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BACKGROUND: Sexual minorities are more likely than their heterosexual counterparts to develop alcohol use disorder (AUD) and understanding the underlying reasons for this heightened risk is a public health priority. This study examined relationships between sexual orientation discrimination and DSM-5 AUD severity. METHODS: The 2012–2013 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC-III) conducted in-person interviews with a nationally representative sample of U.S. adults (n=36,309). Approximately 2.8% of the target population self-identified as lesbian, gay or bisexual, 3.1% had at least one past-year same-sex sexual partner, and 8.3% reported same-sex sexual attraction. RESULTS: Adults who identified as lesbian, gay, bisexual, heterosexual with same-sex attraction and/or current same-sex sexual partner, and those not sure of their sexual identity, had higher rates of individual DSM-5 AUD criteria than heterosexual-identified adults with only opposite-sex attraction and sexual partners. Respondents who were bisexual or unsure of their sexual identity consistently had the highest probabilities of endorsing each of these AUD criteria relative to the other subgroups. Differences in AUD severity across sexual orientation subgroups were much larger among women than among men. Sexual minorities who experienced higher levels of sexual orientation discrimination had significantly higher levels of AUD severity than sexual minorities who experienced lower levels, or no discrimination. In particular, greater levels of sexual orientation discrimination increased the odds of impaired control symptoms and pharmacologic symptoms. Associations between prior-to-past-year sexual orientation discrimination and AUD severity were not as robust as those involving past-year discrimination. CONCLUSIONS: Sexual minorities are at substantially greater risk of severe DSM-5 AUD, and this is particularly true among those who experience high levels of sexual orientation discrimination. Findings indicate that proximal experiences of discrimination are more salient than distal experiences. AUD treatment should address recent sexual orientation discrimination given that such experiences are associated with more severe AUD.

Objective To determine the past-year prevalence rates and correlates of simultaneous co-ingestion of prescription stimulants and other substances among U.S. high school seniors.

Ipilimumab, an antibody that enhances T-cell activation, may augment immunogenicity of tumor cells that are injured by radiation therapy. We hypothesized that patients with melanoma brain metastasis treated with both ipilimumab and radiotherapy would have improved overall survival, and that the sequence of treatments may affect disease control in the brain. We analyzed the clinical and radiographic records of melanoma patients with brain metastases who were treated with whole brain radiation therapy or stereotactic radiosurgery between 2005 and 2012. The hazard ratios for survival were estimated to assess outcomes as a function of ipilimumab use and radiation type. Seventy patients were identified, 33 of whom received ipilimumab and 37 who did not. The patients who received ipilimumab had a censored median survival of 18.3 months (95% confidence interval 8.1–25.5), compared with 5.3 months (95% confidence interval 4.0–7.6) for patients who did not receive ipilimumab. Ipilimumab and stereotactic radiosurgery were each significant predictors of improved overall survival (hazard ratio = 0.43 and 0.45, with P = 0.005 and 0.008, respectively). Four of 10 evaluable patients (40.0%) who received ipilimumab prior to radiotherapy demonstrated a partial response to radiotherapy, compared with two of 22 evaluable patients (9.1%) who did not receive ipilimumab. Ipilimumab is associated with a significantly reduced risk of death in patients with melanoma brain metastases who underwent radiotherapy, and this finding supports the need for multimodality therapy to optimize patient outcomes. Prospective studies are needed and are underway.

Context There is consensus in the research literature that substance use disparities exist among sexual minority women and men; however, few studies have examined risk factors that may contribute to these disparities. Aims To compare reports of life-time victimization experiences in a US national sample of adult heterosexual and sexual minority women and men and to examine the relationships between victimization experiences and past-year substance use disorders. Design, participants, measurements The secondary data analyses used 2004–05 (wave 2) National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) data collected in structured diagnostic face-to-face interviews in the United States. Substance use disorders (SUDs) were defined according to DSM-IV criteria and included past-year alcohol abuse, alcohol dependence, drug abuse and drug dependence. The sample consisted of 34 653 adults aged 20 years and older; approximately 2% of the respondents self-identified as sexual minority (lesbian, gay or bisexual). Findings Results showed strong associations between victimization and any past-year SUDs and confirmed findings from several previous studies indicating that, compared with heterosexuals, sexual minority women and men are at heightened risk for life-time victimization. However, prevalence of the seven victimization experiences and the degree of association between individual victimization experiences and SUDs varied substantially across sexual minority subgroups. The childhood victimization variables—especially childhood neglect—showed the strongest and most consistent associations with SUDs. Odds of SUDs were generally higher among both female and male respondents, regardless of sexual identity, who reported multiple (two or more) victimization experiences than among those who reported no life-time victimization, suggesting a possible cumulative effect of multiple victimization experiences. Conclusions Higher rates of life-time victimization, particularly victimization experienced in childhood, may help to explain higher rates of substance use disorders among sexual minorities. However, more research is needed to understand better the complex relationships among sexual orientation, victimization and substance use.

Photopolymerization is a ubiquitous, indispensable technique widely applied in applications from coatings, inks, and adhesives to thermosetting restorative materials for medical implants, and the fabrication of complex macro-scale, microscale, and nanoscale 3D architectures via additive manufacturing. However, due to the brittleness inherent in the dominant acrylate-based photopolymerized networks, a significant need exists for higher performance resin/oligomer formulations to create tough, defect-free, mechanically ductile, thermally and chemically resistant, high modulus network polymers with rapid photocuring kinetics. This study presents densely cross-linked triazole-based glassy photopolymers capable of achieving preeminent toughness of ≈70 MJ m(−3) and 200% strain at ambient temperature, comparable to conventional tough thermoplastics. Formed either via photoinitiated copper(I)-catalyzed cycloaddition of monomers containing azide and alkyne groups (CuAAC) or via photoinitiated thiol-ene reactions from monomers containing triazole rings, these triazole-containing thermosets completely recover their original dimensions and mechanical behavior after repeated deformations of 50% strain in the glassy state over multiple thermal recovery–strain cycles.

Objective: Prostate cancer (PCa) patients often must decide between several treatment modalities considered equally efficacious, but associated with different benefits and side-effects. For some, the decision-making process can be difficult, but little is known about patient characteristics and cognitive processes that might influence the difficulty of such decisions. This study investigated the roles of dispositional optimism and self-efficacy in PCa treatment decision-making difficulty and satisfaction. Methods: One hundred and twenty-five patients with clinically localized PCa completed a mail-in paper-and-pencil survey after they had made their treatment decision, but prior to treatment. Results: After adjusting for covariates, optimism and treatment decision-making self-efficacy were associated with less difficulty and greater satisfaction with the treatment decision-making process. Effects of optimism on difficulty and satisfaction were partially mediated by self-efficacy for making the treatment decision. Conclusions: Men with PCa and who are low in optimism may be at greater risk for treatment decision-making difficulty and lack of treatment decision-making satisfaction, in part, because they have lower confidence in their ability to make the decision compared with those who are more optimistic. As self-efficacy perceptions are modifiable, consideration should be given to including self-efficacy enhancing components as part of PCa treatment decision-making interventions. Copyright © 2008 John Wiley & Sons, Ltd.

Aims The present study examined the associations between early onset of non-medical use of prescription drugs (NMUPD) (i.e. sedatives, tranquilizers, opioids, stimulants) and the development of prescription drug abuse and dependence in the United States. Design Data were collected from structured diagnostic interviews using the National Institute on Alcohol Abuse and Alcoholism (NIAAA) Alcohol Use Disorder and Associated Disabilities Interview Schedule: Diagnostic and Statistical Manual version IV (DSM-IV). Setting National prevalence estimates were derived from the 2001–2002 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC, n = 43 093). Participants A nationally representative cross-sectional sample of civilian non-institutionalized adults aged 18 years or older in the United States, of whom 52% were women, 71% white, 12% Hispanic, 11% African American, 4% Asian and 2% Native American or of other racial background. Findings A higher percentage of individuals who began using prescription drugs non-medically at or before 13 years of age were found to have developed prescription drug abuse and dependence versus those individuals who began using at or after 21 years of age. Multivariate logistic regression analyses indicated that the odds of developing any life-time prescription drug abuse among non-medical users was reduced by approximately 5% with each year non-medical use was delayed [adjusted odds ratio (AOR) = 0.95, 95% CI = 0.94, 0.97], and that the odds of developing any life-time prescription drug dependence were reduced by about 2% with each year onset was delayed (AOR = 0.98, 95% CI = 0.96, 1.00) when controlling for relevant covariates. Conclusions The results of this study indicate that early onset of NMUPD was a significant predictor of prescription drug abuse and dependence. These findings reinforce the importance of developing prevention efforts to reduce NMUPD and diversion of prescription drugs among children and adolescents.

Objective Our aim is to determine the lifetime and past-year prevalence estimates of multiple Diagnostic and Statistical Manual of Mental Disorders fifth edition (DSM-5) substance use disorders (SUDs) among U.S. adults. Methods The 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions featured in-person interviews with a nationally representative sample of adults aged 18 and older. Results The majority of past-year nonalcohol DSM-5 SUDs had at least 1 other co-occurring past-year SUD, ranging from 56.8% (SE = 3.4) for past-year prescription opioid use disorder to 97.5% (SE = 2.7) for past-year hallucinogen use disorder. In contrast, only 15.0% (SE = 0.6) of past-year alcohol use disorders had a co-occurring past-year SUD. The odds of past-year multiple SUDs were greater among males, younger adults, African-Americans, and those with mood, personality, posttraumatic stress, or multiple psychiatric disorders. Conclusions Assessment, diagnosis, and treatment often focus on individual substance-specific SUDs rather than multiple SUDs, despite evidence for substantial rates of polysubstance use in clinical and epidemiological studies. There are notable differences in the prevalence of multiple SUDs between alcohol use disorders and other nonalcohol SUDs that have important clinical implications; for example, multiple SUDs are more persistent than individual SUDs. These findings suggest that clinical assessment and diagnosis should screen for multiple SUDs, especially among adults with nonalcohol DSM-5 SUDs.

Rhodium(II) azavinyl carbenes generated from sulfonyltriazoles, undergo a facile, mild, and convergent formal 1,3-insertion into N—H and O—H bonds of primary and secondary amides, various alcohols, and carboxylic acids to afford a wide range of vicinally bisfunctionalized (Z)-olefins with perfect regio- and stereoselectivity.

A selective, rapid, scalable, simple synthesis of enaminones and olefins by ring expansion and rearrangement reactions is presented.

Fluorinated molecules are omnipresent in pharmaceuticals and agrochemicals, materials, and as imaging agents for positron emission tomography (PET) scanning. PET imaging has become a widely used technique in medical diagnostics in recent years. This method requires the use of a fluorinecontaining agent enriched with the F nucleus. This fluorine isotope has a notoriously short half-life of 109 minutes, thus imposing strict requirements for the speed and operational simplicity of reactions used for its introduction into imaging probes. Considerations of cost and practicality demand that the fluorine is derived from simple fluoride salts (such as KF and NaF). While methods for the late-stage introduction of fluorine into complex molecules have been reported, a new robust process would be a useful addition to the developing field of medical imaging, especially in light of the growing use of the CuAAC (see below). The copper(I)-catalyzed azide–alkyne cycloaddition reaction (CuAAC; Scheme 1a) has emerged as a powerful method for the creation of covalent links between diverse

A stereoselective arylation of triazole substrates with concomitant loss of N2 is developed to yield 2,2-diaryl enamines.

The first example of C-H functionalizations of pyridine rings at the 3- and 4-positions is developed using Pd(0)/PR3/ArBr. This reaction provides a powerful method for the preparation of structurally diverse nicotinic and isonicotinic acids that are of tremendous importance in drug discovery.