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Background: The optimal timing of vaccination with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccines after cellular therapy is incompletely understood. The objectives of this study are to determine whether humoral and cellular responses after SARS-CoV-2 vaccination differ if initiated <4 months versus 4-12 months after cellular therapy., Methods: We conducted a multicenter, prospective, observational study at 30 cancer centers in the United States. SARS-CoV-2 vaccination was administered as part of routine care. We obtained blood prior to and after vaccinations at up to 5 time points and tested for SARS-CoV-2 spike (anti-S) IgG in all participants and neutralizing antibodies for Wuhan D614G, Delta B.1.617.2, and Omicron B.1.1.529 strains, as well as SARS-CoV-2-specific T-cell receptors, in a subgroup., Results: We enrolled 466 allogeneic hematopoietic cell transplantation (HCT) (n = 231), autologous HCT (n = 170), and chimeric antigen receptor T-cell (CAR-T-cell) therapy (n = 65) recipients between April 2021 and June 2022. Humoral and cellular responses did not significantly differ among participants initiating vaccinations <4 months versus 4-12 months after cellular therapy. Anti-S IgG ≥2500 U/mL was correlated with high neutralizing antibody titers and attained by the last time point in 70%, 69%, and 34% of allogeneic HCT, autologous HCT, and CAR-T-cell recipients, respectively. SARS-CoV-2-specific T-cell responses were attained in 57%, 83%, and 58%, respectively. Pre-cellular therapy SARS-CoV-2 infection or vaccination and baseline B-cell count were key predictors of post-cellular therapy immunity., Conclusions: These data support mRNA SARS-CoV-2 vaccination prior to, and reinitiation 3 to 4 months after, cellular therapies with allogeneic HCT, autologous HCT, and CAR-T-cell therapy., Competing Interests: Potential conflicts of interest . J. A. H—research funding: AlloVir, Geovax, Merck; consulting: Pfizer, Gilead, Moderna, Geovax, AlloVir. J. H. Y.—research funding: AlloVir, Ansun, Cidara, F2G, GSK, NobelPharma, Pulmocide, Scynexis, Shire/Takeda. L. W. L.—employment and equity holder in Adaptive Biotechnologies Corporation. M. V. D.—research funding: Janssen, Roche/Genentech. R. N.—consulting: Ono Pharmaceutical, Jazz Pharmaceuticals, Bluebird Bio, Omeros Pharmaceutical, Sanofi, Pfizer. J. M.—consulting: Evision, Kite, Allovir, Bristol Myers Squibb, Novartis, CRISPR, Nektar, Caribiou Bio, Sana Technologies, Legend Biotech. S. D.—research funding: MSK Leukemia SPORE Career Enhancement Program and MSK Gerstner Physician Scholar program. J. J. A.—employment: National Marrow Donor Program; Advisory Board: AscellaHealth, Takeda. M. H.—research support/funding: Takeda Pharmaceutical Company, ADC Therapeutics, Spectrum Pharmaceuticals, Astellas Pharma; consultancy: Incyte Corporation, MorphoSys, SeaGen, Gamida Cell, Novartis, Legend Biotech, Kadmon, ADC Therapeutics, Omeros, AbbVie, Caribou, CRISPR, Genmab, Kite; Speaker’s Bureau: Sanofi Genzyme, AstraZeneca, BeiGene, ADC Therapeutics, Kite; Data Monitoring Committee: Myeloid Therapeutics, Inc. M. L. R.—research funding from Jazz Pharmaceuticals and Atara Bio-Pharma; employment by IQVIA Biotech and Kura Oncology; stock in Kura Oncology. M. M. H.—research funding from Astellas Pharma, CSL Behring, Incyte, Sanofi; consultancy: Sobi, Inc. M.-A. P.—honoraria from Adicet, Allogene, Allovir, Caribou Biosciences, Celgene, Bristol-Myers Squibb, Equilium, Exevir, ImmPACT Bio, Incyte, Karyopharm, Kite/Gilead, Merck, Miltenyi Biotec, MorphoSys, Nektar Therapeutics, Novartis, Omeros, OrcaBio, Sanofi, Syncopation, VectivBio AG, and Vor Biopharma; he serves on Data and Safety Monitoring Boards (DSMBs) for Cidara Therapeutics and Sellas Life Sciences, and the scientific advisory board of NexImmune; he has ownership interests in NexImmune, Omeros, and OrcaBio; he has received institutional research support for clinical trials from Allogene, Incyte, Kite/Gilead, Miltenyi Biotec, Nektar Therapeutics, and Novartis. All other authors report no potential conflicts. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed., (© The Author(s) 2024. Published by Oxford University Press on behalf of Infectious Diseases Society of America. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

Background: Ultra-low volume (ULV) space sprays aerosolize insecticide formulated products (FP) to contact flying mosquitoes, while barrier sprays expose mosquitoes to FP residue on vegetation and other surfaces. Centers for Disease Control and Prevention bottle bioassays used to assess insecticide resistance are based on residual active ingredient (AI) exposure and do not directly relate to FP efficacy. The current pilot study developed a novel compact wind tunnel for mosquito exposure to FP. Caged Aedes albopictus and Culex pipiens/quinquefasciatus were exposed to undiluted Biomist®3 + 15 FP (permethrin AI) or air (control) within the wind tunnel, transferred to new cages, and held in a 28 °C incubator. Separate mosquitoes were exposed to residual permethrin AI (8 μg mL -1 ) in bottle bioassays. Mortality was monitored 15, 30, 60, and 120 min post-exposure., Results: Chi-square tests (P < 0.05) showed significantly higher mortality in Aedes compared to Culex populations for most time points in both bioassay and wind tunnel exposure groups. As expected, mosquitoes exposed to Biomist®3 + 15 showed higher mortality rates than bottle bioassay exposure to permethrin. Two Culex colonies resistant to permethrin in bottle bioassays were susceptible to Biomist®3 + 15 in the wind tunnel., Conclusion: The novel compact wind tunnel developed here may be an alternative to field trials for testing FP efficacy, avoiding factors such as weather, logistical planning, and extended personnel hours. The wind tunnel could allow programs to conveniently test efficacy of multiple FP. Comparisons of different insecticide exposure methods provide practical information to inform operational decisions. © 2024 The Authors. Pest Management Science published by John Wiley & Sons Ltd on behalf of Society of Chemical Industry., (© 2024 The Authors. Pest Management Science published by John Wiley & Sons Ltd on behalf of Society of Chemical Industry.)

Temporal variation in community composition is central to our understanding of the assembly and functioning of microbial communities, yet the controls over temporal dynamics for microbiomes of long-lived plants, such as trees, remain unclear. Temporal variation in tree microbiomes could arise primarily from seasonal (i.e., intra-annual) fluctuations in community composition or from longer-term changes across years as host plants age. To test these alternatives, we experimentally isolated temporal variation in plant microbiome composition using a common garden and clonally propagated plants, and we used amplicon sequencing to characterize bacterial/archaeal and fungal communities in the leaf endosphere, root endosphere, and rhizosphere of two Populus spp. over four seasons across two consecutive years. Microbial community composition differed among seasons and years (which accounted for up to 21% of the variation in microbial community composition) and was correlated with seasonal dissimilarity in climatic conditions. However, microbial community dissimilarity was also positively correlated with time, reflecting longer-term compositional shifts as host trees aged. Together, our findings demonstrate that temporal patterns in tree microbiomes arise from both seasonal fluctuations and longer-term changes, which interact to generate unique seasonal patterns each year. In addition to shedding light on two important controls over the assembly of plant microbiomes, our results also suggest future studies of tree microbiomes should account for background temporal dynamics when testing the drivers of spatial patterns in microbial community composition and temporal responses of plant microbiomes to environmental change.IMPORTANCEMicrobiomes are integral to the health of host plants, but we have a limited understanding of the factors that control how the composition of plant microbiomes changes over time. Especially little is known about the microbiome of long-lived trees, relative to annual and non-woody plants. We tested how tree microbiomes changed between seasons and years in poplar (genus Populus ), which are widespread and ecologically important tree species that also serve as important biofuel feedstocks. We found the composition of bacterial, archaeal, and fungal communities differed among seasons, but these seasonal differences depended on year. This dependence was driven by longer-term changes in microbial composition as host trees developed across consecutive years. Our findings suggest that temporal variation in tree microbiomes is driven by both seasonal fluctuations and longer-term (i.e., multiyear) development., Competing Interests: The authors declare no conflict of interest.

Background: The optimal timing for SARS-CoV-2 vaccines within the first year after allogeneic hematopoietic cell transplant (HCT) is poorly understood., Methods: We conducted a prospective, multicentre, observational study of allogeneic HCT recipients who initiated SARS-CoV-2 vaccinations within 12 months of HCT. Participants were enrolled at 22 academic cancer centers across the United States. Participants of any age who were planning to receive a first post-HCT SARS-CoV-2 vaccine within 12 months of HCT were eligible. We obtained blood prior to and after each vaccine dose for up to four vaccine doses, with an end-of-study sample seven to nine months after enrollment. We tested for SARS-CoV-2 spike protein (anti-S) IgG; nucleocapsid protein (anti-N) IgG; neutralizing antibodies for Wuhan D614G, Delta B.1.617.2, and Omicron B.1.1.529 strains; and SARS-CoV-2-specific T-cell receptors (TCRs). The primary outcome was a comparison of anti-S IgG titers at the post-V2 time point in participants initiating vaccinations <4 months versus 4-12 months after HCT using a propensity-adjusted analysis. We also evaluated factors associated with high-level anti-S IgG titers (≥2403 U/mL) in logistic regression models., Findings: Between April 22, 2021 and November 17, 2021, 175 allogeneic HCT recipients were enrolled in the study, of whom all but one received mRNA SARS-CoV-2 vaccines. SARS-CoV-2 anti-S IgG titers, neutralizing antibody titers, and TCR breadth and depth did not significantly differ at all tested time points following the second vaccination among those initiating vaccinations <4 months versus 4-12 months after HCT. Anti-S IgG ≥2403 U/mL correlated with neutralizing antibody levels similar to those observed in a prior study of non-immunocompromised individuals, and 57% of participants achieved anti-S IgG ≥2403 U/mL at the end-of-study time point. In models adjusted for SARS-CoV-2 infection pre-enrollment, SARS-CoV-2 vaccination pre-HCT, CD19+ B-cell count, CD4+ T-cell count, and age (as applicable to the model), vaccine initiation timing was not associated with high-level anti-S IgG titers at the post-V2, post-V3, or end-of-study time points. Notably, prior graft-versus-host-disease (GVHD) or use of immunosuppressive medications were not associated with high-level anti-S IgG titers. Grade ≥3 vaccine-associated adverse events were infrequent., Interpretation: These data support starting mRNA SARS-CoV-2 vaccination three months after HCT, irrespective of concurrent GVHD or use of immunosuppressive medications. This is one of the largest prospective analyses of vaccination for any pathogen within the first year after allogeneic HCT and supports current guidelines for SARS-CoV-2 vaccination starting three months post-HCT. Additionally, there are few studies of mRNA vaccine formulations for other pathogens in HCT recipients, and these data provide encouraging proof-of-concept for the utility of early vaccination targeting additional pathogens with mRNA vaccine platforms., Funding: National Marrow Donor Program, Leukemia and Lymphoma Society, Multiple Myeloma Research Foundation, Novartis, LabCorp, American Society for Transplantation and Cellular Therapy, Adaptive Biotechnologies, and the National Institutes of Health., Competing Interests: J.A.H: Research funding: AlloVir; Consulting: Pfizer, Gilead, Moderna. J-A.H.Y.: Research funding: AlloVir. M.V.D.: Research funding: Janssen, Roche/Genentech. S.D.W.: Research funding: MSK Leukemia SPORE Career Enhancement Program and MSK Gerstner Physician Scholar program. M.H.: Research Support/Funding: Takeda Pharmaceutical Company; ADC Therapeutics; Spectrum Pharmaceuticals; Astellas Pharma. Consultancy: Incyte Corporation, MorphoSys, SeaGen, Gamida Cell, Novartis, Legend Biotech, Kadmon, ADC Therapeutics; Omeros, Abbvie, Caribou, CRISPR, Genmab, Kite. Speaker's Bureau: Sanofi Genzyme, AstraZeneca, BeiGene, ADC Therapeutics, Kite. DMC: Myeloid Therapeutics, Inc. M.L.R.: Research funding from Jazz Pharmaceuticals and Atara Bio-Pharma as well as employment by IQVIA Biotech. M-A.P.: Honoraria from Adicet, AlloVir, Caribou Biosciences, Celgene, Bristol-Myers Squibb, Equilium, Exevir, Incyte, Karyopharm, Kite/Gilead, Merck, Miltenyi Biotec, MorphoSys, Nektar Therapeutics, Novartis, Omeros, OrcaBio, Syncopation, VectivBio AG, and Vor Biopharma. He serves on DSMBs for Cidara Therapeutics, Medigene, and Sellas Life Sciences, and the scientific advisory board of NexImmune. He has ownership interests in NexImmune and Omeros. He has received institutional research support for clinical trials from Incyte, Kite/Gilead, Miltenyi Biotec, Nektar Therapeutics, and Novartis. All other authors report no relevant conflicts of interest., (© 2023 The Author(s).)

Diversification of police forces is widely promoted as a reform for reducing racial disparities in police-civilian interactions and increasing police legitimacy. Despite these potential benefits, nearly every municipal police department in the United States remains predominately White and male. Here, we investigate whether the scale and persistence of minority underrepresentation in policing might partly be explained by a lack of support for diversification among voters and current police officers. Across two studies ( N  = 2, 661) sampling the US adult population and residents from a city with one of the least representative police forces in the country, individuals significantly overestimate officer diversity at both the local and national levels. We find that correcting these biased beliefs with accurate information reduces trust in police and increases support for hiring new officers from underrepresented groups. In the municipal sample, these corrections also cause an increase in residents' willingness to vote for reforms to diversify their majority White police department. Additional paired decision-making experiments ( N  = 1, 663) conducted on these residents and current police officers demonstrate that both prefer hiring new officers from currently underrepresented groups, independent of civil service exam performance and other hiring criteria. Overall, these results suggest that attitudes among voters and police officers are unlikely to pose a major barrier to diversity reforms.

Containing the COVID-19 pandemic will confer global benefits that greatly exceed the costs but effective solutions require the redistribution of vaccines, technology, and other scarce resources from high-income to low-income countries. The United States has played a central role in coordinating responses to previous global health challenges, and its policy choices in the current pandemic will have a far-reaching impact on the rest of the world. Yet little is known about domestic support for international recovery efforts. We use a series of conjoint and persuasive messaging experiments, fielded on two national surveys of the US adult population ( N = 5,965), to study mass support for international redistribution. We find clear evidence that the general population strongly supports allocating vaccines to own-country recipients before others. But despite this "vaccine nationalism," Americans are also willing to support the US government playing a major role in global pandemic recovery efforts, provided policymakers forge international agreements that ensure moderate domestic costs, burden-sharing with other countries, and priority for certain types of resources, such as domestically manufactured vaccines and patent buyouts. Finally, we test five different persuasive messaging strategies and find that emphasizing the relatively low costs and large economic benefits of global vaccination is the most promising means of increasing domestic support for international redistribution. Overall, our results demonstrate that policymakers can secure broad public support for costly international cooperation by crafting responses aligned with the economic interests of the United States., (© The Author(s) 2022. Published by Oxford University Press on behalf of National Academy of Sciences.)

Background: Arranging hospice services from the Emergency Department (ED) can be difficult due to physician discomfort, time constraints, and the intensity of care coordination needed. We report patient and visit characteristics associated with successful transition from the ED directly to hospice., Methods: Setting: Academic ED with 82,000 annual visits., Population: ED patients with a referral to hospice order placed during the ED visit from January 2014-December 2018. Charts were abstracted by trained, non-blinded personnel. Primary goal was to evaluate patient and visit factors associated with requiring admission for hospice transition., Results: Electronic Health Record inquiry yielded 113 patients, 93 of which met inclusion criteria. Patients were aged 65.8 years (range 32-92), 54% were female, and 78% were white, non-hispanic. The majority had cancer (78%, n = d72) and were on public insurance (60%, n = 56). Half (55%, n = 51) were full code upon arrival. Average ED length of stay was 4.6 ± 2.6 hours. Discharge from the ED to hospice was successful for 38% (n = 35), a few (n = 5) were dispositioned to an ED observation unit, and 57% (n = 53) were admitted. Only 10 (11%) required an inpatient length of stay longer than an observation visit (2 days). Case management and social work team arranged for transportation (54.8%, n = 51), hospital beds (16.1%, n = 16), respiratory equipment (18.3%, n = 17), facility placement (33.3%, n = 31), and home health aides (29.0%, n = 27)., Conclusion: Transitioning patients to hospice care from the ED is possible within a typical ED length of stay with assistance from a case manager/social work team., (Copyright © 2022. Published by Elsevier Inc.)

Introduction: Conducted electrical weapons, commonly known by their proprietary eponym, TASER, are frequently used by law enforcement. A review of the literature yielded descriptions of taser barb removal from soft tissue and surgical intervention for barbs lodged in sensitive areas such as the eye and head, but not from other osseous sites., Case Report: We report the case of a 30-year-old male transferred from another hospital with a taser dart embedded in his clavicle. Prior attempts at bedside removal had been unsuccessful. We describe bedside removal of the taser barb from bone using local anesthesia and simple fulcrum technique., Conclusion: We describe a novel fulcrum technique for removal of a taser dart embedded in bone. This is a reasonable technique to attempt in patients with involvement of superficial osseous structures to avoid operative intervention.

Desulfobulbus oligotrophicus Prop6 is a sulfate-reducing, propionate-oxidizing Deltabacterota (formerly Deltaproteobacteria ) strain from sewage sludge. Desulfobulbus species are found in anoxic environments, in animal microbiota, and some produce the neurotoxin methylmercury. The 3.1-Mbp D. oligotrophicus genome sequence enables studies of diverse environmental adaptations and the evolutionary genomics of mercury methylation mechanisms., (Copyright © 2021 Podar et al.)

Low levels of trust in government have potentially wide-ranging implications for governing stability, popular legitimacy, and political participation. Although there is a rich normative and empiricial literature on the important consequences of eroding trust in democratic societies, the causes of political trust are less clear. In this article we estimate the effect that changing Americans' views about the perceived honesty and integrity of political authorities (or "political probity") has on their trust in government using randomized survey experiments. In one experiment on a convenience sample and a direct replication on a more representative sample, we find that a single Op-Ed article about political probity increased trust in government by an amount larger than the partisan gap between Democrats and Republicans. These results complement prior observational studies on trust in government by demonstrating that political probity plays an important causal role in shaping Americans' judgments about the trustworthiness of their government and politicians., Competing Interests: The authors have declared that no competing interests exist.

Importance: Women and black physicians encounter workplace challenges because of their gender and race. It is unclear whether these individuals are assessed with lower patient satisfaction or confidence ratings compared with white male physicians., Objective: To examine whether physician gender and race affect participant ratings in scenarios in which physician competence is challenged., Design, Setting, and Participants: This randomized trial enrolled a geographically diverse sample of 3592 online respondents in the United States who were recruited from 2 crowdsourcing platforms: Amazon Mechanical Turk (n = 1741) and Lucid (n = 1851). A 2 × 2 factorial design for the gender and race of simulated physicians was conducted between March 9 and July 25, 2018. Participants were excluded before intervention if they were younger than 18 years, were pregnant, or had a history of cancer or abdominal surgical procedures., Interventions: A clinical vignette was presented to the participant with a picture of the emergency department physician. Participants were randomly assigned to physicians with different gender and race, with 823 assigned to black women, 791 to black men, 828 to white women, and 835 to white men. A contradictory diagnosis from an online symptom checker introduced doubt about the clinical diagnosis., Main Outcomes and Measures: A composite outcome (range, 0-100, with 0 representing low patient confidence and satisfaction and 100 representing the maximum on the composite scale) measured participant (1) confidence in the physician, (2) satisfaction with care, (3) likelihood to recommend the physician, (4) trust in the physician's diagnosis, and (5) likelihood to request additional tests., Results: Among 3277 adult participants, complete data were available for 3215 (median age, 49 years [range, 18-89 years]; 1667 [52%] female; 2433 [76%] white). No significant differences were observed in participant satisfaction and physician confidence for the white male physician control physicians (mean composite score, 66.13 [95% CI, 64.76-67.51]) compared with white female (mean composite score, 66.50 [95% CI, 65.19-67.82]), black female (mean composite score, 67.36 [95% CI, 66.03-68.69]), and black male (mean composite score, 66.96 [95% CI, 65.55-68.36]) physicians. Machine learning with bayesian additive regression trees revealed no evidence of treatment effect heterogeneity as a function of participants' race, gender, racial prejudice, or sexism., Conclusions and Relevance: No significant differences were observed for simulated patients' evaluations of female or black physicians, suggesting that bias in favor of white male physicians is negligible in survey-based measures of patient satisfaction., Trial Registration: ClinicalTrials.gov Identifier: NCT04190901.

Despite decades of declining crime rates, longstanding tensions between police and the public continue to frustrate the formation of cooperative relationships necessary for the function of the police and the provision of public safety. In response, policy makers continue to promote community-oriented policing (COP) and its emphasis on positive, nonenforcement contact with the public as an effective strategy for enhancing public trust and police legitimacy. Prior research designs, however, have not leveraged the random assignment of police-public contact to identify the causal effect of such interactions on individual-level attitudes toward the police. Therefore, the question remains: Do positive, nonenforcement interactions with uniformed patrol officers actually cause meaningful improvements in attitudes toward the police? Here, we report on a randomized field experiment conducted in New Haven, CT, that sheds light on this question and identifies the individual-level consequences of positive, nonenforcement contact between police and the public. Findings indicate that a single instance of positive contact with a uniformed police officer can substantially improve public attitudes toward police, including legitimacy and willingness to cooperate. These effects persisted for up to 21 d and were not limited to individuals inclined to trust and cooperate with the police prior to the intervention. This study demonstrates that positive nonenforcement contact can improve public attitudes toward police and suggests that police departments would benefit from an increased focus on strategies that promote positive police-public interactions., Competing Interests: The authors declare no conflict of interest., (Copyright © 2019 the Author(s). Published by PNAS.)

Objective: Survival of arteriovenous fistulas (AVFs) in hemodialysis patients is associated with both far infrared (FIR) therapy and length polymorphisms of the heme oxygenase-1 (HO-1) promoter. In this study, we evaluated whether there is an interaction between FIR radiation and HO-1 in regulating vascular inflammation., Methods and Results: Treatment of cultured human umbilical vein endothelial cells (ECs) with FIR radiation stimulated HO-1 protein, mRNA, and promoter activity. HO-1 induction was dependent on the activation of the antioxidant responsive element/NF-E2-related factor-2 complex, and was likely a consequence of heat stress. FIR radiation also inhibited tumor necrosis factor (TNF)-alpha-mediated expression of E-selectin, vascular cell adhesion molecule-1, intercellular cell adhesion molecule-1, monocyte chemoattractant protein-1, interleukin-8, and the cytokine-mediated adhesion of monocytes to ECs. The antiinflammatory action of FIR was mimicked by bilirubin, and was reversed by the HO inhibitor, tin protoporphyrin-IX, or by the selective knockdown of HO-1. Finally, the antiinflammatory effect of FIR was also observed in patients undergoing hemodialysis., Conclusions: These results demonstrate that FIR therapy exerts a potent antiinflammatory effect via the induction of HO-1. The ability of FIR therapy to inhibit inflammation may play a critical role in preserving blood flow and patency of AVFs in hemodialysis patients.

The purpose of the study was to evaluate an Ontario Ministry of Health (MOH) cold/flu self-care public education campaign to reduce unnecessary patient visits to doctors. The MOH campaign consisted of an information booklet delivered to every household in an Ontario city, newspaper ads and radio spots. The program ran during January-March 1994. The evaluation consisted of: (1) 2x2 telephone survey in London (experimental area) and Windsor (comparison area), before and during the campaign; and (2) a telephone survey of London family practitioners during the campaign. In addition, data on the incidence of cold/flu visits to three hospital emergency departments and a sample of family physicians' offices were gathered. The data suggest that program rationale may have been questionable because the majority of the surveyed public were knowledgeable and self-reported appropriate doctor visits for cold/flu. Campaign evaluation showed limited impact. Message penetration was low; only one-third of London residents knew of the campaign or read the booklet. Only two of 10 questions showed increases in knowledge in London and no changes were found for beliefs, attitudes, acquisition of new health practices or self-reported visits to the doctor. The physician survey, emergency room and family physician office visit data were consistent with the public survey findings.