Varenicline versus placebo for waterpipe smoking cessation : a double-blind randomized controlled trial

Background and Aims: Waterpipe tobacco smoking is a growing public health concern. There is limited research using pharmacotherapy and no research using varenicline (established treatment for smoking cessation) in waterpipe smokers. We tested the efficacy of varenicline in achieving abstinence from all tobacco use among waterpipe smokers. Design: Two-arm, parallel group, placebo-controlled, double-blind, multi-centre (n = 4), individually randomized trial with follow-up to 25 weeks. Settings: District general hospitals and catchment communities within four districts of Punjab, Pakistan. Participants: Adult daily waterpipe smokers (n = 510; 253 in varenicline and 257 in placebo arms), who were interested in quitting, were recruited and analysed between March and November 2016. Of these, 220 (87%) in the varenicline and 239 (93%) in the placebo arms completed all follow-ups. Participants were on average aged 49 [standard deviation (SD) = 15.2] years, daily smokers and smoked for the last 27 (SD = 15.9) years. More than half (261, 51.2%) also smoked cigarettes. Intervention and comparator: All trial participants received two structured sessions of behavioural support (of 30 and 10 minutes) one at the time of registration and the other 1 week later. Participants were randomized to varenicline (active arm) and placebo (control arm) stratified on district, sex and concomitant cigarette smoking. Varenicline and placebo were dispensed as identical unlabelled tablets for 12 weeks: 0.5 mg for 1 week (once on days 1–3, twice on days 4–7) and 1 mg for the subsequent 11 weeks (twice daily). Measurements: The trial participants were followed-up for a period of 25 weeks post-randomization. The primary outcome was 7-day repeated point prevalence abstinence from all forms of tobacco, self-reported at each of weeks 5, 12 and 25, verified by carbon-monoxide cut-off < 10 parts per million. Findings: No evidence of statistically significant difference in repeated point prevalence abstinence between the varenicline (12 of 253; 4.7%) and placebo (11 of 257; 4.3%) arms (relative risk = 1.11, 95% confidence interval = 0.50–2.47, P = 0.80) was observed (Bayes factor = 0.048). Adverse events reported in 27 participants were 34 (15 in varenicline and 19 in placebo); none was serious. Conclusions: Varenicline was not more effective than placebo in aiding cessation of tobacco use in long-term daily waterpipe smokers

Prevalence of physical health conditions and health risk behaviours in people with severe mental illness in South Asia:protocol for a cross-sectional study (IMPACT SMI survey)

Introduction People with severe mental illness (SMI) die on average 10–20 years earlier than the general population. Most of these deaths are due to physical health conditions. The aim of this cross-sectional study is to determine the prevalence of physical health conditions and their associations with health-risk behaviours, health-related quality of life and various demographic, behavioural, cognitive, psychological and social variables in people with SMI attending specialist mental health facilities in South Asia. Methods and analysis We will conduct a survey of patients with SMI attending specialist mental health facilities in Bangladesh, India and Pakistan (n=4500). Diagnosis of SMI will be confirmed using the Mini-international neuropsychiatric interview V.6.0. We will collect information about physical health and related health-risk behaviours (WHO STEPwise approach to Surveillance (STEPS)); severity of common mental disorders (Patient Health Questionnaire-9 (PHQ-9) and General Anxiety Disorder scale (GAD-7)) and health-related quality of life (EQ-5D-5L). We will measure blood pressure, height, weight and waist circumference according to WHO guidelines. We will also measure glycated haemoglobin, lipid profile, thyroid function, liver function, creatinine and haemoglobin. Prevalence rates of physical health conditions and health-risk behaviours will be presented and compared with the WHO STEPS survey findings in the general population. Regression analyses will explore the association between health-risk behaviours, mental and physical health conditions. Ethics and dissemination The study has been approved by the ethics committees of the Department of Health Sciences University of York (UK), Centre for Injury Prevention and Rehabilitation (Bangladesh), Health Ministry Screening Committee and Indian Council of Medical Research (India) and National Bioethics Committee (Pakistan). Findings will be disseminated in peer-reviewed articles, in local and international conferences and as reports for policymakers and stakeholders in the countries involved

Design of a Planar Sensor Based on Split-Ring Resonator for Non-invasive Permittivity Measurement

The permi)ivity of a material is an important parameter to characterize the degree of polarization of a material and identify components and impurities. This paper presents a non-invasive measurement technique to characterize materials in terms of their permi)ivity based on a modified metamaterial unit-cell sensor. The sensor consists of a complementary split-ring resonator (C-SRR), but its fringe electric field is contained with a conductive shield to intensify the normal component of the electric field. It is shown that by tightly electromagnetically coupling opposite sides of the unit-cell sensor to the input/output microstrip feedlines, two distinct resonant modes are excited. Perturbation of the fundamental mode is exploited here for determining the permi)ivity of materials. The sensitivity of the modified metamaterial unit-cell sensor is enhanced four-fold by using it to construct a tri-composite split-ring resonator (TC-SRR). The measured results confirm that the proposed technique provides an accurate and inexpensive solution to determine the permi)ivity of materials

Therapeutic Uses of Wild Plants by Rural Inhabitants of Maraog Region in District Shimla, Himachal Pradesh, India

The main aim of this study is to document important ethnomedicinal plants from the Maraog region, located in the district of Shimla in Himachal Pradesh, India. A total of 110 medicinal plant species belonging to 102 genera and 57 families were reported from the study site. All of the species were collected from wild habitats. The rural people of the Maraog region were surveyed through interview methods, group discussions, and participatory observations. In the current study, data were collected from 88 informants through the snowball method. A total of 110 plant species were collected from the study area, including 64 herbs, 24 shrubs, 9 trees, 5 climbers, 3 grasses, and 5 ferns. Most of the plant species, reported from the study area, belong to the Rosaceae and Asteraceae families, each contributing 12 plant species, followed by the Lamiaceae family with 6 plant species. The most used part of the plant in the preparation of herbal medications is the leaves, which have been reported in 62 plants, followed by roots in 14 plants, and flowers and other aerial parts in 9 plants. The ethnomedicinal data were analyzed using “Use Value,” a statistical quantitative method, with Artemisia vestita having the highest use value (1.00), followed by Cannabis sativa (0.79), Rhododendron arboreum (0.79), and Datura stramonium (0.71). Older people were found to have a vast knowledge of wild medicinal plants, while the younger generation’s knowledge was lacking. As a result, traditional knowledge about the use of plants as a source of medicine has decreased day-by-day.Therefore, there is a need to document traditional ethnobotanical knowledge. The data could serve as a basis for research by pharmacological and nutraceutical industries for the development of novel drugs

Design of a planar sensor based on split-ring resonators for non-invasive permittivity measurement

The permittivity of a material is an important parameter to characterize the degree of polarization of a material and identify components and impurities. This paper presents a non-invasive measurement technique to characterize materials in terms of their permittivity based on a modified metamaterial unit-cell sensor. The sensor consists of a complementary split-ring resonator (C-SRR), but its fringe electric field is contained with a conductive shield to intensify the normal component of the electric field. It is shown that by tightly electromagnetically coupling opposite sides of the unit-cell sensor to the input/output microstrip feedlines, two distinct resonant modes are excited. Perturbation of the fundamental mode is exploited here for determining the permittivity of materials. The sensitivity of the modified metamaterial unit-cell sensor is enhanced four-fold by using it to construct a tri-composite split-ring resonator (TC-SRR). The measured results confirm that the proposed technique provides an accurate and inexpensive solution to determine the permittivity of materials

Software for the frontiers of quantum chemistry:An overview of developments in the Q-Chem 5 package

This article summarizes technical advances contained in the fifth major release of the Q-Chem quantum chemistry program package, covering developments since 2015. A comprehensive library of exchange–correlation functionals, along with a suite of correlated many-body methods, continues to be a hallmark of the Q-Chem software. The many-body methods include novel variants of both coupled-cluster and configuration-interaction approaches along with methods based on the algebraic diagrammatic construction and variational reduced density-matrix methods. Methods highlighted in Q-Chem 5 include a suite of tools for modeling core-level spectroscopy, methods for describing metastable resonances, methods for computing vibronic spectra, the nuclear–electronic orbital method, and several different energy decomposition analysis techniques. High-performance capabilities including multithreaded parallelism and support for calculations on graphics processing units are described. Q-Chem boasts a community of well over 100 active academic developers, and the continuing evolution of the software is supported by an “open teamware” model and an increasingly modular design

Evolving trends in the management of acute appendicitis during COVID-19 waves. The ACIE appy II study

Background: In 2020, ACIE Appy study showed that COVID-19 pandemic heavily affected the management of patients with acute appendicitis (AA) worldwide, with an increased rate of non-operative management (NOM) strategies and a trend toward open surgery due to concern of virus transmission by laparoscopy and controversial recommendations on this issue. The aim of this study was to survey again the same group of surgeons to assess if any difference in management attitudes of AA had occurred in the later stages of the outbreak. Methods: From August 15 to September 30, 2021, an online questionnaire was sent to all 709 participants of the ACIE Appy study. The questionnaire included questions on personal protective equipment (PPE), local policies and screening for SARS-CoV-2 infection, NOM, surgical approach and disease presentations in 2021. The results were compared with the results from the previous study. Results: A total of 476 answers were collected (response rate 67.1%). Screening policies were significatively improved with most patients screened regardless of symptoms (89.5% vs. 37.4%) with PCR and antigenic test as the preferred test (74.1% vs. 26.3%). More patients tested positive before surgery and commercial systems were the preferred ones to filter smoke plumes during laparoscopy. Laparoscopic appendicectomy was the first option in the treatment of AA, with a declined use of NOM. Conclusion: Management of AA has improved in the last waves of pandemic. Increased evidence regarding SARS-COV-2 infection along with a timely healthcare systems response has been translated into tailored attitudes and a better care for patients with AA worldwide

The impact of immediate breast reconstruction on the time to delivery of adjuvant therapy: the iBRA-2 study

Background: Immediate breast reconstruction (IBR) is routinely offered to improve quality-of-life for women requiring mastectomy, but there are concerns that more complex surgery may delay adjuvant oncological treatments and compromise long-term outcomes. High-quality evidence is lacking. The iBRA-2 study aimed to investigate the impact of IBR on time to adjuvant therapy. Methods: Consecutive women undergoing mastectomy ± IBR for breast cancer July–December, 2016 were included. Patient demographics, operative, oncological and complication data were collected. Time from last definitive cancer surgery to first adjuvant treatment for patients undergoing mastectomy ± IBR were compared and risk factors associated with delays explored. Results: A total of 2540 patients were recruited from 76 centres; 1008 (39.7%) underwent IBR (implant-only [n = 675, 26.6%]; pedicled flaps [n = 105,4.1%] and free-flaps [n = 228, 8.9%]). Complications requiring re-admission or re-operation were significantly more common in patients undergoing IBR than those receiving mastectomy. Adjuvant chemotherapy or radiotherapy was required by 1235 (48.6%) patients. No clinically significant differences were seen in time to adjuvant therapy between patient groups but major complications irrespective of surgery received were significantly associated with treatment delays. Conclusions: IBR does not result in clinically significant delays to adjuvant therapy, but post-operative complications are associated with treatment delays. Strategies to minimise complications, including careful patient selection, are required to improve outcomes for patients

The development and validation of a scoring tool to predict the operative duration of elective laparoscopic cholecystectomy

Background: The ability to accurately predict operative duration has the potential to optimise theatre efficiency and utilisation, thus reducing costs and increasing staff and patient satisfaction. With laparoscopic cholecystectomy being one of the most commonly performed procedures worldwide, a tool to predict operative duration could be extremely beneficial to healthcare organisations. Methods: Data collected from the CholeS study on patients undergoing cholecystectomy in UK and Irish hospitals between 04/2014 and 05/2014 were used to study operative duration. A multivariable binary logistic regression model was produced in order to identify significant independent predictors of long (> 90 min) operations. The resulting model was converted to a risk score, which was subsequently validated on second cohort of patients using ROC curves. Results: After exclusions, data were available for 7227 patients in the derivation (CholeS) cohort. The median operative duration was 60 min (interquartile range 45–85), with 17.7% of operations lasting longer than 90 min. Ten factors were found to be significant independent predictors of operative durations > 90 min, including ASA, age, previous surgical admissions, BMI, gallbladder wall thickness and CBD diameter. A risk score was then produced from these factors, and applied to a cohort of 2405 patients from a tertiary centre for external validation. This returned an area under the ROC curve of 0.708 (SE = 0.013, p  90 min increasing more than eightfold from 5.1 to 41.8% in the extremes of the score. Conclusion: The scoring tool produced in this study was found to be significantly predictive of long operative durations on validation in an external cohort. As such, the tool may have the potential to enable organisations to better organise theatre lists and deliver greater efficiencies in care