Studying stimuli and smoking behaviors among self-identified gifted smokers and strategies for customizing cessation support.

INTRODUCTION: The aim of the study was to examine smoking habits and triggers among self-identified gifted (inner experiences and awareness qualitatively different from the norm in terms of asynchronous development, advanced cognitive abilities, and heightened intensity) adults in order to customize smoking cessation support. METHODS: A total of 123 participants were enrolled through Facility-Based and Snowball Sampling. Quantitative analysis focused on the relationship between overexcitabilities, nicotine dependence, motivation to quit, and smoking triggers, using the following questionnaires: the Overexcitability Questionnaire (OEQ-II) an indicator of areas of overexcitability, a heightened response and lowered threshold to stimuli; the Fagerström Test for Nicotine Dependence; a Cessation Motivation Questionnaire; and a Smoking Triggers Questionnaire. Qualitative analysis drew on six semi-structured interviews. Participant experiences of the relationship between smoking behaviors and experiences of multiple areas of overexcitability were analyzed using process coding. RESULTS: The quantitative data indicate that self-identified gifted smokers who rate themselves as having 3-5 'High' or 'High Average' overexcitabilities (OEs), are less likely to smoke in response to pattern, social, and addiction focused triggers than those self-reporting as having 0-2 OEs (Fisher's exact test, p<0.1). In the interviews, we observed a high level of complexity in stimulation and smoking behavior, with all interviewees explicitly connecting their smoking habits with experiences of overexcitability. Two interviewees had given up smoking prior to the research and of the four who still smoked, three quit within a few days of the interview. CONCLUSIONS: We found that psychometric testing and interviews designed to increase self-knowledge about the relationship between overexcitabilities and triggers for smoking have the potential to improve outcomes for smoking cessation among the gifted.

Optimal Terminology for Services in the United States That Incorporate Horses to Benefit People: A Consensus Document.

Objectives: To recommend (1) the adoption of optimal terminology for referring to services in the United States that incorporate horses and other equines to benefit people, and (2) the discontinuation of especially problematic terminology. Design: A diverse multidisciplinary consortium of individuals, including representatives of relevant national organizations, participated in an inclusive, systematic, and comprehensive 2-year consensus-building process. Results: Twelve specific types of services were identified that relate to one of three broad areas of professional work: therapy, learning, or horsemanship. Related to the area of therapy, five distinct types of therapies were identified: counseling, occupational therapy, physical therapy, psychotherapy, and speech-language pathology. Therapy-first language is recommended that foregrounds the exact therapy (e.g., physical therapy) and adds precise equine-related descriptors as warranted (e.g., physical therapy using equine movement). Related to the area of learning, three distinct types of nontherapy services were identified. The recommended terminology for referring to these services is equine-assisted learning in education, equine-assisted learning in organizations, and equine-assisted learning in personal development. Related to the area of horsemanship, four distinct types of nontherapy services were identified. The recommended terminology for referring to these services is adaptive equestrian sports, adaptive riding or therapeutic riding, driving, and interactive vaulting. The plural term, equine-assisted services, is recommended as a concise shorthand for easily referencing multiple services that differ from each other, yet share the horse as a common thread. Terms recommended for discontinuation include equine therapy, equine-assisted activities and therapies, equine-assisted therapy, equestrian therapy, hippotherapist, hippotherapy clinic (program), horse therapy, horseback riding therapy, and therapy riding. The consensus-building process culminated in extensive but not unanimous endorsements of all terminology recommendations. Conclusions: Terminology recommended for adoption clearly describes and distinguishes 12 distinct types of services. Terminology recommended for discontinuation was found to be ambiguous, misleading, no longer useful, or to have adversely affected stakeholders. It is hoped that all recommendations will prove useful and serve to enhance the professionalism and viability of specific identified services. It is also hoped that improved precision and clarity in terminology for naming specific services will advance their future scientific development and reliable measurement of effectiveness. Not all terminology-related challenges were resolved, however, and new challenges will likely arise as services continue to evolve and diversify. Significant impacts, if any, of the terminology recommendations herein merit ongoing monitoring and the question of optimal terminology merits revisiting in the foreseeable future.

Caring for the Veteran, military and family member nursing competencies: Strategies for integrating content into nursing school curricula.

In the United States, one in every 15 persons is a Veteran (U. S. Department of Veterans Affairs, 2016; U. S. News & World Report, 2017). An estimated 27% of these Veterans receive healthcare through the Veteran's Health Administration (VHA), leaving 73% to seek care in civilian hospitals (Bagalman, 2014). Realistically, most nurses in the United States will care for military members, Veterans or family members in a variety of healthcare systems and settings. Nurse educators are positioned to lead efforts in providing nursing students with the knowledge necessary to provide competent care and serve as advocates for our nation's heroes. Recent military deployments and news about the VHA have increased awareness of this population. This article describes competency development resulting from an academic-practice partnership experience between two baccalaureate programs and a national military medical center. Project SERVE, Students' Education Related to the Veteran Experience, utilizes a didactic-experiential model consisting of activities designed to teach students core concepts, including understanding military culture, poly-trauma, traumatic brain injury (TBI), post-traumatic stress disorder (PTSD), and issues facing families and care-givers. This article includes competencies, delineating the Knowledge, Skills, Attitudes, and resources for the provision of care to the Veteran population. The authors offer strategies to integrate care of Veterans, and military/family members content into nursing programs and replicate similar experiences. Opportunities for future development, challenges, faculty resources for curricular inclusion, and student reflections of the experience are presented.

Addressing psychosocial care using an interactive Web site for combat-wounded patients.

PURPOSE: The aims were to examine military nurses and combat-wounded patients' evaluation of a cognitive behavioral intervention Web site called Stress Gym. DESIGN AND METHODS: The use of the intervention was a proof-of-concept design with 129 military nurses and combat-wounded patients in military medical treatment facilities (MTFs). The nurses and patients logged on to Stress Gym, reviewed the nine modules available, and completed a short evaluation of the Web site. FINDINGS: The evaluation of the military nurses and patients was high. There were no significant differences in the evaluation based on military services, sex, deployment, and education levels. PRACTICE IMPLICATIONS: The strength of Stress Gym is that it enables all military members to learn about and get help with problems such as stress, anxiety, anger, and depressive symptoms anonymously and in private. CLINICAL RELEVANCE: Stress Gym is a versatile tool that can help nurses address the psychosocial needs of their patients by encouraging its use and including it in treatment protocols.

Development of an evidence-based pressure ulcer program at the National Naval Medical Center: nurses' role in risk factor assessment, prevention, and intervention among young service members returning from OIF/OEF.

Since the beginning of the wars in Iraq and Afghanistan, the incidence of pressure ulcers from various causes has increased. This article discusses the knowledge nurses need to care for casualties returning from Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF) who may be at risk for developing pressure ulcers. This article also describes the development of an evidence-based pressure ulcer awareness program for young adults aged 18 to 35 years at a military treatment facility that receives casualties from OIF/OEF. This evidence-based program enables nurses to rapidly assess casualties for risk factors and initiate nursing interventions to mitigate the development of pressure ulcers. Improving the detection of pressure ulcers among the young OIF and OEF casualties may, in turn, reduce mortality and morbidity among these service members.

Protocol for the assessment of potential health effects from embedded metal fragments.

Potential health issues arising from embedded metal fragment injuries are an operational health issue in the military medical community. Embedded fragment injuries can occur not only from standard-use munitions, but also from improvised explosive devices (IEDs). With few exceptions, the behavior of metal fragments, when embedded in the body, is not known. Herein, we propose a multitiered assessment protocol that can be used to both determine future health issues associated with newly developed munitions and, once the composition has been identified, determine potential toxicity of embedded fragments as a result of an IED event. The main premise of this assessment protocol is to view the embedded fragment as an implanted medical device and to utilize the guidelines already in place for testing the safety of such materials. Use of this structured, tiered approach will yield information critical for informed medical decisions.

The use of established skeletal muscle cell lines to assess potential toxicity from embedded metal fragments.

The use of novel materials on the modern battlefield, both in military munitions as well as in Improvised Explosive Devices, opens the possibility of wounds with embedded fragments whose health effects and toxicity characteristics have not been fully investigated, if at all. The costly and time-consuming nature of standard two-year lifespan studies prohibits the testing of many materials. In this report, we describe an in vitro system for rapidly assessing potential toxicity of metals and metal mixtures. Using rat L6 and mouse C2C12 skeletal muscle cells and tests for cellular viability, we have shown that two militarily relevant tungsten alloy mixtures (W/Ni/Co and W/Ni/Fe) significantly decreased the metabolic viability of rat L6 cells, whereas the viability of mouse C2C12 cells was not affected by W/Ni/Co and only slightly affected by W/Ni/Fe. In addition, viability assessed through lysosomal uptake of neutral red dye was not affected by either mixture in either cell line indicating that the mitochondria may be the target organelle of these unique metal mixtures. Development of this in vitro screening system may provide a procedure by which the potential toxicities of embedded metal fragments can be rapidly assessed.