Current state of awareness and safety practices for ionising radiation risks in orthopaedic doctors in Navi Mumbai: an online survey

Background: Radiographic imaging in orthopaedic surgical centers is becoming more common, posing additional risks to the orthopaedic doctors, who become more exposed to ionising irradiation. As a result, orthopaedic surgeons must have a good understanding of radiation hazards. Despite these issues, many orthopaedic specialists do not get basic radiation safety training. A review of orthopaedic specialists' understanding, awareness, and routine radiation safety practices at an academic hospital in Navi Mumbai. Methods: After institutional ethical approval, a panel of experts created an online survey comprising multiple-choice questions, which was utilized to perform a descriptive research. The questionnaire contained several aspects, each of which assessed orthopaedic understanding, awareness, and practices. The research cohort comprised orthopaedic doctors working through our tertiary medical center and medical college. Results: According to our findings, only 82% of respondents were aware of the radiation dangers associated with fluoroscopy. The use of lead aprons, thyroid shields, goggles, and protective caps is 99%, 42%, 25%, and 25%, respectively. Despite the fact that 60% of respondents were aware of TLD badges. Only 23% of those who operate with inosing radiation use TLD badges. Approximately 61% of respondents were ignorant of intermittent fluoroscopy, and 85% utilized the C-arm tube while the device was active. Conclusions: The vast majority of orthopaedic doctors utilise fluoroscopic imagery in the operating room on a daily basis, but they lack in-depth information and awareness about the radiation security hazards connected with this imaging modality. It is consequently advised that a radiation safety training curriculum be implemented

Assessing the fidelity of delivery of an intervention to increase attendance at the English Stop Smoking Services

Background: Implementation fidelity refers to the extent to which a proposed intervention is enacted as designed and is necessary to determine how much the intervention in question is the primary mechanism in any changes observed. Start2quit was a randomised controlled trial that aimed to improve attendance at the English Stop Smoking Service (SSS). The complex intervention combining computer-tailored personal risk letters and no-commitment (“taster”) sessions aimed at encouraging attendance at the SSS doubled attendance at the SSS and significantly increased abstinence rates, although attendance and abstinence varied between participating SSSs. Assessment of the fidelity of the delivery of the taster sessions to the protocol was embedded into the trial and is the focus of this study. / Methods: Eighteen SSSs participated in the study. Taster sessions were delivered by SSS advisors in the area. Of the 131 sessions delivered, 93 (71 %) were recorded and 41 (31.3 %) were selected for transcription and analysis. The taster session protocol contained 73 specified behaviours, which were independently classified into component behaviour change techniques (BCTs) using an established taxonomy for smoking cessation. All transcripts were coded by two authors with 25 % additionally coded by a third. The fidelity of each taster session was expressed as the percentage of overall protocol-specified behaviours that were delivered. Adherence to each BCT was measured as the number of behaviours applied by the advisors within each BCT divided by the total number classified within each. / Results: Adherence of protocol-specified behaviours was relatively high (median 71.23 %), though there was considerable variation (28.76 to 95.89 %) in individual sessions. Median fidelity to specific BCTs across sessions also varied from 50 to 100 %. Shorter sessions, sessions run jointly by two advisors, by female advisors, or by advisors aged 45 to 54 were associated with higher levels of adherence. There was no association between adherence and subsequent attendance at the SSS. / Conclusions: These results suggest that the delivery of the intervention of this study is not likely to have been impacted by issues of fidelity. As such, we can have greater confidence that variability in the main outcome is not due to variability in SSS advisor adherence to the protocol of the taster sessions. / Trial registration: Current Controlled Trials ISRCTN7656191

Study of inspiratory lung function parameters in Indian children

Background: The inspiratory parameters of pulmonary function test commonly used for various purposes in clinical practice including diagnosing airway obstruction. Expiratory portion of the flow volume loop of the pulmonary function test is studied in detail. The prediction equations for expiratory parameters are available for different population. However, the reference equation for inspiratory parameters is not available in Indian context. The current study derived the prediction equation for inspiratory parameters of pulmonary function test.Methods: The current study was carried out in school going 732 healthy girls and 1377 boys aged 6-15 years in India.  The children who meet the inclusion criteria were recruited in the study after detailed medical examination by registered medical practitioner. The lung function parameters were recorded by spirometry. The multivariate regression analysis was done to develop the prediction model.Results: The prediction equation for predicting inspiratory parameter were developed. This study revealed gender-wise and geographical variation in the inspiratory parameters. Hence this study recommends to derive gender wise prediction equations. The reference equations derived in this study can be used in population with similar background.Conclusions: Use of these equations for population having similar backgrounds will help for early and accurate diagnosis of the airway abnormalities in children. The inspiratory parameter assessment shall be included in the routine assessment of respiratory patient

An exploration of the barriers to attendance at the English Stop Smoking Services

INTRODUCTION: Despite the availability of effective stop smoking assistance, most smokers do not utilise formal cessation programmes such as the English Stop Smoking Services (SSS). We modified the Treatment Barriers Questionnaire (TBQ), developed in the USA, and distributed it to a sample of English smokers to explore the most important barriers to the use of the SSS. METHODS: Participants of Start2quit, a randomised controlled trial aiming to increase attendance at the SSS using tailored risk information and ‘taster’ sessions, who reported at follow-up that they had not attended the SSS, were asked to complete the TBQ; 672 (76.9% response rate) were retained for analysis. Principal Component Analysis (PCA) was conducted to examine the structure of the data. Multiple linear regressions were used to determine whether any participant characteristics were associated with particular barriers. RESULTS: The most commonly endorsed items related to a lack of information on and a lack of confidence in the efficacy of the SSS. PCA yielded seven factors: Work and time constraints (Factor1); Smokers should quit on their own (Factor2); Nothing can help in quitting smoking(Factor3); Disinterest in quitting (Factor4); Lack of social support to attend (Factor5); Lack of privacy at programmes (Factor6); Lack of information and perceived availability (Factor7). Age was associated with Factors 1, 3 and 4, motivation to quit with Factors 2 and 4, and confidence in quitting with Factors 1, 2, and 3. CONCLUSIONS: The findings suggest that many barriers exist, and they vary according to smoker demographics and characteristics, pointing to the need for tailored recruitment strategies. TRIAL REGISTRATION: ISRCTN76561916

Electric routing and concurrent flow cutting

We investigate an oblivious routing scheme, amenable to distributed computation and resilient to graph changes, based on electrical flow. Our main technical contribution is a new rounding method which we use to obtain a bound on the L1->L1 operator norm of the inverse graph Laplacian. We show how this norm reflects both latency and congestion of electric routing.Comment: 21 pages, 0 figures. To be published in Springer LNCS Book No. 5878, Proceedings of The 20th International Symposium on Algorithms and Computation (ISAAC'09

Collateral and Debt Maturity Choice. A Signaling Model

This paper derives optimal loan policies under asymmetric information where banks offer loan contracts of long and short duration, backed or unbacked with collateral. The main novelty of the paper is that it analyzes a setting in which high quality firms use collateral as a complementary device along with debt maturity to signal their superiority. The least-cost signaling equilibrium depends on the relative costs of the signaling devices, the difference in firm quality and the proportion of good firms in the market. Model simulations suggest a non-monotonic relationship between firm quality and debt maturity, in which high quality firms have both long-term secured debt and short-term secured or non-secured debt.

Examining acute psychopharmacological effects of nicotine vaping versus heated tobacco products in a randomised crossover study of product naive adult smokers

Nicotine vaping products (NVPs) and heated tobacco products (HTPs) are designed to replicate the sensory and behavioural aspects of smoking cigarettes while avoiding combustion. The success of these products as harm reduction tools will partially depend on their ability to satisfy smokers and alleviate nicotine-related withdrawal symptoms. This study aims to compare short-term effects of NVPs (Juul and Aspire PockeX) versus HTPs (IQOS) on smoking-related withdrawal relief, product satisfaction, intention to switch to NVP/HTP, perceptions and attitudes in UK adult cigarette smokers naïve to these products. In a randomized cross-over study, 45 participants visited the lab twice, at each visit trying one of the two products (NVP/HTP) and completing a questionnaire. Responses were normalized on a 0-100% scale and mean differences (MD) between NVP and HTP scores computed, with positive and negative MD values indicating greater endorsement for NVP and HTP, respectively. Cigarette cravings were reduced similarly (~20.0%) by both products (MD=4.5%, 95%Confidence Interval (CI) -4.8, 13.8). Direct positive effects (MD=-3.5%, 95%CI -7.2, 0.2) and adverse side effects (MD=1.8%, 95%CI -0.3, 3.8) were comparable after each product use, though marginally favouring HTPs. HTPs were perceived as more satisfying overall (MD=-13.2%, 95%CI -20.3 -6.1) than NVPs but both were perceived as similarly addictive (MD=3.6%, 95%CI -4.6, 11.8), relative to cigarettes. Intention to switch to either product was comparable (MD=4.0%, 95%CI -5.7, 13.8). Comparison of acute use of NVP versus HTP in a sample of UK smokers naïve to these products suggests that HTPs are perceived as more satisfying than NVPs, though still less satisfying than cigarettes