Novel Mechanisms of Ozone-Induced Pulmonary Inflammation and Resolution, and the Potential Protective Role of Scavenger Receptor BI.

INTRODUCTION: Increases in ambient levels of ozone (O3), a criteria air pollutant, have been associated with increased susceptibility and exacerbations of chronic pulmonary diseases through lung injury and inflammation. O3 induces pulmonary inflammation, in part by generating damage-associated molecular patterns (DAMPs), which are recognized by pattern recognition receptors (PRRs), such as toll-like receptors (TLRs) and scavenger receptors (SRs). This inflammatory response is mediated in part by alveolar macrophages (AMs), which highly express PRRs, including scavenger receptor BI (SR-BI). Once pulmonary inflammation has been induced, an active process of resolution occurs in order to prevent secondary necrosis and to restore tissue homeostasis. The processes known to promote the resolution of inflammation include the clearance by macrophages of apoptotic cells, known as efferocytosis, and the production of specialized pro-resolving mediators (SPMs). Impaired efferocytosis and production of SPMs have been associated with the pathogenesis of chronic lung diseases; however, these impairments have yet to be linked with exposure to air pollutants. SPECIFIC AIMS: The primary goals of this study were: Aim 1 - to define the role of SR-BI in O3-derived pulmonary inflammation and resolution of injury; and Aim 2 - to determine if O3 exposure alters pulmonary production of SPMs and processes known to promote the resolution of pulmonary inflammation and injury. METHODS: To address Aim 1, female wild-type (WT) and SR-BI-deficient, or knock-out (SR-BI KO), mice were exposed to either O3 or filtered air. In one set of experiments mice were instilled with an oxidized phospholipid (oxPL). Bronchoalveolar lavage fluid (BALF) and lung tissue were collected for the analyses of inflammatory and injury markers and oxPL. To estimate efferocytosis, mice were administered apoptotic cells (derived from the Jurkat T cell line) after O3 or filtered air exposure.To address Aim 2, male WT mice were exposed to either O3 or filtered air, and levels of SPMs were assessed in the lung, as well as markers of inflammation and injury in BALF. In some experiments SPMs were administered before exposure to O3or filtered air, to determine whether SPMs could mitigate inflammatory or resolution responses. Efferocytosis was measured as in Aim 1. RESULTS: For Aim 1, SR-BI protein levels increased in the lung tissue of mice exposed to O3, compared with mice exposed to filtered air. Compared with WT controls, SR-BI KO mice had a significant increase in the number of neutrophils in their airspace 24 hours post O3 exposure. The oxPL levels increased in the airspace of both WT and SR-BI KO mice after O3 exposure, compared with filtered air controls. Four hours after instillation of an oxPL, SR-BI KO mice had an increase in BALF neutrophils and total protein, and a nonsignificant increase in macrophages compared with WT controls. O3 exposure decreased efferocytosis in both WT and SR-BI KO female mice.For Aim 2, mice given SPM supplementation before O3 exposure showed significantly increased AM efferocytosis when compared with the O3exposure control mice and also showed some mitigation of the effects of O3 on inflammation and injury. Several SPMs and their precursors were measured in lung tissue using reverse-phase high performance liquid chromatography (HPLC) with tandem mass spectrometry (MS/MS). At 24 hours after O3 exposure 14R-hydroxydocosahexaenoic acid (HDHA) and 10,17-dihydroxydocosahexaenoic acid (diHDoHE) were significantly decreased in lung tissue, but at 6 hours after exposure, levels of these SPMs increased. CONCLUSIONS: Our findings identify novel mechanisms by which O3 may induce pulmonary inflammation and also increase susceptibility to and exacerbations of chronic lung diseases.

Advancing Behavioral HIV Prevention: Adapting an Evidence-Based Intervention for People Living with HIV and Alcohol Use Disorders.

Alcohol use disorders (AUDs) are highly prevalent among people living with HIV/AIDS (PLWHA) and are associated with increased HIV risk behaviors, suboptimal treatment adherence, and greater risk for disease progression. We used the ADAPT-ITT strategy to adapt an evidence-based intervention (EBI), the Holistic Health Recovery Program (HHRP+), that focuses on secondary HIV prevention and antiretroviral therapy (ART) adherence and apply it to PLWHA with problematic drinking. Focus groups (FGs) were conducted with PLWHA who consume alcohol and with treatment providers at the largest HIV primary care clinic in New Orleans, LA. Overall themes that emerged from the FGs included the following: (1) negative mood states contribute to heavy alcohol consumption in PLWHA; (2) high levels of psychosocial stress, paired with few adaptive coping strategies, perpetuate the use of harmful alcohol consumption in PLWHA; (3) local cultural norms are related to the permissiveness and pervasiveness of drinking and contribute to heavy alcohol use; (4) healthcare providers unanimously stated that outpatient options for AUD intervention are scarce, (5) misperceptions about the relationships between alcohol and HIV are common; (6) PLWHA are interested in learning about alcohol's impact on ART and HIV disease progression. These data were used to design the adapted EBI.

Body piercing: more than skin deep.

Young adult populations (18-25 years of age) throughout the world have latched onto the mainstream trend of body piercing. Best health care practices for these individuals involves the knowledge of proper procedural techniques, postsite care, common complications, and treatment modalities.

Tattooing, body piercing, and branding are on the rise: perspectives for school nurses.

This journal presented the first nursing information on adolescents and tattooing 6 years ago, and 5 years ago, information was provided about body piercing. These were published to help school nurses assist adolescents become informed decision makers. Another purpose was to prevent risks and, if possible, help dissuade adolescents from tattooing and body piercing. Continuing this theme, the latest information and trends are reported and discussed, and new information on scarification and branding is presented. If an adolescent wants some form of body art (tattooing, body piercing, or branding), they will often obtain it regardless of regulations, risks, or money. School nurses can take a powerful, proactive role by sharing applicable information, realistic concerns, and care instructions about tattooing, body piercing, and branding. Specific information, risks, and care about each form of procedure is presented. A convenient reference table is available for nurses and students. Additionally, nursing actions are suggested including making changes in health policies regarding body art on a local and state level.

POTS, PANS, and PEARLs: the nursing profession's rich history with distance education for a new century of nursing.

BACKGROUND: Continuing education via distance education is expanding. A review of the media used to deliver classes in the past as well as future possibilities are presented. METHOD: The personal experience of the authors using these methods to present continuing nursing education is the basis for this article. RESULTS: There is evidence that people learn via distance education as well as they do with traditional formats such as conferences and seminars. Although learners are enrolling in these types of courses for convenience, they enjoy the classes more when there is active involvement and participation. CONCLUSIONS: Continuing education using distance education strategies will expand, especially because computers are available in the homes of learners. A larger number of offerings will be available, and more learners will use these media to remain current professionally.

Adolescent pregnancy, tattooing, and risk taking.

PURPOSE: To determine pregnant adolescents' interest in tattooing and identify additional risk-taking behaviors practiced by tattooed pregnant adolescents. DESIGN: A descriptive study with a convenience sample of 41 pregnant adolescents was conducted. The majority of participants were 16 to 17 years of age, 7 to 9 months gestation, single, in the 10th to 11th grades, and primarily White. A subgroup of five participants were tattooed. Participants completed the 71-item Armstrong Tattoo (AT) questionnaire. Descriptive statistics were used to describe the sample and evaluate responses. RESULTS: The majority of adolescents expressed interest in becoming tattooed; 48% expressed fear (disease, pain) as a deterrent to becoming tattooed. All tattooed participants had received tattoos prior to pregnancy. Decisions to become tattooed were made rapidly at 14 to 16 years of age, and all tattooed participants were impregnated by tattooed males. Most tattooed participants perceived themselves as risk takers, and all denied additional health problems (infection, blood-borne disease) related to the tattooing process. CLINICAL IMPLICATIONS: Proactive, preventive health education regarding maternal/fetal risks related to amateur and professional tattooing during pregnancy is needed. Pregnant adolescents aged 14 to 16 years who are dating a tattooed male may be at greater risk for impulsively deciding to become tattooed.

Tattooed Army soldiers: examining the incidence, behavior, and risk.

Primary prevention is a priority for medical personnel. Despite societal popularity and a long association of the military with tattooing, little is known about the tattooed Army soldier, which hampers primary health planning. Basic recruits and advanced individual training students (N = 1,835) at one mid-western military installation completed a questionnaire about any tattooing experiences. Almost half (48%) of the soldiers were serious/very serious about getting a tattoo, with 31% stating that there were "no reasons" to keep them from getting a tattoo. More than one-third (36%) were tattooed, with 22% possessing three or more tattoos. Many soldiers (64%) entered the military with the tattoos. Limited use (15%) of alcohol and/or drugs before tattooing was reported. Findings included a high incidence of tattooing, a strong determination to obtain tattoos, the possession of tattoos for self-identity reasons, and the supportive role of friends. Reported procedural bleeding (76%) documents the potential for blood-borne disease transmission. These results confirm the need for targeted health education regarding the safety and potential risks of tattooing.

Does baccalaureate nursing education for registered nurses foster professional reading?

Reading activities of registered nurses (RNs) were investigated using an untreated comparison group design study. The study group consisted of RN students (N = 60) enrolled in a baccalaureate in nursing (BSN) program at four distance education sites in northeast and central Texas who were queried about their reading activities. Total reading time of professional literature was reported at the time they started the nursing sequence of courses in their baccalaureate nursing program and 6 months after completion of these courses. The purposes of reading various types of professional literature also were identified by asking the respondent's interest, the perceived amount of application, and the commitment to reading this literature. RN counterparts at worksites of the RN-BSN students (N = 67) were respondents in the comparison group. After completing the BSN program, these nurses showed more interest in and commitment to reading and were more concerned about applying knowledge gained from reading in their nursing practice.

Tattooing and body piercing. Body art practices among college students.

Tattooing and body piercing are increasing, especially among college students. A study of 766 tattooed and/or body-pierced college students in 18 universities across the United States and one in Australia was conducted to discover the demographic characteristics, motivational factors, and health concerns. The traditional college time of 18 to 22 years of age (69%) was when they obtained their tattoo (73%) and/or body piercing (63%). More frequent health problems and impulsive decision making were noted for those with body piercing when compared to those tattooed. Three cases of hepatitis were reported. Health professionals should openly discuss body art with students, convey a nonjudgmental attitude, and assist with informed decision-making information to either reduce risks or dissuade. Open communication and applicable health education will be very important.

Attitudes of health care providers and students towards tattooed people.

Attitudes of health care providers and medical and nursing students (n = 513) towards tattooed adults and adolescents were examined. No respondent group had mean scores reflecting a positive attitude towards tattooed persons. Overall, physicians (MDs) and registered nurses (RNs) rated tattooed people less positively than did students. Womens' attitudes were consistently less favourable than those of men, especially towards tattooed professional women. Attitudes towards tattooed adolescents were generally less positive than attitudes towards the adult groups. Research has found that negative attitudes impact patient care. This study suggests that tattooed persons, especially adolescents, may be at risk of being negatively perceived when they seek health care. Increased efforts are needed to assure that those with tattoos receive non-judgemental and sensitive care.

Gang membership and student behavior: nursing's involvement with prevention, intervention, and suppression.

Gangs are alive, and growing stronger each day, as they infiltrate all socioeconomic levels of most towns, cities, and metropolitan areas. This is the first of two articles in this issue discussing students and gang membership and a school nurse's involvement with gang prevention, intervention, and suppression. It is also about a large metropolitan school district's proactive approach to gang prevention, which includes a meaningful partnership involving the family, community, and school. The program is a comprehensive developmental guidance program to promote pro-social behaviors, equip students with refusal skills, and encourage problem-solving strategies that enable students to avoid engaging in high-risk activities.

D-TAG: erasing the tag of gang membership.

Gangs are noted for establishing their territory, flaunting gang affiliation, intimidating nonmembers, and documenting their "services performed." These examples are a few reasons for the practice of "tagging," the labeling of an area, person, or object with gang-related graffiti or markings, such as tattoos. This article describes a school nurse's response to gang "tagging" and her efforts to assist former gang members who request removal of their tattoos, to get them removed-in essence to D-TAG themselves from their gang affiliation. D-TAG is a volunteer rehabilitation program utilizing family and community interaction to support gang tattoo removal and direct activities away from gang affiliations toward alternative educational programs and life styles.

Tattooing: another adolescent risk behavior warranting health education.

A cross-sectional, convenient sample of adolescents (N = 2101) from 8 states were queried regarding interest in tattooing. Permanent markings and blood-borne diseases were reasons respondents refrain from tattooing, yet 55% (n = 1159) expressed an interest in tattooing. Tattooed adolescents in the sample (10%, n = 213) responded with their experiences. Tattooing was frequently done around the 9th grade and as early as 8 years of age; over half (56%, n = 120) report academic grades of As and Bs. Potential health risks and definite psychosocial findings of purchase and possession risks were evident, building on data from a similar 1994 study by Armstrong and McConnell. Health providers and educators should initiate applicable health education and become community adolescent advocates regarding this risk-taking behavior. Findings indicate that adolescents who want a tattoo will obtain one, regardless of money, regulations, or risks. Adolescents view the tattoos as objects of self-identity and body art, whereas adults perceive the markings as deviant behavior. Informed decision-making could be promoted in health education by incorporating information about the possibility of blood-borne diseases, permanent markings, and themselves as growing and changing people.

Educating APNs for implementing the guidelines for adolescents in Bright futures: guidelines of health supervision of infants, children, and adolescents.

As the scope of what constitutes health and the range of determinants of health-promoting and compromising behaviors among adolescents are expanded, APNs must be well prepared to be powerful influences in the lives of all adolescents. The guidelines offered by Bright Futures challenge nurse educators to prepare APNs who possess the core competencies to knowledgeably address the health issues and concerns of all adolescents in multiple settings. The American Academy of Nursing Expert Panel's recommendations contained herein, if implemented, will further enhance the capabilities of graduate programs to prepare APNs to provide developmentally and culturally relevant disease prevention and health promotion care to adolescents and their families.

You pierced what?

Adolescents have discovered body piercing. Specific information about the piercing procedure, the sites, and the risks are presented along with an educational information sheet that can be distributed to pediatric clients and their families. Further nursing involvement in the community is stressed with one goal being the development of a collaborative education program for body piercers and their counterparts, tattoo artists.

Motivation for tattoo removal.

BACKGROUND AND DESIGN: Motivational issues surrounding tattoo removal are important to understand because tattooing is flourishing, thus creating many requests for tattoo removal. A descriptive study and a 67-item survey were used to examine characteristics of tattooed patients seeking laser therapy for tattoo removal. The setting was the Laser Dermatology Center, Massachusetts General Hospital in Boston, a large metropolitan ambulatory clinic. Patients queried were 64 tattooed males and 41 tattooed females between the ages of 17 and 62 years with a wide variety of vocational and professional occupations. We assessed risk factors surrounding tattooing decisions and experiences that might later influence their motivation to have the tattoos removed by laser therapy. RESULTS: Motivation, treatment, and cost, in terms of money, pain, and risk of disfigurement all entered into the decision making to have the tattoos removed. Strong elements of purchase and possession risks were documented as well as an improved sense of self and maturity. The patient's maturation was in contrast to the notion of a waiting room filled with ill-behaved stereotypical tattooed individuals. Most participants impulsively obtained their tattoos for internal expectations of self-identity at an early age and were still internally motivated to dissociate from the past and improve self-identity. CONCLUSIONS: Poor decision making and subsequent personal regret seem to be frequent motivations for tattoo removal, thus viable methods and accessibility to tattoo removal programs are important. In addition, educational programs for adolescents about tattooing to reduce risks and promote dissuasion should be implemented.

Adolescent tattoos: educating vs. pontificating.

Tattooing is a contemporary teen issue and a flourishing risk-taking behavior, whether the tattoos are amateur markings or studio designs. In order to assist teen clients, nurses in primary health settings need to focus on two important tasks. First, they must examine their own feelings toward tattooed adolescents before they take on the second task, the essential role of health education. Health education is important to assist adolescents become informed decision makers about tattooing.