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Distress tolerance (DT; perceived or actual ability to tolerate aversive physical or emotional states) is related to both posttraumatic stress disorder (PTSD) symptoms and substance use disorders (SUD). This investigation evaluates self-report and behavioral measures of DT as potential predictors of PTSD and SUD cognitive-behavioral therapy outcomes. Participants included 41 treatment-seeking adults (53.7% women; 73.2% African American; M(age)= 44.90, SD = 9.68) who met at least four symptoms of DSM-5 PTSD and DSM-IV substance dependence, assessed via structured interviews. At baseline (pre-treatment), participants completed the Distress Tolerance Scale (DTS), Mirror-Tracing Persistence Task (MTPT), Breath Holding task, and Paced Auditory Serial Addition Task. The Clinician-Administered PTSD Scale for DSM-5 severity scores and percent days of primary substance use, measured via Timeline Follow-back, were used as indicators of PTSD symptoms and substance use, respectively. Covariates included treatment condition, baseline PTSD symptom severity, and baseline substance use. Lower perceived DT at baseline (DTS total score) was associated with higher PTSD symptom severity at end-of-treatment. Lower behavioral DT at baseline (MTPT duration) was associated with higher substance use at the conclusion of treatment (i.e., proportion of number of use days to total number of days between two final treatment sessions).

Objective: Prescription opioids are an effective pain treatment strategy but can lead to long-term opioid misuse. Identifying at risk patients during hospitalization can inform the development of prevention interventions post-discharge. Using the Opioid Risk Tool (ORT) as a screening measure, this study predicted factors associated with pain and opioid use at 2 weeks post-discharge in trauma patients.Design: A quality improvement prospective study design was used.Setting: Participant recruitment took place at an inpatient Level 1 trauma center in Houston, Texas.Participants: Participants (n = 103) were patients admitted to the adult trauma service. Patients completed the ORT in the hospital and a survey at 2 weeks post-discharge.Main outcome measure: The survey assessed pain intensity and interference, injury-related stress, medication use, and need for additional pain treatment. Wilcoxon–Mann–Whitney U test, the Spearman rank-order correlation, and chi-square test of independence tested the ORT as a predictor of follow-up outcomes. Post hoc analyses relied on logistic and quantile regression.Results: The ORT identified 15.5 percent of patients at high risk for opioid-related aberrant behavior. Survey results indicated high percentages of patients reporting moderate to severe pain (79.6 percent), pain interference (77.9 percent), taking pain pills (59.6 percent), experiencing stress (76.9 percent), and needing pain treatment (52.4 percent). The ORT predicted injury-related stress with the high-risk category having higher stress levels than low risk (Z = 2.518, p = 0.012).Conclusion: Risk of opioid misuse assessed in hospitalized trauma patients was associated with injury-related stress reported post-discharge. This highlights the importance of including stress assessments in follow-up appointments.

The behavioral economic measure drug demand and the neural measure late positive potential (LPP) are two measures of motivational value that have been associated with drug relapse risk and treatment outcomes. Despite having overlapping themes, no studies have directly compared drug demand and LPP. Participants (

The present investigation examined the predictive utility of nonjudgmental acceptance, a facet of mindfulness defined as the ability to remain aware and nonevaluative about internal experience, in terms of substance-related cue reactivity among adults with substance use disorders (SUD) and posttraumatic stress (PTS) symptomatology. We hypothesized that higher nonjudgmental acceptance, indexed via self-report, would predict higher levels of self-reported control over oneself and safety 'in the moment', broadly, and lower levels of substance-related craving in response to substance script cues. Effects were expected after subtracting reactivity to neutral script cues from each outcome rating. PTS severity was included as a covariate. The sample was comprised of 53 adults (48.1% women; 75.9% African American; 74.1% with past-month PTSD) with substance dependence per DSM-IV and at least four symptoms of PTSD per DSM-5. Higher baseline nonjudgmental acceptance predicted greater safety and control in response to substance cues; no effects were found for craving. These experimental laboratory results elucidate the potential clinical utility of mindfulness-based interventions in bolstering recovery from addiction among adults with SUD/PTS by fostering safety and control in response to substance cues.

Background: Individuals with post-traumatic stress disorder (PTSD) have a heightened sensitivity to subsequent stressors, addictive drugs, and symptom recurrence, a form of behavioral sensitization. N-methyl-D-aspartate receptors (NMDARs) are involved in the establishment and activation of sensitized behavior. Objective: We describe a protocol of a randomized placebo-controlled Phase 1b proof-of-mechanism trial to examine target engagement, safety, tolerability, and possible efficacy of the NMDAR antagonist lanicemine in individuals with symptoms of PTSD (Clinician Administered PTSD Scale [CAPS-5] score ≥ 25) and evidence of behavioral sensitization measured as enhanced anxiety-potentiated startle (APS; T-score ≥ 2.8). Methods: Subjects (n = 24; age range 21–65) receive three 60-min intravenous infusions of placebo or 100 mg lanicemine over 5 non-consecutive days. Primary endpoint is change in APS from pre-treatment baseline to after the third infusion. NMDAR engagement is probed with resting state EEG gamma band power, 40 Hz auditory steady state response, the mismatch negativity amplitude, and P50 sensory gating. Change in CAPS-5 scores is an exploratory clinical endpoint. Bayesian statistical methods will evaluate endpoints to determine suitability of this agent for further study. Conclusion: In contrast to traditional early-phase trials that use symptom severity to track treatment efficacy, this study tracks engagement of the study drug on expression of behavioral sensitization, a functional mechanism likely to cut across disorders. This experimental therapeutics design is consistent with recent NIMH-industry collaborative studies, and could serve as a template for testing novel pharmacological agents in psychiatry. Clinical Trial Registration: www.ClinicalTrials.gov, identifier NCT03166501.

Objective To investigate if magnetic resonance imaging (MRI) is an accurate predictor for death or moderate-severe disability at 18-22 months of age among infants with neonatal encephalopathy in a trial of cooling initiated at 6-24 hours. Study design Subgroup analysis of infants ≥36 weeks of gestation with moderate-severe neonatal encephalopathy randomized at 6-24 postnatal hours to hypothermia or usual care in a multicenter trial of late hypothermia. MRI scans were performed per each center's practice and interpreted by 2 central readers using the Eunice Kennedy Shriver National Institute of Child Health and Human Development injury score (6 levels, normal to hemispheric devastation). Neurodevelopmental outcomes were assessed at 18-22 months of age. Results Of 168 enrollees, 128 had an interpretable MRI and were seen in follow-up (n = 119) or died (n = 9). MRI findings were predominantly acute injury and did not differ by cooling treatment. At 18-22 months, death or severe disability occurred in 20.3%. No infant had moderate disability. Agreement between central readers was moderate (weighted kappa 0.56, 95% CI 0.45-0.67). The adjusted odds of death or severe disability increased 3.7-fold (95% CI 1.8-7.9) for each increment of injury score. The area under the curve for severe MRI patterns to predict death or severe disability was 0.77 and the positive and negative predictive values were 36% and 100%, respectively. Conclusions MRI injury scores were associated with neurodevelopmental outcome at 18-22 months among infants in the Late Hypothermia Trial. However, the results suggest caution when using qualitative interpretations of MRI images to provide prognostic information to families following perinatal hypoxia–ischemia. Trial registration Clinicaltrials.gov: NCT00614744 .

BACKGROUND AND AIMS: Despite the availability of several efficacious smoking cessation treatments, less than 25% of smokers who quit remain abstinent 1 year post treatment. This study aimed to determine if varenicline and bupropion combination treatment would result in higher abstinence rates than varenicline alone. DESIGN: A double-blind, randomized, parallel groups smoking cessation clinical trial in which participants were exposed to 12 weeks of treatment and followed for 12 months. SETTING: Hospital-based outpatient clinic in Texas, USA specializing in cancer prevention. PARTICIPANTS: 385 community smokers (56% male) who smoked 1 pack cigarettes/day (Mean = 19.66 cigs/day, S.D. = 9.45); had an average CO of 26.43 ppm (S.D. =13.74); and were moderately dependent (FTCD = 4.79; S.D. = 2.07). INTERVENTIONS AND COMPARATOR: Smokers were randomized in a 3:1 (Active: Placebo) ratio to 12 weeks of treatment as follows: Placebo (n=56), Varenicline (Var; n=166), and Varenicline + Bupropion (Combo; n=163). MEASUREMENTS: A priori primary outcome: Prolonged abstinence at 12 months. Secondary outcomes: Seven-day point prevalence abstinence and continuous abstinence; all abstinence measures at end of treatment and 6 month follow-ups. FINDINGS: Intent to treat analysis: the Combo group (n=163) failed to demonstrate superiority to the Var group (n=166) for prolonged abstinence at 12 months [odds ratio (OR) = 0.91, 95% confidence interval (CI) = 0.50–1.64], supported by Bayes Factor = 0.06. Both the Var [OR = 6.66, 95% CI = 1.61–59.27] and Combo groups [OR = 6.06, 95% CI = 1.45–54.09] demonstrated superiority to Placebo group (n=56; Score = 8.38, p< 0.016). CONCLUSIONS: The addition of bupropion to varenicline treatment does not appear to increase smoking abstinence rates above that of varenicline alone. The findings support previous research showing a consistently favorable effect of both varenicline and the combination of varenicline and bupropion on smoking cessation compared with placebo.

Pioglitazone (PIO), a potent agonist of PPAR-gamma, is a promising candidate treatment for cocaine use disorder (CUD). We tested the effects of PIO on targeted mechanisms relevant to CUD: cocaine craving and brain white matter (WM) integrity. Feasibility, medication compliance and tolerability were evaluated.Two-arm double-blind randomized controlled proof-of-concept pilot trial of PIO or placebo (PLC).Single-site out-patient treatment research clinic in Houston, TX, USA.Thirty treatment-seeking adults, 18 to 60 years old, with CUD. Eighteen participants (8 = PIO; 10 = PLC) completed diffusion tensor imaging (DTI) of WM integrity at pre-/post-treatment.Study medication was dispensed at thrice weekly visits along with once-weekly cognitive behavioral therapy for 12 weeks.Measures of target engagement mechanisms of interest included cocaine craving assessed by the Brief Substance Craving Scale (BSCS), the Obsessive Compulsive Drug Use Scale (OCDUS), a visual analog scale (VAS) and change in WM integrity. Feasibility measures included number completing treatment, medication compliance (riboflavin detection) and tolerability (side effects, serious adverse events).Target engagement change in mechanisms of interest, defined as a ≥ 0.75 Bayesian posterior probability of an interaction existing favoring PIO over PLC, was demonstrated on measures of craving (BSCS, VAS) and WM integrity indexed by fractional anisotropy (FA) values. Outcomes indicated greater decrease in craving and greater increase in FA values in the PIO group. Feasibility was demonstrated by high completion rates among those starting treatment (21/26 = 80%) and medication compliance (≥ 80%). There were no reported serious adverse events for PIO.Compared with placebo, patients receiving pioglitazone show a higher likelihood of reduced cocaine craving and improved brain white matter integrity as a function of time in treatment. Pioglitazone shows good feasibility as a treatment for cocaine use disorder.

Project Diamond Ore Phase 2A consisted of the detonation of three 10- ton charges of aluminized ammonium nitrate slurry at different depths of burst (DOB) and stemming conditions near Fort Peck, Montana, in October 1972. The purpose of the investigation described herein was to determine the effectiveness of the three craters as barriers to the performance of an M48A2 tank. The unstemmed charge at optimum DOB that formed crater 2A-1 created a marginal condition of 'go-no go' for the tank. The stemmed charge at optimum DOB that formed crater 2A-2 and the stemmed charge at approximately one-half optimum DOB that formed crater 2A-3 created definite barriers to the tank. There were indications that a more effective barrier for the tank was produced by the stemmed charge at approximately one-half optimum DOB than by the stemmed charge at optimum DOB. The time required for a D-9 tractor to make crater 2A-3 passable for the M48A2 tank was 1 hour.

The diameter of cylindrical transducers employing the radial mode of operation can be extended to permit resonant operation to much lower frequency. Heretofore the techniques for assembly of bars into cylinders have limited the practical physical size because of the dimensions of available ceramic bars. This paper describes an assembly method whereby available barium titanate bars can be oriented to provide cylinder wall thicknesses up to 12 in. A 200‐in. diameter transducer will have an operational depth of 10 000 ft without pressure compensation and will resonate at 160 cycles per sec. This cylinder can supply 2 megawatts of acoustic power, essentially nondirectional. The same construction technique can be employed on units for frequencies up to 2000 cycles per sec. The paper also will indicate the power capability as a function of size, and stacking procedures are shown to realize the optimum source levels. Cylindrical transducers of nickel ferrite employing the conventional technique with permanent ma...

The necessity for an accurate measurement of the directivity factor (DF) or directivity index (DI) of a sonar transducer has become so critically important in the development of high‐power projectors that an easy and accurate method of obtaining that figure is imperative. This paper presents an economical electronic computer that will provide a continuous summation of the power distribution in a directivity pattern. A stylus follows the polar plot of a pattern placed on the computer to obtain a direct readout of the pattern factor in one plane. Patterns taken in appropriate planes are averaged to obtain the DF. Information can be inserted into the computer from the calibration equipment instead of a preplotted pattern. With this system, an equipment capability of better than ±0.1 dB is realized.

The free‐field calibration of sonar transducers requires a test environment free of echoes. This paper describes an anechoic pool designed to channel all sound out of the central area where tests are performed. Sound is reflected from the water surface into surrounding sound trap areas where special materials absorb and dissipate the energy. The system permits steady‐state operation. The pool consists of a central bowl and surrounding shallow. The bowl is generated by the rotation of an ellipse about a vertical axis, the ellipse being oriented so that one focus is below the water surface and the other focus is above the surface and at a distance half as great. The surrounding shallow region that constitutes the sound trap is of a constant depth equal to that of the virtual image. Three different models employing this technique have been constructed and evaluated to prove the theory. Sound originating near the focus is attenuated more than 60 db before returning to this position. The full‐size pool will ha...

This paper describes the construction of and behavior of a large spherical transducer formed as a mosaic of ceramic elements with no inactive material Formulas are shown that describe the several elements which form the building block of the assembly. The developed techniques indicate spheres up to 30 in. in diameter can be easily constructed and a modification of the basic element will permit much larger spheres to be built. Complete evaluation of a 10‐in.‐diam sphere is shown with efficiencies approaching 100%. Correlation between its evaluation and the theoretical report of S. Hanish at NRL is shown. Behavior in water indicates a good acoustic loading and wide‐band operation.

The calibration of sonar transducers under pressure has been a difficult and lengthy task. A pressure vessel has been designed and constructed specifically for such calibration, with walls as acoustically transparent as possible and yet physically strong enough to withstand reasonable internal pressures. The transducer to be calibrated is placed within the vessel and the whole assembly mounted for calibration. The second transducer used in the measurement is located outside the vessel and at the regular calibration distance. The acoustical path from one unit to the other is through the walls of the vessel. A surface‐mounted water pump controls the internal pressure. This system subjects the test transducer to high static water pressure while the calibration is actually carried out in shallow water. The present vessel will accept transducers as large as 20 in. across and 36 in. long and will hold pressures up to 800 psi. The vessel has been successfully used over the range from 1000 cps to 250 kcps without...

The Transducer Evaluation Center constructed on Point Loma, San Diego, is now in full operation with a capability better than that ascertained from the scale model. The anechoic capability of the pool is satisfactory without the use of an absorbent trap as originally planned, even for a spacing between transducers under test as great as 80 ft. The bridge that spans the pool is acoustically isolated from the water and forms a rigid mounting structure for transducers. The electronic equipment is capable of operating over the range from 50 cps to 1 Mc/sec in either a pulse, steady‐state, or narrow‐hand‐tracker mode. The transmitting‐current or voltage‐response level, or the open‐circuit voltage‐sensitivity level of a transducer, is plotted directly on an analog recorder. Some transducers have already been evaluated at frequencies as low as 100 cps and other transducers as high as 1.1 Mc/sec. Accuracies better than ±0.2 dB are the rule.