Objective: We examined the extent to which behavioral ratings of children's executive function (EF) in early adolescence predicted adolescents' cannabis use, and whether associations were independent ...of parents' cannabis and alcohol use and adolescents' alcohol use. Method: Participants were 198 offspring (44% boys) of 127 mothers and 106 fathers. Parents and teachers completed the Behavior Rating Inventory of Executive Function (BRIEF) at ages 11-14 years. Youth were interviewed repeatedly from ages 14 to 20 years regarding frequency of cannabis and alcohol use. Two-level models regressed dichotomous cannabis outcomes (annual, weekly, or daily use) on age at the within-person level and the random intercept of cannabis use on EF, parent substance use, and covariates (age 7 IQ indicators, child gender, parent education, and mean of ages assessed) at the between-person level. Results: Poorer child EF predicted significantly (p < .05) higher likelihood of weekly (bSE = .64.24) and daily (bSE = .65.25), but not annual (bSE = .38.22), cannabis use. Parent cannabis use (bSE = .53.25 to .81.39, p < .05) independently predicted all three outcomes, and effects were distinct from those explained by parent alcohol use (bSE = .66.29 to .81.35, p < .05). EF remained a significant predictor of weekly and daily cannabis use after adjusting for parental alcohol and cannabis use, and adolescents' alcohol use. Conclusions: Children exhibiting poorer EF were more likely to use cannabis weekly and daily in later adolescence. Whereas literature suggests poorer EF may be a consequence of cannabis use, these findings suggest EF should be considered prior to cannabis use initiation. EF during childhood may be a fruitful prevention target.
Public Health Significance Statement
This study shows that older children with poorer executive function (EF)-a subset of cognitive abilities that continue developing into early adulthood-are more likely to use cannabis during adolescence and to do so weekly or daily. This is important because prior research has suggested poorer EF is a consequence of cannabis use, whereas this study indicates poorer EF may occur before youth have even tried cannabis.
Intergenerational studies have identified relations between adolescents' and their future offspring's cannabis and alcohol use, but rarely have examined the association for other illicit drug use. ...Given the low prevalence of such use in community populations, we pooled data from three prospective intergenerational studies to test this link.OBJECTIVEIntergenerational studies have identified relations between adolescents' and their future offspring's cannabis and alcohol use, but rarely have examined the association for other illicit drug use. Given the low prevalence of such use in community populations, we pooled data from three prospective intergenerational studies to test this link.Participants were 1,060 children of 937 parents who had been repeatedly assessed since early adolescence. Children and parents reported on their use of cocaine, stimulants, hallucinogens, sedatives/tranquilizers, and opiates/narcotics from ages 10 to 18 years. Intergenerational similarities in any versus no use of these drugs were formally modeled using logistic regression. Patterns also were descriptively analyzed.METHODParticipants were 1,060 children of 937 parents who had been repeatedly assessed since early adolescence. Children and parents reported on their use of cocaine, stimulants, hallucinogens, sedatives/tranquilizers, and opiates/narcotics from ages 10 to 18 years. Intergenerational similarities in any versus no use of these drugs were formally modeled using logistic regression. Patterns also were descriptively analyzed.Parent illicit substance use was associated with significantly higher odds of child use (adjusted odds ratio 95% confidence interval = 2.682 1.328-5.416, p = 0.006). However, intergenerational continuity was modest; 87% of children whose parent used illicit drugs in adolescence did not use such drugs, and 77% of parents of children who used illicit drugs had not themselves used these drugs during adolescence.RESULTSParent illicit substance use was associated with significantly higher odds of child use (adjusted odds ratio 95% confidence interval = 2.682 1.328-5.416, p = 0.006). However, intergenerational continuity was modest; 87% of children whose parent used illicit drugs in adolescence did not use such drugs, and 77% of parents of children who used illicit drugs had not themselves used these drugs during adolescence.The use of illicit substances by parents during their teenage years poses a risk for their offspring's similar behaviors. However, the discontinuity of these behaviors across generations implies children are largely resilient to or protected from this risk, and conversely that other aspects of parents' and children's experiences or characteristics may be more powerful risks for children's illicit drug use than this transgenerational influence.CONCLUSIONSThe use of illicit substances by parents during their teenage years poses a risk for their offspring's similar behaviors. However, the discontinuity of these behaviors across generations implies children are largely resilient to or protected from this risk, and conversely that other aspects of parents' and children's experiences or characteristics may be more powerful risks for children's illicit drug use than this transgenerational influence.
Background Transesophageal echocardiogram is currently the standard preprocedural imaging for left atrial appendage occlusion. This study aimed to assess the additive value of preprocedural computed ...tomography (CT) planning versus stand-alone transesophageal echocardiogram imaging guidance to left atrial appendage occlusion. Methods and Results We retrospectively reviewed 485 Watchman implantations at a single center to compare the outcomes of using additional CT preprocedural planning (n=328, 67.6%) versus stand-alone transesophageal echocardiogram guidance (n=157, 32.4%) for left atrial appendage occlusion. The primary end point was the rate of successful device implantation without major peri-device leak (>5 mm). Secondary end points included major adverse events, total procedural time, delivery sheath and devices used, risk of major peri-device leak and device-related thrombus at follow-up imaging. A single/anterior-curve delivery sheath was used more commonly in those who underwent CT imaging (35.9% versus 18.8%;
<0.001). Additional preprocedural CT planning was associated with a significantly higher successful device implantation rate (98.5% versus 94.9%;
=0.02), a shorter procedural time (median, 45.5 minutes versus 51.0 minutes;
=0.03) and a less frequent change of device size (5.6% versus 12.1%;
=0.01), particularly device upsize (4% versus 9.4%;
=0.02). However, there was no significant difference in the risk of major adverse events (2.1% versus 1.9%;
=0.87). Only 1 significant peri-device leak (0.2%) and 5 device-related thrombi were detected in follow-up (1.2%) with no intergroup difference. Conclusions Additional preprocedural planning using CT in Watchman implantation was associated with a higher successful device implantation rate, a shorter total procedural time, and a less frequent change of device sizes.
Transcatheter treatment of patients with native aortic valve regurgitation (AR) has been limited by anatomical factors. No transcatheter device has received U.S. regulatory approval for the treatment ...of patients with AR.
The aim of this study was to describe the compassionate-use experience in North America with a dedicated transcatheter device (J-Valve).
A multicenter, observational registry was assembled of compassionate-use cases of J-Valve implantation for the treatment of patients with severe symptomatic AR and elevated surgical risk in North America. The J-Valve consists of a self-expanding Nitinol frame, bovine pericardial leaflets, and a valve-locating feature. The available size matrix (5 sizes) can treat a wide range of anatomies (minimum and maximum annular perimeters 57-104 mm).
A total of 27 patients (median age 81 years IQR: 72-85 years, 81% at high surgical risk, 96% in NYHA functional class III or IV) with native valve AR were treated with the J-Valve during the study period (2018-2022). Procedural success (J-Valve delivered to the intended location without the need for surgical conversion or a second transcatheter heart valve) was 81% (22 of 27 cases) in the overall experience and 100% in the last 15 cases. Two cases required conversion to surgery in the early experience, leading to changes in valve design. At 30 days, there was 1 death, 1 stroke, and 3 new pacemakers (13%), and 88% of patients were in NYHA functional class I or II. No patient had residual AR of moderate or greater degree at 30 days.
The J-Valve appears to provide a safe and effective alternative to surgery in patients with pure AR and elevated or prohibitive surgical risk.
Drawing on Bansal & Roth's model of ecological responsiveness, the study investigates how environmental managers' cognitive framings of sustainability issues and interpretations of field-level ...contextual factors affect decision-making processes with regard to environmental management system (EMS) internalization. Using data from a survey questionnaire of 457 ISO 14001-certified and EMAS-registered European companies, the research analyses the influence of managers' perceptions of contextual factors (i.e. environmental issue salience and governmental regulatory incentives) and managers' cognitive traits (i.e. managers' environmental concern and cognitive framings of environmental practices) on internalization. The results highlight that, while managers' perceived stakeholders' concern for the natural environment directly influences substantive internalization, governmental regulatory reliefs fail to influence the internalization of EMS. Similarly, managers' environmental concern emerges as an antecedent of internalization, while managers' adherence to an alignment logic between economic and environmental objectives does not contribute to internalization. Furthermore, the study contributes to the conceptualization of substantive internalization of environmental practices, by highlighting the existence of two distinct dimensions of EMS internalization, i.e. operational and strategic internalization.
•The paper explores antecedents of environmental management systems (EMS) internalization related to managerial interpretations of contextual factors and managers' cognitive traits.•The study analysis data from a survey of 457 ISO 14001-certified and EMAS-registered European companies in different sectors.•The results highlight that environmental issues salience influences EMS internalization, while governmental regulatory reliefs do not.•Managers' environmental concern emerges as an antecedent of internalization, while managers' adherence to an alignment logic between economic and environmental objectives does not influence internalization.•The study advances the understanding of EMS internalization in terms of operational and strategic internalization.
Background
Dermatofibrosarcoma protuberans (DFSP) is a rare, low‐grade mesenchymal skin tumour, characterized by slow infiltrative growth and common local recurrence, with infrequent distant ...metastases.
Objective
The aim of this study is to better clarify clinicopathological characteristics of this tumour and to evaluate the cure rates of Mohs Tübingen technique (MTT) and wide local excision (WLE). Eventually, we perform a literature review to compare our experience with published data.
Methods
A retrospective review was conducted on 135 patients diagnosed, treated and followed up between 1997 and 2014 at two different institutions. Sixty‐two patients underwent to WLE and 73 to MTT. The primary end‐points were the following: percentage of recurrences, time to progression and recurrence annual risk rate. Then, the PubMed database was searched for DFSP case series treated with standard surgical resection (SSR), WLE, Mohs’ micrographic surgery (MMS) and MTT. The annual risk rate of recurrence calculated and reported for the four separate procedures was pooled to compare them.
Results
Five of the 62 patients with WLE (8.1%) experienced recurrences after a mean follow‐up of 4.7 years; the percentage of recurred patients 9 years after MTT was 5.5%, and the annual recurrence risk rate of 0.6%. Pooling these data with those from literature, the recurrence rate varies from 26% to 60% for SSR, from 0% and 41% for WLE, from 0% and 8.3% for MMS and from 0% to 5.5% for MTT. The lowest annual recurrence risk rate was found for MTT.
Conclusion
Significantly lower recurrence rates were recorded in patients treated with classic or Tübingen Mohs’ technique. To the best of our knowledge, our case series is the widest treated with MTT ever described in the literature; these data may be useful to guide clinicians in the choice of the gold standard treatment for Dermatofibrosarcoma protuberans.
Abstract The Central Atlantic Magmatic Province (CAMP) is a large igneous province (LIP) composed of basic dykes, sills, layered intrusions and lava flows emplaced before Pangea break-up and ...currently distributed on the four continents surrounding the Atlantic Ocean. One of the oldest, best preserved and most complete sub-provinces of the CAMP is located in Morocco. Geochemical, geochronologic, petrographic and magnetostratigraphic data obtained in previous studies allowed identification of four strato-chemical magmatic units, i.e. the Lower, Intermediate, Upper and Recurrent units. For this study, we completed a detailed sampling of the CAMP in Morocco, from the Anti Atlas in the south to the Meseta in the north. We provide a complete mineralogical, petrologic (major and trace elements on whole-rocks and minerals), geochronologic (40Ar/39Ar and U–Pb ages) and geochemical set of data (including Sr–Nd–Pb–Os isotope systematics) for basaltic and basaltic–andesitic lava flow piles and for their presumed feeder dykes and sills. Combined with field observations, these data suggest a very rapid (<0·3 Ma) emplacement of over 95% of the preserved magmatic rocks. In particular, new and previously published data for the Lower to Upper unit samples yielded indistinguishable 40Ar/39Ar (mean age = 201·2 ± 0·8 Ma) and U–Pb ages (201·57 ± 0·04 Ma), suggesting emplacement coincident with the main phase of the end-Triassic biotic turnover (c.201·5 to 201·3 Ma). Eruptions are suggested to have been pulsed with rates in excess of 10 km3/year during five main volcanic pulses, each pulse possibly lasting only a few centuries. Such high eruption rates reinforce the likelihood that CAMP magmatism triggered the end-Triassic climate change and mass extinction. Only the Recurrent unit may have been younger but by no more than 1 Ma. Whole-rock and mineral geochemistry constrain the petrogenesis of the CAMP basalts. The Moroccan magmas evolved in mid-crustal reservoirs (7–20 km deep) where most of the differentiation occurred. However, a previous stage of crystallization probably occurred at even greater depths. The four units cannot be linked by closed-system fractional crystallization processes, but require distinct parental magmas and/or distinct crustal assimilation processes. EC-AFC modeling shows that limited crustal assimilation (maximum c.5–8% assimilation of e.g. Eburnean or Pan-African granites) could explain some, but not all the observed geochemical variations. Intermediate unit magmas are apparently the most contaminated and may have been derived from parental magmas similar to the Upper basalts (as attested by indistinguishable trace element contents in the augites analysed for these units). Chemical differences between Central High Atlas and Middle Atlas samples in the Intermediate unit could be explained by distinct crustal contaminants (lower crustal rocks or Pan-African granites for the former and Eburnean granites for the latter). The CAMP units in Morocco are likely derived from 5–10% melting of enriched peridotite sources. The differences observed in REE ratios for the four units are attributed to variations in both source mineralogy and melting degree. In particular, the Lower basalts require a garnet peridotite source, while the Upper basalts were probably formed from a shallower melting region straddling the garnet–spinel transition. Recurrent basalts instead are relatively shallow-level melts generated mainly from spinel peridotites. Sr–Nd–Pb–Os isotopic ratios in the CAMP units from Morocco are similar to those of other CAMP sub-provinces and suggest a significant enrichment of the mantle-source regions by subducted crustal components. The enriched signature is attributed to involvement of about 5–10% recycled crustal materials introduced into an ambient depleted or PREMA-type mantle, while involvement of mantle-plume components like those sampled by present-day Central Atlantic Ocean Island Basalts (OIB, e.g. Cape Verde and Canary Islands) is not supported by the observed compositions. Only Recurrent basalts may possibly reflect a Central Atlantic plume-like signature similar to the Common or FOZO components.
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