Purpose/Background: Antipsychotic drugs are well established to alter circulating prolactin levels by blocking dopamine D 2 receptors in the pituitary. Prolactin activates many genes important in the development of breast cancer. Prior studies have found an association with antipsychotic use and risk of breast cancer.

Association of Zoos and Aquariums (AZA) institutions provide a variety of benefits to visitors. However, one area that has received little study is the direct human health benefits from zoo and aquarium visits. With the increase in stress related non-infectious diseases in industrialized countries, understanding the extent of these benefits is important. We studied the effects on visitor stress of an experience at a touch tank exhibit featuring stingrays, sharks, and horseshoe crabs. Stress was measured by physiological and psychological parameters. Heart rate was recorded before, during, and after interacting with the animals, and mood was assessed before and after the experience using a psychological instrument. Multilevel models of heart rate show a quadratic trend, with heart rate elevated (b = -3.01, t = 26.4, P < 0.001) and less variable (b = 3.60, t = 15.9, P < 0.001) while touching the animals compared to before or after. Wilcoxon signed-rank tests on mood data suggest that most visitors felt happier (V = 174.5, P < 0.001), more energized (V = 743.5, P < 0.001), and less tense (V = 5618, P < 0.001) after the experience. This suggests that interacting with animals led to a physiological response during interactions reminiscent of a theme park experience along with a decrease in mental stress. The effects of confounding variables such as crowd size are also discussed. Further studies should be conducted to help deepen our understanding of the health benefits of experiences at AZA institutions.

Background The dimorphic mycoses (DM) of the United States, Histoplasma, Coccidioides, and Blastomyces, commonly known as endemic mycoses of North America (in addition to Paracoccidioides), are increasingly being diagnosed outside their historical areas of endemicity. Despite this trend, the maps outlining their geographical distributions have not been updated in more than half a century using a large, nationwide database containing individual patient-level data. Methods Retrospective analysis of &gt;45 million Medicare fee-for-service beneficiaries from 1 January 2007 through 31 December 2016. Diagnoses of histoplasmosis, coccidioidomycosis, and blastomycosis were defined by International Classification of Diseases 9th/10th edition codes. Primary outcome was the incidence of histoplasmosis, coccidioidomycosis, and blastomycosis for each US county. Clinically meaningful thresholds for incidence were defined as 100 cases per 100,000 person-years cases for histoplasmosis and coccidioidomycosis and 50 cases for blastomycosis. Results There were 79,749 histoplasmosis, 37,726 coccidioidomycosis, and 6,109 blastomycosis diagnoses in unique persons from 2007-2016 across 3,143 US counties. Considering all US states plus Washington DC, 94% (48/51) had at least one county above the clinically relevant threshold for histoplasmosis, 69% (35/51) for coccidioidomycosis, and 78% (40/51) for blastomycosis. Conclusion Persons with histoplasmosis, coccidioidomycosis, and blastomycosis are diagnosed in significant numbers outside their historical geographic distributions established more than 50 years ago. Clinicians should consider DM diagnoses based on compatible clinical syndromes with less emphasis placed on patient’s geographic exposure. Increased clinical suspicion leading to a subsequent increase in DM diagnostic testing would likely result in fewer missed diagnoses, fewer diagnostic delays, and improved patient outcomes.

Background: Several antiretroviral therapy (ART) classes have been associated with increased myocardial infarction (MI) risk. Cardiovascular disease in people living with HIV (PLWH) on integrase strand transfer inhibitors (INSTI) has not been examined. Here we aim to examine this. Setting: Retrospective cohort design study. Methods: We used the IBMMarketScan databases for U.S. commercially insured and Medicaid covered adults to identify PLWH newly initiated on ART between January 1, 2008 and December 30, 2015. Major adverse cardiac event (MACE), a composite of acute MI, ischemic stroke, coronary artery bypass grafting, and percutaneous coronary intervention was the primary outcome. We used calendar time-specific probability-weighted Cox proportional hazards models to estimate hazard ratios and 95% confidence intervals for the association between INSTI use and MACE. We used propensity score weighting methods to account for potential confounding. Results: Twenty thousand two hundred forty-two new ART initiators were identified. 5069 (25%) PLWH initiated INSTI-based regimens. 203 MACE events occurred; acute MI 16 (0.32%) vs 66 (0.43%), stroke 24 (0.47%) vs 54 (0.36), coronary artery bypass grafting 2 (0.04%) vs 9 (0.06%), percutaneous coronary intervention 7 (0.14%) vs 25 (0.16%) of INSTI users vs non-users. INSTI-based ART was associated with significantly lower risk of MACE events (hazard ratios 0.79; 95% confidence intervals: 0.64 to 0.96) compared with non–INSTI-based regimens. Conclusion: In this cohort, INSTI-based regimens were associated with a 21% decreased risk of incident cardiovascular disease. These finding require validation in other cohorts and with longer follow-up.

conceptualized and designed study. Mr. Sahrmann curated, cleaned and coded the data. Drs Mintz and Grucza, and Mr. Presnall analyzed the data. All authors interpreted the data. Dr. Mintz drafted the manuscript. All authors critically reviewed and revised the manuscript.Conflict of Interest: Dr. Bierut is listed as an inventor on Issued U.S. Patent 8,080,371, "Markers for Addiction" covering the use of certain SNPs in determining the diagnosis, prognosis, and treatment of addiction. Dr. Borodovsky is on the board of directors and the treasurer of the non-profit scientific research organization MySafeRx Inc. Dr. Borodovsky does not receive any compensation from MySafeRx Inc. The other authors have indicated they have no potential conflicts of interest to disclose.