Adolescent Marijuana Use and Co-Occurrence with Tobacco Use: Implications for Tobacco Regulation

Background: Marijuana use among high school youth has been declining over the past two decades. However, there has been a notable shift in the national landscape with regards to social norms and marijuana legalization that could allow marijuana to become more available and may compete against prevention efforts among youth. Further, youth continue to utilize innovative ways to consume marijuana. There is a documented relationship between marijuana and tobacco use, particularly with the use of blunts. Despite the documented relationship between tobacco and marijuana use, little is known about the modes of marijuana use in relation to different tobacco products. With the recent FDA changes bringing cigars under the purview of the FDA Center for Tobacco Products (CTP), there may be an opportunity for CTP regulations of cigar products to impact youth use of both marijuana and tobacco. Methods: This study used data from the 2015 Cleveland Youth Risk Behavior Survey (n=6197) conducted as a census administration in 26 high schools; overall response rate was 66.5%. Youth were asked “During the past 30 days, how did you usually use marijuana?”. Responses were coded as a blunt; in a joint, bong, or pipe (JBP); or some other way. The standard CDC response categories for this item were altered to allow us to specifically examine blunt use. Analyses were restricted to those who smoked marijuana in the past 30 days and were conducted using SPSSv24. Demographic and tobacco use characteristics were examined for each mode of marijuana use. Result: Overall, 74.6% of past 30-day marijuana users reported usually smoking marijuana as a blunt, 15.1% smoked as a JBP, and 10.4% reported using in some other way. Females were more likely to smoke a blunt (79.5% v 71.1%) and less likely to use some other way (6.7% v 13.1%). Blacks were more likely to smoke a blunt compared to Whites and Hispanics (80.8% v 62.3% and 67.0% respectively); Whites were more likely to smoke a JBP compared to Black and Hispanics (33.8% v. 8.9% and 20.1% respectively). Past 30-day cigarette smokers were more likely to have smoked a JBP and less likely to have smoked a blunt compared to non-cigarette smokers. Conversely, past 30-day cigar smokers were more likely to have smoked a blunt and less likely to have smoked a JBP than non-cigar smokers. Youth who vaped in the past 30-days were more likely to use a JBP and use marijuana in some other way compared to youth who had not vaped. In a multivariable logistic regression predicting blunt use or JBP use, cigar product use increased odds of blunting (OR: 1.98) while hookah use was associated with increased odds of JBP. Conclusion: Cigar products are an easily accessible vehicle for smoking marijuana. Federal regulations to restrict youth access to cigar products could have significant impact on adolescent marijuana use, particularly among females and Black youth

The Cigarillo Purchase Task: A Qualitative Analysis

The cigarillo purchase task is a novel procedure modeled after the cigarette purchase task. This procedure can be used to assess the reinforcing value, or the positive behavioral response, to cigarillo products. Little research has used the cigarillo purchase task and the aim of the current study was to evaluate user’s understanding of and thoughts about a cigarillo purchase task. A convenience sample of young adults ages 21-28 were recruited online to participate in semi-structured interviews about cigarillo and e-cigarette use. The analysis included responses from participants who were current users of cigarillos (n=7) or cigarillos and e-cigarettes (n=8). Audio-recorded interviews conducted remotely were coded by two researchers and thematic analysis was implemented. Emergent themes were related to purchasing price, budget, normal cigarillo usage, cigarillo pack size, and time frame of use. Increased use was mentioned when products were free. When cigarillos were expensive, others introduced strategies to circumvent the 24-hour purchase period of the task. Comments were also made that budget is important and using a calculator during the task is helpful. Finally, some commented that selling in individual units wasn’t realistic and made it more difficult to purchase. Results suggest modifications to the task, including depiction of cigarillo pack size and use of a budget calculator. These enhancements support usability and replicability of results when implementing this purchase task in health behavior and tobacco control research

Identification of regulatory variants associated with genetic susceptibility to meningococcal disease.

Non-coding genetic variants play an important role in driving susceptibility to complex diseases but their characterization remains challenging. Here, we employed a novel approach to interrogate the genetic risk of such polymorphisms in a more systematic way by targeting specific regulatory regions relevant for the phenotype studied. We applied this method to meningococcal disease susceptibility, using the DNA binding pattern of RELA - a NF-kB subunit, master regulator of the response to infection - under bacterial stimuli in nasopharyngeal epithelial cells. We designed a custom panel to cover these RELA binding sites and used it for targeted sequencing in cases and controls. Variant calling and association analysis were performed followed by validation of candidate polymorphisms by genotyping in three independent cohorts. We identified two new polymorphisms, rs4823231 and rs11913168, showing signs of association with meningococcal disease susceptibility. In addition, using our genomic data as well as publicly available resources, we found evidences for these SNPs to have potential regulatory effects on ATXN10 and LIF genes respectively. The variants and related candidate genes are relevant for infectious diseases and may have important contribution for meningococcal disease pathology. Finally, we described a novel genetic association approach that could be applied to other phenotypes

Mitochondrial physiology

As the knowledge base and importance of mitochondrial physiology to evolution, health and disease expands, the necessity for harmonizing the terminology concerning mitochondrial respiratory states and rates has become increasingly apparent. The chemiosmotic theory establishes the mechanism of energy transformation and coupling in oxidative phosphorylation. The unifying concept of the protonmotive force provides the framework for developing a consistent theoretical foundation of mitochondrial physiology and bioenergetics. We follow the latest SI guidelines and those of the International Union of Pure and Applied Chemistry (IUPAC) on terminology in physical chemistry, extended by considerations of open systems and thermodynamics of irreversible processes. The concept-driven constructive terminology incorporates the meaning of each quantity and aligns concepts and symbols with the nomenclature of classical bioenergetics. We endeavour to provide a balanced view of mitochondrial respiratory control and a critical discussion on reporting data of mitochondrial respiration in terms of metabolic flows and fluxes. Uniform standards for evaluation of respiratory states and rates will ultimately contribute to reproducibility between laboratories and thus support the development of data repositories of mitochondrial respiratory function in species, tissues, and cells. Clarity of concept and consistency of nomenclature facilitate effective transdisciplinary communication, education, and ultimately further discovery

Mitochondrial physiology

As the knowledge base and importance of mitochondrial physiology to evolution, health and disease expands, the necessity for harmonizing the terminology concerning mitochondrial respiratory states and rates has become increasingly apparent. The chemiosmotic theory establishes the mechanism of energy transformation and coupling in oxidative phosphorylation. The unifying concept of the protonmotive force provides the framework for developing a consistent theoretical foundation of mitochondrial physiology and bioenergetics. We follow the latest SI guidelines and those of the International Union of Pure and Applied Chemistry (IUPAC) on terminology in physical chemistry, extended by considerations of open systems and thermodynamics of irreversible processes. The concept-driven constructive terminology incorporates the meaning of each quantity and aligns concepts and symbols with the nomenclature of classical bioenergetics. We endeavour to provide a balanced view of mitochondrial respiratory control and a critical discussion on reporting data of mitochondrial respiration in terms of metabolic flows and fluxes. Uniform standards for evaluation of respiratory states and rates will ultimately contribute to reproducibility between laboratories and thus support the development of data repositories of mitochondrial respiratory function in species, tissues, and cells. Clarity of concept and consistency of nomenclature facilitate effective transdisciplinary communication, education, and ultimately further discovery

Plasma lipid profiles discriminate bacterial from viral infection in febrile children

Fever is the most common reason that children present to Emergency Departments. Clinical signs and symptoms suggestive of bacterial infection are often non-specific, and there is no definitive test for the accurate diagnosis of infection. The 'omics' approaches to identifying biomarkers from the host-response to bacterial infection are promising. In this study, lipidomic analysis was carried out with plasma samples obtained from febrile children with confirmed bacterial infection (n = 20) and confirmed viral infection (n = 20). We show for the first time that bacterial and viral infection produces distinct profile in the host lipidome. Some species of glycerophosphoinositol, sphingomyelin, lysophosphatidylcholine and cholesterol sulfate were higher in the confirmed virus infected group, while some species of fatty acids, glycerophosphocholine, glycerophosphoserine, lactosylceramide and bilirubin were lower in the confirmed virus infected group when compared with confirmed bacterial infected group. A combination of three lipids achieved an area under the receiver operating characteristic (ROC) curve of 0.911 (95% CI 0.81 to 0.98). This pilot study demonstrates the potential of metabolic biomarkers to assist clinicians in distinguishing bacterial from viral infection in febrile children, to facilitate effective clinical management and to the limit inappropriate use of antibiotics

Dissonance in Young Adult Cigarillo Users’ Categorization of Concept Flavored and Unflavored Products

This study asks young adult cigarillo users to categorize their preferred flavor in order to examine user consensus and potential methodological and regulatory implications of flavor name-based categorization systems. Young adult (21–28 years) cigarillo users (n = 426) named and categorized their favorite cigarillo flavor into one of seven categories: Fruit, Sweet and Candy, Mint, Alcohol, Menthol, Tobacco, and Other. Flavor responses were coded as characterizing (ex: Grape, Wine) or concept (ex: Jazz, Diamond) flavors. Variation within and between categories was assessed, including the presence of concept flavors and the placement of flavors in multiple categories. Of the 66 unique flavor names provided, participants placed 20 (30.1%) in more than one flavor category. Most of the Tobacco (76.9%) and Other (69.2%) flavor names appeared in multiple categories. The majority of flavor names in the Tobacco (69.2%) and Other (61.5%) categories were concept flavors. Concept flavors were placed in multiple categories (45.0%) twice as often as characterizing flavors (23.9%). This study has identified dissonance among cigarillo users’ flavor categorizations, particularly for concept flavored and unflavored products. Flavor names may obscure how and whether a product is flavored. Research on and regulation of flavored tobacco products should classify products by flavor additives rather than by name alone

Intraoperative transfusion practices in Europe

Transfusion of allogeneic blood influences outcome after surgery. Despite widespread availability of transfusion guidelines, transfusion practices might vary among physicians, departments, hospitals and countries. Our aim was to determine the amount of packed red blood cells (pRBC) and blood products transfused intraoperatively, and to describe factors determining transfusion throughout Europe. We did a prospective observational cohort study enrolling 5803 patients in 126 European centres that received at least one pRBC unit intraoperatively, during a continuous three month period in 2013. The overall intraoperative transfusion rate was 1.8%; 59% of transfusions were at least partially initiated as a result of a physiological transfusion trigger- mostly because of hypotension (55.4%) and/or tachycardia (30.7%). Haemoglobin (Hb)- based transfusion trigger alone initiated only 8.5% of transfusions. The Hb concentration [mean (sd)] just before transfusion was 8.1 (1.7) g dl and increased to 9.8 (1.8) g dl after transfusion. The mean number of intraoperatively transfused pRBC units was 2.5 (2.7) units (median 2). Although European Society of Anaesthesiology transfusion guidelines are moderately implemented in Europe with respect to Hb threshold for transfusion (7-9 g dl), there is still an urgent need for further educational efforts that focus on the number of pRBC units to be transfused at this threshold