Comparing Message Appeals Employed in Efforts to Prevent E-cigarette Use Among Students in a US University.

College students tend to underestimate the risk associated with e-cigarette use while overestimating the prevalence of this behavior. The purpose of this study was to compare the perceived effectiveness of social norms messages to other theoretical appeals regarding the prevention of e-cigarette use. Researchers surveyed 586 college students who assessed five messages. Different appeals were featured in each message. A Rasch Rating Scale Model (RSM) was used to calibrate students' responses to seven items assessing each communication message. The results from the multiple regression models revealed that vape-users were less receptive to the messages than abstainers, and among vape users, males expressed lower message endorsement than females. Overall, the clinical appeal received the highest endorsement in Rasch calibrated logit unit measures, (M = 3.36 for abstainers and M = 2.41 for vape-users), whereas the social norms message was the least favored (M = 1.41 for abstainers and M = 0.22 for vape-users). Qualitative analyses revealed common themes of skepticism and a need for credible scientific information. Findings suggest college students prefer clinical evidence over normative information. An experimental design is needed to determine the extent to which messages influence behavior change.

Prehospital continuous positive airway pressure (CPAP) for acute respiratory distress: a randomised controlled trial.

OBJECTIVE: To compare the efficacy of continuous positive airway pressure (CPAP) versus usual care for prehospital patients with severe respiratory distress. METHODS: We conducted a parallel group, individual patient, non-blinded randomised controlled trial in Western Australia between March 2016 and December 2018. Eligible patients were aged ≥40 years with acute severe respiratory distress of non-traumatic origin and unresponsive to initial treatments by emergency medical service (EMS) paramedics. Patients were randomised (1:1) to usual care or usual care plus CPAP. The primary outcomes were change in dyspnoea score and change in RR at ED arrival, and hospital length of stay. RESULTS: 708 patients were randomly assigned (opaque sealed envelope) to usual care (n=346) or CPAP (n=362). Compared with usual care, patients randomised to CPAP had a greater reduction in dyspnoea scores (usual care -1.0, IQR -3.0 to 0.0 vs CPAP -3.5, IQR -5.2 to -2.0), median difference -2.0 (95% CI -2.5 to -1.6); and RR (usual care -4.0, IQR -9.0 to 0.0 min-1 vs CPAP -8.0, IQR -14.0 to -4.0 min-1), median difference -4.0 (95% CI -5.0 to -4.0) min-1. There was no difference in hospital length of stay (usual care 4.2, IQR 2.1 to 7.8 days vs CPAP 4.8, IQR 2.5 to 7.9 days) for the n=624 cases admitted to hospital, median difference 0.36 (95% CI -0.17 to 0.90). CONCLUSIONS: The use of prehospital CPAP by EMS paramedics reduced dyspnoea and tachypnoea in patients with acute respiratory distress but did not impact hospital length of stay. TRIAL REGISTRATION NUMBER: ACTRN12615001180505.

Challenges and innovations in interprofessional education: Promoting a public health perspective.

Public Health has been a key contributor in the Interprofessional Education Collaborative expert panel for Interprofessional Education (IPE) programs; however, limited programs have directly addressed population health concepts such as social determinants of health and health disparities in healthcare, which directly impact the health and well-being of patients. Thus, this study presents the development and implementation of population health concepts within a traditional, clinically focused IPE program. Within the IPE program conducted in 2016, more than 575 students from 12 health-related disciplines participated in a 4-month academic course. A new curriculum was developed that included a new module on social determinants of health. Previously developed sessions on roles and responsibilities, standardized patient interviewing, patient care planning, and patient safety were re-examined to incorporate the concepts of social determinants of health and health disparities. Course evaluations reported higher mean scores for each new session when compared to scores from previous years evaluation, when social determinants of health had not been addressed. Findings from this evaluation highlight the importance of developing innovative experiential learning experiences that include public health concepts within IPE in order to create a more fulfilling and enriched curriculum to better prepare healthcare students to address the social determinants of health that they will be encountering in their future practice.

Challenges during long-term follow-up of ICU patients with and without chronic disease.

INTRODUCTION: Reflecting on researchers' experiences during follow-up of patients enrolled in research may lead to improved understanding of the challenges faced in maintaining contact when patients leave hospital. AIMS: (1) Describe the challenges researchers face when following-up patients who survive ICU. (2) Identify issues that influenced our ability to follow-up patients. METHODS: This sub-study was part of a larger "case-control" study investigating the quality of life of ICU survivors with and without pre-existing chronic disease. Patients completed self-assessment QLQ and symptom assessment before hospital discharge and at six months, plus they were asked to keep a paper diary of healthcare services used. Patient contact was maintained by monthly telephone calls. Each telephone call was logged and summaries of conversations documented. Our experience of conducting the study was reviewed by the identification of common issues which arose from the follow-up of patients. RESULTS: Thirty patients with a history of chronic disease and 30 patients without underlying chronic disease were followed-up. A total of 582 telephone calls were made for 60 patients discharged from hospital of which 261 (45%) calls led to a telephone interview. Only 19 (30%) of diaries were completed and returned. We identified six challenges associated with issues that arose from the follow-up of patients. CONCLUSION: We underestimated the number of telephone calls required for follow-up after discharge. Diaries were unreliable sources of data suggesting strategies are needed to improve compliance. How patients respond to follow-up is not always predictable. Processes are needed to deal with unexpected information provided during telephone follow-up.

Using the integrated behavioral model to explain and predict cannabis vaping among college students.

Background: Cannabis vaping has become increasingly popular among college students. The purpose of this study was to use the Integrated Behavioral Model to better understand students' motivations for engaging in this high-risk behavior. Methods: A survey instrument was developed to assess six IBM constructs, as well as past use of cannabis and nicotine, and cannabis vaping behavior changes related to COVID-19. A structural equation model was used to assess the effects of IBM predictors on Behavioral Intention. Results: The IBM predictors accounted for 54.2% of the variance in Behavioral Intention. The strongest path coefficients on Behavioral Intention were Perceived Norm and Experiential Attitude. Conclusion: The results from this study can be used to design interventions to decrease cannabis vaping use among college students. More specifically, social norm interventions and addressing other misconceptions about vaping cannabis, appears to be a promising theoretical approach to help ameliorate this unique public health challenge.

A health communication campaign designed to improve study habits and wellness: A feasibility study.

BACKGROUND: Academic success and retention remain priorities on college campuses. Excessive cell phone use, test anxiety, and poor sleep habits are all associated with negative academic performance. OBJECTIVE: To assess college students' perceptions of a health communication campaign designed to improve study habits and wellness behaviors during exams. METHOD: Researchers used a cross-sectional research design to assess participants' (n = 264) perceptions of the study tip messages. Linear regressions were conducted to determine if the number of messages read was predictive of readiness to change. RESULTS: Nearly all participants agreed that the messages were appealing (84.4%), believable (89.8%), relevant (91.5%), provided useful information (91.5%) and a good reminder of how to study (87.1%). Students who reported reading more messages indicated a higher level of readiness to improve their study habits (F(1,219) = 8.89, p = .003, R2 = .04). CONCLUSIONS: Students found the messages useful; their intentions to study increased the more they were exposed to messages.

Factors that influence cannabis vaping habits of college students: A qualitative study.

Objective: The purpose of this study is to examine the attitudes and perceptions of college undergraduates regarding cannabis vaping. Participants: Twenty-one, predominantly male (71.4%; Mage = 22, SD = 2.09), undergraduate college students who reported vaping cannabis in the past 30 days. Methods: Participants were interviewed to determine their attitudes and perceptions regarding cannabis vaping. Findings: Thematic analysis uncovered six primary themes and eighteen subthemes. Main themes included (1) Convenience, (2) Discreetness, (3) Mood-Altering Experience, (4) Social Acceptability, (5) Health and Safety, and (6) COVID-19 Pandemic Impact. Conclusion: College students who use cannabis tend to both vape and use combustible methods, depending upon social and physical environment. This population tends to vaporize cannabis for its perceived mood-altering properties. Additional research is needed to further examine the behaviors and attitudes surrounding cannabis vaping among college undergraduates, as well as the development of interventions specific to this demographic.

Survival to hospital discharge is equivalent to 30-day survival as a primary survival outcome for out-of-hospital cardiac arrest studies.

AIM: The 2015 Utstein guidelines stated that 30-day survival could be used as an alternative to survival to hospital discharge (STHD) as the primary survival outcome in out-of-hospital cardiac arrest (OHCA) studies. We sought to ascertain the equivalence (concordance) of these two survival outcome measures. METHODS: We conducted a population-based retrospective cohort study of OHCA patients who were attended by St John Western Australia (SJ-WA) paramedics in Perth, WA between 1999 and 2018. OHCA patients were included if they received either an attempted resuscitation by SJ-WA or bystander defibrillation; were a resident of WA; and were transported to a hospital emergency department (ED). STHD was determined through hospital record review and 30-day survival via the WA Death Registry and cemetery registration data. RESULTS: The study cohort comprised a total of 7953 OHCA patients, predominantly male (70%), with a median (IQR) age of 63 (46-77 years), a presumed cardiac arrest aetiology (78.9%), and the majority occurred in a private residence (66.8%). Survival rates were identical for STHD and 30-day survival, with both being (13.78%, 95% CI: 13.02-14.54%) (p = 0.99). The overall concordance between the two survival rates was 99.6%. There were only 30 (0.4%) discordant cases in total: 15 cases with STHD-yes but 30-day survival-no; and 15 cases with STHD-no but 30-day survival-yes. CONCLUSION: We found that STHD and 30-day survival were equivalent survival metrics in our OHCA Registry. However, given potential differences in health systems, we suggest that 30-day survival is likely to enable more reliable comparisons across jurisdictions.

Neurological outcome in adult out-of-hospital cardiac arrest - Not all doom and gloom!

AIMS: To describe neurological and functional outcomes among out-of-hospital cardiac arrest (OHCA) patients who survived to hospital discharge; to determine the association between neurological outcome at hospital discharge and 12-month survival. METHODS: Our cohort comprised adult OHCA patients (≥18 years) attended by St John WA (SJWA) paramedics in Perth, Western Australia (WA), who survived to hospital discharge, between 1st January 2004 and 31st December 2019. Neurological and functional status at hospital discharge (and before the arrest) was determined by medical record review using the five-point 'Cerebral Performance Category (CPC)' and 'Overall Performance Category (OPC)' scores. Adjusted multivariable logistic regression analysis was used to estimate the association of CPC score at hospital discharge with 12-month survival, adjusted for prognostic variables. RESULTS: Over the study period, SJWA attended 23,712 OHCAs. Resuscitation was attempted in 43.4% of cases (n = 10,299) with 2171 subsequent admissions, 99.4% (n = 2158) of these were admitted to a study hospital. Of the 1062 hospital survivors, 71.3% (n = 757) were CPC1 (highest category of neurological performance), 21.4% (n = 227) CPC2, 6.3% (n = 67) CPC3 and 1.0% (n = 11) CPC4. OPC scores followed a similar distribution. Of the 1,011 WA residents who survived to hospital discharge, 92.3% (n = 933) survived to 12-months. A CPC1-2 at hospital discharge was significantly associated with 12-month survival (adjusted odds ratio 3.28, 95% confidence interval 1.69-6.39). CONCLUSION: Whilst overall survival is low, most survivors of OHCA have a good neurological outcome at hospital discharge and are alive at 12-months.

Arterial carbon dioxide tension has a non-linear association with survival after out-of-hospital cardiac arrest: A multicentre observational study.

PURPOSE: International guidelines recommend targeting normocapnia in mechanically ventilated out-of-hospital cardiac arrest (OHCA) survivors, but the optimal arterial carbon dioxide (PaCO2) target remains controversial. We hypothesised that the relationship between PaCO2 and survival is non-linear, and targeting an intermediate level of PaCO2 compared to a low or high PaCO2 in the first 24-h of ICU admission is associated with an improved survival to hospital discharge (STHD) and at 12-months. METHODS: We conducted a retrospective multi-centre cohort study of adults with non-traumatic OHCA requiring admission to one of four tertiary hospital intensive care units for mechanical ventilation. A four-knot restricted cubic spline function was used to allow non-linearity between the mean PaCO2 within the first 24 h of ICU admission after OHCA and survival, and optimal PaCO2 cut-points were identified from the spline curve to generate corresponding odds ratios. RESULTS: We analysed 3769 PaCO2 results within the first 24-h of ICU admission, from 493 patients. PaCO2 and survival had an inverted U-shape association; normocapnia was associated with significantly improved STHD compared to either hypocapnia (<35 mmHg) (adjusted odds ratio [aOR] 0.45, 95% confidence interval [CI] 0.24-0.83) or hypercapnia (>45 mmHg) (aOR 0.45, 95% CI 0.24-0.84). Of the twelve predictors assessed, PaCO2 was the third most important predictor, and explained >11% of the variability in survival. The survival benefits of normocapnia extended to 12-months. CONCLUSIONS: Normocapnia within the first 24-h of intensive care admission after OHCA was associated with an improved survival compared to patients with hypocapnia or hypercapnia.

Non-linear association between arterial oxygen tension and survival after out-of-hospital cardiac arrest: A multicentre observational study.

BACKGROUND: Studies to identify safe oxygenation targets after out-of-hospital cardiac arrest (OHCA) have often assumed a linear relationship between arterial oxygen tension (PaO2) and survival, or have dichotomised PaO2 at a supra-physiological level. We hypothesised that abnormalities in mean PaO2 (both high and low) would be associated with decreased survival after OHCA. METHODS: We conducted a retrospective multicentre cohort study of adult OHCA patients who received mechanical ventilation on admission to the intensive care unit (ICU). The potential non-linear relationship between the mean PaO2 within the first 24 -hs of ICU admission and survival to hospital discharge (STHD) was assessed by a four-knot restricted cubic spline function with adjustment for potential confounders. RESULTS: 3764 arterial blood gas results were available for 491 patients in the first 24-hs of ICU admission. The relationship between mean PaO2 over the first 24-hs and STHD was an inverted U-shape, with highest survival for those with a mean PaO2 between 100 and 180 mmHg (reference category) compared to a mean PaO2 of <100 mmHg (adjusted odds ratio [aOR] 0.50 95% confidence interval [CI] 0.30, 0.84), or >180 mmHg (aOR 0.41, 95% CI 0.18, 0.92). Mean PaO2 within 24 -hs was the third most important predictor and explained 9.1% of the variability in STHD. CONCLUSION: The mean PaO2 within the first 24-hs after admission for OHCA has a non-linear association with the highest STHD seen between 100 and 180 mmHg. Randomised controlled trials are now needed to validate the optimal oxygenation targets in mechanically ventilated OHCA patients.

Models of Care Delivery from Rehabilitation to Community for Spinal Cord Injury: A Scoping Review.

Spinal cord injury (SCI) is a chronic condition that results in high healthcare utilization and lifetime cost across the care continuum. In the absence of a standardized model of care delivery for SCI in western countries such as Canada, a scoping review of the literature was performed to identify and summarize existing international SCI models of care delivery. Four databases were searched using key words and subject headings for concepts such as: "spinal cord injury," "delivery of healthcare," "model of care," "patient care planning," and "care pathway." Title, abstract, and full text review were competed by two independent reviewers. A combined total of 46 peer-reviewed and gray literature articles were included. No single SCI model of care has been adopted across different countries internationally. However, optimal attributes of models of care were identified, including the importance of having multidisciplinary SCI specialty care providers along the continuum, provision of rural SCI services and outreach, integration of primary care, peer mentoring, and using a hub and spokes model of care. These findings inform the future development of an SCI model of care, which ideally would serve all geographical locations and span the continuum of care, improving the health status and quality of life of persons with SCI.

Azadirachtin: an effective systemic insecticide for control of Agrilus planipennis (Coleoptera: Buprestidae).

The emerald ash borer, Agrilus planipennis Fairmaire (Coleoptera: Buprestidae), an invasive pest discovered in North America in 2002, is now well established and threatens ash (Fraxinus spp.) trees throughout the continent. Experiments were conducted to 1) examine the efficacy of an alternative natural pesticide, azadirachtin, to control emerald ash borer, and 2) determine foliar uptake and dissipation patterns after systemic injections of azadirachtin into trunks of small (2.2 cm diameter at breast height [dbh]), uninfested green ash trees. We found no evidence of mortality of adult beetles. In contrast, fewer larvae completed their development at dose levels > or = 1.7 mg (AI)/cm dbh and development ceased beyond the second instar at dose levels > or = 13.6 mg (AI)/cm dbh. Substantial concentrations (11.2 microg/g dry mass [SD = 7.55]) of azadirachtin were present in leaves within 7 d of treatment. After rapid initial uptake, concentrations in leaves declined logarithmically during the 55 d after injection. A similar pattern was observed in a separate experiment that examined the uptake and translocation of azadirachtin in larger green ash trees (22 cm dbh) treated with 250 mg (AI) /cm dbh with the EcoJect injection system. In another experiment, recently infested plantation green ash trees treated with doses > or = 40 mg (AI)/cm dbh had significant reductions in adult emergence approximately 1 yr postinjection. Given the inhibition of larval development, reduction of adult emergence, and the occurrence of foliar residues at biologically active concentrations, we conclude that azadirachtin is effective in protecting ash trees from emerald ash borer.

Active Shooter: What Would Health Care Students Do While Caring for Their Patients? Run? Hide? Or Fight?

OBJECTIVE: The aim of this study was to explore the clinical decisions that health care students would make if faced with an active shooter event while providing patient care. METHODS: A cross-sectional study design was used to survey 245 students from 6 different professional programs. Participants read 4 case-based scenarios, selected 1 of 4 actions in a multiple-choice format, and responded to an open-ended question. Demographic questions asked whether participants had been a victim of violence and whether they have taken a certified active shooter course. Statistical analysis included descriptive statistics and chi-square testing. RESULTS: For each case, most students chose "patient-centric" versus "provider-centric" actions (range: 66%-94% and 4%-17%, respectively). The gender of the patient made no difference in actions. Those who attended a certified active shooter course tended to act with more "provider-centric" concerns than those who did not take such a course. CONCLUSION: A significant majority of interprofessional health care students, when presented with specific case-scenarios, declared they would act to protect themselves and their patients during an active shooter event. This "patient-centric" attitude transcends the oversimplified "Run-Hide-Fight" axiom and must be addressed by all health care educational institutions.

The current temperature: A survey of post-resuscitation care across Australian and New Zealand intensive care units.

AIM: Targeted temperature management (TTM) in post-resuscitation care has changed dramatically over the last two decades. However, uptake across Australian and New Zealand (NZ) intensive care units (ICUs) is unclear. We aimed to describe post-resuscitation care in our region, with a focus on TTM, and to gain insights into clinician's opinions about the level of evidence supporting TTM. METHODS: In December 2017, we sent an online survey to 163 ICU medical directors in Australia (n â€‹= â€‹141) and NZ (n â€‹= â€‹22). RESULTS: Sixty-one ICU medical directors responded (50 from Australia and 11 from NZ). Two respondents were excluded from analysis as their Private ICUs did not admit post-arrest patients. The majority of remaining respondents stated their ICU followed a post-resuscitation care clinical guideline (n â€‹= â€‹41/59, 70%). TTM was used in 57 (of 59, 97%) ICUs, of these only 64% had a specific TTM clinical guideline/policy and there was variation in the types of patients treated, temperatures targeted (range â€‹= â€‹33-37.5 â€‹°C), methods for cooling and duration of cooling (range â€‹= â€‹12-72 â€‹h). The majority of respondents stated that their ICU (n â€‹= â€‹45/57, 88%) changed TTM practice following the TTM trial: with 28% targeting temperatures >36 â€‹°C, and 23 (of 46, 50%) respondents expressed concerns with current level of evidence for TTM. Only 38% of post-resuscitation guidelines included prognostication procedures, few ICUs reported the use of electrophysiological tests. CONCLUSIONS: In Australian and New Zealand ICUs there is widespread variation in post-resuscitation care, including TTM practice and prognostication. There also seems to be concerns with current TTM evidence and recommendations.

Synthesis and use of 6,6,6-trifluoro-L-fucose to block core-fucosylation in hybridoma cell lines.

Many monoclonal antibodies (mAbs) used in cancer immunotherapy mediate tumour cell lysis by recruiting natural killer (NK) cells; a phenomenon known as antibody-dependent cellular cytotoxicity (ADCC). Eliminating core-fucose from the N-glycans of a mAb enhances its capacity to induce ADCC. As such, inhibitors of fucosylation are highly desirable for the production of mAbs for research and therapeutic use. Herein, we describe a simple synthesis of 6,6,6-trifluoro-l-fucose (F3Fuc), a metabolic inhibitor of fucosylation, and demonstrate the utility of this molecule in the production of low-fucose mAbs from murine hybridoma cell lines.