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Importance: Cannabis use among pregnant individuals has increased. Depression and stress are frequently reported motives for cannabis use that may prolong using cannabis during pregnancy., Objective: To examine associations between changes in depression, stress, and self-reported prenatal cannabis use (PCU), to examine motives for PCU, and to examine whether trajectories of depression and stress vary across individuals who report using cannabis to cope with mental health symptoms and/or stress, those who use cannabis for other reasons, and those who do not report PCU., Design, Setting, and Participants: This cohort study recruited pregnant individuals at an obstetric clinic at an academic hospital between July 2019 and January 2024 and followed them during pregnancy. Pregnant individuals with a history of lifetime cannabis use were included. Individuals reporting heavy episodic alcohol use or with other illicit drug use were excluded., Exposure: Self-reported PCU., Main Outcomes and Measures: The primary outcomes were self-reported depression (Edinburgh Postnatal Depression Scale), stress (Cohen Perceived Stress Scale), and cannabis use at each trimester during pregnancy, as well as motives for cannabis use during the first trimester (T1). Stability and changes in depression and stress scores and categorical self-reported prenatal cannabis use from T1 to the third trimester (T3) were estimated using individual linear growth curve models., Results: In this sample of 504 patients (all identified as women; median [IQR] age, 26 [18-40] years), 236 individuals (46.8%) reported PCU after pregnancy knowledge. Depression, stress, and PCU decreased from T1 to T3 (all slope estimates less than -0.29; SEs, 0.23-0.7; all P < .001). There were positive associations between depression and PCU at T1 (r = 0.17; P = .004) and in their rate of change (r = 0.18; P = .01). Only T1 stress and PCU were correlated (r = 0.14; P = .004). Participants reporting PCU for mental health reasons (137 participants [58.1%]) had the highest depression scores at each trimester; however, their rate of change in depression was statistically equivalent to those who did not use cannabis., Conclusions and Relevance: In this cohort study of PCU, participants who used cannabis did not experience a more significant decline in stress or depression symptoms compared with those who did not use cannabis. Individuals who used cannabis for mental health reasons did not hasten a decrease in their symptoms. Health care professionals are encouraged to enhance prenatal individuals' access to empirically supported treatments for depression and stress.

Objective: To investigate whether parenting or neonatal brain volumes mediate associations between prenatal social disadvantage (PSD) and cognitive/language abilities and whether these mechanisms vary by level of disadvantage., Study Design: Pregnant women were recruited prospectively from obstetric clinics in St Louis, Missouri. PSD encompassed access to social (eg, education) and material (eg, income to needs, health insurance, area deprivation, and nutrition) resources during pregnancy. Neonates underwent brain magnetic resonance imaging. Mother-child dyads (n = 202) returned at age 1 year for parenting observations and at age 2 years for cognition/language assessments (Bayley Scales of Infant and Toddler Development, Third Edition). Generalized additive and mediation models tested hypotheses., Results: Greater PSD associated nonlinearly with poorer cognitive/language scores. Associations between parenting and cognition/language were moderated by disadvantage, such that supportive and nonsupportive parenting behaviors related only to cognition/language in children with lesser PSD. Parenting mediation effects differed by level of disadvantage: both supportive and nonsupportive parenting mediated PSD-cognition/language associations in children with lesser disadvantage, but not in children with greater disadvantage. PSD-associated reductions in neonatal subcortical grey matter (β = 0.19; q = 0.03), white matter (β = 0.23; q = 0.02), and total brain volume (β = 0.18; q = 0.03) were associated with lower cognition, but did not mediate the associations between PSD and cognition., Conclusions: Parenting moderates and mediates associations between PSD and early cognition and language, but only in families with less social disadvantage. These findings, although correlational, suggest that there may be a critical threshold of disadvantage, below which mediating or moderating factors become less effective, highlighting the importance of reducing disadvantage as primary prevention., Competing Interests: Declaration of Competing Interest This study was funded by R01MH113883, K01MH122735, T32NS121881, and T32 MH100019 from the NIH, the March of Dimes Foundation, grant MI-II-2018-725 from the Children's Discovery Institute, grant P50 HD103525 from the Washington University Intellectual and Developmental Disability Research Center, and National Alliance for Research on Schizophrenia & Depression Young Investigator Grant 28521 from the Brain and Behavior Research Foundation, and grant KL2 TR00234. The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Objective: Prenatal exposure to neighborhood crime has been associated with weaker neonatal frontolimbic connectivity; however, associations with early childhood behavior remain unclear. We hypothesized that living in a high-crime neighborhood would be related to higher externalizing symptoms at age 1 and 2 years, over and above other adversities, and that neonatal frontolimbic connectivity and observed parenting behaviors at 1 year would mediate this relationship., Method: Participants included 399 pregnant women, recruited as part of the Early Life Adversity, Biological Embedding, and Risk for Developmental Precursors of Mental Disorders (eLABE) study. Geocoded neighborhood crime data was obtained from Applied Geographic Solution. A total of 319 healthy, non-sedated neonates underwent scanning using resting-state functional magnetic resonance imaging (fMRI) on a Prisma 3T scanner and had ≥10 minutes of high-quality data. Infant-Toddler Socioemotional Assessment Externalizing T scores were available for 274 mothers of 1-year-olds and 257 mothers of 2-year-olds. Observed parenting behaviors were available for 202 parent-infant dyads at 1 year. Multilevel and mediation models tested longitudinal associations., Results: Living in a neighborhood with high violent (β = 0.15, CI = 0.05-0.27, p = .004) and property (β = 0.10, CI = 0.01-0.20, p = .039) crime was related to more externalizing symptoms at 1 and 2 years, controlling for other adversities. Weaker frontolimbic connectivity was also associated with higher externalizing symptoms at 1 and 2 years. After controlling for other adversities, parenting behaviors mediated the specific association between crime and externalizing symptoms, but frontolimbic connectivity did not., Conclusion: These findings provide evidence that early exposure to neighborhood crime and weaker neonatal frontolimbic connectivity may influence later externalizing symptoms, and suggest that parenting may be an early intervention target for families in high-crime areas., Plain Language Summary: This longitudinal study of 399 women and their children found that toddlers who lived in a high crime area during the first 2 years of their lives displayed more externalizing symptoms. Toddlers with weaker frontolimbic brain function at birth also had higher externalizing symptoms at 1 and 2 years. Interestingly, parenting behaviors, but not neonatal brain function, mediated the relationship between neighborhood crime exposure and externalizing symptoms in toddlerhood., Diversity & Inclusion Statement: We worked to ensure race, ethnic, and/or other types of diversity in the recruitment of human participants. We worked to ensure that the study questionnaires were prepared in an inclusive way. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented racial and/or ethnic groups in science. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented sexual and/or gender groups in science. We actively worked to promote sex and gender balance in our author group. We actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our author group. While citing references scientifically relevant for this work, we also actively worked to promote sex and gender balance in our reference list. While citing references scientifically relevant for this work, we also actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our reference list. The author list of this paper includes contributors from the location and/or community where the research was conducted who participated in the data collection, design, analysis, and/or interpretation of the work., (Copyright © 2023 American Academy of Child and Adolescent Psychiatry. Published by Elsevier Inc. All rights reserved.)

Background: Increasing cannabis use among pregnant people and equivocal evidence linking prenatal cannabis exposure to adverse outcomes in offspring highlights the need to understand its potential impact on pregnancy and child outcomes. Assessing cannabis use during pregnancy remains a major challenge with potential influences of stigma on self-report as well as detection limitations of easily collected biological matrices., Objective: This descriptive study examined the concordance between self-reported (SR) cannabis use and urine drug screen (UDS) detection of cannabis exposure during the first trimester of pregnancy and characterized concordant and discordant groups for sociodemographic factors, modes of use, secondhand exposure to cannabis and tobacco, and alcohol use and cotinine positivity., Study Design: The Cannabis Use During Development and Early Life (CUDDEL) Study is an ongoing longitudinal study that recruits pregnant individuals presenting for obstetric care, who report lifetime cannabis use as well as using (n = 289) or not using cannabis (n = 169) during pregnancy. During the first trimester pregnancy visit, SR of cannabis use and a UDS for cannabis, other illicit drugs and nicotine are acquired from eligible participants, of whom 333 as of 05/01/2023 had both., Results: Using available CUDDEL Study data on both SR and UDS (n = 333; age 26.6 ± 4.7; 88.6% Black; 45.4% below federal poverty threshold; 56.5% with paid employment; 89% with high school education; 22% first pregnancy; 12.3 ± 3.6 weeks gestation), we classified pregnant individuals with SR and UDS data into 4 groups based on concordance (k = 0.49 [95% C.I. 0.40-0.58]) between SR cannabis use and UDS cannabis detection during the first trimester: 1) SR+/UDS+ (n = 107); 2) SR-/UDS- (n = 142); 3) SR+/UDS- (n = 44); 4) SR-/UDS+ (n = 40). Those who were SR+/UDS- reported less frequent cannabis use and fewer hours under the influence of cannabis during their pregnancy. Those who were SR-/UDS+ were more likely to have joined the study at a lower gestational age with 62.5% reporting cannabis use during their pregnancy prior to being aware that they were pregnant. Of the 40 SR-/UDS+ women, 14 (i.e., 35%) reported past month secondhand exposure, or blunt usage. In the subset of individuals with SR and UDS available at trimester 2 (N = 160) and 3 (N = 140), concordant groups were mostly stable and > 50% of those in the discordant groups became concordant by the second trimester. Classifying individuals as exposed or not exposed who were SR+ and/or UDS+ resulted in minor changes in group status based on self-report at screening., Conclusion: Overall, there was moderate concordance between SR and UDS for cannabis use/exposure during pregnancy. Instances of SR+/UDS- discordancy may partially be attributable to lower levels of use that are not detected on UDS. SR-/UDS+ discordancy may arise from recent use prior to knowledge of pregnancy, extreme secondhand exposure, deception, and challenges with completing questionnaires. Acquiring both self-report and biological detection of cannabis use/exposure allows for the examination of convergent evidence. Classifying those who are SR+ and/or UDS+ as individuals who used cannabis during their first trimester after being aware of their pregnancy resulted in only a minor change in exposure status; thus, relying on self-report screening, at least in this population and within this sociocultural context likely provides an adequate approximation of cannabis use during pregnancy., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Ryan Bogdan, Arpana Agrawal, Cynthia Rogers reports financial support was provided by NIH., (Copyright © 2024 Elsevier Inc. All rights reserved.)

An optoelectronic ear oximeter (Hewlett-Packard, model 47201A) was evaluated as a noninvasive method for determining arterial oxygen saturation (SaO2) in human subjects during exposure to various levels of accelerative forces. This physiological calibration involved exposing five subjects, while breathing air and wearing the ear oximeter for 60 s to each of three levels of accelerative forces (3, 5, and 7 G); arterial blood samples were withdrawn concurrently. SaO2 was calculated indirectly from the oxygen tensions (PaO2) measured from the sampled arterial blood with a blood gas analyzer and corrected for pH and base excess. These data were compared, as were similar data taken from the same subjects breathing three different hypoxic gas mixtures while resitng at earth's gravity (1 G). Regression analyses of these data for both experimental groups (a, G exposure, or b, hypoxic exposure), comparing the ear-oximeter SaO2 with the calculated SaO2, showed the ear oximeter to be accurate with correlation coefficients of 0.95 and 0.98, respectively.

Eight experimental subjects from the USAF Sschool of Aerospace Medicine (SAM) and four YF-16/17 test pilots were exposed to a simulated aerial combat maneuver (SACM) which included a maximum G exposure of 6 s at 8 G. The following physiologic parameters were examined relative to seatback angles of 23degrees, 28degrees, and 40degrees; heart rate and rhythm; arterial oxygen saturation; performance; intrathoracic (esophageal) pressure; arterial pressure; and subject comfort, effort, and fatigue. Relaxed and straining high sustained G (HSG) tolerances (6 G for 60 s) were also determined using only SAM subjects. The advantages of the 40 degree setback angle during the SACM included increased subject comfort, less fatigue and effort, greater pilot acceptance and a statisically significant reduction in the increased mean heart rate associated with G exposure. On the other hand, a statistically significant reduction in arterial oxygen saturation was obtained during the SACM at 40 degrees compared with the 23 degree back angle. An increase in relaxed G tolerance was found with the 40degree seatback angle--statistically significant only compared with the 28 degree seatback angle.

Lt Paul R. Wolff, MC, USNR, is the first to receive Pride and Professionalism recognition for his heroic and professional action while responding to the crash of a Japanese Maritime Self Defense Force PS-1 aircraft. At the time of the crash, Dr. Wolff was assigned as the senior flight surgeon representing the First Marine Aircraft Wing and Naval Regional Medical Center Branch Clinic, Marine Corps Air Station, Iwakuni, Japan. On 26 April, 1983, the aircraft crashed just outside the perimeter of the Marine Corps Air Station. Lt Wolff was the first medical person to arrive at the crash site and immediately took charge of the medical aspects of the rescue. Upon learning that several air-crew members were still trapped inside the smoldering wreckage, he unhesitatingly and with complete disregard for his personal safety while fully aware of the personal dangers involved, entered the wreckage to provide medical care to the injured during a 4-hour period. Lt Wolff's bravery, superlative knowledge, exceptional skills, and outstanding leadership abilities under extremely dangerous circumstances led to saving the lives of three crewmen who were trapped. Below is a narration of the events that took place after the crash and Lt Wolff's medical response in the ensuing hours. It is given by Lt Wolff as he recounts the events.

In aerial combat maneuvers (ACMs), at Luke AFB, Az, eight pilots flew their two F-15 aircraft against nine pilots in three F-106 aircraft. A total of nine flights, consisting of 23 ACMs, were accomplished in 5 successive days. The degrees of fatigue, stress, and sympathetic activity were quantified using both subjective analyses and the biochemical constituents in the urine of the pilots of the F-15 or F-106. Biochemical indicators, reported per 100 mg creatinine, included: epinephrine, norepinephrine, 17-OHCS, urea, inorganic phosphate, sodium, potassium, and sodium/potassium ratio. The F-106 pilots exerted more relative effort than did the F-15 pilots--effort which appeared to be associated with high-G experience. Both groups of pilots were equally fatigued following ACMs; however, only the fatigue of the F-106 pilots was directly correlated with the length of the ACM. Sympathetic and stress responses during the ACM--similar for both groups of pilots--showed postflight increases of 54% in epinephrine, 19% in norepinephrine, and 20% in 17-OHCS over preflight values, thus suggesting a moderate stress response. Resting levels of these same indicators, for days the pilots did not fly and for pre-ACM values, were similar but higher than control values previously reported for other stressful activities. By late afternoon, postflight values for these indicators had returned to near-preflight levels.

Two studies were conducted to evaluate physiological responses and possible tolerance to high sustained +Gz forces at the USAF School of Aerospace Medicine, using the 20-ft (6.10 m) radius Human Centrifuge. In the first study (A), 14 human volunteer subjects--fully protected with an anti-G suit and performing the M-1 or L-1 straining maneuver--were exposed to +Gz forces. These forces began at +6.5 Gz, and increased weekly in 0.5 G increments to +9.0 Gz, for a duration of 45 sec at each level. Physiological performance was based mostly on the subjects' ability to maintain clear vision during the 45 sec exposure. Of the 14 subjects, 9 were able to maintain vision and remain at the +9 Gz level for 45 sec. In the second study (B), 12 human volunteer subjects--also protected with anti-G suits and using the straining maneuvers--were exposed to levels of +1, 3, 6, and 8 Gz, for 60 sec at each level. Extensive physiologic parameters were recorded in order to detect objective criteria which could be used as determinants for a medical tolerance endpoint to the particular level of +Gz stress. In both studies, the reasons for stopping the runs at levels exceeding +7.5 Gz included: fatigue, cardiac arrhythmias, blackout, and one occurrence of ventricular tachycardia. Other physiological responses to the sustained +Gz stress (such as heart rate, arterial blood pressure, central venous blood pressure, arterial oxygen saturation, gastric pressure, and ankle venous pressure) did not furnish specific information that could be used as "physiological tolerance limit" criteria.

Because the form of QRS from the body surface of pigs is different from that of carnivores or ungulates, and because that form is dependent upon pathways of ventricular activation, this study was designed to study pathways of ven tricular activation in pigs. Twelve pigs were anesthetized and right or left hemithoracotomies were performed to expose the heart. Contiguous bipolar electrograms were recorded from button electrodes on the epicardium and from both faces of the interventicular septum, and from multipolar plunge electrodes introduced into the intramural regions of both ventricles. Electrograms were recorded simultaneous with the Z-axis ECG at 625 mm/sec paper speed on a photographic oscillograph. Times of arrival of waves of activation at numerous points in the ventricle were referenced to the peak of the R-wave in the Z-axis ECG. During the initial 10 msec of QRS, the apical-third of the interventricular septum is activated from left to right. During the next 40 msec of QRS, waves of activation originating at the cranial portion of the right ventricle and the caudal portion of the left ventricle engulf the epicardium toward the interventricular septum and slightly in an apico-basilar direction. Activity begins slightly earlier at the caudal aspect of the left ventricular free-wall and terminates on the pulmonary conus region. During the terminal 30 msec of QRS, the basilar third of the interventricular septum is activated in a general apico-basilar direction. Through regions of either right or left ventricular free-walls was a general endocardial to epicardial activation observed. These pathways of ventricular activation may be explained by the rather complete penetration of Purkinje fibers through both ventricular free-walls in a manner similar to that of ungulates but different from carnivores and primates.