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This article takes a look at how the customer can be the key to the successful turnaround of a distressed business in any category. It presents the argument that one reason so little attention is paid to the customers is that they are often seen as the reason a business slips into a distressed state, rather than the cure. In reality, customer defection is a symptom of distress, not its cause. The article presents primary examples of successful turnarounds that relied on the customer from the automotive aftermarket and a distributor of machine tools.

The development of auditory word discrimination ability in normal male children has been investigated. 56 school-children (14 from kindergarten and 14 each from second, fourth and sixth grades) were asked to discriminate 50 single-syllable words presented against four levels of background noise (0, +10, +20, and +30). Age, noise level, and ear were all significantly related to auditory word discrimination scores. The results of the study show that with increasing age there is increased ability to discriminate words in the presence of noise. However, although the older the child the greater his ability to discriminate, a far greater effect than age on discrimination is the signal-to-noise treatment level, a finding which suggests that knowledge of the treatment condition may be a better predictor of auditory discrimination scores than a child's age. An additional finding was a general right-ear superiority in the presence of noise, most consistently found under the 0 signal/noise condition for children in kindergarten and in second and fourth grades.

OBJECTIVES To develop, implement, and assess the efficacy of a comprehensive, evidence-based smoking cessation program for entertainment industry workers and their families. METHODS Study participants were recruited from 5 outpatient medical clinics and a worksite setting. Tobacco use data were collected during the initial counseling visit and at 6-month follow-up. Univariate and multivariate regressions were used in analysis. RESULTS More than 50% of participants (n=470) self-reported 7-day abstinence at follow-up. The majority of participants used combination cessation medications, with more than 50% still using at least 1 medication at 6 months. CONCLUSIONS This evidence-based smoking cessation program using behavioral counseling and combination pharmacotherapy was successful with entertainment industry workers.

Background No pharmacotherapies have been shown to increase long-term (≥6 months) tobacco abstinence rates among smokeless tobacco (ST) users. Bupropion SR has demonstrated potential efficacy for ST users in pilot studies. We conducted a multicenter, randomized, double-blind, placebo-controlled, clinical trial to assess the efficacy and safety of bupropion SR for tobacco abstinence among ST users. Methods Adult ST users were randomized to bupropion SR titrated to 150 mg twice daily ( N = 113) or placebo ( N = 112) for 12 weeks plus behavioral intervention. The primary endpoint was the 7-day point-prevalence tobacco abstinence rate at week 12. Secondary outcomes included prolonged and continuous tobacco abstinence rates, craving and nicotine withdrawal, and weight gain. Results The 7-day point-prevalence tobacco abstinence rates did not differ between bupropion SR and placebo at the end treatment (53.1% versus 46.4%; odds ratio (OR) 1.3; p = 0.301). The 7-day point-prevalence abstinence did not differ at weeks 24 and 52. The prolonged and continuous tobacco abstinence rates did not differ at weeks 12, 24, and 52. A time-by-treatment interaction was observed in craving over time with greater decreases in the bupropion SR group. At 12 weeks, the mean (±S.D.) weight change from baseline among abstinent subjects was an increase of 1.7 (±2.9) kg for the bupropion SR group compared to 3.2 (±2.7) kg for placebo ( p = 0.005). Conclusions Bupropion SR did not significantly increase tobacco abstinence rates among ST users, but it significantly decreased craving and weight gain over the treatment period.

THIS IS the 39th annual poll in this now venerable series. The noted pollster George Gallup was one of the poll's founders and, until his death in 1987, played the major role in selecting the questions and writing the article that appeared in each year's Phi Delta Kappan. His son Alec, chairman of the Gallup Poll, stepped into a leadership role after his father's death and has continued to work closely with those at Phi Delta Kappa to maintain the standard of quality established by George Gallup. The Gallup Organization goes far beyond the normal role for a polling firm. Alec Gallup approves the wording of each question and monitors the development of the poll report to guarantee that the suggested interpretations are supported by the data. The poll has changed over the 39 years. It started as an effort to inform educators. While it continues to perform that role, it has come to serve as a source of information for those who shape education policy, and the database that has accumulated over 39 years of polling chronicles the growth and changes in K-12 schooling since the late 1960s. As it has grown in importance, the PDK/Gallup Poll has fueled debate regarding K-12 schooling, and charges of bias are routine. With that in mind, we have gradually reshaped the poll report to make it user-friendly and to draw the reader into the analysis of the data. We report the data, state what we believe they say, and leave it to the reader to reach his or her own conclusions. In this year's report, the statements following a table and designated as "Findings" are in the nature of summaries that we believe offer a fair interpretation of the data. Statements designated as "Conclusions" are highlighted because we think they capture the most significant of the poll results. These are offered as topics for debate. In the end, our aim is to let the data speak for themselves. IMPROVING STUDENT ACHIEVEMENT The 39th poll comes at a time when K-12 schooling is near the top of the agenda in state and national policy discussions, and efforts to improve student achievement dominate those discussions. Chief among the improvement efforts is No Child Left Behind (NCLB), the sweeping federal initiative. Given the importance of this law and the fact that the poll was founded on the belief that public support is a vital component of shaping effective education policy, it is appropriate to open this report with the public's reaction to NCLB and its principal strategy, standardized testing. Public View of NCLB Since 2003 the PDK/Gallup Poll has traced the evolving public response to NCLB. The analysis here focuses primarily on the questions asked in the current poll, but readers interested in more detail on the evolution of the public view should consult earlier poll reports. A question asked every year since 2003 seeks to find out how much people know about NCLB. The responses are reported in Table 1. For the first time, a majority (54%) say they know a great deal or a fair amount about the law. Sixty-five percent of public school parents give this response. However, 46% of the total group still say they know very little or nothing at all about NCLB. This percentage drops to 35% for public school parents. An important question is whether the gradual gain in knowledge about NCLB is causing the public to have a more favorable or more unfavorable view of the law. Trend data for this question are reported in Table 2. While 31 % say they have a very or somewhat favorable view of the law, 40% say they have a somewhat or very unfavorable view. The percentage selecting one of the two favorable responses has grown by 13% since 2003, while the percentage choosing one of the two unfavorable responses has climbed by 27%. An even stronger unfavorable view of NCLB is held by those who say they know a great deal or a fair amount about the law. * FINDING: It seems fair to say that, as the public knowledge of NCLB grows, the public's view of NCLB is becoming less and less favorable. …

Nicotine lozenges have been shown to increase tobacco abstinence rates in cigarette smokers, but they have not been evaluated in smokeless tobacco (ST) users. We conducted an open-label, one-arm, phase II clinical trial to evaluate the efficacy of the 4-mg nicotine lozenge for the treatment of withdrawal and craving associated with tobacco abstinence among ST users. Eligible subjects received 4-mg nicotine lozenges for 6 weeks followed by a 6-week taper. Subjects completed daily tobacco withdrawal diaries, and data on lozenge use, adverse events, and lozenge acceptability were collected. Urine anabasine was collected at 3 and 6 months for biochemical confirmation of self-reported tobacco abstinence. Participants were 30 ST users with a mean age of 35.4 years (SD=6.5) using an average of 4.2 cans or pouches (SD=3.2) of ST per week for a mean of 15.1 years (SD=6.5). Among subjects continuously tobacco abstinent for the first 2 weeks, no significant increases in composite withdrawal symptoms were observed, compared with baseline symptoms, whereas craving decreased significantly. Biochemically confirmed 7-day point-prevalence tobacco abstinence was 53% (95% CI=34%-72%) at 12 weeks (end of treatment) and 47% (95% CI=28%-66%) at 6 months. Few adverse events attributable to the nicotine lozenge occurred, and the lozenge was perceived as helpful in assisting subjects quit ST. The use of the 4-mg nicotine lozenge appears promising for the clinical treatment of withdrawal symptoms and craving associated with tobacco abstinence in ST users. Future phase III clinical trials investigating the efficacy of nicotine lozenges are warranted.

Previous studies of Pacific salmonid passage over Snake River dams indicated slowed passage at transition pools, the transition area between the fishway entrance and the fish ladder. In 2001 and 2002, we conducted an experiment to determine if modified weirs affected adult salmon and steelhead passage times and route selection through the Lower Granite Dam transition pool. Fish attraction flows through the lower ladder weirs were experimentally increased using removable panels. During the experiment we monitored radio-tagged adult Chinook salmon and steelhead to determine passage routes and times through the transition pool. The weir treatment increased the number of spring–summer Chinook salmon passing straight through the transition pool compared to those exiting the transition pool to the collection channel or tailrace. Mean passage times through the transition pool differed among routes and were significantly lower during treatment periods for the exit-to-collection channel route in spring-summer Chinook salmon, but not for other routes. Passage times among routes differed in steelhead, but there was no evidence of treatment effects on route use or passage time. Fall Chinook exhibited similar trends in route use and passage time to spring–summer Chinook, but differences were not significant, perhaps because of relatively small sample size. Total dam passage times did not differ by treatment or route for any run. Fish depth during passage of the transition pool suggested that most fish passed through submerged orifices and supported the hypothesis that increased water velocity through these orifices caused the increase in straight-through passage in spring–summer Chinook. Collectively, the results suggested the weir modifications provided improvement to passage through the transition pool for spring–summer Chinook and no evidence of negative effects on other runs. The results from this study were used to develop new design criteria and modifications of the Lower Granite Dam fishway. Copyright © 2006 John Wiley & Sons, Ltd.

AS THIS poll appears for its 38th consecutive year, it serves as a memorial and a continuing tribute to the work of George Gallup, Sr. He was one of the poll's founders, considered it his poll, picked the panel to select the questions, oversaw the surveying, analyzed the results, and wrote the report. He drew great satisfaction from the poll and watched over it closely until his death in 1984. The close relationship between the Gallup Organization and Phi Delta Kappa International continues today with Alec Gallup, Chairman of the Gallup Poll, replacing his father. Since 1992, I have had the pleasure of directing the poll for PDK. Alec and I share the belief that being true to the poll's heritage requires keeping it free from bias while operating at the cutting edge of issues facing K-12 schools. Alec controls the wording of the questions and is responsible for making sure that the findings and conclusions are supported by the data. We present the results here in a user-friendly fashion intended to permit readers to delve into the data to verify our interpretations or draw their own conclusions.--LCR Major Findings and Conclusions The results of this poll are released at a press conference held in August in the Gallup Building in Washington, D.C. The first question a reporter asked at a recent conference was, "What are the major story lines of this poll?" Opening by answering that question has now become standard practice for the press conference, and we replicate it here by starting with the findings and conclusions that we believe have the greatest significance. Our aim is not to minimize or downplay the remaining findings and conclusions. However, we believe that the findings and conclusions presented here provide a context for interpreting the remaining results. The major findings center on how people want improvement to come about, on the way the public assesses the public schools, and on how it views some of the strategies used in current change efforts. (The tables pertaining to these questions are grouped at the end of this section.) Everything else in this poll builds to the final section, which deals with the change strategy dominating K-12 education today, the implementation of the No Child Left Behind (NCLB) Act. Source of School Improvement We begin with a brief story. A reporter at the 2001 press conference suggested asking the public whether improvement in public education should be sought by reforming the existing system or by finding an alternative system. This question would provide a benchmark to use in weighing the responses to questions dealing with proposals for change. The suggestion was accepted, a question was framed and asked in 2002, and the question has been repeated in each subsequent poll. (See Table 1.) Findings. The 2002 question found that 69% of the public expressed a preference for improvement through reforming the existing system. The number this year is 71%. By contrast, just 27% of respondents in 2002 preferred seeking an alternative system, and that figure is at 24% for 2006. Conclusion I. The public's strong preference is to seek improvement through the existing public schools. Policies shaped with this fact in mind are most likely to gain public approval. Rating of the Public Schools Each year we ask the public to assess its schools using the familiar A to F scale. This practice started in 1974 with a question asking respondents to grade the schools in the local community. Grading of the nation's schools was added in 1981, and, beginning in 1985, parents were asked to grade the school their oldest child attends. Each question has been repeated every year since it was first asked. (See Tables 2, 3, and 4.) Findings. In this year's poll, 49% give the schools in the community an A or a B. The percentage last year was 48%. The percentage of A's and B's climbs to 56% for public school parents and to 64% when parents grade the school their oldest child attends. …

The relationships between lower Columbia River water temperatures and migration rates, temporary tributary use, and run timing of adult fall Chinook salmon Oncorhynchus tshawytscha were studied using historical counts at dams and recently collected radiotelemetry data. The results from more than 2,100 upriver bright fall Chinook salmon radio-tagged over 6 years (1998, 2000–2004) showed that mean and median migration rates through the lower Columbia River slowed significantly when water temperatures were above about 20°C. Slowed migration was strongly associated with temporary use of tributaries, which averaged 2–7°C cooler than the main stem. The proportion of radio-tagged salmon using tributaries increased exponentially as Columbia River temperatures rose within the year, and use was highest in the warmest years. The historical passage data showed significant shifts in fall Chinook salmon run timing distributions concomitant with Columbia River warming and consistent with increasing use of therm...

High spill volume at dams can create supersaturated dissolved gas conditions that may have negative effects on fish. Water spilling over Columbia and Snake River dams during the spring and summer creates plumes with high dissolved gas that extend downstream of dam spillways and throughout reservoirs and creates gas-supersaturated conditions throughout the water column. During the spring and summer of 2000, 228 adult Chinook salmon Oncorhynchus tshawytscha were tagged at Bonneville Dam with archival radio data storage transmitters (RDSTs) that recorded depth and water temperature as the fish migrated through dams and reservoirs of the lower Columbia and Snake rivers. Swimming depths from 131 of the 228 adult spring and summer Chinook salmon tagged with RDSTs were used to estimate the potential for gas bubble formation given in-river dissolved gas concentrations and hydrostatic compensation. We found that adult spring and summer Chinook salmon spent a majority of the time at depths that would have ...

THIS IS the 37th consecutive year for this poll. Its early success can be credited to George Gallup, Sr. Gallup considered it his poll, picked the panel to select the questions, oversaw the surveying, analyzed the results, and wrote the report. The close relationship between Phi Delta Kappa and the Gallup Organization continued after the death of George Gallup, Sr., with his son, Alec Gallup, representing that organization. Since 1992, I have had the privilege of directing the poll for PDK. Alec and I share the beliefs that the procedures used minimize the possibility of bias in the poll and present the results in user-friendly fashion. The Gallup Organization has absolute authority over the phrasing of the questions and certifies that the data support the findings and conclusions. Alec and I use the executive summary to state our best judgment as to what the data mean. Each conclusion cites the table or tables containing the data on which it is based. Some readers tell us that they read the tables first, draw their own conclusions, and then compare those with the ones we have drawn. Alec and I believe the information in this poll is unusually significant and commend it to your use.--LCR Executive Summary In this Executive Summary we present a number of findings and conclusions of this, the 37th Annual Phi Delta Kappa/ Gallup Poll of the Public's Attitudes Toward the Public Schools. Some conclusions strike us as more significant than others. Conclusions 10 and 11, for example, regarding the achievement gap, and conclusions 12 through 16, dealing with the No Child Left Behind (NCLB) Act, seem worthy of special notice. That the public is so strong in its support for closing the achievement gap should send a clear message to policy makers. There is also a message in the conclusions related to NCLB in that they note the public's disagreement with the law's strategies and, at the same time, suggest that there is still time for midcourse corrections. Again, we feel that policy makers would do well to heed the message. Another important contribution of the poll results is that they should help to destroy one of the myths surrounding the public schools: that the public schools are losing public support. The trend lines in this poll suggest the exact opposite. The grades the public assigns the schools remain as high as ever and are truly impressive when public school parents give their evaluation; the public continues to express a strong preference for change through the existing public schools; support for choice shows no sign of increasing and could be said to be lagging; and it is the public schools to which the public turns for closing the achievement gap. Finally, before we move to the specific conclusions, it seems necessary to comment on the important distinction between the nation's schools and schools in the community. These polls have repeatedly documented that the public has a low opinion of the nation's schools and a high opinion of schools in the local community. The media, some education experts, and some government leaders base their comments on the nation's schools and are then surprised when they do not resonate with a public that is concerned primarily with the schools in the community, schools that generally draw approval. As long as those seeking to improve the public schools make their case on the supposed inadequacy of the schools in the community, support for improvement will be hard to build. We turn now to the 20 conclusions that we believe summarize the most significant findings of this year's poll. The data supporting each conclusion are provided, and the tables in which additional supporting data will be found are cited by number. 1. Lack of financial support is solidly entrenched in the public mind as the major problem facing the nation's public schools. Responding to an open-ended question, 20% of those surveyed mention lack of financial support. …

We radio-tagged 577 adult sockeye salmon (Oncorhynchus nerka) returning to the Columbia River in 1997 to determine how migration behaviors were related to migration success in an altered river system. The probability of successful migration declined dramatically for late-entry individuals, concomitant with declines in discharge and the onset of stressful temperatures. Long dam passage times were not related to unsuccessful migration at most dams. However, when migration histories were analyzed across multiple dams or reservoirs, relatively slow migration was significantly associated with unsuccessful migration, suggesting potential cumulative effects. Median passage times at dams were rapid (7.9–33.4 h), although 0.2%–8% of salmon took more than 5 days to pass. Reservoir passage was also rapid, averaging 36.8–61.3 km·day–1, and appeared to compensate for slowed migration at dams. Rates observed in the unimpounded Hanford Reach suggest that total predam migration rates may have been similar to current rates. Overall, our results suggest that cumulative effects may be more important than negative effects of passage at single dams and that hydrosystem alteration of temperature regimes in the migration corridor may have an important indirect negative impact on adults.

An understanding of the migration timing patterns of Pacific salmon Oncorhynchus spp. and steelhead O. mykiss is important for managing complex mixed-stock fisheries and preserving genetic and life history diversity. We examined adult return timing for 3,317 radio-tagged fish from 38 stocks of Columbia River basin spring–summer Chinook salmon O. tshawytscha over 5 years. Stock composition varied widely within and between years depending on the strength of influential populations. Most individual stocks migrated at similar times each year relative to overall runs, supporting the hypotheses that run timing is predictable, is at least partially due to genetic adaptation, and can be used to differentiate between some conspecific populations. Arrival timing of both aggregated radio-tagged stocks and annual runs was strongly correlated with river discharge; stocks arrived earlier at Bonneville Dam and at upstream dams in years with low discharge. Migration timing analyses identified many between-stock ...

We assessed upstream migration rates of more than 12,000 radio-tagged adult Chinook salmon Oncorhynchus tshawytscha and steelhead O. mykiss past a series of dams and reservoirs on the Columbia and Snake rivers. Most fish passed each dam in less than 2 d. Migration behavior in reservoirs and through multiple dam–reservoir reaches varied within and between years and between species. Within years, spring–summer Chinook salmon migrated more rapidly as water temperature and date of migration increased; between years, spring–summer Chinook salmon migrated fastest in low-discharge years. Steelhead migrations slowed dramatically when summer water temperatures peaked within each year, then increased as rivers cooled in fall. Mean summer temperatures explained more between-year variation in steelhead passage rates than did differences in discharge. Fall Chinook salmon migration rates also slowed during periods of warm water. Protracted passage times within the hydrosystem were most likely for fish from all...

Upstream migration rates were assessed for 1801 radio-tagged adult spring-summer Chinook salmon Oncorhynchus tshawytscha through 12 unimpounded river reaches in the Columbia River basin from 1997 to 2002. Reaches were 36 to 241 km long (mean= 130km) and included sections of the large Columbia and Snake Rivers and smaller free-flowing tributaries. Median Chinook salmon migration rates ranged from 35 km day -1 in the Columbia and Snake Rivers. Using multivariate analyses, migration date explained the most variance in Chinook salmon migration rates while river discharge, migration year and migration reach were secondary. Both within and between years, Chinook salmon migrated more rapidly as migration date increased and more slowly when discharge was high. Arrival at high elevation spawning grounds at appropriate times and increased metabolic activity and reproductive maturation may explain the greater power of migration date, relative to river discharge, in predicting migration rates of Columbia basin spring-summer Chinook salmon.

The September report on the 36th Annual Phi Delta Kappa/Gallup Poll of the Public's Attitudes Toward the Public Schools did not go into the finer demographic distinctions that most polls explore. In this election year, Mr. Rose takes a closer look at the data to analyze how various subgroups of the population view the parties' and candidates' stances on education. MUCH OF the data collected in polling efforts goes unreported and unnoticed. The information gathered for the Phi Delta Kappa/Gallup Poll of the Public's Attitudes Toward the Public Schools is no exception. In the 2004 poll, the Gallup Organization summarized the data collected in tabulations that required 210 pages. Within those pages, the data were disaggregated according to gender, race, age, political affiliation, education, region of the country, occupation, type of community, income level, and children in school or not. This exercise produced 41 subgroups, and for the 16-page report in the September Kappan, Alec Gallup and I extracted and summarized findings and drew conclusions. But we made little use of the information about these subgroups. In this article, I delve further into the 2004 data, focusing on the five questions that deal specifically with the politics of education. These questions cover issues that are currently being debated in the Presidential election. I include data from previous polls to provide a more comprehensive picture. However, I offer one caution. In addition to reporting data, I go further in this article than in the September report in attempting to identify cause-and-effect relationships. Where this is the case, the speculative nature of the comments is made clear so that readers can decide for themselves whether they seem valid. K-12 Education Becomes a Major Political Issue In recent years, K-12 education has emerged as an important consideration at all levels of government. Although traditionally regarded as a local responsibility, in the last 40 years of the 20th century, K-12 education evolved into an important political issue at both the state and federal levels. Generally, that trend has meant that power has shifted from the local to the state level and above. The Elementary and Secondary Education Act of 1965 marked the beginning of serious federal involvement. And today, with the latest version of ESEA, the No Child Left Behind (NCLB) Act, some contend that the federal government is seeking, or perhaps already playing, a far more dominant role. Funding considerations triggered, in large part, the shift of control from the local to the state level. Ironically, some of the change can be attributed to the desire on the part of the states to limit spending. But at the same time, the demand for the equalization of educational services, a demand that requires funding that local communities cannot provide, has led the states to become ever more involved in the funding of local schools. And, given that funding and control are inseparable, shifting funding to the state level has tended to shift control there as well. Funding is also an issue for the federal government, as it increases its role through NCLB. Many contend that greater federal involvement must be accompanied by significantly more federal dollars. And, finally, education has become more politicized as we have moved from a society in which higher levels of education were considered the province of the few to one in which a high-quality education is viewed as both a universal right and a necessity for individual welfare. Political Matters and the PDK/Gallup Poll Over time, polls can track trends related to issues in education. Therefore, as educational issues have become more deeply enmeshed in political considerations, the PDK/Gallup poll has taken on a political focus. And the issues covered in the poll have evolved into the same ones that are dominating the political scene. For a short time, education actually topped the list of national concerns. …

During their upstream spawning migration in the Columbia River basin, some adult salmonids Oncorhynchus spp. ascend and then fall back over main-stem hydroelectric dams. Fallback can result in fish injury or death, migration delays, and biases in fishway counts, the primary index for escapement and the basis for production estimates and harvest quotas. We used radiotelemetry to calculate fallback percentages and rates, reascension percentages, biases in fishway escapement estimates due to fallback, and occurrence of behaviorally motivated fallback (correcting overshoot of natal sites) by spring–summer and fall Chinook salmon O. tshawytscha and steelhead O. mykiss. The study area included eight Columbia River and Snake River dams evaluated from 1996 to 2001. For all years combined, about 22% of spring–summer Chinook salmon, 15% of fall Chinook salmon, and 21% of steelhead fell back at least once at a dam. Fallback percentages for spring–summer Chinook salmon were generally highest at Bonneville an...

ACTION On September 9, 2003, the Centers for Medicare and Medicaid Services (CMS) issued final rules seeking to clarify hospital obligations under the Emergency Medical Treatment and Active Labor Act (EMTALA). The new rules clarify several areas of EMTALA, but also raise significant new compliance questions for hospitals, especially with respect to on-call panels and what it means for a person to come to the emergency department. IMPACT As always, hospitals must comply with the new regulations or face possible Medicare decertification action by CMS, civil monetary penalties of up to $50,000 per violation, and civil liability to patients and others. In order to comply, hospitals and physicians will need to examine carefully their current policies, procedures and practices, and to educate thoroughly all medical and support staff.

Aims Spit tobacco use is prevalent in the United States and is associatedwith adverse health consequences. Health-care providers have neitherevidence summaries nor evidence-based guidelines to assist themin treating patients who use spit tobacco. Design We completed a systematic review of the literature to determinethe efficacy and safety of pharmacological and behavioral interventionsfor the treatment of spit tobacco use. Findings We found six randomized controlled trials testing pharmacological interventionsand eight testing behavioral interventions. Using random-effects meta-analyses,bupropion sustained-release (SR) increased point prevalence tobaccoabstinence at 12 weeks [odds ratio (OR) 2.1; 95% confidenceinterval (CI), 1.0–4.2]. Nicotine replacementtherapy with patch or gum increased point prevalence tobacco abstinenceat 6 months (OR 1.3; 95% CI, 1.0–1.6).Behavioral interventions increased long-term (6 month)point prevalence tobacco abstinence (OR 1.7; 95% CI, 1.1–2.9).Studies including an oral examination followed by feedback to thepatient had the highest treatment effect. Conclusions Behavioral interventions for ST users are effective for increasing STabstinence rates. Bupropion SR is probably effective and nicotinereplacement therapy may be effective. This evidence from randomizedcontrolled trials provides health-care professionals with informationnecessary to effectively treat spit tobacco use.

Hydropower dams in the lower Columbia River may contribute to declines in the populations of anadromous Pacific lamprey Lampetra tridentata by limiting access to historical spawning locations. To identify obstacles to migration, we documented the movements of radio-tagged adult Pacific lampreys in specific areas of fishways (entrances, collection channels, transition areas, ladders, and counting stations) at the first three dams they encounter as they move upstream (Bonneville, The Dalles, and John Day). From 1997 to 2000, 147-299 radio-tagged lampreys were released downstream from Bonneville Dam. In 1997 and 2000, we also moved 50 radio-tagged lampreys each year to positions upstream from Bonneville Dam to assess the passage success of fish that had not passed through an entire fishway (i.e., “naive fish”). The passage efficiency of lampreys at Bonneville Dam was 38-47%, and the median time required to pass over the dam ranged from 4.4 to 5.7 d. In contrast, 50-82% of the lampreys passed over Th...

Background: Assessment of nicotine metabolism and disposition has become an integral part of nicotine dependency treatment programs. Serum nicotine concentrations or urine cotinine concentrations can be used to guide nicotine patch dose to achieve biological concentrations adequate to provide the patient with immediate relief from nicotine withdrawal symptoms, an important factor in nicotine withdrawal success. Absence of nicotine metabolites and anabasine can be used to document abstinence from tobacco products, an indicator of treatment success. Methods: The procedure was designed to quantify nicotine, cotinine, trans-3′-hydroxycotinine, anabasine, and nornicotine in human serum or urine. The technique required simple extraction of the sample with quantification by HPLC–tandem mass spectrometry. Results: The procedure for simultaneous analysis of nicotine, its metabolites, and tobacco alkaloids simultaneously quantified five different analytes. Test limit of quantification, linearity, imprecision, and accuracy were adequate for clinical evaluation of patients undergoing treatment for tobacco dependency. The test readily distinguished individuals who had no exposure to tobacco products from individuals who were either passively exposed or were abstinent past-tobacco users from those who were actively using a tobacco or nicotine product. Conclusions: Nicotine, cotinine, trans-3′-hydroxycotinine, nornicotine, and anabasine can be simultaneously and accurately quantified in either serum or urine by HPLC–tandem mass spectrometry with imprecision

Few pharmacological therapies have been shown to increase abstinence rates among spit tobacco (ST) users. Bupropion has been shown to be effective in increasing abstinence rates among smokers but has not been studied in ST users. Sixty-eight adult (aged > or = 18 years old) regular users of ST who were motivated to stop using ST were enrolled in a randomized, double-blind, placebo-controlled pilot study of bupropion sustained release (SR) or placebo for 12 weeks. The primary endpoint was 1-week, biochemically confirmed point-prevalence tobacco abstinence rate at the end of treatment (week 12). Nicotine withdrawal symptoms and weight change were assessed. At the end of 12 weeks of therapy, the point-prevalence tobacco abstinence rate was 44% in the bupropion group and 26% in the placebo group (p = 0.064). At 24 weeks following initiation of medication, the point-prevalence abstinence rate was 29% for both groups. After 7 weeks of medication, subjects on bupropion reported significantly less (p< or = 0.034) nicotine withdrawal than placebo. The mean weight change from baseline to end of treatment was +0.7 +/- 1.9 kg for bupropion and +4.4 +/- 2.4 kg for placebo (p = 0.03). The 6-month weight change for continuously abstinent subjects was 3.4 +/- 3.6 kg in the bupropion group and 6.2 +/- 5.0 kg in the placebo group (p = 0.49). Bupropion may increase abstinence rates in ST users and appears to attenuate weight gain during ST abstinence. Larger randomized, controlled trials of bupropion for ST users are needed.

Objective We explored the possibility that the administration of intravenous dopamine increases the risk for delirium as manifested by need for haloperidol. Design This study was based on a retrospective analysis. To examine the contribution of dopamine in the prediction of need for haloperidol, a multivariate logistic regression model was used. Setting University hospital. Patients All inpatient admissions to Stanford University Hospital over a 1-year period (n = 21,844). Interventions None. Measurements and main results Dopamine administration was associated with nearly a tripling of the odds of subsequent need of the antipsychotic drug (chi-square = 108, df = 1, p =.0001, odds ratio = 2.89), even after intensive care unit admission and diagnostic related group weight were considered as indicators of severity of illness. Even when analysis was limited to patients seen in the intensive care unit setting (n = 3,308), dopamine administration remained a very strong risk factor for haloperidol and hence possibly for delirium. The increased risk of need for haloperidol in patients administered dopamine is evident in every age group after age 20. Conclusions The retrospective nature of this study, the inexact method to assess acuity, and, most of all, the use of haloperidol as an indicator of the presence of delirium preclude concluding that dopamine is directly a risk factor for delirium, much less a causal risk factor. However, the association is potent enough to suggest this possibility strongly and thus supports the need for prospective studies to examine the relationship between dopamine and delirium and to consider possible prophylactic treatment against delirium in those given dopamine.

Objective To describe a medical student-run smoking intervention clinic, report initial outcomes, and assess medical student competence in smoking intervention counseling. Patients and Methods Volunteer medical students of Mayo Medical School in Rochester, Minn, staffed a free smoking intervention clinic in conjunction with the Salvation Army Free Acute Care Clinic between December 1997 and January 1999. Patients received a comprehensive intervention for smoking that comprised counseling, frequent follow-up contact, and pharmacologic therapy, including bupropion and nicotine replacement. Eighty-eight patients seen during the first 13 months of the clinic's operation and 30 medical student volunteer counselors were included in the study. Patients were contacted via telephone to assess 6-month self-reported smoking abstinence. Medical student counselors completed a self-assessment questionnaire surveying competence before and after working in the clinic. Results The 6-month self-reported smoking abstinence rate was 18% (95% confidence interval, 11%-28%). Twelve of 14 medical students completing the survey reported improved competence in smoking intervention counseling. Conclusions A comprehensive smoking intervention program provided by medical students yielded smoking abstinence rates comparable to other treatment programs. Medical students believed they improved their smoking cessation counseling skills.

During times of scarce resources available for providing patient care, it becomes necessary to validate the effectiveness of standard practices that consume caregivers' time and efforts. Three nurse managers of nursing units serving diverse patient populations studied the effectiveness of continuous intake and output in estimating daily fluid balance. They examined 48-hour records of daily weight and intake and output of 73 patients and correlated the two. Their findings suggest that even when caregiver charting compliance is optimal, daily intake and output recording provides unreliable results. The authors recommend daily weights alone be adopted for all patients who are not experiencing acute renal conditions.

trans-3′-Hydroxycotinine (THOC) has been recognized as the most abundant metabolite of nicotine. In an attempt to assess THOC and cotinine (COT) concentrations during nicotine transdermal therapy, we developed a new quantitative gas chromatography–mass spectrometry (GC–MS) method for simultaneous determination of total and free THOC and COT in human urine. The method utilizes the following: (a) hydrolysis of conjugated THOC and COT by β-glucuronidase; (b) basic extraction of THOC and COT with mixed dichloromethane and n-butyl acetate; (c) derivatization of THOC with bis(trimethylflurosilyl)acetamide; and (d) separation and identification by GC–MS with selective ion monitoring. Lower limits of quantification for the assay were 50 and 20 μg/L for THOC and COT, respectively. The intra- and interassay CVs were 4.4% and 11% for THOC, and 3.9% and 10% for COT at 1000 μg/L. The results from six consecutive 24-h urine collections in 71 subjects administered daily transdermal nicotine doses of 11, 22, and 44 mg showed that, on average, free THOC was 76% of total THOC and free COT was 48% of total COT in all subjects. THOC is the major metabolite of nicotine and constitutes 20% of total nicotine intake at steady state, whereas urinary nicotine and COT excretion were 8% and 17%, respectively. The method is useful for simultaneous determination of free and total THOCand COT and can be used to assess the urinary excretion of these metabolites during transdermal nicotine therapy.

PREVIEWHelping patients stop smoking is one of the most important—and frustrating—services primary care physicians can provide. Many physicians are reluctant to spend time talking about tobacco use with patients who show little or no interest in changing their habits. Fortunately, specific techniques have been identified that can make the task easier. This article from the distinguished Nicotine Dependence Center of the Mayo Clinic looks at the “best practices” for dealing with nicotine dependence.

Nicotine nasal spray and nicotine gum have been found to be effective in relieving nicotine withdrawal symptoms. In this randomized single-blind study, 91 cigarette smokers were randomly assigned to a single 1 mg dose of active nicotine nasal spray (n = 29), active 4 mg nicotine gum (n = 31), saline placebo nasal spray (n = 16) or placebo gum (n = 15). Following overnight abstinence, subjects repeatedly completed visual analog scales for assessing nicotine withdrawal symptoms over 30 min preceding (time -30 min to time 0) and 120 min following a single dose of study medication. This sequence was performed 3 times during the day. Nicotine withdrawal symptoms were assessed on a 41-point visual analog scale (1 = no withdrawal, 41 = extreme withdrawal). At the initial session only, blood samples for serum nicotine levels were taken at baseline, then at 5, 10, 30 and 120 min following study drug administration. The mean (± SD) age of the subjects was 38.6 (±10.1) years, 48% were females, smoking rate was 24.5 (±7.8) cigarettes per day, and years of smoking was 19.9 (±10.0). A single 1 mg dose of nicotine nasal spray provided more immediate relief for craving for a cigarette compared to a single 4 mg dose of nicotine gum. Serum venous nicotine levels for the active nicotine nasal spray and nicotine gum were comparable at 5 and 10 min while the levels were higher for nicotine gum at 30 and 120 min. Changes in withdrawal symptoms were not found to be related to serum venous nicotine levels. Our findings provide a rationale for the as needed use of nicotine nasal spray to control withdrawal symptoms, possibly in combination with other medications with longer acting effects.

As part of a clinical trial investigating the level of nicotine replacement with different doses of transdermal therapy for smoking cessation, peak and trough serum nicotine and plasma cotinine concentrations were measured in 70 subjects while they were actively smoking (baseline) and daily for 6 consecutive inpatient days while they were receiving transdermal nicotine. Subjects were randomly assigned to a daily 24-hour patch delivering a transdermal nicotine dose of 0, 11, 22, or 44 mg and stratified by self-reported smoking rate as either light (10-15 cigarettes per day), moderate (16-30 cigarettes per day), or heavy (>30 cigarettes per day). Steady-state concentrations of nicotine and cotinine were attained in 1 and 3 days, respectively, at all doses and were independent of baseline smoking rate. Mean percentage replacement of nicotine was calculated by dividing steady-state peak nicotine or cotinine concentrations by their respective baseline concentrations. Significant underreplacement occurred in subjects receiving the 11 mg/day patch regardless of baseline smoking rate. Underreplacement also occurred in moderate and heavy smokers receiving 22 mg/day and in light smokers at this same dose. Complete replacement occurred only in subjects receiving the 44 mg/day patch. These results have several implications for transdermal nicotine therapy. First, with the higher nicotine and cotinine levels observed with heavier smoking, it is inherent that one size does not fit all, and there is a need to consider more individualization of dosage for nicotine patch therapy. Second, there is substantial underreplacement with the 22 mg/day dose in moderate to heavy smokers and in some light smokers. Third, even with twice the usual dose (i.e., 44 mg/day), there was no accumulation of either nicotine or cotinine. Plasma cotinine levels after achievement of steady state (i.e., after 3 days of patch therapy) can be collected at any time and used to calculate percent replacement using baseline levels.

Phi Delta Kappa and the Gallup Organization have been asking the public what it thinks of the public schools since the late 1960s. Mr. Rose describes the evolution of the PDK/Gallup poll itself and how educators and policy makers are influenced by its findings. THE 37th Annual Phi Delta Kappa/ Gallup Poll of the Public's Attitudes Toward the Public Schools was released in August 2005 at a press conference held at the Gallup Building in Washington, D.C. Members of the national media were in attendance; the president of Phi Delta Kappa International came from Denver to preside; and the poll's director, PDK's executive director, and a consultant to the poll responded to questions for over 40 minutes. The conference was carried on C-SPAN, and numerous media outlets reported the poll results. The poll was subsequently printed in a 16-page article in the September issue of the Phi Delta Kappan. Major publications, such as the Christian Science Monitor and Education Week, analyzed the results, and some reprinted the poll in part or even in its entirety. Those who started this poll in the late 1960s would be amazed at the way it has endured and grown in both content and purpose. Its annual release is widely anticipated. It is disliked by some, respected by others. A former secretary of education, having reviewed the approval ratings given the public schools, commented, "We will never bring about the needed change if people continue to believe that they have good schools." Today's PDK/Gallup poll is a cooperative effort between PDK and the Gallup Organization, a tie established after the first poll had been published in 1969 in the IDEA/ Reporter. The poll was the brainchild of James Kettering and Edward Brainard, two members of the prestigious Kettering Foundation's board. Envisioning a poll that would provide educators with insights regarding the public's views on day-to-day issues, they enlisted the expertise and support of George Gallup, Sr., who was on the way to establishing public-opinion polling as a true science. Gallup, strongly committed to the public schools, liked the idea of an education poll and used his expertise to make it a reality. He was the poll's first director. In a 2004 conversation in Colorado, Brainard recalled that, while the first poll was judged a success, there was general agreement that it needed wider distribution. Stanley Elam, who had established the Phi Delta Kappan as a leading education journal since he took over as its editor in 1956, readily signed on with the understanding that the Kappan would be the poll's publisher. Thus began the partnership between the Gallup Organization and Phi Delta Kappa that has so far endured for nearly four decades. THE EARLY DAYS In the early days, Gallup convened a national panel of experts to discuss the issues the poll should explore. He chaired the meeting, asked questions, listened intently, and took copious notes. At some point, he would thank everyone and declare the meeting over. Then he would draft the questions, prepare the questionnaire, and direct the polling process. When the surveying was complete, Gallup analyzed the results, picked out the significant findings, and wrote the report. Elam edited it, checking frequently with its author, and the poll was published in the Kappan. From 1969 until his death in 1984, this was George Gallup's poll, and he delighted in it. Alec Gallup, co-chair of the Gallup Organization, became the point person for the poll after his father's death. He monitors the questions and co-authors the report. Stan Elam remained a co-author of the report until 1995, and I joined Stan and Alec in 1991 and became co-author, with Alec, in 1995. THE PROCESS TODAY The poll cycle starts in October, when potential questions are sought from and proposed by a variety of sources. Roughly half the questions are trend questions, whose meaning is enriched by the valuable data collected when they were asked in previous years. …