Assessing Attitudes toward Nicotine Replacement Therapy for Adolescent Smoking Cessation

The objective was to ascertain attitudes toward nicotine replacement therapy for adolescent tobacco cessation. The authors created a 17-item survey consisting of demographics, quantitative, and qualitative items which was distributed to middle and high school students in North Central Florida. The authors assessed associations and conducted discriminant analyses to compare results by age. One-hundred ninety-eight students completed the survey (57.6% female, 61.6% white). When asked to select the best way to help teens stop using tobacco, combination of methods was most frequently selected (31.6%), followed by “Cold Turkey” (19.5%), e-cigarettes (16.8%), NRT (14.7%), Counseling (10.5%), and Alternative Therapies (6.8%). Qualitative data from students revealed misconceptions toward tobacco use, but an overall awareness that tobacco is a harmful. High school students were more likely than middle school students to agree that nicotine is harmful and e-cigarettes or chewing tobacco are less harmful than traditional cigarettes. Discriminant analyses were inconclusive. These data highlight misconceptions regarding tobacco use and nicotine that might play a role in attitudes toward NRT for adolescent tobacco cessation. Whereas high school students might be more likely to agree nicotine is harmful, their decreased perception of harm of alternative tobacco products such as e-cigarettes or chewing tobacco could be problematic. Further research in this area remains a priority

Introduction to the Law and the American Legal System

This book chapter offers an introduction to the law and the American legal system

Poor physical function in elderly women in low-level aged care is related to muscle strength rather than to measures of sarcopenia

Julie L Woods1, Sandra Iuliano-Burns2, Susannah J King1, Boyd J Strauss1, Karen Z Walker11Nutrition and Dietetics Department, Monash University, Victoria, Australia; 2Endocrine Centre of Excellence, Department of Medicine, Austin Health, University of Melbourne, West Heidelberg, AustraliaPurpose: To determine the prevalence of sarcopenia and investigate relationships among body composition, muscle strength, and physical function in elderly women in low-level aged care.Subjects and methods: Sixty-three ambulatory women (mean age 86 years) participated in this cross-sectional study where body composition was determined by dual energy X-ray absorptiometry (DXA); ankle, knee, and hip strength by the Nicholas Manual Muscle Tester; and physical function by ‘timed up and go’ (TUG) and walking speed (WS) over 6 meters. Body composition data from a female reference group (n = 62, mean age 29 years) provided cut-off values for defining sarcopenia.Results: Elderly women had higher body mass index (P < 0.001), lower lean mass (P < 0.001), and higher fat mass (P < 0.01) than the young reference group. Only a small proportion (3.2%) had absolute sarcopenia (defined by appendicular skeletal muscle mass/height squared) whereas 37% had relative sarcopenia class II (defined by percentage skeletal muscle mass). Scores for TUG and WS indicated relatively poor physical function, yet these measures were not associated with muscle mass or indices of sarcopenia. In multivariate analysis, only hip abductor strength predicted both TUG and WS (both P = 0.01).Conclusion: Hip strength is a more important indicator of physical functioning than lean mass. Measurement of hip strength may therefore be a useful screening tool to detect those at risk of functional decline and requirement for additional care. Further longitudinal studies with a range of other strength measures are warranted.Keywords: aged care, body composition, muscle strength, sarcopenia&nbsp

The Welfare Caseload, Economics Growth and Welfare-to-Work Policies: An Analysis of Five Urban Areas

This paper uses quarterly data on AFDC (later TANF) recipients in five major urban areas to examine the relative importance of policy reform and economic conditions in explaining the dynamics of the welfare caseload and the employment experiences of welfare leavers. We find that changes in both welfare exits and entries played an important role in the caseload declines of the 1990s. Policy changes were primary in causing changes in these flows, with economic conditions of secondary importance. Although welfare reforms were accompanied by substantial increases in the employment of those leaving welfare, this appears to be largely the result of an increasingly tight labor market rather than the reforms

Mobilisation in the EveNing to TreAt deLirium (MENTAL):protocol for a mixed-methods feasibility randomised controlled trial

INTRODUCTION: Delirium is common in critically ill patients and is associated with longer hospital stays, increased mortality and higher healthcare costs. A number of risk factors have been identified for the development of delirium in intensive care, two of which are sleep disturbance and immobilisation. Non-pharmacological interventions for the management of intensive care unit (ICU) delirium have been advocated, including sleep protocols and early mobilisation. However, there is a little published evidence evaluating the feasibility and acceptability of evening mobilisation. METHODS AND ANALYSIS: Mobilisation in the EveNing to TreAt deLirium (MENTAL) is a two-centre, mixed-methods feasibility randomised controlled trial (RCT). Sixty patients will be recruited from ICUs at two acute NHS trusts and randomised on a 1:1 basis to receive additional evening mobilisation, delivered between 19:00 and 21:00, or standard care. The underpinning hypothesis is that the physical exertion associated with evening mobilisation will promote better sleep, subsequently having the potential to reduce delirium incidence. The primary objective is to assess the feasibility and acceptability of a future, multicentre RCT. The primary outcome measures, which will determine feasibility, are recruitment and retention rates, and intervention fidelity. Acceptability of the intervention will be evaluated through semi-structured interviews of participants and staff. Secondary outcome measures include collecting baseline, clinical and outcome data to inform the power calculations of a future definitive trial. ETHICS AND DISSEMINATION: Ethical approval has been obtained through the Wales Research and Ethics Committee 6 (22/WA/0106). Participants are required to provide written informed consent. We aim to disseminate the findings through international conferences, international peer-reviewed journals and social media. TRIAL REGISTRATION NUMBER: NCT05401461

Defining boat wake impacts on shoreline stability toward management and policy solutions

Coastal economies are often supported by activities that rely on commercial or recreational vessels to move people or goods, such as shipping, transportation, cruising, and fishing. Unintentionally, frequent or intense vessel traffic can contribute to erosion of coastlines; this can be particularly evident in sheltered systems where shoreline erosion should be minimal in the absence of boat waves. We reviewed the state of the science of known effects of boat waves on shoreline stability, examined data on erosion, turbidity, and shoreline armoring patterns for evidence of a response to boat waves in Chesapeake Bay, and reviewed existing management and policy actions in Chesapeake Bay and nearby states to make recommendations for actions to minimize boat wake impacts. In the literature, as well as in our analyses, boat wake energy may be linked to elevated turbidity and shoreline erosion, particularly in narrow waterways. In Chesapeake Bay, three lines of evidence suggest boat waves are contributing to shoreline erosion and poor water clarity in some Bay creeks and tributaries: 1) nearshore turbidity was elevated in many waterways during periods of expected high boating activity, 2) armoring was placed along about a quarter of the low energy shorelines of three examined tidal creeks that are exposed to relatively high boating pressure, and 3) 15% of the shorelines we examined throughout the Bay (9000 km) are low energy shorelines that are experiencing high erosion (≥0.3 m/yr) that cannot be attributed to wind wave energy. Still, there remain significant data gaps that preclude the determination of the overall contribution of boat waves to shoreline erosion throughout the Bay, notably, shoreline erosion data in low energy waterways, recreational boating traffic patterns, and nearshore bathymetry. Interim protective measures can be (and have been) applied in high risk waterways, such as small, low energy waterways that have high recreational boating activity, to help reduce shoreline erosion. Policy options used in Bay states and elsewhere include setbacks from the shore, wake restrictions, and speed restrictions; other more restrictive policies may include prohibition on boats of a certain size or limiting the number of passages. Finally, a systems-approach to boat wake impact management using uniform boat wake policies is likely to be the most effective for consistent shoreline protection

Development and implementation of a new service delivery model for children with disabilities : implications for DCD

There is a general consensus that new service delivery models are needed for children with developmental coordination disorder (DCD). Emerging principles to guide service delivery include the use of graduated levels of intensity and evidence-based services that focus on function and participation. Interdisciplinary, community-based service delivery models based on best practice principles are needed. In this case report, we propose the Apollo model as an example of an innovative service delivery model for children with DCD. We describe the context that led to the creation of a program for children with DCD, describe the service delivery model and services, and share lessons learned through implementation. The Apollo model has 5 components: first contact, service delivery coordination, community-, group- and individual-interventions. This model guided the development of a streamlined set of services offered to children with DCD, including early-intake to share educational information with families, community interventions, inter-disciplinary and occupational therapy groups and individual interventions. Following implementation of the Apollo model, waiting times decreased and numbers of children receiving services increased, without compromising service quality. Lessons learned are shared to facilitate development of other practice models to support children with DCD

Reduced Expression of Inflammatory Genes in Deceased Donor Kidneys Undergoing Pulsatile Pump Preservation

Background The use of expanded criteria donor kidneys (ECD) had been associated with worse outcomes. Whole gene expression of pre-implantation allograft biopsies from deceased donor kidneys (DDKs) was evaluated to compare the effect of pulsatile pump preservation (PPP) vs. cold storage preservation (CSP) on standard and ECD kidneys. Methodology/Principal Findings 99 pre-implantation DDK biopsies were studied using gene expression with GeneChips. Kidneys transplant recipients were followed post transplantation for 35.8 months (range = 24–62). The PPP group included 60 biopsies (cold ischemia time (CIT) = 1,367+/−509 minutes) and the CSP group included 39 biopsies (CIT = 1,022+/−485 minutes) (P Conclusions/Significance Inflammation was the most important up-regulated pattern associated with pre-implantation biopsies undergoing CSP even when the PPP group has a larger number of ECD kidneys. No significant difference was observed in delayed graft function incidence and graft function post-transplantation. These findings support the use of PPP in ECD donor kidneys