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Tobacco promotion is prolific on social media, with each platform setting their own restrictions on tobacco promotion and sales. We evaluated the policies related to tobacco product promotion and sales on 11 sites that are popular with youth in May 2021: Discord, Facebook, Instagram, Pinterest, Reddit, Snapchat, TikTok, Tumblr, Twitch, Twitter and YouTube. Nine of the 11 sites prohibited paid advertisingfor tobacco products. However, only three of them clearly prohibited sponsored content(ie, social influencers) that promotes tobacco. Six platforms restricted content that sells tobacco productsand three tried to prohibit underage accessto content that promotes or sells tobacco products. Although most platform policies prohibited paid tobacco advertising, few addressed more novel strategies, such as sponsored/influencer content and few had age-gating to prevent youth access. There is a pressing need to regulate tobacco promotion on social media platforms.

IntroductionYouTube is a popular social media used by youth and has electronic cigarette (e-cigarette) content. We used machine learning to identify the content of e-cigarette videos, featured e-cigarette products, video uploaders, and marketing and sales of e-cigarette products.MethodsWe identified e-cigarette content using 18 search terms (eg, e-cig) using fictitious youth viewer profiles and predicted four models using the metadata as the input to supervised machine learning: (1) video themes, (2) featured e-cigarette products, (3) channel type (ie, video uploaders) and (4) discount/sales. We assessed the association between engagement data and the four models.Results3830 English videos were included in the supervised machine learning. The most common video theme was ‘product review’ (48.9%), followed by ‘instruction’ (eg, ‘how to’ use/modify e-cigarettes; 17.3%); diverse e-cigarette products were featured; ‘vape enthusiasts’ most frequently posted e-cigarette videos (54.0%), followed by retailers (20.3%); 43.2% of videos had discount/sales of e-cigarettes; and the most common sales strategy was external links for purchasing (34.1%). ‘Vape trick’ was the least common theme but had the highest engagement (eg, >2 million views). ‘Cannabis’ (53.9%) and ‘instruction’ (49.9%) themes were more likely to have external links for purchasing (p<0.001). The four models achieved an F1 score (a measure of model accuracy) of up to 0.87.DiscussionOur findings indicate that on YouTube videos accessible to youth, a variety of e-cigarette products are featured through diverse videos themes, with discount/sales. The findings highlight the need to regulate the promotion of e-cigarettes on social media platforms.

E-cigarettes are the most-used nicotine product among adolescents, but limited psychometrically-sound, e-cigarette-relevant measures exist for adolescents. We examined psychometric properties of the Self-Report Habit Index (SRHI) for assessing adolescents’ habitual e-cigarette use.

Germline succinate dehydrogenase (SDHx) mutation carriers, especially SDHB, are at increased risk for malignancy and require life-long surveillance. Current guidelines recommend periodic whole-body MRI imaging. We assessed the incremental value of 68Ga-DOTA-octreotate (GaTate) positron emission tomography (PET)/CT compared with conventional imaging in such patients.

Prostate-specific membrane antigen (PSMA) is overexpressed in metastatic castration-resistant prostate cancer (mCRPC) and represents a target for imaging and therapy. We undertook a prospective trial of 177Lu-PSMA-617 radioligand therapy in men with high PSMA expression who progressed after standard therapies.

To evaluate the effects of long-acting somatostatin analogue (SSA) therapy on 68Ga-DOTA-octreotate (GaTate) uptake at physiological and metastatic sites in neuroendocrine tumour (NET) patients. Twenty-one patients who underwent GaTate PET/CT before and after commencement of SSA therapy were reviewed. Maximum standardized uptake values (SUVmax) were measured in normal organs. Changes in uptake of 49 metastatic lesions in 12 patients with stable disease were also compared. Serum chromogranin-A (CgA) levels were available for correlation between scans in 17/21 patients. Mean thyroid, spleen and liver SUVmax decreased significantly following SSA therapy from a baseline of 5.9 to 3.5, 30.3 to 23.1 and 10.3 to 8.0, respectively (p= < 0.0001 for all). Pituitary SUVmax increased from 10.2 to 11.0 (p= 0.004) whereas adrenal and salivary gland SUVmax did not change. Tumour SUVmax increased in 7 of 12 patients with stable disease; CgA was stable or decreasing in 5 of these patients. 30/49 (61%) metastatic lesions had an increase in SUVmax and lesion-to-liver uptake ratio increased in 40/49 (82%) following SSA therapy. Long-acting SSA therapy decreases GaTate uptake in the thyroid, spleen and liver but in most cases increases intensity of uptake within metastases. This has significant implications for interpretation of GaTate PET/CT following commencement of therapy as increased intensity alone may not represent true progression. Our findings also suggest pre-dosing with SSA prior to PRRT may enable higher doses to be delivered to tumour whilst decreasing dose to normal tissues.

There is no consensus on optimal follow-up for completely resected gastroenteropancreatic neuroendocrine tumors. Published guidelines for follow-up are complex and emphasize closer surveillance in the first 3 years after resection. Neuroendocrine tumors have a different pattern and timescale of recurrence, and thus require more practical and tailored follow-up. The Commonwealth Neuroendocrine Tumour Collaboration convened an international multidisciplinary expert panel, in collaboration with the North American Neuroendocrine Tumor Society, to create patient-centered follow-up recommendations for completely resected gastroenteropancreatic neuroendocrine tumors. This panel used the RAND/UCLA (University of California, Los Angeles) Appropriateness Method to generate recommendations. A large international survey was conducted outlining current the surveillance practice of neuroendocrine tumor practitioners and shortcomings of the current guidelines. A systematic review of available data to date was supplemented by recurrence data from 2 large patient series. The resultant guidelines suggest follow-up for at least 10 years for fully resected small-bowel and pancreatic neuroendocrine tumors and also identify clinical situations in which no follow-up is required. These recommendations stratify follow-up strategies based on evidence-based prognostic factors that allow for a more individualized patient-centered approach to this complex and heterogeneous malignant neoplasm.

Presents letters to the editor of "TIME" magazine. Thoughts of readers on psychotropic medication, mental health and children; The continued fighting in Afghanistan along the border with Pakistan; Reactions to U.S. Lieutenant General William Boykin's preaching anti-Islamic sermons to evangelical Christian gatherings; Others.

Treatment options for unresectable paraganglioma (PGL)/pheochromocytoma (PCC), especially with uncontrolled secondary hypertension (HTN), are limited. Preliminary studies with peptide receptor radionuclide therapy (PRRT) suggest efficacy, but data on HTN control and survival are lacking. We assessed PRRT outcomes in such patients from two referral centers.

This study aims to validate the BACs-on-Beads (BoB) technology as a robust and high throughput method for pre-implantation genetic screening (PGS) for aneuploidy.

Pheochromocytomas (PCC) and paragangliomas (PGL) are neuroendocrine tumours arising from pluripotent neural crest stem cells and are associated with neurons of the autonomic nervous system. PCCs/PGLs are often hereditary and multifocal, and their biologic behaviour and metabolic activity vary making imaging of these tumours challenging. The imaging gold standard has been I-123 MIBG complemented by CT or MRI. PGLs being neuroendocrine tumours express somatostatin receptors enabling imaging with Ga-68 DOTA-coupled peptides such as DOTATATE. Imaging with F-18 FDG also provides additional information regarding metabolic activity and biologic aggressiveness of these tumours, or, in some situations, reflecting metabolic reprogramming of these tumours. We report our experience using both Ga-68 DOTATATE and F-18 FDG PET/CT imaging in patients with PGLs and PCCs. This was a retrospective review of 23 patients with proven PGL/PCC who underwent both DOTATATE and FDG PET/CT. Seven patients also had I-123 MIBG SPECT/CT and 1 patient had I-124 MIBG PET/CT. Lesional intensity and patterns of uptake were analysed. DOTATATE and FDG were positive at most sites of disease (96.2 % vs 91.4 %), although uptake intensity was significantly higher on DOTATATE with a median SUV of 21 compared to 12.5 for FDG (p< 0.001). SUVmax on F-18 FDG was significantly higher (p< 0.001) in clinically aggressive cases. I-123/I-124 MIBG detected fewer lesions (30.4 %). Overall, Ga-68 DOTATATE PET/CT detected similar number but has significantly greater lesion-to-background contrast compared to F-18 FDG PET/CT. Combined with high specificity, patient convenience and relatively low cost, DOTATATE PET/CT should be considered the ideal first line investigation for imaging PGL/PCC. Depending on DOTATATE findings and the clinical question, FDG and MIBG remain useful and, in selected cases, may provide more accurate staging, disease characterisation and guide treatment choices.

ABSTRACTBackground:Adolescent smoking is a major public health concern, and current treatments are only somewhat effective in promoting abstinence. One way to improve treatments is to identify psychosocial characteristics that impede cessation, allowing development of targeted treatments. This study examined the influence of 2 such characteristics, life event stressors and coping, on initiation of cessation treatment and end-of-treatment abstinence status. Methods:One hundred five adolescent smokers were eligible to participate in a validated contingency management (CM) and cognitive-behavioral (CBT) cessation treatment; of those, 72 completed at least 1 treatment session. Data included sociodemographic characteristics, questionnaires assessing past-year life events and coping behavior use, and abstinence status at the end of the 4-week treatment. Logistic regression was used to predict treatment initiation and abstinence status, with life event stressor number, coping, or their interaction as predictors. Results:Higher levels of cognitive and peer support coping predicted treatment initiation, whereas life events were unrelated. End-of-treatment abstinence was predicted by higher numbers of life events and greater use of avoidant coping. The interaction of helpless coping and life events also predicted abstinence, with greater increases in helpless coping as total life events rose in abstinent but not nonabstinent participants. Finally, greater use of behavioral coping predicted abstinence in participants exposed to only CM treatment, whereas lesser use of behavioral coping predicted abstinence in participants receiving combined CM/CBT treatment. Conclusions:Exposure to life event stressors may promote cessation by forcing use of self-control resources prior to the quit attempt, which may strengthen such resources. Techniques that improve self-control resources may improve cessation outcome, and prevention programs may want to emphasize behavioral coping to improve rates of treatment initiation.

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ABSTRACT.Background:This study sought to determine the relationship between the frequency of current marijuana and alcohol use and cigarette quit attempts in male and female adolescent smokers. Methods:Data from a cross-sectional survey of health behaviors in high-school-aged adolescents were analyzed. Current cigarette smokers (n= 804) who reported use of at least 1 cigarette in the past month were divided into those with and without a history of at least 1 quit attempt (a self-reported episode of trying to “stop smoking”). Logistic regression models were fit to describe the association between the frequency of marijuana/alcohol use and a history of cigarette quit attempts. Results:Among the total sample, higher-frequency marijuana use (more than 6 times in the past 30 days) and frequent binge drinking (more than 5 days of binge drinking in the past 30 days) decreased the odds of having a past cigarette quit attempt (higher-frequency marijuana: adjusted odds ratio [AOR] = 0.56, 95% confidence interval [CI] = 0.36–0.86; frequent binge drinking: AOR = 0.49, 95% CI = 0.29–0.83). A significant gender interaction was observed for the relationship between higher-frequency marijuana use and a history of cigarette quit attempts (P= .03), with decreased odds in boys (AOR = 0.41, 95% CI = 0.22–0.77) but not in girls (AOR = 0.71, 95% CI = 0.37–1.33). Conclusions:Adolescent smokers who report higher-frequency marijuana use or frequent binge drinking have a decreased likelihood of a history of a cigarette quit attempt. The gender-related association between higher-frequency marijuana use and a history of quit attempts suggests that boys with greater substance use may need particularly intensive support to initiate quit attempts.

To examine how factors such as pubertal status, sensation-seeking, and impulsivity are related to substance use (cigarettes, alcohol, and marijuana) in high school students and examine these associations by gender.

The mental health of American military soldiers and veterans is of widespread concern; yet, there has been no prior review of studies on Asian Americans and Pacific Islanders (AAPIs) veterans. This article provides a brief, but comprehensive review of the mental health of AAPI veterans. An exhaustive literature search was conducted using the major medical and mental health literature databases. Of 13 identified articles, nine were empirical studies on either post-traumatic stress disorder among AAPI Vietnam veterans or health functioning of AAPI veterans based on national veteran surveys. Findings from these studies showed that some AAPI veterans who served during the Vietnam War encountered racism from fellow soldiers and race-related stressors were associated with more severe post-traumatic stress disorder symptoms. As a group, AAPI veterans were found to be physically healthier than other veterans, but reported poorer mental health and were less likely to use mental health services. However, these findings were limited by the paucity of studies on AAPI veterans and suggest a need for more research on this subpopulation.

Pancreatic acinar cell carcinoma (ACC) is a rare pancreatic neoplasm, often eluding clinicians because of the lack of diagnosis awareness and expert knowledge regarding clinical, radiological and pathological characteristics of ACC. Main differential diagnoses include pancreatic ductal adenocarcinoma (PDAC) and pancreatic neuroendocrine tumour (PNET) and accurate diagnosis is crucial to ensure optimal treatment and outcomes. This case of a 58-year old male illustrates the correlation between clinical, imaging, molecular histopathological and whole genome and transcriptome profiling that was required to diagnose and guide treatment of this complex pancreatic ACC.

Several letters to the editor are presented in response to the articles in previous issues that focus on disorders that affect many children and teenagers, issues surrounding psychotropic medication, mental health and children, and antidepressant, mood stabilizer or stimulant.

Introduction:To promote the rational use of cardiovascular imaging in the delivery of high-quality and cost-effective care to patients with congenital heart disease (CHD), the American College of Cardiology developed Appropriate Use Criteria (AUC). We aimed to evaluate the appropriateness of indications for cardiac CT and MRI in patients with conotruncal defects and to identify factors associated with Maybe or Rarely Appropriate (M/R) indications.Methods:Twelve US centers contributed a median of 147 studies performed prior to AUC publication (01/2020) on patients with conotruncal defects. Studies were excluded if the patient did not receive primary cardiac care at the center or were not seen > 5 years prior to study date. To account for the nesting of physicians within center, a hierarchical generalized linear mixed model was used to account for center-level variation with physicians nested within center.Results:Of the 1,753 studies (20% CT, 80% MRI) from 12 centers, 16% (range 4-39%) were rated M/R and 2.4% were unclassifiable (Figure 1). Patients age <1 year accounted for 8.4% of studies. In multivariable analyses, patient- and study-level factors associated with M/R rating included: age <1 year (OR 1.9 [95% CI 1.1-3.4]), truncus arteriosus (vs. TOF, OR 2.2 [95% CI 1.2-4.0]), and CT (vs. MRI, OR 2.5 [95% CI 1.7-3.8]). Center-level factors included: part of an adult hospital (vs. stand-alone children’s, OR 0.8 [95% CI 0.2-0.7]) and annual MRI volume (for every 50 unit increase, OR 0.96 [95% CI 0.92-0.99]. Provider-level factors did not remain significant in the multivariable model.Conclusions:Most cardiac CTs and MRIs ordered for the follow-up care of patients with conotruncal defects were rated Appropriate and nearly all were able to be classified. However, there was significant center-level variation and higher annual MRI volume was independently associated with lower odds of M/R rating. These findings inform future quality improvement initiatives.

Presents several letters to the editor of "Time" concerning the impact of psychotropic medications on children and teenagers and other issues. Consideration of a letter about the attempted assassination of Pakistan President Pervez Musharraf; Investigation of the car accident which caused the death of Princess Diana; Development of a design for the World Trade Center Memorial by architect Michael Arad; Others.

The article offers updates about the Victorian/Tasmanian branch of the Australian and New Zealand Society of Nuclear Medicine (ANZSNM), mentioning its participation at the Age Careers Expo and its Annual Day Seminar scheduled on October 22, 2011 at the Royce Hotel in Melbourne.

An introduction is presented in which the author discusses various reports within the issue on topics including some of the events during the Age Careers Expo, the new awards section and some society events related to nuclear medicine.

The article offers news briefs on the Victoria/Tasmania Branch of the Australian and New Zealand Society of Nuclear Medicine (ANZSNM) in 2011 including The Age Careers Expo on May 6-8, the Award for Excellence in Clinical Practice given to Lavera Sovanny, and its meetings in July.