Predictors of quitting smoking behavior: evidence from Pakistan.

This study attempts to identify factors that significantly encourage the cessation of smoking in the context of Pakistan. The study distributes a modified questionnaire among 421 respondents (current as well as former smokers) in the capital city of Pakistan, Islamabad. The binary regression method was employed to data for analyzing predictors of making quit attempts and successful smoking cessation. The result indicates that respondents having strong intentions to quit, high socioeconomic status, low nicotine dependency, and past quit attempts, and those having no-smoking friends, are more likely to quit cigarette smoking successfully. On the other hand, factors like social pressure to quit smoking, religious information against smoking, intention to quit smoking, and public regulation on smoking are more likely to encourage smokers to make quit attempts. The study calls for community and school-wide smoking cessation campaigns involving officials, peers and parents, religious leaders, and other influential individuals to inform people about the dangers of smoking. In addition, religious leaders should be encouraged to issue rulings against smoking especially during "Friday Prayer." Furthermore, the government should pronounce more strict and comprehensive regulations on smoking by properly monitoring its implementation to encourage cessation of cigarette smoking.

Protective Factors for Sexual Violence Perpetration Among High School and College Students: A Systematic Review.

To prevent sexual violence (SV), it is important to understand both risk and protective factors for SV perpetration. Although considerable research has examined risk factors for perpetration of SV among high school and college students, less research is dedicated to investigating protective factors which might mitigate the risk of perpetration. This review summarizes existing research on protective factors for perpetration of SV among high school and college students. Thirteen articles were included in this study after reviewing 5,464 citations. Inclusion criteria included peer-reviewed scholarly journals, written in English, and published between 2010 and 2021. The included articles indicate that 11 factors were significantly related to less SV perpetration. Key protective factors identified in this study include empathy, impulse control, social support, parental factors, peers, church attendance/ religiosity, and school connections. In addition to protective factors, this review also examined study characteristics for the included articles and found that most participants were White and just over half of the studies were longitudinal. Overall, these findings indicate a lack of research focused on protective factors for SV perpetration, and a need for more research on the identified protective factors and to investigate additional protective factors. Such studies should include longitudinal designs and more diverse samples to understand the range of protective factors that can be bolstered through interventions to prevent SV among high school and college students.

Risk of postoperative bleeding after dental extraction in patients on antiplatelet therapy: systematic review and meta-analysis.

OBJECTIVE: To determine the risk of bleeding after minor extraction in patients on different antiplatelet therapy (APT) regimens. STUDY DESIGN: A search was conducted using PubMed and Google Scholar. Thirty-five papers were included in the systematic review, of which 23 papers provided the requisite information for meta-analysis. Subgroups were created based on the controls, as follows: (1) no control, (2) healthy control, and (3) interrupted APT control. In a meta-analysis, the studies were further subdivided into immediate and delayed bleeding. RESULTS: No immediate or delayed bleeding risk was found in patients treated with aspirin vs healthy controls (relative risk [RR] = 1.26; P = .5 and RR = 2.17; P = .09, respectively). A higher immediate bleeding was recorded for patients on single nonaspirin APT vs those in the healthy population (RR = 3.72; P = .0009). A high risk of bleeding was recorded in patients receiving dual APT compared with healthy controls for immediate (RR = 10.3; P < .0001) and delayed (RR = 7.72; P = .001) bleeding. Dual APT continuation showed a higher risk of immediate bleeding (RR = 2.13) than interrupted APT, but the difference was insignificant (P = .07). CONCLUSIONS: Dental extraction can be performed safely in patients on aspirin monotherapy. In contrast, patients receiving dual APT should be considered at risk for immediate and continued bleeding.

Post-renal Transplantation Triple Neuralgia: A Case Report.

Renal transplantation is the most common solid organ transplant in the United States. Post-transplant neuralgia is a frequent complication and may be due to infection, medication side effects, post-transplant lymphoproliferative disorder (PTLD), or the procedure itself. This case report describes an instance of post-renal transplant neuralgia in a 70-year-old Caucasian female. Diagnostic nerve blocks revealed the involvement of the ilioinguinal, genitofemoral, and lateral femoral cutaneous nerves. The case report details management that included nerve blocks, radiofrequency ablation (RFA), and a permanent peripheral nerve stimulator (PNS) implant.

End-of-life care and advance care planning for outpatients with inoperable aortic aneurysms.

OBJECTIVE: A significant proportion of patients with abdominal and thoracic aortic aneurysms (AA) do not proceed to intervention after reaching treatment threshold diameter due to a combination of poor cardiovascular reserve, frailty, and aortic morphology. This patient cohort has a high mortality; however, until this study, there exist no studies on the end-of-life care conservatively managed patients receive. METHODS: This is a retrospective multicenter cohort study of 220 conservatively managed patients with AA referred to Leeds Vascular Institute (UK) and Maastricht University Medical Centre (the Netherlands) for intervention between 2017 and 2021. Demographic details, mortality, cause of death, advance care planning and palliative care outcomes were analysed to examine predictors of palliative care referral and efficacy of palliative care consultation. RESULTS: A total of 1506 patients with AA were seen over this time period, giving a nonintervention rate of 15%. There was a 3-year mortality rate of 55%, a median survival of 364 days, and rupture was the reported cause of death in 18% of the decedents. Median follow-up was 34 months. Only 8% of all patients and 16% of decedents received a palliative care consultation, which took place a median of 3.5 days before death. Patients >81 years of age were more likely to have advance care planning. Only 5% and 23% of conservatively managed patients had documentation of preferred place of death and care priorities respectively. Patients with a palliative care consultation were more likely to have these services in place. CONCLUSIONS: Only a small proportion of conservatively treated patients had advance care planning and this was far below international guidelines on end-of-life care for adults, which recommends it for each of these patients. Pathways and guidance should be implemented to ensure patients not offered AA intervention receive end-of-life care and advance care planning.

Non-edible plant seeds of Acacia farnesiana as a new and effective source for biofuel production.

Currently, the energy crisis is a hot topic for researchers because we are facing serious problems due to overpopulation and natural energy sources are vanishing day-by-day. To overcome the energy crisis, biofuel production from non-edible plant seeds is the best solution for the present era. In the present study, we select the non-edible seeds of Acacia farnesiana for biofuel production from different areas of Pakistan with better oil production results. Different kinds of analytical method, like the American Standard for Testing and Materials and techniques like Fourier transform infra-red spectroscopy, nuclear magnetic resonance spectroscopy, gas chromatography, and inductively coupled plasma optical emission spectrometry, were used to evaluate the chemical compositions. The maximum oil extraction rate (23%) was produced by petroleum ether. Potassium hydroxide exhibited the best conversion result of 96% fatty acid methyl ester. The transesterification method was used for the preparation of fatty acid methyl ester (96%) using potassium hydroxide and methanol. The viscosity and density of Acacia farnesiana seed oil biodiesel was comparable to American Standard for Testing Material biodiesel standards. By using gas chromatography-mass spectrometry, five fatty acids were detected comprising palmitic acid (6.85%), stearic acid (2.36%), oleic acid (12.13%), linoleic acid (46.85%), and α-linolenic acid (1.23%). This study concludes that Acacia farnesiana seed oil biodiesel could be an intriguing raw material for yielding Acacia farnesiana seed oil methyl ester as an alternative fuel source.

Covalent and Noncovalent Loading of Doxorubicin by Folic Acid-Carbon Dot Nanoparticles for Cancer Theranostics.

With special properties such as excellent fluoresce features, low toxicity, good biocompatibility, permeability, and easy clearance from the body, carbon dot (CD)-based nanoparticles (NPs) have the potential to deliver drugs and use in vivo diagnostics through molecular imaging. In this work, folic acid-CD (FA-CD) NPs were prepared to deliver doxorubicin (Dox) covalently and noncovalently as cancer theranostics. FA was conjugated to the surface of CDs for targeting cancer cells with overexpressing folate receptors. CDs prepared with various amounts of precursors lead to their associated NPs with different photoluminescence properties and drug release profiles. The loading of Dox and its releasing data depends on the linkage of drug Dox to FA-CD and CD composition. All NPs were characterized by UV-vis, Fourier transform infrared spectroscopy, and dynamic light scattering. The noncovalent FA-CD-Dox NPs were preferred with a simple preparation process, excellent photoluminescence, and in vitro drug release properties. The noncovalent FA-CD-Dox showed the best efficacy against MDA-MB-231 compared to the CD-Dox and covalent FA-CD-Dox.

Quality of life and other psychological factors in patients with tooth wear.

Aim To investigate the relationship between generic and condition-specific (CS) quality of life, general psychological wellbeing and personality in patients with tooth wear.Materials and methods Ethical approval was granted (REC:10/H0709/21). Patients aged 18-70 years with tooth wear completed the Oral Impact on Daily Performance (OIDP) quality of life questionnaire, the NEO-FFI Personality questionnaire and the General Health Questionnaire-12 (GHQ). Tooth wear was measured with the Basic Erosive Wear Examination (BEWE).Results In total, 102 subjects were recruited. Increased BEWE scores were correlated with older age and worse generic and CS-related quality of life. Increased neuroticism was correlated with increased: generic and CS OIDP scores; generic and CS eating scores; CS smiling scores; and CS carrying out major work scores. Increased GHQ scores were positively correlated with increased: generic and CS OIDP scores; generic and CS eating scores; CS speaking scores; generic and CS cleaning scores; generic relaxing scores; generic and CS smiling scores; and generic emotional state scores (p <0.05). Multivariable linear regression analyses showed that increased neuroticism and decreased GHQ both had an independent effect on generic and CS OIDP scores when adjusted for tooth wear severity (p <0.05).Conclusion Quality of life perception is complex and was not only affected by worsening levels of tooth wear.

The Effectiveness of Mouthwashes With Various Ingredients in Plaque Control: A Systematic Review and Meta-Analysis.

OBJECTIVE: Our study sought to present a solid comprehensive overview of the efficiency of active ingredients in mouthwash to control dental plaque. SOURCE: Cochrane Library, the Library of Medicine, (MEDLINE-PubMed), Web of Science database core collection, the database of the American Dental Association (ADA) Center for Evidence-based Dentistry and Scopus database were used for our review and meta-analysis. METHODOLOGY: This was a systematic review that included papers with and without a meta-analysis on the efficacy of mouthwashes with various active ingredients in the control of dental plaque. In vitro and animal experiments were excluded from the study. Methodologic quality assessment was carried out with AMSTAR. The estimated plausible risk of unfairness was calculated according to the recording, reporting and methodologic quality of the selected systematic reviews per the PRISMA recommendations for systematic reviews. RESULTS: 580 initial hits were reported and 22 papers were chosen for the overview (kappa = 0.89; good agreement). Of these, 12 studies presented moderate methodologic consistency. In these studies, chlorhexidine (CHX) was the most beneficial in monitoring dental plaque data, and 4 meta-analyses showed that essential oils (EO) also had substantial antiplaque activity. CONCLUSION: Descriptive and experimental studies have shown that CHX and EO have antiplaque activity that is useful in maintaining good oral hygiene.

Mutually Reinforced Polymer-Graphene Bilayer Membranes for Energy-Efficient Acoustic Transduction.

Graphene holds promise for thin, ultralightweight, and high-performance nanoelectromechanical transducers. However, graphene-only devices are limited in size due to fatigue and fracture of suspended graphene membranes. Here, a lightweight, flexible, transparent, and conductive bilayer composite of polyetherimide and single-layer graphene is prepared and suspended on the centimeter scale with an unprecedentedly high aspect ratio of 105 . The coupling of the two components leads to mutual reinforcement and creates an ultrastrong membrane that supports 30 000 times its own weight. Upon electromechanical actuation, the membrane pushes a massive amount of air and generates high-quality acoustic sound. The energy efficiency is ≈10-100 times better than state-of-the-art electrodynamic speakers. The bilayer membrane's combined properties of electrical conductivity, mechanical strength, optical transparency, thermal stability, and chemical resistance will promote applications in electronics, mechanics, and optics.

Spectral-Selective Plasmonic Polymer Nanocomposites Across the Visible and Near-Infrared.

State-of-the-art commercial light-reflecting glass is coated with a metalized film to decrease the transmittance of electromagnetic waves. In addition to the cost of the metalized film, one major limitation of such light-reflecting glass is the lack of spectral selectivity over the entire visible and near-infrared (NIR) spectrum. To address this challenge, we herein effectively harness the transmittance, reflectance, and filtration of any wavelength across the visible and NIR, by judiciously controlling the planar orientation of two-dimensional plasmonic silver nanoplates (AgNPs) in polymer nanocomposites. In contrast to conventional bulk polymer nanocomposites where plasmonic nanoparticles are randomly mixed within a polymer matrix, our thin-film polymer nanocomposites comprise a single layer, or any desired number of multiple layers, of planarly oriented AgNPs separated by tunable spacings. This design employs a minimal amount of metal and yet efficiently manages light across the visible and NIR. The thin-film plasmonic polymer nanocomposites are expected to have a significant impact on spectral-selective light modulation, sensing, optics, optoelectronics, and photonics.

Block copolymer-based porous carbon fibers.

Carbon fibers have high surface areas and rich functionalities for interacting with ions, molecules, and particles. However, the control over their porosity remains challenging. Conventional syntheses rely on blending polyacrylonitrile with sacrificial additives, which macrophase-separate and result in poorly controlled pores after pyrolysis. Here, we use block copolymer microphase separation, a fundamentally disparate approach to synthesizing porous carbon fibers (PCFs) with well-controlled mesopores (~10 nm) and micropores (~0.5 nm). Without infiltrating any carbon precursors or dopants, poly(acrylonitrile-block-methyl methacrylate) is directly converted to nitrogen and oxygen dual-doped PCFs. Owing to the interconnected network and the highly optimal bimodal pores, PCFs exhibit substantially reduced ion transport resistance and an ultrahigh capacitance of 66 µF cm-2 (6.6 times that of activated carbon). The approach of using block copolymer precursors revolutionizes the synthesis of PCFs. The advanced electrochemical properties signify that PCFs represent a new platform material for electrochemical energy storage.

Management of Endurance Athletes with Flow Limitation in the Iliac Arteries: A Case Series.

INTRODUCTION: Vascular surgeons increasingly encounter flow limitation of iliac arteries (FLIA) in endurance athletes. An experience of managing this condition is reported. REPORT: This is a retrospective cohort analysis of prospectively collected data at a single vascular centre. Between 2001 and 2017, 12 athletes with exercise induced pain underwent investigation and assessment. Patients with significant radiological findings (iliac kinking ± stenosis demonstrated on duplex ultrasound or catheter angiography) and dynamic flow changes (marked reduction in ankle brachial pressure indices following exertion, or increase in the common iliac artery peak systolic velocity during hip flexion on duplex) underwent surgery after trialling conservative management; the majority were open iliac shortening procedures. Patients with radiological findings, but no dynamic flow changes were managed conservatively. All patients were followed up. DISCUSSION: There were 10 men and two women with a median age of 40 years. Nine patients had iliac kinking (five in isolation, four associated with stenosis), two had stenosis, and one had no iliac disease. Eight patients had severe symptoms (absolute loss of power on maximal exertion) demonstrated dynamic post-exertional flow changes. Seven patients successfully underwent surgery, returning to their sport at similar intensity. One procedure was abandoned owing to severe adhesions from a prior procedure. This patient subsequently changed sport. Three patients with mild symptoms (two had reduction in power at maximal intensity, one was an incidental finding) and who demonstrated no clinical signs of FLIA continued their sport at a lower intensity. Kinking of the iliac arteries in athletes can occur with or without of iliac stenosis. Patients with the most severe iliac symptoms demonstrate dynamic post-exertional flow limitation and may benefit from surgery following a period of conservative management. Patients who have milder symptoms and no dynamic exercise flow limitations can be managed conservatively.

Relationship of the Van Herick Grading System with Peripheral Iris Configuration and Level of Iris Insertion.

OBJECTIVE: To determine the relationship of the van Herick angle grading system with the level of iris insertion and peripheral iris configuration. STUDY DESIGN: Observational study. PLACE AND DURATION OF STUDY: Eye department, Combined Military Hospital, Malir Cantt., Karachi, from May to October 2015. METHODOLOGY: Sixty-five eyes of 65 patients were recruited. Anterior chamber depth at the temporal limbus was measured as a fraction of corneal section thickness using van Herick technique and graded on the standard 4-point scale of the van Herick grading system. Gonioscopy of the temporal quadrant was performed with a Posner 4 mirror goniolens and both the true level of iris insertion and peripheral iris configuration were recorded on a 4-point scale so as to equate with the van Herick 4-point grading system. Spearman's rho test was applied to determine the relationship of the van Herick grading system with level of iris root insertion and peripheral iris configuration. RESULTS: Amoderate positive correlation between van Herick grade and peripheral iris configuration was found which was statistically significant (rs=0.42, p < 0.001). Astatistically significant and moderate positive correlation was also detected between van Herick grade and the level of iris insertion (rs=0.45, p < 0.001). CONCLUSION: The van Herick grade has a moderately positive relationship with the peripheral iris configuration and true level of iris insertion.

Poly(vinylpyrrolidone)-Free Multistep Synthesis of Silver Nanoplates with Plasmon Resonance in the Near Infrared Range.

Herein, a poly(vinylpyrrolidone) (PVP)-free method is described for synthesizing Ag nanoplates that have localized surface plasmon resonance in the near-infrared (NIR) range. Citrate-capped Ag spherical nanoparticles are first grown into small Ag nanoplates that resonate in the range of 500-800 nm. The small Ag nanoplates are used as seeds to further grow into large Ag nanoplates with a lateral dimension of 100-600 nm and a plasmon resonance wavelength of 800-1660 nm and above. The number of growth steps can be increased as desired. Without introducing additional citrate into the solutions of small Ag nanoplate seeds, large Ag nanoplates can be synthesized within minutes. The entire synthesis is completely PVP free, which promotes the nanoparticle growth along the lateral direction to form large Ag nanoplates. The multistep growth and the minimum usage of citrate are essential for the fast growth of high-aspect-ratio Ag nanoplates resonating in the NIR range.

Two-Dimensional Plasmonic Nanoparticle as a Nanoscale Sensor to Probe Polymer Brush Formation.

Conventional analysis and characterization of polymer brush formation relies on laborious methods that use a quartz crystal microbalance, atomic force microscope, microcantilever, or other tools that measure the concentration change of solutions. Herein we develop a simple and easy method that utilizes intrinsically flat two-dimensional (2D) plasmonic nanoparticles as sensors for unveiling the mechanism of polymer brush formation on surfaces. Via ultraviolet-visible spectroscopy, the plasmonic nanoparticles can be used to determine the amount of polymers near the surface in situ. As the amount of polymers increases near the surface, the nanoparticle characteristic localized surface plasmon resonance wavelength redshifts, and the shift amount corresponds linearly to the polymer density near the surface. By functionalizing the nanoparticles in solutions of thiolated polyethylene glycol (PEG-SH) with or without PEG disulfide (PEG-S-S-PEG), the three-regime kinetics of the polymer brush formation is confirmed. The fast adsorption and slow chain rearrangement in the first regime are found to be the causes of the latent regime. In the latent regime, the adsorbed polymer chains rearrange to anchor their ends onto the surface and contract to liberate space so that other polymer chains can graft onto the surface until saturation. The fundamental understanding gained herein enables the design of surfaces with complex chemistries and properties, which can find broad applications in responsive sensors, films, and coatings. Moreover, the novel analytical method of using 2D plasmonic nanoparticle as a sensor to understand the polymer brush formation is applicable to investigating the grafting of other molecules such as self-assembled monolayers, protein, and DNA.

Cyanoacrylate Injury To The Ear Canal.

This is a case regarding a 35-year-old gentleman who presented to the Accident and Emergency department at Walsall Manor Hospital. He had mistakenly placed cyanoacrylate ('superglue') into his right ear canal in the early morning. In terms of its removal, an initial attempt was made in the Ear, Nose and throat (ENT) outpatient clinic which proved to be unsuccessful due to the amount of discomfort it caused the patient. Therefore, it had to be removed under general anaesthesia.

Impact of specialist neurovascular care in subarachnoid haemorrhage.

BACKGROUND: The management of neurosurgical disorders has become increasingly specialised. The care of patients with subarachnoid haemorrhage (SAH) has generally been part of core neurosurgical practice, provided by general neurosurgeons whatever their specialist interest. The aim of this present study therefore is to ascertain if, and to what extent care provided by a dedicated neurovascular team (compared to care provided by a general neurosurgical team) change patient disposition in SAH. METHODS: This is a retrospective analysis of SAH patients, identified from a departmental database of a single neurosurgical centre. In 2008, the service was reorganised such that a neurovascular team cared for all SAH patients. We compared clinical outcome in people admitted prior to this service reorganisation (Period A, 2004-2007) with patients admitted afterwards (Period B, 2009-2011). Survival and recovery were assessed according to the Glasgow Outcome Scale (GOS). Multi-factorial logistic regression analysis was performed to determine the injury and age adjusted incidence of complications, odds of survival at discharge, discharge home, mortality, good recovery (GOS 5) and favourable outcome, by dichotomising GOS (GOS 4-5 vs. GOS 1-3) at 3 months. RESULTS: 1114 patients were included in the study. The mean age of patients presenting in Period A (n = 543) was younger [50 years (SD 13.5)] than those in Period B (n = 571) [53 years (SD 13)]. Patients admitted in Period B were more likely to present as poor grade (World Federation of Neurological surgeons (WFNS) grades 4 and 5) compared to Period A (26.5% vs. 21.3%). No statistical differences between the groups in the incidence of pre-operative re-bleeding (3% vs. 5%) or rates of delayed cerebral ischaemia (16.1% vs. 16.1%) were observed. After adjustment for age, sex and injury severity, the odds of patient time to discharge, discharge home and good recovery (GOS 5) were 27% (p < 0.001), 45% (p = 0.001) and 93% (p < 0.001) higher respectively in Period B than Period A. CONCLUSIONS: The data presented here demonstrates that management of SAH by a dedicated neurovascular team improves the potential for patient recovery.