Taken together, these findings suggest that stimulant misuse typically occurs in a broader pattern of substance use, and that stimulant misusers generally fall along a continuum of substance use severity in terms of psychosocial functioning. PURPOSE To examine the prevalence and correlates of college student use of illicit substances including cocaine, designer drugs, and nonmedical use of prescription stimulants and opioids, and to identify how different drug-related perceptions are related to past year use of these substances. METHODS Data were analyzed from a cross-sectional anonymous web-based survey among a sample (n = 1345, 81% female) of students attending a mid-sized liberal arts college in the US. Logistic regression models were estimated to assess the relationships between substance-specific descriptive norms, injunctive norms, perceived availability, risk perceptions and past year use of cocaine, designer drugs, prescription stimulants, and opioids, adjusting for current marijuana use, alcohol dependence, sensation seeking, and sociodemographic factors. FINDINGS Past year use of illicit substances ranged from 6% for nonmedical prescription opioids to 21% for nonmedical prescription stimulants. The sociodemographic correlates past year substance use differed by substance type. Descriptive norms (perceptions of peer use) and perceived risk were not consistently related to use of these substances. Current marijuana use was the strongest correlate across substances, and both injunctive norms (perceptions of peer approval) and perceived availability were consistently related to use of each substance. CONCLUSIONS Findings suggest that future college student drug prevention efforts should more directly target current marijuana users since they are most at risk of using other illicit substances. Additionally, findings indicate that injunctive norms may be an important consideration for education-focused drug prevention programs. However, findings should be interpreted in light of limitations of the sample, which is predominantly female. Rash impulsiveness, the propensity for approach behaviour despite potential negative consequences, is associated with stronger alcohol craving in patients with Alcohol Use Disorder (AUD). This relationship is poorly understood and implications for treatment response are unexamined. This study explored the relationship between rash impulsiveness, craving, and treatment response among 304 outpatients enrolled in a 12-week abstinence-based Cognitive-Behavioural Therapy (CBT) program for AUD. Assessments were completed pre-and-post treatment, with craving and alcohol consumption monitored at each treatment session. Higher rash impulsiveness predicted more frequent craving over treatment (b = 0.95, 95% CI = 0.40, 1.50). Higher craving was associated with greater lapse-risk (b = 0.04, 95% CI = 0.03, 0.05), with the association between craving and lapse-risk increasing as treatment progressed (b = 0.01, 95% CI = 0.01, 0.02). Craving positively mediated the relationship between rash impulsiveness and lapse-risk (µ = 0.38, 95% CI = 0.10, 0.70). Contrary to hypotheses, the risk of lapse in response to craving was not moderated by rash-impulsiveness. These results suggest that AUD patients with a predisposition for rash impulsiveness are more vulnerable to alcohol craving, and subsequently, poorer treatment outcomes. BACKGROUND Subjective classification of gait pattern in children with cerebral palsy depends on the assessor’s experience, while mathematical methods produce virtual groups with no clinical interpretation. METHODS In a retrospective study, gait data from 66 children (132 limbs) with a mean age of 9.6 (SD 3.7) years with cerebral palsy and no history of surgery or botulinum toxin injection were reviewed. The gait pattern of each limb was classified in four groups according to Rodda using three methods 1) a team of experts subjectively assigning a gait pattern, 2) using the plantarflexor-knee extension couple index introduced by Sangeux et al., and 3) employing a fuzzy algorithm to translate the experiences of experts into objective rules and execute a clustering tool. To define fuzzy repeated-measures, 75% of the members in each group were used, and the remaining were used for validation. Eight parameters were objectively extracted from kinematic data for each group and compared using repeated measure ANOVA and post-hoc analysis was performed. Finally, the results of the clustering of the latter two methods were compared to the subjective method. FINDINGS The plantarflexor-knee extension couple index achieved 86% accuracy while the fuzzy system yielded a 98% accuracy. The most substantial errors occurred between jump and apparent in both methods. INTERPRETATION The presented method is a fast, reliable, and objective fuzzy clustering system to classify gait patterns in cerebral palsy, which produces clinically-relevant results. It can provide a universal common language for researchers. BACKGROUND Neonatal stroke is a leading cause of hemiplegic cerebral palsy that occurs around the time of birth. Infants are diagnosed with cerebral palsy when motor impairments become clinically apparent, months or years after the stroke. Tools/methods for identifying high risk or diagnosis of cerebral palsy in infancy are improving. METHODS We measured spatial and temporal kinematics of pre-reaching upper extremity movements in 2-3 month old infants with neonatal stroke and typical development. We aimed to evaluate the feasibility of applying kinematics in this population and collect preliminary data to explore (1) if asymmetries are present in the infants with neonatal stroke, particularly those with a later diagnosis of cerebral palsy, and (2) to compare differences in the timing and coordination of their movements to infants with typical development, and infants with stroke and no cerebral palsy. Participants were 21 full-term infants, 10 with stroke (4 who later received a cerebral palsy diagnosis) age 72.1 (SD 9.3) days, and 11 typically developing, age 74.3 (SD 9.3) days. FINDINGS Results showed that infants with stroke and cerebral palsy demonstrated significant asymmetry in the average movement length (p = 0.0089) and hand path length (p = 0.0275) between their involved and uninvolved sides and moved less frequently (p = 0.09) and slower (p = 0.041) than infants with stroke and no cerebral palsy. INTERPRETATION Results suggest that kinematic analysis might detect asymmetries and motor impairment indicative of hemiplegic cerebral palsy earlier than current assessments and that asymmetry in speed, length and frequency of arm movements may be early indicators. This study is preliminary, limiting interpretation of the results. Atractylodis Rhizoma, a classical Chinese medicine, exhibits unambiguous therapeutic effect on spleen deficiency in China for decades. The aim of the present study was to explore the different effects on the composition and level of endogenous metabolites in rats with spleen deficiency after oral administration of raw and bran-fired Atractylodis Rhizoma, and to explain the mechanism of pharmacodynamic enhancement of the bran-fried Atractylodis Rhizoma from the perspective of metabolomics. With this purpose, spleen deficiency model was established by diet, excessive fatigue and bitter cold diarrhea. Then, Enzyme-linked immunosorbent assay (ELISA) was used to determine the contents of vasoactive intestinal peptide (VIP), Somatostatin (SS), substance P (SP) and succinodehydrogenase (SDH) in rats of each group, and to compare the contents of VIP, SS, SP and SDH among groups. UHPLC-Q-TOF-MS based metabolomics was adopted to analyze the plasma from spleen deficiency rats and control rats. Principle component analyscantly associated with spleen deficiency, and bran-fried Atractylodis Rhizoma had better intervention and regulation. Through the analysis of metabolic pathways related to these different metabolites of spleen deficiency, and primarily involved in glucosamine metabolism, one carbon pool by folate and so on. This study showed that Atractylodis Rhizoma could provide satisfactory therapeutic effects on spleen deficiency and metabolomics study can be utilized to further understand the molecular mechanisms. V.OBJECTIVES Data on the elemental status, redistribution of the elements, role of occupational exposure and dietary assessment in preeclampsia (PE) are scarce. There are many disparities in the findings of essential and non-essential elements’ role in PE. In this article we overview the changes in the content of selected elements in pregnancy complicated with the disorder of complex and not fully understood etiology. We have focused on important limitations and highlighted shortcomings in research from the last ten years period. METHODS The Scopus and PubMed electronic databases have been searched for English-language articles published within the time interval 2008-2018, with full text available and with the key words „preeclampsia” and „chemical element” (i.e. separately Cd, Pb, As, Ni, Mo, Co, Cr, Mn, Se, I, Fe, Sr, Cu, Zn, Mg, K and Na) appearing in the title, abstract or keywords. RESULTS A total of 48 publications were eligible for this overview. Surprisingly only 4% of papers considered environmental exr possible in the periconceptional period as well. It still needs to be established whether the deficiency of certain elements or their excess may be an etiopathogenic factor and a developmental cause of PE, and if it may serve as a target of actions in the causal treatment or even prevention of the occurrence of this disease. BACKGROUND The safety and efficacy of angiotensin converting enzyme inhibition (ACEI) after heart transplantation (HT) is unknown. This study examined long-term clinical outcomes after ACEI in HT recipients. METHODS The ACEI after HT study was a prospective, randomized trial that tested the efficacy of ACEI with ramipril after HT. In this study, long-term clinical outcomes were assessed in 91 patients randomized to either ramipril or placebo (median, 5.8 years). The primary endpoint was a composite of death, retransplantation, hospitalization for rejection or heart failure, and coronary revascularization. RESULTS The primary endpoint occurred in 10 of 45 patients (22.2%) in the ramipril group and in 14 of 46 patients (30.4%) in the placebo group (Hazard ratio (HR), 0.68; 95% CI, 0.29-1.51; P = .34). When the analysis was restricted to comparing patients who remained on a renin-angiotensin system inhibitor beyond 1 year with those who did not, there was a trend to improved outcomes (HR, 0.54; 95% CI, 0.22-1.28, P = .16). There was no significant difference in creatinine, blood urea nitrogen, and potassium at 3 years after randomization. The cumulative incidence of the primary endpoint was significantly higher in patients in whom the index of microcirculatory resistance increased from baseline to 1 year compared with those in whom it did not (39.1 vs 17.4%, HR 3.36; 95% CI, 1.07-12.7; P = .037). CONCLUSION The use of ramipril after HT safely lowers blood pressure and is associated with favorable long-term clinical outcomes. Clinical Trial Registration-URL https//www.clinicaltrials.gov. Unique identifier NCT01078363.