The Role of Compensation in Nicotine Reduction.

The available research on switching from normal nicotine to very low nicotine content cigarettes shows minimal evidence of compensatory smoking. Mathematical estimations suggest that substantial compensation after switching to very low nicotine cigarettes would be impossible. It is likely that smokers who are unable to tolerate the extent of proposed nicotine reduction would switch to other sources of nicotine, rather than try to compensate by smoking more very low nicotine content cigarettes more intensely

A HISTORY OF HIGH DOSE NICOTINE SELF-ADMINISTRATION INCREASES THE RATE OF SELF-ADMINISTRATION AT LOW NICOTINE DOSES.

Introduction: FDA-mandated product standards that drastically reduce nicotine content in cigarettes may result in decreased smoking and thus, improved health outcomes for millions of U.S. smokers. One issue is whether the rate of smoking at reduced nicotine contents would be different for current smokers from individuals who start smoking for the first time at the reduced content. Method: 48 rats were given the opportunity to self-administer at one of four low nicotine doses (15, 7.5, 3.75, 0.0 µg/kg/infusion) before and after self-administering a higher dose of nicotine (60 µg/kg/infusion). A second group of 57 rats acquired self-administration at the high nicotine dose before experiencing reduction. A cocktail of other cigarette constituents was included in the vehicle and remained constant across the study. Results: The rate of self-administration across the low doses (including vehicle) was higher following self-administration of a high dose. Rates of self-administration following reduction from the high nicotine dose were the same regardless of whether the rats originally acquired at a low dose or the high dose. The effect of self-administering a high nicotine dose was highest for a threshold dose (7.5 µg/kg/infusion). Discussion: The present study suggests rate of self-administering low nicotine doses may be increased by having a history of high dose self-administration. The large effect at a threshold nicotine dose may indicate a shift in the threshold for maintaining behavior as a result of experience with higher doses of nicotine. These data would support the idea that current smokers may smoke at a higher intensity following nicotine reduction than individuals who begin smoking for the first time at the reduced rate. Furthermore, the rate of self-administration following reduction was the same regardless of whether rats acquired at the high dose of nicotine or experienced a low dose before being changed over to a high nicotine dose

Increasing Nicotine Cost and Decreasing Nicotine Dose are not Equivalent Manipulations

Introduction: Two factors that have been shown to affect smoking behavior are the cost of cigarettes and the dose of nicotine. Behavioral economics posits that the two factors may be related through the concept of unit price (unit price = cost/reinforcer magnitude). According to this framework, increases in the cost of a reinforcer and decreases in the magnitude of a reinforcer are equivalent manipulations. However, this assumption has not been thoroughly tested. Method: Across three studies, a rodent self-administration model was used to assess the relationship between increases in nicotine cost and decreases in nicotine dose. In Aim 1, each rat experienced six unit prices twice: cost was manipulated and dose was held constant across one set of combinations, and cost was held constant and nicotine dose was manipulated across the other set of combinations. In Aim 2, the same procedure was used as in Aim 1 except that very low nicotine doses, hypothesized to below the threshold for maintaining self-administration, were used for the dose manipulation. In Aim 3, the hypothesis that consumption should be the same at a single unit price regardless of the cost/dose combination used to create it was tested. Results: Results show that across the range of unit prices that maintain consumption, behavior is more sensitive to nicotine dose than to nicotine cost. However, when above-threshold doses are used, increases in nicotine cost maintain consumption across a smaller range of unit prices than decreases in dose. When very low nicotine doses are used for dose reduction, animals consumed less nicotine than they did for the ratio-escalation manipulation. Finally, nicotine consumption was not equivalent across a variety of unit price combinations forming a single unit price. Discussion: Results of the present study are the first to show that increases in the cost of nicotine and decreases in the dose of nicotine are not equivalent manipulations, and they raise questions about a fundamental assumption within the behavioral economics framework

The Role of Pharmacists in Primary Care Settings

Introduction: The profession of pharmacy has evolved from a dispensing role to an interdisciplinary clinical role in patient care. One area of patient care expertise is Medication Therapy Management Services (MTM), which includes services such as pharmacotherapy, medication therapy reviews, disease management, immunizations and other clinical services. Various studies have shown that pharmacists conducting MTM improve patient outcomes in some clinical settings. Amidst the valuable services all healthcare professionals are providing, increasing medical costs and a lack of primary care physicians have become overwhelming, potentially leading to negative patient outcomes. Gaps in communication between hospital, primary care clinics and community pharmacies also contribute to negative patient outcomes. Pharmacists can help bridge the gap in miscommunication and help improve patient outcomes by working in primary care settings. Objective: To determine if the addition of pharmacists providing clinical services (i.e. MTM) in a primary care setting can support the prescribers’ patient care demands. Methods: The study is an observational, exploratory study. All Federally Qualified Health Centers (FQHCs) in Ohio will be invited to participate. FQHCs are identified from the HRSA Office of Pharmacy Affairs as Consolidated Health Center Programs. IRB approval will be acquired. A Qualtrics survey will be administered via email to the participants which will include a consent form, information about the study and a link to the survey. The survey will include demographic, open-ended and 5-point Likert-type scale (1=strongly agree, 5=strongly disagree) questions. Reliability and validity of the survey will be established by a thorough search of the literature and expert review. Results: Upon approval from the IRB, data will be collected from summer 2014 to summer 2015. Submitted surveys will be analyzed with the appropriate statistical tests in SPSS. Data will be presented in spring of 2016

The Pivotal Role of the Pharmacist in a Primary Care Office

Abstract The profession of pharmacy has evolved from a dispensing role to an interdisciplinary clinical role in patient care. One area of patient care expertise is Medication Therapy Management (MTM), which includes services such as pharmacotherapy, medication therapy reviews, disease management, immunizations and other clinical services. In various studies, pharmacists conducting MTM have shown improved patient outcomes in community pharmacy and hospital settings. Amidst the valuable services all healthcare professionals are providing, increasing medical costs and consequences have become overwhelming, leading to negative patient outcomes. A lack of primary care physicians (PCPs) may contribute to these distressing facts. Gaps in communication between hospital, PCPs and community pharmacies also contribute to negative patient outcomes. Pharmacists can bridge the gap in miscommunication and help improve patient outcomes. Thus far in practice, pharmacists have had a limited role in primary care settings. The objective of this study is to determine if the addition of pharmacists providing clinical services (i.e. MTM) in a primary care setting can support the prescribers’ patient care demands. For this observational, exploratory research, the primary care settings under study will be all Federally Qualified Health Centers (FQHCs) in Ohio. IRB approval will be acquired before contact is made with participants. The contact person from each FQHC has been identified from the HRSA Office of Pharmacy Affairs. A script will be used to gather email addresses for the manager, physician, nurse and pharmacist, if available, from the contact person. A Qualtrics survey will be administered to these participants via email. The purpose of this study is to establish components of patient care in a primary care office, specifically FQHCs, that other medical professionals identify as lacking, which pharmacists can provide. A consent form, information about the study and a link to the survey will be provided in an email. The survey will include demographic, open-ended and 5-point Likert-type scale (1=strongly agree, 5=strongly disagree) questions. Reliability and validity of the survey will be established by a thorough search of the literature and expert review. Submitted answers will be analyzed with the appropriate statistical tests

Effects of Very Low Nicotine Content Cigarettes on Smoking Behavior and Biomarkers of Exposure in Menthol and Non-menthol Smokers.

IntroductionBecause 30% of cigarettes sold in the United States are characterized as menthol cigarettes, it is important to understand how menthol preference may affect the impact of a nicotine reduction policy.MethodsIn a recent trial, non-treatment-seeking smokers were randomly assigned to receive very low nicotine cigarettes (VLNC; 0.4 mg nicotine/g tobacco) or normal nicotine cigarettes (NNC; 15.5 mg/g) for 20 weeks. On the basis of preference, participants received menthol or non-menthol cigarettes. We conducted multivariable regression analyses to examine whether menthol preference moderated the effects of nicotine content on cigarettes per day (CPD), breath carbon monoxide (CO), urinary total nicotine equivalents (TNE), urinary 2-cyanoethylmercapturic acid (CEMA), and abstinence.ResultsAt baseline, menthol smokers (n = 346) reported smoking fewer CPD (14.9 vs. 19.2) and had lower TNE (52.8 vs. 71.6 nmol/mg) and CO (17.7 vs. 20.5 ppm) levels than non-menthol smokers (n = 406; ps < .05). At week 20, significant interactions indicated that menthol smokers had smaller treatment effects than non-menthol smokers for CPD (-6.4 vs. -9.3), TNE (ratio of geometric means, 0.22 vs. 0.10) and CEMA (ratio, 0.56 vs. 0.37; ps < .05), and trended toward a smaller treatment effect for CO (-4.5 vs. -7.3 ppm; p = .06). Odds ratios for abstinence at week 20 were 1.88 (95% confidence interval [CI] = 0.8 to 4.4) for menthol and 9.11 (95% CI = 3.3 to 25.2) for non-menthol VLNC smokers (p = .02) relative to the NNC condition.ConclusionsAlthough menthol smokers experienced reductions in smoking, toxicant exposure, and increases in quitting when using VLNC cigarettes, the magnitude of change was smaller than that observed for non-menthol smokers.ImplicationsResults of this analysis suggest that smokers of menthol cigarettes may respond to a nicotine reduction policy with smaller reductions in smoking rates and toxicant exposure than would smokers of non-menthol cigarettes

Self-Healing Polymer Materials for Wire Insulation, Polyimides, Flat Surfaces, and Inflatable Structures

Materials based on low melt polyimide, polyurea, or polyurethane chemistry have been developed which exhibit self-healing properties. These high performance polymers can be utilized either by themselves or in combination with microcapsule technology to deliver self-healing properties to electrical wire insulation or in other high performance, thin wall technologies such as inflatable structures

A versatile and compact capacitive dilatometer

We describe the design, construction, calibration, and operation of a relatively simple differential capacitive dilatometer suitable for measurements of thermal expansion and magnetostriction from 300 K to below 1 K with a low-temperature resolution of about 0.05 angstroms. The design is characterized by an open architecture permitting measurements on small samples with a variety of shapes. Dilatometers of this design have operated successfully with a commercial physical property measurement system, with several types of cryogenic refrigeration systems, in vacuum, in helium exchange gas, and while immersed in liquid helium (magnetostriction only) to temperatures of 30 mK and in magnetic fields to 45 T.Comment: 8 pages, incorporating 6 figures, submitted to Rev. Sci. Instru

Outpatient versus inpatient uterine polyp treatment for abnormal uterine bleeding: randomised controlled non-inferiority study.

OBJECTIVE: To compare the effectiveness and acceptability of outpatient polypectomy with inpatient polypectomy. DESIGN: Pragmatic multicentre randomised controlled non-inferiority study. SETTING: Outpatient hysteroscopy clinics in 31 UK National Health Service hospitals. PARTICIPANTS: 507 women who attended as outpatients for diagnostic hysteroscopy because of abnormal uterine bleeding and were found to have uterine polyps. INTERVENTIONS: Participants were randomly assigned to either outpatient uterine polypectomy under local anaesthetic or inpatient uterine polypectomy under general anaesthesia. Data were collected on women's self reported bleeding symptoms at baseline and at 6, 12, and 24 months. Data were also collected on pain and acceptability of the procedure at the time of polypectomy. MAIN OUTCOME MEASURES: The primary outcome was successful treatment, determined by the women's assessment of bleeding at six months, with a prespecified non-inferiority margin of 25%. Secondary outcomes included generic (EQ-5D) and disease specific (menorrhagia multi-attribute scale) quality of life, and feasibility and acceptability of the procedure. RESULTS: 73% (166/228) of women in the outpatient group and 80% (168/211) in the inpatient group reported successful treatment at six months (intention to treat relative risk 0.91, 95% confidence interval 0.82 to 1.02; per protocol relative risk 0.92, 0.82 to 1.02). Failure to remove polyps was higher (19% v 7%; relative risk 2.5, 1.5 to 4.1) and acceptability of the procedure was lower (83% v 92%; 0.90, 0.84 to 0.97) in the outpatient group Quality of life did not differ significantly between the groups. Four uterine perforations, one of which necessitated bowel resection, all occurred in the inpatient group. CONCLUSIONS: Outpatient polypectomy was non-inferior to inpatient polypectomy. Failure to remove a uterine polyp was, however, more likely with outpatient polypectomy and acceptability of the procedure was slightly lower

In-Situ Wire Damage Detection System

An in-situ system for detecting damage in an electrically conductive wire. The system includes a substrate at least partially covered by a layer of electrically conductive material forming a continuous or non-continuous electrically conductive layer connected to an electrical signal generator adapted to delivering electrical signals to the electrically conductive layer. Data is received and processed to identify damage to the substrate or electrically conductive layer. The electrically conductive material may include metalized carbon fibers, a thin metal coating, a conductive polymer, carbon nanotubes, metal nanoparticles or a combination thereof