Organizational trust, usability, and inclusivity are key implementation facilitators for a proposed assets-based mobile health intervention.

Assets-based interventions can address child health disparities by connecting families to existing community resources. Community collaboration when designing interventions may identify barriers and facilitators to implementation. The objective of this study was to identify crucial implementation considerations during the design phase of an asset-based intervention to address disparities in childhood obesity, Assets for Health. We conducted focus groups and semi-structured interviews with caregivers of children (<18 years) (N = 17) and representatives of community-based organizations (CBOs) which serve children and families (N = 20). Focus group and interview guides were developed based on constructs from the Consolidated Framework for Implementation Research. Data were analyzed using rapid qualitative analysis and matrices were used to identify common themes within and across groups of community members. Desired intervention characteristics included an easy-to-use list of community programs that could be filtered based on caregiver preferences and local community health workers to promote trust and engagement among Black and Hispanic/Latino families. Most community members felt an intervention with these characteristics could be advantageous versus existing alternatives. Key outer setting characteristics which were barriers to family engagement included families' financial insecurity and lack of access to transportation. The CBO implementation climate was supportive but there was concern that the intervention could increase staff workload beyond current capacity. Assessment of implementation determinants during the intervention design phase revealed important considerations for intervention development. Effective implementation of Assets for Health may depend on app design and usability, fostering organizational trust and minimizing the costs and staff workload of caregivers and CBOs, respectively.

The purpose of our work was to design a program to connect families with children to existing health-promoting resources in their communities (i.e., group exercise, food pantries, community gardens). We specifically wanted to capture the needs and preferences of parents with children and community-based organizations and determine the possible barriers to creating this program. Based on prior community listening sessions, the program, called Assets for Health, would consist of a mobile app which lists community resources and a community health worker to help connect families to these resources. We presented the idea for Assets for Health to a diverse group of parents and community-based organizations using focus groups and interviews to carefully capture their thoughts. We then analyzed what was said. This work showed that parents were struggling to find community programs that fit their needs and thought a program like Assets for Health could be helpful. Also organizations were struggling to show families that they could be trusted and that all families were welcome.

Optimization of Opioid Discharge Prescriptions Following Thyroid and Parathyroid Surgery.

OBJECTIVE: To evaluate the impact of a quality improvement bundle on opioid discharge prescribing following thyroidectomy and parathyroidectomy. METHODS: This before-and-after study included patients undergoing thyroidectomy or parathyroidectomy at an academic medical center. The quality improvement bundle included a patient education flyer, electronic health record order sets with multimodal analgesia regimens, and provider education. The preimplementation cohort included patients treated from January 2018 to December 2019. The postimplementation cohort included patients treated from June 2021 to August 2021. The primary outcome was the proportion of patients who received new opioid discharge prescriptions. RESULTS: A total of 160 patients were included in the preimplementation cohort, and the first 80 patients treated after bundle implementation were included in the postimplementation cohort. Patients receiving new opioid discharge prescriptions decreased from 80% (128/160) in the preimplementation cohort to 35% (28/80) in the postimplementation cohort with an unadjusted absolute reduction of 45% (95% CI, 33%-57%; P < .001; number needed to treat = 3) and an adjusted odds ratio (OR) of 0.08 (95% CI, 0.04-0.19; P < .001). The bundle was associated with reductions in opioid discharge prescriptions that exceeded 112.5 oral morphine milligram equivalents (33% pre- vs 10% postimplementation; adjusted OR, 0.20; P = .001) or 5 days of therapy (17% pre- vs 6% postimplementation; adjusted OR, 0.34; P = .049). DISCUSSION: Implementation of a pain management quality improvement bundle reduced opioid discharge prescribing following thyroidectomy and parathyroidectomy. IMPLICATIONS FOR PRACTICE: Unnecessary opioid prescriptions generate unused opioids in patients' homes that can lead to opioid misuse. We believe that this bundle reduced the risk for opioid misuse in our community. REGISTRATION: The study was registered at ClinicalTrials.gov (NCT04955444) before implementation.

Evaluating the efficacy of telephone-based outreach in addressing hypertension control among black men with severe hypertension: An observational study.

BACKGROUND: The high prevalence of uncontrolled hypertension (systolic blood pressure [SBP] ≥140 mmHg or diastolic blood pressure [DBP] ≥90 mmHg) in Black patients represents a significant racial health disparity in the United States. AIMS: This study evaluated the efficacy of a telephone-based strategy for inviting high-risk patients with severe hypertension to weekly self-management education classes. Further, the study assessed how the outreach intervention correlated with relevant quality improvement outcomes, including improved blood pressure and primary care follow-up among our clinic population of Black men with severe hypertension. METHODS: A cohort of 265 Black men aged ≥18 years with SBP ≥160 mmHg or DBP ≥100 mmHg at the most recent clinic visit were identified using Epic reports formatted for Federal Uniformed Data Set annual reporting. Telephone outreach was used to invite the cohort to attend weekly in-person classes facilitated by various healthcare professionals. Logistic regression was performed to determine the associations between being reached by phone with (1) class attendance and (2) follow-up appointment attendance. RESULTS: Most of the Black men were single (57.4%, n = 152), 49.1% had history of alcohol or substance use (n = 130), and 35.8% (n = 95) was uninsured. The average age was 55.6 years (SD = 11.6). After controlling for sociodemographic factors, being reached by phone was significantly associated with an increased likelihood of patient attendance at follow-up appointments (OR = 1.91, p = .038) but not with class attendance (OR = 2.45, p = .155). Patients who attended a follow-up appointment experienced significant reductions in both SBP and DBP at 9 months. LINKING EVIDENCE TO ACTION: Telephone outreach was labor-intensive but effective in keeping under-resourced patient populations engaged in primary care. Future work should aim to develop more efficient strategies for engaging high-risk patients in self-monitoring education to manage hypertension.

Features of Multiple Endocrine Neoplasia Type 1 and 2A in a Patient with Both RET and MEN1 Germline Mutations.

The coexistence of multiple endocrine neoplasia type 1 (MEN1) and type 2A (MEN2A) is a rare occurrence and has been reported only twice in the literature. We present a patient with primary hyperparathyroidism and medullary thyroid cancer with strong family history of both MEN1- and MEN2A-associated conditions. Genetic testing showed the patient had a novel MEN1 loss-of-function mutation, c0.525_526insTT (p.Ala176Leufs*10), and an uncommon Cys630Tyr RET mutation. This case highlights the importance of obtaining a detailed family history when heritable endocrine disorders are suspected.

Gene expression profiling for molecular staging of cutaneous melanoma in patients undergoing sentinel lymph node biopsy.

BACKGROUND: A gene expression profile (GEP) test able to accurately identify risk of metastasis for patients with cutaneous melanoma has been clinically validated. OBJECTIVE: We aimed for assessment of the prognostic accuracy of GEP and sentinel lymph node biopsy (SLNB) tests, independently and in combination, in a multicenter cohort of 217 patients. METHODS: Reverse transcription polymerase chain reaction (RT-PCR) was performed to assess the expression of 31 genes from primary melanoma tumors, and SLNB outcome was determined from clinical data. Prognostic accuracy of each test was determined using Kaplan-Meier and Cox regression analysis of disease-free, distant metastasis-free, and overall survivals. RESULTS: GEP outcome was a more significant and better predictor of each end point in univariate and multivariate regression analysis, compared with SLNB (P < .0001 for all). In combination with SLNB, GEP improved prognostication. For patients with a GEP high-risk outcome and a negative SLNB result, Kaplan-Meier 5-year disease-free, distant metastasis-free, and overall survivals were 35%, 49%, and 54%, respectively. LIMITATIONS: Within the SLNB-negative cohort of patients, overall risk of metastatic events was higher (∼30%) than commonly found in the general population of patients with melanoma. CONCLUSIONS: In this study cohort, GEP was an objective tool that accurately predicted metastatic risk in SLNB-eligible patients.

Development of a prognostic genetic signature to predict the metastatic risk associated with cutaneous melanoma.

PURPOSE: The development of a genetic signature for the identification of high-risk cutaneous melanoma tumors would provide a valuable prognostic tool with value for stage I and II patients who represent a remarkably heterogeneous group with a 3% to 55% chance of disease progression and death 5 years from diagnosis. EXPERIMENTAL DESIGN: A prognostic 28-gene signature was identified by analysis of microarray expression data. Primary cutaneous melanoma tumor tissue was evaluated by RT-PCR for expression of the signature, and radial basis machine (RBM) modeling was performed to predict risk of metastasis. RESULTS: RBM analysis of cutaneous melanoma tumor gene expression reports low risk (class 1) or high risk (class 2) of metastasis. Metastatic risk was predicted with high accuracy in development (ROC = 0.93) and validation (ROC = 0.91) cohorts of primary cutaneous melanoma tumor tissue. Kaplan-Meier analysis indicated that the 5-year disease-free survival (DFS) rates in the development set were 100% and 38% for predicted classes 1 and 2 cases, respectively (P < 0.0001). DFS rates for the validation set were 97% and 31% for predicted classes 1 and 2 cases, respectively (P < 0.0001). Gene expression profile (GEP), American Joint Committee on Cancer stage, Breslow thickness, ulceration, and age were independent predictors of metastatic risk according to Cox regression analysis. CONCLUSIONS: The GEP signature accurately predicts metastasis risk in a multicenter cohort of primary cutaneous melanoma tumors. Preliminary Cox regression analysis indicates that the signature is an independent predictor of metastasis risk in the cohort presented.

First Report in Chile of Mycocentrospora acerina, Causal Agent of Peony (Paeonialactiflora) Red Spot.

A survey to identify pathogens causing peony diseases in southern Chile (37°95' to 40°58'S) was conducted from 2008 to 2011. A noticeable symptom consisted of small red spots on leaves, stems, sepals, and first petals of the bud. The central part of the lesions (1 cm) enlarged, darkened, and became necrotic, coincident with rainy and cold weather, including frosts. Lesions grew but never coalesced completely. At the edges of leaves, the infected tissues cracked and produced a twisted and corrugated appearance. Rhizome symptoms were also observed and consisted of black spots, which enlarged to elongated lesions. Small pieces (~1 × 1 mm) of symptomatic leaves, previously washed with 2% NaOCl for 2 min were cultured on potato dextrose agar (PDA) and V8 juice agar (20%) media. The cultures were incubated in growth chambers at 20°C (dark) and 5°C (dark)/20°C (light) for 12/12 h (dark/light). Sporulation was obtained only with V8 under the dark and light regime. Mycelia growth was superficial and immersed in the media; hyphae were septate with thick black walls. Conidiophores were flexuous, not branched, and produced a single spore. Spores were elongate, multiseptate, with a long, strongly curved beak. After one week, sporulation decreased and thick-walled, round black clamydospores formed in the media. Spores ranged from 125 to 235 µm long and most frequently were 170 to 220 µm. The number of septa ranged from 5 to 12. Morphological and cultural characteristics fit the description of Mycocentrospora acerina (Harting) Deighton (1,2). DNA was obtained from fungal culture. The internal transcribed spacer (ITS) region was amplified using ITS1/ITS4 primers (3), and part of the amplicon (502 of 550 pb) was sequenced. The sequence was deposited in GeneBank (Accession No. KF015599) and showed 100% identity values with sequences of similar regions from M. acerina (strain ATCC 16259, Accession No. KF278454). Healthy leaves and rhizome pieces were washed with sterile distilled water and placed on sterile moist paper towel. A small agar disc with mycelium was placed on the leaves and rhizomes with and without wounding before inoculation. The inoculated materials were kept in closed boxes with high humidity at 5 to 20°C. Tests were positive in leaves and rhizomes with and without wounds. Seven days after leaf inoculations, necrotic symptoms developed. A second inoculation test in peony leaves of plants bagged with plastic under field conditions corroborated the in vitro test. Inoculated rhizomes developed dark orange lesions initially, then turned black with a watery consistency, similarly to affected rhizomes in the field. In both tests, controls showed no symptoms. To our knowledge, this is the first report of M. acerina on P. lactiflora globally (4). In an evaluation at Carillanca (38°41'S, 72°25'W), using a scale from 0 (no symptoms) to 7 (necrotic lesions covering >60% of foliage, with death of stems), 11 out of 31 peony varieties scored 0-1. As a reference, a score of 3 is the maximum damage allowed on peonies for export. These varieties might help to keep Chilean peonies in the market without an economic impact. References: (1) M. B. Ellis. Dematiaceous Hyphomycetes. CMI. Surrey, England, 1971. (2) B. C. Sutton and I. A. S Gibson. M. acerina. CMI. Descriptions of Pathogenic Fungi and Bacteria, No. 537.1977. (3) T. J. White et al. PCR Protocols. Academic Press, San Diego, CA, 1990. (4) D. F. Farr and A. Y. Rossman. Fungal Databases. Syst. Mycol. Microbiol. Lab., ARS, USDA. Retrieved April 16, 2014.

Comparison of two chemotherapy-induced peripheral neuropathy measurement approaches in children.

PURPOSE: Chemotherapy-induced peripheral neuropathy (CIPN) is a common side effect of cancer treatment in children; however, measurement of CIPN has been hampered by limitations in available tools, which may impact prevalence estimates. The purpose of this study was to assess the relative ability of the Common Terminology Criteria (CTCAE) rating process to detect sensory and motor neuropathy as compared to administration of the pediatric modified Total Neuropathy Score (peds-mTNS). METHODS: The ped-mTNS was administered to 60 children/adolescents ages 5-18 undergoing treatment for acute lymphocytic leukemia, lymphoma, or non-CNS solid tumors. CTCAE v3.0 scores for the same time point were abstracted from the medical record by a separate trained rater. Comparisons were made between scores using descriptive statistics, correlations, and specificity and sensitivity calculations. RESULTS: The median ped-mTNS score was 9 (32 possible), while the median sensory and motor CTCAE ratings were 0 and 2, respectively (4 and 5 possible, respectively). There was no correlation between ped-mTNS and combined sensory and motor CTCAE scores. The only ped-mTNS item with significant correlation to CTCAE scoring was strength testing. Medical record abstraction of CTCAE scores failed to identify sensory neuropathy in 40 % and significant motor neuropathy (manual muscle test grade 3 or worse) in 15 % of subjects. CONCLUSIONS: Prospective measures of CIPN using the ped-mTNS identified a far greater proportion of subjects with peripheral neurotoxicity as compared to CTCAE v3.0 sensory and motor neuropathy ratings, and thus we recommend the use of a specific measure of CIPN such as the ped-mTNS.

Effect of localized muscle fatigue on vertical ground reaction forces and ankle joint motion during running.

The purpose of this study was to examine the changes in the vertical ground reaction force (VGRF) and ankle joint motion during the first 50% of the stance phase of running following fatiguing exercise of either the dorsiflexors or the invertors of the foot. VGRFs, sagittal and rearfoot kinematic data were collected from 11 female recreational runners running at 2.9 m/second on a treadmill prior to and following localized muscle fatigue of either the invertors or dorsiflexors of the right foot. Loading rate of the impact peak force significantly increased following fatiguing exercise of the dorsiflexors, while the peak magnitudes of the impact and push-off forces remained unchanged. There were significant decreases in dorsiflexion at heel contact, but no significant difference in any rearfoot motion parameters tested following dorsiflexor fatigue. Following fatiguing exercise of the invertors, impact peak magnitude, push-off peak magnitude and the rate of decline of the impact peak force significantly decreased; there was no change in the loading rate of the impact peak force. Invertor fatigue also resulted in a less inverted foot position at heel contact, but there were no significant differences in any other kinematic parameters tested. The results demonstrate that localized muscle fatigue of either the invertors or dorsiflexors can have a significant effect on the loading rates, peak magnitudes and ankle joint motion seen during running. These changes, due to localized muscle fatigue, may play a role in many common lower extremity running injuries.

Mixtures of octopamine and serotonin have nonadditive effects on the CNS of the medicinal leech.

It is well established that neural networks respond to a wide variety of modulatory substances by which they can become reconfigured, yet few studies have examined the effects of neurotransmitter mixtures on such networks. In a previous study of the medicinal leech using triple intracellular recordings, we found that stimulation of identified mechanosensory neurons activated both the serotonergic cell 21 (a swimgating neuron) and the dorsal lateral octopamine (DLO) cell. Because these findings suggested that serotonin (5-HT) and octopamine (OA) may be released together, we investigated the effects of 5-HT and OA mixtures on isolated nerve cords of Hirudo medicinalis (which contained both head and tail brains). Fifty micromolar OA, 50 microM 5-HT, or a mixture of 50 microM OA and 50 microM 5-HT was bath applied to the nerve cord under constant perfusion conditions. Additional experiments were performed with combinations of either 25 or 100 microM OA and 5-HT. Neural activity was examined specifically in the segmentally repeated dorsal posterior (DP) nerve because it has been shown to contain identified swim motor units. Nonadditive effects of amine combinations were most apparent in their ability to decrease overall activity in the DP nerve and to alter patterned motor activity in the form of fictive swimming. Whereas swim burst activity has been previously shown to increase in nerve cords bathed in either 5-HT or OA solutions alone, we demonstrated that a mixture of the two amines resulted in a robust decrease in the number of swim bursts expressed and an inhibition of swim activity in preparations already swimming. Most compelling was the observation that when the amine mixture was replaced with normal saline, swim burst activity increased dramatically. We discuss that the effects of amine mixtures may be due to their interaction with descending interneurons known to trigger and inhibit swimming as the mixture-induced effects were not observed in nerve cords lacking the head and tail brains. Because the net effect of the two amines was not simply additive (i.e., 5-HT or OA is known to activate swimming, yet the mix inhibits swimming), this result reveals yet another layer of complexity inherent in "simpler" invertebrate nervous systems.

Steroid regulation of octopamine expression during metamorphic development of the moth Manduca sexta.

Octopamine (OA), a biogenic amine similar to norepinephrine, has profound and well-documented actions on the nervous systems of invertebrates. In the insect, Manduca sexta, we examined the developmental plasticity of OA synthesis, studied its endocrine regulation, and observed previously undescribed OA-immunoreactive (ir) neurons. We found that levels of tyramine beta-hydroxylase (TbetaH), an essential enzyme for the biosynthesis of OA, increase during metamorphosis. Based on the established and influential roles of the steroid hormone 20-hydroxyecdysone (20-HE) during development, we tested the hypothesis that increases in TbetaH levels and OA immunoreactivity are regulated by the rise in 20-HE occurring during pupal-adult development. We determined that the levels of TbetaH in the terminal abdominal ganglion (neuromeres 6-9) remain at a constant level during pupal development and the early stages of adult development. Beginning at ca. pupal stage 8, however, the levels of TbetaH begin to rise, reaching a maximum level by pupal stage 12. By removing the source of ecdysteroid hormone through ligation, and by subsequent replacement of 20-HE via infusion, we found evidence indicating that the preadult rise of 20-HE is both necessary and sufficient for the increased levels of TbetaH. During the course of our study, we also identified previously unreported OA-ir neurons. In particular, adult-specific OA-ir lateral cells were found, as were relatively small OA-ir dorsal median pairs that doubled in size during adult development. Abdominal ganglia not exposed to the preadult rise in 20-HE possessed neither the OA-ir lateral neurons nor the somatic growth of the smaller OA-ir median neurons. These newly described OA-ir neurons probably contribute to the steroid-induced elevations of TbetaH observed at the end of metamorphosis.

Developmental trajectories of disruptive behavior problems in preschool children of adolescent mothers.

Using hierarchical linear modeling (HLM), we analyzed individual developmental trajectories of disruptive behavior problems between ages 3.5 to 6.0 years for 183 children of adolescent mothers. We examined how the level of problem behavior (intercept) and the rate of change over time (slope) are influenced by child's sex, mother's depression/anxiety symptoms, and mother's use of negative control for regulating child behavior. On average, disruptive behavior decreased from age 3.5 to 6.0. Child sex and maternal depression/anxiety related to the level of behavior problems but not to the rate of change. Boys and children of more depressed/anxious mothers exhibited higher levels of disruptive behavior. Maternal negative control was associated with both level of disruptive behavior and rate of change, and negative control mediated the effects of maternal depression/anxiety. Greater negative control corresponded to higher levels of behavior problems and no reduction in their display over time. Child race moderated effects of negative control.

Outcome of a controlled trial of the effectiveness of intensive case management for chronic public inebriates.

OBJECTIVE: The objective of this study was to test whether an intensive case management intervention would be effective with a group of homeless chronic public inebriate clients. The primary goals of the case management were to improve the financial and residential stability of the clients and to reduce their use of alcohol. METHOD: Subjects (N = 298, 81% male) were interviewed at baseline, randomly assigned to treatment and control conditions and given follow-up interviews at 6-month intervals for 2 years. Case management services were provided for the duration of the project. Follow-up rates for the first three interviews averaged 82%. RESULTS: Repeated measures MANCOVAs showed significant group differences favoring the case-managed group in all three areas targeted by the intervention: total income from public sources, nights spent in "own place" out of the previous 60 nights and days drinking out of the previous 30 days. The results held whether the three variables were analyzed jointly or separately and for alternative measures of drinking and homelessness. Although statistically significant, the group differences are generally not large. CONCLUSIONS: The results indicate that case management had a beneficial effect on the clients receiving it. This effect may have been the result of an increase in services received by the case-managed clients.

Coactivation of putative octopamine- and serotonin-containing interneurons in the medicinal leech.

Possible interactions between octopamine-immunoreactive (IR) and serotonergic neurons in the CNS of the medicinal leech were investigated. Simultaneous intracellular recordings of serotonin-containing neurons (either the Retzius neuron or cell 21) and the dorsolateral octopamine-IR (DLO) neuron demonstrated that both sets of neurons are coactive at times. Depolarization of either serotonergic cell 21 or the Retzius neuron did not alter the membrane potential of the DLO. Similarly, depolarization of the DLO did not affect the serotonergic neurons examined. Because it was found that the DLO and either the serotonergic cell 21 or Retzius neuron were at times coactive, we looked for possible sources of common excitatory inputs. The centrally located pressure (P)- and touch (T)-sensitive mechanosensory neurons excited the DLOs through a polysynaptic pathway. Stimulation of nociceptive (N) mechanosensory neurons did not cause a measurable depolarization in the membrane potential of the DLO. Through simultaneous recordings of the DLO, cell 21, and a particular identified mechanosensory neuron, it was demonstrated that activity in the T or P cells can excite both serotonergic cell 21 and the octopamine-IR DLO. These findings indicate that, in many instances, both serotonin and octopamine, biogenic amines with neuromodulatory actions in many different invertebrates, may be released simultaneously in the leech.

A multisegment computer simulation of normal human gait.

The goal of this project was to develop a computer simulation of normal human walking that would use as driving moments resultant joint moments from a gait analysis. The system description, initial conditions and driving moments were taken from an inverse dynamics analysis of a normal walking trial. A nine-segment three-dimensional (3-D) model, including a two-part foot, was used. Torsional, linear springs and dampers were used at the hip joints to keep the trunk vertical and at the knee and ankle joints to prevent nonphysiological motion. Dampers at other joints were required to ensure a smooth and realistic motion. The simulated human successfully completed one step (550 ms), including both single and double support phases. The model proved to be sensitive to changes in the spring stiffness values of the trunk controllers. Similar sensitivity was found with the springs used to prevent hyperextension of the knee at heel contact and of the metatarsal-phalangeal joint at push-off. In general, there was much less sensitivity to the damping coefficients. This simulation improves on previous efforts because it incorporates some features necessary in simulations designed to answer clinical science questions. Other control algorithms are required, however, to ensure that the model can be realistically adapted to different subjects.

Drug use among adolescent mothers: prepregnancy to 18 months postpartum.

PURPOSE: Little is known about the substance use patterns of adolescent mothers, particularly in the postpartum period. This study provides descriptive, longitudinal data on the substance use behavior of a cohort of adolescent mothers. METHODS: A total of 241 pregnant adolescents, under 18 years old and planning to carry the pregnancy to term, completed the initial interview. Respondents were interviewed again at 1, 6, 12, and 18 months postpartum. The data reported here are based on the 229 respondents who completed all five interviews. RESULTS: Use of all substances decreased substantially during pregnancy, but increased steadily in the first 6 months postpartum. A similar pattern was observed for regular use of multiple substances. Regular use before and after the pregnancy, but not during it, was the most common pattern of substance use. CONCLUSIONS: The prevalence of substance use among adolescent mothers is significant. To capitalize on the large decreases in use during pregnancy, drug prevention programs for adolescent mothers should target the first 6 months postpartum.

PIP: To characterize patterns of legal and illicit drug use among pregnant and parenting adolescents, 241 unmarried US teens 17 years of age and younger were recruited from an urban, publicly funded prenatal clinic for a prospective study. Respondents were interviewed during pregnancy and at 1, 6, 12, and 18 months postpartum. 229 (95%) of these adolescents completed all five interviews. A substantial reduction in regular use of tobacco, alcohol, marijuana, and crack/cocaine occurred during pregnancy (e.g., 55% of respondents reported regular alcohol consumption before pregnancy, but only 4% admitted regular use during pregnancy); however, a steady increase in drug use occurred after delivery, especially in the first 6 months postpartum. 38.6% of respondents discontinued drug use during pregnancy, but resumed it in the postpartum period. Another 20.6% reported no use before, during, or after pregnancy. 16.7% initiated drug use in the postpartum period, while 14.5% were continuous users. These findings suggest a need for drug prevention interventions in the first few postpartum months aimed at capitalizing on young mothers' voluntary reductions in drug use during pregnancy. Such interventions could emphasize the findings that secondary cigarette smoke inhaled by children can increase their respiratory problems and alcohol passes to infants through breast milk. ¿

A two-part, viscoelastic foot model for use in gait simulations.

A three-dimensional, two-part model of the foot, for use in a simulation of human gait, is presented. Previous simulations of gait have not included the foot segment (e.g. Siegler et al., 1982, J. Biomechanics 15, 415-425) or have fastened it to the ground (e.g. Onyshko and Winter, 1980, J. Biomechanics 13, 361-368). A foot model based on viscoelastic elements (e.g. Meglan, 1991, Ph.D. thesis, Ohio State Univ.), allows more freedom of movement and thus models the physical system more closely. The current model was developed by running simulations of the foot in isolation from just before heel contact to just after toe-off. The driving inputs to the simulation were the resultant ankle joint forces and moments taken from a gait analysis. Nine linear, vertically oriented spring/damper systems, positioned along the midline of the foot were used to model the combined viscoelastic behaviour of the foot, shoe and floor. Associated with each vertical spring/damper system were two orthogonally placed, linear, horizontal dampers used to provide the shear components of the ground reaction force. Torques at the metatarsal-phalangeal joint were supplied by a linear, torsional spring and damper. Control about the vertical axis and the long axis of the foot was achieved by the use of linear, torsional dampers. The predicted kinetic and kinematic values are very similar to those taken from the gait analysis. The model represents an improvement over previous work because the transition from swing to stance was smooth and continuous without the foot being constrained to any specific trajectory.

Nicotine dependence and intentions to quit smoking in three samples of male and female recovering alcoholics and problem drinkers.

We report gender-specific data on tobacco use and quitting smoking from three studies of nicotine-related issues during alcoholism treatment. Study 1 data are from 309 alcoholism treatment professionals who were current or former smokers with a personal history of alcoholism or problem drinking. Study 2 data are from 496 smokers receiving counseling for their problems with alcohol in outpatient alcoholism treatment centers. Study 3 data are from 90 smokers receiving intensive alcoholism treatment in residential or inpatient programs. Interest in smoking cessation was high in all groups. Significant gender differences were apparent among the recovering alcoholics but not among the problem drinkers. Severity of alcohol use problems also showed some association with smoking cessation behaviors.

Substrate and hormonal responses during exercise classes at selected stages of pregnancy.

This study examined the substrate and hormonal responses during exercise classes for 36 pregnant women at selected stages of pregnancy. Six nonpregnant women served as controls. Blood samples were obtained before exercise, at the end of aerobic exercise, and 45 min after aerobic exercise. All samples were analyzed for substrates (glucose, lactate, FFA) and 7 hormones. Heart rates in the pregnant women were approximately 150 bpm, although some were as high as 180 bpm. Heart rates in the control group were approximately 130 bpm. Modest increments occurred in lactate and FFA during exercise, and decrements in glucose were observed in all groups. Insulin concentrations decreased with exercise and remained depressed after exercise whereas FFA remained elevated postexercise in the pregnant women. Modest transient changes were observed with exercise in the other hormones. A severely blunted norepinephrine response to exercise was observed in the third-trimester group. In conclusion, uncontrolled non-steady-state exercise does not disrupt the substrate and endocrine milieu markedly. Recovery in hormonal and substrate concentrations appears to occur rapidly after exercise. However, decrements in blood glucose do occur for a short time during prenatal exercise classes, most notably for women in the third trimester.