Publications by authors named "Ashley D"

642 Publications

Brief report on IQOS point-of-sale marketing, promotion and pricing in IQOS retail partner stores in Atlanta, Georgia, USA.

Tob Control 2022 Aug 2. Epub 2022 Aug 2.

Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, Atlanta, Georgia, USA

Objectives: Philip Morris has a history of aggressive marketing tactics in its global pursuit of IQOS sales, which extant literature suggests may appeal to non-smokers and young adults. This study was the first to examine point-of-sale (POS) marketing and pricing of IQOS after it entered the US market in October 2019.

Methods: Trained field staff assessed 75 retail partner stores selling IQOS/HeatSticks in the Atlanta area in February-November 2020 using an IQOS-tailored, standardised assessment tool. The tool assessed store characteristics, product availability and accessibility, marketing and promotions and pricing for each store.

Results: All stores assessed sold HeatSticks in at least one of the three flavours (tobacco, smooth menthol, fresh menthol), but did not sell the IQOS device. IQOS/HeatSticks marketing was present inside 98.5% and outside 17.3% of stores assessed. Marketing for other tobacco products was present inside 98.5% and outside 32% of stores. The average price per HeatSticks pack was US$6.40 compared with US$6.08 for Marlboro Red cigarettes.

Conclusion: Our study revealed a considerable amount of POS marketing and promotion for IQOS/HeatSticks at retail partner locations, visible to all retail consumers, including youth and non-smokers. This study was the first to examine IQOS POS marketing and promotion in the US context and findings add to the extant literature on IQOS global marketing strategies. As additional novel tobacco/nicotine products continue to enter the market, targeted monitoring of the POS marketing and promotion for these new products is warranted.
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http://dx.doi.org/10.1136/tc-2022-057285DOI Listing
August 2022

Peracetic Acid Enhances Micropollutant Degradation by Ferrate(VI) through Promotion of Electron Transfer Efficiency.

Environ Sci Technol 2022 Jul 26. Epub 2022 Jul 26.

School of Civil and Environmental Engineering, Georgia Institute of Technology, Atlanta, Georgia 30332, United States.

Ferrate(VI) and peracetic acid (PAA) are two oxidants of growing importance in water treatment. Recently, our group found that simultaneous application of ferrate(VI) and PAA led to much faster degradation of micropollutants compared to that by a single oxidant, and this paper systematically evaluated the underlying mechanisms. First, we used benzoic acid and methyl phenyl sulfoxide as probe compounds and concluded that Fe(IV)/Fe(V) was the main reactive species, while organic radicals [CHC(O)O/CHC(O)OO] had negligible contribution. Second, we removed the coexistent hydrogen peroxide (HO) in PAA stock solution with free chlorine and, to our surprise, found the second-order reaction rate constant between ferrate(VI) and PAA to be only about 1.44 ± 0.12 Ms while that of HO was as high as (2.01 ± 0.12) × 10 Ms at pH 9.0. Finally, further experiments on ferrate(VI)-bisulfite and ferrate(VI)-2,2'-azino-bis(3-ethylbenzothiazoline-6-sulfonic)acid systems confirmed that PAA was not an activator for ferrate(VI). Rather, PAA could enhance the oxidation capacity of Fe(IV)/Fe(V), making their oxidation outcompete self-decay. This study, for the first time, reveals the ability of PAA to promote electron transfer efficiency between high-valent metals and organic contaminants and confirms the benefits of co-application of ferrate(VI) and PAA for alkaline wastewater treatment.
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http://dx.doi.org/10.1021/acs.est.2c02381DOI Listing
July 2022

General and Device-Specific Reasons for ENDS Use: A Qualitative Study with Adult ENDS Users.

Int J Environ Res Public Health 2022 06 2;19(11). Epub 2022 Jun 2.

School of Public Health, Georgia State University, Atlanta, GA 30302, USA.

Background: A scientific consensus on the public health impact of electronic nicotine delivery systems (ENDS) remains elusive. This is partly due to the wide variation in product characteristics often lumped together under one category. Research is needed to better understand what ENDS device type characteristics motivate their use by adults.

Methods: Nine focus groups of 32 current ENDS users who were 18+ years old, had used ENDS in the previous 30 days, and had been using ENDS for more than two months were held either in person or online between February and June 2020.

Results: Participants' reasons for their choice of ENDS characteristics included both general, applying to all ENDS products, and specific, relating to particular ENDS devices. Health benefits and the lack of offensive odor were commonly identified as important reasons for using ENDS in general. Flavor and product discreteness were both general and device-specific determinants of ENDS use. Conversely, nicotine delivery, cloud size, battery properties, aesthetics, ease of use, and cost were device-specific drivers of participants' choice.

Conclusions: The reasons that adults choose to use ENDS are complex and sometimes related to both ENDS as a category and as specific ENDS product types. Regulations and public communication campaigns should reflect their ultimate objective and consider both general and specific motivations when attempting to achieve public health objectives.
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http://dx.doi.org/10.3390/ijerph19116822DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9180821PMC
June 2022

Intentions and Attempts to Quit Smoking Among Sexual Minoritized Adult Smokers After Exposure to the Tips From Former Smokers Campaign.

JAMA Netw Open 2022 05 2;5(5):e2211060. Epub 2022 May 2.

Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, Atlanta.

Importance: Significant disparities exist in smoking behaviors by sexual minority status in the US.

Objective: To examine potential differences in the associations between exposure to the Tips From Former Smokers (Tips) campaign and intentions and attempts to quit smoking by sexual minority status.

Design, Setting, And Participants: This cross-sectional study used data from the wave 5 survey of the Population Assessment of Tobacco and Health study. Data from 8072 adults who were currently established cigarette smokers were collected from December 2018 to November 2019 and analyzed in August 2021. The Population Assessment of Tobacco and Health study is an ongoing cohort study representative of the noninstitutionalized US population. Sample weights were applied to account for the complex sampling strategies.

Exposures: Dichotomized self-reported frequent Tips exposure (often and very often) and infrequent exposure (never, rarely, and sometimes).

Main Outcomes And Measures: Outcomes were intention to quit within 12 months, any serious quit attempts in the past 12 months, and number of serious quit attempts in the past 12 months. Multivariate logistic and ordinal logistic regressions were used to estimate the weighted associations between exposure and each outcome. Interactions between Tips exposure and sexual minority status were examined to explore potential differences.

Results: A total of 8072 participants (mean [SD] age, 44.7 [14.8] years; 3888 [53.2%] male; 4962 [67.4%] non-Hispanic White; and 915 [9.5%] sexual minoritized individuals [ie, those who identified as lesbian, gay, bisexual, or another minoritized sexual identity]) were included. Frequent Tips exposure was associated with higher odds of quit intentions and attempts overall (adjusted odds ratio [aOR], 1.25; 95% CI, 1.07-1.46 for intention to quit within 12 months; aOR, 1.26; 95% CI, 1.08-1.47 for serious quit attempts in the past 12 months; and aOR, 1.24; 95% CI, 1.06-1.44 for number of serious quit attempts in the past 12 months). These associations were significantly stronger for heterosexual smokers than sexual minoritized smokers, as indicated by the significant interaction terms (aOR, 0.58; 95% CI, 0.36-0.96 for intention to quit within 12 months; aOR, 0.41; 95% CI, 0.24-0.70 for serious quit attempts in the past 12 months; and aOR, 0.40; 95% CI, 0.24-0.67 for number of serious quit attempts in the past 12 months). Subgroup analysis showed that heterosexual smokers who reported frequent Tips exposure were more likely to intend to quit within 12 months (aOR, 1.29; 95% CI, 1.10-1.53), have had any serious quit attempts in the past 12 months (aOR, 1.34; 95% CI, 1.13-1.58), and have had more serious quit attempts (aOR, 1.32; 95% CI, 1.12-1.54) than heterosexual smokers who reported infrequent exposure. In contrast, there was no association for sexual minoritized smokers (aOR, 0.82; 95% CI, 0.52-1.30 for intention to quit within 12 months; aOR, 0.65; 95% CI, 0.39-1.07 for serious quit attempts in the past 12 months; and aOR, 0.62; 95% CI, 0.38-1.00 for number of serious quit attempts in the past 12 months).

Conclusions And Relevance: These findings suggest that significant differences exist in the associations between Tips exposure and quit intentions or attempts by sexual minority status. More targeted campaign content for sexual minoritized smokers may be needed to increase quit intentions and attempts among this group.
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http://dx.doi.org/10.1001/jamanetworkopen.2022.11060DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9086838PMC
May 2022

Correlation of D-dimer and Outcomes in COVID-19 Patients.

Am Surg 2022 Apr 29:31348221091940. Epub 2022 Apr 29.

School of Medicine, 5225Mercer University, Macon, GA, USA.

Background: The coronavirus disease 2019 (COVID-19) global pandemic has impacted daily life and medical practices around the world. Hospitals are continually making observations about this unique population as it relates to laboratory data and outcomes. Plasma D-dimer levels have been shown to be promising as a prognostic factor for outcomes in COVID-19 patients. This single institution retrospective study investigates the correlation between D-dimer and patient outcomes in our inpatient COVID-19 patient population.

Methods: COVID-19 confirmed positive patients who were admitted between March 2020 and May 2020 at our hospital were identified. Admission and peak D-dimer values and patient outcomes, including intubation and mortality, were retrospectively analyzed.

Results: Ninety-seven patients met criteria for inclusion in the study Mean age was 63.2 years, median admission D-dimer 2.35ug/mL, and median peak D-dimer 2.74ug/mL. Average time to peak D-dimer was 3.2 days. Patient's requiring intubation had higher admission D-dimers (3.79ug/mL vs. 1.62 ug/mL).

Discussion: Higher admission and peak D-dimer values were associated with worsening clinical outcomes, specifically with higher rates of intubation and mortality. Noting D-dimer trends early in a patients' COVID course, regardless of patients' clinical condition, may allow opportunities for physicians to provide early intervention to prevent these outcomes.
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http://dx.doi.org/10.1177/00031348221091940DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9066233PMC
April 2022

Do All Isolated Traumatic Subarachnoid Hemorrhages Need to Be Transferred to a Level 1 Trauma Center?

Am Surg 2022 Aug 11;88(8):1827-1831. Epub 2022 Apr 11.

Department of Trauma Surgery, 12241Mercer University School of Medicine, Macon, GA, USA.

Background: The management of isolated traumatic subarachnoid hemorrhage (itSAH) in non-trauma centers usually results in transfer to a Level 1 trauma center with neurosurgical capabilities. Due to lack of trauma center resources, we sought to evaluate if patients with itSAH need transfer to a Level I trauma center.

Methods: A retrospective review of the trauma registry was conducted from Jan 2015-Dec 2020. Patients with itSAH on initial computed tomographic imaging and a Glasgow Coma Scale score >13 were included. Patients with any other intracranial pathology, skull fractures, multi-system trauma or age less than 15 were excluded.

Results: 120 patients were identified with itSAH. Mean age was 63 years, and 44% were male. Mean injury severity score was 4.7 with 48% on anticoagulation/antiplatelet therapy. Radiology Reports were reviewed and only 2 scans (1.7%) showed an increase in itSAH, 98.3% reports revealed no change, improvement, or resolution. No patients deteriorated and no patients underwent neurosurgical intervention. Once admitted, 27 (23%) were treated for acute medical conditions and 39 (33%) required subspecialty medical consultations. There was no difference in increased itSAH on repeat imaging between patients on anticoagulation/antiplatelet therapy and those without. The population taking anticoagulant/antiplatelet therapy was older, more likely to have suffered a fall, have more comorbid conditions, was more likely to be treated for a non-traumatic medical condition and have a subspecialty medical consultation.

Discussion: Patients with itSAH do not require transfer to a Level 1 trauma center for acute neurosurgical intervention.
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http://dx.doi.org/10.1177/00031348221084954DOI Listing
August 2022

Prospective randomized trial of metal versus resorbable plates in surgical stabilization of rib fractures.

J Trauma Acute Care Surg 2022 08 8;93(2):147-156. Epub 2022 Apr 8.

From the Department of Surgery (D.W.A., D.B.C., E.L.L.), Trauma Service (R.A., T.J.J., J.F.-D.), Atrium Health Navicent; and Department of Community Medicine (A.M.), Mercer University School of Medicine, Macon, Georgia.

Background: Surgical stabilization of rib fractures has gained popularity as both metal and resorbable plates have been approved for fracture repair. Is there a difference between metal and resorbable plate rib fixation regarding rib fracture alignment, control of pain, and quality-of-life (QOL) scores (Rand SF-36 survey)?

Methods: Eligible patients (pts) included 18 years or older with one or more of the following: flail chest, one or more bicortical displaced fractures (3-10), nondisplaced fractures with failure of medical management. Patients were randomized to either metal or resorbable plate fixation. Primary outcome was fracture alignment. Secondary outcomes were pain scores, opioid use, and QOL scores.

Results: Thirty pts were randomized (15 metal/15 resorbable). Total ribs plated 167 (88 metal/79 resorbable). Patients with rib displacement at day of discharge (DOD) metal 0/14 (one pt died, not from plating) versus resorbable 9/15 or 60% ( p = 0.001). Ribs displaced at DOD metal 0/88 versus resorbable 22/79 or 28% ( p < 0.001), 48% in posterior location. Patients with increased rib displacement 3 months to 6 months: metal, 0/11 versus resorbable, 3/9 or 33% ( p = 0.043). Ribs with increased displacement 3 months to 6 months metal 0 of 67 versus resorbable 6 of 49 or 12.2% ( p < 0.004). Pain scores and narcotic use at postoperative Days 1, 2, 3, DOD, 2 weeks, 3 months and 6 months showed no statistically significant difference between groups. QOL scores were also similar at 3 months and 6 months. Trauma recidivism in outpatient period resulted in fracture of resorbable plates in two pts requiring a second surgery.

Conclusion: Metal plates provided better initial alignment with no displacement over time. Clinical outcomes were similar regarding pain, narcotic use, and QOL scores. Routine use of resorbable plates for posterior rib fractures is not warranted. Lateral repairs were technically most feasible for using resorbable plates but still resulted in significant displacement. Resorbable plates may not maintain rib alignment when exposed to subsequent injury.

Level Of Evidence: Therapeutic/Care Management; Level II.
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http://dx.doi.org/10.1097/TA.0000000000003642DOI Listing
August 2022

Long-chain ceramides are cell non-autonomous signals linking lipotoxicity to endoplasmic reticulum stress in skeletal muscle.

Nat Commun 2022 04 1;13(1):1748. Epub 2022 Apr 1.

School of Medicine, University of Leeds, Leeds, LS2 9JT, UK.

The endoplasmic reticulum (ER) regulates cellular protein and lipid biosynthesis. ER dysfunction leads to protein misfolding and the unfolded protein response (UPR), which limits protein synthesis to prevent cytotoxicity. Chronic ER stress in skeletal muscle is a unifying mechanism linking lipotoxicity to metabolic disease. Unidentified signals from cells undergoing ER stress propagate paracrine and systemic UPR activation. Here, we induce ER stress and lipotoxicity in myotubes. We observe ER stress-inducing lipid cell non-autonomous signal(s). Lipidomics identifies that palmitate-induced cell stress induces long-chain ceramide 40:1 and 42:1 secretion. Ceramide synthesis through the ceramide synthase 2 de novo pathway is regulated by UPR kinase Perk. Inactivation of CerS2 in mice reduces systemic and muscle ceramide signals and muscle UPR activation. The ceramides are packaged into extracellular vesicles, secreted and induce UPR activation in naïve myotubes through dihydroceramide accumulation. This study furthers our understanding of ER stress by identifying UPR-inducing cell non-autonomous signals.
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http://dx.doi.org/10.1038/s41467-022-29363-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8975934PMC
April 2022

Variability in Urinary Nicotine Exposure Biomarker Levels Between Waves 1 (2013-2014) and 2 (2014-2015) in the Population Assessment of Tobacco and Health Study.

Nicotine Tob Res 2022 Mar 25. Epub 2022 Mar 25.

Division of Laboratory Sciences, National Center for Environmental Health, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA.

Introduction: To date, no studies have evaluated the consistency of biomarker levels in people who smoke over a long-time period in real-world conditions with a large number of subjects and included use behavior and measures of nicotine metabolism. We evaluated the variability of biomarkers of nicotine exposure over approximately a 1-year period in people who exclusively smoke cigarettes, including intensity and recency of use and brand switching to assess impact on understanding associations with product characteristics.

Aims And Methods: Multivariate regression analysis of longitudinal repeated measures of urinary biomarkers of nicotine exposure from 916 adults in the Population Assessment of Tobacco and Health (PATH) Study with demographic characteristics and use behavior variables. Intraclass correlation coefficients (ICCs) were calculated to examine individual variation of nicotine biomarkers and the uncertainty of repeat measures at two time points (Waves 1 and 2).

Results: Age, race, and urinary creatinine were significant covariates of urinary cotinine. When including use behavior, recency, and intensity of use were highly significant and variance decreased to a higher extent between than within subjects. The ICC for urinary cotinine decreased from 0.7530 with no use behavior variables in the model to 0.5763 when included. Similar results were found for total nicotine equivalents.

Conclusions: Urinary nicotine biomarkers in the PATH Study showed good consistency between Waves 1 and 2. Use behavior measures such as time since last smoked a cigarette and number of cigarettes smoked in the past 30 days are important to include when assessing factors that may influence biomarker concentrations.

Implications: The results of this study show that the consistency of the nicotine biomarkers cotinine and total nicotine equivalents in spot urine samples from Waves 1 to 2 of the PATH Study is high enough that these data are useful to evaluate the association of cigarette characteristics with biomarkers of exposure under real-world use conditions.
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http://dx.doi.org/10.1093/ntr/ntac056DOI Listing
March 2022

Georgia Quality Improvement Programs Multi-Institutional Collection of Postoperative Opioid Data Using ACS-NSQIP Abstraction.

Am Surg 2022 Jul 25;88(7):1510-1516. Epub 2022 Mar 25.

Department of Surgery, 12239Emory University School of Medicine, Atlanta, GA, USA.

Background: Excessive postoperative opioid prescribing contributes to opioid misuse throughout the US. The Georgia Quality Improvement Program (GQIP) is a collaboration of ACS-NSQIP participating hospitals. GQIP aimed to develop a multi-institutional opioid data collection platform as well as understand our current opioid-sparing strategy (OSS) usage and postoperative opioid prescribing patterns.

Methods: This study was initiated 7/2019, when 4 custom NSQIP variables were developed to capture OSS usage and postoperative opioid oral morphine equivalents (OMEs). After pilot collection, our discharge opioid variable required optimization for adequate data capture and was expanded from a free text option to 4 drop-down selection variables. Data collection then continued from 2/2020-5/2021. Logistic regression was used to determine associations with OSS usage. Average OMEs were calculated for common general surgery procedures and compared to national guidelines.

Results: After variable optimization, the percentage where a total discharge prescription OME could be calculated increased from 26% to 70% ( < .001). The study included 820 patients over 10 operations. There was a significant variation in OSS usage between GQIP centers. Laparoscopic cases had higher odds of OSS use (1.92 (1.38-2.66)) while OSS use had lower odds in black patients on univariate analysis (.69 (.51-.94)). On average 7 out of the 10 cases had higher OMEs prescribed compared to national guidelines recommendations.

Conclusion: Developing a multi-institutional opioid data collection platform through ACS-NSQIP is feasible. Preselected drop-down boxes outperform free text variables. GQIP future quality improvement targets include variation in OSS use and opioid overprescribing.
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http://dx.doi.org/10.1177/00031348221082286DOI Listing
July 2022

Enhanced Degradation of Micropollutants in a Peracetic Acid-Fe(III) System with Picolinic Acid.

Environ Sci Technol 2022 04 23;56(7):4437-4446. Epub 2022 Mar 23.

School of Civil and Environmental Engineering, Georgia Institute of Technology, Atlanta, Georgia 30332, United States.

Activation of peracetic acid (PAA) with iron species is an emerging advanced oxidation process (AOP). This study investigates the use of the chelating agent picolinic acid (PICA) to extend the pH range and enhance the performance of the PAA-Fe(III) AOP. Compared to the PAA-Fe(III) system, the PAA-Fe(III)-PICA system degrades various micropollutants (MPs: methylene blue, naproxen, sulfamethoxazole, carbamazepine, trimethoprim, diclofenac, and bisphenol-A) much more rapidly at higher pH, achieving almost complete removal of parent compounds within 10 min. PAA significantly outperforms the coexistent HO and is the key oxidant for rapid compound degradation. Other chelating agents, EDTA, NTA, citric acid, proline, and nicotinic acid, could not enhance MP degradation in the PAA-Fe(III) system, while 2,6-pyridinedicarboxylic acid with a structure similar to PICA moderately enhanced MP degradation. Experiments with scavengers (-butyl alcohol and methyl phenyl sulfoxide) and a probe compound (benzoic acid) confirmed that high-valent iron species [Fe(IV) and/or Fe(V)], rather than radicals, are the major reactive species contributing to MP degradation. The oxidation products of methylene blue, naproxen, and sulfamethoxazole by PAA-Fe(III)-PICA were characterized and supported the proposed mechanism. This work demonstrates that PICA is an effective complexing ligand to assist the Fenton reaction of PAA by extending the applicable pH range and accelerating the catalytic ability of Fe(III).
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http://dx.doi.org/10.1021/acs.est.1c08311DOI Listing
April 2022

Perceptions of Nicotine Reduction Policy in the United States: A Qualitative Study.

Nicotine Tob Res 2022 Aug;24(9):1422-1429

School of Public Health, Georgia State University, Atlanta, GA, USA.

Introduction: Several countries are considering a reduced nicotine policy that would make cigarettes minimally or nonaddictive. This qualitative study documents reactions to the policy that should be addressed by future communication efforts.

Methods: In 2020, we recruited participants in Atlanta, GA and San Francisco, CA (27 people who exclusively smoke, 25 who dual use cigarettes and e-cigarettes, 32 who formerly smoked, and 31 young adults who do not smoke). We held 16 focus groups: 2 focus groups for each smoking status in each city. Participants viewed messages about very low nicotine content cigarettes (VLNCs) and were asked about their reactions to each message and their overall response to the reduced nicotine policy.

Results: While responses to the policy were predominantly positive, focus group discussion also revealed concerns, questions, and misunderstandings (referred to here collectively as "perceptions") that may need to be addressed if a reduced nicotine policy is enacted. Participants expressed perceptions related to the policy intent, including that the FDA has ulterior motives, adoption/ implementation, including that nicotine would have to be replaced with other chemicals if removed or that the policy would be unfeasible to implement, and effectiveness, including concern that VLNCs would still be addictive or the policy would backfire.

Conclusions: Addressing perceptions about reduced nicotine policy intent, adoption/implementation, and effectiveness could be key in creating public support and political motivation to move forward with such a policy. Countries contemplating adopting such a policy should consider pairing it with communications that address these perceptions.

Implications: This study is one of very few to use qualitative methods to explore potentially problematic perceptions about nicotine reduction policy among US adults. Results illuminated new policy-specific concerns, questions, and misunderstandings about the reduced nicotine policy intent, adoption/implementation, and effectiveness. Identifying, studying, and addressing relevant perceptions may play a key role in generating support in countries contemplating such a policy.
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http://dx.doi.org/10.1093/ntr/ntac071DOI Listing
August 2022

Antitumor Activity of a Mitochondrial-Targeted HSP90 Inhibitor in Gliomas.

Clin Cancer Res 2022 05;28(10):2180-2195

The Preston Robert Tisch Brain Tumor Center, Duke University Medical Center, Durham, North Carolina.

Purpose: To investigate the antitumor activity of a mitochondrial-localized HSP90 inhibitor, Gamitrinib, in multiple glioma models, and to elucidate the antitumor mechanisms of Gamitrinib in gliomas.

Experimental Design: A broad panel of primary and temozolomide (TMZ)-resistant human glioma cell lines were screened by cell viability assays, flow cytometry, and crystal violet assays to investigate the therapeutic efficacy of Gamitrinib. Seahorse assays were used to measure the mitochondrial respiration of glioma cells. Integrated analyses of RNA sequencing (RNAseq) and reverse phase protein array (RPPA) data were performed to reveal the potential antitumor mechanisms of Gamitrinib. Neurospheres, patient-derived organoids (PDO), cell line-derived xenografts (CDX), and patient-derived xenografts (PDX) models were generated to further evaluate the therapeutic efficacy of Gamitrinib.

Results: Gamitrinib inhibited cell proliferation and induced cell apoptosis and death in 17 primary glioma cell lines, 6 TMZ-resistant glioma cell lines, 4 neurospheres, and 3 PDOs. Importantly, Gamitrinib significantly delayed the tumor growth and improved survival of mice in both CDX and PDX models in which tumors were either subcutaneously or intracranially implanted. Integrated computational analyses of RNAseq and RPPA data revealed that Gamitrinib exhibited its antitumor activity via (i) suppressing mitochondrial biogenesis, OXPHOS, and cell-cycle progression and (ii) activating the energy-sensing AMP-activated kinase, DNA damage, and stress response.

Conclusions: These preclinical findings established the therapeutic role of Gamitrinib in gliomas and revealed the inhibition of mitochondrial biogenesis and tumor bioenergetics as the primary antitumor mechanisms in gliomas.
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http://dx.doi.org/10.1158/1078-0432.CCR-21-0833DOI Listing
May 2022

Evolution of tobacco products: recent history and future directions.

Tob Control 2022 03;31(2):175-182

School of Public Health, Georgia State University, Atlanta, Georgia, USA.

Declines in cigarette smoking prevalence in many countries and the consolidation of the tobacco industry have prompted the introduction of other forms of nicotine delivery. These include electronic nicotine delivery systems (ENDS), heated tobacco products (HTPs) and oral nicotine products (ONPs). Evolving over time, some of these products now deliver nicotine at levels comparable to cigarettes and may serve as effective substitutes for smokers. However, certain products, especially ENDS like JUUL, have also appealed to youth and non-smokers, prompting concerns about expanding nicotine use (and potentially nicotine addiction). The tobacco industry could shift away from primarily promoting cigarettes to promoting ENDS, HTPs and/or ONPs, though at this time it continues to heavily promote cigarettes in low and middle-income countries. Differing regulatory regimes may place upward and downward pressures on both cigarettes and these newer products in terms of population use, and may ultimately drive the extent to which cigarettes are or are not displaced by ENDS, HTPs and/or ONPs in the coming decade.
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http://dx.doi.org/10.1136/tobaccocontrol-2021-056544DOI Listing
March 2022

Visible Light-Induced Catalyst-Free Activation of Peroxydisulfate: Pollutant-Dependent Production of Reactive Species.

Environ Sci Technol 2022 02 4;56(4):2626-2636. Epub 2022 Feb 4.

Department of Civil and Environmental Engineering, Texas A&M University, College Station, Texas 77843, United States.

Activation of peroxydisulfate (PDS, SO) via various catalysts to degrade pollutants in water has been extensively investigated. However, catalyst-free activation of PDS by visible light has been largely ignored. This paper reports effective visible light activation of PDS without any additional catalyst, leading to the degradation of a wide range of organic compounds of high environmental and human health concerns. Importantly, the formation of reactive species is distinctively different in the PDS visible light system with and without pollutants [e.g., atrazine (ATZ)]. In addition to SO generated via SO dissociation under visible light irradiation, O and O are also produced in both systems. However, in the absence of ATZ, HO and O are key intermediates and precursors for O, whereas in the presence of ATZ, a different pathway was followed to produce O and O. Both radical and nonradical processes contribute to the degradation of ATZ in the PDS visible light system. The active role of O in the degradation of ATZ besides SO is manifested by the enhanced degradation of contaminants and electron paramagnetic resonance spectroscopy measurements in DO.
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http://dx.doi.org/10.1021/acs.est.1c06696DOI Listing
February 2022

Low tumor mutational burden and immunotherapy in gliomas.

Trends Cancer 2022 05 31;8(5):345-346. Epub 2022 Jan 31.

Department of Neurosurgery, Duke University, Durham, NC, USA. Electronic address:

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http://dx.doi.org/10.1016/j.trecan.2022.01.006DOI Listing
May 2022

Surgical Stabilization of Rib Fractures Improves Outcomes in the Geriatric Patient Population.

Am Surg 2022 Apr 3;88(4):658-662. Epub 2022 Jan 3.

Department of Surgery, 5225Mercer University, Macon, GA, USA.

Introduction: Rib fractures in the ≥65-year-old population have been shown to strongly influence mortality and pneumonia rates. There is a growing body of evidence demonstrating improvements in the geriatric patient's survival statistics and respiratory performances after surgical stabilization of rib fractures (SSRF). We have observed a strong survival and complication avoidance trend in geriatric patients who undergo SSRF. The purpose of our study was to evaluate the outcomes of geriatric patients with rib fractures treated with SSRF compared to those who only receive conservative therapies.

Methods: We performed a retrospective review of our trauma registry analyzing outcomes of patients ≥65 years with rib fractures. Patients admitted from 2015 to 2019 receiving SSRF (RP group) were compared to a nonoperative controls (NO group) admitted during the same time. Bilateral fractures were excluded. Independent variables analyzed = ISS, mortalities, hospital days, ICU days, pleural space complications, and readmissions. Follow-up was 60 days after discharge. Group comparison was performed using Kolmogorov-Smirnov, Shapiro-Wilk, and Mann-Whitney U tests.

Results: 257 patients were analyzed: 172 in the NO group with mean age of 75 (65-10) and 85 in the RP group with mean age of 74 (65-96). Mean ISS = 13 (1-38) for the NO group and 20 (9-59) for the RP group ( < .001). Mean hospital days = 8 (1-39) and 15 (3-49) in NO and RP groups, respectively. Mean ICU days = 10 (1-32) and 8 (1-11) in NO and RP groups, respectively. Deaths, pneumonia, readmissions, and pleural effusions in the NO group were statistically significant ( < .01). Analysis of complications revealed 4 RP patients (4.7%) with respiratory complications out to 60 days and 65 NO patients (37.8%) ( < .001).

Conclusions: Surgical stabilization of rib fractures appears to be associated with a survival advantage and an avoidance of respiratory-related complications in the ≥65-year-old patient population.
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http://dx.doi.org/10.1177/00031348211060432DOI Listing
April 2022

Establishment of patient-derived organoid models of lower-grade glioma.

Neuro Oncol 2022 04;24(4):612-623

Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas,USA.

Background: Historically, creating patient-derived models of lower-grade glioma (LGG) has been challenging, contributing to few experimental platforms that support laboratory-based investigations of this disease. Although organoid modeling approaches have recently been employed to create in vitro models of high-grade glioma (HGG), it is unknown whether this approach can be successfully applied to LGG.

Methods: In this study, we developed an optimized protocol for the establishment of organoids from LGG primary tissue samples by utilizing physiologic (5%) oxygenation conditions and employed it to produce the first known suite of these models. To assess their fidelity, we surveyed key biological features of patient-derived organoids using metabolic, genomic, histologic, and lineage marker gene expression assays.

Results: Organoid models were created with a success rate of 91% (n = 20/22) from primary tumor samples across glioma histological subtypes and tumor grades (WHO Grades 1-4), and a success rate of 87% (13/15) for WHO Grade 1-3 tumors. Patient-derived organoids recapitulated stemness, proliferative, and tumor-stromal composition profiles of their respective parental tumor specimens. Cytoarchitectural, mutational, and metabolic traits of parental tumors were also conserved. Importantly, LGG organoids were maintained in vitro for weeks to months and reanimated after biobanking without loss of integrity.

Conclusions: We report an efficient method for producing faithful in vitro models of LGG. New experimental platforms generated through this approach are well positioned to support preclinical studies of this disease, particularly those related to tumor immunology, tumor-stroma interactions, identification of novel drug targets, and personalized assessments of treatment response profiles.
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http://dx.doi.org/10.1093/neuonc/noab273DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8972292PMC
April 2022

"It's Cool, Modifying and All, but I Don't Want Anything Blowing Up on Me:" A Focus Group Study of Motivations to Modify Electronic Nicotine Delivery Systems (ENDS).

Int J Environ Res Public Health 2021 11 9;18(22). Epub 2021 Nov 9.

School of Public Health, Georgia State University, Atlanta, GA 30302-3995, USA.

Introduction: Modifications to electronic nicoti ne delivery systems (ENDS) can pose health risks to users. This study explored users' motivations for modifying ENDS devices and how perceived risks of modifications influenced modification behaviors as product availability and device characteristics changed over time.

Method: We conducted nine focus groups (February-June 2020) with 32 current ENDS users (18+, used ENDS in the past 30 days, and had been using ENDS for more than 2 months).

Results: Participants primarily modified ENDS devices to improve their experiences, such as experimenting with flavor, controlling nicotine levels, or using cannabis products with ENDS. Another reason for modifying was routine maintenance to ensure a satisfactory experience, including maintaining coils and keeping batteries charged. The broader availability of ENDS products shifted modification behaviors over time, with newer devices making some modifications (e.g., coil replacement) easier and making more intricate modifications (e.g., building coil from scratch) less common. Participants were aware of modification dangers and cited perceived risk as the reason for avoiding certain modifications, such as battery alterations.

Conclusions: Modifications of ENDS are ongoing and evolving among users and should be considered by the Food and Drug Administration (FDA) and other regulatory decision-makers as product authorization reviews are conducted and product standards are developed.
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http://dx.doi.org/10.3390/ijerph182211735DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8619023PMC
November 2021

American Association for the Surgery of Trauma/American College of Surgeons-Committee on Trauma Clinical Protocol for inpatient venous thromboembolism prophylaxis after trauma.

J Trauma Acute Care Surg 2022 03;92(3):597-604

From the Division of Acute Care Surgery, Department of Surgery (B.K.Y., M.P.K.), University of Florida-Jacksonville, Jacksonville, Florida; Division of Trauma Surgical Critical Care, Burns and Acute Care Surgery, Department of Surgery (A.E.B., T.W.C.), UC San Diego School of Medicine, San Diego, California; Department of Surgery (A.C., R.K.), University of Oklahoma Health Science Center, Oklahoma City, Oklahoma; Department of Surgery (C.T.), University of Minnesota, Minneapolis, Minnesota; Trauma Services (G.T.T.), Scripps Memorial Hospital La Jolla, La Jolla, California; Division of Acute Care Surgery/Department of Surgery (D.G.J.), Atrium Health-Carolinas Medical Center, Charlotte, North Carolina; Division of Trauma and Acute Care Surgery (W.H.M.), Upstate Medical University, Syracuse, New York; Department of Surgery (D.W.A.), Mercer University School of Medicine, Atrium Health Navicent, Macon, Georgia; Department of Surgery (E.J.L.), Cedars-Sinai Medical Center, Los Angeles, California; and Trauma and Surgical Critical Care, Department of Surgery (L.N.), University of Michigan Health System, Ann Arbor, Michigan.

Abstract: Trauma patients are at increased risk of venous thromboembolism (VTE), which includes both deep vein thrombosis and pulmonary embolism. Pharmacologic VTE prophylaxis is a critical component of optimal trauma care that significantly decreases VTE risk. Optimal VTE prophylaxis protocols must manage the risk of VTE with the competing risk of hemorrhage in patients following significant trauma. Currently, there is variability in VTE prophylaxis protocols across trauma centers. In an attempt to optimize VTE prophylaxis for the injured patient, stakeholders from the American Association for the Surgery of Trauma and the American College of Surgeons-Committee on Trauma collaborated to develop a group of consensus recommendations as a resource for trauma centers. The primary goal of these recommendations is to help standardize VTE prophylaxis strategies for adult trauma patients (age ≥15 years) across all trauma centers. This clinical protocol has been developed to (1) provide standardized medication dosing for VTE prophylaxis in the injured patient; and (2) promote evidence-based, prompt VTE prophylaxis in common, high-risk traumatic injuries.

Level Of Evidence: Therapeutic/Care Management; Level V.
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http://dx.doi.org/10.1097/TA.0000000000003475DOI Listing
March 2022

Atypical Teratoid Rhabdoid Tumours Are Susceptible to Panobinostat-Mediated Differentiation Therapy.

Cancers (Basel) 2021 Oct 14;13(20). Epub 2021 Oct 14.

Centre for Cancer Research, Hudson Institute of Medical Research, Clayton, VIC 3168, Australia.

Atypical teratoid rhabdoid tumour (ATRT) is a rare but highly aggressive undifferentiated solid tumour arising in the central nervous system and predominantly affecting infants and young children. ATRT is exclusively characterized by the inactivation of , a member of the SWI/SNF chromatin remodelling complex that is essential for the regulation of large sets of genes required for normal development and differentiation. Histone deacetylase inhibitors (HDACi) are a promising anticancer therapy and are able to mimic the normal acetylation functions of SMARCB1 in -deficient cells and drive multilineage differentiation in extracranial rhabdoid tumours. However, the potential efficacy of HDACi in ATRT is unknown. Here, we show that human ATRT cells are highly responsive to the HDACi panobinostat and that sustained treatment leads to growth arrest, increased cell senescence, decreased clonogenicity and induction of a neurogenesis gene-expression profile. Furthermore, in an orthotopic ATRT xenograft model, continuous panobinostat treatment inhibits tumour growth, increases survival and drives neuronal differentiation as shown by the expression of the neuronal marker, TUJ1. Collectively, this preclinical study supports the therapeutic potential of panobinostat-mediated differentiation therapy for ATRT.
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http://dx.doi.org/10.3390/cancers13205145DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8534272PMC
October 2021

"I'm bored and I'm stressed": A qualitative study of exclusive smokers, ENDS users, and transitioning smokers or ENDS users in the time of COVID-19.

Nicotine Tob Res 2021 Oct 5. Epub 2021 Oct 5.

School of Public Health, Georgia State University, Atlanta, GA.

Background: To better understand the various influences of COVID-19 on tobacco use, we examined three different tobacco user groups using qualitative methods.

Methods: Ten online focus groups with 61 adults from the Atlanta, GA area were held in October-November 2020: four with exclusive smokers (n=16), three with Electronic Nicotine Delivery System (ENDS) users (dual and exclusive, n=22), and three with transitioning (recently quit or currently quitting) smokers and/or ENDS users (n=23).

Results: Exclusive smokers reported smoking more frequently, driven by COVID-19-related stress, time at home, and boredom. They were not motivated to quit during the pandemic, and some considered smoking to be protective against COVID-19. ENDS users reported vaping less, with dual users often increasing their smoking; many were concerned about health effects of smoking and ENDS use during the pandemic. Transitioning smokers/ENDS users worried about their health and wanted to quit, but many found the stress of COVID-19 unbearable without tobacco use.

Conclusions: There were some similarities among the groups, but also pronounced differences. Educational campaigns should capitalize on the teachable moment of COVID-19 to increase perceived risk of smoking. Smokers need access to more adaptive ways to deal with stress (such as mindfulness training) in lieu of smoking and systems-level approaches should address structural determinants of health that cause high levels of stress. The proposed policy to lower nicotine in combusted tobacco products might help smokers choose other means of coping instead of cigarettes by reducing the stress-relieving properties of smoking particularly salient during the pandemic.

Implications: Smokers believe that cigarettes help them deal with the stresses and challenges of the COVID-19 pandemic. This needs to be counteracted by educational campaigns to increase perceived harm of smoking, alternative stress-relief strategies, and mandated changes to the combusted tobacco products to make them less appealing.
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http://dx.doi.org/10.1093/ntr/ntab199DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8522380PMC
October 2021

A Modified Nucleoside 6-Thio-2'-Deoxyguanosine Exhibits Antitumor Activity in Gliomas.

Clin Cancer Res 2021 12 30;27(24):6800-6814. Epub 2021 Sep 30.

Department of Computer Science, Ying Wu College of Computing, New Jersey Institute of Technology, Newark, New Jersey.

Purpose: To investigate the therapeutic role of a novel telomere-directed inhibitor, 6-thio-2'-deoxyguanosine (THIO) in gliomas both and .

Experimental Design: A panel of human and mouse glioma cell lines was used to test therapeutic efficacy of THIO using cell viability assays, flow cytometric analyses, and immunofluorescence. Integrated analyses of RNA sequencing and reverse-phase protein array data revealed the potential antitumor mechanisms of THIO. Four patient-derived xenografts (PDX), two patient-derived organoids (PDO), and two xenografts of human glioma cell lines were used to further investigate the therapeutic efficacy of THIO.

Results: THIO was effective in the majority of human and mouse glioma cell lines with no obvious toxicity against normal astrocytes. THIO as a monotherapy demonstrated efficacy in three glioma cell lines that had acquired resistance to temozolomide. In addition, THIO showed efficacy in four human glioma cell lines grown as neurospheres by inducing apoptotic cell death. Mechanistically, THIO induced telomeric DNA damage not only in glioma cell lines but also in PDX tumor specimens. Integrated computational analyses of transcriptomic and proteomic data indicated that THIO significantly inhibited cell invasion, stem cell, and proliferation pathways while triggering DNA damage and apoptosis. Importantly, THIO significantly decreased tumor proliferation in two PDO models and reduced the tumor size of a glioblastoma xenograft and a PDX model.

Conclusions: The current study established the therapeutic role of THIO in primary and recurrent gliomas and revealed the acute induction of telomeric DNA damage as a primary antitumor mechanism of THIO in gliomas.
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http://dx.doi.org/10.1158/1078-0432.CCR-21-0374DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8678347PMC
December 2021

Halogenation affects driving forces, reorganization energies and "rocking" motions in strained [Fe(tpy)] complexes.

Dalton Trans 2021 Oct 26;50(41):14566-14575. Epub 2021 Oct 26.

Department of Chemistry, North Carolina State University, 2620 Yarbrough Dr., Raleigh, NC 27695, USA.

Controlling the energetics of spin crossover (SCO) in Fe(II)-polypyridine complexes is critical for designing new multifunctional materials or tuning the excited-state lifetimes of iron-based photosensitizers. It is well established that the Fe-N "breathing" mode is important for intersystem crossing from the singlet to the quintet state, but this does not preclude other, less obvious, structural distortions from affecting SCO. Previous work has shown that halogenation at the 6 and 6'' positions of tpy (tpy = 2,2';6',2''-terpyridine) in [Fe(tpy)] dramatically increased the lifetime of the excited MLCT state and also had a large impact on the ground state spin-state energetics. To gain insight into the origins of these effects, we used density functional theory calculations to explore how halogenation impacts spin-state energetics and molecular structure in this system. Based on previous work we focused on the ligand "rocking" motion associated with SCO in [Fe(tpy)] by constructing one-dimensional potential energy surfaces (PESs) along the tpy rocking angle for various spin states. It was found that halogenation has a clear and predictable impact on ligand rocking and spin-state energetics. The rocking is correlated to numerous other geometrical distortions, all of which likely affect the reorganization energies for spin-state changes. We have quantified trends in reorganization energy and also driving force for various spin-state changes and used them to interpret the experimentally measured excited-state lifetimes.
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http://dx.doi.org/10.1039/d1dt02314dDOI Listing
October 2021

Designing Clinical Trials for Combination Immunotherapy: A Framework for Glioblastoma.

Clin Cancer Res 2022 02;28(4):585-593

Duke University, Durham, North Carolina.

Immunotherapy has revolutionized treatment for many hard-to-treat cancers but has yet to produce significant improvement in outcomes for patients with glioblastoma. This reflects the multiple and unique mechanisms of immune evasion and escape in this highly heterogeneous tumor. Glioblastoma engenders profound local and systemic immunosuppression and is remarkably effective at inducing T-cell dysfunction, posing a challenge to any immunotherapy-based approach. To overcome these mechanisms, multiple disparate modes of immune-oriented therapy will be required. However, designing trials that can evaluate these combinatorial approaches requires careful consideration. In this review, we explore the immunotherapy resistance mechanisms that have been encountered to date and how combinatorial approaches may address these. We also describe the unique aspects of trial design in both preclinical and clinical settings and consider endpoints and markers of response best suited for an intervention involving multiple agents.
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http://dx.doi.org/10.1158/1078-0432.CCR-21-2681DOI Listing
February 2022

Primary brain tumor patients admitted to a US intensive care unit: a descriptive analysis.

CNS Oncol 2021 09 21;10(3):CNS77. Epub 2021 Sep 21.

Department of Neurology, Duke University Medical Center, Durham, NC 27710, USA.

To describe our population of primary brain tumor (PBT) patients, a subgroup of cancer patients whose intensive care unit (ICU) outcomes are understudied. Retrospective analysis of PBT patients admitted to an ICU between 2013 to 2018 for an unplanned need. Using descriptive analyses, we characterized our population and their outcomes. Fifty-nine PBT patients were analyzed. ICU mortality was 19% (11/59). The most common indication for admission was seizures (n = 16, 27%). Our ICU mortality of PBT patients was comparable to other solid tumor patients and the general ICU population and better than patients with hematological malignancies. Further study of a larger population would inform guidelines for triaging PBT patients who would most benefit from ICU-level care.
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http://dx.doi.org/10.2217/cns-2021-0009DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8461751PMC
September 2021

Are all charge-transfer parameters created equally? A study of functional dependence and excited-state charge-transfer quantification across two dye families.

Phys Chem Chem Phys 2021 Sep 22;23(36):20583-20597. Epub 2021 Sep 22.

Department of Chemistry, North Carolina State University, Raleigh, NC 27695, USA.

Small molecule organic dyes have many potential uses in medicine, textiles, forensics, and light-harvesting technology. Being able to computationally predict the spectroscopic properties of these dyes could greatly expedite screening efforts, saving time and materials. Time-dependent density functional theory (TD-DFT) has been shown to be a good tool for this in many instances, but characterizing electronic excitations with charge-transfer (CT) character has historically been challenging and can be highly sensitive to the chosen exchange-correlation functional. Here we present a combined experimental and computational study of the excited-state electronic structure of twenty organic dyes obtained from the Max Weaver Dye Library at NCSU. Results of UV-vis spectra calculations on these dyes with six different exchange-correlation functionals, BP86, B3LYP, PBE0, M06, BH and HLYP, and CAM-B3LYP, were compared against their measured UV-vis spectra. It was found that hybrid functionals with modest amounts (20-30%) of included Hartree-Fock exchange are the most effective at matching the experimentally determined . The interplay between the observed error, the functional chosen, and the degree of CT was analyzed by quantifying the CT character of using four orbital and density-based metrics, , Δ, and , as well as the change in the dipole moment, Δ. The results showed that the relationship between CT character and the functional dependence of error is not straightforward, with the observed behavior being dependent both on how CT was quantified and the functional groups present in the molecules themselves. It is concluded that this may be a result of the examined excitations having intermediate CT character. Ultimately it was found that the nature of the molecular "family" influenced how a given functional behaved as a function of CT character, with only two of the examined CT quantification methods, Δ and , showing consistent behavior between the different molecular families. This suggests that further work needs to be done to ensure that currently used CT quantification methods show the same general trends across large sets of multiple dye families.
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http://dx.doi.org/10.1039/d1cp03383bDOI Listing
September 2021

Needs Based Assessment of Trauma Systems 2, is it ready for primetime? A natural experiment testing its reliability.

J Trauma Acute Care Surg 2021 09;91(3):489-495

From the Department of Surgery (D.W.A.), Atrium Health Navicent, Macon, Georgia; Department of Health Policy and Management (E.E.P.), University of South Florida, Tampa, Florida; Social Sciences Department (M.J.T.-B.), Augusta University; Department of Surgery (R.S.M.), Augusta University Health, Augusta; and Georgia Trauma Care Network Commission (E.V.A.), Atlanta, Georgia.

Introduction: Needs Based Assessment of Trauma Systems 2 (NBATS-2) attempts to predict the impact on patient volume and travel time for patients when a new trauma center (TC) is added to the system. The purpose of this study was to examine NBATS-2 predictive accuracy regarding expected volume and travel times of trauma patients at a newly designated TC and nearby legacy TCs when compared with actual data.

Methods: Needs Based Assessment of Trauma Systems predictive model for volume of trauma patients at the new TC was run based on 25th, 50th, and 75th percentiles of both state and National Trauma Data Bank (NTDB) patients per 100 TC beds. This was compared with the actual number of trauma patients from the State Discharge Data set before (2011-2012) and after (2016-2017) designation of the TC. Analysis was then augmented using the geographic information system (ArcGIS) spatial modeling to characterize median travel times for actual trauma patients, before and after designation of the TC.

Results: Both state and NTDB 25th, 50th, and 75th percentiles resulted in significant overestimation of volume at the new TC in 2016. After another year of TC maturation (2017), overestimation decreased but was still present. The 25th percentile from state and NTDB data sets provided the most accurate predictions. For the legacy TCs, the model switched from under to overestimation as the state and NTDB percentiles increased. The geographic information system accurately showed patients traveling <40 minutes to a TC nearly doubled.

Conclusion: Needs Based Assessment of Trauma Systems 2 provides an excellent template for state strategic planning; however, it overestimates new TC volume and under/overestimates volumes for legacy TCs depending on the state and NTDB percentiles used. This study shows that population density of the county in which the new or legacy TC is located should be considered when choosing the appropriate state or NTDB percentile. The geographic information system appropriately showed a decrease in trauma patient travel times after TC designation.

Level Of Evidence: Care Management, level V.
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http://dx.doi.org/10.1097/TA.0000000000003288DOI Listing
September 2021

JUUL releases more nicotine in the first puffs.

Tob Control 2021 Jul 13. Epub 2021 Jul 13.

Mechanical Engineering, American University of Beirut, Beirut, Lebanon

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http://dx.doi.org/10.1136/tobaccocontrol-2021-056683DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9281872PMC
July 2021
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