This document summarizes a review of the scientific literature on the use of e-cigarettes for smoking cessation. It discusses surveys of e-cigarette users who report using them to quit smoking. It also summarizes several trials that have compared e-cigarettes to nicotine patches and no nicotine products. The largest trial to date compared a 16mg e-cigarette to a 21mg nicotine patch. At 6 months, abstinence rates were 7.3% for the e-cigarette and 5.8% for the patch, showing e-cigarettes were not inferior to patches for smoking cessation. E-cigarettes were also linked to greater reductions in cigarette consumption compared to patches. Overall,
Electronic cigarettes for smoking cessationTahira Sultana
Electronic cigarettes were found to be more effective than nicotine patches for smoking cessation. In a randomized controlled trial, 7.3% of participants using nicotine e-cigarettes achieved 6 months of continuous smoking abstinence, compared to 5.8% of those using nicotine patches and 4.1% using placebo e-cigarettes. Additionally, nicotine e-cigarettes resulted in longer periods of abstinence for those who relapsed compared to patches or placebo e-cigarettes. Adherence was also significantly higher in the nicotine e-cigarette group than the other groups. The study provides evidence that nicotine e-cigarettes may be more effective than nicotine patches for smoking cessation.
This document discusses principles of radiation therapy and dose selection for various conditions. It provides guidelines for selecting marginal doses for different tumor types based on location and size, including doses of 12-13 Gy for acoustic neuromas, 16-25 Gy for pituitary adenomas, 12-15 Gy for benign meningiomas, and 20-24 Gy for arteriovenous malformations. Risk models are presented for complications after radiosurgery for brain metastases and arteriovenous malformations based on tumor location and volume. Guidelines aim to maximize tumor control while minimizing risks of complications like necrosis and cranial neuropathy.
Phillip Keen, (NAPWA) discusses the background, goals and objectives of NAPWA's billboard and web campaign encouraging people with HIV to get up to date about treatments. This presentation was given at the AFAO/NAPWA Gay Men's HIV Health Promotion Conference in May 2012.
Empowerment by Participation in Online Support Groups for Patients with Arthr...Gunther Eysenbach
The document summarizes research on empowerment experienced by patients who participate in online support groups for arthritis, fibromyalgia, and breast cancer. It finds that participating in online support groups is associated with increased feelings of empowerment in several ways. Key empowering processes included exchanging information, finding recognition, and sharing experiences. These processes were positively correlated with empowerment outcomes like feeling better informed, more confident with doctors and treatments, and improved acceptance of their disease. Patients with breast cancer reported the highest levels of both empowering processes and outcomes.
Delirium in critically ill patients bogota043009hospira2010
The document discusses acute brain dysfunction, specifically delirium, in critically ill patients. Some key points:
- Delirium affects 60-80% of ICU patients and is underdiagnosed. It is linked to higher costs, longer hospital stays, and increased risk of death.
- Survivors often experience long-term cognitive impairment equivalent to mild/moderate dementia.
- Sedatives like benzodiazepines and opioids are risk factors for delirium. Protocols aiming to reduce exposure can help prevent delirium.
- Studies found the alpha-2 agonist dexmedetomidine reduced delirium and cognitive dysfunction compared to lorazepam. Antipsychotics may help
MET vs TAU in 4 large multisite RCTs found:
1) No main effect on retention or substance use for outpatient treatment.
2) One study found a small effect on early retention but not substance use.
3) Studies of pregnant drug users and Spanish speakers also found no main effects of MET vs TAU.
The findings suggest MET may not produce meaningful improvements over TAU in typical substance abuse treatment settings based on these high quality trials.
Making cardiovascular risk reduction happen in primary care final diabetes ukTony Willis
Slides from opening plenary at Diabetes UK, 14th March 2018, London: "Cardiovascular risk reduction in diabetes: Maximising patient benefits"
This is some of the output over the last few years of the North West London Diabetes Transformation Team, demonstrating that urban deprivation doesn't need to be a barrier to improvements in care (as shown elsewhere including Tower Hamlets).
Electronic cigarettes for smoking cessationTahira Sultana
Electronic cigarettes were found to be more effective than nicotine patches for smoking cessation. In a randomized controlled trial, 7.3% of participants using nicotine e-cigarettes achieved 6 months of continuous smoking abstinence, compared to 5.8% of those using nicotine patches and 4.1% using placebo e-cigarettes. Additionally, nicotine e-cigarettes resulted in longer periods of abstinence for those who relapsed compared to patches or placebo e-cigarettes. Adherence was also significantly higher in the nicotine e-cigarette group than the other groups. The study provides evidence that nicotine e-cigarettes may be more effective than nicotine patches for smoking cessation.
This document discusses principles of radiation therapy and dose selection for various conditions. It provides guidelines for selecting marginal doses for different tumor types based on location and size, including doses of 12-13 Gy for acoustic neuromas, 16-25 Gy for pituitary adenomas, 12-15 Gy for benign meningiomas, and 20-24 Gy for arteriovenous malformations. Risk models are presented for complications after radiosurgery for brain metastases and arteriovenous malformations based on tumor location and volume. Guidelines aim to maximize tumor control while minimizing risks of complications like necrosis and cranial neuropathy.
Phillip Keen, (NAPWA) discusses the background, goals and objectives of NAPWA's billboard and web campaign encouraging people with HIV to get up to date about treatments. This presentation was given at the AFAO/NAPWA Gay Men's HIV Health Promotion Conference in May 2012.
Empowerment by Participation in Online Support Groups for Patients with Arthr...Gunther Eysenbach
The document summarizes research on empowerment experienced by patients who participate in online support groups for arthritis, fibromyalgia, and breast cancer. It finds that participating in online support groups is associated with increased feelings of empowerment in several ways. Key empowering processes included exchanging information, finding recognition, and sharing experiences. These processes were positively correlated with empowerment outcomes like feeling better informed, more confident with doctors and treatments, and improved acceptance of their disease. Patients with breast cancer reported the highest levels of both empowering processes and outcomes.
Delirium in critically ill patients bogota043009hospira2010
The document discusses acute brain dysfunction, specifically delirium, in critically ill patients. Some key points:
- Delirium affects 60-80% of ICU patients and is underdiagnosed. It is linked to higher costs, longer hospital stays, and increased risk of death.
- Survivors often experience long-term cognitive impairment equivalent to mild/moderate dementia.
- Sedatives like benzodiazepines and opioids are risk factors for delirium. Protocols aiming to reduce exposure can help prevent delirium.
- Studies found the alpha-2 agonist dexmedetomidine reduced delirium and cognitive dysfunction compared to lorazepam. Antipsychotics may help
MET vs TAU in 4 large multisite RCTs found:
1) No main effect on retention or substance use for outpatient treatment.
2) One study found a small effect on early retention but not substance use.
3) Studies of pregnant drug users and Spanish speakers also found no main effects of MET vs TAU.
The findings suggest MET may not produce meaningful improvements over TAU in typical substance abuse treatment settings based on these high quality trials.
Making cardiovascular risk reduction happen in primary care final diabetes ukTony Willis
Slides from opening plenary at Diabetes UK, 14th March 2018, London: "Cardiovascular risk reduction in diabetes: Maximising patient benefits"
This is some of the output over the last few years of the North West London Diabetes Transformation Team, demonstrating that urban deprivation doesn't need to be a barrier to improvements in care (as shown elsewhere including Tower Hamlets).
Naveen Kumar is applying for a lead position in IT offering innovative IT solutions. He has over 2 years of experience as a Linux Administrator at Symantec Corporation. His role includes managing over 7000 servers running Linux, Solaris, and AIX and migrating legacy infrastructure to a cloud environment. He is proficient in Linux, Solaris, and AIX administration including performance monitoring, user administration, and implementing changes according to ITIL processes. He is familiar with DevOps concepts and tools like AWS, Python, and scripting. He holds an ITIL certification and has received awards for his work.
International journal of marine science and ocean technologyScidoc Publishers
International Journal of Marine Science and Ocean Technology (IJMO) is a peer-reviewed, open access journal, devoted to the publication of visions that contribute to our scientific understanding of marine systems and critical reviews in regard to the impact of human activities on them. IJMO provides a forum to discuss in regard to the current issues in marine science and ocean technology by publishing original, full-length and research articles in this field. IJMO publishes high quality papers, original papers and research letters and case reports.
URL : http://scidoc.org/IJMO.php
The document provides guidance for musicians preparing to record music in a studio. It outlines several key steps: [1] define clear objectives for the recording; [2] choose songs and demo them; [3] assess your abilities and needs; [4] research recording studios and factors like equipment, cost, and time required; [5] determine if you need an engineer, producer, or both to oversee the process; and [6] allow sufficient time for setup, recording, and playback in the studio. Proper planning at each stage is important for a successful recording experience and outcome.
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https://www.facebook.com/garmentspace/
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tai lieu tong hop, thu vien luan van, luan van tong hop, do an chuyen nganh
El documento proporciona un formato para una presentación personal que incluye secciones para proporcionar información sobre el lugar donde vive la persona, su edad, estado civil, número de teléfono, miembros de la familia y ocupación. También incluye secciones para compartir información adicional sobre hábitos, rutinas, actividades de tiempo libre y cierra agradeciendo al tutor.
The document discusses the importance of taking effective notes for a research paper. It recommends evaluating sources critically and only taking notes on useful information to avoid becoming overwhelmed. Good notes are organized, help identify sources properly to avoid plagiarism, and lead to more effective conclusions. The document also provides tips for making note cards, such as including full source information and page numbers to allow citations, and accurately summarizing or quoting information from sources.
This document discusses police human resources and the selection process for police officers. It covers the 1964 Civil Rights Act which prohibited discrimination in hiring. It describes how affirmative action and quotas impacted police departments and led to challenges of entrance exams and selection standards that had disparate impacts. Minimum selection standards for education, background checks, physical agility tests and psychological evaluations are outlined. Training requirements including the police academy and field training are summarized. Factors like stress, performance, behavior differences by race and gender are briefly mentioned.
the broken mirror: reality, identity and crisis in the digital ageMontecarlo -
A reflection about digital age and Transmedia Storytelling. A speech delivered to audiovisual professional public at ABC Guionistas - APAC event. 2015, May 2th.
Ridge augmentation procedures /orthodontic courses by Indian dental academy Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
A series of lectures by Dr. Barry Raphael on Airway-focused orthodontics.
Chapter 7 : Some ways of changing the Function side of the facial growth and adaptation equation.
This document provides guidance on creating an annotated bibliography, which summarizes and evaluates sources for research. An annotated bibliography has four parts for each source: bibliographic citation, summary of main ideas, evaluation of the source's reliability, and reflection on how the source informed the researcher's work. It explains that annotations should summarize using the source's structure, evaluate evidence and reputation, and reflect on the source's usefulness. The document also provides a sample annotation and checklist for creating thorough, properly formatted annotated bibliographies.
A series of lectures by Dr. Barry Raphael on Airway-focused orthodontics from 2013.
Chapter 1: An editorial look at the forces that are changing orthodontics today and how they will influence what orthodontics is to become in the 21st century.
Este documento clasifica y define los diferentes tipos de oraciones en español, incluyendo oraciones activas, pasivas, pasivas reflejas, atributivas/copulativas, predicativas, transitivas, intransitivas, reflexivas, recíprocas y pronominales. También explica el orden recomendado para analizar las oraciones y proporciona un ejemplo de oración personal, activa, predicativa, transitiva y recíproca.
Este documento describe los diferentes valores que puede tomar el pronombre "se" en la lengua castellana. Explica que se puede usar como se eufónico, se reflexivo, se recíproco, se causativo, se pasivo reflejo, se impersonal, se pronominal, y se dativo ético; y provee ejemplos para ilustrar cada uno de estos valores.
This randomized controlled trial compared the effectiveness of cytisine to nicotine replacement therapy (NRT) for smoking cessation. The trial involved 1310 daily smokers who received either a 25-day course of cytisine plus behavioral support or 8 weeks of NRT plus behavioral support. The primary outcome was abstinence at 1 month, with secondary outcomes including abstinence at 2 months and 6 months. Results showed cytisine was at least as effective as NRT for smoking cessation, with abstinence rates of 40% for cytisine vs 31% for NRT at 1 month. Cytisine was also associated with longer time to relapse and fewer withdrawal symptoms compared to NRT. Adverse effects were more common but mostly
Mobile Smoking Cessation Services (Mscs) To Achieve Smokefree WorkplacesPRN USM
- The document describes a study that implemented a Mobile Smoking Cessation Service (MSCS) in Malaysia to help smokers quit at their workplaces.
- 155 smokers were enrolled and randomly assigned to receive either varenicline (Viva QS) or placebo medication, along with counseling. Follow-ups occurred at weeks 2, 4, 12, and 24.
- At the 24-week follow-up, the 7-day abstinence rate was higher in the varenicline group compared to the placebo group (30.7% vs 13.9%). Abstinence rates were also higher in the varenicline group at weeks 4 and 12.
- The MSCS
Naveen Kumar is applying for a lead position in IT offering innovative IT solutions. He has over 2 years of experience as a Linux Administrator at Symantec Corporation. His role includes managing over 7000 servers running Linux, Solaris, and AIX and migrating legacy infrastructure to a cloud environment. He is proficient in Linux, Solaris, and AIX administration including performance monitoring, user administration, and implementing changes according to ITIL processes. He is familiar with DevOps concepts and tools like AWS, Python, and scripting. He holds an ITIL certification and has received awards for his work.
International journal of marine science and ocean technologyScidoc Publishers
International Journal of Marine Science and Ocean Technology (IJMO) is a peer-reviewed, open access journal, devoted to the publication of visions that contribute to our scientific understanding of marine systems and critical reviews in regard to the impact of human activities on them. IJMO provides a forum to discuss in regard to the current issues in marine science and ocean technology by publishing original, full-length and research articles in this field. IJMO publishes high quality papers, original papers and research letters and case reports.
URL : http://scidoc.org/IJMO.php
The document provides guidance for musicians preparing to record music in a studio. It outlines several key steps: [1] define clear objectives for the recording; [2] choose songs and demo them; [3] assess your abilities and needs; [4] research recording studios and factors like equipment, cost, and time required; [5] determine if you need an engineer, producer, or both to oversee the process; and [6] allow sufficient time for setup, recording, and playback in the studio. Proper planning at each stage is important for a successful recording experience and outcome.
Để xem full tài liệu Xin vui long liên hệ page để được hỗ trợ
:
https://www.facebook.com/garmentspace/
https://www.facebook.com/thuvienluanvan01
HOẶC
https://www.facebook.com/thuvienluanvan01
https://www.facebook.com/thuvienluanvan01
tai lieu tong hop, thu vien luan van, luan van tong hop, do an chuyen nganh
El documento proporciona un formato para una presentación personal que incluye secciones para proporcionar información sobre el lugar donde vive la persona, su edad, estado civil, número de teléfono, miembros de la familia y ocupación. También incluye secciones para compartir información adicional sobre hábitos, rutinas, actividades de tiempo libre y cierra agradeciendo al tutor.
The document discusses the importance of taking effective notes for a research paper. It recommends evaluating sources critically and only taking notes on useful information to avoid becoming overwhelmed. Good notes are organized, help identify sources properly to avoid plagiarism, and lead to more effective conclusions. The document also provides tips for making note cards, such as including full source information and page numbers to allow citations, and accurately summarizing or quoting information from sources.
This document discusses police human resources and the selection process for police officers. It covers the 1964 Civil Rights Act which prohibited discrimination in hiring. It describes how affirmative action and quotas impacted police departments and led to challenges of entrance exams and selection standards that had disparate impacts. Minimum selection standards for education, background checks, physical agility tests and psychological evaluations are outlined. Training requirements including the police academy and field training are summarized. Factors like stress, performance, behavior differences by race and gender are briefly mentioned.
the broken mirror: reality, identity and crisis in the digital ageMontecarlo -
A reflection about digital age and Transmedia Storytelling. A speech delivered to audiovisual professional public at ABC Guionistas - APAC event. 2015, May 2th.
Ridge augmentation procedures /orthodontic courses by Indian dental academy Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
A series of lectures by Dr. Barry Raphael on Airway-focused orthodontics.
Chapter 7 : Some ways of changing the Function side of the facial growth and adaptation equation.
This document provides guidance on creating an annotated bibliography, which summarizes and evaluates sources for research. An annotated bibliography has four parts for each source: bibliographic citation, summary of main ideas, evaluation of the source's reliability, and reflection on how the source informed the researcher's work. It explains that annotations should summarize using the source's structure, evaluate evidence and reputation, and reflect on the source's usefulness. The document also provides a sample annotation and checklist for creating thorough, properly formatted annotated bibliographies.
A series of lectures by Dr. Barry Raphael on Airway-focused orthodontics from 2013.
Chapter 1: An editorial look at the forces that are changing orthodontics today and how they will influence what orthodontics is to become in the 21st century.
Este documento clasifica y define los diferentes tipos de oraciones en español, incluyendo oraciones activas, pasivas, pasivas reflejas, atributivas/copulativas, predicativas, transitivas, intransitivas, reflexivas, recíprocas y pronominales. También explica el orden recomendado para analizar las oraciones y proporciona un ejemplo de oración personal, activa, predicativa, transitiva y recíproca.
Este documento describe los diferentes valores que puede tomar el pronombre "se" en la lengua castellana. Explica que se puede usar como se eufónico, se reflexivo, se recíproco, se causativo, se pasivo reflejo, se impersonal, se pronominal, y se dativo ético; y provee ejemplos para ilustrar cada uno de estos valores.
This randomized controlled trial compared the effectiveness of cytisine to nicotine replacement therapy (NRT) for smoking cessation. The trial involved 1310 daily smokers who received either a 25-day course of cytisine plus behavioral support or 8 weeks of NRT plus behavioral support. The primary outcome was abstinence at 1 month, with secondary outcomes including abstinence at 2 months and 6 months. Results showed cytisine was at least as effective as NRT for smoking cessation, with abstinence rates of 40% for cytisine vs 31% for NRT at 1 month. Cytisine was also associated with longer time to relapse and fewer withdrawal symptoms compared to NRT. Adverse effects were more common but mostly
Mobile Smoking Cessation Services (Mscs) To Achieve Smokefree WorkplacesPRN USM
- The document describes a study that implemented a Mobile Smoking Cessation Service (MSCS) in Malaysia to help smokers quit at their workplaces.
- 155 smokers were enrolled and randomly assigned to receive either varenicline (Viva QS) or placebo medication, along with counseling. Follow-ups occurred at weeks 2, 4, 12, and 24.
- At the 24-week follow-up, the 7-day abstinence rate was higher in the varenicline group compared to the placebo group (30.7% vs 13.9%). Abstinence rates were also higher in the varenicline group at weeks 4 and 12.
- The MSCS
1) Early molecular response at 3 months is an important predictor of long-term outcomes for CML patients on TKI therapy. Failure to achieve BCR-ABL ≤10% at 3 months is associated with higher risk of disease progression or death.
2) Achieving deeper levels of response such as MMR and MR4.5 is associated with improved progression-free and overall survival compared to lesser responses. TKIs like nilotinib and dasatinib have shown higher rates of deep molecular response compared to imatinib.
3) Avoiding progression to advanced phases such as accelerated or blast crisis is critical for long-term survival, as outcomes are much poorer once CML progresses beyond chronic phase
The Effectiveness Of Group Counseling Module In Smoking Cessation ProgramPRN USM
The effectiveness of a group counseling smoking cessation program for adolescents was measured using quantitative and qualitative approaches. The study found higher quit rates at 4 months for those in the counseling intervention group compared to the non-intervention group. However, the differences in quit rates diminished after 8 and 12 months, possibly due to a lack of continued monitoring and support. Qualitative analysis found strengths of the program included improved student behavior and motivation, but weaknesses included time constraints and lack of school administrator commitment.
Quit Smoking An Intervention Study Among ArmyPRN USM
The document summarizes an intervention study conducted among Army personnel in Malaysia to encourage smoking cessation. The study involved an intervention group that received a health education campaign promoting a healthy lifestyle, as well as counseling, medication, and weekly quit smoking clinics, compared to a control group. After 32 weeks, 49.4% of the intervention group had quit smoking completely compared to only 6.3% of the control group. The integrative approach combining education, counseling, and medication was effective in helping Army personnel quit smoking long-term.
A Decade of Behavioral HIV Prevention and Care Engagement Research in Uganda: Responding to Evolving Epidemic Response Priorities
Susan M. Kiene, PhD, MPH
March 2nd, 2018
UCSD HIV & Global Health Rounds
Professor Peter Hajek - E-Cigarette Summit 2014Neil Mclaren
This document provides a progress report on a Cochrane review examining the efficacy of e-cigarettes for smoking cessation and harm reduction. The review team has found only a few randomized controlled trials and cohort studies eligible for inclusion that examine e-cigarette use over 6 months or more. Preliminary results suggest e-cigarettes were not associated with any serious adverse events and the most common side effects like throat irritation were mild and decreased over time. Two randomized trials compared e-cigarettes containing nicotine to no nicotine and found similar quit rates between the groups after 6 months. The full Cochrane review synthesizing all eligible studies will be published within the next few weeks.
DASH - does arthritis self-management help?epicyclops
This lecture was given by Dr Marta Buszewicz, General Practitioner from North London and Senior Lecturer in Community Based Teaching & Research at UCL, to the North British Pain Association Spring Scientific Meeting in Edinburgh on Friday 18th May, 2007. Her lecture forms part of a conference "Blurring the Boundaries - Managing Pain in Primary Care and Secondary Care".
Pragmatic Open-Label Randomized Trial of Pre-Exposure Prophylaxis: the PROUD ...Office of HIV Planning
Kathleen Brady of the Philadelphia Department of Public Health shared slides about the PROUD study, originally presented at the 2015 Conference on Retroviruses and Opportunistic Infections (CROI), at the March 2015 meeting of the Philadelphia HIV Prevention Planning Group (HPG).
Non-pharmacologic interventions for dementia management include activities, environmental modifications, and sensory therapies. While studies on their effectiveness have small sample sizes and varying methods, some interventions like music therapy and bright light therapy have shown benefits for cognition, mood, and behavior. More research is still needed, but non-pharmacologic approaches can be considered due to their safety, low cost, and potential for improving symptoms alone or as an adjunct to medication.
Professor Riccardo Polosa - E-Cigarette Summit 2014Neil Mclaren
- Professor Riccardo Polosa is the director of the Institute of Internal Medicine and Clinical Immunology at the University of Catania. He has conducted research on e-cigarettes and has received funding from pharmaceutical companies and the e-cigarette industry.
- He presented on clinical studies that have evaluated the effects of e-cigarettes on withdrawal symptoms and cravings. Studies have found that e-cigarettes can reduce withdrawal symptoms and cravings, though the effect on cravings depends more on the ritual than nicotine.
- Larger randomized controlled trials have also found that e-cigarettes help smokers reduce or quit smoking compared to other nicotine replacement therapies or no aid. Success rates were
This randomized, double-blind, placebo-controlled clinical trial tested whether a genetically-informed biomarker of nicotine metabolism (nicotine metabolite ratio or NMR) could predict responses to nicotine patch or varenicline for smoking cessation. 1246 smokers were randomized to receive placebo, nicotine patch, or varenicline. The primary outcome was 7-day point abstinence at end of treatment. For normal metabolizers, varenicline was more effective than nicotine patch, but for slow metabolizers there was no difference. Secondary outcomes and side effects also varied by treatment and NMR group. The authors concluded the NMR may help direct therapy selection to increase quit rates while decreasing side effects.
This document discusses research on unassisted smoking cessation. It notes that the majority of ex-smokers quit unassisted, yet most smoking cessation research and programs focus on professionally or pharmacologically assisted methods. The document summarizes several studies conducted by the author and colleagues on unassisted cessation. It argues that unassisted cessation should be presented as a viable first-line option to smokers, rather than an afterthought, since it is how most smokers successfully quit. The document also questions the effectiveness and population-level impact of smoking cessation aids based on limitations of clinical trials and real-world use.
1) Dapagliflozin is a sodium-glucose co-transporter 2 (SGLT2) inhibitor that works by inhibiting glucose reabsorption in the kidney and increasing glucose excretion in the urine.
2) Studies have shown that dapagliflozin reduces HbA1c and body weight when used as monotherapy or as add-on therapy to other glucose-lowering medications, including metformin, sulfonylureas, pioglitazone, and insulin. Reductions in HbA1c were sustained over 102 weeks.
3) Common side effects of dapagliflozin include increased urinary tract and genital infections, as well
This talk was given by Dr. Daniel Lovell of Cincinnati Children's Hospital to a group of patient families, at Systemic Juvenile Idiopathic Arthritis (or SJIA) Family Day on July 22nd, 2017.
This randomized controlled trial evaluated the effectiveness of acetyl-L-carnitine (ALC) for treating diabetic neuropathy. Over 1,200 patients with type 1 or 2 diabetes and mild neuropathy were randomized to receive 500 mg or 1,000 mg ALC 3 times daily or placebo for 52 weeks. ALC treatment significantly improved vibration perception threshold and nerve fiber regeneration compared to placebo. Adverse effects were mild and similar between groups. While limited by a short trial period and some baseline differences, ALC appears to be a relatively safe and potentially effective treatment option for mild diabetic neuropathy.
A Look at a Consumer Peer Based Program with Jill Williams, MDsfary
From the the first Annual National Conference on Tobacco and Behavioral Health, which occurred May 19-20, 2014 in Bethesda, MD and was hosted by the Central East Addiction Technology Transfer Center, a program of The Danya Institute. You can see videos from the conference on our website www.ceattc.org (go to “Tobacco and Behavioral Health Resources” under “Special Topics”).
Having peers who have succeeded in recovering from tobacco dependence talk to smokers with mental illness offers advantages. Advantages of using peer counselors include reduced language and cultural barriers, increased trust and lowered defenses, and low cost. Peer counselors are often rated highly by other consumers and there is an added benefit in the modeling that comes from seeing peers do well and return to work. We have promoted community based advocacy and education through the CHOICES Program (Consumers Helping Others Improve their Condition by Ending Smoking). CHOICES employs mental health peer counselors known as Consumer Tobacco Advocates (CTA) to deliver the vital message to smokers with mental illness that addressing tobacco use is important and to motivate them to seek treatment. The philosophy of CHOICES is to bring information to smokers with mental illness about the harm of tobacco, as well as the benefits of quitting and possibilities of treatment. Additional goals are to enhance advocacy and education about addressing tobacco in mental health treatment settings through strong partnerships with a consumer advocacy organization (Mental Health America) and state government (New Jersey Division of Mental Health Services).
Participants will be able to:
- Understand the benefits of using peer counselors to disseminate health education information and increase demand for tobacco services
- Examine existing community relationships and partnerships that will help promote culture change in mental health systems.
- Understand how materials like newsletters and websites increase the reach of peer counselors
- Become familiar with CHOICES, a peer delivered tobacco dependence education and intervention program in New Jersey
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share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
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In some case, your chronic prostatitis may be related to over-masturbation. Generally, natural medicine Diuretic and Anti-inflammatory Pill can help mee get a cure.
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Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Osteoporosis - Definition , Evaluation and Management .pdfJim Jacob Roy
Osteoporosis is an increasing cause of morbidity among the elderly.
In this document , a brief outline of osteoporosis is given , including the risk factors of osteoporosis fractures , the indications for testing bone mineral density and the management of osteoporosis
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
TEST BANK For An Introduction to Brain and Behavior, 7th Edition by Bryan Kol...rightmanforbloodline
TEST BANK For An Introduction to Brain and Behavior, 7th Edition by Bryan Kolb, Ian Q. Whishaw, Verified Chapters 1 - 16, Complete Newest Versio
TEST BANK For An Introduction to Brain and Behavior, 7th Edition by Bryan Kolb, Ian Q. Whishaw, Verified Chapters 1 - 16, Complete Newest Version
TEST BANK For An Introduction to Brain and Behavior, 7th Edition by Bryan Kolb, Ian Q. Whishaw, Verified Chapters 1 - 16, Complete Newest Version
Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachAyurveda ForAll
Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
Integrating Ayurveda into Parkinson’s Management: A Holistic Approach
E cig Benefits
1. E-Cigarettes: A 21st Century Cessation
Device? A Review of the Literature
Dr Natalie Walker (PhD)
2. Disclosures
Heart Foundation Douglas Senior Fellowship in
Heart Health (Prevention)
• Pharmaceutical industry
– Consultancy, honoraria, benefits in kind, travel support and
research grants
• Tobacco industry
– Purchased very low nicotine content cigarettes for
research purposes
• e-cigarette industry
– Co-investigator on an e-cigarette trial (funded by
Health Research Council of New Zealand)
3. Objective
• To summarize the scientific
evidence for the use of e-
cigarettes for smoking cessation
– Hypothesis generating
– Hypothesis proving
– Information ‘waiting in the wings’
4. What do e-cig users say about quitting?
• Vapers ‘on-line’ blogs
• On-line user surveys
• Etter J-F. BMC Public Health 2010 (n=81)
• Etter & Bullen. Addiction 2011 (N=3587)
• 96% helped them quit, 92% helped them reduce cpd
• Siegel et al. Am J Prevent Med 2011 (n=222)
• First time purchasers in 2010
• 6 month self-reported PPA = 31% (57% of these people were still using
e-cigs at 6 months)
• 70% quit rate in those than used >20 times per day, 67% reduced cpd.
• Dawkins et al. Addiction 2013, n=1347, 33 countries
• 76% wanted a complete alternative to smoking
• 89% had used them to help stop smoking
• 68% said they were as satisfying as normal cigarettes
5. What do e-cig users say about quitting?
Surveys
• USA panel 2009-10 (n~10,000): found no difference in desire to quit tobacco
between e-cig users (n=120) and non-users (n=662) [Regan et al. Tob Control, 2013]
• ITC Four country survey 2010/11 (n=5,939) 85% using them to help quit, 75% to
reduce cpd [Adkison et al. Am Prevent Med 2013]
• USA: Quitline callers (n=2,758) 31% reported ‘ever used’ or ‘tried’ , 51% used to
quit, 30 day PPA lower (22%, 17%, 31% p<0.001) [Vickerman et al. Nic Tob Control
2013]
Case series
• Italy: Caponnetto et al. J Med Case Reports 2011
• Italy: Caponnetto et al. Inter J Clin Med 2011
Prospective follow-up studies
• Italy: n=40 smokers unwilling to quit, 24 weeks. CA (not even a puff in last 30 days) in
9 (22.5%). [Polosa et al. BMC Public Heath 2011]
• Italy: n=100 [Polosa et al. # NCT01194583]
6. How might e-cigs help with quitting?
Deliver nicotine at low dose (like NRT)
Help address the behavioural aspects of smoking
• Placebo e-cigs:
– Cross-over trial (n=40), unmotivated to quit: Reduced desire
to smoke, withdrawal and cpd (Bullen et al Tob Control 2010)
• Placebo inhalers
– Trial (n=120), motivated to quit: Higher cessation at 26 week
if the handling of cigarettes important to them (Caponnetto et al
ERJ 2011)
• Very low nicotine content cigarettes
– Trial (n=1410) motivated to quit: < 1.5mg nicotine content
and ≤ 0.05mg nicotine per cigarette. Higher 6 month CA and
PP quit rates, time to relapse, and cpd (Walker et al Addiction 2012)
7. Reducing CPD and quitting
“Reducing cigarettes smoked before quit day and quitting abruptly,
with no prior reduction, produced comparable quit rates”
Lindson et al. Reduction versus abrupt cessation in smokers
who want to quit. Cochrane Systematic Review 2010
8. Published trials
Caponnetto (2013)
(PlosOne)
Bullen (2013)
(Lancet)
Population Unmotivated to quit Motivated to quit
Inclusion
criteria
≥10cpd for at least 5 years,
18-70 years
≥10cpd for last year,
≥18 years
Brand Categoria Elusion
Sample size 300 657
Intervention 7.2 mg E-cig
7.2-5.4 mg E-cig
0 mg E-cig
No behavioural support
16mg E-cig
21mg NRT patch
0mg E-cig
Minimal behavioural support
Intervention
period
12 weeks 13 weeks
(includes one week pre-quit)
Follow-up 12 months 6 months
Power 75% 80%
Primary
outcome
Verified continuous
abstinence at 6 months
Verified continuous
abstinence at 6 month
9. Published trials
• Both trials excluded :
– Pregnant or breastfeeding women
– Current users of smoking cessation therapies, or currently enrolled in
a smoking cessation programme or another cessation study
– Those with cardiovascular disease
– Those with a serious medical condition
– Those with symptomatic respiratory disease / poorly controlled asthma
or other airways disease (e.g. emphysema, COPD)
– Those using regular psychotropic medication / poorly controlled
psychiatric disorder
– Those with current or past alcohol abuse / a current chemical
dependency other than nicotine
– Using smokeless tobacco [Italian study only]
13. • Collected long term (12 months)
•
• Dry cough, mouth irritation,
shortness of breathe, throat
irritation and headache
• No difference in frequency of side
effects between groups
• A significant reduction in frequency
of side effects over time
• No serious side effects reported
• No significant changes in body
weight, resting heart rate or blood
pressure over time or between
groups
Safety data
16. Study design
Screening, Eligibility, Baseline evaluations,
Randomisation to treatment or control groups
Quit date set (n= 657)
16 mg e-cig
Treatment group
n = 289
21 mg patch
Control group
n = 295
0 mg e-cig
Control group
n = 73
16 mg e-cig
ad libitum use
21 mg patch
daily use
Quit
date
0 mg e-cig
ad libitum use
1 week
familiarisation
12 weeks use
N=241, Loss to
follow-up 17%
Assessments undertaken at Baseline, Quit date, 1, 3 and 6 months
N=57, Loss to follow-
up 22%
N=215, Loss to
follow-up 27%
6 months
17. Baseline
16mg e-cig Patch 0mg e-cig
(n=289) (n=295) (n=73)
Age (years) 43.6 (12.7) 40.4 (13.0) 43.2 (12.4)
Women 178 (62%) 182 (62%) 45 (62%)
Maori ethnicity 95 (33%) 95 (32%) 23 (32%)
Education < year 12 or none 150 (52%) 123 (42%) 38 (52%)
Cigarettes per day 18.4 (7.2) 17.6 (6.0) 17.7 (5.6)
Age started smoking (years) 15.6 (4.7) 15.2 (3.8) 15.7 (5.1)
Years smoked 25.9 (13.1) 23.5 (12.9) 24.8 (13.7)
Type of tobacco smoked
- Factory only 167 (58%) 167 (57%) 47 (64%)
- RYO only 92 (32%) 92 (31%) 21 (29%)
- Both 30 (10%) 35 (12%) 5 (7%)
Lives with other smokers 151 (52%) 149 (51%) 42 (58%)
>= 1 quit attempt in past 12 months 158 (55%) 169 (57%) 39 (53%)
FTND score 5.6 (2.0) 5.5 (2.0) 5.5 (2.0)
GN-SBQ Score 20.1 (7.9) 20.1 (8.4) 21.4 (8.6)
Self-efficacy 3.7 (1.0) 3.7 (0.9) 3.6 (1.0)
AUTOS 22.6 (7.2) 23.1 (7.6) 23.4 (7.3)
21. Summary of number of
events and censored
values
Total Relapsed Censored Duration (days)
n n % n % Median
Lower
CI
Upper
CI Mean
16 mg ENDS 289 197 68.2 92 31.8 35 15 56 74.5
Nicotine patch 295 200 67.8 95 32.2 14 8 18 54.1
Log-rank test P-value =
<0.0001
Summary of number of
events and censored
values
Total Relapsed Censored Duration (days)
n n % n % Median
Lower
CI
Upper
CI Mean
16 mg ENDS 289 197 68.2 92 31.8 35 15 56 74.5
0 mg ENDS 73 51 69.9 22 30.1 12 5 34 69.8
Log-rank test P-value =
0.0957
Time to first lapse
22. Change from baseline in CPD
Reduced cpd by 50% at 6 months
• 16mg e-cig = 57% of smokers
• 0 mg e-cig = 45% of smokers
• Patch = 41% of smokers
Reduced cpd by 25% at 6 months
• 16mg e-cig = 71% of smokers
• 0 mg e-cig = 63% of smokers
• Patch = 55% of smokers
23. Safety – number of events
16mg e-cig: 0.8 events/person/month
0mg e-cig: 0.9 events/person/month
Patch: 0.8 events/person/month
Incidence rate ratio = 1.05, 95% CI: 0.82-1.34, p=0.7
16mg e-cig Patch 0mg e-cig
Total 137
(in 107 people)
119
(in 96 people)
36
(in 26 people)
Event type
- Serious
- Non-serious
27 (20%)
110 (80%)
14 (12%)
105 (88%)
5 (14%)
31 (86%)
Related to treatment
- Definitely
- Probably
- Possibly
- Unrelated
0
1 (1%)
5 (4%)
131 (96%)
1 (1%)
1 (1%)
4 (3%)
113 (95%)
0
1 (3%)
1 (3%)
34 (94%)
24. Autonomy over smoking (AUTOS)
0
4
8
12
16
20
24
28
32
36
Baseline Quit day 1 month 3 months 6 months
Total Score
16mg e-cig
Patch
0
2
4
6
8
10
12
Withdrawal
0
2
4
6
8
10
12
Cue induced craving
0
2
4
6
8
10
12
Dependence
Change from baseline to
six months for 16mg e-cig
vs patch:
Withdrawal: p= 0.0424
Craving: p= 0.0378
Dependence= 0.0115
Total: p= 0.0181
25. 78
82
46
51 53
18
29
35
8
0
20
40
60
80
100
16mg e-cig 0mg e-cig Patch
Percentage
One month
Three months
Six months
Compliance
Poor compliance to NRT well known:
• Walker et al. Addiction 2011
• Etter et al. Nicotine & Tobacco Research 2013.
26. Amount of product used
16mg e-cig (mean)
• 1 month = 1.3 cartridges per day
• 3 months = 1.1 cartridges per day
• 6 months = 0.7 cartridges per day
0mg e-cig (mean)
• 1 month = 1.1 cartridges per day
• 3 months = 1.2 cartridges per day
• 6 months = 0.7 cartridges per day
Patches
• 1 per day as requested
Few used other cessation products
29. Trial strengths
• Largest trials conducted to date with cessation
outcome
• Focus was on sustained abstinence
• Pragmatic trial looking at real-world effectiveness
• The low quit rate is similar to that seen in NRT
trials with limited behavioural support
Stead et al. NRT for smoking cessation. Cochrane Review 2012
30.
31. Limitations, criticisms, comments
“…I’m so disappointed in you…. the trial was
underpowered!”
The trial was correctly powered to detect the
chosen effect sizes
• 10% for 16mg e-cig vs patch, 15% for 16mg e-cig vs
0mg e-cig; 15% QR in 0mg e-cig and 20% QR patch.
Yes, the effect size and estimates of abstinence
we used now appear overly optimistic
At least we narrowed down the true difference
Non-inferiority design may be a better choice.
32. Limitations, criticisms, comments
“Did the e-cigarette you used deliver any
nicotine?”
Nicotine level was less than labelled
• Liquid analysis: 10-16mg per mL
• Vapour analysis: 300 puffs from one cartridge =
3-6 mg nicotine (about 1-5 cigarettes)
But low levels of nicotine may be sufficient
• VLNC cigarette have sufficient nicotine to occupy
~ 26% of the main receptors
Goniewicz M et al. Nicotine Tob Res 2013; 15: 158-66
Brody A et al, Neuropsychopharmacology 2009; 34: 282-9
http://www.healthnz.co.nz/HealthNZstandard_Ecigs.htm
33. Limitations, criticisms, comments
“How generalisable are these findings?”
Bullen
(2013)
3 NZ Quitline
trials
Caponnetto
(2013)
(n=657) (n=3,900) (n=300)
Age (years) 42 41 44
Women 62% 60% 37%
Māori ethnicity 33% 24-28% -
Education: < 12 years or none 49% 53% 31% low
Cigarettes per day (mean) 18 20 20* (15-25)
Self-efficacy 3.7 4.2 -
≥1 quit attempt in past 12 months 55% 29% 51%**
Mean FTND score 5.5 6.2 5.8
* Medium (IQR)
**Past attempts to quit
34. Limitations, criticisms, comments
“How many people in the study would have been
current or previous users of e-cigarettes?”
NZ survey (2011) of 840 current smokers and
recent quitters
• 7% had ever purchased an e-cigarette
More likely to be aged 18-24 years & have a medium level income
No difference by gender, ethnicity , education, or quit attempts
Given demographics of trial population,
previous use is likely to be < 7%
Li J et al, NZ Med J May 2013
35. Limitations, criticisms, comments
“Access to the intervention differed between
the groups”
E-cigs were posted and provided free
NRT via posted Quitcard, visit to Pharmacy and not free
(US$4)
A NZ trial comparing free access to selection box of NRT
vs Quitcard system found no effect on quit rates at six
months
• But did delay time to relapse (medium 70 days vs 28 days)
Walker et al, Addiction 2011
36. Limitations, criticisms, comments
“There was differential drop-out between the
treatment arms”
27% in patch compared to 22% and 17% in E-cigs
Baseline characteristics: Those that withdrew/LTFU were
no different to those that participated
• But slightly younger and less educated in ‘patch’ group
16 withdrew in patch group
• 5 because they wanted e-cigs
• 8 for no reason
• 3 other
37. Summary of trial evidence
In smokers who use e-cigs for 12-13 weeks with little
to no behavioural support
• Six month quit rates are low (5-12%)
• Quit rates are similar for nicotine vs nicotine-free e-cigs
• Cigarette consumption is reduced
• Mild, self limiting side effects are reported
• E-cigs are highly acceptable to users
• In those motivated to quit:
– E-cigs are of similar effectiveness to nicotine patches
– Nicotine e-cigs delay relapse back to regular smoking
38. Registered unpublished trials
Gartner
(Australia)
Arouni
(USA)
Hajek
(UK, Spain, Czech
Rep)
Population Varying motivation to quit Motivated to quit Motivated to quit
Product 18.6 mg Vype Red STAM CE4 eGo
Clearmizer
Gamucci
Sample size 1600 240 220
Intervention • NRT choice for short term
use
• NRT choice for short and/or
long term use
• Choice of NRT and ‘cigarette
like’ nicotine products for
short and/or long term use
• e-cig (strength
unknown)
• 2 and 4 mg NRT
gum
• Standard care
(Varenicline or NRT
plus behavioural
support)
• Standard care plus
e-cig (bold strength)
Intervention
period
3 weeks free, 6 weeks
discounted
? 12 weeks 4 weeks
Follow-up 12 months 12 weeks 24 weeks
Power 80% ? 80%
Primary
outcome
Self-reported 12 month
continuous abstinence
Verified 12 week
continuous abstinence?
Verified 4 week
continuous abstinence