bluuebunny/crossref_metadata_2025 huggingface dataset:
Understanding usual care for patients with multimorbidity: baseline data from a cluster-randomised trial of the 3D intervention in primary care
Authors: Chaplin Katherine , Bower Peter , Man Mei-See , Brookes Sara T , Gaunt Daisy , Guthrie Bruce , Mann Cindy , Mercer Stewart W , Rafi Imran , Shaw Alison R G , Salisbury Chris
Published: August 2018

Objectives

Recent evidence has highlighted the high prevalence and impact of multimorbidity, but the evidence base for improving management is limited. We have tested a new complex intervention for multimorbidity (the 3D model). The paper describes the baseline characteristics of practices and patients in order to establish the external validity of trial participants. It also explores current ‘usual primary care’ for multimorbidity, against which the 3D intervention was tested.

Design

Analysis of baseline data from patients in a cluster-randomised controlled trial and additional data from practice staff.

Setting

Primary care in the UK.

Participants

Patients with multimorbidity (n=5253) and 154 practice staff.

Primary and secondary outcome measures

Using surveys and routinely available data, we compared the characteristics of participating and non-participating practices and participating and non-participating eligible patients.

Baseline questionnaire data from patient participants was used to examine participant illness burden, treatment burden and perceptions of receiving patient-centred care. We obtained data about usual care preintervention from practice staff using questionnaires and a structured pro forma.

Results

Participating practices were slightly larger, in less deprived areas, and with slightly higher scores for patient satisfaction compared with non-participating practices. Patients with dementia or learning difficulties were likely to be excluded by their general practitioners, but comparison of participants with non-participants identified only minor differences in characteristics, suggesting that the sample was otherwise representative. Patients reported substantial illness burden, and an important minority reported high treatment burden. Although patients reported relatively high levels of satisfaction with care, many reported not having received potentially important components of care.

Conclusion

This trial achieved good levels of external validity. Although patients were generally satisfied with primary care services, there was significant room for improvement in important aspects of care for multimorbidity that are targeted by the 3D intervention.

Trial registration number

ISRCTN06180958; Post-results.
Project SWEAT (Summer Weight and Environmental Assessment Trial): study protocol of an observational study using a multistate, prospective design that examines the weight gain trajectory among a racially and ethnically diverse convenience sample of economically disadvantaged school-age children
Authors: Hopkins Laura C , Penicka Christine , Evich Carly , Jones Blake , Gunther Carolyn
Published: August 2018

Introduction

Racial/ethnic minority school-age children are at risk for unhealthy weight gain during the summer, and there is a dearth of information regarding the underlying behavioural and environmental factors. The study objective is to provide an in-depth examination of dietary and physical activity behaviours and food, physical activity, and social environments of African American and Hispanic school-age children during the summer.

Methods and analysis

An observational study will be conducted using a multistate (Ohio and Indiana, USA) prospective design examining the weight gain trajectory among a racially/ethnically diverse convenience sample of economically disadvantaged school-age children. In addition, a subset of these children will be evaluated to learn their daily health behaviours and food, physical activity, and social environments during the summer. Comparisons will be made between children who routinely attend programming and those who do not, both in the larger sample and subset. Determinants of programme participation and factors that may enhance the beneficial effects of programme participation will also be identified. Data collection at the Indiana site is planned for summer 2018.

Ethics and dissemination

This study is approved by The Ohio State University Behavioral and Social Sciences Institutional Review Board. Results from this study will be disseminated in publications for practitioners, scientists and stakeholders.

Trial registration number

NCT03010644; Pre-results.
Cost-effectiveness of a domestic violence and abuse training and support programme in primary care in the real world: updated modelling based on an MRC phase IV observational pragmatic implementation study
Authors: Barbosa Estela Capelas , Verhoef Talitha Irene , Morris Steve , Solmi Francesca , Johnson Medina , Sohal Alex , El-Shogri Farah , Dowrick Susanna , Ronalds Clare , Griffiths Chris , Eldridge Sandra , Lewis Natalia V , Devine Angela , Spencer Anne , Feder Gene
Published: August 2018

Objectives

To evaluate the cost-effectiveness of the implementation of the Identification and Referral to Improve Safety (IRIS) programme using up-to-date real-world information on costs and effectiveness from routine clinical practice. A Markov model was constructed to estimate mean costs and quality-adjusted life-years (QALYs) of IRIS versus usual care per woman registered at a general practice from a societal and health service perspective with a 10-year time horizon.

Design and setting

Cost–utility analysis in UK general practices, including data from six sites which have been running IRIS for at least 2 years across England.

Participants

Based on the Markov model, which uses health states to represent possible outcomes of the intervention, we stipulated a hypothetical cohort of 10 000 women aged 16 years or older.

Interventions

The IRIS trial was a randomised controlled trial that tested the effectiveness of a primary care training and support intervention to improve the response to women experiencing domestic violence and abuse, and found it to be cost-effective. As a result, the IRIS programme has been implemented across the UK, generating data on costs and effectiveness outside a trial context.

Results

The IRIS programme saved £14 per woman aged 16 years or older registered in general practice (95% uncertainty interval −£151 to £37) and produced QALY gains of 0.001 per woman (95% uncertainty interval −0.005 to 0.006). The incremental net monetary benefit was positive both from a societal and National Health Service perspective (£42 and £22, respectively) and the IRIS programme was cost-effective in 61% of simulations using real-life data when the cost-effectiveness threshold was £20 000 per QALY gained as advised by National Institute for Health and Care Excellence.

Conclusion

The IRIS programme is likely to be cost-effective and cost-saving from a societal perspective in the UK and cost-effective from a health service perspective, although there is considerable uncertainty surrounding these results, reflected in the large uncertainty intervals.
Lifetime cigarette smoking and chronic widespread and regional pain in later adulthood: evidence from the 1946 British birth cohort study
Authors: Bendayan Rebecca , Cooper Rachel , Muthuri Stella G
Published: August 2018

Objective

To examine whether different lifetime patterns of cigarette smoking are associated with chronic widespread pain (CWP) and chronic regional pain (CRP) at age 68.

Design

Prospective cohort study.

Setting

England, Scotland and Wales.

Participants

Up to 2347 men and women from the Medical Research Council National Survey of Health and Development, who have been followed up since birth in 1946 and provided sufficient information on cigarette smoking across adulthood to be classified as never smoker, predominantly non-smoker, predominantly smoker or lifelong smoker and pain assessment at age 68.

Primary outcome measures

Pain was self-reported at age 68, and CWP was defined according to American College of Rheumatology criteria. Participants who reported having pain for ≥3 months but who did not meet the CWP definition were classified as having CRP; those who reported pain which had lasted for <3 months were classified as ‘other’ pain. No pain was the reference group.

Results

Findings from multinomial logistic regression models indicated that compared with never smokers, predominantly non-smokers, predominantly smokers and lifelong smokers all had an increased risk of CWP; relative risk ratios=1.70(95% CI 1.16 to 2.49); 2.10(95% CI 1.34 to 3.28) and 1.88(95% CI 0.99 to 3.57), respectively, after adjusting for sex, own occupational class, educational level, body mass index, leisure time physical activity, alcohol intake, long-standing illness and symptoms of anxiety and depression. No association was observed between smoking history and CRP or other pain.

Conclusions

These results suggest that exposure to cigarette smoking at any stage in adulthood was associated with higher risk of CWP in later adulthood; highlighting the ongoing importance of smoking prevention programmes. It also suggests that assessment of lifetime smoking behaviour may be more useful in identifying those at greater risk of CWP in later life than assessment of current smoking status.
Design of a treatment pathway for insomnia in prison settings in England: a modified Delphi study
Authors: Dewa Lindsay H , Hassan Lamiece , Shaw Jenny , Senior Jane
Published: August 2018

Objective

Insomnia is highly prevalent in prisoners and is a risk factor for poor mental well-being, depression, suicidality and aggression, all common concerns in this vulnerable population. Improving sleep management options in prison offers the potential to impact positively on a number of these common risk factors. The study aim was to design a treatment pathway for insomnia in prisons informed by stakeholders with professional or lived experience of insomnia and prison-based interventions.

Design

A modified Delphi technique, adapted to the stakeholder (either receiving controlled feedback online or face to face on a series of statements), was used over three rounds to gain consensus on a final treatment pathway design.

Participants

Academic sleep researchers, prison staff and prisoners were invited to develop the treatment pathway.

Results

Fifteen stakeholders took part in round 1 and thirteen in round 2. There were six statements of contention that comprised concerns over the inclusion of sleep observations, sleep restriction therapy and promethazine. Consensus was high (>80%). Thirteen stakeholders agreed the final pathway in round 3. The final treatment pathway comprised a standardised stepped-care approach for insomnia in prison populations. The pathway resulted in five main stages: (1) transition from community; (2) detection and assessment; (3) treatment for short-term insomnia; (4) treatment for long-term insomnia and (5) transition from prison to community or another establishment.

Conclusions

The treatment pathway is designed to promote early detection of insomnia, potentially reducing unnecessary prescriptions and medication trading, misuse and diversion in the prison setting. It should make a substantial difference in reducing the large number of sleep complaints and positively impact on prisoners, staff and the prison environment. Specifically, improving sleep should have a positive impact on prisoners’ mental and physical well-being and aid smooth running of the prison.
Psychosocial factors at work and inflammatory markers: protocol for a systematic review and meta-analysis
Authors: Eguchi Hisashi , Watanabe Kazuhiro , Kawakami Norito , Ando Emiko , Arima Hideaki , Asai Yumi , Inoue Akiomi , Inoue Reiko , Iwanaga Mai , Imamura Kotaro , Kobayashi Yuka , Nishida Norimitsu , Otsuka Yasumasa , Sakuraya Asuka , Tsuno Kanami , Shimazu Akihito , Tsutsumi Akizumi
Published: August 2018

Introduction

Chronic inflammation may be a mediator for the development of cardiovascular disease (CVD), metabolic diseases and psychotic and neurodegenerative disorders. Meta-analytic associations between work-related psychosocial factors and inflammatory markers have shown that work-related psychosocial factors could affect the flexibility and balance of the immune system. However, few systematic reviews or meta-analyses have investigated the association between work-related psychosocial factors and inflammatory markers. Based on prospective studies, the present investigation will conduct a comprehensive systematic review and meta-analysis of the association between work-related psychosocial factors and inflammatory markers.

Methods and analysis

The systematic review and meta-analysis will include published studies identified from electronic databases (PubMed, EMBASE, PsycINFO, PsycARTICLES, Web of Science and Japan Medical Abstracts Society) according to recommendations of the Meta-analysis of Observational Studies in Epidemiology guideline. Inclusion criteria are studies that: examined associations between work-related psychosocial factors and increased inflammatory markers; used longitudinal or prospective cohort designs; were conducted among workers; provided sufficient data for calculating ORs or relative risk with 95% CIs; were published as original articles in English or Japanese; and were published up to the end of 2017. Study selection, data extraction, quality assessment and statistical syntheses will be conducted by 14 investigators. Any inconsistencies or disagreements will be resolved through discussion. The quality of studies will be evaluated using the Risk of Bias Assessment Tool for Non-randomized Studies.

Ethics and dissemination

The investigation study will be based on published studies, so ethics approval is not required. The results of this study will be submitted for publication in a scientific peer-reviewed journal. The findings may be useful for assessing risk factors for increased inflammatory markers in the workplace and determining future approaches for preventing CVD, metabolic diseases and psychotic and neurodegenerative disorders.

PROSPERO registration number

CRD42018081553.
Predictive value of the urinary dipstick test in the management of patients with urinary tract infection-associated symptoms in primary care in Indonesia: a cross-sectional study
Authors: Ginting Franciscus , Sugianli Adhi Kristianto , Kusumawati R Lia , Parwati Ida , de Jong Menno D , Schultsz Constance , van Leth Frank
Published: August 2018

Objective

To assess the test characteristics of a urine dipstick test in predicting a positive urine culture in an outpatient setting in Indonesia.

Design

Cross-sectional study.

Setting

Two outpatient clinics in Medan, Indonesia.

Participants

616 consecutively enrolled participants suspected of having a urinary tract infection.

Outcome measures

The primary outcome is the estimates of accuracy (sensitivity, specificity, predictive values) where urine culture is the reference test. The secondary outcome is the post-test probability of a positive urine culture.

Results

The optimal test characteristics were obtained when index test positivity was defined as any leucocyte esterase reaction and/or a nitrite reaction and reference test positivity was defined as a urine culture with a growth of at least 103colony-forming units/mL (sensitivity: 88.2% (95% CI 81.6 to 93.1), negative predictive value: 93.0% (95% CI 88.9 to 95.9)). The post-test probability of a positive urine culture after a negative urinary dipstick test was 7% in the obstetric/gynaecology clinic and 8% in the internal medicine clinic.

Conclusion

The use of a urine dipstick test in arule-outstrategy can reduce the need for urine culture and avoid the prescription of (ineffective) antibiotics in a non-urology outpatient setting.
New graduate doctors’ preparedness for practice: a multistakeholder, multicentre narrative study
Authors: Monrouxe Lynn V , Bullock Alison , Gormley Gerard , Kaufhold Kathrin , Kelly Narcie , Roberts Camille Emilie , Mattick Karen , Rees Charlotte
Published: August 2018

Objective

While previous studies have begun to explore newly graduated junior doctors’ preparedness for practice, findings are largely based on simplistic survey data or perceptions of newly graduated junior doctors and their clinical supervisors alone. This study explores, in a deeper manner, multiple stakeholders’ conceptualisations of what it means to be prepared for practice and their perceptions about newly graduated junior doctors’ preparedness (or unpreparedness) using innovative qualitative methods.

Design

A multistakeholder, multicentre qualitative study including narrative interviews and longitudinal audio diaries.

Setting

Four UK settings: England, Northern Ireland, Scotland and Wales.

Participants

Eight stakeholder groups comprising n=185 participants engaged in 101 narrative interviews (27 group and 84 individual). Twenty-six junior doctors in their first year postgraduation also provided audio diaries over a 3-month period.

Results

We identified 2186 narratives across all participants (506 classified as ‘prepared’, 663 as ‘unprepared’, 951 as ‘general’). Seven themes were identified; this paper focuses on two themes pertinent to our research questions: (1) explicit conceptualisations of preparedness for practice; and (2) newly graduated junior doctors’ preparedness for the General Medical Council’s (GMC)outcomes for graduates. Stakeholders’ conceptualisations of preparedness for practice included short-term (hitting the ground running) and long-term preparedness, alongside being prepared for practical and emotional aspects. Stakeholders’ perceptions of medical graduates’ preparedness for practice varied across different GMC outcomes for graduates (eg, Doctor as Scholar and Scientist, as Practitioner, as Professional) and across stakeholders (eg, newly graduated doctors sometimes perceived themselves as prepared but others did not).

Conclusion

Our narrative findings highlight the complexities and nuances surrounding new medical graduates’ preparedness for practice. We encourage stakeholders to develop a shared understanding (and realistic expectations) of new medical graduates’ preparedness. We invite medical school leaders to increase the proportion of time that medical students spend participating meaningfully in multiprofessional teams during workplace learning.
Pioglitazone use and Parkinson’s disease: a retrospective cohort study in Taiwan
Authors: Wu Hsiu-Feng , Kao Li-Ting , Shih Jui-Hu , Kao Hui-Han , Chou Yu-Ching , Li I-Hsun , Kao Senyeong
Published: August 2018

Objectives

Many researchers have expected pioglitazone to serve as an effective neuroprotective agent against Parkinson’s disease (PD). Therefore, we conducted this cohort study to investigate the association between pioglitazone use and PD by using a large Asian population-based dataset in Taiwan.

Design

Retrospective cohort study.

Setting

Taiwan.

Participants

7906 patients with diabetes who had received pioglitazone were defined as the study cohort, and 7906 matched patients with diabetes who had not received pioglitazone were defined as the comparison cohort.

Primary and secondary outcome measures

We tracked each patient individually over a 5-year follow-up period to identify those diagnosed as having PD during this period. We performed Cox proportional hazard regression analyses to evaluate the HRs for PD between the study and comparison cohorts.

Results

The findings indicated that among the sampled patients, PD occurred in 257 (1.63%): 119 (1.51%) pioglitazone users and 138 (1.75%) non-users. The adjusted HR for PD within the follow-up period was 0.90 (95% CI: 0.68 to 1.18) in the patients who had received pioglitazone compared with the matched patients who had not received pioglitazone. Moreover, this study revealed that pioglitazone use was not associated with PD incidence in men (HR: 1.06, 95% CI: 0.71 to 1.59) or women (HR: 0.84, 95% CI: 0.61 to 1.15).

Conclusions

This study did not find the relationship between pioglitazone use and PD incidence, regardless of sex, among an Asian population of patients with diabetes.
Established and novel risk factors for atrial fibrillation in women compared with men
Authors: Peters Sanne A E , Woodward Mark
Published: August 2018

Background

Atrial fibrillation (AF) is a stronger risk factor for cardiovascular disease in women than men. We assessed whether there are sex differences in the effects of 43 established and novel risk factors and the risk of incident AF.

Methods

Data were used from the Scottish Heart Health Extended Cohort, a prospective cohort study with over 20 years of follow-up for AF incidence. Cox regression models were used to obtain the adjusted sex-specific HRs and 95% CIs, and the women-to-men ratio of HRs (RHRs), of incident AF associated with personal characteristics, smoking, physical measurements, diabetes mellitus, lipid, inflammatory, cardiac, and diet- and renal-related markers.

Results

Overall, 15 737 participants (52% women) were included. There were sex differences in the relationship between a 1 SD increase in body mass index (BMI), NT-pro-BNP, uric acid, and cystatin-C and the risk of AF. The HRs were 1.17 (95% CI 1.08 to 1.27) in women and 1.36 (95% CI 1.24 to 1.49) in men for BMI (RHR 0.86, 95% CI 0.77 to 0.97); 1.84 (95% CI 1.62 to 2.09) in women and 1.54 (95% CI 1.40 to 1.68) in men for NT-pro-BNP (RHR 1.22, 95% CI1.05 to 1.42); 1.27 (95% CI 1.14 to 1.41) in women and 1.10 (95% CI 1.00 to 1.20) in men for uric acid (RHR 1.17, 95% CI 1.01 to 1.35); and 1.22 (95% CI 1.13 to 1.32) in women and 1.07 (95% CI 0.96 to 1.18) in men for cystatin-C (RHR 1.16, 95% CI 1.05 to1.27).

Conclusion

Higher BMI is a stronger risk factor for AF in men whereas elevated NT-pro-BNP, uric acid and cystatin-C were more strongly associated with the risk of AF in women.
Biomarkers to diagnose ventricular dysfunction in childhood cancer survivors: a systematic review
Authors: Leerink Jan M , Verkleij Simone J , Feijen Elizabeth A M , Mavinkurve-Groothuis Annelies M C , Pourier Milanthy S , Ylänen Kaisa , Tissing Wim J E , Louwerens Marloes , van den Heuvel Marry M , van Dulmen-den Broeder Eline , de Vries Andrica C H , Ronckers Cecile M , van der Pal Heleen J H , Kapusta Livia , Loonen Jacqueline , Bellersen Louise , Pinto Yigal M , Kremer Leontien C M , Kok Wouter E M
Published: August 2018

Objective

To systematically review the literature and assess the diagnostic value of biomarkers in detection of late-onset left ventricular (LV) dysfunction in childhood cancer survivors (CCS) treated with anthracyclines.

Methods

We systematically searched the literature for studies that evaluated the use of biomarkers for detection of LV dysfunction in CCS treated with anthracyclines more than 1 year since childhood cancer diagnosis. LV dysfunction definitions were accepted as an ejection fraction <50% or <55% and/or a fractional shortening <28%, <29% or <30%. Contingency tables were created to assess diagnostic accuracies of biomarkers for diagnosing LV dysfunction.

Results

Of 1362 original studies screened, eight heterogeneous studies evaluating four different biomarkers in mostly asymptomatic CCS were included. In four studies, an abnormal N-terminal pro-B-type natriuretic peptide (NT-proBNP, cut-off range 63–125 ng/L) had low sensitivity (maximally 22%) and a specificity of up to 97% for detection of LV dysfunction. For troponin levels, in five studies one patient had an abnormal troponin value as well as LV dysfunction, while in total 127 patients had LV dysfunction without troponin elevations above cut-off values (lowest 0.01 ng/mL). Two studies that evaluated brain natriuretic peptide and nitric oxide were underpowered to draw conclusions.

Conclusions

In individual studies, the diagnostic value of NT-proBNP for detection of LV dysfunction in CCS is limited. Troponins have no role in detecting late-onset LV dysfunction with cut-off values as low as 0.01 ng/mL. Further study on optimal NT-proBNP cut-off values for rule out or rule in of LV dysfunction is warranted.
Impact of modified risk tobacco product claims on beliefs of US adults and adolescents
Authors: El-Toukhy Sherine , Baig Sabeeh A , Jeong Michelle , Byron M Justin , Ribisl Kurt M , Brewer Noel T
Published: August 2018

Objective

Under US law, tobacco product marketing may claim lower exposure to chemicals, or lower risk of health harms, only if these claims do not mislead the public. We sought to examine the impact of such marketing claims about potential modified risk tobacco products (MRTPs).

Methods

Participants were national samples of 4797 adults and 969 adolescent US smokers and non-smokers. We provided information about a potential MRTP (heated tobacco product, electronic cigarette or snus). Experiment 1 stated that the MRTP was as harmful as cigarettes or less harmful (lower risk claim). Experiment 2 stated that the MRTP exposed users to a similar quantity of harmful chemicals as cigarettes or to fewer chemicals (lower exposure claim).

Results

Claiming lower risk led to lower perceived quantity of chemicals and lower perceived risk among adults and adolescents (all p<0.05, Experiment 1). Among adults, this claim led to higher susceptibility to using the MRTP (p<0.05). Claiming lower exposure led to lower perceived chemical quantity and lower perceived risk (all p<0.05), but had no effect on use susceptibility (Experiment 2). Participants thought that snus exposed users to more chemicals and was less safe to use than heated tobacco products or electronic cigarette MRTPs (Experiments 1 and 2).

Discussion

Risk and exposure claims acted similarly on MRTP beliefs. Lower exposure claims misled the public to perceive lower perceived risk even though no lower risk claim was explicitly made, which is impermissible under US law.
Electronic cigarette chemicals transfer from a vape shop to a nearby business in a multiple-tenant retail building
Authors: Khachatoorian Careen , Jacob III Peyton , Benowitz Neal L , Talbot Prue
Published: August 2018

Background

Electronic cigarettes (ECs) are nicotine delivery devices that produce aerosol without combustion of tobacco; therefore, they do not produce sidestream smoke. Nevertheless, many users exhale large clouds of aerosol that can result in passive exposure of non-users. Analogous to thirdhand cigarette smoke, the exhaled aerosol also settles on indoor surfaces where it can produce a residue. We refer to this residue as EC exhaled aerosol residue (ECEAR). Our objective was to determine if exhaled EC aerosol transferred from a vape shop in a multiple-tenant retail building, where it was produced, to a nearby business (field site) where it could deposit as ECEAR.

Methods

We examined the build-up of ECEAR in commonly used materials (cotton towel and paper towels) placed inside the field site across from the vape shop. Materials were subjected to short-term (days) and long-term (months) exposures. Nicotine, other alkaloids and tobacco-specific nitrosamines (TSNAs) were identified and quantified in controls and field site samples using analytical chemical techniques.

Results

Nicotine and other alkaloids were detected after 1 day of exposure in the field site, and these chemicals generally increased as exposure times increased. TSNAs, which have been linked to carcinogenesis, were also detected in short-term and long-term exposed samples from the field site.

Conclusions

In a multiple-tenant retail building, chemicals in EC aerosol travelled from a vape shop into an adjacent business where they deposited forming ECEAR. Regulatory agencies and tenants occupying such buildings should be aware of this potential environmental hazard.
IQOS: examination of Philip Morris International’s claim of reduced exposure
Authors: St.Helen Gideon , Jacob III Peyton , Nardone Natalie , Benowitz Neal L
Published: August 2018

Background

New electronic heated tobacco products are being introduced in the global market and are gaining popularity. In 2016, Philip Morris International, Inc. (PMI) submitted a modified risk tobacco product (MRTP) application to the Food and Drug Administration (FDA) to market IQOS in the USA with claims of reduced exposure and reduced risk.

Methods

We examined PMI’s MRTP application, specifically sections on aerosol chemistry and human exposure assessment, to assess the validity of PMI’s claims of reduced exposure and risk.

Findings

PMI reported levels for only 40 of 93 harmful and potentially harmful constituents (HPHCs) on FDA’s HPHC list in IQOS mainstream aerosol. All substances in PMI’s list of 58 constituents (PMI-58) were lower in IQOS emissions compared with mainstream smoke of 3R4F reference cigarettes. However, levels of 56 other constituents, which are not included in the PMI-58 list or FDA’s list of HPHCs, were higher in IQOS emissions; 22 were >200% higher and seven were >1000% higher than in 3R4F reference cigarette smoke. PMI’s studies also show significantly lower systemic exposure to some HPHCs from use of IQOS compared with smoking combustible cigarettes.

Conclusion

PMI’s data appear to support PMI’s claim that IQOS reduces exposure to HPHCs. However, PMI’s data also show significantly higher levels of several substances that are not recognised as HPHCs by the FDA in IQOS emissions compared with combustible cigarette smoke. The impact of these substances on the overall toxicity or harm of IQOS is not known.
Awareness and use of heated tobacco products among US adults, 2016–2017
Authors: Nyman Amy L , Weaver Scott R , Popova Lucy , Pechacek Terry Frank , Huang Jidong , Ashley David L , Eriksen Michael P
Published: August 2018

Introduction

Although heated tobacco products (HTP) have been on and off the commercial market for the past three decades (eg, Premier, Eclipse and Accord), they have not received widespread consumer acceptance as an alternative to combustible cigarettes. This may change with recent product innovations, shifts in consumer preferences and the tobacco market landscape and a US regulatory environment that may permit an internationally available HTP to be sold in the USA, possibly with a reduced exposure or risk statement. This study examined the extent of awareness and use of HTP in the USA and assessed the characteristics of those aware of and using these products.

Methods

Data came from the 2016 and 2017 Tobacco Products and Risk Perceptions Surveys of national probability samples of US adults, conducted online during September–October 2016 (n=6014) and August–September 2017 (n=5992). Weighted χ2tests and regression analyses examined changes in awareness and use of HTP between 2016 and 2017 and characteristics associated with awareness and use.

Results

From 2016 to 2017, awareness of HTP among US adults increased from 9.3% to 12.4% (p<0.001), ever use increased from 1.4% to 2.2% (p=0.005) and current use increased two fold, from 0.5% to 1.1% (p=0.004). Men and adults under age 45 years had higher rates of awareness than women and those 45 and older, respectively. Non-white adults, cigarette smokers and both current and former users of electronic nicotine delivery systems were more likely to be using HTP.

Conclusions

Awareness and use of HTP in the USA are increasing. These products are more familiar to men and younger adults and may be being used disproportionately by racial/ethnic minorities. With increases in HTP availability and the potential for reduced-risk claims ahead, surveillance of patterns and consequences of use by both smokers and non-smokers is needed.
IQOS labelling will mislead consumers
Authors: McKelvey Karma , Popova Lucy , Kim Minji , Lempert Lauren Kass , Chaffee Benjamin W , Vijayaraghavan Maya , Ling Pamela , Halpern-Felsher Bonnie
Published: August 2018

Background

Philip Morris International (PMI) continually expands and diversifies their nicotine product portfolio, which includes IQOS, a heated tobacco product. In December 2016, PMI filed a modified risk tobacco product (MRTP) application with the US Food and Drug Administration (FDA), seeking authorisation to market IQOS in USA with three claims of reduced harm: ‘switching completely from conventional cigarettes to theIQOSsystem…’ (1) ‘can reduce the risks of tobacco-related diseases;’ (2) ‘significantly reduce[s] your body’s exposure to harmful or potentially harmful chemicals;’ and (3) ‘presents less risk of harm than continuing to smoke cigarettes.’ Consumers may misunderstand what is meant by ‘switching completely'.

Methods

We critically reviewed study reports submitted to FDA by PMI in support of proposed marketing claims in its MRTP application for IQOS and focused on the statement that switching completely to IQOS reduces risk.

Results

We found deficiencies with evidence provided by PMI supporting their assertions that: current smokers will understand what is meant by the phrase ‘switching completely'; the proposed claims will not decrease smokers’ intentions to quit; and IQOS users will in fact ‘switch completely’ from smoking cigarettes to using IQOS. The studies and measurement instruments employed by PMI suffer from design flaws and their reporting of associated findings is misleading.

Conclusion

Consumers will not understand the condition of the claims—that they must quit using cigarettes completely to achieve the inferred health benefits of IQOS. Rather, they are likely to misunderstand the unsupported claims of reduced risks to mean IQOS are harm-free.
Waterpipe tobacco package warning exposure’s impact on risk perceptions and use among young adults in the USA: a longitudinal analysis of the population assessment of tobacco and health study
Authors: King Jessica L , Reboussin Beth A , Cornacchione Ross Jennifer , Sutfin Erin L
Published: August 2018

Background

Although Food and Drug Administration (FDA)-mandated waterpipe tobacco warnings were not required until August 2018, some waterpipe tobacco packaging (WTP) sold in the USA, contained warnings prior to this date. We examined the prevalence of WTP warning exposure and whether exposure influenced risk perceptions or use among young adult (aged 18–24 years) current waterpipe users.

Methods

We used data from waves 1 (2013–2014) and 2 (2014–2015) of the Population Assessment of Tobacco and Health Study, a nationally representative longitudinal study of US adults and youth. We conducted logistic regression analyses to identify factors associated with wave 1 warning exposure, and whether wave 1 WTP warning exposure predicted wave 2 relative risk perceptions and waterpipe use.

Results

More than one-third of our sample (35.9%, 95% CI 33.5 to 38.4) reported past-month WTP warning exposure. Exposure was higher among males (adjusted OR (AOR)=1.34, 95% CI 1.04 to 1.72), those who usually do not share the waterpipe (AOR=3.10, 95% CI 1.45 to 6.60), those who purchased waterpipe tobacco (AOR=1.73, 95% CI 1.28 to 2.34), and those with a regular brand (AOR=1.84, 95% CI 1.26 to 2.68). Those exposed to WTP warnings at wave 1 were more likely than those not exposed to perceive waterpipe tobacco to be as or more harmful than cigarettes at wave 2 (AOR=1.35, 95% CI 1.02 to 1.78). There was no association between wave 1 WTP exposure and wave 2 waterpipe use.

Conclusions

More than one-third of US young adult current waterpipe users reported WTP warning exposure prior to FDA-mandated warning implementation. Findings suggest the mandated warning may result in high exposure among users; it will be critical to assess exposure’s impact on risk perceptions and behaviour after FDA-mandated warnings are implemented.
Static Casimir condensate of conformal scalar field in Friedmann universe
Authors: Arbuzov Andrej B. , Pavlov Alexander E.
Published: August 2018

The quantum Casimir condensate of a conformal massive scalar field in a compact Friedmann universe is considered in the static approximation. The Abel–Plana formula is used for renormalization of divergent series in the condensate calculation. A differential relation between the static Casimir energy density and static Casimir condensate is derived.
Nonequilibrium quantum electrodynamics: Entropy production during equilibration
Authors: Nishiyama Akihiro , Tuszynski Jack A.
Published: August 2018

We study nonequilibrium processes of Quantum Electrodynamics (QED) with relativistic charged Bose fields. The aim is to describe thermal equilibration, based on the Klein–Gordon equation for background coherent fields and the Kadanoff–Baym (KB) equation including the leading-order (LO) self-energy of the coupling expansion (the Hartree–Fock approximation). We introduce a gauge invariant relativistic kinetic entropy current at the first-order in the gradient expansion of the KB equation and we show the proof of the H-theorem in d + 1 dimensions (d = 1, 2, 3) in the presence of nonzero background coherent fields. Finally, we present numerical simulation in 1 + 1 dimensions and aim to investigate whether decoherence of the system occurs or not. We find that equilibrium states are realized with remaining background coherent charged Bose and photon fields by preparing distributions of incoherent charged particles asymmetrically in frequency mode as initial conditions in the KB equation even if LO self-energy is present.
A four-way decision-making system for the Indian summer monsoon rainfall
Authors: Singh Pritpal , Rabadiya Kinjal , Dhiman Gaurav
Published: August 2018

Due to non-stationary nature of Indian summer monsoon rainfall (ISMR), analysis of its patterns and behaviors is a very tedious task. Advance prediction and behaviors play a significant role in various domains. Literature review reveals that researchers’ works are limited to design predictive models but not on inherited patterns and behaviors for the ISMR. In this study, a novel method based on the hybridization of two computational techniques, viz., fuzzy and rough sets is proposed for patterns and behaviors. The proposed method initially classifies the information into the four distinct regions, as fuzzy positive region, fuzzy negative region, completely fuzzy region, and gray fuzzy region. Based on four regions, four different patterns of decision rules are explored. Further, a method is discussed to represent such decision rules in terms of graph, which helps to analyze the patterns of ISMR by discovering new knowledge. The proposed method is validated by performing various statistical analyses.
Graph polynomials and symmetries
Authors: Chbili Nafaa
Published: August 2018

In a recent paper, we studied the interaction between the automorphism group of a graph and its Tutte polynomial. More precisely, we proved that certain symmetries of graphs are clearly reflected by their Tutte polynomials. The purpose of this paper is to extend this study to other graph polynomials. In particular, we prove that if a graph [Formula: see text] has a symmetry of prime order [Formula: see text], then its characteristic polynomial, with coefficients in the finite field [Formula: see text], is determined by the characteristic polynomial of its quotient graph [Formula: see text]. Similar results are also proved for some generalization of the Tutte polynomial.
DFT studies on the diastereoselectivity of four-component Ugi reaction
Authors: Sharifzadeh Elaheh Sadat , Shiraz Nader Zabarjad
Published: August 2018

In this study, mechanism and stereochemistry of four-component Ugi reaction was investigated theoretically. Structures of reagents, products, intermediates, and transition states were optimized at B3LYP/6-31[Formula: see text]G(d,p) level of theory. Mechanism and stereoselectivity of the reaction depended on several processes, including bond rotation, ring closure ring opening, acid-base, nucleophile-electrophile competitions, and rearrangements. These diverse phenomena were studied to provide a clearer picture of the mechanism of this valuable reaction, especially in terms of stereochemistry considerations. According to the results, (E)-oxazolidinols were considered as proper intermediates in Ugi reaction mechanism. In addition, the key point of diastereoselectivity of the reaction was under kinetic and thermodynamic controls of nucleophilic attack of isocyanide to less hindered re-face (E[Formula: see text] compared to 10.19[Formula: see text]kcal/mol for si-face) of chiral (E)-iminium ion.
Classification of static spherically symmetric space-times in f(R) theory of gravity according to their conformal vector fields
Authors: Shabbir Ghulam , Ramzan Muhammad , Hussain Fiaz , Jamal S.
Published: August 2018

A classification of static spherically symmetric space-times in [Formula: see text] theory of gravity according to their conformal vector fields (CVFs) is presented. For this analysis, a direct integration technique is used. This study reveals that for static spherically symmetric space-times in [Formula: see text] theory of gravity, CVFs are just Killing vector fields (KVFs) or homothetic vector fields (HVFs). For this classification, six cases have been discussed out of which there exists only one case for which CVFs become HVFs while in the rest of the cases CVFs become KVFs.
Bianchi type-III cosmological model with quadratic EoS in Lyra geometry
Authors: Mollah Mahbubur Rahman , Singh Kangujam Priyokumar , Singh Pheiroijam Suranjoy
Published: August 2018

The paper deals with the investigation of a homogeneous and anisotropic space-time described by Bianchi type-III metric with perfect fluid in Lyra geometry setting. Exact solutions of Einstein’s field equations have been obtained under the assumption of quadratic equation of state (EoS) of the form [Formula: see text], where [Formula: see text] is a constant and strictly [Formula: see text]. The physical and geometrical aspects are also examined in detail.
Graphene oxide-polypyrrole composite as sulfur hosts for high-performance lithium-sulfur batteries
Authors: Wang Qian , Yang Chengkai , Tang Hui , Wu Kai , Zhou Henghui
Published: August 2018

Lithium-sulfur batteries are considered as a promising candidate for the next-generation high energy density storage devices. However, they are still hindered by serious capacity decay on cycling caused by the dissolution of redox intermediates. Here, we designed a unique structure with polypyrrole (ppy) inserting into the graphene oxide (GO) sheet for accommodating sulfur. Such a sulfur host not only exhibits a good electronic and ionic conductivity, but also can suppress polysulfide dissolution effectively. With this advanced design, the composite cathode showed a high specific capacity of 548.4[Formula: see text]mA[Formula: see text]h[Formula: see text]g[Formula: see text] at 5.0 C. A stable Coulombic efficiency of [Formula: see text]99.5% and a capacity decay rate as low as 0.089% per cycle along with 300 cycles at 1.0 C were achieved for composite cathodes with 78[Formula: see text]wt.% of S. Besides, the interaction mechanism between PPy and lithium polysulfides (LPS) was investigated by density-functional theory (DFT), suggesting that only the polymerization of N atoms can bind strongly to Li ions of LPS rather than single N atoms. The 3D structure GO-PPy host with high conductivity and excellent trapping ability to LPS offered a viable strategy to design high-performance cathodes for Li–S batteries.
Turning electrical switching behaviors in WOx thin films by thickness
Authors: Duan Weijie
Published: August 2018

The tunability of electrical switching behaviors in WOx thin films were investigated in this paper. Electrical responses of the WOx films were observed to be highly sensitive to the film thickness. As the film thickness increases from 50 to 100[Formula: see text]nm, the switching behavior changes from complementary resistive switching (CRS) to threshold switching (TS). A defect-related dynamic evolution of filament is responsible for the switching behavior. Such a controllable electrical switching can well broaden the application of the WOx thin film.
A Low-Cost Monocular Vision-Based Obstacle Avoidance Using SVM and Optical Flow
Authors: Shankar Ajay , Vatsa Mayank , Sujit P. B.
Published: August 2018

Development of low-cost robots with the capability to detect and avoid obstacles along their path is essential for autonomous navigation. These robots have limited computational resources and payload capacity. Further, existing direct range-finding methods have the trade-off of complexity against range. In this paper, we propose a vision-based system for obstacle detection which is lightweight and useful for low-cost robots. Currently, monocular vision approaches used in the literature suffer from various environmental constraints such as texture and color. To mitigate these limitations, a novel algorithm is proposed, termed as Pyramid Histogram of Oriented Optical Flow ([Formula: see text]-HOOF), which distinctly captures motion vectors from local image patches and provides a robust descriptor capable of discriminating obstacles from nonobstacles. A support vector machine (SVM) classifier that uses [Formula: see text]-HOOF for real-time obstacle classification is utilized. To avoid obstacles, a behavior-based collision avoidance mechanism is designed that updates the probability of encountering an obstacle while navigating. The proposed approach depends only on the relative motion of the robot with respect to its surroundings, and therefore is suitable for both indoor and outdoor applications and has been validated through simulated and hardware experiments.
Insect-Computer Hybrid Robot
Authors: Li Yao , Sato Hirotaka
Published: August 2018

An insect–computer hybrid robot, often referred to as a biological machine or an insect cyborg, is the fusion of a living insect platform and artificial microdevices, including stimulators, sensors, and computers. When compared with the artificial robots, a hybrid robot can be operated as an autonomous mobile machine with low energy consumption and hardware costs. A hybrid machine can verify various biological hypotheses, such as function determination, by stimulating a muscle or any other structure.
Aeroacoustic Investigation of High Subsonic Jets in Crossflow
Authors: Souza Pedro R. C. , de Almeida Odenir , da Silva Carlos R. Ilário
Published: August 2018

The present work investigates the flow and the sound field generated by high subsonic jets in crossflow (JICF). The problem arises when a jet is exhausted perpendicularly into a moving medium. Although being characterized as a very complex flow, the JICF has a well-known fluid dynamics, but a sound field yet to be more explored. Therefore, a hybrid methodology of low computational cost aeroacoustic prediction tool is applied in this work for the complete investigation of this problem. A single jet operating at Mach number 0.75 in a crossflow regime with effective velocity ratios of 4 and 8 is studied herein. The fluid dynamics is solved by the Reynolds Average Navier–Stokes (RANS) equations, and the noise calculations are performed using a statistical method known as the Lighthill Ray-Tracing (LRT) method. The numerical results for the acoustic and flow fields were in reasonable agreement with the experimental data available showing good applicability of this kind of methodology for solving JICF.
Mixed-Dimensional Modeling of Time-Dependent Wave Problems Using the Panasenko Construction
Authors: Amar Hanan , Givoli Dan
Published: August 2018

We consider the coupling of two-dimensional (2D) and one-dimensional (1D) models to form a single hybrid 2D–1D model for time-dependent linear wave problems. The 1D model is used to represent a 2D computational domain where the solution behaves approximately in a 1D way. This hybrid model, if designed properly, is a more efficient way to solve the full 2D model over the entire problem. Two important issues related to such hybrid 2D–1D models are (a) the design of the hybrid model and its validation (with respect to the original problem) and (b) the way the 2D–1D coupling is done, and the coupling error generated. This paper focuses on the second issue. The method used in this paper to couple the 1D and 2D models is the one proposed by Panasenko. This method has been used for mixed-dimensional coupling in many steady-state problems, and here it is being used for the first time for time-dependent problems. The hybrid formulation is derived, and the numerical accuracy and efficiency of the method are explored for a couple of basic problems.