It’s possible that I shall make an ass of myself. But in that case one can always get out of it with a little dialectic. I have, of course, so worded my proposition as to be right either way (K.Marx, Letter to F.Engels on the Indian Mutiny)
Sunday, April 04, 2021
Amazon apologizes for tweets attacking criticism of working conditions Jon Fingas
Amazon isn't normally one to say sorry for its behavior, but it just made a notable exception — more or less. GeekWirereports that company has apologized to Rep. Mark Pocan for Twitter posts blasting the Wisconsin politician when he criticized working conditions that included drivers peeing in bottles as they faced pressure to meet quotas. The tweets were "incorrect" by focusing on warehouse workers rather than drivers facing these problems, according to Amazon. A flawed process also meant the tweets didn't receive "proper scrutiny."
An Amazon Prime delivery truck drives through the Port of Los Angeles and Long Beach April 22, 2020 in Long Beach, California. (Photo by Robyn Beck / AFP)
The company partly downplayed the drivers' experience, arguing that peeing in bottles was a "long-standing, industry-wide" problem made worse by the COVID-19 pandemic. However, it also recognized this wasn't acceptable and that it would "look for solutions."
There was no explanation for why Amazon issued a rare social media attack. Recodesources recently claimed that outgoing CEO Jeff Bezos was frustrated with his company's lack of resistance to accusations he felt were inaccurate or misleading. On top of its response to Pocan, Amazon recently defended its practices against criticism from Senators Bernie Sanders and Elizabeth Warren.
It's not certain why Amazon took over a week to apologize to Pocan, although it comes as warehouse staff in Alabama vote to unionize. The internet shopping giant has also faced growing scrutiny of its union-busting tactics and overall labor conditions. Amazon isn't necessarily trying to draw attention away with the apology (the move arguably highlights those concerns), but it is recognition that the tech firm's work environment is a hot-button issue.
CANADA
National Centre for Truth and Reconciliation launches website on residential schools history
The National Centre for Truth and Reconciliation (NCTR) launched its new website and archive database to provide Survivors, educators, researchers and learners interested in the residential schools’ history an accessible tool for resources.
NCTR has access to approximately five million documents kept in locations such as government and church offices.
These documents were primarily collected to meet these institutions’ colonial needs. The website and archive database connects the information gathered so that it can be easily accessible to all.
“I think that the access to the NCTR achieves and the records they hold are a public good. Canada should acknowledge its exploitive history, and Indigenous communities need this understanding to heal and prosper,” said Raymond Frogner, Head of Archives at NCTR said on Wednesday.
“This digital infrastructure promotes reconciliation through acknowledgement. It is recognition that we are who we choose to remember but we are also what we choose to forget. As you see on the opening page of our website, it is Canada’s story, not just an Indigenous story.” The easy-to-navigate website at nctr.ca includes a space where communities can submit their Truth and Reconciliation-related news and events, to bring people together on the path to reconciliation.
Educational resources are categorized by grade level, including adult learning as well as pre-developed resources for teachers to use in their classrooms in English and French.
The centre also delivers free demonstrations on the available tools for teachers, organizations and researchers to support their work development and programs using the records.
“The website enables advance discovery and access of the digital archival records of the NCTR. It will promote innovative research which is meaningful to Indigenous communities,” said Frogner.
“It provides research materials that examine the colonial relationship between academic researchers and Indigenous communities, and it allows for the understanding of the rights and identity of Indigenous peoples,” he added.
The new data system, Access to Memory, makes it easier for Survivors and the general public to search for the location of schools and gravesites of children who attended the schools, as well as dates, statements, attendance records, pictures and other archival material.
As it is open-sourced, it gives the NCTR the ability to maintain its work decolonizing the archives while incorporating Indigenous languages into the records.
This web-based platform has high international standards in archiving along with several multilingual capabilities.
Free presentations to navigate the archives are also available to those who need them.
“By itself, the database is a portal that promotes discussion, recognitions, acknowledgement and engagement across Indigenous and non-Indigenous Canadian society,” said Frogner.
Presently, the NCTR is actively engaging with Indigenous communities to bring out the voice of the records collected by the centre.
While the administrative records take notes of building records and salaries of those working in residential schools, within them still hold the experiences of Indigenous children.
“These are the documents that record some of the most traumatic incidents of their lives. With that in mind, we are trying to find the Indigenous voices of these administrative records,” said Frogner.
After the launch of the website and archive database, Frogner hopes that researchers, Indigenous communities, Survivors and Canadians in general start engaging with the records and educate themselves on the history of residential schools.
Nicole Wong is a Local Journalism Initiative reporter who works out of the Winnipeg Sun. The Local Journalism Initiative is funded by the Government of Canada.
Radicalization to extremist ideologies is often triggered by negative life events
Rejection of extremism often aided by friends and groups
People who radicalize to extremist ideologies often are triggered by negative life events or exposure to propaganda, and those who escape from extreme groups frequently are aided by an individual or group that intervenes to help them reject the philosophy, according to a new RAND Corporation study.
Expanding access to mental health care, creating opportunities for exposure to diverse cultural groups and media literacy education all are important strategies that may aid the battle against extremism, according to researchers. However, harsh law enforcement actions often are unproductive in changing people's extremist beliefs.
The RAND study describes personal accounts based on interviews with more than two dozen former white supremacists, Islamic extremists and their family members about what leads people to join extremist groups and, at least in some cases, leave these groups and their radical ideologies.
"Terrorism and ideologically-inspired violence represent persistent and serious threats to the security of the United States," said Ryan Andrew Brown, the study's lead author and a senior social scientist at RAND, a nonprofit research organization. "By better understanding the pathways individuals take to radicalization, we can improve our prevention and deradicalization strategies."
The study is one of the first public reports to incorporate the experiences of white supremacists, Islamic extremists and their family members to look for common factors and signs along the pathway to radicalization.
Events such as the Jan. 6 attack on the U.S. Capitol underscore a growing threat to America's national security posed by homegrown terrorism and ideologically inspired violence. Domestic attacks have maintained a steady and growing pace in recent years, foreshadowing recent events.
The RAND study is based on interviews about 32 people who became radicalized -- 24 white supremacists and 8 Islamic extremists. Those interviewed included 24 former extremists, 10 family members and two friends. To recruit study participants, the team worked with Parents for Peace and Beyond Barriers, two organizations that work with former members of radical extremist organizations and family members who have assisted with deradicalization efforts.
The study provides findings across four areas: background characteristics of radical extremists, pathways to radicalization, deradicalizing and leaving organizations, and participant perspectives on mitigation strategies.
The RAND interviews highlight several factors that may contribute to individuals becoming radicalized, including facing financial instability, mental health challenges such as trauma and PTSD, and social factors such as victimization and marginalization.
In more than half of the cases, a "re-orienting" event was described that prompted an individual to reconsider previously accepted views and embrace extremist ideologies. These events included a gun possession charge, rejection by the military, a friend's suicide and an extended period of unemployment.
In a majority of cases, individuals described consuming propaganda during radicalization, especially online materials, but also music and books.
In seven cases (4 white supremacist, 3 Islamic extremist), recruitment involved top-down action by recruiters from radical organizations. In 18 cases (15 white supremacist, 3 Islamic extremist), recruitment involved "bottom-up" entry in which individuals radicalize on their own and then sought membership in extremist organizations.
"It may be difficult to observe noticeable changes in individuals until they are radicalized and those changes often are a surprise to their family," Brown said. "It is only after the radicalization takes place that family members and friends may understand what has happened."
Individuals in the RAND study said they also benefited socially while participating in extremist groups, most notably finding friends and developing a sense of camaraderie and friendship that was previously missing in their lives. Some noted a new sense of power.
The most commonly mentioned factor for exiting a group was a sense of disillusionment and burnout. Hypocrisy or other negative behaviors by group members were often cited as reasons for these feelings.
Individuals or groups helped 22 of the individuals in the RAND sample to exit extremist groups, with such interventions most often conducted intentionally. The interventions included diverse cultural and demographic exposures, providing emotional support, and providing pathways to financial and/or domestic stability.
In half of those cases, the intervention was orchestrated and conducted by an institution, including religious groups, law enforcement, and secular nonprofits. Twenty-two of the 32 cases also described processes of self-driven exit from extremism, in which former extremists sought their own paths out of groups and ideologies.
A majority of the study participants also indicated that they experienced interventions that had failed, most often efforts that had been initiated by family members. Punitive interventions by law enforcement also often led to paradoxical effects of increased extremism.
"Our work suggests that the punitive approach should be used sparingly because it seldom ends radicalization and frequently has negative consequences for community members," Brown said.
The RAND study provides recommendations that community organizations and researchers should pursue in the future to strengthen both practice and understanding of what works.
Those recommendations include expanding community based mental health services in areas at risk for radicalization and exploring whether interventions based on an addiction treatment model can help deter radicalization.
Community organizations also should consider ways to expand exposure to diverse populations, help at-risk families recognize and react to signs of extremism, and improve ways to present deradicalization messages at the right time and place.
Researchers should work to better identify geographic and demographic hot spots for radicalization, develop educational and outreach efforts to help recognize and address the signs of radicalization, and explore social network approaches to deradicalization.
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Support for the study was provided by the National Institute of Justice.
The report, "Violent Extremism in America: Interviews With Former Extremists and Their Families on Radicalization and Deradicalization," is available at http://www.rand.org. Other authors of the study are Todd C. Helmus, Rajeev Ramchand, Alina Palimaru, Sarah Weilant, Ashley L. Rhoades and Liisa Hiatt.
The RAND Justice Policy Program conducts research across the criminal and civil justice system on issues such as public safety, effective policing, drug policy and enforcement, corrections policy, court reform and insurance regulation.
Cannabis use disorder linked to increased complications after spinal surgery
April 2, 2021 -For patients undergoing spinal surgery, the diagnosis of cannabis use disorder is associated with higher complication rates, including substantially increased risks of stroke and respiratory complications, reports a study in Spine. The journal is published in the Lippincott portfolio by Wolters Kluwer.
"Chronic cannabis use among patients undergoing spine surgery is associated with higher rates of inpatient neurovascular, thromboembolic, and pulmonary complications, and less favorable overall discharge disposition," according to the new research by Ankit Indravadan Mehta, MD, FAANS and colleagues of the University of Illinois at Chicago. "The treatment of these patients is also associated with increased length of stay and cost of hospitalization."
For chronic cannabis users, surgical care may be 'extremely complex and difficult'
Using a national hospital database (Nationwide Inpatient Sample), the researchers identified nearly 433,000 patients who underwent common elective spinal surgery procedures between 2012 and 2015. About 2,400 patients had a diagnosis of cannabis use disorder, defined as continued use of cannabis despite significant distress or impairment.
On initial analysis, there were some important differences between patients with and without cannabis use disorder. Patients diagnosed with problematic cannabis use were younger, more likely to be male, and had lower rates of accompanying medical disorders (comorbidity). They were also much more likely to use tobacco: about 71 versus 31 percent.
Using a technique called propensity score matching, Dr. Mehta and colleagues created matched groups of 2,184 chronic cannabis users versus non-users with similar characteristics and comorbidities. A wide range of complications and other hospital outcomes of spinal surgery were compared between groups.
Patients with cannabis use disorder were at increased risk for several types of complications after spinal surgery. The cannabis users were about twice as likely to develop respiratory and blood clot-related (thromboembolism) complications. They also had nearly a threefold increase in the risk of stroke and other neurologic complications. Risk of bloodstream infection (septicemia or sepsis) was increased by 50 percent.
There were also more myocardial infarctions (heart attacks) among patients with cannabis use disorder. However, on further analysis, this was related to their much higher rate of tobacco use.
Patients with cannabis use disorder also spent nearly two more days in the hospital (about seven versus five days) and had hospital costs nearly $15,000 higher. They were also more likely to be discharged to a nursing or rehabilitation facility and less likely to receive home health care.
The results are of special concern as cannabis use becomes increasingly legalized and accepted in the United States. Estimates suggest that more than 15 percent of Americans use cannabis. Rates of cannabis use and cannabis use disorder have "increased drastically" in recent years, according to the authors.
The findings have important implications for anesthesia and surgical management in patients with cannabis use disorder, Dr. Mehta and colleagues believe. For example, such patients may need higher doses of opioid medications to achieve adequate pain management after spinal surgery. That may lead to slower recovery, requiring longer hospital stays and more intensive rehabilitation that cannot be done at home. The researchers also note previous studies outlining the mechanisms by which cannabis use may lead to increased risk of respiratory, thromboembolic, and neurologic complications.
"This study reveals multiple aspects of perioperative care that are extremely complex and difficult in patients with cannabis use disorder," Dr. Mehta and coauthors write. "Their high-risk cardiorespiratory profiles combined with specialized anesthetic considerations [before, during, and after surgery] necessitate very unique perioperative management. We hope this research will lead to future prospective trials for specific interventions that could improve outcomes in this specific population."
Recognized internationally as the leading journal in its field, Spine (http://www.spinejournal.com) is an international, peer-reviewed, bi-weekly periodical that considers for publication original articles in the field of spine. It is the leading subspecialty journal for the treatment of spinal disorders. Only original papers are considered for publication with the understanding that they are contributed solely to Spine. According to the latest ISI Science Citation Impact Factor, Spine is the most frequently cited spinal deformity journal among general orthopaedic journals and subspecialty titles.
About Wolters Kluwer
Wolters Kluwer (WKL) is a global leader in professional information, software solutions, and services for the clinicians, nurses, accountants, lawyers, and tax, finance, audit, risk, compliance, and regulatory sectors. We help our customers make critical decisions every day by providing expert solutions that combine deep domain knowledge with advanced technology and services.
Wolters Kluwer reported 2019 annual revenues of €4.6 billion. The group serves customers in over 180 countries, maintains operations in over 40 countries, and employs approximately 19,000 people worldwide. The company is headquartered in Alphen aan den Rijn, the Netherlands.
Wolters Kluwer provides trusted clinical technology and evidence-based solutions that engage clinicians, patients, researchers and students with advanced clinical decision support, learning and research and clinical intelligence. For more information about our solutions, visit https://www.wolterskluwer.com/en/health and follow us on LinkedIn and Twitter @WKHealth.
EU imports of certain products contribute significantly to deforestation in other parts of the world.
In a new study, researchers from Chalmers University of Technology, Sweden, and University of Louvain, Belgium, evaluated thousands of policy proposals for how the EU could reduce this impact, to assess which would have the largest potential to reduce deforestation - while also being politically feasible.
"Unsurprisingly, there is weaker support for tougher regulations, such as import restrictions on certain goods. But our study shows that there is broad support in general, including for certain policies that have real potential to reduce imported deforestation," says Martin Persson, Associate Professor of Physical Resource Theory at Chalmers University of Technology.
Previous research has already shown the EU's great impact in this area. More than half of tropical deforestation is linked to production of food and animal feed, such as palm oil, soybeans, wood products, cocoa and coffee - goods which the EU imports in vast quantities. The question is, what can the EU do to reduce its contribution to deforestation?
"This issue is particularly interesting now, as this year the EU is planning to present legislative proposals for reducing deforestation caused by European consumption. The question has been discussed by the EU since 2008, but now something political is actually happening," says Simon Bager, a doctoral student at the University of Louvain (UCLouvain), and lead author of the study.
The authors of the article mapped 1 141 different proposals, originating from open consultations and workshops, where the EU has collected ideas from companies, interest groups and think tanks. The researchers also compiled proposals from a large number of research reports, policy briefs and other publications, where different stakeholders have put forward various policy proposals. After grouping together similar proposals, they arrived at 86 unique suggestions.
Two suggestions stand out from the crowd
Finding proposals for measures that would have the desired effect but are also possible to implement in practice, and enjoy the necessary political support, is no easy task. But after their extensive survey, the researchers identify two policy options in particular which show particular promise:
- The first is to make importers of produce responsible for any deforestation in their supply chains, by requiring them to carry out the requisite due diligence."If the importing companies' suppliers have products that contribute to deforestation, the company may be held responsible for this. We consider such a system to be credible and possible to implement both politically and practically - there are already examples from France and England where similar systems have been implemented or are in the process thereof," says Simon Bager. "Due diligence is also the measure which is most common in our survey, put forward by many different types of actors, and there is broad support for this proposal. However, it is important to emphasise that for such a system to have an impact on deforestation, it must be carefully designed, including which companies are affected by the requirements, and which sanctions and liability options exist."
- The other possibility is to support multi-stakeholder forums, where companies, civil society organisations, and politicians come together to agree on possible measures for ridding a supply-chain, commodity, or area, of deforestation. There are positive examples here too, the most notable being the Amazon Soy Moratorium from 2006, when actors including Greenpeace and the World Wide Fund for Nature gathered with soy producers and exporters and agreed to end soy exports from deforested areas in the Amazon rainforest. "Examples such as these demonstrate the effect that multi-stakeholder forums can have. And in our opinion, it is a measure that is easier to get acceptance for, because it is an opportunity for the affected parties to be directly involved in helping design the measures themselves," says Martin.
A delicate balance
The researchers also investigated how to deal with the trade-off between policy impacts and feasibility. An important part of this is combining different complementary measures. Trade regulations on their own, for example, risk hitting poorer producing countries harder, and should therefore be combined with targeted aid to help introduce more sustainable production methods, increasing yields without having to resort to deforestation. This would also reduce the risk of goods that are produced on deforested land simply being sold in markets other than the EU.
"If the EU now focuses on its contribution to deforestation, the effect may be that what is produced on newly deforested land is sold to other countries, while the EU gets the 'good' products. Therefore, our assessment is that the EU should ensure that the measures introduced are combined with those which contribute to an overall transition to sustainable land use in producing countries," says Simon Bager.
In conclusion, the researchers summarise three essential principles needed for new measures, if the EU is serious about reducing its impact on tropical deforestation. "First, enact measures that actually are able to bring about change. Second, use a range of measures, combining different tools and instruments to contribute to reduced deforestation. Finally, ensure the direct involvement of supply chain actors within particularly important regions, expanding and broadening the measures over time," concludes Simon Bager.
The authors hope that the research and identified policy options can serve as inspiration for policy makers, NGOs, industries, and other stakeholders working to address the EU's deforestation footprint. With at least 86 different unique alternatives, there is a wide range of opportunities to focus on the problem - very few of these are political 'non-starters' or proposals which would have no effect on the issue.
VIDEO: VIDEO SHOWING THE QUENCHING OF TERBIUM GREEN EMISSION WHEN COTTON IS IN CONTACT WITH THE AQUEOUS FLUORIDE SOLUTION, THIS CHANGE IS PROPORTIONAL TO THE FLUORIDE CONCENTRATION AND USED IN THE... view more
In United Nations Sustainable Development Goals, Number 6, addresses the need for access to clean water and sanitation for all. In the worldwide situation, one in three people do not have access to safe drinking water, and two out of five do not have basic hand-washing facilities with soap and water.
Water quality also address to elements dissolved. In the case of fluoride, controlled amount are recommended for protect tooth, e.g. included in toothpaste. Higher levels can cause fluorosis, interfere in tooth enamel formation, correct growth of the bones, and cause crippling deformities of the spine and joints. The incidence of higher concentrations of fluoride in water is higher in rural areas without access to an appropriate water network.
Fluoride in water sources has a geogenic origin instead of anthropogenic, the fluoride concentration in water is determined by geological formations in riverbeds. This, making the fluoride distribution inhomogeneous in the affected regions, finding water sources with safe and unsafe fluoride levels in a close distance. In this case, the fluoride problem could be solved by the local population provided with specific equipment to detect the levels of fluoride in the water and help them to consume safe water.
The equipment cost for fluoride detection is moderate to high, and requires training to be used effectively. This cost is not affordable for the populations in rural areas. For these reasons, the group led by Professor Mutsumi Kimura and Dr. Eugenio Otal from Shinshu University decided to develop an affordable portable equipment which can detect fluoride in a simple manner at low costs, which was recently published in Chemistry - A European Journal. The cost of the developed tech-demo is about US$23, but this price can be reduced to less than the half if production is scaled up. The main cost is related to electronics which is useful for many determinations.
Lanthanide-based metal-organic frameworks (MOFs) offer a good platform for fluoride sensing due to their high affinity by fluoride and intense emission in the visible spectrum. The strong affinity of lanthanides by fluorides transforms the MOFs into the corresponding fluorides, quenching the lanthanide fluorescence. This intensity change can be used to determine the fluoride level in drinking water. Researchers at Shinshu University chose cotton as a substrate for their hydrophilic nature, allowing a good synergy with the porous MOFs and a good control over the amount of liquid sample introduced in the device, making the results reproducible and simplifying the previous systems used.
These innovations are compatible with the group's previous developments, which were published in ACS-Sensors in January of this year. In this previous article, they present the electronic platform based on an Arduino microcontroller, which uses a smartphone as a power source and data acquisition platform. This innovation eliminates the battery and screen, reducing the costs and allowing to transfer the fluoride quantification information directly to the smartphone. The Arduino code used in the device can be also modified according to the requirements of the local population.
To transfer the information, a friendly graphical interface was developed (https://hello.fridie.de/zensorics-app/), it collects the fluoride quantification data, the time, date, and position from the smartphone GPS and transfer them via email, SMS, WhatsApp or any instant messaging service to be included in a safe-water map to be shared with the rest of the local population.
This novel system accomplishes the 4.0 Industry concepts, it is 3D printable, Arduino programmable, open-source, and the device can be produced locally and distributed. All this innovation produced a low-cost device which can be easily operated by non-trained users.
Many times, science and technology are dissociated, but represents two aspects of the same search. Science provides intellectual satisfaction, feeds our curiosity, while technology provides the ability to implement science to achieve comfort, and health, among other things. The research group used both to find new ways to reduce the impact of fluorosis in areas without access to safe water, like synchrotron measurements, to understand the basics phenomena in the material and helped them to design a more sensitive and reliable sensing device. To the device development also contributed, Hideki Tanaka (Shinshu University), Manuela L. Kim (Shinshu University), Juan P. Hinestroza (Cornell University).
The next step is to implement a MOF with even better performance. The actual system uses a UV LED for excitation of the lanthanide MOF and detects the green emission. First author Eugenio Otal states, "we developed a modification of this MOF which can be excited with visible light and the signal will be detected in the Infrared. This innovation could reduce the cost of the electronics and use cheaper and more sensitive detectors in the infrared region of electromagnetic spectra."
Their final goal is to develop a portable device for water quality using the same concepts they used here, making it modular according to the requirements of each region and make their contribution to the Goal 6 of the UN Sustainable Development Goals: Ensure access to water and sanitation for all a reality, with a portable and affordable device.
CAPTION
Concepts used in the tech-demo design: Identification of the water quality problem in the local population, modification of cotton to emit light indicating the fluoride content, tech-demo design and construction, and transferring of the fluoride levels to the smartphone to be processed and shared.
IMAGE: HEADSHOT OF THE STUDY'S FIRST AUTHOR AMANDA PALMER, PH.D., POSTDOCTORAL FELLOW IN THE DEPARTMENT OF PUBLIC HEALTH SCIENCES AT THE MEDICAL UNIVERSITY OF SOUTH CAROLINA view more
CREDIT: MUSC HOLLINGS CANCER CENTER
More than 60% of U.S. adults who vape are interested in quitting, according to a study published today in JAMA Network Open by MUSC Hollings Cancer Center researchers. And among those who vape to help them to quit smoking, some are successful while others continue smoking and using electronic cigarettes.
The study, which analyzed longitudinal survey data from more than 30,000 adults across the country, aimed to provide the most up-to-date estimate of how many Americans are interested in stopping their use of e-cigarettes or have made past attempts to quit.
According to the findings, former cigarette smokers had the highest intentions and interest in quitting. This is likely due to an increasing number of smokers using e-cigarettes to transition away from cigarettes, said the study's authors.
While evidence has shown that switching to e-cigarettes can be as effective as medication-based treatments for smoking cessation in some cases, many people continue to vape even after they've quit smoking. Those who aren't able to stop smoking often end up using both cigarettes and e-cigarettes simultaneously, increasing potential risks to their health.
"One of the best things you can do for your health is to stop smoking. While e-cigarettes may work for some people, they're hindering quit attempts for other people," said Amanda Palmer, Ph.D., a postdoctoral fellow in MUSC's Department of Public Health Sciences and the study's first author.
"What's interesting about the people who keep using e-cigarettes after they've quit smoking is that we don't really see that effect with other types of nicotine replacement drugs. It's rare to see someone still using a nicotine patch or nicotine gum months or years after they've quit smoking, so there's something special about e-cigarettes, even though they're delivering the same drug."
From one addictive habit to another
Unlike other nicotine replacement therapies, e-cigarettes are created to be addictive and have a similar nicotine curve to regular cigarettes, making it difficult for people to quit. People who use both cigarettes and e-cigarettes often report feeling more addicted and have trouble quitting either product.
To make matters worse, there are currently no evidence-based treatments that help people who want to quit vaping. Psychologists like Benjamin Toll, Ph.D., chief of Tobacco Cessation and Health Behaviors at Hollings and the study's senior author, can only offer methods that are proven to help people to quit smoking, which may not be relevant to adults who vape.
"I think we're doing patients a disservice by not having rigorous research to give these patients appropriate evidence-based care," said Toll, who also co-directs Hollings' Lung Cancer Screening Program. "Many of my patients who have switched to e-cigarettes find it challenging to stop using them. I would like to have data supporting the methods I share with them, and we currently don't have those in any of our clinical practice guidelines."
Smoking cessation is best achieved through a combination of medication and behavioral counseling that helps people to break the habit with coping skills and substituted behaviors. But because there may be different reasons and situations that cause people to pick up an e-cigarette versus a cigarette, the methods that help people to quit successfully may vary.
Palmer explained it this way. "If you use cigarettes, you're probably smoking for a short duration 10 to 20 times per day, whereas a lot of our e-cigarette users are vaping continuously all day and in situations where they might not otherwise be smoking," she said. "That's evidence that there needs to be different behavioral treatments, because the coping strategies I would recommend to someone who smokes are not the same for someone using e-cigarettes."
A growing need for data
Aside from uncovering how many people want to quit vaping, this study sheds light on the urgent need to understand e-cigarette use among adults more fully. Recent estimates show that roughly 3% of U.S. adults vape, but the popularity of these products may be rising.
"A lot of the press and attention around e-cigarette use has to do with youth and adolescents, but it feels like a lot of people older than 25 who use e-cigarettes tend to be left out of that conversation," said Palmer, who noted that adults are likely vaping for different reasons than those age 18 and younger.
Young people are more likely to vape on an experimental basis, whereas adults - especially those who are using e-cigarettes to quit smoking - are often using them consistently, resulting in a need for tailored interventions.
Now that they know that most adults who vape want to quit eventually, Hollings researchers plan to focus on developing data-driven interventions to help people to achieve that goal.
Palmer is beginning a new pilot study to test basic self-help kits that combine tailored medications and behavioral support that providers can offer to patients who express interest in quitting e-cigarettes. The study will also solicit feedback from providers and adults who vape about what they think they may need to quit or to help their patients to quit.
Until more data is available, Palmer and Toll recommend that people who want to use e-cigarettes as a method to stop smoking weigh the pros and cons of all available interventions before making that decision. They also urge patients to speak with their medical providers to determine which approach may be best for them.
"E-cigarettes are addictive and are not 100% safe," said Palmer. "If you're considering vaping as a method to quit smoking, consider some of the risks and benefits, and be aware that many people continue to vape after they quit smoking."
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About MUSC
Founded in 1824 in Charleston, MUSC is the oldest medical school in the South, as well as the state's only integrated, academic health sciences center with a unique charge to serve the state through education, research and patient care. Each year, MUSC educates and trains more than 3,000 students and nearly 800 residents in six colleges: Dental Medicine, Graduate Studies, Health Professions, Medicine, Nursing and Pharmacy. The state's leader in obtaining biomedical research funds, in fiscal year 2019, MUSC set a new high, bringing in more than $284 million. For information on academic programs, visit musc.edu.
As the clinical health system of the Medical University of South Carolina, MUSC Health is dedicated to delivering the highest quality patient care available, while training generations of competent, compassionate health care providers to serve the people of South Carolina and beyond. Comprising some 1,600 beds, more than 100 outreach sites, the MUSC College of Medicine, the physicians' practice plan, and nearly 275 telehealth locations, MUSC Health owns and operates eight hospitals situated in Charleston, Chester, Florence, Lancaster and Marion counties. In 2019, for the fifth consecutive year, U.S. News & World Report named MUSC Health the No. 1 hospital in South Carolina. To learn more about clinical patient services, visit muschealth.org.
MUSC and its affiliates have collective annual budgets of $3.2 billion. The more than 17,000 MUSC team members include world-class faculty, physicians, specialty providers and scientists who deliver groundbreaking education, research, technology and patient care.
About MUSC Hollings Cancer Center
MUSC Hollings Cancer Center is a National Cancer Institute-designated cancer center and the largest academic-based cancer research program in South Carolina. The cancer center comprises more than 100 faculty cancer scientists and 20 academic departments. It has an annual research funding portfolio of more than $44 million and a dedication to reducing the cancer burden in South Carolina. Hollings offers state-of-the-art diagnostic capabilities, therapies and surgical techniques within multidisciplinary clinics that include surgeons, medical oncologists, radiation therapists, radiologists, pathologists, psychologists and other specialists equipped for the full range of cancer care, including more than 200 clinical trials. For more information, visit hollingscancercenter.musc.edu.
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US deaths normally change less than 2% eachyear; in 2020, they rose nearly 23%
Black Americans experienced highest per capita excess death rates, while regional surges contributed to higher excess death rates from COVID-19 and other causes, a VCU-led JAMA study finds
IMAGE: A MAP OF THE UNITED STATES SHOWING THE RATE OF EXCESS DEATHS. THE DAKOTAS, NEW ENGLAND, THE SOUTH AND SOUTHWEST HAD SOME OF THE HIGHEST EXCESS DEATHS PER 100,000 PEOPLE... view more
CREDIT: VIRGINIA COMMONWEALTH UNIVERSITY
Extended surges in the South and West in the summer and early winter of 2020 resulted in regional increases in excess death rates, both from COVID-19 and from other causes, a 50-state analysis of excess death trends has found. Virginia Commonwealth University researchers' latest study notes that Black Americans had the highest excess death rates per capita of any racial or ethnic group in 2020.
The research, publishing Friday in the Journal of the American Medical Association, offers new data from the last 10 months of 2020 on how many Americans died during 2020 as a result of the effects of the pandemic -- beyond the number of COVID-19 deaths alone -- and which states and racial groups were hit hardest.
The rate of excess deaths -- or deaths above the number that would be expected based on averages from the previous five years -- is usually consistent, fluctuating 1% to 2% from year to year, said Steven Woolf, M.D., the study's lead author and director emeritus of VCU's Center on Society and Health. From March 1, 2020, to Jan. 2, 2021, excess deaths rose a staggering 22.9% nationally, fueled by COVID-19 and deaths from other causes, with regions experiencing surges at different times.
"COVID-19 accounted for roughly 72% of the excess deaths we're calculating, and that's similar to what our earlier studies showed. There is a sizable gap between the number of publicly reported COVID-19 deaths and the sum total of excess deaths the country has actually experienced," Woolf said.
For the other 28% of the nation's 522,368 excess deaths during that period, some may actually have been from COVID-19, even if the virus was not listed on the death certificates due to reporting issues.
But Woolf said disruptions caused by the pandemic were another cause of the 28% of excess deaths not attributed to COVID-19. Examples might include deaths resulting from not seeking or finding adequate care in an emergency such as a heart attack, experiencing fatal complications from a chronic disease such as diabetes, or facing a behavioral health crisis that led to suicide or drug overdose.
The percentage of excess deaths among non-Hispanic Black individuals (16.9%) exceeded their share of the U.S. population (12.5%), reflecting racial disparities in mortality due to COVID-19 and other causes of death in the pandemic, Woolf and his co-authors write in the paper. The excess death rate among Black Americans was higher than rates of excess deaths among non-Hispanic white or Hispanic populations.
Woolf said his team was motivated to break down this information by race and ethnicity due to mounting evidence that people of color have experienced an increased risk of death from COVID-19.
"We found a disproportionate number of excess deaths among the Black population in the United States," said Woolf, VCU's C. Kenneth and Dianne Wright Distinguished Chair in Population Health and Health Equity. "This, of course, is consistent with the evidence about COVID-19 but also indicates that excess deaths from some conditions other than COVID-19 are also occurring at higher rates in the African American population."
Surges in excess deaths varied across regions of the United States. Northeastern states, such as New York and New Jersey, were among the first hit by the pandemic. Their pandemic curves looked like a capital "A," Woolf said, peaking in April and returning rapidly to baseline within eight weeks because strict restrictions were put in place. But the increase in excess deaths lasted much longer in other states that lifted restrictions early and were hit hard later in the year. Woolf cited economic or political reasons for decisions by some governors to weakly embrace, or discourage, pandemic control measures such as wearing masks.
"They said they were opening early to rescue the economy. The tragedy is that policy not only cost more lives, but actually hurt their economy by extending the length of the pandemic," Woolf said. "One of the big lessons our nation must learn from COVID-19 is that our health and our economy are tied together. You can't really rescue one without the other."
According to the study's data, the 10 states with the highest per capita rate of excess deaths were Mississippi, New Jersey, New York, Arizona, Alabama, Louisiana, South Dakota, New Mexico, North Dakota and Ohio.
Nationally, Woolf expects the U.S. will see consequences of the pandemic long after this year. For example, cancer mortality rates may increase in the coming years if the pandemic forced people to delay screening or chemotherapy.
Woolf said future illness and deaths from the downstream consequences of the devastated economy could be addressed now by "bringing help to families, expanding access to health care, improving behavioral health services and trying to bring economic stability to a large part of the population that was already living on the edge before the pandemic." Among other research, his team's 2019 JAMA study of working-age mortality underscores the importance of prioritizing public health measures like these, he said.
"American workers are sicker and dying earlier than workers in businesses in other countries that are competing against America," Woolf said. "So investments to help with health are important for the U.S. economy in that context just as they are with COVID-19."
Derek Chapman, Ph.D., Roy Sabo, Ph.D., and Emily Zimmerman, Ph.D., of VCU's Center on Society and Health and the School of Medicine joined Woolf as co-authors on the paper published Friday, "Excess Deaths From COVID-19 and Other Causes in the United States, March 1, 2020, to January 2, 2021."
Their study also confirms a trend Woolf's team noted in an earlier 2020 study: Death rates from several non-COVID-19 conditions, such as heart disease, Alzheimer's disease and diabetes, increased during surges.
"This country has experienced profound loss of life due to the pandemic and its consequences, especially in communities of color," said Peter Buckley, M.D., dean of the VCU School of Medicine. "While we must remain vigilant with social distancing and mask-wearing behaviors for the duration of this pandemic, we must also make efforts to ensure the equitable distribution of care if we are to reduce the likelihood of further loss of life."
Based on current trends, Woolf said the surges the U.S. has seen might not be over, even with vaccinations underway.
"We're not out of the woods yet because we're in a race with the COVID-19 variants. If we let up too soon and don't maintain public health restrictions, the vaccine may not win out over the variants," Woolf said. "Unfortunately, what we're seeing is that many states have not learned the lesson of 2020. Once again, they are lifting restrictions, opening businesses back up, and now seeing the COVID-19 variants spread through their population.
"To prevent more excess deaths, we need to hold our horses and maintain the public health restrictions that we have in place so the vaccine can do its work and get the case numbers under control."
Fewer than half of inmates in jails and prisons surveyed in a study by the CDC and University of Washington said they would accept a COVID-19 vaccine, while the majority either said they wanted to wait before getting the vaccine or would refuse one.
"This is a population already at risk for COVID-19, and outbreaks among incarcerated people can worsen inequities in COVID-19 outcomes as well as contribute to spread in the surrounding community," said lead author Dr. Marc Stern, affiliate assistant professor of health services in the UW School of Public Health. "So culturally and health-literacy informed interventions are needed to help them feel more confident about getting vaccinated."
The study conducted by CDC researchers and led by Stern was published Wednesday on the CDC's Morbidity and Mortality Weekly Report. The researchers surveyed more than 5,000 inmates, men and women, in late 2020 from three prisons and 13 jails in Washington, California, Florida and Texas.
Among those asked about their willingness to receive a vaccine, only 45% said they were willing. More than 45% said they would refuse, and nearly 10% said they might or weren't sure they would receive it.
The most common reasons the participants gave for vaccine hesitancy fell into the response categories of waiting for more information or to see others take it first, and efficacy or safety concerns. The most common reason for given for refusal was distrust of the health care system, correctional or government personnel and institutions.
The survey was conducted before vaccines were available, but at the time Black and younger respondents were the least willing to get the vaccine. The researchers added that a lower willingness to receive a vaccine among Black participants was "not unexpected given historical mistreatment and higher rates of distrust" of these institutions.
"People of color are subject to a 'double whammy' -- they are at higher risk of serious illness from COVID-19 and they are disproportionately incarcerated, living in facilities where they are more likely to become infected," Stern said.
"I hope this study sheds light on the need to find ways of assuring high levels of vaccination of incarcerated individuals," Stern added, "not just for their own health, but for the health of the community. Vaccinating incarcerated individuals not only decreases the risk that officers and other staff will bring COVID-19 home to their family, friends and community, it is also an efficient way to vaccinate a large number of people who are otherwise hard for public health providers to reach once they return to their communities."
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Co-authors include Alexandra Piasecki, Priti Patel, Rena Fukunaga and Nathan Furukawa from the CDC COVID-19 Response Team; Poornima Rajeshwar, Erika Tyagi and Sharon Dolovich from University of California, Los Angeles; and Lara Strick, at the UW and the Washington State Department of Corrections.
