A Global Health Survey of People Who Vape but Never Smoked: Protocol for the VERITAS (Vaping Effects: Real-World International Surveillance) Study.

BACKGROUND: There is only limited information about the health effects of regular vaping. Research on the health status of people who used to smoke faces the challenge that previous smoking may have caused unknown health effects. Only studies of people who vape but have never smoked combustible cigarettes can enable the detection of harms attributable to vaping. Large prospective studies of well-characterized electronic cigarette users with and without a history of combustible cigarette smoking are warranted to establish the long-term effects of regular vaping on respiratory health. OBJECTIVE: We will conduct a global cross-sectional survey of individuals from 6 world regions. Respiratory symptoms will be assessed using a validated questionnaire-the Respiratory Symptom Experience Scale (RSES). Current vapers who are nonusers of other tobacco or nicotine products will be compared with matched controls who are nonusers of vapes and other tobacco or nicotine products. METHODS: This will be a multicountry, cross-sectional internet-based survey of 750 adults aged ≥18 years who satisfy the criteria for inclusion in either a cohort of people who exclusively vape and who are nonusers of other tobacco or nicotine products ("vapers cohort"; target N=500) or a cohort of nonvapers who are also nonusers of other tobacco or nicotine products ("controls cohort"; target N=250). The primary end point of the study is the RSES score. RSES scores of people in the "vapers cohort" will be compared with those of people in the "controls cohort." Additionally, the study will collect data to characterize patterns of vaping product use among the vapers cohort. Data collection will include information about the age initiation of using vape products, reasons for starting and continuing the use of vape products, specific types of products used, flavors and nicotine strengths of recently used products, as well as the frequency and intensity of product use in the past 30 days. RESULTS: Participant recruitment started in April 2023, and enrollment was completed by November 2023 with 748 participants. Results will be reported in 2024. CONCLUSIONS: This will be the first study providing key insights into respiratory health effects associated with using electronic cigarettes in people who vape with no established use of combustible cigarettes or other tobacco or nicotine products. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/54236.

Influences of Native American land use on the Colonial Euro-American settlement of the South Carolina Piedmont.

We test the hypothesis that prehistoric Native American land use influenced the Euro-American settlement process in a South Carolina Piedmont landscape. Long term ecological studies demonstrate that land use legacies influence processes and trajectories in complex, coupled social and ecological systems. Native American land use likely altered the ecological and evolutionary feedback and trajectories of many North American landscapes. Yet, considerable debate revolves around the scale and extent of land use legacies of prehistoric Native Americans. At the core of this debate is the question of whether or not European colonists settled a mostly "wild" landscape or an already "humanized" landscape. We use statistical event analysis to model the effects of prehistoric Native American settlement on the rate of Colonial land grants (1749-1775). Our results reveal how abandoned Native American settlements were among the first areas claimed and homesteaded by Euro-Americans. We suggest that prehistoric land use legacies served as key focal nodes in the Colonial era settlement process. As a consequence, localized prehistoric land use legacies likely helped structure the long term, landscape- to regional-level ecological inheritances that resulted from Euro-American settlement.

The patients' perspective of international normalized ratio self-testing, remote communication of test results and confidence to move to self-management.

AIMS AND OBJECTIVES: To elicit the perceptions of patients, who self-tested their international normalized ratio and communicated their results via a text or phone messaging system, to determine their satisfaction with the education and support that they received and to establish their confidence to move to self-management. BACKGROUND: Self-testing of international normalized ratio has been shown to be reliable and is fast becoming common practice. As innovations are introduced to point of care testing, more research is needed to elicit patients' perceptions of the self-testing process. DESIGN: This three site study used a cross-sectional prospective descriptive survey. METHODS: Three hundred and thirty patients who were prescribed warfarin and using international normalized ratio self-testing were invited to take part in the study. The anonymous survey examined patient profile, patients' usage, issues, perceptions, confidence and satisfaction with using the self-testing system and their preparedness for self-management of warfarin dosage. RESULTS: The response rate was 57% (n = 178). Patients' confidence in self-testing was high (90%). Patients expressed a high level of satisfaction with the support received, but expressed the need for more information on support groups, side effects of warfarin, dietary information and how to dispose of needles. When asked if they felt confident to adjust their own warfarin levels 73% agreed. Chi-squared tests for independence revealed that none of the patient profile factors examined influenced this confidence. The patients cited the greatest advantages of the service were reduced burden, more autonomy, convenience and ease of use. The main disadvantages cited were cost and communication issues. CONCLUSION: Patients were satisfied with self-testing. The majority felt they were ready to move to self-management. RELEVANCE TO CLINICAL PRACTICE: The introduction of innovations to remote point of care testing, such as warfarin self-testing, needs to have support at least equal to that provided in a hospital setting.

Living on a flammable planet: interdisciplinary, cross-scalar and varied cultural lessons, prospects and challenges.

Living with fire is a challenge for human communities because they are influenced by socio-economic, political, ecological and climatic processes at various spatial and temporal scales. Over the course of 2 days, the authors discussed how communities could live with fire challenges at local, national and transnational scales. Exploiting our diverse, international and interdisciplinary expertise, we outline generalizable properties of fire-adaptive communities in varied settings where cultural knowledge of fire is rich and diverse. At the national scale, we discussed policy and management challenges for countries that have diminishing fire knowledge, but for whom global climate change will bring new fire problems. Finally, we assessed major fire challenges that transcend national political boundaries, including the health burden of smoke plumes and the climate consequences of wildfires. It is clear that to best address the broad range of fire problems, a holistic wildfire scholarship must develop common agreement in working terms and build across disciplines. We must also communicate our understanding of fire and its importance to the media, politicians and the general public.This article is part of the themed issue 'The interaction of fire and mankind'.

Wildland Arson as Clandestine Resource Management: A Space-Time Permutation Analysis and Classification of Informal Fire Management Regimes in Georgia, USA.

Forest managers are increasingly recognizing the value of disturbance-based land management techniques such as prescribed burning. Unauthorized, "arson" fires are common in the southeastern United States where a legacy of agrarian cultural heritage persists amidst an increasingly forest-dominated landscape. This paper reexamines unauthorized fire-setting in the state of Georgia, USA from a historical ecology perspective that aims to contribute to historically informed, disturbance-based land management. A space-time permutation analysis is employed to discriminate systematic, management-oriented unauthorized fires from more arbitrary or socially deviant fire-setting behaviors. This paper argues that statistically significant space-time clusters of unauthorized fire occurrence represent informal management regimes linked to the legacy of traditional land management practices. Recent scholarship has pointed out that traditional management has actively promoted sustainable resource use and, in some cases, enhanced biodiversity often through the use of fire. Despite broad-scale displacement of traditional management during the 20th century, informal management practices may locally circumvent more formal and regionally dominant management regimes. Space-time permutation analysis identified 29 statistically significant fire regimes for the state of Georgia. The identified regimes are classified by region and land cover type and their implications for historically informed disturbance-based resource management are discussed.

Traditional fire-use, landscape transition, and the legacies of social theory past.

Fire-use and the scale and character of its effects on landscapes remain hotly debated in the paleo- and historical-fire literature. Since the second half of the nineteenth century, anthropology and geography have played important roles in providing theoretical propositions and testable hypotheses for advancing understandings of the ecological role of human-fire-use in landscape histories. This article reviews some of the most salient and persistent theoretical propositions and hypotheses concerning the role of humans in historical fire ecology. The review discusses this history in light of current research agendas, such as those offered by pyrogeography. The review suggests that a more theoretically cognizant historical fire ecology should strive to operationalize transdisciplinary theory capable of addressing the role of human variability in the evolutionary history of landscapes. To facilitate this process, researchers should focus attention on integrating more current human ecology theory into transdisciplinary research agendas.

Evaluation of a nurse-led haemophilia counselling service.

Genetic counselling and testing for females with a family history of haemophilia has long been advocated. However, there is little research in regard to clients' satisfaction with the existing counselling models in haemophilia, and in particular with nurse-led clinics. The purpose of this study was to evaluate whether clients were satisfied with a nurse-led carrier testing clinic and counselling service. A retrospective quantitative study of clients' satisfaction and perceived knowledge was undertaken using an anonymous questionnaire. A sample of 42 women who had attended the clinic in the last 12 months was identified. The response rate for the study was 71% (n = 30).Two thirds of the respondents were 35 years of age or younger, 93% had a family history of haemophilia and 56% were diagnosed as carriers. Perceived understanding and knowledge increased significantly between the first and second appointments (p < 0.001). Overall, the study identified a high level of client satisfaction with the nurse-led carrier testing clinic and counselling service.

Nursing care, education and support for patients with neutropenia.

Neutropenia is reduced white blood cell count. It is a side effect of cytotoxic chemotherapy for cancer and haematological patients. This article aims to help nursing students and qualified nurses who are novices in caring for neutropenic patients to become familiar with the usual body defences against infection; understand how the body's ability to fight infection is affected by neutropenia; recognise potential sources of infection; and support the patient who is at risk of infection as a result of neutropenia.

Undertaking a literature review: a step-by-step approach.

Nowadays, most nurses, pre- and post-qualification, will be required to undertake a literature review at some point, either as part of a course of study, as a key step in the research process, or as part of clinical practice development or policy. For student nurses and novice researchers it is often seen as a difficult undertaking. It demands a complex range of skills, such as learning how to define topics for exploration, acquiring skills of literature searching and retrieval, developing the ability to analyse and synthesize data as well as becoming adept at writing and reporting, often within a limited time scale. The purpose of this article is to present a step-by-step guide to facilitate understanding by presenting the critical elements of the literature review process. While reference is made to different types of literature reviews, the focus is on the traditional or narrative review that is undertaken, usually either as an academic assignment or part of the research process.

The experiences of patients and relatives/significant others of overcrowding in accident and emergency in Ireland: a qualitative descriptive study.

Overcrowding in Accident and Emergency Departments (A&E) in Ireland has reached crisis proportions since the dawning of the new millennium. Although this phenomenon is not unique to Ireland and many authors have suggested causes and management strategies to deal with these crises, little appears to have been written regarding the experiences of patients or their families waiting in the A&E. The aim of this qualitative descriptive study was to describe the experiences of patients and/or their relatives/significant others who had spent 12 h or more in A&E awaiting admission to hospital. Four patients and three relatives/significant others volunteered to participate in the study. Participants described the A&E departments as resembling a disaster zone or a hospital scene from a third world country. Descriptions portrayed an environment that was overcrowded, dirty and lacking in resources. Participants were generally positive in their attitudes towards the care they received, but some descriptions appeared to suggest that the quality of care was not always ideal. Recommendations from participants included reduced waiting times with a maximum of 6 h from admission to transfer or discharge; better communications systems with perhaps a liaison person who could advise them about the expected duration of stay in A&E and what was happening regarding their care; and better privacy and security within the departments.

Step-by-step guide to critiquing research. Part 2: Qualitative research.

As with a quantitative study, critical analysis of a qualitative study involves an in-depth review of how each step of the research was undertaken. Qualitative and quantitative studies are, however, fundamentally different approaches to research and therefore need to be considered differently with regard to critiquing. The different philosophical underpinnings of the various qualitative research methods generate discrete ways of reasoning and distinct terminology; however, there are also many similarities within these methods. Because of this and its subjective nature, qualitative research it is often regarded as more difficult to critique. Nevertheless, an evidenced-based profession such as nursing cannot accept research at face value, and nurses need to be able to determine the strengths and limitations of qualitative as well as quantitative research studies when reviewing the available literature on a topic.

Step-by-step guide to critiquing research. Part 1: quantitative research.

When caring for patients, it is essential that nurses are using the current best practice. To determine what this is, nurses must be able to read research critically. But for many qualified and student nurses, the terminology used in research can be difficult to understand, thus making critical reading even more daunting. It is imperative in nursing that care has its foundations in sound research, and it is essential that all nurses have the ability to critically appraise research to identify what is best practice. This article is a step-by-step approach to critiquing quantitative research to help nurses demystify the process and decode the terminology.

Kinetic parameters and mode of action of the cellobiohydrolases produced by Talaromyces emersonii.

Three forms of cellobiohydrolase (EC 3.2.1.91), CBH IA, CBH IB and CBH II, were isolated to apparent homogeneity from culture filtrates of the aerobic fungus Talaromyces emersonii. The three enzymes are single sub-unit glycoproteins, and unlike most other fungal cellobiohydrolases are characterised by noteworthy thermostability. The kinetic properties and mode of action of each enzyme against polymeric and small soluble oligomeric substrates were investigated in detail. CBH IA, CBH IB and CBH II catalyse the hydrolysis of microcrystalline cellulose, albeit to varying extents. Hydrolysis of a soluble cellulose derivative (CMC) and barley 1,3;1,4-beta-D-glucan was not observed. Cellobiose (G2) is the main reaction product released by CBH IA, CBH IB, and CBH II from microcrystalline cellulose. All three CBHs are competitively inhibited by G2; inhibition constant values (K(i)) of 2.5 and 0.18 mM were obtained for CBH IA and CBH IB, respectively (4-nitrophenyl-beta-cellobioside as substrate), while a K(i) of 0.16 mM was determined for CBH II (2-chloro-4-nitrophenyl-beta-cellotrioside as substrate). Bond cleavage patterns were determined for each CBH on 4-methylumbelliferyl derivatives of beta-cellobioside and beta-cellotrioside (MeUmbG(n)). While the Tal. emersonii CBHs share certain properties with their counterparts from Trichoderma reesei, Humicola insolens and other fungal sources, distinct differences were noted.

Using people.

KIE: Debate over human embryo research often has centered around the embryo's human status, with the assumption that beings accorded full humanhood may not be used as means to an end for other humans. Britain's Warnock Committee, for example, concluded that since the early embryo was potentially, not actually, a full human being, it legitimately could be treated, albeit briefly, as a means to an end for research purposes. Coughlan discusses the "Warnock principle," which precludes the use of human beings, the broader "Pauline principle," (from St. Paul's Epistle to the Romans), which forbids the doing of evil to achieve good, and the principle of double effect, which sets down the conditions under which the occasioning of evil is justifiable. He concludes that the Warnock and Pauline principles are untenable if construed as exceptionless. Anscombe questions Coughlan's understanding of the principle of double effect, and Coughlan defends his arguments.^ieng

When Did I Begin? Conception of the Human Individual in History, Philosophy and Science by Norman M. Ford.

KIE: Coughlan reviews Norman M. Ford's When Did I Begin? Conception of the Human Individual in History, Philosophy and Science (Cambridge University Press; 1988). Ford, master of a Catholic theological college, has written a critique of the view that the life of the human person begins at the fertilization of the ovum. He believes that "when does a human being begin?" is an ontological question, and that attainment of personhood is a fact which calls for appropriate moral and legal attitudes, rather than a product of moral or legal attitudes or conventions. Ford bases his arguments on a detailed analysis of both the biological facts and the significance of early human embryology. Coughlan, while taking issue with some of Ford's reasoning, praises the book for its spirit of honesty, its well-argued transitions, and its instructiveness in human embryology. Ford's response to Coughlan follows the review.^ieng

'From the moment of conception...': the Vatican instruction on artificial procreation techniques.

KIE: An analysis is presented of Instruction on Respect for Human Life in Its Origins and on the Dignity of Procreation, the official response of the Catholic Church to moral questions raised by the new reproductive technologies which sets down ethical guidelines for the treatment to be accorded human embryos and for procreative techniques from artificial insemination to surrogate motherhood. The document is viewed in the perspective of earlier Church pronouncements, such as The Declaration on Procured Abortion , and its definition of a person as an individual animated by a rational soul is explored in detail for its implications for discussions on the personhood of the human embryo.^ieng