyde, superoxide dismutase, catalase, and glutathione peroxidase-1. Nuclear factor erythroid 2-related factor 2, Kelch-like ECH-associated protein 1, NAD-dependent deacetylase sirtuin-1, tumor necrosis factor-alpha and tumor protein P53 mRNA expressions were assessed in testis via real-time polymerase chain reaction. Results: The results showed that hAMSCs secreted factors alleviated testicular T/D injury by attenuating oxidative stress, inflammatory response, and apoptosis via modulating the sirtuin-1/ nuclear factor erythroid 2-related factor 2 / tumor necrosis factor-alpha signaling pathway. Conclusion: hAMSCs secreted factors increased antioxidative, anti-inflammatory, and antiapoptotic properties which consequently increased testosterone levels, spermatogenesis, and sperm quality parameters.

BackgroundRelapsing multiple sclerosis (RMS) is a chronic, inflammatory disease of the central nervous system. Ublituximab, an anti-CD20 monoclonal antibody (mAb), is indicated for the treatment of RMS. We performed a systematic literature review (SLR) to identify randomized trials reporting the clinical efficacy and tolerability of ublituximab or comparator disease-modifying therapies (DMTs) for treatment of RMS, and assessed their comparative effects using network meta-analysis (NMA).MethodsThe SLR involved a comprehensive search across various medical databases to identify relevant studies. Included studies were randomized controlled trials (RCTs) of an adult RMS population, focusing on treatment with at least one of ublituximab, alemtuzumab, natalizumab, ocrelizumab, or ofatumumab. For outcomes included in the NMA (annualized relapse rate (ARR), confirmed disability progression (CDP), and treatment discontinuation rate), rate ratios (RR) or hazard ratios (HR), along with their 95% confidence intervals (CIs), were calculated. We performed NMA using a contrast-based random-effects model within a frequentist framework for all outcomes. Ranking probabilities among comparators, and intervention rankings for the NMA, were estimated using surface under the cumulative ranking curve (SUCRA).ResultsWe included 15 RCTs in the review. For the ARR outcome, there was no statistically significant difference between ublituximab and the other included mAbs [ofatumumab (RR 1.02 (95% CI 0.64–1.62)), natalizumab (RR 0.99 (0.59–1.65)), alemtuzumab (RR 0.86 (0.51–1.46)), and ocrelizumab (RR 0.75 (0.44–1.28))]. For CDP at 6 months, our results showed no statistically significant difference between ublituximab and the comparator mAbs [ofatumumab (HR 0.97 (0.49–1.92)), natalizumab (HR 1.13 (0.53–2.40)), alemtuzumab (HR 1.25 (0.56–2.81)), and ocrelizumab (HR 1.29 (0.57–2.90))]. For CDP at 3 and 6 months, there was no statistically significant difference between ublituximab and placebo. The all-cause treatment discontinuation rate analysis showed no significant difference between ublituximab and other mAbs, except for alemtuzumab.ConclusionsResults of this SLR-informed NMA showed that there is no statistically significant difference between ublituximab and the other mAbs in terms of clinical efficacy. Additionally, the findings show that there is no statistically significant difference in discontinuation rates with the exception of the comparison with alemtuzumab, which may be attributed to its unique dosing schedule.

Introduction: Influenza causes significant mortality and morbidity in the U.S., yet less than half of adults receive influenza vaccination. We use census-tract level social vulnerability index (SVI) to examine community- and individual-level characteristics of influenza vaccine coverage among primary care patients at an academic health system in Los Angeles, CA. Methods: We used electronic medical records (EMR) data of 247,773 primary care patients for 2017-18 and 2018-19 influenza seasons. We geocoded patients' addresses to identify their SVI and merged them with EMR data. We specified mixed-effects logistic regression models estimating the association between patient's vaccine receipt and SVI, adjusting for sociodemographics, Charlson Comorbidity Index, and health insurance. Results: Vaccination coverage was higher during the 2018-19 influenza season (34%) compared to the 2017-18 season (23%). In adjusted analyses, higher SVI, lower individual socioeconomic status and racial and ethnic minority status were independently associated with lower odds of vaccination. Patients on Medicaid had lower odds of vaccine receipt (adjusted Odds Ratio [aOR] = 0.77 for

Background: Fear- and trauma-related conditions, such as post-traumatic stress disorder (PTSD) and social phobia, often manifest as socially avoidant behaviours, which commonly contribute to social and occupational disability transdiagnostically. While gold-standard treatments (i.e. exposure therapy, psychotropic medications) are effective, they are hindered by high dropout rates and limited impact on real-world functioning. Furthermore, most existing interventions only target symptom reduction, with few addressing avoidance-related deficits in social and occupational functioning.Objectives: This methods paper introduces an innovative augmented reality exposure therapy (ARET) technology designed to address the limitations of traditional interventions for anxiety disorders and PTSD, by directly targeting social and occupational dysfunction through exposure to real-life social contexts.Method: We introduce an ARET system, using artificial intelligence (AI)-driven, augmented reality (AR) technology, that enables exposure to realistic scenarios within the patient's real-world environment, fostering contextual generalization and functional improvement. Featuring holographic three-dimensional humans, precise surface mapping, wireless mobility, and telemedicine capabilities, the software provides customizable exposure scenarios to transform an environment into various spaces (e.g. grocery store, house party) with diverse human characters, as well as flexible AI-driven human interactions tailored to individual needs.Results: We share observations and feedback from the treatment of first responders with PTSD. Patients found the technology easy to use, with immersive realism, active engagement, and strong emotional responses needed for effective exposure therapy. Advances in AI-driven character development and AR hardware accessibility support the wider adoption of ARET by clinicians.Conclusion: By bridging the gap between clinical interventions and real-world functioning, ARET offers a transformative approach to addressing the pervasive impact of psychiatric disorders on social and occupational outcomes.

For more than a year, the world has been exposed to the ongoing conflict in Gaza, and the destruction, medical devastation, and the death toll of this crisis. What has been largely missing from the picture, has been an attention to the long-term mental health impact of the ongoing trauma among the Palestinian civilians and the Israeli hostages in Gaza. This article anticipates the enduring generational impact of war trauma on mental health of the civilians in Gaza, drawing from the author’s clinical and research experiences of Iraqi, Syrian, Afghan, African, and Ukrainian war-exposed civilians, refugees, and survivors of torture. Across most different studies, war exposure leads to PTSD in nearly 30–50% of adult civilians, and similar rates of depression and anxiety. Civilians in Gaza, facing daily horrors and a profound sense of helplessness, are likely experiencing even greater psychological distress. Children, significantly affected during critical developmental stages, are at risk of long-term mental and physical health issues. The psychological, cultural, and epigenetic aspects of the intergenerational transmission of trauma can lead to psychological torment across generations. Addressing the mental health needs of these populations is crucial to mitigating the profound and lasting impact of war.

Abstract The nonspecific nature of cancer drug delivery often results in substantial toxic side effects during treatments for breast cancer. To mitigate these negative outcomes, our approach involves loading methotrexate (MTX) within carbon quantum dots (CQDs) synthesized from folic acid, which are then enveloped in exosomal membranes obtained from breast cancer cells (Ex@MTX-CQDs). Analysis utilizing nanoparticle tracking techniques has demonstrated that these Ex@MTX-CQDs maintain the physical and biochemical properties of their exosomal precursors. The release profile of MTX indicated a restricted release percentage (less than 10%) under normal physiological conditions, which is contrasted by a more consistent release rate (approximately 65%) when emulating the conditions found within tumor tissues. The toxicological assessments have confirmed that the presence of exosomes combined with leftover folic acid significantly improves the delivery efficacy of MTX directly to the cancerous cells through the binding to folate and heparan sulfate proteoglycan receptors. This process results in increased disruption of the mitochondrial membrane potential and subsequently triggers apoptosis, ultimately leading to the destruction of cancerous cells. Our research could potentially contribute to the further innovation and application of nanocarriers derived from biological sources for the targeted treatment of breast cancer.

Abstract Background In the available literature, levels of BDNF and CRP have been reported to correlate with suicide in depressive patients but there are inconsistencies in the results. We aimed to evaluate and compare BDNF and CRP concentrations in MDD patients with(MDD + SA) and without suicide attempts (MDD-SA) and healthy controls. Methods 30 (MDD + SA) patients, 30 (MDD-SA) patients, and 26 healthy controls were enrolled in the study. Age, sex, and BMI of patients were recorded. Blood sample was obtained for measurement of BDNF and CRP. Smoking and drug history, family history of suicide, and history of self-harm were also documented. Data were analyzed with SPSS version 22 and R version 4.1.1. Results 86 patients in three groups were evaluated (mean age: 28.45 ± 9.27 years, 56.71% female). Baseline and demographic parameters except for self-harm (40%, 3.3%, and 0% for MDD + SA, MDD-SA, and healthy controls, respectively, p = 0.001) did not differ between groups. CRP level was not significantly different between groups. BDNF showed a significant difference between groups (17.35, 16.45, and 19.43 for three groups, respectively, p