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Background Despite measures to reduce young people’s access to electronic cigarettes (ECs), or “vapes”, many countries have recorded rising youth vaping prevalence. We summarised studies documenting how underage youth in countries with minimum age sales restrictions (or where sales are banned) report accessing ECs, and outline research and policy implications. Methods We undertook a focused literature search across multiple databases to identify relevant English-language studies reporting on primary research (quantitative and qualitative) and EC access sources among underage youth. Results Social sourcing was the most prevalent EC access route, relative to commercial or other avenues; however, social sourcing dynamics (i.e., who is involved in supplying product and why) remain poorly understood, especially with regard to proxy purchasing. While less prevalent, in-person retail purchasing (mainly from vape shops) persists among this age group, and appears far more common than online purchasing. Conclusions Further research examining how social supply routes operate, including interaction and power dynamics, is crucial to reducing youth vaping. Given widespread access via schools and during social activities and events, exploring how supply routes operate and evolve in these settings should be prioritized. Inadequate compliance with existing sales regulations suggest greater national and local policy enforcement, including fines and licence confiscation for selling to minors, is required at the retailer level.

Background. Estimating environmental impacts has become an integral part of dietary assessments. These estimations rely on available life cycle assessment (LCA) data and databases of LCA information, which should be as recent and context specific as possible. Objectives. We aimed to update the existing New Zealand (NZ) dietary LCA database with recently available NZ data and provide documentation to streamline regular future updates. Following the update, we also aimed to investigate the impact of the updated database on emission estimates for dietary intakes in the population. Methods. A search was developed and conducted on November 18th, 2024. Recently published or identified LCA data for food items produced in NZ were integrated into the database. A comparison of the estimates of total greenhouse gas emissions due to dietary intake between the original database and updated database was conducted on existing NZ dietary intake data. Results and discussion. Updates in nine food items resulted in small net emissions decreases in fourteen food categories of the New Zealand Adult Nutrition Survey 2008/09. The estimate of average daily emissions due to dietary intake per adult in NZ decreased by approximately 1%, from 4.99 kgCO2eq to 4.91 kgCO2eq. This resulted in a decreased estimate of 350 tCO2eq per day for the entire population. Small changes in LCA data can accumulate to substantial effects over the entire population; however, a 1% decrease in production emissions over 15 years shows that efficiencies in status quo patterns of food production alone are vastly inadequate to meet Paris obligations. More transformative changes will rapidly be needed.

Both human health and the health systems we depend on are increasingly threatened by a range of environmental crises, including climate change. Paradoxically, health care provision is a significant driver of environmental pollution, with surgical and anesthetic services among the most resource-intensive components of the health system. This analysis aimed to summarize the state of life cycle assessment (LCA) practice as applied to surgical and anesthetic care via review of extant literature assessing environmental impacts of related services, procedures, equipment, and pharmaceuticals. A state-of-the-science review was undertaken following a registered protocol and a standardized, LCA-specific reporting framework. Three bibliographic databases (Scopus®, PubMed, and Embase®) and the gray literature were searched. Inclusion criteria were applied, eligible entries critically appraised, and key methodological data and results extracted. From 1,316 identified records, 44 studies were eligible for inclusion. The annual climate impact of operating surgical suites ranged between 3,200,000 and . The climate impact of individual surgical procedures varied considerably, with estimates ranging from . Anesthetic gases; single-use equipment; and heating, ventilation, and air conditioning system operation were the main emissions hot spots identified among operating room- and procedure-specific analyses. Single-use equipment used in surgical settings was generally more harmful than equivalent reusable items across a range of environmental parameters. Life cycle inventories have been assembled and associated climate impacts calculated for three anesthetic gases ( ) and 20 injectable anesthetic drugs ( ). Despite the recent proliferation of surgical and anesthesiology-related LCAs, extant studies address a miniscule fraction of the numerous services, procedures, and products available today. Methodological heterogeneity, external validity, and a lack of background life cycle inventory data related to many essential surgical and anesthetic inputs are key limitations of the current evidence base. This review provides an indication of the spectrum of environmental impacts associated with surgical and anesthetic care at various scales. https://doi.org/10.1289/EHP8666.

The global food system is driving both the climate crisis and the growing burden of noncommunicable disease. International research has highlighted the climate and health co-benefit opportunity inherent in widespread uptake of plant-based diets. Nevertheless, uncertainty remains as to what constitutes healthy and climate-friendly eating patterns in specific world regions. Using New Zealand as a case study, this research investigates the extent to which potential contextual differences may affect the local applicability of international trends. It further examines the potential for demand-end avenues to support a transition toward a healthier, more climate-friendly food system in New Zealand. A New Zealand-specific life-cycle assessment (LCA) database was developed by modifying cradle to point-of-sale reference emissions estimates according to the New Zealand context. This food emissions database, together with a New Zealand-specific multistate life-table model, was then used to estimate climate, health, and health system cost impacts associated with shifting current consumption to align with dietary scenarios that conform to the New Zealand dietary guidelines (NZDGs). Whole plant foods, including vegetables, fruits, legumes, and whole grains were substantially less climate-polluting ( ) than animal-based foods, particularly red and processed meats ( ). Shifting population-level consumption to align with the NZDGs would confer diet-related emissions savings of 4-42%, depending on the degree of dietary change and food waste minimization pursued. NZDG-abiding dietary scenarios, when modeled out over the lifetime of the current New Zealand population, would also confer large health gains (1.0-1.5 million quality-adjusted life-years) and health care system cost savings ( ). Guideline-abiding dietary scenarios, particularly those that prioritize plant-based foods, have the potential to confer substantial climate and health gains. This research shows that major contextual differences specific to New Zealand's food system do not appear to cause notable deviation from global trends, reinforcing recent international research. https://doi.org/10.1289/EHP5996.

We present a case of 2-dimensional ultrasound-assisted confirmation of nasogastric tube (NGT) placement using both soft tissue neck and epigastric sonographic imaging. Given our findings and review of the literature, we suggest that bedside ultrasound evaluation of NGT placement is a straightforward, rapid, and novel alternative method to the “gold standard” of a portable chest radiograph in the emergency department (ED).

Policies to mitigate climate change are essential. The objective of this paper was to estimate the impact of greenhouse gas (GHG) food taxes and assess whether such a tax could also have health benefits in Aotearoa NZ. We undertook a systemised review on GHG food taxes to inform four tax scenarios, including one combined with a subsidy. These scenarios were modelled to estimate lifetime impacts on quality-adjusted health years (QALY), health inequities by ethnicity, GHG emissions, health system costs and food costs to the individual. Twenty-eight modelling studies on food tax policies were identified. Taxes resulted in decreased consumption of the targeted foods (e.g., −15.4% in beef/ruminant consumption, N = 12 studies) and an average decrease of 8.3% in GHG emissions (N = 19 studies). The “GHG weighted tax on all foods” scenario had the largest health gains and costs savings (455,800 QALYs and NZD 8.8 billion), followed by the tax—fruit and vegetable subsidy scenario (410,400 QALYs and NZD 6.4 billion). All scenarios were associated with reduced GHG emissions and higher age standardised per capita QALYs for Māori. Applying taxes that target foods with high GHG emissions has the potential to be effective for reducing GHG emissions and to result in co-benefits for population health.

Introductory Physics (IP) forms part of the foundational knowledge necessary to success in an undergraduate engineering degree. Here, the impact of IP is studied to address three research questions: 1) What is the correlation of performance in IP with institutionally relevant metrics? 2) How well is IP course content aligned with subsequent engineering coursework? and 3) Does a new online supplemental resource improve student learning in the IP sequence? Impact of a student’s IP Mechanics grade on the metrics of subsequent academic performance, retention, and matriculation rate is analyzed using two decades of academic records of engineering students at Texas A&M University (TAMU). Correlations are quantified using the Spearman Correlation Coefficient, with separate analyses performed for three versions, called flavors, of IP Mechanics available to TAMU students. Alignment of content between courses is examined using a set of q-matrices developed for three flavors of IP Mechanics and two subsequent engineering courses. The strength of alignment between each flavor of IP Mechanics with each course is examined for the courses as a whole, along with specific physical concepts and mathematical skills. The procedure employed here may be an effective evaluative tool for service based courses to ensure adequate coverage of material for client departments. Supported by a grant from TAMU Provost’s Office and Instructional Technology Services, a new online supplemental resource was created for the IP sequence titled Freshman Physics Classroom (FPC). Development and results from the first deployment of this resource will be discussed, including quantitative analysis of exam scores and conceptual assessments along with qualitative analysis from student surveys. Initial results show positive results from use of the resource and high student approval.

Introduction: An index must be used to quantify the improvement in the position of teeth treated by orthodontics. The Cast-Radiograph Evaluation is the index used by the American Board of Orthodontics. The purpose of this study is to use this index to evaluate treatment outcomes in the graduate orthodontic clinic at Loma Linda University from 2012-2016.Materials and Methods: Patients included were comprehensively treated, debonded between 1/1/2012 and 12/31/2016, and under age 30. A total of 80 patients were randomly selected, with 16 coming from each year. The ABO DI was used to score the T1 models, and the CR-Eval was used to score the T2 models. For scoring reliability, a set of 5 calibration models were scored with the P.I., who has had experience as an examiner for the ABO.Results: It was found that DI scores ranged from 2 to 48, with the mean being 14.55±8.41. CR-Eval scores ranged from 15 to 47, with the mean being 30.09±7.596. There were no significant differences in mean CR-Eval scores for malloclusion types, between years included in the study, between cases treated with extractions verses those treated without, and between cases that started with a cross bite or impacted canine and those that didn’t. In this sample, Alignment/Rotations was the highest scored category of the CR-Eval (6.65±2.66), followed by Buccolingual Inclination (4.987±3.10), and Occlusal Contacts (4.875±2.71). Interproximal Contacts scored the least (0.30±0.75).Conclusions: According to the results found in this data set, there was no statistically significant change in the mean CR-Eval scores from year to year. There was also no statistically significant correlation between DI at T1 and CR-Eval at T2. Alignment and Rotations are the category that have the most room for improvement. Buccolingual Inclination was the second highest, followed by the Occlusal Contacts category.Discussion: This study confirms the value and need for progress models prior to debond with sufficient time to perform a CR-Eval and make the necessary adjustments.

Computational models are essential tools for prediction and planning in water resources systems to ensure human water security and environmental health. Water systems models merely approximate the processes by which water moves through natural and built environments; their value depends on assumptions regarding climate, demand, land use, and other uncertain factors that may influence decision making. Numerical techniques to explore the role of these uncertain factors, known as diagnostic methods, can highlight opportunities to improve the accuracy of prediction as well as identify influential uncertainties to inform additional research and policy. This dissertation advances diagnostic methods for water resources models to identify (1) time-varying dominant processes driving modeled hydrologic predictions in flood forecasting, and (2) tradeoffs and vulnerabilities to changing climate and demands in regional urban water supply systems planning for drought. This work proposes diagnostic methods as a key element of a posteriori decision support, in which decision alternatives and vulnerable scenarios are identified following computational modeling and data analysis. Consistent with this theme, this work follows a multi-objective approach in which stakeholders can analyze tradeoffs between conflicting objectives as part of an iterative constructive learning process. For a spatially distributed flood forecasting model, results show that dominant uncertainties vary in space and time, and can inform model-based scientific inference as well as decision making. Similarly, the results of the urban water supply study indicate that sensitivity analysis can suggest costeffective paths to mitigate vulnerability to deeply uncertain future scenarios, for which likelihoods remain unknown or disputed. The multi-objective approach allows stakeholders to explore tradeoffs in their modeled robustness to inform intra-regional policies such as transfer contracts and shared infrastructure investments. Bridging the areas of hydrology and water systems planning is increasingly valuable, as hydrologic modelers begin to incorporate anthropogenic influences on the water cycle, and water systems planners begin to explore uncertainty in hydrologic process representation. In summary, this work develops diagnostic methods to identify time-varying dominant processes in distributed flood forecasting as well as tradeoffs and vulnerabilities under change in regional urban water supply, ultimately seeking to improve model-based planning for extreme floods and droughts in water resources systems.

The use of single-occupancy vehicles (SOVs) has had a profound impact on human health and the environment. In order to change the impact our travel behavior has on both the environment and our health, change needs to occur at an individual level. The purpose of this study was to determine effective framing strategies that will encourage individuals to use alternative, or sustainable transportation (ST), i.e. commuting by means other than SOV, and to compare the efficacy of this intervention to that of a \"green\" eating (GE) intervention. Using the Transtheoretical model (TTM) and its key constructs, self-efficacy and decisional balance, data were collected from 134 undergraduate students at the University of Rhode Island measuring their attitudes towards ST and GE, respectively. The intervention consisted of a pretest survey, four educational modules, tailored messaging and finally, a posttest. Data from the pretest survey contained each participant's Stage of Change reflecting attitudes toward ST and GE. After the pretest, participants were randomized into the GE group or the ST group. Participants in the GE and ST groups received educational modules over the course of three weeks. Between each educational module, participants received motivational messages tailored to their respective stage, as determined in the pretest. Results from tests revealed that there were small positive shifts in stages in each of the treatment groups as well as small increases in decisional balance and self-efficacy as a result of the ST intervention.