Reprint of: COVID-19 messaging in U.S. state parks: Extensions of the outdoor recreation strategies and practices framework unmasked by the pandemic.

U.S. state parks are a considerable part of the nation's recreation landscape. Understanding their management concerns, including impacts from pandemics, is imperative for sustainably achieving park objectives. Our study aimed to 1) examine park managers' responses to a novel stressor (COVID-19); 2) aid managers in communicating these strategies to visitors in their pre-visit phase; and 3) test a park management framework's ability to adapt to this novel stressor in this pre-visit phase. Manning and colleagues' outdoor recreation strategies and practices framework provides parks with up to 24 response options to an issue: four strategies intersecting with six practices. This framework has been limited to common in-park concerns and visitors. We examined how park systems communicate with potential visitors about COVID-19, to advance the framework toward broader concerns and scales. We analyzed the 50 U.S. state park systems' official COVID-19 communications at the traditional start of the peak use season (summer 2020). We qualitatively coded these for reference to the framework's components and mentions of scale. This highlighted that while "limit use" and "reduce impact of use" were the only strategies used, different practices and recognitions of beyond-park and beyond-visit scales were acknowledged (e.g., "please recreate close to home"). We suggest the data reveal a seventh practice in use and for framework inclusion: "influence pre-visit decisions." The pandemic provided an opportunity for parks to communicate their managerial responses with consistency and creativity, as well as an opportunity for researchers and managers to advance the strategies and practices framework. Management implications: The temporal issue of COVID-19 as a stressor and the spatial nature of its impact across whole social landscapes implores park managers to pay special attention to the critical time in a potential visitor's visit-cycle: the planning and anticipation stages. It is here that effective messaging about the park's integration of expert authority data, detailed communication about park-level responses, and awareness of beyond-park contexts can help potential visitors decide how to safely recreate. This examination highlights the importance of pre-visit safety messaging and provides specific examples of how the outdoor recreation strategies and practices framework can assist park managers in targeting visitor use management communications and actions. Given this strategies and practices framework's usefulness to park managers and ubiquity across parks, we examine ways to expand it to consider broader and emergent contexts.

Religious Beliefs, Treatment Seeking, and Treatment Completion among Persons with Substance Abuse Problems.

BACKGROUND: Religious beliefs can assist with the success of treatment in persons with substance abuse problems by providing social support, confidence, and hope. METHODS: As such, a secondary analysis using 2013 National Survey on Drug Use and Health (NSDUH), of 20219 participants with self-identified illicit substance use problems was conducted. Survey was weighted bivariate and multivariate regression analysis was used to adjust for potential confounders. FINDINGS: Approximately, 15.0% of the study sample were between ages of 18-25 years and 71.5% were Non-Hispanic Black, 11.3% were Non-Hispanic White, and 12.1% were Hispanic. About 10.3% had less than a high school education, 28.0% graduated high school, 30.0% had some college education, and 32.0% were college graduates. Only 1.3% reported receiving substance abuse treatment in the past 12 months and 5.4% perceived a need for substance abuse treatment in the last 12 months. 65.0% reported that religious beliefs were an important part of their life and 62.5% reported that their religious beliefs influenced their decision making. After adjustment for sociodemographic factors, both the importance of religious beliefs and the influence of religious beliefs on decision making were associated with increased odds of having treatment [odds ratio (OR) = 1.56, 95% confidence interval (CI): 1.14-2.14 and OR = 1.51, 95% CI: 1.11-2.05, respectively]. However, there was no association between the importance of religious beliefs or the influence of religious beliefs on decision making and perceived need for substance abuse treatment. CONCLUSION: These findings suggest that religious beliefs may be an important determinant in receiving treatment among substance abusers and also have implications for exploration of faith-based and faith-placed interventions.

Study on the anti-hepatocarcinoma effect and molecular mechanism of Prunella vulgaris total flavonoids.

ETHNOPHARMACOLOGICAL RELEVANCE: The traditional use of Prunella vulgaris is for the treatment of liver cancer in a few areas of China. At present, it is used primarily for the treatment of thyroid cancer, throat cancer, and lymphosarcoma among others. However, there are few current scientific reports regarding its use for the treatment of liver cancer. In this paper, the effective treatment for liver cancer is studied to provide an experimental basis for the application of Prunella vulgaris, which is related to preparations in the treatment of liver cancer. AIM OF THE STUDY: To study the anti-hepatocarcinoma effect of Prunella vulgaris total flavonoids and explores the possible molecular mechanism. METHODS: The effects of Prunella vulgaris total flavonoids on the proliferation of SMMC-7721 cells were respected by RTCA analysis system. The tumor volume and weight were found in H22 tumor bearing mice. ELISA was used to observe the apoptosis and autophagy protein expressions in tumor tissue homogenate, along with the immune serum factor. Tumor tissue apoptosis was respected by the TUNEL method. And Bax, Bcl2, PI3K, Akt, mTOR, Beclin-1 and LC3-I/LC3-II expression were observed through Western blot. We also observed the expression of Beclin-1 and LC3-I/LC3-II through immunohistochemistry. RESULTS: The total flavonoids of Prunella vulgaris inhibited the activity of SMMC-7721 cells, and reduced the tumor volume and weight in H22 tumor bearing mice. HE staining showed that the Prunella vulgaris total flavonoids inhibited liver metastasis of H22 tumor. The Prunella vulgaris total flavonoids significantly made the expressions of IL-6, TNF-α and IFN-γ immune factors increasing in the serum of tumor bearing mice, and the contents of caspase-3 and caspase-9 increase as well in tumor tissue homogenate. TUNEL showed that the mean density in the intervention group was significantly higher than that in the control group. P62 content in tumor tissue homogenate increased and ATG5 decreased after intervention. Immunohistochemistry showed Beclin-1 expression decreased and LC3-I/LC3-II increased in the tumor tissue. Western blot showed Bcl2, Beclin-1 expression decreased and Bax, PI3K, Akt, mTOR, LC3-I/LC3-II increased in the tumor tissue. CONCLUSION: Prunella vulgaris total flavonoids have an obvious anti-hepatocarcinoma effect, and the mechanism may be linked to the inhibition of autophagy and promotion of apoptosis in liver cancer cells. The inhibition of autophagy may be related to activation of the PI3K/Akt/mTOR pathway.

COVID-19 messaging in U.S. state parks: Extensions of the outdoor recreation strategies and practices framework unmasked by the pandemic.

U.S. state parks are a considerable part of the nation's recreation landscape. Understanding their management concerns, including impacts from pandemics, is imperative for sustainably achieving park objectives. Our study aimed to 1) examine park managers' responses to a novel stressor (COVID-19); 2) aid managers in communicating these strategies to visitors in their pre-visit phase; and 3) test a park management framework's ability to adapt to this novel stressor in this pre-visit phase. Manning and colleagues' outdoor recreation strategies and practices framework provides parks with up to 24 response options to an issue: four strategies intersecting with six practices. This framework has been limited to common in-park concerns and visitors. We examined how park systems communicate with potential visitors about COVID-19, to advance the framework toward broader concerns and scales. We analyzed the 50 U.S. state park systems' official COVID-19 communications at the traditional start of the peak use season (summer 2020). We qualitatively coded these for reference to the framework's components and mentions of scale. This highlighted that while "limit use" and "reduce impact of use" were the only strategies used, different practices and recognitions of beyond-park and beyond-visit scales were acknowledged (e.g., "please recreate close to home"). We suggest the data reveal a seventh practice in use and for framework inclusion: "influence pre-visit decisions." The pandemic provided an opportunity for parks to communicate their managerial responses with consistency and creativity, as well as an opportunity for researchers and managers to advance the strategies and practices framework. Management implications: The temporal issue of COVID-19 as a stressor and the spatial nature of its impact across whole social landscapes implores park managers to pay special attention to the critical time in a potential visitor's visit-cycle: the planning and anticipation stages. It is here that effective messaging about the park's integration of expert authority data, detailed communication about park-level responses, and awareness of beyond-park contexts can help potential visitors decide how to safely recreate. This examination highlights the importance of pre-visit safety messaging and provides specific examples of how the outdoor recreation strategies and practices framework can assist park managers in targeting visitor use management communications and actions. Given this strategies and practices framework's usefulness to park managers and ubiquity across parks, we examine ways to expand it to consider broader and emergent contexts.

PD-1 blockade for diffuse large B-cell lymphoma after autologous stem cell transplantation.

Disease relapse remains the leading cause of failure after autologous stem cell transplantation (ASCT) for patients with relapsed/refractory diffuse large B-cell lymphoma (R/R DLBCL). We conducted a phase 2, multicenter, single-arm study of the anti-PD-1 monoclonal antibody pembrolizumab given after ASCT in patients with chemosensitive DLBCL, hypothesizing that it would improve the progression-free survival (PFS) at 18 months after ASCT (primary endpoint) from 60% to 80%. Pembrolizumab was administered at 200 mg IV every 3 weeks for up to 8 cycles, starting within 21 days of post-ASCT discharge. Twenty-nine patients were treated on this study; 62% completed all 8 cycles. Seventy-nine percent of patients experienced at least one grade 3 or higher adverse event, and 34% experienced at least one grade 2 or higher immune-related adverse event. Overall, 59% of patients were alive and progression free at 18 months, which did not meet the primary endpoint. The 18-month overall survival was 93%. In conclusion, pembrolizumab was successfully administered as post-ASCT consolidation in patients with R/R DLBCL, but the PFS did not meet the protocol-specific primary objective and therefore does not support a larger confirmatory study. This trial was registered at www.clinicaltrials.gov as #NCT02362997.

PD-1 blockade with pembrolizumab for classical Hodgkin lymphoma after autologous stem cell transplantation.

Autologous stem cell transplantation (ASCT) remains the standard of care for patients with relapsed/refractory (RR) classical Hodgkin lymphoma (cHL) who respond to salvage chemotherapy. However, relapse after ASCT remains a frequent cause of treatment failure, with poor subsequent prognosis. Because cHL is uniquely vulnerable to programmed cell death-1 (PD-1) blockade, PD-1 blockade given as consolidation after ASCT could improve ASCT outcomes. We therefore conducted a multicohort phase 2 study of pembrolizumab in patients with RR cHL after ASCT, hypothesizing that it would improve the progression-free survival (PFS) at 18 months after ASCT (primary end point) from 60% to 80%. Pembrolizumab was administered at 200 mg IV every 3 weeks for up to 8 cycles, starting within 21 days of post-ASCT discharge. Thirty patients were treated on this study. The median age was 33 years, and 90% were high-risk by clinical criteria. Seventy-seven percent completed all 8 cycles. Toxicity was manageable, with 30% of patients experiencing at least 1 grade 3 or higher adverse event (AE), and 40% at least 1 grade 2 or higher immune-related AE. Two patients were lost to follow-up in complete remission at 12 months. The PFS at 18 months for the 28 evaluable patients was 82%, meeting the primary end point. The 18-month overall survival was 100%. In conclusion, pembrolizumab was successfully administered as post-ASCT consolidation in patients with RR cHL, and resulted in a promising PFS in a high-risk patient cohort, supporting the testing of this strategy in a randomized trial. This trial was registered at www.clinicaltrials.gov as #NCT02362997.

Exploring dynamism of cultural ecosystems services through a review of environmental education research.

The field of cultural ecosystem services (CES) explores the non-material benefits that ecosystems provide to people. Human perceptions and valuations change, for many reasons and in many ways; research on CES, however, rarely accounts for this dynamism. In an almost entirely separate academic world, research on environmental education (EE) explores how EE programming affects peoples' attitudes and values toward the natural world. In this review of 119 EE research publications, we explore whether CES (and the adjacent concept of relational values) can be dynamic. We approach this via two lines of inquiry that explore whether EE may instigate this change. First, we investigate whether the EE community measures (and tries to affect) CES-related outcomes. Second, we ask: Has EE research detected changes in CES-related outcomes? We find the EE programs measure many CES outcomes (e.g., aesthetic appreciation, social connectedness), and that in most cases studies observe increases in these outcomes after EE experiences.

Impulsivity, expectancies, and evaluations of expected outcomes as predictors of alcohol use and related problems.

BACKGROUND: While the association between outcome expectancies and drinking is well documented, few studies have examined whether evaluations of expected outcomes (outcome evaluations) moderate that association. OBJECTIVES: The present study tested the hypotheses that outcome evaluations moderate the outcome expectancy-drinking association and that outcome expectancies mediate the association between impulsive personality and drinking. METHODS: College students (N = 201; 55.5% female) enrolled in a mid-sized metropolitan university completed measures assessing outcome expectancies and evaluations, alcohol consumption, and drinking-related problems. RESULTS: Consistent with study hypotheses, expectation of negative outcomes predicted lower levels of drinking, but only when these outcomes were evaluated as highly aversive. However, impulsivity was found to be a far stronger predictor of both drinking and related problems than were outcome expectancies or evaluations. CONCLUSION: The association between negative expectancy and drinking was moderated by negative evaluation, such that individuals who both expected that negative outcomes were likely to occur and who judged such outcomes as highly undesirable consumed significantly fewer drinks per week. Impulsivity was found to be a strong predictor of both alcohol consumption and alcohol-related problems.

Modulation of hepatocyte growth factor secretion in human female reproductive tract stromal fibroblasts by poly (I:C) and estradiol.

PROBLEM: Hepatocyte Growth Factor (HGF) secretion facilitates epithelial cell growth and development in the female reproductive tract (FRT) and may contribute to pathological conditions such as cancer and endometriosis. We hypothesized that estradiol and poly (I:C), a synthetic RNA mimic, may have a regulatory effect on HGF secretion by stromal fibroblasts from FRT tissues. METHOD OF STUDY: Following hysterectomies, normal tissue from the uterus, endocervix, and ectocervix were dispersed into stromal cell fractions by enzymatic digestion and differential filtering. Stromal fibroblasts were cultured and treated with estradiol and/or poly (I:C), and conditioned media were analyzed for HGF via enzyme-linked immunosorbent assay. RESULTS: Treating uterine fibroblasts with estradiol or poly (I:C) significantly increased HGF secretion. When uterine fibroblasts were co-treated with estradiol and poly (I:C), the effect on HGF secretion was additive. In contrast, stromal fibroblasts from endo- and ecto-cervix were unresponsive to estradiol, but were stimulated to secrete HGF by poly (I:C). CONCLUSION: HGF secretion is uniquely regulated in the uterus, but not in ecto- and endo-cervix, by estradiol. Moreover, potential viral pathogens further induce HGF. These findings have potential applications in understanding both hormonal regulation of normal tissue as well as the role of HGF in tumorogenesis, endometriosis, and human immunodeficiency virus infection.

Breathing evaluation and retraining as an adjunct to manual therapy.

Back and neck pain are extremely common reasons for patients seeking manual therapy treatment. Epidemiological evidence supports a link between breathing difficulties and back pain. Since trunk muscles perform both postural and breathing functions, it is theorized that disruption in one function can negatively impact the other. Altered breathing mechanics can change respiratory chemistry and therefore pH causing smooth muscle constriction, altered electrolyte balance and decreased tissue oxygenation. These changes can profoundly impact any body system. Increased excitability in the muscular and nervous systems may be most relevant to a manual therapist. Respiratory function can be tested via capnography which measures CO2 at the end of exhale known as End Tidal CO2 (ETCO2). ETCO2 closely reflects arterial CO2 in people with normal cardiopulmonary function. A case series of twenty nine outpatients with neck or back pain who had plateaued with manual therapy and exercise were identified all of whom were found to have low ETCO2. Breathing retraining improved ETCO2, pain and function in all patients with 93% achieving at least a clinically important change in either pain or function. Screening for breathing dysfunction using capnography may improve patient outcomes in those patients where manual therapy, exercise and education do not provide full resolution of symptoms.

Estradiol modulation of hepatocyte growth factor by stromal fibroblasts in the female reproductive tract.

Primary human uterine, cervical, and ectocervical stromal fibroblasts constitutively secrete hepatocyte growth factor (HGF), yet only uterine stromal fibroblasts increase HGF secretion in response to estradiol. Estradiol-induced HGF secretion by uterine stromal fibroblasts may have a significant effect on uterine cancer and endometriosis.

Adapting the popular opinion leader intervention for Latino young migrant men who have sex with men.

Young Latino migrantmen who have sex with men are at high risk for HIV infection. The Popular Opinion Leader intervention, shown to be effective with White gay men, was adapted by the Farmworker Justice Fund, Inc., for this Latino migrant population. This project, called the Young Latino Promotores, was implemented over a 2-year period by community-based organizations in Vista, California, and McAllen, Texas, with capacity building assistance from the Farmworker Justice Fund, Inc. We report on challenges, preliminary findings, and lessons learned from adapting this intervention.