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African Americans (AA) have historically been targeted by the tobacco industry and have the highest rates of current cigar use among racial/ethnic groups in the U.S. Yet, there is limited evidence on other factors influencing cigar use. Amongst a sample of 78 AA current cigar (any type) smokers, log-linear regression models examined correlates of cigar demand obtained from a validated behavioral economic purchase task. Mean intensity, or cigar demand when free, was 6.68 cigars (standard deviation [SD]: 8.17), while mean breakpoint, or the highest price a participant was willing to pay, was $4.62 (SD: 3.88). Mean maximum daily expenditure, Omax was $15.20 (SD: 25.73) and Pmax, the price at Omax was $5.25 (SD: 3.95). Participants aged 21 to 30 years compared to those aged 18 to 20 years, those with higher levels of dependence, and females compared to males, had a significantly higher intensity. Participants with cannabis use above the sample median in the last 30 days (4 + days) had significantly higher intensity and Omax than those below the median. Further, participants with a high school education or more had a significantly lower intensity, breakpoint, and Omax than those with less than high school education. Individuals with income below the federal poverty line (FPL) also had a significantly lower breakpoint and Omax than those above. Finally, tobacco harm perceptions were inversely associated with Pmax. Stricter policies on cigar products, such as higher taxes and product-specific harm messaging, may have an immediate and sustained impact on health disparities related to cigar use. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

The United States leads the world in several chronic health conditions (CHCs). Yet, CHCs are preventable. This paper examines influences on rating of the seriousness of CHCs among American adults. The study involved 1011 American adults aged 18 or older. Data came from Obesity in the United States: Public perceptions. We explored factors that are associated with knowledge of the seriousness of CHCs, via a multiple linear regression analysis. Significant associations were found between the rating of the seriousness of CHCs and obesogenic environment, age, sex, race, and education. For instance, respondents living in obesogenic environments rated CHCs as less serious. Younger people rated CHCs as less serious compared to older people. Also, Blacks and Hispanics rated CHCs as serious health issues facing America compared to Whites. However, the joint association of education and race showed that Blacks who had at most a high school degree rated CHCs as less serious compared to Whites and all college graduates. The determinants of rating of the seriousness of CHCs facing America may be complex and need more studies. However, inadequate knowledge of frequently occurring health conditions may possibly contribute to high incidence of CHCs. It is therefore necessary that Americans know about the seriousness of CHCs facing the United States. This knowledge may also help American adults buy into health policies geared toward health disparities reduction.

Purpose: To understand the effect of pro-tobacco marketing on electronic cigarette and combustible cigarette dual use among US middle and high school students under 18 years of age. Design: Data were derived from the 2018 National Youth Tobacco Survey, an annual self-administered school-based cross-sectional survey. Setting: The survey was administered in public and private middle and high schools across the United States. Participants: The probability sample size was 15 238 middle and high school students with complete responses who were under 18 years of age during the study period. Measures: The study measured self-reported exposure to online combustible and electronic cigarette advertisements, dual use of combustible and electronic cigarettes during the past 30 days, exposure to the Real Cost antitobacco campaign advertisements, and other sociodemographic factors (eg, race/ethnicity, gender, and grade). Analysis: Logistic regressions were used to measure pro-tobacco marketing exposure and dual use as a function of pro-tobacco marketing exposure. Results: Descriptive analyses show that 59.0% of respondents were exposed to pro-tobacco online marketing, and 2.9% were dual users. Dual users (odds ratio [OR] = 1.73) and high school students (OR = 1.43) were more likely to report exposure to online pro-tobacco marketing. Conclusions: Findings indicate that a gap in electronic cigarette pro-tobacco marketing regulatory oversight may exist. Further policy action may be warranted to protect the public health of minors and other vulnerable populations who are most susceptible to pro-tobacco marketing.

A pandemic can arise without warning, and it is important for those in charge of managing the outbreak to understand how diseases spread. Being able to simulate the spread of a disease in varying environments can help the world be more prepared when an outbreak occurs. The COVID-19 City Simulator allows the user to test the spread of the virus under multiple different scenarios. Parallel computing can help to make these simulations more efficient by allowing data to be gathered at a faster rate on a particle simulation. This paper shows how OpenMP and MPI can improve a pandemic simulation by cutting the runtime from over 25 s to under 10 s when 4 threads and 4 boxes are used. We also find that the speed of implementing a lockdown largely impacts the amount of cases and deaths in the city.

HIV-1-infected, virologically suppressed adults wanting to simplify or change their non-nucleoside reverse transcriptase inhibitor (NNRTI)-based regimens may benefit from switching to the single-tablet regimen of elvitegravir, cobicistat, emtricitabine, and tenofovir disoproxil fumarate (E/C/F/TDF).We examined differences in the proportion of participants with HIV-1 RNA 50 copies/mL (Snapshot analysis), change in CD4 cell count, safety, and patient-reported outcomes in participants switching to E/C/F/TDF from an NNRTI + FTC/TDF (TVD) regimen.STRATEGY-NNRTI was a 96-week, phase 3b, randomized, open-label, study examining the efficacy, safety, and tolerability of switching to E/C/F/TDF in virologically suppressed individuals (HIV-1 RNA 50 copies/mL) on an NNRTI + TVD regimen. Participants were randomized to switch or remain on their NNRTI-based regimen (no-switch).At Week 96, 87% (251/290) of switch and 80% (115/143) of no-switch participants maintained HIV-1 RNA 50 copies/mL (difference 6.1%; 95% CI -1.3 to 14.2%; p = 0.12) according to the FDA-defined snapshot algorithm. Both groups had similar proportions of subjects with virologic failure (2.8% switch, 1.4% no-switch). Discontinuations resulting from adverse events were infrequent (3% [9/291] switch, 2% [3/143] no-switch). Three switch participants (1%) discontinued due to renal adverse events (2 of the 3 before Week 48). Switch participants reported significant improvements in neuropsychiatric symptoms by as early as Week 4, and which were maintained through Week 96.E/C/F/TDF is safe and effective and reduces NNRTI-associated neuropsychiatric symptoms for virologically suppressed HIV-positive adults switching from an NNRTI plus FTC/TDF-based regimen.

Al Capone is a brand of cigar products—little cigars, cigarillos and large cigars—manufactured and distributed in the USA by the Inter-Continental Cigar.1 2 Burger Sohne, which owns the Al Capone brand, has the stated goal of cultivating ‘smiling consumers, loyal to (its) brands, in every continent.’3 To that end, Inter-Continental Cigar relies heavily on online marketing through social media platforms to advertise, market and promote the Al Capone brand of cigar products to consumers.4–6 A specific example of the Al Capone brand’s use of social media marketing is its paid sponsorship and promotional collaboration with cult-favourite battle rap league, Ultimate Rap League (URL). Battle rap is a subgenre of Hip-Hop music that originated in the African-American and Hispanic community of the South Bronx, New York in the late ’70s and early ’80s. A type of lyrical boxing match, battle rap is typified by its poetic ‘braggadocio with the quest for lyrical superiority.’7 As with other forms of transgressive play practices, battle rap is an inherently subversive lyrical exchange where players are offensive for …

In clinical studies GS-US-380-1489 (study 1489) and GS-US-380-1490 (study 1490), bictegravir-emtricitabine-tenofovir alafenamide (B-F-TAF), dolutegravir-abacavir-lamivudine (DTG-ABC-3TC), and dolutegravir plus emtricitabine-tenofovir alafenamide (DTG+F-TAF) treatment achieved high rates of virologic suppression in HIV-1 treatment-naive participants through week 48. Preexisting primary drug resistance was present at levels of 1.3% integrase strand transfer inhibitor resistance (INSTI-R), 2.7% nucleoside reverse transcriptase inhibitor resistance (NRTI-R), 14.1% nonnucleoside reverse transcriptase inhibitor resistance (NNRTI-R), and 3.5% protease inhibitor resistance (PI-R) in the 1,274 participants from these studies. These mutations did not affect treatment outcomes. Resistance analyses in 13 virologic failures found no emergent resistance to study drugs.

Background: African American breast cancer survivors have a higher incidence of estrogen receptor negative and basal-like (e.g., triple negative) tumors, placing them at greater risk for poorer survival when compared to women of other racial and ethnic groups. While access to equitable care, late disease stage at diagnosis, tumor biology, and sociodemographic characteristics contribute to health disparities, poor lifestyle characteristics (i.e., inactivity, obesity, and poor diet) contribute equally to these disparities. Lifestyle interventions hold promise in shielding African American survivors from second cancers, comorbidities, and premature mortality, but they are often underrepresented in studies promoting positive behaviors. This review examined the available literature to document health behaviors and lifestyle intervention (i.e., obesity, physical activity, and sedentary behavior) studies in African American breast cancer survivors.Methods: We used PubMed, Academic Search Premier, and Scopus to identify cross-sectional and intervention studies examining the lifestyle behaviors of African American breast cancer survivors. Identified intervention studies were assessed for risk of bias. Other articles were identified and described to provide context for the review.Results: Our systematic review identified 226 relevant articles. The cross-sectional articles indicated poor adherence to physical activity and dietary intake and high rates of overweight and obesity. The 16 identified intervention studies indicated reasonable to modest study adherence rates (>70%), significant reductions in weight (range −1.9 to −3.6%), sedentary behavior (−18%), and dietary fat intake (range −13 to −33%) and improvements in fruit and vegetable intake (range +25 to +55%) and physical activity (range +13 to +544%). The risk of bias for most studies were rated as high (44%) or moderate (44%).Conclusions: The available literature suggests that African American breast cancer survivors adhere to interventions of various modalities and are capable of making modest to significant changes. Future studies should consider examining (a) mediators and moderators of lifestyle behaviors and interventions, (b) biological outcomes, and (c) determinants of enhanced survival in this population.

Pill burden, dosing frequency, and concerns about safety and tolerability are important obstacles to maintaining adequate medication adherence. Raltegravir (RAL) is indicated for twice-daily dosing and when taken with emtricitabine (FTC)/tenofovir disoproxil fumarate (TDF), it becomes a twice-daily multiple-tablet regimen. Elvitegravir (EVG)/cobicistat (COBI)/FTC/TDF, STB, is the first approved once-a-day integrase strand transfer inhibitor (INSTI) containing single-tablet regimen that combines EVG, an INSTI, and COBI, a novel pharmacoenhancer, with the preferred nucleos(t)ide backbone of FTC/TDF.This was a 48-week prospective, single-arm open-label study of the switch to STB in virologically sup-pressed HIV-1-infected adult patients on FTC/TDF and twice-daily RAL for at least 6 months. Objectives were to evaluate the tolerability and safety of a regimen simplification to once-a-day STB, while maintaining viral suppression through 48 weeks.Forty-eight individuals in the United States were enrolled. The median age was 44 years, 96% were male, and 83% were White. The median time on RAL + FTC/TDF treatment prior to enrollment was 34 months. Ninety-six percent of participants cited regimen simplification as the reason to enroll in the switch study. At base-line, the median CD4 count was 714 cell/µL and estimated glomerular filtration rate (eGFR) was 105 mL/min. At week 48, all assessed study participants remained viro-logically suppressed to the lower limit of quantification (HIV-1 RNA50 copies/mL) and maintained high CD4 cell count (median, 751 cells/mL) and stable eGFR (median, 100.5 mL/min). STB was well tolerated with no discontinuations, no study drug-related serious adverse events, and no study drug-related grade 3/4 adverse events.All participants switching to 1 tablet once-a-day STB from a twice-daily RAL + FTC/TDF regimen remained virologically suppressed. STB was well tolerated. Switching to STB may be a viable option for virologically suppressed patients wanting to simplify from a twice-daily RAL-containing regimen.

The purposes of this study were to examine students' perceptions and attitudes toward changes in Distance Education (DE) course management systems and to evaluate their instructional delivery preferences. Students (N = 145) enrolled in an online master's degree program on either a full- or part-time basis completed an online survey instrument specifically designed for this study. Results showed a strong preference for distance education, but no significant differences in student perceptions toward changes in Course Management Systems (CMS). The benefit of transparency in course design is discussed along with other findings.

Introduction : COBI, a PK enhancer with no ARV activity is a more selective cytochrome P450 (CYP)3A inhibitor than ritonavir (RTV), does not induce CYP isozymes, and thus has less potential for drug-drug interactions. COBI boosts DRV PK as effectively as RTV in healthy volunteers. Materials and Methods : This 48-week, phase IIIb, open-label, single-arm, US multicentre study (NCT01440569) included HIV-infected treatment-nave and experienced adults with no DRV RAMs, viral load (VL) ≥1000 c/mL, eGFR ≥80 mL/min and genotypic sensitivity to investigator-selected N[t]RTIs. Patients received DRV/COBI 800/150 mg qd (as single agents) plus two fully active N[t]RTIs. The primary endpoint was any treatment-emergent grade 3 or 4 AEs through Week 24. We report 48-week safety, efficacy and PK/PD results in treatment-nave patients. Results : Of 313 ITT patients, 295 were treatment-nave (94%). In the treatment-nave cohort, 90% were male, 60% white and 294 (99.7%) received a TDF-containing regimen. Median baseline (BL) VL was 4.8 log 10 c/mL and CD4 + 370 cells/mm 3 . Treatment-emergent grade 3 or 4 AEs regardless of causality were reported in 21 (7%) patients. AEs regardless of causality (any grade; ≥10% of patients) were: diarrhoea (27%), nausea (23%), URTI (15%) and headache (12%). Sixteen (5%) patients had AEs leading to study drug discontinuation, most frequently rash (three patients), hypersensitivity and nausea (two patients each). Consistent with the known inhibition of tubular creatinine secretion by COBI, there was a mean increase from BL in serum creatinine by week 2 (0.09 mg/dL), remaining stable through week 48 (mean 0.10 mg/dL increase from BL). At week 48, 83% of patients achieved VL

Weight loss after bariatric surgery is commonly reported as either a percentage of initial body weight (%IBW) or 100 % minus %IBW which is a percentage of total weight loss (%TWL). These are basically equivalent expressions. Weight loss is also reported as %EWL or as a percentage of excess body mass index loss (%EBMIL). These last two expressions incorporate the concepts of ideal body weight and BMI = 25 as reference points. More straightforward but less commonly used is absolute weight loss. This study compares these various measures using the Bariatric Outcomes Longitudinal Database (BOLD). BOLD data, 2008–2011, was accessed for outcomes on 239,659 gastric bypass (GB) and sleeve gastrectomy (SG) patients with approval of the Surgical Review Corporation. The outcome data was converted into %TWL, %EWL, and %EBMIL. %EBMIL was varied by changing the reference BMI from 1 to 25 kg/m2. The post operation data was analyzed for both procedures. Variation coefficients (VC) were compared using different measurements on the same data pool. We assumed that the lesser the variation, the more reliable the measure is, and therefore, we made use of the VC to compare the different reporting methods. There were 164,247 patients who remained after removal of errors and missing data. Demographics are as follows: 78.1 % female, 73.1 % white, 12.5 % black, 8.71 % Hispanic, 81.6 % GB, 18.4 % SG, mean age of 44.8 years, height of 167.0 cm, weight of 132.0 kg, and BMI of 47.1 kg/m2. GB patients had 26.8 %TWL at 6 months (VC = 21.5) and 34.2 %TWL at 12 months (VC = 27.0). %EWL was 54.7 at 6 months (VC = 27.3) and 69.4 at 12 months (VC = 30.9). Varying the reference BMI for %EBMIL showed the lowest VC to be 0–2 kg/m2 for GB up to 12 months post operation. SG patients had 24.0 %TWL at 6 months (VC = 25.4) and 29.5 at 12 months (VC = 30.5). %EWL was 50.0 % at 6 months (VC = 31.4) and 60.2 % at 12 months (VC = 34.5). Varying the reference BMI for %EBMIL showed that the lowest VC occurred when the reference weight was chosen as 0 kg/m2 for both GB and SG. %TWL or, equivalently, %IBW had the lowest variation coefficient and therefore is the more accurate measure of weight loss following bariatric surgery. For ease and accuracy of comparison, the percentage of initial body weight or percentage of total weight loss should be used for the expression of weight loss after surgery.

Factors postulated to predict weight loss after gastric bypass surgery, include race, age, gender, technique, height, and initial weight. This paper contained 1551 gastric bypass patients (85.9% female). Operations were performed by one surgeon (MLO) at community hospitals in Southern California from 1989 to 2008 with 314 being laparoscopic and 1237 open. We created the following equation: In[percent weight] = 𝐴 𝑡 2 − 𝐵 𝑡 , where 𝑡 was the time after operation (days) and 𝐴 and 𝐵 are constants. Analysis was completed on R-software. The model fits with 𝑅 2 value 0.93 and gives patients a realistic mean target weight with a confidence interval of 95% for the first year. Conclusion. We created a curve predicting weight loss after surgery as a percentage of initial weight. Initial weight was the single most important predictor of weight loss after surgery. Other recorded variables accounted for less than 1% of variability. Unknown factors account for the remaining 6-7%.

Neuronal thread proteins (NTP) are a family of phosphoproteins expressed during neuritic sprouting. The 15 to 18 kD NTP cluster is associated with development and neuronal differentiation, whereas the 21 kD and 39 to 42 kD species are overexpressed in Alzheimer's disease, correlating with neurodegenerative sprouting and synaptic disconnection. Empirical observations suggested that NTP might also be modulated with central nervous system injury and stroke. In this study of both human and experimental (rat) focal cerebral infarcts, in situ hybridization and immunocytochemical staining revealed NTP gene expression up-regulated in perifocal neurons. These findings were confirmed by quantitative Northern and Western blot analyses. Moreover, Western blot analysis demonstrated selectively increased expression of the 15 to 18 kD NTP species during the acute, subacute, and healing phases of cerebral infarction in both humans and experimental animals, corresponding with the expected period of neuronal repair. These results suggest an additional role for the 15 to 18 kD NTP species in neuritic sprouting required for neuronal regeneration after injury in the mature central nervous system.

Ronen, D., Magaritz, M., Gvirtzman, H. and Garner, W., 1987. Microscale chemical hetereogeneity in groundwater. J. Hydrol., 92: 173-178. Large variations in the concentration of Cl-, NO a and SO42 in the upper water layers of a polluted aquifer were found between samples that were vertically separated by as little as 3 cm. This was disclosed when a multilayer dialysis cell device was used to obtain undisturbed, real-time samples from test wells. This first time presentation of chemical fine structure provides new insights into mechanisms of contamination of an aquifer by surface inputs and raises the question of the validity of groundwater quality data based on single samples, however obtained.

Employing a transplantable guinea pig leukemia (L 2 C), animals treated with MeCCNU were completely free of disease 180 days post chemotherapy. However, these animals were not refractory to a subsequent challenge with viable L 2 C leukemic blast cells. In an attempt to augment the host's immune response to tumor associated antigens (TAA) while enhancing the immunogenicity and expression of the TAA on the surface of the blast cell, guinea pigs were injected with either irradiated syngeneic blast cells, immunostimulators (BCG or C. parvum ) or combinations of both. Guinea pigs treated with either BCG or C. parvum plus irradiated cells were now resistant to tumor re-inoculation. Use of irradiated blast cells or BCG or C. parvum alone was ineffective and did not protect against a bio-challenge. Therapeutic benefit was only observed following the mixture of vaccine with the immunostimulator. Application of immunostimulation at sites separate from the vaccine was less effective. Maximum stimulation of the immune response in the form of tumor rejection immunity occurred following repeated immunization (3 times vs 1 time) every other week with the vaccine-immunostimulator mixture. These results were substantiated by in vitro studies in which significant increases in both cellular and humoral mediated immunity were noted in only those animals receiving the combined mixture of irradiated blasts plus immunostimulator. These data suggest the need for enhancing tumor-specific recognition in situations where the host is immunologically competent but the TAA are too weak to elicit an immune response beneficial to the host.

Background: Cobicistat is an alternative pharmacoenhancer to ritonavir. In healthy volunteers, darunavir exposure was comparable when darunavir 800 mg once daily was co-administered with cobicistat 150 mg once daily (as single agents or a fixed-dose combination) vs. with ritonavir 100 mg once daily. Methods: This 48-week, Phase IIIb, single-arm, US multicenter study (NCT01440569) evaluated safety, efficacy and pharmacokinetics of darunavir/cobicistat 800/150 mg once daily (as single agents) plus two investigator-selected nucleoside/tide reverse transcriptase inhibitors (N[t]RTIs) in HIV-1-infected adults. Patients had no darunavir resistance-associated mutations (RAMs), plasma viral load (VL) ≥1000 HIV-1 RNA copies/ml, eGFR ≥80 ml/min and genotypic sensitivity to the two N[t]RTIs. The primary endpoint was any treatment-emergent grade 3 or 4 adverse events (AEs) through Week 24. Results: The majority of the 313 intent-to-treat patients were treatment-naive (295/313; 94%), male (89%), White (60%) and received a tenofovir-based regimen (99%). Median baseline VL and CD4 + count overall were 4.8 log10 HIV-1 RNA copies/ml and 361 cells/mm 3 , respectively. Overall, 86% of patients (268/313) completed the study. The majority of discontinuations were for AEs (15/313; 5%). The incidence of treatment-emergent grade 3 or 4 AEs regardless of causality was 6% through Week 24 and 8% through Week 48. Most common AEs through Week 48 were diarrhea (27%) and nausea (23%), which were grade 1 or 2 in severity. Week 48 virologic response rates (% with VL