Analysis of leadership and team management skills of middle-level healthcare managers of Valsad district, Gujarat.

Background: The healthcare managers need to develop the managerial skills and use it for better healthcare delivery. A manager requires leadership skill to empower employees and motivate them to work in an efficient manner to achieve organizational goal. Motivating employees/subordinates and developing positive attitude toward them is one of the crucial skills that the leader needs to develop. The way health team works as a unit affects the outcome and needs good leader. With this background, the current study tends to explore the managerial skills of middle-level managers. Objectives: 1. To assess the leadership and team management skills of middle-level managers and 2. To find out motivational factors used by managers. Materials and Methods: A cross-sectional study was conducted among district-level healthcare managers and medical officers. Data collection was performed via semistructured and scale-based questionnaire and analyzed using Microsoft office excel. Results: 60% of managers had participative leadership style. Team work skills were fair enough among the managers. 53% of medical officers were freshly appointed with experience of less than one year. The middle-level managers used appreciation of work (41.8%) as major motivator of the team. Conclusions: The middle-level healthcare managers have good leadership quality as well as teamwork skills. Appreciation of work is commonly used motivator.

Prevalence of Psychiatric Morbidity and Alcohol use Disorders Among Adolescent Indigenous Tribals from Three Indian States.

Background: Among the Indian adolescents, the prevalence of psychiatric morbidity and alcohol use disorders (AUD) are 7.3% and 1.3%. However, no separate data are available for indigenous tribal populations. This study estimated the prevalence of psychiatric morbidity and AUD and associated socio-demographic factors among adolescents in the tribal communities in three widely varying states in India. Methods: Using validated Indian versions of the MINI 6.0, MINI Kid 6.0, and ICD-10 criteria, we conducted a cross-sectional survey from January to May 2019 in three Indian sites: Valsad, Gujarat (western India); Nilgiris, Tamil Nadu (south India); and East Khasi Hills district of Meghalaya (north-east India) on 623 indigenous tribal adolescents. Results: Aggregate prevalence of any psychiatric morbidity was 15.9% (95% CI: 13.1-19.0) (males: 13.6%, 95% CI: 10.0-18.1; females: 17.9%, 95% CI: 13.9-22.6), with site-wise statistically significant differences: Gujarat: 23.8% (95% CI: 18.1-30.2), Meghalaya: 17.1% (95% CI: 12.4-22.7), Tamil Nadu: 6.2% (95% CI: 3.2-10.5). The prevalence of diagnostic groups was mood disorders 6.4% (n = 40), neurotic- and stress-related disorders 9.1% (n = 57), phobic anxiety disorder 6.3% (n = 39), AUD 2.7% (n = 17), behavioral and emotional disorders 2.7% (n = 17), and obsessive-compulsive disorder 2.2% (n = 14). These differed across the sites. Conclusion: The prevalence of psychiatric morbidity in adolescent tribals is approximately twice the national average. The most common psychiatric morbidities reported are mood (affective) disorders, neurotic- and stress-related disorders, phobic anxiety disorder, AUD, behavioral and emotional disorders, andobsessive-compulsive disorder.

Outcomes of Non-surgical Management of Zygomaticomaxillary Complex Fractures.

Introduction: With little evidence available in the literature, this study tries to clinically determine the efficiency and outcomes of non-surgical management of post-traumatic Zygomaticomaxillary complex (ZMC) fractures. Materials and Methods: One hundred and three patients with post-traumatic isolated ZMC fractures managed conservatively for various reasons were identified. The patients were classified based on the Zingg et al. criteria into Types A, B, and C. We evaluated the resolution of signs and symptoms of six standard parameters over 6 months-persistent pain, restriction in mouth opening, infraorbital nerve (ION) paresthesia, aesthetic deformity, infraorbital step deformity with associated tenderness on palpation, and ophthalmic status. The study variables were then statistically analyzed using Cochran's Q test with an associated confidence interval of 95%. Results: A six-month follow-up revealed persisting residual deformities for all three groups. However, Type A and Type B showed significant improvement in pain reduction, mouth opening, and infraorbital nerve (ION) paresthesia. No significant improvement was noted in any of the groups for aesthetic deformity, infraorbital step deformity, and ophthalmic status. Type C, which had comminuted fracture patterns, exhibited significant defects in all the parameters. Significant inter-variable relationship between certain paired parameters was also observed. Conclusion: The Type A group is most suited for non-surgical management. Type B with a mono-bloc fracture is a crucial group that demands broader, long-term studies to extract a proper treatment protocol. Type C with severe fracture displacement validates surgical correction.

Efficacy and Safety of Leuprolide Acetate 6-Month Depot for the Treatment of Central Precocious Puberty: A Phase 3 Study.

Context: Treatment options for central precocious puberty (CPP) are important for individualization of therapy. Objective: We evaluated the efficacy and safety of 6-month 45-mg leuprolide acetate (LA) depot with intramuscular administration. Methods: LA depot was administered at weeks 0 and 24 to treatment-naïve (n = 27) or previously treated (n = 18) children with CPP in a phase 3, multicenter, single-arm, open-label study (NCT03695237). Week 24 peak-stimulated luteinizing hormone (LH) suppression (<4 mIU/mL) was the primary outcome. Secondary/other outcomes included basal sex hormone suppression (girls, estradiol <20 pg/mL; boys, testosterone <30 ng/dL), suppression of physical signs, height velocity, bone age, patient/parent-reported outcomes, and adverse events. Results: All patients (age, 7.8 ± 1.27 years) received both scheduled study doses. At 24 weeks, 39/45 patients (86.7%) had LH suppressed. Six were counted as unsuppressed; 2 because of missing data, 3 with LH of 4.35-5.30 mIU/mL and 1 with LH of 21.07 mIU/mL. Through 48 weeks, LH, estradiol, and testosterone suppression was achieved in ≥86.7%, ≥97.4%, and 100%, respectively (as early as week 4 for LH and estradiol and week 12 for testosterone). Physical signs were suppressed at week 48 (girls, 90.2%; boys, 75.0%). Mean height velocity ranged 5.0 to 5.3 cm/year post-baseline in previously treated patients and declined from 10.1 to 6.5 cm/year at week 20 in treatment-naïve patients. Mean bone age advanced slower than chronological age. Patient/parent-reported outcomes remained stable. No new safety signals were identified. No adverse event led to treatment discontinuation. Conclusion: Six-month intramuscular LA depot demonstrated 48-week efficacy with a safety profile consistent with other GnRH agonist formulations.

Assessment of quality of life in patients with surgically treated maxillofacial fractures.

Background: The complex nature of maxillofacial injuries can affect the surgical treatment outcomes and general well-being of the patient. To evaluate the efficiency of the surgical treatment, assessment of the quality of life (QOL) of the patients is of vital importance. Due to the absence of an exclusive QOL assessment tool for maxillofacial fractures, we introduce the 'Twenty-point quality of life assessment in facial trauma patients in Indian population'. The aim of this study was to assess and evaluate the QOL following surgical management of maxillofacial trauma patients based on the severity of the injury. Methods: The study consisted of 182 subjects divided into two groups of 91 each (Group A: severe facial injury and Group B: mild to moderate facial injury). The Facial Injury Severity Scale (FISS) was used to determine the severity of facial fractures and injuries. The twenty-point quality of life assessment tool includes Zone 1 (Psychosocial impact) and Zone 2 (Functional and aesthetic impact), with ten domains each to assess QOL. Results: In Zone 1, the mean scores for Group A and Group B were 38.6 and 39.26, respectively. In Zone 2, Group B (44.56) had higher mean scores compared to Group A (32.92) (p< 0.001). Group B (83.8) had higher mean scores compared to Group A (71.58) when the total of both Zone 1 and Zone 2 were taken into consideration (p<0,001). In Group A, 9 out of 91 patients had a total score of 81- 100 compared to 68 in the same range in Group B. Conclusions: Proper surgical management with adequate care to the hard and soft tissues can improve the QOL by reducing postoperative psychosocial and functional complications. Aesthetic outcomes play an important role in determining the QOL. Mild/ Moderate injuries show better QOL compared to severe maxillofacial injuries.

Mother and child protection card as a resource tool for health care providers on VHND sessions: Providers' views in rural area of Valsad district in south Gujarat, India.

Background: The Mother and Child Protection card (MCP card) is used for tracking of each child right from conception till 3 years of age by community health workers. It is a rich source of information for HCPs about mother and child health. A well-versed health care provider (HCP) can deliver the services efficiently to the beneficiaries. Objectives: To assess knowledge of HCPs about information provided in the MCP card. Methodology: It was a descriptive cross-sectional study carried out in the rural area of Valsad. Nineteen HCPS were interviewed on VHND sessions for their knowledge about health information provided in MCP card. Results: Mean age of HCPs was 38.11 years with mean 9.3 years of work experience. Of these 94.7% were providing the MCP card while registering the beneficiary. Around 78.9% knew growth chart, 68.4% knew vaccination information and nearly half were aware about the various government schemes. About 36.84% could mention five cleans of safe delivery at home. Conclusion: HCPs were aware about vaccination, antenatal care, growth chart but their knowledge about five cleans of home delivery and postnatal care needs to be improved.

Continuing medical education about postexposure prophylaxis of rabies in tribal area medical college hospital of Gujarat, India: One step towards rabies elimination.

Background: Continuing Medical Education (CME) is an essential feature of the clinical practice and helps to improve the health care provider's ability to provide quality patient care. The World Health Organization has given a global strategic plan to end human deaths from dog-mediated rabies by 2030 known as "Zero by thirty." Methodology: A CME session was organized for staff nurses working in a tertiary medical care hospital of Valsad district about anti rabies vaccination. Ninety-one participants were administered the questionnaire about antirabies vaccine (ARV) and related practical aspects before and after the CME session. Results: Mean pre- and post-CME Score of the participants was 5.38 and 8.68 out of 10, respectively which was statistically significant. The majority of the participants could score from 5 to 6 (33, 36.2%) before CME which rose to 9 to 10 after CME (58, 63.7%). A total of 52 participants (57%) showed improvement in total score by more than 5 points after attending CME, whereas 13 (14%) showed no improvement. The maximum improvement (52.1%) was found in the fact that currently available vaccine vials are the same for intradermal (ID) and intramuscular (IM) regimes, followed by the need for immunoglobulins in category III animal bites (44.3%). Conclusion: CME showed significant improvement in knowledge regarding rabies and antirabies vaccination. The knowledge regarding the similar schedule for both adults and children needs improvement. Subsequent CME programs should focus on these aspects for the effective management of animal bite patients.

Retrieval of Fractured Implant Abutment Screws: A Narrative Review.

Objective: Implant abutment screws can fracture due to various biomechanical factors. Improper fit of the prosthesis, inadequate seating of the abutment, occlusal interference, and manufacturing errors are some of the causes that can result in an abutment screw fracture. Retrieval of the retained fractured abutment screw is quite challenging to the clinician. The objective of this review is to provide information on various fractured abutment screw retrieval techniques reported in literature and to formulate a structured treatment protocol for the management of fractured abutment screws. Materials and Methods: An electronic search of Scopus and PubMed databases was performed for articles between January 1989 and December 2021 using the keywords "Implant screw fracture" and "screw retrieval." Results: Most of the articles were of the opinion that abutment screw fractures occurred due to screw loosening. Both conservative approaches and the use of commercial retrieval kits have been advocated to retrieve the fractured abutment screws. Based on various review articles, an innovative novel technique to retrieve an abutment screw fractured due to excessive torque was devised in our unit. Conclusion: Although clinicians can use various techniques to remove fractured abutment screws, every effort should be made to eliminate the cause of screw fracture. Retrieval of the broken screw fragment should be done judiciously to prevent any internal damage to the implant structure.

Pathogenesis of Aeromonas caviae in Clariasmagur.

Aeromonas spp. is a pathogenic bacteria that potentially cause infection in farmed fish, including Catfishes. In the present study, dominant bacteria were isolated from diseased Clarias magur and tentatively named BLBM-05. Based on morphological, physiological, and biochemical features as well as 16S rRNA gene sequence and gyrB gene sequences (Gen Bank accession number: MT973994.1 and MZ398017.1), the bacteria in the isolate was found to be Aeromonas caviae. Further, the isolate was screened for five known virulence genes, namely ß-hemolysin, lafA, exu, ompA1 and ascV. Among them, three virulence genes related to pathogenicity, including aerolysin (aer), outer membrane protein (ompA1), lateral flagella (lafA), were identified in the A. caviae isolate. The median lethal dosage (LD50) of the BLBM-05 isolate for magur was determined as 1.53x106 CFU/mL. The histopathological analysis showed that the BLBM-05 isolate induced considerable histological lesions in the magur fish, including necrosis, hemolysis of erythrocytes, myolysis, hemorrhage, and desquamation in the intestinal tissue, tissue loosening, and infiltration of inflammatory cells. Drug sensitivity test showed that the isolate was susceptible to Gentamicin, Ceftazidine, Ceftrioxone, Amikacin, Tetracycline, Meropener and Oxytetracycline. The present results provide a scientific basis to identify A. caviae further, a line of treatment for magur infected by this pathogen.

Teleost Nonapeptides, Isotocin and Vasotocin Administration Released the Milt by Abdominal Massage in Male Catfish, Clarias magur.

In the present work the nonapeptides i.e., isotocin and vasotocin alone or in a combination were tested in C. magur to evaluate their effect on stripping by abdominal massage. Also, we used chitosan-carbon nanotube nanocomposites to conjugate the nonapetides isotocin (abbreviated as COOH-SWCNTCSPeP) and isotocin and vasotocin (COOH-SWCNTCSPePs) with the aim of sustaining the effect for a longer duration. The conjugation of nonapeptides with nanocomposites was confirmed by Fourier-transform infrared spectroscopy (FTIR), Scanning electron microscopy (SEM), Transmission electron microscopy (TEM), Thermogravimetric analysis (TGA) and X-ray photoelectron spectroscopy (XPS). Two experiments were conducted to study the effect of naked (without nanoparticles) and conjugated nonapeptides on the milt release by stripping. Both the experiments consisted of eight treatments which included four naked groups two nanoconjugated groups and two controls. Both naked and nonconjugated formulations were successful in stripping the male catfish. The mRNA expression of selected reproductive genes was analysed to decipher the effect of nanopeptides at the molecular level. Nonapeptide treatment either naked or nanoconjugated, resulted in the upregulation of the transcript level of genes. Histological analysis revealed the concentration of spermatozoa was more in peptide injected groups than in the controls. The synergistic effects of nonapeptides and Ovatide had a positive impact on GSI. Thus, the present formulations were successful in stripping the male catfish to obtain the milt with significant reproductive success. Even though the naked groups perform better but the number of males required to fertilize the eggs in nanoconjuagted groups was smaller making it worth using for the delivery of nonapeptides.

Paradoxical anxiolytic effect of the 'bath salt' synthetic cathinone MDPV during early abstinence is inhibited by a chemokine CXCR4 or CCR5 receptor antagonist.

Chemokine CXCR4 and CCR5 receptors are best known as HIV co-entry receptors, but evidence that CXCR4 or CCR5 blockade reduces rewarding and locomotor-stimulant effects of psychostimulants in rats suggests a role in psychostimulant use disorders. We investigated the impact of CXCR4 or CCR5 receptor antagonism on anxiety-related effects of the synthetic cathinone 3,4-methylenedioxypyrovalerone (MDPV) in the elevated zero-maze (EZM) assay. Rats exposed to a 4-day MDPV binge dosing paradigm and tested 24 or 72 h post-treatment spent more time in the open compartment at the 24-h time point but less time at the 72-h post-binge time point. Daily administration of AMD 3100, a CXCR4 antagonist (10 mg/kg), or maraviroc, a CCR5 antagonist (2.5 mg/kg), during MDPV treatment inhibited the MDPV-induced increase in time spent in the open compartment. Neither antagonist affected the MDPV-induced reduction in time spent in the open compartment at the 72-h post-binge time point. Cocaine, administered in the same paradigm as MDPV, did not increase time spent in the open compartment 24-h post-binge, suggesting specificity to MDPV. The present results identify a surprising anxiolytic-like effect of MDPV 24 h after cessation of repeated exposure that is sensitive to chemokine CXCR4 and CCR5 receptor activity.

Thickness and width of the menisci of adult knee joint: a descriptive cross-sectional observational study in cadavers.

Background: The goal was to determine the thickness and width of the knee joint meniscus at their different regions. The objective was to compare the dimensions at these regions and over the right- and left-sided specimens. Methods: The present study included 50 adult cadaveric knee joints, and 100 menisci (50 medial menisci and 50 lateral menisci) were studied. The meniscus was distributed into anterior, middle and posterior parts. Thickness and width at the mid-point of these three parts were determined by using the Vernier caliper. Results: The breadth of the medial meniscus was 8.38 ± 1.64 mm, 7.68 ± 1.92 mm and 13.93 ± 2.69 mm at the anterior, middle and posterior one-third regions. Same measurements for the lateral menisci at these regions were 9.84 ± 1.78 mm, 8.82 ± 2.01 mm and 10.18 ± 2.23 mm, respectively. The thickness of the medial meniscus was 4.49 ± 0.78 mm, 4.07 ± 0.81 mm and 4.79 ± 0.93 mm at these regions. The lateral meniscus thickness was 3.82 ± 0.69 mm, 4.43 ± 0.98 mm and 4.36 ± 0.8 mm, respectively. Conclusion: It is believed that this data is enlightening to the arthroscopic surgeon during the meniscus transplantation either by using synthetic material or allograft as the proper sizing of the meniscus is important to prevent complications due to inaccurate sizing.

The Influence of the Mandibular Chin Angle on the Occurrence of Mandibular Condylar Fracture: A Retrospective Study.

BACKGROUND: Condylar fractures are commonly associated with symphysis/parasymphysis fractures. Condylar fractures have been attributed to direct and indirect traumatic forces, the direction and magnitude of the forces, and the condylar anatomy. The chief aim of this study was to determine the association between the newly defined mandibular chin angle and the occurrence of condylar fractures. MATERIALS AND METHODS: A retrospective study was conducted to analyze two-dimensional computed tomography (2D CT) scans of patients with a history of chin trauma. The outcome was a symphysis/parasymphysis fracture with or without fracture of the mandibular condyle. The Mediff InstaRISPACS web-based platform was used to measure the chin angle. The cerebral aqueduct of Sylvius in the corresponding 2D CT midsagittal image was the standard reference plane to measure the chin angle. The SPSS Version 20 (IBM Corp, Armonk, NY) was used for data analysis. RESULTS: The sample size included 120 2D CT scans of patients with symphysis/parasymphysis fractures (60 associated with condylar fractures and 60 without condylar fractures). The mean chin angle in the group without condylar fracture was 133.35 ± 3.87°, which was approximately 15° lesser than in the condylar fracture group (mean, 148.56 ± 5.49°), and these findings were statistically significant (P < 0.05). CONCLUSION: Individuals with a high chin angle are potentially at a higher risk of sustaining associated condylar fractures.

Gonadotropin inhibitory hormone receptors (GnIHRs): Molecular characterization and synergistic effect of different drugs in Indian major carp, Labeo catla.

After the discovery of Gonadotropin-inhibitory hormone (GnIH) in birds in 2000, it showed different roles in different vertebrate classes and even in different species of same classes. In birds and mammals, GnIH inhibits the expression of gonadotropins during reproduction, while in fishes it exerts both inhibitory and stimulatory effect on reproduction. The current study evaluates the role of GnIH during reproduction in Labeo catla. The partial cDNA sequence of GnIHR1 and GnIHR3 receptor genes was identified by degenerate PCR. The mRNA expression analysis of GnIHRs during different reproductive phases showed that the expression of all three GnIH receptor genes is highest during spawning phase. The expression of GnIH receptors is detected in both brain and gonads except for GnIHR3 which only expressed in gonads. The in vivo experiments with GnIH antagonist, RF313 drastically reduced the expression level of reproduction related genes like LH, FSH, and GnRH at 1 h post-injection. In another experiment the surge induced by cGnIH-III peptide on gonadotropins gene expression is further increased when co-injected with LHRHa. However, co-injection of melatonin along with cGnIH-III peptide had opposite effects. These results showed that the GnIH/GnIHRs system has positive effect on reproduction in L. catla.

Laparoscopic D2 gastrectomy in advanced gastric cancer: Postoperative outcomes and long-term survival analysis.

INTRODUCTION: Data on laparoscopic treatment of operable gastric cancer from India is sparse. This study aims to document outcomes of laparoscopic D2 gastrectomy in an Indian population. MATERIALS AND METHODS: Data of patients who underwent laparoscopic D2 gastrectomy for operable advanced gastric cancer between February 2012 and January 2017 were collected from electronic hospital records supplemented by telephonic interviews and analyzed. Survival was evaluated using Kaplan-Meier survival analysis curves. RESULTS: In total 121 patients were included. Conversion to open gastrectomy was 5.7%. One hundred and fourteen patients (73 laparoscopic subtotal gastrectomy and 41 laparoscopic total gastrectomy) were included for analysis. D2 lymphadenectomy was done in all cases; mean number of dissected lymph nodes was 23.12 ± 9.14 (12-45). Major complications (Clavien-Dindo Grade III and IV) was seen in 6.1% of cases with reoperation rate of 3.5% (4/114). Stage 3 disease was seen in 60.6% cases and stage 2 disease in 32.5%. Follow-up data were available for 76.3% of patients with mean follow-up of 29.5 months. Overall survival across all stages was 38.7 months. Five-year disease-free survival and overall survival were 36.7% and 55.9% respectively, across all stages. CONCLUSION: Laparoscopic D2 gastrectomy is safe, feasible with similar postoperative complications and comparable survival outcomes across all stages when compared to available literature on open gastrectomy cases.

MRSA infection of masticatory spaces in a paediatric patient.

Diagnosis of source of maxillofacial infection in paediatric patients can be challenging due to difficulty in eliciting a proper history and multiple potential sources of infection. Identification and removal of the nidus of infection with decompression and institution of antibiotic therapy as per the culture-sensitivity report form the mainstay treatment of the infection. Deviation from it may result in persistence or even progression of infection, resulting in significant morbidity and mortality. In the past decade, the incidence of community-acquired methicillin-resistant Staphylococcus aureus infection in the oral cavity has seen an upward trend. This has further led to an increase in complexity in the diagnosis of maxillofacial infections. In this case, the authors want to bring to light the challenges faced in managing a paediatric patient with persistent fascial space infection even after removal of the offending tooth, which signifies the importance of managing the infection by the time-tested protocol.

"Orofacial Dystonia-A Silent Killer": Mandibular Fractures with Orofacial Dystonia, A Report of a Case and Review.

Mandibular parasymphysis fracture is very commonly observed especially in old age when there is resorptions of the alveolar ridges. In cervical dystonia, there is centrally mediated disease in which there is uncontrolled and spasmodic contraction of the facial and the masticatory muscles. Due to the application of this sudden and uncontrolled force, there is a tendency of the bone to unfavourably remodel and weaken. The case presented here is of a geriatric patient who presented to us with a fracture at the right parasymphysis and left dentoalveolar region of the mandible and was suffering from cervical dystonia. Management of this case posed a challenge in every step, and it needed a resurgery where the fracture was managed by the placement of reconstruction plate. Not many cases in the literature have been reported where dystonic movements have resulted in the fracture of the mandible.

Laparoscopic approach in cholecystogastric fistula with cholecystectomy and omental patching: A case report and review.

Cholecystoenteric fistulas are rare complications of cholelithiasis, with cholecystogastric fistulas (CGFs) being the rarest. Recommended treatment is surgery; however, select asymptomatic patients can be managed conservatively. The population frequently involved is old age with multiple comorbidities. Open surgery comes with its added morbidities, especially in this subgroup and hence laparoscopic surgery might be beneficial. Sometimes, these fistulas can be incomplete. Here, we describe a case of incomplete CGF managed by laparoscopic cholecystectomy and omental patching along with a brief review of the literature.

Robotic transduodenal excision of duodenal duplication cyst: Case report and review.

Duodenal duplication cysts are rare congenital anomalies that generally present with abdominal pain and vomiting or may have nonspecific symptoms. Surgical excision is the recommended treatment owing to possible complications, including malignancy. However, difficult locations like the periampullary region are problematic and major surgical procedures, for example, pancreaticoduodenectomy is necessary for total resection. These have a high complication rate resulting in a poor quality of life, especially in children and young adults. Here, we describe a case of duodenal duplication cyst managed by robotic (transduodenal) excision along with a brief review of the literature.

Evaluating a school-based science program that teaches the physiological effects of nicotine.

School-based drug prevention programs represent a widely endorsed public health goal, with an important aspect of knowledge-based curricula being education about the physiological effects of drugs. Nicotine is one of the world's most addictive substances and in this program we have used nicotine-induced mammalian-like behaviors in flatworms called planarians to successfully teach students (4th-12th grade; n = 1,616 students) about the physiological and addictive effects of nicotine. An initial study tested the change in knowledge about addictive substances in 6th-12th grade students after they completed a lab examining the effects of two concentrations of nicotine on the number of stereotypies (C-shaped spasms) planarians demonstrate in a 5-minute period of time. Lab discussion focused on developing and testing hypotheses, measurement reliability, and mechanisms of nicotine action. Surveys given pre- and post-lab experience showed that 6th grade students have significantly lower knowledge about nicotine than 7th-12th grade students (6th grade: 40.65 ± 0.78% correct, 7th-12th grade: 59.29 ± 1.71%, p < 0.001) pre-lab, but that students in all grades showed a significant increase in knowledge post-lab (p < 0.001). In 6th grade the lab was effective in improving knowledge about nicotine in urban, suburban and rural schools, p < 0.001, with students in suburban schools showing significantly greater knowledge both pre-test (urban: 37.62 ± 1.45%; suburban: 48.78 ± 1.62%; rural: 37.33 ± 0.99%; p < 0.001) and post-test (urban:60.60 ± 1.85%; suburban: 67.54 ± 1.82%; urban: 61.66 ± 1.18%; p < 0.001). A second study, modifying the lab so that the time spent observing the planarians is reduced to a 1-minute period, showed that students in both 4th and 5th grades had a significant increase in knowledge about the physiological and addictive effects of nicotine post-lab (p < 0.001).