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ObjectiveTo describe how young adults use electronic cigarettes (electronic nicotine delivery systems (ENDS)) for smoking cessation and reasons why they may or may not successfully quit smoking.MethodsLongitudinal qualitative data were collected annually from 2017 to 2019 for 25 young adult tobacco users (aged 18-29 years) in California (USA) who used ENDS to quit/reduce smoking. Thematic and trajectory analyses were used to identify key within-person and between-person changes in tobacco/nicotine use over time.ResultsFive types of tobacco use transition were identified among baseline dual users of cigarettes and ENDS: sustained dual use without reduced smoking (n=8), transition to exclusive daily ENDS use (n=6), sustained dual use with reduced smoking (n=5), transition back to exclusive smoking (n=4) and transition to neither smoking nor vaping (n=2). Participants' ENDS use behaviour varied over time in terms of vaping quantity and device characteristics (eg, changing nicotine concentrations/flavours, switching between multiple devices). Three themes that related to successfully replacing cigarettes with ENDS were perceived positive physical effects, perceived satisfaction and enjoyment and context changes. Four themes for unsuccessful replacement were perceived negative physical discomforts, perceived addictiveness and harm, unsatisfactory substitution for cigarettes and device malfunction.ConclusionsYoung adults' experiences with using ENDS as a smoking cessation aid were highly variable. Adequate nicotine delivery and perceived safety and benefits contributed to successfully reducing or quitting cigarettes. Providing behavioural counselling and standardising ENDS products may enhance cessation for young adults.

Background: The Transitional Hotel Project (THP) is a noncongregate emergency hotel initiative with comprehensive wraparound services implemented at the onset of the COVID-19 pandemic. It was designed to address the emergency housing needs of adults transitioning from incarceration (returning citizens) to community reintegration. Objective: The study aims to explore the external and internal recovery needs of returning citizens participating in the THP, with a focus on their housing stability, mental and behavioral health, employment, and the development of prosocial relationships. Methods: This mixed-methods case study used de-identified case management data, focus groups, and interviews with 24 participants, including employees, key partners, and returning citizens. A thematic analysis was conducted to identify key themes related to the recovery process of returning citizens. Findings: A thematic analysis revealed three primary themes: (a) safety, including both physical and psychological aspects; (b) mutual empathy; and (c) person-centered decision-making. Two subthemes emerged under the safety theme: (a) physical safety and (b) psychological safety. Mutual empathy between participants and peer mentor staff played a critical role in fostering the recovery of returning citizens. Conclusions: The findings suggest that the physical and psychological safety provided within the hotel setting, along with the empathy and support from peer mentor staff, were significant factors contributing to positive changes in returning citizens. These elements of the THP appear to have facilitated improvements in both external recovery needs (e.g., housing stability and employment) and internal recovery processes (e.g., restructured self-identity, human agency, and perceptions of hope). [ABSTRACT FROM AUTHOR]

Background: Although carrying external load has negative effects on gait biomechanics, little evidence has been provided regarding its impact on body asymmetry. The main purpose of the present study was to examine, whether standardized equipment produced greater gait asymmetries in ground reaction force and plantar pressure. Methods: For the purpose of this study, we recruited 845 police recruits (609 men and 236 women; 72.1% men and 27.9% women) measured in two conditions: (i) 'no load' and (ii) 'a 3.5 kg load'. Absolute values in ground reaction forces and plantar pressures beneath the different foot regions were assessed with pedobarographic platform (Zebris FDM). Asymmetry was calculated as (xright − xleft)/0.5 × (xright + xleft) × 100%, where 'x' represented a given parameter being calculated and a value closer to 0 denoted greater symmetry. Results: Significant differences in ground reaction forces and plantar pressures between the left and right foot were observed, when adding 'a 3.5 kg load'. Compared to the 'no load' condition, carrying 'a 3.5 kg load' significantly increased gait asymmetries for maximal ground reaction forces beneath the forefoot (ES = 0.29), midfoot (ES = 0.20) and hindfoot (ES = 0.19) regions of the foot. For maximal plantar pressures, only the asymmetry beneath the midfoot region of the foot significantly increased (ES = 0.19). Conclusions: Findings of this study indicate that 'a 3.5 kg load' significantly increases ground reaction force and plantar pressure gait asymmetries beneath the forefoot and midfoot regions, compared to 'no load' condition. Due to higher loads, increases in kinetic gait asymmetries may have negative effects on future pain and discomfort in the foot area, possibly causing stress fractures and deviated gait biomechanics in police recruits. [ABSTRACT FROM AUTHOR]

Introduction: Even if mild forms of atopic dermatitis (AD) are usually well controlled with topical prescription drugs and emollients, the management of severe forms of the disease may be challenging, especially in special populations (SPs). These patients include groups of disadvantaged people (elderly, patients with disabilities and serious medical conditions) who are usually excluded from clinical trials. As a consequence, most of the data about the efficacy and safety of a drug in these patients derives from post-marketing experiences. In this context, the aim of our study was to retrospectively investigate the effectiveness and safety of tralokinumab in the management of AD in SPs. Methods: A 24-weeks retrospective, dual-center study was performed enrolling patients with a diagnosis of moderate-to-severe AD undergoing treatment with tralokinumab at labelled dosage. Disease severity was assessed using Eczema Area Severity Index (EASI), Pruritus–Numerical Rating Scale (P-NRS), and Dermatology Life Quality Index (DLQI) score at baseline and after 4 weeks (W4), W16, and W24. Adverse events (AEs) were monitored at the same timepoints. Statistical significance of clinical improvement (EASI, P-NRS, DLQI) at week 4, week 16, and week 24 as compared with baseline was evaluated by using Student's t-test, considering significant a p-value < 0.05. Results: Our study enrolling 27 SPs patients showed a significant improvement in EASI and P-NRS since week 4, continuing to improve up to week 24. Similarly, DLQI significantly decreases at each timepoint as compared with baseline. Finally, no AEs were reported during the study period. Of interest, our cohort included oncologic patients, a patient with a history of severe infection, as well as subjects affected by severe neurological, psychiatric, pulmonary, and/or cardiovascular disease. Discussion: Our experience showed that tralokinumab is effective and safe in elderly patients and subjects affected by severe comorbidities. [ABSTRACT FROM AUTHOR]

The Halliwick Concept has become a very popular method for use by professionals involved in instructional swimming and in therapeutic aquatics. Through a detailed look at the principles of Halliwick, this article expands on Halliwick theory by detailing applications of Halliwick to specific population groups. The practicality of implementing Halliwick methodology with and for individuals experiencing a variety of limiting challenges, both physical and cognitive/sensory, are discussed. Hints for success-oriented implementation are provided. For those unfamiliar with the Halliwick Method background resource material is included. [ABSTRACT FROM AUTHOR]

Objectives: Research in adults suggests that intrusive memories and intrusive thoughts (often referred to as intrusive cognitions) are common in members of the general population and are often seen in clinical disorders. However, little is known about the experience of intrusive cognitions in adolescents, particularly in adolescents with major depressive disorder (MDD) and post‐traumatic stress disorder (PTSD). The present study sought to gather fundamental data on these phenomena (i.e., frequency, characteristics and appraisals of intrusive cognitions) in adolescents with MDD and PTSD. Methods: Adolescents aged 11–18 with MDD (n = 11), PTSD (n = 13) and a non‐clinical control group (n = 25) completed structured interviews concerning their intrusive memories and thoughts. Results: Intrusive thoughts were common in all three groups but were particularly frequently experienced in the MDD group. Intrusive memories were expectedly very common in the PTSD group but also experienced by over half of the adolescents with MDD. Both clinical groups reported more negative emotions in response to their intrusive thoughts or memories and appraised these cognitions more negatively than the non‐clinical group. Conclusion: Intrusive memories and thoughts are common experiences in adolescents with MDD and PTSD. Emotions and appraisals relating to these cognitions may be targets for psychological intervention in this age group. However, small sample sizes limit the conclusions that can be drawn. Replication is needed with larger numbers of clinical participants. [ABSTRACT FROM AUTHOR]

AbstractThe geriatric population encompasses the largest part of the health care system worldwide. Chronic medical conditions are highly prevalent in the elderly, consequently, due to their complex health needs, there is a significant rate of multi-drug therapy. Despite the high numbers of medications prescribed, geriatric patients face several barriers when it comes to successful drug delivery including alterations in cognitive and physical function. The current review highlights the impact of chronic diseases on the ageing population along with how changes in drug pharmacokinetics could impact drug efficacy and safety. Also discussed are applications of administration routes in the geriatric population and complications that could arise. A focus is placed on the traditional and upcoming drug delivery advancements being employed in seniors with a focus addressing obstacles faced by this patient category. Nanomedicines, three-dimensional printing, long-acting formulations, transdermal systems, orally disintegrating tablets, and shape/taste modification technologies are discussed. Several barriers to drug delivery in the elderly have been identified in literature and directions for future studies should focus on addressing these gaps for geriatric drug formulation development including personalised medicine, insights into novel drug delivery systems like nanomedicines, methods for decreasing pill burden and shape/size modifications.Typically, senior citizens take more medications than any other patient population, yet most drug delivery technologies are not tailored to address the specific cognitive and physical barriers that these individuals encounter.The safety of drug delivery systems in the elderly patients should be prioritised with considerations on changes in pharmacokinetics with age, use of non-toxic excipients, and selecting drugs with minimal off-target side effects.Several commercialised and upcoming drug delivery technologies have begun to address the current limitations that the ageing population faces.Future research should focus on applying novel strategies like 3D printing, personalised medicine, and long-acting formulations to improve drug delivery to elderly patients. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Food Safety & Quality is the property of Journal of Food Safety & Quality Editorial Department and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

In the dynamic landscape of education, homeschooling continues to offer a compelling alternative to traditional schooling. Homeschool numbers surged through the pandemic and have not decreased to pre-pandemic levels. This study examines the shared connections between homeschooled families in Connecticut and local public libraries by looking at how home educators use library resources and participate in library programming; and examining how Connecticut libraries perceive and respond to the diverse needs of homeschooling communities. Based on 2 Connecticut statewide surveys, one sent to public librarians and another to homeschoolers, the study sought to identify areas of strengths, weaknesses and disconnects in the homeschool community and public library relationships in Connecticut. Both qualitative and quantitative data was collected and reviewed to identify potential improvements to the evolving role of libraries in supporting alternative education pathways, and the potential for an infusion of public library support from the homeschool community. [ABSTRACT FROM AUTHOR]

Accounting for variability in plasma protein binding of drugs is an essential input to physiologically-based pharmacokinetic (PBPK) models of special populations. Prediction of fraction unbound in plasma (fu) in such populations typically considers changes in plasma protein concentration while assuming that the binding affinity remains unchanged. A good correlation between predicted vs observed fu data reported for various drugs in a given special population is often used as a justification for such predictive methods. However, none of these analyses evaluated the prediction of the fold-change in fu in special populations relative to the reference population. This would be a more appropriate assessment of the predictivity, analogous to drug-drug interactions. In this study, predictive performance of the single protein binding model was assessed by predicting fu for alpha-1-acid glycoprotein and albumin bound drugs in hepatic impairment, renal impairment, paediatric, elderly, patients with inflammatory disease, and in different ethnic groups for a dataset of >200 drugs. For albumin models, the concordance correlation coefficients for predicted fu were >0.90 for 16 out of 17 populations with sub-groups, indicating strong agreement between predicted and observed values. In contrast, concordance correlation coefficients for predicted fold-change in fu for the same dataset were <0.38 for all populations and sub-groups. Trends were similar for alpha-1-acid glycoprotein models. Accordingly, the predictions of fu solely based on changes in protein concentrations in plasma cannot explain the observed values in some special populations. We recommend further consideration of the impact of changes in special populations to endogenous substances that competitively bind to plasma proteins, and changes in albumin structure due to posttranslational modifications. PBPK models of special populations for highly bound drugs should preferably use measured fu data to ensure reliable prediction of drug exposure or compare predicted unbound drug exposure between populations knowing that these will not be sensitive to changes in fu. [ABSTRACT FROM AUTHOR]

Remdesivir (RDV) is the mainstay antiviral therapy for moderate to severe COVID-19. Although remdesivir was the first drug approved for COVID-19, information about its efficacy and safety profile is limited in a significant segment of the population, such as people with underlying diseases, the elderly, children, and pregnant and lactating women. The efficacy and safety profile of RDV in disease progression, renal impairment, liver impairment, immunosuppression, geriatrics, pediatrics, pregnancy, and breastfeeding in COVID-19 patients was evaluated. The databases searched included Embase, Scopus, and PubMed. Only English language studies enrolling specific subpopulations with COVID-19 and treated with RDV were included. Thirty-nine clinical trials, cohorts, cross-sectional studies, and case series/reports were included. Most supported the benefits of RDV therapy for COVID-19 patients, such as lessening the duration of hospitalization, alleviating respiratory complications, and reducing mortality. Adverse effects of RDV, including liver and kidney impairment, were, for the most part, moderate to mild, supporting the safety profile of RDV therapy. RDV therapy was well tolerated, no new safety signals were detected, and liver function test abnormalities were the most common adverse events. Moreover, RDV, for the most part, was effective in managing the complications of COVID-19 and reducing mortality in these patients, except for patients with kidney impairment. Future studies, including RCTs, should include these subpopulations of patients to avoid delays associated with receiving proper medication through compassionate use programs. [ABSTRACT FROM AUTHOR]

Opioid agonist therapy is first line in the management of opioid use disorder (OUD). Many guidelines support buprenorphine as the optimal treatment due to its preferred safety profile. Extended-release buprenorphine (BUP-XR) is a weekly or monthly subcutaneously administered formulation of buprenorphine. Emerging research has explored the use of BUP-XR in a variety of patient populations to guide clinicians in determining which patients may or may not benefit from BUP-XR. We conducted a literature review in Medline, PsycInfo and Embase to capture the literature to date on BUP-XR. Abstracts were reviewed, and papers which guided selection of individuals who would or would not benefit from BUP-XR were included. Our search returned 359 articles, and 31 met inclusion criteria. Special populations who may benefit from BUP-XR include individuals experiencing homelessness, incarceration, and medical or psychiatric comorbidity, while caution should be used around pregnancy. Patient preference and patient-centered outcomes were recurring considerations to guide the selection of BUP-XR. Extended-release buprenorphine formulations represent a relatively new tool for managing OUD and may specifically benefit patients undergoing transitions in care. Further research on the comparative effectiveness of extended-release versus daily-dosing formulations and in other populations of interest is needed. [ABSTRACT FROM AUTHOR]

Copyright of Revista Médica Clínica Las Condes is the property of Editorial Sanchez y Barcelo and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The primary objective of this article is to consider the impact of the coronavirus disease-19 pandemic on pediatric anxiety from both a clinical and system-of-care lens. This includes illustrating the impact of the pandemic on pediatric anxiety disorders and consideration of factors important for special populations, including children with disabilities and learning differences. We consider the clinical, educational, and public health implications for addressing mental health needs like anxiety disorders and how we might promote better outcomes, particularly for vulnerable children and youth.

The US Food and Drug Administration (FDA) applies the Population Health Standard in tobacco product review processes by weighing anticipated health benefits against risks associated with a given commercial tobacco product at the population level. However, systemic racism (ie, discriminatory policies and practices) contributes to an inequitable distribution of tobacco-related health benefits and risks between white and Black/African Americans at the population level. Therefore, Black-centered, antiracist data standards for tobacco product review processes are needed to achieve racial equity and social justice in US tobacco control policy. Regardless of whether FDA implements such data standards, non-industry tobacco scientists should prioritise producing and disseminating Black-centred data relevant to FDA's regulatory authority. We describe how systemic racism contributes to disparities in tobacco-related outcomes and why these disparities are relevant for population-level risk assessments, then discuss four possible options for Black-centred data standards relevant to tobacco product review processes.

IntroductionFlavoured tobacco control policy exemptions and electronic cigarette products may contribute to increased youth access and tobacco use disparities.MethodsWe assessed public support among California Central Valley residents for four policies to regulate flavoured tobacco products and e-cigarettes. The probability-based, multimode survey was conducted with English-speaking and Spanish-speaking registered voters (n=845) across 11 counties between 13 and 18 August 2020. Weighted logistic regression analyses measured odds of policy support, adjusting for predictor variables (attitudes and beliefs) and covariates.ResultsThe weighted sample was 50% female and predominantly Latino (30%) or non-Hispanic white (46%); 26% had a high school education or less, and 22% an annual household income DiscussionFindings add to mounting evidence of support for policies to regulate flavoured tobacco and e-cigarette products. Results on attitudes and beliefs elucidate how these factors influence support.

Hepatocellular carcinoma （HCC） has become the second leading cause of cancer-related death worldwide, ranking 6th among all tumors. Due to the lack of obvious early symptoms, most patients are diagnosed in the advanced stage, and the clinical benefits of surgical resection and hepatic artery chemoembolization and radiofrequency ablation are very limited. In recent years, the advent of immune-targeted therapies has revolutionized the systemic and systemic treatment of patients with advanced HCC, however, there is a lack of strong clinical evidence on the safety and efficacy of immune and targeted therapies for special populations, including patients with human immunodeficiency virus （HIV） infection, active autoimmune disease, decompensated cirrhosis （Child B or C）, patients with diabetes-associated metabolic syndrome, patients with portal hypertension, vascular invasion, or portal vein thrombosis （PVT）, and patients with liver transplantation （LT）. This article reviews the current research progress of immune and targeted drugs in special populations. [ABSTRACT FROM AUTHOR]

Background. The main purpose of the study was to examine whether heavier loads might have an effect on ground reaction forces and plantar pressures. Methods. Ninety-six elite intervention police officers were recruited in this crosssectional study. Ground reaction forces and plantar pressures beneath the different foot regions were evaluated using Zebris FDM pressure platform, while a graduate increase in load carriage was as following: (i) 'no load', (ii) 'a 5-kg load', (iii) 'a 25-kg load' and (iv) 'a 45-kg load'. Results. Carrying heavier loads increased ground reaction forces beneath forefoot and hindfoot regions of both feet, and midfoot region for the right foot. For plantar pressures, increases beneath the hindfoot region of both feet and midfoot region of the right foot were observed, while carrying heavier loads. Conclusion. This study shows significant increases in both ground reaction forces and plantar pressures, especially beneath the forefoot and hindfoot regions of both feet. Since the largest forces and pressures are produced beneath the hindfoot and forefoot, future research should pay special attention to these regions and their ground absorptions, additionally preventing from muscle and joint injuries. [ABSTRACT FROM AUTHOR]

IntroductionCritically ill patients show large variability in drug disposition due to e.g., age, size, disease and treatment modalities. Physiologically-based pharmacokinetic (PBPK) models can be used to design individualized dosing regimens taking this into account. Dexamethasone, prescribed for the prevention post-extubation stridor (PES), is metabolized by the drug metabolizing enzyme CYP3A. As CYP3A4 undergoes major changes during childhood, we aimed to develop age-appropriate dosing recommendations for children of dexamethasone for PES, as proof of concept for PBPK modeling to individualize dosing for critically ill patients.MethodsAll simulations were conducted in Simcyp™ v21 (a population-based PBPK modeling platform), using an available dexamethasone compound model and pediatric population model in which CYP3A4 ontogeny is incorporated. Published pharmacokinetic (PK) data was used for model verification. Evidence for the dose to prevent post-extubation stridor was strongest for 2–6 year old children, hence simulated drug concentrations resulting from this dose from this age group were targeted when simulating age-appropriate doses for the whole pediatric age range.ResultsDexamethasone plasma concentrations upon single and multiple intravenous administration were predicted adequately across the pediatric age range. Exposure-matched predictions of dexamethasone PK indicated that doses (in mg/kg) for the 2–6 years olds can be applied in 3 month-2 year old children, whereas lower doses are needed in children of other age groups (60% lower for 0–2 weeks, 40% lower for 2–4 weeks, 20% lower for 1–3 months, 20% lower for 6–12 year olds, 40% lower for 12–18 years olds).DiscussionWe show that PBPK modeling is a valuable tool that can be used to develop model-informed recommendations using dexamethasone to prevent PES in children. Based on exposure matching, the dose of dexamethasone should be reduced compared to commonly used doses, in infants

Abstract Background This study explores how Special Interest Meetings (SIMs), also called topic-specific meetings (e.g., meetings for young people), support recovery in 12-Step fellowships for Special Populations like young people, women and LGBTQIA+ members. Despite their emergence to address the needs of these groups, the specific ways Special Interest Meetings contribute to recovery experiences are understudied. Methods In-depth interviews were conducted with 12 participants who had attended Special Interest Meetings in 12-Step fellowships to explore the role of these meetings in recovery. The interviews were analysed using the CHIME-D personal recovery framework (Connectedness, Hope, Identity, Meaning in life, Empowerment, Difficulties). Results Special Interest Meetings serve as recovery pathways for Special Populations, incorporating CHIME-D elements to aid recovery and address challenges. This study found four "Special Population Pathways” for recovery: Traditional, Hybrid, SIM-Only, and Outside-Sim Hybrid Pathway. Conclusions Special Interest Meetings address specific challenges like discrimination and exclusion faced by Special Populations in recovery. These meetings offer tailored support, deeper connections, improved recovery outcomes, and a sense of empowerment. The existence of "Special Population Pathways” emphasises the ongoing need to address diverse individuals’ specific needs throughout the recovery process.

Background: Although carrying external load has negative effects on gait biomechanics, little evidence has been provided regarding its impact on body asymmetry. The main purpose of the present study was to examine, whether standardized equipment produced greater gait asymmetries in ground reaction force and plantar pressure. Methods: For the purpose of this study, we recruited 845 police recruits (609 men and 236 women; 72.1% men and 27.9% women) measured in two conditions: (i) ‘no load’ and (ii) ‘a 3.5 kg load’. Absolute values in ground reaction forces and plantar pressures beneath the different foot regions were assessed with pedobarographic platform (Zebris FDM). Asymmetry was calculated as (xright − xleft)/0.5 × (xright + xleft) × 100%, where ‘x’ represented a given parameter being calculated and a value closer to 0 denoted greater symmetry. Results: Significant differences in ground reaction forces and plantar pressures between the left and right foot were observed, when adding ‘a 3.5 kg load’. Compared to the ‘no load’ condition, carrying ‘a 3.5 kg load’ significantly increased gait asymmetries for maximal ground reaction forces beneath the forefoot (ES = 0.29), midfoot (ES = 0.20) and hindfoot (ES = 0.19) regions of the foot. For maximal plantar pressures, only the asymmetry beneath the midfoot region of the foot significantly increased (ES = 0.19). Conclusions: Findings of this study indicate that ‘a 3.5 kg load’ significantly increases ground reaction force and plantar pressure gait asymmetries beneath the forefoot and midfoot regions, compared to ‘no load’ condition. Due to higher loads, increases in kinetic gait asymmetries may have negative effects on future pain and discomfort in the foot area, possibly causing stress fractures and deviated gait biomechanics in police recruits.

Background: This study explores how Special Interest Meetings (SIMs), also called topic-specific meetings (e.g., meetings for young people), support recovery in 12-Step fellowships for Special Populations like young people, women and LGBTQIA+ members. Despite their emergence to address the needs of these groups, the specific ways Special Interest Meetings contribute to recovery experiences are understudied. Methods: In-depth interviews were conducted with 12 participants who had attended Special Interest Meetings in 12-Step fellowships to explore the role of these meetings in recovery. The interviews were analysed using the CHIME-D personal recovery framework (Connectedness, Hope, Identity, Meaning in life, Empowerment, Difficulties). Results: Special Interest Meetings serve as recovery pathways for Special Populations, incorporating CHIME-D elements to aid recovery and address challenges. This study found four "Special Population Pathways" for recovery: Traditional, Hybrid, SIM-Only, and Outside-Sim Hybrid Pathway. Conclusions: Special Interest Meetings address specific challenges like discrimination and exclusion faced by Special Populations in recovery. These meetings offer tailored support, deeper connections, improved recovery outcomes, and a sense of empowerment. The existence of "Special Population Pathways" emphasises the ongoing need to address diverse individuals' specific needs throughout the recovery process. [ABSTRACT FROM AUTHOR]

Anticoagulants are a cornerstone of treatment in atrial fibrillation. Nowadays, direct oral anticoagulants (DOACs) are extensively used for this condition in developed countries. However, DOAC treatment may be inappropriate in certain patient populations, such as: patients with chronic kidney disease in whom DOAC concentrations may be dangerously elevated; frail elderly patients with an increased risk of falls; patients with significant drug–drug interactions (DDI) affecting either DOAC concentration or effect; patients at the extremes of body mass in whom an "abnormal" volume of distribution may result in inappropriate drug concentrations; patients with recurrent stroke reflecting an unusually high thromboembolic tendency; and, lastly, patients who experience major hemorrhage on an anticoagulant and in whom continued anticoagulation is deemed necessary. Herein we provide a fictional case-based approach to review the recommendations for the use of DOACs in these special patient populations. [ABSTRACT FROM AUTHOR]

Obesity is a growing global health concern associated with high comorbidity rates, leading to an increasing number of patients who are obese requiring medication. However, clinical trials often exclude or under‐represent individuals who are obese, creating the need for a methodology to adjust labeling to ensure safe and effective dosing for all patients. To address this, we developed a 2‐part decision tree framework to prioritize drugs for dedicated pharmacokinetic studies in obese subjects. Leveraging current drug knowledge and modeling techniques, the decision tree system predicts expected exposure changes and recommends labeling strategies, allowing stakeholders to prioritize resources toward the drugs most in need. In a case study evaluating 30 drugs from literature across different therapeutic areas, our first decision tree predicted the expected direction of exposure change accurately in 73% of cases. We conclude that this decision tree system offers a valuable tool to advance research in obesity pharmacology and personalize drug development for patients who are obese, ensuring safe and effective medication. [ABSTRACT FROM AUTHOR]

Anticoagulant therapy is commonly associated with a high incidence of avoidable adverse events, especially in the acute care setting. This has led to several initiatives by key national health care stakeholders, including specific attention to The Joint Commission's National Patient Safety Goals, to improve anticoagulation management. The subject of special populations has long been identified as challenging by clinicians with the use of anticoagulants. This is driven in part by numerous variables that can contribute to hard outcomes such as bleeding, thrombosis, length of stay, hospital re‐admission, morbidity, and mortality. Despite the notable effort to improve the use of anticoagulants with numerous clinical trials, guidelines, guidance statements, and other sources of published evidence, notable difficulties continue to challenge practitioners in managing this class of medications. This is especially the case with very diverse critically ill populations where countless variables exist, many of which were never explored in trials or have historically been frequently excluded. Trials evaluating anticoagulation therapy often can only account for small portions of variables that may affect thrombosis and hemostasis, and study methods often do not reflect the constantly changing dynamic conditions seen in unique critically ill patients. Clinicians providing care to the numerous critically ill populations are faced with conditions that lead to relatively small therapeutic windows, which makes designing safe optimal anticoagulation management plans difficult when dealing with complex patients and mechanical support devices. The approach to crafting a successful management plan for anticoagulant therapy must incorporate the numerous variables that are continuously assessed and revised during the patient's time in the intensive care unit. We explore considerations and approaches when developing, assessing, and implementing an individualized or precision‐based management plan that involves the use of anticoagulants in the critically ill. The skills and thought process provided will assist clinicians in managing this unique, variable, and challenging population. [ABSTRACT FROM AUTHOR]

This article discusses the challenges and importance of developing precision-based pharmacotherapy management plans for critically ill patients. It emphasizes the need to consider various factors such as drug interactions, comorbid conditions, and socioeconomic backgrounds when creating these plans. Effective communication and collaboration among healthcare professionals are also highlighted. The text emphasizes the importance of taking a comprehensive approach and making adjustments based on trends and potential risks. It acknowledges the limitations of existing guidelines and emphasizes the need for precision-based management in complex cases. The document provides guidance on obtaining accurate information, modifying management plans as needed, and optimizing drug-related management plans for individual patients in the intensive care unit. [Extracted from the article]

Background The main purpose of the study was to examine whether heavier loads might have an effect on ground reaction forces and plantar pressures. Methods Ninety-six elite intervention police officers were recruited in this cross-sectional study. Ground reaction forces and plantar pressures beneath the different foot regions were evaluated using Zebris FDM pressure platform, while a graduate increase in load carriage was as following: (i) ‘no load’, (ii) ‘a 5-kg load’, (iii) ‘a 25-kg load’ and (iv) ‘a 45-kg load’. Results Carrying heavier loads increased ground reaction forces beneath forefoot and hindfoot regions of both feet, and midfoot region for the right foot. For plantar pressures, increases beneath the hindfoot region of both feet and midfoot region of the right foot were observed, while carrying heavier loads. Conclusion This study shows significant increases in both ground reaction forces and plantar pressures, especially beneath the forefoot and hindfoot regions of both feet. Since the largest forces and pressures are produced beneath the hindfoot and forefoot, future research should pay special attention to these regions and their ground absorptions, additionally preventing from muscle and joint injuries.

At the end of 2019, a new coronavirus was identified as the cause of many pneumonia cases in Wuhan, a city in China's Hubei Province. These cases spread rapidly, causing an epidemic throughout China, followed by increasing cases in other countries. In February 2020, the World Health Organization defined the definition of Coronavirus disease-2019 (COVID-19), which means 2019 coronavirus disease. The virus that causes COVID-19 is called severe acute respiratory syndrome-coronavirus-2. The rapidly expanding COVID-19 pandemic has affected all areas of daily life, including medical care. Although this epidemic significantly affected individuals from all parts of society, the clinical course, diagnosis, and treatment approaches may differ in some specific populations. The association of COVID-19 with various medical comorbidities and its impact on specific and vulnerable populations need to be addressed separately. This information will also assist in the management of COVID-19. The effects and the relationship of COVID-19 on comorbidities (chronic renal, diabetes mellitus, chronic liver, etc.) and special populations (pregnant, elderly, transplant patients, etc.) are comprehensively presented in the text.

IntroductionThis study examined the impact of a San Francisco City and County ban on all flavoured tobacco products, including menthol cigarettes, among clients in residential substance use disorder (SUD) treatment.MethodsWe conducted cross-sectional surveys of clients at two residential SUD programmes before the County began enforcing the ban (n=160) and twice after enforcement began (n=102, n=120). The samples were compared on demographic characteristics, smoking status, smoking behaviours and the proportion reporting menthol as their usual cigarette. Menthol smokers were asked whether they smoked only menthol cigarettes, mostly menthol, both menthol and non-menthol or mostly non-menthol. Post-ban samples were asked about awareness of the ban and access to menthol cigarettes.ResultsIn multivariate analyses, we found no evidence that the ban was associated with decreased number of cigarettes per day or increased readiness to quit among current smokers. However, odds were lower post-ban for reporting menthol as the usual cigarette (OR=0.80, 95% CI 0.72 to 0.90), and for smoking only menthol cigarettes (OR=0.19, 95% CI 0.18 to 0.19). Perhaps most importantly, and with the ability to influence all other findings, 50% of self-identified menthol smokers reported purchasing menthol cigarettes in San Francisco nearly 1 year after the ban was implemented.ConclusionIn subgroups where smoking has remained elevated, like those receiving SUD treatment, local menthol bans may have only modest impacts on smoking behaviour. Broader regional, state or national bans, that effectively restrict access to menthol products, may be needed to show stronger effects on smoking behaviour.

IntroductionPast studies have documented disparities in regulation compliance among tobacco retailers with respect to ethnic diversity in neighbourhoods. This study investigated the association between compliance with the Food and Drug Administration (FDA) and California state rules and neighbourhood ethnic composition of a vape shop location.MethodsWe recruited 122 vape shops located in 'ethnic enclave' neighbourhoods in Southern California. Trained teams of data collectors visited each of the consented vape shops and coded items in the shops that were visible and on display. Location data for the percentages of ethnic composition for a given city were obtained from the U.S. Census Bureau, American FactFinder. Multilevel logistic regression models examined the relationship between the city-level neighbourhood ethnic composition and vape shop rule violation status: not displaying Ask4ID sign and offering free samples.ResultsVape shops located in neighbourhoods/communities with more white residents were significantly less likely to not display Ask4ID sign (p=0.03) and less likely to offer free sampling (p=0.009), controlling for other neighbourhood ethnic characteristics.DiscussionGreater enforcement for proper signage display is needed for vape shops located in racial/ethnic minority locations to ensure that minors are discouraged from purchasing e-products.

There is a notable gap in empirical research regarding how Latino men define and demonstrate machismo, masculinity, and manhood as well as the behavioral consequences associated with these concepts. In our study, we employed a phenomenological thematic approach to analyze 20 semi-structured individual interviews conducted with Latino men residing in South Florida. Our primary objectives were twofold: to examine (1) how do Latino men ages 35 to 60 years describe what it means to be a man and (2) what are the attributes that these men seek to show others that demonstrate their character, cultural values, and gender identity. Findings suggest that Latino men understood expectations associated with machismo and explained that fulfillment of their role as provider, protector, and head of the family was important to their perception of self. While some participants reported a desire to embody characteristics associated with traditional machismo, others strived to demonstrate character, familism, and respect and to provide financial and other instrumental support to their families. Participants reported that their transition into middle age was accompanied by a shift in their perspectives on gender roles, moving away from rigid patriarchal views. Exposure to a more fluid and flexible approach to manhood offered relief from the pressures associated with inflexible manifestations of machismo, which can have negative social, behavioral, and physical health implications. The implications of our research extend to the conceptualization of gender ideals, highlighting the need to incorporate intersectionality, role strain, precarious manhood, and culturally specific notions of manhood as foundational elements in this discourse. [ABSTRACT FROM AUTHOR]

Research into populations of male sex workers who have sex with men (MSMSW) has historically been stymied given the illegal, stigmatized nature of the profession. The internet has shaped how many sex workers advertise their services to clients. Few studies, however, have leveraged internet advertising data to inform MSMSW-specific public health programming and/or outreach efforts. The primary aim of this study was to describe the association between MSMSW advertising during LGBTQIA+ events in U.S. cities during the 2022 pride season. Data were web-scraped at weekly intervals from an internet platform popular among MSMSW in 16 U.S. cities with scheduled LGBTQIA+ events over 18 weeks June to October 2022. For each city, a Poisson regression was fitted for the outcome of number MSMSW advertisements/week and the association with LGBTQIA+ pride events (binary, no/yes), adjusted for month. Cities with the greatest number of MSMSW advertisements were New York City, San Francisco, and Chicago, with 848.2 (SD = 48.0), 293.3 (SD = 34.7), and 252.3 (SD = 22.8) mean weekly advertisements, respectively. LGBTQIA+ events were significantly (p < .05) associated with an increased number of MSMSW advertisements in San Francisco (incidence rate ratios (IRRs) = 1.16, 95% confidence interval (CI) = 1.07-1.25, p < .001), New York City (IRR = 1.15, 95% CI = 1.05-1.26, p < .005), and Chicago (IRR = 1.25, 95% CI = 1.12-1.39, p < .001). In these jurisdictions, LGBTQIA+ events could represent opportunities to overcome barriers to reaching MSMSW; findings from this study may assist in identifying priority cities for MSMSW-specific sexual health initiatives. [ABSTRACT FROM AUTHOR]

Over the last decade, the therapeutic scenario for advanced non-small-cell lung cancer (NSCLC) has undergone a major paradigm shift. Immune checkpoint inhibitors (ICIs) have shown a meaningful clinical and survival improvement in different settings of the disease. However, the real benefit of this therapeutic approach remains controversial in selected NSCLC subsets, such as those of the elderly with active brain metastases or oncogene-addicted mutations. This is mainly due to the exclusion or underrepresentation of these patient subpopulations in most pivotal phase III studies; this precludes the generalization of ICI efficacy in this context. Moreover, no predictive biomarkers of ICI response exist that can help with patient selection for this therapeutic approach. Here, we critically summarize the current state of ICI efficacy in the most common "special" NSCLC subpopulations. [ABSTRACT FROM AUTHOR]

At the end of 2019, a new coronavirus was identified as the cause of many pneumonia cases in Wuhan, a city in China's Hubei Province. These cases spread rapidly, causing an epidemic throughout China, followed by increasing cases in other countries. In February 2020, the World Health Organization defined the definition of Coronavirus disease-2019 (COVID-19), which means 2019 coronavirus disease. The virus that causes COVID-19 is called severe acute respiratory syndrome-coronavirus-2. The rapidly expanding COVID-19 pandemic has affected all areas of daily life, including medical care. Although this epidemic significantly affected individuals from all parts of society, the clinical course, diagnosis, and treatment approaches may differ in some specific populations. The association of COVID-19 with various medical comorbidities and its impact on specific and vulnerable populations need to be addressed separately. This information will also assist in the management of COVID-19. The effects and the relationship of COVID-19 on comorbidities (chronic renal, diabetes mellitus, chronic liver, etc.) and special populations (pregnant, elderly, transplant patients, etc.) are comprehensively presented in the text. [ABSTRACT FROM AUTHOR]

Abstract Measles, or rubeola, is a highly contagious acute febrile viral illness. Despite the availability of an effective vaccine since 1963, measles outbreaks continue worldwide. This article seeks to provide emergency physicians with the contemporary knowledge required to rapidly diagnose potential measles cases and bolster public health measures to reduce ongoing transmission.

Depression is common in pregnant women. However, the rate of antidepressant treatment in pregnancy is significantly lower than in nonpregnant women. Although some antidepressants may cause potential risks to the fetus, not treating or withdrawing the treatment is associated with relapsing and adverse pregnancy outcomes such as preterm birth. Pregnancy‐associated physiologic changes can alter pharmacokinetics (PK) and may impact dosing requirements during pregnancy. However, pregnant women are largely excluded from PK studies. Dose extrapolation from the nonpregnant population could lead to ineffective doses or increased risk of adverse events. To better understand PK changes during pregnancy and guide dosing decisions, we conducted a literature review to catalog PK studies of antidepressants in pregnancy, with a focus on maternal PK differences from the nonpregnant population and fetal exposure. We identified 40 studies on 15 drugs, with most data from patients taking selective serotonin reuptake inhibitors and venlafaxine. Most of the studies have relatively poor quality, with small sample sizes, reporting concentrations at delivery only, a large amount of missing data, and not including times and adequate dose information. Only four studies collected multiple samples following a dose and reported PK parameters. In general, there are limited data available regarding PK of antidepressants in pregnancy and deficiencies in data reporting. Future studies should provide accurate information on drug dosing and timing of dose, PK sample collection, and individual‐level PK data. [ABSTRACT FROM AUTHOR]

As pregnant individuals have traditionally been excluded from clinical trials, there is a gap in knowledge at the time of drug approval regarding safety, efficacy, and appropriate dosing for most prescription medications used during pregnancy. Physiologic changes in pregnancy can result in changes in pharmacokinetics that can impact safety or efficacy. This highlights the need to foster further research and collection of pharmacokinetic data in pregnancy to ensure appropriate drug dosing in pregnant individuals. Therefore, the US Food and Drug Administration and the University of Maryland Center of Excellence in Regulatory Science and Innovation hosted a workshop on May 16 and 17, 2022, titled "Pharmacokinetic Evaluation in Pregnancy." This is a summary of the workshop proceedings. [ABSTRACT FROM AUTHOR]

Cancers affecting pregnant women include breast cancer, melanoma, thyroid cancer, cervical cancer, lymphomas, and leukemias. The medical management of cancer during pregnancy with molecularly targeted oncology drugs remains quite challenging, with knowledge gaps about the drugs' safety and efficacy due to exclusion of pregnant women from cancer clinical trials, discontinuation of individuals who become pregnant during clinical trials, and limited information on appropriate dosing of molecularly targeted oncology drugs during pregnancy. Physiological changes occur during pregnancy and may result in alterations in the absorption, distribution, metabolism, and excretion of drugs used in pregnant women. Physiologically based pharmacokinetic modeling that incorporates physiological changes induced by both the cancer disease state and pregnancy has the potential to inform dosing of molecularly targeted oncology drugs for pregnant women, improve our understanding of the pharmacokinetic changes associated with pregnancy in patients with cancer, facilitate the design of potential studies of molecularly targeted oncology drugs in pregnant women to support dosing recommendations, and provide model‐informed pharmacokinetic data to support regulatory decision making. [ABSTRACT FROM AUTHOR]

The coronavirus disease 2019 (COVID-19) pandemic, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has been widespread globally, and vaccination is critical for preventing further spread or resurgence of the outbreak. Inactivated vaccines made from whole inactivated SARS-CoV-2 virus particles generated in Vero cells are currently the most widely used COVID-19 vaccines, with China being the largest producer of inactivated vaccines. As a result, the focus of this review is on inactivated vaccines, with a multidimensional analysis of the development process, platforms, safety, and efficacy in special populations. Overall, inactivated vaccines are a safe option, and we hope that the review will serve as a foundation for further development of COVID-19 vaccines, thus strengthening the defense against the pandemic caused by SARS-CoV-2. [ABSTRACT FROM AUTHOR]

In the years of Coronavirus Disease 2019 (COVID-19), various treatment options have been utilized. COVID-19 continues to circulate in the global population, and the evolution of the Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus has posed significant challenges to the treatment and prevention of infection. Remdesivir (RDV), an anti-viral agent with in vitro efficacy against coronaviruses, is a potent and safe treatment as suggested by a plethora of in vitro and in vivo studies and clinical trials. Emerging real-world data have confirmed its effectiveness, and there are currently datasets evaluating its efficacy and safety against SARS-CoV-2 infections in various clinical scenarios, including some that are not in the SmPC recommendations according for COVID-19 pharmacotherapy. Remdesivir increases the chance of recovery, reduces progression to severe disease, lowers mortality rates, and exhibits beneficial post-hospitalization outcomes, especially when used early in the course of the disease. Strong evidence suggests the expansion of remdesivir use in special populations (e.g., pregnancy, immunosuppression, renal impairment, transplantation, elderly and co-medicated patients) where the benefits of treatment outweigh the risk of adverse effects. In this article, we attempt to overview the available real-world data of remdesivir pharmacotherapy. With the unpredictable course of COVID-19, we need to utilize all available knowledge to bridge the gap between clinical research and clinical practice and be sufficiently prepared for the future. [ABSTRACT FROM AUTHOR]

IntroductionDeaths from HIV/AIDS have long been of concern to the gay community, but less attention has focused on smoking-attributable deaths despite the relatively high smoking rates among gay and bisexual men. This study compared deaths from HIV/AIDS with smoking-attributable deaths among California gay and bisexual men from 2005 to 2050.MethodsSmoking-attributable fractions (SAFs) were estimated using smoking prevalence for gay and bisexual men from the 2011-2014 California Health Interview Surveys and published relative risks of death. Smoking-attributable deaths were calculated by multiplying the SAFs by deaths among gay and bisexual men. Deaths from HIV/AIDS among men who have sex with men was obtained from the California Department of Public Health. Future deaths from smoking and HIV/AIDS were projected using regression equations based on time trends.ResultsFrom 2005 to 2014, smoking caused over 6800 deaths among gay and bisexual men, while nearly 9500 died from HIV/AIDS. Mortality from both causes has been falling, but deaths from HIV/AIDS have been falling more rapidly. Projections suggest that in the mid-2040s, more gay/bisexual men will die from smoking than from HIV/AIDS.ConclusionSmoking will surpass HIV/AIDS as a cause of death among gay and bisexual men in California within a few decades. The lesbian, gay, bisexual and transgender (LGBT) community was highly effective in drawing attention and resources to the fight against HIV/AIDS, saving untold lives by hastening effective treatments. Lessons learnt in the fight against AIDS should be used to help fight the tobacco epidemic.

BackgroundThe risks of polytobacco use among young adults are unclear because we know relatively little about the consistency of multiproduct patterns over time and how these patterns impact cigarette smoking. The purpose of this study was to examine changes in multiple tobacco product use over time and associations with cigarette smoking quantity.MethodsParticipants (n=335; 55% male) were 18-24 years old non-daily cigarette smokers living in California. Polytobacco use patterns were assessed quarterly for 2 years.ResultsTransition analyses showed that while the number of products that had been used recently was volatile, the most common pattern was stability between timepoints. A longitudinal negative binomial regression model indicated that those who used more non-cigarette products also reported greater cigarette quantity. The strength of this relationship increased over time.ConclusionsFindings suggest that individuals who use more tobacco products are at greater risk for increased cigarette smoking and maintaining a multiple product use pattern.

Background: Considering the adverse reactions to vaccination against coronavirus disease 2019 (COVID-19), some people, particularly the elderly and those with underlying medical conditions, are hesitant to be vaccinated. This study aimed to explore the prevalence of adverse reactions and provide direct evidence of vaccine safety, mainly for the elderly and people with underlying medical conditions, to receive COVID-19 vaccination. Methods: From 1st March to 30th April 2022, we conducted an online survey of people who had completed three doses of COVID-19 vaccination by convenience sampling. Adverse reaction rates and 95% confidence intervals were calculated. In addition, conditional logistic regression was used to compare the differences in adverse reactions among the elderly and those with underlying medical conditions with the general population. Results: A total of 3339 individuals were included in this study, of which 2335 (69.9%) were female, with an average age of 32.1 ± 11.4 years. The prevalence of adverse reactions after the first dose of inactivated vaccine was 24.6% (23.1–26.2%), 19.2% (17.8–20.7%) for the second dose, and 19.1% (17.7–20.6%) for the booster dose; among individuals using messenger RNA vaccines, the prevalence was 42.7% (32.3–53.6%) for the first dose, 47.2% (36.5–58.1%) for the second dose, and 46.1% (35.4–57.0%) for the booster dose. Compared with the general population, the prevalence of adverse events did not differ in individuals with underlying medical conditions and those aged 60 and above. Conclusions: For individuals with underlying medical conditions and those aged 60 and above, the prevalence of adverse reactions is similar to that of the general population, which provides a scientific basis regarding vaccination safety for these populations.

Abstract Background With advances in antiretroviral therapy, people with HIV (PWH) are living longer and are less likely to die from AIDS-related complications. Yet, prior research has shown that smoking is often not addressed in the context of HIV care, and few individuals are offered cessation treatment. Optimizing tobacco treatment delivery for PWH may increase engagement with evidence-based treatments and successful quit attempts. Methods The current study is a type 1 hybrid effectiveness-implementation trial to evaluate the impact of a proactive, opt-out tobacco treatment intervention on cessation outcomes and advance understanding of key barriers and facilitators of implementation processes. A total of 230 PWH who smoke will be recruited from an infectious diseases clinic at an academic medical center and will be randomized to receive (1) treatment as usual (TAU) or (2) Proactive Outreach with Medication Opt-out for Tobacco Treatment Engagement (PrOMOTE). Primary outcomes include: biochemically verified 7-day point prevalence abstinence (PPA) rates, continuous abstinence (Weeks 9–12), and the number of 24-hour quit attempts at the end of study treatment (Week 12). Secondary outcomes include: participant reach (proportion reached out of contact attempts), implementation fidelity (including number of prescriptions written), participant adherence to prescribed pharmacotherapy, acceptability (participant and provider satisfaction with intervention delivery and content), and perceived barriers. Discussion This study will examine a novel approach to optimizing tobacco treatment delivery for PWH. Integrating effectiveness and implementation results will help define best practices for engaging PWH with evidence-based tobacco treatment interventions. The intervention is low-cost, has the potential to be highly scalable, and could be translatable to other ambulatory HIV clinic settings. Trial Registration ClinicalTrials.gov: NCT05019495 (August 24, 2021).