This systematic review of prospective longitudinal primary studies sought to determine whether electronic cigarette (e-cigarette) use by teenagers who had never smoked conventional tobacco cigarettes ...(tobacco cigarettes) at baseline was associated with subsequently commencing tobacco cigarette smoking.
The review followed the principles of a systematic review and meta-analysis. A key word search identified peer-reviewed articles published between 1 January 2005 and 2 October 2019 from seven bibliographic databases and one search engine. Using pre-prepared inclusion/exclusion criteria two researchers independently screened abstracts, and subsequently, full text papers. Selected articles were quality assessed in duplicate. Data on study participants characteristics, exposure and outcome measures were recorded in an adapted Cochrane Data Extraction Form. Feasibility assessment was done to detect clinical heterogeneity and choose an approach to meta-analysis. Analysis comprised pairwise random effects meta-analyses, and sensitivity and subgroup analyses.
From the 6619 studies identified, 14 one-off primary studies in 21 articles were suitable for inclusion. The participants ages ranged from 13 to 19 years and comprised teenagers based in Europe and North America. Nine of the 14 one-off studies, with follow-up periods between 4 and 24 months, met the criteria for inclusion in a meta-analysis of the association between ever use of e-cigarettes and subsequent initiation of tobacco cigarette use. Based on primary study adjusted odds ratios, our meta-analysis calculated a 4.06 (95% confidence interval (CI): 3.00-5.48, I
68%, 9 primary studies) times higher odds of commencing tobacco cigarette smoking for teenagers who had ever used e-cigarettes at baseline, though the odds ratio were marginally lower (to 3.71 times odds, 95%CI: 2.83-4. 86, I
35%, 4 primary studies) when only the four high-quality studies were analysed.
The systematic review found that e-cigarette use was associated with commencement of tobacco cigarette smoking among teenagers in Europe and North America, identifying an important health-related harm. Given the availability and usage of e-cigarettes, this study provides added support for urgent response by policymakers to stop their use by teenagers to decrease direct harms in this susceptible population group, as well as to conserve achievements in diminishing tobacco cigarette initiation.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Aim
Describe the epidemiology, resource use and adverse outcomes of COVID-19 patients hospitalised during wave 1 of the COVID-19 pandemic in Ireland. Use this data to identify specific cohorts at ...high risk of adverse outcomes and to inform acute hospital requirements for future COVID-19 waves in Ireland.
Methods
The Health Service Executive’s (HSE) Hospital Inpatient Enquiry (HIPE) system produced a daily database of COVID-19 discharge episodes from the onset of the COVID-19 pandemic in Ireland. This study analysed data on episodes of COVID-19 hospitalisation recorded between February 29 and July 31, 2020. A deterministic record linkage process transformed records from episode to patient level. Logistic regression modelling identified factors associated with long length of stay (LLOS), intensive care unit (ICU) admission and inhospital mortality.
Results
Median length of stay was 9 days; 12.8% of patients had ICU admission and 16.6% died in hospital. Male patients were more likely to have ICU admission and die in hospital. Likelihood of LLOS and inhospital mortality increased with age. Obesity, hypertension and diabetes were associated with ICU admission while chronic kidney disease and chronic obstructive pulmonary disease were associated with inhospital mortality. Nursing home residents were less likely to be admitted to ICU and more likely to die in hospital compared to patients admitted from home.
Conclusion
This study provides patient-level epidemiological characterisation of hospitalisations during the first COVID-19 pandemic wave in Ireland. The higher risk of adverse outcomes in older age groups supports the age-based prioritisation of COVID-19 vaccinations currently used in Ireland.
•Hydrophilic anode surfaces promote rapid start-up of current generation.•Early stage biofilms on hydrophilic surfaces are dominated by a Desulfuromonas sp.•The Desulfuromonas sp. is identified to be ...D. acetexigens: a novel electroactive bacterium.•D. acetexigens has the ability to maximize H2 recovery in a microbial electrochemical system.
Surface chemistry is known to influence the formation, composition, and electroactivity of electron-conducting biofilms. However, understanding of the evolution of microbial composition during biofilm development and its impact on the electrochemical response is limited. Here we present voltammetric, microscopic and microbial community analysis of biofilms formed under fixed applied potential for modified graphite electrodes during early (90 h) and mature (340 h) growth phases. Electrodes modified to introduce hydrophilic groups (-NH2, -COOH and -OH) enhance early-stage biofilm formation compared to unmodified or electrodes modified with hydrophobic groups (-C2H5). In addition, early-stage films formed on hydrophilic electrodes are dominated by the gram-negative sulfur-reducing bacterium Desulfuromonas acetexigens while Geobacter sp. dominates on -C2H5 and unmodified electrodes. As biofilms mature, current generation becomes similar, and D. acetexigens dominates in all biofilms irrespective of surface chemistry. Electrochemistry of pure culture D. acetexigens biofilms reveal that this microbe is capable of forming electroactive biofilms producing considerable current density of > 9 A/m2 in a short period of potential-induced growth (~19 h following inoculation) using acetate as an electron donor. The inability of D. acetexigens biofilms to use H2 as a sole source electron donor for current generation shows promise for maximizing H2 recovery in single-chambered microbial electrolysis cell systems treating wastewaters.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Tobacco smoking remains a key cause of preventable illness and death globally. In response, many countries provide extensive services to help people to stop smoking by offering a variety of effective ...behavioural and pharmacological therapies. However, many people who wish to stop smoking do not have access to or use stop smoking supports, and new modes of support, including the use of financial incentives, are needed to address this issue. A realist review of published international literature was undertaken to understand how, why, for whom, and in which circumstances financial incentives contribute to success in stopping smoking for general population groups and among pregnant women.
Systematic searches were undertaken from inception to February 2022 of five academic databases: MEDLINE (ovid), Embase.com, CIHAHL, Scopus and PsycINFO. Study selection was inclusive of all study designs. Twenty-two studies were included. Using Pawson and Tilley's iterative realist review approach, data collected were screened, selected, coded, analysed, and synthesised into a set of explanatory theoretical findings.
Data were synthesised into six Context-Mechanism-Outcome Configurations and one overarching programme theory after iterative rounds of analysis, team discussion, and expert panel feedback. Our programme theory shows that financial incentives are particularly useful to help people stop smoking if they have a financial need, are pregnant or recently post-partum, have a high threshold for behaviour change, and/or respond well to external rewards. The incentives work through a number of mechanisms including the role their direct monetary value can play in a person's life and through a process of reinforcement where they can help build confidence and self-esteem.
This is the first realist review to synthesise how, why, and for whom financial incentives work among those attempting to stop smoking, adding to the existing evidence demonstrating their efficacy. The findings will support the implementation of current knowledge into effective programmes which can enhance the impact of stop smoking care.
CRD42022298941.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Since the pandemic onset, deprivation has been seen as a significant determinant of COVID-19 incidence and mortality. This study explores outcomes of COVID-19 in the context of material deprivation ...across three pandemic waves in Ireland.
Between 1st March 2020 and 13th May 2021, 252,637 PCR-confirmed COVID-19 cases were notified in Ireland. Cases were notified to the national Computerised Infectious Disease Reporting (CIDR) system. Each case was geo-referenced and assigned a deprivation category according to the Haase-Pratschke (HP) Deprivation Index. Regression modelling examined three outcomes: admission to hospital; admission to an intensive care unit (ICU) and death.
Deprivation increased the likelihood of contracting COVID-19 in all age groups and across all pandemic waves, except for the 20-39 age group. Deprivation, age, comorbidity and male gender carried increased risk of hospital admission. Deprivation was not a factor in predicting ICU admission or death, and diagnosis in wave 2 was associated with the lowest risk of all three outcomes.
Our study suggests that COVID-19 spreads easily through all strata of society and particularly in the more deprived population; however this was not a consistent finding. Ireland is ethnically more homogenous than other countries reporting a larger deprivation gradient, and in such societies, structural racial differences may contribute more to poor COVID outcomes than elements of deprivation.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Background
Smoking continues to cause harm on a huge scale in Ireland. Doctors can help this harm through providing safe, effective and clinically sound stop smoking care, but the needs of Irish ...doctors in this area are largely uncharted.
Aims
We assessed the knowledge, attitudes and practices of Irish doctors regarding stop smoking care and electronic cigarettes.
Methods
An Internet-based cross-sectional survey was administered to members of the Royal College of Physicians in Ireland and the Irish College of General Practitioners. Descriptive statistics for key parameters were derived and factors associated with more consistent practice of brief intervention, a key component of stop smoking care, were analysed using chi-square testing.
Results
There were 250 responses (58.7% female, 53.0% aged under 45 years, 55.1% graduated in medicine before 2000 and 57.2% worked in general practice). Most (84.9%) reported often or always asking about patient’s smoking behaviour, and most (86.1%) reported often or always advising patients to stop. However, providing or arranging effective stop smoking care was weak and less consistently practised, and while most (91.4%) saw it as a responsibility, few doctors (28.5%) agreed they were sufficiently trained in this area of clinical care. Confidence in the knowledge of e-cigarettes was poor.
Conclusions
While there is a strong reservoir support and areas of good reported practice in stop smoking care among doctors in Ireland, the development of their knowledge and skills in arranging effective care should be supported if doctors are to fulfil their huge potential role in tackling the harm caused by smoking.
Chest computed tomography is one of the most common diagnostic tests, with 15 million scans performed annually in the United States. Coronary calcium can be visualized on these scans, but other ...measures of cardiac risk such as atrial and ventricular volumes have classically required administration of contrast. Here we show that a fully automated pipeline, incorporating two artificial intelligence models, automatically quantifies coronary calcium, left atrial volume, left ventricular mass, and other cardiac chamber volumes in 29,687 patients from three cohorts. The model processes chamber volumes and coronary artery calcium with an end-to-end time of ~18 s, while failing to segment only 0.1% of cases. Coronary calcium, left atrial volume, and left ventricular mass index are independently associated with all-cause and cardiovascular mortality and significantly improve risk classification compared to identification of abnormalities by a radiologist. This automated approach can be integrated into clinical workflows to improve identification of abnormalities and risk stratification, allowing physicians to improve clinical decision-making.
Low-dose ungated CT attenuation correction (CTAC) scans are commonly obtained with SPECT/CT myocardial perfusion imaging. Despite the characteristically low image quality of CTAC, deep learning (DL) ...can potentially quantify coronary artery calcium (CAC) from these scans in an automatic manner. We evaluated CAC quantification derived with a DL model, including correlation with expert annotations and associations with major adverse cardiovascular events (MACE).
We trained a convolutional long short-term memory DL model to automatically quantify CAC on CTAC scans using 6,608 studies (2 centers) and evaluated the model in an external cohort of patients without known coronary artery disease (
= 2,271) obtained in a separate center. We assessed agreement between DL and expert annotated CAC scores. We also assessed associations between MACE (death, revascularization, myocardial infarction, or unstable angina) and CAC categories (0, 1-100, 101-400, or >400) for scores manually derived by experienced readers and scores obtained fully automatically by DL using multivariable Cox models (adjusted for age, sex, past medical history, perfusion, and ejection fraction) and net reclassification index.
In the external testing population, DL CAC was 0 in 908 patients (40.0%), 1-100 in 596 (26.2%), 100-400 in 354 (15.6%), and >400 in 413 (18.2%). Agreement in CAC category by DL CAC and expert annotation was excellent (linear weighted κ, 0.80), but DL CAC was obtained automatically in less than 2 s compared with about 2.5 min for expert CAC. DL CAC category was an independent risk factor for MACE with hazard ratios in comparison to a CAC of zero: CAC of 1-100 (2.20; 95% CI, 1.54-3.14;
< 0.001), CAC of 101-400 (4.58; 95% CI, 3.23-6.48;
< 0.001), and CAC of more than 400 (5.92; 95% CI, 4.27-8.22;
< 0.001). Overall, the net reclassification index was 0.494 for DL CAC, which was similar to expert annotated CAC (0.503).
DL CAC from SPECT/CT attenuation maps agrees well with expert CAC annotations and provides a similar risk stratification but can be obtained automatically. DL CAC scores improved classification of a significant proportion of patients as compared with SPECT myocardial perfusion alone.
Electron transfer between microorganisms and an electrode — even across long distances — enables the former to live by coupling to an electronic circuit. Such a system integrates biological ...metabolism with artificial electronics; studying these systems adds to our knowledge of charge transport in the chemical species involved, as well as, perhaps most importantly, to our knowledge of charge transport and chemistry at the cell–electrode interfaces. This understanding may lead to microbial electrochemical systems finding widespread application, particularly in the energy sector. Bioelectrochemical systems have already shown promise for electricity generation, as well as for the production of biochemical and chemical feedstocks, and with improvement are likely to give rise to viable applications.Electrodes colonized by microbial electrocatalysts can serve as useful components in the electrosynthesis of valuable chemical products. This Review outlines the mechanisms by which electrons are transferred between microorganisms and electrodes, and describes the challenges involved in designing robust and efficient systems.
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