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• HTP and NVP users reported comparable product dependence and nicotine intake. • HTPs and NVPs were similarly effective in controlling cigarette cravings and withdrawal symptoms. • HTP and NVP users perceived their respective products as similarly safe, satisfying and helpful for smoking cessation. • HTP use appears to maintain a stronger smoker identity than NVP use. • HTP use was associated with stronger perceived addiction than NVP use. There is limited long-term and independent research on heated tobacco products (HTPs). We compared people who used HTPs with those who used nicotine vaping products (NVP) or cigarettes on smoker identity, indicators of effectiveness and, among NVP/HTP users, perceptions of these products. Adults exclusive cigarette smokers (N = 45) and ex-smokers with medium/long-term (>3months) NVP (N = 46) or HTP use (N = 45) were recruited in London, UK. Participants completed a questionnaire assessing socio-demographics, smoking characteristics, smoker identity, dependence, intention to stop and attitudes towards HTP/NVP. In adjusted analysis, people who used cigarettes (Mean Difference (MD) = 1.4, 95%Confidence Intervals (CI) 0.7,2.0) and HTPs (MD = 0.8, 95%CI 0.1, 1.5) reported stronger smoker identities than those who used NVPs. Compared with smokers, HTP/NVP users had lower cravings for cigarettes (MD = 3.0, 95%CI 1.6, 4.3; MD = 3.1, 95%CI 1.9, 4.3, respectively), and higher intention to stop product use (MD = −0.8, 95%CI −1.7,-0.01; MD = −1.2, 95%CI −2.0, -0.3, respectively). People using HTPs or NVPs reported similar perceived product satisfaction (HTP:M = 3.4, 95%CI 2.8, 3.9; NVP:M = 3.0, 95%CI 2.5, 3.5), efficacy for smoking cessation (HTP:M = 4.5, 95%CI 4.2, 4.9; NVP:M = 4.6, 95%CI 4.3, 4.9) and safety (HTP:M = 2.1, 95%CI 2.0, 2.2; NVP:M = 2.0, 95%CI 1.8, 2.1). HTP users reported greater perceived addictiveness than NVPs (MD = 0.3, 95%CI 0.2, 0.6). HTP and NVP users perceived products to be similarly acceptable and effective suggesting that HTPs, like NVPs, may support smoking cessation. However, since HTP use appears to maintain a stronger smoker identity and perceived addiction, this may suggest a more limited role of HTP for a permanent transition away from cigarettes. [ABSTRACT FROM AUTHOR]

Improved short-term outcomes have been demonstrated with higher surgical volume in shoulder arthroplasty. There is however, little data regarding long-term outcomes. Revision data from the Australian Orthopaedic Association National Joint Replacement Registry from 2004-2017 was analyzed according to 3 selected surgeon volume thresholds: <10, 10-20, and >20 shoulder arthroplasty cases per surgeon, per year. There was a significantly higher rate of revision for stemmed total shoulder arthroplasty (TSA) for osteoarthritis (OA) for the <10/yr compared with the >20/yr group for the first 1.5 years only (hazard ratio [HR] 1.36, 95% confidence interval [CI] 1.08-1.71, P =.009). For reverse total shoulder arthroplasty (rTSA) performed for OA, there was a higher revision rate for the <10/yr compared with the >20/yr group for the first 3 months only (HR 2.58, 95% CI 1.67-3.97, P <.001). In rTSA for cuff arthropathy, there was a significantly higher rate of revision for the <10/yr compared with the >20/yr group throughout the follow-up period (HR 1.66, 95% CI 1.21-2.28, P =.001). There was no significant difference for the primary diagnosis of fracture. Lower surgical volume was associated with higher all-cause revision rates in the early postoperative period in TSA and rTSA for OA and throughout the follow-up period in rTSA for cuff arthropathy. Despite increases in the volume of shoulder arthroplasties performed in recent years, more than 78% of surgeons undertake fewer than 10 procedures per year. [ABSTRACT FROM AUTHOR]

Introduction: Concern about weight gain is a barrier to smoking cessation. E-cigarettes may help quitters to control their weight through continued exposure to the appetite-suppressant effects of nicotine and behavioural aspects of vaping. This study explored the views and practices of smokers, ex-smokers and current e-cigarette users relating to vaping and weight control.Methods: Cross-sectional survey of past-year smokers (n = 1320), current smokers (n = 1240) and current e-cigarette users (n = 394) in England, conducted April-July 2018. Data were weighted to match the English population on key sociodemographic characteristics.Results: Of e-cigarette users, 4.6% (95%CI 2.6-6.6) reported vaping for weight control, and 1.9% (95%CI 0.6-3.2) reported vaping to replace meals/snacks. It was rare for individuals who had smoked in the past year to have heard (8.8%, 95%CI 7.3-10.3) or believe (6.4%, 95%CI 5.1-7.7) that vaping could help control weight. Women (OR = 0.62, 95%CI 0.42-0.93) and older people (OR = 0.30, 95%CI 0.13-0.72) were less likely to have heard the claim and women were less likely to believe it (OR = 0.44, 95%CI 0.27-0.72). However, 13.4% (95%CI 11.3-15.5) and 13.1% (95%CI 11.0-15.2) of current smokers who did not use e-cigarettes said they would be more likely to try e-cigarettes or quit smoking, respectively, if vaping could help control their weight.Conclusion: One in 16 English people who have smoked in the last year believe that vaping would prevent weight gain after stopping. One in 22 people who vape are using e-cigarettes for this purpose. However, should evidence emerge that e-cigarettes prevent weight gain, one in eight people who smoke would be tempted to quit smoking and use e-cigarettes. [ABSTRACT FROM AUTHOR]

Abstract Introduction Exercise (ESE) and dobutamine stress echocardiography (DSE) have high sensitivity and specificity to detect inducible myocardial ischemia in patients with significant coronary artery disease (CAD). High-sensitivity cardiac troponin (hs-cTn) assays detect troponin concentrations in the ng/L range. The aim of this study was to determine the kinetics of hs-cTnT in patients undergoing ESE and DSE and possible association of hs-cTnT with inducible myocardial ischemia. Methods In this prospective study adult patients undergoing ESE/DSE were enrolled. Peripheral blood samples were obtained before, and 30 min, 1, 2, and 4–6 h after completion of ESE/DSE. Hs-cTnT was measured on a Roche Diagnostics Elecsys 2010 analyzer. Results We enrolled 48 patients (33 ESE and 15 DSE); 11 patients (23%) had elevated baseline hs-cTnT concentrations >14 ng/L (99th percentile URL); 31/48 (65%) developed an hs-cTnT increase after ESE/DSE (peak 4–6 h post stress test), but only three patients (all in ESE group) had a positive stress test. Absolute and relative hs-cTnT increases were higher after DSE (median Δhs-cTnT +9.7 ng/L [IQR 4.5, 27.2]; +123% [IQR 49, 271]) compared to ESE (median Δhs-cTnT +2.3 ng/L [IQR 1, 4.9]; +37% [IQR 9.1, 221]). Conclusions One in four patients undergoing ESE/DSE had increased hs-cTnT values prior to stress testing. Hs-cTnT increased above the upper limit of normal occurred commonly after ESE/DSE but was more pronounced after DSE. Increases in hs-cTn did not appear to be associated with inducible myocardial ischemia. These findings may have important implications for the clinical use of hs-cTnT within 6 h after ESE/DSE. [ABSTRACT FROM AUTHOR]

One of the most successful uses of nuclear energy, other than nuclear fission reactors, is the use of radioisotopes to provide a simple source for heat and electrical power in space applications. The alpha decay heat from suitable radioisotopes can be harnessed to heat instrumentation and generate electricity through thermoelectric generators. Within Europe, the feasibility of using americium ( 241 Am) in such applications is being considered. Part of this study is to develop a way to access a stock of suitable material and the UK stockpile of separated civil plutonium dioxide, generated through reprocessing operations, is a rich source of americium. This paper summarises 5 years of development work performed to establish a way to separate americium from the plutonium dioxide in a safe and cost effective way, generating a high purity product with high recovery efficiency. [ABSTRACT FROM AUTHOR]

• Tobacco smoking cessation is associated with improvements in mental health. • Never-smokers and >1 year ex-smokers had lower levels of distress than smokers. • Nicotine product use among ex-smokers was associated with greater distress. • Associations with nicotine product use are likely confounded by nicotine dependence. Tobacco smoking cessation is associated with improvements in mental health. This study assessed psychological distress, using the K6 non-specific screening tool ((items cover feelings of nervousness, hopelessness, restlessness, depression, 'everything an effort' and worthlessness), by smoking status, time since quit, and use of a non-combustible nicotine product. Monthly repeat cross-sectional household survey of adults (18 +) from October 2020–February 2022 in Great Britain (N = 32,727). Using unadjusted and adjusted logistic regression (adjusted models included socio-demographic characteristics and ever diagnosis with a mental health condition), we assessed: associations between any/serious past-month psychological distress and smoking status and time since quit, whether these relationships were moderated by ever diagnosis with a mental health condition, and associations between distress and use of a nicotine product by people who formerly smoked. In the unadjusted model, those who had not smoked for > 1y and who had never smoked had lower odds of any distress (OR = 0·42, 95 % CI 0·39-0·45; OR = 0·44, 0·41-0·47) compared with those who currently smoked. Moreover, the association of lower distress in those who had not smoked for > 1y and never smoked compared with those who currently smoked was more pronounced among those who had ever been diagnosed with a mental health condition (AOR = 0·58, 0·51-0·66; AOR = 0·60, 0·53-0·67) than among those who had not (AOR = 0·86, 0·76-0·98; AOR = 0·72, 0·65-0·81). In adjusted models of people who formerly smoked, current use of any nicotine product was associated with higher odds of distress compared with not using any nicotine product (AOR 1·23, 1·06-1·42). People who had never smoked, or had not smoked for > 1y had lower levels of distress than those who currently smoked. The lower odds of distress among people who had not smoked for > 1y was more pronounced among those with an ever (vs never) diagnosis of a mental health condition. Nicotine product use among those who formerly smoked was associated with greater distress. Due to potential residual confounding and selection bias more research is needed to determine causality. [ABSTRACT FROM AUTHOR]

Background Central line–associated bloodstream infections (CLABSIs) are a common life-threatening risk factor associated with central venous catheters (CVCs). Research has demonstrated benefit in reducing CLABSIs when CVCs coated with antimicrobials are inserted. The impact of chlorhexidine (CHG)-impregnated versus non-CHG peripherally inserted central catheters (PICCs) on risk of CLABSI is unknown. Venous thromboembolism (VTE) is also a complication associated with CVCs. This study compares the impact of both PICC lines on these outcomes. Methods Patients in 3 high-risk units were randomly assigned to receive either a CHG-impregnated or non-CHG PICC line. Laboratory data were collected and reviewed daily on all study patients. The PICC dressing site was assessed daily. Medical record documentation was reviewed to determine presence of CLABSI or VTE. Results There were 167 patients who completed the study. Three patients developed CLABSI (2 in the CHG group, and 1 in the non-CHG group), and 3 patients developed VTE (2 in the non-CHG group, and 1 in the CHG group). No significant relationship was noted between the type of PICC line on development of a CLABSI ( P  = .61) or VTE ( P > .99). A significant difference was noted in moderate bleeding ( P  ≤ .001) requiring thrombogenic dressing in the patients who had the CHG PICC line. Conclusions No differences were noted in the development of CLABSI and VTE between the CHG and non-CHG groups. [ABSTRACT FROM AUTHOR]

Purpose: To characterize functional complaints of new low-vision rehabilitation patients. Design: Prospective observational study. Participants: The Low Vision Rehabilitation Outcomes Study recruited 819 patients between 2008 and 2011 from 28 clinical centers in the United States. Methods: New patients referred for low-vision rehabilitation were asked, "What are your chief complaints about your vision?" before their appointment. Full patient statements were transcribed as free text. Two methods assessed whether statements indicated difficulty in each of 13 functional categories: (1) assessment by 2 masked clinicians reading the statement, and (2) a computerized search of the text for specific words or word fragments. Logistic regression models were used to predict the influence of age, gender, and visual acuity on the likelihood of reporting a complaint in each functional category. Main Outcome Measures: Prevalence and risk factors for patient concerns within various functional categories. Results: Reading was the most common functional complaint (66.4% of patients). Other functional difficulties expressed by at least 10% of patients included driving (27.8%), using visual assistive equipment (17.5%), mobility (16.3%), performing in-home activities (15.1%), lighting and glare (11.7%), and facial recognition and social interactions (10.3%). Good agreement was noted between the masked clinician graders and the computerized algorithm for categorization of functional complaints (median κ of 0.84 across the 13 categories). Multivariate logistic regression models demonstrated that the likelihood of reading difficulties increased mildly with age (odds ratio, 1.4 per 10-year increment in age; 95% confidence interval, 1.3-1.6), but did not differ with visual acuity (P = 0.09). Additionally, men were more likely to report driving difficulties and difficulties related to lighting, whereas women were more likely to report difficulty with either in-home activities or facial recognition or social interaction (P<0.05 for all). Mobility concerns, defined as walking difficulty and out-of-home activities, showed no relationship to gender, age, or visual acuity. Conclusions: Reading was the most commonly reported difficulty, regardless of the patient's diagnosis. Neither visual acuity nor gender were predictive of reading concerns, although, age showed a small effect. Addressing reading rehabilitation should be a cornerstone of low-vision therapy. [ABSTRACT FROM AUTHOR]

Background: Internet-based Smoking Cessation Interventions could help pregnant women quit smoking, especially those who do not wish to, or cannot, access face-to-face or telephone support. This study aimed to preliminarily evaluate the effectiveness and usage of a fully automated smoking cessation website targeted to pregnancy, 'MumsQuit', and obtain an initial effect-size estimate for a full scale trial.Methods: We recruited 200 UK-based pregnant adult smokers online to a two-arm double-blind pilot RCT assessing the effectiveness of MumsQuit compared with an information-only website. MumsQuit was adapted from a generic internet smoking cessation intervention, 'StopAdvisor'. The primary outcome was self-reported continuous 4-week abstinence assessed at 8 weeks post-baseline. Secondary outcomes were automatically collected data on intervention usage.Results: Participants smoked 15 cigarettes per day on average, 73% were in the first trimester of their pregnancy, 48% were from lower socioeconomic backgrounds, and 43% had never used evidence-based cessation support. The point estimate of odds ratio for the primary outcome was 1.5 (95% CI=0.8-2.9; 28% vs. 21%). Compared with control participants, those in the MumsQuit group logged in more often (3.5 vs. 1.3, p<0.001), viewed more pages (67.4 vs. 5.7, p<0.001) and spent more time browsing the website (21.3min vs. 1.0min, p<0.001).Conclusions: MumsQuit is an engaging and potentially helpful form of support for pregnant women who seek cessation support online, and merits further development and evaluation in a full-scale RCT. [ABSTRACT FROM AUTHOR]

Background: E-cigarettes may be effective smoking cessation aids and their use by smokers has been growing rapidly. It is important to observe and assess natural patterns in the use of e-cigarettes whilst experimental data accumulates. This paper reports the prevalence of e-cigarette awareness, beliefs and usage, including brand choice, and characterises the socio-demographic and smoking profile associated with current use, among the general population of smokers and recent ex-smokers. Methods: Data were obtained from 3538 current and 579 recent ex-smokers in a cross-sectional online survey of a national sample of smokers in Great Britain in November and December 2012. Differences between current and recent ex-smokers in the prevalence of e-cigarette awareness, beliefs and usage were examined and the socio-demographic and smoking profile associated with current use of e-cigarettes was assessed in a series of simple and multiple logistic regressions. Results: Ninety-three percent of current and recent ex-smokers (n=3841) were aware of e-cigarettes. Approximately a fifth (n=884) were currently using e-cigarettes, whilst just over a third (n=1507) had ever used them. Sixty-seven percent of the sample (n=2758) believed e-cigarettes to be less harmful than cigarettes; however, almost a quarter (n=994) remained unsure. Among both current and recent ex-smokers, the most popular reasons for using were health, cutting down and quitting (each >80%) and 38% used the brand ‘E-lites’. Among current smokers who were aware of but had never used e-cigarettes, approximately half (n=1040) were interested in using them in the future. Among current smokers, their use was associated with higher socio-economic status (OR=1.48, 95%CI=1.25–1.75), smoking more cigarettes (OR=1.02, 95%CI=1.01–1.03) and having a past-year quit attempt (OR=2.82, 95%CI=2.38–3.34). Conclusions: There is a near universal awareness of e-cigarettes and their use appears to be common among smokers in Great Britain although a quarter of all smokers are unsure as to whether e-cigarettes are less harmful than cigarettes. E-lites – a brand that delivers a low dose of nicotine – is the most popular. E-cigarette users appear to have higher socio-economic status, to smoke more cigarettes per day and to have attempted to quit in the past year. [Copyright &y& Elsevier]

Background: A national smoking cessation campaign based on behaviour change theory and operating through both traditional and new media was launched across England during late 2012 ('Stoptober'). In addition to attempting to start a movement in which smokers would quit at the same time in response to a positive mass quitting trigger, the campaign set smokers the goal of being smoke-free for October and embodied other psychological principles in a range of tools and communications.Methods: Data on quit attempts were obtained from 31,566 past-year smokers during nationally representative household surveys conducted monthly between 2007 and 2012. The effectiveness of the campaign was assessed by the increase in national quit attempt rate in October relative to other months in 2012 vs. 2007-2011.Results: Relative to other months in the year, more people tried to quit in October in 2012 compared with 2007-2011 (OR=1.79, 95%CI=1.20-2.68). In 2012 there was an approximately 50% increase in quitting during October compared with other months of the same year (9.6% vs. 6.6%; OR=1.50, 95%CI=1.05-2.15), whereas in 2007-2011 the rate in October was non-significantly less than in other months of the same period (6.4% vs. 7.5%; OR=0.84, 95%CI=0.70-1.00). Stoptober is estimated to have generated an additional 350,000 quit attempts and saved 10,400 discounted life years (DLY) at less than £415 per DLY in the modal age group.Conclusions: Designing a national public health campaign with a clear behavioural target (making a serious quit attempt) using key psychological principles can yield substantial behaviour change and public health impact. [ABSTRACT FROM AUTHOR]

Abstract: Background: This article reports a pilot study of a new smoking cessation website (‘StopAdvisor’), which has been developed on the basis of PRIME theory, evidence, web-design expertise and user-testing. The aims were to i) evaluate whether cessation, website usage and satisfaction were sufficiently high to warrant a randomised controlled trial (RCT) and ii) assess whether outcomes were affected by socio-economic status. Methods: This was an uncontrolled pilot study. Two hundred and four adult daily smokers willing to make a serious quit attempt were included. All participants received support from ‘StopAdvisor’, which recommends a structured quit plan and a variety of evidence-based behaviour change techniques for smoking cessation. A series of tunnelled sessions and a variety of interactive menus provide tailored support for up to a month before quitting through until one-month post-quit (http://www.lifeguideonline.org/player/play/stopadvisordemonstration). The primary outcome was self-report of at least 1month of continuous abstinence collected at 2months post-enrolment and verified by saliva cotinine or anabasine. Usage was indexed by log-ins and page views. Satisfaction was assessed by dichotomous ratings of helpfulness, personal relevance, likelihood of recommendation and future use, which were collected using an online questionnaire at 2months post-enrolment. Outcomes according to socio-economic status were assessed. Results: At 8weeks post-enrolment, 19.6% (40/204) of participants were abstinent according to the primary outcome criteria (95% C.I.=14.1% to 25.1%). Participants viewed a mean of 133.5 pages (median=71.5) during 6.4 log-ins (median=3). A majority of respondents rated the website positively on each of the four satisfaction `ratings (range=66.7% to 75.3%). There was no evidence of an effect of socio-economic status on abstinence (OR=1.01, C.I.=0.50–2.07), usage (page-views, t(202)=0.11, p =.91; log-ins, t(202)=0.21, p =.83), or satisfaction (helpfulness, OR=1.09, C.I.=0.41–2.88; personal relevance, OR=0.55, C.I.=0.20–1.56; recommendation, OR=0.98, C.I.=0.34–2.81; use in future, OR=1.45, C.I.=0.49–4.27). Conclusions: The systematic application of theory, evidence, web-design expertise, and user-testing has resulted in a website that shows sufficiently promising efficacy and usability to warrant evaluation in a RCT. The website appears to be similarly effective and acceptable to users across the social spectrum. [Copyright &y& Elsevier]

Abstract: Part one in our series covered the basic surgical anatomy and techniques used for hip arthroscopy. Part two covers the specific indications and complications of hip arthroscopy. Hip arthroscopy can be used to treat a diverse range of conditions affecting both the central and peripheral compartments of the hip, including loose bodies, femoroacetabular impingement, coxa sultans and septic arthritis. The body of evidence supporting these indications continues to expand; however, there is still much work to be done. Failure to follow the correct technique for patient positioning and portal placement significantly increases the risk of damaging important local neurovascular structures. Complications include neuropraxia secondary to traction or pressure from the perineal post, cartilage injury, infection, fluid extravasation and trochanteric bursitis. [Copyright &y& Elsevier]

Abstract: Although first described in the 1930’s, it was not until the late 20th century that hip arthroscopy became a well-recognized procedure. Correct patient positioning and portal placement are critical, and failure of either may result in inability to access the joint or damage to important local neurovascular structures. In the hands of an experienced surgeon and anaesthetist the risks are small, but attention to detail is critical. The future of hip arthroscopy is exciting and as the scientific evidence builds it is likely to be an important adjunct to more traditional open hip procedures. [Copyright &y& Elsevier]

Background: In contrast to mitral valve repair, residual and recurrent regurgitation after tricuspid valve (TV) repair for functional tricuspid regurgitation (TR) is common. We have systematically used undersized, rigid 3-dimensional annuloplasty rings to treat functional TR. Methods: From March 2006 to October 2009, 101 consecutive patients with moderate or greater functional TR underwent TV repair with an undersized rigid 3-dimensional annuloplasty ring. All patients had a predischarge echocardiography evaluation in a core echocardiography laboratory. Follow-up echocardiography was available for 96% of surviving patients. Mean follow-up was 17 ± 9 months. Results: Twenty-nine percent of patients had undergone previous cardiac operations, 74% were in New York Heart Association functional class III or IV, and 48% had atrial fibrillation. Mitral valve operations were performed in 93 patients, aortic valve operations in 17, coronary artery bypass grafting in 21, and CryoMaze procedures in 40. Size 26 or 28 rigid tricuspid annuloplasty rings were used in 88% of patients, and no ring larger than a 28 has been used since November 2008. The operative mortality rate was 6% (n = 6). Freedom from significant TR (TR > moderate) at hospital discharge, as assessed by the clinical core laboratory, was 97%. Only 3% of patients had TR greater than moderate during follow-up. No patient required TV reoperation. New postoperative permanent pacemakers were inserted in 3 patients. Conclusions: Tricuspid valve repair with an undersized (size 26 or 28) rigid 3-dimensional annuloplasty ring is the method of choice for reliable and durable treatment of functional TR. [ABSTRACT FROM AUTHOR]

Objectives: Endothelial disruption within saphenous vein and radial artery grafts increases thrombosis risk. However, no clinically applicable method for imaging the intima currently exists. We used a novel infrared imaging technology, optical coherence tomography (OCT; LightLab Imaging, Inc, Westford, Mass), to visualize the intima within harvested conduits. Methods: Conduits were procured endoscopically (37 saphenous vein grafts and 8 radial artery grafts) or with the open technique (9 radial artery grafts) from 50 patients. Surplus segments were analyzed by means of OCT for evidence of preexisting pathology or traumatic injury. Focal plaques in radial artery grafts and the intimal hyperplasia area in saphenous vein grafts were quantified as having an intimal/medial thickness ratio of greater than 0.5. Biopsy specimens were obtained for histologic confirmation and to analyze matrix metalloproteinase 2 levels (saphenous vein grafts) and prostacyclin/nitric oxide metabolites (radial artery grafts). Interobserver κ coefficients and a Bland–Altman analysis were used to determine the reproducibility and accuracy of OCT interpretations. Results: Radial artery imaging revealed plaque in 76%. Endoscopically harvested vessels showed intraluminal clot (38%) and intimal tears ranging from severe (6%) to mild (88%). In saphenous vein grafts intimal thickening was detected in 86% and intraluminal clotting in 68%. The intimal/medial thickness ratio determined by means of OCT correlated directly with matrix metalloproteinase 2 levels (R = 0.6804) in saphenous vein grafts and inversely with metabolites of prostacyclin (R = −0.55) and nitric oxide (R = −0.58) in radial artery grafts. OCT imaging was reproducible (interobserver κ coefficients of >0.81 for the characterization of plaque types) and showed a strong correlation with histology (R = 0.8, P < .001). Conclusions: OCT imaging provides an accurate, real-time, and reproducible means for assessing saphenous vein graft and radial artery graft bypass conduits. As a quality assurance tool, this technology might afford a more objective basis for conduit selection. [Copyright &y& Elsevier]

Background: Interest in percutaneous therapy of heart valve disease has focused attention on the high-risk patient with aortic stenosis. Aortic valve bypass (apicoaortic conduit) surgery is the construction of a vascular graft containing a bioprosthetic valve from the apex of the left ventricle to the descending thoracic aorta. We have undertaken a programmatic effort to perform aortic valve bypass surgery as an alternative to conventional aortic valve replacement in selected high-risk patients, and now report our recent experience. Methods: Between April 2003 and May 2005, 14 patients with aortic stenosis underwent aortic valve bypass surgery at two institutions. All patients selected for aortic valve bypass surgery were deemed to be at very high risk for conventional aortic valve replacement. These patients represented 14 (5.8%) of all 243 patients undergoing isolated aortic valve surgery during the same time period. Mean Society of Thoracic Surgeons predicted risk for operative mortality (11%) was between the 90th and 95th percentile. Results: Twelve of 14 patients had previous cardiac surgery with patent bypass grafts. Average age was 78 years. Mean aortic valve area was 0.68 cm2. All operations were performed through a left thoracotomy on the beating heart (cross-clamp time, 0 minutes). Cardiopulmonary bypass was used for 6 patients (median cardiopulmonary bypass time, 15 minutes). There were 2 perioperative deaths. Median postoperative length of stay was 9 days. Two noncardiac late deaths occurred. Nine of 10 surviving patients are functional class I and are living independently. Early postoperative echocardiography confirms excellent aortic valve bypass function with preservation of ventricular ejection performance. Conclusions: Treatment of high-risk aortic stenosis patients with aortic valve bypass surgery is promising. Avoidance of sternotomy and cardiopulmonary bypass supports broader application to moderate-risk patients with aortic stenosis and as a control arm for studies of novel interventional therapies. [Copyright &y& Elsevier]

Introduction: Smoking is more prevalent in smokers from lower compared with higher socioeconomic (SES) groups, but studies are inconsistent regarding underlying mechanisms. We aimed to assess associations between SES indicators and three distinct aspects of the smoking cessation process: attempting to quit; use of evidence-based cessation treatments; and success.Methods: We analysed data of 12,161 last-year smokers (i.e., current smokers and recent ex-smokers who quit ≤ 12 months) from 20 waves (June/July 2016 to August/September 2019) of the German Study on Tobacco Use (DEBRA) - a representative household survey. Associations between indicators of SES (income and education) and (1) last-year quit attempts; (2) use of evidence-based cessation treatment or electronic cigarettes during the last attempt; and (3) short-term self-reported abstinence were analysed using multivariable logistic regression, adjusted for potential confounders.Results: Of all last-years smokers, 18.6% had attempted to quit, of whom 15.2% had successfully stopped. Higher income (OR 0.82, 95%CI = 0.77-0.88 per 1000€) but low vs. high education (OR 0.83, 95%CI = 0.73-0.95) were associated with lower odds of quit attempts. In smokers with quit attempts, higher income but not education was associated with higher odds of using cessation medication (OR 1.31, 95%CI = 1.08-1.59 per 1000 €). Neither income nor education were associated with using behavioural support or success.Conclusions: In the German healthcare system without free access to evidence-based cessation therapy, low-income smokers are more likely to make a quit attempt but less likely to use cessation medication than high-income smokers. Equitable access to such medication is crucial to reduce SES-related health disparities. [ABSTRACT FROM AUTHOR]

Memantine is commonly used for the treatment of moderate-to-severe Alzheimer's disease. Due to its antagonism of the N-methyl-d-aspartate (NMDA) receptor, which has been shown to block rewarding and reinforcing effects of morphine, memantine has been investigated for potential utilization in opioid use disorder (OUD). The objective of this systematic review is to assess the evidence available to determine the safety and efficacy of memantine as treatment for OUD. Pubmed (1946-August 2019) and Embase (1947-August 2019) were queried using the following search terms: opioid-related disorders, opioids, substance withdrawal syndrome, withdrawal syndrome, opiate addiction, opiate, opiate dependence, opiate substitution treatment, managed opioid withdrawal, or drug withdrawal and memantine. After assessing studies appropriate for the objective, one single-blind and five double-blind, placebo-controlled trials were included. Of the included studies, four demonstrated beneficial effects of memantine either as monotherapy or adjunct to methadone or buprenorphine on reducing opioid cravings and methadone dose, increasing retention rates, and improving cognitive performance in patients with OUD. Two studies did not show benefit on patient retention rates with memantine adjunct to naltrexone. Study durations ranged from 3 to 13 weeks, and memantine dosing ranged from 5 to 60 mg/day. Memantine was well tolerated with similar rates of adverse effects between treatment groups. Based on the reviewed literature, memantine appears most beneficial as an adjunctive treatment for OUD when combined with methadone or buprenorphine, but not naltrexone. Larger studies with longer periods of treatment and follow-up are needed to support the use of memantine in the management of OUD. [ABSTRACT FROM AUTHOR]

The UK government is consulting on banning disposable e-cigarettes. This study aimed to describe trends in disposable e-cigarette use among adults in Great Britain since 2021 and establish who would currently be affected by a ban on disposables. Nationally-representative monthly cross-sectional survey. We analysed data from 69,973 adults surveyed between January 2021 and August 2023. We estimated monthly time trends in the weighted prevalence of current disposable e-cigarette use among adults and by sociodemographic characteristics and smoking status. From January 2021 to August 2023, the prevalence of disposable e-cigarette use grew from 0.1 % to 4.9 %. This rise was observed across all population subgroups but was most pronounced among younger adults (e.g. reaching 15.9 % of 18-year-olds compared with 1.3 % of 65-year-olds), those who currently smoke (16.3 %), and those who stopped smoking in the past year (18.2 %). Use among never smokers remained relatively rare (1.5 %), except among 18- to 24-year-olds (7.1 %). Use was significantly higher in England than Wales or Scotland (5.3 % vs. 2.0 % and 2.8 %) and among less (vs. more) advantaged social grades (6.1 % vs. 4.0 %), those with (vs. without) children (6.4 % vs. 4.4 %), and those with (vs. without) a history of mental health conditions (9.3 % vs. 3.1 %). A ban on disposable e-cigarettes would currently affect one in 20 adults in Great Britain (approximately 2.6 million people). The proportion who would be affected would be greatest among young people, including the 316,000 18-24 year-olds who currently use disposables but who have never regularly smoked tobacco, which may discourage uptake of vaping in this group. However, a ban would also affect 1.2 million people who currently smoke and a further 744,000 who previously smoked. It would also have a disproportionate impact on disadvantaged groups that have higher rates of smoking and typically find it harder to quit. [ABSTRACT FROM AUTHOR]

• Mass media campaign expenditure was positively associated with quit attempts. • Level of motivation to stop did not moderate this association. • The effect size was relatively small compared with other smoking interventions. • However, mass media campaigns have wide reach at low cost. To explore whether expenditure on national tobacco control mass media campaigns moderates the association between motivation to stop smoking and future quit attempts. Data were from 2601 people who smoke participating in a population survey with 12-month follow-up between April 2015 and February 2021. We used logistic regression to test associations of (i) baseline level of motivation to stop smoking, (ii) mean monthly tobacco control mass media campaign expenditure in England between baseline and follow-up, and (iii) their interaction, on past-year quit attempts assessed at 12-month follow-up. Covariates included age, sex, occupational social grade, and region. Between baseline and follow-up, 38.6% of participants made a quit attempt. Each one-point increase in baseline motivation to stop smoking was associated with 1.37 times greater odds (95%CI = 1.31–1.43) of making a quit attempt over 12-month follow-up. Each one standard deviation increase in tobacco control mass media expenditure between baseline and 12-month follow-up was associated with 13% greater odds of making a quit attempt (95%CI = 1.05–1.23). There was no significant interaction between mass media expenditure and motivation to stop on quit attempts (OR = 1.01, 95%CI = 0.97–1.05); the data provided strong evidence for the null (Bayes factors = 0.07 and 0.04 based on expected effect sizes of OR = 1.5 and OR = 0.67, respectively). Among people who smoke, self-reported level of motivation to stop strongly predicted whether they made a quit attempt in the subsequent year. Increased expenditure on tobacco control mass media campaigns was associated with increased quit attempts. The association between motivation and quit attempts did not differ according to tobacco control mass media expenditure over this period. [ABSTRACT FROM AUTHOR]

Aims: In seeking to provide more accurate models of population quit attempt rates, this study assessed whether a single self-report measure of consistent motivation to stop smoking adds useful explanatory power over and above an established measure of current motivation to stop.Method: Data from 16,657 current smokers in England were collected between October 2012 and June 2017 using cross-sectional household surveys. Smokers were asked whether they had made a serious quit attempt in the past year and they answered two questions on motivation to stop (current motivation and consistent motivation to stop smoking). Having made at least one quit attempt in the past year was regressed in logistic models onto current motivation to stop and consistent motivation to stop individually and then together, with both models adjusting for sociodemographic variables and a measure of nicotine dependence.Results: The addition of consistent motivation to stop smoking added substantially to the fit of the model over and above the established measure of current motivation to quit (χ2(1, N = 16,657) = 901.7, p < 0.001) with an adjusted odds ratio of 4.1 (95% CI = 3.7-4.5, p < 0.001).Conclusion: Consistent motivation to stop smoking substantially improves the modelling of recent smoking cessation attempts over and above current motivation to stop. The consistency of smokers' motivation to quit may be a useful explanatory and target variable in future intervention studies. [ABSTRACT FROM AUTHOR]

Purpose Assess the impact of false-positives (FP), false-negatives (FN), fixation losses (FL), and test duration (TD) on visual field (VF) reliability at different stages of glaucoma severity. Design Retrospective. Participants A total of 10 262 VFs from 1538 eyes of 909 subjects with suspect or manifest glaucoma and ≥5 VF examinations. Methods Predicted mean deviation (MD) was calculated with multilevel modeling of longitudinal data. Differences between predicted and observed MD (ΔMD) were calculated as a reliability measure. The impact of FP, FN, FL, and TD on ΔMD was assessed using multilevel modeling. Main Outcome Measures ΔMD associated with a 10% increment in FP, FN, and FL, or a 1-minute increase in TD. Results FL had little impact on ΔMD (<0.2 decibels [dB] per 10% abnormal catch trials), and no level of FL produced ≥1 dB of ΔMD at any disease stage. FP yielded greater than expected MD, with a 10% increment in abnormal catch trials associated with a ΔMD = 0.42, 0.73, and 0.66 dB in mild (MD >−6 dB), moderate (−6 ≤MD <−12 dB), and severe (−12 ≤MD ≤−20 dB) disease, respectively, up to 20% abnormal catch trials, and a ΔMD = 1.57, 2.06, and 3.53 dB beyond 20% abnormal catch trials. FNs generally produced observed MDs below expected MDs. FN were minimally impactful up to 20% abnormal catch trials (ΔMD per 10% increment >−0.14 dB at all levels of severity). Beyond 20% abnormal catch trials, each 10% increment in abnormal catch trials was associated with a ΔMD = −1.27, −0.53, and −0.51 dB in mild, moderate, and severe disease, respectively. |ΔMD| ≥1 dB occurred with 22% FP and 26% FN in early, 14% FP and 34% FN in moderate, and 16% FP and 51% FN in severe disease. A 1-minute increment in TD produced ΔMDs between −0.35 and −0.40 dB. Conclusions FL have little impact on reliability in patients with established glaucoma. FP, and to a lesser extent FNs and TD, significantly affect reliability. The impact of FP and FN varies with disease severity and over the range of abnormal catch trials. On the basis of our findings, we present evidence-based, severity-specific standards for classifying VF reliability for clinical or research applications. [ABSTRACT FROM AUTHOR]

The distribution and variability of surface temperature fronts in the Great Lakes is studied using an 11 year time series (1985 to 1995) of Advanced Very High Resolution Radiometer (AVHRR) images. After theremoval of cloud contaminated pixels as well as those potentially ice covered, an edge detection algorithm identifies surface temperaturefronts in each image. The probability of detecting a front in the Great Lakes is highly variable from lake to lake as well as seasonally.Fronts during the winter months generally have cold water on their shallow side and appear in progressively deeper water as winter progresses. The properties of the winter fronts are consistent with a formation mechanism involving strong surface cooling over a sloping bottom. A spring transition occurs, whereby these fronts disappear and are replaced by nearshore thermal bar fronts with warm water found on their shallow side. The time of this transition depends upon the lake, occurring first in Lake Erie, next in Lakes Ontario, Huron, and Michigan, and finally in Lake Superior. These fronts are also observed to progress slowly into deeper water as nearshore waters warm. The classical thermal bar front (4 deg. C) is seen in all of the lakes but mostof the fronts during the spring peak in frontal activity have temperatures greater than 4 deg. C, suggesting that the thermal bar marks the offshore edge of a more extensive frontal zone. Frontal activity declines during summer in all lakes except Superior. [ABSTRACT FROM AUTHOR]

Aims ‘Categorical self-labels’ (e.g. thinking of oneself as a smoker or non-smoker) are important aspects of identity that can have a fundamental influence on behaviour. To explore the role identity aspects relating to smoking can play in smoking cessation and relapse, this study assessed the prospective associations between taking on a non-smoker identity following quitting and long-term abstinence. Methods A representative sample of 574 ex-smokers in England who quit smoking in the past year was followed-up at three ( N = 179) and six months ( N = 163). Post-quit identity relating to smoking (‘I still think of myself as a smoker’ or ‘I think of myself as a non-smoker’), and demographic and smoking-related characteristics were assessed at baseline. Self-reported smoking abstinence was assessed at follow-ups. Results Non-smoker identity was reported by 80.3% (95%CI 76.8–83.4) of recent ex-smokers. Younger age ( p = 0.017) and longer abstinence ( p < 0.001) were independently associated with a post-quit non-smoker identity. After adjusting for covariates, non-smoker identity ( p = 0.032) and length of abstinence at baseline ( p < 0.001) were associated with continued abstinence at three month follow-up, and baseline length of abstinence ( p = 0.003) predicted continued abstinence at six months. Conclusions The majority of people who quit smoking recently consider themselves as non-smokers. Younger people and those who have been abstinent for longer are more likely to take on a non-smoker identity. Ex-smokers who make this mental transition following a quit attempt appear more likely to remain abstinent in the medium term than those who still think of themselves as smokers. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To assess extent of electronic cigarette use by smokers attending Stop Smoking Services, the advice given about electronic cigarettes and whether this usage is recorded. Methods: Fifty-eight managers and 1284 practitioners completed an online survey. Questions covered use of electronic cigarettes, the advice given and whether use was recorded in client databases. Results: Ninety per cent (n =1150) and 95% (n =1215) of practitioners respectively, reported that their clients were using electronic cigarettes and that they had been asked about them. Seventy-one per cent (n =41) of managers reported that they had a policy on the advice to be given; of whom 85% (n =35) said that practitioners should say that products were unlicensed. Fifty-five per cent (n =707) of practitioners reported giving such advice and 11% (n =138) said they warned smokers about their safety. Only 9% (n =119) reported that they recorded clients’ use. Conclusion: Although use of electronic cigarettes by smokers in Stop Smoking Services is common, few provisions are in place to record their use. Practitioners mostly advise that products are not licensed. Practical implications: There is a need to consider additional training for practitioners on use of e-cigarettes and harm reduction generally to ensure that advice is consistent and evidence-based. [Copyright &y& Elsevier]

Abstract: Background: It has been proposed that positive smoker identity may be an important factor undermining smoking cessation but very little research exists on this. This study tested the hypothesis that a simple measure of positive smoker identity would predict quit attempts over and above other known predictors in a population sample. More tentatively it explored whether this measure would also predict quit success. Methods: A representative sample of adult smokers in England (n =9456) was included at baseline and 2099 were followed-up at six months. Demographic and smoking characteristics, a single item measure of positive smoker identity (endorsing the statement: ‘I like being a smoker’), measures of smoking-related attitudes, quit attempts and quit success were included. Results: A total of 18.3% (95% CI=17.5–19.2) of smokers reported a positive smoker identity. Adjusting for all other predictors, those with a positive smoker identity were more likely to be older (p <0.001), male (p =0.013), more nicotine dependent (p <0.001), have lower motivation to stop (p <0.001), have not made a quit attempt in the past year (p =0.025), enjoy smoking (p <0.001), and consider themselves to be addicted (p <0.001). Having a positive smoker identity independently predicted failure to make a quit attempt at six months (p =0.007). The independent association with quit success was similar in magnitude but did not reach statistical significance (p =0.053). Conclusions: Only a minority of smokers in England have a positive smoker identity. However, where it is present it may be an important barrier to quitting smoking and merits further study. [Copyright &y& Elsevier]

In the UK, smoking prevalence in people with depression (34%) and anxiety (29%) is more than double that of the general population (13%). People who stop smoking improve their mental health with comparable effect sizes found for antidepressants. In England, online psychological therapy is a standard treatment for depression and anxiety. Online therapy is an acceptable setting for smoking cessation support; however, integrated smoking and mental health support is not available. This novel study aims to assess the acceptability and feasibility of an online smoking cessation intervention, and trial procedures, offered alongside online mental health treatment as it offers increased reach to people with common mental health difficulties who smoke. A two-armed; Intervention (Integrated SilverCloud smoking cessation support) and control group (SilverCloud usual care), pragmatic, randomised controlled feasibility trial. We aim to recruit 500 adult smokers eligible for online mental health treatment. Follow-up will be conducted at 3-months and 6-months. We will assess the acceptability and feasibility of the trial procedures (i.e., recruitment, data completeness, self-reported acceptability and satisfaction) and the intervention (i.e., self-reported quit attempt, engagement with the smoking cessation and mental health programs, smoking cessation medicine and e-cigarette use, self-reported acceptability and satisfaction) and pilot clinical outcomes (i.e., biologically validated smoking abstinence, anxiety, depression, quality of health). If the Trial is successful, a randomised controlled effectiveness trial will follow to examine whether integrated smoking cessation and mental health treatment increases smoking abstinence and improves depression and anxiety compared to usual care. Trial registration : ISRCTN10612149 (https://doi.org/10.1186/ISRCTN10612149), 02/02/2023. [ABSTRACT FROM AUTHOR]

Abstract: Background: Smokers who use nicotine replacement therapy (NRT) to aid smoking reduction (SR) are more likely to quit smoking than those who try to reduce without NRT. This could be because NRT enhances the likelihood of quitting or because those who are motivated to quit choose to use NRT (i.e., selection bias). Methods: ‘Propensity score matching’ was used to assess whether the increased likelihood of a quit attempt in those using NRT for SR would remain in a subsample of smokers paired on variables indicative of the likelihood of making a quit attempt and using NRT (i.e., when selection bias is reduced). Measures were obtained on a range of smoking and socio-demographic variables at baseline, then after 3 and 6 months. Fifty-eight smokers who were attempting SR at 3 months were matched on baseline measures to 58 smokers not using NRT for SR. The odds of their going on to make a quit attempt in the following 3 months were then compared. Results: In smokers matched on motivational and other variables for their propensity to use NRT to aid smoking reduction, those using NRT for SR had three times greater odds of reporting a quit attempt than those not using NRT (OR 3.23; CI 1.49–7.01; p <0.01). Conclusion: The increased likelihood of subsequently trying to stop smoking among smokers who use NRT to aid SR versus those who try to reduce without NRT, remains following the matching of participants on motivational and other potentially relevant variables. [Copyright &y& Elsevier]

Background: To assess the prevalence of ever-drinking and hazardous drinking among adults in Germany, and investigate the factors associated with level of alcohol consumption.Methods: Cross-sectional population survey of a representative sample of 11,331 adults in Germany (2018 to 2019). The Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) was used to define ever-drinking (AUDIT-C>=1), hazardous drinking (AUDIT-C>=5) and an overall AUDIT-C (alcohol consumption) score (from 0 to 12). Regression models were used to examine sociodemographic and health-related characteristics associated with AUDIT-C score.Results: The prevalence of ever-drinking and hazardous drinking was 84.7% (95% CI = 84.1-85.4) and 19.4% (95% CI = 18.6-20.1), respectively. The mean AUDIT-C score was 2.8 (SD = 2.16). AUDIT-C scores were independently positively associated with having medium (Badj = 0.12, 95% CI = 0.02-0.21) and high (Badj = 0.11, 95% CI = 0.01-0.21) educational qualifications (compared with low), monthly income (Badj = 0.31 per €1,000, 95% CI = 0.26-0.36), being a current smoker (Badj = 0.94, 95% CI = 0.86-1.02), anxiety (Badj = 0.26, 95% CI = 0.02-0.50), and living in North East (Badj = 0.43, 95% CI = 0.29-0.58), North West (Badj = 0.47, 95% CI = 0.39-0.55) and South East (Badj = 0.79, 95% CI = 0.64-0.93) Germany (compared with South West), and negatively associated with age (Badj = -0.17, 95% CI = -0.21- -0.13), being female (Badj = -1.21, 95% CI = -1.28- -1.14) and depression (Badj = -0.22, 95% CI = -0.43- -0.02).Conclusion: In a large, representative sample of adults in Germany, the majority were ever-drinkers and one fifth were hazardous drinkers. Higher alcohol consumption scores were associated with being younger, male, current smoker, of high socioeconomic position, anxiety, and not living in South West Germany, and lower scores were associated with depression. These groups may benefit from targeted alcohol reduction policies and support. [ABSTRACT FROM AUTHOR]

Objective: To assess the association between likelihood of success of smoking cessation attempts and time since most recent attempt.Methods: Prospective study of 823 smokers who reported a failed quit attempt in the last 12 months at baseline and ≥1 quit attempt over 6-month follow-up. The input variable was time in months between the end (and in an exploratory analysis, the start) of the most recent failed quit attempt reported retrospectively at baseline and start of the first attempt made during the 6-month follow-up period. The outcome variable was success in the latter quit attempt.Results: Success rates for failed quitters who waited <3, 3-6, and 6-12 months between their failed quit attempt ending and making a subsequent quit attempt were 13.8%, 17.5%, and 19.0% respectively. After adjustment for covariates, the odds of cessation relative to those who made a subsequent quit attempt within 3 months were 1.42 (95%CI 0.79-2.55) and 1.52 (95%CI 0.81-2.86) for those who waited 3-6 and 6-12 months respectively before trying again. Bayes factors indicated the data were insensitive. The exploratory analysis showed the odds of cessation were 1.55 (95%CI 0.78-3.08), 1.92 (95%CI 0.94-3.92), and 2.47 (95%CI 1.04-5.83) greater for those with an interval of 3-6, 6-12, and 12-18 months respectively than those who tried again within 3 months.Conclusions: While pre-planned analyses were inconclusive, exploratory analysis of retrospective reports of quit attempts and success suggested the likelihood of success of quit attempts may be positively associated with number of months since beginning a prior quit attempt. However, only the longest inter-quit interval examined (12-18 months) was associated with significantly greater odds of quit success relative to a <3 month interval in fully adjusted models; all other comparisons were inconclusive. [ABSTRACT FROM AUTHOR]

Background It is unclear if cardiac troponin values are stable in patients prior to undergoing non-cardiac surgery, or if they tend to rise towards the day of surgery. Methods In this small pilot study (n = 18) among patients with cardiac risk undergoing non-cardiac surgery, we determined if high-sensitivity cardiac troponin I (hscTnI) changes between the preoperative clinic visit and the day of surgery. HscTnI was measured on an Abbott Architect STAT (Abbott Laboratories, USA) platform. Results The mean duration between preoperative clinic visit and day of surgery was 8.7 ± 2.8 (SD) days. Median hscTnI was 3.4 ng/L [2.0–4.8, IQR] at the preoperative visit and 2.8 ng/L [2.3–4.4] on the day of surgery (mean difference − 0.24 ng/L, 95% CI - 0.73 to 0.24 ng/L, p = 0.30). Only one patient had a large change (> 50%) along with symptoms. Discussion Evidence from this small study suggests that cardiac troponin values are stable in most high-risk patients, absent clinical events, within 10 days prior to non-cardiac surgery. [ABSTRACT FROM AUTHOR]

Aims: Some argue that perceived addiction to smoking (PAS) might undermine motivation to stop. We examined the association of PAS with motivation to stop in a population sample and assessed its association with past and future quit attempts and future quit success.Method: 12,700 smokers in England were surveyed between September 2009-March 2012 as part of the Smoking Toolkit Study. 2796 smokers were followed up after 6 months. PAS was assessed at baseline by a single self-report item. The outcome variables were ratings of motivation to stop and reports of past-year quit attempts at baseline, and quit attempts in the past 6 months and smoking status at follow-up. Baseline covariates were sex, age, social grade and daily cigarette consumption.Results: In adjusted analyses, PAS was positively associated with at least some degree of motivation to stop versus no motivation (ORs = 1.97-2.96, all p's < 0.001). PAS was also positively associated with past-year quit attempts (OR = 1.43, 95% CI = 1.32-1.55, p < 0.001), but not with future quit attempts (OR = 1.17, 95% CI = 0.99-1.39, p = 0.064) or quit success (OR = 1.04, 95% CI = 0.73-1.47, p = 0.83).Conclusion: In smokers in England, perceived addiction to smoking is positively associated with motivation to stop and having recently made a quit attempt but is not clearly associated with future quit attempts or success. These findings provide no grounds for believing that increasing smokers' perceived addiction through promotion of stop-smoking support has undermined motivation to stop. [ABSTRACT FROM AUTHOR]

Background and Aims: Tobacco smoking is prevalent among Arab smokers. Interventions to support smoking cessation may differ in effectiveness in this population from Western populations usually studied. This review assessed evidence of effectiveness of clinical smoking interventions in Arab smokers.Methods: A systematic search for comparative trials evaluating tobacco cessation interventions in Arab populations was conducted in the MEDLINE, EMBASE, PyschINFO, CINHAL and Web of Science databases. Behavioural, pharmacological and combined interventions were included. Reference lists of included studies were hand searched. The outcome measure was self- reported tobacco abstinence at the final follow-up, with biochemical verification where available. Assessment of evidence for effectiveness was undertaken using Bayes Factors.Results: A total of 659 titles and abstracts were identified. Five studies met the inclusion criteria. Four of these were randomized controlled trials and one was a non-randomized comparative trial. Differences between study features precluded meaningful aggregation for a meta-analysis. The four randomized trials all yielded Bayes Factors <1, suggesting no effect of the intervention compared with the control condition. The non-randomized trial, conducted in tuberculosis clinics in Sudan, yielded an extremely high Bayes Factor (>1000), supporting the hypothesis of effectiveness; however, the study was judged to have a high risk of bias.Conclusions: As yet, there is no convincing direct evidence that clinical smoking cessation interventions, which are found to be effective in Western populations, are also effective for Arab smokers. There is an urgent need for high quality randomized trials evaluating interventions in this population. [ABSTRACT FROM AUTHOR]

Labile carbon (C) input to soil can accelerate or slow the decomposition of soil organic matter, a phenomenon called priming. However, priming is difficult to predict, making its relationship with C input elusive. To assess this relationship, we added 13 C-glucose at five levels (8 to 1606 μg C g −1 week −1 ) to the soil from four different ecosystems for seven weeks. We observed a positive linear relationship between C input and priming in all soils: priming increased from negative or no priming at low C input to strong positive priming at high C input. However, the sensitivity of priming to C input varied among soils and between ways of expressing C input, and decreased with elevation. Positive substrate thresholds were detected in three soils (56 to 242 μg C g −1 week −1 ), suggesting the minimum C input required to trigger positive priming. Carbon input expressed as a fraction of microbial biomass explained 16.5% less variation in priming than did C input expressed as a fraction of dry soil mass, indicating that priming is not strongly related to the size of the soil microbial biomass. We conclude that priming increases with the rate of labile C input, once that rate exceeds a threshold, but the magnitude of increase varies among soils. Further research on mechanisms causing the variation of priming sensitivity to increasing labile C input might help promote a quantitative understanding of how such phenomenon impacts soil C cycling, offering the potential to improve earth system models. [ABSTRACT FROM AUTHOR]

Objective: To examine the real-world effectiveness of popular smoking cessation aids, adjusting for potential confounders measured up to 12 months before the quit attempt.Methods: 1,045 adult (≥18y) smokers in England provided data at baseline (April 2015-November 2020) and reported a serious past-year quit attempt at 12-month follow-up. Our outcome was smoking cessation, defined as self-reported abstinence at 12 months. Independent variables were use in the most recent quit attempt of: varenicline, prescription NRT, over-the-counter NRT, e-cigarettes, and traditional behavioural support. Potential confounders were age, sex, social grade, alcohol consumption, and level of dependence (measured at baseline), variables relating to the most recent quit attempt (measured at 12-month follow-up), and survey year.Results: Participants who reported using varenicline in their most recent quit attempt had significantly higher odds of abstinence than those who did not, after adjustment for potential confounders and use of other aids (OR = 2.69, 95 %CI = 1.43-5.05). Data were inconclusive regarding whether using prescription NRT, over-the-counter NRT, e-cigarettes, or traditional behavioural support was associated with increased odds of abstinence (p > 0.05; Bayes factors = 0.41-1.71, expected effect size OR = 1.19), but provided moderate evidence that using e-cigarettes was more likely associated with no effect than reduced odds (Bayes factor = 0.31, expected effect size OR = 0.75).Conclusions: Use of varenicline in a quit attempt was associated with increased odds of successful smoking cessation. Data were inconclusive regarding a benefit of e-cigarettes for cessation but showed use of e-cigarettes was unlikely to be associated with reduced odds of cessation. Associations between other cessation aids and cessation were inconclusive. [ABSTRACT FROM AUTHOR]

Objective: Because hyperlipidemia is asymptomatic, many veterans affairs (VA) patients may not perceive it seriously. We assessed key Health Belief model concepts to describe patients' cholesterol-related health beliefs and examine associations between patient-level factors and desire to improve cholesterol control.Methods: We used baseline data from an ongoing randomized clinical trial. Eligible patients were receiving care at the Durham VA and had CVD risk-total cholesterol levels >130 mg/dL and/or <80% medication adherence in the previous 12 months. A survey assessed patients' health beliefs about high cholesterol and self-reported medication adherence. Multivariable logistic regression examined whether there was an association between desire to control cholesterol and cholesterol status.Results: Approximately 64% (n=155) of patients perceived high cholesterol as 'very serious'. In multivariable logistic regression analysis, patients who perceived high cholesterol as 'very serious' (OR 2. 26, p=0.032) and/or with high self-efficacy (OR 4.70, p<0.001) had increased odds of desiring cholesterol control.Conclusion: The factors most significantly associated with desire to improve cholesterol control were perceiving hyperlipidemia as 'very serious and self-efficacy for cholesterol control.Practice Implication: Educating patients, with the goal of appropriately increasing their perceived risk of disease, is likely necessary to impact cholesterol control. [ABSTRACT FROM AUTHOR]