IMPORTANCE: Electronic cigarettes (e-cigarettes) entered the US market in 2007 and, with little regulatory oversight, grew into a $2-billion-a-year industry by 2013. The Centers for Disease Control ...and Prevention has reported a trend of increasing e-cigarette use among teens, with use rates doubling from 2011 to 2012. While several studies have documented that teens can and do buy cigarettes online, to our knowledge, no studies have yet examined age verification among Internet tobacco vendors selling e-cigarettes. OBJECTIVE: To estimate the extent to which minors can successfully purchase e-cigarettes online and assess compliance with North Carolina’s 2013 e-cigarette age-verification law. DESIGN, SETTING, AND PARTICIPANTS: In this cross-sectional study conducted from February 2014 to June 2014, 11 nonsmoking minors aged 14 to 17 years made supervised e-cigarette purchase attempts from 98 Internet e-cigarette vendors. Purchase attempts were made at the University of North Carolina Internet Tobacco Vendors Study project offices using credit cards. MAIN OUTCOME AND MEASURE: Rate at which minors can successfully purchase e-cigarettes on the Internet. RESULTS: Minors successfully received deliveries of e-cigarettes from 76.5% of purchase attempts, with no attempts by delivery companies to verify their ages at delivery and 95% of delivered orders simply left at the door. All delivered packages came from shipping companies that, according to company policy or federal regulation, do not ship cigarettes to consumers. Of the total orders, 18 failed for reasons unrelated to age verification. Only 5 of the remaining 80 youth purchase attempts were rejected owing to age verification, resulting in a youth buy rate of 93.7%. None of the vendors complied with North Carolina’s e-cigarette age-verification law. CONCLUSIONS AND RELEVANCE: Minors are easily able to purchase e-cigarettes from the Internet because of an absence of age-verification measures used by Internet e-cigarette vendors. Federal law should require and enforce rigorous age verification for all e-cigarette sales as with the federal PACT (Prevent All Cigarette Trafficking) Act’s requirements for age verification in Internet cigarette sales.
This article reviews the history and current status of clinical trial registrations and results data posted on the National Library of Medicine's Web site ClinicalTrials.gov.
The ClinicalTrials.gov ...trial registry was launched more than a decade ago. Since that time, it has been evolving in response to various policy initiatives. The registry now contains information on more than 100,000 clinical studies and has emerged as a key element of many public health policy initiatives aimed at improving the clinical research enterprise. In 2008, a database for reporting summary results was added to the registry. In this article, we present an update on relevant policies, summarize the structure and contents of the results database, and show how ClinicalTrials.gov data can be used to gain insight into the . . .
Perineal trauma at the time of vaginal delivery is common, and when the anal sphincter is included, these injuries can be associated with additional morbidity including incontinence, pelvic pain, and ...sexual dysfunction.
The aim of this systematic review with meta-analysis was to evaluate whether a hands-on technique during vaginal delivery results in less incidence of perineal trauma than a hands-off technique.
Electronic databases were searched from their inception until June 2018. No restrictions for language or geographic location were applied. The reference lists of identified articles were examined to identify studies not captured by electronic searches. Randomized controlled trials comparing a hands-on technique of perineal support during vaginal delivery (i.e. intervention group) with a hands-off technique (i.e. control group) were included in the meta-analysis. Hands-on was defined as involving one hand on the fetal head, applying pressure to control expulsion, with the other hand applying pressure on the maternal perineum. The primary outcome was severe perineal trauma, defined as either third- or fourth-degree lacerations. The meta-analysis was performed using the random effects model of DerSimonian and Laird, to produce summary treatment effects in terms of relative risk (RR) with 95% confidence interval (CI).
Five trials, including 7287 women, were analyzed. All studies included singleton gestations with cephalic presentation at term undergoing spontaneous vaginal delivery. Women randomized to the hands-on technique had similar incidence of severe perineal trauma (1.5 versus 1.3%; RR 2.00, 95% CI 0.56-7.15). There was no significant between-group difference in the incidence of intact perineum, first-, second- and fourth-degree laceration. Hands-on technique was associated with increased risk of third-degree lacerations (2.6 versus 0.7%; RR 3.41, 95% CI 1.39-8.37) and of episiotomy (13.6 versus 9.8%, RR 1.59, 95% CI 1.14-2.22) compared to the hands-off technique.
Hands-on technique during spontaneous vaginal delivery of singleton gestations results in similar incidence of several perineal traumas compared to a hands-off technique. The incidence of third-degree lacerations and of episiotomy increases with the hands-on technique. Key Message A hands-on technique during vaginal delivery results in similar incidence of severe lacerations compared to hands-off.
Have you ever been a fan of a show that was canceled abruptly or that killed off a beloved character unexpectedly? Or perhaps it was rebooted after a long absence and now you're worried it won't be ...as good as the original? Anyone who has ever followed entertainment closely knows firsthand that such transitions can be jarring.
Indeed, for truly loyal fans, the loss can feel very real-even throwing their own identity into question. Examining how fans respond to and cope with transitions, endings, or resurrections in everything from band breakups (R.E.M.) to show cancellations (Hannibal) to closing down popular amusement park rides, this collection brings together an eclectic mix of scholars to analyze the various ways fans respond to change. Essays explore practices such as fan discussion and creating alternative fan fictions, as well as cases where fans abandon their objects of interest completely and move on to new ones. Shedding light on how fans react, both individually and as a community, the contributors also trace the commonalities and differences present in fandoms across a range of media, and they pay close attention to the ways fandom operates across paratexts and transmedia forms including films, comics, and television.
This fascinating approach promises to make an important contribution to the fields of fan, media, and cultural studies, and should appeal widely to students, scholars, and anyone else with a genuine interest in understanding why these transitions can have such a deep impact on fans' lives.Contributors: Stuart Bell, Anya Benson, Lucy Bennett, Paul Booth, Joseph Brennan, Kristina Busse, Melissa A. Click, Ruth Deller, Evelyn Deshane, Nichola Dobson, Simone Driessen, Emily Garside, Holly Willson Holladay, Bethan Jones, Nicolle Lamerichs, Kathleen Williams, Rebecca Williams
This book argues that serious study of theme parks and their adult fans has much to tell us about contemporary transmediality and convergence, themed and immersive spaces, and audience relationships ...with places of meaning. Considering the duopoly of Disney and Universal in Orlando, the book explores a range of theme park experiences including planning trips, meeting characters, eating and drinking, engaging in practices such as cosplay and re-enactment, and memorializing lost attractions. Highlighting key themes such as immersion, materiality, cultural distinctions, and self-identity, the book argues that theme parks are a crucial site for the exploration of transmediality and the development of paratexts. Proposing the key concepts of spatial transmedia and haptic fandom, the book offers analysis of the intersections between fandom, media texts, and merchandise, as well as fans' own affective and physical responses to visiting the parks.
ABSTRACT
We present near-infrared observations of 42 gravitationally lensed galaxies obtained in the framework of the KMOS Lensed Emission Lines and VElocity Review (KLEVER) Survey, a programme aimed ...at investigating the spatially resolved properties of the ionized gas in 1.2 < z < 2.5 galaxies by means of a full coverage of the YJ, H, and K near-infrared bands. Detailed metallicity maps and gradients are derived for a subsample of 28 galaxies from reconstructed source-plane emission-line maps, exploiting the variety of different emission-line diagnostics provided by the broad wavelength coverage of the survey. About $85 {{\, per\ cent}}$ of these galaxies are characterized by metallicity gradients shallower than $0.05\ \rm dex\, kpc^{-1}$ and $89{{\ \rm per\ cent}}$ are consistent with a flat slope within 3σ ($67{{\ \rm per\ cent}}$ within 1σ), suggesting a mild evolution with cosmic time. In the context of cosmological simulations and chemical evolution models, the presence of efficient feedback mechanisms and/or extended star formation profiles on top of the classical ‘inside-out’ scenario of mass assembly is generally required to reproduce the observed flatness of the metallicity gradients beyond z ∼ 1. Three galaxies with significantly (>3σ) ‘inverted’ gradients are also found, showing an anticorrelation between metallicity and star formation rate density on local scales, possibly suggesting recent episodes of pristine gas accretion or strong radial flows in place. Nevertheless, the individual metallicity maps are characterized by a variety of different morphologies, with flat radial gradients sometimes hiding non-axisymmetric variations on kpc scales, which are washed out by azimuthal averages, especially in interacting systems or in those undergoing local episodes of recent star formation.
Abstract
The National Center for Biotechnology Information (NCBI) produces a variety of online information resources for biology, including the GenBank® nucleic acid sequence database and the PubMed® ...database of citations and abstracts published in life science journals. NCBI provides search and retrieval operations for most of these data from 35 distinct databases. The E-utilities serve as the programming interface for the most of these databases. Resources receiving significant updates in the past year include PubMed, PMC, Bookshelf, RefSeq, SRA, Virus, dbSNP, dbVar, ClinicalTrials.gov, MMDB, iCn3D and PubChem. These resources can be accessed through the NCBI home page at https://www.ncbi.nlm.nih.gov.
Amidst the opioid crisis, many people are turning to plant-based kratom for self-treatment of pain, opioid addiction, and for recreational use. Its legality is variable and its safety and medicinal ...effects are not agreed upon. It is broadly available from Internet Kratom Vendors (IKVs).
An examination of the online marketplace for kratom was conducted to provide context to the market amidst regulatory attempts by the Food and Drug Administration (FDA) and state legislatures. A complex search strategy identified 663 English-language IKVs selling kratom for home delivery. The 100 most popular were selected for in-depth content analysis. IKVs were visited once for content analysis data collection in December, 2017 and revisited in April 2018 to assess responses to FDA action. IKV website and social media profiles were coded for topics including location, payment and shipping options, age verification, health warnings and disclaimers, and grassroots advocacy regarding upcoming state/federal regulations.
Forty-seven percent of IKVs claimed that kratom provides pain relief, 25% claimed it provides relief from opioid withdrawal, 81% featured a disclaimer that kratom is addictive, 54% stated that kratom is not FDA approved, and 66% featured disclaimers that it was not intended for consumption. Only 5% of vendors advertised effective age verification (such as verifying age at delivery). Compliance on the vendor's part with state and local bans varied by ban location, with only 27% prohibiting sales to Rhode Island while 65% did not ship to Indiana.
IKVs provide easy access to a wide variety of unregulated intoxicating products with poor age verification and low adherence to US state- and local-level restrictions. There is a high prevalence of vendors featuring health claims forbidden by the Food and Drug Administration. Lessons learned from regulating the Internet cigarette sales industry could be effectively applied to IKVs with future efforts.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Introduction
The National Institute of Child Health and Human Development, American College of Obstetricians and Gynecologists, and Society for Maternal‐Fetal Medicine have emphasized the need to ...promote vaginal delivery and have offered recommendations to safely prevent primary cesarean delivery. However, there has been limited discussion regarding management of intravenous fluids and other aspects of labor management that may influence mode of delivery. Therefore the aim of our study was to determine whether an intravenous fluid rate of 250 vs. 125 mL/h is associated with a difference in cesarean delivery rate.
Material and methods
Searches were performed in MEDLINE, OVID, Scopus, ClinicalTrials.gov, the PROSPERO International Prospective Register of Systematic Reviews, Embase, Web of Science, and the Cochrane Library for randomized controlled trials. We included all randomized controlled trials comparing intravenous fluid rates of 250 vs. 125 mL/h in nulliparous women in spontaneous labor at term with singleton pregnancies at ≥36 weeks. Studies were included regardless of the type of intravenous fluids used and regardless of whether oral intake was restricted during labor. Studies including multiparous women or women whose labor was induced were excluded. The primary outcome was the incidence of cesarean delivery. We planned to assess a subgroup analysis according to type of fluids used and according to restriction of oral fluid intake.
Results
Seven trials including 1215 nulliparous women in spontaneous labor at term were analyzed; 593 (48.8%) in the 250 mL/h group, and 622 (51.2%) in the 125 mL/h group. Five studies used lactated Ringer's solution, one used normal saline in dextrose water, and in one study it was unclear which intravenous fluid was used. Women who received intravenous fluids at 250 mL/h had a significantly lower incidence of cesarean delivery for any indication (12.5 vs. 18.1%; RR 0.70, 95% CI 0.53–0.92; seven studies, 1215 participants; I2 = 0%) and for dystocia (4.9 vs. 7.7%; RR 0.60, 95% CI 0.38–0.97; five studies, 1093 participants; I2 = 18%), a significantly shorter mean duration of labor of about one hour (mean difference −64.38 min, 95% CI −121.88 to −6.88; six studies, 1155 participants; I2 = 83%) and a significantly shorter mean length of second stage of labor (mean difference −2.80 min, 95% CI −4.49 to −1.10; 899 participants; I2 = 22%) compared with those who received intravenous fluid at 125 mL/h. No differences were found in the other secondary outcomes. There were no maternal or perinatal deaths and only one woman, in the 125 mL/h group, developed pulmonary edema. The findings persisted regardless of the type of intravenous fluid used. No significant reduction in the incidence of cesarean delivery was demonstrated in women with unrestricted oral intake; however, this was limited to only two studies evaluating 254 women.
Conclusions
Our findings provide evidence that the duration of labor in low‐risk nulliparous women may be shortened by a policy of intravenous fluids at a rate of 250 mL/h rather than 125 mL/h. A rate of 250 mL/h seems to be associated with a reduction in the incidence of cesarean delivery compared to 125 mL/h. The number needed to treat to prevent one cesarean delivery is 18 women. Our data support increased hydration among nulliparous women in labor when oral intake is restricted. Further study is needed regarding risks and benefits of increased hydration among women with unrestricted oral intake, those undergoing induction of labor, and those with medical comorbidities.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
Introduction Public perceptions of electronic nicotine delivery systems (ENDS) remain poorly understood because surveys are too costly to regularly implement and, when implemented, there are long ...delays between data collection and dissemination. Search query surveillance has bridged some of these gaps. Herein, ENDS’ popularity in the U.S. is reassessed using Google searches. Methods ENDS searches originating in the U.S. from January 2009 through January 2015 were disaggregated by terms focused on e-cigarette (e.g., e-cig ) versus vaping (e.g., vapers ); their geolocation (e.g., state); the aggregate tobacco control measures corresponding to their geolocation (e.g., clean indoor air laws); and by terms that indicated the searcher’s potential interest (e.g., buy e-cigs likely indicates shopping)—all analyzed in 2015. Results ENDS searches are rapidly increasing in the U.S., with 8,498,000 searches during 2014 alone. Increasingly, searches are shifting from e-cigarette- to vaping-focused terms, especially in coastal states and states where anti-smoking norms are stronger. For example, nationally, e-cigarette searches declined 9% (95% CI=1%, 16%) during 2014 compared with 2013, whereas vaping searches increased 136% (95% CI=97%, 186%), even surpassing e-cigarette searches. Additionally, the percentage of ENDS searches related to shopping (e.g., vape shop ) nearly doubled in 2014, whereas searches related to health concerns (e.g., vaping risks ) or cessation (e.g., quit smoking with e-cig s) were rare and declined in 2014. Conclusions ENDS popularity is rapidly growing and evolving. These findings could inform survey questionnaire development for follow-up investigation and immediately guide policy debates about how the public perceives the health risks or cessation benefits of ENDS.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK, ZRSKP
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