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Paleoceanographic proxy archives encode information about the marine environment, which can yield key insights into past climate variability. In particular, marine calcifiers' stable oxygen isotopic composition (δ18Ocarb ${{\delta }^{18}\mathrm{O}}_{\mathrm{carb}}$) tells us about seawater temperature and oxygen isotope composition. Here, we use a proxy system model (PSM) framework to systematically evaluate the drivers of skeletal/shell δ18Ocarb ${{\delta }^{18}\mathrm{O}}_{\mathrm{carb}}$ in three taxa of fast‐growing marine calcifiers (crustose coralline algae, bivalves, and sclerosponges) from disparate locations, including high latitudes and deeper waters. We evaluate the impact of the quality of environmental data, the recording season in which the calcifier might document the environmental variability, and the importance of uncertainties on the PSM. Whereas the overall PSM‐modeled δ18Opseudocarb ${{\delta }^{18}\mathrm{O}}_{\mathrm{pseudocarb}}$ captured the measured δ18Ocarb ${{\delta }^{18}\mathrm{O}}_{\mathrm{carb}}$ well at some locations, local environmental variability derived from a reanalysis product and chronological uncertainties limit the ability to effectively model δ18Ocarb ${{\delta }^{18}\mathrm{O}}_{\mathrm{carb}}$ at other locations. Using the PSM approach we highlight the complexity of interpreting δ18Ocarb ${{\delta }^{18}\mathrm{O}}_{\mathrm{carb}}$ as seawater temperature and oxygen isotope composition in these remote locations. Plain Language Summary: Marine stony algae, clams, and sponges, form hard skeletons or shells and can live for hundreds of years, making them important recorders of their environment. Chemical measurements of the hard parts of these marine organisms capture changes in seawater temperature and how water cycles between the ocean and atmosphere as rainfall, both of which are changing due to human activities. By measuring the chemistry throughout the lifespan of the organisms, we can understand environmental variability before and since these human pressures. We test a simple model that relates the environmental changes to the chemical composition recorded in the hard parts of these marine organisms across a geographical range of ocean environments. We evaluate the importance of the quality of the environmental data, biological information about the growth of the organism, and uncertainty in the measurement itself on the model's effectiveness. We find that the model performs well at some locations, supporting its applications to these diverse types of marine life from different locations. Key Points: Proxy system modeling captures oxygen isotopic composition of marine calcifiersQuality of environmental data, calcifier growth characteristics, and age uncertainties impact model performanceAnalysis emphasizes the importance of strong environmental signals [ABSTRACT FROM AUTHOR]

Background: Molecular analysis of fine‐needle aspiration biopsies (FNAB) improves the diagnostic accuracy of cytologically indeterminate thyroid nodules (ITNs). Recently, the use of MPTXv2 has been shown to further improve the accuracy of risk stratification of ITNs. Methods: A total of 338 patient samples with atypia of undetermined significance (n = 258) or follicular neoplasm (n = 80) cytology diagnosis and corresponding surgical outcomes or clinical follow‐up, collected between 2016 and 2020 were included [Correction added on 19 June 2024, after first online publication: In the preceding sentence, the n values 260 and 78 have been changed to 258 and 80, respectively.]. All samples underwent multiplatform testing (MPTXv1), which includes an oncogene panel (ThyGeNEXT®) plus a microRNA risk classifier (ThyraMIR®). A blinded, secondary analysis was performed to assess the added utility of MPTXv2 (ThyraMIR®v2). The average length of follow‐up for the surveillance group (n = 248) was 30 months. Results: Sensitivity at moderate threshold was 96% and specificity at positive threshold was 99% for MPTXv2. At 14% disease prevalence, the negative predictive value at the moderate threshold was 99% and the positive predictive value at the positive threshold was 89% for MPTXv2. MPTXv2 had fewer patients classified into the moderate‐risk group than MPTXv1, which was statistically significant (p <.001). Using surgical resection, the gold standard for outcomes, MPTXv2 showed a statistically greater area under the curve (p =.028) than MPTXv1, demonstrating greater accuracy for MPTXv2. Conclusion: Both test versions demonstrated robust performance with low false‐positive molecular results. Data suggest that incorporation of MPTXv1, and more recently MPTXv2, into clinical practice within our healthcare network resulted in improved accuracy of ITN risk stratification. The use of MPTXv2 (multi‐platform molecular testing) improves the accuracy of indeterminate thyroid nodule risk stratification. Using surgical resection, the gold standard for outcomes, MPTXv2 showed a statistically greater area under the curve (p =.028) than MPTXv1, demonstrating greater accuracy for MPTXv2. [ABSTRACT FROM AUTHOR]

The geochemistry of tropical coral skeletons is widely used in paleoclimate reconstructions. However, sub‐aerially exposed corals may be affected by diagenesis, altering the aragonite skeleton through partial dissolution, or infilling of secondary minerals like calcite. We analyzed the impact of intra‐skeletal calcite on the geochemistry (δ18O, Sr/Ca, Mg/Ca, Li/Mg, Li/Ca, U/Ca, B/Ca, Ba/Ca, and Mn/Ca) of a sub‐aerially exposed Porites sp. coral. Each micro‐milled coral sample was split into two aliquots for geochemistry and X‐ray diffraction (XRD) analysis to quantify the direct impact of calcite on geochemistry. We modified the sample loading technique for XRD to detect low calcite levels (1%–2%; total uncertainty = 0.33%, 2σ) in small samples (∼7.5 mg). Calcite content ranged from 0% to 12.5%, with higher percentages coinciding with larger geochemical offsets. Sr/Ca, Li/Mg, Li/Ca, and δ18O‐derived sea‐surface temperature (SST) anomalies per 1% calcite were +0.43°C, +0.24°C, +0.11°C, and +0.008°C, respectively. A 3.6% calcite produces a Sr/Ca‐SST signal commensurate with local SST seasonality (∼1.5°C), which we propose as the cut‐off level for screening calcite diagenesis in paleo‐temperature reconstructions. Inclusion of intra‐skeletal calcite decreases B/Ca, Ba/Ca, and U/Ca values, and increases Mg/Ca values, and can therefore impact reconstructions of paleoclimate and the carbonate chemistry of the semi‐isolated calcifying fluid in corals. This study emphasizes the importance of quantifying fine‐scale calcite diagenesis to identify coral preservation levels and assure robust paleoclimate reconstructions. Key Points: The modified sample loading technique adopted for X‐ray diffraction significantly reduced the uncertainty of calcite measurement down to 0.33%Temperature reconstructions based on Sr/Ca, Li/Mg, and Li/Ca are significantly affected by low levels of intra‐skeletal calcite (1%–2%)Impact of low levels of intra‐skeletal calcite on δ18O, Ba/Ca, Mn/Ca, and U/Ca is not significant [ABSTRACT FROM AUTHOR]

Obtaining dispersal estimates for a species is key to understanding local adaptation and population dynamics and to implementing conservation actions. Genetic isolation‐by‐distance (IBD) patterns can be used for estimating dispersal, and these patterns are especially useful for marine species in which few other methods are available. In this study, we genotyped coral reef fish (Amphiprion biaculeatus) at 16 microsatellite loci across eight sites across 210 km in the central Philippines to generate fine‐scale estimates of dispersal. All sites except for one followed IBD patterns. Using IBD theory, we estimated a larval dispersal kernel spread of 8.9 km (95% confidence interval of 2.3–18.4 km). Genetic distance to the remaining site correlated strongly with the inverse probability of larval dispersal from an oceanographic model. Ocean currents were a better explanation for genetic distance at large spatial extents (sites greater than 150 km apart), while geographic distance remained the best explanation for spatial extents less than 150 km. Our study demonstrates the utility of combining IBD patterns with oceanographic simulations to understand connectivity in marine environments and to guide marine conservation strategies. [ABSTRACT FROM AUTHOR]

Climate observations in much of the tropical oceans are scarce during most of the 20th century, so paleoclimate proxies are needed to understand the full range of natural climate variability. Past proxy studies have focused primarily on sea surface temperatures, but there are comparatively few salinity reconstructions. Such reconstructions can extend our understanding of hydroclimate across the tropical oceans, including variability in precipitation, evaporation, and ocean circulation. Here we compile a network of salinity‐sensitive coral δ18O records, then apply a reduced‐space method based on empirical orthogonal function analysis to reconstruct annual tropical salinity anomalies over the 20th century. A comparison of surface salinity data sets, including reanalyzes (SODA2/3, Ocean ReAnalysis System 5 (ORAS5), Global Ocean Data Assimilation System) and objective analyses (Institute of Atmospheric Physics (IAP), EN4, Delcroix), show large discrepancies in the spatial structure, temporal evolution, and importance of the leading modes of variability. Two salinity data sets, IAP and ORAS5, are retained for climate reconstruction. Our coral‐based salinity reconstructions reveal significant long‐term trends over the 20th century, which are likely associated with hydrological cycle intensification and possibly a weakening of the Walker Circulation. These reconstructions also capture the spatial and temporal patterns of salinity anomalies associated with the El Niño‐Southern Oscillation, Interdecadal Pacific Oscillation, and Atlantic Multidecadal Oscillation. Ultimately, this approach can enhance our understanding of tropical hydroclimate prior to the observational era. Key Points: A network of coral geochemical records reconstructs annual sea surface salinity across the global tropics (30°S–30°N) over the 20th centuryThe leading modes of variability differ widely among salinity reanalyzes and objective analysesReconstructed salinity shows hydrological variability associated with El Niño‐Southern Oscillation, the Interdecadal Pacific Oscillation and Atlantic Multidecadal Oscillation, and long‐term trends [ABSTRACT FROM AUTHOR]

Coral Sr/Ca records have been widely used to reconstruct and understand past sea surface temperature (SST) variability in the tropical Pacific. However, in the eastern equatorial Pacific, coral growth conditions are marginal, and strong El Niño events have led to high mortality, limiting opportunities for coral Sr/Ca‐based SST reconstructions. In this study, we present two ∼25‐year Sr/Ca and Mg/Ca records measured on modern Porites lobata from Wolf and Darwin Islands in the northern Galápagos. In these records, we confirm the well‐established relationship between Sr/Ca and SST and investigate the impact of heat stress on this relationship. We demonstrate a weakened relationship between Sr/Ca and SST after a major (Degree Heating Months 9°C‐months) heat stress event during the 1997–1998 El Niño, with a larger response in the Wolf core. However, removing data that covers the 1997–1998 El Niño from calibration does not improve reconstruction statistics. Nevertheless, we find that excluding data after the 1997–1998 El Niño event from the calibration reduces the SST reconstruction error slightly. These results confirm that coral Sr/Ca is a reliable SST proxy in this region, although it can respond adversely to unusual heat stress. We suggest that noise in Sr/Ca‐SST calibrations may be reduced by removing data immediately following large heat extremes. Plain Language Summary: The ratio of strontium to calcium (Sr/Ca) in reef‐building coral skeletons has long been recognized to covary with the seawater temperature in which the corals grew and has been measured in many corals to understand past temperature changes. However, there are few examples from the eastern equatorial Pacific, an important region that drives variations in the climate system. Furthermore, this ratio might not reflect temperature as reliably after a heat stress event because of the physiological impacts on calcification processes. To test if Sr/Ca in corals from this region can reflect past temperature reliably and if this coral "thermometer" is compromised by heat stress, we analyze two coral records from the northern Galápagos. We find that Sr/Ca in these corals reflect temperature, but their relationship is weaker following heat stress and during the 21st century portion of our coral records. Although the heat stress event itself does not affect how well we can infer past temperature, using data after the event to establish the Sr/Ca‐temperature relationship impacts the accuracy of temperature reconstruction. Our results demonstrate that excluding post‐heat stress periods from the intervals during which these chemistry‐climate relationships are developed may reduce the uncertainty of the resulting temperature reconstructions. Key Points: We present Sr/Ca and Mg/Ca measurements of two corals from the northern Galápagos, spanning 25–30 years following the 1982‐3 El Niño eventIn the faster‐growing colony, the Sr/Ca‐SST relationship weakens after heat stressExcluding data after the heat stress event from proxy calibration improves temperature reconstruction statistics [ABSTRACT FROM AUTHOR]

Coral geochemical climate reconstructions can extend our knowledge of global climate variability and trends over time scales longer than those of instrumental data. However, such reconstructions can be biased by coral growth and skeletal architecture, such as growth troughs, off‐axis corallite orientation, and changing growth direction. This study quantifies the impact of skeletal architecture and growth on geochemistry using measurements of coral skeletal density, extension rate, and calcification rate, and uses these metrics to improve paleoclimate reconstructions. We present paired geochemistry‐density records at Wolf Island, Galápagos, from three Porites lobata corals: two new paired density and geochemistry records from one fossil coral, and new density data from two previously published modern geochemistry records. We categorize each sampling transect used in this record by the quality of its orientation with respect to skeletal architecture. We observe relationships between geochemistry and density that are not detected using extension or calcification rate alone. These density‐geochemistry relationships likely reflect both the response of coral growth to environmental conditions and the nonclimatic impact of skeletal architecture on geochemistry in suboptimal sampling transects. Correlations of density with Sr/Ca, Ba/Ca, and Mg/Ca are consistent with the Rayleigh fractionation model of trace element incorporation into coral skeletons. Removing transects with suboptimal skeletal architecture increases mean reconstructed SST closer to instrumental mean SST, and lowers errors of reconstruction by up to 20%. These results demonstrate the usefulness of coral density data for assessing skeletal architecture and growth when generating coral paleoclimate records. Key Points: We present a paired trace element and density record from one fossil coral from Wolf Island, Galápagos, and new density data from two published modern Wolf Island corals (all Porites lobata)Density is more sensitive than extension rate for identifying relationships of coral growth/skeletal architecture with geochemistryRelationships between density and Sr/Ca, Mg/Ca, and Ba/Ca are consistent with a Rayleigh fractionation model of trace element incorporation into coral skeletons [ABSTRACT FROM AUTHOR]

Global surface temperatures during the twentieth century are characterized by multidecadal periods of accelerated or reduced warming, which are thought to be driven by Pacific decadal variability, specifically changes in trade‐wind strength. However, the relationship between trade‐wind strength and global surface warming remains poorly constrained due to the scarcity of instrumental wind observations. Previous work has shown that corals growing at Tarawa Atoll (1.3°N, 173°E) incorporate dissolved Mn flushed from lagoon sediments by El Niño‐related westerly wind events (WWEs), providing records of both westerly wind variability and trade‐wind strength (on decadal time scales). Here, we explore the utility of this novel coral Mn/Ca‐wind proxy at two nearby islands that also feature west‐facing lagoons. Short coral Mn/Ca records from Butaritari (3°N, 173°E) and Kiritimati (2°N, 157.5°W) track WWEs, albeit with some intercolony variability in the magnitude and timing of the signal. Variability in coral Mn/Ca signal intensity among records from Butaritari suggests that wind‐driven mixing of the sediment Mn reservoir may be finite and/or localized. At Kiritimati, a coral growing outside the lagoon shows higher Mn/Ca concentrations during the 1997/1998 El Niño event, suggesting that nearshore sediments may be an overlooked dissolved Mn reservoir. Taken together, these results highlight a need for additional studies of Mn reservoir variability within and across atolls that hold promise for recording WWEs. These results also suggest that Mn/Ca records from multiple coral colonies and sites are needed to generate robust coral‐based wind reconstructions, particularly from sites with unknown or complex Mn transport pathways. Key Points: Coral Mn/Ca captures westerly wind events (WWEs) at Kiritimati and Butaritari, albeit with a 1‐year lag and key variations among sitesFidelity of the Mn/Ca proxy across sites demonstrates the potential to extend this proxy to additional islands, and even new environmentsWWE location, Mn reservoir, transport pathways, and coral biomineralization may impact the timing and amplitude of the Mn/Ca‐wind signal [ABSTRACT FROM AUTHOR]

The El Niño–Southern Oscillation (ENSO) represents the largest source of year‐to‐year global climate variability. While Earth system models suggest a range of possible shifts in ENSO properties under continued greenhouse gas forcing, many centuries of preindustrial climate data are required to detect a potential shift in the properties of recent ENSO extremes. Here we reconstruct the strength of ENSO variations over the last 7,000 years with a new ensemble of fossil coral oxygen isotope records from the Line Islands, located in the central equatorial Pacific. The corals document a significant decrease in ENSO variance of ~20% from 3,000 to 5,000 years ago, coinciding with changes in spring/fall precessional insolation. We find that ENSO variability over the last five decades is ~25% stronger than during the preindustrial. Our results provide empirical support for recent climate model projections showing an intensification of ENSO extremes under greenhouse forcing. Plain Language Summary: Recent modeling studies suggest that El Niño will intensify due to greenhouse warming. Here new coral reconstructions of the El Niño–Southern Oscillation (ENSO) record sustained, significant changes in ENSO variability over the last 7,000 years and imply that ENSO extremes of the last 50 years are significantly stronger than those of the preindustrial era in the central tropical Pacific. These records suggest that El Niño events already may be intensifying due to anthropogenic climate change. Key Points: Line Island corals provide 1,751 years of monthly resolved ENSO variability from the mid‐Holocene to presentENSO strength is significantly weaker between 3,000 and 5,000 years ago compared to the 2,000‐year periods both before and afterENSO extremes of the last 50 years are significantly stronger than those of the preindustrial era in the central tropical Pacific [ABSTRACT FROM AUTHOR]

In light of rapid environmental change, quantifying the contribution of regional‐ and local‐scale drivers of coral persistence is necessary to characterize fully the resilience of coral reef systems. To assess multiscale responses to thermal perturbation of corals in the Coral Triangle (CT), we developed a spatially explicit metacommunity model with coral–algal competition, including seasonal larval dispersal and external spatiotemporal forcing. We tested coral sensitivity in 2,083 reefs across the CT region and surrounding areas under potential future temperature regimes, with and without interannual climate variability, exploring a range of 0.5–2.0°C overall increase in temperature in the system by 2054. We found that among future projections, reef survival probability and mean percent coral cover over time were largely determined by the presence or absence of interannual sea surface temperature (SST) extremes as well as absolute temperature increase. Overall, reefs that experienced SST time series that were filtered to remove interannual variability had approximately double the chance of survival than reefs subjected to unfiltered SST. By the end of the forecast period, the inclusion of thermal anomalies was equivalent to an increase of at least 0.5°C in SST projections without anomalies. Change in percent coral cover varied widely across the region within temperature scenarios, with some reefs experiencing local extinction while others remaining relatively unchanged. Sink strength and current thermal stress threshold were found to be significant drivers of these patterns, highlighting the importance of processes that underlie larval connectivity and bleaching sensitivity in coral networks. [ABSTRACT FROM AUTHOR]

In diagnosing cardiac and paracardiac masses, cardiac MRI (CMR) has gained acceptance as the gold standard. CMR has been observed to be superior to echocardiography in characterizing soft‐tissue structures and, specifically, in classifying cardiac masses. The aim of our study was to evaluate the association between mortality and cardiac or paracardiac masses initially identified by echocardiography (ECHO) and confirmed by CMR. Between January 2002 and August 2007, a total of 158 patients underwent both ECHO and CMR for the evaluation of cardiac masses that were equivocal or undefined by ECHO. The primary study endpoints were 5‐year all‐cause mortality and 5‐year cardiac mortality. Causes of death as of April 1, 2015 were obtained from medical records or the National Death Index. Patients were analyzed according to mass type determined by CMR using the Kruskal–Wallis test, Kaplan–Meier curves, and the log‐rank test. Over a mean duration of follow‐up of 10.4 ± 2.9 years (range: 0.01–12 years) post‐CMR, the overall all‐cause mortality rate was 25.9% (41/158). Median age at death was 76 years and there were 21 females (51.2%). Mortality rates in the different classifications of cardiac masses by CMR were as follows: 20% (1/5) in patients with a Nondiagnostic CMR; 20% (1/5) in Other Diagnoses; 17.9% (7/39) in No Masses (includes Normal Anatomical Variants); 16.7% (3/18) in Benign Masses; 23.8% (15/63) in Fat; 50% (5/10) in Thrombus; and 61.5% (8/13) in Malignant Mass. The mean survival time in patients with No Mass (n = 39) was not significantly longer than patients with any type of cardiac mass (n = 114) (P = .16). No significant difference was found in age at death between patients when grouped by CMR classification (P = .40). However, among CMR‐confirmed masses, there were some significant differences by mass classification type (P = .006). During the follow‐up period, 26% (41/158) of patients died and 22% (9/41) of the deaths were cardiovascular related; there was no significant difference in mean survival times with respect to cause of mortality (P = .23). In patients with cardiac masses, dually confirmed by ECHO and CMR, significant differences in survival time were observed based upon CMR classified type of mass while CMR was instrumental in obviating invasive biopsy. [ABSTRACT FROM AUTHOR]

Abstract: Models and observations disagree regarding sea surface temperature (SST) trends in the eastern tropical Pacific. We present a new Sr/Ca‐SST record that spans 1940–2010 from two Wolf Island corals (northern Galápagos). Trend analysis of the Wolf record shows significant warming on multiple timescales, which is also present in several other records and gridded instrumental products. Together, these data sets suggest that most of the eastern tropical Pacific has warmed over the twentieth century. In contrast, recent decades have been characterized by warming during boreal spring and summer (especially north of the equator), and subtropical cooling during boreal fall and winter (especially south of the equator). These SST trends are consistent with the effects of radiative forcing, mitigated by cooling due to wind forcing during boreal winter, as well as intensified upwelling and a strengthened Equatorial Undercurrent. [ABSTRACT FROM AUTHOR]

Coral reefs are increasingly exposed to elevated temperatures that can cause coral bleaching and high levels of mortality of corals and associated organisms. The temperature threshold for coral bleaching depends on the acclimation and adaptation of corals to the local maximum temperature regime. However, because of larval dispersal, coral populations can receive larvae from corals that are adapted to very different temperature regimes. We combine an offline particle tracking routine with output from a high-resolution physical oceanographic model to investigate whether connectivity of coral larvae between reefs of different thermal regimes could alter the thermal stress threshold of corals. Our results suggest that larval transport between reefs of widely varying temperatures is likely in the Coral Triangle and that accounting for this connectivity may be important in bleaching predictions. This has important implications in conservation planning, because connectivity may allow some reefs to have an inherited heat tolerance that is higher or lower than predicted based on local conditions alone. [ABSTRACT FROM AUTHOR]

Background Many older people use one or more prescribed medicines on a daily basis. Effective medicines management at hospital discharge can support appropriate use of medicines following discharge and help avoid unnecessary hospital re-admission. Many people, however, feel they receive insufficient information about medicines on discharge from hospital. Objectives To explore older people and their family carers' experience of hospital discharge in relationship to the organization and management of medicines. Design Qualitative interviews with older people over 75 years old, taking four or more medicines, and their carers, following discharge from hospital in the United Kingdom (UK). Participants completed medication diaries prior to the interview. Setting Interviews took place in the participant's home. Results Nineteen interviews were conducted involving 12 carers and seven older people. Participants were generally not satisfied with the discharge process, particularly concerning perceived delays in discharge. Inadequate explanations about medicines at discharge were commonly reported and led to omission of medicines, incorrect dosage, anxiety and confusion. Poor communication between the hospital and general practitioners or community pharmacists was also evident. Conclusions Despite significant policy recommendations and research in this area, many problems with the management of medicines during hospital discharge were shown, and a lack of partnership was evident between hospital staff and patients/family carers regarding the use of medicines post-discharge. Improved medicines management during hospital discharge is required to ensure older people take their medications as prescribed and to protect them from the adverse effects of medicines not being taken correctly. [ABSTRACT FROM AUTHOR]

Background: School-based body mass index (BMI) measurement has attracted much attention across the nation from researchers, school officials, legislators, and the media as a potential approach to address obesity among youth. Methods: An expert panel, convened by the Centers for Disease Control and Prevention (CDC) in 2005, reviewed and provided expertise on an earlier version of this article. The panel comprised experts in public health, education, school counseling, school medical care, and a parent organization. This article describes the purposes of BMI measurement programs, examines current practices, reviews existing research, summarizes the recommendations of experts, identifies concerns, and provides guidance including a list of safeguards and ideas for future research. Results: The implementation of school-based BMI measurement for surveillance purposes, that is, to identify the percentage of students in a population who are at risk for weight-related problems, is widely accepted; however, considerable controversy exists over BMI measurement for screening purposes, that is, to assess the weight status of individual students and provide this information to parents with guidance for action. Although some promising results have been reported, more evaluation is needed to determine whether BMI screening programs are a promising practice for addressing obesity. Conclusions: Based on the available information, BMI screening meets some but not all of the criteria established by the American Academy of Pediatrics for determining whether screening for specific health conditions should be implemented in schools. Schools that initiate BMI measurement programs should evaluate the effects of the program on BMI results and on weight-related knowledge, attitudes, and behaviors of youth and their families; they also should adhere to safeguards to reduce the risk of harming students, have in place a safe and supportive environment for students of all body sizes, and implement science-based strategies to promote physical activity and healthy eating. [ABSTRACT FROM AUTHOR]

Tamoxifen is widely used for the treatment of breast cancer. While it is generally well tolerated, clinically relevant depression may be a common side effect. This article reviews reports of depression associated with tamoxifen and considers the specific qualities of tamoxifen that may account for depressive symptomatology. A multitude of factors may be responsible for depression in the breast cancer patient such as adjuvant therapy, stage of treatment, and poor body image. Tamoxifen distinguishes itself due to its potential activity at the neuroendocrine level. Antagonist qualities of tamoxifen may block the neuroprotective effects of estrogen. This may result in down-regulation of neurotransmitters associated with mood regulation such as serotonin and norepinephrine. Additional research into the mechanism of tamoxifen-associated depression is needed. As the use of tamoxifen increases, it will be essential to consider the potential side effect of depression, which in itself may alter immune function and overall survival. The risk and benefits of tamoxifen must be carefully weighed and depressive symptoms should be monitored and treated in women receiving tamoxifen therapy. [ABSTRACT FROM AUTHOR]

This study was conducted to investigate the effect of therapeutic estrogen on cytochrome P450 1A2–mediated metabolism in postmenopausal women using caffeine as a model substrate. Twelve healthy postmenopausal women underwent estrogen replacement therapy in the form of estradiol (Estrace). Estradiol was initiated at a dose of 0.5 mg a day and titrated to achieve a steady-state plasma concentration of 50 to 150 pg/ml. Caffeine metabolic ratios (CMR; paraxanthine/ caffeine) were assessed both before and after 8 weeks of estrogen replacement. For the 12 subjects, there was a mean reduction in CMR of –29.2 ± 25.0 (p = 0.0019). Consistent with previous results found in younger women, these results indicate that exogenous estrogen in older women may inhibit CYP1A2-mediated caffeine metabolism. [ABSTRACT FROM PUBLISHER]

Drinkers' expectancies regarding alcohol effects are cognitive factors hypothesized to affect decisions to drink and responses to alcohol. Recent research in this area has yielded descriptive data mostly on nonalcoholic drinkers' motives for drinking and alcohol expectancies. Much less attention has been focused on assessing the extent to which these findings generalize to a broader array of drinkers. Alcohol expectancies were assessed in this report among 260 alcoholics, 79 problem drinkers, and 81 nonproblem drinkers (all subjects were male) using a comprehensive alcohol expectancy measure. Alcoholics almost uniformly scored higher than the problem and nonproblem drinkers in their endorsements of alcohol's effects in different domains (e.g., alcohol acts as a global positive transforming agent, enhances physical and social pleasure, engenders asser-tiveness, reduces tension). Problem drinkers also tended to score higher than the nonproblem drinkers in these domains. A multiple discriminant analysis yielded two functions which together were moderately successful in classifying these subjects according to drinker group. Taken together, these data suggest that important individual differences exist in drinkers' expectations regarding alcohol's utility, and that alcohol expectancies vary considerably as a function of problem drinking severity. The clinical implications of these findings are discussed. [ABSTRACT FROM AUTHOR]