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PURPOSE: This paper describes the factors that American Indian teachers in the Native American Diabetes Project (NADP) reported affected participation in the NADP lifestyle education sessions. METHODS: A postsession exit interview was conducted with each of the 7 mentors (teachers) of the NADP sessions. Interview questions addressed general perceptions of the sessions, factors that kept participants from coming to the sessions, and attitudes toward diabetes and persons with diabetes. Interviews were transcribed and responses reflecting factors related to participation were marked and organized into topic areas. RESULTS: Mentors reported a range of factors that affected participation in the sessions, such as conflicts with community activities and beliefs/attitudes about diabetes. The latter factor includes program knowledge, recruitment methods, attitudes toward the program, and beliefs about diabetes. CONCLUSIONS: Asking community members what factors they believe affect participation is an important component of increasing participation in community-based programs. Community members can provide a valuable personal perspective of actual and potential conflicts in the community. [ABSTRACT FROM AUTHOR]

E-cigarette or vaping product use-associated lung injury (EVALI) is a severe pulmonary illness associated with the use of e-cigarettes or vaping products that was officially identified and named in 2019. This American Thoracic Society workshop was convened in 2021 to identify and prioritize research and regulatory needs to adequately respond to the EVALI outbreak and to prevent similar instances of disease associated with e-cigarette or vaping product use. An interdisciplinary group of 26 experts in adult and pediatric clinical care, public health, regulatory oversight, and toxicology were convened for the workshop. Four major topics were examined: 1 ) the public health and regulatory response to EVALI; 2 ) EVALI clinical care; 3 ) mechanisms contributing to EVALI; and 4 ) needed actions to address the health effects of EVALI. Oral presentations and group discussion were the primary modes used to identify top priorities for addressing EVALI. Initiatives including a national EVALI case registry and biorepository, integrated electronic medical record coding system, U.S. Food and Drug Administration regulation and enforcement of nicotine e-cigarette standards, regulatory authority over nontobacco-derived e-cigarettes, training in evaluating exogenous exposures, prospective clinical studies, standardized clinical follow-up assessments, ability to more readily study effects of cannabinoid e-cigarettes, and research to identify biomarkers of exposure and disease were identified as critical needs. These initiatives will require substantial federal investment as well as changes to regulatory policy. Overall, the workshop identified the need to address the root causes of EVALI to prevent future outbreaks. An integrated approach from multiple perspectives is required, including public health; clinical, basic, and translational research; regulators; and users of e-cigarettes. Improving the public health response to reduce the risk of another substantial disease-inducing event depends on coordinated actions to better understand the inhalational toxicity of these products, informing the public of the risks, and developing and enforcing regulatory standards for all e-cigarettes.

Background: Evidence-based guidelines are needed for effective delivery of home oxygen therapy to appropriate patients with chronic obstructive pulmonary disease (COPD) and interstitial lung disease (ILD). Methods: The multidisciplinary panel created six research questions using a modified Delphi approach. A systematic review of the literature was completed, and the Grading of Recommendations Assessment, Development and Evaluation approach was used to formulate clinical recommendations. Recommendations: The panel found varying quality and availability of evidence and made the following judgments: 1 ) strong recommendations for long-term oxygen use in patients with COPD (moderate-quality evidence) or ILD (low-quality evidence) with severe chronic resting hypoxemia, 2 ) a conditional recommendation against long-term oxygen use in patients with COPD with moderate chronic resting hypoxemia, 3 ) conditional recommendations for ambulatory oxygen use in patients with COPD (moderate-quality evidence) or ILD (low-quality evidence) with severe exertional hypoxemia, 4 ) a conditional recommendation for ambulatory liquid-oxygen use in patients who are mobile outside the home and require >3 L/min of continuous-flow oxygen during exertion (very-low-quality evidence), and 5 ) a recommendation that patients and their caregivers receive education on oxygen equipment and safety (best-practice statement). Conclusions: These guidelines provide the basis for evidence-based use of home oxygen therapy in adults with COPD or ILD but also highlight the need for additional research to guide clinical practice.

Background: Current tobacco treatment guidelines have established the efficacy of available interventions, but they do not provide detailed guidance for common implementation questions frequently faced in the clinic. An evidence-based guideline was created that addresses several pharmacotherapy-initiation questions that routinely confront treatment teams. Methods: Individuals with diverse expertise related to smoking cessation were empaneled to prioritize questions and outcomes important to clinicians. An evidence-synthesis team conducted systematic reviews, which informed recommendations to answer the questions. The GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) approach was used to rate the certainty in the estimated effects and the strength of recommendations. Results: The guideline panel formulated five strong recommendations and two conditional recommendations regarding pharmacotherapy choices. Strong recommendations include using varenicline rather than a nicotine patch, using varenicline rather than bupropion, using varenicline rather than a nicotine patch in adults with a comorbid psychiatric condition, initiating varenicline in adults even if they are unready to quit, and using controller therapy for an extended treatment duration greater than 12 weeks. Conditional recommendations include combining a nicotine patch with varenicline rather than using varenicline alone and using varenicline rather than electronic cigarettes. Conclusions: Seven recommendations are provided, which represent simple practice changes that are likely to increase the effectiveness of tobacco-dependence pharmacotherapy.

Rationale: The tobacco harm reduction literature is replete with vague language, far-reaching claims, and unwarranted certainty. The American Thoracic Society has increasingly recognized the need for a framework for reliably making such claims. Evidence-based standards improving the scientific value and transparency of harm reduction claims are expected to improve their trustworthiness, clarity, and consistency., Methods: Experts from relevant American Thoracic Society committees identified key topic areas for discussion. Literature search strategy included English language articles across Medline, Google Scholar, and the Cochrane Collaborative databases, with expanded search terms including tobacco, addiction, smoking, cigarettes, nicotine, and harm reduction. Workgroup members synthesized their evidentiary summaries into a list of candidate topics suitable for inclusion in the final report. Breakout groups developed detailed content maps of each topic area, including points to be considered for suggested recommendations. Successive draft recommendations were modified using an iterative consensus process until unanimous approval was achieved. Patient representatives ensured the document's relevance to the lay public., Results: Fifteen recommendations were identified, organized into four framework elements dealing with: estimating harm reduction among individuals, making claims on the basis of population impact, appropriately careful use of language, and ethical considerations in harm reduction., Discussion: This statement clarifies important principles guiding valid direct and inferential harm reduction claims. Ideals for effective communication with the lay public and attention to unique ethical concerns are also delineated. The authors call for formal systems of grading harm reduction evidence and regulatory assurances of longitudinal surveillance systems to document the impact of harm reduction policies.

Introduction: Since the mid-20th century, the scientific community has substantially improved its understanding of the worldwide tobacco epidemic. Although significant progress has been made, the sheer enormity and scope of the global problem put it on track to take a billion lives this century. Curbing the epidemic will require maximizing the impact of proven tools as well as the development of new, breakthrough methods to help interrupt the spread of nicotine addiction and reduce the downstream morbidity., Methods: Members of the Tobacco Action Committee of the American Thoracic Society queried bibliographic databases, including Medline, Embase, and the Cochrane Collaborative, to identify primary sources and reviews relevant to the epidemic. Exploded search terms were used to identify evidence, including tobacco, addiction, smoking, cigarettes, nicotine, and smoking cessation. Evidence was consolidated into three thematic areas: (1) determinants of risk, (2) maternal-fetal exposure, and (3) current tobacco users. Expert panel consensus regarding current gaps in understanding and recommendations for future research priorities was generated through iterative discussion., Results: Although much has been accomplished, significant gaps in understanding remain. Implementation often lags well behind insight. This report identifies a number of investigative opportunities for significantly reducing the toll of tobacco use, including: (1) the need for novel, nonlinear models of population-based disease control; (2) refinement of "real-world" models of clinical intervention in trial design; and (3) understanding of mechanisms by which intrauterine smoke exposure may lead to persistent, tobacco-related chronic disease., Discussion: In the coming era of tobacco research, pooled talent from multiple disciplines will be required to further illuminate the complex social, environmental and biological codeterminants of tobacco dependence.

Use of electronic cigarettes, devices that deliver a nicotine-containing vapor, has increased rapidly across the country and globally. Perceived and marketed as a "healthier alternative" to conventional cigarettes, few data exist regarding the safety of these devices and their efficacy in harm reduction and treatment of tobacco dependence; even less is known about their overall impact on population health. This review highlights the recent data regarding electronic cigarette toxicity, impact on lung function, and efficacy in smoking reduction and cessation. Studies show that the vapor generated from electronic cigarettes has variable amounts of nicotine and potential harmful toxins, albeit at levels lower than in conventional cigarettes. The long-term carcinogenic and lung function effects of electronic cigarettes are not known. Although some data demonstrate that electronic cigarettes may be effective in reducing conventional cigarette consumption, there are no data demonstrating the efficacy of electronic cigarettes as a tool to achieve cessation. Until robust longitudinal evaluations demonstrate the safety of electronic cigarettes and efficacy in treatment of tobacco dependence, their role as a harm reduction tool is unclear.

Women's Cardiovascular Health Network members representing 10 Prevention Research Centers completed a literature review of approximately 65 population-based studies focused on improving women's cardiovascular health through behavior change for tobacco use, physical inactivity, or diet. A framework was developed for conducting the search. Databases (Medline, Psychlit, Smoking and Health, Cumulative Index to Nursing and Allied Health Literature) of studies published from 1980 to 1998 were searched. The review was presented at a meeting of experts held in Atlanta, Georgia. Output from the meeting included identification of what has worked to improve cardiovascular health in women and recommendations for future behavioral research. Additional information is available at www.hsc.wvu.edu/womens-cvh. Cardiovascular health interventions geared toward women are scant. Based on the available studies, program components that emerged as effective included personalized advice on diet and physical activity behaviors and tobacco cessation, multiple staff contacts with skill building, daily self-monitoring, and combinations of strategies. Recommendations for community-based tobacco, physical activity, and diet interventions are discussed. A few overarching recommendations were to (1) conduct qualitative research to determine the kinds of interventions women want, (2) examine relapse prevention, motivation, and maintenance of behavior change, (3) tailor programs to the stage of the life cycle, a woman's readiness to change, and subgroups, that is, minority, low socioeconomic, and obese women, and (4) evaluate policy and environmental interventions. The effects of cardiovascular interventions in women have been inappropriately understudied in women. Our review found that few studies on cardiovascular risk factor modification have actually targeted women. Hence, adoption and maintenance of behavior change in women are elusive. Intervention research to improve women's cardiovascular health is sorely needed.

An increasing barrier to the development and implementation of effective youth smoking prevention and cessation programs involves recruiting adolescents into research studies. Even for non-intervention studies, issues of consent, confidentiality, and motivation to participate are important considerations. In 1996, 11 Prevention Research Center sites across the country conducted qualitative research using focus groups to explore ethnic differences in smoking among adolescents. The diversity in strategies used to interest, motivate, and retain potential focus group subjects provided a rich data set for information about effective strategies and challenges to recruitment. This article presents an overview of recruitment methods used in a multi-site qualitative study on adolescent tobacco use, reports on successful and less successful strategies, and provides recommendations for future recruitment.

Plasma pharmacokinetics were compared for 40 cattle dosed by subcutaneous injection with doramectin or ivermectin (200 micrograms kg-1), commercial formulations of doramectin or ivermectin, 20 cattle per product). Doramectin exhibited a similar peak plasma concentration to ivermectin (about 32 ng ml-1), but the time to Cmax was longer for doramectin (5.3 +/- 0.35 days) than for ivermectin (4.0 +/- 0.28 days). The area under the curve from time 0 to infinity post-injection was significantly higher (p < 0.001) for doramectin (511 +/- 16 ng day ml-1) than for ivermectin (361 +/- 17 ng day ml-1). This was explained by a lower clearance, a lower volume of distribution and, probably, a higher bioavailability of doramectin over ivermectin. It is concluded that the pharmacokinetic differences between doramectin and ivermectin may explain the longer duration of preventive efficacy of doramectin.

Relative to a compounded product, the following are responsibilities of the veterinarian. I. They must be able to prepare the product and have knowledge of all ingredients. II. They must be responsible for the safety of the product to the target animal, and that there are no violative residues. III. The product must have efficacy for the intended indications. IV. The veterinarian must establish need for the product to improve the health and/or welfare of the animals. This, therefore, involves: jurisprudence; responsibility to the animals and their owners; and responsibility to society. A common sense approach to this discussion would simply be that if one is not totally comfortable and satisfied medically and pharmacologically with any treatment, including compounded medications, do not use it. This also follows and is based on proper diagnosis, need for treatment, objectives of the treatment, and setting up the regimen. This is as Hippocrates admonished us, "above all, do no harm."

Plasma and lung tissue pharmacokinetics of danofloxacin in calves with naturally induced acute pneumonia were determined in 2 separate studies. A maximal pneumonic tissue concentration of 1.17 micrograms/g was achieved 1.8 hours after IM injection of 1.25 mg of danofloxacin/kg of body weight. Pneumonic tissue danofloxacin concentrations were 5.5 times greater than those in plasma at 1 and 2 hours after injection. Cranioventral pneumonic tissue had significantly decreased danofloxacin concentration, compared with that of grossly normal tissue from the caudodorsal part of the lungs at 2 of 6 sample times. After IV injection, the apparent steady-state volume of distribution was 3.44 +/- 1.13 L/kg, and the elimination half-life was 6.26 +/- 2.27 hours. Maximal plasma danofloxacin concentration of 0.25 micrograms/ml was detected 0.80 hour after IM injection. Bioavailability was 91%. Our findings indicated that a large percentage of danofloxacin is rapidly absorbed after IM administration to calves with acute pneumonia. Extensive tissue penetration was suggested by a high steady-state volume of distribution and was indicated by high concentrations in pneumonic tissue.

Six calves with areas of pulmonary consolidation attributable to bronchopneumonia, and 6 calves with no areas of consolidation were given i.v. injections of danofloxacin. This injection was followed approximately 55 minutes later by injection of 15-microns radio-labeled microspheres to measure regional pulmonary blood flow. Calves were euthanatized exactly 1 hour after the danofloxacin injection. Six samples for determination of danofloxacin concentration, each surrounded by 4 samples for determination of gamma emission counts, were taken from each lung. Additional samples focusing on the line of demarcation between consolidated and nonconsolidated tissue were taken from calves with pulmonary consolidation. Data from calves with no areas of pulmonary consolidation indicated that blood flow was significantly reduced in the caudodorsal position of the left lung and the caudodorsal and cranioventral positions of the right lungs. Danofloxacin concentrations in the cranioventral positions of the right and left lungs were significantly lower than those in the middle-dorsal positions. Differences in danofloxacin concentrations and blood flow were analyzed in consolidated and non-consolidated cranioventral and middle-ventral positions of the lungs from calves with pulmonary consolidation. Decreases in blood flow in consolidated lung tissue ranged from 83.3 to 91.7%. Danofloxacin concentrations in consolidated lung tissue were significantly reduced by 41% in the middle-ventral position of the left lung. The line of demarcation step study revealed a significant reduction of blood flow at 2 and 4 cm into consolidated lung tissue, with reductions of 84 and 88%, respectively. Danofloxacin concentration did not significantly decrease in consolidated tissue.

Aspects of drug disposition, metabolism, and toxicity in the ruminant animal are discussed, and illustrative examples are provided. The effects of the reticulo-rumen on drug disposition in the ruminant are highlighted.

Mass medication is a health management tool that, when used appropriately, results in cost savings and sound economic return to the food animal producer. Careful planning and consideration should precede the implementation of a mass treatment program, clearly defining the goal to be achieved and a detailed plan of execution. For economic as well as professional reasons, indiscriminate administration of antimicrobials to large groups of food animals should be avoided.

Nonanesthetized cats of both sexes were given oral digoxin (0.011 mg/kg of body weight) 3 forms: elixir, tablet, and crushed tablet mixed with food. Mean peak plasma concentrations of digoxin were highest with the elixir (1.89 +/- 1.02 ng/ml) and lowest with the crushed tablet mixed with food (0.66 +/- 0.35 ng/ml). Male cats had significantly higher (P less than 0.10) mean plasma digoxin concentrations than did female cats. A 2nd group of nonanesthetized cats of both sexes was given digoxin elixir orally at therapeutic amounts (0.011 mg/kg) once a day for 4 consecutive days. The cumulative effect of digoxin resulted in 62% increase in the mean peak plasma concentration and 231% increase in the 24-hour plasma concentration of digoxin over the 4-day period. Male cats had a significantly (P less than 0.05) higher mean plasma digoxin concentration than did the female cats. Significant changes in the ECG were not recorded. A 3rd group of nonanesthetized cats of both sexes was given a single toxic dose (0.11 mg/kg) of digoxin elixir orally. All cats showed clinical signs of digitalis toxicosis (depression, vomiting, salivation, and anorexia) before ECG changes appeared. Alterations in the ECG were minimal; the most important changes were a slight increase in the PQ interval, an elevated ST segment, and decreased heart rate. Plasma concentrations of digoxin at the time of vomition ranged from 4.45 to 12.12 ng/ml with a mean peak plasma value of 7.37 +/- 3.61 ng/ml. The cats were clinically ill for 48 to 96 hours. A plasma digoxin concentration of 2.3 ng/ml was not toxic.

Oxytetracycline (OTC) concentration in plasma and tissues, plasma pharmacokinetics, depletion from tissue, and toxicity were studied in 30 healthy calves after IM administration of a long-acting OTC preparation (40 mg/kg of body weight) at double the label dosage (20 mg/kg). Plasma OTC concentration increased rapidly after drug administration, and by 2 hours, mean (+/- SD) values were 7.4 +/- 2.6 micrograms/ml, Peak plasma OTC concentration was 9.6 +/- 2.6 micrograms/ml, and the time to peak plasma concentration was 7.6 +/- 4.0 hours. Plasma OTC concentration decreased slowly for 168 hours (elimination phase) after drug administration, and the elimination half-life was 23.9 hours. Plasma OTC concentration exceeded 3.8 micrograms/ml at 48 hours after drug administration. From 168 to 240 hours after drug administration, plasma OTC concentration decreased at a slower rate than that seen during the elimination phase. This slower phase was termed the depletion phase, and the depletion half-life was 280.7 hours. Tissue OTC concentration was highest in kidneys and liver. Lung OTC concentration exceeded 4.4 micrograms/g of tissue and 2.0 micrograms/g of tissue at 12 and 48 hours after drug administration, respectively. The drug persisted the longest in kidneys and liver. At 42 days after drug administration, 0.1 micrograms of OTC/g of kidney was detected. At 49 days after drug administration, all OTC tissue concentrations were below the detectable limit. Reactions and toxicosis after drug administration were limited to an anaphylaxis-like reaction (n = 1) and injection site swellings (n = 2).

The live animal swab test (LAST) was compared with quantitative oxytetracycline (OTC) assay of urine samples and tissue specimens to determine the accuracy of the LAST in detecting OTC in bovine urine and predicting violative residues in tissues. When urine OTC concentration was greater than 4.3 micrograms/ml, the LAST result was 100% accurate. When urine OTC concentration was less than 4.3 micrograms/ml, the LAST result was 60% accurate; 20% of the LAST results were false-positive, and 20% were false-negative. Urine osmolarity was highest (P less than 0.05) in samples with false-positive results and lowest (P less than 0.05) in samples with false-negative results. A similar trend was observed for urine pH, but was not statistically significant. Urine samples with false-positive results apparently had osmolarity and pH conditions that inhibited growth of Bacillus subtilis when OTC was lacking. False-negative results probably were obtained because urine osmolarity and pH conditions were favorable for the growth of bacteria even in the presence of OTC or because OTC concentration was below the limit of detection by the LAST. The LAST was inconsistent in detecting urine OTC in small concentrations and correspondingly failed to accurately predict OTC residues in tissues.

A blinded, prospective trial of the effects of branched-chain amino acid (BcAA)-enriched total parenteral nutrition (TPN) versus standard TPN was undertaken in nonseptic noncirrhotic abdominal surgery patients and patients with multiple traumatic injuries. The study reflected data from the immediate 7-day postoperative period. With isocaloric and isonitrogenous input, the BcAA-TPN patients achieved positive nitrogen balance on day 3. Although the urinary nitrogen output was decreased by day 3 in BcAA-TPN, the plasma BcAA levels did not increase until day 6. With no change in 3-methylhistidine urinary excretion, the early nitrogen retention with BcAA-TPN probably reflects a stimulation of protein synthesis. The ability to favorably modulate the metabolic stress response with alternate fuels has become a clinical reality.

Changes in the composition of bile accompanying the maximum biliary excretion (Emax) of bilirubin were investigated in sheep. Sheep fitted with chronic 'T-tubes' in the common bile duct were infused with taurocholate and bilirubin at various rates. Bile collected during both pre- and post-bilirubin steady-state periods was analyzed for the biliary concentration of electrolytes, bile salts, and bilirubin. Bilirubin Emax was 24.6 mumol/min while bile salt excretion during this period was 103 mumol/min. At Emax bilirubin entry into bile reached a concentration of 16.1 mumol/mL, increased the biliary concentration of sodium, did not change osmolarity of bile, and did not increase bile flow. The data suggest that bilirubin either interacts with mixed micelles in bile or forms molecular aggregates.