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As NASA prepared for the launch of Apollo 11 in July 1969, many African American leaders protested the billions of dollars used to fund \"space joyrides\" rather than help tackle poverty, inequality, and discrimination at home. This volume examines such tensions as well as the ways in which NASA's goal of space exploration aligned with the cause of racial equality. Essays provide new insights into the complex relationship between the space program and the civil rights movement in the Jim Crow South and abroad. NASA and the Long Civil Rights Movement offers important lessons from history as today's activists grapple with the distance between social movements like Black Lives Matter and scientific ambitions such as NASA's mission to Mars.

The All of Us Research Program enrolls diverse US participants which provide a unique opportunity to better understand the problem of opioid use. This study aims to estimate the prevalence of opioid use and its association with sociodemographic characteristics from survey data and electronic health record (EHR). A total of 214,206 participants were included in this study who competed survey modules and shared EHR data. Adjusted logistic regressions were used to explore the associations between sociodemographic characteristics and opioid use. The lifetime prevalence of street opioids was 4%, and the nonmedical use of prescription opioids was 9%. Men had higher odds of lifetime opioid use (aOR: 1.4 to 3.1) but reduced odds of current nonmedical use of prescription opioids (aOR: 0.6). Participants from other racial and ethnic groups were at reduced odds of lifetime use (aOR: 0.2 to 0.9) but increased odds of current use (aOR: 1.9 to 9.9) compared with non-Hispanic White participants. Foreign-born participants were at reduced risks of opioid use and diagnosed with opioid use disorders (OUD) compared with US-born participants (aOR: 0.36 to 0.67). Men, Younger, White, and US-born participants are more likely to have OUD. All of Us research data can be used as an indicator of national trends for monitoring the prevalence of receiving prescription opioids, diagnosis of OUD, and non-medical use of opioids in the US. The program employs a longitudinal design for routinely collecting health-related data including EHR data, that will contribute to the literature by providing important clinical information related to opioids over time. Additionally, this data will enhance the estimates of the prevalence of OUD among diverse populations, including groups that are underrepresented in the national survey data.

Background Individuals with major depressive disorder (MDD) and bipolar disorder (BD) have particularly high rates of chronic non-cancer pain (CNCP) and are also more likely to receive prescription opioids for their pain. However, there have been no known studies published to date that have examined opioid treatment patterns among individuals with schizophrenia. Methods Using electronic medical record data across 13 Mental Health Research Network sites, individuals with diagnoses of MDD ( N  = 65,750), BD ( N  = 38,117) or schizophrenia or schizoaffective disorder ( N  = 12,916) were identified and matched on age, sex and Medicare status to controls with no documented mental illness. CNCP diagnoses and prescription opioid medication dispensings were extracted for the matched samples. Multivariate analyses were conducted to evaluate (1) the odds of receiving a pain-related diagnosis and (2) the odds of receiving opioids, by separate mental illness diagnosis category compared with matched controls, controlling for age, sex, Medicare status, race/ethnicity, income, medical comorbidities, healthcare utilization and chronic pain diagnoses. Results Multivariable models indicated that having a MDD (OR = 1.90; 95% CI = 1.85–1.95) or BD (OR = 1.71; 95% CI = 1.66–1.77) diagnosis was associated with increased odds of a CNCP diagnosis after controlling for age, sex, race, income, medical comorbidities and healthcare utilization. By contrast, having a schizophrenia diagnosis was associated with decreased odds of receiving a chronic pain diagnosis (OR = 0.86; 95% CI = 0.82–0.90). Having a MDD (OR = 2.59; 95% CI = 2.44–2.75) or BD (OR = 2.12; 95% CI = 1.97–2.28) diagnosis was associated with increased odds of receiving chronic opioid medications, even after controlling for age, sex, race, income, medical comorbidities, healthcare utilization and chronic pain diagnosis; having a schizophrenia diagnosis was not associated with receiving chronic opioid medications. Conclusions Individuals with serious mental illness, who are most at risk for developing opioid-related problems, continue to be prescribed opioids more often than their peers without mental illness. Mental health clinicians may be particularly well-suited to lead pain assessment and management efforts for these patients. Future research is needed to evaluate the effectiveness of involving mental health clinicians in these efforts.

Introduction This study sought to quantify food hinsecurity prevalence in a sample of the U.S. Army Reserve (USAR) as well as identify demographic groups most at-risk for food insecurity. Methods An electronic questionnaire was administered to all soldiers in 21 U.S. Army Reserve Command units between July and December 2021. The Six Item Short Form Food Security Survey Module was used to assess the prevalence of food insecurity. A multivariable logistic regression was used to determine what demographic covariates were independently associated with food insecurity. Results The estimated prevalence of food insecurity was 22% among this sample of USAR soldiers, with 16% experiencing low food security and 6% experiencing very low food security ( n  = 2,019). USAR soldiers with a high school degree or lower (Adjusted Odds Ratio (AOR): 2.21; 95% Confidence Interval (CI): 1.21–4.05) and respondents with an associate degree or some college (AOR: 2.44; 95% CI: 1.32–4.51) had greater odds of food insecurity when compared to respondents who had a graduate degree or above. Black and African American respondents had 1.48-fold greater adjusted odds of food insecurity (95% CI: 1.14–1.92) when compared to White respondents. There were no statistically significant differences observed in the adjusted relative odds of food insecurity by sex, age, rank group, ethnicity, number of child dependents, or civilian occupation category. Conclusion USAR soldiers in this sample experienced a high prevalence of food insecurity. Leadership and policy makers should consider education, programming, and connection to resources for military demographic groups at heightened risk for food insecurity.

Tobacco smoking is the leading preventable cause of morbidity and mortality in the United States, and young adults have high smoking rates. Although most young adult smokers are interested in quitting, they underutilize professional cessation support. Smartphones have wide reach and integration into young adults' lives, and these devices offer great opportunities to deliver cessation interventions by delivering messages suggesting coping strategies \"in the moment\" when smokers need cessation support. The overall goal of this trial is to evaluate the efficacy of cognitive behavioral therapy (CBT) and mindfulness or acceptance and commitment therapy (ACT) messages for young adults targeted at specific high-risk situations for smoking. We will conduct a microrandomized trial (MRT; within-subject randomization) to test the efficacy of CBT and mindfulness or ACT compared with control messages for reducing smoking urge up to 15 minutes after message delivery, nested in a conventional between-subject randomized controlled trial (RCT). A conventional between-subject control group of participants who will complete ecological momentary assessment (EMA) only without intervention messages will allow us to test if messages reduce cigarettes per day at the end of treatment, 3-month follow-up, and 6-month follow-up. Among MRT intervention group participants, we will explore how message efficacy may be moderated by substance co-use (cannabis, alcohol, other drugs) and exposure to specific settings (home, work, bars). As of June 2025, we had enrolled 58 participants of the target sample of 160, with 52% (30/58) assigned to the MRT group and 48% (28/58) assigned to the EMA-only control. Smoking onset is now more common among young adults than adolescents, and early cessation substantially reduces morbidity and mortality from smoking, making age-appropriate, tailored, and scalable interventions for this high-priority population even more important. Results of this trial will provide evidence on the efficacy of tailored intervention messages to help young adult smokers cope with smoking urges as an integral part of smartphone interventions. Findings will inform the field about key principles, strategies, and efficacy of situational tailoring of app-based tobacco use urge reduction messages. ClinicalTrials.gov NCT05836103; https://clinicaltrials.gov/study/NCT05836103. DERR1-10.2196/74388.

Varenicline and oral nicotine replacement therapy (NRT) have each been shown to increase the likelihood of smoking cessation, but their combination has not been studied. In addition, smoking cessation medication adherence is often poor, thus, challenging the ability to evaluate medication efficacy. This study examined the effects of combined varenicline and oral NRT and smartphone medication reminders on pharmacotherapy adherence and smoking abstinence among adults enrolled in smoking cessation treatment. A 2×2 factorial design was used. Participants (N=34) were randomized to (1) varenicline + oral NRT (VAR+NRT) or varenicline alone (VAR) and (2) smartphone medication reminder messages (REM) or no reminder messages (NREM) over 13 weeks. Participants assigned to VAR+REM received varenicline reminder prompts, and those assigned to VAR+NRT+REM also received reminders to use oral NRT. The other 2 groups (VAR+NREM and VAR+NRT+NREM) did not receive medication reminders. Participants were not blinded to intervention groups. All participants received tobacco cessation counseling. Smartphone assessments of smoking as well as varenicline and NRT use (if applicable) were prompted daily through the first 12 weeks after a scheduled quit date. Descriptive statistics were generated to characterize the relations between medication and reminder group assignments with daily smoking, daily varenicline adherence, and daily quantity of oral NRT used. Participants completed follow-up assessments for 26 weeks after the quit date. Participants were predominantly White (71%), and half were female (50%). On average, participants were 54.2 (SD 9.4) years of age, they smoked an average of 19.0 (SD 9.0) cigarettes per day and had smoked for 34.6 (SD 12.7) years. Descriptively, participants assigned to VAR+NRT reported more days of smoking abstinence compared to VAR (29.3 vs 26.3 days). Participants assigned to REM reported more days of smoking abstinence than those assigned to NREM (40.5 vs 21.8 days). Participants assigned to REM were adherent to varenicline on more days compared to those assigned to NREM (58.6 vs 40.5 days), and participants assigned to VAR were adherent to varenicline on more days than those assigned to VAR + NRT (50.7 vs 43.3 days). In the subsample of participants assigned to VAR+NRT, participants assigned to REM reported more days where ≥5 pieces of NRT were used than NREM (14.0 vs 7.4 days). Average overall medication adherence (assessed via the Medication Adherence Questionnaire) showed the same pattern as the daily smartphone-based adherence assessments. Preliminary findings indicated that smoking cessation interventions may benefit from incorporating medication reminders and combining varenicline with oral NRT, though combining medications may be associated with poorer adherence. Further study is warranted. ClinicalTrials.gov NCT03722966; https://classic.clinicaltrials.gov/ct2/show/NCT03722966.

Although 24 Alzheimer's disease (AD) risk loci have been reliably identified, a large portion of the predicted heritability for AD remains unexplained. It is expected that additional loci of small effect will be identified with an increased sample size. However, the cost of a significant increase in Case-Control sample size is prohibitive. The current study tests whether exploring the genetic basis of endophenotypes, in this case based on putative blood biomarkers for AD, can accelerate the identification of susceptibility loci using modest sample sizes. Each endophenotype was used as the outcome variable in an independent GWAS. Endophenotypes were based on circulating concentrations of proteins that contributed significantly to a published blood-based predictive algorithm for AD. Endophenotypes included Monocyte Chemoattractant Protein 1 (MCP1), Vascular Cell Adhesion Molecule 1 (VCAM1), Pancreatic Polypeptide (PP), Beta2 Microglobulin (B2M), Factor VII (F7), Adiponectin (ADN) and Tenascin C (TN-C). Across the seven endophenotypes, 47 SNPs were associated with outcome with a p-value ≤1x10(-7). Each signal was further characterized with respect to known genetic loci associated with AD. Signals for several endophenotypes were observed in the vicinity of CR1, MS4A6A/MS4A4E, PICALM, CLU, and PTK2B. The strongest signal was observed in association with Factor VII levels and was located within the F7 gene. Additional signals were observed in MAP3K13, ZNF320, ATP9B and TREM1. Conditional regression analyses suggested that the SNPs contributed to variation in protein concentration independent of AD status. The identification of two putatively novel AD loci (in the Factor VII and ATP9B genes), which have not been located in previous studies despite massive sample sizes, highlights the benefits of an endophenotypic approach for resolving the genetic basis for complex diseases. The coincidence of several of the endophenotypic signals with known AD loci may point to novel genetic interactions and should be further investigated.

Injuries from falls are major contributors to death and complications in older adults. In this pragmatic, cluster-randomized trial, a multifactorial intervention that was administered by nurses did not result in a significantly lower rate of first adjudicated serious fall injury than enhanced usual care.

Most studies that infer geographic distributions of fish using otolith microchemistry assume that environmental factors (e.g. temperature, salinity) outweigh intrinsic effects (e.g. size, condition); however, this assumption has not been rigorously tested, particularly in marine fish. Here, we report the results of a long-term experimental study of European plaice Pleuronectes platessa L. and explore relationships between blood plasma and ambient water chemistry over a 12 mo reproductive cycle. Overall, blood plasma was found to be highly regulated, with few elements exhibiting strong, if any, correlation with ambient concentrations. This sets a first order limit on the sensitivity of otolith chemistry to fluctuations in ambient seawater chemistry. The observed temporal, ontogenetic and sex-specific variations in blood plasma elemental concentrations indicated significant physiological influences on elemental uptake and processing mechanisms. Physiological variables exerted relatively strong influences on the uptake and regulation of the softer, more thiophilic elements (Mn, Cu, Zn, Se and Pb), as well as Sr and Ca. By contrast, seasonal and sex-related variations were relatively minor among the hard acid metal ions (Li⁺, Mg2⁺, K⁺, Rb⁺, Ba2+). Overall, plasma elemental concentrations covaried most strongly and consistently with plasma protein concentrations. For this exclusively marine species, seasonal changes in physiology governed intra-annual variations in blood chemistry and, by implication, also regulate ion availability to the otolith. Based on these observations, we recommend that sex and age should be controlled for in future experimental designs using otolith microchemistry to infer stock structure or migration patterns.

Adults with schizophrenia, schizoaffective disorder, or bipolar disorder, collectively termed serious mental illness (SMI), have shortened life spans compared with people without SMI. The leading cause of death is cardiovascular (CV) disease. To assess whether a clinical decision support (CDS) system aimed at primary care clinicians improves CV health for adult primary care patients with SMI. In this cluster randomized clinical trial conducted from March 2, 2016, to September 19, 2018, restricted randomization assigned 76 primary care clinics in 3 Midwestern health care systems to receive or not receive a CDS system aimed at improving CV health among patients with SMI. Eligible clinics had at least 20 patients with SMI; clinicians and their adult patients with SMI with at least 1 modifiable CV risk factor not at the goal set by the American College of Cardiology/American Heart Association guidelines were included. Statistical analysis was conducted on an intention-to-treat basis from January 10, 2019, to December 29, 2021. The CDS system assessed modifiable CV risk factors and provided personalized treatment recommendations to clinicians and patients. Patient-level change in total modifiable CV risk over 12 months, summed from individual modifiable risk factors (smoking, body mass index, low-density lipoprotein cholesterol level, systolic blood pressure, and hemoglobin A1c level). A total of 80 clinics were randomized; 4 clinics were excluded for having fewer than 20 eligible patients, leaving 42 intervention clinics and 34 control clinics. A total of 8937 patients with SMI (4922 women [55.1%]; mean [SD] age, 48.4 [13.5] years) were enrolled. There was a 4% lower rate of increase in total modifiable CV risk among intervention patients relative to control patients (relative rate ratio [RR], 0.96; 95% CI, 0.94-0.98). The intervention favored patients who were 18 to 29 years of age (RR, 0.89; 95% CI, 0.81-0.98) or 50 to 59 years of age (RR, 0.93; 95% CI, 0.90-0.96), Black (RR, 0.93; 95% CI, 0.88-0.98), or White (RR, 0.96; 95% CI, 0.94-0.98). Men (RR, 0.96; 95% CI, 0.94-0.99) and women (RR, 0.95; 95% CI, 0.92-0.97), as well as patients with any SMI subtype (bipolar disorder: RR, 0.96; 95% CI, 0.94-0.99; schizoaffective disorder: RR, 0.94; 95% CI, 0.90-0.98; schizophrenia: RR, 0.92; 95% CI, 0.85-0.99) also benefited from the intervention. Despite treatment effects favoring the intervention, there were no significant differences in individual modifiable risk factors. This CDS intervention resulted in a rate of change in total modifiable CV risk that was 4% lower among intervention patients compared with control patients. Results were driven by the cumulative effects of incremental and mostly nonsignificant changes in individual modifiable risk factors. These findings emphasize the value of using CDS to prompt early primary care intervention for adults with SMI. ClinicalTrials.gov Identifier: NCT02451670.